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These questions cover some of the fundamental pathophysiology of diabetes and glucose regulation, and finish off with some simple clinical application.

Reviewed by Jonathan Loomes-Vrdoljak

Pathophysiology of Diabetes MCQ

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Question 1
Which of the following requires a hyperglycaemic state to permit entry of glucose into the cell?
A
GLUT1
B
GLUT2
C
GLUT3
D
GLUT4
Question 1 Explanation: 
GLUT2 is the glucose transporter found in the beta cells of the pancreas. It has a poor affinity for glucose and therefore requires a high blood glucose concentration for glucose to enter the cell. When this threshold is reached, glucose can enter the cell, triggering a cascade of events to release insulin.
Question 2
Where is GLUT5 preferentially upregulated?
A
Hepatocyte
B
Sinusoids
C
Enterocyte
D
Islets of Langerhan
Question 2 Explanation: 
GLUT5 transports fructose from the lumen of the gut into the body.
Question 3
Autoimmunity to beta cells in the islets of Langerhans would result in what physiological state?
A
Arousal
B
Hyperreflexia
C
Polydipsia
D
Increase of transmembrane ATPase activity
Question 3 Explanation: 
Type I diabetes causes autoimmune destruction of beta cells. Beta cells produce insulin. Without beta cells, there is no insulin, and blood glucose levels consequently rise. This leads to more glucose in the filtrate in the kidneys which exceeds the kidneys' capacity to reabsorb it all. Consequently, more water is excreted by the kidney and the patient needs to drink more water to compensate for this loss.
Question 4
Which of the following is utilised in fast twitch muscles during long-distance running?
A
Glycerol catabolism
B
Glutamine anabolism
C
Alanine catabolism
D
Cori cycle
Question 4 Explanation: 
The Cori cycle involves lactate produced in the muscles (as a result of anaerobic respiration) being transported to the liver where it is converted back into glucose for the muscles to use.
Question 5
Which of the following is increased by insulin?
A
Inhibition of glycogen synthase
B
Proteolysis
C
Lipolysis
D
Mitogenesis
Question 5 Explanation: 
Cell growth and division requires glucose. Insulin up-regulates the ability of cells to absorb glucose and thereby helps to promote growth and division.
Question 6
In which state is ketone formation predominant?
A
When insulin:glucagon ratio is high
B
Primarily anabolic state of basal metabolic rate
C
Immediately post-prandial
D
During unrestrained lipolysis and proteolysis
Question 7
Beta cell destruction is directly responsible for
A
Hyperglycaemia
B
Polyuria
C
Polydipsia
D
Weight loss
Question 7 Explanation: 
All of these options are signs and symptoms of type I diabetes, but the three wrong answers are secondary effects of the lack of insulin while hyperglycaemia is the primary effect.
Question 8
Which of the following are ketone bodies?
A
Acetone
B
Acetoacetate
C
Beta-hydroxybutyrate
D
All of the above
Question 9
What change would you expect to see in the serum levels of the hormone released from alpha cells in the type 2 diabetic patient?
A
Significantly increased
B
Slightly increased
C
Decreased
D
No change
Question 9 Explanation: 
Alpha cells produce glucagon but this production is reduced by insulin. However, in type 2 diabetes, cells become resistant to the effects of insulin, including the alpha cells.
Question 10
DPP4 inhibitors
A
Reduce insulin resistance
B
Promote glycosuria
C
Prevent GLP breakdown
D
Decrease hepatic gluconeogenesis
Question 11
Which type of cell is targeted by sulfonyureas?
A
L-cell
B
D-cell
C
Alpha cell (islet)
D
Beta cell (islet)
Question 12
SGLT2 inhibitors...
A
Prevent breakdown of GLP
B
Act preferentially on enterocytes of the ileum
C
Increase secretion of insulin directly
D
Reduce proximal convoluted tubular reabsorpative capacity.
Question 12 Explanation: 
SGLT2 is a sodium-glucose co-transporter found in the kidneys that allows glucose to be reabsorbed. You have SGLT1 transporters in the gut. Remember: you have ONE gut and TWO kidneys.
Question 13

STEM 1 - Question 1

A 12 year old male is brought by their concerned parents to see the advanced nurse practitioner (ANP).  On general examination the patient has recent unexplained weight loss, confusion and polyuria.
Which is the best-fit diagnosis?
A
Type one diabetes
B
Insulin insensitive diabetes
C
Gestational diabetes
D
DKA
Question 14

Stem 1 - question 2

The sudden onset of this condition occurs after how much of the beta cells are destroyed?
A
Half
B
60%
C
90%
D
100%
Question 15

Stem 1 - question 3

What accounts for the patient’s weight loss?
A
Cancer
B
Infection
C
Pancreatic insufficiency
D
Decreased carbohydrate utilisation
Question 16

Stem 1 - question 4

The patient also appears to have a goitre.  The ANP explains to the family that autoimmune conditions often cluster together.  Which concomitant condition may this patient also have?
A
Calcitonin-deficiency
B
Crohn’s disease
C
Graves’ disease
D
Pott’s disease
Question 17

Stem 2 - Question 1

A 59 year old female, Julia, presents to her GP frustrated that she is “peeing more than usual” at work.  On examination she has an obese BMI, is hypertensive and has significantly elevated blood glucose.  Other than the given symptom she states she feels fit and well.
How is BMI calculated?
A
Weight (g) / height (m2)
B
Weight (kg) / height (m2)
C
Height (m2) / weight (kg)
D
Height (cm2) / weight (kg)
Question 18

Stem 2 - Question 2

The patient is diagnosed with diabetes. Which HLA subtype is linked to this form of diabetes?
A
DR1
B
DR2
C
DR3
D
None
Question 18 Explanation: 
Type 2 diabetes is not an auto-immune condition and therefore HLA subtypes are not a risk factor.
Question 19

Stem 2 - Question 3

On further examination, the patient is found to have reduced visual acuity and a “blind spot” in her centre of vision. This is best described as?
A
Amaurosis fugax
B
Macrovascular retinopathy
C
IHD
D
Microvascular retinopathy
Question 20

Stem 4 - Question 4

The patient’s urine is positive for nitrites. Why is this the case?
A
Hypertension
B
Chronic kidney disease
C
Effect of glycosuria
D
Alpha islet cell insufficiency
Question 20 Explanation: 
Diabetes can lead to increased glucose in the urine. The presence of glucose in the urine leads to the growth of bacteria, leading to the production of nitrites.
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