NCCPA Diagnostic Studies 2

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?

Accepted Answer

Troponin I level

Answer

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?

Accepted Answer

D-dimer assay

Answer

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?

Accepted Answer

3+ proteinuria with fatty casts

Answer

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?

Accepted Answer

Overt hyperthyroidism

Answer

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?

Accepted Answer

Bacterial meningitis

Answer

Bacterial meningitis classically presents with low CSF glucose, high protein, and predominantly neutrophilic pleocytosis.

(NCCPA) National Commission on Certification of Physician Assistants Practice Test