AANP Chronic Disease Management 2

Question 1

A patient with rheumatoid arthritis has inadequate response after 3 months of methotrexate monotherapy. She has no comorbidities. What is the most appropriate next step per current guidelines?

Accepted Answer

Add a TNF inhibitor or other biologic DMARD

Answer

Switch to hydroxychloroquine monotherapy

Answer

Add prednisone 20 mg daily indefinitely

Answer

Increase methotrexate to maximum dose before adding another agent

Question 2

A patient with stable angina is found to have an LDL of 98 mg/dL on high-intensity statin therapy. His 10-year ASCVD risk is 28%. What is the most appropriate next step?

Accepted Answer

Add ezetimibe to further reduce LDL

Answer

Switch to a moderate-intensity statin

Answer

Add niacin for additional LDL lowering

Answer

No additional intervention is needed

Question 3

A 68-year-old patient with atrial fibrillation and a CHA₂DS₂-VASc score of 4 is not on anticoagulation. He has no contraindications. What is the appropriate management?

Accepted Answer

Initiate oral anticoagulation with a DOAC

Answer

Prescribe aspirin 325 mg daily

Answer

Observe and reassess in 6 months

Answer

Initiate rate control only

Question 4

A patient with a 40-pack-year smoking history, age 58, is seen for an annual visit. He currently smokes 1 PPD. Which lung cancer screening recommendation applies?

Accepted Answer

Annual low-dose CT scan of the chest

Answer

Annual chest X-ray

Answer

Sputum cytology every 6 months

Answer

No screening is indicated until symptoms develop

Question 5

A 48-year-old patient with type 2 diabetes has an eGFR of 68 and urine albumin-to-creatinine ratio (UACR) of 180 mg/g. He is on metformin and linagliptin. Which medication should be added for renoprotection?

Accepted Answer

An SGLT-2 inhibitor

Answer

A GLP-1 receptor agonist

Answer

A loop diuretic

Answer

A calcium channel blocker

Question 6

A patient with inflammatory bowel disease (Crohn's disease) on long-term corticosteroids presents for a routine visit. Which monitoring intervention is most important?

Accepted Answer

Bone density scan (DEXA)

Answer

Pulmonary function testing

Answer

Serum ferritin only

Answer

Colonoscopy every 6 months

Question 7

A patient with poorly controlled hypertension (BP 162/96) is on lisinopril 20 mg. He has no edema, normal renal function, and no diabetes. What is the best addition to his regimen?

Accepted Answer

Chlorthalidone (thiazide-type diuretic)

Answer

Clonidine

Answer

Doxazosin

Answer

Hydralazine