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WorksheetsDiabetes Mellitus MCQs
Total questions: 30
Worksheet time: 18mins
Name
Class
Date
1.
Insulin secretion is regulated by
a)
Circulating nutrients
b)
Incretin hormones
c)
Neurotransmitters
d)
All of the above
2.
Beta cells respond to glucose primarily through
a)
Cell surface receptors
b)
Increased metabolism
c)
Opening K+ ATP channels
d)
Decreased intracellular calcium
3.
Which of the following is not an incretin hormone?
a)
Cholecystokinin
b)
Glucagon like peptide-1
c)
Somatostatin
d)
Glucose dependent insulinotropic peptide
4.
Which signaling pathway emanates from insulin receptor substrate docking proteins and has a critical role in cell growth and mitogenesis?
a)
RAS/Mitogen activated protein (MAP) kinase
b)
PI-3 kinase - Akt/Protein kinase B (Akt/PKB)
c)
AMP Kinase (AMPK)
d)
Mammalian target of rapamycin (mTOR)
5.
Which signaling pathway mediates the following cellular responses: stimulation of GLUT 4 translocation to the plasma membrane, inhibition of glycogen synthase kinase 3 (GSK3) and induction of triglyceride synthesis?
a)
RAS/Mitogen activated protein (MAP) kinase
b)
PI-3 kinase - Akt/Protein kinase B (Akt/PKB)
c)
AMP Kinase (AMPK)
d)
Mammalian target of rapamycin (mTOR)
6.
Which of the following is predictive of future obesity?
a)
Too little sleep
b)
Too much exercise
c)
Teenage cigarette smoking
d)
Neonatal thyroid function
7.
Which of the following insulin secretion abnormalities is found in obese individuals with normal glucose tolerance?
a)
Diminished second phase release
b)
Abnormal oscillatory secretion pattern
c)
Decrease in maximal insulin secretory capacity
d)
None of the above
8.
All of the following statements about pancreatic islets & β cells are true in type 2 DM except:
a)
β cell function and life cycle are known to be influenced by cytokines especially the pro-inflammatory cytokine IL-1β.
b)
Increased extracellular deposits of islet amyloid int the pancreatic islets universally precedes diabetes
c)
β-cell mass in type 2 diabetes is reduced by about 30-50% compared to that of weight matched individuals with normal glucose tolerance
d)
Evidence from in vitro studies suggests that fatty acids impair insulin gene expression and promote of β-cell apoptosis
9.
Which of the following especially characterizes deterioration of glucose tolerance from impaired to type 2 diabetes:
a)
Insulin resistance
b)
A decrease in first phase insulin release
c)
Failure of the insulin secretory response to glucose to increase linearly as a function of hyperglycemia
d)
Hyperglucagonemia
10.
The main cause of a low HDL cholesterol concentration in type 2 diabetes is:
a)
Increased catabolism of HDL particles
b)
Low lipoprotein lipase acitivity
c)
Increased production of VLDL
d)
Visceral adiposity
11.
The pre-diabetic state is characterized by:
a)
Increased endogenous glucose production
b)
Decreased glucose disappearance
c)
2-hour glucose tolerance test values >200 mg/dl
d)
No increase in risk of microvascular and macrovascular complications
12.
Which of the following statements is correct?
a)
Insulin suppresses the actiivity of hormone-sensitive lipase
b)
Insulin mediates glucose uptake in brain
c)
Diabetic ketoacidosis as a metabolic state is unique to type 1 DM
d)
The rate of rise in insulin concentrations after meal ingestion has no bearing on post-prandial glucose concentrations
13.
Post-prandial glucose concentrations are affected by which of the following?
a)
Insulin action
b)
Insulin secretion
c)
Glucose effectiveness
d)
Glucagon suppression
e)
All of the above
14.
Which of the following is not essential to assess the risk of an overweight/obese subject for developing type 2 diabetes?
a)
Body mass index
b)
Waist circumference
c)
Family history of diabetes
d)
Birth weight
15.
Adipose tissue inflammation in obese subjects is characterized by all of the following except:
a)
Accumulation of macrophages
b)
Accumulation of lymphocytes
c)
Elevated free fatty acids in serum
d)
Elevated leptin concentrations
e)
Elevated adiponectin concentrations
16.
Which of the following does not slow progression of nephropathy in DM?
a)
Angiotensin II receptor blocker
b)
Reducing blood pressure
c)
Decreased dietary protein intake
d)
Multiple CVS risk factor control
e)
Commencing insulin therapy
17.
Which of the following statements is incorrect?
a)
The increasing incidence of end-stage renal disease (ESRD) caused by diabetes is brought about by type 2 diabetes
b)
The risk of cardiovascular disease is increased two- to fourfold in people with type 2 diabetes who have microalbuminuria
c)
Anemia is rare in patients with diabetes who have diabetic nephropathy
d)
The dose of insulin may have to be reduced as ESRD develops
e)
Metformin should be stopped if the estimated glomerular filtration rate is 29 mL/min/1.73 m2
18.
Blood relatives of individuals diagnosed with type 1 or type 2 DM are studied for 10 years. Lab testing for glucose and insulin levels and autoantibody formation is performed on a periodic basis. The HLA types of the subjects are determined. A cohort of the subjects who are 8 to 22 years old has no overt clinical illnesses and no hyperglycemia; however, autoantibodies to glutamic acid decarboxylase are present. Many subjects in this cohort have the HLA-DR3 and HLA-DR4 alleles. Which of the following pancreatic abnormalities is most likely to be found in this cohort of study subjects?
a)
Acinar acute inflammation and necrosis
b)
Acinar fibrosis and fatty replacement
c)
Islet amyloid deposition
d)
Insulitis
e)
Normal islets in fibrous stroma
19.
A 23-year-old woman has a routine health status examination. Her body mass index is 22. Laboratory studies show fasting plasma glucose is 130 mg/dL. Urinalysis shows mild glucosuria, but no ketonuria or proteinuria. She has no detectable insulin autoantibodies. Her father was similarly affected at age 20 years. She is most likely to have a mutation in a gene encoding for which of the following?
a)
Glucagon
b)
Glucokinase
c)
GLUT 4
d)
Insulin
e)
MHC DR
20.
A 52-year-old man is concerned about a gradual weight gain over the past 30 years. He is having body mass index of 30. He is taking no medications. On physical examination, he has decreased sensation to pinprick and light touch over the lower extremities. Patellar reflexes are reduced. Motor strength seems to be normal in all extremities. Laboratory studies show blood glucose of 169 mg/dL, creatinine of 1.9 mg/dL, total cholesterol of 220 mg/dL, HDL cholesterol of 27 mg/dL, and triglycerides of 261 mg/dL. A chest radiograph shows mild cardiomegaly. Five years later, he has claudication in the lower extremities when he exercises. Based on these findings, which of the following complications is most likely to occur in this man?
a)
Gangrene
b)
Hypoglycemic coma
c)
Ketoacidosis
d)
Pancreatitis
e)
Systemic amyloidosis
21.
A 57-year-old woman with a long history of type 2 diabetes mellitus is being evaluated for progressive renal failure. A kidney biopsy reveals nodular glomerulosclerosis and hyaline arteriolosclerosis. Electron microscopic examination finds a diffuse thickening of the basement membrane of the glomerular capillaries. Which of the following is the primary defect responsible for the thickening of renal basement membrane in this individual?
a)
Deposition of immune complexes in the subendothelial space
b)
Increased intracellular production of sorbitol
c)
Loss of glomerular polyanions
d)
Nonenzymatic glycosylation of proteins
e)
Production of antibodies to type IV collagen
22.
A 50-year-old man has a 35-year history of diabetes mellitus. During this time, he has had hemoglobin A1c values between 7% and 10%. He now has problems with sexual function, including difficulty attaining an erection. He also is plagued by mild but recurrent low-volume diarrhea and difficulty with urination. He has delayed gastric emptying. These problems are most likely to originate from which of the following mechanisms of cellular injury?
a)
Cross-linking extracellular matrix proteins
b)
Production of VEGF
c)
Abormal TGF-β signalling
d)
Non-enzymatic glycosylation
e)
Polyol induced susceptibilty to oxidative stress
23.
A 40-year-old woman has experienced chest pain on exertion for the past 2 months. On physical examination, she has a body mass index of 35. A random blood glucose value is 132 mg/dL. The next day, a fasting blood glucose is 120 mg/dL, followed by a value of 122 mg/ dL on the following day. She is given an oral glucose tolerance test, and her blood glucose is 240 mg/dL 2 hours after receiving the standard 75-g glucose dose. On the basis of these findings, she is prescribed an oral thiazolidinedione (TZD) drug. After 2 months of therapy, her fasting blood glucose is 90 mg/ dL. The beneficial effect of TZD in this patient is most likely related to which of the following processes?
a)
Activation of PPARγ nuclear receptorin adipocytes
b)
Greater density of insulin receptors in adipocytes
c)
Increased half life of circulating plasma insulin
d)
Reduced secretion of glucagon
e)
Regeneration of β cells in islets
24.
A family is followed longitudinally for two generations. Four of eight children develop hyperglycemia by age 18 years. They are found to have serum islet autoantibodies. They have similar MHC I and MHC II loci. Treatment with insulin injections normalizes their Hgb A1c levels. Which of the following is the most likely mechanism leading to their disease?
a)
Chloride ion channel abnormality
b)
Ch 21 trisomy
c)
Glucokinase gene mutation
d)
Peripheral insulin resistance
e)
Loss of T-cell tolerance
25.
A healthy 22-year-old man participates in a study of glucose metabolism. At the beginning of the study, his serum glucose concentration is within the reference range. He consumes an 800-calorie meal consisting of protein, fat, and carbohydrates. He then sleeps through the night without additional food or drink. Twelve hours later, his serum glucose concentration remains within the reference range. Which of the following mechanisms is most likely involved in maintaining this man's serum glucose concentration?
a)
Continued gut absorption of calories from ingested meal
b)
Glucose release from skeletal muscle
c)
Glycogenolysis in liver
d)
Increased leptin release from adipose tissue
e)
Inhibition of Glucagon release
26.
A 45-year-old man comes to the physician because of increased frequency of urination. He voids approximately 12 times a day and three times each night. He describes the inability to maintain an erection but reports no decrease in libido. BMI is 34 kg/m2. He has an elevated waist-to-hip-ratio. Cardiac auscultation reveals an audible S1 and S2, with a regular rate and rhythm. The lungs are clear. Urinalysis shows 3+ glucose and is negative for ketones. Fasting serum glucose is 195 mg/dL and the fasting insulin level of 78 mIU/L (normal: less than 25mIU/L). Which of the following blood laboratory findings in serum is most likely in this patient?
a)
Decreased concenetration of C peptide
b)
Elevated anion gap
c)
Elevated concentration of β-hydroxybutyrate
d)
Increased antibodies against islet cell proteins
e)
Increased osmolality
27.
. A 12-year-old nonobese boy presents for evaluation after becoming sick at school. Pertinent recent medical history includes weight loss with polyphagia, polydipsia, and polyuria. Laboratory examination finds hyper-glycemia, while urinary examination reveals increased glucose and trace ketones. Which of the following abnormalities is most likely to be present in this boy?
a)
Amyloid deposition in the pancreatic islets
b)
Atrophy and destruction of the pancreatic acini
c)
Decreased numbers of insulin receptors on adipocytes
d)
Lymphocytic infiltration in the pancreatic islets
e)
Mutations in the gene that codes for hexokinase
28.
Which of the following confirmed values meet the diagnostic threshold for diabetes?
a)
Fasting blood glucose ≥ 140 mg/dl
b)
Random glucose > 160 mg/dl
c)
2 hour post prandial glucose ≥ to 126 mg/dl
d)
Fasting blood glucose ≥ 126 mg/dl
29.
Which of the following is not a beneficial effect of exercise in people with diabetes?
a)
Reduction of triglycerides
b)
Hypoglycemia
c)
Increase in Insulin sensitivity
d)
Help controlling hypertension
30.
Which of the following are the recommended blood pressure and lipid goalsfor the prevention of cardiovascular disease in adults with diabetes?
a)
BP <140/90, TRGs <150, LDL <100
b)
BP <130/85, TRGs <300, LDL <100
c)
BP <135/80, TRGs <200, LDL <130
d)
BP <130/80, TRGs <150, LDL <100
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