Explanation/Reference: Explanation: Categorical data includes ordinal (ordered categories) and nominal (unordered categories). NYHA I-IV and grade of breast cancer are considered ordinal data because the categories for the answer choice are in order, you can have NYHA class I, II, III, or IV. Grade of breast cancers are also in order, grade 1, 2, or 3. Sex, Improvemnet Yes/No, Alive or Dead is considered nominal, unordered data because the answer choices are female or male, and do not have a set order. Reference: http://www.bmj.com/about-bmj/resources-readers/publications/statistics-square-one
Question 2
Select the class of Anti-diabetic medication that works in the specified organ to prevent hyperglycemia. Select all that applies. Brain (E)
Correct Answer: D
Explanation Glucagon-like peptide-1 receptor agonists Sulfonylureas work in beta cells in the pancreas that are still functioning to enhance insulin secretion. Alpha-Glucosidase Inhibitors stop -glucosidase enzymes in the small intestine and delay digestion and absorption of starch and disaccharides which lowers the levels of glucose after meals. DPP4 blocks the degradation ofGLP-1, GIP, and a variety of other peptides, including brain natriuretic peptide. Glucagon-like peptide-1 receptor agonists work in various organs of the body. Glucagon-like peptide-1 receptor agonists enhance glucose homeostasis through: (i) stimulation of insulin secretion; (ii) inhibition of glucagon secretion; (iii) direct and indirect suppression of endogenous glucose production; (iv) suppression of appetite; (v) enhanced insulin sensitivity secondary to weight loss; (vi) delayed gastric emptying, resulting in decreased postprandial hyperglycaemia. Thiazolidinediones are the only true insulin-sensitising agents, exerting their effects in skeletal and cardiac muscle, liver, and adipose tissue. It ameliorates insulin resistance, decreases visceral fat. Biguanides work in liver, muscle, adipose tissue via activation of AMP-activated protein kinase (AMPK) reduce hepatic glucose production. SGLT2 inhibitors work in the kidneys to inhibit sodium-glucose transport proteins to reabsorb glucose into the blood from muscle cells; overall this helps to improve insulin release from the beta cells of the pancreas.
Question 3
An order is received to start Milrinone at 0.75mcg/kg/min, Milrinone comes as 20mg/100ml D5W. What is the infusion rate in mL/hr? Patient weighs 115kg.
Which of the following beta-blocker is NOT proven to reduce mortality in patients with Systolic CHF?
Correct Answer: E
Nadolol is not proven to reduce mortality in patients with systolic CHF. The efficacy of nadolol in HF has not been determined. For patients taking nadolol, it should be used with caution in those with compensated heart failure and patients should be monitored for a worsening of the condition. Bisoprolol, carvedilol, and sustained- release metoprolol succinate are the beta-blockers that have been proven to reduce mortality in patients with systolic CHF. These 3 beta-blockers have been effective in reducing the risk of death in patients with chronic HFrEF. Other beta-blockers were found to be less effective. Bucindolol did not exhibit uniform effectiveness across different populations. Metoprolol tartrate was found to be less effective in HF clinical trials. Reference: http://circ.ahajournals.org/content/128/16/e240
Question 5
Which of the following class of antidiabetic medications can increase triglycerides?
Correct Answer: A
Explanation The only bile acid sequestrant, colesevelam (Welchol), has been shown to increase triglycerides through mechanism of: activation of phosphatidic acid phosphatase with promotes triglyceride synthesis. GLP-1 agonists work on GLP 1 receptors to increase insulin secretion, decrease glucagon secretion, and increase satiety. Thiazolidinediones activate nuclear transcription factor PPAR gamma to increase insulin sensitivity. SGLT2 inhibitors inhibit glucose reabsorption in the kidney. Alpha-glucosidase inhibitors slow down digestion and absorptions of carbs in the gut.
