NCCPA Internal Medicine 4

Question 1

A 48-year-old man with type 2 diabetes has an HbA1c of 9.2% on metformin alone. He also has heart failure with reduced ejection fraction. Which add-on agent is most appropriate?

Accepted Answer

SGLT2 inhibitor (empagliflozin)

Answer

SGLT2 inhibitors reduce hospitalizations and cardiovascular death in patients with HFrEF and type 2 diabetes, making them the preferred add-on.

Question 2

A 72-year-old woman with osteoporosis on bisphosphonates for 7 years presents with thigh pain. X-ray shows a transverse subtrochanteric fracture. What is the most likely complication?

Accepted Answer

Atypical femoral fracture

Answer

Long-term bisphosphonate use is associated with atypical femoral fractures, typically transverse at the subtrochanteric region.

Question 3

A 35-year-old woman presents with progressive dysphagia to solids and liquids, regurgitation of undigested food, and bird-beak esophagus on barium swallow. What is the diagnosis?

Accepted Answer

Achalasia

Answer

Dysphagia to both solids and liquids with a bird-beak pattern on barium swallow is classic for achalasia due to failure of LES relaxation.

Question 4

A 60-year-old man with a history of alcohol use disorder presents with painless jaundice, weight loss, and a palpable gallbladder. Which is the most likely diagnosis?

Accepted Answer

Pancreatic head adenocarcinoma

Answer

Painless obstructive jaundice with a palpable, non-tender gallbladder (Courvoisier's sign) is classic for pancreatic head cancer compressing the common bile duct.

Question 5

A 25-year-old woman has recurrent DVT and a prolonged activated partial thromboplastin time (aPTT) that does not correct with mixing. What is the likely diagnosis?

Accepted Answer

Antiphospholipid antibody syndrome

Answer

A prolonged aPTT that fails to correct on mixing study indicates a lupus anticoagulant, a feature of antiphospholipid antibody syndrome.

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

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

NCCPA Internal Medicine 4