TDM Examination sample case H
Get familiar with the multiple-choice and short-menu question types you will see on the TDM Examination.
A 52-year-old man presents to your clinic to discuss his type 2 diabetes. He had the condition diagnosed 2 years ago and he is taking metformin 1000 mg BID. He is a single father with a stressful job and he reports that he has not made any lifestyle changes since receiving the diagnosis. His only regular physical activity is golfing once a week. He rarely cooks and eats fast food at least 3 times per week. On examination, his BMI is 35. His hemoglobin A1C level is 8.1% (4.8–6.0).
Which of the following evidence-based lifestyle changes are most appropriate to recommend today? Select 2.
Six months later, the patient returns for follow-up. After trying to implement the lifestyle changes in question 1, his BMI is now 33.9 and his hemoglobin A1C level is 7.9% (4.8–6.0). He asks about starting a weight loss drug and an injectable medication is prescribed. Which of the following are the most common adverse effects that the patient should be counselled about? Select 2.
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For an adult with type 2 diabetes and high BMI that is classified as obesity, 2 evidence-based pillars to recommend include starting structured physical activity of no less than 150 minutes weekly of moderate-to-vigorous aerobic activity and adopting a whole-grain eating pattern (Mediterranean-style diet) that emphasizes vegetables, fruit, legumes, whole grains, nuts, and healthy fats. Avoiding high-sugar fruits is not guideline-based; whole fruits can fit within a healthy nutrition plan, even for patients with diabetes. Fat-free diets are also not guideline-based; they are unnecessary and nutritionally imbalanced. An herbal tea “detox” diet lacks evidence. Severe carbohydrate or calorie restriction is not first-line general advice; when considered, it requires careful supervision and individualized planning. Protein or fibre restriction is not a correct strategy to improve glycemic control. Strength training can be a core component of exercise; however, there is no evidence this must be done daily for 20 minutes.
Wexler DJ. Initial management of hyperglycemia in adults with type 2 diabetes mellitus. UpToDate. Updated January 7, 2026. Accessed January 21, 2026.
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Before starting a weight loss drug, such as GLP-1 agonists, it would be important to counsel the patient about gastrointestinal upset, which is common, particularly diarrhea and constipation. Nausea and abdominal pain are also notable common adverse effects, although they are not in the list of options. These common adverse effects are often seen early in therapy and are related to dosing; they can be mitigated by slow titration. Gastric ulcers are not seen as part of the gastrointestinal upset category observed with GLP-1 agonists. Pancreatitis and thyroid cancer are rare adverse effects. The remaining adverse effects are not typically seen with GLP-1 agonists.