Ambulatory Care Test Ambulatory Care Clinical Data Interpretation 5 — Questions and Answers
Question 1: A patient's fasting glucose is 118 mg/dL on two separate occasions. How should this be classified?
- Normal fasting glucose
- Impaired fasting glucose (prediabetes) (Correct answer)
- Type 2 diabetes mellitus
- Stress hyperglycemia
Correct answer: Impaired fasting glucose (prediabetes)
Fasting plasma glucose between 100-125 mg/dL on two occasions meets the ADA criteria for impaired fasting glucose, classified as prediabetes.
Question 2: A 30-year-old woman's CBC shows hemoglobin 9.8 g/dL, MCV 72 fL, and serum ferritin 6 ng/mL. What is the most likely diagnosis?
- Anemia of chronic disease
- Iron deficiency anemia (Correct answer)
- Vitamin B12 deficiency anemia
- Hemolytic anemia
Correct answer: Iron deficiency anemia
Microcytic anemia (low MCV) combined with very low serum ferritin (<12 ng/mL) is diagnostic of iron deficiency anemia.
Question 3: A 24-hour urine protein is 3.8 g/day in a patient with new-onset edema and serum albumin of 2.2 g/dL. What syndrome does this represent?
- Nephritic syndrome
- Nephrotic syndrome (Correct answer)
- Acute tubular necrosis
- Prerenal azotemia
Correct answer: Nephrotic syndrome
Nephrotic syndrome is defined by proteinuria >3.5 g/day, hypoalbuminemia, edema, and hyperlipidemia, all of which are present in this patient.
Question 4: A patient on lithium therapy has a trough serum lithium level of 1.6 mEq/L. What finding would you expect?
- Subtherapeutic level; titrate dose upward
- Therapeutic level for acute mania
- Toxic level; hold lithium and evaluate for toxicity symptoms (Correct answer)
- Normal maintenance level
Correct answer: Toxic level; hold lithium and evaluate for toxicity symptoms
Lithium levels above 1.5 mEq/L are considered toxic, with symptoms including tremor, ataxia, confusion, and in severe cases, seizures or cardiac arrhythmias.
Question 5: A patient's ECG shows a corrected QT interval (QTc) of 510 ms after starting azithromycin. What is the primary concern?
- Increased risk of atrial fibrillation
- Increased risk of torsades de pointes ventricular tachycardia (Correct answer)
- Increased risk of heart block
- Increased risk of supraventricular tachycardia
Correct answer: Increased risk of torsades de pointes ventricular tachycardia
A QTc above 500 ms significantly increases the risk of torsades de pointes, a potentially fatal polymorphic ventricular tachycardia.
Question 6: A patient with an acute gout flare has a serum uric acid of 5.8 mg/dL during the attack. What is the correct interpretation?
- Gout is ruled out because uric acid is normal
- Serum uric acid can be normal or low during an acute attack and does not rule out gout (Correct answer)
- The patient has pseudogout, not gout
- The patient's allopurinol is working effectively
Correct answer: Serum uric acid can be normal or low during an acute attack and does not rule out gout
Serum uric acid can drop during an acute gout attack due to uricosuric effects of inflammation; diagnosis requires synovial fluid analysis or clinical criteria.
Question 7: A patient's CMP shows sodium 128 mEq/L, serum osmolality 258 mOsm/kg, urine sodium 42 mEq/L, and urine osmolality 520 mOsm/kg. What is the most likely etiology?
- Psychogenic polydipsia
- Syndrome of inappropriate antidiuretic hormone secretion (SIADH) (Correct answer)
- Diabetes insipidus
- Hyperglycemia-induced hyponatremia
Correct answer: Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
SIADH presents with hyponatremia, low serum osmolality, inappropriately concentrated urine (>100 mOsm/kg), and elevated urine sodium (>40 mEq/L).
Ambulatory Care Test Ambulatory Care Clinical Data Interpretation 5
A patient's fasting glucose is 118 mg/dL on two separate occasions.
How should this be classified?