FREE BCACP Patient-Centered Care Questions and Answers
A 67-year-old male with Type 2 Diabetes presents to the clinic for follow-up. His recent lab results include:
A1C: 8.4%
Blood Pressure: 138/88 mmHg
LDL cholesterol: 112 mg/dL
Current medications: Metformin 1000 mg BID, Lisinopril 10 mg daily.
Which of the following interventions is MOST appropriate to optimize his therapy?
Please select 3 correct answers
A. Add Empagliflozin: Empagliflozin (SGLT2 inhibitor) is appropriate as the patient has uncontrolled A1C > 7.0% and has cardiovascular benefits for patients with diabetes and hypertension.
B. Increase Lisinopril: Blood pressure (138/88 mmHg) exceeds the target for diabetes (<130/80 mmHg per ACC/AHA guidelines). Titrating Lisinopril to 20 mg is appropriate.
C. Start Atorvastatin: For patients with diabetes aged 40-75 years, moderate- to high-intensity statin therapy is recommended regardless of LDL level. Atorvastatin 20 mg aligns with this.
D. Add Aspirin: While Aspirin is beneficial for secondary prevention, there’s insufficient evidence for primary prevention unless additional risk factors exist.
E. Continue current therapy: Inappropriate given his elevated A1C, blood pressure, and LDL.
A 55-year-old female with a 10-year history of hypertension and dyslipidemia reports muscle aches after starting Simvastatin 40 mg. Labs show normal kidney and liver function.
What is the BEST next step?
Statin intolerance: Muscle symptoms are common with Simvastatin. Switching to a lower dose, less lipophilic statin like Atorvastatin can reduce side effects while maintaining LDL reduction.
A. Reducing Simvastatin: May not adequately address LDL goals.
C. Coenzyme Q10: Not evidence-based for muscle symptoms.
D. Continue therapy: Inappropriate since symptoms warrant action.
A 72-year-old patient with heart failure and reduced ejection fraction (HFrEF) is taking:
Metoprolol succinate 25 mg daily
Furosemide 40 mg daily
Lisinopril 10 mg daily
His symptoms are well-controlled, but his potassium is 5.4 mEq/L (normal 3.5-5.0). What is the MOST appropriate intervention?
Hyperkalemia: Lisinopril (ACE inhibitor) can cause elevated potassium. Potassium at 5.4 mEq/L exceeds safe limits, so temporarily holding Lisinopril is appropriate.
A. Increase Lisinopril: Contraindicated with hyperkalemia.
B. Switch to Sacubitril/Valsartan: Not appropriate until potassium is normalized.
C. Start Spironolactone: Spironolactone can further increase potassium and is unsafe here.
A 60-year-old man with COPD presents with increasing dyspnea and a recent exacerbation. Current medications:
Tiotropium 18 mcg daily
Albuterol inhaler PRN
What is the BEST addition to his therapy?
ICS/LABA combination: Recommended for COPD patients with frequent exacerbations despite long-acting bronchodilator therapy (Tiotropium). Fluticasone/Salmeterol is an appropriate choice.
B. Theophylline: Rarely used due to side effects and drug interactions.
C. Increase Albuterol: Overuse does not address the need for maintenance therapy.
D. Roflumilast: Reserved for severe COPD with chronic bronchitis.
A 50-year-old woman with obesity, hypertension, and osteoarthritis seeks advice on lifestyle changes for managing her hypertension.
What is the MOST effective intervention for lowering blood pressure?
Please select 3 correct answers
A. DASH diet: Proven to significantly reduce blood pressure.
B. Weight loss: Even 5-10% body weight reduction can lower blood pressure.
C. Sodium restriction: Limiting sodium to <2400 mg/day helps reduce hypertension.
D. Increase caffeine: Caffeine can transiently increase BP and is inappropriate.
E. Resistance exercise: Beneficial, but aerobic exercise (not resistance) has the strongest BP-lowering effect.