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.
2.
3.
4.
5.

Gestational Diabetes TRUE

Chronic iron deficiency anaemia TRUE
Steroid-induced diabetes FALSE
Pancreatic diabetes TRUE
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.
2.
3.
4.
5.

Low or absent C-peptide levels FALSE

Overweight or obese BMI FALSE
Presence of pancreatic autoantibodies FALSE
Insulin dependence FALSE
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.
2.
3.
4.
5.

5*
25
50
75
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.
2.
3.
4.
5.

42mmol/mol (6%)
48mmol/mol (6.5%)*
53mmol/mol (7%)
58mmol/mol (7.5%)
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.
2.
3.
4.
5.

A 70-year-old man with >10 years duration T2DM FALSE

A 40-year-old lady newly diagnosed with T2DM TRUE
A 65-year-old man with a background of IHD and stenting and T2DM for 7 years FALSE
A 55-year-old man with inoperable pancreatic cancer and pancreatic diabetes FALSE
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.
2.
3.
4.
5.

DESMOND TRUE
X-PERT TRUE
BERTIE FALSE
DAFNE FALSE
RECLAIM FALSE

Examples of low glycaemic index (GI) foods include: (answer each TRUE or FALSE)
1.
2.
3.
4.
5.

Cornflakes FALSE
Baked potatoes FALSE
Muesli TRUE
Cows milk TRUE
Cous cous FALSE

When counting carbohydrates, 1 carbohydrate serving equals how many grams of carbohydrate:
(choose one)
1.
2.
3.
4.
5.

5g
10g
15g*
20g
25g

1 pint of draught Guinness contains how many calories: (choose one)

1.
2.
3.
4.
5.

150kcal
200kcal*
250kcal
300kcal
350kcal

The Pharmacological Management of Hyperglycaemia

At what eGFR should metformin therapy be stopped due to concerns regarding lactic acidosis:
1.
2.
3.
4.
5.

15
30*
45
60
No need to stop

The following drugs do not cause hypoglycaemia (answer each TRUE or FALSE)
1.
2.
3.
4.
5.

Metformin TRUE
Sulphonylureas FALSE
Pioglitazone TRUE
Gliptins TRUE
GLP1 analogues TRUE

The following drugs do not cause weight gain (answer each TRUE or FALSE)
1.
2.
3.
4.
5.

Metformin TRUE
Sulphonylureas FALSE
Pioglitazone FALSE
Gliptins TRUE
GLP1 analogues TRUE

The following classes of drugs have established cardiovascular safety data (answer each TRUE or
FALSE)
1.
2.
3.
4.
5.

Metformin TRUE
Sulphonylureas FALSE
SGLT2 inhibitors TRUE
Gliptins TRUE
GLP1 analogues TRUE

NICE recommends the following as first line treatment when starting insulin therapy in T2DM (answer
each TRUE or FALSE)
1.
2.
3.
4.
5.

Biphasic (pre-mixed) insulin e.g. Humulin M3 FALSE

Long-acting insulin analogue e.g. insulin glargine (Lantus) FALSE
Rapid-acting insulin e.g. Novorapid FALSE
Ultra-lomg acting insulin e.g. insulin degludec (Tresiba) FALSE
Human isophane insulin e.g. Insulatard TRUE

The following insulin types need to be resuspended prior to injection: (answer each TRUE or FALSE)
1.
2.
3.
4.
5.

Biphasic (pre-mixed) insulin e.g. Humulin M3 TRUE

Long-acting insulin analogue e.g. insulin glargine (Lantus) FALSE
Rapid-acting insulin e.g. Novorapid FALSE
Ultra-lomg acting insulin e.g. insulin degludec (Tresiba) FALSE
Human isophane insulin e.g. Insulatard TRUE

The following GLP1 drugs are administered weekly: (answer each TRUE or FALSE)
1.
2.
3.
4.
5.

Exenatide (Bydureon) TRUE

Exenatide (Byetta) FALSE
Lixisenatide (Lyxumia) FALSE
Liraglutide (Victoza) FALSE
Dulaglutide (Trulicity) TRUE

The following GLP1 drugs should be administered up to 1 hour before food: (answer each TRUE or
FALSE)
1.
2.
3.
4.
5.

Exenatide (Bydureon) FALSE

Exenatide (Byetta) TRUE
Lixisenatide (Lyxumia) TRUE
Liraglutide (Victoza) FALSE
Dulaglutide (Trulicity) FALSE

Diabetes in Pregnancy
Which of the following are the NICE 2015 criteria for diagnosing gestational diabetes: (choose one)?
1.
2.
3.
4.
5.

FBG 5.1mmol/l or 2hr BG post 75g OGTT 8.5mmol/l

FBG 5.6mmol/l or 2hr BG post 75g OGTT 7.8mmol/l *
FBG 5.6mmol/l or 2hr BG post 75g OGTT 11.1mmol/l
FBG 7.0mmol/l or 2hr BG post 75g OGTT 7.8mmol/l
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.
2.
3.
4.
5.

A 34-year-old female who developed T1DM aged 21 years TRUE

All those aged over 40 years with T2DM FALSE
A 44-year-old man with T2DM and CKD3 TRUE
A 42-year-old female with T2DM and a 10-year CV risk score of 12% TRUE
An 18-year-old man newly diagnosed with T1DM FALSE

Diabetic nephropathy
Answer each of the following statements TRUE or FALSE
1.
2.
3.
4.
5.

A person with eGFR 25 and ACR 15 is classified as having CKD G4A3 FALSE
Increased ACR and decreased GFR in combination multiple the risk of adverse outcomes TRUE
CKD is an independent risk factor for developing CVD TRUE
CKD does not directly cause hypoglycaemia FALSE
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.
2.
3.
4.
5.

Peripheral pulses present and sensation intact but evidence of callus formation TRUE
Peripheral pulses present, sensation and skin intact but inappropriate footwear FALSE
History of previous foot ulceration since successfully treated FALSE
Peripheral pulses present but loss of monofilament sensation and skin intact TRUE
Unexplained hot, red, swollen foot FALSE

Depression and distress in diabetes

Answer each of the following statements TRUE or FALSE
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.
2.
3.
4.
5.

Osteoarthritis TRUE
Intermittent claudication TRUE
Plantar fasciitis TRUE
Tarsal tunnel syndrome TRUE
Radiculopathy TRUE

Abnormal blood tests in diabetes

Answer each of the following statements TRUE or FALSE
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
Answer each of the following statements TRUE or FALSE
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