Family Practice Exam Chronic Disease Management 5 — Questions and Answers
Question 1: A 45-year-old man with gout has his third attack in one year. Serum uric acid is 8.9 mg/dL. Which is the most appropriate preventive strategy?
- Initiate urate-lowering therapy with allopurinol targeting uric acid <6 mg/dL (Correct answer)
- Use NSAIDs only during acute attacks indefinitely
- Begin colchicine prophylaxis alone without urate-lowering therapy
- Advise dietary changes only without medication
Correct answer: Initiate urate-lowering therapy with allopurinol targeting uric acid <6 mg/dL
Recurrent gout (≥2 attacks/year) with elevated uric acid warrants urate-lowering therapy; allopurinol is first-line with a target serum uric acid below 6 mg/dL.
Question 2: A patient with chronic kidney disease stage 3 has a hemoglobin of 9.8 g/dL. Iron stores are adequate. What is the most appropriate next step?
- Initiate erythropoiesis-stimulating agent (ESA) therapy (Correct answer)
- Prescribe oral iron supplementation alone
- Transfuse packed red blood cells immediately
- No treatment needed until hemoglobin falls below 8 g/dL
Correct answer: Initiate erythropoiesis-stimulating agent (ESA) therapy
Anemia of CKD with adequate iron stores and hemoglobin below 10 g/dL is appropriately treated with ESA therapy to reduce transfusion dependence.
Question 3: Which of the following is the most important modifiable risk factor for slowing progression of diabetic retinopathy?
- Tight glycemic control (HbA1c <7%) (Correct answer)
- Blood pressure control alone
- Lipid-lowering therapy with statins
- Annual dilated fundus exam frequency
Correct answer: Tight glycemic control (HbA1c <7%)
The DCCT and UKPDS trials demonstrated that tight glycemic control is the most powerful intervention for preventing and slowing progression of diabetic retinopathy.
Question 4: A patient on long-term prednisone for COPD exacerbations is found to have a T-score of -1.8. Which prevention strategy is most appropriate?
- Initiate bisphosphonate therapy due to glucocorticoid-induced osteoporosis risk (Correct answer)
- Calcium and vitamin D supplementation alone is sufficient
- Bone density monitoring every 5 years without treatment
- Discontinue prednisone immediately to prevent bone loss
Correct answer: Initiate bisphosphonate therapy due to glucocorticoid-induced osteoporosis risk
Patients on long-term glucocorticoids with any T-score below -1.0 are at increased fracture risk and should receive bisphosphonate therapy per ACR guidelines.
Question 5: A patient with stable chronic heart failure develops a serum potassium of 5.6 mEq/L while on lisinopril and spironolactone. What is the most appropriate action?
- Reduce or discontinue the mineralocorticoid antagonist and reassess potassium (Correct answer)
- Add a potassium-wasting diuretic to counteract hyperkalemia
- Discontinue all heart failure medications immediately
- Continue all medications and recheck in 3 months
Correct answer: Reduce or discontinue the mineralocorticoid antagonist and reassess potassium
Hyperkalemia above 5.5 mEq/L in HFrEF patients on dual RAAS blockade requires dose reduction or discontinuation of the aldosterone antagonist to prevent life-threatening arrhythmia.
Question 6: Which of the following best describes the role of the SGLT-2 inhibitor empagliflozin in chronic disease management beyond glycemic control?
- Reduces cardiovascular mortality and hospitalizations for heart failure in type 2 diabetes (Correct answer)
- Primarily used for weight loss without cardiovascular benefit
- Indicated only when GLP-1 agonists fail
- Provides renal protection but no cardiac benefit
Correct answer: Reduces cardiovascular mortality and hospitalizations for heart failure in type 2 diabetes
The EMPA-REG OUTCOME trial demonstrated that empagliflozin significantly reduces cardiovascular death and heart failure hospitalizations in type 2 diabetes patients with established CVD.
Question 7: A patient with multiple chronic conditions asks about the recommended frequency of comprehensive medication reviews to prevent polypharmacy harm. What is the standard recommendation?
- At least annually or with any significant change in health status (Correct answer)
- Every 5 years if medications are stable
- Only when a new specialist is involved
- When the patient reports side effects only
Correct answer: At least annually or with any significant change in health status
Annual medication reconciliation and comprehensive review, or review with each major health change, is recommended to identify drug interactions, duplications, and deprescribing opportunities in polypharmacy.
Family Practice Exam Chronic Disease Management 5
A 45-year-old man with gout has his third attack in one year.
Serum uric acid is 8.9 mg/dL.
Which is the most appropriate preventive strategy?