Family Practice Exam Chronic Disease Management 3 — Questions and Answers
Question 1: A 65-year-old woman with osteoporosis has a T-score of -2.8 at the lumbar spine. She has no history of fracture. What is the preferred first-line pharmacologic treatment?
- Oral bisphosphonate (alendronate or risedronate) (Correct answer)
- Teriparatide (anabolic therapy)
- Denosumab as first-line
- Raloxifene for all postmenopausal women
Correct answer: Oral bisphosphonate (alendronate or risedronate)
Oral bisphosphonates are the preferred first-line pharmacologic treatment for osteoporosis due to their established efficacy, safety, and low cost.
Question 2: In a patient with CKD stage 3b (eGFR 35 mL/min/1.73m²) and type 2 diabetes, which glucose-lowering agent requires dose adjustment or avoidance?
- Metformin (contraindicated below eGFR 30, use caution 30-45) (Correct answer)
- Empagliflozin
- Linagliptin
- Insulin
Correct answer: Metformin (contraindicated below eGFR 30, use caution 30-45)
Metformin requires caution when eGFR is 30–45 mL/min and is contraindicated below 30 mL/min due to lactic acidosis risk, while many other agents are safer in moderate CKD.
Question 3: Which spirometry pattern is diagnostic of COPD?
- Post-bronchodilator FEV1/FVC ratio less than 0.70 (Correct answer)
- FVC below 80% predicted with normal FEV1/FVC
- FEV1 below 80% predicted with normal FVC
- Peak expiratory flow rate below 70% predicted
Correct answer: Post-bronchodilator FEV1/FVC ratio less than 0.70
COPD is confirmed by a post-bronchodilator FEV1/FVC ratio less than 0.70, indicating irreversible airflow obstruction.
Question 4: A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 3. What is the recommended management?
- Anticoagulation with a DOAC or warfarin (Correct answer)
- Aspirin therapy alone
- No antithrombotic therapy needed
- Rate control only without anticoagulation
Correct answer: Anticoagulation with a DOAC or warfarin
A CHA₂DS₂-VASc score ≥2 in men or ≥3 in women indicates a high stroke risk warranting anticoagulation, preferably with a DOAC over warfarin.
Question 5: Which of the following is the most appropriate treatment for stable angina refractory to nitrates and beta-blockers?
- Add a long-acting calcium channel blocker (amlodipine) (Correct answer)
- Immediate coronary artery bypass grafting
- Start anticoagulation with heparin
- Switch to aspirin only and monitor
Correct answer: Add a long-acting calcium channel blocker (amlodipine)
Adding a long-acting dihydropyridine calcium channel blocker like amlodipine is appropriate for stable angina not controlled by nitrates and beta-blockers.
Question 6: A patient with type 1 diabetes presents with recurrent hypoglycemia unawareness. What is the most important management step?
- Raise glycemic targets temporarily and implement structured hypoglycemia avoidance (Correct answer)
- Discontinue insulin and manage with diet alone
- Increase insulin doses to prevent wide glucose swings
- Prescribe glucagon kit only and make no other changes
Correct answer: Raise glycemic targets temporarily and implement structured hypoglycemia avoidance
Hypoglycemia unawareness is treated by raising glucose targets temporarily and structured avoidance of hypoglycemia, which can restore counterregulatory responses over weeks.
Question 7: Which finding on urinalysis is most consistent with early diabetic nephropathy?
- Microalbuminuria (30–300 mg albumin/g creatinine) (Correct answer)
- Gross hematuria with RBC casts
- Heavy proteinuria greater than 3.5 g/day
- Leukocyte esterase with nitrites
Correct answer: Microalbuminuria (30–300 mg albumin/g creatinine)
Microalbuminuria is the earliest marker of diabetic nephropathy, reflecting early glomerular damage before overt proteinuria develops.
Family Practice Exam Chronic Disease Management 3
A 65-year-old woman with osteoporosis has a T-score of -2.8 at the lumbar spine.
She has no history of fracture.
What is the preferred first-line pharmacologic treatment?