Family Practice Exam Chronic Disease Management 2 — Questions and Answers
Question 1: A 58-year-old patient with type 2 diabetes has an HbA1c of 9.2% despite metformin monotherapy. What is the most appropriate next step?
- Add a second oral agent or injectable therapy (Correct answer)
- Switch to insulin monotherapy immediately
- Increase metformin to maximum dose only
- Recheck HbA1c in 6 months without changes
Correct answer: Add a second oral agent or injectable therapy
When HbA1c remains above target on metformin monotherapy, guidelines recommend adding a second agent such as a GLP-1 agonist, SGLT-2 inhibitor, or sulfonylurea.
Question 2: Which blood pressure target is recommended for a 72-year-old patient with hypertension but no diabetes or CKD, according to current ACC/AHA guidelines?
- Less than 130/80 mmHg (Correct answer)
- Less than 140/90 mmHg
- Less than 150/90 mmHg
- Less than 160/90 mmHg
Correct answer: Less than 130/80 mmHg
The 2017 ACC/AHA guidelines recommend a BP target of less than 130/80 mmHg for most adults, including older patients who can tolerate treatment.
Question 3: A COPD patient with frequent exacerbations (≥2/year) and severe airflow limitation is best treated with which maintenance regimen?
- LABA + LAMA + ICS triple therapy (Correct answer)
- SABA alone as needed
- ICS monotherapy
- LABA monotherapy
Correct answer: LABA + LAMA + ICS triple therapy
Patients with frequent exacerbations and severe COPD benefit most from triple therapy combining LABA, LAMA, and inhaled corticosteroids to reduce exacerbation risk.
Question 4: Which laboratory finding most strongly indicates the need to initiate statin therapy in a patient without known cardiovascular disease?
- 10-year ASCVD risk ≥7.5% with LDL ≥70 mg/dL (Correct answer)
- LDL of 110 mg/dL in a 30-year-old with no risk factors
- HDL of 55 mg/dL in an otherwise healthy adult
- Triglycerides of 180 mg/dL with normal LDL
Correct answer: 10-year ASCVD risk ≥7.5% with LDL ≥70 mg/dL
ACC/AHA guidelines recommend initiating statin therapy for primary prevention when the 10-year ASCVD risk is ≥7.5% and LDL is ≥70 mg/dL.
Question 5: A patient with heart failure with reduced ejection fraction (HFrEF) is already on ACE inhibitor and beta-blocker. Which additional drug class has been shown to reduce mortality?
- Mineralocorticoid receptor antagonist (spironolactone) (Correct answer)
- Calcium channel blocker (amlodipine)
- Loop diuretic (furosemide)
- Digoxin as first add-on
Correct answer: Mineralocorticoid receptor antagonist (spironolactone)
Aldosterone antagonists such as spironolactone reduce mortality in HFrEF when added to ACE inhibitor and beta-blocker therapy, as shown in the RALES trial.
Question 6: Which of the following best describes the recommended monitoring interval for diabetic nephropathy screening in a patient with type 2 diabetes and normal renal function?
- Annual urine albumin-to-creatinine ratio and serum creatinine (Correct answer)
- Every 5 years if baseline is normal
- Only if symptomatic proteinuria develops
- Every 6 months regardless of risk factors
Correct answer: Annual urine albumin-to-creatinine ratio and serum creatinine
Annual screening with urine albumin-to-creatinine ratio and eGFR is recommended starting at diagnosis for type 2 diabetes to detect early nephropathy.
Question 7: A patient with rheumatoid arthritis on methotrexate develops a persistent dry cough and dyspnea. What is the most likely cause?
- Methotrexate-induced pneumonitis (Correct answer)
- RA-associated interstitial lung disease
- Community-acquired pneumonia
- GERD-related cough
Correct answer: Methotrexate-induced pneumonitis
Methotrexate pneumonitis is a serious but uncommon adverse effect characterized by dry cough, dyspnea, and fever, requiring drug discontinuation.
Family Practice Exam Chronic Disease Management 2
A 58-year-old patient with type 2 diabetes has an HbA1c of 9.2% despite metformin monotherapy.
What is the most appropriate next step?