BANCO DE QUESTÕES ACLM

SECTION 3 – Key clinical processes in Lifestyle Medicine

Question 1 (1 point)
During a 49-year-old woman's annual physical, her health care provider
decides to screen her for alcohol use using the Alcohol Use Disorders
Identification Test (AUDIT-C). The woman states that she only drinks wine
and does not drink other alcohol. Which of the following questions should
be asked as part of the AUDIT-C for this woman?
Question 1 options:

a. How many drinks of alcohol did you have in the last two weeks?

b. How many glasses of wine do you have on a typical day when you are
drinking?

c. How often do you have a glass of wine?

d. How often do you have six or more drinks on one occasion?

Question 2 (1 point)
Which of the following statements about lifestyle medicine assessments is
true?

Question 2 options:

a. Stress can be assessed with a brief questionnaire on perceived stress.

b. The two-item Physical Activity Vital Sign is considered a valid measure to

classify cardiorespiratory fitness levels.
c. The diet vital sign should focus on specific nutrients, rather than whole
foods.

d. The Alcohol Use Disorders Identification Test-Concise (AUDIT-C) should

be done annually for patients who regularly consume alcohol.

Question 3 (1 point)
A 25-year-old woman powerlifter presents to an outpatient clinic for her
annual exam. She is 5'1'' (155 cm. and weighs 163 pounds (74 kilograms),
giving her a body mass index (BMI) of 30.8 kg/m². The woman would be
categorized into which weight category?

Question 3 options:

a. Normal weight

b. Overweight

c. Class I Obesity

d. Class II Obesity

Question 4 (1 point)
A 51-year-old man has a history of hypertension and a body mass index
(BMI) of 28 kg/m². He has a strong family history of type 2 diabetes and
reports having polyuria and polydipsia. A random glucose level is 271
mg/dL (15.04 mmol/L) and hemoglobin A1c is 8.3%. He does not want to
start any medication today and is extremely confident that he can increase
his physical activity, eliminate most processed foods, and consume a
predominantly whole food, plant-based diet, starting immediately. When
would be the most appropriate time to recheck his hemoglobin A1c?
Question 4 options:

a. 1 month

b. 3 months

c. 6 months

d. 9 months

Question 5 (1 point)
A 53-year-old man presents for routine evaluation with a past medical
history of hypertension. His only medication is lisinopril and he takes no
over the counter medications. Overall, he has no health-related concerns,
aside from noting that he has put on some weight over recent years. He
was a three-sport high school athlete, but no longer engages in regular
physical activity. His blood pressure is 124/82 mmHg and his body mass
index (BMI) is 37 kg/m². Routine screening and diagnostic testing have the
following results:

LMBQ Section 3_Q5 Image

The man and his physician agree on lifestyle modifications to initially

address his elevated cholesterol and fasting plasma glucose. Which of the
following would be the best testing interval to monitor for response to
treatment?
Question 5 options:

a. 1 week

b. 3 weeks

c. 6 weeks

d. 24 weeks

Question 6 (1 point)
A clinical practice that provides care to an underserved community is
designing a strategy to maintain a list of up-to-date information about
local community resources for patients. Which of the following would be
an important consideration when deciding what resources to include?

Question 6 options:

a. Prioritizing proximity to the patient over out-of-pocket cost

b. Identifying places with low out-of-pocket costs that require insurance

c. Locating low cost or free services, regardless of proximity to the patient

d. Ensuring that patients can afford and access the services they are
referred to
Question 7 (1 point)
A 63-year-old man with a 50 pack/year history of smoking recently
underwent lung resection for a localized lung cancer discovered on low-
dose CT screening. He was referred to the office from the regional cancer
center due to his desire to quit smoking. Which of the following would be
most likely to improve referral rates for smoking cessation counseling in
settings with high patient volumes?

Question 7 options:

a. Recommendation of smoking cessation counseling by mail

b. Direct transmission of patient's name and phone number to a quit line

c. Use of quit line cards

d. Integration of clinician reminders with clinical flow

Question 8 (1 point)
A 67-year-old man has a recent history of a hip fracture status post fixation
and post-operative pneumonia. He progressed well in the skilled nursing
facility and is now being discharged from physical therapy. He arises from
bed independently and ambulates with a walker but is still weak. Pre-
injury he was active with recreational hiking, golfing, and windsurfing. He
would like to return to his previous fitness level but is unsure how.
Referrals to which of the following would be the best recommendation?

Question 8 options:

a. Medical exercise specialist

b. Strength and conditioning specialist

c. Physiatrist

d. Health coach

Question 9 (1 point)
A 38-year-old who is obese and has type 2 diabetes has a recorded weight
of 285 lbs (129.3 kg) today. He has lost 15 lbs (6.8 kg) in the last 3 months.
He attributes this success to the social support he received from an online
support group, which he has participated in after completing a series of
weight management group visits. He attributes ongoing use of new salad
making skills to interaction with the group. According to the chronic care
model, patients' assessment of their own healthy living skills is an example
of which of the following?

Question 9 options:

a. Decision support

b. Delivery system design

c. Self-management support
d. Clinical information systems

Question 10 (1 point)
While counseling a 60-year-old man with type 2 diabetes, his health care
provider shares that she and her clinic staff have started wearing
pedometers, have set individual daily goals, and are communicating on an
interactive website. The provider invites the patient to join the staff in the
activity. When a clinic implements a health behavior change intervention,
which of the following needs to be considered?
Question 10 options:

a. Behavior interventions preclude changes in the existing system.

b. Behavior intervention tools circumvent additional technical expertise.

c. Patients prefer methods of assistance that include personal contact.

d. Patients require interactive websites to vary based on health literacy.

Question 11 (1 point)
A clinic director decides to initiate routine group medical visits. Three
months into the implementation of the group visits, the clinic is sold to a
large system. Which of the following would likely make it more difficult to
maintain group medical visits after the organizational change?
Question 11 options:

a. The clinic director influenced the organizational change.

b. The clinic director believed the change would hinder patients.

c. The clinic director was prepared for the change.

d. The clinic director valued the change.

Question 12 (1 point)
Which of the following is included in the Physical Activity Vital Sign?
Question 12 options:

a. Mode of physical activity being performed

b. Number of minutes of daily exercise

c. Number of weekly stretching sessions

d. Number of minutes of light intensity physical activity

Question 13 (1 point)
A 66-year-old man with cardiovascular disease would like to initiate an
exercise program. Upon further questioning, it is revealed that he has
stable angina. Which of the following is the most appropriate place to
refer this man?
Question 13 options:

a. A local gym with personal training

b. Physical therapy

c. Cardiac rehabilitation

d. Emergency room

Question 14 (1 point)
Saved
How can muscular strength be assessed in a typical clinic office visit?
Question 14 options:

a. Step testing

b. Sit and reach test

c. Dynamometer

d. 1 repetition maximum barbell squat

Question 15 (1 point)
A 51-year-old male with a BMI of 36 would like to work on losing weight
and requests a referral to work with a dietitian. What would be an
appropriate daily caloric deficit to try and achieve?
Question 15 options:

a. Reduce caloric intake 0-250 kcal

b. Reduce caloric intake 250-500 kcal

c. Reduce caloric intake 500-750 kcal

d. Reduce caloric intake 750-1000 kcal

Question 16 (1 point)
Patients have provided feedback that their online check-in process has
resulted in them having longer wait times in the lobby as compared to
before. You decide to conduct a quality improvement project to try and
improve this process using a PDSA cycle. What are the different steps in a
PDSA cycle?
Question 16 options:

a. Plan-Do-Study-Act

b. Plan-Demonstrate-Synthesize-Act

c. Prepare-Decide-Synthesize-Act

d. Prepare-Demonstrate-Synthesize-Analyze

RESPOSTAS SECTION 3

Question 1 0 / 1 point
During a 49-year-old woman's annual physical, her health care provider
decides to screen her for alcohol use using the Alcohol Use Disorders
Identification Test (AUDIT-C). The woman states that she only drinks wine
and does not drink other alcohol. Which of the following questions should
be asked as part of the AUDIT-C for this woman?

a. How many drinks of alcohol did you have in the last two weeks?

b. How many glasses of wine do you have on a typical day when you are
drinking?

c. How often do you have a glass of wine?

Correct Answer
d. How often do you have six or more drinks on one occasion?

Hide question 1 feedback

Feedback: The Alcohol Use Disorders Identification Test (AUDIT-C) consists
of three items: 1) How often did you have a drink containing alcohol? 2)
How many drinks containing alcohol did you have on a typical day? 3) How
often do you have six or more drinks on one occasion? The AUDIT-C
questions inquire about alcoholic drinks in general, and do not inquire
about wine specifically. Instead of asking about how many drinks were
consumed over a two-week period, the questionnaire asks how often one
consumes alcohol and how many drinks they have during those instances.
This distinction is important, as one could have 14 drinks over a two-week
period by having one drink per day or could meet the criteria for binge
drinking (5 or more drinks in men or 4 or more drinks in women in 2
hours) if the drinks were consolidated to 1-2 nights.

Citation(s):
Bradley KA, Bush KR, Epler AJ, et al. Two brief alcohol-screening tests From
the Alcohol Use Disorders Identification Test (AUDIT): Validation in a
female Veterans Affairs patient population. Arch Intern Med. 2003;
163:821-829.
Bush K, Kivlahan DR, McDonell MB, et al. The AUDIT alcohol consumption
questions (AUDIT-C): an effective brief screening test for problem drinking.
Ambulatory Care Quality Improvement Project (ACQUIP). Arch Intern Med.
1988; 158:1789-1795.
National Institute of Alcohol Abuse and Alcoholism. NIAAA council
approves definition of binge drinking. NIAAA newsletter. 2004;3(3).
Question 2 0 / 1 point
Which of the following statements about lifestyle medicine assessments is
true?

Correct Answer
a. Stress can be assessed with a brief questionnaire on perceived stress.

b. The two-item Physical Activity Vital Sign is considered a valid measure to

classify cardiorespiratory fitness levels.

c. The diet vital sign should focus on specific nutrients, rather than whole
foods.

d. The Alcohol Use Disorders Identification Test-Concise (AUDIT-C) should

be done annually for patients who regularly consume alcohol.

Hide question 2 feedback

Feedback: Lifestyle vital signs include assessments of physical activity, diet,
stress, sleep, emotional well-being, tobacco use, alcohol use, and BMI. The
Perceived Stress Scale (PSS) is a 10-item questionnaire that evaluates
symptoms of stress on a 5-point scale over the past month. The two-item
Physical Activity Vital Sign is considered a valid measure to classify activity
levels but cannot classify cardiorespiratory fitness levels. The diet vital sign
should focus on whole food intake, including vegetables, fruits, nuts,
seeds, legumes, whole grains, dairy, and animal products, rather than on
specific nutrients specifically. The AUDIT-C should be performed at every
visit for patients that regularly consume alcohol but can be done annually
in patients who do not regularly drink alcohol.

Citation(s):

Exercise is Medicine. The Physical Activity Vital Sign. Accessed July 30,
2023. https://exerciseismedicine.org/wp-content/uploads/2021/04/EIM-
Physical-Activity-Vital-Sign.pdf
Bush K, Kivlahan DR, McDonell MB, et al. The AUDIT alcohol consumption
questions (AUDIT-C): an effective brief screening test for problem drinking.
Ambulatory Care Quality Improvement Project (ACQUIP). Arch Intern Med.
1988; 158: 1789-1795.
Cohen S, Kamarck T, Mermelstein R. A Global Measure of Perceived Stress,
Journal of Health and Social Behavior, Vol. 24. In:1983.
Question 3 0 / 1 point
A 25-year-old woman powerlifter presents to an outpatient clinic for her
annual exam. She is 5'1'' (155 cm. and weighs 163 pounds (74 kilograms),
giving her a body mass index (BMI) of 30.8 kg/m². The woman would be
categorized into which weight category?

a. Normal weight

b. Overweight
Correct Answer
c. Class I Obesity
d. Class II Obesity

Hide question 3 feedback

Feedback: BMI categories by kg/m² are as follows: Underweight <18.5;
Normal Weight 18.5 - 24.9; Overweight 25 - 29.9; Obese Class I 30 - 34.9;
Obese Class II 35 - 39.9; Obese Class III >=40.Although this patient is a
powerlifter and likely has increased muscle mass, as opposed to fat mass,
she would still be considered obese by BMI standards. This is a significant
limitation of using BMI, particularly with certain subgroups of individuals.
Athletes with significant muscle mass can be categorized into higher
categories, but will have lower health risks associated with their weight
because the additional weight is muscle, as opposed to fat. Conversely, the
elderly may have a BMI in the "Normal Weight" but could have significant
visceral fat that has displaced lost muscle mass over time. It is the
increased fat mass, specifically the visceral fat that is associated with
worse health outcomes. BMI can be a helpful measure for the general
population but it is important to take into account individual patients and
their body composition to correctly gauge the impact of their weight on
their health.

Citation(s):

World health Organization Consultation on Obesity. Obesity: preventing

and managing the global epidemic. Published 2000. Accessed: February
21, 2023. Http://apps.who.int/iris/handle/10665/42330.
Question 4 0 / 1 point
A 51-year-old man has a history of hypertension and a body mass index
(BMI) of 28 kg/m². He has a strong family history of type 2 diabetes and
reports having polyuria and polydipsia. A random glucose level is 271
mg/dL (15.04 mmol/L) and hemoglobin A1c is 8.3%. He does not want to
start any medication today and is extremely confident that he can increase
his physical activity, eliminate most processed foods, and consume a
predominantly whole food, plant-based diet, starting immediately. When
would be the most appropriate time to recheck his hemoglobin A1c?

a. 1 month
Correct Answer
b. 3 months

c. 6 months

d. 9 months

Hide question 4 feedback

Feedback: Hemoglobin A1c serves as a measure of the concentration of
glucose to which erythrocytes in the blood are exposed. It is based on the
assumption that red blood cells live 100-120 days. For someone with
newly diagnosed diabetes making significant lifestyle changes, the A1c
could appropriately be repeated in 3 months. One month would be
inadequate time to realize the full effect of whatever lifestyle changes
were being made. Although hemoglobin A1c could be rechecked at 6-
month intervals, particularly once the patient's glucose readings are
stable, it would be beneficial from a behavior change standpoint to have
earlier and more frequent check-ins with the patient to increase their
motivation. It is important to note that any condition that alters
hemoglobin properties (i.e. hemoglobinopathies, sickle cell disease,
pregnancy, glucose-6-phosphate dehydrogenase deficiency, etc.) can result
in misleading HbA1c measures (either increased or decreased). If there is
marked discordance between HbA1c measures and fasting and
postprandial glucose measures, only plasma blood glucose criteria should
be used to diagnose diabetes.
Citation(s):

Riddle MC, Bakris G, Blonde L. American Diabetes Association standards of

medical care in diabetes–2019. Diabetes Care. 2019;42(Suppl 1): S34-S60.
Sacks DB, Bruns DE, Goldstein DE, et al. Guidelines and recommendations
for laboratory analysis in the diagnosis and management of diabetes
mellitus. Clin Chem. 2002; 48:436–472.
Question 5 0 / 1 point
A 53-year-old man presents for routine evaluation with a past medical
history of hypertension. His only medication is lisinopril and he takes no
over the counter medications. Overall, he has no health-related concerns,
aside from noting that he has put on some weight over recent years. He
was a three-sport high school athlete, but no longer engages in regular
physical activity. His blood pressure is 124/82 mmHg and his body mass
index (BMI) is 37 kg/m². Routine screening and diagnostic testing have the
following results:

LMBQ Section 3_Q5 Image

The man and his physician agree on lifestyle modifications to initially

address his elevated cholesterol and fasting plasma glucose. Which of the
following would be the best testing interval to monitor for response to
treatment?

a. 1 week

b. 3 weeks
Correct Answer
c. 6 weeks

d. 24 weeks

Hide question 5 feedback

Feedback: This patient has been diagnosed with hyperlipidemia and pre-
diabetes and recommended to pursue lifestyle modifications for initial
treatment. . Certainly, close follow-up with laboratory testing will help to
guide continued management. In this case, 1- and 3-week follow-ups are
likely too close to observe significant response to treatment. Likewise, 24
weeks is likely too long and would delay prompt follow-up. Improvement
in fasting serum glucose and cholesterol would be likely to be observed
with adequate response to recommendations for lifestyle modifications
within 6 weeks. This would be a crucial time to follow up, reassess BMI
and any weight loss, and to continue with monitoring and healthy lifestyle
goals as well.

Citation(s):

Lavie C, Swift D. Clinical strategies for managing dyslipidemias: emphasis

on physical activity and exercise training. Am J Lifestyle Med.
2014;8(4):235-238.
Leon A, Bronas U. Dyslipidemia and risk of coronary heart disease: role of
lifestyle approaches for its management. Am J Lifestyle Med.
2009;3(4):257-273.
Grundy S, Stone N, Bailey A, et al. Guideline on the management of blood
cholesterol: a report of the American College of Cardiology/American
heart association Task force on clinical practice guidelines. J Am Coll
Cardiol. 2018;73(24):e285-350.
Question 6 0 / 1 point
A clinical practice that provides care to an underserved community is
designing a strategy to maintain a list of up-to-date information about
local community resources for patients. Which of the following would be
an important consideration when deciding what resources to include?

a. Prioritizing proximity to the patient over out-of-pocket cost

b. Identifying places with low out-of-pocket costs that require insurance

c. Locating low cost or free services, regardless of proximity to the patient

Correct Answer
d. Ensuring that patients can afford and access the services they are
referred to

Hide question 6 feedback

Feedback: Effective clinical practices maintain an up-to-date list of
community resources and seek to connect and assist patients with
appropriate referrals. Working with patients who have limited means
requires a thoughtful discussion with them about how and if they can
afford health services that they need. Many patients will not be able to
afford significant out-of-pocket costs and may not have health insurance.
Being able to identify low cost and free services is important, but if they
are not accessible to patients, they will not be able to utilize them.

Citation(s):

Reilly BM, Schiff G, Conway T. Primary care for the medically underserved:
challenges and opportunities. Dis Mon. 1998; 44(7):320-346.
Question 7 0 / 1 point
A 63-year-old man with a 50 pack/year history of smoking recently
underwent lung resection for a localized lung cancer discovered on low-
dose CT screening. He was referred to the office from the regional cancer
center due to his desire to quit smoking. Which of the following would be
most likely to improve referral rates for smoking cessation counseling in
settings with high patient volumes?

a. Recommendation of smoking cessation counseling by mail

b. Direct transmission of patient's name and phone number to a quit line

c. Use of quit line cards

Correct Answer
d. Integration of clinician reminders with clinical flow

Hide question 7 feedback

Feedback: According to Abdelmutti, et al., the integration of clinician
reminders into clinical flow was effective in increasing referrals for smoking
cessation counseling. According to Senesael, et al. and McClure and
Anderson, mail was ineffective at improving referral rates for smoking
cessation counseling and cardiovascular risk factor intervention. Vidrine, et
al. found that referrals using quit line cards are low, while directly sending
the patient's phone number to the quit line was much more effective in
getting the patient enrolled in smoking cessation treatment. However, a
referral via sending the patient's phone number to the quit line is only
effective if the clinician remembers to do it.

Citation(s):

Abdelmutti N, Brual J, Papadakos J, et al. Implementation of a

comprehensive smoking cessation program in cancer care. Curr Oncol
(Toronto, Ont.). 2019; 26(6):361-368.
McClure JB, Anderson ML. Evaluation of a population-level strategy to
promote tobacco treatment use among insured smokers: a pragmatic,
randomized trial. BMC Public Health. 2018;18: 228.
Senesael E, Borgermans L, Van De Vijver E, Devroey D. Effectiveness of a
quality improvement intervention targeting cardiovascular risk factors: are
patients responsive to information and encouragement by mail or post?
Vasc Health Risk Manag. 2013; 9:13–20.
Vidrine JI, Shete S, Cao Y, et al. Ask-Advise-Connect: a new approach to
smoking treatment delivery in health care settings. JAMA Intern Med.
2013;173(6):458–464.
Question 8 0 / 1 point
A 67-year-old man has a recent history of a hip fracture status post fixation
and post-operative pneumonia. He progressed well in the skilled nursing
facility and is now being discharged from physical therapy. He arises from
bed independently and ambulates with a walker but is still weak. Pre-
injury he was active with recreational hiking, golfing, and windsurfing. He
would like to return to his previous fitness level but is unsure how.
Referrals to which of the following would be the best recommendation?

Correct Answer
a. Medical exercise specialist

b. Strength and conditioning specialist

c. Physiatrist

d. Health coach

Hide question 8 feedback

Feedback: A medical exercise specialist is specifically trained to design
exercise programs for people recovering from injury who wish to get back
to their pre-injury fitness levels. Strength and conditioning specialist is
primarily focused on athletes and would not be the best recommendation
for this patient. A physiatrist is another name for a physical medicine and
rehabilitation physician who would be needed in the setting of diagnostic
and treatment efforts in a patient who may be slow to improve in rehab or
who is actively at a rehabilitation center. They are not the best
recommendation in this scenario. While a health coach is a great option
for improving motivation and providing accountability, they would be
unlikely to be able to design a specialized exercise program this patient
needs.

Citation(s):

Medical Exercise Training Institute. Medical Exercise Specialist. Medical

Exercise Training Institute. Accessed March 31, 2020.
http://www.medicalexercisespecialist.com/
American Council on Exercise. Medical Exercise Specialist. American
Council on Exercise. Accessed March 31, 2020.
https://www.acefitness.org/fitness-certifications/certified-medical-
exercise-specialist/default.aspx
Question 9 0 / 1 point
A 38-year-old who is obese and has type 2 diabetes has a recorded weight
of 285 lbs (129.3 kg) today. He has lost 15 lbs (6.8 kg) in the last 3 months.
He attributes this success to the social support he received from an online
support group, which he has participated in after completing a series of
weight management group visits. He attributes ongoing use of new salad
making skills to interaction with the group. According to the chronic care
model, patients' assessment of their own healthy living skills is an example
of which of the following?
a. Decision support

b. Delivery system design

Correct Answer
c. Self-management support

d. Clinical information systems

Hide question 9 feedback

Feedback: According to the Chronic Care Model, assessment of the
patients own healthy living skills is an example of self-management
support.

Citation(s):

ACT Center for Accelerating Care Transformation. The Chronic Care Model.
Accessed July 30, 2023.
https://www.act-center.org/application/files/1616/3511/6445/Model_Chr
onic_Care.pdf
Question 10 0 / 1 point
While counseling a 60-year-old man with type 2 diabetes, his health care
provider shares that she and her clinic staff have started wearing
pedometers, have set individual daily goals, and are communicating on an
interactive website. The provider invites the patient to join the staff in the
activity. When a clinic implements a health behavior change intervention,
which of the following needs to be considered?

a. Behavior interventions preclude changes in the existing system.

b. Behavior intervention tools circumvent additional technical expertise.

Correct Answer
c. Patients prefer methods of assistance that include personal contact.

d. Patients require interactive websites to vary based on health literacy.

Hide question 10 feedback

Feedback: According to Cohen, et al., patients prefer methods of
assistance that include personal contact. Behavior interventions do not
preclude changes in the existing system; rather, they may require changes
in the existing system in order to properly accomplish the behavior
intervention. Behavior intervention tools do not circumvent additional
technical expertise and often require additional technical expertise that
current clinic staff may not have. While patient levels of health literacy
vary widely, varying the interactive website would be much more difficult
than making the website simple and easy to navigate even for those with a
very low level of literacy.

Citation(s):

Cohen DJ, Tallia AF, Crabtree BF, Young DM. Implementing health behavior
change in primary care: lessons from Prescription for Health. Ann Fam
Med. 2005; 3(suppl 2): S12-S19.
Question 11 0 / 1 point
A clinic director decides to initiate routine group medical visits. Three
months into the implementation of the group visits, the clinic is sold to a
large system. Which of the following would likely make it more difficult to
maintain group medical visits after the organizational change?

a. The clinic director influenced the organizational change.

Correct Answer
b. The clinic director believed the change would hinder patients.

c. The clinic director was prepared for the change.

d. The clinic director valued the change.

Hide question 11 feedback

Feedback: According to Nilsen, et al., characteristics of successful changes
in health care organizations include having the opportunity to influence
the change, being prepared for the change, and valuing the change.
Believing that a change will hinder the care of your patients would make it
more difficult to maintain group visits after the change.

Citation(s):

Nilsen P, Seing I, Ericsson C, Birken SA, Schildmeijer K. Characteristics of

successful changes in health care organizations: an interview study with
physicians, registered nurses and assistant nurses." BMC Health Serv Res.
2020; 20(1):147.
Question 12 0 / 1 point
Which of the following is included in the Physical Activity Vital Sign?
a. Mode of physical activity being performed
Correct Answer
b. Number of minutes of daily exercise

c. Number of weekly stretching sessions

d. Number of minutes of light intensity physical activity

Hide question 12 feedback

Feedback: The two-question Physical Activity Vital Sign includes: 1) How
many days a week do you engage in moderate to strenuous exercise, such
as a brisk walk? 2) On average, how many minutes per day do you exercise
at this level?

An additional question that can be included pertains to strength training

"How many days a week do you perform muscle strengthening exercises,
such as bodyweight exercises or resistance training?" Mode of physical
activity, minutes of light intensity activity, and number of weekly stretching
sessions are not part of the physical activity Exercise Vital Sign.

Citation(s):

American College of Sports Medicine. Exercise is Medicine: Healthcare

providers' action guide. In: Exercise is Medicine. American College of
Sports Medicine Indianapolis, IN; 2014.

Exercise is Medicine. The Physical Activity Vital Sign. Accessed July 30,
2023. https://exerciseismedicine.org/wp-content/uploads/2021/04/EIM-
Physical-Activity-Vital-Sign.pdf
Question 13 0 / 1 point
A 66-year-old man with cardiovascular disease would like to initiate an
exercise program. Upon further questioning, it is revealed that he has
stable angina. Which of the following is the most appropriate place to
refer this man?

a. A local gym with personal training

b. Physical therapy
Correct Answer
c. Cardiac rehabilitation

d. Emergency room

Hide question 13 feedback

Feedback: Cardiac rehabilitation is an underutilized comprehensive
multidisciplinary program that is tailored to the needs of patients with
cardiovascular disease. It is covered by Medicare and recommended for
patients following myocardial infarction, bypass surgery, stent placement,
and for patients with heart failure, stable angina, and other conditions as
well. Although a personal trainer and physical therapist could help with
program design, this patient has a history of cardiovascular disease and
stable angina and it would be more appropriate to refer him to cardiac
rehabilitation. It is not necessary to refer this patient to the Emergency
Room since he has stable angina. Active chest pain and unstable angina
should be referred to the Emergency Room.

Citation(s):

Servey JT, Stephens M. Cardiac rehabilitation: Improving function and

reducing risk. Am Fam Physician. 2016;94(1):37-43.
Question 14 0 / 1 point
How can muscular strength be assessed in a typical clinic office visit?

a. Step testing
Incorrect Response
b. Sit and reach test
Correct Answer
c. Dynamometer

d. 1 repetition maximum barbell squat

Hide question 14 feedback

Feedback: Step testing would be an appropriate test for cardiorespiratory
fitness in an office setting. A sit and reach test can assess flexibility. A
dynamometer can be used to assess hand grip strength. This has been
shown to be a good proxy for overall strength and would be small enough
and quick enough to be done in a typical clinical office. A 1 repetition
maximum barbell squat would be an ideal way to assess strength,
however, this would not be appropriate in a a typical office setting. It could
be used for athletic performance, but a leg press would likely be more
appropriate for the general population if this type of evaluation were to be
done.

Citation:

Bohannon RW. Grip Strength: An Indispensable Biomarker For Older

Adults. Clin Interv Aging. 2019 Oct 1;14:1681-1691. doi:
10.2147/CIA.S194543. PMID: 31631989; PMCID: PMC6778477. Available
from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6778477/
Question 15 0 / 1 point
A 51-year-old male with a BMI of 36 would like to work on losing weight
and requests a referral to work with a dietitian. What would be an
appropriate daily caloric deficit to try and achieve?

a. Reduce caloric intake 0-250 kcal

b. Reduce caloric intake 250-500 kcal

Correct Answer
c. Reduce caloric intake 500-750 kcal

d. Reduce caloric intake 750-1000 kcal

Hide question 15 feedback

Feedback: Guidelines for weight loss from the obesity society, American
Heart Association, and the American College of Cardiology suggest aiming
for a daily caloric deficit of 500-750 kcal per day to achieve slow and
consistent weight loss. Lesser amounts may not result in significant weight
loss being achieved.

Citation:

Jensen MD, Ryan DH, Apovian CM, et al; American College of

Cardiology/American Heart Association Task Force on Practice Guidelines;
Obesity Society. 2013 AHA/ACC/TOS guideline for the management of
overweight and obesity in adults: a report of the American College of
Cardiology/American Heart Association Task Force on Practice Guidelines
and The Obesity Society. Circulation. 2014 Jun 24;129(25 Suppl 2):S102-38.
doi: 10.1161/01.cir.0000437739.71477.ee. Epub 2013 Nov 12. Erratum in:
Circulation. 2014 Jun 24;129(25 Suppl 2):S139-40. PMID: 24222017;
PMCID: PMC5819889.
Question 16 0 / 1 point
Patients have provided feedback that their online check-in process has
resulted in them having longer wait times in the lobby as compared to
before. You decide to conduct a quality improvement project to try and
improve this process using a PDSA cycle. What are the different steps in a
PDSA cycle?
Correct Answer
a. Plan-Do-Study-Act

b. Plan-Demonstrate-Synthesize-Act

c. Prepare-Decide-Synthesize-Act

d. Prepare-Demonstrate-Synthesize-Analyze

Hide question 16 feedback

Feedback: PDSA stands for Plan-Do-Study-Act. It is a systematic way for
testing a change by developing a plan to test the change (Plan), carrying
out the test (Do), observing and learning from the consequences (Study),
and determining what modification should be made to the test (Act).

Citation:

Institute for Healthcare Improvement. The Plan-Do-Study-Act (PDSA)

Worksheet. Accessed: Aug 13, 2023.
https://www.ihi.org/resources/Pages/Tools/PlanDoStudyActWorksheet.as
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