Deck 24: Diabetes Mellitus

Question 1

Non -enzymatic glycosylation of what protein is used as a marker for measuring the one -to -three -month average of blood glucose levels?

A) albumin
B) glucagon
C) fibrin
D) hemoglobin
E) insulin

Answer 1

D

Question 2

What is a microaneurysm?

A) large leakage of blood from the microvasculature
B) weak bulges in the walls of small blood vessels
C) perforation of the basement membrane of fenestrated capillaries
D) development of new blood vessels
E) small leakage of blood from the microvasculature

Answer 2

B

Question 3

Which of the following is NOT an adverse effect of glycation caused by hyperglycemia?

A) oxidative stress
B) beta cell degeneration
C) increased capillary permeability
D) lipolysis
E) delayed wound healing

Answer 3

B

Question 4

Which of the following is NOT an effect of epinephrine?

A) increase ketone production
B) stimulate protein synthesis
C) stimulate lipolysis
D) increase blood fatty acid levels
E) stimulate gluconeogenesis

Question 5

What is the polyol associated with glucose?

A) glycerol
B) ascorbic acid
C) lactose
D) aldose
E) sorbitol

Question 6

Which of the following does NOT cause coma?

A) a person with diabetes mellitus taking too much insulin causing hypoglycemia
B) a blood glucose concentration greater than 600 mg/dL
C) a person with diabetes mellitus type 1 taking too little insulin causing hyperglycemia
D) a partial pressure of carbon dioxide of 40 mm Hg in arterial blood
E) a blood osmolarity greater than 350 mOsm

Question 7

Which of the following is NOT a symptom of ketoacidosis?

A) electrolyte imbalance
B) dehydration
C) fruity odor to breath
D) polyuria
E) decreased ventilation

Question 8

What is angiogenesis?

A) developments of perforations in the basement membrane of fenestrated capillaries
B) development of new blood vessels
C) large leakage of blood from the large blood vessels
D) small leakage of blood from the microvasculature
E) weak bulges in the walls of small blood vessels

Question 9

By what percentage has the incidence of diabetes mellitus type 1 (both a and b subtypes) increased in the United States over the last twenty years?

A) 0
B) 10
C) 25
D) 50
E) 100

Question 10

In diabetes mellitus type 2, current theories suggest that blood vessel damage probably occurs through what process?

A) decrease in nitric oxide release from endothelial cells
B) increase in carbon dioxide levels in blood
C) increase in histamine production
D) shear stress on the blood vessels due to elevated pressure
E) sclerosis of the basement membrane

Question 11

Symptoms of hypoglycemia include all of the following EXCEPT

A) anxiety.
B) hunger.
C) blurred vision.
D) polyuria.
E) tingling sensation.

Question 12

Which of the following best describes diabetes mellitus type 1a?

A) an autoimmune disease that attacks alpha cells of the pancreas
B) a genetic disorder associated with the Y chromosome
C) a genetic disorder associated with the X chromosome
D) an autoimmune disease that attacks insulin receptors
E) an autoimmune disease that attacks beta cells of the pancreas

Question 13

What is the significance of Coxsackie B virus in diabetes mellitus type 1a?

A) This virus attacks beta cells of the pancreas causing an immune response against these cells.
B) Coxsackie B increases the availability of glucose for energy.
C) Coxsackie B increases the availability of lipids for energy.
D) Coxsackie B increases the availability of proteins for energy.
E) A person with diabetes mellitus type 1 is more susceptible to infection with Coxsackie B.

Question 14

Which of the following chemical messengers induces the sensation of feeling full (satiety effect)?

A) somatostatin
B) acetylcholine
C) glucagon
D) epinephrine
E) insulin

Question 15

What happens when excessive angiogenesis occurs?

A) Hypotension occurs due to decreased total peripheral resistance.
B) The new blood vessel walls are weak and tend to leak.
C) The heart rate increases significantly.
D) The new blood vessel walls are stiff and tend to clog.
E) The heart can no longer beat strongly.

Question 16

In diabetes mellitus type 1, blood vessel damage occurs primarily through what process?

A) increase in carbon dioxide build up in blood
B) increase in nitric oxide release from endothelial cells
C) increase in histamine production
D) increase in oxygen levels in blood
E) shear stress on the blood vessels due to elevated pressure

Question 17

In type 1a DM, the immune system attacks beta cell antigens. Therefore, which of the following is a potential antigen?

A) preproinsulin
B) preproglucagon
C) ketones
D) glucose
E) glucagon

Question 18

In diabetes mellitus, polydipsia is triggered by what hormone?

A) leptin
B) relaxin
C) angiotensin II
D) glucagon
E) angiotensin I

Question 19

Damage to the microvasculature that occurs with diabetes contributes to which of the following conditions?

A) delayed wound healing
B) nephropathy
C) neuropathy
D) retinopathy
E) All of the answers are correct.

Question 20

At approximately what age do symptoms of diabetes mellitus type 1 first appear?

A) at conception
B) at birth
C) before age 5
D) after age 7
E) after age 40

Question 21

What are the epidermal cells that proliferate to cover the opening of a wound?

A) macrophages
B) neutrophils
C) keratinocytes
D) fibroblasts
E) granule cells

Question 22

Adequate treatment of diabetes includes maintaining fasting blood glucose levels below what value?

A) 85 mg/dL
B) 115 mg/dL
C) 60 mg/dL
D) 130 mg/dL
E) 100 mg/dL

Question 23

What is paresthesia?

A) abnormal sensation of the skin such as tingling or numbness
B) simultaneous activation of afferent and efferent axons to the same region of the body
C) abnormal activation of motor neurons causing muscle twitches
D) unpleasant sensation produced by innocuous stimuli
E) muscle spasms

Question 24

What two cytokines, released by platelets during hemostasis, promote inflammation?

A) interleukin 1 and thrombin
B) transforming growth factor fi and platelet -derived growth factor
C) prostaglandin I₂ and platelet factor 3
D) interleukin 2 and platelet -derived growth factor
E) thrombin and leukotriene

Question 25

Why do many diabetics have to have a foot amputated?

A) Decreased blood flow to the foot causes gangrene.
B) Decreased blood flow to the foot directly causes wounds to develop that will not heal.
C) Neuropathy causes intense pain that can only be relieved by amputation.
D) Decreased blood flow to the foot causes extreme pain that can only be relieved by amputation.
E) Decreased peripheral blood flow with its consequent low tissue pO₂, elevated interstitial glucose levels and abnormal wound healing, coupled with lack of sensation from the foot to warn of an injury, creates a very favorable anaerobic growth environment that can lead to gangrene.

Question 26

What cell type secretes collagen as a wound heals?

A) fibroblasts
B) keratinocytes
C) neutrophils
D) macrophages
E) monocytes

Question 27

Phagocytosis of debris in the area of wound is carried out by what cell types?

A) neutrophils and fibroblasts
B) lymphocytes and fibroblasts
C) macrophages and neutrophils
D) eosinophils and neutrophils
E) basophils and eosinophils

Question 28

What is end -stage renal disease?

A) Bowman's capsule becomes leaky causing a systemic infection.
B) Infection of the kidneys causes blood loss in the urine.
C) Bowman's capsule becomes leaky and proteins appear in the urine.
D) The kidneys fail and dialysis or kidney transplant is essential.
E) The glomerular membrane becomes leaky and proteins appear in the urine.

Question 29

What cell type is the first on the scene to act in the inflammatory response?

A) neutrophils
B) macrophages
C) lymphocytes
D) fibroblasts
E) eosinophils

Question 30

What cell type lays down the new extracellular matrix as a wound heals?

A) neutrophils
B) macrophages
C) megakaryocytes
D) fibroblasts
E) monocytes

Question 31

Dietary control of diabetes mellitus types 1 and 2 includes limiting the intake of

A) triglycerides.
B) carbohydrates.
C) proteins.
D) cellulose.
E) cholesterol.

Question 32

Which of the following is characteristic of diabetic cardiomyopathy?

A) decreased heart rate
B) decreased size of the heart
C) decreased stroke volume
D) decreased likelihood of myocardial infarction
E) All of the answers are correct.

Question 33

Which of the following is an early sign of diabetic nephropathy?

A) blood in the urine
B) glucose in the urine
C) frequent urinary tract infections
D) proteinuria
E) systemic edema

Question 34

Which of the following does NOT contribute to diabetes enhanced atherosclerosis?

A) increased lipid transport in HDLs
B) increased production of reactive oxygen species
C) increased lipid transport in LDLs
D) increased non -enzymatic glycosylation
E) microvascular disease

Question 35

Diabetic neuropathies generally affect what area of the nervous system?

A) glial cells
B) peripheral nervous system
C) spinal cord
D) sensory receptors
E) brain

Question 36

What effect does diabetes have on wound healing?

A) speeds it up by increasing angiogenesis
B) speeds it up by increasing the rate of proliferation
C) delays it by slowing the rate of all phases
D) slows it down by increasing inflammation
E) speeds it up, but in the process leads to a larger scar formation

Question 37

What is the correct order of the three steps of wound healing?

A) proliferation, inflammation, remodeling
B) proliferation, remodeling, inflammation
C) inflammation, proliferation, remodeling
D) remodeling, inflammation, proliferation
E) inflammation, remodeling, proliferation

Question 38

What is dysesthesia?

A) muscle twitches
B) muscle spasms
C) tingling sensation
D) unpleasant sensation produced by innocuous stimuli
E) numbness

Question 39

What is silent myocardial ischemia?

A) a cardiac arrhythmia that decreases contractility of the atria
B) a heart attack without pain
C) a stroke
D) a cardiac arrhythmia that shuts down the pacemaker cells of the SA node
E) a cardiac arrhythmia that decreases contractility of the ventricles

Question 40

Collagen becomes organized and cross -linked during what phase of wound healing?

A) inflammation
B) remodeling
C) angiogenesis
D) hemostasis
E) proliferation

Question 41

Which type of DM may result in polyuria?

A) type 1 DM
B) type 2 DM
C) neither type 1 nor type 2 DM
D) both type 1 DM and type 2 DM

Question 42

What medication's mechanism of action is to inhibit brush border enzymes that hydrolyze disaccharides, trisaccharides, and oligosaccharides to glucose or other monosaccharides, thereby decreasing absorption of glucose?

A) a -glucosidase inhibitors
B) glucagon -like peptide -1
C) sulfonylureas
D) thiazolidinediones
E) biguanides

Question 43

Which type of DM may result in hyperglycemia?

A) type 2 DM
B) neither type 1 nor type 2 DM
C) both type 1 DM and type 2 DM
D) type 1 DM
E) both type 1 DM and type 2 DM

Question 44

What cells arrive at the wound area by chemotaxis and assist in fighting the infection through phagocytosis and secreting cytokines?

A) neutrophils
B) macrophages
C) keratinocytes
D) fibroblasts
E) endothelial cells

Question 45

What medication's mechanism of action is to close potassium channels on pancreatic beta cells causing a depolarization that triggers insulin release by exocytosis?

A) thiazolidinediones
B) biguanides
C) a -glucosidase inhibitors
D) sulfonylureas
E) glucagon -like peptide -1

Question 46

What cells secrete collagen and are most active during the remodeling phase of wound healing?

A) neutrophils
B) endothelial cells
C) macrophages
D) keratinocytes
E) fibroblasts

Question 47

Which type of DM is caused by damage to beta cells of the pancreas?

A) types 1a and 1b DM
B) neither type 1 nor type 2 DM
C) type 2 DM
D) both type 1 DM and type 2 DM
E) both type 1 DM and type 2 DM

Question 48

What medicine for the treatment of diabetes sensitizes tissue to insulin?

A) biguanides
B) thiazolidinediones
C) glucagon
D) alpha -glucosidase inhibitors
E) sulfonylureas

Question 49

What are the first cells in the wound area, which contribute to inflammation while fighting the infection through phagocytosis and secreting cytokines?

A) endothelial cells
B) macrophages
C) fibroblasts
D) neutrophils
E) keratinocytes

Question 50

Which type of DM is caused by a decreased response in the tissues to insulin?

A) neither type 1 nor type 2 DM
B) both type 1 DM and type 2 DM
C) type 1 DM
D) type 2 DM
E) both type 1 DM and type 2 DM

Question 51

Age of onset has traditionally been thought to be in people over 40 years of age, but occurrence in children is found to be increasing, indicating a reduction in the average age of onset for what type of DM?

A) neither type 1 nor type 2 DM
B) both type 1 DM and type 2 DM
C) both type 1 DM and type 2 DM
D) type 1 DM
E) type 2 DM

Question 52

Which type of DM can occur secondary to obesity, while obesity can also occur secondary to it?

A) type 2 DM
B) type 1 DM
C) both type 1 DM and type 2 DM
D) neither type 1 nor type 2 DM
E) both type 1 DM and type 2 DM

Question 53

What is the primary medicine for regulating diabetes mellitus type 1?

A) biguanides
B) glucagon inhibitors
C) glucagon
D) exogenous insulin
E) sulfonylureas

Question 54

Which type of DM is the most common form of diabetes mellitus?

A) both type 1 DM and type 2 DM
B) type 1 DM
C) neither type 1 nor type 2 DM
D) type 2 DM
E) both type 1 DM and type 2 DM

Question 55

Which type of DM is caused by inadequate insulin secretion?

A) both type 1 DM and type 2 DM
B) type 2 DM
C) type 1 DM
D) neither type 1 nor type 2 DM
E) both type 1 DM and type 2 DM

Question 56

Which type of DM is caused by damage to alpha cells of the pancreas?

A) type 1 DM
B) type 2 DM
C) both type 1 DM and type 2 DM
D) both type 1 DM and type 2 DM
E) neither type 1 nor type 2 DM

Question 57

What medication's mechanism of action is to sensitize tissue to insulin, thereby countering the resistance to insulin?

A) biguanides
B) thiazolidinediones
C) a -glucosidase inhibitors
D) sulfonylureas
E) glucagon -like peptide -1

Question 58

How do alpha -glucosidase inhibitors decrease blood glucose levels?

A) stimulating glycogenesis in the liver
B) stimulating insulin release from beta cells of the pancreas
C) inhibiting glycogenesis in the liver
D) inhibiting digestion of carbohydrates in the small intestine
E) inhibiting gluconeogenesis in the liver

Question 59

What diabetes medication stimulates insulin release from beta cells of the pancreas?

A) biguanides
B) thiazolidinediones
C) none
D) sulfonylureas
E) alpha -glucosidase inhibitors

Question 60

What medication's mechanism of action is in reducing glucose production in the liver and increasing the sensitivity of receptors to insulin?

A) glucagon -like peptide -1
B) thiazolidinediones
C) biguanides
D) a -glucosidase inhibitors
E) sulfonylureas

Question 61

Blood levels of what form of lipoproteins are decreased by diabetes mellitus?

A) VLDLs
B) Apo A
C) HDLs
D) LDLs
E) chylomicra

Question 62

Which is NOT one of the "three polys" of diabetes mellitus?

A) polyol
B) polyphagia
C) polyuria
D) polydipsia

Question 63

The age of onset of diabetes mellitus type 2 is decreasing.

Question 64

Under hyperglycemic conditions, what causes mesangial cells to secrete excess extracellular matrix in kidneys?

A) protein kinase C
B) HbA1c
C) angiotensin II
D) PGE2
E) renin

Question 65

What is the primary protein that appears in the urine with nephropathy?

A) albumin
B) myoglobin
C) tumor necrosis factor
D) creatinine
E) bilirubin

Question 66

People with diabetes are more prone to develop atherosclerosis.

Question 67

When glucose levels exceed 600 mg/dL, especially in the elderly, a nonketotic coma can occur.

Question 68

What are proteins that have been glycosylated through a non -enzymatic process (known as glycation) collectively called?

A) browning reactions
B) advanced glycosylation end -products (AGEs)
C) HbA1c
D) brittle proteins
E) acrylamides

Question 69

Diabetic ketoacidosis is more common in diabetes mellitus type 2.

Question 70

What is the normal fasting blood glucose level?

A) < 100 mg/dL
B) 100 -129 mg/dL
C) 130 -140 mg/dL
D) > 140 mg/dL
E) 120 -139 mg/dL

Question 71

What drug class used originally to treat typhoid fever during World War II is now used to treat diabetes mellitus type 2?

A) chloramphenicol
B) penicillin
C) sulfanilamides
D) sulfonylureas
E) metformin

Question 72

The diabetes epidemic is due to increases in diabetes mellitus 2 only; there has been no significant increase in diabetes mellitus type 1.

Question 73

What is the leading cause of adult -onset blindness in the United States?

A) cataracts
B) glaucoma
C) retinitis pigmentosa
D) diabetic retinopathy
E) retinoblastoma

Question 74

Why must insulin be injected into patients with diabetes mellitus type 1 as opposed to oral administration?

A) Since the absorbed contents of the GI tract first passes through the liver before moving on into the general circulation, it creates a first -pass effect which weakens its effectiveness.
B) Insulin is a peptide that would be degraded in the gastrointestinal tract and would therefore only be absorbed as individual amino acids.
C) Insulin is such a small molecule that it easily passes through the highly vascularized tissue of the oral mucosa and enters the blood stream too quickly, causing a hypoglycemic crash.
D) Insulin is a hormone, so it must be injected directly into the bloodstream to be effective.

Question 75

What phases of wound healing is/are delayed with diabetes mellitus?

A) inflammatory and proliferative only
B) inflammatory only
C) remodeling and proliferative only
D) inflammatory, proliferative, and remodeling
E) inflammatory and remodeling only

Question 76

Diabetes mellitus type 1 is a genetic disorder that affects the genes for insulin synthesis.

Question 77

Hyperglycemia can ultimately lead to activation of the sympathetic nervous system and release of epinephrine.

Question 78

Which one of DM's effects on the peripheral nervous system results in a tingling sensation of the skin?

A) formication
B) parasthesia
C) facial palsy
D) hyperesthesia
E) neuropathy

Question 79

Which of the following enzymes has a greater affinity for glucose, thereby initiating a more frequent outcome?

A) aldose reductase
B) hexokinase
C) GFAT
D) glucose 6 phosphatase

Question 80

People with uncontrolled diabetes mellitus may suffer from polyphagia.