CMN 571 Unit 3 Exam Questions with Correct Answers Primary prevention - Answer -when we are able to stop a disease or injury prior to the occurrence. Secondary prevention - Answer -when we impact a disease that has already occurred, sometimes providing cures. Tertiary prevention - Answer -when we manage disease that is chronic in order for it not to progress or worsen. Blood Pressure - Answer -Normal <120/80 Elevated 120 -129/<80 Stage 1 hypertension 130-139/80 -89 Stage 2 hypertension >140/90 **Based on an accurate measurement >2 times on > 2 occasions What Does the Guideline Say About Sleep Apnea? - Answer -OSA is a risk factor for several cardiovascular diseases, including hypertension, coronary, and cerebrovascular diseases. Studies have shown that the presence of OSA is associated with an increased risk of hypertension. It has also been hypothesized that treatment for OSA will have more pronounced effects on blood pressure reduction in resistant hypertension. The guideline specifically mentions CPAP therapy as a successful form of treatment. But we can still look to oral appliances to play an important role as well. Studies that have looked at the effects of CPAP on blood pressure (BP) have demonstrated only small improvements in BP. The results were dependent on the patient's compliance with CPAP use, severity of OSA, and presence of daytime sleepiness. As you know, many patients are noncompliant to CPAP therapy, which is often when an oral appliance can be prescribed and used. It helps to provide these patients with a successful alternative to not only treating their sleep apnea, but also possibly improving their BP. What do I need to know for the exam? Application of the lifestyle modification guidelines will be important. In order for you to talk with a patient about HTN, you should also know what B/P measurement indicates lifestyle modification would likely be successful, if implemented? Diabetes can be classified into the following general categories: - Answer -Type 1 diabetes (due to autoimmune β-cell destruction, usually leading to absolute insulin deficiency) Type 2 diabetes (due to a progressive loss of β-cell insulin secretion frequently on the background of insulin resistance) Gestational diabetes mellitus (GDM) (diabetes diagnosed in the second or third trimester of pregnancy that was not clearly overt diabetes prior to gestation) Specific types of diabetes due to other causes, e.g., monogenic diabetes syndromes (such as neonatal diabetes and maturity -onset diabetes of the young), diseases of the exocrine pancreas (such as cystic fibrosis and pancreatitis), and drug - or chemical - induced diabetes (such as with glucocorticoid use, in the treatment of HIV/AIDS, or after organ transplantation) Diagnostic Tests for Diabetes - Answer -Diabetes and prediabetes may be screened based on plasma glucose criteria, either the fasting plasma glucose (FPG) or the 2-h plasma glucose (2 -h PG) value during a 75 -g oral glucose tolerance test (OGTT), or A1C criteria. A1C Prediabetes 5.7-6.4% Diabetes ≥6.5% FPG Prediabetes 100-125 mg/dL (5.6-6.9 mmol/L) Diabetes ≥126 mg/dL (7.0 mmol/L)† OGTT Prediabetes 140 -199 mg/dL (7.8 -11.0 mmol/L) Diabetes ≥200 mg/dL (11.1 mmol/L) RPG — Diabetes ≥200 mg/dL (11.1 mmol/L) Categories of Increased Risk for Diabetes (Prediabetes) - Answer -"Prediabetes" is the term used for individuals whose glucose levels do not meet the criteria for diabetes but are too high to be considered normal (see Table 1). Prediabetes should not be viewed as a clinical entity in its own right but rather as an increased risk for diabetes and cardiovascular disease (CVD). Criteria for Testing for Diabetes or Prediabetes in Asymptomatic Adults - Answer - Testing should be considered in overweight or obese (BMI ≥25 kg/m2 or ≥23 kg/m2 in Asian Americans) adults who have one or more of the following risk factors: First-degree relative with diabetes High-risk race/ethnicity (e.g., African American, Latino, Native American, Asian American, Pacific Islander) History of CVD Hypertension (≥140/90 mmHg or on therapy for hypertension) HDL cholesterol level <35 mg/dL (0.90 mmol/L) and/or a triglyceride level >250 mg/dL (2.82 mmol/L) Women with polycystic ovary syndrome Physical inactivity Other clinical conditions associated with insulin resistance (e.g., severe obesity, acanthosis nigricans) Patients with prediabetes (A1C ≥5.7% [39 mmol/mol], IGT, or IFG) should be tested yearly. Women who were diagnosed with GDM should have lifelong testing at least every 3 years. For all other patients, testing should begin at age 45 years. If results are normal, testing should be repeated at a minimum of 3-year intervals, with consideration of more frequent testing depending on initial results and risk status. Risk-Based Screening for Type 2 Diabetes or Prediabetes in Asymptomatic Children and Adolescents in a Clinical Setting - Answer -Criteria ● Overweight (BMI >85th percentile for age and sex, weight for height >85th percentile, or weight >120% of ideal for height) A ● Plus one or more additional risk factors based on the strength of their association with diabetes as indicated by evidence grades: ● Maternal history of diabetes or GDM during the child's gestation A ● Family history of type 2 diabetes in first- or second -degree relative A ● Race/ethnicity (Native American, African American, Latino, Asian American, Pacific Islander) A ● Signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, polycystic ovary syndrome, or small -for- gestational -age birth weight) B LIFESTYLE MANAGEMENT - Diabetes - Answer -Lifestyle management is a fundamental aspect of diabetes care and includes diabetes self-management education and support (DSMES), medical nutrition therapy (MNT), physical activity, smoking cessation counseling, and psychosocial care. Patients and care providers should focus together on how to optimize lifestyle from the time of the initial comprehensive medical evaluation, throughout all subsequent evaluations and follow -up, and during the assessment of complications and management of comorbid conditions in order to enhance diabetes care. PREVENTION OR DELAY OF TYPE 2 DIABETES - Answer -Recommendations At least annual monitoring for the development of diabetes in those with prediabetes is suggested. Patients with prediabetes should be referred to an intensive behavioral lifestyle intervention program modeled on the Diabetes Prevention Program to achieve and maintain 7% loss of initial body weight and increase moderate -intensity physical activity (such as brisk walking) to at least 150 min/week. PREVENTION OR DELAY OF TYPE 2 DIABETES - Pharmacologic - Answer -Metformin therapy for prevention of type 2 diabetes should be considered in those with
