Question 1

In an oral glucose tolerance test, a two-hour blood glucose concentration of 9.0 mmol l⁻¹ would be classified as: A) Normal B) High C) Impaired glucose tolerance D) Diabetes mellitus

Accepted Answer

Impaired glucose tolerance is diagnosed when the two-hour blood glucose concentration is between 7.8 and 11.0 mmol/L, so a result of 9.0 mmol/L falls within this range.

Question 2

What is the underlying principle of the 'adipose tissue overflow hypothesis'?&#10;A) Ability of adipose tissue to take up non-esterified fatty acids from the blood and store them as triglyceride&#10;B) Accumulation of non-esterified fatty acids and triglycerides in the blood once the storage capacity of subcutaneous depots is exceeded&#10;C) Capacity to increase subcutaneous fat storage to prevent elevated blood triglyceride concentrations&#10;D) Accumulation of fat in visceral and ectopic depots once subcutaneous stores are saturated

Accepted Answer

The adipose tissue overflow hypothesis states that once the storage capacity of subcutaneous adipose tissue depots is exceeded, excess energy is stored in visceral and ectopic depots such as liver and muscle, leading to metabolic dysfunction and disease. Therefore, the correct answer is D - accumulation of fat in visceral and ectopic depots once subcutaneous stores are saturated.

Question 3

Which of the following statements is false?&#10;A) Physical activity is only associated with type 2 diabetes risk in individuals with obesity&#10;B) Accounting for adiposity attenuates the relationship between physical activity and the risk of type 2 diabetes&#10;C) Both weight training and aerobic exercise are associated with a lower risk of type 2 diabetes&#10;D) The association between physical activity level and the risk of type 2 diabetes is non-linear

Accepted Answer

Physical activity is associated with a lower risk of type 2 diabetes in both individuals with obesity and those without. Therefore, statement A is false.

Question 4

Which of the following studies provides the most convincing evidence that lifestyle intervention can prevent or delay the development of type 2 diabetes and its complications?&#10;A) The Indian Diabetes Prevention Programme&#10;B) The Da Qing Diabetes Prevention Study&#10;C) The Look AHEAD (Action for Health in Diabetes) study&#10;D) The Nurses' Health Study

Accepted Answer

The Da Qing Diabetes Prevention Study is a randomized controlled trial, considered the gold standard of evidence, which showed that lifestyle intervention reduced the incidence of type 2 diabetes by 31% over 6 years. The other studies are observational or non-randomized trials, which are less convincing forms of evidence.

Question 5

Which of the following statements correctly summarises the exercise training effect on glycated haemoglobin (HbA1c) in patients with type 2 diabetes?&#10;A) Neither aerobic nor resistance exercise reduces HbA1c concentrations&#10;B) Resistance, but not aerobic, exercise reduces HbA1c concentrations&#10;C) Resistance exercise reduces HbA1c concentrations to a greater extent than aerobic exercise&#10;D) The combination of aerobic and resistance exercise maximises the reduction in HbA1c concentrations

Accepted Answer

Many studies have shown that exercise training, especially a combination of aerobic and resistance exercise, can significantly reduce HbA1c concentrations in patients with type 2 diabetes. Both aerobic and resistance exercise alone may also reduce HbA1c, but the combination is more effective. Therefore, options A, B, and C are incorrect.

Question 6

The earliest visible sign of atherosclerosis is:&#10;A) Raised lesion&#10;B) Thrombus&#10;C) Fibrous plaque&#10;D) Fatty streak

Accepted Answer

The earliest visible sign of atherosclerosis is a fatty streak, which is made up of lipid-laden macrophages found in the arterial wall. It is not raised, does not contain a thrombus, and is not yet fibrous.

Question 7

In Jeremy Morris's classic study of London transport workers, the risk of heart attack in bus conductors compared with bus drivers was approximately:&#10;A) One-half&#10;B) One-third&#10;C) One-quarter&#10;D) One-fifth

Accepted Answer

The classic study by Jeremy Morris found that bus conductors, who were more physically active due to moving up and down the bus, had approximately half the risk of heart attack compared to bus drivers, who were mostly sedentary.

Question 8

Which of the following is false with respect to the Harvard Alumni Health Study?&#10;A) Men who participated in university sport did not have a lower risk of CHD unless they maintained a high level of physical activity&#10;B) Energy expenditure in physical activity was inversely associated with CHD risk&#10;C) Active men had a lower risk of CHD in the presence and absence of other major risk factors&#10;D) Very high levels of physical activity were associated with an elevation in CHD risk

Accepted Answer

The statement that very high levels of physical activity were associated with an elevation in CHD risk is false. The Harvard Alumni Health Study actually found that individuals who engaged in high levels of physical activity had a reduced risk of CHD.

Question 9

A person weighing 70 kg and expending energy at a rate of 42 kJ min⁻¹ would be exercising at approximately: A) 6 METs B) 8 METs C) 10 METs D) 12 METs

Accepted Answer

A MET (Metabolic Equivalent of Task) is a unit that estimates the energy expenditure of physical activities, defined as the ratio of the metabolic rate during a specific physical activity to a reference metabolic rate, set by convention to 3.5 ml O2 per kg body weight per minute. To convert the energy expenditure from kJ/min to METs, we first convert kJ to kcal (since 1 MET = 1 kcal/kg/hr), knowing that 1 kJ = 0.239 kcal. The person is expending 42 kJ/min, which equals 42 * 0.239 = 10.038 kcal/min. To find METs, we convert kcal/min to kcal/hr (10.038 kcal/min * 60 min/hr = 602.28 kcal/hr), and then divide by the person's weight in kg (602.28 kcal/hr / 70 kg = 8.61 kcal/kg/hr). Since 1 MET = 1 kcal/kg/hr, the person is exercising at approximately 8 METs.

Question 10

Which of the following is thought to be the primary mechanism by which exercise improves outcomes in patients with cardiovascular disease?&#10;A) Increase in stroke volume&#10;B) Reduction in cardiac fibrosis&#10;C) Improvement in myocardial perfusion&#10;D) Reduction in biomarkers of myocardial injury

Accepted Answer

Improvement in myocardial perfusion is considered the primary mechanism by which exercise improves outcomes in patients with cardiovascular disease. Exercise enhances blood flow to the heart muscle, improving oxygen and nutrient delivery, which is crucial for the health of cardiac tissues.

Deck 3: Type 2 Diabetes and Cardiovascular Disease