NCCPA Internal Medicine 5

Question 1

A 67-year-old man presents with hematuria and a right flank mass. CT shows a 5-cm renal mass with venous thrombus. What is the most likely diagnosis?

Accepted Answer

Renal cell carcinoma

Answer

Renal cell carcinoma classically presents with hematuria, flank pain, and a palpable mass, and commonly invades the renal vein.

Question 2

A 50-year-old man with alcohol use disorder presents with acute severe epigastric pain radiating to the back, nausea, and serum lipase 1,200 U/L. Which initial management is most appropriate?

Accepted Answer

Aggressive IV fluid resuscitation and NPO

Answer

Aggressive early IV fluid resuscitation (preferably with Lactated Ringer's) and bowel rest are the cornerstones of acute pancreatitis management.

Question 3

A 38-year-old woman with fatigue, proximal muscle weakness, and a heliotrope rash is found to have elevated CK and aldolase. What is the diagnosis?

Accepted Answer

Dermatomyositis

Answer

Heliotrope rash with proximal muscle weakness and elevated muscle enzymes is diagnostic of dermatomyositis.

Question 4

A 70-year-old man on warfarin for atrial fibrillation presents with sudden-onset severe headache and altered consciousness. CT shows hyperdense blood in ventricles. INR is 3.8. What is the most urgent reversal agent?

Accepted Answer

4-factor prothrombin complex concentrate (PCC)

Answer

4-factor PCC provides the fastest and most complete reversal of warfarin in life-threatening bleeding and is superior to FFP for this indication.

Question 5

A 55-year-old woman with celiac disease presents with fatigue and macrocytic anemia. She adheres to a gluten-free diet. Which deficiency is most likely contributing?

Accepted Answer

Folate deficiency

Answer

Celiac disease causes malabsorption in the proximal small intestine where folate is predominantly absorbed, leading to folate-deficiency macrocytic anemia.

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

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

NCCPA Internal Medicine 5