FRACGP Chronic Disease Management 1 — Questions and Answers
Question 1: Which HbA1c target is generally recommended for most adults with type 2 diabetes in Australian general practice?
- Less than 6.0%
- Less than 7.0% (Correct answer)
- Less than 8.0%
- Less than 9.0%
Correct answer: Less than 7.0%
An HbA1c of less than 7.0% (53 mmol/mol) is the standard target for most adults with type 2 diabetes, balancing glycaemic control with minimising hypoglycaemia risk.
Question 2: A 65-year-old patient with hypertension and chronic kidney disease (eGFR 45 mL/min/1.73m²) presents for medication review. Which antihypertensive class is most recommended as first-line in this scenario?
- Calcium channel blocker
- Beta-blocker
- ACE inhibitor or ARB (Correct answer)
- Thiazide diuretic
Correct answer: ACE inhibitor or ARB
ACE inhibitors and ARBs are preferred in patients with CKD and hypertension due to their nephroprotective effects and reduction in proteinuria progression.
Question 3: According to COPD management guidelines, which intervention has the greatest evidence for reducing mortality in patients with severe COPD and resting hypoxaemia?
- Inhaled corticosteroids
- Long-acting bronchodilators
- Long-term oxygen therapy (Correct answer)
- Pulmonary rehabilitation
Correct answer: Long-term oxygen therapy
Long-term oxygen therapy (LTOT) for ≥15 hours/day has the strongest evidence for reducing mortality in COPD patients with resting hypoxaemia (PaO2 ≤55 mmHg).
Question 4: A patient with established cardiovascular disease is commenced on a statin. What is the primary LDL-cholesterol target recommended in Australian guidelines?
- Less than 3.0 mmol/L
- Less than 2.5 mmol/L
- Less than 2.0 mmol/L
- Less than 1.8 mmol/L (Correct answer)
Correct answer: Less than 1.8 mmol/L
For patients with established cardiovascular disease (secondary prevention), Australian guidelines recommend an LDL-C target of less than 1.8 mmol/L.
Question 5: Which medication used in heart failure management has been shown to reduce both hospitalisation and mortality and belongs to the SGLT2 inhibitor class?
- Metformin
- Empagliflozin (Correct answer)
- Sitagliptin
- Acarbose
Correct answer: Empagliflozin
Empagliflozin (an SGLT2 inhibitor) has demonstrated significant reductions in heart failure hospitalisation and cardiovascular mortality in the EMPEROR-Reduced and EMPEROR-Preserved trials.
Question 6: In managing a patient with asthma, when should a preventer inhaler (inhaled corticosteroid) be initiated?
- Only when symptoms occur more than once daily
- When reliever use exceeds 2 days per week (Correct answer)
- Only when FEV1 drops below 60% predicted
- When a patient fails two courses of oral corticosteroids
Correct answer: When reliever use exceeds 2 days per week
Preventer therapy should be initiated when reliever (SABA) use is required more than twice per week, indicating uncontrolled asthma that needs regular anti-inflammatory treatment.
Question 7: A patient with osteoarthritis of the knee has failed paracetamol therapy. Which is the most appropriate next pharmacological step according to evidence-based guidelines?
- Opioid analgesics
- Topical or oral NSAIDs (Correct answer)
- Intra-articular corticosteroid injection only
- Tramadol
Correct answer: Topical or oral NSAIDs
Topical NSAIDs (preferred for localised knee OA) or oral NSAIDs are recommended as the next step after paracetamol failure, given their anti-inflammatory efficacy with lower systemic risk for topical preparations.
FRACGP Chronic Disease Management 1
Which HbA1c target is generally recommended for most adults with type 2 diabetes in Australian general practice?