MCQ's from the Chapters based on 4th Edition of Board Review Manual Flashcards

Question

Regarding adverse drug reactions, which one of the following is incorrect? A) They often occur despite appropriate use. B) They are the 3rd leading cause of death in the US, ranking higher than pulmonary disease, diabetes, AIDS, pneumonia, accidents and motor vehicle accidents. C) There are more than two million serious reactions per year. D) The total cost of adverse drug reactions is more than that of cardiovascular disease or diabetes

Answer 1

Answer: B 4th leading cause

Answer 2

Answer E: its chronic systemic inflammation F. Decrease in LDL-C

Answer 3

9 in IH: psychosocial factors 10 in IS: psychological stress and depression were identified separately

Answer 4

Chicago Heart Association Detection Project in Industry (low risk CAD men had less than 2/3 Medicare costs of controls, low risk women less than 1/2) Diabetes Prevention Program CHIP Lifestyle program - Vanderbilt Community Weight-loss program for obese patients

Answer 5

B. 20% (21% in adolescents)

Answer 6

United Kingdom New Zealand (USA is the worst in both - 17% of GDP)

Answer 7

1. Heart Disease 2. Cancer 3. COVID-19 4. Accidents 5. Stroke 6. Chronic lower respiratory 7. Alzheimer’s 8. Diabetes

Answer 8

1. Hospitalizations 30% 2. Prescriptions for DM complications 30% 3. Prescriptions for DM 15%

Answer 9

23% 11% of total US population has it Almost 15% of adult population

Answer 10

1. DM2 - 327 billion 2. CVD - $216 billion (+ $147b lost productivity ) 3. Cancer (over $200b) 4. Obesity - $147 billion

Answer 11

CVD (48%) Pre diabetes Hypertension Obesity (41.9%)

Answer 12

1.assess the readiness level for change from TTM 2.offer stage-matched brief intervention 3.empower patients 4.create an inclusive environment in which patient feels comfortable and valued.

Answer 13

Four General principles of MI [ESRD] Express Empathy Support self efficacy Roll with Resistance (stay non-judgmental, supportive, curious) Discuss discrepancy (between current and desired future state) Helpful in Precontemplation and contemplation stages

Answer 14

Four core skills of MI - OARS Open ended questions: tell me more explore patients needs, ideas, concerns expectations, experiences, feelings, priorities Affirmations: use the word You rather than I. enhance patients self efficacy by recognising their strengths, intentions or efforts Reflections Summaries

Answer 15

**HARP** What do you **H**ear in your internal dialogue? **A**nalyse your internal dialogue: any cognitive distortions? **R**econstruct your thinking: write factual statements to replace distorted thinking. **P**ractice: to eliminate distorted thinking. | takes a lot of practice...

Answer 16

1. **All or Nothing Thinking**: i have not accomplished anything since i have been in graduate school 2. **Overgeneralisation**: he never washes his dishes 3. **Mental Filter**: my boss' review of full of criticism 4. **Mind Reading**: i know my partner think i did a terrible job on that presentation 5.**Fortune Telling**: i will probably just mess up and make a fool of myself. 6. **Magnification/Minimisation**: i haven't accomplished anything since i've been in medical school. 7.**Personlisation and blame**: that jerk just cut me off and made me spill my coffee they just ruined my day. 8.**Emotional Reasoning**: i feel like an idiot so i really must be one. 9. **Labelling/Mislabelling**: i am such a disorganised person. 10. **Disqualifying the positive**: giving up caffeine may have benefits but those benefits will be worthless since i might have a headache for a few days.

Answer 17

A: what **A**ction or Event occurred B: what **B**eliefs do you have about what happened C: What are the **C**onsequences of those beliefs? how does it make you feel? D: how can you **D**isrupt those beliefs that seem to be distorted and unhealthy? E: what **E**ffect does this new way of thinking have on how you feel and how you will move forward?

Answer 18

1. APPROACH emphasizes patient's current skills and abilities, strengths and positive actions (and associated successes) Values positive emotions, engagement relationships and meaning - healthy ratio of positive to negative 2. BENEFITS Builds patient's confidence Reinforces autonomy and self efficacy which are keys to sustainable self management. Enhances resiliency and helps undo negative feelings. Increases the positivity of the patient-provider interaction.

Answer 19

lifestyle prescriptions are brief, clear instructions for care or treatment pertaining to an individual patient prescriptions describe the action or behaviour change in the full extent necessary to treat or prevent. e:g a prescription for 150 minutes of moderate PA for a week. action plan: the life style prescription is adjusted and personalized for the patient's ability, readiness and confidence. e:g of action plan: start with walking 5 minutes a day for 5 days a week increased as tolerated up to the recommended amount of 150 minutes per week.

Answer 20

Importance, relevance, readiness

Answer 21

specific: identify the exact behaviour to be addressed measurable: how one will know when the goal is reached. Attainable: the goal is achievable and can be accomplished with current resources Relevant: the goal is in alignment with the specific behaviour change time-bound: the time frame for achieving that goal.

Answer 22

what benefits have you gained from the changes you have made what have you learnt from the challenging areas how do you feel about your situation.

Answer 23

common components of these theories: 1. beliefs about risks and benefits 2.motivation 4.self efficacy 5.environmental influence e:g social norms.

Answer 24

**assess**: practice in context of health risks **advice**: changing practice with clear, specific and personalised advice for behaviour change **agree**: on the focus of counselling and treatment based on patient's interest and willingness to change and collaboratively set specific goals. **assist**: the patient in achieving goals to change practices, address motivational barriers via counselling, if needs additional info or help, refer to dietitian **arrange**: regular follow up and support.

Answer 25

Answer C and E C Physician's with high empathy scores from their patient were more likely to achieve good HbA1c control than those with low empathy scores ( 56% vs 40%) E Health outcomes for HT, glucose levels and functional status are related to the patient-provider relationship.

Answer 26

Answer C and E C be empathic E share where disclosure will be beneficial to the patient. Self motivation is also known as autonomous or internal motivation. Self confidence is the trust a person has in their reasoning, capabilities and qualities.

Answer 27

PCPAMT Pre-contemplation Contemplation (start within 6 months) Preparation (start within 1 month) Action (< 6 mo) Maintenance (6 months without relapse) Termination (~5 years no desire to relapse?)

Answer 28

1. Mastery experiences (strongest) 2. Vicarious experiences 3. Social (verbal) persuasion 4. Physiological feedback- somatic and emotional states

Answer 29

ANSWER: D There are 6 constructs. ABC,E + Perceived benefit (of intervention) Perceived severity | There are 4 perceptions! ## Footnote p28, 4thEd.

Answer 30

ANSWER: B *subjective norms = what we think others will think* | Perceived power = internal locus of control

Answer 31

Autonomy Competency Relatedness

Answer 32

Provide information (brief) O: "How will you know it's time to think about making a change?" Listening Reflecting | **O**pen ended questions

Answer 33

Encourage patient to evaluate benefits and barriers Provide resources/info Encourage problem-solving

Answer 34

develop or refine action plan (guide goals to be specific and clear)

Answer 35

Celebrate successes Plan for relapses Reframe unhealthy thought patterns Establish systems of self-monitoring/accountability

Answer 36

Encourage reconnection to reasons for change, keep guiding specific and clear goals

Answer 37

Preparation Action Maintenance | MI good for Pre-con and contemplation

Answer 38

Benevolence Honesty Openness Reliability Competence

Answer 39

Starting the Conversation (8-items) Mediterranean Diet Adherence (MEDAS) ASA24 - NCI DHQ - National Cancer Institute (NCI)

Answer 40

``` TEE= Resting energy expenditure+ PA+ Diet induced Thermogenesis TEE= 60-75% of TEE+15->30% of TEE+10% of TEE ```

Answer 41

1. how many days a week do you engage in moderate to strenuous exercise such as brisk walking. 2.on average how many minutes per day do you exercise at this level. | sufficiently active = 150 minutes or more per week

Answer 42

training increase resting energy expenditure | improves activities of daily living, reduce the risk of falls especially in elderly.

Answer 43

Question to ask: how many serving s of Veg do you have in a day? repeat the question with Fruit, Whole grains, Beans, Legumes, nuts, seeds, herbs and spices then low fat diary products.

Answer 44

Vitamin A,D, E, C, folate, calcium, magnesium, Fiber and potassium they are found in veg fruit, whole grains, beans, legumes and low fat diary products.

Answer 45

A 1.dietary screener questionnaire in the National health and nutritional examination survey (NHANES) 2.Dietary screener in National Health Interview Survey (NHIS) Cancer control Survey (CCS) 3. Dietary screeners in the California health interview survey (CHIS) 4.Fruit and vegetables intake screeners in Eating at Americas Table Study (EATS) 5. Percentage of energy from fat screener. 6.Multifactor screener in observing protein and energy nutrition (OPEN) study. B The Mediterranean DASH diet intervention for neurodegenerative delay (MIND) diet score is a dietary screening tool. A positive score is associated with slower decline in global cognitive score, but findings needs to replicate in an intervention trial. C. The SOS free ( Salt/oil/sugar free) diet screener from T Colin Campbell centre for nutrition studies Food included: vegetables 10-30 + servings per day fruit 4-10+ servings per day, Whole grains 0-10+ servings per day, Legumes 0-5+ servings per day, Nuts and seeds 1 ounce per day. food not included: animal products, added sugar, salt and oil, refined grains, other processed foods. D. A short form food frequency questionnaire (SFFFQ) for primary care patient but didnt show significant agreement with a 24 hours telephone based diet recall.

Answer 46

10 item questionnaire scale 0- never to 4- very often over the last one month 1. upset because of something happened unexpectedly. 2. unable to control the important things in your life. 3.Felt nervous and stressed. 4. Felt confident about your ability to handle your personal problems. 5. felt that things were going your way. 6.could not cope with the things that you had to do. 7.able to control irritations in your life 8.felt that you were on top of things. 9.angered because of things that happened that were outside of your control. 10. felt that difficulties were pilling up so high that you could not overcome them. Negatively phrased questions: 1,2,3,6,9,10 never =0 almost never=1 sometimes=2 fairly often=3 very often=4 Positively Phrased: 4,5,7,8 Never=4 almost never=3 sometimes =2 fairly often=1 very often=0 higher the score more perceived stress one is under.

Answer 47

24 item assessing 3 aspects: task engagement, distress, worry

Answer 48

``` mini sleep assessment ask 1.typical weekend hours of sleep 2.typical weekend hours of sleep 3.perceived sleep quality Epworth sleepiness scale (ESS) 8 question assessment for daytime sleepiness. high scores consistent with moderate to severe excessive day time sleepiness. ```

Answer 49

ask scale 1= lowest to 5= highest 1.in most ways my life is close to my ideal 2.i am satisfied with my life. these two questions are from satisfied with life scale (SWLS) total 5 questions. older age, higher education and higher income associated with greater subjective well being. lower satisfaction= not being white, black and hispanic, lowest level of education and lower household income.

Answer 50

current, past or never used. | cigarettes cigars, chew and e cigarettes amount and years

Answer 51

screen at every visit if regular drinker otherwise annually. AUDIT-C The Alcohol Use disorders Identification Test-Concise 3 items 0= never low number of occurrences to 4=often high number of occurrences. 1. how often do you have drink containing alcohol. 2.how many drinks containing alcohol do you have on a typical day when you're drinking? 3. how often do you have six or more drinks on one occasion?

Answer 52

BMI= weight in Kg/ (height in metres)2 | imperial (weight in pounds/ (height in inches)2) x703

Answer 53

asians 18.5-22.9= normal 23-24.9= overweight >=25 =obese

Answer 54

1 Screening tools are helpful to start early discussion of lifestyle factors/intervention. 2. CVD 1.life's simple 7 questionnaire 2.ASCVD ( Atherosclerotic CVD) risk estimator plus by the American college of cardiology. *the assessment indicates the patient's risk of MI in the next 10 years. *20-79 years age without heart disease * non hispanic white and african americans underestimate risk = in American indian, some asian american of south asian ancestary and some hispanic ( Puerto ricans) overestimate risk in = Asian americans of east asian ancestary and some hispanics ( Mexican Americans) * age, gender, total cholesterol, HDL-C, LDL-C, Smoking status, Diabetes history, Treatment for HT, such as use of aspirin and or statin therapy. * low risk, borderline risk, intermediate risk and high risk

Answer 55

10 year coronary heart disease risk in multiethnic study | 39% non hispanic whites, 12% chinese americans, 28% african americans 22% hispanic americans.

Answer 56

considers family history and high sensitivity CRP which predicts risk of global CVD.

Answer 57

1. Waist circumference 2. Waist/Hip ratio 3. Bioimpedence analysis 4. pulse 5. BP 6. Measure of fitness 7. Fitness testing options.

Answer 58

increased risk of diabetes, HT and CVD relative to increased weight and waist circumference waist circumference is increase if >=40 inches or >=102cm in men >=35 inches or >=88cm in women

Answer 59

<=0.90 for men | <=0.85 for women

Answer 60

*AHA/ ACC 2017 normal BP <120/80 Elevated BP systolic 120-129/<80 stage 1 - 130-139/80-89 stage 2- >= 140/>=90 *high mortality from heart disease, stroke and other vascular disease. high morbidity from CVD incidence, angina, MI, Heart failure, stroke, PVD and AAA * prevalence of HT increases with age 42 more than 50% on adult over 60 have HT *screen for HT at each periodic visit every 6-12 months. * 2 mm Hg reduction= stroke 6% coronary heart disease 4% total 3% 3= 8,5,4 5= 14,9,7

Answer 61

U&ES LFTs Blood Glucose, Blood proteins, Acid base balance, FBC Fasting lipids ( TC, HDL-C, LDL-C, TG, High sensitivity CRP). HbA1c, OGTT, Fasting serum insulin, possibly c peptide, Homeostatic model assessment for insulin resistance ( HOMA-IR) Vitamin D, TFTs.

Answer 62

particle size has been shown to help stratify risk. particle density alone doesnt completely describe the role and function of cholesterol fractions. TG elevation is often associated with low HDL and increase girth waist circumference.

Answer 63

HOMA-IR is an estimate of insulin sensitivity and beta cell function based on the fasting plasma glucose concentration, fasting plasma insulin or c peptide measurements.

Answer 64

HbA1c of >6.5% but this diagnose 1/3 fewer cases of undiagnosed diabetes then looking at fasting plasma glucose test Fasting serum glucose >126mg/dl or 7 mmol/L 2 hours postprandial glucose of >=200mg/dl ( 11.1mmol/L) during in OGTT

Answer 65

fasting serum glucose of >= 100 mg/dl (5.6mmol/L)but <126 mg/dl (<7 mmol/L) 2 hours serum glucose in the 75gm OGTT of 140-199mg/dl (7.8-11 mmol/L) HbA1c 5.7-6.4%

Answer 66

if no risk factors begin screen at 45 years and then 3 yearly

Answer 67

Healthcare effectiveness data and information set. HEDIS most widely used healthcare improvement tool. HEDIS rates health plans, programs and providers on their quality and public can review the rating online. In LM tracking is essential for patient care, treatment analysis and reimbursement and follow up. EMR electronic medical records. can often helpful in traking metrics and high risk patient. it is improtant to know what EMR is traking and how the info is stored, maintained and if automatic prompts are possible.

Answer 68

Acupunctures and oriental medicine 2-4 years training National certification commission for acupuncture and oriental medicine NCCAOM chripractice DC- 4 years training federation of chiropractic licensing boards. FCLB Midwifery CPM, variable training North American Registry of midwives massage therapy, 500-1000 hours training National certification board for Therapeutic massage and bodywork NCBTMB naturopathic medicine 4 year training North American Board of Naturopathic examiners NABNE

Answer 69

Academy of nutrition and dietetics National association of nutrition professionals. American colleage of sports medicine ( registered clinical exercise physiologist, certified clinical exercise physiologist, certified perosnal trainer) US registry of exercise professionals. Certified Medical fitness Facility personal trainer directory The Yale Griffin Prevention research centre tips for Chronic disease prevention.

Answer 70

1. positive leaderships and management attributes. 2. communication strategies and structures. 3. Personal rewards, training and development. 4. Appropriate resources and procedures. 5. appropriate skill mix. 6. supportive team climate. 7. individual characterisitics that support interdisciplinary teamwork. 8. clarity of vision 9. quality and outcomes of care. 10. respecting and understanding roles.

Answer 71

1. National diabetes education program 2. Centre for disease control and prevention National diabetes prevention program. 3. California smokers helpline. 4. american heart association 5. Million heart initiative. 6. Human services referrals and information 7. state or area agency on aging 8. Classes and educational resources offered by local health systems, hospitals and public health departments. 9. local parks and recreation classes and services. 10. senior centre services.

Answer 72

1. improved access to care 2. increased patient adherance, satisfaction, lower hospiltalization rates, higher trust in providers, improved access for complex and elderly patient, better monitoring, received greater education from group discussions and peer support, improved access, gain additional choices in their care treatment options) and 3. provider satisfaction (more efficient use of time, enhances quality, outocomes patients' health experiences while containing cost and improving income, something different interesting and fun, reduces repitition allows more time and more frequent contact with patients, Group support and collaborative care is helpful in managing difficult, time consuming and psychologically needy patients) 4. reduce cost. among uncontrolled type 2DM patients group visits reduce total health care expenditure cost by ~30% 5. group visits also increases physician's productivity. 6. billiable when billing criteria are met.

Answer 73

Interdisciplinary team is associated with 1. hgh level of treatment compliance 2. improved health outcomes. 3. enhanced patient engagement and chronic disease self management. 4. enhanced weight loss after one year compared to standard care when provider or dietitian and dietitian/dietitian bth provided educational interventions

Answer 74

Interdisciplinary team is associated with 1. hgh level of treatment compliance 2. improved health outcomes. 3. enhanced patient engagement and chronic disease self management. 4. enhanced weight loss after one year compared to standard care when provider or dietitian and dietitian/dietitian bth provided educational interventions Healthy eating activites and lifestlye programs are associated with 1. weight reduction 2. improved in BP and PA parameters 3. Maintained behaviour change at 5 months after the program's completion. Training Lay healht educator is associated with improved implentation of lifestlye intervention in rural senour centres. life style modification in primary care. acceptance and referral to a collaborative or chronic care program from a primary care practice needs regular communications, follow ups to be easy and make sure doesnt take much of primary care time. Primary care nurse help with that.

Answer 75

1. Ornish spectrum program 2.Medical fitness collaboration 1.Ornish: intensive cardiac rehad program Team: registered nurse:education, biometric assessments, continuity of care, follow up of chrnoci conditions. Exercise physiologist: Physical activity rediness questionnaire assessment, individual and group exercise supervision. biometric assessment, fitness safety and principles presentation. health coach: consistent source of social support throughout change stress management specialist: mid body techniques, group facilitation and support, participation in group and individual fitness instriction. registered dietitian: recipe referral, nutrition counselling individually and group presentation on nutrition guidelines. chef and food services: training in food selection and prep, removes barriers on healthy eating. group support specialist.focus on lifestyle impact of intervention, facilitating dyanamic and group growth. administration and medical assistant. Marketing director. 2 Medical fitness collaboration. medically supervised inegrated outcomes and accountability based fitness program: active and regular medical oversight, qualified and crednetial staff. disease management and clinical integration of pragrams. individual exercise prescriptions. help transition from structured clinical treatment setting to community or home based exercise program. helpful for patient who need medical oversight and counselling

Answer 76

1. innovative care for chronic conditions (ICCC). report by the WHO at Micro level: patient and family meso level: health care organisation and community, Macro level: policy 2.Collaborative care model by the agency for healthcare research and quality (AHRQ) patient. nurse practitioner/ physician assistant, clinical expert, resident, interdisciplinary care team. they coordinate and facilitate patient care. 3. Value based care: financial incentives for accountable care organisations. 4.Chronic care model created by MacCall institute and Ed Wagner: helpful in explaining the involvement of the community and health care system in chronic disease care. they must work with local community: local gyms, politicians, community centres, oraganisations and faither systems. 5. implementing ch care model 6.the US deptt of veterans affairs hospital system comprehensive multisite model of care called 'whole health model' of care.

Answer 77

1. implementing the chronic care model into the a local medical practice. 2. health care delivery support 3. self management support 4. delivery system design 5. decision support 6. clinical information system.

Answer 78

- funded by Robert wood Johnson foundation in collaboration with the agency for healthcare research and quality (AHRQ) - 22 primary care based research network (PBRNs) that developed, piloted and evaluated 27 evidence based strategies to improve delivery and effectiveness of healthcare behaviour in the field of primary care. - four health risk behaviours: tobacco use, Risky alcohol use, unhealthy diet, lack of PA. - findings- **primary care offices were capable and wanted to address health behaviour when funding and support were available via PBRNs. - **health care delivery model such as patient centre medical home was important. * *substantial practice design needed to occur with the integration of public health and community resources. * * dozens of studies were published * * prescription for health toolkit not accessible now. * *AHRQ developed electronic preventive services selector (ePSS) used by provider at time of visit for decision support with screening, counselling and preventive services. website and app.

Answer 79

Physician's personal health behaviours. 2009 survey of californian physicians: number 763 severe to moderate stress: 53% no or occasional exercise 35% 6 or few hours of sleep 34% never or occasionally ate breakfast 27% sedative/tranquilizer use 13% depression 7% Marijuana use 4% 2012 survey 53% of primary care physicians were obese. in 2013 36% of canadian 4th year medical students surveyed didnt meet PA guidelines in 2013 article overweight resident physicians under acknowledged their overweight status and their under- acknowledgement increased by training year. other studies have found physicians are practising healthy behaviours therefore arguing against unhealthy doctors' in 2000 study in men, mortality outcome suggest that physicians live longer than same race professionals and non professional in the US population. in 2015 study: physicians and medical students engage in more PA than the general US adult population.

Answer 80

A. in Life style medicine 3rd edition 2019 by J Rippe. Erica Franks says 1. providers need to focus on their own health. 2.healthy doctors are more likely to produce healthy patients. B. meta-analysis of 24 studies high correlation between physician's PA habits and counselling frequency odds of counselling 1.4-5.7 times higher among the exercising physicians. C. Cross sectional study on 1349 internists Male internists: with smoking, alcohol, seat belt use, and PA were positively associated with counselling for each health behaviour except alcohol use. Female: with PA positively associated with counselling patients about exercise and alcohol use. D. physician who exercise( aerobic and strength) are more likely to counsel patients on exercise than who dont E.physician attempting to chase their own poor habits counsel more F. training primary care physician in behavioural counselling and providing them with tools and resources helps in their practice of weight related care. G. in 2014 study physician and medical student with normal BMI felt confident about counselling their patients about PA. H. non smoking physician emphasize the risk of smoking. I physician more likely to record diagnosis of obesity and initiate a conversation if they perceived patient weight to be more than their own. J. female physician's personal health practices, counsel of behaviour change at least once a year= if they ate less fat counsel on cholesterol, if ate five fruit and veg per day they counsel more on nutrition, if consumed veg diet counsel on weight loss and nutrition. K. poor physician health habits impact counselling they provide to their patients. L. The American Medical association code of medical ethics'' physician health and wellness'' physicians have responsibility to maintain their health and wellness for safety and effectiveness of the medical care they provide. M. Physicians are high risk of burn out: which is syndrome of high emotional exhaustion, high depersonalization and a low sense of personal accomplishment from work. 2019 consensus study by national medical academy NAM report US 35-45% on nurses and physicians have substantial symptoms of burnout. medical students 45-60%. suboptimal care for patient may be one of the unintended consequences of physician burnout. NAM suggests interventions to prevent and reduce burnout need to be both individual based and organisationally focused strategies.

Answer 81

PA opportunities inside and outside office: gym on site, local gym discounts. implement wellness culture in office with breaks for PA and healthy foods. provide healthy meals inside and outside office dont serve or provide unhealthy food at office events. install standing workstations or treadmill desks especially for those who primarily work on the computer. consider using technology to assist in tracking activities such as phone applications or pedometers. engage colleagues in health challenges and competitions. involve in local community changes '' walk with Doc'' supporting and incorporating wellness programs in the office helps promote the practices and set an example for patients.

Answer 82

1. Readiness for personal action plan for providers. similar to patient. stage of change SMART goals confidence scale and importance scale etc. 2. reassess progress, confidence and importance of making change. 3. celebrate success, brainstorm ways to overcome barriers and to help specific actions.

Answer 83

Mobilising physicians for community level changes. 1. advocacy 2. community advocacy for public health needs. 3. goals of acquiring advocacy skills. 4. provider in advocate role 5. ways one can begin to advocate. a. be a resource by supplying information and educational material, set an example by being a life style medicine champion in one's social and medical network, offer expertise to elected officials, local decision makers and community organisations, reach out through one's network both online and in person. plan or host an event. speak at a community meeting or with the media. 6. advocacy check list.: a. define the problem and desired solution or policy intervention. ( E;g access to healthy food, walking paths, safe places to be PA, neighbourhood design) b. understand one's audience stakeholders, who might help or hinder to achieve goals. ideal time to approach the stakeholders. c. determine strategy tactics and timeline: decision maker meet individually or in group, legal or regulatory guidelines to consider, develop strategies to overcome resistance who might oppose. d. evaluate outcomes: metrics need to be tracked to determines whether and when then implemented change has worked, predetermine what a successful intervention will look like.

Answer 84

1. Blue Zone project. its a community led collaboration north America. blue zone five geographical location in the world where world's heathiest people live ( oinawa in japan, sardinia italy, Nicoya peninsula costa rica, Ikaria Greece, Loma Linda california communities with 9 common characteristics: 1. they move naturally in their day to day life 2. feel a sense of purpose 3.eat mainly a plant based diet 4.stop eating after becoming 80% full 5.relax 6. downshift 7. put family first 8.find the right tribe to engage with 9.belong to something greater than yourself. 2. Robert Wood Johnson foundation. '' creating a culture of health'' community leaders and medical providers collaborate in these cities to bring about better health. 3.Dean ornish's plant based cardica rehab program. 4.Plan4health intiative by the american public health association and american planning association. 5.project for public spaces new york connection between place and health. 6.the urban land institute network community designs and place acitivation. 7.main street america: 4 points economic vitality, design, promotion and organisation. 8.creative placemaking by national endownment of arts: incorporating the art to transform communties. 9. national complete street coalition : to design and construct streets that are safe and accessible to all members of the community.

Answer 85

G. 45-60% medical students 35-45% nurses and physicians

Answer 86

B. understanding one's audience is important.

Answer 87

C and G C: Dean Ornish G: no such project apart from Blue zone

Answer 88

D. Overall benefits of physical activity include: a. Higher health-related fitness. b. Higher control and maintenance of a health body weight. c. Lower risk of disabling medical conditions. d. Lower chronic disease rates than inactive people. e. Most interventions to increase physical activity are cost effective, as health care spending increases as activity levels decrease.

Answer 89

C. Meditation is not a form of physical exercise. The different types of exercise include: a. Aerobic and endurance (cardiovascular). b. Strengthening (resistance training). c. Flexibility (stretching). d. Static and dynamic exercises (balance).

Answer 90

B. Most health benefits are achieved at 150 minutes a week of moderate-intensity of physical activity, or 75 minutes of vigorous physical activity or an equivalent combination. Beyond 150 minutes there are still benefits, but they are much less in amplitude.

Answer 91

A. | Exercise is better than medications for post-stroke patients.

Answer 92

E. Poor cardiorespiratory fitness Physical inactivity is the fourth leading risk factor for global mortality. Low cardiorespiratory fitness was the no. 1 cause of preventable deaths from all-cause mortality in 40,842 men and women who were enrolled in the Aerobics Center Longitudinal Study. [Sui et al. Percentage of Deaths Attributable to Poor Cardiovascular Health Lifestyle Factors: Findings from the Aerobics Center Longitudinal Study. Epidemiology Research International. 2013.]

Answer 93

E. All of the above are true statements.

Answer 94

A. Begin walking at a moderate intensity for 45 minutes at least five days per week. The FITT exercise prescription for cardiovascular exercise includes Frequency, Intensity, Type of exercise, Time (duration). For example, begin a slow jog/race walk (type) at a moderate intensity (intensity) for 45 minutes (time) for at least five days per week (duration).

Answer 95

C. With vigorous exercise, one should be able to carry on a conversation without difficulty. The Talk Test is a common measure of exercise intensity. a. Very light to light exercise (63% or less of maximum HR) and are able to talk and/or sing. b. Moderate exercise (64% to 77% of maximum HR) and are able to talk but not sing. c. Vigorous to maximal exercise (77 to 100% of maximal HR) and have difficulty speaking.

Answer 96

A. 40-50% 1-RM B. 60-80% 1-RM C. 80% 1-RM | Reps usually 8-12 per set. Older adults & endurance training 10-15 reps

Answer 97

A. Physical activity. Fitness is defined as “the ability to carry out daily tasks with vigor and alertness without undue fatigue, with ample energy to enjoy leisure-time pursuits and the ability to respond to emergencies.” Exercise is a subset of physical activity that is formally defined as “physical activity that is planned, structured, repetitive, and purposeful in the sense that the improvement or maintenance of one or more components.” Isokinetic exercise is a type of strength training that uses special machines or dynamometers to maintain a constant (iso) speed (kinetic) of movement. PLANS R PURPOSEFUL [CDC. Glossary of Terms. Physical Activity. June 10, 2015.]

Answer 98

E. All of the above These are all considered components of health-related physical fitness. Flexibility (which is not listed) is also considered a component. [ACSM. Benefits and Risks Associated with Physical Activity. In: Whaley MH, ed. ACSM’s Guidelines for Exercise Testing and Prescription. 7th Ed. Baltimore: Lippincott Williams & Wilkins; 2006:3.]

Answer 99

B. 60 minutes or more per day of moderate- to vigorous-intensity physical activity. The current Centers for Disease Control and Prevention (CDC) guidelines recommend 60 minutes or more a day of moderate- to vigorous-intensity physical activity for children. Choice C is the recommended physical activity guidelines for adults, while choice D provides additional health benefits to adults above and beyond choice C. Thirty minutes per day is generally a good goal for most adults, but that’s not a specifically recommended amount of time by the CDC. [CDC. 2008 Physical Activity Guidelines. Children. 2008. [2/25/18]; Available from https://health.gov/paguidelines/guidelines/children.aspx]

Answer 100

B. 10. While there is evidence that high-intensity interval training is effective in reaping health benefits and fitness improvements, guidelines still recommend that exercise bouts last at least 10 minutes. Thirty minutes is generally a good goal for most adults, while 60 minutes is a good daily goal for children. [CDC. 2008 Physical Activity Guidelines. Active Adults. 2008. [2/25/18]; Available from https://health.gov/ paguidelines/guidelines/chapter4.aspx]

Answer 101

C. Type. A FITT prescription includes the Frequency, Intensity, Time and Type of activity. [ACSM. Guidelines for exercise testing and prescription. 8. Philadelphia: Lippincott Williams & Wilkins; 2010.]

Answer 102

B. 1 and 2. This meta-epidemiological study included 305 randomized controlled trials (RCTs) and found that exercise decreased mortality more than medications in post-stroke studies. Exercise also had an equivalent effect on mortality to medications for the secondary prevention of coronary artery disease (CAD) and pre-diabetes, but it was inferior to medications with regard to heart failure patients. [Naci et al. Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. BMJ. 2013]

Answer 103

D. The correct order is: assess, advise, agree, assist, arrange. The 5A’s begin with assessing patient beliefs, behaviors, and knowledge, then advising by providing information about the health benefits of change, and then agreeing on a collaborative goal. Next, the provider assists the patient in identifying barriers, strategies and problem-solving techniques before finally arranging to follow up on plans. and for tobacco or intervention counseling are Ask, Advise, Assess, Assist, and Arrange.

Answer 104

A. 1, 3 and 4. Referral to a health provider should be made on the basis of current physical activity levels and presence of signs or symptoms and/or known cardiovascular, metabolic or renal disease. While one might modify an exercise prescription for someone with pulmonary disease, pulmonary disease alone does not require medical clearance, as it has not been shown to increase the risk of cardiovascular complications. [Riebe D, et al. Updating ACSM’s Recommendations for Exercise Preparticipation Health Screening. 2015;47:2473-2479.]

Answer 105

D. Barely talk The Talk Test is an intensity measure that’s easy for patients to perform on their own. Very light or light activity should allow patients to talk and/or sing without difficulty (HR 63% or less of maximal). Moderate exercise (64 to 76% of maximal) should allow individuals to talk but not sing (Answer C). Vigorous to maximal exercise (77 to 100% of maximal) should make it difficult for an individual to talk or hold a conversation. [Persinger R, et al. Consistency of the talk test for exercise prescription. Med Sci Sports Exerc, 2004. 36(9): p. 1632-6.]

Answer 106

C. A 30-year-old female who has known diabetes, does not currently participate in regular exercise and is asymptomatic. An asymptomatic male with no known cardiovascular, metabolic or renal disease does not require medical clearance before beginning a moderate-intensity or vigorous-intensity exercise program. An adult with known cardiovascular, metabolic or renal disease who is already participating in regular moderate-intensity exercise and is asymptomatic does not need a referral for moderate-intensity exercise. However, a referral is recommended if they want to pursue vigorous-intensity exercise. It’s recommended that an adult with known cardiovascular, metabolic (e.g., diabetes), or renal disease who does not currently exercise should be referred for medical clearance, even if they are asymptomatic. Any symptomatic individual should be referred for medical clearance. [Riebe D, et al. Updating ACSM’s Recommendations for Exercise Preparticipation Health Screening. 2015;47:2473-2479.]

Answer 107

C. Five hours. People who want to lose a substantial amount of weight (more than 5% of body weight) and people who are trying to keep a significant amount of weight off once it has been lost need a high amount of physical activity unless they also reduce their caloric intake. Many people need to do more than 300 minutes of moderate-intensity activity a week to meet weight–control goals. Seventy-five minutes is likely insufficient to meet health recommendations or weight loss goals. Two and a half hours would be appropriate for general health benefits. Seven hours may offer additional health benefits and further assist with weight loss efforts. [CDC. 2008 Physical Activity Guidelines. Active Adults. 2008. [2/25/18]; Available from https://health.gov/ paguidelines/guidelines/chapter2.aspx.]

Answer 108

B. 5 to 10% of initial weight; 15 to 20%. Research has shown that goal weight loss for health benefits is five to 10%, however weight loss of 15 to 20% may be necessary for continued disease improvement in individuals who have a BMI > 35 and comorbidities.

Answer 109

D. Leptin and amylin. One year after initial weight loss, a change occurs in the circulating hormones of appetite that encourage weight gain, including increased gherlin, GIP, PP, and decreased leptin, peptide YY, CCK and amylin.

Answer 110

C. Weight loss medications help with adherence to a lower-calorie diet and physical activity. Medications should be used for the FDA approved duration of time with target weight loss in mind. Approximately 50% of people who undergo bariatric surgery will experience weight regain within five years. Patients who are physically active pre- and post-surgery may experience fewer surgical complications.

Answer 111

B. Intensive behavioral therapy for obesity is a US Preventative Services Task Force (USPSTF) grade B recommendation and includes screening using BMI, nutritional assessment, intensive behavioral counseling and behavioral therapy.

Answer 112

D. | The effects of lifestyle change include all the above.

Answer 113

D Children should exercise one hour/day, with ≥ three days/week of vigorous activity with muscle-strengthening or bone-strengthening exercises for one hour/day, ≥ three days/week. Adults >65 should exercise 150 minutes/week of moderate to vigorous aerobic activity, or as close to guidelines as possible.

Answer 114

D Respiratory diseases are not a significant cause of death associated with exercise and do not need to be evaluate in routine exercise screening. The three components of exercise screening are: Current physical activity level Desired physical activity level Presence of cardiovascular, renal, or metabolic disease

Answer 115

A. A sedentary patient with diabetes who is uncontrolled True B. Patient with chest pain with light walking True C. Patient with asthma and wheezing during exercise False D. A patient with high cholesterol False E. Moderately active patient with chronic kidney disease who was cleared six months ago False

Answer 116

E. 36 year old male physician, who has a bottle of wine every evening and six beers once a weekend, AUD 18 AUDIT Scores help guide therapy 5-10: at risk drinker (20% will have alcohol use disorder) 11-15: more at risk (40% have alcohol use disorder) 16+: high probability of moderate + alcohol use disorder (90%) Higher scores = greater sensitivity An audit score of 18 is consistent with a 90% chance the patient will have alcohol use disorder.

Answer 117

D Physical activity is a validated vital sign; all others have not been validated by research but rather are markers suggested by expert opinion

Answer 118

A Singleness and being overweight are risk factors for physical inactivity (Answer A). Currently smoking is still listed as the number one cause of preventable deaths, but physical inactivity is becoming increasingly more important as a public health concern (Answer B). Weight training incorporation often takes a referral to an exercise specialist (Answer C). Muscular endurance is easy to test in clinic but muscular strength requires assistance with a machine like a bench or squat press (Answer D).

Answer 119

A. 0.9 METs B. 1.0 METs C. 3 METs [3 = 3!] D. 5 METs E. 18 METs | Biking 12mph = 6 METs Jumping rope = 9 METs

Answer 120

METs are an absolute measure, so the patient would need to increase the number of METs/hour/week over time to continue increasing their fitness

Answer 121

A. NO, VEGF: Enhanced endothelial function B. Adiponectin, catecholamines C. catecholamines, IL-6, myonectin D. Adiponectin, myostatin, IL-6, -7,-15, GLUT-4 E. follistatin, IL-6 F. BDNF, BDNF-trophic factor G. anti-inflammatory cytokines H. increased SCFA I. TGF beta 1, sclerostin

Answer 122

at **400 minutes** of moderate or vigorous exercise a week [this is about **15-22.4** **METs**] though benefits still accrue, just diminishing returns (gain another 0.5 year at 500 minutes)

Answer 123

1. Improved diastolic dysfunction 2. increased cardiac efficiency 3. improved insultin-mediated glucose control 4. more energy expended in shorter timeframe ## Footnote No other verified benefits. Any dislike is due to being above lactate and ventilatory thresholds

Answer 124

Average 6MWD = 400-700 meters (how far do they go in 6 minutes) | 6MWD Used to estimate COPD severity

Answer 125

## Footnote p203, 4th Ed.

Answer 126

Answer: 1. A D E B less likely C suppression of immune system and long-term organ and tissue damage E women

Answer 127

3. B and D Its decreased heart rate variability and hypercoagulability

Answer 128

4. D 14-26 is moderate stress and 27-40 is high stress

Answer 129

ANSWER: D and E A. Adolescents are included B; its positive screen C; 72% sensitivity and 85% specificity F; Spanish speaking Latinos are more likely to endorse crying vs English speaking Latinos

Answer 130

6. B and E B; no specific recommendation by the USPSTF E: score of 0-2= normal, 3-5= mild, 6-8= moderate, 9-12= severe

Answer 131

7. A and C but Band D are non-modifiable

Answer 132

8. B it is too much Arachidonic acid

Answer 133

9. A and C A; Bidirectional C: Negative perceptions

Answer 134

10. B, D and E. B: modifiable and several years D: decreased heart rate variability E: treatment improves symptoms and quality of life. There are no clear findings regarding survival.

Answer 135

11. A G I A; blue light G: meaningful causes I: outdoor in nature

Answer 136

12. F its emotional intelligence

Answer 137

13. E, F, G, H A: exercise is not more effective B: First line C: risk of depression D: These foods are risk on arachidonic acid leading to inflammation to and increase risk of depression I: C is consequences not complications.

Answer 138

14. B cognitive restructuring is to not to focus on events that can't be changed. Find another way to look at the situation.

Answer 139

15. A, B, E A: ideal ratio 3:1 B: unlikely people will be able to overcome obstacles E: It's happiest days

Answer 140

16. E: its 6 days per week.

Answer 141

ANSWER: C | Adults can grow 700 neurons a day!

Answer 142

18. A, B, D C: decreased

Answer 143

19. A: prefrontal

Answer 144

21. E and F E: low octane diet e:g white bread/white pasta/white rice/Bakery items F: too little physical exercise.

Answer 145

D. Multifactorial lifestyle variables contribute to nearly 70% of primary care provider visits and can be successfully diagnosed and treated. Lifestyle medicine: contributes to 70% of primary care provider visits; is multifactorial both in disease generation and treatment; is less likely to be engaged by over-stressed and overwhelmed individuals; and is more likely to be impactful when people in need of close follow up are identified.

Answer 146

D. A prior self-harm episode via ingestion of only three pills without hospitalization was not documented in the patient’s chart. Depression causes more harm when it’s untreated, unrecognized or undocumented in a patient’s past medical history. It’s diagnosed with DSM-V and a high psychometric assessment score upon screening. Depression can be treated with lifestyle modifications rather than pharmaceuticals based on certain screening protocols

Answer 147

A. Cognitive Behavioral Therapy (CBT). Fitness and exercise is comparable to cognitive behavioral therapy (CBT), but it’s not as directly effective as pharmacotherapies. Increasing omega 3 fatty acids demonstrates a good response with bipolar depression and not mania

Answer 148

E. Egocentricity. Unnecessary suffering is wanting a different outcome than the one that has happened. It begins with egocentricity (wants, likes, dislikes, attachments, cravings and aversions), has anticipatory thinking (imagining the worst), can include repeating stories about the past and trying to resist pain.

Answer 149

E. | Pain level.

Answer 150

A. Compassion fatigue is distress and tension in which the helper is traumatized and preoccupied with suffering. Compassion fatigue can lead to poor coping, poor self-care and self-sacrifice, which is similar to PTSD. Compassion burnout is associated with lack of job satisfaction, to many hours, low pay and stress.

Answer 151

B. Cognitive agility and deep focus. Mindfulness skills enable presence, clarity and curiosity in a clinical encounter. These skills directly affect the pre-frontal cortex, thereby decreasing scattered brain states and allowing for deep focus inside of sequential tasking. This kind of focus is how roughly 95% of the population processes information and performs tasks, as opposed to the less than 5% of the population who are able to perform multitasking.

Answer 152

A. In-person coaching and phone coaching. Phone coaching has a 38% effectiveness rate, while in-person coaching has a 41% effectiveness rate. A placebo has a 19% effectiveness rate.

Answer 153

E. Measuring disease alteration and prevalence. Facilitating health behavior change is a process of altering a behavioral pattern from stimulus, to thought, to action via both internal and external resources. It isn’t a tool to measure an already existing disease pathology, the prevalence of that disease pathology, or the observable change of that disease pathology (regardless of mental or physical symptomatology and disease pathology).

Answer 154

2 question screening tool, over the past two weeks have you felt: 1. down depressed or hopeless 2. little interest or pleasure in doing things 0-3 points each, 3 or more = positivie

Answer 155

1. unintended weight loss/anorexia 2. insomnia/hypersomnia 3. psychomotor changes 4. fatigue/loss of energy 5. feelings of worthlessness/excessive guilt 6. trouble concentrating/indecisiveness 7. recurrent thoughts of death/SI

Answer 156

Screening tool for anxiety and depression: * over last two weeks * 2Q anxiety * 2Q depression (PHQ-2 questions)

Answer 157

Maximum score is 12 1. 6-8 2. 3 or higher

Answer 158

D. Taking melatonin (1 mg sublingual) one hour before the new ideal sleep time. Melatonin may help with entrainment. The other responses would all contribute to a delay of sleep onset at the new ideal time.

Answer 159

B. A cortisol spike during the first four hours of sleep. With healthy sleep, cortisol spikes upon awakening, not during the first four hours of sleep. The remaining answers characterize normal sleep during the initial hours of sleep.

Answer 160

C. Obstructive sleep apnea. The patient profile best fits obstructive sleep apnea

Answer 161

E. Watching television in bed while falling asleep each night. Watching television exposes people to blue light, which contributes to a delay of the onset of sleep.

Answer 162

A. Behaviorally Induced Insufficient Sleep Syndrome (BIISS). The patient profile best fits BIISS: A chronic, voluntary sleep restriction that commonly causes excessive daytime sleepiness and daytime fatigue.

Answer 163

B. Shift meals that have a higher concentration of carbohydrates to earlier in the day. Eliminate daytime caffeine, but eliminate alcohol within three hours of bedtime. Avoid high sodium foods as they restrict vasodilation. Dim lights 30 to 60 minutes prior to bedtime.

Answer 164

C. Going outside for a walk in the sunshine in the late afternoon. Shift breakfast and any caffeine until 45 minutes after her ideal wakeup time. Avoid any bright lights until her ideal wakeup time. Light in the late afternoon increases melatonin production and will help her sleep cycle. D is true, but patient may be able to change her lifestyle to help improve her sleep.

Answer 165

E. All are correct. A Mini Sleep Assessment includes asking about typical weekday hours of sleep, typical weekend hours of sleep and perceived sleep quality. In addition to the above, other “red flags” include poor sleep quality despite seven or more hours in bed and getting more than nine hours of sleep.

Answer 166

D. A and C Melatonin and peripheral skin temperature are directly related. B is incorrect because as melatonin increases, so does the peripheral skin temperature.

Answer 167

D. Leads to delayed phase sleep similar to westward travel. Blue light creates greater melatonin suppression at higher intensities and higher durations. It increases nighttime heart rate, blood pressure and core body temperature. Blue light decreases sleepiness. It also leads to delayed phase sleep that is similar to westward travel (e.g., it postpones sleep onset by making the body think it’s earlier than it is).

Answer 168

C. Impaired sleep quality leads to decreased fear extinguishing and preserved memory of fearful events.

Answer 169

A. impaired B. increased (lack of production inhibition) C. increased D. decreased

Answer 170

1. Cortisol increased 2. Insulin sensitivity decreased 3. glucose elevated 4. leptin decreased 5. testosterone decreased 6. growth hormones decreased 7. AGE deposition increased 8. dyslipidemia 9. endothelial dysfunction

Answer 171

A. stomach B. tells brain we are hungry (it "ghrrrrgles") C. short-term weight hormone

Answer 172

BEP-CA: breast endometrial prostate colorectal AML

Answer 173

1. increased risk of CA (skin) 2. increased risk of infection (pneumonia) 3. unpredictable response in the short-term 4. CBT is more effective in the long term

Answer 174

STOP-BANG Snoring (loud) Tired often Observed apneic episodes Pressure is elevated or on HTN meds BMI > 35 Age >50 Neck size 17" or more for men, 16" or more for women Gender is male 5-8 is high risk, or 2 STOP questions + 1 non-age BANG risk factor

Answer 175

1. Environment (dark, cool) 2. Light (increase early light exposure, exercise outdoors, red-light if needed at night) 3. Diet - increase hydration and avoid diuretics (caffeine/alcohol) 4. increase exercise 5. Stress - address nighttime worrying/ruminating

Answer 176

A. appliance displays B.halogen, fluorescent bulbs, electronic LED screens C. incandescent, warm white bulbs, candles | shorter wavelengths (blue) trigger more alert response & inhib melatonin

Answer 177

1. circadian rhythm disorders 2. primary insomnia 3. age-related insomnia 4. jet lag | remember melatonin is a phase-shifter, not a sleep aid

Answer 178

A. Noon - no effect B. Just after 6pm, 30 minute delay (fall asleep later) C. Around 8-9pm, 60 minute delay D. Around 3am, 60 min advance - will wake up too early! E. On awakening (end of night), advances the clock 30 minutes, but is normal and necessary (because the natural clock lasts 24.1-24.4 hours!)

Answer 179

C. Tobacco use is the leading cause of preventable death in the United States. Physical inactivity is the fourth leading risk factor for global mortality.

Answer 180

D. All of the above. Smoking worsens or leads to erectile dysfunction, diabetes mellitus and infertility.

Answer 181

B. Quitting at age 30 adds 10 years of life expectancy versus quitting at age 60, which adds three years of life expectancy.

Answer 182

D. A and B. The combination of counseling and medication is more effective than either alone, and hypnosis is less effective than either counseling or medication.

Answer 183

D. Clonidine is currently a second-line medication for tobacco cessation as an off-label use. It should be prescribed on a case-by-case basis when the first-line medications are contraindicated or have not been effective.

Answer 184

B. Counseling is the best option for pregnant smokers, as there could be a potential risk of birth defects with NRT. Bipolar patients should not use bupropion but can use the patch. NRT is safe for adolescents. There is no association between nicotine patch use and acute coronary syndrome.

Answer 185

D. Accept The 5 A’s model for tobacco cessation helps to facilitate behavior change. It is comprised of: Ask, Advise, Assess, Assist, Arrange. The 5 A’s of behavior change counseling are Assess, Advise, Agree, Assist, Arrange.

Answer 186

B. At-risk drinking is drinking that increases the risk for future problems, but with no current symptoms; binge drinking ≥ 1 time a month; or exceeding the low risk drinking guidelines at any time. Getting a DUI would be considered a sign of alcohol use disorder as it is continued use despite internal consequences. Drinking to avoid withdrawal symptoms is not part of the definition of at-risk drinking or of alcohol use disorder. “Alcohol abuse and dependence” was the DSM4 terminology for alcohol use disorder.

Answer 187

C. A male who does not like to go to a party if there is not going to be alcohol there, has developed tolerance to alcohol use, wakes up craving vodka, and has experienced alcohol withdrawal over a 12 month period. Alcohol abuse disorder is diagnosed by the presence of at least two out of 11 possible signs or symptoms of the DSM5 alcohol use disorder criteria during a 12-month period. Moderate alcohol use disorder is categorized by the presence of four to five signs or symptoms that occur over a 12-month period.

Answer 188

D. Nortriptyline is not an anti-relapse medication. Anti-relapse medications include naltrexone, acamprosate, disulfiram, gabapentin and topiramate.

Answer 189

10 years Most of the benefit gained in first 5 years (40%)

Answer 190

Ask (screen for use) Advise (of risks/consequences) Assess (is patient ready?) Assist (includes pharmacotherapy, counseling) Arrange (schedule f/u within a week of quit date and 1 month after)

Answer 191

PALS don't use patches pregnant women adolescents light smokers (<10 per day) smokeless tobacco users

Answer 192

1. How soon until first cigarette (in minutes)? <5 (3 pts) >60 (0 points) 2. How many cigarettes a day? 10 or less (0 points) to 31 or more (3 points)

Answer 193

5 levels 2-4-5-7-10 (upper limits)

Answer 194

Varenicline nicotinic receptor partial agonist, renally cleared Cautions: psych or seizure hx, EtOH use, CVD. no other specific contraindications

Answer 195

FDA: Naltrexone, Acamprosate, Disulfiram (= placebo) off-label: gabapentin increases abstinence rates, topiramate may reduce % days of heavy drinking

Answer 196

Answer A, D, E are correct. A – True p 289 B – False. Tobacco products kill 1 in 2 of those people who use them! P289 C – False. - Cigarette smoking causes: -- 87% of lung cancer deaths (of which lung adenocarcinoma is the most common) = True, -- 32% of coronary heart disease deaths = True -- 70% of all deaths from COPD = False, it’s actually 80%, p289. D – True. Cigarette smoking may worsen all of the mentioned conditions pg. 290. Please regarding AMD risk is from Rotterdam Study doi:10.1001/archopht.1996.01100140393005 E –True p291

Answer 197

Answer - E. A – False p295 B – False p295 C – False p295-296 D – False p 296 advise the patient to quit in a clear, strong and personalised manner e.g. continuing smoking will worsen your asthma E – True p295

Answer 198

Answer: C Rationale: a. The AUDIT-C should be done on heavy drinkers/those you suspect of heavy drinking at every visit (BR video) b. The AUDIT-C is an evidenced based screening tool c. Correct answer d. The higher the score the higher the sensitivity that the patient has AUD (p. 303)

Answer 199

Answer: C Rationale: a. Women - binge drinking is 4 per 2 hours, men is 5 per 2 hours (p. 301) b. No safe amount for those with breast or liver cancer c. Correct d. In the USA, no alcohol recommended for those < 21!

Answer 200

Answer: B Rationale: a. Smokers died 10 years younger https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5298160/ b. Correct c. Quitting at 60 lead to a 3-year increase (p. 290) d. Study was conducted over a 50- year time span

Answer 201

Answer: C Rationale: a. Smoking is more damaging than chewing b. At 10 years the risk of lung cancer is reduced by 50% (p. 290) c. Correct d. Tobacco use is the number one cause of preventable death (p. 289)

Answer 202

Answers: 1. c 2. a 3. b 4. c p. 301

Answer 203

A & D are correct 1 in 5 deaths 32% of CHD deaths (p.289)

Answer 204

Answer c. At risk drinking p301 Option b binge drinking.

Answer 205

Correct answer: D Clonidine and Nortriptyline are second-line medications. (p.293)

Answer 206

Answer d. (p. 302)

Answer 207

Answer C pg 305-306

Answer 208

Answer d (being the key drug in tobacco, pg 290)

Answer 209

ANSWER d and f a. F p 294 b. F p 291 4 in person sessions seem to be especially effective but minimal interventions (<3mins) still increase abstinence rates c. Tobacco products kill 1/3 of people who use them d. T e. P 295 F (they tend to continue to smoke and use the e cigarettes) f. T p 289 g. F p 294 h. F p 294 (No assoc between patches and acute CV events but caution recommended for NRT)

Answer 210

Answer B. Standard beer weight is 340g

Answer 211

Answer- 3, 5 Pg 290 1 is an immediate effect 2 takes 10 years 4 is within 2 weeks

Answer 212

E. Counseling sessions with behavioral health providers could help with mental and emotional health, but this counseling falls under the category of psychotherapy and not personal lifestyle change. All others are correct. Other therapeutic lifestyle changes include: nutrition and diet and time in nature.

Answer 213

B. An increased rate of depression occurs in a linear dose-response curve with higher trans-fat intake. Whereas, depression is negatively associated with intake of mono- and poly-unsaturated fats. Depression was 40% more likely to develop in adults who frequently ate fast food compared to those who avoided it. Some studies show fish oil may help reduce symptoms of depression. However, other studies show little benefit of treating depression with fatty acids. Treatment with omega-3 fatty acids does appear beneficial among some populations, such as those with depression or bipolar disease.

Answer 214

E. All the above are correct.

Answer 215

B. Doing activities that feel meaningful, and connecting and interacting with others regularly through social media. Connecting and interacting with others is important. However, it’s most important to regularly connect and interact with others in person and not solely or mainly through social media. The use of social media has been connected to higher rates of depression.

Answer 216

ANSWER: A. B. Description of *Positive affect * C. Many of the strengths and virtues studied in positive psychology. D. Description of *Engagement* E. Description of *Positive emotion * Engagement and positive emotion are two of the pillars of positive psychology, along with relationships, meaning and accomplishments. (=**PERMA**)

Answer 217

D. a, d, e, f Eudaimonia, the perspective that happiness comes from inherent meaning and purpose, and human nature works to discover that meaning, finding what nourishes and what dampens it in order to live life in a full and deeply satisfying manner. Eudaimonia is associated with: less activation of the amygdala; more engagement of higher cortical function with negative stimuli; and sustained activation of the reward circuit with positive stimuli. Eudaimonia appears to aid adaptive and protective functions, and it’s associated with greater insular cortex volume. Hedonia is the perspective that happiness is characterized by the presence of positive emotions and expressions and the absence of negative emotions and expressions, with an overall high amount of life satisfaction. The thought process behind hedonia is that humans are born empty, and they acquire meaning through social and cultural interaction. Eudaimonia is associated with gene regulation: pro-inflammatory genes are down-regulated while antibody synthesis genes are up-regulated. Hedonia is associated with the opposite pattern.

Answer 218

E. The food components that Americans get too much of are: 1. added sugars: candies, desserts and sugar sweetened beverages, 2. processed grains: white flour, white rice and white pasta, 3. cholesterol mostly from animal foods, 4. sodium: processed and packaged foods, 5. saturated fats: meats, dairy, eggs, processed foods and oils and 6. trans fat: hydrogenated plant oils, processed foods (trans fats are banned after 2018). Answers A through D listed the shortfall nutrients: fiber, potassium, Vitamin C and Vitamin E, which are predominately found in nutrient-dense, whole, plant-based foods. Less than 9% of the US population consumes more than two cups of vegetables daily.

Answer 219

E. The top five sources of saturated fats in the US are: cheese, pizza, refined grain-based desserts, dairy desserts and chicken. Walnuts are high in polyunsaturated fats and low in saturated fats.

Answer 220

B. Participants who ate the dietary portfolio of cholesterol-lowering foods, (plant sterols, soy protein, nuts and viscous fiber) were able to lower LDL-cholesterol concentrations >20%. This was statistically significantly compared to the control group and almost equal (no significant difference found) to the response to Lovastatin 20 mg, a first-generation statin medication.

Answer 221

B. Ornish Diet A. DASH Diet for hypertension: a combination of vegetables, low salt and low-fat dairy, which has been found to be adequate first-line treatment for essential hypertension. B. The Ornish diet for coronary artery disease (CAD): a low-fat, plant-based diet reversed coronary artery disease stenosis in one year and maintained reversal at the five year follow-up. C. Mediterranean diet for secondary prevention of coronary artery disease: the Mediterranean diet was found to be superior to a prudent Western diet in preventing recurrence of coronary artery disease events. D. CHIP program and diet for diabetes: The CHIP multifactorial lifestyle intervention was effective in treating type 2 diabetes. E. Walnuts for hyperlipidemia and hypertension: adding a daily serving of walnuts to ad libitum diet (as you desire) showed effectiveness in lowering serum cholesterol.

Answer 222

E. | Nutrition prescriptions are one of the 15 Physician Competencies for Prescribing Lifestyle Medicine.

Answer 223

E. The SMART acronym for nutrition prescriptions includes: Specific type of foods. Measurable, meaning how much of the food. Achievable/attainable goals for who will be doing the cooking and the shopping. Realistic goals for what food is available, the budget, time commitment and what will the patient actually do. Time connected, meaning what is the frequency for eating the food, and for what duration of time is the prescription written. The doctor or health care provider’s roles are not part of the patient’s written prescription.

Answer 224

E. Trans fats are associated with increased risks of heart attacks and strokes. Starting in 2018 in the US, trans fats are no longer allowed to be used by the food industry.

Answer 225

A. The best sources of fiber are legumes, whole grains, vegetables, fruits, nuts and seeds. Meat and dairy products do not contain fiber.

Answer 226

D. Cruciferous vegetables. Anti-inflammatory foods include all of the following: Cruciferous vegetables (broccoli, cauliflower and Brussels sprouts) Cabbage and bok choy Dark berries and fruits Allium vegetables Carotenoids Dark green leafy vegetables

Answer 227

D. Foods that are fried, smoked, grilled, baked or roasted have higher AGEs. Foods that are prepared with moist heat cooking, such as boiling, stewing and broiling, have fewer AGEs.

Answer 228

C. Sodium restriction typically reduces blood pressure by 2.5 to 7 mmHg. According the American Heart Association, the ideal limit of sodium should be less than 1.5 grams daily, with the upper limit being 2,300 mg daily. The largest sources of sodium in the US are processed foods and canned foods.

Answer 229

E. Type 2 diabetes is generally a reversible disease with aggressive therapeutic lifestyle changes, such as: reducing dietary saturated fats, trans fats, processed sugars and processed grains; eliminating artificial sweeteners; and increasing daily exercise.

Answer 230

D. The risk of breast, colon and prostate cancer are increased with the consumption of red meat, processed meat, highly processed grains, added sugars, high saturated fats and trans fats.

Answer 231

D. Facts learned from 2013 Baylor University Conference: If the serum total cholesterol is 90 to 140 mg/dl (2.327 - 3.620mmol/L), there is no evidence that cigarette smoking, systemic hypertension, diabetes, inactivity or obesity produces atherosclerotic plaques. Hypercholesterolemia is the only direct atherosclerotic risk factor, the others are all indirect. Optimal LDL is 50 to 70 mg/dl (1.293 - 1.810mmol/L). Plaque progression ceases with total cholesterol < 150 mg/dl (3.879mmol/L).

Answer 232

ANSWER: D D. Participants were not placed on a strict diet. Rather, they were encouraged to gradually achieve the fat and calorie levels through: better choices of meals and snack items. The initial focus of the dietary intervention was on reducing total fat rather than calories. Goal <25% of daily calories. *Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. Knowler et al. N Engl J Med. 2002 Feb 7;346(6):393-403.

Answer 233

A. Insulin resistance begins to occur as inflammatory mediators cause damage to liver and beta cells and as muscle and adipocyte cells begin resisting further fat storage. Adipocytes are key factors in the development of insulin resistance. As weight gain occurs, adipocytes undergo hyperplasia and hypertrophy (that is, they grow in number and in size) and begin accumulating in ectopic tissues, such as the liver and muscle cells. Intramyocellular fat accumulation disrupts insulin receptors via production of lipotoxic mediators, causing insulin resistance. Muscle insulin resistance determines the rate of fatty liver progression. Fatty liver progression and the deposit of fatty acids in pancreas are responsible for the rate of hepatic insulin resistance (failure to appropriately respond to blood glucose levels) and beta cell dysfunction.

Answer 234

A. | 63% of US food consumption comes from processed foods with added fats, oils, sugars and refined grains.

Answer 235

E. | Diet, exercise, sleep, obesity and hyperglycemia are able to up-regulate or down-regulate gene expression

Answer 236

D. Although Dean Ornish, MD has found that reversing coronary artery stenosis requires the total daily caloric intake from fat to be less than 10% of the total daily intake, that’s not one of the American College of Cardiology (ACC) / American Heart Association (AHA) guidelines.

Answer 237

C. | There’s strong evidence that children who consume sugar-sweetened beverages have higher body weights.

Answer 238

B is incorrect | Epigenetic changes can all be induced by diet, exercise, sleep, stress, obesity and many other environmental factors.

Answer 239

B is incorrect Compared with vegetarians, the relative risk of diabetes on the death certificate, adjusted only for age, was 2.2 (1.5, 3.4) for male non-vegetarians and 1.4 (1.0, 1.9) for female non-vegetarians. [1] During 10 years of follow-up, 918 incident cases of diabetes were documented. Diabetes risk increased with higher total protein (hazard ratio 2.15 [95% CI 1.77 to 2.60] highest versus the lowest quartile) and animal protein (2.18 [1.80 to 2.63]) intake. Adjustment for confounders essentially did not change these results. Further adjustment for adiposity measures attenuated the associations. Vegetable protein was not related to diabetes. Consuming 5% energy from total or animal protein at the expense of 5% energy from carbohydrates or fat increased diabetes risk. Diets high in animal protein are associated with an increased diabetes risk. [2] | Barnard et al., 2014 ## Footnote [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3942738/ [2] https://diabetesjournals.org/care/article/33/1/43/29676/Dietary-Intake-of-Total-Animal-and-Vegetable

Answer 240

C. Positive food prescriptions can help patients focus on including nutrient-dense, low-calorie foods like fruits, vegetables, whole grains and legumes rather than focus on caloric restriction. Though patients who regularly track food intake on their own show higher rates of weight loss, this is very tedious to complete. Usually, formal tracking of all the patient’s meals and beverages for one month would be too time consuming to complete and review in a provider visit. A three-day food log or 24-hour recall may be options that could be completed within the time of a visit. Most studies show a benefit from eating more than five servings of fruits and vegetables a day, with increasing benefits with more servings. Weight checks can be helpful for weight maintenance, but they may cause patient to focus more on meeting a number instead of forming healthy habits and behaviors.

Answer 241

A. Researchers tested the effect of a low-fat, high-carbohydrate (9% of energy from fat, 70% from carbohydrate) near-vegetarian diet containing 65 grams of fiber and 65 grams of cholesterol per day. Participants were 20 normal-weight men with insulin-treated type 2 diabetes, and it was a 16-day trial. Energy intake was individualized to prevent changes in body weight. By the end of the study period, insulin use was discontinued in 11 participants and, in the rest of the participants, it was reduced from a mean of 26 to 11 units per day (P < 0.001). Despite this reduction in medication use, mean fasting plasma glucose concentration still decreased from an average of 164 mg/dL to 152 mg/dL (amount decreased was not significant). | https://pubmed.ncbi.nlm.nih.gov/495550/

Answer 242

B. For BMI of <18 to >32, there is a linear association with blood pressure, from lowest to highest for both systolic and diastolic. Adjusted for age and gender, significantly lower blood pressure was found in non-treated vegans and lacto-ovo-vegetarians compared to omnivores. Adding alcohol intake to the models studied did not identify an alcohol effect, however alcohol intake was infrequent and small. For vegans, lacto-ovo vegetarians and partial vegetarians, effects were reduced (but not reversed) after adjustment for BMI.

Answer 243

C. The study found women who were obese but had high levels of physical activity (≥ 540 MET-min/wk) and ate high amounts of fruits and vegetables daily (>5 servings per day) had the same mortality rates as women who were not obese but also had high physical activity and high fruit and vegetable intake. [Pierce et. al. Greater survival after breast cancer in physically active | https://pubmed.ncbi.nlm.nih.gov/17557947/

Answer 244

D. Normoglycemia can be achieved as part of the normal physiologic process of a functioning pancreas and liver and of responsive muscle and adipose cells or through medications, exercise or lifestyle changes. Medication use will not reverse the cause of muscle resistance. Although changing to a whole food, plant-based diet can improve insulin resistance, this effect can take several days to several years and is not instantaneous with achievement of normoglycemia. [Weickert. Impact of Dietary Fiber Consumption on Insulin Resistance and the Prevention of Type 2 Diabetes. J Nutr. 2018;148(1):7-12.]

Answer 245

C. Environment in utero is a significant contributor to epigenetic programming. A substantial component of metabolic disease risk has a prenatal developmental basis with greater methylation of RXRA chr9:136355885+ measured at birth being strongly correlated with greater adiposity in later childhood. Novel research demonstrated that paternal nutrition and lifestyles during the peri-conceptional period also contribute to the offspring’s epigenetic programming and risk of future diseases. “One link between environment and disease is epigenetics influencing gene transcription and subsequently organ function. We have previously shown that epigenetic modifications may accumulate during aging, and that DNA methylation in humans is influenced by diet, birth weight, and exercise, suggesting that epigenetics could be involved in age-related and life style–related diseases such as Type 2 Diabetes. Indeed, studies from our group and others have identified epigenetic modifications in patients with Type 2 Diabetes.” [Duhl et al. Neomorphic agouti mutations in obese yellow mice. Nat Genet. 1994;8(1):59-65.]

Answer 246

B. Trans fats are the most damaging fats and are formed by adding hydrogen to liquid vegetable oils to make them solid. Trans fats also occur naturally in meat and dairy products. They are known to increase LDL cholesterol and lower HDL cholesterol, increasing risk for heart disease. Saturated fats come mainly from meat and dairy products. Plant foods that contain saturated fats include coconut, coconut oil, palm oil and cocoa butter. The American Heart Association recommends keeping the amount of saturated fat in the diet to less than 5 to 6% of total daily calories. The 2015 Dietary Guidelines no longer include a recommendation to limit dietary cholesterol to less than 300 mg a day. But the guidelines acknowledge this does not mean dietary cholesterol should not be limited, as diets lower in dietary cholesterol are associated with lower risk of heart disease and obesity. Of note, foods high in dietary cholesterol are mainly higher in saturated fats, except those egg yolks and shell fish that are high in cholesterol but low in saturated fat. [2015 USDA Guidelines, https://health.gov/dietaryguidelines/2015/guidelines/chapter-1/a-closer-look-inside-healthy-eating-patterns/.] Poly unsaturated fats may help improve blood cholesterol levels, especially if they are used to replace saturated and trans fats. Egg whites do not contain any fat or dietary cholesterol. Insoluble fiber is a carbohydrate, and that may help lower cholesterol levels by not allowing it to be reabsorbed in the colon.

Answer 247

D. Cheese. Foods that are high in saturated fat (more than 8 grams of saturated fat per serving) include higher fat cuts of beef, pork and lamb, salami, sausages and other processed meats, many fast foods (e.g., cheeseburgers), coconut and coconut oil. Cheese is moderately high in saturated fat with 4 to 7 grams per serving, but it’s consumed in high quantities, making it the number one source of saturated fat in the US

Answer 248

B.Only statements b, c and d are true. Insoluble fiber is mainly found in vegetables, wheat, wheat bran, nuts and seeds. Legumes, fruits and oats are high in soluble fiber (Answer A). Phytochemicals are only produced by plants (Answer B). Foods should be viewed as “packages,” not as sources of individual nutrients. Therefore, in a food “package” the macronutrient profiles of fat, carbohydrate and protein influence the micronutrient density. A food package of steak will be high in protein and saturated fat and low in antioxidants. Leafy green vegetables will be high in carbohydrates, have some protein, be low in fat and contain high amounts of vitamins and minerals. (Answer C). When total serum cholesterol is less than 150, progression of plaque development in blood vessels appears to cease even in the presence of other risk factors like smoking, hypertension, obesity and diabetes (Answer D). Exercise is great for maintenance of weight loss, but caloric restriction must be included weight loss (Answer E).

Answer 249

Reduced hypertension 1. Dash diet Regression of coronary artery disease and atherosclerosis and coronary event rate was 100 times higher over four years in those who did not adhere versus those who did. 2. Esselstyn diet Regression of coronary artery disease and atherosclerosis, Telomere length increased, and Inhibition of prostate cancer cells 3. Ornish diet (+lifestyle intervention) As effective in lowering LDL cholesterol as statins 4. Portfolio diet

Answer 250

A. All statements are true. All of these mechanisms have been shown to impact endothelial integrity. ## Footnote https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.120.14759

Answer 251

C. Only statements c, d and e are true. The World Health Organization (WHO) has not declared red meat a group 1 carcinogen, but it was labeled as group 2A. This means it’s probably carcinogenic to humans, but insufficient evidence exists to rule out chance or bias as the cause. Processed meats have been labeled group 1, meaning they are carcinogenic to humans. Coconut oil has not been shown to reduce Alzheimer’s disease. The other statements are true.

Answer 252

Answer C. Walk ≥ 30 minutes four days a week for three months “Exercise” and “most days” are not sufficiently specific. “Prepare for a triathlon” is not realistic or achievable, nor is it specific or achievable. “Swim or walk on alternating days” is not measurable and not time connected. Answer C is specific, measurable, achievable, realistic and time connected, and includes frequency, intensity, type and time.

Answer 253

Answer B. Fats, and especially trans fats and saturated fats, are among the leading over-consumed nutrients. Added sugars and HFCS (high-fructose corn syrup), are also a leading over-consumed food/nutrient. Minerals and vitamins are, indeed, among the most under-consumed nutrients. Sodium is over-consumed but potassium is under-consumed.

Answer 254

Answer B. The clinical assessment should include age, gender, medical and surgical history, activity level, nutritional history, vital signs and physical exam. The ABCD (anthropometric, biochemical, clinical and dietary) assessment is one technique, but not the only valid method. The dietary assessment need not be performed by a dietitian, nor does it need to include a 24-hour recall, although both of these can be used. The assessment should include lab tests to assess nutritional status.

Answer 255

Answer C. Each daily serving of fruits or vegetables was associated with a 4% reduction in risk of fatal coronary heart disease and non-fatal myocardial infarction. The study did not examine diet type (Mediterranean) but daily fruit and vegetable intake. The study found that fruits and vegetables were protective for men and women, with a 4% reduction per daily serving. The study was a prospective cohort study and not a randomized trial.

Answer 256

Answer C. Each substitute food reduced risk of type 2 diabetes versus red meat, and whole grains reduced risk most compared to processed red meat by ~35%. Both processed and unprocessed red meat increased risk compared to substitute foods. All substitute foods reduced risk. Whole grains reduced risk more than other substitute foods, and the reduction was greatest for processed red meat. The risk reductions were consistent across all three cohorts studied.

Answer 257

Answer B. PUFAs, MUFAs and whole grains lowered risk of CHD compared to SFAs, but trans fats and added sugars elevated risk. Not all fats increased CHD risk compared to SFAs, and not all carbohydrates decreased risk. Trans fats and refined starches/added sugars elevated CHD risk compared to SFAs. PUFAs and MUFAs reduced risk more than whole grains; PUFAs reduced risk most by 25%. The smallest difference was between SFAs and refined starches/added sugars.

Answer 258

Correct answer = D | Nuts is also a component of the Portfolio diet.

Answer 259

Correct answer = C (p 118-120) | Other shortfall nutrients include fibre, magnesium, vitamin C, vitamin D, vitamin E & vitamin K

Answer 260

Correct answer = C | A is for Achievable/Attainable (p127)

Answer 261

Correct answer = C | Many plant foods are rich in protein (p127-128)

Answer 262

Correct answer = B | Fibre stabilises blood sugar (p132). Also decreases risk of diabetes and colon cancer

Answer 263

Correct answer = A A - p131 B, C & D - p134

Answer 264

Correct answer = D AGEs in food occur more in protein rich foods than fatty foods, and lastly carbohydrate rich foods (p134) A - When temperatures are higher B - When heat is applied for a longer period of time C - When food is dry

Answer 265

Correct answer = C | To improve hypertension, reduce intake of sodium, saturated fat, alcohol caffeine and tobacco (p137)

Answer 266

Correct answer = C Type 2 diabetes, hypertension, cataracts, COPD, Crohn’s disease (p141-142) MS improves with restricted saturated fat (p142) Some speculate that poultry and eggs may affect mood (p142)

Answer 267

Correct answer = C 1. Gastric bypass surgery (p152) 2. High protein, low carbohydrate diets (p152) 3. Mediterranean diet (p152) 4. Low-fat vegan diet (p153) 5. Plant-based diet (p154)

Answer 268

1 & 2) Bad: - Saturated fats in general raise cholesterol (see [here](http://www.nutrientsreview.com/lipids/saturated-fats.html)) - Trans fat - increases MI & strokes Good (should replace above) - polyunsaturated - Omega 3s, omega 6 (bad = arachadonic acid, good = linolenic) - Monounsaturated - help lower LDL - **_C_**anola, **_O_**live, **_P_**eanut (C.O.P.) Avocado 3) Saturated fats - Lauric - coconuts, palm oil, meat - ^ Chol-T, ^ LDL, ^ HDL - Stearic - cheese, dairy, meat, poultry - may lower LDL - Palmitic - palm oil, dairy, meats - ^ Chol-T, ^LDL, ^ HDL

Answer 269

In trans fats, there are two carbons joined by a double bond. If the hydrogens are on **OPPOSITE** sides, it is called 'trans'; if they are on the same side, it is called 'CIS'. - **Cis** are more **flexible** and thus _liquid at room temp_; trans are less flexible, leading to oils which are solida at room temp and have longer shelf life. - natural trans fats occur in the body fat & milk of ruminant animals, mainly cows & sheep - [not harmful](https://www.ncbi.nlm.nih.gov/pubmed/21427742) - commercial trans fats **_[raise LDL-C & lower HDL](https://www.ncbi.nlm.nih.gov/pubmed?term=16611951)_** - a **2%** increase in energy intake from bad trans fat (vs carbohydrates) is [assoc with riks of CAD of **1.93** (P\<0.001)](https://www.ncbi.nlm.nih.gov/pubmed?term=9366580)

Answer 270

1&2) Lauric acid, a **_saturated_** fat, makes up 47% of coconut oil and is the #1 oil in it. 3) Lauric acid increases Chol-T, LDL, and HDL 4) [Harvard recommends](https://www.hsph.harvard.edu/nutritionsource/food-features/coconut-oil/) AGAINST coconut oil. 4) Net effect is to increase heart disease

Answer 271

WHO: Max 10% of calories (goal is max <5%, 6 level tsp=24 grams) AHA: Max 100 calories (=25g, about 6 tsp)

Answer 272

1. outside the home (70.9%) 2. Inherent to food (14%) 3. Added in home prep (5.6%) 4. Added at the table (4.9%)

Answer 273

ranking for most underconsumed nutrients with least overconsumed per kCal: 1. Vegetables (including mushrooms) 2. Herbs and spices 3. Fruits

Answer 274

Lauric acid

Answer 275

1. Fiber* 2. Calcium* 3. Potassium* 4. Vitamin D* 5. Magnesium The rest is vitamins C-A-K-E | *of public health concern per manual, p132

Answer 276

FAST BOCK fortified plant milks acorn squash soybeans tofu prepared with CaSO4 black-eyed peas okra chia seeds kale

Answer 277

baked potato yams avocado white beans banana beet greens/spinach dried apricots/dates

Answer 278

orange colored (retinol) sweet potato cantaloupe butternut squash carrots

Answer 279

poor wound healing DM (type 1 and 2) atherosclerosis kidney disease | All due to incrased oxidative stress and inflammation

Answer 280

35" or greater for women 40" or greater for men

Answer 281

1. broken down into SCFA by gut bacteria (e.g. butyrate) 2. increased circulatory SCFA leads to: * increased insulin sensitivity (decr glucose) * weight regulation * reduced inflammation * prevents ectopic lipid deposition * increases beta-oxidation of fatty acids (makes acetylene-coA)

Answer 282

1. Unprocessed (in natural form) 2. Minimally processed (roasting, grilling, grinding, milling) 3. Processed (added salt, oil or sugar) - includes freshly made bread 4. Ultra-processed (anything with artificial colors, flavors, emulsifiers, preservatives)

Answer 283

EPA: algae, seaweed, spirulina, nori chlorella ALA: nuts, flax seed, certain vegetable oils | ALA can be converted into EPA/DHA, but poor yield

Answer 284

5 steps - open-ended, fill in blanks, associations, details, what else?

Answer 285

calcium, potassium, magnesium

Answer 286

1. decreased BP, serum TG, cholesterol 2. High adherence = 41% lower risk of CVD mortality 27% lower risk of CVD limited evidence about reduced CAD events and breast CA

Answer 287

* Lower CVD incidence, DM/CV mortality * Decreases LDL, BP * May help with weight loss | low sat/trans fat, low sodium, rich in K, Ca, Mg, fiber protein

Answer 288

Combo of mediterranean and DASH. Focused on neuroprotection In addition to whole food-plant based, emphasizes daily leafy greens, berry intake fish no more than once per week

Answer 289

1. NHS (Harvard Nurse Health Study) 2. HPFS (Harvard Health Prof F/U study) 3. WHI (Women's Health Initiative) 4. EPIC (European Prospective Investigation into Cancer and Nutrition 5. AHS (7th-day Adventist Health Study) 6. Framingham Heart Study 7. MESA (Multi-Ethnic Study of Atherosclerosis) 8. NHANES (Nutritional Health and Nutrition Examination Survey)

Answer 290

1. Lyon Heart Trial 2. OmniHeart 3. DASH 4. PREDIMED

Answer 291

* CHD risk reduced by moderate alcohol intake, medi diet, nuts/whole grains * Stroke risk reduced by medi diet and fish * INCREASED risk of CHD with refined carbs (by 16%) and trans fats * Breast/Colon CA risk increases with EtOH (1/2 per day pre-menopausal), red meat intake * Folate, B6, Ca and VD are protective for colon CA

Answer 292

For White men * More than 2 sugar-sweetened beverages a day associated with 21% increased risk of all-cause mortality and 31% increased risk of CHD death * High red meat intake 11-15% higher risk of CHD * replacing margarine/butter with olive oil reduced CVD and CHD risk by 5-7% * compared to no olive oil, consumption of at least 1.5 tsp a day had lower risk for CVD (14%) CHD (18%)

Answer 293

161K women across 40 centers * HRT did not decrease CHD * lowering dietary fat to 24% did not lower CA (breast/colorectal) or CHD risk * CaD supplementation slightly increased bone density but did not impact other disease processes

Answer 294

Comparison of 4 dietary cohorts (meat-eaters, fish-eaters, vegetarians, vegans). Stats compare to rates in meat-eating cohort 5 Outcome Areas: CODIC **CVD** Vegeterians/Vegans had 20% **higher** risk of stroke (?!?) Lower risk of heart disease (Fish 13%, veget 22%) Decreased BP, Total and non=HDL cholesterol **OBESITY** Vegan BMI 22.5 Meat BMI 25 **DM/PRE-DM** 37% lower risk of DM for veg/vgn = *Vegans 47% lower risk of DM* **INTAKE** Vgn sat fat intake 5% (meat 2x that) *Vgn lowest retinol, B12, v. D, Ca, Zinc* (A-B-C-D-Z) **CANCER** 12% lower risk of cancer.

Answer 295

Cancer-CHD-T2D-Weight-vD Vegetarians lower risk for all cancers compared to non-vegetarians * Fruit twice a day (75% cancer risk reduction) * "higher" fiber intake (40% less colon CA) * Legumes twice weekly (42% lower colon CA), thrice weekly (47% lower prostate CA) * Meat eating increased risks for colon cancer (60%), bladder cancer (2x=100%), ovarian cancer CHD * Nut intake reduced risk of nonfatal MI (74%), fatal CHD (73%) and risk of CHD 39-54% with greatest effects on pts over 80 T2D Half the prevalence in veg/vgn * Trend to lower weight, BP, chol, DM the more vegetarian Vegetarians NOT more vD deficient (in contrast to EPIC) - done in California!

Answer 296

1. 18% increased risk of DM2 with high intake of tomatoes, beans, refined grains, high fat dairy and red meat 2. 15% lower risk with whole grains, fruits ,nuts/seeds, green leafy vegetables, low fat dairy

Answer 297

NHANES (National Health and Nutrition Examination Survey) * More than 50% of calories come from UPF * Every 5% increase in calories from UPF is associated with .14 drop in CVH score

Answer 298

**L**ess beef, lamb pork (switch to chicken), more fish Root and leaf**Y** green vegetables Replace butter/cream with high alpha-linolenic **O**il **N**o day without fruit averaged 30% of calories from fat, 8% saturated

Answer 299

To keep study arms isocaloric, the carb-rich study arm was allowed more sweets/desserts, which may have resulted in increased intake of refined carbohydrates.

Answer 300

Largest and longest RCT to date showing benefit of Mediterranean dietary pattern over just lower-fat pattern. (extra EVOO, extra nuts vs low fat) Greater emphasis on plant-derived foods reduced all-cause mortality

Answer 301

The formation of glycoconjugates leads to: 1. inflammatory responses 2. viral immune escape 3. spread of cancer cells 4. apoptosis

Answer 302

FAB-VP 1. Firmicutes 2. Actinobacteria 3. Bacteroidetes 4. Verrucomicrobia 5. Proteobacteria | 90% of total are either Firmicutes or Bacteroidetes

Answer 303

Sodium (<2300mg daily, <1500mg per AHA) Alcohol (or drink just a little - J-curve relationship) Caffeine

Answer 304

1. calcium 2. magnesium 3. potassium 4. garlic

Answer 305

1. potatoes/sweet potatoes 2. fruit (cantaloupe, banana, peach) 3. Vegetables (squash, broccoli, spinach) 4. Legumes (lentils and beans)

Answer 306

1. low-oxalate greens (collards, kale, turnip, mustard, bok choy... all except beet, chard, spinach) 2. beans 3. fortified non-dairy milk 4. low-fat dairy

Answer 307

PA BANQ 1. potatoes 2. avocados 3. beans (black, soy, kidney) 4. amaranth 5. Nuts 6. quinoa

Answer 308

1. brazil nuts 2. sunflower seeds 3. fish 4. mushrooms

Answer 309

By 2050 it's predicted that 100 million will have it

Answer 310

LARTTIIC 1. Leptin 2. adiponectin 3. resistin 4. TNF 5. TGF-beta 6. IL-6 7. IL-10 8. CCL19 | chemokine ligand 19 - T cell activiation

Answer 311

An item that is 5% DV or less is considered low-sodium 20% DV or more is considered high

Answer 312

Decreased LDL, cholesterol, other cardiometabolic risks Decreased BP Reduced DM/CV mortality

Answer 313

About a third (Effect size 0.19 - 0.51)

Answer 314

1) US RDA for fiber = **_25 grams_** (women) & 38g (men) 2) Kelly recommends we take no more than 100% per day of total or saturated fat.

Answer 315

1) 'Saturated fat' - all carbon chain bonds are filled. There are no double or triple bonds to give the molecule **bends or turns** in the chain. 2) Result - **stiff** molecules -\> **stiff** cell walls 3) Unsaturated fats - have at least one double or triple bond to cause the molecule to have a bend in the carbon chain. =\> more flexible in the cell membrane.

Answer 316

1) Structurally: 'Cis' fats - H on SAME side - crooked - lower melting point. 'Trans' fats - H on OPPOSITE side - more straight - higher melting point 2) Function Cis - crooked - flexible - low melting point Trans - straight - stiff - high melting point - stiff in cell membrane. 3) Body doesn't make trans fats.

Answer 317

1) POLYUNSATURATED fats have lots of unsaturated bonds in the carbon chain =\> multiple bends or turns =\> lower melting point at room temp =\> flexible in cell membrane. 2) Animal fats =\> generally saturated (solid @ room temp) Plant fats =\> unsaturated =\> liquid at room temp.

Answer 318

1) Vitamin B9 is **folate (is benign)** 2) Only source of vitamin B12 is bacteria 3) Folate (B9) is plentiful in dark **leafy greens**, **cruciferous** vegetables and **peas**. 4) Elevated homocysteine assoc w CV disease; doesn't add much to other biomarkers (eg lipids, CRP) 5) B12 = cobalamin

Answer 319

1) Good Tot chol:HDL ratio \< 3 2) Soft drinks (ie regular pop) can raise TG

Answer 320

Mono-unsaturated fats: (COP) Avocado Nuts - almonds, hazelnuts, peanuts, pecans Olives Seeds - pumpkin, sesame Soft margarine (also MONO unsat) - liquid, tub Vegetable oils - **_C_**anola, **_O_**live, **_P_**eanut, safflower

Answer 321

Polyunsaturated fats: Fish - herring, mackerel, salmon, trout, tuna Nuts - pine, walnuts Seeds - sunflower Soft margarine (also MONO unsat) **Veg oils** - **corn**, cottonseed, **soybean**, **sunflower.**

MCQ's from the Chapters based on 4th Edition of Board Review Manual Flashcards

(357 cards)