Internal Medicine PA Easy (Med/Hard Questions

Internal Medicine PA Easy (Med/Hard Questions 2023/2024 Graded A+) A patient presents with symptoms of polyuria for several months. There is no history of diabetes mellitus or intrinsic kidney disease. Which of the following tests can best determine whether the polyuria is resulting from primary polydipsia or some form of diabetes insipidus? A 24-hour urine volume test B Routine urinalysis C Water deprivation test D Urine culture and sensitivity E Vasopression suppression test - Answer Explanation C The correct choice is C, water deprivation test. This test helps the practitioner determine if the patient can concentrate his/her urine with or without becoming hyperosmolar. The patient is restricted from liquids and food during the test, which must be done in a controlled environment. A patient with primary polydipsia will be able to concentrate his/her urine without becoming hyperosmolar. A patient with diabetes insipidus will become hyperosmolar without concentrating the urine. Choice A, 24-hour urine volume test, can provide quantification of the polyuria, but will not determine its cause. Choice B, routine urinalysis, may provide evidence of dilute urine, but will not provide evidence of its cause. Choice D, urine culture and sensitivity, is used when trying to determine the cause of a urinary tract infection. Choice E, vasopression suppression test, is not a test that is performed. It could be dangerous to try to suppress a hormone that is already thought to be deficient. A 15-year-old obese male presents with annularly configured lesions in a generalized distribution. They are asymptomatic. What can these lesions be associated with? A Diabetes mellitus B Hyperlipidemia C Hypertension D Hypocalcemia - Answer Explanation The Correct Answer is: A This patient presents with a generalized form of granuloma annulare (GA). Generalized GA can be associated with diabetes mellitus. Bueno A 66-year-old female is admitted to the hospital with a new onset of atrial fibrillation. Her past medical history has hypertension, diabetes mellitus type II, hypercholesterolemia, and rheumatoid arthritis. Her vital signs show a blood pressure of 136/78, pulse of 89, respirations 18, and oxygen saturation of 96%. Her lungs are clear to auscultation, and an irregularly irregular rhythm is appreciated. There is no edema on peripheral examination. Given this clinical scenario, what is the most appropriate test in determining if an intracardiac thrombus is present? A Transthoracic echocardiography B Electrocardiogram C Transesophageal echocardiography D Cardiac catheterization E Magnetic resonance arteriography - Answer Explanation The Correct Answer is: C The best and most appropriate test to evaluate for an intra-atrial thrombus is the transesophageal echocardiogram (C). This test has the better sensitivity and specificity when compared to the transthoracic echocardiogram (A). Electrocardiograms (B), cardiac catheterizations (D), and magnetic resonance imaging (E) do not give any specific information related to the evaluation of an intracardiac thrombus. What is the hallmark finding on an EKG that is consistent with Wolff-Parkinson-White syndrome? A Prolonged PR interval B Long QT interval C Widened QRS complex D Sinus arrhythmia E Delta wave formation - Answer Explanation The Correct Answer is: E The delta wave appears as an up-sloping curvature that begins the QRS complex (as seen on the ECG shown). A 14-year-old female presents with a 24-hour history of episodic outbreaks on her hands and feet. She describes the outbreaks as beginning on the sides of her fingers and toes, with small intensely pruritic vesicles. What should be the next step in treatment? A bacterial culture and KOH B punch biopsy and viral culture C viral culture and shave biopsy D shave biopsy and KOH - Answer Explanation The Correct Answer is: A This patient is experiencing probable dyshidrotic eczema. It is necessary to rule out a secondary bacterial infection, so a bacterial culture is necessary. It is also necessary to rule out a fungal infection or parasitic by performing a KOH. This does not have any features of a viral infection, so a viral culture is not necessary. A punch biopsy is also not necessary because it can be diagnosed with a non-invasive procedure. A shave biopsy is not indicated because non-invasive techniques can be used to diagnose. Shave biopsies are not indicated when vesicles are present. A physician assistant student suffers a needlestick injury while caring for an HIV-positive patient whose viral load is currently undetectable. Of the following, which is the most appropriate management for the student? A no drug treatment unless HIV testing performed immediately and at 6 weeks, 3 months, and 6 months results become positive B administration of zidovudine and lamivudine until results of baseline testing are received C administration of zidovudine and lamivudine for 4 weeks D administration of zidovudine, lamivudine, and indinavir for 4 weeks - Answer Explanation The Correct Answer is: C After a needle-stick injury, a health-care worker should have baseline testing with follow-up testing at 6 weeks, 3 months, and 6 months. Risk of seroconversion is approximately 1:300. Administration of antiviral therapy decreases this risk by 79%, so the worker should be offered treatment with zidovudine and lamivudine as soon as possible after the injury, for a total of 4 weeks. However, workers with a high-risk exposure (source patient with advanced disease, a viral load 50,000, or with resistant organisms) should have a protease inhibitor added to the prophylactic regimen. (Katz and Zolopa, 2009, p. 1192) Katz MH , Zolopa AR. HIV infection. In: McPhee SJ , Papadakis MA, eds. Current Medical Diagnosis and Treatment. 48th ed. New York, NY: McGraw-Hill; 2009. A patient exhibits air hunger and labored, deep respirations due to increased stimulation of the respiratory center in the brain. Which of the following is the most likely cause? A Congestive heart failure B Metabolic acidosis C Obstructive sleep apnea D Respiratory acidosis E Traumatic brain injury - Answer Explanation The Correct Answer is: B Kussmaul's respiration is a form of respiratory compensation, and is most commonly associated with metabolic acidosis. During early acidosis, breathing may be rapid, but when advanced the breaths become deep, slow and labored with an urge to breathe described as "air hunger." The other etiologies suggest other causes of breathing variation, such as tachypnea, apnea, and Cheyne-Stokes respiration. Radiculopathy due to nerve root compression occurs most commonly at which nerve root within the brachial plexus? A C5 B C6 C C7 D C8 E T1 - Answer Explanation The Correct Answer is: C The C7 nerve root is affected the most often (approximately 45-60%). This radiculopathy can result from foraminal encroachment of the spinal nerve, cervical disk herniation, tumor, and multiple sclerosis. C7 radiculopathy can present with weakness in the triceps, which cause elbow extension, and finger flexion and extension. C6 is another common site of radiculopathy. C6 radiculopathy can present with weakness in the biceps, brachioradialis, and wrist extensor muscles. Cervical radiculopathy at the C5, C8, and T1 are less common, but still possible. C5 radiculopathy can present with deltoid and biceps muscle weakness. C8 radiculopathy can present with finger flexor weakness and T1 radiculopathy with finger abduction weakness A 42-year-old woman, with a history of struvite renal calculus, calls the office with a complaint of a urinary tract infection. As part of the interview, she reports intermittent, mild right flank pain for 4 days. Her urine dipstick is positive for microscopic hematuria, and the urine pH is 7.5. The KUB film is positive with two visible stones in the right kidney. Which of the following organisms is most likely to be cultured from the urine specimen? A Escherichia coli B Klebsiella C Proteus D Chlamydia trachomatis - Answer the Correct Answer is: C This patient has struvite stones. They are frequently associated with recurrent urinary tract infections, visible stones, and high urine pH. These stones are formed by urease-producing organisms including Proteus and Pseudomonas while being caused less commonly by Klebsiella. Struvite stones are not typically caused by E. coli and C. trachomatis. A 15-year-old male presents with lesions on his palms, dorsum of his hands and lower arm. They began as red macules that developed a central vesicle over a few days. The lesions are pruritic with no other symptoms. What is the most common etiology? A Herpes simplex infection B Insect bites C