CVD, diabetes and renal disease in elderly people / drug testing in adolescents

Source document: Best tests March 2012
Closes 30th April 2012, Late submissions may not receive personalised feedback
1 Which of the following statements about CVD risk assessment in elderly people are true?
Risk assessment should be stopped for all people aged > 75 years
Risk assessment for people aged > 75 years should be calculated using the risk associated with the age 65 – 74 years bracket
When to stop CVD risk assessment should be based on the likelihood of ten year survival
When to stop CVD risk assessment should take into consideration the patient’s wishes
As life expectancy diminishes, it becomes more important to calculate CVD risk
2 Which of the following statements about lipids and lipid testing are true?
Lipid levels naturally increase after age 75 years, regardless of lifestyle factors
Lipid testing should occur at least six-monthly in all people aged > 75 years
Some research suggests that all-cause mortality in elderly people is highest when total cholesterol levels are lowest
There is strong evidence that lipid-lowering treatment for primary prevention of CVD reduces mortality in people aged > 80 years
The optimal level of cholesterol is not known in people aged > 80 years
3 Which of the following statements about testing in people aged over 75 years with diabetes are true?
The threshold for diagnosis of diabetes in people aged > 75 years is HbA1c ≥ 55 mmol/mol
Glycaemic targets should be more stringent in people aged > 75 years with diabetes (i.e. tighter control)
Once HbA1c levels are stable, testing can be three-yearly
Microalbuminuria is reversible if detected early
ACR is a less robust predictor of nephropathy in elderly people
4 Which of the following statements about testing renal function in elderly people are true?
An eGFR level < 60 mL/min/1.73m2 is indicative of chronic kidney disease (CKD) in all people regardless of age
A decline of > 15% in eGFR over three months should prompt investigation for CKD or other causes in a person aged > 75 years
An initial result of a decreased eGFR level in a person aged > 75 years should be repeated within two weeks
In people with diabetes an albumin:creatinine ratio > 1.0 mg/mmol indicates clinically significant microalbuminuria
Haematuria can be assessed using a urine “dipstick”
5 Which of the following statements about non-evidential urine sample collection are true?
Non-evidential drug testing does not require a strict “chain of custody” protocol
The patient should wash and dry their hands prior to testing
Dipstick analysis of urine should be used to indicate authenticity of the sample
A clinician of the same gender as the patient must observe urination
A thermometer should be used on the sample to test authenticity
6 Which of the following drugs will be detected on a standard preliminary drug screen?
Cocaine
Ecstasy
Heroin
Valium
Oxycodone
7 Which of the following statements about interpreting and managing drug test results are true?
A dilute sample of urine indicates a high likelihood of drug use
Confirmatory testing must always follow a positive preliminary screen in non-evidential drug testing
Testing has a low specificity but high sensitivity
Drug test results should not be divulged to parents, unless there is prior consent from the adolescent, or the adolescent is deemed not to be “Gillick competent”
A positive test result does not always indicate drug misuse
8 For some drug classes, a positive test does not always indicate illicit drug use; which of the following substances may produce a positive result in a standard preliminary drug screen?
Poppy seed bagels
Ciprofloxacin
Fluticasone
Sertraline
Citalopram