Ambulatory Care Test Ambulatory Care Chronic Disease Management 4 — Questions and Answers
Question 1: Which SGLT2 inhibitor has FDA approval for reducing the risk of hospitalization for heart failure in patients with type 2 diabetes?
- Sitagliptin
- Empagliflozin (Correct answer)
- Pioglitazone
- Acarbose
Correct answer: Empagliflozin
Empagliflozin (and other SGLT2 inhibitors such as dapagliflozin) have demonstrated significant reductions in heart failure hospitalization and are FDA-approved for this indication.
Question 2: A patient with CKD stage 4 has a hemoglobin of 9.8 g/dL with low reticulocyte count and normal iron stores. The MOST likely cause is:
- Iron deficiency anemia
- Anemia of chronic kidney disease (erythropoietin deficiency) (Correct answer)
- Vitamin B12 deficiency
- Hemolytic anemia
Correct answer: Anemia of chronic kidney disease (erythropoietin deficiency)
CKD-associated anemia is primarily caused by insufficient erythropoietin production by damaged kidneys, resulting in normocytic, normochromic anemia with low reticulocyte count.
Question 3: Which class of antihypertensive is CONTRAINDICATED in a patient with bilateral renal artery stenosis?
- Calcium channel blockers
- Beta-blockers
- ACE inhibitors (Correct answer)
- Thiazide diuretics
Correct answer: ACE inhibitors
ACE inhibitors (and ARBs) are contraindicated in bilateral renal artery stenosis because they block the compensatory efferent arteriole constriction, causing a precipitous drop in GFR.
Question 4: A patient with gout has a serum uric acid of 9.8 mg/dL and two flares in the past year. After flare resolution, which urate-lowering therapy is FIRST-LINE?
- Colchicine
- Allopurinol (Correct answer)
- Indomethacin
- Probenecid
Correct answer: Allopurinol
Allopurinol is the first-line urate-lowering therapy for chronic gout management; it is initiated after acute flare resolution to avoid prolonging the acute attack.
Question 5: Which finding on a diabetic foot exam indicates the HIGHEST risk for future ulceration and amputation?
- Mild callus formation over the metatarsal heads
- Loss of protective sensation to 10-g monofilament (Correct answer)
- Onychomycosis of the toenails
- Mild pedal edema
Correct answer: Loss of protective sensation to 10-g monofilament
Loss of protective sensation detected by 10-g monofilament testing is the strongest independent predictor of diabetic foot ulceration and subsequent amputation.
Question 6: A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 3. According to guidelines, which intervention is MOST indicated to reduce stroke risk?
- Aspirin 81 mg daily
- Clopidogrel plus aspirin
- Oral anticoagulation with a DOAC (Correct answer)
- Rate control only without anticoagulation
Correct answer: Oral anticoagulation with a DOAC
A CHA₂DS₂-VASc score ≥2 in males or ≥3 in females indicates a high stroke risk, and oral anticoagulation with a DOAC is strongly recommended over antiplatelet therapy.
Question 7: Which counseling point is MOST important for a patient newly diagnosed with hypertension who refuses medication?
- Sodium restriction to less than 2,300 mg per day (Correct answer)
- Caffeine elimination
- Drinking 8 glasses of water daily
- Taking weekly blood pressure readings only
Correct answer: Sodium restriction to less than 2,300 mg per day
Sodium restriction to less than 2,300 mg/day (ideally 1,500 mg/day) is the most evidence-based dietary intervention for lowering blood pressure in hypertensive patients.
Ambulatory Care Test Ambulatory Care Chronic Disease Management 4
Which SGLT2 inhibitor has FDA approval for reducing the risk of hospitalization for heart failure in patients with type 2 diabetes?