Physician Assistant Clinical Knowledge 2

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?

Accepted Answer

Right coronary artery

Answer

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?

Accepted Answer

Perform lumbar puncture

Answer

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)?

Accepted Answer

Muddy brown granular casts

Answer

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?

Accepted Answer

4-factor prothrombin complex concentrate (PCC) plus vitamin K IV

Answer

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?

Accepted Answer

Calcium gluconate IV

Answer

Calcium gluconate stabilizes cardiac membranes immediately and is the first priority when ECG changes indicate life-threatening hyperkalemia.

Physician Assistant Practice Test

Physician Assistant Practice Test

Physician Assistant Clinical Knowledge 2