Can You Pass This Ambulatory Trivia Test?
Can you pass this ambulatory trivia test? It is the first in a series of tests that are designed to help a learner pass their main exams at the end of the year. Take it up and consider it as Ambulatory diagnostics practice for the midterm exams. All the best and keep an eye out for others just like it!
Questions and Answers
- 1.
Specificity (in the context of laboratory testing) refers to
- A.
The ability of a test to be negative in the absence of disease
- B.
The likelihood that a person suffering from a particular disease will have a positive test result
- C.
How often false negative results are encountered
- D.
The ability of a test method to detect small quantities of the measured component
Correct Answer
A. The ability of a test to be negative in the absence of diseaseExplanation
Specificity refers to the ability of a test to correctly identify individuals who do not have the disease. In other words, it measures the likelihood of a test being negative when the disease is not present. A highly specific test will have a low rate of false negative results, meaning it rarely gives a negative result when the person actually has the disease. Therefore, the correct answer is "The ability of a test to be negative in the absence of disease."Rate this question:
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- 2.
Serial tests are:
- A.
A group of tests done simultaneously to support a diagnosis
- B.
Useful for justifying procedures that involve risks or expense
- C.
Repeated tests done to approach the same value (coefficient of variation)
- D.
Blood tests drawn at specific time intervals
Correct Answer
B. Useful for justifying procedures that involve risks or expenseExplanation
Serial tests are useful for justifying procedures that involve risks or expense. This means that when a series of tests are done one after another, it helps to provide a stronger justification for performing procedures that may be risky or expensive. By conducting multiple tests and obtaining consistent results, it increases the confidence in the need for the procedure and helps to ensure that the risks and expenses associated with it are justified.Rate this question:
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- 3.
Waived CLIA tests include:
- A.
Western blot test
- B.
Urine sediment microscopy
- C.
Urine dipstick
- D.
Wet prep slides
Correct Answer
C. Urine dipstickExplanation
CLIA (Clinical Laboratory Improvement Amendments) tests are regulated by the Centers for Medicare and Medicaid Services (CMS) to ensure accurate and reliable testing in clinical laboratories. Waived CLIA tests are considered to have a low risk of erroneous results and are therefore exempt from certain regulatory requirements. The Western blot test, urine sediment microscopy, and wet prep slides are more complex tests that require a higher level of proficiency and quality control. On the other hand, the urine dipstick test is a simple and straightforward test that can be easily performed with minimal risk of error, hence it is considered a waived CLIA test.Rate this question:
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- 4.
Which statement is FALSE regarding wellness screening?
- A.
Wellness screening is defined as testing for asymptomatic individuals who are basically healthy according to their risk profile
- B.
There is general consensus for screening recommendations in all age groups
- C.
Insurance companies differ on coverage for screening tests
- D.
Nurse practitioners focus on this aspect of primary care
Correct Answer
B. There is general consensus for screening recommendations in all age groups -
- 5.
A new male patient in your office with no reported health problems provides a urine specimen which is positive for protein. Your response to this finding it to:
- A.
Repeat the urine for protein test and check for blood
- B.
Schedule an IVP test
- C.
Treat empirically for a UTI
- D.
Do nothing at this time. Protein is a benign finding
Correct Answer
A. Repeat the urine for protein test and check for bloodExplanation
The correct answer is to repeat the urine for protein test and check for blood. This is because a positive protein result in the urine may indicate kidney dysfunction or damage. By repeating the test and checking for blood, the healthcare provider can further investigate the cause of the proteinuria and determine the appropriate course of action for the patient.Rate this question:
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- 6.
Ideally, urine protein is best measured by a:
- A.
Protein electrophoresis urine test
- B.
24 hour urine for protein and creatinine
- C.
Random specimen collection with calculated protein/creatinine ratio
- D.
Microscopic exam of the urine sediment
Correct Answer
B. 24 hour urine for protein and creatinineExplanation
The 24 hour urine for protein and creatinine is the best method for measuring urine protein because it provides a more accurate and comprehensive assessment of protein excretion over a 24 hour period. This test measures the total amount of protein excreted in the urine over a 24 hour period, as well as the creatinine level, which is used to assess the completeness of the collection. This method is preferred over other options because it accounts for variations in protein excretion throughout the day and provides a more reliable measure of proteinuria.Rate this question:
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- 7.
Protein in the urine that measures over 3 gm/24 hour is:
- A.
Usually coming from the renal tubules
- B.
Protein immunoglobulin
- C.
Mainly albumin
- D.
Indicative of mild renal insufficiency
Correct Answer
C. Mainly albuminExplanation
Protein in the urine that measures over 3 gm/24 hour is mainly albumin. This indicates that there is a significant amount of albumin, a type of protein, present in the urine. Albuminuria, or the presence of albumin in the urine, is commonly associated with kidney damage or dysfunction. Therefore, the elevated levels of albumin in the urine suggest the possibility of renal insufficiency, which is a condition characterized by reduced kidney function.Rate this question:
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- 8.
Microalbuminuria is a condition that:
- A.
Is not detected by dipstick when
- B.
Indicates end stage nephropathy
- C.
Requires calcium channel blocker therapy to halt progression
- D.
Should be checked every two years in diabetic patients
Correct Answer
A. Is not detected by dipstick when -
- 9.
The diagnosis of urinary tract infection is based on a patient’s symptoms and the result of a urinalysis that includes all the following elements EXCEPT:
- A.
White blood cells
- B.
Nitrite
- C.
Leukocyte esterase
- D.
Urobilinogen
Correct Answer
D. UrobilinogenExplanation
The diagnosis of urinary tract infection is based on a patient's symptoms and the result of a urinalysis that includes white blood cells, nitrite, and leukocyte esterase. Urobilinogen, however, is not a component used in the diagnosis of urinary tract infections.Rate this question:
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- 10.
A 62 yo patient presents for a physical examination with no complaints. You instruct him to collects stool specimens using three guaic stool cards. A week later, he returns them to the lab and all three test positive. Your response will be to :
- A.
Schedule him for an air contrast barium enema
- B.
Schedule him for a colonoscopy
- C.
Repeat the stool guiac tests
- D.
Schedule him for an upper endoscopy
Correct Answer
B. Schedule him for a colonoscopyExplanation
The patient is a 62-year-old individual who has tested positive for stool guaiac tests. Stool guaiac tests are used to detect the presence of blood in the stool, which can be an indication of gastrointestinal bleeding. Given the positive test results, it is important to further investigate the cause of the bleeding. A colonoscopy is a procedure that allows for a visual examination of the colon and rectum, making it the most appropriate next step to identify the source of the bleeding. Therefore, scheduling the patient for a colonoscopy is the correct response in this case.Rate this question:
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- 11.
A common risk factor for patients who develop infectious diarrhea is:
- A.
Exposure to day care centers
- B.
Drinking contaminated water
- C.
Eating undercooked pork
- D.
Ingesting water from a swimming pool
Correct Answer
A. Exposure to day care centersExplanation
Exposure to day care centers is a common risk factor for patients who develop infectious diarrhea because these centers often have a high concentration of young children who may not have developed proper hygiene practices. Young children are more susceptible to infections and can easily spread them to others through close contact and sharing of toys or food. This close proximity and potential for exposure to various pathogens increases the risk of developing infectious diarrhea.Rate this question:
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- 12.
M.R. is undergoing chemotherapy for breast cancer. Her CBC is as follows: WBC: 2,000 Differential: 10% neutrophils, 85% lymphocytes, 5% monocytes What is her absolute neutrophil count?
- A.
100
- B.
200
- C.
1000
- D.
1700
Correct Answer
B. 200Explanation
The absolute neutrophil count is calculated by multiplying the total white blood cell count by the percentage of neutrophils. In this case, the total white blood cell count is 2,000 and the percentage of neutrophils is 10%. Therefore, the absolute neutrophil count is 200.Rate this question:
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- 13.
An 80 yo male patient has the following CBC: Hematocrit 29.2 Hemoglobin: 12.8 Platelets 150,000 WBC 83,000 PMN 12% Lymph 83% Mono 4% Eos 1%What is the diagnosis?
- A.
Anemia of chronic disease
- B.
Thrombocytopenia
- C.
Microcytic anemia
- D.
Chronic lymphocytic leukemia
Correct Answer
D. Chronic lymphocytic leukemiaExplanation
The diagnosis of chronic lymphocytic leukemia is supported by the patient's age (80 years old), the elevated WBC count (83,000), and the differential count showing a high percentage of lymphocytes (83%). Chronic lymphocytic leukemia is a type of cancer that affects the white blood cells, specifically the lymphocytes. It is more commonly seen in older individuals and is characterized by an abnormal increase in lymphocytes in the blood. The other options (anemia of chronic disease, thrombocytopenia, and microcytic anemia) do not fit the given CBC results and clinical presentation.Rate this question:
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- 14.
Macrocytes can be seen on the peripheral smear of patients with all of the following EXCEPT:
- A.
Iron deficiency
- B.
Vitamin B deficiency
- C.
Folate deficiency
- D.
Liver disease
Correct Answer
A. Iron deficiencyExplanation
Macrocytes are abnormally large red blood cells. They can be seen on the peripheral smear in patients with vitamin B deficiency, folate deficiency, and liver disease. However, they are not typically seen in patients with iron deficiency. Iron deficiency usually leads to microcytic (smaller than normal) red blood cells rather than macrocytic ones.Rate this question:
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- 15.
After migration into tissues, basophils undergo transformation into:
- A.
Macrophages
- B.
Mast cells
- C.
Kuppfer cells
- D.
Monocytes
Correct Answer
B. Mast cellsExplanation
After migrating into tissues, basophils undergo transformation into mast cells. This transformation occurs in response to certain signals and conditions in the tissues. Mast cells play a crucial role in the immune response by releasing various substances such as histamine, which are involved in allergic reactions and inflammation. This transformation allows basophils to differentiate into a different cell type that is better suited for their function in the tissues.Rate this question:
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- 16.
CD4 and CD8 markers are found on:
- A.
T-lymphocytes
- B.
B-cells
- C.
Eosinophils
- D.
Basophils
Correct Answer
A. T-lymphocytesExplanation
CD4 and CD8 markers are found on T-lymphocytes. These markers are proteins that help identify and regulate different types of T-cells. CD4 is found on helper T-cells, which play a crucial role in coordinating the immune response. CD8 is found on cytotoxic T-cells, which are responsible for killing infected cells. B-cells, eosinophils, and basophils do not express CD4 or CD8 markers, making T-lymphocytes the correct answer.Rate this question:
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- 17.
All of the following statements regarding WBC’s are true EXCEPT:
- A.
Monocytes become macrophages
- B.
Lymphocytes are the most numerous cells
- C.
Eosinophils may be associated with pararsitic infections
- D.
Neutrophils are phagocytic
Correct Answer
B. Lymphocytes are the most numerous cellsExplanation
The given answer is correct because it states that lymphocytes are the most numerous cells, which is not true. In fact, neutrophils are the most numerous type of white blood cells in the human body. Lymphocytes play an important role in the immune system, but they are not the most numerous.Rate this question:
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- 18.
All of the following are characteristic findings in a patient with iron-deficiency anemia EXCEPT:
- A.
Microcytic, hypochromic red cell morphology
- B.
Elevated reticulocyte count
- C.
Elevated platelet count along with small platelets
- D.
Decreased ferrritin
Correct Answer
B. Elevated reticulocyte countExplanation
Iron-deficiency anemia is characterized by a decrease in red blood cell size (microcytic) and color (hypochromic), as well as a decrease in ferritin levels. These findings are due to a lack of iron, which is necessary for the production of hemoglobin. In iron-deficiency anemia, the body tries to compensate by increasing the production of red blood cells, leading to an elevated reticulocyte count. However, an elevated platelet count is not typically seen in iron-deficiency anemia.Rate this question:
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- 19.
Your patient’s labs reveal Hgb 10 (12-16), Hct 30 (37-47), MCV 88 (80-100), MCH 30 (27-31) and MCHC 34 (33-37). The RBC’s on the peripheral smear would appear:
- A.
Hypochromic, microcytic
- B.
Normochromic, microcytic
- C.
Normochromic, normocytic
- D.
Hypochromic, normocytic
Correct Answer
C. Normochromic, normocyticExplanation
The patient's labs show normal values for MCHC and MCV, indicating that the red blood cells are of normal size and have a normal amount of hemoglobin. Therefore, the RBC's on the peripheral smear would appear normochromic (normal color) and normocytic (normal size).Rate this question:
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- 20.
Which of the following tests is NOT usually included in a routine CBC?
- A.
Reticulocyte count
- B.
Total erythrocyte count
- C.
Platelet count
- D.
Total leukocyte count
Correct Answer
A. Reticulocyte countExplanation
A complete blood count (CBC) is a common blood test that provides information about the different components of blood. It typically includes measurements of red blood cells, white blood cells, and platelets. The reticulocyte count, however, is not usually included in a routine CBC. Reticulocytes are immature red blood cells, and their count is typically used to evaluate the production of new red blood cells in the bone marrow. Since a routine CBC focuses on the overall levels of mature blood cells, the reticulocyte count is not typically included.Rate this question:
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- 21.
When the body is invaded by pyogenic bacteria, a dramatic increase in the number of what type of white cell occurs?
- A.
Circulating eosinophils
- B.
Circulating neutrophils
- C.
Large lymphocytes
- D.
Monocytes
Correct Answer
B. Circulating neutrophilsExplanation
When the body is invaded by pyogenic bacteria, there is a rapid increase in the number of circulating neutrophils. Neutrophils are a type of white blood cell that are the first responders to bacterial infections. They are highly effective in engulfing and destroying bacteria through a process called phagocytosis. This increase in neutrophils is part of the body's immune response to combat the bacterial infection and protect against further harm.Rate this question:
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- 22.
An acutely ill, mildly febrile patient presents with the following CBC: WBC 5,100 (5,000-10,000) Neutrophils 25% (60-70%) Bands 7% (<5%) Lymphs 54% (20-40%) Atypical lymphs 14% This is most likely consistent with infection caused by:
- A.
Protozoans
- B.
Viruses
- C.
Encapsulated bacteria
- D.
Mycobacterium
Correct Answer
B. VirusesExplanation
The CBC results show a mild febrile state with a slightly decreased WBC count. The neutrophil count is lower than normal, while the lymphocyte count is higher than normal. These findings are consistent with a viral infection. Viruses typically cause a decrease in neutrophils and an increase in lymphocytes, which is reflected in the CBC results. Therefore, the most likely cause of the infection in this patient is viruses.Rate this question:
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- 23.
Mrs. J is a 48 yo woman who developed iron deficiency anemia secondary to perimenopausal bleeding successfully treated by endometrial ablation. Her hematocrit is 25% and she was started on iron therapy. At five days into therapy, you wish to check the efficacy of the treatment. The best laboratory test would be:
- A.
FE/TIBC
- B.
Hematocrit
- C.
Reticulocyte count
- D.
Ferritin
Correct Answer
C. Reticulocyte countExplanation
The best laboratory test to check the efficacy of iron therapy in this case would be the reticulocyte count. Reticulocytes are immature red blood cells that are released into the bloodstream in response to anemia. By measuring the reticulocyte count, we can determine if the bone marrow is responding adequately to the iron therapy and producing new red blood cells. If the reticulocyte count is low, it suggests that the iron therapy may not be effective in treating the anemia.Rate this question:
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- 24.
One month into therapy you wish to check the efficacy of the intervention. The best laboratory test is:
- A.
FE/TIBC
- B.
Hematocrit
- C.
Reticulocyte count
- D.
Ferritin
Correct Answer
B. HematocritExplanation
The hematocrit is the best laboratory test to check the efficacy of the intervention after one month of therapy. Hematocrit measures the percentage of red blood cells in the total blood volume, which can help determine if the therapy is effectively addressing any underlying blood disorders or deficiencies. By comparing the hematocrit levels before and after therapy, healthcare professionals can assess if the intervention has improved the patient's blood health.Rate this question:
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- 25.
The majority of the body’s iron is obtained from:
- A.
Food sources
- B.
Water supply
- C.
Endoplasmic reticulum production
- D.
Recycled iron content from aged RBC’s
Correct Answer
D. Recycled iron content from aged RBC’sExplanation
The majority of the body's iron is obtained from recycled iron content from aged RBC's. This is because when red blood cells (RBC's) reach the end of their lifespan, they are broken down and their iron content is recycled. The iron is then transported to the bone marrow where it is used to produce new RBC's. This recycling process ensures that the body can maintain a steady supply of iron for the production of new blood cells.Rate this question:
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- 26.
Pernicious anemia causes which of the following changes on the RBC indices?
- A.
Microcytic, normochromic
- B.
Normocytic, normochromic
- C.
Microcytic, hypochromic
- D.
Macrocytic, normochromic
Correct Answer
D. Macrocytic, normochromicExplanation
Pernicious anemia is a type of anemia that occurs due to the lack of intrinsic factor, which is necessary for the absorption of vitamin B12. This deficiency leads to impaired DNA synthesis and maturation of red blood cells (RBCs), resulting in macrocytic RBCs. Macrocytic RBCs are larger than normal RBCs. However, the anemia is normochromic, meaning that the amount of hemoglobin in the RBCs is normal. Therefore, the correct answer is "Macrocytic, normochromic."Rate this question:
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- 27.
A 22 yo female patient from Asian ancestry is without complaint in your office and her CBC shows a Hgb 9.1( 12-16) Hct 28% (37-47%) RBC 5 million (3.6-5.0 million) MCV 68 (87-103) RDW 13% (11.5-14.5%). The most likely diagnosis is:
- A.
Iron deficiency anemia
- B.
Cooley’s anemia
- C.
Alpha thalassemia minor
- D.
Hemoglobin Barts
Correct Answer
C. Alpha thalassemia minorExplanation
The most likely diagnosis in this case is Alpha thalassemia minor. This is indicated by the low levels of hemoglobin (Hgb) and hematocrit (Hct), as well as the low mean corpuscular volume (MCV) and normal red blood cell (RBC) count. Alpha thalassemia minor is a genetic disorder that affects the production of hemoglobin, leading to mild anemia. It is commonly found in individuals of Asian ancestry. Cooley's anemia and Hemoglobin Barts are more severe forms of thalassemia, while iron deficiency anemia would typically present with low iron levels.Rate this question:
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- 28.
A 68 yo man is usually healthy but presents with new onset of “huffing and puffing” with exercise. Physical examination reveals conjunctival pallor and a flow murmur murmur. Hgb 7.6 (12-16) MCV 71 (87-103). The most likely problem is:
- A.
Poor nutrition
- B.
Occult blood loss
- C.
Malabsorption
- D.
Macrocytosis
Correct Answer
B. Occult blood lossExplanation
The patient's presentation of huffing and puffing with exercise, conjunctival pallor, and a low hemoglobin level suggests anemia. The low MCV indicates microcytic anemia. The most likely cause of microcytic anemia in this case is occult blood loss. Occult blood loss refers to small, hidden amounts of bleeding that are not visible to the naked eye. It can be caused by conditions such as gastrointestinal bleeding, peptic ulcers, or colon cancer.Rate this question:
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- 29.
Many community centers provide cholesterol screening programs for the public. Which result(s) would be considered a risk factor for coronary heart disease with regard to lipid levels? 1. Total cholesterol greater than 240 2. LDL cholesterol less than 100 3. HDL cholesterol greater than 60 4. HDL less than 35
- A.
1 and 3
- B.
2 and 3
- C.
1 and 4
- D.
1, 2 and 3
Correct Answer
C. 1 and 4Explanation
A total cholesterol level greater than 240 is considered a risk factor for coronary heart disease because high levels of total cholesterol can contribute to the buildup of plaque in the arteries, leading to blockages and reduced blood flow to the heart. Similarly, an HDL cholesterol level less than 35 is also considered a risk factor because low levels of HDL cholesterol are associated with an increased risk of coronary heart disease. Therefore, options 1 and 4 are the correct choices as they both represent risk factors for coronary heart disease with regard to lipid levels.Rate this question:
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- 30.
Used mainly for screening
- A.
Serum cholesterol
- B.
Hypertriglyceridemia
- C.
LDL
- D.
HDL
Correct Answer
A. Serum cholesterolExplanation
Serum cholesterol is used mainly for screening because it is a commonly measured blood test that provides information about a person's lipid profile. It helps in assessing the risk of developing cardiovascular diseases, as high levels of serum cholesterol, specifically LDL (low-density lipoprotein) cholesterol, are associated with an increased risk. Additionally, it can also provide information about HDL (high-density lipoprotein) cholesterol levels, which is considered "good" cholesterol. Hypertriglyceridemia, which refers to high levels of triglycerides in the blood, is another important parameter that can be evaluated through serum cholesterol testing.Rate this question:
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- 31.
Associated with diabetes
- A.
Serum cholesterol
- B.
Hypertriglyceridemia
- C.
LDL
- D.
HDL
Correct Answer
B. HypertriglyceridemiaExplanation
Hypertriglyceridemia refers to high levels of triglycerides in the blood, which is a type of fat. It is often associated with diabetes, as individuals with diabetes tend to have higher levels of triglycerides. High triglyceride levels can contribute to the development of cardiovascular diseases, such as heart disease and stroke. Therefore, managing hypertriglyceridemia is important in individuals with diabetes to reduce the risk of these complications. The other options mentioned, serum cholesterol, LDL (low-density lipoprotein), and HDL (high-density lipoprotein), are also related to lipid levels in the blood, but hypertriglyceridemia specifically refers to elevated triglyceride levels.Rate this question:
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- 32.
High level is cardiac risk factor
- A.
Serum cholesterol
- B.
Hypertriglyceridemia
- C.
LDL
- D.
HDL
Correct Answer
C. LDLExplanation
LDL (low-density lipoprotein) is the correct answer because it is a type of cholesterol that is considered a high level cardiac risk factor. LDL is often referred to as "bad cholesterol" because high levels of LDL can lead to the buildup of plaque in the arteries, increasing the risk of heart disease and stroke. Therefore, monitoring and managing LDL levels is crucial in assessing and reducing cardiac risk.Rate this question:
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- 33.
High level thought to be protective
- A.
Serum cholesterol
- B.
Hypertriglyceridemia
- C.
LDL
- D.
HDL
Correct Answer
D. HDLExplanation
HDL, also known as high-density lipoprotein, is considered to be protective against cardiovascular diseases. It is often referred to as "good cholesterol" because it helps remove excess cholesterol from the bloodstream and carries it back to the liver for disposal. High levels of HDL are associated with a lower risk of heart disease, while low levels are linked to an increased risk. Therefore, in the context of the given information, HDL is the correct answer as it is known to have a positive effect on overall health.Rate this question:
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- 34.
Mrs. T, 34 yo, presents in your office with vague complaints of fatigue, weight loss and crying episodes. You order screening blood work and all are within normal limits except the TSH which is 0.1 (nl 0.5-5.0 and the T4 is 10. Your diagnosis based on these findings is:
- A.
Sublinical hypothyroidism
- B.
Overt hypothyroidism
- C.
Subclinical hyperthryoidism
- D.
Overt hyperthyroidism
Correct Answer
C. Subclinical hyperthryoidismExplanation
Based on the given information, the patient's TSH level is below the normal range (0.1 instead of 0.5-5.0), while the T4 level is within normal limits. This indicates subclinical hyperthyroidism, which is a condition where the thyroid gland is producing excessive amounts of thyroid hormone, but the patient does not show any symptoms of hyperthyroidism. This diagnosis is supported by the patient's complaints of fatigue, weight loss, and crying episodes, which can be attributed to the hyperthyroid state.Rate this question:
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- 35.
A patient with signs and symptoms of hyperthyroidism presents with a TSH <0.1 and a normal T4. What test would you order to support your diagnosis?
- A.
T3
- B.
Repeat TSH
- C.
TRH stimulation test
- D.
Synthroid level
Correct Answer
A. T3Explanation
In a patient with signs and symptoms of hyperthyroidism and a low TSH level (Rate this question:
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- 36.
A 71 yo female patient presents as a new patient to your practice. She has no specific complaints. Her screening lab tests shows TSH 10 and T4 of 2. What is your diagnosis?
- A.
Subclinical hyperthyroidism
- B.
Overt hyperthyroidism
- C.
Subclinical hypothyroidism
- D.
Overt hypothyroidism
Correct Answer
C. Subclinical hypothyroidismExplanation
Based on the given information, the patient's TSH level is elevated (TSH 10) while the T4 level is within the normal range (T4 of 2). This indicates that the patient has subclinical hypothyroidism. In subclinical hypothyroidism, the TSH level is high while the thyroid hormone levels are still within normal limits. This condition often does not present with specific symptoms, hence the patient's lack of complaints. Treatment may be considered based on the patient's age, symptoms, and other factors.Rate this question:
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- 37.
Your adjust the dose of a patient on Synthroid, a thyroid hormone replacement medication, and schedule the patient to have a TSH drawn in:
- A.
One week
- B.
Two weeks
- C.
6 weeks
- D.
6 months
Correct Answer
C. 6 weeksExplanation
The correct answer is 6 weeks because it takes approximately 4-6 weeks for the full effect of Synthroid to be seen in the body. TSH (thyroid-stimulating hormone) levels are typically measured to assess the effectiveness of the medication. Drawing the TSH level after 6 weeks allows enough time for the medication to reach its maximum effect and for any necessary adjustments to be made to the dose.Rate this question:
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- 38.
The most common cause of hypothyroidism is:
- A.
Drug induced hypothyroidism
- B.
Hashimoto’s disease
- C.
Postpartum necrosis
- D.
A pituitary tumor
Correct Answer
B. Hashimoto’s diseaseExplanation
Hashimoto's disease is the most common cause of hypothyroidism. It is an autoimmune disorder in which the body's immune system mistakenly attacks the thyroid gland, leading to inflammation and damage. This results in a decrease in thyroid hormone production, leading to hypothyroidism. Drug-induced hypothyroidism can occur as a side effect of certain medications, but it is not as common as Hashimoto's disease. Postpartum necrosis refers to the death of thyroid tissue following childbirth, which can also cause hypothyroidism, but it is less common than Hashimoto's disease. A pituitary tumor can disrupt the production of thyroid-stimulating hormone (TSH), leading to hypothyroidism, but it is not the most common cause.Rate this question:
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- 39.
Laboratory test abnormalities in hypothyroidism may include:
- A.
Increased cholesterol
- B.
Decreased creatinine kinase
- C.
Hypernatremia
- D.
Microcytic anemia
Correct Answer
A. Increased cholesterolExplanation
In hypothyroidism, the thyroid gland does not produce enough thyroid hormones, leading to a decrease in metabolic rate. This can result in an increase in cholesterol levels as the body is unable to efficiently break down and remove cholesterol from the bloodstream. Therefore, increased cholesterol is a laboratory test abnormality commonly seen in hypothyroidism.Rate this question:
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- 40.
Assessment of antithyroid antibodies titers are helpful in determining therapy in patients with:
- A.
Hyperthyroidism
- B.
Subclinical hyperthyroidism
- C.
Hypothyroidism
- D.
Subclinical hypothyroidism
Correct Answer
D. Subclinical hypothyroidismExplanation
Assessment of antithyroid antibodies titers are helpful in determining therapy in patients with subclinical hypothyroidism. Subclinical hypothyroidism is a condition where the thyroid stimulating hormone (TSH) levels are elevated, indicating an underactive thyroid, but the thyroid hormone levels (T3 and T4) are within the normal range. Antithyroid antibodies, such as thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies (TgAb), are often present in subclinical hypothyroidism. The presence of these antibodies suggests an autoimmune cause for the thyroid dysfunction. Determining the titers of these antibodies can help in guiding the appropriate therapy for subclinical hypothyroidism, such as the initiation of levothyroxine treatment.Rate this question:
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- 41.
Screening for thyroid disorders would be appropriate in all of the following EXCEPT:
- A.
Female patients 40 yo or older
- B.
Male patients under 50 yo
- C.
Geriatric patients
- D.
Adults with hyperlipidemia
Correct Answer
B. Male patients under 50 yoExplanation
Screening for thyroid disorders is typically recommended for certain populations, such as females over the age of 40 and geriatric patients, as they are more likely to develop thyroid issues. Additionally, adults with hyperlipidemia may also benefit from thyroid screening due to the potential correlation between thyroid dysfunction and lipid abnormalities. However, male patients under the age of 50 are generally not considered a high-risk group for thyroid disorders, hence screening may not be necessary for this specific population.Rate this question:
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- 42.
The most common cause of adrenal insufficiency is:
- A.
Pituitary tumor
- B.
Adrenal tumor
- C.
Adrenal hyperplasia
- D.
Automimmune disease
Correct Answer
D. Automimmune diseaseExplanation
Adrenal insufficiency is a condition where the adrenal glands do not produce enough hormones. The most common cause of adrenal insufficiency is an autoimmune disease, where the body's immune system mistakenly attacks the adrenal glands. This leads to damage and dysfunction of the glands, resulting in reduced hormone production. Pituitary tumors can also cause adrenal insufficiency, as they can interfere with the production of adrenocorticotropic hormone (ACTH), which stimulates the adrenal glands. Adrenal tumors and adrenal hyperplasia can also affect hormone production but are less common causes of adrenal insufficiency.Rate this question:
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- 43.
A patient with secondary or tertiary adrenal insufficiency would display which test results?
- A.
Decreased ACTH, decreased Cortisol
- B.
Increased ACTH, increased Cortisol
- C.
Increased ACTH, decreased Cortisol
- D.
Decreased ACTH, increased Cortisol
Correct Answer
A. Decreased ACTH, decreased CortisolExplanation
In secondary or tertiary adrenal insufficiency, the problem lies in the pituitary gland or hypothalamus, which leads to a decrease in the production of ACTH. ACTH is responsible for stimulating the adrenal glands to produce cortisol. Therefore, in this condition, both ACTH and cortisol levels would be decreased.Rate this question:
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- 44.
To validate your diagnosis in the previous situation, you would order a:
- A.
Cortisol level
- B.
Aldosterone/Renin ratio
- C.
Adrenalin level
- D.
CT scan of the brain
Correct Answer
B. Aldosterone/Renin ratioExplanation
To validate the diagnosis in the previous situation, ordering an Aldosterone/Renin ratio would be appropriate. This test helps in evaluating the functioning of the adrenal glands and detecting any abnormalities related to aldosterone and renin levels. Aldosterone is a hormone that regulates sodium and potassium levels, while renin is an enzyme involved in blood pressure regulation. An imbalance in these hormones can indicate conditions such as primary aldosteronism or secondary hypertension. Therefore, measuring the aldosterone/renin ratio can provide valuable information to confirm or rule out these conditions.Rate this question:
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- 45.
A new patient presents in your office with obesity, a moon face appearance with facial plethora, hypertension and reported high blood glucose levels. What lab test would you add to your screening panel?
- A.
24 hour urine for free cortisol, 17-OHCS, 17-KGS
- B.
Glucocorticoid stimulation test
- C.
Adrenal antibody titers
- D.
Prolactin level
Correct Answer
A. 24 hour urine for free cortisol, 17-OHCS, 17-KGSExplanation
In this scenario, the patient is presenting with symptoms that are consistent with Cushing's syndrome, a condition characterized by excessive cortisol production. The lab tests listed in the answer choice, 24-hour urine for free cortisol, 17-OHCS, and 17-KGS, are used to assess cortisol levels in the body. Measuring cortisol in the urine over a 24-hour period can help determine if there is excessive cortisol production. Additionally, 17-OHCS and 17-KGS are metabolites of cortisol that can also be elevated in Cushing's syndrome. Therefore, adding these lab tests to the screening panel would help in the diagnosis of Cushing's syndrome.Rate this question:
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- 46.
A 76 yo female patient has a serum chemistry panel that reveals an elevated serum calcium. You eliminate her calcium supplements and repeat the test. The serum calcium remains elevated. What would you do?
- A.
Refer her to Endocrinology
- B.
Order a serum albumin
- C.
Order a serum PTH level
- D.
Monitor the levels every month
Correct Answer
C. Order a serum PTH levelExplanation
Ordering a serum PTH level would be the appropriate next step in this case. PTH (parathyroid hormone) is responsible for regulating calcium levels in the body. If the serum calcium remains elevated even after eliminating calcium supplements, it suggests that there may be an issue with the regulation of calcium by PTH. Therefore, ordering a serum PTH level would help in evaluating the function of the parathyroid gland and determining the cause of the elevated serum calcium.Rate this question:
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- 47.
Patients with Pheochromocytoma exhibit a triad of symptoms to include all of the following EXCEPT:
- A.
Headache
- B.
Hypotension
- C.
Palpatations
- D.
Diaphoresis
Correct Answer
B. HypotensionExplanation
Patients with Pheochromocytoma exhibit a triad of symptoms including headache, palpitations, and diaphoresis. However, hypotension is not typically seen in patients with Pheochromocytoma. This is because Pheochromocytoma is a tumor of the adrenal glands that causes excessive production of catecholamines, which results in increased blood pressure. Therefore, the absence of hypotension is expected in patients with Pheochromocytoma.Rate this question:
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- 48.
The most common disorder of the anterior pituitary is:
- A.
SIADH
- B.
Diabetes Insipidus
- C.
Hyperprolactinemia
- D.
Hypogonadism
Correct Answer
C. HyperprolactinemiaExplanation
Hyperprolactinemia is the most common disorder of the anterior pituitary. It is characterized by an overproduction of prolactin, a hormone responsible for milk production in women. This condition can result in various symptoms such as irregular menstrual periods, infertility, breast milk production in men, and decreased libido. Hyperprolactinemia can be caused by various factors including certain medications, tumors in the pituitary gland, and hypothalamic dysfunction. Treatment options may include medication to lower prolactin levels, surgical removal of tumors, or radiation therapy.Rate this question:
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- 49.
A 42 yo female patient presents in your office with amenorrhea for three months. She states that her husband has had a vasectomy. What diagnositic test(s) would you perform first?
- A.
Pregnancy test, TSH, Prolactin
- B.
Progesterone challenge
- C.
LH, FSH
- D.
Testosterone, DHEA
Correct Answer
A. Pregnancy test, TSH, ProlactinExplanation
The patient's amenorrhea could be due to pregnancy, thyroid dysfunction, or elevated prolactin levels. Therefore, the first diagnostic tests to perform would be a pregnancy test to rule out pregnancy, TSH (thyroid-stimulating hormone) to assess thyroid function, and prolactin levels to check for hyperprolactinemia. These tests will help identify the potential causes of the patient's amenorrhea and guide further evaluation and management. LH (luteinizing hormone) and FSH (follicle-stimulating hormone) levels would be more relevant if there were suspicions of ovarian dysfunction. Testosterone and DHEA (dehydroepiandrosterone) would be more appropriate if there were signs of androgen excess.Rate this question:
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- 50.
A 50 yo male scheduled for an annual examination reports diminished libido and sexual functioning. He has no other health problems. You would order:
- A.
DHEA, hCG levels
- B.
Prolactin, testosterone levels
- C.
A referral to urology
- D.
Clomiphene stim test
Correct Answer
B. Prolactin, testosterone levelsExplanation
Diminished libido and sexual functioning in a 50-year-old male could be indicative of hormonal imbalances. Prolactin and testosterone levels are commonly ordered to assess hormonal function in such cases. Prolactin levels can help identify any abnormalities in the pituitary gland, which can affect testosterone production. Testosterone levels, on the other hand, can provide insights into the overall hormonal balance and help diagnose conditions like hypogonadism. Therefore, ordering prolactin and testosterone levels would be appropriate in this scenario to evaluate the patient's hormonal status.Rate this question:
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