Ambulatory Care Test Ambulatory Care Chronic Disease Management 5 — Questions and Answers
Question 1: A patient with stable coronary artery disease asks about exercise. Which recommendation is MOST appropriate?
- Avoid all aerobic exercise to prevent cardiac events
- Perform moderate-intensity aerobic exercise 150 minutes per week (Correct answer)
- Limit activity to stretching only
- Exercise only in supervised hospital settings
Correct answer: Perform moderate-intensity aerobic exercise 150 minutes per week
Moderate-intensity aerobic exercise for 150 minutes per week is recommended for stable CAD patients and reduces cardiovascular mortality and morbidity.
Question 2: Which monitoring schedule is recommended for a patient with well-controlled type 2 diabetes on non-insulin therapy?
- A1C every 3 months
- A1C every 6 months (Correct answer)
- A1C every 12 months
- Weekly fasting glucose only
Correct answer: A1C every 6 months
For patients with well-controlled diabetes on stable non-insulin regimens, A1C monitoring every 6 months is appropriate per ADA standards of care.
Question 3: A patient with moderate persistent asthma is on a low-dose ICS but remains poorly controlled. The MOST appropriate step-up therapy is:
- Add a LABA to the existing ICS (Correct answer)
- Switch to an oral corticosteroid
- Add a leukotriene receptor antagonist only
- Increase SABA use as needed
Correct answer: Add a LABA to the existing ICS
Per NAEPP/GINA guidelines, adding a LABA to low-dose ICS is the preferred step-up for moderate persistent asthma uncontrolled on ICS alone.
Question 4: Which vaccine is recommended ANNUALLY for all patients with chronic obstructive pulmonary disease?
- Pneumococcal polysaccharide vaccine (PPSV23)
- Influenza vaccine (Correct answer)
- Herpes zoster vaccine
- Hepatitis B vaccine
Correct answer: Influenza vaccine
Annual influenza vaccination is strongly recommended for all COPD patients because respiratory infections are a major trigger of COPD exacerbations.
Question 5: A patient with type 2 diabetes develops a creatinine of 2.1 mg/dL (eGFR 32 mL/min/1.73m²). Which medication adjustment is MOST appropriate?
- Continue metformin at full dose
- Discontinue metformin due to risk of lactic acidosis (Correct answer)
- Add a sulfonylurea at full dose
- Start insulin with no other changes
Correct answer: Discontinue metformin due to risk of lactic acidosis
Metformin is contraindicated when eGFR falls below 30 mL/min/1.73m² and should be stopped at eGFR <30-45 depending on guidelines to prevent lactic acidosis accumulation.
Question 6: In a patient with newly diagnosed hypertension who is Black, which antihypertensive drug class is recommended as PREFERRED first-line therapy?
- ACE inhibitor alone
- Calcium channel blocker or thiazide diuretic (Correct answer)
- Beta-blocker alone
- ARB plus beta-blocker
Correct answer: Calcium channel blocker or thiazide diuretic
ACC/AHA guidelines recommend calcium channel blockers or thiazide diuretics as preferred initial therapy in Black patients because ACE inhibitors are less effective in this population.
Question 7: A patient with chronic heart failure reports 3 lb weight gain in 2 days and increased ankle swelling. The MOST appropriate ambulatory management step is:
- Schedule an elective clinic visit in 2 weeks
- Instruct patient to increase diuretic dose per a pre-established titration plan (Correct answer)
- Recommend fluid restriction alone without medication change
- Advise the patient to rest and monitor
Correct answer: Instruct patient to increase diuretic dose per a pre-established titration plan
Pre-established flexible diuretic titration plans allow patients to self-adjust diuretic dose in response to rapid weight gain, reducing emergency hospitalizations for decompensated heart failure.
Ambulatory Care Test Ambulatory Care Chronic Disease Management 5
A patient with stable coronary artery disease asks about exercise.
Which recommendation is MOST appropriate?