lifestyle modifications

Practice targeted AMC-style multiple-choice questions on lifestyle modifications.

A 52-year-old woman with a 10-year history of type 2 diabetes mellitus presents to your clinic for a routine follow-up. She has been experiencing difficulty in controlling her blood glucose levels despite being on metformin and glipizide. Her HbA1c is 8.5%. She has a BMI of 32 kg/m² and a sedentary lifestyle. She reports consuming a diet high in processed foods and sugary beverages. Her blood pressure is 140/85 mmHg, and her lipid profile shows elevated LDL cholesterol. Which of the following dietary and lifestyle modifications is most likely to improve her glycemic control and overall cardiovascular risk profile?

A. Switching to a vegetarian diet and incorporating yoga

B. Adopting a Mediterranean diet and engaging in regular aerobic exercise

C. Reducing sodium intake and focusing on high-intensity interval training

D. Increasing protein intake and starting resistance training

E. Following a low-carbohydrate, high-fat diet and practicing intermittent fasting

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A 62-year-old Aboriginal and Torres Strait Islander man presents for a routine check-up. He has a history of smoking, obesity, and type 2 diabetes, managed with metformin. His blood pressure is 150/90 mmHg. Which of the following is the MOST significant modifiable risk factor for cardiovascular disease in this patient?

A. Type 2 diabetes

B. Smoking

C. Obesity

D. Indigenous status

E. Hypertension

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A 62-year-old female has high blood pressure (162/97 mmHg) but is not concerned. She has white coat hypertension and declines 24-hour BP monitoring. What is the correct instruction about home blood pressure readings?

A. Check blood pressure immediately after waking up.

B. Check BP before daily medications.

C. Check blood pressure while talking or watching TV.

D. Check blood pressure only when feeling unwell.

E. Check blood pressure after food and exercise.

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A 60-year-old non-smoker has a calculated 5-year cardiovascular disease risk of 12%. Based on current Australian guidelines, what is the most appropriate initial management focus?

A. Annual risk reassessment without intervention

B. Lifestyle modification and shared decision-making regarding pharmacotherapy

C. Immediate initiation of high-intensity statin therapy

D. Referral for specialist cardiology review

E. Low-dose aspirin therapy for primary prevention

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A 55-year-old non-smoker with no known comorbidities has a consistent office BP of 155/98 mmHg. His 10-year CVD risk is calculated as low. According to Australian guidelines, what is the most appropriate initial management?

A. Recommend lifestyle modifications and review in 3-6 months

B. Investigate for secondary causes of hypertension

C. Initiate single antihypertensive therapy

D. Refer for ambulatory blood pressure monitoring

E. Initiate dual antihypertensive therapy

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A 45-year-old Aboriginal man from a remote community presents to the clinic for a routine health check. He has a history of smoking (20 pack-years) and reports drinking alcohol occasionally (3-4 standard drinks per week). He denies any chronic medical conditions. His blood pressure is 145/95 mmHg. BMI is 32 kg/m2. Fasting blood glucose is 6.5 mmol/L. Which of the following is the MOST appropriate initial management strategy, considering the principles of culturally safe care?

A. Prescribe an antihypertensive medication (e.g., ACE inhibitor) and metformin to address the elevated blood pressure and glucose levels immediately.

B. Initiate lifestyle modification counseling, including smoking cessation, dietary advice, and encourage increased physical activity, while also arranging a follow-up appointment to reassess blood pressure and glucose levels.

C. Provide him with written information about hypertension and diabetes and instruct him to follow up with the clinic if he develops any symptoms.

D. Refer him to a specialist physician for further evaluation and management of his hypertension and pre-diabetes.

E. Advise him to reduce his alcohol consumption and schedule a follow-up appointment in six months to monitor his blood pressure and glucose levels.

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A 55-year-old man with a history of hypertension and smoking presents for a routine check-up. He is concerned about his risk of cardiovascular disease and asks for advice on lifestyle modifications. Which of the following lifestyle changes would most significantly reduce his risk of cardiovascular events?

A. Adopting a Mediterranean diet

B. Smoking cessation

C. Increasing physical activity

D. Limiting alcohol consumption

E. Reducing dietary salt intake

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A 55-year-old male with a history of hypertension presents for a routine check-up. His blood pressure is consistently measured at 150/95 mmHg despite lifestyle modifications. According to Australian guidelines, what is the most appropriate next step in managing his hypertension?

A. Prescribe a diuretic

B. Increase lifestyle modifications

C. Refer to a cardiologist

D. Start a beta-blocker

E. Initiate an ACE inhibitor

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A 20-year-old female medical student arrives late, parties, and is attentive in consultations. What is the next step?

A. Discuss lateness and concerns.

B. Ignore the behavior as she is attentive in consultations.

C. Refer her for mandatory counseling.

D. Advise her to reduce partying.

E. Notify the university regarding suspected alcohol use during placement.

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A middle-aged man who already has a 20% cardiovascular risk and is on lifestyle modification and statin therapy: Which one of the following helps you assess his cardiovascular risk?

A. Coronary artery angiogram

B. ECG

C. Exercise ECG

D. Echocardiogram

E. Coronary artery calcium score

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A 68-year-old man with a history of smoking and hypertension presents with intermittent claudication in his right leg. Ankle-brachial index (ABI) is 0.6 on the right and 0.9 on the left. He has been on a supervised exercise program and optimal medical therapy for 6 months with no improvement in symptoms. What is the most appropriate next step in management?

A. Continue with the current exercise program and medical therapy

B. Consideration for revascularization with angioplasty or bypass surgery

C. Start a trial of cilostazol

D. Increase the dose of his antihypertensive medication

E. Refer for a vascular ultrasound to reassess the ABI

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A 20-year-old female medical student arrives late, parties, but is attentive in consultations. What is the next step?

A. Notify the university regarding suspected alcohol use during placement.

B. Advise her to reduce partying without discussing lateness.

C. Discuss lateness and concerns.

D. Report her directly to the Medical Board.

E. Ignore the behavior as long as she is attentive in consultations.

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A 55-year-old man with a history of hypertension presents for a routine check-up. His blood pressure is consistently measured at 160/95 mmHg despite lifestyle modifications. He is currently on perindopril 5 mg daily. According to Australian guidelines, what is the most appropriate next step in managing his hypertension?

A. Switch to losartan

B. Refer for renal artery imaging

C. Add hydrochlorothiazide

D. Add amlodipine

E. Increase perindopril to 10 mg daily

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A 58-year-old man with a 10-year history of Type 2 diabetes presents to the clinic for a routine follow-up. He is currently on metformin and lifestyle modifications, but his HbA1c has increased to 8.5% over the past six months. He reports adherence to his medication and diet but has a sedentary lifestyle. What is the most appropriate next step in managing his diabetes?

A. Refer for bariatric surgery

B. Add a GLP-1 receptor agonist

C. Add a sulfonylurea

D. Increase the dose of metformin

E. Start basal insulin therapy

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lifestyle modifications

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