Chronic and Stable Conditions
What the exam tests
Chronic care questions reward individualized targets, safe titration, and monitoring. Know major guidelines but expect to adjust for age, frailty, kidney function, and cost.
Concepts
Hypertension: confirm with repeated readings; ACC/AHA stage 1 is 130–139/80–89; start lifestyle change and add medication based on ASCVD risk and comorbidity. Diabetes: A1c below 7% for many, but 7.5–8% for frail older adults or limited life expectancy, with avoidance of hypoglycemia; adjust metformin by eGFR (do not start below 45, avoid below 30). Lipids: choose statin intensity by risk and use shared decision-making in older adults. CKD: ACE inhibitor or ARB with albuminuria, monitor potassium and creatinine; SGLT2 inhibitors for kidney and heart protection. HFrEF: guideline-directed therapy-ARNI/ACEi/ARB, evidence-based beta blocker, MRA, SGLT2 inhibitor. COPD: GOLD groups, inhaler technique, smoking cessation. Asthma: assess control and step therapy. Depression: screen, treat, and reassess at 4–6 weeks.
Traps
Treating to a number rather than a patient; intensifying therapy in a frail older adult with symptomatic hypotension; using NSAIDs in CKD or heart failure; missing drug interactions; failing to check adherence before escalating; and not monitoring labs after starting an ACE inhibitor, ARB, or diuretic.
Rule of thumb
Start low, go slow, and monitor. For older adults, prioritize function and quality of life over tight numbers, and deprescribe medications that no longer serve a goal.