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:

a) First metatarsal

b) Second Metatarsal

c) Third Metatarsal

d) Fourth Metatarsal

e) 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

• 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

Dept of Endo:Dept of Endo:Dept of Endo:Dept of Endo:

• 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 non-pregnant 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 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. 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


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


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



36. Treatment of choice for early proliferative diabetic retinopathy

• a. Pan retinal photocoagulation

• b. Focal retinal photocoagulation

• c. Vitrectomy



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



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


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


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) Microcellular footwear

b) Molded Insole

c) Rocker bottom shoe

d) All 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. Beta blockers• b. Thiazide diuretics• c. Alpha blockers• d. glucocorticoids• e. 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) Osteomyelitis

b) Neuropathic joint

c) Crush Fracture

d) All 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 brainc. 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


• 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

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