NCCPA Clinical Medicine 3

Question 1

A 60-year-old woman with type 2 diabetes and CKD stage 3b (eGFR 32) requires better glycemic control. Which antidiabetic agent should be avoided due to risk of lactic acidosis?

Accepted Answer

Metformin

Answer

Metformin is contraindicated when eGFR falls below 30 mL/min/1.73m² due to accumulation and risk of lactic acidosis; it should be used cautiously with eGFR 30–45.

Question 2

A 35-year-old woman develops bilateral ptosis, diplopia, and generalized weakness that worsens with repetitive muscle use and improves with rest. Anti-AChR antibodies are positive. What is the most likely diagnosis?

Accepted Answer

Myasthenia gravis

Answer

Myasthenia gravis is an autoimmune disorder with antibodies against acetylcholine receptors, causing fatigable weakness that worsens with activity.

Question 3

A 70-year-old man presents with progressive dysphagia to solids, 15-lb weight loss over 3 months, and iron-deficiency anemia. He drinks alcohol daily and smokes 2 packs/day. Upper endoscopy reveals a mid-esophageal mass. Which histology is most expected?

Accepted Answer

Squamous cell carcinoma

Answer

Squamous cell carcinoma arises in the mid-esophagus and is strongly associated with smoking and alcohol use, while adenocarcinoma arises in the distal esophagus from Barrett's.

Question 4

A 28-year-old pregnant woman (32 weeks) presents with sudden-onset severe headache, visual changes, BP 160/110 mmHg, and 3+ proteinuria. Platelet count is 85,000/µL, LDH is elevated, and AST is 3x normal. Which syndrome does she have?

Accepted Answer

HELLP syndrome

Answer

HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a severe variant of preeclampsia requiring urgent delivery.

Question 5

A patient with long-standing GERD develops Barrett's esophagus. Which cellular change characterizes this condition?

Accepted Answer

Squamous to intestinal-type columnar metaplasia

Answer

Barrett's esophagus is defined by replacement of normal squamous epithelium with specialized intestinal columnar metaplasia (goblet cells) due to chronic acid exposure.

(NCCPA) National Commission on Certification of Physician Assistants Practice Test

(NCCPA) National Commission on Certification of Physician Assistants Practice Test

NCCPA Clinical Medicine 3