Diabetes in Primary Care course MCQ Answers 2016 Diagnosis of Diabetes HbA1C should not be used as a diagnostic tool in the following situations: (answer each TRUE or FALSE) 1. Gestational Diabetes TRUE 2. Chronic iron deficiency anaemia TRUE 3. Steroid-induced diabetes FALSE 4. Pancreatic diabetes TRUE 5. Recent blood transfusion TRUE Classification of Diabetes The following are typical features of Maturity Onset Diabetes of the Young (MODY): (answer each TRUE or FALSE) 1. Low or absent C-peptide levels FALSE 2. Overweight or obese BMI FALSE 3. Presence of pancreatic autoantibodies FALSE 4. Insulin dependence FALSE 5. Marked features of insulin resistance FALSE Pre-diabetes & the prevention of T2D The Finnish Diabetes Prevention Study demonstrated that early intensive lifestyle intervention can prevent the progression to T2DM. The NNT to prevent 1 case of T2DM over 13 years of follow-up was: (choose one) 1. 5 * 2. 25 3. 50 4. 75 5. 100 HbA1C Targets in Diabetes The recently published NICE guidance on the management of T1DM encourage us to support all adults with T1DM to aim for a target HbA1C of: (choose one) 1. 42mmol/mol (6%) 2. 48mmol/mol (6.5%)* 3. 53mmol/mol (7%) 4. 58mmol/mol (7.5%) 5. 64mmol/mol (8%)
Tight glycaemic control ideally striving for an HbA1C 48mmol/mol (6.5%) is appropriate for the following patients: (answer each TRUE or FALSE) 1. A 70-year-old man with >10 years duration T2DM FALSE 2. A 40-year-old lady newly diagnosed with T2DM TRUE 3. A 65-year-old man with a background of IHD and stenting and T2DM for 7 years FALSE 4. A 55-year-old man with inoperable pancreatic cancer and pancreatic diabetes FALSE 5. A 70-year-old man with dementia and newly diagnosed T2DM FALSE Dietary management and behaviour change in diabetes The following are structured education programmes for T2DM: (answer each TRUE or FALSE) 1. DESMOND TRUE 2. X-PERT TRUE 3. BERTIE FALSE 4. DAFNE FALSE 5. RECLAIM FALSE Examples of low glycaemic index (GI) foods include: (answer each TRUE or FALSE) 1. Cornflakes FALSE 2. Baked potatoes FALSE 3. Muesli TRUE 4. Cow s milk TRUE 5. Cous cous FALSE When counting carbohydrates, 1 carbohydrate serving equals how many grams of carbohydrate: (choose one) 1. 5g 2. 10g 3. 15g* 4. 20g 5. 25g 1 pint of draught Guinness contains how many calories: (choose one) 1. 150kcal 2. 200kcal* 3. 250kcal 4. 300kcal 5. 350kcal
The Pharmacological Management of Hyperglycaemia At what egfr should metformin therapy be stopped due to concerns regarding lactic acidosis: 1. 15 2. 30* 3. 45 4. 60 5. No need to stop The following drugs do not cause hypoglycaemia (answer each TRUE or FALSE) 1. Metformin TRUE 2. Sulphonylureas FALSE 3. Pioglitazone TRUE 4. Gliptins TRUE 5. GLP1 analogues TRUE The following drugs do not cause weight gain (answer each TRUE or FALSE) 1. Metformin TRUE 2. Sulphonylureas FALSE 3. Pioglitazone FALSE 4. Gliptins TRUE 5. GLP1 analogues TRUE The following classes of drugs have established cardiovascular safety data (answer each TRUE or FALSE) 1. Metformin TRUE 2. Sulphonylureas FALSE 3. SGLT2 inhibitors TRUE 4. Gliptins TRUE 5. GLP1 analogues TRUE NICE recommends the following as first line treatment when starting insulin therapy in T2DM (answer each TRUE or FALSE) 1. Biphasic (pre-mixed) insulin e.g. Humulin M3 FALSE 2. Long-acting insulin analogue e.g. insulin glargine (Lantus) FALSE 3. Rapid-acting insulin e.g. Novorapid FALSE 4. Ultra-lomg acting insulin e.g. insulin degludec (Tresiba) FALSE 5. Human isophane insulin e.g. Insulatard TRUE
The following insulin types need to be resuspended prior to injection: (answer each TRUE or FALSE) 1. Biphasic (pre-mixed) insulin e.g. Humulin M3 TRUE 2. Long-acting insulin analogue e.g. insulin glargine (Lantus) FALSE 3. Rapid-acting insulin e.g. Novorapid FALSE 4. Ultra-lomg acting insulin e.g. insulin degludec (Tresiba) FALSE 5. Human isophane insulin e.g. Insulatard TRUE The following GLP1 drugs are administered weekly: (answer each TRUE or FALSE) 1. Exenatide (Bydureon) TRUE 2. Exenatide (Byetta) FALSE 3. Lixisenatide (Lyxumia) FALSE 4. Liraglutide (Victoza) FALSE 5. Dulaglutide (Trulicity) TRUE The following GLP1 drugs should be administered up to 1 hour before food: (answer each TRUE or FALSE) 1. Exenatide (Bydureon) FALSE 2. Exenatide (Byetta) TRUE 3. Lixisenatide (Lyxumia) TRUE 4. Liraglutide (Victoza) FALSE 5. Dulaglutide (Trulicity) FALSE Diabetes in Pregnancy Which of the following are the NICE 2015 criteria for diagnosing gestational diabetes: (choose one)? 1. FBG 5.1mmol/l or 2hr BG post 75g OGTT 8.5mmol/l 2. FBG 5.6mmol/l or 2hr BG post 75g OGTT 7.8mmol/l * 3. FBG 5.6mmol/l or 2hr BG post 75g OGTT 11.1mmol/l 4. FBG 7.0mmol/l or 2hr BG post 75g OGTT 7.8mmol/l 5. FBG 7.0mmol/l or 2hr BG post 75g OGTT 11.1mmol/l The management of cardiovascular risk factors in diabetes According to NICE CG181 July 2014: CV risk assessment and reduction, the following people should be offered atorvastatin 20mg: (answer each TRUE or FALSE) 1. A 34-year-old female who developed T1DM aged 21 years TRUE 2. All those aged over 40 years with T2DM FALSE 3. A 44-year-old man with T2DM and CKD3 TRUE 4. A 42-year-old female with T2DM and a 10-year CV risk score of 12% TRUE 5. An 18-year-old man newly diagnosed with T1DM FALSE
Diabetic nephropathy 1. A person with egfr 25 and ACR 15 is classified as having CKD G4A3 FALSE 2. Increased ACR and decreased GFR in combination multiple the risk of adverse outcomes TRUE 3. CKD is an independent risk factor for developing CVD TRUE 4. CKD does not directly cause hypoglycaemia FALSE 5. Lowering HbA1C to 53mmol/mol (7%) improves renal outcomes in CKD FALSE Diabetic foot disease The foot assessment of the following people with T2DM would be classified as moderate risk: (answer each TRUE or FALSE) 1. Peripheral pulses present and sensation intact but evidence of callus formation TRUE 2. Peripheral pulses present, sensation and skin intact but inappropriate footwear FALSE 3. History of previous foot ulceration since successfully treated FALSE 4. Peripheral pulses present but loss of monofilament sensation and skin intact TRUE 5. Unexplained hot, red, swollen foot FALSE Depression and distress in diabetes 1. Depression and anxiety is 5 times as common in those with T1DM and T2DM compared to the general population FALSE 2. Depression in diabetes is associated with an increased risk of mortality TRUE 3. Major depression in T2DM is associated with an increased risk of macrovascular and macrovascular complications TRUE 4. Paroxetine is the best option for treating depression in diabetes FALSE 5. Diabetes distress is a DSM-V defined disorder FALSE Diabetic neuropathy The following conditions can mimic painful diabetic neuropathy (answer each TRUE or FALSE) 1. Osteoarthritis TRUE 2. Intermittent claudication TRUE 3. Plantar fasciitis TRUE 4. Tarsal tunnel syndrome TRUE 5. Radiculopathy TRUE
Abnormal blood tests in diabetes 1. Around 50% of men with T2Dm have evidence of hypogonadotrophic hypogonadism FALSE 2. Testosterone levels of 8nmol/L are suggestive of a true androgen deficiency in an overweight person with T2DM FALSE 3. In those with established hypothyroidism levothyroxine dose should be increased by 25mcg as soon as pregnancy is confirmed TRUE 4. All those with T2DM need an annual check of TFTs FALSE 5. An AST:ALT ratio of 1.1 suggests NAFLD with a low risk of progression to NASH FALSE Diabetic emergencies 1. DKA is always associated with hyperglycaemia FALSE 2. The mortality rate associated with hyperosmolar hyperglycaemic state is around 1-2% FALSE 3. The rate of hypoglycaemia in those with T2DM managed with sulphonylureas is similar to those with T2DM on insulin TRUE 4. Renal impairment doubles the risk of hypoglycaemia in T2DM TRUE 5. A blood ketone level of 3mmol/l can be safely managed at home FALSE