CCMA sample questions, with worked answers

B: An adult with a respiratory rate of 34 and blue lips. A very rapid respiratory rate with cyanosis suggests an emergency in oxygenation. The other findings are normal or minor variations.

The trap: Going to the nervous patient because they are in front of you. A fast respiratory rate with blue lips is an oxygen problem and comes first.

D: 100.4°F. 38 × 9/5 = 68.4, plus 32 = 100.4°F.

C: 101.3°F. 38.5 × 9/5 = 69.3, plus 32 = 101.3°F.

C: enlargement of the liver. Hepatomegaly means enlargement of the liver. Break a term into its root, prefix and suffix to work out its meaning.

A: At 20 feet, the patient reads what a person with normal vision can read at 70 feet. The top number is the testing distance (20 feet); the bottom number is the distance at which a person with normal vision can read that line. 20/70 means the patient reads at 20 feet what normal vision reads at 70 feet, so the vision is worse than normal.

B: An enlarged liver. hepat/o means liver and -megaly means enlargement, so hepatomegaly is an enlarged liver. Inflammation would be hepatitis, removal a hepatectomy and pain hepatalgia.

1. Root: hepat/o, liver.
2. Suffix: -megaly, enlargement.
3. Together: an enlarged liver.

The trap: Choosing inflammation because hepatitis is the liver word most people know. Read the suffix.

C: Endocrine. The thyroid releases hormones (T3 and T4) into the blood, which makes it part of the endocrine system, along with the pituitary, adrenal glands and pancreatic islets.

1. What does the thyroid do? It makes hormones.
2. Hormone-making glands form the endocrine system.
3. So: endocrine.

The trap: Picking respiratory because the thyroid sits in the neck near the windpipe. Systems are grouped by job, not location.

C: Stage 1 hypertension. Stage 1 hypertension is a systolic of 130 to 139 or a diastolic of 80 to 89. The systolic 132 is in that range, so the reading is stage 1 even though the diastolic is under 80.

1. Systolic 132: 130 to 139 is stage 1.
2. Diastolic 78: under 80, normal on its own.
3. The higher category wins: stage 1 hypertension.

The trap: Calling it elevated because the diastolic is normal. Elevated needs a systolic of 120 to 129.

A: Deltoid, at 90 degrees. Intramuscular injections go in at 90 degrees, and the deltoid is the usual site for an adult vaccine. 45 degrees is used for subcutaneous injections, and 10 to 15 degrees on the inner forearm is intradermal, as for a TB skin test.

1. Route: intramuscular, so 90 degrees.
2. Adult vaccine: the deltoid.
3. The other options describe subcutaneous and intradermal injections.

The trap: Choosing 45 degrees for the deltoid. The angle comes from the route, and IM is always 90.

A: 2 tablets. 0.5 g is 500 mg. 500 mg ÷ 250 mg per tablet = 2 tablets.

1. Same units first: 0.5 g × 1,000 = 500 mg.
2. Desired ÷ have: 500 ÷ 250.
3. = 2 tablets.

The trap: Dividing without converting: 0.5 ÷ 250 gives a nonsense answer. Convert grams to milligrams first.

C: 101.3°F. Multiply by 9/5 (1.8) and add 32: 38.5 × 1.8 = 69.3, and 69.3 + 32 = 101.3°F.

1. °F = °C × 1.8 + 32
2. 38.5 × 1.8 = 69.3
3. 69.3 + 32 = 101.3°F

The trap: Adding 32 before multiplying. The order is multiply, then add.

B: Influenza and pertussis. Influenza and pertussis spread by large respiratory droplets, so a mask is used. Tuberculosis, measles, and varicella are airborne; C. difficile and MRSA are contact diseases.

The trap: Picking tuberculosis and measles because they are the best-known "isolation" diseases. They are airborne; influenza and pertussis are droplet.

A: Normal. Fasting glucose: 70 to 99 mg/dL is normal, 100 to 125 is the prediabetes range and 126 or more is the diabetes range (a diagnosis needs confirmation by the provider). Below 70 is hypoglycemia. So 84 mg/dL is normal.

B: Gown, mask or respirator, goggles or face shield, gloves. The CDC donning sequence is gown, then mask or respirator, then goggles or face shield, then gloves. Gloves go on last so they cover the gown cuffs and stay clean.

1. Gown first: it is the largest item.
2. Then mask, then eye protection.
3. Gloves last, pulled over the gown cuffs.

The trap: Putting gloves on first. They would be contaminated by handling the rest of the PPE.

C: Airborne precautions. Measles spreads on tiny particles that stay in the air, so it needs airborne precautions: a private room with the door closed (an airborne infection isolation room where available) and an N95 or higher respirator for staff.

1. How does measles spread? On airborne particles.
2. Airborne spread needs airborne precautions.
3. Room the child at once to protect the waiting room.

The trap: Choosing droplet, as for influenza or pertussis. Measles, chickenpox and TB are the classic airborne three.

B: Prediabetes range. The ADA ranges are: under 5.7% normal, 5.7% to 6.4% prediabetes, 6.5% or higher diabetes. 6.0% is in the prediabetes range. The medical assistant records and reports it; the provider interprets it.

1. Under 5.7%: normal.
2. 5.7% to 6.4%: prediabetes. 6.0% fits.
3. 6.5% or more: diabetes.

The trap: Calling it normal because 6 sounds low. The cutoffs are narrow, so learn the exact numbers.

B: 125 beats per minute. With the 1,500 method, divide 1,500 by the number of small boxes between R waves: 1,500 ÷ 12 = 125.

D: Lavender. A hemoglobin A1c is collected in a lavender top. Lavender (EDTA) is for whole-blood hematology tests such as the CBC and A1c; light blue (citrate) for coagulation; gray (fluoride) preserves glucose and alcohol.

B: Light blue, green, lavender. In the CLSI order of draw, light blue (citrate) comes before green (heparin), which comes before lavender (EDTA). That keeps EDTA and heparin from carrying over into the coagulation tube and EDTA out of the chemistry tube.

1. Order of draw: cultures, light blue, red/gold, green, lavender, gray.
2. Of these three: light blue, then green, then lavender.
3. EDTA (lavender) is drawn late because it ruins calcium-dependent tests.

The trap: Drawing lavender first because the CBC is the most common test. The order depends on additives, not on which test is ordered most.

B: Release the tourniquet, remove the needle and apply pressure. Fast swelling is a hematoma forming: blood is leaking into the tissue. Stop the draw: release the tourniquet, withdraw the needle and press on the site, then document it and redraw at another site if needed.

1. Swelling at the site = a hematoma.
2. Stop: tourniquet off, needle out.
3. Firm pressure, then document.

The trap: Finishing the tubes first. A hematoma gets worse every second the needle stays in.

C: 70 beats per minute. The six-second method multiplies the QRS complexes in 6 seconds by 10: 7 × 10 = 70 beats per minute. It works for regular and irregular rhythms.

1. Count the QRS complexes in 6 seconds: 7.
2. Multiply by 10 (6 seconds × 10 = 1 minute).
3. 7 × 10 = 70.

The trap: Multiplying by 6. The strip is 6 seconds long, so multiply by 10 to reach 60 seconds.

B: Fifth intercostal space, left midclavicular line. V4 goes in the fifth intercostal space at the left midclavicular line. V2 is the fourth space at the left sternal border, and V6 the midaxillary line level with V4 and V5.

1. V1 and V2: fourth intercostal space, either side of the sternum.
2. V4: fifth intercostal space, midclavicular line.
3. V3 sits midway between V2 and V4; V5 and V6 continue level with V4.

The trap: Putting V4 in the fourth space. V1 and V2 are in the fourth; V4 drops to the fifth.

B: Move or unplug nearby electrical equipment and check the machine's grounding. Even, regular spikes are 60-cycle (AC) interference from nearby electrical equipment or poor grounding. Unplug or move other devices, keep the lead wires from crossing cords, and check the machine is grounded.

1. Regular, uniform spikes point to electrical interference.
2. Shivering gives irregular, jagged artifact instead.
3. So remove the electrical source and check grounding.

The trap: Warming the patient. That fixes somatic tremor, which looks irregular, not evenly spiked.

D: Stream. Stream (time-specified) scheduling assigns each patient an exact time slot at set intervals. Wave scheduling instead books several patients at the same time and sees them in order of arrival.

The trap: Choosing wave because patients arrive in a steady flow. Wave books several patients at the same time; stream gives each one their own slot.

A: Recording a blood pressure reading. MAs work under provider supervision and may measure and record data. Diagnosing, prescribing, and interpreting results belong to licensed providers.

The trap: Choosing interpreting a lab result because medical assistants often handle results. They record and pass them on; the provider interprets.

A: $120.00. The patient pays the unmet deductible first: $100.00. That leaves $200.00, of which the patient pays 10%, or $20.00. Total: $120.00.

C: $260. The patient first pays the $200 left on the deductible. The remaining $300 is shared: the patient pays 20%, which is $60. $200 + $60 = $260.

1. Deductible first: $200.
2. Left over: $500 − $200 = $300; patient share 20% = $60.
3. Total: $200 + $60 = $260.

The trap: Taking 20% of the whole $500 ($100). The deductible comes off before coinsurance starts.

B: CPT. CPT (Current Procedural Terminology) codes describe procedures and services in outpatient settings. ICD-10-CM codes the diagnosis, ICD-10-PCS codes inpatient hospital procedures, and NDC identifies drug products.

1. What was done (a service) or why (a diagnosis)? What was done.
2. Outpatient services use CPT.
3. ICD-10-CM answers "why".

The trap: Choosing ICD-10-PCS because it says "procedure". It is for inpatient hospital procedures only.

B: "Can you tell me more about how you have been feeling?". An open-ended question invites the patient to describe the problem in their own words. A yes-or-no question closes the topic, reassurance dismisses it, and sending it straight to the doctor skips the history the medical assistant is there to take.

1. Goal: get the patient talking.
2. Open-ended questions cannot be answered with yes or no.
3. Only one option is open-ended.

The trap: Choosing the sleep question because it sounds clinical. It narrows the answer before you know the problem.

B: Decline to confirm or deny, and explain that written authorization is needed. Whether someone is a patient is itself protected health information. Without the patient's written authorization, the medical assistant may not confirm the visit to an employer, even partly. The patient can bring a work note instead.

1. Is the caller entitled to PHI? An employer is not, without authorization.
2. Is "yes, they came in" PHI? Yes.
3. So decline politely and explain the authorization rule.

The trap: Confirming "only the appointment". Confirming the visit discloses PHI.