Diabetes Quiz Practice exam with correct answers 2024

A thin 38-year-old white female presents to the clinic for evaluation of her glycemic control. She was diagnosed with diabetes 9 months ago with an A1C of 13% and started on metformin and glipizide. Three months later her glycemic control was much improved (A1C of 7.4%), but today she reports increased thirst and urination. Her A1C today is 11.2% despite confirmed adherence with her medications and a negative pregnancy test. Which of the following is the MOST likely diagnosis? A) Type 1 diabetes (T1DM) B) Type 2 diabetes (T2DM) C) Latent autoimmune diabetes of adults (LADA) D) Gestational diabetes (GDM) - answers-Latent autoimmune diabetes of adults (LADA) C: Latent autoimmune diabetes of adults (LADA) is the correct answer (C). Patients with LADA are typically less than 40 years old and often misdiagnosed with type 2 diabetes at presentation (B). Because these patients initially respond to oral agents and do not require insulin, they are usually not diagnosed with type 1 diabetes (A). However, these patients usually progress to insulin requirement over a period of several months, leading some experts to consider LADA related to type 1 diabetes. This patient would not be diagnosed with gestational diabetes because she is not pregnant (D). At the conclusion of a general diabetes education group class, a 55-year-old man sitting in the back proudly announces that he plans to start training for the upcoming marathon. He reports being a runner in high school but has not done any exercise since his popliteal bypass surgery 10 years ago. Which of the following is the most appropriate response to this announcement? A) Advise him to first obtain a graded exercise test with electrocardiogram. B) Encourage the patient to walk for the first 20 minutes, then start running. C) Encourage him to check his blood glucose after every mile of consistent walking. D)Advise the patient that pain at night while at rest signifies improvement. - answers-Advise him to first obtain a graded exercise test with electrocardiogram. A: Given the patient's age and history of peripheral artery disease, a graded exercise test would give key information on how his heart responds to exertion—information he must know before beginning an exercise program in the absence of exercise over the last 10 years. Otherwise, he may put himself at undue risk for a cardiac event. The presence of atherosclerosis in the leg arteries is a strong indicator that there may also be atherosclerosis in the arteries of the heart. Answers B, C, and D are incorrect because they do not address the primary concern, which is his cardiac health and preventing a cardiac event. Pain at rest would definitely not signify improvement (he should not experience pain at rest) (D). According to the Diabetes Prevention Program (DPP), which of the following was the MOST effective for preventing diabetes? A) Intensive lifestyle modifications B) Metformin C) Arcabose D) Rosiglitazone - answers-Intensive lifestyle modifications A: Intensive lifestyle modifications (A) is correct. The Diabetes Prevention Program (DPP) enrolled patients at high risk to develop diabetes and randomized them to usual care, intensive lifestyle modification, or metformin. The group that engaged in intensive lifestyle modifications, including loss of 7% of body weight and 150 minutes of exercise each week, was least likely to develop diabetes. Which of the following islet cell antibodies is the best predictor of future type 1 diabetes? A) Islet antigen A2 and A2 beta B) Heat shock protein C) Glutamic acid decarboxylase D) Insulin autoantibodies - answers-Glutamic acid decarboxylase C: Early type 1 diabetes is first identified by the appearance of active autoimmunity directed against pancreatic beta cells and their products. Glutamic acid decarboxylase (GAD) appears to be the best immunologic predictor for the future development of type 1 diabetes (C). These islet cell antibodies may play a permissive or pathologic role in the causation of type 1 but are not the best predictor (A, B, and D). An individual with diabetes is training for a half marathon. During the training run lasting about 2 hours, what carbohydrate replacement, if any, is needed? A) 15g of carbohydrate each hour B) Carbohydrate replacement is not likely needed C) 30-50 g of carbohydrate each hour D) 75 g of carbohydrate each hour - answers-30-50 g of carbohydrate each hour C: To prevent hypoglycemia, the body generally requires 30 to 50 g of carbohydrate replacement each hour for high-intensity physical activity with duration 60 minutes. To truly gauge the amount of change in blood glucose during physical activity and determine if additional carbohydrate is needed, blood glucose readings can be taken at the start and end of the exertion, After his primary care appointment, a patient presents 2 new prescriptions for glargine insulin and lispro insulin to the diabetes educator. The patient has been taking NPH insulin and lispro insulin for several years and feels very comfortable with this combination. Which of the following is the MOST important counseling point for the patient today? A) Glargine insulin is stable at an acidic pH and must not be mixed with any other insulin in the same syringe B) Glargine insulin and lispro insulin are both clear, so care must be taken when mixing the 2 in a syringe C) Glargine crystallizes when injected subcutaneously, and no other insulin should be injected within 60 minutes D) Glargine insulin is 5 times more concentrated than NPH insulin, so only doses less than 0.2 ml should be injected - answers-Glargine insulin is stable at an acidic pH and must not be mixed with any other insulin in the same syringe A: Insulins come in a variety of concentrations, so B is not correct. Other insulin types should not be mixed with glargine because of irregular disruption of the absorption kinetics of both products (C). Glargine and other insulin products can be administered at the same time but should be injected in separate areas on the body using different syringes (D). FM's insulin-to-carbohydrate ratio is 1:12. His correction factor is 1 unit of rapid-acting insulin per 50 mg/dL of glucose. His target is 100 mg/dL, his pre-breakfast blood glucose is 205 mg/dL, and he calculates the carbohydrate in his breakfast to be 50 g. Which of the following is the MOST appropriate aspart insulin dose for this patient? A) 3 units B) 4 units C) 5 units D) 6 units - answers-6 units D: The calculation is as follows: Prebreakfast blood glucose (205 mg/dL) minus his target blood glucose (100 mg/dL) equals 105 mg/dL. Multiply the difference (105 mg/dL) by his correction factor (1 unit per 50 mg/dL) to equal 2 units. Multiply his calculated breakfast carbohydrate intake (50 g) by his insulin-to-carbohydrate ratio (1 unit per 12 g of carbohydrate) to equal 4 units. Add the amount of the correction insulin (2 units) to the amount of insulin to compensate for the meal (4 units) to equal 6 units of aspart insulin before breakfast. Which of the following is an interfering factor that may affect the accuracy of A1C levels? A) Low doses of aspirin (81 mg) B) Sickle-cell hemoglobin and other hemoglobinopathies C) High white blood cell count D) Oral contraceptives - answers-Sickle-cell hemoglobin and other hemoglobinopathies B: Since A1C is based on normal hemoglobin, hemoglobinopathies can affect the test in 3 ways: (1) altering the normal process of glycation from HbA to A1C; (2) causing an abnormal peak on chromatograph, making the estimation or A1C unreliable; (3) making the red blood cells more prone to hemolysis, thereby decreasing the time for glycosylation to occur and thereby producing a falsely low A1C. There is lack of evidence to support interference of low-dose aspirin usage with A1C result. Ingesting large doses of aspirin may, however, impact A1C result (A). White blood cell count is not related to hemoglobin A1C, which is a measure of the amount of glucose attached to the hemoglobin in the red blood cells (C). Oral contraceptives do not affect the accuracy of A1C result (D). Alcohol consumption by individuals using insulin or insulin secretagogues can increase: A) ketone production B) gluconeogenesis C) risk of hyperglycemia D) risk of hypoglycemia - answers-risk of hypoglycemia D: Alcohol can enhance glucose-stimulated insulin secretion and reduce gluconeogenesis (making B incorrect) in the liver, leading to an increased risk of hypoglycemia in individuals taking insulin or insulin secretagogues, especially if food intake has been restricted. Which of the following is the MOST frequent cause of inaccurate results from self-monitoring of blood glucose? A) Operator technique B) Improper calibration C) Expired or defective strips D) Inadequate blood sample - answers-Operator technique A: Operator technique is correct. Inaccurate results from self-monitoring of blood glucose come from a variety of sources; however, the most common is operator technique. Many newer blood glucose meters are self-calibrating (B) and do not start the test until an adequate sample is applied (D). Using expired or defective test strips may also cause inaccurate results; however, newer testing methodologies make this error less significant (C). LT comes to you for counseling. Her blood glucose levels are poorly controlled, she has stopped monitoring her blood glucose levels, and she reports sleep disturbances and difficulty concentrating. You should first: A) Screen her for depression B) Encourage her to enroll in diabetes self-management education and support services C) Reinforce the importance of blood glucose monitoring D) Work with her to set realistic self-care goals - answers-Screen her for depression. A patient with previously good blood pressure readings has an office-based blood pressure reading of 146/96 mmHg. What is the appropriate plan of action? A) Blood pressure is in the acceptable range, so no action is necessary B) Re-check blood pressure at a 3-month follow-up appointment C) Confirm blood pressure at a 3-month follow-up appointment D) Initiate antihypertensive drug therapy today - answers-Confirm blood pressure at a 3-month follow-up appointment. You are seeing K for counseling. She has a 10-year history of type 1 diabetes and a 1% increase in her A1C since her last medical visit. She tells you that she became divorced 2 months ago and has been having difficulty functioning at work and following her self-management plan for several weeks now. Which of the following is the MOST likely diagnosis to accompany these symptoms? A) Major depressive disorder B) Adjustment disorder with depressed mood C) Dysthmic disorder D) Adjustment disorder with anxiety - answers-Adjustment disorder with depressed mood. The prioritization of learning objectives should be based on the: A) Review of the medical record B) Recommendation of the referring physician C) Diabetes education curriculum D) Patient's identified interests or needs - answers-Patient's identified interests or needs. Changes in physical activity levels and problem-solving abilities are good indicators of: A) Learning B) Continuous quality improvement C) Behavior change D) Improved health status - answers-Behavior Change