Family Practice Exam Chronic Disease Management 5

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?

Accepted Answer

Initiate urate-lowering therapy with allopurinol targeting uric acid <6 mg/dL

Answer

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?

Accepted Answer

Initiate erythropoiesis-stimulating agent (ESA) therapy

Answer

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?

Accepted Answer

Tight glycemic control (HbA1c <7%)

Answer

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?

Accepted Answer

Initiate bisphosphonate therapy due to glucocorticoid-induced osteoporosis risk

Answer

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?

Accepted Answer

Reduce or discontinue the mineralocorticoid antagonist and reassess potassium

Answer

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.

Family Practice Exam Practice Test

Family Practice Exam Practice Test

Family Practice Exam Chronic Disease Management 5