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Chronic Disease Management Flashcards

7 cards from real AANP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

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  1. A 70-year-old patient with stage 3b CKD (eGFR 38) and hyperkalemia (K+ 5.8 mEq/L) is on an ACE inhibitor for diabetic nephropathy. What is the most appropriate immediate management?

    Answer: Reduce ACE inhibitor dose and add a potassium binder if needed

    In mild-to-moderate hyperkalemia with clear indication for ACE inhibitor (diabetic nephropathy), dose reduction combined with potassium binders (e.g., patiromer) allows continuation of renoprotective therapy.

  2. A patient with heart failure with preserved ejection fraction (HFpEF, EF 58%) presents with dyspnea and lower extremity edema. What is the primary pharmacologic treatment for symptom relief?

    Answer: Loop diuretics

    Loop diuretics are the cornerstone of symptomatic treatment in HFpEF by reducing volume overload, as no therapy has yet demonstrated mortality reduction in HFpEF.

  3. A patient with asthma is classified as having moderate persistent disease. He is currently on a low-dose inhaled corticosteroid (ICS) with persistent symptoms. What is the next step per NAEPP guidelines?

    Answer: Step up to low-dose ICS plus a long-acting beta-agonist (LABA)

    NAEPP Step 3 therapy for moderate persistent asthma is low-dose ICS combined with a LABA, which improves symptom control compared to ICS monotherapy.

  4. A 62-year-old patient with type 2 diabetes and established cardiovascular disease has an HbA1c of 8.2%. He is on metformin. Which agent should be added for its proven cardiovascular mortality benefit?

    Answer: Empagliflozin (SGLT-2 inhibitor)

    SGLT-2 inhibitors such as empagliflozin have demonstrated cardiovascular mortality reduction in patients with T2DM and established ASCVD in landmark trials (EMPA-REG OUTCOME).

  5. A 55-year-old patient with gout has a serum uric acid of 9.8 mg/dL and two gout flares in the past year. He is not on urate-lowering therapy. What is the appropriate treatment goal?

    Answer: Serum uric acid < 6 mg/dL with allopurinol

    ACR guidelines recommend initiating urate-lowering therapy (first-line allopurinol) in patients with ≥2 flares/year, with a target serum urate < 6 mg/dL to prevent crystal deposition and flares.

  6. A patient with hypothyroidism has been stable on levothyroxine 100 mcg for 2 years. A repeat TSH returns at 6.8 mIU/L (reference 0.4–4.0). She reports fatigue and cold intolerance. What is the most appropriate action?

    Answer: Increase levothyroxine dose by 12.5–25 mcg

    A mildly elevated TSH with symptoms consistent with hypothyroidism indicates under-replacement; the standard approach is a small incremental increase in levothyroxine dose.

  7. A patient with chronic obstructive pulmonary disease (COPD) has an oxygen saturation of 86% at rest on room air. Which intervention has been shown to improve survival in COPD?

    Answer: Long-term supplemental oxygen therapy ≥15 hours/day

    The NOTT and MRC trials demonstrated that long-term oxygen therapy ≥15 hours/day improves survival in COPD patients with resting hypoxemia (PaO₂ ≤55 mmHg or SpO₂ ≤88%).