American Board of Family Medicine Knowledge Self-Assessment Questions: Diabetes

American Board of Family Medicine
Knowledge Self-Assessment Questions: Diabetes

Note: The order in which these questions are listed is the order in which they will be presented the first time through the
Knowledge Self-Assessment. On subsequent visits to the assessment, the questions will be presented in groups organized by
competency (content area).
1. 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
○ All patients with insulin resistance syndrome should be advised to engage in 30
minutes of modest aerobic exercise at least 4–5 times/week
The American Association of Clinical Endocrinologists Medical Guidelines for the Management of Diabetes Mellitus:
The AACE System of Intensive Diabetes Self-Management—2002 Update. Endocr Pract 2002;8(suppl 1):40-65.
Howard AA, Arnsten JH, Gourevitch MN: Effect of alcohol consumption on diabetes mellitus: A systematic review.
Ann Intern Med 2004;140(3):211-219.
Einhorn D, Reaven GM, Cobin RH, et al: American College of Endocrinology position statement on the insulin
resistance syndrome. Endocr Pract 2003;9(3):237-252.
Rao G: Insulin resistance syndrome. Am Fam Physician 2001;63(6):1159-1163, 1165-1166.
(Last Modified: February 2005)
2. Which one of the following neurologic tests is most useful for predicting the future
occurrence of a diabetic foot ulcer?
A) Pressure sensation with Semmes-Weinstein monofilament (10 g)

B) Deep tendon reflexes of the ankle
C) Proprioception
D) Vibratory sensation with a 128-mHz tuning fork
E) Light touch with a wisp of cotton
Rith-Najarian SJ, Stolusky T, Gohdes DM: Identifying diabetic patients at high risk for lower-extremity amputation in
a primary health care setting. Diabetes Care 1992;15(10):1386-1389.
Copyright © 2015 American Board of Family Medicine, Inc.

Document Last Modified: December 2015
Singh N, Armstrong DC, Lipsky BA: Preventing foot ulcers in patients with diabetes. JAMA 2005;293(2):217-218.
Feng Y, Schlösser FJ, Sumpio BE: The Semmes Weinstein monofilament examination is a significant predictor of the
risk of foot ulceration and amputation in patients with diabetes mellitus. J Vasc Surg 2011;53(1):220-226.
Boulton AJ, Vinik AI, Arezzo JC, et al: Diabetic neuropathies: A statement by the American Diabetes Association.
Diabetes Care 2005;28(4):956-962.
3. 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)
National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood
Cholesterol in Adults (Adult Treatment Panel III): Third Report of the National Cholesterol Education Program (NCEP)
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)
final report. Circulation 2002;106(25):3143-3421.
Preiss D, Seshasai SR, Welsh P, et al: Risk of incident diabetes with intensive-dose compared with moderate-dose
statin therapy: a meta-analysis. JAMA 2011;305(24):2556-2564.
FDA Drug Safety Communication: Important safety label changes to cholesterol-lowering statin drugs. US Food and
Drug Administration, 2012.
American Diabetes Association: Standards of medical care in diabetes—2014. Diabetes Care 2014;37(Suppl
1):S14-S80.
Rodbard HW, Blonde L, Braithwaite SS, et al; AACE Diabetes Mellitus Clinical Practice Guidelines Task Force:
American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of
diabetes mellitus. Endocr Pract 2007;13(suppl 1):1-68.
Sattar N, Preiss D, Murray HM, et al: Statins and risk of incident diabetes: a collaborative meta-analysis of
randomised statin trials. Lancet 2010;375(9716):735-742.
(Last Modified: May 2006)
4. 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 cracker
○ Raisins
○ Glucagon
Precose package insert. Bayer HealthCare Pharmaceuticals, 2011.

Rodbard HW, Jellinger PS, Davidson JA, et al: Statement by an American Association of Clinical
Endocrinologists/American College of Endocrinology consensus panel on type 2 diabetes mellitus: An algorithm for
glycemic control. Endocr Pract 2009;15(6):540-559.
Riethof M, Flavin PL, Lindvall B, et al: Diagnosis and Management of Type 2 Diabetes Mellitus in Adults.. Institute for
Clinical Systems Improvement (ICSI), 2012, p 141.
(Last Modified: September 2011)
5. Which of the following medications can cause hyperglycemia? (Mark all that are
true.)
○ Niacin
○ Clozapine (Clozaril)
○ Prednisone
○ Spironolactone
○ Ramipril (Altace)
American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists,
North American Association for the Study of Obesity: Consensus development conference on antipsychotic agents
and obesity and diabetes. Diabetes Care 2004;27(2):596-601.
Yusuf S, Sleight P, Pogue J, et al: Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular
events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med
2000;342(3):145-153.
American Diabetes Association: Diagnosis and classification of diabetes mellitus. Diabetes Care 2013;36(suppl
1):S67-S74.
6. 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?
A) Have the patient return in 6 months for a repeat urine test for albumin and
creatinine
B) Order a 24-hour urine collection for creatinine
C) Recommend that the patient reduce his daily protein intake to 1.5 g/kg/day
D) Begin an ACE inhibitor
E) Begin an angiotensin receptor blocker
Chobanian AV, Bakris GL, Black HR, et al: The Seventh Report of the Joint National Committee on Prevention,
Detection, Evaluation, and Treatment of High Blood Pressure-The JNC 7 Report. National Heart Lung and Blood
Institute (NHLBI), 2003.
Gross JL, de Azevado MJ, Silveiro SP, et al: Diabetic nephropathy: Diagnosis, prevention, and treatment. Diabetes
Care 2005;28(1):164-176.
Hunt SA, Abraham WT, Chin MH, et al: ACC/AHA 2005 guideline update for the diagnosis and management of
chronic heart failure in the adult: A report of the American College of Cardiology/American Heart Association Task
Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management
of Heart Failure). Circulation 2005;112(12):e154-e235.
American Diabetes Association: Standards of medical care in diabetes—2015: 9. Microvascular complications and
foot care. Diabetes Care 2015;37(Suppl 1):S58-S66.
Mauer M, Zinman B, Gardiner R, et al: Renal and retinal effects of enalapril and losartan in type 1 diabetes. N Engl J
Med 2009;361(1):40-51.
Bilous R, Chaturvedi N, Sjolie AK, et al: Effect of candesartan on microalbuminuria and albumin excretion in
diabetes: Three randomized trials. Ann Intern Med 2009;151(1):11-20, W3-W4.
7. 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

○ Patients should be advised to avoid sucrose since it increases glycemia more
than a comparable amount of starch
○ 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
American Diabetes Association: Nutrition recommendations and interventions for diabetics. Diabetes Care
2008;31(suppl 1):S61-78.
Barclay A, Gilbertson H, Marsh K, Smart C: Dietary management in diabetes. Aust Fam Physician
2010;39(8):579-583.
1):S14-S80.
8. 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?
A) Vitamin E
B) Vitamin C
C) Omega-3 fatty acids
D) Folate
E) Chromium
Kris-Etherton PM, Harris WS, Appel LJ, for the Nutrition Committee: Fish consumption, fish oil, omega-3 fatty acids,
and cardiovascular disease. Circulation 2002;106(21):2747-2757.
Fletcher B, Berra K, Ades P, et al: Managing abnormal blood lipids: A collaborative approach. Circulation
2005;112(20):3184-3209.
Miller M, Stone NJ, Ballantyne C, et al; American Heart Association Clinical Lipidology, Thrombosis, and Prevention
Committee of the Council on Nutrition, Physical Activity, and Metabolism; Council on Arteriosclerosis, Thrombosis
and Vascular Biology; Council on Cardiovascular Nursing; Council on the Kidney in Cardiovascular Disease:
Triglycerides and cardiovascular disease: A scientific statement from the American Heart Association. Circulation
2011;123(20):2292-2333.
9. Which one of the following is INEFFECTIVE for treating pain syndromes arising from
diabetic neuropathy?
A) Tricyclic antidepressants

B) SSRIs
C) Duloxetine (Cymbalta)
D) Pregabalin (Lyrica)
McCarberg B: Pharmacotherapy for neuropathic pain: The old and the new. Adv Stud Med 2006;6(9):399-408.
Newton WP, Collins L: What is the best treatment for diabetic neuropathy? J Fam Pract 2004;53(5):403-406.
Bril V, England J, Franklin GM, et al: Evidence-based guideline: Treatment of painful diabetic neuropathy: Report of
the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine,
and the American Academy of Physical Medicine and Rehabilitation. Neurology 2011;76(20):1758-1765.
1):S14-S80.
10. At a routine health maintenance visit, a 42-year-old obese male is found to have a
fasting plasma glucose level of 118 mg/dL. Which one of the following is the most
appropriate initial intervention for preventing or delaying the development of
diabetes mellitus in this patient?
A) Lifestyle modification

B) Metformin (Glucophage)
C) A thiazolidinedione
D) An oral sulfonylurea agent
E) An ACE inhibitor
American Diabetes Association, National Institute of Diabetes and Digestive and Kidney Diseases: Prevention or
delay of type 2 diabetes. Diabetes Care 2004;27(suppl 1):S47-S54.
Diabetes Prevention Program Research Group: Reduction in the incidence of type 2 diabetes with lifestyle
intervention or metformin. N Engl J Med 2002;346(6):393-403.
Tuomilehto J, Lindstrom J, Eriksson JG, et al: Prevention of type 2 diabetes mellitus by changes in lifestyle among
subjects with impaired glucose tolerance. N Engl J Med 2001;344(18):1343-1350.
1):S11-S66.
1):S67-S74.
11. A 77-year-old obese male sees you for a routine visit. He has a 20-year history of
hypertension, a 12-year history of type 2 diabetes mellitus complicated by the
development of microalbuminuria and proliferative diabetic retinopathy, and a

history of an inferior myocardial infarction 2 years ago. Although his diabetes had
been adequately controlled with extended-release metformin (Glucophage XR),
500 mg twice daily, you recently added extended-release glipizide (Glucotrol XL),
2.5 mg once daily in the morning, because his hemoglobin A1c rose to 7.1%. He
reports that since then he has episodically experienced shakiness and diaphoresis
in the late morning, relieved by drinking orange juice. Several of these episodes
have occurred during walks he takes with his wife before eating lunch.
Which one of the following would be the most appropriate management?
A) Reducing his metformin dosage to 500 mg in the morning

B) Discontinuing glipizide and keeping the patient on his previous drug regimen
C) Discontinuing glipizide and substituting nateglinide (Starlix)
D) Advising the patient to eat lunch earlier in the day
E) Advising the patient to delay his walk until after lunch
Skyler JS, Bergenstal R, Bonow RO, et al: Intensive glycemic control and the prevention of cardiovascular events:
Implications of the ACCORD, ADVANCE, and VA diabetes trials: A position statement of the American Diabetes
Association and a scientific statement of the American College of Cardiology Foundation and the American Heart
Association. Diabetes Care 2009;32(1):187-192.
Inzucchi SE, Bergenstal RM, Buse JB, et al: Management of hyperglycemia in type 2 diabetes: A patient-centered
approach: Position statement of the American Diabetes Association (ADA) and the European Association for the
Study of Diabetes (EASD). Diabetes Care 2012;35(6):1364-1379.
12. True statments regarding dipeptidyl peptidase-4 inhibitors include which of the
following? (Mark all that are true.)
○ They are more effective than metformin for lowering hemoglobin A1c
○ They reduce insulin resistance

○ They augment glucagon secretion
○ They are weight neutral
○ They are not associated with hypoglycemia
Dicker D: DPP-4 inhibitors: impact on glycemic control and cardiovascular risk factors. Diabetes Care 2011;34(Suppl
2):S276-S278.

(Last Modified: March 2014)
13. Microalbuminuria is strongly linked to which of the following diabetic

complications? (Mark all that are true.)
○ Progressive nephropathy
○ Acanthosis nigricans
○ Autonomic neuropathy
○ Increased cardiovascular risk
○ Chronic interstitial nephritis
1):S14-S80.
14. A 66-year-old postmenopausal female smoker is diagnosed with metabolic

syndrome. Interventions recommended to reduce her cardiovascular risk include
which of the following? (Mark all that are true.)
○ Smoking cessation
○ Aerobic exercise
○ Postmenopausal hormone therapy
○ Vitamin E, 400–800 IU/day
○ Aspirin, 81 mg/day
Miller ER III, Pastor-Barriuso R, Dalal D, et al: Meta-analysis: High-dosage vitamin E supplementation may increase
all-cause mortality. Ann Intern Med 2005;142(1):37-46.
Mosca L, Benjamin EJ, Berra K, et al: Effectiveness-based guidelines for the prevention of cardiovascular disease in
women—2011 update: A guideline from the American Heart Association. Circulation 2011;123(11):1243-1262.
1):S14-S80.
(Last Modified: December 2012)
15. Hypoglycemia is a possible side effect of which of the following diabetes agents?
(Mark all that are true.)
○ Insulin
○ Pioglitazone (Actos)
○ Metformin (Glucophage)
○ Sulfonylureas

○ Repaglinide (Prandin)
○ Acarbose (Precose)
Nathan DM, Buse JB, Davidson MB, et al: Medical management of hyperglycemia in type 2 diabetes: A consensus
algorithm for the initiation and adjustment of therapy: A consensus statement of the American Diabetes Association
and the European Association for the Study of Diabetes. Diabetes Care 2009;32(1):193-203.
Phung OJ, Scholle JM, Talwar M, Coleman CI: Effect of noninsulin antidiabetic drugs added to metformin therapy on
glycemic control, weight gain, and hypoglycemia in type 2 diabetes. JAMA 2010;303(14):1410-1418.
Actos (pioglitazone): Ongoing safety review - Potential increased risk of bladder cancer. US Food and Drug
Administration, 2011.
16. True statements regarding dietary fat intake in patients with diabetes mellitus
○ Cholesterol intake should generally not exceed 200 mg/day

○ Trans fatty acids have been shown to lower LDL-cholesterol and raise
HDL-cholesterol
○ Saturated fats should provide 10% of caloric intake
○ Omega-3 (or n-3) fatty acid supplementation is associated with a
cardioprotective effect
○ A gram of fat contains 50% more calories than a gram of carbohydrate
American Diabetes Association: Nutrition recommendations and interventions for diabetics. Diabetes Care
2008;31(suppl 1):S61-78.
1):S14-S80.
17. True statements regarding coronary heart disease in patients with diabetes
mellitus include which of the following? (Mark all that are true.)
○ Diabetic patients with no previous history of myocardial infarction have the

same risk for an acute coronary event as nondiabetic patients who have had a
previous myocardial infarction
○ β-Blockers should be avoided in diabetic patients with coronary artery disease,

due to the risk of masking hypoglycemia and reducing insulin secretion
○ Long-term outcomes following percutaneous transluminal coronary
angioplasty are as good in diabetic patients as in nondiabetic patients
○ The survival of diabetic patients with multivessel disease is better with
coronary revascularization with coronary artery bypass graft (CABG) surgery
than with percutaneous transluminal coronary angioplasty
○ Optimal glycemic control has been shown to reduce the risk of coronary heart
disease in patients with type 2 diabetes mellitus
American Diabetes Association: Implications of the United Kingdom Prospective Diabetes Study. Diabetes Care
2003;26(suppl 1):S28-32.
Hurst RT, Lee RW: Increased incidence of coronary atherosclerosis in type 2 diabetes mellitus: Mechanisms and
management. Ann Intern Med 2003;139(10):824-834.
Nathan DM, Cleary PA, Barklund JY, et al: Diabetes Control and Complications Trial/Epidemiology of Diabetes
Interventions and Complications (DCCT/EDIC) Study Research Group: Intensive diabetes treatment and
cardiovascular disease in patients with type 1 diabetes. N Engl J Med 2005;353(25):2643-2653.
BARI Investigators: The final 10-year follow-up results from the BARI randomized trial. J Am Coll Cardiol
2007;49(15):1600-1606.
Hillis LD, Smith PK, Anderson JL, et al: 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A report
of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
Circulation 2011;124(23):e652-e735.
1):S11-S66.
Farkouh ME, Domanski M, Sleeper LA, et al; FREEDOM Trial Investigators: Strategies for multivessel
revascularization in patients with diabetes. N Engl J Med 2012;367(25):2375-2384.
Deb S, Wijeysundera HC, Ko DT, et al: Coronary artery bypass graft surgery vs percutaneous interventions in
coronary revascularization: A systematic review. JAMA 2013;310(19):2086-2095.
18. The threshold fasting plasma glucose level recommended for confirming the
diagnosis of diabetes mellitus is
_______ mg/dL
American Diabetes Association: 2. Classification and diagnosis of diabetes. Diabetes Care 2015;38(suppl):S8-S16.
19. A patient with type 2 diabetes mellitus is found to have an LDL-cholesterol level of
140 mg/dL, an HDL level of 45 mg/dL, and a triglyceride level of 425 mg/dL.
Which one of the following lipid-lowering agents should be avoided in this patient
because of its effect on serum triglycerides?

A) Cholestyramine (Questran)
B) Atorvastatin (Lipitor)
C) Fenofibrate (Tricor, Lofibra)
D) Niacin
E) Ezetimibe (Zetia)
Miller M, Stone NJ, Ballantyne C, et al; American Heart Association Clinical Lipidology, Thrombosis, and Prevention
Committee of the Council on Nutrition, Physical Activity, and Metabolism; Council on Arteriosclerosis, Thrombosis
and Vascular Biology; Council on Cardiovascular Nursing; Council on the Kidney in Cardiovascular Disease:
Triglycerides and cardiovascular disease: A scientific statement from the American Heart Association. Circulation
2011;123(20):2292-2333.
20. Endocrinopathies associated with diabetes mellitus include which of the following?
○ Cushing’s syndrome
○ Acromegaly
○ Pheochromocytoma
○ Gastrinoma
○ Glucagonoma
1):S67-S74.
21. According to National Cholesterol Education Program guidelines, criteria for the
diagnosis of metabolic syndrome include which of the following? (Mark all that are
true.)
○ A waist circumference >40 inches in males

○ An HDL-cholesterol level <50 mg/dL in females
○ An LDL-cholesterol level ≥160 mg/dL
○ A serum triglyceride level ≥150 mg/dL
○ Diastolic blood pressure ≥85 mm Hg

22. A 62-year-old female is diagnosed with type 2 diabetes mellitus on the basis of
consecutive fasting plasma glucose levels of 138 mg/dL and 143 mg/dL. Current
American Diabetes Association guidelines recommend which of the following as
part of her initial management? (Mark all that are true.)
○ Lifestyle intervention
○ An oral sulfonylurea
○ A thiazolidinedione
○ Pramlintide (Symlin)
(Last Modified: April 2008)
23. Antidiabetic agents found to be effective in reducing the progression of impaired

glucose tolerance to overt diabetes include which of the following? (Mark all that
are true.)
○ Acarbose (Precose)
○ Non-sulfonylurea secretagogues
○ Orlistat (Alli, Xenical)
American Diabetes Association: Prevention or delay of type 2 diabetes. Diabetes Care 2004;27(suppl 1):S47-S54.
Rao SS, Disraeli P, McGregor T: Impaired glucose tolerance and impaired fasting glucose. Am Fam Physician
2004;69(8):1961-1968,1971-1972.

DeFronzo RA, Tripathy D, Schwenke DC, et al; ACT NOW Study: Pioglitazone for diabetes prevention in impaired
glucose tolerance. N Engl J Med 2011;364(12):1104-1115.
1):S14-S80.
24. A 29-year-old female with polycystic ovary syndrome (PCOS) asks if you can
correct her oligomenorrhea. Her fasting glucose level is 100 mg/dL and her
hemoglobin A1c is in the desirable range.
Which of the following diabetes medications have been found to improve insulin
sensitivity and the ovulation rate in PCOS? (Mark all that are true.)
○ Glyburide (DiaBeta)
○ Miglitol (Glyset)
○ Repaglinide (Prandin)
Nissen SE, Wolski K: Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular
causes. N Engl J Med 2007;356(24):2457-2471.
Singh S, Loke YK, Furberg CD: Long-term risk of cardiovascular events with rosiglitazone: A meta-analysis. JAMA
2007;298(10):1189-1195.
Ehrmann DA: Polycystic ovary syndrome. N Engl J Med 2005;352(12):1223-1236.
Diamanti-Kandarakis E, Christakou CD, Kandaraki E, Economou FN: Metformin: An old medication of new fashion:
Evolving new molecular mechanisms and clinical implications in polycystic ovary syndrome. Eur J Endocrinol
2010;162(2):193-212.
Palomba S, Falbo A, Zullo F, Orio F Jr: Evidence-based and potential benefits of metformin in the polycystic ovary
syndrome: A comprehensive review. Endocr Rev 2009;30(1):1-50.
American College of Obstetricians and Gynecologists: Polycystic ovary syndrome. ACOG Practice Bulletin, no 108,
2009.
FDA Drug Safety Communication: FDA requires removal of some prescribing and dispensing restrictions for
rosiglitazone-containing diabetes medicines. US Food and Drug Administration, 2014.
25. A 53-year-old obese male with a history of type 2 diabetes mellitus sees you for
the first time. He tells you that his previous physician had him see a dietician and
started him on metformin (Glucophage), 500 mg twice daily. He brings in a copy

of his most recent laboratory tests and you note that his hemoglobin A1c is 7.7%.
He admits he has always been sedentary, and wonders if it would be worthwhile
for him to join an exercise facility and begin an exercise program.
Which of the following would be appropriate advice? (Mark all that are true.)
○ Aerobic exercise can be expected to lower hemoglobin A1c by at least 1

percentage point
○ Resistance training has been shown to improve glycemic control
○ Combined aerobic and resistance training results in greater glycemic
improvement than either method alone
○ A minimum of 150 minutes of moderate-intensity exercise per week is
recommended
○ Improved glycemic control is seen only in those who exercise and achieve a
reduction in BMI
Sigal RJ, Kenny GP, Boule NG, et al: Effects of aerobic training, resistance training, or both on glycemic control in
type 2 diabetes: A randomized trial. Ann Intern Med 2007;147(6):357-369.
Marwick TH, Hordern MD, Miller T, et al: Exercise training for type 2 diabetes mellitius: Impact on cardiovascular
risk: A scientific statement from the American Heart Association. Circulation 2009;119(25):3244-3262.
1):S14-S80.
26. A 35-year-old male sees you for a routine health maintenance visit. He admits he
has gained a few pounds over the past few years. He is 173 cm (68 in) tall and
weighs 82 kg (181 lb), giving him a BMI of 27.3 kg/m2.
According to current American Diabetes Association guidelines, which of the

following would warrant screening for prediabetes and diabetes? (Mark all that are
true.)
○ An LDL-cholesterol level >160 mg/dL

○ A serum triglyceride level >250 mg/dL
○ A family history of diabetes mellitus in his father
○ Blood pressures in the prehypertensive range at his last two office visits
○ A history of physical inactivity

1):S14-S80.
27. A 72-year-old African-American female with a history of hypertension, stage 4

chronic kidney disease, heart failure, and recurrent urinary tract infections is
found to have type 2 diabetes mellitus. A trial of dietary therapy is unsuccessful.
Her laboratory evaluation is notable for a random glucose level of 240 mg/dL, a
hemoglobin A1c of 8.2%, macroalbuminuria, and a serum creatinine level of 3.4
mg/dL.
Which one of the following diabetes agents would be most appropriate?
A) Metformin (Glucophage)

B) Glyburide (DiaBeta)
C) Pioglitazone (Actos)
D) Repaglinide (Prandin)
E) Exenatide (Byetta)
Amori RE, Lau J, Pittas AG: Efficacy and safety of incretin therapy in type 2 diabetes: Systematic review and
meta-analysis. JAMA 2007;298(2):194-206.
Information for healthcare professionals: Reports of altered kidney function in patients using exenatide (marketed
as Byetta). US Food and Drug Administration, 2009.
Inzucchi SE, Bergenstal RM, Buse JB, et al: Management of hyperglycemia in type 2 diabetes, 2015: A
patient-centered approach: Update to a position statement of the American Diabetes Association and the European
Association for the Study of Diabetes. Diabetes Care 2015;38(1):140-149.
28. A significantly higher risk for prediabetes and diabetes mellitus has been noted in
persons with a body mass index (BMI) ≥25 kg/m2 who have which of the following
racial/ethnic backgrounds? (Mark all that are true.)
○ African-American

○ Hispanic
○ Slavic
○ Australian
○ Pacific Islander
American Diabetes Association: Standards of medical care in diabetes—2015: 2. Classification and diagnosis of
diabetes. Diabetes Care 2015;37(Suppl 1):S8-S16.
29. Which of the following oral agents should be used with caution in patients with
advanced heart failure? (Mark all that are true.)
○ Thiazolidinediones
○ Sulfonylureas
○ Meglitinides
○ α-Glucosidase inhibitors
Holmboe ES: Oral antihyperglycemic therapy for type 2 diabetes: Clinical applications. JAMA 2002;287(3):373-376.
Inzucchi SE: Oral antihyperglycemic therapy for type 2 diabetes—Scientific review. JAMA 2002;287(3):360-372.
30. Clinical conditions associated with insulin resistance syndrome include which of
the following? (Mark all that are true.)
○ Atherosclerotic cardiovascular disease

○ Polycystic ovary syndrome
○ Acanthosis nigricans
○ Nonalcoholic steatohepatitis
○ Polycythemia

31. True statements regarding aspirin therapy in patients with diabetes mellitus
○ The recommended dosage is 75–162 mg/day

○ It is recommended for routine use in diabetic patients over 40 years of age
○ It is recommended for teenage diabetic patients with dyslipidemia
○ Its use in patients under 21 years of age is associated with an increased risk of
Reye’s syndrome
○ It is recommended for all adults with microalbuminuria
American Diabetes Association: Standards of medical care in diabetes—2015: 8. Cardiovascular disease and risk
management. Diabetes Care 2015;38(Suppl 1):S49-S57.
32. True statements regarding diabetic retinopathy include which of the following?
○ Laser photocoagulation therapy has not been shown to be of benefit in

patients with macular edema
○ Retinopathy is a contraindication to aspirin therapy
○ Glycemic control has been shown to prevent and delay progression of
retinopathy
○ There is no evidence that blood pressure control has a favorable impact on the
progression of diabetic retinopathy
○ Panretinal photocoagulation has been shown to reduce severe visual loss in
patients with proliferative retinopathy
Mohammed Q, Gillies MC, Wong TY: Management of diabetic retinopathy: A systematic review. JAMA
2007;298(8):902-916.
1):S14-S80.
33. Which of the following can cause a high anion gap metabolic acidosis? (Mark all
that are true.)
○ Severe diarrhea

○ Ethylene glycol toxicity
○ Salicylate toxicity
○ Alcoholic ketoacidosis
○ Renal tubular acidosis
Lim S: Metabolic acidosis. Acta Med Indones 2007;39(3):145-150.

Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN: Hyperglycemic crises in adult patients with diabetes. Diabetes Care
2009;32(7):1335-1343.
34. Select the three most effective oral agents for lowering hemoglobin A1c in
diabetic patients.
○ Thiazolidinediones
○ Sulfonylureas
○ Dipeptidyl-peptidase 4 inhibitors
○ α-Glucosidase inhibitors
35. A 67-year-old male with type 2 diabetes mellitus is evaluated for intermittent
claudication and is found to have a right ankle-brachial index of 0.65. He has no
history of hypertension and his urine is negative for microalbuminuria. Mark all
options below that are true in this situation.
○ Cilostazol (Pletal) has been shown to improve walking distance

○ Supervised exercise therapy has been shown to improve walking distance
○ Evidence supports starting him on an ACE inhibitor
○ Peripheral artery disease is an indication for starting aspirin therapy
○ Percutaneous revascularization with iliac artery stenting is as successful in
diabetic patients as in non-diabetic patients

American Diabetes Association: Peripheral arterial disease in people with diabetes. Diabetes Care
2003;26(12):3333-3341.
Beckman JA, Creager MA, Libby P: Diabetes and atherosclerosis: Epidemiology, pathophysiology, and management.
JAMA 2002;287(19):2570-2581.
Smith SC Jr, Allen J, Blair SN, et al: AHA/ACC guidelines for secondary prevention for patients with coronary and
other atherosclerotic vascular disease: 2006 update: Endorsed by the National Heart, Lung, and Blood Institute.
Circulation 2006;113(19):2363-2372.
Hirsch AT, Haskal ZJ, Hertzer NR, et al: ACC/AHA 2005 Practice Guidelines for the management of patients with
peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): A collaborative report from
the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography
and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA
Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With
Peripheral Arterial Disease): Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation;
National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and
Vascular Disease Foundation. Circulation 2006;113(11):e463-e654.
McDermott MM, Liu K, Guralnik JM, et al: Home-based walking exercise intervention in peripheral artery disease: a
randomized clinical trial. JAMA 2013;310(1):57-65.
Ahimastos AA, Walker PJ, Askew C, et al: Effect of ramipril on walking times and quality of life among patients with
peripheral artery disease and intermittent claudication: A randomized controlled trial. JAMA 2013;309(5):453-460.
36. A 28-year-old patient with a 10-year history of type 1 diabetes mellitus is found to
have reduced vibratory sensation in both feet, as well as reduced sensation to
10-g monofilament. Which of the following exercise activities should be
recommended? (Mark all that are true.)
○ Swimming
○ Jogging
○ Bicycling
○ Prolonged walking
○ Rowing
American Diabetes Association: Physical activity/exercise and diabetes mellitus. Diabetes Care 2003;26(suppl
1):S73-S77.
American College of Sports Medicine; American Diabetes Association: Exercise and type 2 diabetes: American
College of Sports Medicine and the American Diabetes Association: Joint position statement. Exercise and type 2
diabetes. Med Sci Sports Exerc 2010;42(12):2282-2303.
37. A 55-year-old male with type 2 diabetes mellitus has a chronic history of reduced

libido and erectile dysfunction. On examination you note hepatomegaly and mild
testicular atrophy. You perform a nonfasting laboratory workup, with the following
serum levels reported:
Glucose............250 mg/dL
AST (SGOT)............260 U/L (N 10–40)
ALT (SGPT)............210 U/L (N 10–55)
FSH............5.0 U/mL (N 1.0–12.0)
LH............8.1 U/mL (N 2.0–12.0)
Testosterone............180 ng/mL (N 280–1250)
What is the most likely diagnosis?
A) Glucagonoma
B) Hemochromatosis
C) Pheochromocytoma
D) Acromegaly
E) Cushing’s syndrome
Brandhagen DJ, Fairbanks VF, Baldus W: Recognition and management of hereditary hemochromatosis. Am Fam
Physician 2002;65(5):853-860.
Pietrangelo A: Hereditary hemochromatosis: Pathogenesis, diagnosis, and treatment. Gastroenterology
2010;139(2):393-408, 408.
38. A 72-year-old male sees you for a routine annual visit. His past medical history is
notable for type 2 diabetes, hyperlipidemia, stage 3 chronic kidney disease,
transient ischemic attacks, carotid endarterectomy, and bladder cancer. His
current medications are metformin (Glucophage), 500 mg twice daily; sitagliptin
(Januvia), 50 mg/day; nateglinide (Starlix), 120 mg 3 times daily with meals;
simvastatin, (Zocor), 40 mg/day; and aspirin, 81 mg/day.
The patient’s blood pressure is 134/76 mm Hg and his BMI is 28.2 kg/m2. The
physical examination is notable only for scattered actinic keratoses on his
forearms and absent pedal pulses.
Laboratory Findings

Serum creatinine............1.9 mg/dL (N 0.6-1.5)
Estimated glomerular filtration rate............52 mL/min/1.73 m2
BUN............45 mg/dL (N 8-25)
Hemoglobin A1c............7.8 %
LDL-cholesterol............95 mg/dL
HDL-cholesterol............33 mg/dL
Serum triglycerides............163 mg/dL
Which of the following would be appropriate at this time? (Mark all that are true.)
○ Increasing the dosage of simvastatin to 80 mg/day

○ Starting basal insulin
○ Starting extended-release niacin, 500 mg/day
○ Starting lisinopril (Prinivil, Zestril), 5 mg/day
○ Starting pioglitazone (Actos), 15 mg/day
Smith SC Jr, Benjamin EJ, Bonow RO, et al; World Heart Federation and the Preventive Cardiovascular Nurses
Association: AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other
Atherosclerotic Vascular Disease: 2011 update: A guideline from the American Heart Association and American
College of Cardiology Foundation. Circulation 2011;124(22):2458-2473.
AIM-HIGH Investigators, Boden WE, Probstfield JL, Anderson T, et al: Niacin in patients with low HDL cholesterol
levels receiving intensive statin therapy. N Engl J Med 2011;365(24):2255-2267.
Fihn SD, Gardin JM, Abrams J, et al; American College of Cardiology Foundation/American Heart Association Task
Force: 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with
stable ischemic heart disease: A report of the American College of Cardiology Foundation/American Heart
Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for
Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and
Interventions, and Society of Thoracic Surgeons. Circulation 2012;126(25):e354-e471.
Kirkman MS, Briscoe VJ, Clark N, et al: Diabetes in older adults. Diabetes Care 2012;35(12):2650-2664.
American Geriatrics Society 2012 Beers Criteria Update Expert Panel: American Geriatrics Society updated Beers
Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2012;60(4):616-631.
Mancini GB, Baker S, Bergeron J, et al: Diagnosis, prevention, and management of statin adverse effects and
intolerance: Proceedings of a Canadian Working Group Consensus Conference. Can J Cardiol 2011;27(5):635-662.
Zocor (simvastatin tablets). US Food and Drug Administration, 2012.
Stone NJ, Robinson J, Lichtenstein AH, et al: 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce
atherosclerotic cardiovascular risk in adults: A report of the American College of Cardiology/American Heart
Association Task Force on Practice Guidelines. Circulation 2014;129(25 Suppl 2):S1-S45.
39. A 60-year-old groundskeeper is brought to the emergency department

unconscious. His temperature is 38.1°C (100.6°F) rectally, blood pressure 96/70
mm Hg, pulse 128 beats/min, and respirations 15/min. The examination is
otherwise unremarkable except for very dry skin and mucous membranes.
Laboratory Findings
Serum sodium............150 mEq/L (N 135–145)

Serum potassium............3.1 mEq/L (N 3.5–5.0)
Serum chloride............112 mEq/L (N 100–108)
CO2............26 mEq/L (N 24–30)
Serum glucose............1080 mg/dL
Serum creatinine............4.0 mg/dL (N 0.6–1.5)
BUN............70 mg/dL (N 8–25)
Serum ketones............small amount present
Which one of the following is the most likely diagnosis?
A) Diabetic ketoacidosis

B) Diabetes mellitus with lactic acidosis
C) Diabetes mellitus with sepsis
D) Hyperosmolar, hyperglycemic state
E) Paraldehyde toxicity
2009;32(7):1335-1343.
40. A 71-year-old male with a history of type 2 diabetes mellitus and long-standing
hypertension sees you because of worsening ankle edema, weight gain, and
“getting more winded” when climbing stairs. His current medications are glipizide
(Glucotrol), 10 mg/day; pioglitazone (Actos), 30 mg/day; extended-release
metformin (Glucophage XR), 1000 mg/day; acarbose (Precose), 25 mg three times
a day; lisinopril (Prinivil, Zestril), 40 mg/day; and hydrochlorothiazide, 12.5
mg/day.
Which one of his medications is most likely responsible for his symptoms?
A) Metformin

B) Glipizide
C) Pioglitazone
D) Acarbose
Singh S, Loke YK, Furberg CD: Long-term risk of cardiovascular events with rosiglitazone: A meta-analysis. JAMA
2007;298(10):1189-1195.
Lincoff AM, Wolski K, Nicholls SJ, et al: Pioglitazone and the risk of cardiovascular events in patients with type 2
diabetes mellitus: A meta-analysis of randomized trials. JAMA 2007;298(10):1180-1188.
US Food and Drug Administration: Manufacturers of some diabetes drugs to strengthen warning on heart failure risk.
August 14, 2007.
41. Which one of the following types of insulin should never be mixed with any other
form of insulin?
A) Lente
B) Ultralente
C) Insulin glargine
D) NPH
E) Insulin lispro
American Diabetes Association: Insulin administration. Diabetes Care 2003;26(suppl 1):S121-S124.
42. Which one of the following agents is most likely to produce weight loss in the
diabetic patient?
A) Thiazolidinediones
B) GLP-1–receptor agonists
C) Sulfonylureas
D) Metformin (Glucophage)
E) α-Glucosidase inhibitors
Love-Osborne K, Sheeder J, Zeitler P: Addition of metformin to a lifestyle modification program in adolescents with
insulin resistance. J Pediatr 2008;152(6):817-822.
Ripsin CM, Kang H, Urban RJ: Management of blood glucose in type 2 diabetes mellitus. Am Fam Physician
2009;79(1):29-36.

43. What is the minimum degree of weight loss recommended to reduce the risk of
diabetes mellitus in a patient with impaired glucose tolerance?
A) Weight reduction of 2%–4%

B) Weight reduction of 5%–10%
C) Weight reduction of 10%–20%
D) Weight reduction of 20%–30%
E) Achievement of ideal body weight
Diabetes Prevention Program Research Group: Reduction in the incidence of type 2 diabetes with lifestyle
intervention or metformin. N Engl J Med 2002;346(6):393-403.
Tuomilehto J, Lindstrom J, Eriksson JG, et al: Prevention of type 2 diabetes mellitus by changes in lifestyle among
subjects with impaired glucose tolerance. N Engl J Med 2001;344(18):1343-1350.
1):S14-S80.
44. A 39-year-old female with type 2 diabetes mellitus develops microalbuminuria

and is started on enalapril (Vasotec). At a follow-up visit 2 months later, an
electrolyte panel reveals an unchanged serum creatinine level of 1.4 mg/dL, but
her potassium level has risen from a baseline of 4.0 mEq/L to its present level of
5.4 mEq/L (N 3.5–5.0).
Which one of the following is the most likely cause of her potassium elevation?
A) Diabetic glomerulosclerosis

B) Hyporeninemic hypoaldosteronism
C) Hyperaldosteronism
D) Hemolytic anemia
E) Bilateral renal artery stenosis
American Diabetes Association. Diabetic nephropathy. Diabetes Care 2003;26(suppl 1):S94-S98.

Hollander-Rodriguez JC, Calvert JF Jr: Hyperkalemia. Am Fam Physician 2006;73(2):283-290.
Palmer BF: Managing hyperkalemia caused by inhibitors of the renin-angiotensin-aldosterone system. N Engl J Med
2004;351(6):585-592.
45. A 42-year-old female with a body mass index (BMI) of 31 kg/m2 has a 3-week

history of polyuria and polydipsia, accompanied by a 10-lb weight loss. Her fasting
plasma glucose level is 320 mg/dL, and her hemoglobin A1c is 11.1%.
Which one of the following is most likely to reverse her glucose toxicity and
improve her glycemic response?
A) Metformin (Glucophage)

B) Pioglitazone (Actos)
C) Glipizide (Glucotrol)
D) Acarbose (Precose)
E) Insulin
Holmboe ES: Oral antihyperglycemic therapy for type 2 diabetes: Clinical applications. JAMA 2002;287(3):373-376.
Nathan DM, Buse JB, Davidson MB, et al: Management of hyperglycemia in type 2 diabetes: A consensus algorithm
for the initiation and adjustment of therapy: A consensus statement from the American Diabetes Association and
the European Association for the Study of Diabetes. Diabetes Care 2006;29(8):1963-1972.
1):S14-S80.
46. A 60-year-old female sees you for her annual checkup. Her past medical history is
notable for a 15-year history of type 2 diabetes and hypercholesterolemia. Her
current medications are extended-release metformin (Glucophage XR), 2000
mg/day; extended-release glipizide (Glucotrol XL), 5 mg/day; atorvastatin
(Lipitor), 10 mg/day; and aspirin, 81 mg/day.
The physical examination is unremarkable. The patient’s blood pressure is 128/78

mm Hg and her BMI is 29.1 kg/m2. Laboratory testing reveals a hemoglobin A1C of
7.2%, an LDL-cholesterol level of 95 mg/dL, an HDL-cholesterol level of 36 mg/dL,
and a serum triglyceride level of 190 mg/dL.
The patient tells you that she plans to start “jogging,” and you order an exercise
nuclear stress test which reveals findings suspicious for exercise-induced
ischemia. Coronary angiography reveals a 65% stenosis of the mid-right coronary
artery.

True statements regarding this situation include which of the following? (Mark all
that are true.)
○ The patient’s aspirin dosage should be increased to 325 mg/day since it is now
for secondary prevention
○ The patient’s atorvastatin dosage should be increased
○ The patient’s glipizide dosage should be increased
○ Prompt revascularization has been shown to be superior to intensive medical
therapy in terms of mortality and major cardiovascular events
○ Percutaneous coronary intervention and coronary artery bypass graft (CABG)
surgery are equally effective in patients with diabetes mellitus and coronary
heart disease
BARI Investigators: The final 10-year follow-up results from the BARI randomized trial. J Am Coll Cardiol
2007;49(15):1600-1606.
Hlatky MA, Boothroyd DB, Bravata DM, et al: Coronary artery bypass surgery compared with percutaneous coronary
interventions for multivessel disease: A collaborative analysis of individual patient data from ten randomised trials.
Lancet 2009;373(9670):1190-1197.
BARI 2D Study Group, Frye RL, August P, et al: A randomized trial of therapies for type 2 diabetes and coronary
artery disease. N Engl J Med 2009 ;360(24):2503-2515.
Smith SC Jr, Benjamin EJ, Bonow RO, et al; World Heart Federation and the Preventive Cardiovascular Nurses
Association: AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other
Atherosclerotic Vascular Disease: 2011 update: A guideline from the American Heart Association and American
College of Cardiology Foundation. Circulation 2011;124(22):2458-2473.
Farkouh ME, Domanski M, Sleeper LA, et al; FREEDOM Trial Investigators: Strategies for multivessel
revascularization in patients with diabetes. N Engl J Med 2012;367(25):2375-2384.
47. Patients must eat within 15 minutes of administration of which one of the
following types of insulin?
A) Lente
B) Ultralente
C) Insulin glargine
D) NPH
E) Insulin lispro

American Diabetes Association: Insulin administration. Diabetes Care 2003;26(suppl 1):S121-S124.
48. The United Kingdom Prospective Diabetes Study found which one of the following
interventions to be most effective in reducing the risk of stroke and heart failure
in diabetics?
A) Good glycemic control

B) Aggressive treatment of mild-to-moderate hypertension
C) Aggressive treatment to lower triglyceride levels and raise HDL-cholesterol
levels
D) Aspirin therapy
E) Use of an ACE inhibitor
American Diabetes Association: Implications of the United Kingdom Prospective Diabetes Study. Diabetes Care
2003;26(suppl 1):S28-32.
49. You are evaluating a patient with diabetes mellitus and hypertension with 24-hour
ambulatory blood pressure monitoring. You note a rise in systolic blood pressure
during sleep.
This has been shown to be an early indicator of which one of the following?
A) Microalbuminuria
B) Orthostatic hypotension
C) Gustatory sweating
D) Proliferative diabetic retinopathy
E) Systolic hypertension
Lurbe E, Redon J, Kesani A, et al: Increase in nocturnal blood pressure and progression to microalbuminuria in type 1
diabetes. N Engl J Med 2002:347(11):797-805.
Palmas W, Pickering T, Teresi J, et al: Nocturnal blood pressure elevation predicts progression of albuminuria in
elderly people with type 2 diabetes. J Clin Hypertens (Greenwich) 2008;10(1):12-20.
50. The strongest predictor for the development and progression of diabetic
retinopathy is

A) glycemic control
B) blood pressure
C) lipid levels
D) duration of disease
E) smoking history
American Diabetic Association: Diabetic retinopathy. Diabetes Care 2003;26(suppl 1):S99-S102.

Lightman S, Towler HMA: Diabetic retinopathy. Clin Cornerstone 2003;5(2):12-21.
Mohammed Q, Gillies MC, Wong TY: Management of diabetic retinopathy: A systematic review. JAMA
2007;298(8):902-916.
51. The most common cause of sudden monocular loss of vision in a patient with
diabetic retinopathy is
A) acute glaucoma

B) vertebrobasilar stroke
C) central retinal vein occlusion
D) ischemic optic neuropathy
E) vitreous hemorrhage
Lightman S, Towler HMA: Diabetic retinopathy. Clin Cornerstone 2003;5(2):12-21.
52. A 58-year-old male with type 2 diabetes mellitus is started on a twice-daily insulin
regimen consisting of 20 units of NPH and 10 units of regular insulin in the
morning, and 10 units of NPH and 4 units of regular insulin in the evening before
dinner. His fasting glucose levels have generally been in the 140–180 mg/dL
range, as have his glucose levels just before lunch and dinner. He complains of
frequent midmorning hypoglycemic episodes requiring midmorning snacks, as
well as hypoglycemic episodes just before bedtime, also requiring snacks.
Which one of the following adjustments is most likely to minimize his

hypoglycemic episodes?
A) Reduce the regular insulin dosage

B) Reduce the NPH dosage
C) Have the patient eat later in the morning and evening

D) Have the patient increase meal sizes at breakfast and dinner
E) Change the patient’s regimen to a long-acting insulin analogue in the evening
and a short-acting insulin analogue for each meal
DeWitt DE, Hirsch IB: Outpatient insulin therapy in type 1 and type 2 diabetes mellitus: Scientific review. JAMA
2003:289(17):2254-2264.
Hirsch IB: Insulin analogues. N Engl J Med 2005;352(2):174-183.
Borgoño CA, Zinman B: Insulins: Past, present, and future. Endocrinol Metab Clin North Am 2012;41(1):1-24.
53. A 16-year-old male has a 1-week history of polyuria, polydipsia, and polyphagia.
On laboratory evaluation he is found to have a serum glucose level of 270 mg/dL,
a serum bicarbonate level of 9 mEq/L (N 22–26), a serum pH of 7.0, and a serum
potassium level of 4.0 mEq/L (N 3.5–5.0).
Which one of the following most accurately describes this patient’s total body
potassium?
A) Mild total body potassium excess

B) Normal total body potassium stores
C) Mild total body potassium deficiency
D) Severe total body potassium deficiency
Rastegar A, Soleimani M: Hypokalaemia and hyperkalaemia. Postgrad Med J 2001;77(914):759-764.

2009;32(7):1335-1343.
54. A 58-year-old male with type 2 diabetes mellitus has a blood pressure of 147/92
mm Hg. You start him on benazepril (Lotensin) and order a baseline serum
creatinine level, which is 1.7 mg/dL. Two weeks later his blood pressure is 128/80
mm Hg, and his serum creatinine level is 2.1 mg/dL. His creatinine level is
unchanged 1 week later.
Which one of the following is the most appropriate course of action?
A) Continue benazepril at the same dosage

B) Reduce the benazepril dosage
C) Discontinue benazepril

D) Evaluate the patient for bilateral renal artery stenosis
E) Have the patient increase his sodium intake
Palmer BF: Renal dysfunction complicating the treatment of hypertension. N Engl J Med 2002;347(16):1256-1261.
Roett MA, Liegl S, Jabbarpour Y: Diabetic nephropathy—The family physician's role. Am Fam Physician
2012;85(9):883-889.
55. Mechanisms of action of exenatide (Byetta) include which of the following? (Mark
all that are true.)
○ Enhanced insulin secretion

○ Suppression of glucagon secretion
○ Enhanced insulin sensitivity of muscle
○ Slowing of gastric motility
○ Reduction of the rate of polysaccharide digestion in the small intestine
56. A 51-year-old African-American female homemaker sees you for her annual
examination. Her past medical history is notable only for a 2-year history of type
2 diabetes mellitus. Her only medication is metformin (Glucophage), 500 mg twice
daily before breakfast and dinner. She is a nonsmoker. Her family history is
notable for her mother having a heart attack in her late 50s. Her physical
examination is unremarkable, and her blood pressure is 128/76 mm Hg.
Laboratory evaluation reveals a serum creatinine level of 0.8 mg/dL (N 0.6–1.5), a
hemoglobin A1c of 6.9%, and no microalbuminuria. Her lipid profile includes an
LDL-cholesterol level of 105 mg/dL, an HDL-cholesterol level of 42 mg/dL, and a
serum triglyceride level of 160 mg/dL.
According to current American Diabetes Association guidelines, which of the

following interventions would be appropriate? (Mark all that are true.)
○ Increasing the dosage of metformin

○ Beginning an ACE inhibitor or angiotensin receptor blocker
○ Beginning aspirin, 81 mg/day

○ Beginning a statin
○ Beginning a fibric acid derivative
57. A 58-year-old obese male comes to your office with a 2-week history of fatigue
associated with polyuria, polydipsia, and weight loss. You suspect he has type 2
diabetes mellitus. This diagnosis would be corroborated by a random glucose
level greater than or equal to
_______ mg/dL
American Diabetes Association: 2. Classification and diagnosis of diabetes. Diabetes Care 2015;38(suppl):S8-S16.
58. A 63-year-old handyman is brought to the emergency department unconscious.

His temperature is 38.1°C (100.6°F) rectally, blood pressure 90/70 mm Hg, pulse
128 beats/min, and respirations 13/min. The examination is otherwise
unremarkable except for very dry skin and mucous membranes.
Laboratory Findings

CO2............22 mEq/L (N 24–30)
Serum creatinine............4.0 mg/dL (N 0.6–1.5)
BUN............70 mg/dL (N 8–25)
Serum ketones............small amount present
Adjusting for the hyperglycemia, what is the patient’s corrected serum sodium
level?
_______ mEq/L
2009;32(7):1335-1343.

59. A 16-year-old female is admitted to the hospital with a 1-week history of polyuria,
polydipsia, and polyphagia. Examination reveals a lethargic, volume-depleted
female with the smell of acetone on her breath. Her blood pressure is 96/70 mm
Hg, her pulse rate is 120 beats/min, and she has Kussmaul respirations at a rate
of 32/min.
Laboratory Findings

CO2............7 mEq/L (N 24–30)
Arterial blood gases
pH............7.10 (N 7.35–7.45)
pCO2............15 mm Hg (N 35–45)
pO2............98 mm Hg (N 80–100)
After initiation of intravenous fluid therapy, which one of the following should be
done next?
A) Initiation of insulin therapy

B) Potassium replacement
C) Bicarbonate therapy
D) Phosphate therapy
E) Dexamethasone therapy
2009;32(7):1335-1343.
60. According to the 2015 American Diabetes Association guidelines, statin therapy
should be considered for which of the following patients with diabetes mellitus?
(Mark all that apply.)
○ A 36-year-old male nonsmoker with normal blood pressure and a normal BMI

who has an LDL-cholesterol level of 95 mg/dL, an HDL-cholesterol level of 50
mg/dL, and a triglyceride level of 195 mg/dL
○ A 45-year-old female nonsmoker with a normal blood pressure and BMI, an
LDL-cholesterol level of 120 mg/dL, an HDL-cholesterol level of 56 mg/dL, and
a triglyceride level of 105 mg/dL
○ A 35-year-old obese male smoker with prehypertension, an LDL-cholesterol
level of 125 mg/dL, an HDL-cholesterol level of 39 mg/dL, and a triglyceride
level of 125 mg/dL
○ A 72-year-old normotensive male nonsmoker with a BMI of 23.1 kg/m2, a past
history of stroke, an LDL-cholesterol level of 65 mg/dL, an HDL-cholesterol
level of 50 mg/dL, and a triglyceride level of 145 mg/dL
○ A 65-year-old female nonsmoker with a normal blood pressure and BMI, an
LDL-cholesterol level of of 80 mg/dL, an HDL-cholesterol level of 50 mg/dL,
and a triglyceride level of 294 mg/dL
(Last Modified: June 2015)


American Board of Family Medicine Knowledge Self-Assessment Questions: Diabetes

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American Board of Family Medicine Knowledge Self-Assessment Questions: Diabetes

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American Board of Family Medicine

Knowledge Self-Assessment Questions: Diabetes

1. True statements regarding nonpharmacologic therapy to reduce insulin resistance

○ Decreasing caloric intake will increase insulin sensitivity independent of weight

(Last Modified: February 2005)

A) Pressure sensation with Semmes-Weinstein monofilament (10 g)

Copyright © 2015 American Board of Family Medicine, Inc.

(Last Modified: February 2005)

(Last Modified: May 2006)

Copyright © 2015 American Board of Family Medicine, Inc.

Precose package insert. Bayer HealthCare Pharmaceuticals, 2011.

(Last Modified: September 2011)

(Last Modified: February 2005)

Copyright © 2015 American Board of Family Medicine, Inc.

Which one of the following would be most appropriate initially?

(Last Modified: September 2013)

○ The glycemic index is not useful in the management of diabetes mellitus

Copyright © 2015 American Board of Family Medicine, Inc.

(Last Modified: September 2013)

(Last Modified: February 2005)

A) Tricyclic antidepressants

Copyright © 2015 American Board of Family Medicine, Inc.

(Last Modified: February 2005)

A) Lifestyle modification

(Last Modified: May 2006)

Copyright © 2015 American Board of Family Medicine, Inc.

Which one of the following would be the most appropriate management?

A) Reducing his metformin dosage to 500 mg in the morning

(Last Modified: September 2013)

○ They reduce insulin resistance

Copyright © 2015 American Board of Family Medicine, Inc.

13. Microalbuminuria is strongly linked to which of the following diabetic

(Last Modified: September 2013)

14. A 66-year-old postmenopausal female smoker is diagnosed with metabolic

(Last Modified: December 2012)

Copyright © 2015 American Board of Family Medicine, Inc.

(Last Modified: February 2005)

○ Cholesterol intake should generally not exceed 200 mg/day

(Last Modified: March 2014)

○ Diabetic patients with no previous history of myocardial infarction have the

Copyright © 2015 American Board of Family Medicine, Inc.

(Last Modified: September 2011)

(Last Modified: February 2005)

Copyright © 2015 American Board of Family Medicine, Inc.

(Last Modified: February 2005)

(Last Modified: December 2012)

○ A waist circumference >40 inches in males

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(Last Modified: September 2013)

(Last Modified: April 2008)

23. Antidiabetic agents found to be effective in reducing the progression of impaired

Copyright © 2015 American Board of Family Medicine, Inc.

(Last Modified: April 2008)

(Last Modified: December 2012)

Copyright © 2015 American Board of Family Medicine, Inc.

○ Aerobic exercise can be expected to lower hemoglobin A1c by at least 1

(Last Modified: September 2011)

According to current American Diabetes Association guidelines, which of the

○ An LDL-cholesterol level >160 mg/dL

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(Last Modified: September 2011)

27. A 72-year-old African-American female with a history of hypertension, stage 4

Which one of the following diabetes agents would be most appropriate?