MTM Chronic Disease Management 2 — Questions and Answers
Question 1: A patient with type 2 diabetes has an HbA1c of 9.2% despite metformin 1000 mg twice daily. Which is the most appropriate next step in therapy?
- Add a GLP-1 receptor agonist or SGLT-2 inhibitor with cardiovascular benefit if indicated (Correct answer)
- Switch metformin to insulin glargine immediately
- Add a sulfonylurea as the sole intensification strategy
- Discontinue metformin due to inadequate response
Correct answer: Add a GLP-1 receptor agonist or SGLT-2 inhibitor with cardiovascular benefit if indicated
Current ADA guidelines recommend adding agents with proven cardiovascular or renal benefit (GLP-1 RA or SGLT-2i) as preferred second-line therapy when HbA1c remains above goal.
Question 2: Which blood pressure target is recommended for most patients with hypertension and established cardiovascular disease according to current guidelines?
- Less than 130/80 mmHg (Correct answer)
- Less than 140/90 mmHg
- Less than 150/90 mmHg
- Less than 120/70 mmHg
Correct answer: Less than 130/80 mmHg
The AHA/ACC 2017 guidelines recommend a BP target of <130/80 mmHg for patients with hypertension and established CVD.
Question 3: A COPD patient uses a short-acting beta-agonist (SABA) more than twice per week for symptom relief. According to GOLD guidelines, this indicates:
- Inadequately controlled symptoms requiring therapy escalation (Correct answer)
- Normal COPD management at any GOLD stage
- The need to discontinue all inhaled therapy
- Requirement for immediate oral corticosteroids
Correct answer: Inadequately controlled symptoms requiring therapy escalation
Frequent rescue inhaler use (>2 days/week) signals uncontrolled symptoms and warrants reassessment and escalation of maintenance therapy per GOLD guidelines.
Question 4: Which monitoring parameter is MOST critical when initiating an ACE inhibitor in a patient with chronic kidney disease?
- Serum creatinine and potassium within 1–2 weeks (Correct answer)
- Monthly complete blood count for 6 months
- Weekly fasting glucose for the first month
- Annual thyroid function tests
Correct answer: Serum creatinine and potassium within 1–2 weeks
ACE inhibitors can cause acute rises in creatinine and hyperkalemia in CKD patients, so renal function and electrolytes must be rechecked within 1–2 weeks of initiation.
Question 5: A patient with heart failure with reduced ejection fraction (HFrEF) is on optimal medical therapy. Which medication class has demonstrated mortality reduction in this population?
- Beta-blockers (carvedilol, metoprolol succinate, or bisoprolol) (Correct answer)
- Calcium channel blockers (amlodipine or diltiazem)
- Class I antiarrhythmics (flecainide or propafenone)
- Short-acting nitrates (isosorbide dinitrate prn)
Correct answer: Beta-blockers (carvedilol, metoprolol succinate, or bisoprolol)
Evidence-based beta-blockers (carvedilol, metoprolol succinate, bisoprolol) are proven to reduce mortality in HFrEF and are part of the guideline-directed medical therapy quartet.
Question 6: In a patient with asthma, a written asthma action plan should be based primarily on:
- Symptom monitoring and/or peak flow measurements (Correct answer)
- Spirometry results obtained annually in the clinic
- FeNO levels measured at each office visit
- Allergen-specific IgE testing results
Correct answer: Symptom monitoring and/or peak flow measurements
NAEPP guidelines recommend that asthma action plans be guided by symptom assessment and/or peak expiratory flow monitoring to allow patients to self-manage exacerbations.
Question 7: Which lipid-lowering strategy is recommended for a 55-year-old patient with type 2 diabetes and a 10-year ASCVD risk of 14%?
- High-intensity statin therapy (Correct answer)
- Low-intensity statin therapy only
- Fibrate monotherapy
- Ezetimibe monotherapy without a statin
Correct answer: High-intensity statin therapy
ACC/AHA guidelines recommend high-intensity statin therapy for diabetic patients aged 40–75 with a 10-year ASCVD risk ≥7.5%.
MTM Chronic Disease Management 2
A patient with type 2 diabetes has an HbA1c of 9.2% despite metformin 1000 mg twice daily.
Which is the most appropriate next step in therapy?