Physician Assistant Physician Assistant 5 — Questions and Answers
Question 1: A 68-year-old woman with osteoporosis is started on alendronate. Which instruction is most important to give her?
- Take it with a full glass of milk for better absorption
- Remain upright for at least 30 minutes after taking it (Correct answer)
- Take it with food to reduce GI upset
- It can be taken at bedtime for convenience
Correct answer: Remain upright for at least 30 minutes after taking it
Bisphosphonates like alendronate must be taken on an empty stomach with water and the patient must remain upright for at least 30 minutes to prevent esophageal irritation and ulceration.
Question 2: A 40-year-old male presents with acute monoarthritis of the first MTP joint, redness, warmth, and severe pain that started overnight. Serum uric acid is 9.2 mg/dL. What is the best initial treatment for acute gout?
- Allopurinol
- Probenecid
- Colchicine or NSAIDs (Correct answer)
- Febuxostat
Correct answer: Colchicine or NSAIDs
The acute gout attack is treated with anti-inflammatory agents such as colchicine, NSAIDs, or corticosteroids; urate-lowering agents like allopurinol are not initiated during acute attacks.
Question 3: Which of the following findings is most consistent with cardiac tamponade?
- Wide pulse pressure, bradycardia, hypertension
- Beck's triad: hypotension, distended neck veins, muffled heart sounds (Correct answer)
- Loud S3 gallop, pulmonary edema, peripheral edema
- Fever, friction rub, pleuritic chest pain
Correct answer: Beck's triad: hypotension, distended neck veins, muffled heart sounds
Beck's triad (hypotension, jugular venous distension, and muffled heart sounds) is the classic presentation of cardiac tamponade caused by pericardial fluid compressing the heart.
Question 4: A 55-year-old male presents with progressive bilateral lower extremity weakness, fasciculations, hyperreflexia, and bulbar symptoms. There is no sensory deficit. What is the most likely diagnosis?
- Multiple sclerosis
- Guillain-Barré syndrome
- Amyotrophic lateral sclerosis (ALS) (Correct answer)
- Myasthenia gravis
Correct answer: Amyotrophic lateral sclerosis (ALS)
ALS is characterized by combined upper and lower motor neuron findings (hyperreflexia + fasciculations) with bulbar involvement and absence of sensory deficits.
Question 5: A PA has reasonable suspicion that a patient is being abused by a caregiver. Which of the following is the most appropriate action?
- Inform the caregiver and give them a chance to explain
- Document the concern and revisit it at the next visit
- File a mandatory report with Adult Protective Services or child protective services (Correct answer)
- Discuss only with the supervising physician and take no further action
Correct answer: File a mandatory report with Adult Protective Services or child protective services
PAs are mandatory reporters in all US states; suspected abuse must be reported to the appropriate protective services, and failure to report is a legal and ethical violation.
Question 6: A 32-year-old woman at 36 weeks gestation presents with severe headache, visual disturbances, and BP of 162/110 mmHg. Urinalysis shows 3+ proteinuria. What is the definitive treatment?
- Oral labetalol and outpatient monitoring
- IV magnesium sulfate alone
- Delivery of the fetus (Correct answer)
- Corticosteroids and expectant management
Correct answer: Delivery of the fetus
Delivery is the only definitive treatment for preeclampsia with severe features; at 36 weeks gestation, the risks of continuing the pregnancy outweigh those of delivery.
Question 7: Which of the following findings on spirometry is most consistent with obstructive lung disease such as COPD?
- FVC decreased, FEV1 normal, FEV1/FVC ratio normal
- FEV1 decreased, FVC normal or decreased, FEV1/FVC ratio < 0.70 (Correct answer)
- FEV1 normal, FVC decreased, FEV1/FVC ratio > 0.70
- Both FEV1 and FVC decreased proportionally with normal ratio
Correct answer: FEV1 decreased, FVC normal or decreased, FEV1/FVC ratio < 0.70
Obstructive disease is defined by a post-bronchodilator FEV1/FVC ratio < 0.70, reflecting airflow limitation with air trapping causing a disproportionate reduction in FEV1.
Physician Assistant Physician Assistant 5
A 68-year-old woman with osteoporosis is started on alendronate.
Which instruction is most important to give her?