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1.The daughter of one of your patients accompanies her mother to the office to discuss her The mother seems to have had progressive cognitive failure over the last year. According to the daughter, she loses func- tion in a stepwise fashion. She seems to stabilize, but suddenly becomes less able to remember things or care for herself. This has happened several times in the last year. Given this history, what is the likely etiology of her dementia?
- Alzheimer’s disease
- Parkinson’s disease
- Alcoholic dementia
- Vascular dementia
2. You are concerned that a 66-year-old man is developing signs of Alzheimer’s His mother suffered from it, and he has an older brother currently battling dementia. Which of the following is considered a routine laboratory test used in the evaluation of dementia?
- Erythrocyte sedimentation rate
- Toxicology screening
- Syphilis serology
- An MRI of the brain
- A heavy metal screen
3. You decide to treat a 72-year-old man for Alzheimer’s You choose to use donepezil (Aricept), and begin therapy. Which of the follow- ing effects is not likely with the use of this medication?
- Improvement in cognition
- Improvement in behavior
- Improvement in the ability to accomplish activities of daily living
- Improvement in global measurements of functioning
- Improvement in the progression of neurodegeneration
4. You are treating a patient with the classic signs of His care- taker reports that he has been having complex visual hallucinations and a tremor. On examination, he appears to have masked facies, has a slight tremor, and a shuffling gait. His cognitive decline is stable and present. Which of the following medications should be avoided in this case?
- Cholinesterase inhibitors
- Selective serotonin reuptake inhibitors
- Tricyclic antidepressants
5. You are performing a screening physical examination on a 47-year- old He is generally healthy, and his review of systems is negative. His mother has type 2 diabetes, and he is overweight. Which of the following is generally accepted as the test of choice to screen for type 2 diabetes?
- A random glucose test
- A fasting glucose
- A urinalysis to screen for glycosuria
- A 1-hour glucose tolerance test
- A 3-hour glucose tolerance test
6. You are evaluating a 36-year-old obese woman who complains of She denies polydipsia, polyuria, polyphagia, or weight loss. Which of the following laboratory reports confirms the diagnosis of diabetes?
- One random glucose of 221 mg/dL
- One random glucose reading of 221mg/dL, and another, on a later date, of 208 mg/dL
- One fasting glucose measurement of 128 mg/dL
- A glucose reading, taken 2 hours after a 75 g glucose load, of 163 mg/dL
- A fasting glucose of 114 mg/dL, and a reading of 184 mg/dL 2 hours after a 75 g glucose load
7. An 18-year-old morbidly obese patient in your office is found to have a fasting glucose of 314 mg/dL. Which of the following test results indi- cates that he is a type 1 diabetic?
- Low levels of c-peptide
- Markedly elevated levels of c-peptide
- Elevated levels of microalbumin in the urine
- A markedly elevated hemoglobin A1C
- Nerve conduction studies showing mild peripheral neuropathy
8. You are obtaining a family history from a new patient, and trying to determine her risk for various health She reports that her grandmother died of renal failure, but is unsure why her grandmother had that problem. What is the most common cause of end stage renal disease?
- Hypertensive nephropathy
- Diabetic nephropathy
- Polycystic kidney disease
- Contrast-induced nephropathy
9. You are managing a 36-year-old woman with a new diagnosis of type 2 Her hemoglobin A1C was 7.2% at diagnosis. Her subsequent sugars were well-controlled using metformin, 1000 mg BID. At her visit 3 months later, her blood pressure is 100/72, her hemoglobin A1C was 6.0%, but her microalbumin screen is positive. Which of the following is the most appropriate response?
- Continue weight loss and recheck in 3 months
- Limit dietary protein intake
- Intensify diabetic therapy to more tightly control glucose
- Initiate therapy with an ACE inhibitor
- Refer to nephrology
10. A 44-year-old man is seeing you for a routine diabetic He was diagnosed with type 2 diabetes 2 years ago. He is worried because his grandmother went blind as a complication from her diabetes. Which of the following statements about diabetic retinopathy is true?
- The risk of retinopathy increases with increased hemoglobin A1C levels
- It generally takes 10–20 years to see signs of retinopathy in a diabetic patient
- A daily aspirin decreases the risk of retinopathy development
- The first sign of retinopathy is usually the growth of new vessels on the retina
- Retinopathy is an uncommon cause of visual loss in this day and age
11. You have just diagnosed a patient with type 2 After dis- cussing the importance of glucose control to limit long term complications from the illness, she asks what the most common cause of death is among diabetes. Which of the following is the answer to her question?
- Heart disease
12. You are seeing an African American man with newly diagnosed dia- His blood pressure at the last visit was 148/86, and at this visit it is 142/90. What should your first choice for blood pressure control be?
- A beta-blocker
- A thiazide diuretic
- An ACE inhibitor
- A calcium-channel blocker
- An alpha-blocker
13. You are following a type 2 diabetic woman in her Six months ago, you checked her lipid profile. At that time, her total cholesterol was 245 mg/dL, her LDL was 148 mg/dL, her HDL was 30 mg/dL and her triglyc- erides were 362. She has tried lifestyle modifications, but despite losing weight and exercising, her profile hasn’t substantially changed. What is the treatment of choice for this patient?
- Continued lifestyle modifications
- A 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) [P1]reductase inhibitor (a “statin”)
- Fibric acid derivatives
- A bile acid resin
14. A 39-year old diabetic man asks you questions about his Which of the following is true?
- A high fiber diet improves glycemic control
- A low carbohydrate diet improves glycemic control
- A high protein diet improves glycemic control
- Sucrose should not be included in the diabetic diet
- A formalized dietary program is more likely to produce long term sustained effects
15. A 44-year-old African American with type 2 diabetes transfers care to Reviewing her records, you find she is on the maximum dose of sul- fonylurea, but her hemoglobin A1C is 9.2% (H). Review of her baseline laboratory tests reveals normal liver enzymes and a creatinine of 2.3 mg/dL. Which of the following management options would be most beneficial?
- Change to another sulfonylurea
- Add a biguanide
- Add a meglitinide
- Add a thiazolidinedione
- Add an alpha-glucosidase inhibitor
16. A 48-year-old woman has been treated for type 2 diabetes for 6 years with metformin 2000 mg daily, and glyburide 10 mg She is modestly compliant with her diet, medications, and exercise. She is 69 in. tall and weighs 278 lb. Her most recent HbA1C is 8.2% which has been rel- atively unchanged over the past 18 months. If weight loss is a therapeutic priority for this patient, which of the following would represent a logical next step?
- Increase her glyburide to the maximum dose of 10 mg twice daily
- Add a long-acting, basal insulin such as insulin glargine, discontinue glyburide, and maintain metformin
- Add an insulin sensitizing agent such a pioglitazone or rosiglitazone to her regimen
- Add an incretin-mimetic such as exenatide to her regimen
- Simplify the regimen by discontinuing all oral medications and substituting a long-acting basal insulin plus a rapid-acting preprandial insulin such as insulin aspart
17. You have been treating a 46-year-old woman for type 2 diabetes for 2 years with metformin 2000 mg She is compliant with her diet and medications, and exercises regularly. She is 65 in. tall and weighs 200 lb. Her most recent HbA1C is 8.0% which is elevated from 7.8% 3 months ago. You added the insulin-sensitizing agent rosiglitizone to her regimen 2 weeks ago. The patient presents today complaining of a problem that she attributes to the new medication. Which of the following is a likely complaint?
- Symptomatic hypoglycemia
- Edema and weight gain
- Paradoxical hyperglycemia
- Gastrointestinal intolerance
18. A 48-year-old man with type 2 diabetes talks to you at a routine appoint- ment about a drug he heard discussed on the This patient currently takes gliplizide, pioglitazone, and acarbose. He wants to know more about sitagliptin (Januvia). Which of the following best explains its mechanism of action?
- Inhibition of glucagon release
- Increases the sensitivity of the body to insulin
- Inhibition of hepatic gluconeogenesis
- Inhibition of gastric emptying
- Suppression of glucagon elaboration and delayed gastric emptying
19. You are thinking about starting a type 2 diabetic on insulin therapy to improve her glucose Which of the following insulin types has the most rapid onset of action?
- Aspart (Novolog)
- Glargine (Lantus)
20. You are thinking about starting a type 2 diabetic on insulin therapy to improve her glucose Which of the following insulin prepara- tions has a peak or maximum action at approximately 5 hours?
- Aspart (Novolog)
- Glargine (Lantus)