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Poultry CDE Written Exam Practice Questions (1)
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Poultry CDE Written Exam Practice Questions (1)
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CDE Practice Exam 2"I have looked at all the diets out there. I think I'll stick with the meal plan I learned at my
last diabetes clinic visit." This statement indicates the individual is in what stage of
change?
A. Precontemplation
B. Contemplation
C. Preparation
D. Maintenance - ANS-C. Preparation
This individual is ready to change in the near future and is taking steps to begin making
a change.
A 22 year old patient with T1DM checks her bg at 11:00 am after skipping breakfast.
Her bg is 68 mg/dL and she reports feeling jittery and weak. Which of the following
would be the best recommendation for this patient?
A. Inject glucagon 1 mg subcutaneously
B. Eat something with 30 to 60 g of protein
C. Consume tablets with 15 to 20g of glucose
D. Call 911 and transport to the nearest hospital - ANS-C. Consume tablets with 15 to
20g of glucose
A 28 year old patient with poorly controlled T1DM presents for f/u. Her A1C three
months ago was 9.2%. Which of the following is the best recommendation regarding
repeat testing of her A1C?
A. Repeat A1C monthly until less than 7%
B. Repeat A1C today and every 3 months after
C. Repeat A1C after home BG levels are <180 mg/dL
D. Repeat A1C every 12 months regardless of BG levels - ANS-B. Repeat A1C today
and every 3 months after
A 34 year old woman with GDM was well controlled for 2 months with nutritional
interventions. Recently her bg levels started rising and her doctor would like to initiate
pharmacotherapy. Which of the following would be the MOST appropriate oral therapy
recommendation for this patient?
A. Canagliflozin
B. Metformin
C. Repaglinide
D. Pioglitazone - ANS-B. Metformin
,Insulin is considered the safest pharmacotherapy option during pregnancy; however,
many pts prefer a trial with oral agents. Glyburide and metformin possess efficacy and
safety data supporting their short-term use during pregnancy. The other agents lack
human data supporting their use.
A 37 year old woman with a fasting glucose of 115 mg/dL and BP of 138/88 presents to
the clinic. Which of the following would be necessary to diagnose this patient with
metabolic syndrome?
A. BMI >30
B. Waist circumference >30 inches
C. Family hx of DM
D. LDL cholesterol >190 mg/dL - ANS-B. Waist circumference >30 inches
Metabolic syndrome is a constellation of metabolic abnormalities that place patients at
high risk of cardiovascular disease. Diagnosis of metabolic syndrome is made in
patients possessing any 3 of the following 5 criteria: large waist circumference (>35
inches for women, >40 inches for men); fasting triglyceride level >150 mg/dL; low HDL
cholesterol (<50 mg/dL for women, <40 mg/dL for men); fasting bg >100 mg/dL; BP
>130/85 mm Hg or on treatment.
A 38 year old patient with T2DM presents for f/u. She takes metformin 1g with bfast
(8am) and dinner (6pm). She also takes determir 15 units before breakfast (8am) and
before bedtime (10pm). Her average self-monitored bg levels are 136 mg/dL at 8 am,
132 mg/dL at 6 pm, and 220 mg/dL at 10 pm. Which of the following represents the
MOST appropriate change to her regimen?
A. Increase 8 am determir to 20 units
B. Increase 10 pm determir to 20 units
C. Move 6 pm metformin dose to 10 pm
D. Add predinner (6pm) aspart - ANS-D. Add predinner (6pm) aspart
This patient has fasting and predinner (6pm) bgs that are at goal, but her bedtime
values are elevated. Increasing her determir doses will result in hypoglycemia 8 to 10
hours later. Because the duration of action of metformin is so long, moving the evening
dose from 6 pm to 10 pm will not affect glycemic control. The most likely cause of the
elevated bedtime (10pm) bg levels is inadequate mealtime insulin.
A 42 year old male with T2DM presents to the clinic for f/u on his fasting lab values.
Total cholesterol is 300 mg/dL, triglyceride 683 mg/dL, HDL cholesterol 35 mg/dL, and
LDL cholesterol 130 mg/dL. Which of the following represents the MOST appropriate
drug therapy option for this patient?
A. Atorvastatin 10 mg daily
B. Pitavastatin 1 mg daily
,C. Fenofibrate 145 mg daily
D. Ezetimibe 10 mg daily - ANS-C. Fenofibrate 145 mg daily
Patients with triglyceride levels greater than 500 mg/dL area at high risk of pancreatitis.
The first choice of drug therapy for elevated triglyceride levels is fabric acid derivatives
(fenofibrate) or omega-3 fatty acids (fish oil). Statins (atorvastatin, pitavastatin) are
considered first line to lower cardiovascular risk but have little impact on triglycerides.
Ezetimibe primarily lowers LDL cholesterol levels and is most useful as adjective
therapy to statins in patients at high risk of cardiovascular events.
A 42 year old patient with T2DM on metformin 1000 mg twice daily presents for
evaluation. His A1C is 7.8% despite excellent compliance with his metformin, diet, and
exercise recommendations. His health insurance supplements his gym membership and
he would like to "lose a few more pounds." Which of the following would be the best
option for this patient?
A. Dapagliflozin
B. Glipizide
C. Pioglitazone
D. Glargine - ANS-A. Dapagliflozin
Combination of an SGLT2 inhibitor (dapagliflozin) may promote weight loss with low
hypoglycemia risk in this active patient. Glipizide and glargine may increase the risk of
hypoglycemia and weight gain due to the present of excess plasma insulin.
Thiazolidinediones (pioglitazone) activate PPAR-gamma receptors that promote
deposition of free fatty acids into subcutaneous adipose tissue, reducing circulating
plasma levels of ffa and leading to improved insulin resistance, but also results in weight
gain.
A 43 year old AA female pt with T2DM for 8 years and hypothyroidism for 10 years
presents to the clinic complaining of a toothache. Her current medications include
levothyroxine 0.75 mcg daily, metformin 1 g twice daily, and glipizide 10 mg twice daily.
Her laboratory values today are as follows: A1C 7.2%, fasting plasma glucose 268
mg/dL, TSH 0.8 uIU/mL. Which fo the following is the MOST likely reason why her
fasting plasma glucose is elevated today?
A. Hyperthyroidism
B. Secondary to glipizide failure
C. Secondary to infection of tooth
D. Progressive beta-cell destruction - ANS-C. Secondary to infection of tooth
A 44 year old with T2DM on metformin 1 g twice daily also takes glargine 40 units at
bedtime. His fasting bg is 210 mg/dL. Which of the following represents the MOST
appropriate glargine dose change?
, A. Decrease to 36 units
B. Increase to 41 units
C. Increase to 46 units
D. Move glargine to morning at current dose - ANS-C. Increase to 46 units
increase by 10% to 15%
A 45 year old female pt is newly diagnosed with T2DM. Her A1C is 8.8% and her serum
creatinine is 0.6%. Which of the following drug therapy options would be MOST
appropriate?
A. Exenatide
B. Saxagliptin
C. Acarbose
D. Metformin - ANS-D. Metformin
This patient has an A1C value that is 1.8% away from her goal. Biguanides (metformin)
and sulfonylureas lower A1C by approximately 1% to 2%, whereas GLP-1 agonists
(exenatide), DPP-4 inhibitors (saxagliptin), and alphaglucosidase inhibitors (acarbose)
lower A1C by 0.5% to 1%.
A 45 year old man presents for a 1 month f/u after starting immediate release metformin
500 mg twice daily. Today he brought in his bg meter and bottle of metformin, which is
nearly full. Which of the following is the MOST appropriate next step to evaluate his
adherence to the regimen?
A. Confront the patent about his noncompliance
B. Telephone the pharmacy to verify the last refill date
C. Change to the extended release formulation of metformin
D. Review self-monitored bg log - ANS-B. Telephone the pharmacy to verify the last
refill date
The provider suspects poor adherence with this patient, but needs to confirm with
additional information. Confronting the patient will likely only result in denial. Additional
questioning of the patient may reveal intolerable side effects, but changing the
metformin formulation is premature at this point. Review of the self monitored bg log is
important, but will confirm the suspected poor adherence.
A 45 year old patient with T1DM reports several hypoglycemic episodes over the past
20 years requiring hospitalization. He currently takes glargine (Lantus) every morning
and lispro before main meals. His A1C is 8.2% with fasting bg of 250 mg/dL. He reports
eating 3 meals daily with a large bedtime snack for with he does not bolus. Which of the
following is the MOST likely reason for his resistance to taking insulin before the
bedtime snack?
A. Fear of insulin antibodies
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