Sample 10 question quiz #2
Quiz-summary
0 of 10 questions completed
Questions:
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
Information
Hello this is Sample Quiz #2 which has a selection of 10 questions from Practice Examination #2. The format of the 165 question Practice Examination #1 is the same as this quiz. Please read the following instructions CAREFULLY or you will LOSE your answers and your quiz.
The content of these exams is copyrighted. You are not allowed to copy or distribute the content in any way, shape or form.
1) Closing the window or navigating to another page will end the exam and erase your answers
2) The way I suggest to write the Sample quiz is to finish a question and then hit the “skip question” button to go to the next question. After completing all of the questions, go back to the first question and click on the “check” button to see if you got the right answer and review the answer
3) Pressing the “Quiz Summary” and then the “Finish Quiz” button at the end of the exam will score the exam. You will not be able to go back and review your answers after hitting the “Finish Quiz” button. The system will score your test and show you a breakdown of how you did in each of the eight competencies for the exam
4) There is a timer bar on the top. On the May exam you have 165 questions to answer in 210 minutes (3.5 hours) giving you ~1.25 minutes per question. To simulate this, you have 10 x 1.25= ~12.5 minutes to complete the quiz. After 12.5 minutes the quiz will automatically kick you out of the system and score your quiz.
I hope you enjoy this quiz and find it helpful
You have already completed the quiz before. Hence you can not start it again.
Quiz is loading...
You must sign in or sign up to start the quiz.
You have to finish following quiz, to start this quiz:
Results
0 of 10 questions answered correctly
Your time:
Time has elapsed
You have reached 0 of 0 points, (0)
Categories
- Education/Research 0%
- Medications 0%
- Microvascular/Macrovascular Complications 0%
- Nutrition 0%
- Pathophysiology 0%
- Psychosocial/lifestyle 0%
- Self Care Management 0%
- Special Situations 0%
-
It seems you have some areas where you need more review for the exam. The entire 2018 Diabetes Canada clinical guidelines should be reviewed. The guidelines are the most important document to study and I cannot emphasize how important it is to fully read and understand the guidelines. You will not be able to pass unless you have read and are familiar with the guidelines.
For a full 165 question exam simulation please see click here for the Purchase page for exam simulation packages
However if you are having trouble in certain areas please see After Practice Exam Review for competency specific suggestions. You will need to pass all competencies to pass the exam.
-
Congratulations it seems your studies are going well. The entire 2018 Diabetes Canada guidelines should be reviewed.
For a full 165 question exam simulation please see click here for the Purchase page for exam simulation packages
However if you are having trouble in certain areas please see After Practice Exam Review for competency specific suggestions. You will need to pass all competencies to pass the exam.
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- Answered
- Review
-
Question 1 of 10
1. Question
All of the following may help with reducing insulin resistance EXCEPT?
Correct
A) Incorrect – Atypical antipsychotics are associated with significant weight gain, insulin resistance and impaired fasting glucose/type 2 diabetes. Please see pg S137 of the 2018 Diabetes Canada clinical practice guidelines for more information
B) Incorrect – Actos works by activating the PPAR system in cells to reduce insulin resistance. Please see Table 1 on pg S90 of the 2018 Diabetes Canada clinical practice guidelines for more information.
C) Correct – Eating more artificial sweeteners will not raise blood glucose but they do not generally improve insulin sensitivity. Substituting sugar already in the diet for artificial sweeteners will likely improve blood glucose but do little for insulin resistance. The best answer out of all the available answers. Please see pg S72 of the 2018 Diabetes Canada clinical practice guidelines.
D) Incorrect – Resistance exercise improves skeletal muscle insulin sensitivity. Please see pg S55 of the 2018 Diabetes Canada clinical practice guidelines for more information.Incorrect
A) Incorrect – Atypical antipsychotics are associated with significant weight gain, insulin resistance and impaired fasting glucose/type 2 diabetes. Please see pg S137 of the 2018 Diabetes Canada clinical practice guidelines for more information
B) Incorrect – Actos works by activating the PPAR system in cells to reduce insulin resistance. Please see Table 1 on pg S90 of the 2018 Diabetes Canada clinical practice guidelines for more information.
C) Correct – Eating more artificial sweeteners will not raise blood glucose but they do not generally improve insulin sensitivity. Substituting sugar already in the diet for artificial sweeteners will likely improve blood glucose but do little for insulin resistance. The best answer out of all the available answers. Please see pg S72 of the 2018 Diabetes Canada clinical practice guidelines.
D) Incorrect – Resistance exercise improves skeletal muscle insulin sensitivity. Please see pg S55 of the 2018 Diabetes Canada clinical practice guidelines for more information. -
Question 2 of 10
2. Question
Which of the following is NOT part of the Chronic Care Model (CCM)
Correct
The CCM model consists of:
1) Delivery systems designs – The system that the team (and the different roles in the team) uses to deliver care to patients
2) Self-management support – Involves active patient participation in self-monitoring and/or decision making
3) Decision support – Providing healthcare practitioners with best practice information at the point of care to help support decision making
4) Clinical information System – Electronic medical records or patient registries that that allow for a population-based approach to diabetes assessment
5) The Community – Environmental factors, such as food security, the ability to lead an active lifestyle, as well as access to care and social supports, also impact diabetes outcomes
6) Health systems – Support for diabetes care from the broader level of the healthcare system, such as the national and provincial systems, is essential.C) Correct – A reward/punishment system is not part of the CCM model. Patients are adults who can make their own decisions and we, as health care professionals, need to respect that. It is not our job to hand out punishments. Given our strained health care system, the rewards we can hand out are limited.
Please see pg S29 of the 2018 Diabetes Canada clinical practice guidelines for more information.
Incorrect
The CCM model consists of:
1) Delivery systems designs – The system that the team (and the different roles in the team) uses to deliver care to patients
2) Self-management support – Involves active patient participation in self-monitoring and/or decision making
3) Decision support – Providing healthcare practitioners with best practice information at the point of care to help support decision making
4) Clinical information System – Electronic medical records or patient registries that that allow for a population-based approach to diabetes assessment
5) The Community – Environmental factors, such as food security, the ability to lead an active lifestyle, as well as access to care and social supports, also impact diabetes outcomes
6) Health systems – Support for diabetes care from the broader level of the healthcare system, such as the national and provincial systems, is essential.C) Correct – A reward/punishment system is not part of the CCM model. Patients are adults who can make their own decisions and we, as health care professionals, need to respect that. It is not our job to hand out punishments. Given our strained health care system, the rewards we can hand out are limited.
Please see pg S29 of the 2018 Diabetes Canada clinical practice guidelines for more information.
-
Question 3 of 10
3. Question
You meet with a new patient who has just been diagnosed with type 2 diabetes by his family physician. He has had an A1c of 9.1% (0.091) and a confirmatory test of 9.0% (0.09). When you being the consult with him, he shouts out “This is complete bullshit! I have friends who drink a six pack of beer and eat ice cream every day and they don’t have diabetes! I rarely drink and never have sweets and I have diabetes! Why the hell did I catch it?”. Your initial response should be:
Correct
A) Incorrect- he is not worried about threats from having diabetes such as “I am so worried that diabetes will rob of my vision”. He is expressing unfairness that his friends don’t have diabetes and he does. While cognitive behavioral therapy may help his anger this is not the best answer.
B) Incorrect- while technically correct this is not an empathetic answer and given the patients anger you will be unlikely to convince him to start insulin. This answer does not take into account his feelings of unfairness and is not the best answer.
C) Correct- he is expressing unfairness that he has diabetes while his friends who eat poorly do not. Acceptance and use commitment therapy could be used to relieve his anger
D) Incorrect- he is not expressing any loss from having diabetes such as “I guess I can never have ice cream with my grandchildren ever again, that’s so sad”. He is expressing unfairness that his friends don’t have diabetes and he does. Motivational interview may or may not help his anger but this is not the best answer.Please see pg 311 of the 2023 Diabetes and Mental Health update for more details
Incorrect
A) Incorrect- he is not worried about threats from having diabetes such as “I am so worried that diabetes will rob of my vision”. He is expressing unfairness that his friends don’t have diabetes and he does. While cognitive behavioral therapy may help his anger this is not the best answer.
B) Incorrect- while technically correct this is not an empathetic answer and given the patients anger you will be unlikely to convince him to start insulin. This answer does not take into account his feelings of unfairness and is not the best answer.
C) Correct- he is expressing unfairness that he has diabetes while his friends who eat poorly do not. Acceptance and use commitment therapy could be used to relieve his anger
D) Incorrect- he is not expressing any loss from having diabetes such as “I guess I can never have ice cream with my grandchildren ever again, that’s so sad”. He is expressing unfairness that his friends don’t have diabetes and he does. Motivational interview may or may not help his anger but this is not the best answer.Please see pg 311 of the 2023 Diabetes and Mental Health update for more details
-
Question 4 of 10
4. Question
You have a 54-year-old patient who’s had diabetes for 14 years. He has no history of retinopathy, nephropathy or neuropathy. He is allergic to peanuts and ASA. He suffered a stroke 4 years ago. His cholesterol is on target. According to the 2018 Diabetes Canada guidelines, which of the following medications should he be on?
Correct
A) Incorrect – The patient has had a stroke and should be on a number of medications to manage his CV risk. His cholesterol being on target does not mean he does not need any medications.
B) Incorrect – He has already had a CV event (stroke) which puts him in the high risk category of experiencing another CV event. He should be on a statin as well as other medications to reduce his CV risk.
C) Incorrect – Several studies like HOPE, EUROPA and ONTARGET show the cardiovascular benefits of ACE inhibition. Subset analysis of patients with diabetes from the studies above show similar vascular protective effects. However he should still be on additional meds.
D) Correct – The patient is allergic to ASA, so clopidogrel which also inhibits platelets from aggregating and forming clots, is a reasonable alternative
E) Incorrect – Platelet aggregation plays a key role in atherothrombosis. Even though ASA seems to be less effective in patients with diabetes, ASA has been shown to reduce CVD events in patients with established CVD disease and diabetes. However, since this patient is allergic to ASA, clopidogrel is a reasonable alternative.Please see the recommendations on pg S166 of the 2018 Diabetes Canada clinical practice guidelines. Also see the Reducing Vascular Risk tool in the Diabetes Canada website (will open in new window) http://guidelines.diabetes.ca/health-care-provider-tools . Its under For Health Care Providers then Tool and Resources and then Macrovascular Complications.
Incorrect
A) Incorrect – The patient has had a stroke and should be on a number of medications to manage his CV risk. His cholesterol being on target does not mean he does not need any medications.
B) Incorrect – He has already had a CV event (stroke) which puts him in the high risk category of experiencing another CV event. He should be on a statin as well as other medications to reduce his CV risk.
C) Incorrect – Several studies like HOPE, EUROPA and ONTARGET show the cardiovascular benefits of ACE inhibition. Subset analysis of patients with diabetes from the studies above show similar vascular protective effects. However he should still be on additional meds.
D) Correct – The patient is allergic to ASA, so clopidogrel which also inhibits platelets from aggregating and forming clots, is a reasonable alternative
E) Incorrect – Platelet aggregation plays a key role in atherothrombosis. Even though ASA seems to be less effective in patients with diabetes, ASA has been shown to reduce CVD events in patients with established CVD disease and diabetes. However, since this patient is allergic to ASA, clopidogrel is a reasonable alternative.Please see the recommendations on pg S166 of the 2018 Diabetes Canada clinical practice guidelines. Also see the Reducing Vascular Risk tool in the Diabetes Canada website (will open in new window) http://guidelines.diabetes.ca/health-care-provider-tools . Its under For Health Care Providers then Tool and Resources and then Macrovascular Complications.
-
Question 5 of 10
5. Question
You have a patient whom you have recently started on bolus insulin. He calls you from a grocery store and says he is buying some high fibre spaghetti. He says the package says:
One serving: Half a cup of uncooked spaghetti
Total Carbohydrate: 45 grams per serving
Fibre: 10 grams per serving
Sugar: 15 grams per servingHe plans on cooking one cup of spaghetti for dinner tonight. His insulin-to-carbohydrate ratio is 1-unit-per-5 grams. How much bolus insulin should he be taking to cover the carbohydrate in the spaghetti tonight?
Correct
Food labels usually contain the following three parameters: Total Carbohydrate, Fibre and Sugar. The available carbohydrate in a food is equal to Total Carbohydrate minus the Fibre content. Fibre is included in Total Carbohydrate but does not actually break down into sugar; therefore, it should not be included in calculations for bolus insulin. Sugar is part of the total carbohydrate and does not need to be counted separately.
A) Incorrect – This answer does not take into account the 10 grams of fibre, which should be subtracted from the total carbohydrate
B) Correct – 45 grams of total carbohydrate minus 10 grams of fibre =35 grams available carbohydrate for 1/2 cup serving. 35 grams x 2 (pt eating 1 full cup) =70 grams. 70 grams divided by 1-unit-of-insulin per 5-grams-of-carbohydrate = 14 units
C) Incorrect – This answer does not taking into account that the patient is eating one full cup
D) Incorrect – This answer is basing the amount of bolus insulin on the sugar content, not the carbohydrate content; hence, it is incorrect.Incorrect
Food labels usually contain the following three parameters: Total Carbohydrate, Fibre and Sugar. The available carbohydrate in a food is equal to Total Carbohydrate minus the Fibre content. Fibre is included in Total Carbohydrate but does not actually break down into sugar; therefore, it should not be included in calculations for bolus insulin. Sugar is part of the total carbohydrate and does not need to be counted separately.
A) Incorrect – This answer does not take into account the 10 grams of fibre, which should be subtracted from the total carbohydrate
B) Correct – 45 grams of total carbohydrate minus 10 grams of fibre =35 grams available carbohydrate for 1/2 cup serving. 35 grams x 2 (pt eating 1 full cup) =70 grams. 70 grams divided by 1-unit-of-insulin per 5-grams-of-carbohydrate = 14 units
C) Incorrect – This answer does not taking into account that the patient is eating one full cup
D) Incorrect – This answer is basing the amount of bolus insulin on the sugar content, not the carbohydrate content; hence, it is incorrect. -
Question 6 of 10
6. Question
Acute Charcot neuroarthropathy has all of the following features, except:
Correct
A) Incorrect – If unrecognized or left untreated, Charcot neuroarthropathy can result in a severely misshapen and unstable foot and ankle
B) Correct – Charcot foot (neuropathic osteoarthropathy) is a progressive condition characterized by joint dislocation, pathologic fractures, and severe destruction of the pedal architecture. It is not characterized by infection and unless an infection is also present, then antibiotics are not required.
C) Incorrect – Increased warmth is the first indicator of inflammation in an insensate foot
D) Incorrect – Total immobilization is required for the bones and joints to heal
For more information, please see pg S223 of the 2018 Diabetes Canada clinical practice guidelines and pg 36 of the Guidelines for the Diabetic foot at http://onlinelibrary.wiley.com/doi/10.1002/dmrr.848/abstract (will open link in new tab)Incorrect
A) Incorrect – If unrecognized or left untreated, Charcot neuroarthropathy can result in a severely misshapen and unstable foot and ankle
B) Correct – Charcot foot (neuropathic osteoarthropathy) is a progressive condition characterized by joint dislocation, pathologic fractures, and severe destruction of the pedal architecture. It is not characterized by infection and unless an infection is also present, then antibiotics are not required.
C) Incorrect – Increased warmth is the first indicator of inflammation in an insensate foot
D) Incorrect – Total immobilization is required for the bones and joints to heal
For more information, please see pg S223 of the 2018 Diabetes Canada clinical practice guidelines and pg 36 of the Guidelines for the Diabetic foot at http://onlinelibrary.wiley.com/doi/10.1002/dmrr.848/abstract (will open link in new tab) -
Question 7 of 10
7. Question
You have a patient who wants to switch to once-daily basal insulin for convenience. He is currently on 25 units of NPH twice daily. He would like to switch to once daily Lantus (glargine) in the morning. He is also starting a new exercise program in hopes of losing some weight. Currently here is his sugars:
May 9 May 10 May 11 Fasting 4.2 4.6 4.0 Before lunch 4.9 4.1 4.3 Before supper 5.4 6.7 5.1 Before bed 4.0 4.1 4.3 When switching over you suggest:
Correct
A) Incorrect – The patient’s sugars are already quite low and he is about to start an exercise program which would push the sugars even lower. Increasing the Lantus would likely cause more hypoglycemia
B) Correct – For 2 reasons: 1) the patient’s blood sugars are already quite low and he is about to start an exercise program which would push the sugars even lower. Lowering the dose may prevent hypoglycemia. 2) As a general rule, when switching to from a twice-daily basal insulin to a once-daily insulin, the dose is reduced by 20% to avoid hypoglycemia. This general rule isn’t in the guidelines and doesn’t apply in all cases (such as when the patient’s blood sugars significantly above target) but it is commonly done in real life practice
C) Incorrect – Lantus does not have to be taken only at bedtime
D) Incorrect – Technically, long-acting analogues do cause a small amount of weight gain. However, so does NPH which the patient is already on. Lantus causes less weight gain than NPH. So, to tell a patient that he is going to gain weight on a new insulin (when he may actually lose weight) would not be correct.Incorrect
A) Incorrect – The patient’s sugars are already quite low and he is about to start an exercise program which would push the sugars even lower. Increasing the Lantus would likely cause more hypoglycemia
B) Correct – For 2 reasons: 1) the patient’s blood sugars are already quite low and he is about to start an exercise program which would push the sugars even lower. Lowering the dose may prevent hypoglycemia. 2) As a general rule, when switching to from a twice-daily basal insulin to a once-daily insulin, the dose is reduced by 20% to avoid hypoglycemia. This general rule isn’t in the guidelines and doesn’t apply in all cases (such as when the patient’s blood sugars significantly above target) but it is commonly done in real life practice
C) Incorrect – Lantus does not have to be taken only at bedtime
D) Incorrect – Technically, long-acting analogues do cause a small amount of weight gain. However, so does NPH which the patient is already on. Lantus causes less weight gain than NPH. So, to tell a patient that he is going to gain weight on a new insulin (when he may actually lose weight) would not be correct. -
Question 8 of 10
8. Question
Which of the following organs or tissues in the body stores roughly 75 grams of glycogen?
Correct
A) Incorrect- skeletal muscle stores roughly 300-500 grams of glycogen and is the largest reservoir of glycogen in the body
B) Incorrect- the pancreas does not store significant amounts of glycogen
C) Correct- the liver stores roughly 75 grams of glycogen and is the principal reservoir where glycogen can be converted to glucose
D) Incorrect- adipose tissues stores its energy as lipidsIncorrect
A) Incorrect- skeletal muscle stores roughly 300-500 grams of glycogen and is the largest reservoir of glycogen in the body
B) Incorrect- the pancreas does not store significant amounts of glycogen
C) Correct- the liver stores roughly 75 grams of glycogen and is the principal reservoir where glycogen can be converted to glucose
D) Incorrect- adipose tissues stores its energy as lipids -
Question 9 of 10
9. Question
Which of the following answers has the correct percentage reduction of pre-diabetes to diabetes for Glucophage (metformin), Actos (pioglitazone) and weight loss?
Correct
A) Incorrect- correct, incorrect, correct
B) Correct- all of these percentages are correct. Metformin reduces the progression to pre-diabetes by about 30%, pioglitazone about 70% (rosiglitazone the other thiazolidinedione reduces risk about 60%) and lifestyle interventions by about 60% with just 5% weight loss!
C) Incorrect- incorrect, incorrect- incorrect
D) Incorrect- correct, correct, incorrectPlease see pg S21 – S23 of the 2018 Diabetes Canada clinical practice guidelines for more information
Incorrect
A) Incorrect- correct, incorrect, correct
B) Correct- all of these percentages are correct. Metformin reduces the progression to pre-diabetes by about 30%, pioglitazone about 70% (rosiglitazone the other thiazolidinedione reduces risk about 60%) and lifestyle interventions by about 60% with just 5% weight loss!
C) Incorrect- incorrect, incorrect- incorrect
D) Incorrect- correct, correct, incorrectPlease see pg S21 – S23 of the 2018 Diabetes Canada clinical practice guidelines for more information
-
Question 10 of 10
10. Question
Zeno is 60 and has type 2 diabetes but has never experienced a heart attack or other CV event. Zeno comes to see you asking if he should be on medications like his brother (Marcus who had a stroke) as he is concerned about having a cardiovascular event. He is a smoker and is on medications for high blood pressure. You respond that the following medication has the best evidence to help Zeno:
Correct
The 2020 Pharmacologic Glycemic Management of Type 2 Diabetes in Adults update emphasizes primary prevention in diabetes. The main difference between Marcus and Zeno is that in Marcus we are aiming for secondary prevention as he has had a cardiovascular event and in Zeno we are aiming for primary prevention since he has never had a cardiovascular event. The medications used to prevent major adverse cardiovascular events (MACE) are different. For primary prevention only GLP-1 analogs have shown significant primary prevention benefits.
A) Incorrect- SGLT-2 inhibitors have not shown the highest evidence primary prevention cardiovascular benefit
B) Correct- GLP-1 analogs have shown to have significant primary prevention cardiovascular benefits especially Trulicity (dulaglutide)
C) Incorrect- DPP-4 inhibitors have not shown significant primary prevention or secondary prevention cardiovascular benefit
D) Incorrect- SGLT-2 inhibitors have not shown the highest evidence of primary prevention cardiovascular benefitPlease see Figure 2A on pg 577 of the Pharmacologic Glycemic Management of Type 2 Diabetes in Adults: 2020 Update for more details. There were a lot of questions on the 2018 Guidelines updates (2019 cannabis, 2020 medications, 2021 blood glucose monitoring, 2019 Ramadan, 2022 Remission, 2023 Mental Health) so make sure you read those in addition to the guidelines.
Incorrect
The 2020 Pharmacologic Glycemic Management of Type 2 Diabetes in Adults update emphasizes primary prevention in diabetes. The main difference between Marcus and Zeno is that in Marcus we are aiming for secondary prevention as he has had a cardiovascular event and in Zeno we are aiming for primary prevention since he has never had a cardiovascular event. The medications used to prevent major adverse cardiovascular events (MACE) are different. For primary prevention only GLP-1 analogs have shown significant primary prevention benefits.
A) Incorrect- SGLT-2 inhibitors have not shown the highest evidence primary prevention cardiovascular benefit
B) Correct- GLP-1 analogs have shown to have significant primary prevention cardiovascular benefits especially Trulicity (dulaglutide)
C) Incorrect- DPP-4 inhibitors have not shown significant primary prevention or secondary prevention cardiovascular benefit
D) Incorrect- SGLT-2 inhibitors have not shown the highest evidence of primary prevention cardiovascular benefitPlease see Figure 2A on pg 577 of the Pharmacologic Glycemic Management of Type 2 Diabetes in Adults: 2020 Update for more details. There were a lot of questions on the 2018 Guidelines updates (2019 cannabis, 2020 medications, 2021 blood glucose monitoring, 2019 Ramadan, 2022 Remission, 2023 Mental Health) so make sure you read those in addition to the guidelines.