Transcript ETIOLOGY OF DIABETES

1.
a)
b)
c)
d)
e)
Which of the
following regarding
this picture is true.
The toe you would like
to amputate least is:
First metatarsal
Second Metatarsal
Third Metatarsal
Fourth Metatarsal
Fifth Metatarsal
2. Which of the following is not true about the
immunology of Type 1 Diabetes Mellitus.
• a. The antibody with the highest prevalence
throughout life in Type 1 Diabetes Mellitus is
GAD-65
• b. IAA and ICA Ab are at their peak levels
prior to 10 years of age
• c. GAD Ab titres are higher in prevalence
amongst South Indians and Japanese with
Type 1 Diabetes Mellitus when compared to
Caucasians
• d. There is a higher prevalence of thyroid
microsomal antibodies in first degree relatives
with Type I diabetes mellitus
• e Cyclosporine may reduce the insulin
requirement in a subset of Type I diabetes
3. Drugs known to produce hyperglycemia
include all of the following except
• a. Benzodiazepines
• b. Phenytoin sodium
• c. Hydrochlorthiazide
• d. Octreotide
• e. Olanzapine
Dept of Endo:
Dept of Endo:
• 4. Genetic syndromes associated with diabetes
mellitus include all the following except
• a. Lipodystrophy
• b. Myotonic dystrophy
• c. Kearns Sayre syndrome
• d. Von Gierke’s disease
• e. Lawrence Moon Biedl syndrome
• 5. Features of a patient who is suspected
to have MODY include all except
• a. Young individual
• b. Mild hyperglycemia
• c. Genetic transmission is usually
Autosomal dominant
• d. Patient is ketosis prone
• e. Commonest type of MODY is due to
mutation in the glucokinase gene
• 6. A 30 year man from Orissa presents with a
history of weight loss, diarrhoea and recurrent
abdomen pain over a period of 3 years. All of
the following are true except
• a. He may have diabetes mellitus
• b. The risk of chronic diabetic complications is
akin to that of type II diabetes.
• c. He may have associated Osteomalacia
• d. Giving him pancreatic enzyme supplements
will improve his glycemic control
• e. He is less likely to develop ketosis compared
to some one with type 1 diabetes
7. Behavioural and life style related risk
factors to develop diabetes include all
except
• a. Obesity
• b. Urbanization
• c. Diet
• d. Highly stressed lifestyles
• e. Regular exercise
8. The instruments
below measure:a) Plasma Glucose
b) Capillary Glucose
c) Blood Glucose
d) Interstitial Glucose
e) Urine Glucose
9. In Diabetes, which of the following is true • a. Fasting plasma glucose of >126 is abnormal
• b. It usually takes 6 years or more for insulin levels in
Type 1 Diabetes Mellitus to decline from normal to near
zero
• c. Impaired Glucose tolerance is associated with a risk of
microvascular complications similar to that of diabetes
itself
• d. In pregnancy, the criteria for diagnosis of diabetes is
less strict than those used to diagnose diabetes in nonpregnant subjects
• e. The risk of developing diabetes is decreased if the
patient has suffered an episode of gestational diabetes
10. Which is least likely to be true –
• a. Cyclosporine is known to induce diabetes
• b. Progesterones cause more glucose
intolerance than estrogens
• c. Nicotinamide worsens diabetic control in
Type 2 Diabetes Mellitus
• d. Diabetes is known to occur with Indinavir
therapy
• e. Corticosteroids induce diabetes in all
patients
• 11. The ethnic groups with the lowest
propensity for diabetes amongst the
following is:•
•
•
•
a. Pima Indians
b. Australian Aborigines
c. Orientals from China
d. Asian Indians / Pakistanis living in
UK / US
• e. Maoris of New Zealand
12. Wolfram or DIDMOAD syndrome
comprises all of the following except –
•
•
•
•
•
a. Diabetes mellitus
b. Optic atrophy
c. Deafness
d. Pancreatic agenesis
e. Diabetes insipidus
13. Indications for insulin therapy:•
•
•
•
•
a. Type I diabetes mellitus
b. Diabetic Ketoacidosis
c. Diabetic maculopathy
d. Severe painful progressive
neuropathy
e. All of the above
• 14. Which of the following statements
regarding chronic pancreatitis is true
• a. Diabetes Mellitus may invariably be present
at presentation
• b. Ketoacidosis occurs more commonly than in
type I diabetes
• c. There is greater chance of diabetes mellitus
occuring if there is pancreatic calcification
• d. The Incidence is higher in Scandinavian
countries
• e. Cassava (Tapioca) use is proven to be
the cause of tropical pancreatitis
15. Which of the following
is true about the
following devices:They are:
a) Disposable
b) Rechargeable (ie. refill)
c) Glucagon containing
d) Metallic
e) None of the above
16. Pancreatic agenesis is associated with a
MODY with associated
• a. Mutation in glucokinase gene
• b. Mutation in HNF 1 alpha gene
• c. Mutation in HNF 4 alpha gene
• d. Mutation in IPF 1 gene
• e. Mutation in HNF 1 beta gene
• 17. The biochemical abnormality seen early in
the evaluation of Type 2 Diabetes mellitus in
response to an IV glucose load is:•
•
•
•
•
a. Absent 1st phase insulin secretion
b. Absent 2nd phase insulin secretion
c. Absent 3rd phase insulin secretion
d. None of the above
e. Absent 1st phase and a reduced 2nd phase
insulin and “C” peptide response
18. Which of the following is an Insulin
Analogue
• a. NPH
• b. Lente
• c. Lispro
• d. Ultralente
• e. Actrapid
19. Glargine is
• a. Clear solution at PH 4
• b. Cloudy insulin mixture
• c. Short acting insulin analogue
• d. All the above
• e. None of the above
20. This patient presents with
diabetes. Which of the following are true:a) Surgery is the therapy of choice
b) Urinary tract infection is a major problem
c) Oxalate renal stones can develop
d) Spontaneous hypoglycaemia without medications is
common
e) It is a part of multiple endocrine neoplasia
21. Diabetic retinopathy is characterized
by all of the following except:•
•
•
•
•
a. Hard exudates
b. Microaneurysms
c. AV nipping
d. Neovascularization
e. Vitreous Haemorrhage
22. About Glargine : which of the following statement is
false.
a. Decreases the number of hypoglycemic
episodes, compared to NPH insulin
insulin.
b. Cannot be used in Type 2 Diabetes mellitus.
c. The duration of action could be upto 24 hours.
d. Cannot be mixed with other insulins
e. Is used in Type I diabetes
23. 28 year old lady known case of Type 1
Diabetes Mellitus of 10 years duration with
HbA1c of 8 % comes to the diabetic clinic at 6
weeks gestation. Choose the incorrect
statement
• a. She requires an Ophthalmological
evaluation
• b. You advise termination of pregnancy if
there is severe proliferative diabetic
retinopathy
• c. You advise Laser treatment if there is
macular exudates
• d. Glibenclemide can be used
• e. There is a chance of fetal malformation
24. 30 year old obese lady with Type 2 Diabetes
Mellitus of 4 years duration on Glibenclamide.
Her HbA1c is 8 - 9 %, Serum Creatinine 1.0
mg%. Choose the correct statement:
a. Immediate conception, as she has good
diabetic control and normal Serum Creatinine
b. Better control of diabetes and conception
while continuing Glibenclamide
c. Better control of diabetes for at least 3-4
months prior to conception with insulin
injections
d. After conception she does not require
regular monitoring of blood sugar control
e. Diet control is enough for diabetes
25. A 30 year old lady with Type 2 Diabetes Mellitus of 4
years duration shows mild nonproliferative diabetic
retinopathy on an ophthalmologist’s evaluation prior to
pregnancy. Her HbA1c is 8%, Serum Creatinine is 1.2
mg%. She has a 5 years old child, would like to have a
2nd child. Your advice will not include:• a. Avoid pregnancy due to risk of progression of
retinopathy during pregnancy
• b. She can become pregnant with better control of
diabetes mellitus
• c. She can become pregnant after better control of
diabetes mellitus and she requires regular eye
examination
• d. She needs good diet control
• e. She needs insulin if she wants to become pregnant
26. Insulin Lispro is
• a. Insulin Analogue
• b. Lysine to proline switch in beta chain
• c. Lysine to proline switch in alpha chain
• d. a and b
• e. a and c
27. Insulin induced hypoglycemia is characterized
by :• a. Increased insulin and increased C-Peptide
• b. Increased insulin ; decreased C-Peptide
• c. Decreased insulin ; decreased C-Peptide
• d. Decreased insulin ; increased C-Peptide
• e. None of the above
28. The size of the
needle used by this
device is :
a. 31g b.24g
c. 26g d. 28g e. 30g
29. 20- year old male with diabetes mellitus of 2
years duration on Oral hypoglycemic agents.
His BMI is 19 kgs/m2, HbA1c 9 %. He has
hypothyroidism and taking Eltroxine 0.1 mg
once daily in the morning and is on a
physiological replacement of steroid for
Addison’s disease. Ultrasonogram of the
abdomen is normal.The Type of Diabetes is
most likely to be:• a. Pancreatic diabetes mellitus(Calcific)
• b. LADA (Type I variant)
• c. Type II diabetes
• d. Acromegaly
• e. Steroid induced diabetes
30. Correct method of mixing regular and
lente insulin is
• a. Regular followed by NPH insulin
• b. Lente followed by regular insulin
• c. Both simultaneously
• d. Only a and b are correct
• e. None of the above
31. Insulin induced problems include • a. Lipoatrophy
• b. Lipohypertrophy
• c. Weight gain
• d. Oedema
• e. All the above
32.The pink structures
labeled in the
histopathology in this
diabetic kidney are:
a) Fibrin Caps
b) Vitamin Drops
c) Kidney droppings
d) Urine cysts
e) Amyloid
33. The most important treatment of the patient
mentioned in the previous question is:• a. Large volume of fluids, insulin,
treat concurrent illness
• b. Bicarbonate infusion
• c. Rapid glucose lowering with IV insulin
• d. 30 meq per hour of KCL
• e. None of the above
34. The most common cause of
preventable blindness in
developed countries is
• a. Vitamin A Deficiency
• b. Injury
• c. Diabetic retinopathy
• d. Uveitis
• e. Hypertensive retinopathy
35. Proliferative diabetic retinopathy
involves:• a. Neovascularisation at the disc
• b. Vitreous haemorrhage
• c. Retinal detachment
• d. All the above
• e. None of the above
36. Treatment of choice for early
proliferative diabetic retinopathy
• a. Pan retinal photocoagulation
• b. Focal retinal photocoagulation
• c. Vitrectomy
• d. All the above
• e. None of the above
37. A 19 year old with insulin dependent
diabetes mellitus is taking 30 units
NPH(Monotard) in the morning and 15
units at night. Because of persistent
morning Glycosuria, the evening dose is
increased to 20 units. This worsens the
morning Glycosuria. The next step in
management -
37(contd.)
• a. Increase evening dose of insulin
• b. Increase morning dose of insulin
• c. Switch from Human NPH to pork
insulin
• d. Obtain a blood sugar level between
2 AM & 5 AM
• e. Change to insulin lispro twice a day
38. Complications of Laser
Photocoagulation include:
• a. Night blindness
• b. Visual loss
• c. Pain
• d. All the above
• e. None of the above
39. All of the following are proposed mechanisms
of how long term hyperglycaemia produces
diabetic complications, except • a. Increased polyol pathway
• b. Advanced glycation end products
• c. Activation of protein Kinase A
• d. Increased Hexosamine pathway flux
• e. Activation of protein Kinase C
40. This 34 year old gentleman with diabetes and
acromegaly developed headache due to
apoplexy and lost his acromegalic features
over 6 months. His blood sugars normalised
thereafter, without medications. The reason
for normalisation is:
40.(contd). Deficiency of
A. Growth Hormone
B. Cortisol
C. Glucagon
D. A and B
E. B and C
41. Nodular Glomerulosclerosis is seen in • a. Diabetic nephropathy
• b. Amyloidosis
• c. Dysproteinemias
• d. Glomerulonephritis
• e. All of the above
42. Which of the following agents is used to
prevent radio contrast induced
nephropathy
• a. Aminoguanidine
• b. Sorbitol
• c. Glyoxal
• d. N-Acetylcysteine
• e. Aspirin
43. All of the following agents accentuate
hyperkalemia of hyporeninemic
hypoaldosteronism in diabetes except • a. NSAIDs
• b. ACE inhibitors
• c. Cyclosporine
• d. Trimethoprim
• e. Furosemide
44. ACE inhibitors decrease intraglomerular
pressure by acting on • a. Afferent arteriole
• b. Efferent arteriole
• c. Macula densa
• d. Juxtaglomerular cells
• e. mesangium
45. The most common peripheral
neuropathy in diabetic patients is • a. Distal symmetric polyneuropathy
• b. Proximal motor neuropathy
• c. Acute mononeuropathies
• d. Small fibre neuropathy
• e. Large fibre neuropathy
46. Diabetes control and complications trial
(DCCT) demonstrates that improved glycemic
control reduces macro and microvascular
complications in
• a. Type 1
• b. Type 2
• c. Calcific Pancreatic diabetes mellitus
• d. MODY
• e. Steroid induced diabetes
47. The Anomaly Seen here is:
47.(contd.)
a) Vitreous haemorrhage
b) Subhyaloid Haemorrhage
c) Central Retinal Venous Occlusion
d) Central Retinal Arterial Occlusion
e) Retinal Detachment
48. Which following trials first showed that
strict blood pressure control significantly
reduced both macrovascular and
microvascular complications in
Type II Diabetes mellitus • a. HOPE study
• b. UKPDS
• c. DCCT
• d. PRIME
• e. ENDIT
49. Albuminuria in a patient with diabetes
is due to which of the following causes
• a. Hypertension
• b. CCF
• c. Urinary Tract Infection
• d. Uncontrolled diabetes
• e. All of the above
50. The ideal blood pressure for
individuals with overt diabetic
nephropathy is
• a. 120/80 mmHg
• b. 130/90 mmHg
• c. 140/90 mmHg
• d. 110/50 mmHg
• e. 170/90 mmHg
51. The most common diabetic
mononeuropathy is
• a. Oculomotor nerve palsy
• b. Foot drop
• c. Wrist drop
• d. Bells palsy
• e. 4th cranial nerve palsy
52. The most common pattern of dyslipidemia in
diabetes in this set is:
• a. Increased Triglyceridemia ; decrease HDL
• b. Increased S. Cholesterol ; increase LDL
• c. Increased VLDL ; increase LDL
• d. Increased Triglyceridemia,
increased HDL
• e. Chylomicronemia
53. Which of the following anti-lipid drugs
worsen glycemic control
• a. Statins
• b. Fibrates
• c. Nicotinic acid
• d. Cholestyramine
• e. Probucol
54.
What are you looking at?
54. (contd)
a)
b)
c)
d)
e)
Microcellular footwear
Molded Insole
Rocker bottom shoe
All of the above
None of the above
55. Which of the following antihypertensive class
of drugs improve both insulin sensitivity and
do not have a negative effect on lipid profile:•
•
•
•
•
a.
b.
c.
d.
e.
Beta blockers
Thiazide diuretics
Alpha blockers
glucocorticoids
Centrally acting adrenergic antagonists
56. The most specific modality in distinguishing
between charcot’s arthropathy and osteomyelitis
is
• a. Indium scan
• b. X-Ray foot
• c. MRI foot
• d. Angiography
• e. CT Scan
57. A diabetic patient is referred for management
of foot ulcer. He has no fever and the wound
looks healthy, which of the following topical
agents is currently advocated for the foot
• a. Topical sulphadiazine
• b. Betadine ointment
• c. Neosporin ointment
• d. Saline dressing
• e. Bacitracin ointment
58. Malignant otitis externa is most often
caused by
• a. Pseudomonas aeruginosa
• b. Staphylococcus aureus
• c. Group B Streptococcus
• d. Otomycosis
• e. Klebsiella
59. All of the following are associated with
diabetes except a. Pigmented pretibial papules
b. Acanthosis nigricans
c. Necrobiosis lipoidica diabeticorun
d. Granuloma annulare
e. Erythema induratum
60. What is the Abnormality?
60.(contd)
a)
b)
c)
d)
e)
Osteomyelitis
Neuropathic joint
Crush Fracture
All of the above
None of the above
61. Type 2 Diabetes Mellitus is characterized by
the following except
• a. Insulin resistance precedes failure of insulin
secretion
• b. Post prandial hyperglycaemia is due to loss
of first phase insulin response
• c. Nocturnal Hepatic glucose output is
responsible for fasting hyperglycaemia
• d. Diabetic Ketoacidosis is more common in
Type 2 Diabetes Mellitus.
• e .Initial response to oral hypoglycaemic agents
in most patients
62. Capsaicin is useful in painful diabetic
peripheral neuropathy by depleting__________
from sensory nerve endings
• a. Substance P
• b. Acetylcholine
• c. Adrenaline
• d. Serotonin
• e. Histamine
63. After 14 hours fast, percentage of
glucose consumption in decreasing order
is as follows in the following organs
• a. Brain, heart, skin muscle, kidney
• b. Kidneys, brain, heart, skin muscle
• c. Brain, kidneys, heart, skin muscle
• d. Heart,brain, kidneys, skin muscle
• e. Kidneys, heart, brain, skin muscle
64. The following is true about glucose
transporters(GLUT) except:
a. GLUT-2 are mainly present in the beta cells
as part of glucose sensor system
b. GLUT-4 mediates glucose transport in brain
c. GLUT-2 mediated glucose uptake is energy
independent
• GLUT-5 is a fructose transporter
• GLUT-1 is present ubiquitously
65. This patient presents with high grade fever
and abdomenal pain. The CT scan shows a
normal liver and spleen and this anomaly.
What is the commonest organism present?
65. (contd.)
65. (contd.)
a) Clostridium perfinges
b) Staphylococcus aureus
c) Nocardia
d) Streptococcus
e) Escherichia Coli
66. The Anomaly Seen here is:
66. (contd.)
a) Mild Nonproliferative
Diabetic Retinopathy
b) Moderately Severe Nonproliferative
Diabetic Retinopathy
c) Proliferative Retinopathy
d) Vitreous Haemorrhage
e) Retinitis Pigmentosa
67. All of the following may be present in
Charcot's foot except
• a. Foot ulcer
• b. Absent pulses
• c. Hammer toes
• d. Loss of arch
• e. Loss of vibration sensation
68. A 48 year old man who had been a patient
with diabetes was admitted with history
of decreased urine output. His serum
creatinine was found to be 4.0 mg/dl
The drug of choice in this setting is:A. Glimeperide
B. Metformin
C. Insulin
D. Gliclazide
E. Glibenclamide
69. A 70 year old Man who is a known case of coronary
artery disease and LV dysfunction has been diagnosed
to have diabetes now. The ideal drug which can be
started in this patient is
A. Glibenclemide
B. Glimeperide
C. Pioglitazone
D. Rosiglitazone
E. Phenformin
• 70.Megaloblastic anaemia is caused by:
A. Metformin
B. Acarbose
C. Insulin
D. Rosiglitazone
E. None of the above
• 71. A 36-year old is a known diabetic and a
business executive who has irregular
timings for the meals, but is generally
compliant with his medications. Which one
of the following drugs is most appropriate
in this situation.
A) Glimeperide
B) Metformin
C) Repaglinide
D) Pioglitazone
E) Glibenclamide
72. The following is hypoglycaemic agent
with a predominant action in the liver
A. Pioglitazone
B. Metformin
C. Glimeperide
D. All of the above.
E. None of the above.
Upright X-ray
73. How does one treat this anomaly?
73.(contd.)
a) Amputation
b) Disarticulation
c) Antibiotics for 6 months
d) Total contact cast
e) None of the above
• 74. A 50 year old obese female is taking OHAs,
while being treated for an upper respiratory tract
infection. She develops lethargy and is brought
to Emergency Department. OPD examination no focal neurologic finding or neck rigidity.
• Lab results are - Sodium 134 m.mol/L ;
Potassium 4.0 m.mol/L ; Bicarbonate 25 mmol/L;
Glucose 900 mg/dl , S. Creatinine 3.0 mg% /
Blood pressure 120/80 mmHg. The most like
cause of this patient’s coma is:-
74(contd).
• a. Hyperosmolar Nonketototic state
• b. SIADH
• c. Bacterial Meningitis
• d. Tuberculous Meningitis
• e. Diabetic Ketoacidosis
75. A patient with
diabetes shows this
anomaly. Your
most likely
diagnosis is:
a) Papular Dermatitis
b) Bullosis
diabeticorum
c) Iodine dermatitis
d) Necrobiosis
diabeticorum
e) Malignant
dermatitis