NCCPA Diagnostic Studies 2 — Questions and Answers
Question 1: A 45-year-old male presents with chest pain. ECG shows ST elevation in leads V1-V4. Which additional diagnostic test is most appropriate FIRST?
- Chest X-ray
- Troponin I level (Correct answer)
- Echocardiogram
- CT pulmonary angiography
Correct answer: Troponin I level
Troponin I is the preferred biomarker for myocardial injury and should be drawn immediately alongside ECG in suspected STEMI.
Question 2: A patient with suspected deep vein thrombosis has a low pre-test probability. Which test is the most appropriate initial step?
- Venography
- D-dimer assay (Correct answer)
- Doppler ultrasound
- CT venography
Correct answer: D-dimer assay
A D-dimer assay is highly sensitive and appropriate for ruling out DVT in low pre-test probability patients; if negative, DVT is excluded.
Question 3: Which finding on urinalysis is most consistent with nephrotic syndrome?
- 3+ proteinuria with fatty casts (Correct answer)
- WBC casts
- RBC casts
- Granular casts with hematuria
Correct answer: 3+ proteinuria with fatty casts
Nephrotic syndrome is characterized by massive proteinuria (>3.5 g/day) and lipiduria, often presenting as fatty casts on urinalysis.
Question 4: A 60-year-old woman has a TSH of 0.05 mIU/L and a free T4 of 2.8 ng/dL. What is the most likely diagnosis?
- Primary hypothyroidism
- Secondary hypothyroidism
- Subclinical hyperthyroidism
- Overt hyperthyroidism (Correct answer)
Correct answer: Overt hyperthyroidism
Suppressed TSH with elevated free T4 indicates overt hyperthyroidism due to excess thyroid hormone production.
Question 5: Lumbar puncture CSF analysis shows: glucose 20 mg/dL (serum 90), protein 200 mg/dL, WBC 800 (90% neutrophils). Which diagnosis is most consistent?
- Viral meningitis
- Bacterial meningitis (Correct answer)
- Fungal meningitis
- Tuberculous meningitis
Correct answer: Bacterial meningitis
Bacterial meningitis classically presents with low CSF glucose, high protein, and predominantly neutrophilic pleocytosis.
Question 6: A patient with rheumatoid arthritis has a positive anti-CCP antibody. What is the significance of this finding?
- Indicates active infection
- Predicts more erosive disease (Correct answer)
- Rules out SLE
- Indicates drug toxicity
Correct answer: Predicts more erosive disease
Anti-CCP antibodies are highly specific for RA and their presence is associated with a more aggressive, erosive disease course.
Question 7: Which imaging modality is the gold standard for diagnosing acute appendicitis in an adult?
- Plain abdominal X-ray
- Ultrasound abdomen
- CT abdomen with contrast (Correct answer)
- MRI abdomen
Correct answer: CT abdomen with contrast
CT of the abdomen and pelvis with contrast is the gold standard for diagnosing acute appendicitis due to its high sensitivity and specificity.
NCCPA Diagnostic Studies 2
A 45-year-old male presents with chest pain.
ECG shows ST elevation in leads V1-V4.
Which additional diagnostic test is most appropriate FIRST?