CDE Exam Review

Question 1

Physical activity recommendations for children and adolescents

Answer 1

At least 60 minutes of moderate intensity physical activity daily

Question 2

Large doses of aspirin, 4grams/day, can cause?

Answer 2

Increased basal and stimulated release of insulin

Question 3

States of the Trans-theoretical model of behavior change

Answer 3

Precontemplation
Contemplation
Preparation
Action
Maintenance
Termination

Question 4

Trans-theoretical model of behavior change

Stage 1: PRECONTEMPLATION

Answer 4

The individual is not aware of the problem and has no intention of change the health behavior

Question 5

Trans-theoretical model of behavior change

Stage 2: CONTEMPLATION

Answer 5

The individual is aware of the problem & intends to change the behavior, knows benefits of the behavior change and the drawbacks. Can be a state of ambivalence

Question 6

Trans-theoretical model of behavior change

Stage 3: PREPARATION

Answer 6

The individual makes plans to facilitate the health behavior change

Question 7

Trans-theoretical model of behavior change

Stage 4: ACTION

Answer 7

The individual is taking action to change the health behavior

Question 8

Trans-theoretical model of behavior change

Stage 5: MAINTENANCE

Answer 8

The individual demonstrates the ability to sustain behavior

Question 9

Stages of CKD

Answer 9

5 stages

Question 10

CKD Stage 1

Answer 10

Stage 1 - Kidney damage with normal or elevated GFR

GFR >90

Question 11

CKD Stage 2

Answer 11

Kidney damage with mild decreased in GFR

GFR 60-89

Question 12

CKD Stage 3

Answer 12

Moderate decreased in GFR
GFR 30-59 - evaluate and treat complications
Metformin is contraindicated
if GFR <45 do not start metformin

Question 13

CKD Stage 4

Answer 13

Severe decreased in GFR

GFR 15-29 - prepare for kidney replacement therapy

Question 14

CKD Stage 5

Answer 14

Kidney failure

GFR <15 (or dialysis) Replacement if uremia present

Question 15

Screening for CKD

Answer 15

Type 1: 5 years after diagnosis, annually after that

Type 2: At diagnosis and annually also during pregnancy.

Question 16

Lipid medication contraindicated in dialysis

Answer 16

Statins

Question 17

Diabetes Medications contraindicated in Heart Failure

Answer 17

TZDs
Saxagliptin (Onglyza)
metformin
alogliptin (Nesina)

Question 18

Niacin

Answer 18

an alternative for statin-intolerant people
SE: Flusing, pruritis, rash, GI
Flushing resolves with use and better tolerated with meals
Minimize flushing by taking asa 30 min prior to niacin

Question 19

Triglyceride management

Answer 19

People with high TG need to normalize BG first before adding Omega 3, fibrates or niacin.
May need to start insulin if BG are too high
High TG contribute to increased insulin resistance

Question 20

St John’s Wort

Answer 20

Anti-depressive properties

Is thought to lower serum concentrations of other drugs

Question 21

GLP-1

albiglutide

Answer 21

albiglutide (Tanzium) does have the same wt loss as other GLP-1s. 0.6 kg compared to 2.2-3kg with others at 6 weeks.
Requires mixing and waiting 15-30 mins prior to injection.

Question 22

ASA recommendations

Answer 22

low dose asa is recommended in:
T1 and T2
>50 years old
10 year ASCVD risk >10%

Question 23

Insulin resistance

Answer 23

Abdominal fat is more metabolic active and turn over of free fatty acids (FFA)
In the liver FFA contributes to insulin resistance (lipotoxicity).
FFA may be used as a fuel source instead of glucose, they can contribute to hyperglycemia

Question 24

ADA 2016 B/P Guidelines for adults with T2D & HTN

Answer 24

<140/90

Question 25

ADA 2016 B/P Guidelines for younger individuals

Answer 25

lower targets <130/80 are appropriate considering the potential duration of the disease

Question 26

ADA 2016 B/P Guidelines in pregnancy

Answer 26

120/80 - 160/105

Lower targets may impair fetal growth

Question 27

ADA Guidelines for starting basal insulin

Answer 27

start basal insulin:

• 10 units a day
• 0.1 - 0.2 units/kg/day

Adjust 10-15% or 2-4 units once or twice weekly to reach FBG target

For hypo decrease dose by 4 units or 10-20%

Post meal BG reflects efficacy

Question 28

ADA Guidelines for starting meal insulin

Answer 28

start meal insulin at:
- 10% of basal rate
- 0.1 units/kg
- 4 units 
Adjust in 1-2 units increments or by 10-15% of the dose
For hypo decrease by 2-4 units or 10-20%
Fasting BG reflects efficacy