Random LM questions - exam style!

Question 1

Which of the following statements is TRUE regarding food sources of calcium?

a. Calcium is a shortfall nutrient along with magnesium and phosphate
b. 40-60% of the calcium from high oxalate dark greens can be absorbed, compared to 32-34% from dairy
c. The calcium available in greens such as spinach, swiss chard and beet greens is readily absorbed
d. Food groups which are high in calcium (>20% DV per serve) include dairy, poppy seeds, calcium-fortified non-dairy beverages and tofu

Answer 1

D
High calcium: dairy, seeds (chia, poppy, sesame), calcium fortified non-dairy veg and tofuModerately high: almonds, beans, low oxalate dark greens (kale, bok choi) and okraCalcium, magnesium and POTASSIUM are all shortfall nutrients

Question 2

You see Joe, 67yo, who has been referred by a colleague with a wish to lose weight for health reasons. In your first appointment to address this your basic nutrition assessment includes:

a. Anthropometric data - weight, height and BMI; BMI is especially valid for Joe as he is over 65yo
b. A clinical assessment, including age, gender, medical and surgical history, activity level, nutritional and weight history, vital signs and physical examination
c. A dietary assessment; the best choice for this appointment would be a 3 day food recall as it gives you the most information
d. All of the above in addition to biochemical data

Answer 2

B
BMI is less valid for people under 20yo or over 65yo. Anthropometric data includes a waist circumference. A dietary assessment can be completed using a variety of tools (eg daily intake of solids/liquids, 24 hour recall, 3 day food record (usually given as an assignment for the next appointment), mini nutritional ax for the elderly, a variety of online tools, calculators and apps, or a dietician in-depth assessment). A basic nutrition assessment includes ABC and D – anthropometric data, biochemical data, clinical data and dietary assessment.

Question 3

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

a. He is higher risk due to his sedentary job and he should change professions to a more active role or reduce his work hours immediately
b. He could consider 2 minute bouts of light or moderate intensity walking every 20 minutes whilst working – this has been shown to decrease both blood glucose and insulin levels in a population of overweight and obese adults, and may attenuate his longer term risk
c. The risk from sedentary behaviour is offset by his excellent exercise regime, but he should consider adding a strength and flexibility training to his regime
d. Results from a large trial following adults older than 45 years old for an average of 2.8 years showed that 6.9% of all-cause mortality was attributed to sitting. This effect was diminished to non-significant levels when physical activity level was taken into account.

Answer 3

B (BR manual p 192)
Sedentary behaviour is an independent risk factor for all-cause mortality. Results from a large trial following adults older than 45 years old for an average of 2.8 years showed that 6.9% of all-cause mortality was attributed to sitting. This was consistent across genders, age groups, BMI, physical activity and in healthy participants vs participants with pre-existing CVD/diabetes.

Question 4

Which of the following is correct regarding the American College of Sports Medicine’s three stages of exercise progression?

a. The three stages are: Initial stage (1-6 weeks), Improvement stage (4-8 months), and Maintenance stage (indefinite)
b. In the initial stage, moderate intensity activities should be performed starting at 15 minutes and increasing to 30 minutes; recommended frequency is 3-4 times a week
c. In the improvement stage, frequency and intensity are increased first, then duration is increased, aiming for 20-30 minutes of continuous moderate to vigorous activity
d. A and B are correcte. All of the above are correct

Answer 4

D (BR manual p.196)
In the improvement stage, intensity is the last variable to be increased - AFTER target duration and frequency have been achieved.

Question 5

Which of the following are true regarding stress?

a. It is a USPTFS grade B recommendation that screening for stress and a brief discussion on the role of stress in a healthy lifestyle is undertaken at all patient visits
b. It is not recommended to screen for stress as it is due to external life circumstances and cannot be treated
c. Work stressors increased the incidence of cardiovascular disease in a group of middle-aged women studied for 15 years
d. Stress can be assessed using the perceived stress scale assessment, which is a 10 item questionnaire. The higher the total score, the more perceived stress one is under, with a low score being 13 or under, moderate stress with a score between 14 and 26, and the highest stress scores being between 27 and 40

Answer 5

D (BR manual p 233-234)

a) is from “Physician competencies” article, c) this study showed an increase in T2DM

Question 6

Which of the following is correct regarding depression?

a. Depression as an independent marker for mortality is twice as strong as that of smoking
b. A diagnosis of depression predicts diabetes, and vice versa (ie there is a bidirectional association)
c. Coronary artery disease is a risk factor for depression that generally precedes depression by several years
d. There is clear evidence that treatment of depression improves survival in patients with coronary artery disease

Answer 6

B (BR manual p.236-237)Depression is as strong as smoking as an independent marker for mortality. c) - other way around. There is no clear evidence that treatment for depression impacts survival for pts with CAD

Question 7

Which of the following is INCORRECT regarding smoking cessation?

a. Varencicline is the most effective monotherapy, with approximately half of study subjects maintaining abstinence after 12 weeks
b. If a tobacco user is not ready to quit, a brief CBT intervention is recommended to increase future quit attempts
c. All patients who smoke cigarettes should be offered medication except where there is a contraindication, or in groups where the evidence is limited (eg. pregnancy, light smokers, adolescents and vaping)
d. Weight gain after quitting is on average around 10lbs or 4.5kg. This gain may be delayed with use of buproprion and NRT

Answer 7

B –If a tobacco user is not ready to quit, MOTIVATIONAL INTERVIEWING should be used

Question 8

Which of the following is correct regarding medication for smoking cessation?

a. Light smokers generally benefit from nicotine replacement therapy in addition to counselling
b. Nicotine patches are contraindicated in patients with a history of cardiovascular disease
c. There is good data to suggest that triple therapy (varencicline, buproprion and nicotine replacement therapy) is effective in individuals with chronic illness or with psychiatric illness.
d. Buproprion is contraindicated in bipolar disorder and if any history of anorexia or bulimia

Answer 8

D –No significant benefit in light smokers (< 10 /day). No evidence of an increased association between acute cardiovasc events and nicotine patch. Combination data comes from pts with NO chronic or psych disease, only prelim data available for combo in question c. Patch is recommended if bipolar or schizophrenia. “Triple therapy” (bupriprion, NRT patch and short acting NRT) recommended by Manual for chronic disease or mental illness, although note buproprion CI in bipolar, AN and BN, and caution in schizophrenia. See: Manual p. 293 and 294; also, https://www.aafp.org/dam/AAFP/documents/patient_care/tobacco/clinicians-presentation.pdf

Question 9

Which of the following is correct regarding tobacco cessation?

a. The 5 As of tobacco cessation are Ask, Advise, Assess, Assist, Arrange
b. The 5 As of tobacco cessation are Assess, Advise, Agree, Assist, Arrange
c. If time constraints are present, the alternative model is Ask, Assess, Refer
d. Motivational interviewing techniques include expressing empathy, developing discrepancy, identifying core values and supporting self efficacy

Answer 9

A –Alternative model is Ask, Advise, Refer – eg to quit line. Motivational interviewing techniques include expressing empathy, developing discrepancy, roll with resistance and support self efficacy

Question 10

With regard to sleep hygeine, which of the following is correct?

a. The average half-life of caffeine is 5-7 hours
b. The sleep hygiene index for assessing sleep hygeine includes the daily personal hygiene routine
c. Reading, watching TV or eating in bed can occur but is not recommended within 2 hours of desired sleep time
d. Thinking, worrying and planning, provided they are in writing (eg in a journal) are recommended activities to do in bed prior to sleep

Answer 10

A

Question 11

Which of the following is INCORRECT regarding sleep hygiene?

a. It is advisable to dim evening lights 60-90 minutes prior to bedtime
b. Evening light exposure, but not daytime light exposure, influences melatonin production
c. Digestion warms the body which can interrupt sleep; ideally the last meal of the day should be at least 3 hours prior to bedtime, 1/3 or less of total daily calories
d. One should avoid alcohol in the last 3-4 hours prior to sleep, and increase free water intake during the day to maximise sleep quality

Answer 11

BLifestyleFacts.org – “Lifestyle Habits for falling asleep easily” – increased light exposure during the day can decrease sensitivity to light in the evening

Question 12

In a study looking at 3 large prospective cohorts of men and women with regard to red meat consumption and type 2 diabetes risk, which of the following is CORRECT?

a. Processed red meat, but not total or unprocessed red meat, was significantly associated with development of Type 2 diabetes
b. There was no significant difference in diabetes outcomes when a substitution analysis carried out comparing one serving of unprocessed red meat to one serving of poultry or fish
c. In the substitution analysis, the greatest benefit/ reduction in risk of diabetes for all groups (processed, unprocessed and total red meat) appeared to be from whole grains, nuts and low fat dairy
d. Once diabetes was established, a vegan diet appeared to confer the most benefit for glucose control compared to diets containing animal products

Answer 12

CPan et al study; fish and poultry associated with decreased risk compared to all red meat groups, but less of a risk reduction than whole grains, nuts or low fat dairy. Glucose control wasn’t assessed in this study.

Question 13

Which of the following is CORRECT regarding diet?

a. A large prospective cohort study of 84,251 women in the Nurses’ Health Study and 42,148 men in the Health Professionals Follow-up Study showed people with the highest quintile of fruit and vegetable intake had a 30% higher risk of CVD compared to those with the lowest quintile of intake
b. In the same study, for each increase of one serving per day in fruit and vegetables, a 4% higher risk of CHD and a 6% higher risk of ischemic stroke was observed
c. Clinical trials support the use of dietary antioxidants (especially vitamins C and E) for the prevention and treatment of CVD
d. The fatty acids that vegans are most likely to be deficient in are the omega-3 fats (n-3 fats). Foods that are good sources of n-3 fats should be emphasized for these individuals; these include ground flax seeds, flax oil, walnuts, and canola oil

Answer 13

D (From article: Nutritional Update for Physicians - Plant-Based Diets)

Question 14

Which of the following is INCORRECT regarding the Blue Zones?

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

Answer 14

B
“Move naturally. The world’s longest-lived people do not pump iron, run marathons, or join gyms. Instead, they live in environments that constantly nudge them into moving without thinking about it. They grow gardens and do not have mechanical conveniences for house and yard work.”From: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6125071/pdf/10.1177_1559827616637066.pdf

Question 15

In a study of 1,152 patients with established cardiovascular disease enrolled in a Multisite Cardiac Lifestyle Intervention Program, which of the following statements is TRUE?

a. The study compared a 12 week intensive lifestyle program with a “usual care” control group and assessed changes in angina symptoms, coronary risk factors, quality of life and lifestyle behaviours
b. There were no patients who experienced a worsening of their angina symptoms over the 12 week period
c. It can be concluded from this study that the improvements in cardiac risk factors, angina symptoms and quality of life was a direct result of participation in the intensive lifestyle program (consisting of a low fat plant based diet, a tailored exercise program based on an initial exercise test, stress management and group support)
d. At 12 weeks, 74% of patients who reported initial symptoms of angina pectoris no longer had angina, and an additional 9% had improved from limiting to mild angina

Answer 15

D

Angina Pectoris and Atherosclerotic RFs, Am J Cardiol 2008

Question 16

In a study looking at the effects of cumulative risk factors on CVD and non-CVD death in a population of middle-aged men and women in Chicago over a 6 year period, which of the following is FALSE?

a. The study looked at four different risk factors (smoking, blood pressure, total cholesterol and BMI), and stratified participants into 5 groups depending on risk profile, with the lowest risk group having BP less than or equal to 120/80, total cholesterol at or below 200mg/dL (5.1mmol/L), non-smoking, and a BMI of <25
b. There was an association between having a favourable risk factor profile and low lifetime risk of CVD death in addition to a lower risk of non-CVD death
c. There was no association between the presence of a single risk factor in middle age and CVD death d. The study looked at both CVD death and non-fatal CVD events

Answer 16

C and D are false(Chicago Heart Association Detection Project in Industry – Am J Cardiol 2007)

Question 17

Which of the following is FALSE regarding the Multiple Risk Factor Intervention trial (1982)?

a. The study found a significantly lower rate of cardiovascular events and all-cause mortality in the intervention group compared with the usual care group
b. The study was conducted across multiple centres and included over 12,000 men aged between 35 and 57 years old
c. This was a randomised primary prevention study which involved a usual care group and an intervention group (consisting of treatment of hypertension, smoking cessation counselling and dietary advice for lowering cholesterol)
d. There was a substantial improvement in risk factors in the intervention group

Answer 17

A(Multiple Risk Factor Intervention trial)

Question 18

Sylvia is a 55yo woman who comes to you for a general health check. She has had blood tests including cholesterol levels which show a total cholesterol of 5.7mmol/L with an LDL of 3.8mmol/L. She has a family history of CHD (her father had an AMI at 58yo), is a non smoker and is not diabetic. Her blood pressure is 118/70. Her calculated 5 year cardiovascular risk is 2%. She is worried about cardiovascular risk in view of her family history and asks about dietary modification including an online search which described the “portfolio” diet. Which of the following statements is FALSE regarding the 2003 study looking at this diet?

a. It consisted of 3 arms – a control group who ate a diet low in saturated fat, a second group who the same diet and took a statin, and a third group who ate a ‘portfolio’ of cholesterol lowering foods and no statin
b. The ‘dietary portfolio’ comprised of plant sterols, soy protein, soluble fibre and almonds
c. The study found that a large proportion of patients were able to incorporate and maintain the portfolio of cholesterol-lowering foods long-term
d. The portfolio diet lowered both total and LDL cholesterol to similar levels compared with a statin; these changes were statistically significant when compared with controls

Answer 18

C is false – 4 week trial, food provided, no long term follow up

Question 19

Jan, 50 year old with a BMI of 30 and a recent slightly high fasting sugar (6.1mmol/L or 110g/dL) comes to you for advice regarding weight loss. Her best friend has recently lost 5kg over a 12 month period with the Atkins diet. She is wanting to lose a similar amount of weight, but tells you that she loves bread and she doesn’t think that she would be able to stick to a dietary plan which minimises carbohydrates. What can you tell her, based on a randomised controlled study comparing 4 popular diets over 12 months?

a. The Atkins diet would be best for her diabetes risk given her high fasting sugar, and she should consider making this change despite her love of bread
b. The study design included monthly phone calls for support and motivation, and advice regarding physical activity as per national guidelines
c. Jan would do best to look at a range of options for dietary change and pick an approach that she feels she could incorporate into her life long term
d. Participants were asked to adhere as much as possible to the prescribed diet for the 12 month study period

Answer 19

C
No diet was superior to any other in terms of cardiovascular RFs or weight loss. The participants from all 4 groups received advice to take a multivitamin and do at least 60 minutes of physical activity per week – far below the advice per national guidelines. To approximate real world circumstances, participants were advised to stick to the prescribed diet to the best of their ability for 2 months, then choose their own level of adherence.(Comparison of the Atkins, Ornish, Weight Watchers, and Zone Diets for Weight Loss and Heart Disease Risk Reduction – JAMA 2005)

Question 20

Gabby is 55yo, and was diagnosed with T2DM last year. Her weight is 75kg and height 150cm (BMI 33.3). She has been commenced on metformin and her latest HbA1c was 6.8. Gabby is wondering if there is anything she can do which may arrest or reverse the changes associated with her diabetes. With regard to a study looking at caloric restriction and the effect on beta cell function and liver and pancreatic triacylglycerol, which of the following could be discussed with Gabby?

a. After 4 weeks of an energy restricted diet, fasting plasma glucose decreased from 9.2mmol/L to 5.9mmol/L
b. After 8 weeks, hepatic triacylglycerol had decreased by 70%, and the first phase insulin response had improved to approach the level of the controls. Pancreatic triacylglyerol decreased from 8.1-6.2%
c. This study lends weight to the hypothesis that insulin resistance and issues with insulin secretion are caused by increased lipid accumulation in both the liver and the pancreas
d. Patients in this study continued their usual medications including insulin, metformin, sulfonylureas and statins
e. B and C

Answer 20

E
Fasting glucose improved to these levels by week 1. Patients were excluded if on insulin, steroids, b-blockers, or had significantly impaired renal or liver function. Statins were continued. Sulfonylureas were ceased 2 months before and metformin 1 week before the baseline testing.(“Reversal of Type 2 Diabetes: normalisation of B-cell function in association…” - DIABETOLOGIA 2011)

Question 21

Ash is 48 years old. She was diagnosed with diabetes 3 years ago. She is on metformin and perindopril, and has a HbA1c of 6.9. She has been advised to add a second medication for her diabetes. She comes to see you for a second opinion as she is reluctant to add more medication. She explains that although it was recommended at the time, she was not in a place where she could consider significant weight loss when she was diagnosed, however she feels that she would be motivated to do so now if it would make a difference and give her some chance of avoiding more medication. You discuss a large randomised trial held across 49 primary care practices in England and Scotland which looked at diabetes remission and weight loss as the primary end points of an intervention. Which of the following is correct regarding this study?

a. The intervention comprised a very low calorie diet (whole foods, plant-based) for 3-5 months, with advice to build up to 150 minutes per week of moderate physical activity
b. At 12 months, 74% of participants in the intervention group remained off all diabetic medication, compared with 18% of the control group (baseline rates of patients taking 0, 1, 2 or more than 2 diabetic medications was similar)
c. Quality of life scores improved in the control group and decreased in the intervention group
d. Mean blood pressure improved in the intervention group compared with the control group at 12 months

Answer 21

B
( Primary care-led weight management for remission of type 2 diabetes (DiRECT) - Lancet 2018)Intervention was a VLCD (total meal replacement) for 3-5 months, with stepped food re-introduction (2-8 weeks), and support for weight maintenance. Advice re physical activity was not given in the initial diet replacement phase. Step counters were provided at the start of food reintroduction, and physical activity strategies were introduced, to help participants in the intervention group to reach and maintain their individual sustainable maximum—up to 15 000 steps per day. (However there was no significant change in measured physical activity between groups at the 12 months mark).C – false – other way aroundAntihypertensive drugs had been withdrawn in 38 (48%) of 80 participants who had taken them at baseline in the intervention group, and in no participants in the control group. At 12 months, antihypertensive drugs were being prescribed to 47 (32%) of 148 participants in the intervention group (n=29 one drug, n=18 two or more drugs), compared with 91 (61%) of 148 participants in the control group (n=43 one drug, n=48 two or more drugs; p=0·0001).

Question 22

Regarding the LOOK AHEAD trial, which of the following is NOT CORRECT?

a. The Look AHEAD study sample was predominantly middle-aged or older (mean age, 59 years) and of diverse race/ethnicity, education level, and medication status, and the median time since diagnosis of DM was 5 years
b. Remission during the first year was significantly associated with fewer years since diabetes diagnosis (especially if within 2 years of diagnosis), low BMI, low baseline HbA1c, not taking insulin, and greater 1-year weight loss
c. 11.5% of lifestyle intervention participants had partial or complete remission within the first year of intervention and 7% had partial or complete remission after 4 years; these rates were 3 to 6 times those of participants in the DSE group
d. In line with the findings of improved fitness, increased weight loss and greater rates of diabetes remission shown in the ILI group, there was a corresponding decrease in cardiovascular event rates over the follow-up period of 8-11 years

Answer 22

D ( Association of an Intensive Lifestyle Intervention With Remission of Type 2 Diabete, JAMA 2012) After 8 to 11 years of participant follow-up, the Look AHEAD intervention was stopped by the study sponsor when it was determined that the ILI did not decrease the occurrence of cardiovascular events, the primary trial outcome relative to the DSE group

Question 23

Sandra is a lady of 50. She is a non-smoker with no family history of CVD, cancer or diabetes. She sees you for a general check. You establish that she currently drinks 1-2 glasses of wine once a week, and that she walks at a moderate intensity for 20 minutes 3 times a week. She has a total cholesterol of 4.3mmol/L, a BP of 118/78 and no evidence of diabetes or pre-diabetes. She does not enjoy vegetables and eats approximately 1 serve a day. Her BMI is 24.2. Which of the following is CORRECT regarding her management?

a. The US preventative services taskforce (USPSTF) would recommend intensive behavioural health nutrition counselling and physical activity counselling for Sandra
b. As per the USPSTF, nutrition and physical activity counselling should be based on Sandra’s readiness for change.
c. There is strong evidence which exists for nutrition prescriptions
d. If a nutrition prescription was written for Sandra, the format TAF (type of food, amount to be eaten and frequency that the food should be eaten) should be used – it is generally very accepted to ‘deprescribe’, ie decrease the frequency of foods such as processed meats and sweets rather than specifying foods to eat more of such as leafy greens

Answer 23

B
As she has no chronic disease and no risk factors, USPSTF recommends counselling be based on readiness for change (Grade C recommendation – service should be offered in a selective manner). Nutrition prescriptions are not well documented in the literature, but there is reason to believe they would be helpful given they are similar to exercise prescriptions, for which there is strong evidence. “Positive” prescriptions (consume more of a certain food) are generally more acceptable to patients than “negative” (consume less of a type of food).

Question 24

Marty is a middle aged man with a past history of hypertension and angina. He comes to you for a health check. He appears anxious, so you include a PHQ-4 questionnaire in your assessment. His score today is 9. Which of the following is correct?

a. The PHQ-4 is a validated screening tool for stress and depression
b. Marty’s score reflects mild depression and anxiety. He should be given education and resources and re-screened at future visits
c. Marty’s score is ‘severe’. He should be further assessed for both depression and anxiety symptoms, including a suicide risk assessment
d. If Marty is depressed his cardiac risk could be elevated up to 15-20%, with major depression predicting increased risk from cardiac death, MAI, cardiac arrest and non-elective revascularisation over a 2 year follow up. Treatment with an SSRI improves survival and should be commenced immediately.

Answer 24

C (BR manual p. 236-237)

Question 25

Julie comes to you for help with her sleep. She is a 38yo practice nurse, and single mother to 3 children. She works full time, usually averaging 45 hours per week. She reports mild depression. She generally gets up at 6am on weekdays, and stays up late after her kids are in bed to get some ‘alone time’. She sleeps in on weekends to ‘catch up’ when the kids are at their dads house, generally getting up at 10am. What disorder best describes Julie’s scenario?

a. Insomnia
b. Restless legs syndrome
c. Secondary insomnia
d. BIISS (behaviourally induced insufficient sleep syndrome)

Answer 25

D

Question 26

Which is correct about assessment for OSA?

a. The ‘STOP’ assessment includes: Snoring, Tired/fatigued/daytime sleepiness, Observed apnoea and Pressure (hypertension or taking antihypertensives)
b. The ‘STOP’ assessment includes: Somnolence (daytime sleepiness), Tongue (Mallampatty class 3 or above), Observed apnoea and Pressure (hypertension or taking antihypertensives)
c. If the patients scores 0 or 1 they are low risk for OSA
d. If the patient scores 1 or above they are high risk for OSAe. a. and c. are correctf. b. and d. are correct

Answer 26

E (Also see here http://www.stopbang.ca/osa/screening.php and here https://www1.racgp.org.au/ajgp/2019/april/adult-obstructive-sleep-apnoea

Question 27

Which of the following is correct regarding AUD (alcohol use disorder)

a. The DSM-5 criteria defines alcohol use disorder as 2 or more of 11 symptoms over the preceding 6 months
b. An individual who meets 1 of the 11 criteria has mild alcohol use disorder, someone who meets 4 criteria has moderate alcohol use disorder, and severe alcohol use disorder is defined as meeting 6 or more criteria
c. The AUDIT screen can be used to identify alcohol use disorder. The abbreviated version, the AUDIT-C, is a validated screening tool for alcohol use.
d. Mild to moderate alcohol use disorder should be managed with involvement of an addiction specialist, and anti-relapse medication is not recommended unless AUD is severe

Answer 27

C is correct – AUD defined as 2 or more symptoms over the previous 12 months. Mild AUD is 2-3 symptoms, Moderate 4-5 symptoms, severe 6+. Mild-mod AUD can be managed in primary care, anti-relapse medication (ARM) is effective (ARM similar effectiveness to SSRIs for depression)

Question 28

Which of the following scenarios constitute moderate alcohol use disorder?

i. A 35 year old mother of 2 children who has been homeschooling and working from home during the COVID-19 pandemic. She has been drinking more than intended, which is affecting her ability to complete her work. She has tried to cut down several times as she is aware it is contributing to her depression and anxiety, but has been unable to do so.
ii. A 19 year old male having difficulty with transitioning to university. He has had multiple times where he has had more to drink than he intended, mostly triggered by social anxiety, and more than once has gone swimming whilst drunk in the university pool. He has tried to cut down as he feels like drinking is affecting his mood, and has been able to do so. His drinking has not affected his general function or relationships.
iii. A 55yo executive who drinks daily, often at the expense of activities he used to enjoy. He has had periods where he can’t remember what happened when drinking, including episodes of having unprotected intercourse with strangers. His drinking has caused issues in his marriage and other relationships. He finds that he needs to drink more alcohol these days to feel the beneficial effects, and that on days when he doesn’t drink he tends to have difficulty sleeping, and feels restless and agitated.
iv. A 26yo computer engineer who has fallen into the company culture of ‘drinks nights’ several times a week. He often drinks more than he intends to on these evenings, and has tried to cut down but has been unable to do so. As a result he is nauseated and “hung over” on several mornings of the week, and is struggling to meet deadlines at work, which his boss has started to comment on. He has not experienced blackouts, or risky behaviour whilst drinking, his relationships are not affected and he does not experience any withdrawal effects on days where he doesn’t drink.
a. i and ii
b. i, ii and iii
c. ii and iv
d. i and iv
e. all of the above

Answer 28

D is correct. ii is mild, iii is severe

Question 29

Which of the following is correct regarding the Diabetes Prevention Program?

a. The study participants were allocated to either intensive lifestyle intervention or metformin
b. The education and coaching for the intensive lifestyle group was predominantly delivered by group sessions throughout the intervention period
c. The study demonstrated that to prevent one case of diabetes during a period of three years, 6.9 persons would have to participate in the lifestyle-intervention program, and 13.9 would have to receive metformin.
d. The lifestyle intervention consisted of a goal weight loss of 7%,150 minutes per week of moderate intensity exercise and 1 hour per day of stress management

Answer 29

C
3 arms - metformin, placebo and lifestyle. Education/coaching predominantly one-on-one with allocated health coach/casemanager - tailored to individual, with capacity to increase sessions as needed after initial 16 ‘core curriculum’ sessions. No stress management.

Question 30

With regard to the Physical Activity Guidelines for Americans, which of the following is INCORRECT?

a. There is at least moderate evidence that habitual exercise decreases risk of low mood and depression in children (6-17yo) and adults
b. There is at least moderate evidence that physical activity decreases anxiety both acutely (state anxiety) with an acute episode of activity, and longer term (trait anxiety) with habitual exercise
c. There is at least moderate evidence that habitual physical exercise decreases risk of dementia, and increases cognitive function in adults>50yo
d. There is insufficient evidence to support the conclusion that exercise improves sleep

Answer 30

D
“In addition to feeling better, adults who are more physically active sleep better. Greater volumes of moderate-to-vigorous physical activity are associated with reduced sleep latency (taking less time to fall asleep), improved sleep efficiency (higher percentage of time in bed actually sleeping), improved sleep quality, and more deep sleep. Greater volumes of moderate-to-vigorous physical activity are also associated with significantly less daytime sleepiness, better sleep quality, and reduced frequency of use of sleep-aid medications.The improvements in sleep with regular physical activity are also reported by people with insomnia and obstructive sleep apnea.”Page 40 - guidelineshttps://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf