Ambulatory Care Test Ambulatory Care Clinical Data Interpretation 4 — Questions and Answers
Question 1: An ambulatory patient's spirometry shows FEV1/FVC ratio of 0.62 with FEV1 of 58% predicted. How is this classified?
- Restrictive pattern, mild
- Obstructive pattern, moderate (Correct answer)
- Normal spirometry
- Mixed obstructive-restrictive pattern
Correct answer: Obstructive pattern, moderate
An FEV1/FVC ratio below 0.70 confirms obstruction, and an FEV1 between 50-80% predicted classifies severity as moderate per GOLD criteria.
Question 2: A patient's random urine albumin-to-creatinine ratio (UACR) is 180 mg/g. What category of albuminuria does this represent?
- Normal (A1)
- Moderately increased (A2) (Correct answer)
- Severely increased (A3)
- Normal variant, no action needed
Correct answer: Moderately increased (A2)
A UACR of 30-300 mg/g is classified as moderately increased albuminuria (A2), indicating early diabetic or hypertensive nephropathy.
Question 3: A patient's CBC shows MCV of 110 fL and hypersegmented neutrophils. Which finding would most confirm the underlying cause?
- Low serum iron and elevated TIBC
- Low serum vitamin B12 or folate level (Correct answer)
- Elevated reticulocyte count
- Positive direct Coombs test
Correct answer: Low serum vitamin B12 or folate level
Macrocytosis (elevated MCV) with hypersegmented neutrophils is a classic presentation of megaloblastic anemia caused by B12 or folate deficiency.
Question 4: A patient with hypertension has a morning home blood pressure reading averaging 148/92 mmHg over 7 days despite being well-controlled in the office. What phenomenon does this suggest?
- White coat hypertension
- Masked hypertension (Correct answer)
- Pseudohypertension
- Orthostatic hypotension
Correct answer: Masked hypertension
Masked hypertension refers to normal office blood pressure with elevated out-of-office readings, which carries significant cardiovascular risk and requires treatment adjustment.
Question 5: A hemoglobin electrophoresis shows HbS 40%, HbA 55%, HbF 5%, HbA2 2%. How should this pattern be interpreted?
- Sickle cell disease (HbSS)
- Sickle cell trait (HbAS) (Correct answer)
- HbSC disease
- Beta-thalassemia major
Correct answer: Sickle cell trait (HbAS)
The presence of both HbA and HbS with HbS around 40% is characteristic of sickle cell trait (HbAS), a carrier state not typically causing sickling crises.
Question 6: A patient's CMP reveals AST 310 U/L, ALT 420 U/L, total bilirubin 1.1 mg/dL, and alkaline phosphatase 88 U/L. Which pattern does this represent?
- Cholestatic liver injury
- Hepatocellular liver injury (Correct answer)
- Infiltrative hepatic disease
- Normal liver function
Correct answer: Hepatocellular liver injury
Marked elevation of aminotransferases (AST and ALT) with near-normal bilirubin and alkaline phosphatase is characteristic of hepatocellular injury from causes like viral hepatitis or drug toxicity.
Question 7: A 45-year-old woman has a DEXA scan showing a T-score of -2.6 at the lumbar spine. What is the correct diagnosis?
- Normal bone density
- Osteopenia
- Osteoporosis (Correct answer)
- Severe osteoporosis with fragility fracture
Correct answer: Osteoporosis
A T-score at or below -2.5 meets the WHO diagnostic criterion for osteoporosis, regardless of fracture history.
Ambulatory Care Test Ambulatory Care Clinical Data Interpretation 4
An ambulatory patient's spirometry shows FEV1/FVC ratio of 0.62 with FEV1 of 58% predicted.
How is this classified?