CLT Patient Assessment & Clinical Evaluation 3 — Questions and Answers
Question 1: A 65-year-old male with chest pain has troponin I of 0.04 ng/mL (reference <0.04). The most appropriate clinical interpretation is:
- Definitively normal; no cardiac injury
- Borderline elevation requiring serial testing and clinical correlation (Correct answer)
- Confirms acute MI without further testing
- Indicates skeletal muscle injury only
Correct answer: Borderline elevation requiring serial testing and clinical correlation
A borderline troponin at the 99th percentile requires serial measurements and clinical correlation to evaluate for rising or falling patterns consistent with acute MI.
Question 2: Which urinalysis finding requires the laboratory to immediately notify the ordering clinician regardless of the clinical setting?
- Trace protein in a diabetic patient
- Bacteriuria without WBCs
- Glucose 1+ in a non-diabetic patient
- Greater than 50 RBCs/HPF (Correct answer)
Correct answer: Greater than 50 RBCs/HPF
Greater than 50 RBCs/HPF represents heavy hematuria, a critical finding that may indicate serious pathology such as malignancy or glomerulonephritis.
Question 3: A patient's hemoglobin A1c is 10.2%. Which average blood glucose level does this most closely correspond to?
- Approximately 180 mg/dL
- Approximately 240 mg/dL (Correct answer)
- Approximately 126 mg/dL
- Approximately 300 mg/dL
Correct answer: Approximately 240 mg/dL
An HbA1c of 10.2% corresponds to an estimated average glucose of approximately 240 mg/dL over the preceding 2–3 months.
Question 4: A patient with suspected deep vein thrombosis has a D-dimer of 0.28 µg/mL FEU (reference <0.50). The most appropriate clinical interpretation is:
- Confirms active DVT
- Low probability of thrombotic disease (Correct answer)
- Indicates fibrinogen deficiency
- Warrants immediate anticoagulation
Correct answer: Low probability of thrombotic disease
A normal D-dimer has high negative predictive value, making active thrombosis unlikely and supporting low clinical probability when pre-test probability is low.
Question 5: A specimen from a febrile patient shows WBC count of 28,000/µL with 90% neutrophils and 8% bands. This leukocytosis pattern is most consistent with:
- Viral syndrome
- Allergic reaction
- Bacterial infection (Correct answer)
- Chronic lymphocytic leukemia
Correct answer: Bacterial infection
Marked neutrophilia with bandemia (left shift) is classically associated with acute bacterial infection driving bone marrow release of immature neutrophils.
Question 6: Which finding on a peripheral blood smear is most consistent with iron deficiency anemia?
- Macrocytosis with hypersegmented neutrophils
- Microcytosis with hypochromia and target cells (Correct answer)
- Spherocytes with polychromasia
- Rouleaux formation with elevated ESR
Correct answer: Microcytosis with hypochromia and target cells
Iron deficiency anemia characteristically produces small (microcytic), pale (hypochromic) red cells that may include target cells on peripheral smear.
Question 7: A patient's arterial blood gas shows pH 7.28, PaCO2 55 mmHg, HCO3 24 mEq/L. This pattern indicates:
- Metabolic acidosis
- Respiratory acidosis (Correct answer)
- Metabolic alkalosis
- Mixed respiratory and metabolic alkalosis
Correct answer: Respiratory acidosis
Low pH with elevated PaCO2 and normal bicarbonate indicates respiratory acidosis from CO2 retention without metabolic compensation.
CLT Patient Assessment & Clinical Evaluation 3
A 65-year-old male with chest pain has troponin I of 0.04 ng/mL (reference <0.04).
The most appropriate clinical interpretation is: