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Dr. Gupta Endocrine exam 2

Total questions: 65

Worksheet time: 2hrs 10mins

Name
Class
Date
1.

-Formation of glycerol 

  -Formation of fatty acids (↑ various enzymes)

  -glycerol + fatty acids = triglycerides

  -Increased expression of lipoprotein lipases

  -Adipose tissue deposits

a)

Lipogenesis

b)

Glycogenesis

c)

Gluconeogenesis

2.

When does excretion of glucose in the urine occur?

a)

blood glucose levels high

b)

blood glucose levels low

3.

Produce in pancreatic B cell

a)

INsulin

b)

Glucagon

4.

What happens in the secretion of insulin when there is absence of glucose?

a)

In resting b cell, ATP is low, ADP is high

b)

K+ diffuses out through the K+/ATP channel

c)

Glucose metabolism raises ATP concentration

d)

K+ conductance causes depolarization

5.

What happens in the secretion of insulin when there is presence of glucose?

a)

•Glucose metabolism raises ATP concentration

b)

•Voltage-gated Ca2+ channel activated

c)

•Ca2+ mediates insulin secretion

d)

•Intracellular potential is hyperpolarized (-)

6.

GLUT4 promotes glucose intake in :

a)

muscles

b)

Brain

c)

Lumen

d)

adipose cells

7.

Which of the following is polypeptide synthesized by pancreatic α-cells and counterbalances insulin action?

a)

Glucagon

b)

Insulin

8.

Glucagon is catabolic and released when plasma glucose levels are low.

a)

True

b)

False

9.

Which of the following are the action of glucagon?

a)

•Mobilizes glucose, fat, and protein storages

b)

•Lipolysis

c)

•Gluconeogenesis & glycogenolysis

10.

Where is produce Incretins?

a)

GI tract

b)

Muscles

c)

Mouth

d)

Liver

11.

What are the function of incretins?

a)

increases insulin secretion

b)

Suppresses glucagon secretion

c)

Decrease blood glucose

d)

Increase blood glucose

12.

Diabetes that starts during adolescence or early adulthood and occurs due to the destruction of beta cells. (several months to years)

a)

Type 1 diabetes mellitus

b)

Type 2 diabetes mellitus

13.

HLA-DR is an MHC class II cell surface receptor encoded by the human leukocyte antigen complex

a)

True

b)

False

14.

What are the effects of type 1 diabetes mellitus?

a)

•Low insulin levels cause reduction in glucose intake by cells

b)

•Increased glucose synthesis

c)

•Increased glycogen breakdown

15.

Which of the following drugs can be called as weight neutral?

a)

DPP4 INHIBITORS

b)

AMYLIN ANALOGUES

c)

GLP-1 AGONIST

16.

SHORT-ACTING insulin products include lispro, aspart, glargine and regular insulins.

a)

True

b)

False

17.

Incretins (GLP-1 and GIP) are a group of gastric hormones that increases insulin and decreases glucagon levels.

a)

True

b)

False

18.

Pramlintide and exenatide are parenterally active peptides that cannot be given orally.

a)

True

b)

False

19.

Vigorous shaking of insulin vials can be break insulin crystals and can alterl the pharmacokinetics of the drug.

a)

True

b)

False

20.

Which of the following is least likely to cause hypoglycemia?

a)

Rosiglitazone

b)

Detemir insulin

c)

Amylin

d)

Glimepiride

21.

Cyanide group present in which of the following drugs increase it's half-life?

a)

Chlorpropamide

b)

Alogliptin

c)

Albiglutide

d)

Exenatide

22.

Which of the following is NOT a characteristics of diabetes ketoacidosis (DKA)?

a)

Decrease plasma bicarbonate levels

b)

Decreased ketone levels causing acidosis

c)

High levels of acetoacetic acid and B-hydroxybutyric acid

d)

High glucose

23.

A patient on alpha-glucosidase inhibitor is experiencing hypoglycemia. What should NOT be given?

a)

Soft drinks

b)

Glucose tablets

c)

Milk

d)

Fruit juice

24.

Which of the following is NOT an important consideration with glimepiride?

a)

Elderly population

b)

Hypoglycemia

c)

Use for weight loss

d)

Sulfonamide allergies

25.

Which of the following is NOT TRUE regarding second generation sulfonylureas? [When compared with first generation drugs]

a)

Decreased dose

b)

Greater risk of hypoglycemia

c)

Increase duration of action

d)

Bulky substitutions

26.

Depolarization of beta cells in pancreas leads to

a)

Glucagon secretion

b)

Insulin secretion

c)

Hyperpolarization

d)

Potassium efflux

27.

Which of the following is INACTIVATED by insulin?

a)

Lipase

b)

Glycogen synthesis

c)

Protein synthesis

d)

Growth promoting genes

28.

Which of the following is NOT secreted by pancreatic cells?

a)

Glucagon

b)

Insulin

c)

Amylin

d)

GLP-1

29.

Which os the following is NOT a complication os diabetes?

a)

Hypoglycemia

b)

Peripheral neropathy

c)

Slow healing of feet wounds

d)

Cognitive impairment

30.

All of the following amino acids residues in insulin can be modified EXCEPT

a)

GlyB23

b)

AspA21

c)

ProB28

d)

ThiB30

31.

Different insulin formulation have different efficacy as well as pharmacokinetics.

a)

True

b)

False

32.

Which of the following GLUT receptor types promotes uptake in fat cells?

a)

Glut 1

b)

Glut 2

c)

Glut 4

d)

Glut 5

33.

Increade glucose leads to PARP activation, which in turn inactivates Protein Kinase C.

a)

True

b)

False

34.

Which of the following causes fruity scent (like nail polish remover) type smell in patient with diabetic ketoacidosis?

a)

Acetone

b)

Plasma bicarbonate

c)

Acetoacetic acid

d)

Beta-hydroxybutyric acid

35.

Which of the following GLP-1 agonists has the longest half-life?

a)

Semaglutide (ozempic)

b)

Dulaglutide (Trulicity)

c)

Liraglutide (Victoza)

d)

Exenatide (Byetta)

36.

Chronic disease (may go undetected for years) with

increased risk of CV disease (with low HDL & high TG).

a)

Type 2 diabetes mellitus

b)

Type 1 diabetes mellitus

37.

-Insulin resistance in tissues

  -Tissues require higher levels of insulin

  -Beta cells compensate by producing more

a)

Type 2 diabetes

Stage I

b)

Type 2 diabetes

Stage II

38.

* Some decline (some age related) in pancreatic beta cells

•Decreased rate of beta cell renewal

•Apoptosis of beta cells

•Beta cells cannot keep up with increased insulin demand

•Beta cells are “exhausted”

•Hyperglycemia

a)

Type 2 diabetes

Stage I

b)

Type 2 diabetes

Stage II

39.

When Protein Kinace C activation ↓ Endothelial nitric oxide synthase (eNOS) and ↑ Endothelein-1 (ET-1) what pathology occurs?

a)

Blood flow abnormalities

b)

Vascular permeability and angiogenesis

c)

Capillary occlusion

d)

Pro inflammatory gene expression

40.

When Protein Kinace C activation ↑ VEGF what pathology occurs?

a)

Vascular permeability and angiogenesis

b)

Capillary occlusion

c)

↓ Fibrinolysis and vascular occlusion

d)

Increased reactive oxygen species and multiple effects

41.

When Protein Kinace C activation ↑ Collagen and ↑ Fibrinonectin what pathology occurs?

a)

Capillary occlusion

b)

↓ Fibrinolysis and vascular occlusion

c)

Vascular permeability and angiogenesis

d)

Blood flow abnormalities

42.

What are the major complications of diabetes?

a)

Cataracts and glaucoma

b)

Nephropathy

c)

Neuropathy

d)

Coronary heart disease

e)

increase risk of stroke

43.

What is the protective mechanism in case of starvation in Diabetic ketoacidosis?

a)

Acetyl CoA

b)

CAC

c)

Energy

44.

In Diabetic ketoacidosis the absence of insulin cause

a)

release of free fatty acids by liver

b)

excretion of glucose by kidney

c)

release of free fatty acids by pancreas

45.

DKA is characterized by

a)

High glucose (>250mg/dL)

b)

Arterial pH <7.2 (acidic)

c)

Low ketones

d)

increase CO2

46.

Bicarbonate helps in buffering effect but not sufficient to neutralize acid pH in Diabetic ketoacidosis

a)

True

b)

False

47.

Lipotoxicity is a metabolic syndrome that results from the accumulation of lipid intermediates in non-adipose tissue, leading to cellular dysfunction and death.

a)

True

b)

False

48.

Which tissue are affected in lipotoxicity?

a)

Kidney & liver

b)

Heart & skeletal muscle

c)

Neural & Brain

49.

What anti-diabetic drugs are peptides (parenterally active)?

a)

Insulin

b)

Amylin antagonist

c)

GLP-1 Antagonist

d)

SGLT2

50.

What anti-diabetic drugs are non-peptides (orally active)?

a)

Dipeptidyl peptidase-4 inhibitor (DPP4Is)

b)

Substituted Benzoic Acids

c)

α-Glucosidase Inhibitors

d)

Biguanides

e)

GLP-1 agonist

51.

Insulin product cointain two peptide chains connected by disulfide linkages and one disulfide linkage within chain A

a)

True

b)

False

52.

Which of the following of amino acid residues in the insulin product can be modified?

a)

ProB28

b)

LysB29

c)

ThrB30

d)

PheB25

53.

Short acting insulin begins working in 15 min and peaks in 1-2 hours (30-90min)

a)

Regular Human

b)

Synthetic

54.

Which of the following are fast acting insulin

begins working in 5 min and peaks in 1 hour?

a)

Lispro

b)

Aspart

c)

Glulisine

d)

Fiasp

55.

Which of the following are Insulin aspart with addition of niacinamide (vitamin B3) which helps in faster absorption?

a)

Aspart

b)

Fiasp

c)

Glulisine

d)

Lispro

56.

Which of the following amino acids addition prevents dimer formation and acts as stabilizing agent?

a)

L-arginine

b)

L-Threonine

c)

L-alanine

d)

L-valine

57.

Which of the following is an ultra rapid-acting inhaled insulin?

a)

Afrezza

b)

Degludec

c)

Detemir

d)

Glargine

58.

Which of the following is myristic acid, binds to albumin, released slowly and is ultra long-acting, DOA upto 42 h?

a)

Degludec

b)

Detemir

c)

Lispro

d)

Aspart

59.

What is the Chemical Modifications present in Glargine long acting insulin ?

a)

A21Asn -> Gly

Addition of ArgB31 and Arg B32

b)

B30Thr removed

Addition of C-14 FA to B29Lys

c)

B30Thr removed, C-16 FA to B29

60.

What is the Chemical Modifications present in Detemir long acting insulin ?

a)

A21Asn -> Gly

Addition of ArgB31 and Arg B32

b)

B30Thr removed

Addition of C-14 FA to B29Lys

c)

B30Thr removed, C-16 FA to B29

61.

What is the Chemical Modifications present in Degludec long acting insulin ?

a)

A21Asn -> Gly

Addition of ArgB31 and Arg B32

b)

B30Thr removed

Addition of C-14 FA to B29Lys

c)

B30Thr removed, C-16 FA to B29

62.

Insulin product contain considerations for storage.

What is the ph of deamidation of Asn A21?

a)

pH 2-3

b)

pH 7

c)

pH 8

63.

Insulin product contain considerations for storage.

What is the ph of deamidation of Asn B3?

a)

Neutral pH

b)

pH 7

c)

pH 2-3

d)

pH 8-9

64.

Insulin forms fibrils at high temperatures when exposed to hydrophobic environment

a)

True

b)

False

65.

For storage in the liver

a)

Glycogenesis

b)

Gluconeogenesis

c)

Lipogenesis

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