Physician Assistant Formulating a Diagnosis 3

Question 1

A PA is evaluating a 40-year-old with fatigue, weight gain, cold intolerance, and constipation. Which diagnosis fits this illness script best?

Accepted Answer

Hypothyroidism

Answer

Fatigue, weight gain, cold intolerance, and constipation together form the classic illness script for hypothyroidism, driven by reduced metabolic activity.

Question 2

Which diagnostic approach is most appropriate when two diagnoses on a differential have similar presentations but very different treatments?

Accepted Answer

Order the test with the highest likelihood ratio for the most dangerous diagnosis

Answer

When dangerous diagnoses must be ruled out, prioritizing tests with the highest likelihood ratios for the most life-threatening condition ensures patient safety.

Question 3

A 35-year-old man presents with sudden severe headache described as 'the worst of my life.' Which diagnosis is the priority to exclude?

Accepted Answer

Subarachnoid hemorrhage

Answer

A thunderclap headache—sudden and maximal at onset—mandates urgent evaluation to exclude subarachnoid hemorrhage, a neurological emergency.

Question 4

Which finding most strongly supports a diagnosis of heart failure with preserved ejection fraction (HFpEF) over chronic obstructive pulmonary disease (COPD) in a dyspneic patient?

Accepted Answer

Elevated BNP with bilateral crackles and orthopnea

Answer

Elevated BNP, bilateral crackles, and orthopnea are cardinal features of heart failure that help distinguish HFpEF from obstructive lung disease.

Question 5

A PA considers the sensitivity of a test when ruling out a disease. Which mnemonic aids this reasoning?

Accepted Answer

SnNout — a highly Sensitive test, when Negative, rules OUT disease

Answer

SnNout indicates that a highly sensitive test with a negative result effectively rules out the disease due to its low false-negative rate.

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Physician Assistant Practice Test

Physician Assistant Formulating a Diagnosis 3