AANP Chronic Disease Management

Question 1

A 58-year-old patient with type 2 diabetes has an HbA1c of 8.9%. Current treatment is metformin 1000 mg twice daily. Which is the most appropriate next step?

Accepted Answer

Add a GLP-1 receptor agonist

Answer

Switch to insulin glargine monotherapy

Answer

Reduce metformin dose and recheck in 6 months

Answer

Refer to endocrinology before any change

Question 2

A patient with stage 3 chronic kidney disease (eGFR 42 mL/min) and type 2 diabetes asks about medication adjustments. Which agent requires dose reduction or avoidance at this eGFR?

Accepted Answer

Metformin

Answer

Sitagliptin

Answer

Glipizide

Answer

Dulaglutide

Question 3

A 65-year-old with COPD is on a short-acting bronchodilator PRN. Spirometry shows FEV1/FVC < 0.70 and FEV1 55% predicted. He reports two exacerbations in the past year. What is the most appropriate maintenance therapy?

Accepted Answer

Long-acting muscarinic antagonist (LAMA) plus long-acting beta-agonist (LABA)

Answer

Inhaled corticosteroid (ICS) monotherapy

Answer

Oral theophylline

Answer

Short-acting beta-agonist scheduled four times daily

Question 4

A patient with heart failure with reduced ejection fraction (HFrEF, EF 35%) is already on an ACE inhibitor and beta-blocker at target doses. Which additional medication has been shown to reduce mortality in this patient?

Accepted Answer

Spironolactone

Answer

Amlodipine

Answer

Digoxin

Answer

Hydralazine alone

Question 5

A 72-year-old patient with hypertension and stage 3a CKD has a blood pressure of 148/88 mmHg on amlodipine 10 mg. Which antihypertensive class should be added first?

Accepted Answer

ACE inhibitor or ARB

Answer

Thiazide diuretic

Answer

Beta-blocker

Answer

Alpha-1 blocker

Question 6

A patient with osteoporosis has a T-score of -2.6 at the lumbar spine. She is already taking calcium and vitamin D. What is the first-line pharmacologic treatment?

Accepted Answer

Alendronate

Answer

Raloxifene

Answer

Calcitonin nasal spray

Answer

Denosumab

Question 7

A 55-year-old male with hyperlipidemia has an LDL of 145 mg/dL. He has a 10-year ASCVD risk of 12% calculated by the Pooled Cohort Equations. Which intervention is indicated?

Accepted Answer

Moderate-intensity statin therapy

Answer

High-intensity statin therapy

Answer

Lifestyle modification alone for 6 months

Answer

Ezetimibe monotherapy