Chapter 3 Key Clinical Processes in Lifestyle Medicine

Question 1

Question 1.what is one of the parameters to confirm the diagnosis of pre-diabetes:

A HbA1c>/= 6.5%
B HgA1c =5.7%
C Glu >/= 100 mg/dl
D 2h post-prandial glucose <140

Answer 1

C

Question 2

Question 2. Diabetes testing should be considered in all of the following except (Wendy Killin)

A.Male aged 43 with BMI 29
B.Female aged 51 with BMI 25 and physically inactive
C.Male aged 35 with BMI 28 and father with type 2 DM
D.Female aged 24 with BMI 27 previous gestational diabetes
E.Female aged 31 with BMI 25 and history of PCOS

Answer 2

A

Question 3

The following are true for strength training except

a) It can increase basal metabolic expenditure
b) It improves activities of daily living
c) It increases the risk for falls (esp in elderly)
d) After a strength training session metabolism stays elevated through a process called EPOC.

Answer 3

C

Question 4

4. Which one of the following are true of risk factor management?

a. Framingham risk assessment of MI in the next 10 years applies to patients including those with heart disease
b. 2015 MESA multiethnic risk score uses a coronary calcium score to measure 10 year risk of stroke
c. The 2013 ACC/AHA guidelines on the assessment of cardiovascular risk tool estimates 10 year and lifetime risk of atherosclerotic cardiovascular disease in those aged 40-79 to aid decision making for starting statin
d. The Reynolds risk score considers calcium levels for global risk of cardiovascular disease

Answer 4

C. Framingham study excludes those with heart disease and diabetes. 2015 MESA score is 10 yr risk of cardiovascular disease. Reynolds risk score for women uses family history and high sensitivity CRP.

Question 5

Which of these vital signs used in the assessment of patients are tested and validated screening tools?

a.Tobacco use, Alcohol consumption and BMI
b.Physical activity, BMI and Diet
Physical activity, BMI and AUDIT-C for alcohol consumption
c.Tobacco use, Physical activity, BMI & AUDIT-C for alcohol consumption
d.Physical activity, Diet, Tobacco use and Alcohol consumption

Answer 5

Answer C

Question 6

Which of the following regarding vital signs is false?

a.Resting energy expenditure is 60-75% total daily energy expenditure
b.Typical shortfall nutrients are vitamin A, C, D and E, folate, calcium, magnesium, fibre and potassium
c,Approximately 70% of visits to primary care are related to stress
d.If a patient is regularly consuming alcohol, they must be screened once a year
e.A white male with BMI 37 is categorised as class II obesity

Answer 6

D - if patient is regularly consuming alcohol, you must screen at every visit

Question 7

Which of the following is true?

a.A man with a waist circumference of 42 is at increased risk of cardiovascular disease
b.A woman with a waist to hip ratio of 0.8 is at increased risk of type 2 diabetes
c.An asian man with BMI of 24 is not at increased risk of disease
d.A blood pressure of 125/85 is considered normal
30% of adults of over 60 years have hypertension

Answer 7

A - waist circumference >40 in male - higher risk of disease (B- hip:waist ratio 0.8 normal, C- asian male with BMI 24 is considered overweight, D- BP 125/85 elevated, E- 50% over 60s have hypertension)

Question 8

Regarding the root cause analysis process for quality improvement, which of the following are false?

a.The root cause analysis tool is useful when something goes wrong, or a ‘near-miss’ is experienced
b.Ask 5 “whys” to get to the root cause of an incident
Consider the consequence of something not going as planned
d.Use cause and effect diagrams such as the chicken bone diagram
e.After analysis identifies a few causes, apply the Plan, Do, Study, Act cycle

Answer 8

D

Question 9

Regarding strength training exercises which of the following statement is NOT true (Rupesh Jha)

A- Strength training is usually asked separately to physical activity questions
B- It is important as it increases basal metabolic expenditure , improve ADLs and reduce risk of falls in elderly
C.The current guideline for physical activity recommends strengthening exercises for all major muscles three times a week
D- Muscle needs 48 hours to recover between strength sessions to recover
E- All above are true

Answer 9

C

Question 10

Regarding Overweight/ Obesity classification by BMI, Waist circumstances, and association disease risk, All of the following are correct except

a. Asian, BMI 18.5- 22.9, normal weight, average comorbidity risk
b. Non- Asian, BMI 35.0 - 39.9, Extreme Obesity, Severe Comorbidity risk
c. Non- Asian BMI 30.0- 34.9, Obese class 1, Moderate Comorbidity risk
d. Asian, BMI 23-27.4, Overweight, Increased Comorbidity risk

Answer 10

B. Non- Asian, BMI  35.0 - 39.9, Obesity class 2, Severe Comorbidity risk  
Page. 72, Table of Overweight/ Obesity Classification.

Question 11

11. Effective interdisciplinary teams should be able to demonstrate 10 characteristics. All of the following are correct except:

a. Personal rewards, training and development
b. Supportive team climate
c. Positive leadership and management attributes
d. Clarity of vision
e. Supporting high level of self- efficacy and self-management

Answer 11

E Supporting a high level of self- efficacy and self-management is not a characteristic of an effective multidisciplinary team.
Supporting high level of self- efficacy and self- management in patients is one of the outcomes of interdisciplinary team care for patients. ( page 77)

Question 12

12.what is one of the parameters to confirm the diagnosis of pre-diabetes: (added by mariana sousa)

A HgbA1 >/= 6.5%
B HgbA1 =5.7%
C Glu >/= 100 mg/dl
D 2h post-prandial glucose <140

Answer 12

C

Question 13

13. Diabetes testing should be considered in all of the following except (Wendy Killin)

A.Male aged 43 with BMI 29
B.Female aged 51 with BMI 25 and physically inactive
C.Male aged 35 with BMI 28 and father with type 2 DM
D.Female aged 24 with BMI 27 previous gestational diabetes
E.Female aged 31 with BMI 25 and history of PCOS

Answer 13

A. in absence of other risk factors screen if over 45 and repeat every 3 years. See page 74

Question 14

14. ( Sunil Kumar )
    The following are true for strength training except

a) It can increase basal metabolic expenditure
b) It improves activities of daily living
c) It increases the risk for falls (esp in elderly)
d) After a strength training session metabolism stays elevated through a process called EPOC.

Answer 14

C , EPOC also known as the afterburn effect. It stands for Excess postexercise oxygen consumption.Research shows that strength training is especially effective at raising EPOC.

Question 15

15. (Suzy Scarlett)

Which one of the following are true of risk factor management?

a) Framingham risk assessment of MI in the next 10 years applies to patients including those with heart disease
b) 2015 MESA multiethnic risk score uses a coronary calcium score to measure 10 year risk of stroke
c) The 2013 ACC/AHA guidelines on the assessment of cardiovascular risk tool estimates 10 year and lifetime risk of atherosclerotic cardiovascular disease in those aged 40-79 to aid decision making for starting statin
d) The Reynolds risk score considers calcium levels for global risk of cardiovascular disease

Answer 15

C. Framingham study excludes those with heart disease and diabetes. 2015 MESA score is 10 yr risk of cardiovascular disease. Reynolds risk score for women uses family history and high sensitivity CRP.

Question 16

16. (Niru Sritharan)
    Which of these vital signs used in the assessment of patients are tested and validated screening tools?

a) Tobacco use, Alcohol consumption and BMI
b) Physical activity, BMI and Diet
c) Physical activity, BMI and AUDIT-C for alcohol consumption
d) Tobacco use, Physical activity, BMI & AUDIT-C for alcohol consumption
e) Physical activity, Diet, Tobacco use and Alcohol consumption

Answer 16

C - Physical activity, BMI and AUDIT-C for alcohol consumption

Question 17

17.(Cat Walden)
Which of the following is true?

a)A man with a waist circumference of 42 is at increased risk of cardiovascular disease
b)A woman with a waist to hip ratio of 0.8 is at increased risk of type 2 diabetes
c)An asian man with BMI of 24 is not at increased risk of disease
d)A blood pressure of 125/85 is considered normal
30% of adults of over 60 years have hypertension

Answer 17

A - waist circumference >40 in male - higher risk of disease (B- hip:waist ratio 0.8 normal, C- asian male with BMI 24 is considered overweight, D- BP 125/85 elevated, E- 50% over 60s have hypertension)

Question 18

18.(Cat Walden)

Which of the following regarding vital signs is false?

a) Resting energy expenditure is 60-75% total daily energy expenditure
b) Typical shortfall nutrients are vitamin A, C, D and E, folate, calcium, magnesium, fibre and potassium
c) Approximately 70% of visits to primary care are related to stress
d) If a patient is regularly consuming alcohol, they must be screened once a year
e) A white male with BMI 37 is categorised as class II obesity

Answer 18

D - if patient is regularly consuming alcohol, you must screen at every visit

Question 19

19.(Kate Holliman)
Regarding the root cause analysis process for quality improvement, which of the following are false?

a) The root cause analysis tool is useful when something goes wrong, or a ‘near-miss’ is experienced
b) Ask 5 “whys” to get to the root cause of an incident
c) Consider the consequence of something not going as planned
d) Use cause and effect diagrams such as the chicken bone diagram
e) After analysis identifies a few causes, apply the Plan, Do, Study, Act cycle

Answer 19

D. Fishbone diagrams are used to consider cause and effect

Question 20

20. (Rupesh Jha)
    Regarding strength training exercises which of the following statement is NOT true

A- Strength training is usually asked separately to physical activity questions
B- It is important as it increases basal metabolic expenditure , improve ADLs and reduce risk of falls in elderly
CThe current guideline for physical activity recommends strengthening exercises for all major muscles three times a week
D- Muscle needs 48 hours to recover between strength sessions to recover
E- All above are true

Answer 20

E - All are true

Question 21

21. ( Lana)
    Regarding Overweight/ Obesity classification by BMI, Waist circumstances, and association disease risk, All of the following are correct except

a) Asian, BMI 18.5- 22.9, normal weight, average comorbidity risk
b) Non- Asian, BMI 35.0 - 39.9, Extreme Obesity, Severe Comorbidity risk
c) Non- Asian BMI 30.0- 34.9, Obese class 1, Moderate Comorbidity risk
d) Asian, BMI 23-24.9, Overweight, Increased Comorbidity risk
e) Asian, BMI 32.5-37.4, Obese class 2, Severe Comorbidity risk

Answer 21

B. Non- Asian, BMI  35.0 - 39.9, Obesity class 2, Severe Comorbidity risk  
Page. 72, Table of Overweight/ Obesity Classification.

Question 22

22. (Lana)
    Effective interdisciplinary teams should be able to demonstrate 10 characteristics. All of the following are correct except:

a) Personal rewards, training and development
b) Supportive team climate
c) Positive leadership and management attributes
d) Clarity of vision
e) Supporting high level of self- efficacy and self-management

Answer 22

E Supporting a high level of self- efficacy and self-management is not a characteristic of an effective multidisciplinary team.
Supporting high level of self- efficacy and self- management in patients is one of the outcomes of interdisciplinary team care for patients. ( page 77)