A Comprehensive Review for the Certification and Recertification Examinations for Physician Assistants Acquisitions Editor: Matt Hauber Development Editor: Andrea Vosburgh Editorial Coordinator: John Larkin Marketing Manager: Michael McMahon Production Project Manager: David Saltzberg Design Coordinator: Joan Wendt Manufacturing Coordinator: Margie Orzech Prepress Vendor: S4Carlisle Publishing Services Sixth Edition Copyright © 2018 Wolters Kluwer. Copyright © 2015, 2010, 2007, 2004, 1999 Wolters Kluwer Health/Lippincott Williams & Wilkins. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at [email protected], or via our website at lww.com (products and services). 9 8 7 6 5 4 3 2 1 Printed in China Library of Congress Cataloging-in-Publication Data eISBN: 978-1-4963-6880-5 Cataloging-in-Publication data available on request from the Publisher. This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content of this work. This work is no substitute for individual patient assessment based upon healthcare professionals’ examination of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data and other factors unique to the patient. The publisher does not provide medical advice or guidance and this work is merely a reference tool. Healthcare professionals, and not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments. Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made and healthcare professionals should consult a variety of sources. When prescribing medication, healthcare professionals are advised to consult the product information sheet (the manufacturer’s package insert) accompanying each drug to verify, among other things, conditions of use, warnings and side effects and identify any changes in dosage schedule or contraindications, particularly if the medication to be administered is new, infrequently used or has a narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work. LWW.com In memory of my parents, Thomas G. Babcock, Jr. and Claire Smith Babcock, RN, MEd. —Claire Babcock O’Connell With loving thanks to my family: Daniel, Leo, and Thomas Cogan-Drew. —Thea Cogan-Drew Acknowledgments Once again, the effort required to revise and update this comprehensive review has been tremendous. However, the assistance, support, and encouragement from excellent colleagues have guided those efforts and succeeded in producing a high-qualitytext and review book. We are indebted to the program directors, Jill Reichman and Matthew McQuillan, and fellow faculty at the Rutgers Physician Assistant Program. Their confidence in us provides encouragement and support in our growth as PAs and educators. We are also grateful to the contributing authors, item writers, and reviewers; the personnel at Wolters Kluwer; and the leadership of the Physician Assistant Education Association and American Academy of Physician Assistants. Finally, we wish to thank family and friends for their endless patience and constant support and love. —Claire Babcock O’Connell and Thea Cogan-Drew Preface Taking certification and recertification examinations are a fact of life for physician assistants (PAs). The certification examination is taken upon graduation from an accredited PA program, and the recertification examination is taken every 10 years thereafter. The National Commission on Certification of Physician Assistants (NCCPA), using test data from the National Board of Medical Examiners (NBME) as well as the experience and aptitude of test-item writers, develops the two examinations and refines them on an annual basis to keep current with clinical practice and medical advances. Traditionally, test-preparation books have consisted of practice questions, answers, and explanations. This format provided the opportunity for both new and experienced PAs to improve their test- taking skills by becoming more accustomed to the test experience, and by reading the answers and explanations provided with each question, the candidate could learn from his or her successes and mistakes. This edition continues to include content outline and review test items. Each chapter contains a set of test items and explanations to review major concepts contained in the chapter. All of these test items plus several hundred more are available online to simulate the computer format of the certification and recertification examinations. All test items have been written by experienced, NBME-trained PA educators and compiled using the proportions per subject area and skill areas as delineated in the NCCPA guidelines. Each test question is also written according to the NCCPA structure for multiple-choice format, an especially important feature of the last three editions. For further information and explanation of the NCCPA subject and skill areas, see http://www.nccpa.net. In addition to the practice questions and answers, this book provides, in a condensed outline format, all the necessary information not only to take and successfully complete the tests but also to refer to, on a day-to-day basis, in clinical practice. Each chapter has been completely reviewed and rewritten to reflect changes in clinical practice. The test items are new and revised, making the sixth edition even more comprehensive and able to be used as a quick and easy-to- read reference. In other words, this book is a practical, “real-time” educational tool for busy practitioners—a handy resource to be used on the front line of patient care. The chapters are carefully formatted to give general characteristics of diseases (e.g., incidence, pathophysiology, prognosis), clinical signs and symptoms, diagnostic and laboratory evaluation, and treatment. These chapters, as well as the accompanying questions and their explanations, closely mirror the body of knowledge that is tested on the certification examinations and is needed for the reality of clinical practice. Regardless of their practice setting, PAs can use this book to review and test themselves on the material most likely to be included in their examination. The American Academy of Physician Assistants (AAPA) and the Physician Assistant Education Association (PAEA) have continued their close collaboration in the development of this book. This partnership serves to enhance the value and credibility of the book and to ensure that it meets certification and continuing medical education needs of the PA constituency. We believe that you will find this book helpful in preparing to take either of the NCCPA examinations. Equally important, however, we hope that you use this book as a quick and valuable reference in clinical practice. We encourage you to make the book a permanent addition to your library not only upon graduation and every 10 years