Ambulatory Care Test Ambulatory Care Clinical Data Interpretation 2 — Questions and Answers
Question 1: A patient's HbA1c is 8.9%. According to ADA standards, what does this result indicate?
- Well-controlled diabetes
- Poorly controlled diabetes requiring therapy intensification (Correct answer)
- Prediabetes range
- Normal glucose metabolism
Correct answer: Poorly controlled diabetes requiring therapy intensification
An HbA1c above 8% indicates poor glycemic control, and the ADA recommends intensifying therapy to reach a goal below 7% for most adults.
Question 2: A 68-year-old on warfarin has an INR of 4.8 with no bleeding. What is the most appropriate action?
- Continue current dose and recheck in 1 week
- Hold 1-2 doses and recheck INR more frequently (Correct answer)
- Administer vitamin K 10 mg IV immediately
- Discontinue warfarin permanently
Correct answer: Hold 1-2 doses and recheck INR more frequently
For supratherapeutic INR 4.5–10 without serious bleeding, holding doses and rechecking INR is the recommended approach per ACCP guidelines.
Question 3: A serum potassium of 3.1 mEq/L is reported in a patient on hydrochlorothiazide. Which symptom is most directly associated with this value?
- Hypertension
- Muscle weakness and cramping (Correct answer)
- Peripheral edema
- Polydipsia
Correct answer: Muscle weakness and cramping
Hypokalemia commonly causes neuromuscular symptoms including weakness, fatigue, and muscle cramps due to altered membrane potential.
Question 4: A patient's LDL is 145 mg/dL and they have established ASCVD. Per ACC/AHA guidelines, what is the treatment goal?
- LDL < 130 mg/dL
- LDL < 100 mg/dL
- LDL < 70 mg/dL with ≥50% reduction (Correct answer)
- No specific LDL target; treat with maximum tolerated statin
Correct answer: LDL < 70 mg/dL with ≥50% reduction
For very high-risk ASCVD patients, ACC/AHA 2019 guidelines recommend an LDL goal of <70 mg/dL with at least a 50% reduction from baseline.
Question 5: A urinalysis shows >100,000 CFU/mL of E. coli in an asymptomatic 55-year-old woman with type 2 diabetes. What is the recommended approach?
- Treat with a 7-day course of ciprofloxacin
- Treat with a 3-day course of trimethoprim-sulfamethoxazole
- No antibiotic treatment is indicated (Correct answer)
- Refer to urology for cystoscopy
Correct answer: No antibiotic treatment is indicated
Current IDSA guidelines do not recommend treating asymptomatic bacteriuria in patients with diabetes, as treatment does not reduce complications and increases antibiotic resistance.
Question 6: A 72-year-old patient has an eGFR of 28 mL/min/1.73m². Which medication should be dose-adjusted or avoided?
- Amlodipine
- Atorvastatin
- Metformin (Correct answer)
- Lisinopril
Correct answer: Metformin
Metformin is contraindicated when eGFR falls below 30 mL/min/1.73m² due to the risk of lactic acidosis from drug accumulation.
Question 7: A TSH of 0.08 mIU/L is found in a 60-year-old woman on levothyroxine. What is the most appropriate clinical interpretation?
- Hypothyroidism requiring dose increase
- Euthyroid state; continue current dose
- Subclinical hyperthyroidism; consider dose reduction (Correct answer)
- Primary adrenal insufficiency
Correct answer: Subclinical hyperthyroidism; consider dose reduction
A suppressed TSH below 0.4 mIU/L in a patient on levothyroxine suggests overreplacement and subclinical hyperthyroidism, warranting dose reduction.
Ambulatory Care Test Ambulatory Care Clinical Data Interpretation 2
A patient's HbA1c is 8.9%.
According to ADA standards, what does this result indicate?