Ambulatory Care Test Ambulatory Care Chronic Disease Management 2 — Questions and Answers
Question 1: A patient with type 2 diabetes has an A1C of 9.2% despite metformin monotherapy. Which medication class is MOST appropriate to add given the patient also has established cardiovascular disease?
- Sulfonylurea
- GLP-1 receptor agonist (Correct answer)
- DPP-4 inhibitor
- Alpha-glucosidase inhibitor
Correct answer: GLP-1 receptor agonist
GLP-1 receptor agonists (e.g., semaglutide, liraglutide) have demonstrated cardiovascular mortality benefit in patients with established CVD and are preferred add-on therapy per ADA guidelines.
Question 2: Which parameter is the BEST indicator of long-term glycemic control when monitoring a patient with diabetes in the ambulatory setting?
- Fasting plasma glucose
- Postprandial glucose at 2 hours
- Hemoglobin A1C (Correct answer)
- Urine glucose dipstick
Correct answer: Hemoglobin A1C
Hemoglobin A1C reflects average blood glucose over the prior 2-3 months and is the standard measure for assessing long-term glycemic control.
Question 3: A 58-year-old with COPD uses a SABA inhaler daily and wakes with symptoms twice a week. According to GOLD guidelines, what is the MOST appropriate next step?
- Add oral theophylline
- Step up to a LAMA or LABA (Correct answer)
- Begin systemic corticosteroids
- Refer immediately for lung transplant evaluation
Correct answer: Step up to a LAMA or LABA
Frequent SABA use and nighttime symptoms indicate inadequate control; GOLD guidelines recommend adding a long-acting bronchodilator (LAMA or LABA) as first-line maintenance therapy.
Question 4: A patient with chronic kidney disease (CKD stage 3b) and hypertension is started on an ACE inhibitor. Which lab value requires close monitoring within 1-2 weeks of initiation?
- Serum sodium
- Serum potassium and creatinine (Correct answer)
- Serum calcium
- Complete blood count
Correct answer: Serum potassium and creatinine
ACE inhibitors can cause hyperkalemia and an acute rise in creatinine, particularly in CKD patients, requiring potassium and creatinine monitoring within 1-2 weeks of initiation.
Question 5: Which blood pressure target is recommended by ACC/AHA guidelines for most patients with hypertension and confirmed cardiovascular disease?
- Less than 150/90 mmHg
- Less than 140/90 mmHg
- Less than 130/80 mmHg (Correct answer)
- Less than 120/70 mmHg
Correct answer: Less than 130/80 mmHg
ACC/AHA 2017 guidelines recommend a BP target of less than 130/80 mmHg for patients with established cardiovascular disease or high cardiovascular risk.
Question 6: A patient with heart failure with reduced ejection fraction (HFrEF) is on optimal medical therapy. Which device therapy has been shown to reduce sudden cardiac death risk when EF remains ≤35%?
- Implantable cardioverter-defibrillator (ICD) (Correct answer)
- Cardiac resynchronization therapy pacemaker only
- Wearable cardioverter vest indefinitely
- Subcutaneous loop recorder
Correct answer: Implantable cardioverter-defibrillator (ICD)
An ICD is indicated for primary prevention of sudden cardiac death in HFrEF patients with EF ≤35% on optimal medical therapy for at least 3 months.
Question 7: A patient with rheumatoid arthritis on methotrexate reports new fatigue and mouth sores. Which supplement deficiency is MOST likely contributing to these side effects?
- Vitamin D
- Vitamin B12
- Folate (Correct answer)
- Iron
Correct answer: Folate
Methotrexate is a folate antagonist; folate supplementation (1 mg daily) is routinely co-prescribed to reduce side effects such as mucositis and fatigue.
Ambulatory Care Test Ambulatory Care Chronic Disease Management 2
A patient with type 2 diabetes has an A1C of 9.2% despite metformin monotherapy.
Which medication class is MOST appropriate to add given the patient also has established cardiovascular disease?