Physician Assistant Clinical Knowledge 2 — Questions and Answers
Question 1: A 58-year-old male presents with crushing chest pain radiating to the left arm. ECG shows ST elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
- Left anterior descending artery
- Right coronary artery (Correct answer)
- Left circumflex artery
- Left main coronary artery
Correct answer: Right coronary artery
ST elevation in leads II, III, and aVF indicates an inferior wall STEMI, which is most commonly caused by right coronary artery (RCA) occlusion.
Question 2: A 35-year-old woman with no prior history presents with sudden onset severe headache she describes as 'the worst headache of my life.' Neck stiffness and photophobia are present. CT head is negative. What is the next best step?
- Start empiric antibiotics and discharge
- Perform lumbar puncture (Correct answer)
- Obtain MRI brain with contrast
- Administer sumatriptan and observe
Correct answer: Perform lumbar puncture
A negative CT with classic subarachnoid hemorrhage (SAH) presentation requires lumbar puncture to detect xanthochromia or blood that CT may miss.
Question 3: Which finding on urinalysis is most specific for acute tubular necrosis (ATN)?
- White blood cell casts
- Red blood cell casts
- Muddy brown granular casts (Correct answer)
- Waxy casts
Correct answer: Muddy brown granular casts
Muddy brown granular casts are the hallmark finding of acute tubular necrosis, representing sloughed renal tubular epithelial cells.
Question 4: A 72-year-old woman on warfarin presents with INR of 8.2 and active GI bleeding. What is the most appropriate immediate treatment?
- Vitamin K 10 mg IV only
- Hold warfarin and observe
- 4-factor prothrombin complex concentrate (PCC) plus vitamin K IV (Correct answer)
- Fresh frozen plasma alone
Correct answer: 4-factor prothrombin complex concentrate (PCC) plus vitamin K IV
Life-threatening bleeding on warfarin is best managed with 4-factor PCC for rapid INR reversal plus IV vitamin K to sustain the effect.
Question 5: A patient with chronic kidney disease stage 3 develops hyperkalemia to 6.8 mEq/L with peaked T-waves on ECG. What medication should be given FIRST?
- Sodium polystyrene sulfonate (Kayexalate)
- Furosemide IV
- Sodium bicarbonate IV
- Calcium gluconate IV (Correct answer)
Correct answer: Calcium gluconate IV
Calcium gluconate stabilizes cardiac membranes immediately and is the first priority when ECG changes indicate life-threatening hyperkalemia.
Question 6: A 45-year-old male with HIV (CD4 count 50 cells/µL) presents with fever, headache, and altered mental status. CSF shows India ink positive organisms. What is the first-line treatment?
- Fluconazole alone
- Amphotericin B deoxycholate plus flucytosine (Correct answer)
- Voriconazole IV
- Caspofungin IV
Correct answer: Amphotericin B deoxycholate plus flucytosine
Cryptococcal meningitis in HIV patients is treated with induction therapy using liposomal amphotericin B plus flucytosine for 2 weeks.
Question 7: Which physical exam finding is most consistent with cardiac tamponade?
- Widened pulse pressure
- Kussmaul's sign
- Pulsus paradoxus (Correct answer)
- S3 gallop
Correct answer: Pulsus paradoxus
Pulsus paradoxus (>10 mmHg drop in systolic BP with inspiration) is the classic hemodynamic finding of cardiac tamponade.
Physician Assistant Clinical Knowledge 2
A 58-year-old male presents with crushing chest pain radiating to the left arm.
ECG shows ST elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?