FREE BCACP Patient-Centered Care Questions and Answers

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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

Correct! Wrong!

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?

Correct! Wrong!

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?

Correct! Wrong!

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?

Correct! Wrong!

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

Correct! Wrong!

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.

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