Physician Assistant Physician Assistant 4 — Questions and Answers
Question 1: A 25-year-old male athlete presents with sudden severe headache described as 'the worst headache of his life' after exertion. CT head is negative. What is the next most appropriate step?
- Reassure and discharge
- MRI brain with contrast
- Lumbar puncture (Correct answer)
- Start sumatriptan
Correct answer: Lumbar puncture
A thunderclap headache with a negative CT requires lumbar puncture to rule out subarachnoid hemorrhage, as CT misses up to 2% of cases in the first 6 hours.
Question 2: Which of the following best describes the PA profession's scope of practice in the United States?
- Defined solely by federal law and is uniform in all states
- Determined by the supervising physician's preference only
- Defined by state law, clinical training, and institutional policy (Correct answer)
- Limited to emergency medicine and primary care settings only
Correct answer: Defined by state law, clinical training, and institutional policy
PA scope of practice is determined by a combination of state law, the PA's education and experience, the supervising physician's delegation, and institutional policies.
Question 3: A 58-year-old male presents with progressive difficulty swallowing solids, then liquids, and an 18 lb weight loss over 3 months. What is the most likely diagnosis?
- Achalasia
- Esophageal carcinoma (Correct answer)
- GERD with stricture
- Zenker's diverticulum
Correct answer: Esophageal carcinoma
Progressive dysphagia starting with solids then progressing to liquids combined with significant weight loss in an older adult is the classic presentation of esophageal carcinoma.
Question 4: A PA prescribes a medication that inhibits HMG-CoA reductase. A patient on this medication begins taking clarithromycin for an infection. What adverse effect is most concerning?
- Serotonin syndrome
- QT prolongation
- Rhabdomyolysis (Correct answer)
- Agranulocytosis
Correct answer: Rhabdomyolysis
Clarithromycin inhibits CYP3A4, increasing statin plasma levels and dramatically raising the risk of rhabdomyolysis when co-administered with statins metabolized by CYP3A4.
Question 5: Which vaccine is contraindicated in a 26-year-old pregnant woman at 20 weeks gestation?
- Inactivated influenza vaccine
- Tdap
- MMR vaccine (Correct answer)
- COVID-19 mRNA vaccine
Correct answer: MMR vaccine
MMR is a live attenuated vaccine and is contraindicated during pregnancy due to theoretical risk of fetal infection; it should be given postpartum.
Question 6: A 3-year-old is brought in with inspiratory stridor, a barking cough, and low-grade fever. Neck X-ray shows a 'steeple sign.' What is the most likely diagnosis?
- Epiglottitis
- Croup (laryngotracheobronchitis) (Correct answer)
- Foreign body aspiration
- Bacterial tracheitis
Correct answer: Croup (laryngotracheobronchitis)
The steeple sign on anteroposterior neck X-ray reflects subglottic narrowing and, combined with barking cough and inspiratory stridor in a toddler, is diagnostic of croup.
Question 7: A PA documents in a patient's chart that a procedure was performed, but it was actually done by a different provider. This constitutes which type of misconduct?
- Battery
- Negligence
- Falsification of medical records (Correct answer)
- Breach of confidentiality
Correct answer: Falsification of medical records
Documenting a procedure as personally performed when it was not constitutes falsification of medical records, which is both an ethical violation and potentially illegal.
Physician Assistant Physician Assistant 4
A 25-year-old male athlete presents with sudden severe headache described as 'the worst headache of his life' after exertion.
CT head is negative.
What is the next most appropriate step?