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ABFM ITE EXAM TEST BANK ALL 200 REAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) LATEST UPDATE | ALREADY GRADED A+ (REVISED EXAM)
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ABFM ITE EXAM TEST BANK ALL 200 REAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) LATEST UPDATE | ALREADY GRADED A+ (REVISED EXAM)
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ABFM ITE EXAM TEST BANK ALL 200 REAL EXAM
QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) LATEST UPDATE |
ALREADY GRADED A+ (REVISED EXAM)
True statements regarding nonpharmacologic therapy to reduce insulin resistance
include which of the following? (Mark all that are true.)
Decreasing caloric intake will increase insulin sensitivity independent of weight loss
Moderate alcohol intake increases insulin resistance
Exercise has been shown to enhance insulin action in skeletal muscle
A decrease of as little as 5% in body weight can result in a substantial reduction in
insulin resistance
If there are no contraindications, patients with insulin resistance syndrome should
be advised to engage in 30 minutes of modest aerobic exercise at least 4-5
times/week - ANSWER: A, C, D, E
Lifestyle interventions play a pivotal role in the management of insulin resistance
syndrome. Losing even 5% of body weight has been shown to substantially reduce
insulin resistance. In addition, insulin sensitivity can be increased by reducing caloric
intake, even if no weight is lost. Exercise is an important adjunct to weight loss, since
it has been shown to enhance insulin action in skeletal muscle not only during
physical activity but for up to a week following exercise. All patients with insulin
resistance syndrome should be advised to engage in 30 minutes of aerobic exercise
at least 4-5 times/week. Moderate alcohol intake lowers insulin resistance.
Which one of the following neurologic tests is most useful for predicting the future
occurrence of a diabetic foot ulcer?
Pressure sensation with Semmes-Weinstein monofilament (10 g)
Deep tendon reflexes of the ankle
Proprioception
Vibratory sensation with a 128-mHz tuning fork
Light touch with a wisp of cotton - ANSWER: A
Failure to perceive a pressure sensation produced by Semmes-Weinstein
monofilament indicates a loss of protective sensation in the diabetic foot and is
highly predictive of foot ulceration. Traditional neurologic examination techniques
for evaluating reflexes, proprioception, vibration, or light touch are highly subjective
and less predictive of future ulceration.
Which of the following lipid-lowering agents can worsen glycemic control? (Mark all
that are true.)
Colestipol (Colestid)
Ezetimibe (Zetia)
,Gemfibrozil (Lopid)
Niacin
Atorvastatin (Lipitor) - ANSWER: D AND E
Niacin is not only the most effective agent for raising HDL-cholesterol, producing an
increase of 15%-35%, it also reduces triglycerides by 20%-50% and LDL-cholesterol
by 5%-25%. Hyperglycemia is a side effect of niacin therapy, particularly at high
doses. A dosage of 750-2000 mg/day is associated with only moderate rises in blood
glucose, and at one time was considered a treatment option in patients with
diabetes, particularly those with low HDL-cholesterol levels. However, the
recommendations for niacin use were changed as a result of the AIM-HIGH trial
(Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High
Triglycerides: Impact on Global Health Outcomes), which found no incremental
clinical benefit from the addition of niacin to statin therapy in patients with coronary
heart disease and LDL-cholesterol levels >70 mg/dL.Recent studies support a link
between statin use and the development of diabetes mellitus. In a meta-analysis of
13 studies, statin therapy was associated with a 9% increased risk for incident
diabetes. Another meta-analysis corroborated this result and found that intensive-
dose statin therapy was associated with a higher risk of new-onset diabetes
compared with moderate-dose statin therapy. In 2012, the FDA modified the
package labeling of statins to include the risk of increased blood glucose levels and
the development of type 2 diabetes. The benefit of statin therapy, however,
outweighs the risk; it was estimated there would be 1 additional case of diabetes for
every 498 patients treated for 1 year, compared with 1 less patient experiencing a
cardiovascular event for every 155 patients treated for 1 year.
A 58-year-old male with type 2 diabetes mellitus comes in during the early afternoon
for his annual physical examination. His current medication regimen consists of
insulin glargine (Lantus), 18 units in the evening; glipizide (Glucotrol), 20 mg/day;
metformin (Glucophage), 1000 mg twice a day; and acarbose (Precose), 100 mg
three times a day. He suddenly becomes shaky, diaphoretic, and pale, and tells you
he thinks it is because he skipped lunch before his appointment.Which of the
following would be effective for managing this episode? (Mark all that are true.)
Glucose tablets
A sugar cube
A banana
A soft drink containing sugar
Raisins
Glucagon - ANSWER: A AND F
Acarbose, an α-glucosidase inhibitor, inhibits an enzyme present in the brush border
of the proximal intestinal epithelium that breaks down disaccharides and more
complex carbohydrates. As a result, if hypoglycemia were to occur in a patient on an
α-glucosidase inhibitor, reversal requires either the consumption of glucose itself (as
opposed to complex carbohydrates) or the injection of glucagon.
,Which of the following medications can cause hyperglycemia? (Mark all that are
true.)
Niacin
Clozapine (Clozaril)
Prednisone
Spironolactone
Ramipril (Altace) - ANSWER: A, B, C
Several medications have been shown to affect glucose homeostasis, resulting in
impaired glucose tolerance and hyperglycemia. Agents associated with the
development of hyperglycemia include pentamidine, niacin, glucocorticoids, thyroid
hormone, diazoxide, β-adrenergic agonists, thiazide diuretics, phenytoin, and α-
interferon. In addition, second-generation antipsychotic agents, particularly
clozapine and olanzapine, have also been linked to the development of
hyperglycemia and diabetes mellitus. Spironolactone and ramipril have not been
linked to the development of diabetes. In fact, in the HOPE (Heart Outcomes
Prevention Evaluation) study, the use of ramipril, an ACE inhibitor, appeared to
reduce the risk for developing type 2 diabetes mellitus by 20%-35%.
A 55-year-old African-American male sees you for a routine visit. His past medical
history is notable for an 8-year history of diabetes mellitus and a past history of
hypercholesterolemia. His current medications are atorvastatin (Lipitor), 20 mg/day,
and extended-release metformin (Glucophage XR), 1000 mg/day. He also reports a
history of peanut allergy manifested by lip angioedema, and carries an epinephrine
auto-injector (EpiPen).On examination he has a blood pressure of 124/80 mm Hg. His
hemoglobin A1c is 6.7%. A spot urine sample contains 40 µg albumin/mg
creatinine.You see the patient 6 months later for a follow-up visit, and a spot urine
sample has an albumin/creatinine ratio of 45 µg/mg.Which one of the following
would be most appropriate initially?
Have the patient return in 6 months for a repeat urine test for albumin and
creatinine
Order a 24-hour urine collection for creatinine
Recommend that the patient - ANSWER: E
Diabetic nephropathy develops in 20%-40% of patients with diabetes, and is the
leading cause of end-stage renal disease. Persistent albuminuria in the range of 30-
200 mg/24 hr (microalbuminuria) is the earliest sign of nephropathy in patients with
type 1 diabetes, and is a marker for nephropathy in type 2 diabetes. Patients with
microalbuminuria who progress to macroalbuminuria (>300 mg/24 hr) are likely to
progress to end-stage renal disease over a period of years.Although timed 4- and 24-
hour urine collections for creatinine can be used to screen for microalbuminuria, a
random spot urine specimen for measurement of the albumin-to-creatinine ratio is
the preferred method. A minimum of two of three tests showing a urine albumin
level >30 µg/mg creatinine or more over a 6-month period confirms the diagnosis of
microalbuminuria.Intensive diabetic management and the use of ACE inhibitors and
angiotensin receptor blockers (ARBs) have been shown to delay the progression
, from microalbuminuria to macroalbuminuria in patients with type 1 or type 2
diabetes. Since the antiproteinuric effect is believed to be independent of blood
pressure, current ADA guidelines recommend the use of ACE inhibitors or ARBs as
first-line therapy for both type 1 and type 2 diabetic patients with microalbuminuria,
even if their blood pressure is normal. Some studies, however, have raised questions
about the value of early renin-angiotensin blockade for preventing microalbuminuria
in normotensive patients with type 1 or type 2 diabetes, and ADA guidelines
recommend against the use of these drugs for patients with normal blood pressure
and no albuminuria.Compared to whites, African-Americans and Asians have a three-
to fourfold higher risk of angioedema associated with the use of ACE inhibitors. The
American Heart Association recommends that ACE in
True statements regarding carbohydrate intake and diabetes mellitus include which
of the following? (Mark all that are true.)
The glycemic index is not useful in the management of diabetes mellitus
Carbohydrate sources high in protein are effective for treating hypoglycemia
Low-fat diets are more effective for achieving weight loss than low-carbohydrate
diets (<130 g/day)
Excessive intake of sugar-sweetened beverages has been shown to increase the risk
for diabetes mellitus
Carbohydrates have fewer calories per gram than alcohol - ANSWER: D AND E
Weight loss is an important therapeutic objective in overweight or obese individuals
with prediabetes or diabetes mellitus. Although low-fat diets have traditionally been
promoted for weight loss, studies indicate that diets that provide the same caloric
restriction but differ in protein, carbohydrate, or fat content are equally effective
(SOR A). Both the amount and type of carbohydrates in food influence blood glucose
levels. Monitoring the total grams of carbohydrates and using the glycemic index are
both regarded as helpful strategies for achieving glycemic control. Dietary sucrose
does not increase glycemia more than isocaloric amounts of starch, and intake of
sucrose and sucrose-containing foods does not need to be restricted because of
concerns about aggravating hyperglycemia in patients with diabetes mellitus. The
use of nonnutritive sweeteners in place of caloric sweeteners has the potential to
reduce carbohydrate intake. However, it has been shown that consumption of
excessive amounts of sugar-sweetened beverages by nondiabetic persons is
associated with a greater risk of developing type 2 diabetes. Although the energy
content of alcohol is approximately 7 kcal/g, compared to 4 kcal/g for carbohydrates,
alcohol consumption may place patients with diabetes at higher risk for
hypoglycemia, especially if they are on insulin or insulin secretagogues.
A 51-year-old male with type 2 diabetes mellitus controlled with diet is found to
have a serum triglyceride level of 350 mg/dL, an LDL-cholesterol level of 101 mg/dL,
and an HDL-cholesterol level of 45 mg/dL.Which one of the following supplements
would most likely reduce his serum triglyceride levels?
Vitamin E
Vitamin C
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