Physician Assistant Clinical Knowledge 5

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?

Accepted Answer

Levothyroxine (T4) replacement

Answer

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?

Accepted Answer

Stop warfarin, bridge with low molecular weight heparin

Answer

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?

Accepted Answer

Hydrocele

Answer

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?

Accepted Answer

Iron deficiency anemia

Answer

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?

Accepted Answer

Papillary thyroid carcinoma

Answer

Papillary thyroid carcinoma is the most common thyroid malignancy and is characterized histologically by Orphan Annie eye nuclei (empty-appearing) and psammoma bodies.

Physician Assistant Practice Test

Physician Assistant Practice Test

Physician Assistant Clinical Knowledge 5