Physician Assistant Physician Assistant 3 — Questions and Answers
Question 1: A 35-year-old female presents with weight gain, cold intolerance, constipation, and dry skin. TSH is elevated and free T4 is low. What is the most appropriate treatment?
- Methimazole
- Levothyroxine (Correct answer)
- Radioactive iodine
- Propranolol
Correct answer: Levothyroxine
Elevated TSH with low free T4 indicates primary hypothyroidism, treated with levothyroxine (synthetic T4) replacement therapy.
Question 2: Which maneuver is used to diagnose benign paroxysmal positional vertigo (BPPV)?
- Romberg test
- Dix-Hallpike maneuver (Correct answer)
- Head impulse test
- Unterberger test
Correct answer: Dix-Hallpike maneuver
The Dix-Hallpike maneuver repositions the head to provoke nystagmus and vertigo, confirming the diagnosis of BPPV involving the posterior semicircular canal.
Question 3: A 70-year-old male with a history of atrial fibrillation is found unresponsive with right-sided weakness. CT head shows no hemorrhage. What is the most appropriate immediate intervention?
- Aspirin 325 mg
- IV alteplase (tPA) (Correct answer)
- Heparin infusion
- Warfarin loading dose
Correct answer: IV alteplase (tPA)
In the absence of contraindications and within the therapeutic window, IV alteplase (tPA) is the standard of care for acute ischemic stroke.
Question 4: A newborn is noted to have a continuous 'machine-like' murmur at the left upper sternal border. What is the most likely congenital heart defect?
- Ventricular septal defect
- Atrial septal defect
- Patent ductus arteriosus (Correct answer)
- Tetralogy of Fallot
Correct answer: Patent ductus arteriosus
A continuous machine-like murmur at the left upper sternal border is pathognomonic for patent ductus arteriosus (PDA).
Question 5: Which of the following lab findings is most consistent with iron deficiency anemia?
- Elevated ferritin, low TIBC, microcytic RBCs
- Low ferritin, elevated TIBC, microcytic RBCs (Correct answer)
- Normal ferritin, low TIBC, macrocytic RBCs
- Elevated ferritin, normal TIBC, normocytic RBCs
Correct answer: Low ferritin, elevated TIBC, microcytic RBCs
Iron deficiency anemia is characterized by low ferritin (depleted stores), elevated TIBC (the body compensates by upregulating transferrin), and microcytic, hypochromic RBCs.
Question 6: A PA is treating a patient with major depressive disorder who has failed two adequate SSRI trials. What is the most appropriate next step?
- Add an antipsychotic and discharge
- Refer for psychotherapy only
- Switch to an SNRI or augment with bupropion (Correct answer)
- Initiate MAO inhibitor immediately
Correct answer: Switch to an SNRI or augment with bupropion
After two failed SSRI trials, switching to a different class (SNRI) or augmentation strategies such as adding bupropion or an atypical antipsychotic are evidence-based next steps.
Question 7: A 52-year-old woman presents with urinary frequency, urgency, and dysuria. Urinalysis shows pyuria and bacteriuria. Which organism is the most common cause of uncomplicated urinary tract infections in women?
- Staphylococcus saprophyticus
- Klebsiella pneumoniae
- Escherichia coli (Correct answer)
- Enterococcus faecalis
Correct answer: Escherichia coli
Escherichia coli accounts for approximately 80–85% of uncomplicated urinary tract infections in women due to its virulence factors that facilitate uroepithelial adherence.
Physician Assistant Physician Assistant 3
A 35-year-old female presents with weight gain, cold intolerance, constipation, and dry skin.
TSH is elevated and free T4 is low.
What is the most appropriate treatment?