Family Practice Exam Chronic Disease Management 4 — Questions and Answers
Question 1: A 50-year-old obese patient with newly diagnosed type 2 diabetes has no cardiovascular disease. Which medication offers the best combination of glycemic control and weight loss?
- GLP-1 receptor agonist (semaglutide or liraglutide) (Correct answer)
- Sulfonylurea (glipizide)
- Thiazolidinedione (pioglitazone)
- Basal insulin (glargine)
Correct answer: GLP-1 receptor agonist (semaglutide or liraglutide)
GLP-1 receptor agonists provide robust HbA1c reduction along with significant weight loss, making them ideal for obese type 2 diabetes patients.
Question 2: Which lifestyle intervention has the strongest evidence for reducing cardiovascular mortality in patients with established coronary artery disease?
- Cardiac rehabilitation program with structured exercise (Correct answer)
- Sodium restriction to less than 1,000 mg/day
- Vitamin E supplementation
- Stress reduction meditation alone
Correct answer: Cardiac rehabilitation program with structured exercise
Cardiac rehabilitation programs incorporating structured exercise have been shown in multiple trials to reduce cardiovascular mortality and hospitalizations in CAD patients.
Question 3: A patient with hypothyroidism is stable on levothyroxine but reports fatigue and weight gain. TSH is 6.8 mU/L. What is the next step?
- Increase the levothyroxine dose and recheck TSH in 6–8 weeks (Correct answer)
- Add liothyronine (T3) immediately
- Switch to natural desiccated thyroid hormone
- Attribute symptoms to aging and make no changes
Correct answer: Increase the levothyroxine dose and recheck TSH in 6–8 weeks
An elevated TSH indicates under-replacement; increasing the levothyroxine dose with follow-up TSH in 6–8 weeks is the appropriate management.
Question 4: Which drug class is preferred for hypertension management in a patient with diabetes and microalbuminuria?
- ACE inhibitor or ARB (Correct answer)
- Beta-blocker
- Thiazide diuretic as monotherapy
- Alpha-1 blocker
Correct answer: ACE inhibitor or ARB
ACE inhibitors and ARBs are preferred in diabetic patients with microalbuminuria because they reduce intraglomerular pressure and slow progression of nephropathy beyond blood pressure control.
Question 5: A 70-year-old patient with COPD has a resting oxygen saturation of 87% on room air. What is the appropriate oxygen therapy recommendation?
- Long-term supplemental oxygen to maintain SpO₂ ≥90% (Correct answer)
- Oxygen only during exercise, not at rest
- No oxygen unless SpO₂ falls below 80%
- Nocturnal oxygen only without daytime supplementation
Correct answer: Long-term supplemental oxygen to maintain SpO₂ ≥90%
Long-term oxygen therapy is indicated when resting SpO₂ is ≤88%, as it has been shown to improve survival in severe hypoxemic COPD.
Question 6: A patient with heart failure presents with worsening dyspnea and bilateral lower extremity edema. Current medications include carvedilol and lisinopril. What should be added?
- Loop diuretic (furosemide) to relieve congestion (Correct answer)
- Calcium channel blocker for afterload reduction
- Nonsteroidal anti-inflammatory drug for comfort
- Increase carvedilol dose as first step
Correct answer: Loop diuretic (furosemide) to relieve congestion
Loop diuretics are the cornerstone of symptom management for acute decompensation in heart failure, rapidly relieving pulmonary and peripheral congestion.
Question 7: Which complication screening is uniquely required for patients with type 1 diabetes that differs from type 2 diabetes screening recommendations?
- Celiac disease antibody screening (anti-tTG IgA) (Correct answer)
- Annual foot exam
- Dilated eye exam
- Lipid panel screening
Correct answer: Celiac disease antibody screening (anti-tTG IgA)
Type 1 diabetes is associated with other autoimmune conditions, including celiac disease, which warrants periodic antibody screening not routinely performed in type 2 diabetes.
Family Practice Exam Chronic Disease Management 4
A 50-year-old obese patient with newly diagnosed type 2 diabetes has no cardiovascular disease.
Which medication offers the best combination of glycemic control and weight loss?