FRACGP Chronic Disease Management 2 — Questions and Answers
Question 1: Which screening interval is recommended for colorectal cancer using the faecal occult blood test (FOBT) in average-risk adults in Australia?
- Annually
- Every 2 years (Correct answer)
- Every 3 years
- Every 5 years
Correct answer: Every 2 years
The National Bowel Cancer Screening Program in Australia recommends FOBT every 2 years for average-risk adults aged 50–74 years.
Question 2: A patient with type 2 diabetes is started on metformin. At what eGFR threshold should metformin be discontinued due to risk of lactic acidosis?
- eGFR below 60 mL/min/1.73m²
- eGFR below 45 mL/min/1.73m²
- eGFR below 30 mL/min/1.73m² (Correct answer)
- eGFR below 15 mL/min/1.73m²
Correct answer: eGFR below 30 mL/min/1.73m²
Metformin is contraindicated when eGFR falls below 30 mL/min/1.73m² due to impaired renal clearance increasing the risk of metformin accumulation and lactic acidosis.
Question 3: In chronic heart failure with reduced ejection fraction (HFrEF), which combination of medications forms the cornerstone of evidence-based therapy?
- Digoxin, diuretic, and calcium channel blocker
- ACE inhibitor/ARB, beta-blocker, and MRA (Correct answer)
- Nitrates, hydralazine, and aspirin
- Amiodarone, warfarin, and diuretic
Correct answer: ACE inhibitor/ARB, beta-blocker, and MRA
The evidence-based triad for HFrEF includes an ACE inhibitor or ARB (or ARNI), a beta-blocker, and a mineralocorticoid receptor antagonist (MRA), all proven to reduce mortality.
Question 4: A patient with rheumatoid arthritis is started on methotrexate. Which supplement should be co-prescribed to reduce the risk of adverse effects?
- Vitamin D
- Folic acid (Correct answer)
- Vitamin B12
- Calcium
Correct answer: Folic acid
Folic acid supplementation (5 mg weekly or 1 mg daily) is co-prescribed with methotrexate to reduce folate-antagonist side effects such as mucositis, nausea, and hepatotoxicity.
Question 5: Which spirometry result pattern is most consistent with COPD?
- FEV1/FVC ratio > 0.70 with reduced FVC
- FEV1/FVC ratio < 0.70 post-bronchodilator with reduced FEV1 (Correct answer)
- Normal FEV1/FVC with reduced DLCO
- FEV1/FVC ratio > 0.70 with normal FEV1 and FVC
Correct answer: FEV1/FVC ratio < 0.70 post-bronchodilator with reduced FEV1
COPD is defined by a post-bronchodilator FEV1/FVC ratio of less than 0.70, indicating fixed airflow obstruction with a reduced FEV1 reflecting the degree of severity.
Question 6: A GP performs an AUDIT-C screening on a patient. Which total score threshold indicates hazardous or harmful alcohol use requiring further assessment?
- Score ≥ 3 for women, ≥ 4 for men (Correct answer)
- Score ≥ 5 for all patients
- Score ≥ 7 for all patients
- Score ≥ 2 for women, ≥ 3 for men
Correct answer: Score ≥ 3 for women, ≥ 4 for men
An AUDIT-C score of ≥3 for women and ≥4 for men indicates hazardous drinking and warrants further assessment and brief intervention.
Question 7: What is the recommended first-line treatment for gout during an acute attack in a patient with no contraindications?
- Allopurinol
- NSAIDs or colchicine (Correct answer)
- Probenecid
- Febuxostat
Correct answer: NSAIDs or colchicine
NSAIDs (e.g., indomethacin, naproxen) or colchicine are the first-line treatments for acute gout flares; allopurinol and febuxostat are urate-lowering therapies used for prevention, not acute treatment.
FRACGP Chronic Disease Management 2
Which screening interval is recommended for colorectal cancer using the faecal occult blood test (FOBT) in average-risk adults in Australia?