Sample 10 question quiz
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Hello. This is Sample Quiz #1, which has a selection of 10 questions from Practice Examination #1. 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.
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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.
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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.
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Question 1 of 10
1. Question
Which of the following symptoms are neuroglycopenic?
Correct
A) Incorrect – This is a neurogenic symptom
B) Correct – Out of the options, this is the only neuroglycopenic symptom
C) Incorrect – This is a neurogenic symptom
D) Incorrect – This is a neurogenic symptom
Hypoglycemia reactions are split into neurogenic (autonomic) and neuroglycopenic. Neurogenic symptoms are mostly caused by glucagon and epinephrine (adrenaline). Side effect of glucagon include nausea. Epinephrine causes trembling, anxiety, sweating etc. Think of autonomic symptoms as the fight or flight response. The state of neuroglycopenia is a lack of glucose for nerve cells to function properly. I like to think about it as being drunk, so symptoms of confusion, difficulty speaking, drowsiness etc. Autonomic symptoms usually appear before neuroglycopenic symptoms. Counter regulatory responses start around 3.8 mmol/L and neuroglycopenic symptoms at 3.2 mmol/L. However, this is highly individual.Please see Table 1 pg S104 of the 2018 Diabetes Canada clinical practice guidelines for more details
Incorrect
A) Incorrect – This is a neurogenic symptom
B) Correct – Out of the options, this is the only neuroglycopenic symptom
C) Incorrect – This is a neurogenic symptom
D) Incorrect – This is a neurogenic symptom
Hypoglycemia reactions are split into neurogenic (autonomic) and neuroglycopenic. Neurogenic symptoms are mostly caused by glucagon and epinephrine (adrenaline). Side effect of glucagon include nausea. Epinephrine causes trembling, anxiety, sweating etc. Think of autonomic symptoms as the fight or flight response. The state of neuroglycopenia is a lack of glucose for nerve cells to function properly. I like to think about it as being drunk, so symptoms of confusion, difficulty speaking, drowsiness etc. Autonomic symptoms usually appear before neuroglycopenic symptoms. Counter regulatory responses start around 3.8 mmol/L and neuroglycopenic symptoms at 3.2 mmol/L. However, this is highly individual.Please see Table 1 pg S104 of the 2018 Diabetes Canada clinical practice guidelines for more details
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Question 2 of 10
2. Question
Your patient has a carb ratio of 1-unit-of-insulin for every 17.5-grams-of-carbohydrate. If he is using 4 units, the correct amount of food to consume would be:
Correct
Lactose, fructose and sucrose are all carbohydrates which increase blood sugars, so insulin may be adjusted based on these nutrients. Sorbitol and isomalt are sugar alcohols which have erratic absorption and affect blood sugars minimally. Insulin should not be adjusted for these sugar alcohols. Fibre does not break down into glucose, so insulin should not be dosed for fibre. Cyclamate is an artificial sweetener and has little effect on blood sugars; thus, insulin should not be adjusted for this sweetener either. A person taking 4 units of insulin with a carb ratio of 1:17.5 means he is consuming 4×17.5 g carbohydrates = 70 carbohydrates
A) Incorrect – Only the 35 grams from lactose counts for adjusting insulin
B) Correct – The 70 grams of fructose counts, while the fibre does not. 4 x 17.5= 70 grams of carbohydrate. Note: when carbohydrate-counting off a food label, you subtract the fibre from the TOTAL amount of carbohydrate to get to carbohydrate portions.
C) Incorrect – Neither would break down into glucose
D) Incorrect- 15 grams of sucrose counts, but the isomalt does notPlease see pg S72-73 of the 2018 Diabetes Canada clinical practice guidelines and the Sugar and Sweeteners webpage at https://guidelines.diabetes.ca/docs/patient-resources/sugars-and-sweeteners.pdf (will open in new window) for more information.
Incorrect
Lactose, fructose and sucrose are all carbohydrates which increase blood sugars, so insulin may be adjusted based on these nutrients. Sorbitol and isomalt are sugar alcohols which have erratic absorption and affect blood sugars minimally. Insulin should not be adjusted for these sugar alcohols. Fibre does not break down into glucose, so insulin should not be dosed for fibre. Cyclamate is an artificial sweetener and has little effect on blood sugars; thus, insulin should not be adjusted for this sweetener either. A person taking 4 units of insulin with a carb ratio of 1:17.5 means he is consuming 4×17.5 g carbohydrates = 70 carbohydrates
A) Incorrect – Only the 35 grams from lactose counts for adjusting insulin
B) Correct – The 70 grams of fructose counts, while the fibre does not. 4 x 17.5= 70 grams of carbohydrate. Note: when carbohydrate-counting off a food label, you subtract the fibre from the TOTAL amount of carbohydrate to get to carbohydrate portions.
C) Incorrect – Neither would break down into glucose
D) Incorrect- 15 grams of sucrose counts, but the isomalt does notPlease see pg S72-73 of the 2018 Diabetes Canada clinical practice guidelines and the Sugar and Sweeteners webpage at https://guidelines.diabetes.ca/docs/patient-resources/sugars-and-sweeteners.pdf (will open in new window) for more information.
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Question 3 of 10
3. Question
In the new 2022 Diabetes Canada guideline on Remission of Diabetes, which of the following patients is in remission to pre-diabetes?
Correct
A) Correct- this patient is in remission to pre-diabetes
B) Incorrect- even though this patient is on Jardiance for heart failure and not diabetes the definition of remission includes not being on any antihyperglycemic medications. Therefore we wouldn’t classify this as remission but as pharmacologically managed diabetes.
C) Incorrect- remission is currently only possible for type 2 diabetes not type 1 diabetes
D) Incorrect- this patient is in remission to normal blood glucose levelsPlease see pg 754 of the Remission of Type 2 Diabetes chapter for more details
Incorrect
A) Correct- this patient is in remission to pre-diabetes
B) Incorrect- even though this patient is on Jardiance for heart failure and not diabetes the definition of remission includes not being on any antihyperglycemic medications. Therefore we wouldn’t classify this as remission but as pharmacologically managed diabetes.
C) Incorrect- remission is currently only possible for type 2 diabetes not type 1 diabetes
D) Incorrect- this patient is in remission to normal blood glucose levelsPlease see pg 754 of the Remission of Type 2 Diabetes chapter for more details
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Question 4 of 10
4. Question
Which of the following actions would lower the glycemic index of a pasta dish?
Correct
A) Correct – Adding fat increases the amount of time required for digestion and, therefore, lowers the glycemic index. In general, switching consumption from higher glycemic-index carbohydrates to lower glycemic-index carbohydrates is beneficial for glycemic control, but it is not always the case
B) Incorrect- In general, decreasing fibre increases the glycemic index. As well, decreasing acidity can also increase the glycemic index. Sourdough breads, generally, have a lower index than other breads.
C) Incorrect- In general, the easier it is to digest the the food, the higher the glycemic index. This is because it spends less time in digestion and is more rapidly absorbed, causing higher post-prandial sugars. I counsel patients to cook their pasta al dente to lower the glycemic index.
D) Incorrect- For the same reason above and also grossPlease see the Diabetes Canada glycemic index webpage at https://guidelines.diabetes.ca/docs/patient-resources/glycemic-index-food-guide.pdf (will open in new window) for more details
Incorrect
A) Correct – Adding fat increases the amount of time required for digestion and, therefore, lowers the glycemic index. In general, switching consumption from higher glycemic-index carbohydrates to lower glycemic-index carbohydrates is beneficial for glycemic control, but it is not always the case
B) Incorrect- In general, decreasing fibre increases the glycemic index. As well, decreasing acidity can also increase the glycemic index. Sourdough breads, generally, have a lower index than other breads.
C) Incorrect- In general, the easier it is to digest the the food, the higher the glycemic index. This is because it spends less time in digestion and is more rapidly absorbed, causing higher post-prandial sugars. I counsel patients to cook their pasta al dente to lower the glycemic index.
D) Incorrect- For the same reason above and also grossPlease see the Diabetes Canada glycemic index webpage at https://guidelines.diabetes.ca/docs/patient-resources/glycemic-index-food-guide.pdf (will open in new window) for more details
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Question 5 of 10
5. Question
Your patient, who has type 1 diabetes, is leaving for an overseas flight. You advise him/her to do all of the following, except:
Correct
A) Correct – Patients should keep their insulin on their carry on luggage and not in their checked baggage, which goes into the plane’s baggage area. Checked-in luggage may be lost or be placed on the wrong plane. Also, insulin may freeze in the baggage area if it is depressurized, rendering the insulin useless. The insulin will then thaw out while waiting to be picked up. You patient will not be aware that the insulin had froze
B) Incorrect – Patients should carry extra insulin on trips
C) Incorrect – Though its likely an airline will have juice or snacks, there may be delays in attaining it, especially if the plane is experiencing turbulence. It’s better to be well prepared
D) Incorrect – That is a good idea to prepare for the tripPlease check the Diabetes Canada webpage “Travel Tips for People with Diabetes” at https://www.diabetes.ca/learn-about-diabetes/your-rights/air-travel (will open in new window) for more details
Incorrect
A) Correct – Patients should keep their insulin on their carry on luggage and not in their checked baggage, which goes into the plane’s baggage area. Checked-in luggage may be lost or be placed on the wrong plane. Also, insulin may freeze in the baggage area if it is depressurized, rendering the insulin useless. The insulin will then thaw out while waiting to be picked up. You patient will not be aware that the insulin had froze
B) Incorrect – Patients should carry extra insulin on trips
C) Incorrect – Though its likely an airline will have juice or snacks, there may be delays in attaining it, especially if the plane is experiencing turbulence. It’s better to be well prepared
D) Incorrect – That is a good idea to prepare for the tripPlease check the Diabetes Canada webpage “Travel Tips for People with Diabetes” at https://www.diabetes.ca/learn-about-diabetes/your-rights/air-travel (will open in new window) for more details
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Question 6 of 10
6. Question
You have finally convinced one of you patients to start exercising. He tells you that the pros outweigh the cons of starting exercise, but he isn’t ready to start quite yet. He decides to start going to they gym in 5 months. According to the transtheoretical model of change, which state is he in?
Correct
A) Incorrect – Patients at this stage do not intend to start the behavior change in the near future (greater than 6 months), and may be unaware of the need to change at all
B) Correct – The pros outweigh the cons for this patient and he intends to start within 6 months
C) Incorrect – Patients at this stage are ready to start taking action soon, generally within the next 30 days. He is not ready for 5 months
D) Incorrect – He has not yet taken actionPlease see pg 2-39 of Building Competency: The Essentials for more information on the transtheoretical model
Incorrect
A) Incorrect – Patients at this stage do not intend to start the behavior change in the near future (greater than 6 months), and may be unaware of the need to change at all
B) Correct – The pros outweigh the cons for this patient and he intends to start within 6 months
C) Incorrect – Patients at this stage are ready to start taking action soon, generally within the next 30 days. He is not ready for 5 months
D) Incorrect – He has not yet taken actionPlease see pg 2-39 of Building Competency: The Essentials for more information on the transtheoretical model
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Question 7 of 10
7. Question
What is the upper limit of daily fibre intake for people with diabetes?
Correct
A) Incorrect – That is below the maximum limit
B) Incorrect – That is below the maximum limit
C) Correct – The Diabetes Canada guidelines recommends 30-50 grams of dietary fibre intake daily because of the benefits of fibre for glycemic control. This is higher than what is recommended for people without diabetes ( 25 g and 38 g for women and men, and 21 g and 30 g for women and men over 51 years.).
D) Incorrect- That is above the maximum limitPlease see Recommendation 10 pg S74 of the 2018 Diabetes Canada clinical practice guidelines for details
Incorrect
A) Incorrect – That is below the maximum limit
B) Incorrect – That is below the maximum limit
C) Correct – The Diabetes Canada guidelines recommends 30-50 grams of dietary fibre intake daily because of the benefits of fibre for glycemic control. This is higher than what is recommended for people without diabetes ( 25 g and 38 g for women and men, and 21 g and 30 g for women and men over 51 years.).
D) Incorrect- That is above the maximum limitPlease see Recommendation 10 pg S74 of the 2018 Diabetes Canada clinical practice guidelines for details
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Question 8 of 10
8. Question
Insulin has the following properties:
Correct
Insulin is a hormone that stimulates the body to build things up and is, therefore, anabolic. Catabolic hormones, like cortisol, do the opposite to stimulate the body to break things down. Free fatty acids are the building blocks of triglycerides. Glucose is the building block of glycogen. Amino acids are the building blocks of proteins. Therefore, insulin stimulates building free fatty acids into triglycerides, glucose into glycogen and amino acids into protein for storage in the body or other functions. Catabolic hormones do the reverse by stimulating the body to break apart more complex molecules into simpler molecules, usually to burn for energy.
A) Incorrect – Anabolic hormones, like insulin, stimulates conversion from glucose to glycogen and amino acids into proteins. Converting free fatty acids to triglycerides is correct.
B) Incorrect – Insulin is an anabolic hormone, not a catabolic one
C) Correct – All of the information is correct
D) Incorrect – Insulin is an anabolic hormone, not a catabolic one. Insulin stimulates conversion from glucose to glycogen, amino acids to proteins and free fatty acids to triglyceridesFor more information, please see pg 3-6 of Building Competency: The Essentials
Incorrect
Insulin is a hormone that stimulates the body to build things up and is, therefore, anabolic. Catabolic hormones, like cortisol, do the opposite to stimulate the body to break things down. Free fatty acids are the building blocks of triglycerides. Glucose is the building block of glycogen. Amino acids are the building blocks of proteins. Therefore, insulin stimulates building free fatty acids into triglycerides, glucose into glycogen and amino acids into protein for storage in the body or other functions. Catabolic hormones do the reverse by stimulating the body to break apart more complex molecules into simpler molecules, usually to burn for energy.
A) Incorrect – Anabolic hormones, like insulin, stimulates conversion from glucose to glycogen and amino acids into proteins. Converting free fatty acids to triglycerides is correct.
B) Incorrect – Insulin is an anabolic hormone, not a catabolic one
C) Correct – All of the information is correct
D) Incorrect – Insulin is an anabolic hormone, not a catabolic one. Insulin stimulates conversion from glucose to glycogen, amino acids to proteins and free fatty acids to triglyceridesFor more information, please see pg 3-6 of Building Competency: The Essentials
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Question 9 of 10
9. Question
A patient of yours recently had a cardiovascular (CV) event. He is concerned about having another CV event and he is willing to switch medications to lower his CV risk. He is already on a statin and ACE inhibitor. He has an excellent drug plan. As per the 2020 Pharmacological Update, which of the following medications has been shown to lower CV risk?
Correct
A) Incorrect – Invokana (canagliflozin) has shown cardiac benefit in the CANVAS trial. Bydureon (extended release exanatide) and Trajenta (linagliptin) has not yet shown cardiac benefit.
B) Correct – All three of these medications have shown cardiac benefit.
C) Incorrect – Victoza (liraglutide) did show cardiac benefit in the LEADER trial. However both Januvia (sitagliptin) and Trulicity (dutaglutide) did not
D) Incorrect – Jardiance (Empagliflozin) did show cardiac benefit in the EMPA-REG trial and Invokana (canagliflozin) in the CANVAS trial. However Mounjaro (tirzepatide) has not yet shown CV benefits. Mounjaro’s CV trials are expected to come out at the end of 2024 or early 2025.Please see Figure 1 on pg S92 of the 2018 Diabetes Canada clinical practice guidelines for more details. Also see the 2020 Pharmacological update for more details on which medications have cardiac benefits. There are typically many 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
A) Incorrect – Invokana (canagliflozin) has shown cardiac benefit in the CANVAS trial. Bydureon (extended release exanatide) and Trajenta (linagliptin) has not yet shown cardiac benefit.
B) Correct – All three of these medications have shown cardiac benefit.
C) Incorrect – Victoza (liraglutide) did show cardiac benefit in the LEADER trial. However both Januvia (sitagliptin) and Trulicity (dutaglutide) did not
D) Incorrect – Jardiance (Empagliflozin) did show cardiac benefit in the EMPA-REG trial and Invokana (canagliflozin) in the CANVAS trial. However Mounjaro (tirzepatide) has not yet shown CV benefits. Mounjaro’s CV trials are expected to come out at the end of 2024 or early 2025.Please see Figure 1 on pg S92 of the 2018 Diabetes Canada clinical practice guidelines for more details. Also see the 2020 Pharmacological update for more details on which medications have cardiac benefits. There are typically many 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.
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Question 10 of 10
10. Question
A patient of yours, whose glycemic control was previously excellent for several years, comes to you with an A1c of 9.1%. Upon further discussion, you discover that he divorced his wife 2 months ago and he’s not handling it well. You notice that he smells strongly of alcohol and is poorly groomed. He is on metformin 500 mg BID and pioglitazone 30 mg once daily. You:
Correct
A) Incorrect – The personal burden of diabetes is enormous and, obviously, this patient does not need additional stressors placed on him by other health care professionals
B) Incorrect – While technically correct, this is not the best answer as it ignores the patient. Unless the patient is drinking very heavily and there are other co-morbidities, the risk of lactic acidosis is very low
C) Correct – This is the best answer as there is empathy, screening, acknowledgement of patient difficulty and counseling. There will be similar questions on the exam that test empathy
D) Incorrect – While technically correct, this is not the best answer as it ignores the patientIncorrect
A) Incorrect – The personal burden of diabetes is enormous and, obviously, this patient does not need additional stressors placed on him by other health care professionals
B) Incorrect – While technically correct, this is not the best answer as it ignores the patient. Unless the patient is drinking very heavily and there are other co-morbidities, the risk of lactic acidosis is very low
C) Correct – This is the best answer as there is empathy, screening, acknowledgement of patient difficulty and counseling. There will be similar questions on the exam that test empathy
D) Incorrect – While technically correct, this is not the best answer as it ignores the patient