Dermatology
Which of the following is considered a risk factor for the development of malignant melanoma?
a. White female over 50
b. inability to tan
c. Japanese ethnicity
d. brown-haired individuals
Inability to tan
Inability to tan and propensity to burn are risk factors for developing malignant melanoma.
A 28-year-old male presents with a recent onset of upsetting dreams, anxiety, and disturbing flashbacks. The patient reports that he returned from active duty in Iraq 3 months ago and was adjusting to life back at home until about 7 weeks ago when he began having an intense fear of loud noises and seeing sudden flashbacks to bombing attacks he endured during his time in Iraq. He had to take a leave from his army instructor duties as he was not able to handle the familiar settings of practice shooting ranges and sudden loud explosions during battalion training. After refusing to leave his house, he was finally persuaded by his wife to visit your clinic. What is the most likely diagnosis?
a. acute stress disorder
b. performance anxiety
c. schizophrenia
d. post-traumatic stress disorder
e. panic attack
A patient complaining of flashbacks, nightmares, and avoidance of specific stimuli is likely suffering from PTSD. PTSD is often seen in war veterans, rape victims and survivors of traumatic events. PTSD symptoms do not have to manifest right after the vent, but they must last for longer than 1 month to qualify as PTSD.
Anginal chest pain is most commonly described as which of the following?
a. pain changing with position or respiration
b. a sensation of discomfort
c. tearing pain radiating to the back
d. pain lasting for several hours
A sensation of discomfort
Myocardial ischemia is often experienced as a sensation of discomfort lasting 5-15 minutes, described as dull, aching or pressure.
What test is the single most useful test in establishing the diagnosis of multiple sclerosis?
a. cerebral spinal fluid cell count and protein level
b. cerebral spinal fluid immunoglobulin studies
c. evoked potentials
d. magnetic resonance imaging
Magnetic resonance imaging
The presence of plaques on MRI is a key finding in establishing the diagnosis of MS.
Describe the role of the PA profession
PAs are medical providers, most with graduate-level educations. They are licensed to diagnose and treat illness and disease and to prescribe medication for patients. PAs work in physician offices, hospitals, and clinics in collaboration with a licensed physician.
A mother brings in her 2 year-old child stating that the child has had a 3-day history of a nonproductive cough, thick copious rhinorrhea, conjunctivitis, and a fever to 103˚. Physical examination reveals a well-hydrated child, with numerous 1-2 mm white papules on both buccal mucosa, normal heart and breath sounds. This presentation is most consistent with early...
a. rubeola (measles)
b. rubella
c. varicella
d. streptococcal pharyngitis
Rubeola
Rubeola (measles) is characterized by cough, coryza, and conjunctivitis, along with a fever as a prodrome. Koplik spots appear prior to the onset of the typical erythematous, maculopapular rash and are pathognomonic for rubeola.
A patient with obsessive-compulsive disorder would most likely have which of the following findings?
a. raw, red hands
b. priapism
c. memory impairment
d. abdominal pain
Raw, red hands
Common manifestations of obsessive-compulsive disorder include phobias of germ and contaminants, which results in frequent hand washing leading to chafe and reddened hands. The other answers are inconsistent with obsessive-compulsive disorder.
A 22-year-old male received a stab wound in the chest an hour ago. The diagnosis of pericardial tamponade is strongly supported by the presence of:
a. pulmonary edema
b. wide pulse pressure
c. distended neck veins
d. an early diastolic murmur
Distended neck veins
Cardiac compression will manifest with distended neck veins and cold clammy skin.
Which of the following interventions is most effective during the early stages of Alzheimer's disease?
a. frequent change of caregivers in the home
b. utilization of memory aids, such as post-it notes
c. encouragement of independent activities, such as driving
d. emphasis of new learning activities, such as computer training
Utilization of memory aids, such as post-it notes
Memory aids are extremely helpful in assisting Alzheimer's patients during the early stages of the disease.
Which program was the first to graduate a class cohort of PAs?
Duke Universtiy
A 56 year-old, right hand dominant, carpenter presents to your clinic complaining of a prolonged bruise under his left thumbnail. He states that he first noticed it one year ago. Physical examination reveals a nontender left thumb with a 6 mm macular lesion located under the distal nail bed. It is mixed dark brown and black in color, with irregular borders. The most likely diagnosis is...
a. lentigo
b. trauma
c. melanoma
d. nevus
Melanoma
Acral lentiginous melanoma may occur on the palm, sole, nail bed, or mucus membrane. This lesion is suspicious for a melanoma due to its irregular borders, being variegated in color, and its size. A biopsy is required and will ensure the diagnosis.
Rates of alcohol use in the adolescent are reportedly higher in:
a. families with rigorous parental monitoring
b. Japanese families
c. adoptive children whose biological parent is an alcoholic
d. mood disorders in a grandparent
Adoptive children whose biological parent is an alcoholic
There is a three-to fourfold increase in risk for alcohol dependence in adopted children whose biological parents are alcohol dependents.
A 36-year-old male complains of occasional episodes of "heart fluttering". The patient describes these episodes as frequent, short-lived and episodic. He denies any associated chest pain. Based on this information, which one of the following tests would be the most appropriate to order?
a. holter monitor
b. cardiac catheterization
c. stress testing
d. cardiac nuclear scanning
Holter monitor
Holter monitoring is a non-invasive test done to obtain a continuous monitoring of the electrical activity of the heart. This can help to detect cardiac rhythm disturbances that can correlate with the patient's symptoms.
An 82-year-old female is brought to the ED after being found unresponsive in her apartment. On physical exam, her pupils are 7 mm on the right and 3 mm on the left. What is your initial choice in managing this patient?
a. order a CBC, electrolytes, and toxicology screen
b. order a CT of the head
c. hyperventilate the patient
d. administer streptokinase
Order a CT of the head
What are some of the top specialties practiced by PAs?
Family/general medicine, emergency medicine, internal medicine, dermatology
A person with atopic dermatitis should be advised to
a. avoid cutaneous irritants
b. take hot water baths or showers
c. use a high potency glucocorticoid on the skin after bathing
d. begin a prophylactic antibiotic
Avoid cutaneous irritants
Avoidance of cutaneous irritants, such as wool and other rough clothing, is the cornerstone of therapy for atopic dermatitis.
The most important initial component of evaluating a patient with depressive illness is
a. assessment of suicidal risk
b. assessment of memory function
c. determination of the presence of hallucinations
d. determination of the degree of intellectual impairment
Assessment of suicidal risk
Two-thirds of all depressed patients contemplate suicide, and 10 to 15% commit suicide.
A 68 year-old female comes to the office for an annual physical examination. Her past medical history is significant for a 40-pack year cigarette smoking history. She takes no medications and has not been hospitalized for any surgery. Family medical history reveals that her mother is living, age 87, in good health without medical problems. Her father is deceased at age 45 from a motor vehicle crash. She has two siblings that are alive and well. From this information, how many identifiable risk factors for cardiovascular heart disease exist in this patient?
a. 0
b. 1
c. 2
d. 3
2
This patient has 2 identifiable risk factors based upon the information provided. These include her age 68 and her history of cigarette smoking.
A 58-year-old truck driver is found to have a positive Romberg test and loss of vibratory sensation in his lower extremities. What anatomical structure is likely affected?
a. cerebellum
b. posterior column
c. sensory cortex
d. vestibular apparatus
Posterior column
The posterior column is responsible for vibratory sensation and proprioception. Romberg test is a general test of proprioception with the disease of the cerebellum, vestibular apparatus, or posterior column being the most likely source.
What is the AAPA and what is their purpose?
The American Academy of Physician Associates is the national professional society for PAs. They are a non-profit organization that advocates and educates on behalf of the profession and the patients that PAs serve. They work to ensure professional growth, personal excellence, and recognition of PAs. (AAPA is a great resource for practicing PAs, PA students, and Pre-PA students to connect with each other and learn as well.)
An elderly woman presents to your clinic complaining of unilateral facial pain and painful lesions. She also complains of blurred vision in the ipsilateral eye. On examination, she has several vesicles on an erythematous base, some of the lesions with crusts. They are distributed in a dermatomal pattern and involve the skin overlying the maxillary region and the tip of her nose. Which of the following is the next most appropriate intervention in the care of this patient?
a. KOH prep
b. culture for bacteria
c. referral to an ophthalmologist
d. application of corticosteroids
Referral to an ophthalmologist
Immediate referral to an ophthalmologist is needed when herpes keratitis is suspected, as in this case. A fluorescein stain of the eye might reveal the typical dendritic corneal lesion.
Which of the following is effective in the long-term treatment of panic attacks?
a. Triazolam (halcion)
b. Propranolol (inderal)
c. Lorazepam (ativan)
d. Fluoxetine (prozac)
Fluoxetine (prozac)
SSRI's, such as fluoxetine, are the initial drugs of choice for the long-term treatment of panic disorders.
A 55-year-old male is seen in follow-up for a complaint of chest pain. Patient states that he ahs had this chest pain for about one year now. The patient further states that the pain is retrosternal with radiation to the jaw. "It feels as though a tightness, or heaviness is on and around my chest". This pain seems to come on with exertion, however, over the past two weeks he has noticed that he has episodes while at rest. If the patient remains non-active the pain usually resolves in 15-20 minutes. Patient has a 60-pack-year smoking history and drinks a martini daily at lunch. Patient appears overweight on inspection. Based on this history what is the most likely diagnosis?
a. acute myocardial infarction
b. prinzmetal variant angina
c. stable angina
d. unstable angina
Unstable angina
Pain in unstable angina is precipitated by less effort than before or occurs at rest.
A 74-year-old female is being treated for mild hypertension. She is found at home with right hemiparesis and brought to the ER. Her daughter states that the patient fell in her kitchen 2 days ago, but had no complaints at that time. She did state that her mother sounded a little confused this morning. The patient's left pupil is dilated. Which of the following diagnostic studies should be ordered first?
a. MRI of the brain
b. CT scan of the brain
c. skull x-ray
d. lumbar puncture
CT scan of the brain
This patient presents with a history of minor trauma and progressive neurological abnormalities consistent with subdural hematoma. Diagnosis would be confirmed by a CT scan, which is less expensive and more sensitive for blood than an MRI.
Why was the PA profession created?
To help assist in the physician shortage by graduating advanced practice providers in a span of 2-3 years post-baccalaureate