NCCPA Internal Medicine 3

Question 1

A 55-year-old man presents with hemoptysis, weight loss, and a cavitary lung lesion. He is an immigrant from Southeast Asia. Which organism is most likely?

Accepted Answer

Mycobacterium tuberculosis

Answer

Cavitary upper-lobe infiltrate with hemoptysis and systemic symptoms in an immigrant population is classic for pulmonary tuberculosis.

Question 2

A 40-year-old woman with SLE develops pleuritis and a positive anti-dsDNA with low complement. Which complication most directly correlates with anti-dsDNA titers?

Accepted Answer

Lupus nephritis

Answer

Anti-dsDNA titers and low complement (C3/C4) are strongly correlated with lupus nephritis disease activity.

Question 3

A 68-year-old man with atrial fibrillation has a CHADS2-VASc score of 4. Which anticoagulation strategy is most appropriate?

Accepted Answer

Direct oral anticoagulant (DOAC)

Answer

A CHA2DS2-VASc score ≥2 in men warrants oral anticoagulation, with DOACs preferred over warfarin for non-valvular AF.

Question 4

A patient presents with ascending muscle weakness after a Campylobacter infection 3 weeks ago. CSF shows albuminocytologic dissociation. What is the diagnosis?

Accepted Answer

Guillain-Barré syndrome

Answer

Post-infectious ascending flaccid paralysis with elevated CSF protein and normal cell count (albuminocytologic dissociation) is pathognomonic for Guillain-Barré syndrome.

Question 5

A 52-year-old woman with cirrhosis develops confusion and asterixis after starting a high-protein diet. Ammonia is elevated. What is the best initial treatment?

Accepted Answer

Lactulose

Answer

Lactulose acidifies the colon, trapping ammonia as ammonium and reducing its absorption, and is first-line for hepatic encephalopathy.

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

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

NCCPA Internal Medicine 3