D118 practice test questions WITH ANSWERS |\ |\ |\ |\ |\
1.1. A 55-year-old male with a 75 pack-year history of smoking presents to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
the clinic to establish primary care and discuss age-appropriate screening
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
options for cancer. His pulse rate is 78/min, blood pressure is 140/80 mmHg,
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
and saturation at room air is 96%. Air entry is decreased bilaterally with
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
occasional rhonchi and crepitations on chest auscultation. He is advised by
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
the primary care provider to undergo a low dose CT scan (LDCT) for screening.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
Which of the following are the criteria for undergoing this screening test for
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
this patient? * |\ |\
1 point
|\
A. All adults between ages 55 and 80 years
|\ |\ |\ |\ |\ |\ |\
B. Adults more than 40 years of age with a 20 pack-year smoking history
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
C. Adults aged 55 to 80 years with a 30 pack-year smoking history
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
D. Adults less than 60 years of age who are active smokers and have no other
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
risk factors: C. Adults aged 55 to 80 years with a 30 pack-year smoking
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
history Feedback |\
A, B, D Rationale: All adults aged 55 to 80 years do not meet the criteria
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |
for a |\
high-risk population. As lung cancer screening involves exposure to
|\ |\ |\ |\ |\ |\ |\ |\ |\
possible harmful radiation, and there are potential other risks to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
screening, identifying a high-risk population is essential.According to the
|\ |\ |\ |\ |\ |\ |\ |\
National Comprehensive Cancer Network (NCCN), there is a utility in
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
screening patients with a 20 pack-year history of smoking. However,
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
1 |\/ |\23
,recommendations are for patients more than 55 years of age with an |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
additional risk factor such as family history, occupational exposure to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
carcinogens, or personal history of chronic obstructive pulmonary |\ |\ |\ |\ |\ |\ |\ |\
disease (COPD).According to the National Lung Screening Trial, patients
|\ |\ |\ |\ |\ |\ |\ |\ |\
aged 55 to 80 years with a 30 pack-year history of smoking who are active
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
smokers or quit within the last 15 years qualify for annual low-dose CT
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
screening.Patients with a life-limiting condition should not be screened. |\ |\ |\ |\ |\ |\ |\ |\
2.2. A preventative medicine task force is trying to identify and combat
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
peripheral arterial disease among the rural population they serve. They seek
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
information regarding a rapid, low cost, and sensitive tool to detect this
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
disease that can be used at health fairs scheduled to take place in the rural
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
town centers. Which of the following would be the best screening tool for this
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
situation? * |\
1 point
|\
A. Doppler ultrasound |\
B. 5-minute treadmill test |\ |\
C. Ankle-brachial pressure index (ABI) |\ |\ |\
D. Pedal pulse palpation: D. Pedal pulse palpation Rationale: In a study
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
of over 18,000 men, the presence of bilateral dorsalis pedis and
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
posterior tibial pulses |\ |\
2 |\/ |\23
, ruled out peripheral arterial disease (PAD) with enough reliability for the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |
authors to conclude it could be used as an appropriate initial screening too
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
for PAD.In order for pedal pulse palpation (PPP) to effectively screen for PAD
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
|\ if any of the 4 pedal pulses are absent, the patient should be referred to a
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
primary care provider to receive ABI testing for PAD, which is a more |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
specific tool.ABI testing, which involves calculating a pressure ratio betwee
|\ |\ |\ |\ |\ |\ |\ |\ |\
|\ the ankle and arm blood pressure, involves specific training and
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
equipment. Although it is often used as an initial test for PAD in the office |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
setting with one clinician and patient, at a health fair where rapid low
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
cost, low equipment screening is needed, there is a better option.PAD is
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
common at the population level, with estimates of around 10% prevalenc |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
|\ in adults over 55.
|\ |\ |\
3.3. A 35-year-old woman with a history of gestational diabetes at age 23 is
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
seen for an annual physical exam. Based on the American Diabetes Associa-
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
tion (ADA) recommendations for screening for type 2 diabetes in those with
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
a prior history of gestational diabetes, what is the maximum recommended
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
testing interval for screening this patient for diabetes? *
|\ |\ |\ |\ |\ |\ |\ |\
0 points
|\
A. Annually
B. Biannually
C. When she turns 45 |\ |\ |\
D. Every three years: D. Every three years |\ |\ |\ |\ |\ |\
|\ Rationale: Women with a history of gestational diabetes should have life |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
long screening for the development of type 2 diabetes at least once every
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
3 |\/ |\23
1.1. A 55-year-old male with a 75 pack-year history of smoking presents to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
the clinic to establish primary care and discuss age-appropriate screening
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
options for cancer. His pulse rate is 78/min, blood pressure is 140/80 mmHg,
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
and saturation at room air is 96%. Air entry is decreased bilaterally with
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
occasional rhonchi and crepitations on chest auscultation. He is advised by
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
the primary care provider to undergo a low dose CT scan (LDCT) for screening.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
Which of the following are the criteria for undergoing this screening test for
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
this patient? * |\ |\
1 point
|\
A. All adults between ages 55 and 80 years
|\ |\ |\ |\ |\ |\ |\
B. Adults more than 40 years of age with a 20 pack-year smoking history
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
C. Adults aged 55 to 80 years with a 30 pack-year smoking history
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
D. Adults less than 60 years of age who are active smokers and have no other
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
risk factors: C. Adults aged 55 to 80 years with a 30 pack-year smoking
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
history Feedback |\
A, B, D Rationale: All adults aged 55 to 80 years do not meet the criteria
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |
for a |\
high-risk population. As lung cancer screening involves exposure to
|\ |\ |\ |\ |\ |\ |\ |\ |\
possible harmful radiation, and there are potential other risks to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
screening, identifying a high-risk population is essential.According to the
|\ |\ |\ |\ |\ |\ |\ |\
National Comprehensive Cancer Network (NCCN), there is a utility in
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
screening patients with a 20 pack-year history of smoking. However,
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
1 |\/ |\23
,recommendations are for patients more than 55 years of age with an |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
additional risk factor such as family history, occupational exposure to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
carcinogens, or personal history of chronic obstructive pulmonary |\ |\ |\ |\ |\ |\ |\ |\
disease (COPD).According to the National Lung Screening Trial, patients
|\ |\ |\ |\ |\ |\ |\ |\ |\
aged 55 to 80 years with a 30 pack-year history of smoking who are active
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
smokers or quit within the last 15 years qualify for annual low-dose CT
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
screening.Patients with a life-limiting condition should not be screened. |\ |\ |\ |\ |\ |\ |\ |\
2.2. A preventative medicine task force is trying to identify and combat
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
peripheral arterial disease among the rural population they serve. They seek
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
information regarding a rapid, low cost, and sensitive tool to detect this
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
disease that can be used at health fairs scheduled to take place in the rural
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
town centers. Which of the following would be the best screening tool for this
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
situation? * |\
1 point
|\
A. Doppler ultrasound |\
B. 5-minute treadmill test |\ |\
C. Ankle-brachial pressure index (ABI) |\ |\ |\
D. Pedal pulse palpation: D. Pedal pulse palpation Rationale: In a study
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
of over 18,000 men, the presence of bilateral dorsalis pedis and
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
posterior tibial pulses |\ |\
2 |\/ |\23
, ruled out peripheral arterial disease (PAD) with enough reliability for the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |
authors to conclude it could be used as an appropriate initial screening too
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
for PAD.In order for pedal pulse palpation (PPP) to effectively screen for PAD
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
|\ if any of the 4 pedal pulses are absent, the patient should be referred to a
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
primary care provider to receive ABI testing for PAD, which is a more |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
specific tool.ABI testing, which involves calculating a pressure ratio betwee
|\ |\ |\ |\ |\ |\ |\ |\ |\
|\ the ankle and arm blood pressure, involves specific training and
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
equipment. Although it is often used as an initial test for PAD in the office |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
setting with one clinician and patient, at a health fair where rapid low
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
cost, low equipment screening is needed, there is a better option.PAD is
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
common at the population level, with estimates of around 10% prevalenc |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
|\ in adults over 55.
|\ |\ |\
3.3. A 35-year-old woman with a history of gestational diabetes at age 23 is
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
seen for an annual physical exam. Based on the American Diabetes Associa-
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
tion (ADA) recommendations for screening for type 2 diabetes in those with
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
a prior history of gestational diabetes, what is the maximum recommended
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
testing interval for screening this patient for diabetes? *
|\ |\ |\ |\ |\ |\ |\ |\
0 points
|\
A. Annually
B. Biannually
C. When she turns 45 |\ |\ |\
D. Every three years: D. Every three years |\ |\ |\ |\ |\ |\
|\ Rationale: Women with a history of gestational diabetes should have life |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
long screening for the development of type 2 diabetes at least once every
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
3 |\/ |\23
