MOCK EXAM

Question 1

Mike, a 50-year-old man, has been overweight for several years and has tried
multiple diets without lasting success. He believes that his weight is beyond his
control and that nothing will work. What stage of change in the Transtheoretical
Model is Mike in if he is not currently considering any weight loss efforts?

A. Precontemplation
B. Contemplation
C. Preparation
D. Action

Question 2

Moderate activity levels will fall under which category of METS:

A. 5 METS
B. 10 METS
C. 2 METS
D. 7 METS

Question 3

Julian (age 50) comes to you for advice on disease prevention. He is an
executive working long hours (10-12 hour work days including up to 10 hours
sitting in meetings or at his desk). He exercises religiously for at least 1 hour per
day (walking or cycling at a moderate-vigorous intensity). He does not smoke, he
eats a balanced diet with minimal animal products or processed foods, and his
BMI, blood pressure and cholesterol are all low-normal range. Which of the
following do you discuss with Julian?

A. He is higher risk due to his sedentary job and he should change professions to
a more active role or reduce his work hours immediately

B. He could consider 2-minute bouts of light or moderate intensity walking every
20 minutes whilst working – this has been shown to decrease both blood
glucose and insulin levels in a population of overweight and obese adults, and
may attenuate his longer term risk

C. The risk from sedentary behaviour is offset by his excellent exercise regime,
but he should consider adding a strength and flexibility training to his regime

D. Results from a large trial following adults older than 45 years old for an
average of 2.8 years showed that 6.9% of all-cause mortality was attributed to
sitting. This effect was diminished to non-significant levels when physical
activity level was considered.

Question 4

A 34 year old businesswoman is travelling east on a long haul journey and
comes to ask for some advice to combat jet lag. Which of the following is the
most helpful advice for her?

A. Eat a good breakfast within two to three hours of the new ideal wake up time

B. Eat a good breakfast within 30–45 minutes of the new ideal wake up time

C. Eat complex carbohydrate rich dinner two to three hours before ideal sleep time

D. Get exposure to outdoor’s bright light just before bedtime

Question 5

Which of the following lifestyle medicine interventions can serve as a buffer
against the development of burnout?

A. Building social support networks in the workplace
B. Exercising job control and monitoring workload
C. Avoiding exercise and maintaining a sedentary lifestyle
D. Promoting stigma about burnout to raise awareness

Question 6

VO2 max /Step Testing/Rockport fitness Walking Test/12 min Cooper walk /run
test are tools for assessment of
A. Flexibility
B. Muscular Fitness
C. Cardiorespiratory fitness
D. Body composition

Question 7

What does the Composite Scale for Morningness Questionnaire (CSM) primarily
assess?
A. Eveningness preference
B. Sleep quality
C. Chronotype or morningness-eveningness preference
D. Sleep duration

Question 8

Which of the following is NOT a criterion for disease reversal?
A. All laboratory markers or diagnostic tests of a disease are within normal range.
B. There is no current use of any medications.
C. There are no present signs or symptoms of disease.
D. The disease is an acute infectious process.

Question 9

Non Pharmacologic approaches according to APA treatment guidelines that may
be considered if pharmacotherapy is undesired
A. Ginseng
B. Omega 3 Fatty Acid
C. SAMe monotherapy
D. ST John’s wort monotherapy

Question 10

How does culinary medicine differ from traditional medicine?
A. It replaces medication entirely.
B. It focuses exclusively on surgical procedures.
C. It uses food as a therapeutic tool to prevent and treat health conditions.
D. It promotes the use of herbal remedies.

Question 11

Steps in behavioural counselling include:
1. Readiness stage assessment,
2. empowering the patient
3. Offering stage matched responses to the patient’s confidence level.
A. True
B. False

Question 12

Which one of the following recommendations is consistent with the ACSM
Exercise Pre Participation Health screening
A. A 65 year old man with a known cardiovascular condition should not perform cardiorespiratory exercises
B. A 30 year old asymptomatic woman should undergo an ECG test prior to being recommended to walk 150 min each week
C. A 50 year old man with hypertension and mild obesity who intends to take up mountain bike riding should be recommended to perform exercise testing prior to beginning this activity
D. A 20 year old man with a systolic heart murmur can continue playing tennis without further evaluation

Question 13

When transitioning a patient to a whole food plant-based diet:
A. Monitor quantity of caloric intake closely to avoid potential overeating
B. Avoid berries due to blood sugar
C. Monitor blood glucose more frequently
D. Avoid legumes and beans due to the starch content

Question 14

Sarah is a 30-year-old woman with a sedentary lifestyle and a strong desire to
become more physically active. Her healthcare provider is using MI to help her
set achievable exercise goals. In MI, what is the process of helping Sarah
identify her own reasons for increasing physical activity and the benefits she
envisions?
A. Eliciting change talk
B. Developing discrepancy
C. Rolling with resistance
D. Expressing empathy

Question 15

Insulin resistance occurs only in type 2 diabetes. True or False?
A. True
B. False

Question 16

Anthony is a 42 year old male who presents to your office for an annual physical
exam and reports some increased fatigue and weight gain. You order lab work
and find an A1C of 6.2% and fasting glucose of 110. What is his diagnosis?
A. Type 2 Diabetes
B. Prediabetes
C. Normal blood work, no diagnosis

Question 17

Flow experiences are most likely to occur when individuals are:
A. Highly anxious and stressed.
B. Bored and disengaged.
C. Fully immersed in an activity and completely focused.
D. Avoiding challenging tasks.

Question 18

The sufficient intake of which macronutrient is considered to be essential in the
prevention of sarcopenic ageing?
A. Fats
B. Carbohydrates
C. Protein
D. Calcium

Question 19

Energy that is expended for standing at an office desk, walking to a file cabinet,
and other office job related activities are referred to which energy expenditure
component:
A. Non-exercise activity thermogenesis (NEAT)
B. Structured (volitional) exercise activity thermogenesis
C. Physical activity (non-resting) energy expenditure
D. Estimated energy requirement

Question 20

Which is true of the National Diabetes Prevention Program?
A. Did not reduce blood pressure or cholesterol
B. Outcomes were equal to treatment with metformin
C. Designed to treat people living with type 2 diabetes
D. Is covered by some insurers and demonstrated a 3:1 return on investment

Question 21

The primary factor of type 2 diabetes that contributes directly to insulin
resistance is
A. Sugar beverages
B. Caffeine
C. Beta cell dysfunction
D. Intramyocellular fat

Question 22

How does a Mediterranean diet influence the risk of depression?
A. It increases the risk of depression by 27% to 32%.
B. It has no effect on the risk of depression.
C. It reduces the risk of depression by 27% to 32%.
D. It solely depends on individual genetics.

Question 23

In HPFS How often do study participants receive questionnaires about their
diseases and Health related topics
A. Every month
B. Every year
C. Every two years
D. Every four years

Question 24

John Doe, a 45-year-old male, presents to the sleep clinic with a complaint of
persistent difficulty falling asleep and staying asleep. He reports experiencing
this issue for the past six months. He describes his sleep as “fitful” and
mentions waking up multiple times during the night. John has also noticed that
he wakes up early in the morning and has trouble getting back to sleep. Despite
spending sufficient time in bed, he feels unrested and fatigued during the day.
John denies any history of psychiatric disorders or substance abuse, and there
is no significant stress or life changes he can attribute to his sleep problem
What is the most likely diagnosis for John Doe’s sleep problem?
A. Sleep apnea
B. Narcolepsy
C. Insomnia
D. Restless legs syndrome

Question 25

What does the term “therapeutic alliance” refer to in the context of healthcare
and psychotherapy?
A. A formal agreement between a therapist and a client
B. A strong friendship between a therapist and a client
C. The collaborative and trusting relationship between a therapist and a client
D. A legal contract outlining therapy terms and conditions

Question 26

Patients are less likely to accept a plant-based diet compared to the ADA diet.
True or False?
A. True
B. False

Question 27

After you have reviewed the lab findings with Anthony, what is an effective and
natural way to introduce a lifestyle intervention and begin a conversation?
A. Informed Consent
B. Referral to outside dietician
C. Review all of the most detrimental foods that should be removed from his diet

Question 28

A 57-year-old male presents to your office for a physical exam. His exam is
normal, but laboratory tests show a total cholesterol of 305, a triglycerides of
329, an HDL cholesterol of 35, and an LDL cholesterol of 204. A typical daily
food intake indicates that he eats very little in the way of red meat, but eats
chicken 5-7 times per week. He does not limit dairy, and enjoys ice cream, as
well as pizza and other products with cheese on them regularly. You recommend
beginning a statin medication, but he states he does not want a pill, but is willing
to do whatever it takes from a nutrition perspective. Which of the following is the
most important nutrition prescription for this patient:
A. Negative prescription – Eat no cheese for the next 12 weeks
B. Negative prescription – Limit chicken to twice monthly for the next 12 weeks
C. Positive prescription – Eat two cups of dark green leafy vegetables daily for 12 weeks
D. Positive prescription – Begin red yeast rice 1200 mg twice daily for 12 weeks

Question 29

Which stage of sleep is often referred to as “light sleep,” characterized by the
presence of sleep spindles and K-complexes on an EEG?
A. Stage 1
B. Stage 2
C. Stage 3
D. REM sleep

Question 30

Which of the following is a typical treatment approach for insomnia?
A. Prescribing stimulants
B. Recommending increased caffeine consumption
C. Cognitive-behavioral therapy for insomnia (CBT-I)
D. Administering muscle relaxants

Question 31

A 45-year-old man recently diagnosed with prediabetes presents to the clinic for
a follow-up appointment. He reports that he is feeling well and is tolerating
metformin 500 mg twice daily. The patient’s blood glucose at home is reported
to be in the range of 110 to 140 mg/dL. His vital signs are within normal limits,
his BMI is 29 kg/m2, and the physical examination is unremarkable. In the clinic
today, the patient’s blood glucose is 145 mg/dL. He inquires whether there are
any preventative methods he can attempt before being placed on a higher dose
of metformin. According to the Diabetes Prevention Program, one intervention
method was found to have a 58% reduction in risk for developing diabetes when
studied over the course of four years. How does this intervention work to reduce
the risk of developing diabetes mellitus?
A. Increased glucose uptake as the intensity of muscle activity increases
B. Improved blood pressure control’s impact on pancreatic function
C. Decreased amount of glucose in the diet
D. decreased amount of salt in the diet

Question 32

In the study comparing exercise with PCI in stable coronary artery disease What
percentage of event-free survival was observed in the exercise training group?
A. 70%
B. 88%
C. 50%
D. 90%

Question 33

If Mike had had a 7 RPE after a set of strength training, what does this indicate
about his effort during the set?
A. He could have performed 3 more repetitions with the same weight.
B. He reached muscle failure during the set.
C. He should have used a lighter weight.
D. He did not perform any repetitions during the set.

Question 34

Which element of the PERMA model emphasizes experiencing joy, gratitude, and
contentment in life, even in the face of challenges?
A. Engagement
B. Relationships
C. Positive Emotions
D. Accomplishment
E. Meaning

Question 35

How would you make a prescription for moderate-intensity activity after having
performed an exercise stress test?
A. Preferred target heart rate during peak exercise of 50–60% of average maximum heart rate,
B. Preferred target heart rate during peak exercise of 60–75% of average maximum heart rate,
C. Preferred target heart rate during peak exercise of 75–85% of average maximum heart rate,
D. Preferred target heart rate during peak exercise of at least 85% of average maximum heart rate.

Question 36

What are short-chain fatty acids (SCFAs)?
A. A type of sugar found in fruits
B. Fatty acids with long carbon chains
C. Fatty acids with fewer than six carbon atoms
D. A type of protein found in meat

Question 37

Endurance type exercise training modulates fuel storage and substrate use.
Adaptive responses include:
A. lowering intramuscular lipid storage.
B. Increasing liver glycogen content.
C. Increasing intramuscular lipid use during exercise
D. Increasing muscle glycogen use during exercise

Question 38

Which of the following is correct regarding the American College of Sports
Medicine’s three stages of exercise progression?
A. The three stages are: Initial stage (1-6 weeks), Improvement stage (4-8 months), and Maintenance stage (indefinite)
B. In the initial stage, moderate intensity activities should be performed starting at 15 minutes and increasing to 30 minutes; recommended frequency is 3-4 times a week
C. In the improvement stage, frequency and intensity are increased first, then duration is increased, aiming for 20-30 minutes of continuous moderate to vigorous activity
D. A and B are correct
E. All the above are correct.

Question 39

Which of the following scales is used by Cochrane to measure levels of physical
activity
A. International Physical Ability Questionnaire
B. Physical Activity for everyone Questionnaire
C. Daily exercise scale
D. Quick Physical Activity Rating

Question 40

Framingham Heart Study: men and women with optimal risk status have ___%
and ___% lifetime risk of atherosclerotic CVD.
A. 8%in men 5% women
B. 5% in men 8 % in women
C. 5% in men and women
D. 8% in men and women

Question 41

According to Fredrickson’s Broaden-and-Build Theory, what is the primary
function of positive emotions?
A. To narrow an individual’s focus and attention.
B. To eliminate negative emotions completely.
C. To broaden one’s thought expand personal recources
D. To reinforce existing thought patterns.

Question 42

In the Precaution Adoption Model, what stage represents a person who has no
intention of taking action to prevent a health issue?
A. Unaware stage
B. Contemplation stage
C. Action stage
D. Inactive stage

Question 43

According to Reinforcing Spirals Theory, what is the primary mechanism by
which media influence individuals’ attitudes and behaviors?
A. Media consumption has no impact on attitudes and behaviors.
B. Media consumption shapes individuals’ beliefs and behaviors directly.
C. Media consumption reinforces and strengthens existing attitudes and behaviors.
D. Media consumption always contradicts individuals’ existing attitudes and behaviors

Question 44

Which of the following best characterizes the time frame of extended selfreference?
A. Focusing on the self in the present moment
B. Reflecting on the self across a broad temporal range, including past and future
C. Ignoring the concept of self entirely
D. Narrowing one’s focus solely on sensory experiences

Question 45

According to a meta-analysis of 339,000 subjects in 305 randomized controlled
trials comparing the mortality outcomes of Exercise vs. Medications exercise
was as good or better than medication in all of the following conditions except:
A. Post stroke
B. Secondary prevention of coronary heart disease
C. Pre-diabetes
D. Heart failure

Question 46

What endogenous substrate source provides the most energy during moderate
to high-intensity exercise?
A. Liver glycogen.
B. Muscle glycogen.
C. Intramuscular lipid.
D. Adipose tissue lipid

Question 47

All statements are correct about the current status of type 2 Diabetes EXCEPT:
A. Rates of diabetes are rising, but are predicted to level off in the next decade, due to expanding prevention programs, such as the NDPP.
B. The great majority of people with prediabetes do not know they have it.
C. A significant percent of people with diabetes are undiagnosed.
D. Ethnic groups born in the past couple of decades are disproportionately affected.

Question 48

Which of the following statements is true about the definition of disease
reversal?
A. It is a well-established and universally accepted definition.
B. It is a controversial definition, with some people believing that it is only possible for acute infectious diseases.
C. It is a definition that is still evolving, as new research is being conducted.
D. Both (b) and (c).

Question 49

Which brain region is often associated with emotional regulation and is
influenced by CBT interventions for mood disorders?
A. Prefrontal cortex
B. Hippocampus
C. Amygdala
D. Cerebellum

Question 50

All of the following are correct, except:
A. Non-smoking physicians were more likely to emphasise the risks of smoking.
B. Female internists’ personal health practices for physical activity were associated with positively counselling patients about exercise and smoking.
C. Female physicians who consumed a vegetarian diet were more likely to counsel on weight loss and nutrition.
D. Doctors who exercise were more likely to counsel patients on exercise than those who don’t.

Question 51

Lifestyle intervention programs
A. Have not been proven cost-effective
B. Have demonstrated improvements in clinical outcomes but not improved weight
C. Have demonstrated consistently improved clinical outcomes and weight reduction
D. Have not been shown to be superior to medication management with metformin

Question 52

A 59-year-old man with obstructive sleep apnea, coronary artery disease, and a
BMI of 35.5 kg/m2 presents for a return visit with persistent concerns of erectile
dysfunction and insomnia. In counseling about obesity, the clinician seeks
permission from the patient to discuss his weight, assess his weight-related
comorbidities and risks, and advise him on modest weight loss of 5 to 10% total
body weight. What other skill in the 5A model is most appropriate to use for
obesity motivational interviewing for this patient?
A. Align: Ensure the patient understands the clinician’s direction and how these instructions align to address the patient’s needs.
B. Assist: Assist the patient in prioritizing current concerns and avoiding any discussion on barriers related to weight loss.
C. Agree: Agree on treatment targets, behavioral changes, pharmacotherapy, and specific details of the treatment plans.
D. Autonomy: Allow the patient to determine follow-up intervals to cultivate self efficacy in meeting their goal.

Question 53

You confirm with the patient that he followed the prescription. You provide him
with generous amounts of congratulations and positive reinforcements. You tell
him that it would be wonderful to lower the triglycerides a bit more, and to get
his LDL cholesterol below 100. You encourage him to continue with the
restrictions he implemented at the last visit. You also decide at this point that
the patient should receive a nutrition prescribe that adds additional foods to his
current eating regimen. Which of the following is the best positive prescription
for lowering cholesterol?
A. Metamucil 4.3 grams daily for 12 weeks
B. Oatmeal 1.5 cups daily for 12 weeks
C. Garlic 3 grams fresh daily for 12 weeks
D. Legumes 1.5 cups daily for 12 weeks

Question 54

All of the following are good examples of creating a wellness culture in a
workplace, except:
A. Replace biscuits and cakes in the tearoom with healthy snacks, such as nuts and fruit.
B. Replace sitting desks with standing desks, particularly for those who spend most of the day sitting in front of a computer.
C. Start up a walking group at lunch time and go for a 15 minute walk with others.
D. Encourage staff to exercise their autonomy on what they would like to eat at work functions.

Question 55

Which of the following aspects of women’s health is NOT a focus of the Harvard
Nurses’ Health Study?
A. Reproductive health
B. Mental health
C. Cancer prevention
D. Cardiovascular health

Question 56

A 50-year-old female with no past medical history was brought to the emergency
department after a syncopal episode at work. She reported having prodromal
symptoms, including nausea and a warm or fuzzy feeling in the chest, followed
by loss of consciousness. She also complained about having 5 or 6 diarrhoea
episodes since yesterday. Her vitals were stable with a normal physical exam.
EKG was unremarkable, and troponins were negative. She was admitted for
observation. Upon further discussion, the patient mentioned that she jogs about
300 minutes weekly. She was concerned this would contribute to her symptoms.
What would be your explanation?
A. Decrease the duration of jogging and follow the current recommended duration of 150 to 300 minutes per week
B. Continue following the same regimen once recovered from the diarrhoea episode
C. Decrease the duration of jogging and follow the current recommended duration of 57 to 150 minutes per week
D. Prescribe cardiac event monitor at discharge

Question 57

Miriam is a 56- year old female with a history of obesity and hypertension and
presents to your office with complaints of fatigue and frequent urination. You
order comprehensive lab work based on your differential diagnosis and discover:
+ urinalysis and fasting glucose of: 150. You decide to order additional testing.
The A1C comes back from the lab at 8.2% and you inform Miriam that she has
lab work consistent with a diagnosis of diabetes In addition to a team approach,
what type of medical visit setting may be beneficial for Miriam
A. Office visits every three months
B. One on one physician visits
C. Group visit with other people living with type 2 diabetes
D. None of the Above

Question 58

What is considered a standard alcoholic drink in the United States?
A. 4 ounces of 12% wine
B. 8 ounces of beer
C. 1.5 ounces 12% shot
D. 12 ounces of beer 5% ABV regular beer

Question 59

Sarah Thompson aged 55 an office manager by profession presents to the clinic
with complaints of persistent fatigue, difficulty concentrating, and increasing
stress levels. She also mentions that she has gained weight over the past few
years and feels generally unwell.
Medical History: Sarah has a history of hypertension and elevated cholesterol
levels. She is on medications for both conditions. Her recent blood work also
revealed elevated blood sugar levels, indicating a risk of developing type 2
diabetes. She has a family history of heart disease and diabetes.
Lifestyle History: Sarah’s typical day involves long hours at the office, often
leading to a sedentary lifestyle. She admits to poor eating habits, consuming
fast food and sugary snacks throughout the day. She rarely engages in physical
activity due to her busy schedule. Sarah reports feeling overwhelmed and
stressed due to work responsibilities and family obligations.
Clinical Assessment: Physical examination reveals that Sarah is overweight, and
her blood pressure and cholesterol levels are still elevated despite medication.
She shows signs of abdominal obesity and reports disrupted sleep patterns.
Sarah’s chief complaints of persistent fatigue, difficulty concentrating, and
increasing stress levels are likely attributed to:
A. Allergic reactions
B. Lack of social interactions
C. Underlying chronic diseases
D. Overconsumption of caffeine

Question 60

In the RAIN acronym, what does the “A” stand for?
A. Acknowledge
B. Act
C. Assess
D. Abandon

Question 61

What the largest endogenous substrate source in the body?
A. Liver glycogen.
B. Muscle glycogen.
C. Intramuscular lipid.
D. Adipose tissue

Question 62

Dr. Smith, a therapist, is working with a patient, Sarah, who has been struggling
with depression and social isolation. Sarah often feels disconnected from others
and finds it challenging to form meaningful relationships. Dr. Smith has been
implementing the concept of “micromoments of connection” as part of Sarah’s
therapy to help her improve her social interactions and emotional wellbeing.
What are “micromoments of connection” in the context of Sarah’s therapy?
A. Lengthy and intensive therapy sessions focused on building social skills.
B. Brief, positive, and emotionally resonant interactions that help strengthen social connections.
C. Silent moments in therapy where both the therapist and patient reflect on their feelings.
D. Formal assessments of the patient’s progress in forming relationships.

Question 63

In Ornish telomere and prostate cancer study, Telomere shortness is an indicator
of
A. Increased morbidity and shorter lifespan.
B. Increased morbidity and longer lifespan.
C. Decreased morbidity and longer lifespan.
D. Decreased morbidity and shorter lifespan

Question 64

You have partnered with your patient, Ms. B, to better manage her hypertension
with a goal of reducing or eliminating her medication regimen. Besides
adjustments to her dietary habits and physical activity, Ms. B’s home BP log has
demonstrated significant exacerbation of her hypertension by emotional stress.
You recommend that she sign up for a mindfulness-based stress management
(MBSR) course to reduce emotional reactivity. What can you tell her to expect?
A. MBSR courses must be attended in person for the participant to benefit.
B. Biofeedback is one of the modalities explored.
C. The “S.T.O.P.” practice – Stop, Take a breath, Observe, Proceed – is one of MBSR’s foundational tools for managing reactivity.
D. The HeadSpace mobile application provides a full, free course that is is an exact substitute for an in-person MBSR course.

Question 65

What is the recommended guideline on activity for children and youth
A. 20 minutes or more of physical activity a day for children and youth.
B. 30 minutes or more of physical activity a day for children and youth.
C. 40 minutes or more of physical activity a day for children and youth.
D. 60 minutes or more of physical activity daily for children and youth.

Question 66

What is the relationship between the number of ACEs a person experiences and
their risk of negative outcomes?
A. There is no relationship between the number of ACEs and negative outcomes
B. The risk increases linearly with each additional ACE
C. The risk decreases with each additional ACE
D. The number of ACEs has no impact on a person’s risk of negative outcomes

Question 67

Which of the following is NOT a potential benefit of incorporating culinary
medicine into healthcare?
A. Improved patient compliance with dietary recommendations
B. Reduced risk of diet-related diseases
C. Lower healthcare costs
D. Faster recovery from surgical procedures

Question 68

Adult humans can grow _ 700 neurons a day
A. 0
B. 100
C. 1000
D. 700

Question 69

Exerkines can influence the pancreas by enhancing cell viability and influencing
insulin secretion. Which exerkine is mentioned in this context?
A. Adiponectin
B. Myostatin
C. Interleukin-6 (IL-6)
D. Interleukin-6 (IL6) and Follistatin

Question 70

The physiologically normal LDL is likely closer to:
A. 50-70 mg/dl
B. 70-90 mg/dl
C. 90-100 mg/dl
D. 100-120 mg/dl

Question 71

John, a 40-year-old man, recently went through a breakup. He believes that he’ll
never find love again and that he’s destined to be alone for the rest of his
life. What cognitive distortion is John exhibiting?
A. Overgeneralization
B. Emotional reasoning
C. Discounting the positive
D. Fortune telling

Question 72

What does the A stand for in TAF
A. Allowed
B. Assess
C. Amount
D. Advise

Question 73

Which one(s) of the following individuals should seek advice before engaging in
more physical activity
1) an individual who answered 1 question ‘yes’ on the follow up questions in the
PAR Q+ questionnaire
2) an individual who answered 2 questions ‘yes’ on the follow up questions in the
PAR Q+ questionnaire
3)an individual who answered 3 questions ‘yes’ on the follow up questions in the
PAR Q+ questionnaire
4) an individual who answered 4 questions ‘yes’ on the follow up questions in the
PAR Q+ questionnaire
Select one
A. 4 only
B. 3 and 4 only
C. 2, 3 and 4 only
D. 1,2,3 and 4

Question 74

How did the percent stenosis change in the control group from baseline to 5
years?
A. Increased by 10.6%
B. Decreased by 7.9%
C. Increased by 10.6%
D. Decreased by 14.4%

Question 75

For jet lag travelling west, which of the following recommendations is the most
relevant to combat jet lag?
A. Eat a good breakfast two to three hours after the new ideal wake‐up time
B. Eat protein‐rich breakfast two to three hours before new ideal sleep time
C. Eat a good breakfast 30–45 minutes after the ideal wake‐up time
D. Take melatonin 1 mg sublingual at ideal sleep time

Question 76

Off label medications for Alcohol use include
A. Acamprosate
B. Gabapentin
C. Topiramate
D. B & C

Question 77

What is one key principle of CBT’s impact on the brain’s plasticity?
A. It has no effect on brain plasticity.
B. It enhances the brain’s ability to adapt and change over time.
C. It solely focuses on pharmacological interventions.
D. It induces permanent changes in brain structure.

Question 78

A patient presents with an alpha tocopherol (Vitamin E) levelof 5.9 mg/L (normal
is5.7-19.9 mg/L). She is concerned that she gets frequent colds and doesn’t heal
quickly when she is injured. You decide you want to increase her Vitamin E blood
level. The healthiest/best way to achieve this goalwould be to prescribe which
ONE of the following?
A. Sunflower Seeds (unsalted) 1 ounce by mouth daily
B. Vitamin E 400 IU by mouth daily
C. Almonds (unsalted) ¼ cup by mouth daily
D. Wheat Germ Oil 1 tbsp. by mouth daily

Question 79

What is planetary health?
A. The health of human civilization and the natural systems on which it depends.
B. The impacts of human disruptions to Earth’s natural systems on human health.
C. The need for a solutions-oriented, transdisciplinary approach to planetary health.
D. The importance of lifestyle medicine in addressing planetary health challenges.

Question 80

How many character strengths are identified in the VIA Classification of
Strengths and Virtues?
A. 6
B. 12
C. 24
D. 48

Question 81

What is the primary focus of culinary medicine?
A. Surgical techniques
B. Medication management
C. The use of food and nutrition in disease prevention and treatment
D. Traditional Chinese medicine

Question 82

Encouraged but somewhat reticent because he is not sure how his family would
respond or support his decision. You respond by: encouraging him with
supportive gain framed messaging and invite his significant other to attend the
next visit. Anthony responds, “OK what’s next?” You invite him to join your DPP
program and he asks if it will be covered by his Medicare insurance. You
responded by telling him that it is:
A. An out of pocket expense
B. Only covered by a select number of insurance companies
C. Covered by Medicare

Question 83

Which of the following is not characteristic of the “Western Diet”?
A. Lack of fiber
B. Lack of antioxidants
C. Emphasis on complex carbohydrates
D. Emphasis on animal protein

Question 84

What is the nature of the association between Major Depressive Disorder (MDD)
and diabetes?
A. MDD is a risk factor for developing diabetes.
B. Diabetes is a risk factor for developing MDD.
C. There is no established association between MDD and diabetes
D. a & d

Question 85

Anthony responds positively to your presentation and states that he does not
want to take medications in the future. The research has shown that lifestyle
interventions compared to medications are…
A. Equal in outcomes
B. Superior to medications like metformin
C. Inferior to medications

Question 86

When is a food considered low in a nutrient
A. 5% DV or less per serving
B. 5% DV of total weight
C. 1 % DV per serving
D. 10% DV of total weight

Question 87

What is the primary focus of the PREDIMED trial?
A. Studying the effects of exercise on cardiovascular health
B. Investigating the health benefits of the Mediterranean diet
C. Analyzing the impact of smoking cessation on cancer risk
D. Assessing the benefits of a vegetarian diet on mental health

Question 88

What is the primary focus of “primordial prevention” in the context of burnout?
A. Identifying burnout symptoms and providing treatment
B. Reducing risk factors before they lead to burnout
C. Reacting to burnout symptoms once they are already present
D. Enhancing personal resilience after experiencing burnout

Question 89

Which of the following statements about Advanced glycated end-products AGEs
is incorrect?
A. AGEs are formed non enzymatically
B. AGEs are found only in patients with diabetes
C. AGEs can be derived from ingested food
D. AGEs bind to a specific receptor

Question 90

John, a 45-year-old man, engages in brisk walking for 30 minutes every day.
John’s brisk walking activity has an MET value of 4.0. How many MET hours per
week does he accumulate?
A. 1.5 MET hours per week
B. 7.0 MET hours per week
C. 14.0 MET hours per week
D. 28.0 MET hours per week

Question 91

Tom is a 65 year old African American widowed male who has been struggling
with metabolic syndrome for a few years. He is working on an action plan to shift
to a plant based diet and to walk a couple of miles every day. He admits that he
still likes some occasional meat and fried foods, especially when his daughter is
away on business trips.
*His daughter is his main social support. He occasionally plays cards with a
former co-worker; but scheduling games has been a challenge as the co-worker
has been getting ill often lately. So he has been back on social media trying to
connect with other old friends.
*He likes to get out to the park for his walk, but has few other fun activities.
Sometimes he finds it hard to get out for the walk, because he is glued to
watching the news. He has gotten out of the habit of playing his guitar, an old
passion of his.
What activity or lifestyle change would you discuss with him that could have the
greatest short term impact on his emotional well-being?
A. Adding more vegetables to his diet and cutting out fried foods
B. Walking more than two miles a day
C. Getting back to playing his guitar by taking a class or joining a music meet up group
D. Increasing his efforts to expand his social circle by connecting with old friends on social media

Question 92

What term is commonly used to describe the fear of missing out on social media
updates and activities?
A. Social media fatigue
B. FOMO
C. Offline withdrawal
D. Cyberphobia

Question 93

Problematic social media use is often associated with:
A. Reduced feelings of loneliness and isolation
B. Enhanced face-to-face social interactions
C. Addiction-like behaviors and a need for constant online validation
D. Improved time management skills

Question 94

Which of the following scenarios is an example of at-risk drinking?
A. An individual has one glass of wine with dinner every evening.
B. An individual consumes a single alcoholic beverage at a family gathering.
C. An individual drinks excessively on weekends but abstains during the week.
D. An individual consumes eight beers in one evening during a party.

Question 95

Which type of dietary fiber is a common source of SCFAs in the human diet?
A. Simple sugars
B. Soluble fibre
C. Insoluble Fibre
D. Fatty acids

Question 96

The best advice to a pregnant woman seeking to maintain vigorous physical
activity is:
A. She must get clearance from her Obstetrician before any vigorous activity
B. She risks premature labor and should restrict her physical activity intensity to moderate intensity
C. She may continue her customary vigorous activity
D. Light intensity physical activity is sufficient and safest

Question 97

A 55-year-old male with a past medical history of schizoaffective disorder
presents to the clinic for an annual well visit. He smokes half a pack of
cigarettes per day and expresses his willingness to quit smoking. He states he is
depressed due to work-related issues and smoking helps him cope. He is not
taking any other medications and denies alcohol use. Which of the following is a
suitable treatment option for smoking cessation at this time.
A. Venlafaxine
B. Varenicline
C. Bupropion
D. Nicotine Replacement

Question 98

A 34 y/o female presents to your office as a new patient wanting to know the
best approach to eating. She would like to lose 10 lbs, and wants to make sure
her 6 y/o and 8 y/o children are getting the best nutrition possible. She and her
husband have tried both plant based diet and a ketogenic dietary patterns. Both
worked, but they preferred the ketogenic diet. Neither, however, seemed
sustainable long term. You begin your discussion by explaining to them the most
important nutritional principle is to focus on whole foods.As you are trying to
explain the difference between whole foods and processed foods, which ONE of
the following statements would be a correct part of this discussion?
A. Brown rice, wild rice and white rice are all appropriately labeled as “whole food”
B. Whole wheat bread and whole wheat pasta are not considered “whole food”
C. Apple sauce is considered whole food, but apple juice is considered processed food
D. The best whole food source for milk is almond milk

Question 99

Case Study: Shawna
Shawna, a 65 year old African American female patient presents with a BMI of
28 and persistent
right knee pain. She reports that her last doctor told her that her weight was
aggravating the knee
pain. But she says that she is really stressed right now and needs her comfort
food, especially her ice
cream at night. You acknowledge her stress and ask her whether she is
considering increasing her
physical activity level. She says she has been walking a couple of times a week
with a friend, but
quit due to the knee pain and would like to start again.
What is her stage of change for decreasing her ice cream snack?
A. Precontemplation
B. Contemplation
C. Preparation
D. Action

Question 100

An 81 y/o male comes to your office for a routine annual exam. He weighs 80 kg,
has an 18% body fat, and is generally healthy. He is eating a primarily whole
food, plant based diet. He sleeps well and is not experiencing significant stress.
He is well connected to family and friends. He currently walks 30 minutes/day
between five and six times each week. You recognize he needs to improve his
strength training. As you prescribe a muscle toning and maintenance regimen,
you recommend which of the following as the BEST nutritional prescription?
A. Increase daily legume intake to at least 1.5 cups per day. Consider fish and/or eggs as desired and appropriate
B. Incorporate a pea protein based drink or bar that provides at least 10 grams of additional plant based protein as part of each strength training session
C. Increase dark green leafy and/or cruciferous vegetables so that total protein intake is at least 60 grams daily, or at least 10% of his daily dietary intake
D. Incorporate regular legumes, nuts and seeds into his diet and inform him that if he eats a balanced, whole food, plant based diet he doesn’t need to worry about protein

Question 101

What percentage of primary care provider visits are related to stress and lifestyle
A. 50%
B. 20%
C. 80%
D. 5%

Question 102

Which of the following actions would most likely contribute to a sleep disorder?
A. Drinking three cups of coffee every morning.
B. Drinking a glass of red wine with dinner each evening.
C. Watching television in bed while falling asleep each night.
D. Taking a 30-minute nap after lunch each day.

Question 103

Who developed the Mindfulness-Based Stress Reduction (MBSR) program?
A. Sigmund Freud
B. Jon Kabat-Zinn
C. Carl Rogers
D. Abraham Maslow

Question 104

In the context of behavior change, what does it mean if a patient rates their
confidence level as 5 on a 10-point scale?
A. The patient is highly confident in their ability to change.
B. The patient is uncertain and has moderate confidence.
C. The patient is not at all confident in their ability to change.
D. The patient is overly confident and does not need support.

Question 105

Your patient asks what you think of the latest on-line ad for a weight lifting
program that promises to help her lose 1 pound per week by “turning fat into
muscle” just by using their machine 30 minutes per day. You advise her that:
A. 30 minutes a day of weight lifting is not sufficient for losing that much weight
B. She should start with a basic walking program because she is not yet in shape to lift weights
C. Resistance training is an important part of her exercise program but that some reduction in her caloric intake will also be necessary to lose weight
D. Resistance training does not need to be part of her exercise program

Question 106

Exerkines play a role in enhancing muscle formation, maintenance, and repair in
skeletal muscle. Which exerkine is mentioned as being involved in these
processes?
A. Myostatin
B. Follistatin
C. Catecholamines
D. Nitric Oxide

Question 107

What were the main dietary interventions tested in the PREDIMED trial?
A. High-protein diet and low-carbohydrate diet
B. Low-fat diet and high-fiber diet
C. Mediterranean diet with extra virgin olive oil and Mediterranean diet with nuts
D. Vegan diet and paleolithic diet

Question 108

People living with type 2 diabetes have a 2 fold increased risk of depression.
True or False?
A. True
B. False

Question 109

One of the following is not a component of the CAGE questionnaire.
A. Has someone been Concerned about your drinking?
B. Have you ever felt guilty about drinking?
C. Do you get annoyed when people criticize your drinking?
D. Do you feel like you need a drink as soon as you get up?

Question 110

The only statistically significant risk factor for OSA is
A. Smoking
B. Alcohol consumption
C. Overweight and Obesity
D. Polycystic Ovary Syndrome

Question 111

How long is a physical activity clearance valid for
A. 6 months
B. 6 months unless medical condition changes
C. 1 year
D. 1 year unless medical condition changes
E. 2 years unless medical condition changes

Question 112

Tighter medication management is associated with improved all-cause mortality
and fewer complications. True or False?
A. True
B. False

Question 113

Basal Metabolic Rate (BMR):
A. is measured in comfortable sitting position
B. is unaltered in hypothyroidism and hyperthyroidism
C. is primarily determined by the amount of skeletal muscle in the body.
D. Is higher after weight gain because part of the excess weight is fat-free mass

Question 114

In Chronic Fatigue Syndrome the patients are alleged to have ‘unhelpful
cognition’ and ‘dysfunctional beliefs’ that their symptoms are caused by an
organic disease. This is best explained by
A. Impaired belief theory
B. Dysfunctional belief theory
C. Maladjusted belief theory
D. Inhibited belief theory

Question 115

How does climate change impact human health?
A. It increases the risk of heat-related illness.
B. It increases the risk of respiratory illness.
C. It increases the risk of vector-borne diseases.
D. All of the above.

Question 116

What is not correct regarding the Mediterranean diet?
A. It is characterized by a high intake of monounsaturated fat, plant proteins, whole grains, and fish; moderate intake of alcohol; and low consumption of red meat, refined grains, and sweets,
B. A stricter adherence to the Mediterranean diet is inversely associated with total and cardiovascular mortality,
C. It is less effective than a low-fat diet in the secondary prevention of cardiac events.
D. A stricter adherence to the Mediterranean diet is inversely associated with the risk of stroke in women.

Question 117

In which stage does emotional consolidation occur
A. REM
B. Stage 1
C. Stage 2
D. Stage 3

Question 118

Ajay is a 62 year old non smoking male.
He has been jogging 5 km 3 times a week for the past year. Recently he
experienced shortness of breath near the very end of his run.
What would be your approach with this patient concerning physical activity
A. Perform medical tests to clear him for activity and in the meantime advise him to perform moderate -intensity exercises only
B. Perform medical tests to clear him for activity and in the meantime advise him to perform low intensity exercises only
C. Suggest that he stop exercises and run tests to clear him for activity
D. Suggest that he run 4 kilometers instead of 5

Question 119

What is incorrect about the precaution adoption model
A. It has 7 stages
B. It is a linear change
C. It is a cyclical change
D. Patient cannot go backward in stages

Question 120

Participation in regular physical activity reduces the risk of
A. Breast and Colon cancers
B. Anemia
C. Coronary heart disease and stroke
D. a and c

Question 121

When a patient presents with symptoms of acute stress (such as high heart rate,
hypertension, diaphoresis, and rapid speech), what next steps should you take in
a lifestyle medicine setting?
A. Conduct a brief stress questionnaire, initiate a brief discussion about stress and its role in healthy lifestyles, and recommend stress relievers.
B. Conduct a brief stress questionnaire, discuss the role of lifestyle and help the patient develop a stress management plan that he is confident he can do at a level 7 (on a scale of 1—least confident— to 10—most confident).
C. Conduct a brief stress questionnaire, ask about both stressors and what’s going well in the patient’s life, point out the role of healthy lifestyles to improve physical and emotional well-being, and check readiness to develop a stress management plan.
D. Conduct a brief stress questionnaire, point out that you see that the patient is stressed and inquire about what is going well to help build an action plan.

Question 122

John, a 55-year-old male patient, has been admitted to the hospital with an acute
myocardial infarction (MI), commonly known as a heart attack. He is a long-term
smoker and has expressed a desire to quit smoking to reduce his risk of further
cardiovascular events. John’s healthcare provider is considering the use of
Nicotine Replacement Therapy (NRT) as part of a smoking cessation
strategy. When should John consider using NRT for smoking cessation after his
acute MI?
A. NRT should be used during a heart attack to relieve stress.
B. NRT can be initiated immediately while in the hospital.
C. John should wait at least one year after the heart attack to start NRT.
D. NRT is not recommended for patients with heart conditions.

Question 123

In the Lifestyle Heart Trial What was the average percent stenosis in the
experimental group at the 5-year follow-up?
A. 40.7%
B. 37.3%
C. 42.3%
D. 51.9%

Question 124

Nuts/beans/amaranth quinoa and potatoes are high in
A. Potassium
B. Calcium
C. Magnesium
D. Phosphorus

Question 125

What are the two questions typically included in the PHQ-2 screening tool?
A. “Have you ever experienced depression?” and “How long have you felt this way?”
B. “Do you have a family history of depression?” and “Are you currently taking medication for depression?
C. “In the last month, have you often been bothered by feeling down, depressed, or hopeless?” and “In the last month, have you often been bothered by little interest or pleasure in doing things?”
D. “Do you think you might be depressed?” and “Are you experiencing any physical health issues?”

Question 126

Exercise in type 2 diabetes:
A. Upregulates of beta cell function due to increased insulin sensitivity
B. Increased transport of glucose into cells via GLUT4 transporter
C. Can result in a loss of the GLUT4 transporter
D. Decreased responsiveness in muscle glucose uptake to insulin

Question 127

Which of the following is INCORRECT regarding the Blue Zones?
A. The Blue Zones uncovered 9 evidence-based common denominators among the world’s centenarians in 5 distinct zones – Loma Linda (USA), Okinawa (Japan), Sardinia (Italy), Ikaria (Greece) and Nicoya Peninsula (Costa Rica)
B. All Blue Zone populations have in common a regular exercise regime that they perform consistently in small groups in their local community
C. 2 of the 9 common denominators in the Blue Zones are regular moderate alcohol consumption (for all except Adventists) and putting loved ones first
D. A plant-based diet featuring beans is a common denominator between all Blue Zones; meat is either not consumed at all (Loma Linda), or in small portions approximately 5 times a month.

Question 128

MBSR programs often involve mindfulness meditation practices. What is the
primary focus of mindfulness meditation in MBSR?
A. Controlling thoughts and emotions
B. Suppressing negative feelings
C. Paying non-judgmental attention to the present moment
D. Achieving a state of deep sleep

Question 129

Sarah is a 35-year-old smoker who has been smoking for 15 years. She has
recently expressed an interest in quitting smoking and has started researching
smoking cessation methods. Which stage of change in the Transtheoretical
Model is Sarah most likely in?
A. Precontemplation
B. Contemplation
C. Preparation
D. Action

Question 130

Which is not one of the 5 R’s of Motivational Interviewing
A. Relevance
B. Roll with resistance
C. Repetition
D. Risks of Use