Deck 24: Diabetes Mellitus

Question 1

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

Answer 1

D

Question 2

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

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

Answer 2

A

Question 3

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

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

Answer 3

D

Question 4

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 5

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

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

Question 6

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

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

Question 7

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

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

Question 8

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

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

Question 9

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

A)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.
B)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.
C)Insulin is a hormone, so it must be injected directly into the bloodstream to be effective.
D)Insulin is a peptide that would be degraded in the gastrointestinal tract and would therefore only be absorbed as individual amino acids.

Question 10

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

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

Question 11

How do alpha- glucosidase inhibitors decrease blood glucose levels?

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

Question 12

Which type of DM is caused by inadequate insulin secretion?

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

Question 13

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

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

Question 14

What is end- stage renal disease?

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

Question 15

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

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

Question 16

Which of the following is NOT a symptom of ketoacidosis?

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

Question 17

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)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 18

Symptoms of hypoglycemia include all of the following EXCEPT

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

Question 19

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

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

Question 20

What effect does diabetes have on wound healing?

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

Question 21

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

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

Question 22

Which of the following does NOT cause coma?

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

Question 23

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

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

Question 24

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)sulfonylureas
C)thiazolidinediones
D)glucagon- like peptide- 1
E)biguanides

Question 25

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

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

Question 26

Which type of DM may result in hyperglycemia?

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

Question 27

What is a microaneurysm?

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

Question 28

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

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

Question 29

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 30

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

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

Question 31

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

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

Question 32

In diabetes mellitus, polydipsia is triggered by what hormone?

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

Question 33

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

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

Question 34

What is the polyol associated with glucose?

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

Question 35

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

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

Question 36

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

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

Question 37

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 38

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

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

Question 39

What is silent myocardial ischemia?

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

Question 40

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 41

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

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

Question 42

Which of the following is characteristic of diabetic cardiomyopathy?

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

Question 43

What is dysesthesia?

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

Question 44

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

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

Question 45

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

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

Question 46

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

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

Question 47

Why do many diabetics have to have a foot amputated?

A)Decreased blood flow to the foot directly causes wounds to develop that will not heal.
B)Decreased blood flow to the foot causes extreme pain that can only be relieved by amputation.
C)Decreased blood flow to the foot causes gangrene.
D)Neuropathy causes intense 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 48

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

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

Question 49

Which of the following is NOT an effect of epinephrine?

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

Question 50

What is angiogenesis?

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

Question 51

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

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

Question 52

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

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

Question 53

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)muscle spasms
D)unpleasant sensation produced by innocuous stimuli
E)abnormal activation of motor neurons causing muscle twitches

Question 54

Diabetic neuropathies generally affect what area of the nervous system?

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

Question 55

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

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

Question 56

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

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

Question 57

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

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

Question 58

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

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

Question 59

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

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

Question 60

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

Question 61

Diabetic neuropathy can cause erectile dysfunction.

Question 62

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

Question 63

Diabetic neuropathy is a disease of the central nervous system.

Question 64

What is the normal fasting blood glucose level?

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

Question 65

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

Question 66

What cell type secretes collagen as a wound heals?

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

Question 67

Which type of DM may result in polyuria?

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

Question 68

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

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

Question 69

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

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

Question 70

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

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

Question 71

In diabetes mellitus type 2, the beta cells of the pancreas undergo apoptosis.

Question 72

Diabetes mellitus type 2 promotes obesity and obesity promotes diabetes mellitus type 2.

Question 73

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

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

Question 74

Nasal inhalation of insulin is the newest innovation in diabetes treatment such that more patients use inhaled insulin instead of injected insulin.

Question 75

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

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

Question 76

Diabetic foot ulcer, with its subsequent infection, is the leading cause of amputation in diabetes.

Question 77

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

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

Question 78

What happens when excessive angiogenesis occurs?

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

Question 79

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 lipids for energy.
C)Coxsackie B increases the availability of proteins for energy.
D)A person with diabetes mellitus type 1 is more susceptible to infection with Coxsackie B.
E)Coxsackie B increases the availability of glucose for energy.

Question 80

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

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