Ambulatory Care Test Ambulatory Care Chronic Disease Management 3 — Questions and Answers
Question 1: A 65-year-old with osteoporosis is prescribed alendronate. Which instruction is MOST critical to prevent esophageal injury?
- Take with a full glass of milk
- Remain upright for at least 30 minutes after taking (Correct answer)
- Take at bedtime to reduce GI upset
- Crush the tablet and mix with applesauce
Correct answer: Remain upright for at least 30 minutes after taking
Bisphosphonates like alendronate must be taken with a full glass of water and the patient must remain upright for at least 30 minutes to prevent esophageal irritation or ulceration.
Question 2: Which of the following is considered a macrovascular complication of poorly controlled type 2 diabetes?
- Diabetic retinopathy
- Peripheral neuropathy
- Diabetic nephropathy
- Coronary artery disease (Correct answer)
Correct answer: Coronary artery disease
Coronary artery disease is a macrovascular complication of diabetes, while retinopathy, nephropathy, and neuropathy are microvascular complications.
Question 3: A patient with stable COPD has an FEV1/FVC ratio of 0.58 and FEV1 of 52% predicted. According to GOLD staging, this patient is classified as:
- GOLD 1 (Mild)
- GOLD 2 (Moderate) (Correct answer)
- GOLD 3 (Severe)
- GOLD 4 (Very Severe)
Correct answer: GOLD 2 (Moderate)
GOLD stage 2 (Moderate) is defined by FEV1 50-79% predicted with confirmed airflow obstruction (FEV1/FVC < 0.70).
Question 4: Which medication used in chronic heart failure management is classified as an ARNI (angiotensin receptor-neprilysin inhibitor)?
- Carvedilol
- Sacubitril/valsartan (Correct answer)
- Spironolactone
- Ivabradine
Correct answer: Sacubitril/valsartan
Sacubitril/valsartan (Entresto) is the only approved ARNI, combining neprilysin inhibition with angiotensin receptor blockade and is preferred over ACE inhibitors in HFrEF.
Question 5: A patient with hypothyroidism has a TSH of 8.2 mIU/L on levothyroxine 75 mcg daily. The MOST appropriate action is:
- Switch to liothyronine (T3)
- Increase the levothyroxine dose (Correct answer)
- Add iodine supplementation
- Order a thyroid ultrasound
Correct answer: Increase the levothyroxine dose
An elevated TSH indicates under-replacement; increasing the levothyroxine dose is the appropriate response to normalize TSH.
Question 6: Which lifestyle intervention has the STRONGEST evidence for reducing LDL cholesterol in patients with hyperlipidemia?
- Increasing dietary fiber intake
- Reducing saturated fat intake (Correct answer)
- Aerobic exercise 150 minutes per week
- Eliminating dietary cholesterol entirely
Correct answer: Reducing saturated fat intake
Reducing saturated fat intake has the strongest dietary evidence for lowering LDL cholesterol, as saturated fats upregulate LDL receptor activity reduction.
Question 7: A patient with asthma uses an inhaled corticosteroid (ICS) daily. Which technique error MOST commonly reduces ICS effectiveness?
- Exhaling before actuation
- Using the inhaler without a spacer (Correct answer)
- Not shaking the MDI before use
- Taking the medication with food
Correct answer: Using the inhaler without a spacer
Using a metered-dose inhaler without a spacer significantly reduces lung deposition of the drug, as many particles impact the oropharynx instead.
Ambulatory Care Test Ambulatory Care Chronic Disease Management 3
A 65-year-old with osteoporosis is prescribed alendronate.
Which instruction is MOST critical to prevent esophageal injury?