APEA Patient Management Questions and Answers Flashcards

A patient with newly diagnosed hypertension has a BP of 148/92 on two separate visits with no end-organ damage or comorbidities. The first-line treatment is:

Answer: Lifestyle modification for 3-6 months plus thiazide diuretic

For Stage 1 hypertension without compelling indications, JNC guidelines recommend lifestyle modifications alongside initiation of a thiazide diuretic as first-line pharmacotherapy.

A 65-year-old patient has an HbA1c of 7.9% on metformin alone. The NP adds a second agent. Per ADA guidelines, which comorbidity would favor adding an SGLT-2 inhibitor over a sulfonylurea?

Answer: Established cardiovascular disease

SGLT-2 inhibitors have demonstrated cardiovascular mortality benefit in patients with established CVD, making them preferred second-line agents in this population.

A patient with community-acquired pneumonia has a CURB-65 score of 2. The appropriate management is:

Answer: Short-term inpatient admission or close outpatient follow-up

A CURB-65 score of 2 indicates intermediate severity CAP; guidelines recommend either brief hospitalization or close outpatient monitoring with low-risk criteria.

A patient with GERD fails twice-daily PPI therapy after 8 weeks. The next appropriate management step is:

Answer: Refer for upper endoscopy to rule out complications

Persistent GERD symptoms despite adequate PPI therapy warrant upper endoscopy to evaluate for Barrett's esophagus, erosive esophagitis, or alternative diagnoses.

A patient with persistent asthma not controlled on low-dose ICS alone should have which medication added per NAEPP guidelines?

Answer: Long-acting beta-agonist (LABA)

For asthma uncontrolled on low-dose ICS, NAEPP guidelines recommend adding a LABA as the preferred step-up therapy before increasing ICS dose.

A patient with type 2 DM has a urine albumin-to-creatinine ratio of 45 mg/g on two separate tests. The most appropriate treatment to slow CKD progression is:

Answer: Start an ACE inhibitor or ARB

ACE inhibitors or ARBs are the first-line treatment for diabetic nephropathy; they reduce proteinuria and slow progression of CKD through angiotensin blockade.