Diabetes Mellitus (Pancreas) 1. Regarding the hormones released by the pancreas, a.

Excess production of somatostatin causes hyperglycaemia and other manifestations of DM b. Plasma levels of pancreatic polypeptide falls after administration of atropine c. The secretion of pancreatic somatostatin is reduced by several of the same stimuli that increase the insulin secretion d. The B cells of pancreas secrete proinsulin e. Glucagon inhibits somatostatin secretion by the pancreatic D cells 2. Insulin, a. Consists of 2 polypeptide chains connected by disulphide bonds b. Binds to beta subunit of its receptor c. Response that initially occurs following a meal is due to beta cell stimulation by an increase in blood glucose d. Secretion is linked to catabolism of glucose by the beta cells of the pancreas e. Represses hepatic PFK-1 activity 3. Regarding insulin synthesis and secretion, a. b. c. d. Amino acids stimulate the synthesis of insulin Glucose is the most potent stimulus for insulin secretion Effect is enhanced by secretin Glutamate is known to be the cause of initial rapid phase of insulin secretion after a meal e. Ketone bodies stimulate the secretion of insulin by increasing intracellular ATP 4. Regarding C peptide, a. b. c. d. e. Insulin is secreted along with equimolar amounts of C peptide It is not catabolised by the liver It has no known biological activity It is of diagnostic value in type 2 DM Its levels in blood provide an index of beta cell function in patients receiving exogenous insulin

5. WOTF is/are True regarding the action of insulin, a. Decrease fatty acid synthesis in adipose tissue b. Increases protein catabolism in muscles c. Increases ketogenesis in liver

d. Increases K+ ion uptake in muscles e. Decreases hepatic glucose output 6. T/F a. b. c. d. e. Glucagon secretion is increased following a high protein meal Resistin increases insulin sensitivity in adipose tissue Fasting plasma insulin is elevated in obese individuals Insulin secretion is biphasic in type 2 DM GLUT 4 vesicles are inserted into the cell membranes independently on insulin action during exercise

7. Glucagon, a. b. c. d. e. 8. T/F a. b. c. d. e. Insulin receptor is a dimer linked together by disulphide bonds Half life of endogenously secreted insulin is about 7 hours Insulin like activity of IGF-1 is not suppressed by antiinsulin antibodies GLUT 2 is a two way transporter Insulin increases the activity of Na+ - K+ ATPase in cell membranes Does not cause glycogenolysis in muscles Decreases hepatic deamination of amino acids In large doses, exerts a positively ionotropic effect on the heart Stimulate the secretion of Growth hormone Levels in blood rises in patients with cirrosis

9. A decrease in Insulin/Glucagon in the liver leads to, a. b. c. d. e. A decrease in gluconeogenesis An increase in glycolysis A decrease in glycogenesis A decrease in fructose 2,6 bisphosphate level An increase in glycogenolysis

10. WOTF is/are associated with diabete, a. b. c. d. e. Downs syndrome Kleinfelter syndrome Turner syndrome Sheehans syndrome Cushings syndrome

11. WOTF is/are True,

a. Insulin resistance is a major leading cause of diabetes insipidus b. Primary beta cell failure of the pancreas can directly lead to type 2 DM without a state of insulin resistance c. Insulin resistance is often detected 10 to 20years before the onset of type 2 DM in predisposed individuals d. Classical manifestations of type 1 DM are hidden until more than 90% of the beta cells have been destroyed e. Islet amyloidosis is associated with decrease in beta cell mass in type 1 DM 12. Typical presentation of DM include, a. b. c. d. e. Weight loss and nocturia Balanitis and Pruritus vulvae Epigastric pain and vomiting Limb pain with absent ankle jerk reflexes Increase myopia and glycosuria

13. T/F regarding IDDM, a. b. c. d. e. Obesity is a recognised feature Serum insulin levels are known to be decreased Islet cell antibodies are known to be present Spontaneous ketoacidosis is known to occur In most patients, onset is in childhood or adolescence

14. Regarding maturity onset diabetes of young (MODY) a. It is a subgroup of type 1 DM b. Patients with MODY have an autosomal dominant single gene inheritance pattern c. MODY 2 is associated with defective or deficiency of pancreatic glucokinase d. In almost all cases of MODY, genetic defects of beta cell function can be seen e. It is treated with sulfonylurea 15. T/F a. The most commen type of DM in children is type 2 DM b. There is a peak in the incidence of DM in pubertal age group due to increase exposure to infections c. Reduction of insulin levels results in reduced peripheral utilization of glucose d. There is an association between Coxsackie B group and mumps viruses with type 1 DM e. Type 2 DM is not seen in the paediatric age group

16. Type 1 DM in children, a. Is due to an absolute deficiency of insulin b. Trauma, Psychological stress and infections will precipitate diabetic ketoacidosis in children c. Tight glycaemic control with strict regulation of food is essential for dietary management d. Polyuria, Plydypsia and Weight loss are the three classical symptoms e. OGTT is the main test used for diagnosis 17. T/F a. b. c. d. e. BMI is a direct measure of obesity The absolute criterion for diagnosing metabolic syndrome is central obesity NASH (Non Alcoholic Steato Hepatitis) is observed in obese people Acanthosis nigricans is associated with insulin resistance Obesity in children causes fewer complications than obesity in adults

18. Regarding amyloidosis seen in diabetes, a. b. c. d. e. It is seen in type 1 DM Protein deposited is amyline secreted by beta cells Amyloid appears to consist in parts of precipitated insulin It is considered diagnostic for diabetes It is associated with fibrosis

19. Biochemical consequences in DM include, a. b. c. d. e. Extracellular fluid depletion Decrease glycogenolysis Decrease lipolysis Increased gluconeogenesis Increased urinary excretion of ketone bodies

20. Typical clinical features of diabetic ketoacidosis include, a. b. c. d. e. Answers 1. T T F F T Abdominal pain and air hunger Rapid weak pulse and hypotension Profuse sweating and olyguria Vomiting and constipation Coma with extensor plantar response

2. T F T T F 3. T T T F T 4. T T T T T 5. T F F T T 6. T F T F T 7. T T T T T 8. F F T T T 9. F F T T T 10. T T T F T 11. F F T T F 12. T T T T T 13. F T T T T 14. F T T T T 15. F T T F F 16. T T T T F 17. T T T T .. 18. F T .. T F 19. T F F T T 20. T T T T ..