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

ACR guidelines recommend adding a biologic or targeted synthetic DMARD (such as a TNF inhibitor) after 3 months of inadequate response to methotrexate monotherapy.

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

In very high-risk ASCVD patients with LDL ≥70 mg/dL despite maximally tolerated statin, adding ezetimibe is the recommended next step to further reduce cardiovascular risk.

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

A CHA₂DS₂-VASc score ≥2 in males indicates high stroke risk, and oral anticoagulation with a DOAC is recommended over aspirin, which is no longer guideline-supported for AF stroke prevention.

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

USPSTF recommends annual low-dose CT (LDCT) for adults aged 50–80 with a 20+ pack-year history who currently smoke or quit within the past 15 years.

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

SGLT-2 inhibitors (e.g., empagliflozin, dapagliflozin) have demonstrated significant renoprotective benefits in diabetic kidney disease with albuminuria, reducing CKD progression and cardiovascular events.

AANP - American Association of Nurse Practitioners Practice Test

AANP - American Association of Nurse Practitioners Practice Test

AANP Chronic Disease Management 2