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Terms in this set (51)
Diabetes can be controlled with which of the following?
*e. All of the above
What is gluten?
a. Sugar found in wheat, barley, and rye *b. Protein found in wheat, barley, and rye c. Fat found in wheat, barley, and rye d. Carbohydrate found in wheat, barley, and rye e. None of the above
Which disease process best describes celiac disease?
a. Inflammatory response
b. Neurological response
*c. Immune response
d. A and B
e. B and C
A patient that has celiac disease receives damage where?
C. large intestine
*D. small intestine
E. all the above
Dr. Urban presents to your clinic with complaints of diarrhea and abdominal pain. He states that he has been feeling like his stomach is full and sensitive after eating. He mentions that his dad used to have the same issues when he was growing up. You ask him if anything he eats specifically causes his discomfort and diarrhea, and he says the only time he doesn't notice it is when he eats the fruits and vegetables that his wife makes him eat. You ask what the diarrhea looks like, and he states, "It looks yellow." What diagnostic test would be indicated for the suspected diagnosis?
B. Stool culture
C. Abdominal x-ray
*D. Intestinal biopsy
Evan comes in and wants to be tested for celiac disease because his parents and siblings have it. You do a biopsy and find that he indeed has celiac disease. You have the ability to show him one of his intestinal cells under a microscope, what clinical significant features of the cell will be present?
A. Abnormally large nuclei
B. Absent cell membrane
*C. Destroyed microvilli
D. None of the above
A patient presents to the doctor's office for her annual checkup and has noted frequent urination and increased thirst. The patient's BMI is 31, her BP is 143/92, pulse rate 80bpm, and RR 21. A fasting glucose test was ordered and her A1C was 7.1. Which of the following is the most appropriate recommendation to your patient?
a. Eat a lot of fruits and nothing else
b. Take diet replacement supplements
c. Decrease saturated fats and processed foods
d. Eat vegetables in abundance
*e. C & D
Which of the following is NOT a nutritional misconception regarding the underlying condition in patients who present with acanthosis nigricans, neuropathy, polyuria, and central obesity?
a. Eating too much sugar causes this disease
*b. Eating starches decreases your chances of developing Type II diabetes
c. You can't eat your favorite foods if you have diabetes
d. While on Type II diabetes medications, you can eat whatever you want
e. All the above are true
DM is a 53 YOM that presents to your office for a follow up visit for his type 2 diabetes. He takes Metformin and Dulaglutide. His spontaneous blood glucose today is 241 mg/dL, and he mentions that he has lost his job and hasn't been able to go to the grocery store in about a week. Which of the following diet changes would most likely contribute to his high blood glucose today?
a. More veggies than usual in diet
b. Increased sodium in diet
*c. Switching from small amounts of whole grain bread to large amounts of white bread
d. Switching from eating chicken 3x per week to eating fish 3x per week
Which of the following can exacerbate a type II diabetic's A1c and blood glucose?
a. Increased fat intake
b. Increased blood glucose
c. Decreased exercise
d. Increased soda intake
*e. All of the above
Which of the following is a common trigger of Crohn's and Colitis?
a. One specific food
Which of the following is a common symptom of IBD?
*a. Rectal bleeding and bloody stools
b. Pelvic pain
A 25 yo Caucasian female came into the ER with abdominal pain, hematochezia, diarrhea, fatigue, and urgency to defecate. Patient has no fever, vitals are within normal limits, normal BMI, bowel sounds are present, and anemia is present. Patient rated the pain as a 7 out of 10 and expressed that she had these symptoms in the past since she was 16 but milder. A colonoscopy was performed and skip lesions were present. Based on this information, what is the most likely diagnosis?
b. Bowel obstruction
d. Upper GI bleed
A patient comes in concerned that she will develop IBD after her friend tells her she should avoid stress in her rigorous graduate program because stress can cause IBD. How do you respond to this patient?
a. IBD can be caused by stress and you advise your patient to do breathing exercises
a. IBD can be caused by stress and you advise your patient to do breathing exercises
*b. You explain to your patient that stress cannot cause IBD, however, stress can exacerbate existing IBD flare-ups
c. You tell your patient that stress has no effect on existing IBD and cannot cause IBD
d. You advise your patient to seek out their school counselor as stress is a major cause of IBD
A patient with a 10-year history of colitis has been well controlled on sulfasalazine. After recently being prescribed amoxicillin after an ear infection they are experiencing a severe colitis flare-up. What is the first line treatment of choice that you would prescribe for this patient?
c. Surgical treatment
B and D
Which of the following are processes the PCOS diet aims to prevent? (MA)
*B. Insulin resistance
Which of the following is true about PCOS?
A. Women with PCOS should avoid all carbohydrates to prevent spikes in blood glucose
B. The curative treatment for PCOS is to achieve a healthy BMI and maintain a healthy diet
*C. Pregnancy is possible for women with PCOS
D. PCOS patients should limit the amount of salmon and tuna they eat
A and C
Miss ED. is a patient, who comes to your primary care office with a chief complaint of amenorrhea. She has not had a period in 7 months and hopes to become pregnant. Her BMI is 30 and she is already taking metformin for pre-diabetes. You emphasize lifestyle modifications like diet and exercise, and she becomes argumentative with you like many patients with PCOS who do not trust their primary care providers, according to UpToDate. You show her the free app on your phone you use to monitor your own diet, which also offers concurrent period tracking. She comes back one month later with a positive pregnancy test and an apology note. What is/are a(n) important takeaway from this interaction? (MA)
*A. Because PCOS can sometimes take up to years to diagnose, it is important to consider this condition in your differential, especially with women who experience infertility
B. Patients generally do not like to exercise
*C. Finding creative ways to compassionately offer advice on lifestyle modifications can improve patient satisfaction and outcomes
D. Diet is not as powerful as pharmaceutical management when it comes to the treatment of PCOSE. Sometimes it is too late to say sorry
Scarlet, your 26yof patient returns for a follow-up visit after taking combined oral contraceptives for her recently diagnosed PCOS. She reports improvement in her acne and hirsutism but asks you, her fully competent and compassionate PA, what else she can be doing to set herself up for success. Which is the best recommendation?
A. Take daily aspirin to reduce infertility caused by chronic inflammation
B. Use skin-sensitive facial shaving cream you prescribe for her today, since typically this is only marketed OTC for men
C. Incorporate white wine into her daily diet to lower her chances of heart disease
*D. Incorporate moderate physical activity to her daily routine along with her healthy diet
All of the following host nutritional benefits for a PCOS patient EXCEPT:
B. Flax seeds
*C. White rice
D. Apple cider vinegar
An 18 y/o F presents to the office with her mother who is concerned because the patient has not had a period for the past 4 mos. Pt is sexually active and uses condoms. The patient is a cross-country runner and has been training over the summer for the fall season. She has been trying to lose weight to attain a PR as this is her senior year. She notes that she has not had much of an appetite recently and upon standing she sometimes feels lightheaded and dizzy. She notes that she has also felt fatigued. The patient's vitals are BP of 100/70, HR of 55, temperature of 98.5 F and an oxygen saturation of 98% on RA. Laboratories are performed and her UAP is negative, UA is pale yellow, clear with pH of 5.0, specific gravity of 1.005, glucose of 129, no ketones or nitrites. CBC is significant for hemoglobin of 9.0 and a hematocrit of 30%. A CMP was significant for a sodium of 127 mEq/L and a potassium of 3.1 mEq/L. How would you best treat and counsel this pt?
A. Perform an iron study and treat the patient for anemia.
B. Perform an iron study and treat the patient for anemia and hypokalemia and hyponatremia.
*C. Perform an iron study and treat the patient for anemia, hypokalemia and hyponatremia. Refer to a therapist.
D. Perform an iron study and treat the patient for anemia, hyperkalemia and hyponatremia. Refer to a therapist.
A 14 y/o male presents to the office with his mother and father complaining of atraumatic pain in his left upper arm. Father states that the patient is trying to make the high school basketball team and has been working out twice a day and has been following a rigorous plant based diet that involves regular juice cleanses. Notes that the patient recently grew six inches over the course of several months and is concerned that he has a growth plate injury. Upon examining the patient, a humeral squeeze test isolates that pain to the distal humerus. Radiographic images are ordered of the upper extremity that show a mid distal humeral stress fracture. What is the best course of treatment?
A. The patient should avoid weight bearing activity in that arm and be referred to physical therapy.
B. The patient's upper extremity should be splinted and he should be referred to orthopedics.
C. The patient can be released in a splint and sling with instructions to avoid weight bearing for 4 weeks and then reinstate gradual ROM exercises to pain tolerance. Follow-up with orthopedics in 6 weeks or earlier if condition worsens.
*D. The patient should be referred to physical therapy with instructions to avoid weight bearing. Should also discuss diet and exercise regimens and refer to a therapist specializing in disordered eating.
JR is a 22 y/o male is a bodybuilder who has been prepping for the Arnold Classic for several months. He counts and records his macronutrients daily and is very cautious about eating out. He only does so when he can access and record the nutritional data, to the annoyance of his friends and girlfriend. He has noticed that he begins to get anxious when his caloric intake or macronutrients are higher or lower than what he had planned out. He states he has been and will be maintaining his weight between workouts and diet until the competition. With the information given, what is the most likely diagnosis for JR?
A. Anorexia nervosa
B. Binge eating
*C. Orthorexia nervosa
A. Refer her to a dietitian and to cognitive behavioral therapy
B. Order a CMP and CBC to determine need for further treatment
C. Advise her to stop taking Miralax post binge episodes
D. Advise her to check out sites like NEDA for online support for eating disorders*E. All of the above
J.R is a 15-year-old female who presents to the clinic with her mom for a follow up visit. J.R has been diagnosed with Bulimia Nervosa. Her mother is worried and nervously asks what are the treatment options available to her daughter. You tell her that all of the following are treatment options except:
A. CBT which will provide education and support for connect JR with helpful resources
B. Antidepressants such as SSRIs to help reduce symptoms such as binges and depressed mood
*C. High doses corticosteroids to prevent binges
D. 20-30 minutes of physical exercise daily to improve her cardiovascular health
C.K is a 21-year-old male who shares a house with 3 friends. He has been consuming larger amounts of food than the rest of his peers, his friends have expressed their concern over, the amount of food C.K eats and how fast he is eating. C.K promises he is in control and can stop himself anytime he wishes. He has not stopped but has resorted to eating in his room instead of with his friends. C.K's friends think he might have an eating disorder. Considering the likely diagnosis, you tell them
A. C.K must be really hungry and it's okay for him eat as long as he pays his fair share
B. C.K has life threatening condition which cannot be treated
C. Not to worry about C.K, he has everything under control
*D. C.K has a condition recognized in the DSM-5, it is a severe, life threatening but treatable condition
Which of the following are risk factors for IBS?
a. Being male
b. Over 50 years of age
*c. Having fibromyalgia, anxiety, or depression
d. All of the above
Patients with IBS should follow a:
a. High FODMAP diet
*b. Low FODMAP diet
c. Gluten-free diet
d. Dairy-free diet
IBS is a psychiatric disease
Which of the following is not a type of IBS?
* d. Nausea
LJ a 28-year-old woman has anxiety about episodes of abdominal pain that have alternated with diarrhea and constipation over the past year. She often has these episodes when she is stressed or tired. She states that her abdominal pain becomes better after she has a bowel movement. Physical examination and laboratory studies are within normal limits during these episodes. Which of the following is the most likely diagnosis?
b. Generalized anxiety disorder
*d. Irritable bowel syndrome
e. Major depressive disorder
Which substance is a leading cause of nutritional deficiency in the U.S.?
Carbohydrates and tryptophan aid in the production of what hormone, which is commonly deficient during and after substance abuse recovery?
Alcoholism often leads to a deficiency in which of the following?
A. Vitamin A
B. *Vitamin B
C. Vitamin D
D. Vitamin E
Abuse of which substance can lead to constipation?
Dehydration and electrolyte imbalances are complications associated with...
A. Alcohol abuse and recovery
B. Opiate abuse and recovery
C. Stimulant abuse and recovery
D. *All of the above
A 65-year-old Hispanic woman presents to your clinic today for a routine check-up. You speak to her regarding her blood work that was drawn two weeks ago in that the results show she has Chronic Kidney Disease. You discuss the importance of eating healthier and ask your patient which foods she normally eats. Which food would should be removed from this patient's diet?
d. Unsweet Iced Tea
You are in an outpatient clinic evaluating a gentleman with a chief complaint of "not peeing a lot." This patient's past medical history includes HTN, elevated BMI, 30 pack year smoking history, and Congestive Heart Failure. Blood work shows decreased GFR, elevated BUN and Creatinine, and low urine output. What is a possible diagnosis for this patient?
a. Kidney stones
b. Bladder Cancer
*d. Chronic Kidney Disease
On average, how many people living in the United States have Chronic Kidney Disease?
Mr. Jones was diagnosed with CKD 1 year ago and has noticed that despite his diagnosis he is still urinating frequently and consistently. Mr. Jones desires to be removed from his medications and states that he feels fine. What is a correct response to Mr. Jones?
a. Wonderful, we will start tapering you off medications today.
*b. In the early stages of CKD, your kidney function reduces gradually, and your urine output may appear normal.
c. Refer Mr. Jones to Nephrology as this is an abnormal finding.
d. Tell Mr. Jones you think he needs to start a new medication.
Ms. Rodriguez was recently diagnosed with CKD. She presents to your clinic today with a chief complaint of swelling in her legs. You perform a thorough H&P and determine that the cause of her edema is due to her diet. Which of the following foods is most likely responsible for the edema?
a. Sonic Double Stacked Bacon Cheeseburger
b. Long John Silver's Beer Battered Fish sandwich w/ tartar sauce
c. Quarter Pounder w. Cheese and extra Fries
d. Panda Express Double Serving of Orange Chicken
*e. All of the above
What is the recommended rate of weight loss?
a. 2-4 kg per week
b. 1-2 kg per week
c. 2-4 lbs per week
*d. 1-2 lbs per week
e. A and D
ccording to the CDC, which of the following is considered overweight for the pediatric population?
a. BMI greater than or equal to 95th percentile
*b. BMI greater than or equal to 85th percentile
c. BMI 30.0-30.9
d. BMI greater than or equal to 75th percentile
e. B and C
Which of the following would be the best recommendation in educating a parent on ways to achieve weight loss or management of their obese child?
a. Supply their favorite sweet snack when they've complied with their exercise plan.
b. Offering food rewards for when goals are achieved.
c. Keep the child's favorite treats in the house to reward them when they have achieved their weight loss goal.
*d. Having a variety of colors constituting their meal.
e. B and C
All of the following are risk factors for childhood obesity EXCEPT:
a. Genetic factors
b. Endocrine disorders
c. Metabolic disorders
*d. Having few or no siblings
e. Poor sleeping habits
Which of the following statements related to childhood obesity is FALSE?
a. It is recommended that children exercise for 30 min - 1 hour/day
*b. Females are less likely to develop mental health disorders with obesity than males
c. Screen time limitations should be included when planning a sleep routine
d. Teenagers should get an average of 8-10 hours of sleep/night
e. The recommended amount of fruits and vegetables for children is 5 servings/day
A female 30 y/o patient comes into your clinic with a chief complaint of pain in the back and joints. She also complains of dyspnea, fatigue and a snoring problem. When you are gathering information about this patient, you notice that she is 5'1" and 180 lbs. You learn that she works at a McDonalds and her diet consists mostly of fast food and soda. What should be the most important part of this patient's healthcare plan?
a. Getting more exercise b. Prescribing a medication for weight loss
*c. Eating more fruits and vegetables with a caloric deficit
d. Recommending that the patient gets more sleep
e. Recommending that the patient tries to reduce stress in life
Which of the following is NOT a risk factor for obesity?
b. Family history
e. Social Factors
Which of these foods would you most likely recommend for a patient to include in their healthy diet?
c. Fruit juice
e. Sugary cereal
Which of the following are tips to maintain a healthy weight?
a. Eat minimally processed foods
b. Drink zero calorie beverages
c. Be mindful about what you consume
d. Eat when you are hungry*e. All of the above
What are the three CV effects that cholesterol causes?
*a. MI, stroke, CVD
b. CHF, MI, VSD
c. ASD, stroke, CHD
d. CVD, MI, HTN
e. MI, CHF, CVD
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