NCCPA Internal Medicine 2

Question 1

A 58-year-old man with chronic kidney disease has a serum potassium of 6.2 mEq/L. Which ECG finding is most characteristic of hyperkalemia?

Accepted Answer

Peaked T waves

Answer

Peaked (tall, narrow, symmetric) T waves are the earliest ECG manifestation of hyperkalemia.

Question 2

A 45-year-old woman presents with fatigue, constipation, and a serum calcium of 11.8 mg/dL. PTH is elevated. Which is the most likely diagnosis?

Accepted Answer

Primary hyperparathyroidism

Answer

Elevated PTH with hypercalcemia in an asymptomatic or mildly symptomatic outpatient is classic for primary hyperparathyroidism.

Question 3

A patient with COPD exacerbation has an ABG showing pH 7.30, PaCO2 62 mmHg, HCO3 29 mEq/L. Which acid-base disorder is present?

Accepted Answer

Acute-on-chronic respiratory acidosis

Answer

The elevated bicarbonate indicates partial compensation, suggesting chronic retention with an acute worsening superimposed.

Question 4

A 62-year-old man with diabetes and hypertension develops proteinuria >300 mg/day and creatinine 2.1 mg/dL. Which medication class best slows progression of diabetic nephropathy?

Accepted Answer

ACE inhibitors or ARBs

Answer

RAAS blockade with ACE inhibitors or ARBs reduces intraglomerular pressure and proteinuria, slowing CKD progression in diabetic nephropathy.

Question 5

Which finding best differentiates restrictive cardiomyopathy from constrictive pericarditis on echocardiography?

Accepted Answer

Septal bounce and respiratory variation in mitral inflow

Answer

Constrictive pericarditis shows a septal bounce and exaggerated respiratory variation in mitral/tricuspid inflow on echo, unlike restrictive cardiomyopathy.

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

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

NCCPA Internal Medicine 2