MCQ's Random Flashcards
Fat minimization is a vital intervention to treat CVD using LS interventions. Choose types of fat that DO NOT need to be minimised or avoided in order to treat CVD: A) mayonnaise B) oily fish C) extra virgin olive oil D) margerine E) butter F) all of the above need to be minimized for best outcomes G)
answer F
With regards to the lifestyle interventions for common chronic diseases, all of the statements below are correct EXCEPT:
A) dietary fats are known to promote cardiovascular disease by the following mechanisms: increase calories –> wt gain,
elevate LDL, paralyse vascular endothelium
B) salt intake is associated with BP elevation in approx 2/3 of population
C) to treat T2D and MetS: MInimise refined carbs and fats
D) there is a genetic test to ascertain whether or not a person’s BP is going to respond to salt reduction
E) all of the above is true
answer: B,D
B: FALSE (it’s 50%)
D: FALSE (no genetic test, a trial of treatment is recommended - at least 2 weeks)
Below are the cornerstones of treatment of chronic disease with lifestyle interventions. What is missing?
- Whole Food Plant-based Diet
- Minimise processed/ refined food
- drink plenty of water
- regular moderate aerobic exercise
- resilience training
- good sleep
ANSWER: Regular Resistance exercise
With regards to DASH (Study, Dietary Approach to Stop Hypertension), all of the statements below are CORRECT EXCEPT:
A) the results are difficult to interpret because there was no control group and
B) did not look at the association between fats and improvement of BP
C) looked primarily at reduced dietary sodium intake
D) intervention lasted for 8 weeks
E) one of the arms was eating AHA diet
G) all of the answers above are incorrect
answer: G (all are incorrect)
A) FALSE: 3 arms: 1. Control diet 2. SAD rich in fruits and vegetables 3. DASH “combination diet” rich in fruits and vegetables and reduced saturated and total fats
B) FALSE: as above
C) FALSE: sodium intake and body wt were constant
D) FALSE: 3 weeks intervention but last follow up measurement at 7-8 weeks
E) FALSE: “control diet” resembled SAD: low fruit and veg, lots of diary and meat and fat)
With regards to DASH study, all of the statements below are true EXCEPT:
A) only severely hypertensive subjects were included in the study: baseline SBP had to be >160 mmHg
DASH diet reduced both systolic and diastolic BP in a statistically significant way, when compared to the control diet
C) fruits-and-vegetable diet reduced both SBP and DBP but with a lesser effect compared to DASH diet
D) For subjects with hypertension, the effect of DASH diet was comparable to pharmacotherapy
E) For subjects without hypertension, the DASH diet did not show any effect on either systolic or diastolic blood pressure
answer: A & E
A) FALSE: baseline = <160/80-95 at baseline; mean SBP 131.3+/-10.8, DBP 84.7+/-4.7
B) TRUE (SBP reduced by 5.5, DBP by 3.0) , p<0.001
C) TRUE (SBP 2.8, p<0.001 and DBP 1.1, p<0.07)
D) TRUE
E) FALSE (stat sig reduction, although more modest than in hypertensive subjects SBP 3.5, DBP 2.1)
COUNTERPOINT STUDY, all of the statements below are true EXCEPT:
A) was a large, multicenter study, comparing low caloric intake to normal caloric intake in diabetic subjects
B) looked at the effect of caloric restriction on Beta pancreatic cell function (ie ability to produce insulin in response to gl. load) and insulin resistance
C) the intervention was very low calories diet
D) pancreatic and hepatic TAG content was assessed, as well as hepatic glucose output, hepatic and peripheral insulin sensitivity and beta cell function
answer: A
A) False: small study 11 subjects, 8 matched non-diabetic controls
B) true
C) true (600 kcal/ day)
D) true MRI was used to look at hepatic and pancreatic fat
With regards to COUNTERPOINT STUDY: all of the statements below are true EXCEPT:
A) insulin suppression of hepatic glucose improved after one week on the intervention diet
B) showed that T2D inevitably leads to irreversible beta cell failure
C) fasting plasma glucose normalised after one week
D) FAtty liver and pancreas improved after 8 weeks on 600kcal diet
E) showed that low-calories diet can reverse the abnormalities underlying T2D, including Beta cell function and insulin sensitivity as well as improve fatty liver and pancreas
F) maximal insulin sensitivity improved to exceed that of the controls
answer: B
A) TRUE B) FALSE C) TRUE (from 9.2 +/-0.4 to 5.9 +/- 0.4, p<0.003) D) TRUE E) TRUE F) TRUE
All of the statements about DASH study are correct, EXCEPT:
A) This study showed that the DASH diet lowered blood pressure in those with HTN a similar amount as would beginning a medication.
B) The study used a matched controls design
C) All interventions were effective when compared to SAD (standard Americal Diet)
D) there was a “dose-response” relationship to increased intensity of dietary intervention
E) Most of the improvement occurred in the first two weeks
answer: B
A) TRUE
B) FALSE randomized parallel design with three arms (controls, fruit-and-vegetable diet, and DASH diet) rather than matched controls
C) TRUE The fruit-and-vegetable diet was more effective than the control diet, and the DASH diet was > twice as effective as the fruit-and-vegetable diet
D) TRUE The treatment effect in HTN subjects was -11 mmHg and -5.5 mmHg, much better than on fruit and veg + SAD
E) TRUE
What are the pillars of Positive Psychology? (PERMA)
A) Positive Emotion, Endeavour (full involvement in life), Relationships, Meaning, Accomplishments
B) Positive emotion, Engagement, Relationships, Meaning, Accomplishments
C) Positive Emotions, Engagement, Relationships, Mindset, Accomplishments
answer: B Positive emotion Engagement Relationships MEaning Accomplishments
With regards to lifestyle interventions, choose FALSE statement(s):
A) ITLC stands for Intensive Therapeutic Lifestyle Change, TLC stands for Therapeutic Lifestyle change
B) ITLC has been studied more extensively than smaller TLC’s and has been shown to be more effective compared to one-dimensional, or incremental TLC’s, particularly for severe or advanced conditions
C) ITLCs often have an immersion phase, which can be delivered within, or outside of a residential facility, witch controlled conditions and multidimensional interventions
D) ITLC has two components (dimensions): 1.contact hours and 2. the extent of change made. The aim is to carefully balance both components and not to overwhelm the patient for the best results
E) ITLC can produce dramatic treatment effects, at times very quickly (hours), which improves self-efficacy (and adherence)
F) ITLC has been shown to effect epigenetic changes
Answer: D A) TRUE B) TRUE C) TRUE D) FALSE (the aim is to maximise both components as this improves outcomes) D) TRUE E) TRUE
Choose the appropriate action to patient’s answers to behaviour change questions:
Patient= Mary, 40 yo PI, BMI 42
Prov: I see that you have already started walking to feel better. Are you managing to do 30 min of brisk walking 4 times a week as we discussed in your goal setting session?
Pat: No, I’m not quite there yet. I can only manage about 15 min 4 times a week.
A) Oh, that must be disappointing for you. Can you try to achieve your goal before our next session?
B) Never mind. 15 min is better than nothing. Keep it up!
C) Let’s see what can be done to make it a bit easier for you to reach this goal.
D) Did you know that excess weight and high blood pressure make heart disease and other problems more likely? If you don’t start doing something about it soon it may be too late.
answer: C (PREPARATION STAGE) : refine action plan, identify barriers, encourage problem solving, identify supports, etc.
Choose the appropriate action to patient’s answers to behaviour change questions:
Patient= Mary, 40 yo PI, BMI 42
Prov: Are you considering making a change in how you eat?
Mary: YES , I often think about it. I know I’m ugly.
A) Lets talk about how you can do it.
B) Are you considering a change in the next month or before your next visit?
C) What do you foresee could make this change difficult?
D) Did you know that excess weight and high blood pressure make heart disease and other problems more likely? However, losing as little as 5% of your weight can significantly reduce your risk?
E) I used to be overweight and had high blood pressure. Once I started eating more healthy and exercising regularly both of the problems improved and I feel great.
Answer:
B) (CONTEMPLATION STAGE): need to determine time frame, this will guide further action
Choose the appropriate action to patient’s answers to behaviour change questions:
Patient= Mary, 40 yo PI, started LS change 7 months ago, moved from BMI 42 to 40
Prov: Well done Mary, you should be really proud of what you have achieved! How are you getting on with the changes?
Mary: To be honest, I am quite disheartened. At the beginning the kilos were shedding off quite fast but almost nothing in the past 2 months or so. I often feel like “what’s the point?” and sometimes slip back to my bad old habits….
A) Oh no Mary, that would be a huge shame. You must go on or you could have a heart attack or a stroke soon!
B) How about we change your action plan? Your goal was quite unrealistic, anyway.
C) Don’t worry about that Mary. You have lost a lot of weight already. Would you be willing to share your success story with some of my struggling patients?
D) I hear you, Mary, it must be hard when you have been working so hard and there are no “numbers to show for it”. It is quite common for the body to find it’s “new normal” and the numbers don’t change much. It could also be because you are gaining in muscles, which are heavier than fat you have lost. You are still getting fitter and stronger, you may even feel better in yourself… How about we figure out the best way today how to support you and keep you on the right track?
answer D) (RELAPSE) ; PROBLEM SOLVE, REFRAME, ENLSIT SUPPORT, WORK ON CBT
