AANP Chronic Disease Management 3

Question 1

A 70-year-old patient with stage 3b CKD (eGFR 38) and hyperkalemia (K+ 5.8 mEq/L) is on an ACE inhibitor for diabetic nephropathy. What is the most appropriate immediate management?

Accepted Answer

Reduce ACE inhibitor dose and add a potassium binder if needed

Answer

Discontinue the ACE inhibitor permanently

Answer

Add a potassium supplement to correct imbalance

Answer

Start high-dose furosemide immediately

Question 2

A patient with heart failure with preserved ejection fraction (HFpEF, EF 58%) presents with dyspnea and lower extremity edema. What is the primary pharmacologic treatment for symptom relief?

Accepted Answer

Loop diuretics

Answer

ACE inhibitor

Answer

Ivabradine

Answer

Digoxin

Question 3

A patient with asthma is classified as having moderate persistent disease. He is currently on a low-dose inhaled corticosteroid (ICS) with persistent symptoms. What is the next step per NAEPP guidelines?

Accepted Answer

Step up to low-dose ICS plus a long-acting beta-agonist (LABA)

Answer

Add an oral leukotriene receptor antagonist and keep same ICS dose

Answer

Switch to a high-dose ICS monotherapy

Answer

Add an oral corticosteroid for 2 weeks then reassess

Question 4

A 62-year-old patient with type 2 diabetes and established cardiovascular disease has an HbA1c of 8.2%. He is on metformin. Which agent should be added for its proven cardiovascular mortality benefit?

Accepted Answer

Empagliflozin (SGLT-2 inhibitor)

Answer

Glimepiride (sulfonylurea)

Answer

Sitagliptin (DPP-4 inhibitor)

Answer

Acarbose (alpha-glucosidase inhibitor)

Question 5

A 55-year-old patient with gout has a serum uric acid of 9.8 mg/dL and two gout flares in the past year. He is not on urate-lowering therapy. What is the appropriate treatment goal?

Accepted Answer

Serum uric acid < 6 mg/dL with allopurinol

Answer

Serum uric acid < 7 mg/dL with colchicine monotherapy

Answer

Serum uric acid < 5 mg/dL with high-dose NSAIDs

Answer

No pharmacologic treatment until the next acute flare

Question 6

A patient with hypothyroidism has been stable on levothyroxine 100 mcg for 2 years. A repeat TSH returns at 6.8 mIU/L (reference 0.4–4.0). She reports fatigue and cold intolerance. What is the most appropriate action?

Accepted Answer

Increase levothyroxine dose by 12.5–25 mcg

Answer

Switch to combination T3/T4 therapy

Answer

Recheck TSH in 6 months without dose change

Answer

Add liothyronine (T3) to current dose

Question 7

A patient with chronic obstructive pulmonary disease (COPD) has an oxygen saturation of 86% at rest on room air. Which intervention has been shown to improve survival in COPD?

Accepted Answer

Long-term supplemental oxygen therapy ≥15 hours/day

Answer

Systemic corticosteroids daily

Answer

Theophylline for bronchodilation

Answer

Mucolytics such as N-acetylcysteine