APEA APEA Patient Management Questions and Answers 1 — Questions and Answers
Question 1: 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:
- Lifestyle modification for 3-6 months plus thiazide diuretic (Correct answer)
- Immediate ACE inhibitor therapy
- Beta-blocker initiation
- Immediate referral to cardiology
Correct 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.
Question 2: 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?
- Established cardiovascular disease (Correct answer)
- Stage 1 CKD
- Obesity alone
- Peripheral neuropathy
Correct 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.
Question 3: A patient with community-acquired pneumonia has a CURB-65 score of 2. The appropriate management is:
- Short-term inpatient admission or close outpatient follow-up (Correct answer)
- Outpatient oral antibiotics only
- Immediate ICU admission
- Home IV antibiotics without hospitalization
Correct 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.
Question 4: A patient with GERD fails twice-daily PPI therapy after 8 weeks. The next appropriate management step is:
- Refer for upper endoscopy to rule out complications (Correct answer)
- Switch to H2 blocker therapy
- Add antacids to current regimen
- Discontinue PPI and start prokinetic agent
Correct 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.
Question 5: A patient with persistent asthma not controlled on low-dose ICS alone should have which medication added per NAEPP guidelines?
- Long-acting beta-agonist (LABA) (Correct answer)
- Short-acting beta-agonist (SABA) scheduled dosing
- Oral corticosteroid
- Cromolyn sodium
Correct 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.
Question 6: 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:
- Start an ACE inhibitor or ARB (Correct answer)
- Increase metformin dose
- Refer immediately to nephrology
- Start a loop diuretic
Correct 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.
APEA APEA Patient Management Questions and Answers 1
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: