Physician Assistant Clinical Knowledge 5 — Questions and Answers
Question 1: A 45-year-old woman presents with fatigue, cold intolerance, weight gain, and constipation. TSH is 18 mIU/L and free T4 is low. Which is the most appropriate treatment?
- Levothyroxine (T4) replacement (Correct answer)
- Liothyronine (T3) replacement
- Combined T3/T4 therapy
- Methimazole
Correct answer: Levothyroxine (T4) replacement
Levothyroxine (synthetic T4) is the standard treatment for hypothyroidism; the body converts T4 to T3 as needed.
Question 2: A 68-year-old male with a history of atrial fibrillation on warfarin requires urgent hip replacement surgery. INR is currently 2.8. What is the most appropriate perioperative anticoagulation strategy?
- Proceed with surgery with INR of 2.8
- Stop warfarin, bridge with low molecular weight heparin (Correct answer)
- Continue warfarin and give vitamin K 1 mg orally
- Switch to aspirin perioperatively
Correct answer: Stop warfarin, bridge with low molecular weight heparin
High-risk patients on warfarin undergoing major surgery require bridging with LMWH while warfarin is held to maintain some anticoagulation protection.
Question 3: A 3-year-old boy presents with painless scrotal swelling that transilluminates. Ultrasound confirms fluid around the testis with no blood flow abnormality. What is the most likely diagnosis?
- Testicular torsion
- Epididymo-orchitis
- Hydrocele (Correct answer)
- Inguinal hernia
Correct answer: Hydrocele
A painless, transilluminating scrotal mass in a child is a hydrocele, caused by accumulation of fluid within the tunica vaginalis.
Question 4: A patient is found to have hemoglobin of 9.2 g/dL, MCV of 72 fL, low serum ferritin, and low serum iron with elevated TIBC. What is the most likely diagnosis?
- Anemia of chronic disease
- Iron deficiency anemia (Correct answer)
- Thalassemia trait
- Sideroblastic anemia
Correct answer: Iron deficiency anemia
Iron deficiency anemia presents with microcytic anemia, low ferritin (depleted stores), low serum iron, and high TIBC (transferrin upregulation).
Question 5: A 55-year-old woman presents with a painless thyroid nodule. Fine needle aspiration biopsy shows papillary structures with 'Orphan Annie eye' nuclei and psammoma bodies. What is the diagnosis?
- Follicular thyroid carcinoma
- Medullary thyroid carcinoma
- Papillary thyroid carcinoma (Correct answer)
- Anaplastic thyroid carcinoma
Correct answer: Papillary thyroid carcinoma
Papillary thyroid carcinoma is the most common thyroid malignancy and is characterized histologically by Orphan Annie eye nuclei (empty-appearing) and psammoma bodies.
Question 6: A 30-year-old pregnant woman at 28 weeks is found to have a 1-hour glucose challenge test result of 185 mg/dL. She subsequently completes a 3-hour oral glucose tolerance test. How many abnormal values are needed to diagnose gestational diabetes?
- One abnormal value
- Two or more abnormal values (Correct answer)
- Three or more abnormal values
- Any value above fasting threshold
Correct answer: Two or more abnormal values
Using the Carpenter-Coustan criteria, gestational diabetes is diagnosed when 2 or more values on the 3-hour OGTT meet or exceed threshold levels.
Question 7: A 50-year-old male develops acute onset monoarthritis of the first metatarsophalangeal joint, described as exquisitely tender, red, and swollen. Synovial fluid analysis shows negatively birefringent needle-shaped crystals. What is the first-line treatment for acute attack?
- Allopurinol
- Colchicine or NSAIDs (Correct answer)
- Probenecid
- Febuxostat
Correct answer: Colchicine or NSAIDs
Acute gout attacks are treated with anti-inflammatory agents—NSAIDs, colchicine, or corticosteroids—not urate-lowering therapy which can worsen acute flares.
Physician Assistant Clinical Knowledge 5
A 45-year-old woman presents with fatigue, cold intolerance, weight gain, and constipation.
TSH is 18 mIU/L and free T4 is low.
Which is the most appropriate treatment?