NEWEST FAMILY MEDICINE
CERTIFICATION EXAM FOR THE
AMERICAN BOARD OF FAMILY
MEDICINE (ABMS) | Q&A WITH
RATIONALES
PRACTICE EXAMINATION jh
SECTION 1: ACUTE CARE AND DIAGNOSIS (35%) jh jh jh jh jh jh
Question 1 jh
A 45-year-old woman presents with a 3-
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day history of right upper quadrant pain, nausea, and fever. She reports the pain began after eatin
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
g a fatty meal. On examination, she has tenderness in the right upper quadrant with a positive Mur
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
phy's sign. Vital signs: temperature 38.2°C (100.8°F), heart rate 102 bpm, blood pressure 138/85 m
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
mHg. Laboratory studies show WBC 14,500/μL, total bilirubin 2.1 mg/dL, direct bilirubin 1.4 mg/dL
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, AST 85 U/L, ALT 92 U/L, and alkaline phosphatase 320 U/L.
jh jh jh jh jh jh jh jh jh jh jh
What is the most appropriate next step in management?
jh jh jh jh jh jh jh jh
A) Outpatient oral antibiotics and follow-up in 48 hours
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B) Laparoscopic cholecystectomy within 24-48 hours
jh jh jh jh jh
C) Endoscopic retrograde cholangiopancreatography (ERCP) urgently
jh jh jh jh jh
D) Observation with intravenous fluids and bowel rest
jh jh jh jh jh jh jh
E) Percutaneous cholecystostomy tube placement
jh jh jh jh
Correct Answer: C jh jh
Explanation: This patient presents with findings consistent with acute cholecystitis (Murphy's sig
jh jh jh jh jh jh jh jh jh jh jh
n, RUQ pain, fever, leukocytosis) with evidence of cholestasis (elevated bilirubin, alkaline phosphat
jh jh jh jh jh jh jh jh jh jh jh jh
ase) and transaminitis. The elevated liver enzymes and bilirubin suggest possible choledocholithia
jh jh jh jh jh jh jh jh jh jh jh
sis with obstruction. ERCP is indicated urgently for patients with suspected common bile duct st
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
ones causing obstruction, particularly with cholangitis . While laparoscopic cholecystectomy is the
jh jh jh jh jh jh jh jh jh jh jh j
definitive treatment for acute cholecystitis, when there is evidence of choledocholithiasis, ERCP wi
h jh jh jh jh jh jh jh jh jh jh jh jh
th sphincterotomy and stone extraction should be performed first, followed by interval cholecyste
jh jh jh jh jh jh jh jh jh jh jh jh
ctomy. Outpatient management is inappropriate for this presentation. Percutaneous cholecystost
jh jh jh jh jh jh jh jh jh
omy is reserved for patients who are poor surgical candidates.
jh jh jh jh jh jh jh jh jh
,Question 2 jh
A 28-year-old man presents with a 2-
jh jh jh jh jh jh
week history of cough, fever, and night sweats. He reports a 10-
jh jh jh jh jh jh jh jh jh jh jh
pound unintentional weight loss over the past month. He emigrated from India 6 months ago. Ch
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
est radiograph shows a right upper lobe infiltrate with cavitation. Sputum acid-
jh jh jh jh jh jh jh jh jh jh jh
fast bacilli (AFB) smear is positive.
jh jh jh jh jh
What is the most appropriate initial treatment regimen?
jh jh jh jh jh jh jh
A) Isoniazid and rifampin for 6 months
jh jh jh jh jh jh
B) Isoniazid, rifampin, pyrazinamide, and ethambutol for 2 months, then isoniazid and rifampin for
jh jh jh jh jh jh jh jh jh jh jh jh jh j
4 months
h jh
C) Isoniazid, rifampin, pyrazinamide, and ethambutol for 4 months, then isoniazid and rifampin for
jh jh jh jh jh jh jh jh jh jh jh jh jh j
2 months
h jh
D) Isoniazid, rifampin, and pyrazinamide for 6 months
jh jh jh jh jh jh jh
E) Levofloxacin, ethambutol, and pyrazinamide for 6 months
jh jh jh jh jh jh jh
Correct Answer: B jh jh
Explanation: This patient has pulmonary tuberculosis confirmed by positive AFB smear and cha
jh jh jh jh jh jh jh jh jh jh jh jh
racteristic radiographic findings (upper lobe cavitary disease) in a patient from an endemic region
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
with classic symptoms (cough, fever, night sweats, weight loss). The standard initial treatment regi
jh jh jh jh jh jh jh jh jh jh jh jh jh
men for drug-susceptible TB is a 4-
jh jh jh jh jh jh
drug regimen: isoniazid, rifampin, pyrazinamide, and ethambutol for the initial 2-
jh jh jh jh jh jh jh jh jh jh
month intensive phase, followed by isoniazid and rifampin for the continuation phase (4 months f
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
or most patients, extended to 7-
jh jh jh jh jh
9 months for cavitary disease or delayed sputum conversion) . A 2-
jh jh jh jh jh jh jh jh jh jh jh
month initial phase is appropriate; 4 months would be too long for the intensive phase. Empiric tre
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
atment for TB should not be started without confirmed diagnosis or high clinical suspicion.
jh jh jh jh jh jh jh jh jh jh jh jh jh
Question 3 jh
A 65-year-
jh
old woman with a history of hypertension and type 2 diabetes presents with acute onset of severe,
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh j
tearing chest pain that radiates to her back. On examination, she has a blood pressure of 210/110
h jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
mmHg in the right arm and 150/85 mmHg in the left arm. A diastolic murmur is heard at the left st
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
ernal border. jh
What is the most appropriate initial imaging study?
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,A) Transthoracic echocardiogram
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B) CT angiography of the chest
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C) Chest radiograph
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D) Transesophageal echocardiogram
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E) MRI of the chest
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Correct Answer: B jh jh
Explanation: This patient's presentation is highly concerning for acute aortic dissection (tearing
jh jh jh jh jh jh jh jh jh jh jh jh
chest pain radiating to back, unequal blood pressures in arms, aortic regurgitation murmur). CT a
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
ngiography of the chest is the initial imaging study of choice for suspected aortic dissection in m
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
ost emergency settings due to its high sensitivity and specificity (>95%), rapid acquisition, and abil
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
ity to define the extent of dissection . Transesophageal echocardiography (TEE) is an alternative b
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
ut is more invasive and operator-
jh jh jh jh jh
dependent. While TTE may detect aortic regurgitation or pericardial effusion, it has limited sensitiv
jh jh jh jh jh jh jh jh jh jh jh jh jh
ity for visualizing the ascending aorta. Chest radiograph may show widened mediastinum but is n
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
ot diagnostic or sensitive. MRI has high accuracy but is time-
jh jh jh jh jh jh jh jh jh jh
consuming and not readily available in acute settings. jh jh jh jh jh jh jh
Question 4 jh
A 22-year-
jh
old woman presents with 2 days of dysuria, urinary frequency, and suprapubic pain. She reports n
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
o vaginal discharge or fever. She has no known drug allergies. Urinalysis shows leukocyte esterase
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
positive and nitrites positive. She is sexually active with one partner and uses condoms inconsisten
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
tly.
What is the most appropriate empiric antibiotic therapy?
jh jh jh jh jh jh jh
A) Ciprofloxacin 500 mg twice daily for 7 days
jh jh jh jh jh jh jh jh
B) Nitrofurantoin 100 mg twice daily for 5 days
jh jh jh jh jh jh jh jh
C) Trimethoprim-sulfamethoxazole DS twice daily for 3 days
jh jh jh jh jh jh jh
D) Amoxicillin 500 mg three times daily for 7 days
jh jh jh jh jh jh jh jh jh
E) Doxycycline 100 mg twice daily for 7 days
jh jh jh jh jh jh jh jh
Correct Answer: B jh jh
Explanation: This patient has acute uncomplicated cystitis in a young, healthy non-
jh jh jh jh jh jh jh jh jh jh jh
pregnant woman. Nitrofurantoin 100 mg twice daily for 5 days is recommended as first-
jh jh jh jh jh jh jh jh jh jh jh jh jh
line empiric therapy due to its low resistance rates, excellent efficacy, and minimal impact on gut fl
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
ora . Fluoroquinolones (ciprofloxacin) should be reserved for more complicated infections or whe
jh jh jh jh jh jh jh jh jh jh jh jh
n resistance is suspected due to increasing resistance and adverse effects. TMP-
jh jh jh jh jh jh jh jh jh jh jh
SMX has high resistance rates (>20%) in many regions. Amoxicillin is not recommended for empiri
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
, c UTIs due to high resistance. Doxycycline is not appropriate for cystitis as it does not achieve ade
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
quate urinary concentrations and is used primarily for sexually transmitted infections.
jh jh jh jh jh jh jh jh jh jh
Question 5 jh
A 55-year-old man with a 30-pack-year smoking history presents with a 3-
jh jh jh jh jh jh jh jh jh jh jh
month history of hoarseness and a persistent sore throat. He reports occasional blood-
jh jh jh jh jh jh jh jh jh jh jh jh
tinged sputum. He has a 20- jh jh jh jh jh
pound unintentional weight loss over the past 6 months. On examination, there is a palpable left c
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
ervical lymph node measuring 2 cm. Flexible laryngoscopy reveals a lesion on the left vocal cord.
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
What is the most appropriate diagnostic test?
jh jh jh jh jh jh
A) CT scan of the neck
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B) MRI of the neck
jh jh jh jh
C) Biopsy of the vocal cord lesion
jh jh jh jh jh jh
D) PET-CT scan
jh jh
E) Chest radiograph
jh jh
Correct Answer: C jh jh
Explanation: This patient's presentation (hoarseness >3 weeks, smoking history, weight loss, cerv
jh jh jh jh jh jh jh jh jh jh jh
ical lymphadenopathy, vocal cord lesion) is concerning for laryngeal squamous cell carcinoma.
jh jh jh jh jh jh jh jh jh jh jh jh
The most appropriate diagnostic test is biopsy of the vocal cord lesion via direct laryngoscopy t
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
o obtain histologic confirmation . Imaging studies (CT, MRI, PET-
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CT) are important for staging once the diagnosis is confirmed but should not replace tissue diagn
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
osis. Chest radiograph is insufficient for diagnosis. The gold standard for diagnosis of laryngeal ca
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ncer is direct laryngoscopy with biopsy.
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SECTION 2: CHRONIC CARE MANAGEMENT (25%) jh jh jh jh jh
Question 6 jh
A 62-year-old woman with type 2 diabetes for 15 years presents for follow-
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up. Her medications include metformin 1000 mg twice daily, glipizide 10 mg daily, and lisinopril 2
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0 mg daily. Her current HbA1c is 8.9% (target <7.0%). She has microalbuminuria (urine albumin-
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
to-creatinine ratio 120 mg/g). Her eGFR is 52 mL/min/1.73m². Blood pressure is 138/84 mmHg.
jh jh jh jh jh jh jh jh jh jh jh jh jh
What is the most appropriate next step in diabetes management?
jh jh jh jh jh jh jh jh jh
A) Increase glipizide to 20 mg daily
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B) Add sitagliptin 100 mg daily
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CERTIFICATION EXAM FOR THE
AMERICAN BOARD OF FAMILY
MEDICINE (ABMS) | Q&A WITH
RATIONALES
PRACTICE EXAMINATION jh
SECTION 1: ACUTE CARE AND DIAGNOSIS (35%) jh jh jh jh jh jh
Question 1 jh
A 45-year-old woman presents with a 3-
jh jh jh jh jh jh
day history of right upper quadrant pain, nausea, and fever. She reports the pain began after eatin
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
g a fatty meal. On examination, she has tenderness in the right upper quadrant with a positive Mur
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
phy's sign. Vital signs: temperature 38.2°C (100.8°F), heart rate 102 bpm, blood pressure 138/85 m
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
mHg. Laboratory studies show WBC 14,500/μL, total bilirubin 2.1 mg/dL, direct bilirubin 1.4 mg/dL
jh jh jh jh jh jh jh jh jh jh jh jh jh
, AST 85 U/L, ALT 92 U/L, and alkaline phosphatase 320 U/L.
jh jh jh jh jh jh jh jh jh jh jh
What is the most appropriate next step in management?
jh jh jh jh jh jh jh jh
A) Outpatient oral antibiotics and follow-up in 48 hours
jh jh jh jh jh jh jh jh
B) Laparoscopic cholecystectomy within 24-48 hours
jh jh jh jh jh
C) Endoscopic retrograde cholangiopancreatography (ERCP) urgently
jh jh jh jh jh
D) Observation with intravenous fluids and bowel rest
jh jh jh jh jh jh jh
E) Percutaneous cholecystostomy tube placement
jh jh jh jh
Correct Answer: C jh jh
Explanation: This patient presents with findings consistent with acute cholecystitis (Murphy's sig
jh jh jh jh jh jh jh jh jh jh jh
n, RUQ pain, fever, leukocytosis) with evidence of cholestasis (elevated bilirubin, alkaline phosphat
jh jh jh jh jh jh jh jh jh jh jh jh
ase) and transaminitis. The elevated liver enzymes and bilirubin suggest possible choledocholithia
jh jh jh jh jh jh jh jh jh jh jh
sis with obstruction. ERCP is indicated urgently for patients with suspected common bile duct st
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
ones causing obstruction, particularly with cholangitis . While laparoscopic cholecystectomy is the
jh jh jh jh jh jh jh jh jh jh jh j
definitive treatment for acute cholecystitis, when there is evidence of choledocholithiasis, ERCP wi
h jh jh jh jh jh jh jh jh jh jh jh jh
th sphincterotomy and stone extraction should be performed first, followed by interval cholecyste
jh jh jh jh jh jh jh jh jh jh jh jh
ctomy. Outpatient management is inappropriate for this presentation. Percutaneous cholecystost
jh jh jh jh jh jh jh jh jh
omy is reserved for patients who are poor surgical candidates.
jh jh jh jh jh jh jh jh jh
,Question 2 jh
A 28-year-old man presents with a 2-
jh jh jh jh jh jh
week history of cough, fever, and night sweats. He reports a 10-
jh jh jh jh jh jh jh jh jh jh jh
pound unintentional weight loss over the past month. He emigrated from India 6 months ago. Ch
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
est radiograph shows a right upper lobe infiltrate with cavitation. Sputum acid-
jh jh jh jh jh jh jh jh jh jh jh
fast bacilli (AFB) smear is positive.
jh jh jh jh jh
What is the most appropriate initial treatment regimen?
jh jh jh jh jh jh jh
A) Isoniazid and rifampin for 6 months
jh jh jh jh jh jh
B) Isoniazid, rifampin, pyrazinamide, and ethambutol for 2 months, then isoniazid and rifampin for
jh jh jh jh jh jh jh jh jh jh jh jh jh j
4 months
h jh
C) Isoniazid, rifampin, pyrazinamide, and ethambutol for 4 months, then isoniazid and rifampin for
jh jh jh jh jh jh jh jh jh jh jh jh jh j
2 months
h jh
D) Isoniazid, rifampin, and pyrazinamide for 6 months
jh jh jh jh jh jh jh
E) Levofloxacin, ethambutol, and pyrazinamide for 6 months
jh jh jh jh jh jh jh
Correct Answer: B jh jh
Explanation: This patient has pulmonary tuberculosis confirmed by positive AFB smear and cha
jh jh jh jh jh jh jh jh jh jh jh jh
racteristic radiographic findings (upper lobe cavitary disease) in a patient from an endemic region
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
with classic symptoms (cough, fever, night sweats, weight loss). The standard initial treatment regi
jh jh jh jh jh jh jh jh jh jh jh jh jh
men for drug-susceptible TB is a 4-
jh jh jh jh jh jh
drug regimen: isoniazid, rifampin, pyrazinamide, and ethambutol for the initial 2-
jh jh jh jh jh jh jh jh jh jh
month intensive phase, followed by isoniazid and rifampin for the continuation phase (4 months f
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
or most patients, extended to 7-
jh jh jh jh jh
9 months for cavitary disease or delayed sputum conversion) . A 2-
jh jh jh jh jh jh jh jh jh jh jh
month initial phase is appropriate; 4 months would be too long for the intensive phase. Empiric tre
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
atment for TB should not be started without confirmed diagnosis or high clinical suspicion.
jh jh jh jh jh jh jh jh jh jh jh jh jh
Question 3 jh
A 65-year-
jh
old woman with a history of hypertension and type 2 diabetes presents with acute onset of severe,
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh j
tearing chest pain that radiates to her back. On examination, she has a blood pressure of 210/110
h jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
mmHg in the right arm and 150/85 mmHg in the left arm. A diastolic murmur is heard at the left st
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
ernal border. jh
What is the most appropriate initial imaging study?
jh jh jh jh jh jh jh
,A) Transthoracic echocardiogram
jh jh
B) CT angiography of the chest
jh jh jh jh jh
C) Chest radiograph
jh jh
D) Transesophageal echocardiogram
jh jh
E) MRI of the chest
jh jh jh jh
Correct Answer: B jh jh
Explanation: This patient's presentation is highly concerning for acute aortic dissection (tearing
jh jh jh jh jh jh jh jh jh jh jh jh
chest pain radiating to back, unequal blood pressures in arms, aortic regurgitation murmur). CT a
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
ngiography of the chest is the initial imaging study of choice for suspected aortic dissection in m
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
ost emergency settings due to its high sensitivity and specificity (>95%), rapid acquisition, and abil
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
ity to define the extent of dissection . Transesophageal echocardiography (TEE) is an alternative b
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
ut is more invasive and operator-
jh jh jh jh jh
dependent. While TTE may detect aortic regurgitation or pericardial effusion, it has limited sensitiv
jh jh jh jh jh jh jh jh jh jh jh jh jh
ity for visualizing the ascending aorta. Chest radiograph may show widened mediastinum but is n
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
ot diagnostic or sensitive. MRI has high accuracy but is time-
jh jh jh jh jh jh jh jh jh jh
consuming and not readily available in acute settings. jh jh jh jh jh jh jh
Question 4 jh
A 22-year-
jh
old woman presents with 2 days of dysuria, urinary frequency, and suprapubic pain. She reports n
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
o vaginal discharge or fever. She has no known drug allergies. Urinalysis shows leukocyte esterase
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
positive and nitrites positive. She is sexually active with one partner and uses condoms inconsisten
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
tly.
What is the most appropriate empiric antibiotic therapy?
jh jh jh jh jh jh jh
A) Ciprofloxacin 500 mg twice daily for 7 days
jh jh jh jh jh jh jh jh
B) Nitrofurantoin 100 mg twice daily for 5 days
jh jh jh jh jh jh jh jh
C) Trimethoprim-sulfamethoxazole DS twice daily for 3 days
jh jh jh jh jh jh jh
D) Amoxicillin 500 mg three times daily for 7 days
jh jh jh jh jh jh jh jh jh
E) Doxycycline 100 mg twice daily for 7 days
jh jh jh jh jh jh jh jh
Correct Answer: B jh jh
Explanation: This patient has acute uncomplicated cystitis in a young, healthy non-
jh jh jh jh jh jh jh jh jh jh jh
pregnant woman. Nitrofurantoin 100 mg twice daily for 5 days is recommended as first-
jh jh jh jh jh jh jh jh jh jh jh jh jh
line empiric therapy due to its low resistance rates, excellent efficacy, and minimal impact on gut fl
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
ora . Fluoroquinolones (ciprofloxacin) should be reserved for more complicated infections or whe
jh jh jh jh jh jh jh jh jh jh jh jh
n resistance is suspected due to increasing resistance and adverse effects. TMP-
jh jh jh jh jh jh jh jh jh jh jh
SMX has high resistance rates (>20%) in many regions. Amoxicillin is not recommended for empiri
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
, c UTIs due to high resistance. Doxycycline is not appropriate for cystitis as it does not achieve ade
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
quate urinary concentrations and is used primarily for sexually transmitted infections.
jh jh jh jh jh jh jh jh jh jh
Question 5 jh
A 55-year-old man with a 30-pack-year smoking history presents with a 3-
jh jh jh jh jh jh jh jh jh jh jh
month history of hoarseness and a persistent sore throat. He reports occasional blood-
jh jh jh jh jh jh jh jh jh jh jh jh
tinged sputum. He has a 20- jh jh jh jh jh
pound unintentional weight loss over the past 6 months. On examination, there is a palpable left c
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
ervical lymph node measuring 2 cm. Flexible laryngoscopy reveals a lesion on the left vocal cord.
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
What is the most appropriate diagnostic test?
jh jh jh jh jh jh
A) CT scan of the neck
jh jh jh jh jh
B) MRI of the neck
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C) Biopsy of the vocal cord lesion
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D) PET-CT scan
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E) Chest radiograph
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Correct Answer: C jh jh
Explanation: This patient's presentation (hoarseness >3 weeks, smoking history, weight loss, cerv
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ical lymphadenopathy, vocal cord lesion) is concerning for laryngeal squamous cell carcinoma.
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The most appropriate diagnostic test is biopsy of the vocal cord lesion via direct laryngoscopy t
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o obtain histologic confirmation . Imaging studies (CT, MRI, PET-
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CT) are important for staging once the diagnosis is confirmed but should not replace tissue diagn
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osis. Chest radiograph is insufficient for diagnosis. The gold standard for diagnosis of laryngeal ca
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ncer is direct laryngoscopy with biopsy.
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SECTION 2: CHRONIC CARE MANAGEMENT (25%) jh jh jh jh jh
Question 6 jh
A 62-year-old woman with type 2 diabetes for 15 years presents for follow-
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up. Her medications include metformin 1000 mg twice daily, glipizide 10 mg daily, and lisinopril 2
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0 mg daily. Her current HbA1c is 8.9% (target <7.0%). She has microalbuminuria (urine albumin-
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to-creatinine ratio 120 mg/g). Her eGFR is 52 mL/min/1.73m². Blood pressure is 138/84 mmHg.
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What is the most appropriate next step in diabetes management?
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A) Increase glipizide to 20 mg daily
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B) Add sitagliptin 100 mg daily
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