Can You Pass This Ambulatory Trivia Test?
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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!
- 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
- 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
- 3.Waived CLIA tests include:
- A.
Western blot test
- B.
Urine sediment microscopy
- C.
Urine dipstick
- D.
Wet prep slides
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 15.After migration into tissues, basophils undergo transformation into:
- A.
Macrophages
- B.
Mast cells
- C.
Kuppfer cells
- D.
Monocytes
- 16.CD4 and CD8 markers are found on:
- A.
T-lymphocytes
- B.
B-cells
- C.
Eosinophils
- D.
Basophils
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 30.Used mainly for screening
- A.
Serum cholesterol
- B.
Hypertriglyceridemia
- C.
LDL
- D.
HDL
- 31.Associated with diabetes
- A.
Serum cholesterol
- B.
Hypertriglyceridemia
- C.
LDL
- D.
HDL
- 32.High level is cardiac risk factor
- A.
Serum cholesterol
- B.
Hypertriglyceridemia
- C.
LDL
- D.
HDL
- 33.High level thought to be protective
- A.
Serum cholesterol
- B.
Hypertriglyceridemia
- C.
LDL
- D.
HDL
- 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
- 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
- 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
- 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
- 38.The most common cause of hypothyroidism is:
- A.
Drug induced hypothyroidism
- B.
Hashimoto’s disease
- C.
Postpartum necrosis
- D.
A pituitary tumor
- 39.Laboratory test abnormalities in hypothyroidism may include:
- A.
Increased cholesterol
- B.
Decreased creatinine kinase
- C.
Hypernatremia
- D.
Microcytic anemia
- 40.Assessment of antithyroid antibodies titers are helpful in determining therapy in patients with:
- A.
Hyperthyroidism
- B.
Subclinical hyperthyroidism
- C.
Hypothyroidism
- D.
Subclinical hypothyroidism
- 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
- 42.The most common cause of adrenal insufficiency is:
- A.
Pituitary tumor
- B.
Adrenal tumor
- C.
Adrenal hyperplasia
- D.
Automimmune disease
- 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
- 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
- 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
- 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
- 47.Patients with Pheochromocytoma exhibit a triad of symptoms to include all of the following EXCEPT:
- A.
Headache
- B.
Hypotension
- C.
Palpatations
- D.
Diaphoresis
- 48.The most common disorder of the anterior pituitary is:
- A.
SIADH
- B.
Diabetes Insipidus
- C.
Hyperprolactinemia
- D.
Hypogonadism
- 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
- 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
- 51.What is the percentage of people experiencing an acute MI with a non-diagnostic EKG?
- A.
25%
- B.
50%
- C.
75%
- D.
100%
- 52.What is the normal FEV1/FVC ratio?
- A.
Less than 25%
- B.
Greater than 80%
- C.
Less than 70%
- D.
100%
- 53.What is the term for frequency of disease in a group?
- A.
Frequency measurements
- B.
Occurrences
- C.
Prevalence
- D.
Endemic
- 54.What is the most specific of the cardiac markers that can be measured 3 hours after the onset of an MI, that peaks in 24 hours and remains elevated up to 2 weeks after the event?
- A.
Myoglobin
- B.
Creatinine kinase MB (CK-MB)
- C.
Lactate dehydrogenase (LDH)
- D.
Troponin I, T
- 55.Which of the following is not a secondary cause of hyperlipidemia?
- A.
Hypothyroidism
- B.
Familial hypercholesterolemia
- C.
Medications
- D.
ETOH abuse
- 56.Which of the following conditions does not cause a macrocytic anemia
- A.
B12 deficiency
- B.
Addison’s disease
- C.
Folate deficiency
- D.
ETOH abuse
- 57.BNP (B natriuretic paptide’s) main benefit is its negative predictive value. If BNP levels are less than 100, which of the following conditions is ruled out?
- A.
Hyperparathyroidism
- B.
Acute MI
- C.
Congestive heart failure
- D.
COPD
- 58.A patient has an FEV1 of 1.91 liters (52% of the predicted value). Which of the following might result in this low value? 1. Small airways obstruction 2. Poor effort at the start of the test 3. Restriction due to fibrosis 4. COPD
- A.
All of the above
- B.
1,3, 4
- C.
1,2, 3
- D.
1,2,4
- E.
2,3,4
- 59.In analyzing the PFT’s of a patient with restrictive lung disease, you recognize that:
- A.
Both the FEV1 and FVC are increased proportionally
- B.
The size of the loop is larger than normal loops
- C.
Spirometry alone cannot diagnose this condition
- D.
FVC and FEV1 are both decreased proportionately
- 60.The volume of air expelled in the first second of the FVC
- A.
FRC (functional residual capacity
- B.
FEV1/FVC
- C.
FVC (forced vital capacity)
- D.
FEV1
- 61.The percent of lung capacity that can be exhaled in one second
- A.
FRC (functional residual capacity
- B.
FEV1/FVC
- C.
FVC (forced vital capacity)
- D.
FEV1
- 62.Air left in the lungs after a normal unforced expiration
- A.
FRC (functional residual capacity
- B.
FEV1/FVC
- C.
FVC (forced vital capacity)
- D.
FEV1
- 63.Produced by forceful expulsion from the lungs after maximum inhalation
- A.
FRC (functional residual capacity
- B.
FEV1/FVC
- C.
FVC (forced vital capacity)
- D.
FEV1
- 64.When you are evaluating the ppd results of someone you know is the household contact of someone with TB, you know that which of the following reactions is considered a positive test?
- A.
5 mm
- B.
10mm
- C.
15mm
- D.
20mm
- 65.COPD is a subset of diverse pulmonary diseases. The progressive slowing of the respiratory flow rate is measured by:
- A.
An increase in the carbon monoxide diffusing capacity (DLCO)
- B.
A decrease in the anterior-posterior (A-P) diameter of the chest
- C.
A reduction in the ratio of the forced expiratory volume (FEV1) to forced vital capacity (FVC)
- D.
None of the above
- 66.What are the 2 most important measurements in spirometry?
- A.
FVC and FEV1
- B.
PEFR and FRC
- C.
FVC and FRC
- D.
PEFR and FVC
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