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2. Which of the following is not true about the immunology of Type 1 Diabetes Mellitus.

1. 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.

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2. Which of the following is not true about the immunology of Type 1 Diabetes Mellitus.

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  1. 1. 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. 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. 3. Drugs known to produce hyperglycemia include all of the following except • a. Benzodiazepines • b. Phenytoin sodium • c. Hydrochlorthiazide • d. Octreotide • e. Olanzapine

  4. 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. 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. 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. 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. 8. The instruments below measure:- • Plasma Glucose • Capillary Glucose • Blood Glucose • Interstitial Glucose • Urine Glucose

  9. 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 non-pregnant subjects • e. The risk of developing diabetes is decreased if the patient has suffered an episode of gestational diabetes

  10. 10. Which is leastlikely 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. 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. 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. 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. 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. 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. 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. 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. 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. 20. This patient presents with diabetes. Which of the following are true:-a) Surgery is the therapy of choiceb) Urinary tract infection is a major problem c) Oxalate renal stones can developd) Spontaneous hypoglycaemia without medications is common e) It is a part of multiple endocrine neoplasia

  21. 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. 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. 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. 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. 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. 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. 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. 28. The size of the needle used by this device is : • 31g b.24g c. 26g d. 28g e. 30g

  29. 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 mostlikely to be:- • a. Pancreatic diabetes mellitus(Calcific) • b. LADA (Type I variant) • c. Type II diabetes • d. Acromegaly • e. Steroid induced diabetes

  30. 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. 31. Insulin induced problems include - • a. Lipoatrophy • b. Lipohypertrophy • c. Weight gain • d. Oedema • e. All the above

  32. 32.The pink structures labeled in the histopathology in this diabetic kidney are: • Fibrin Caps • Vitamin Drops • Kidney droppings • Urine cysts • Amyloid

  33. 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. 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. 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. 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. 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 -

  38. 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

  39. 38. Complications of Laser Photocoagulation include: • a. Night blindness • b. Visual loss • c. Pain • d. All the above • e. None of the above

  40. 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

  41. 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:

  42. 40.(contd). Deficiency of A. Growth Hormone B. Cortisol C. Glucagon D. A and B E. B and C

  43. 41. Nodular Glomerulosclerosis is seen in - • a. Diabetic nephropathy • b. Amyloidosis • c. Dysproteinemias • d. Glomerulonephritis • e. All of the above

  44. 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

  45. 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

  46. 44. ACE inhibitors decrease intraglomerular pressure by acting on - • a. Afferent arteriole • b. Efferent arteriole • c. Macula densa • d. Juxtaglomerular cells • e. mesangium

  47. 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

  48. 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

  49. 47. The Anomaly Seen here is:

  50. 47.(contd.) • Vitreous haemorrhage • Subhyaloid Haemorrhage • Central Retinal Venous Occlusion • Central Retinal Arterial Occlusion • Retinal Detachment

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