Metabolism Study Buddy Revision

Created by Bwwongy

p.3

What is the primary goal of energy homeostasis? A) To increase blood pressure B) To maintain blood glucose within relatively narrow limits C) To decrease body temperature D) To enhance muscle growth E) To improve digestion

Select an answer

p.3

Explanation

No explanation provided.

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p.3

Regulation of Fuel Metabolism

What is the primary goal of energy homeostasis?
A) To increase blood pressure
B) To maintain blood glucose within relatively narrow limits
C) To decrease body temperature
D) To enhance muscle growth
E) To improve digestion

B) To maintain blood glucose within relatively narrow limits

Explanation: Energy homeostasis focuses on maintaining blood glucose levels within a narrow range, ensuring that the body has a stable supply of energy.

p.55

Diabetes Pathology

Which of the following is a criterion for diagnosing muscle loss?
A) High muscle strength
B) Low muscle strength (probable)
C) Increased physical performance
D) Increased muscle quantity
E) High protein intake

B) Low muscle strength (probable)

Explanation: Low muscle strength is one of the criteria used to diagnose muscle loss, along with low muscle quality/quantity and low physical performance.

p.57

Exercise and Metabolic Adaptations

What happens to the utilization of fats as exercise intensity increases?
A) Fats are used more than carbohydrates
B) Fats are converted into carbohydrates
C) Fats are not used at all
D) Fats are stored in the body
E) Fats are converted into proteins

B) Fats are converted into carbohydrates

Explanation: As exercise intensity increases, the body shifts from utilizing fats to converting them into carbohydrates, highlighting the metabolic adaptations that occur during physical activity.

p.25

Insulin and Glucagon Functions

What is a key characteristic of peripheral tissues in relation to insulin in the context of Type 2 Diabetes Mellitus (T2DM)?
A) Increased sensitivity to insulin
B) Insensitivity to insulin
C) Complete insensitivity to glucose
D) Enhanced insulin secretion
E) Normal insulin function

B) Insensitivity to insulin

Explanation: Peripheral tissues exhibit insensitivity to insulin, which is a fundamental characteristic that precedes the development of Type 2 Diabetes Mellitus (T2DM).

p.3

Regulation of Fuel Metabolism

What process occurs during the fed state?
A) Glycogenolysis
B) Lipolysis
C) Glycogen synthesis
D) Ketone synthesis
E) Proteolysis

C) Glycogen synthesis

Explanation: During the fed state, the body engages in glycogen synthesis, where glucose is stored as glycogen, along with other anabolic processes.

p.32

Diabetes Pathology

What is a characteristic feature of diabetic microangiopathy affecting endoneurial vessels?
A) Increased blood flow
B) Endoneurial arteriole thickening
C) Decreased nerve conduction velocity
D) Axonal regeneration
E) Increased oxygen supply

B) Endoneurial arteriole thickening

Explanation: Diabetic microangiopathy is characterized by the thickening of endoneurial arterioles, which contributes to impaired blood flow and nerve function in diabetic patients.

p.11

Lipogenesis and Lipogenesis

Where does lipogenesis primarily occur in the body?
A) Brain and lungs
B) Muscle and kidney
C) Liver and adipose tissue
D) Heart and pancreas
E) Spleen and intestines

C) Liver and adipose tissue

Explanation: Lipogenesis primarily occurs in the liver and adipose tissue, where fatty acids are synthesized and stored.

p.36

Pharmacological Treatments for Diabetes

When should insulin be initiated in the management of Type 2 Diabetes (T2D) according to the updated NZSSD algorithm?
A) If HbA1c is ≥ 40 mmol/mol
B) If HbA1c is ≥ 50 mmol/mol
C) If HbA1c is > 80 mmol/mol
D) If HbA1c is < 50 mmol/mol
E) Only in emergencies

C) If HbA1c is > 80 mmol/mol

Explanation: The algorithm states that insulin should be used immediately if HbA1c exceeds 80 mmol/mol, indicating a critical level of hyperglycemia that requires urgent intervention.

p.29

Diabetes Pathology

Which of the following is a risk associated with neovascularization?
A) Increased vision clarity
B) Intraocular hemorrhage
C) Decreased eye pressure
D) Improved retinal health
E) Enhanced color perception

B) Intraocular hemorrhage

Explanation: Neovascularization poses risks such as intraocular hemorrhage and retinal detachment, which can lead to significant impairment and potential blindness.

p.35

Diabetes Pathology

Which of the following is a symptom that diabetes management aims to prevent?
A) Hyperglycaemia symptoms
B) Increased energy levels
C) Weight loss
D) Dehydration
E) Increased appetite

A) Hyperglycaemia symptoms

Explanation: Preventing hyperglycaemia symptoms is crucial in diabetes management to ensure that individuals maintain stable blood glucose levels.

p.25

Diabetes Pathology

What compensatory mechanism occurs in response to insulin resistance?
A) Decreased insulin production
B) Beta-cell hyperfunction
C) Increased insulin sensitivity
D) Decreased glucose levels
E) Enhanced peripheral tissue response

B) Beta-cell hyperfunction

Explanation: In response to insulin resistance, there is a compensatory beta-cell hyperfunction leading to hyperinsulinaemia, which is an attempt to maintain glucose homeostasis.

p.16

Insulin and Glucagon Functions

What happens to insulin effects in Type 1 Diabetes Mellitus (T1DM)?
A) Insulin effects are enhanced
B) Insulin effects are lost entirely
C) Insulin effects are partially preserved
D) Insulin effects are normal
E) Insulin effects are reversed

B) Insulin effects are lost entirely

Explanation: In Type 1 Diabetes Mellitus (T1DM), insulin effects are completely lost, leading to impaired lipogenesis and uninhibited lipolysis/beta-oxidation.

p.3

Regulation of Fuel Metabolism

What occurs during the fasting state?
A) Glycogen synthesis
B) Lipogenesis
C) Fuel mobilization
D) Protein synthesis
E) Cellular uptake

C) Fuel mobilization

Explanation: During the fasting state, the body undergoes fuel mobilization, utilizing catabolic pathways such as glycogenolysis and gluconeogenesis to release energy.

p.9

Gluconeogenesis and Lipogenesis

What is the primary organ responsible for gluconeogenesis?
A) Heart
B) Muscle
C) Liver
D) Pancreas
E) Spleen

C) Liver

Explanation: The liver is the primary organ responsible for gluconeogenesis, with the kidney also contributing under certain conditions, particularly during fasting.

p.35

Diabetes Pathology

What is a common risk factor for individuals with diabetes?
A) Decreased infection susceptibility
B) Increased physical endurance
C) Infection susceptibility
D) Improved vision
E) Enhanced kidney function

C) Infection susceptibility

Explanation: Individuals with diabetes often experience increased susceptibility to infections, which is a significant concern in managing their overall health.

p.7

Insulin and Glucagon Functions

Which process is NOT stimulated by glucagon?
A) Ketogenesis
B) Fatty acid oxidation
C) Glycogen synthesis
D) Gluconeogenesis
E) Glycogenolysis

C) Glycogen synthesis

Explanation: Glucagon does not stimulate glycogen synthesis; instead, it promotes glycogenolysis. Glycogen synthesis is stimulated by insulin.

p.46

Insulin and Glucagon Functions

Which of the following can result from missing meals while on insulin?
A) Weight loss
B) Weight gain
C) Oedema
D) Increased appetite
E) Improved glycemic control

B) Weight gain

Explanation: Missing meals while on insulin can lead to weight gain, as the body may respond to the lack of caloric intake with increased insulin sensitivity and fat storage.

p.8

Insulin and Glucagon Functions

What is the primary effect of adrenaline on adipose tissue?
A) Lipogenesis
B) Glycogen synthesis
C) Lipolysis
D) Glycogenolysis
E) Gluconeogenesis

C) Lipolysis

Explanation: Adrenaline primarily stimulates lipolysis in adipose tissue, promoting the breakdown of fats into fatty acids, which can then be used for energy.

p.57

Exercise and Metabolic Adaptations

What happens to circulating fuels as exercise intensity rises?
A) They decrease in availability
B) They are prioritized for muscle glycogen stores
C) They are converted to fat
D) They become less effective
E) They are completely consumed

B) They are prioritized for muscle glycogen stores

Explanation: With increasing exercise intensity, circulating fuels are directed towards replenishing muscle glycogen stores, which are crucial for sustaining high-intensity activities.

p.7

Insulin and Glucagon Functions

What is the primary function of glucagon in the liver?
A) Glycogen synthesis
B) Lipogenesis
C) Glycolysis
D) Gluconeogenesis
E) Fatty acid synthesis

D) Gluconeogenesis

Explanation: Glucagon primarily stimulates gluconeogenesis in the liver, which is the process of producing glucose from non-carbohydrate sources, especially during fasting or low glucose availability.

p.55

Exercise and Metabolic Adaptations

What is the recommended approach to prevent muscle loss in older adults?
A) Decrease protein intake
B) Engage in resistance exercises
C) Increase sedentary behavior
D) Focus solely on aerobic exercises
E) Avoid physical activity altogether

B) Engage in resistance exercises

Explanation: Increased protein intake and resistance exercises are recommended strategies to help prevent muscle loss in older adults, promoting better muscle quality and quantity.

p.55

Gluconeogenesis and Lipogenesis

What physiological change contributes to the increased catabolism and decreased anabolism in older adults?
A) Increased muscle strength
B) Enhanced aerobic capacity
C) Age-associated changes in body composition
D) Higher levels of physical activity
E) Decreased water retention

C) Age-associated changes in body composition

Explanation: Age-associated changes in body composition lead to increased catabolism and decreased anabolism, impacting muscle quality and overall physical performance.

p.46

Insulin and Glucagon Functions

What is a common adverse effect of insulin analogues?
A) Hypoglycemia
B) Increased energy levels
C) Weight loss
D) Enhanced insulin sensitivity
E) Improved kidney function

A) Hypoglycemia

Explanation: Hypoglycemia is a well-known adverse effect of insulin analogues, which occurs when blood sugar levels drop too low, often due to excessive insulin administration or missed meals.

p.36

Pharmacological Treatments for Diabetes

What should be done if HbA1c is ≥ 50 mmol/mol in the management of T2D?
A) Start insulin therapy
B) Continue current management
C) Add other drugs to management
D) Refer to a specialist
E) Increase physical activity

A) Start insulin therapy

Explanation: The management algorithm indicates that treatment should start if HbA1c is ≥ 50 mmol/mol, highlighting the need for intervention at this level.

p.8

Insulin and Glucagon Functions

Which process is NOT stimulated by adrenaline in the liver?
A) Glycogenolysis
B) Gluconeogenesis
C) Lipolysis
D) Ketogenesis
E) Glycogen synthesis

E) Glycogen synthesis

Explanation: While adrenaline stimulates glycogenolysis, gluconeogenesis, and ketogenesis in the liver, it does not promote glycogen synthesis; this process is typically stimulated by insulin.

p.8

Insulin and Glucagon Functions

What role does adrenaline play in muscle tissue?
A) Promotes glycogen synthesis
B) Stimulates fatty acid oxidation
C) Increases insulin sensitivity
D) Enhances lipogenesis
E) Reduces gluconeogenesis

B) Stimulates fatty acid oxidation

Explanation: In muscle tissue, adrenaline promotes fatty acid oxidation, providing energy during stress or physical activity.

p.8

Metabolic Syndrome and Insulin Resistance

Which metabolic process is primarily associated with cortisol?
A) Glycogen synthesis
B) Lipogenesis
C) Insulin resistance
D) Fatty acid oxidation
E) Glycogenolysis

C) Insulin resistance

Explanation: Cortisol is associated with promoting insulin resistance, which affects glucose metabolism and can lead to increased blood sugar levels.

p.23

Metabolic Syndrome and Insulin Resistance

What is a key characteristic of metabolic syndrome according to the provided criteria?
A) Central adiposity
B) Low blood sugar
C) Elevated physical activity
D) Decreased triglycerides
E) Low body mass index (BMI)

A) Central adiposity

Explanation: Central adiposity is a key characteristic of metabolic syndrome, particularly when assessed using ethnic-specific data. It is indicated that if BMI is greater than 30 kg/m², central adiposity can be assumed.

p.15

Nitrogen Metabolism and Urea Cycle

What is carnitine primarily made from in the body?
A) Glucose and fructose
B) Lysine and methionine
C) Alanine and serine
D) Leucine and isoleucine
E) Tyrosine and phenylalanine

B) Lysine and methionine

Explanation: Carnitine is synthesized in the liver and kidneys from the essential amino acids lysine and methionine, indicating its biochemical origins.

p.32

Diabetes Pathology

What is a consequence of axonal degeneration in diabetic microangiopathy?
A) Improved nerve function
B) Increased myelination
C) Nerve conduction impairment
D) Enhanced sensory perception
E) Decreased blood sugar levels

C) Nerve conduction impairment

Explanation: Axonal degeneration in diabetic microangiopathy leads to nerve conduction impairment, which can result in various neurological symptoms associated with diabetes.

p.23

Metabolic Syndrome and Insulin Resistance

What is the recommended weight loss target for managing metabolic syndrome?
A) 10%
B) 2%
C) 5%
D) 15%
E) 20%

C) 5%

Explanation: A weight loss of more than 5% is recommended for the management of metabolic syndrome, which can help improve associated risk factors.

p.7

Insulin and Glucagon Functions

What role does glucagon play in fatty acid metabolism?
A) It inhibits fatty acid oxidation
B) It promotes fatty acid oxidation
C) It stimulates fatty acid synthesis
D) It has no role in fatty acid metabolism
E) It converts fatty acids to glucose

B) It promotes fatty acid oxidation

Explanation: Glucagon promotes fatty acid oxidation, allowing the body to utilize fats as an energy source, particularly during fasting or low carbohydrate intake.

p.9

Gluconeogenesis and Lipogenesis

Which of the following is NOT a precursor for gluconeogenesis?
A) Alanine
B) Lactate
C) Glycerol
D) Fructose
E) Pyruvate

D) Fructose

Explanation: Fructose is not listed as a precursor for gluconeogenesis. The main precursors include alanine, lactate, and glycerol.

p.24

Diabetes Pathology

Which gene is specifically mentioned as being involved in T2DM?
A) Insulin
B) Glucokinase
C) Amylin
D) Leptin
E) Ghrelin

B) Glucokinase

Explanation: Glucokinase is highlighted as one of the genes involved in insulin production and glucose metabolism, which is relevant to the mutations causing T2DM in teens and young adults.

p.16

Gluconeogenesis and Lipogenesis

What stimulates de novo lipogenesis from excess glucose in diabetes?
A) Increased insulin levels
B) Decreased glucose availability
C) Insulin-mediated processes
D) Absence of insulin
E) Insulin still stimulates it despite resistance

E) Insulin still stimulates it despite resistance

Explanation: Despite insulin resistance, de novo lipogenesis from excess glucose is still stimulated by insulin, indicating that some metabolic pathways remain functional.

p.29

Diabetes Pathology

What does VEGF production lead to in the context of neovascularization?
A) Apoptosis
B) Angiogenesis
C) Cell necrosis
D) Fibrosis
E) Inflammation

B) Angiogenesis

Explanation: VEGF (Vascular Endothelial Growth Factor) production is directly associated with angiogenesis, which is the formation of new blood vessels, particularly in pathological conditions.

p.35

Diabetes Pathology

What complication is associated with microvascular damage in diabetes?
A) Heart attack
B) Stroke
C) Retinopathy
D) Hypertension
E) Osteoporosis

C) Retinopathy

Explanation: Microvascular complications in diabetes include conditions such as retinopathy, nephropathy, and neuropathy, which are directly related to damage in small blood vessels.

p.32

Diabetes Pathology

What pathway disturbance is associated with diabetic microangiopathy?
A) Glycolytic pathway
B) Polyol pathway
C) Krebs cycle
D) Fatty acid synthesis
E) Urea cycle

B) Polyol pathway

Explanation: The disturbance of the polyol pathway is linked to diabetic microangiopathy, leading to complications such as axonal degeneration and demyelination.

p.7

Insulin and Glucagon Functions

Which of the following processes does glucagon promote in the liver?
A) Glycogenolysis
B) Glycolysis
C) Lipogenesis
D) Protein synthesis
E) Fatty acid synthesis

A) Glycogenolysis

Explanation: Glucagon promotes glycogenolysis in the liver, which is the breakdown of glycogen into glucose, providing a quick source of energy during periods of low blood sugar.

p.14

Regulation of Fuel Metabolism

Which hormone inhibits lipolysis?
A) Glucagon
B) Adrenaline
C) Cortisol
D) Insulin
E) TNF-alpha

D) Insulin

Explanation: Insulin is known to inhibit lipolysis, promoting fat storage rather than mobilization of fatty acids for energy.

p.16

Diabetes Pathology

What is the consequence of uninhibited lipolysis in diabetes?
A) Decreased fatty acid delivery to the liver
B) Increased fatty acid delivery to the liver
C) Decreased hepatic lipogenesis
D) Increased glucose utilization
E) Enhanced insulin sensitivity

B) Increased fatty acid delivery to the liver

Explanation: Uninhibited lipolysis results in increased fatty acid (FA) delivery to the liver, which stimulates hepatic lipogenesis.

p.25

Metabolic Syndrome and Insulin Resistance

What type of arteriolosclerosis is accelerated in diabetes?
A) Hyaline arteriolosclerosis
B) Atherosclerotic arteriolosclerosis
C) Fibromuscular arteriolosclerosis
D) Calcific arteriolosclerosis
E) Medial arteriolosclerosis

A) Hyaline arteriolosclerosis

Explanation: Diabetes is associated with accelerated hyaline arteriolosclerosis, which is a vascular complication linked to chronic hyperglycaemia and insulin resistance.

p.32

Diabetes Pathology

What is the primary effect of disturbances in the polyol pathway in diabetes?
A) Increased insulin sensitivity
B) Enhanced glucose metabolism
C) Accumulation of sorbitol
D) Decreased fat storage
E) Improved renal function

C) Accumulation of sorbitol

Explanation: Disturbances in the polyol pathway lead to the accumulation of sorbitol, which can cause osmotic and oxidative stress, contributing to complications like diabetic microangiopathy.

p.29

Diabetes Pathology

What are potential consequences of retinal detachment due to neovascularization?
A) Improved vision
B) Impairment and blindness
C) Color blindness
D) Increased peripheral vision
E) No consequences

B) Impairment and blindness

Explanation: Retinal detachment resulting from neovascularization can lead to severe consequences, including vision impairment and blindness, highlighting the seriousness of this condition.

p.24

Diabetes Pathology

What is the primary cause of T2DM in teens and young adults (MODY)? A) ObesityB) Mutations in genes involved with insulin production and glucose metabolismC) Sedentary lifestyleD) High sugar dietE) Viral infections

B) Mutations in genes involved with insulin production and glucose metabolism

Explanation: T2DM in teens and young adults is primarily caused by mutations in genes that affect insulin production and glucose metabolism, such as glucokinase, which highlights the genetic component of this condition.

p.16

Insulin and Glucagon Functions

In Type 2 Diabetes Mellitus (T2DM), how are insulin effects altered?
A) Insulin effects are enhanced
B) Insulin effects are lost entirely
C) Insulin effects are lost only peripherally
D) Insulin effects are normal
E) Insulin effects are reversed

C) Insulin effects are lost only peripherally

Explanation: In Type 2 Diabetes Mellitus (T2DM), insulin effects are primarily lost in peripheral tissues, leading to dysregulated lipid metabolism.

p.3

Gluconeogenesis and Lipogenesis

What is the main function of lipolysis?
A) To store fats
B) To synthesize proteins
C) To break down fats
D) To create glucose
E) To produce ketones

C) To break down fats

Explanation: Lipolysis is the process of breaking down stored fats into fatty acids and glycerol, which can then be used for energy during the fasting state.

p.15

Metabolic Syndrome and Insulin Resistance

What are the consequences of carnitine deficiency?
A) Increased muscle strength
B) Muscle fatigue, hypoglycemia, and fatty liver
C) Enhanced metabolism
D) Improved brain function
E) Weight loss

B) Muscle fatigue, hypoglycemia, and fatty liver

Explanation: A deficiency in carnitine leads to muscle fatigue, hypoglycemia, and fatty liver, highlighting the importance of carnitine in energy metabolism.

p.50

Nitrogen Metabolism and Urea Cycle

What is a common consequence of negative nitrogen balance?
A) Increased muscle mass
B) Decrease in lean mass
C) Improved immune function
D) Enhanced metabolic rate
E) Increased energy levels

B) Decrease in lean mass

Explanation: Negative nitrogen balance is associated with a decrease in lean mass, which can occur due to various conditions such as illness, trauma, malnutrition, or starvation.

p.30

Diabetes Pathology

Which condition might lead to thickening of Bowman’s capsule?
A) Dehydration
B) Diabetes mellitus
C) Hypertension
D) Hyperthyroidism
E) Anemia

B) Diabetes mellitus

Explanation: Diabetes mellitus can lead to various renal complications, including thickening of Bowman’s capsule due to changes in kidney structure and function.

p.14

Insulin and Glucagon Functions

What role does glucagon play in lipolysis?
A) Inhibits hormone-sensitive lipase
B) Activates hormone-sensitive lipase
C) Converts glycerol to glucose
D) Stimulates insulin release
E) Promotes lipogenesis

B) Activates hormone-sensitive lipase

Explanation: Glucagon promotes lipolysis by activating hormone-sensitive lipase, which facilitates the breakdown of stored fats.

p.47

Pharmacological Treatments for Diabetes

What is the mechanism of action (MOA) of sulfonylureas like gliclazide?
A) Increases insulin resistance
B) Blocks K+ ATP channels on beta cells
C) Inhibits glucagon secretion directly
D) Stimulates glucagon release
E) Increases glucose absorption in the intestines

B) Blocks K+ ATP channels on beta cells

Explanation: Sulfonylureas, such as gliclazide, work by blocking K+ ATP channels on beta cells, leading to membrane depolarization, calcium entry, and subsequent insulin secretion.

p.55

Regulation of Fuel Metabolism

What is a key factor contributing to reduced muscle quality and quantity in older adults?
A) Increased hydration levels
B) Age-associated changes in body composition
C) Higher aerobic capacity
D) Increased flexibility
E) Reduced caloric intake

B) Age-associated changes in body composition

Explanation: Age-associated changes in body composition, including increased body fat and decreased muscle mass, significantly contribute to reduced muscle quality and quantity in older adults.

p.55

Metabolic Syndrome and Insulin Resistance

What type of fat increases with age and contributes to muscle quality decline?
A) Subcutaneous fat
B) Intramuscular fat
C) Brown fat
D) Essential fat
E) Saturated fat

B) Intramuscular fat

Explanation: With age, there is an increase in both visceral fat and intramuscular fat, which negatively impacts muscle quality and contributes to overall muscle decline.

p.3

Insulin and Glucagon Functions

Which hormone primarily regulates fuel storage during the fed state?
A) Glucagon
B) Insulin
C) Cortisol
D) Adrenaline
E) Thyroxine

B) Insulin

Explanation: Insulin plays a crucial role in regulating fuel storage during the fed state, promoting anabolic pathways such as glycogen synthesis and lipogenesis.

p.35

Diabetes Pathology

What is a macrovascular complication of diabetes?
A) Retinopathy
B) Neuropathy
C) Infection susceptibility
D) Accelerated atherosclerosis
E) Microangiopathy

D) Accelerated atherosclerosis

Explanation: Macrovascular complications, such as accelerated atherosclerosis and hyaline arteriolosclerosis, are significant concerns in diabetes management and are related to larger blood vessel damage.

p.17

Diabetes Pathology

How does chronic alcoholism affect gluconeogenesis?
A) It enhances gluconeogenesis
B) It has no effect on gluconeogenesis
C) It impairs gluconeogenesis
D) It increases pyruvate levels
E) It converts lactate to pyruvate efficiently

C) It impairs gluconeogenesis

Explanation: Chronic alcoholism leads to impaired gluconeogenesis due to the consumption of NAD+ and the production of high levels of NADH, which inhibits the conversion of lactate to pyruvate, resulting in low pyruvate levels and hypoglycemia.

p.24

Diabetes Pathology

What is a notable characteristic of T2DM in teens and young adults?
A) It always requires insulin therapy
B) It is often asymptomatic
C) It often doesn’t require insulin
D) It is only found in adults
E) It is reversible with diet alone

C) It often doesn’t require insulin

Explanation: Unlike typical type 2 diabetes, T2DM in teens and young adults often does not require insulin treatment, indicating a different management approach compared to classic diabetes cases.

p.9

Gluconeogenesis and Lipogenesis

What happens to glucose production after 2 days of fasting?
A) It increases significantly
B) It stops completely
C) It provides all glucose
D) It remains the same
E) It decreases gradually

C) It provides all glucose

Explanation: After 2 days of fasting, gluconeogenesis becomes the primary source of glucose, providing all the glucose needed by the body once glycogen stores are depleted.

p.11

Lipogenesis and Lipogenesis

Which metabolite is involved in TAG synthesis from fatty acids?
A) Acetyl-CoA
B) Glycerol-3-P
C) Glucose
D) Citrate
E) Pyruvate

B) Glycerol-3-P

Explanation: TAG (triglyceride) synthesis from fatty acids involves glycerol-3-P, a metabolite in the glycolysis/gluconeogenesis pathway.

p.36

Pharmacological Treatments for Diabetes

When should second or third-line antidiabetic drugs be considered according to the management algorithm?
A) If the patient is not adhering to lifestyle changes
B) If the patient has a low income
C) If CVD and renal disease risk is high/increases
D) If the patient is pregnant
E) If HbA1c is below 50 mmol/mol

C) If CVD and renal disease risk is high/increases

Explanation: The algorithm recommends adding second and third-line antidiabetic drugs if there is a high risk of cardiovascular disease (CVD) and renal disease, indicating the importance of addressing these risks in diabetes management.

p.50

Nitrogen Metabolism and Urea Cycle

Where does urea synthesis primarily occur in the body?
A) Kidneys
B) Brain
C) Liver
D) Muscle
E) Pancreas

C) Liver

Explanation: Urea synthesis primarily occurs in the liver, specifically in periportal hepatocytes, which play a crucial role in nitrogen metabolism and the urea cycle.

p.46

Pharmacological Treatments for Diabetes

What modification is made in long-acting insulin glargine?
A) Addition of two prolines
B) Addition of two arginines
C) Removal of beta-chain
D) Substitution of aspartate for proline
E) Increased solubility

B) Addition of two arginines

Explanation: Long-acting insulin glargine (Lantus) includes two additional arginines at the terminal of the beta-chain, which increases its isoelectric point and reduces its solubility.

p.25

Diabetes Pathology

What happens to beta-cells as they compensate for insulin resistance over time?
A) They become more efficient
B) They exhaust and fail
C) They increase in number
D) They produce less insulin
E) They become more sensitive to glucose

B) They exhaust and fail

Explanation: Compensatory beta-cell hyperfunction eventually exhausts the cells, leading to inadequate insulin secretion in the face of ongoing insulin resistance and hyperglycaemia.

p.14

Lipolysis and Fatty Acid Metabolism

What are the products of lipolysis from triacylglycerols (TAGs)?
A) Glycerol and glucose
B) Glycerol and free fatty acids (FFAs)
C) Acetyl-CoA and malonyl-CoA
D) Fatty acids and ketones
E) Glycerol and amino acids

B) Glycerol and free fatty acids (FFAs)

Explanation: Lipolysis breaks down triacylglycerols (TAGs) into glycerol and free fatty acids (FFAs), which can be used for energy and gluconeogenesis.

p.13

Lipogenesis and Lipid Metabolism

What is the first committed step of lipogenesis mediated by Acetyl-CoA?
A) Acetyl-CoA → Fatty Acids
B) Acetyl-CoA → Malonyl-CoA
C) Acetyl-CoA → Glycerol
D) Acetyl-CoA → Glucose
E) Acetyl-CoA → Cholesterol

B) Acetyl-CoA → Malonyl-CoA

Explanation: The first committed step of lipogenesis is the conversion of Acetyl-CoA to Malonyl-CoA, which is a crucial reaction in the synthesis of fatty acids.

p.11

Lipogenesis and Lipogenesis

What is the primary substrate for fatty acid synthesis in lipogenesis?
A) Glucose
B) Acetyl-CoA
C) Glycerol
D) Lactate
E) Pyruvate

B) Acetyl-CoA

Explanation: Fatty acid synthesis during lipogenesis starts with acetyl-CoA, which is converted into fatty acids in the liver and adipose tissue.

p.18

Diabetes Pathology

What is glucotoxicity associated with in diabetes?
A) Increased insulin production
B) Damage to beta cells
C) Enhanced incretin secretion
D) Increased exercise tolerance
E) Weight loss

B) Damage to beta cells

Explanation: Glucotoxicity refers to the harmful effects of high glucose levels on beta cells, leading to their dysfunction, which is a significant factor in the pathology of diabetes.

p.3

Insulin and Glucagon Functions

What role does glucagon play in energy metabolism?
A) It promotes fuel storage
B) It stimulates anabolic pathways
C) It regulates fuel mobilization
D) It inhibits protein synthesis
E) It increases fat storage

C) It regulates fuel mobilization

Explanation: Glucagon primarily regulates fuel mobilization during the fasting state, promoting catabolic pathways that release energy from stored fuels.

p.17

Gluconeogenesis and Lipogenesis

Which condition is associated with increased gluconeogenesis?
A) Alcoholism
B) Trauma
C) Genetic diseases
D) Obesity
E) Insulin resistance

B) Trauma

Explanation: Trauma is associated with increased gluconeogenesis, as the body responds to stress and injury by mobilizing energy reserves, which includes enhancing gluconeogenic pathways.

p.2

Nitrogen Metabolism and Urea Cycle

What area of metabolism is related to the breakdown of amino acids?
A) Lipogenesis
B) Glycolysis
C) Nitrogen metabolism
D) Gluconeogenesis
E) Ketogenesis

C) Nitrogen metabolism

Explanation: Nitrogen metabolism involves the breakdown of amino acids and the removal of nitrogen, which is essential for maintaining amino acid balance and overall metabolic health.

p.28

Diabetes Pathology

What type of diabetic eye disease is characterized by microaneurysms?
A) Proliferative retinopathy
B) Non-proliferative retinopathy
C) Diabetic nephropathy
D) Diabetic neuropathy
E) Accelerated atherosclerosis

B) Non-proliferative retinopathy

Explanation: Non-proliferative retinopathy is characterized by the presence of microaneurysms, which are small bulges in the blood vessels of the retina, indicating early-stage diabetic eye disease.

p.13

Gluconeogenesis and Lipogenesis

What role does Malonyl-CoA play in fatty acid oxidation?
A) Stimulates CPT1
B) Inhibits CPT1
C) Converts fatty acids to glucose
D) Enhances beta-oxidation
E) Inhibits lipogenesis

B) Inhibits CPT1

Explanation: Malonyl-CoA inhibits carnitine palmitoyl transferase-1 (CPT1), which is necessary for fatty acyl groups to enter the mitochondria for oxidation, thereby promoting their conversion into triglycerides instead.

p.39

Pharmacological Treatments for Diabetes

What is a key indication for the use of metformin in diabetes management?
A) Indicated only for T1DM
B) Indicated for both T1DM and T2DM to increase insulin sensitivity
C) Indicated for patients with severe renal impairment
D) Indicated only during pregnancy
E) Indicated for patients with hepatic failure

B) Indicated for both T1DM and T2DM to increase insulin sensitivity

Explanation: Metformin is indicated for both Type 1 and Type 2 Diabetes Mellitus (T1DM and T2DM) specifically to enhance insulin sensitivity, making it a versatile medication in diabetes management.

p.51

Nitrogen Metabolism and Urea Cycle

Which tissues primarily release amino acids for the urea cycle?
A) Muscle and skin
B) Brain and liver
C) Alanine and glutamine
D) Fat and bone
E) Heart and lungs

C) Alanine and glutamine

Explanation: The primary amino acids released by tissues for the urea cycle are alanine and glutamine, which are taken up by the liver for nitrogen excretion.

p.13

Insulin and Glucagon Functions

What happens to beta-oxidation during the fed state due to insulin release?
A) It is stimulated
B) It is inhibited
C) It has no effect
D) It increases cellular FA uptake
E) It converts glucose to fatty acids

B) It is inhibited

Explanation: In the fed state, insulin release inhibits beta-oxidation while simultaneously stimulating lipogenesis, directing fatty acids towards storage rather than energy production.

p.7

Insulin and Glucagon Functions

Which process is stimulated by glucagon in adipose tissue?
A) Glycolysis
B) Lipogenesis
C) Lipolysis
D) Glycogenolysis
E) Gluconeogenesis

C) Lipolysis

Explanation: Glucagon stimulates lipolysis in adipose tissue, leading to the breakdown of stored fats into fatty acids and glycerol, which can be used for energy production.

p.8

Insulin and Glucagon Functions

What is the effect of adrenaline on glycogen stores in muscle?
A) Increases glycogen stores
B) Decreases glycogen stores
C) No effect on glycogen stores
D) Converts glycogen to glucose for blood release
E) Stimulates fatty acid synthesis from glycogen

B) Decreases glycogen stores

Explanation: Adrenaline stimulates glycogenolysis in muscle, leading to a decrease in glycogen stores as glucose is released for energy use.

p.23

Metabolic Syndrome and Insulin Resistance

Which of the following is NOT a criterion for diagnosing metabolic syndrome?
A) Raised triglycerides (>1.7mmol/L)
B) Reduced HDL cholesterol
C) Elevated fasting plasma glucose (>5.6mmol/L)
D) Increased physical activity
E) Raised blood pressure (systolic >135mm Hg, diastolic >80mm Hg)

D) Increased physical activity

Explanation: Increased physical activity is not a criterion for diagnosing metabolic syndrome. Instead, the criteria include raised triglycerides, reduced HDL cholesterol, elevated fasting plasma glucose, and raised blood pressure.

p.25

Diabetes Pathology

Which of the following complications is associated with diabetes?
A) Hypertension
B) Retinopathy
C) Osteoporosis
D) Asthma
E) Arthritis

B) Retinopathy

Explanation: Retinopathy, which includes both non-proliferative and proliferative forms, is a common complication associated with diabetes resulting from chronic hyperglycaemia.

p.17

Diabetes Pathology

What is a consequence of pre-term babies having underdeveloped livers?
A) Increased gluconeogenesis
B) High glycogen stores
C) Impaired gluconeogenesis
D) Enhanced lactate production
E) Normal glucose metabolism

C) Impaired gluconeogenesis

Explanation: Pre-term babies with underdeveloped livers and low glycogen stores experience impaired gluconeogenesis, which can lead to difficulties in maintaining normal blood glucose levels.

p.13

Insulin and Glucagon Functions

Which hormone stimulates lipogenesis?
A) Glucagon
B) Cortisol
C) Insulin
D) Adrenaline
E) Somatostatin

C) Insulin

Explanation: Insulin is known to stimulate lipogenesis, promoting the conversion of Acetyl-CoA to Malonyl-CoA and facilitating the synthesis of fatty acids.

p.24

Diabetes Pathology

What is the risk associated with T2DM in teens and young adults?
A) Low blood sugar episodes
B) High risk of heart disease
C) Risk of transmission in relatives
D) Increased risk of stroke
E) Increased risk of kidney failure

C) Risk of transmission in relatives

Explanation: T2DM in teens and young adults poses a risk of transmission to relatives, emphasizing the importance of identifying MODY (maturity onset diabetes of the young) due to its hereditary nature.

p.15

Metabolic Syndrome and Insulin Resistance

Which of the following is NOT a cause of carnitine deficiency?
A) Liver disease
B) Inadequate diet
C) Genetic defects
D) Excessive exercise
E) Surgery/trauma/illness

D) Excessive exercise

Explanation: While liver disease, inadequate diet, genetic defects, and surgery/trauma/illness can lead to carnitine deficiency, excessive exercise is not listed as a cause.

p.48

Nitrogen Metabolism and Urea Cycle

Why is nitrogen essential in the body?
A) For energy production
B) For nitrogen-containing molecules, especially proteins/amino acids
C) For carbohydrate synthesis
D) For fat storage
E) For water retention

B) For nitrogen-containing molecules, especially proteins/amino acids

Explanation: Nitrogen is crucial for the synthesis of nitrogen-containing molecules, particularly proteins and amino acids, which are vital for various bodily functions.

p.18

Hypoglycemia Management

Which of the following is NOT a symptom of hypoglycemia?
A) Increased heart rate
B) Sweating
C) Drowsiness
D) Excessive thirst
E) Trembling

D) Excessive thirst

Explanation: Symptoms of hypoglycemia include increased heart rate, sweating, trembling, and drowsiness, but excessive thirst is not typically associated with low blood glucose levels.

p.36

Pharmacological Treatments for Diabetes

What action should be taken if glycemic targets are not being met in T2D management?
A) Increase insulin dosage only
B) Add additional antidiabetic drugs
C) Decrease physical activity
D) Switch to a different diet
E) Refer to a psychologist

B) Add additional antidiabetic drugs

Explanation: The management algorithm suggests adding second or third-line antidiabetic drugs if glycemic targets are not being met, indicating the need for more aggressive treatment to achieve desired blood glucose levels.

p.11

Lipogenesis and Lipogenesis

What activates SREBP-1c and ChREBP transcription factors?
A) High protein intake
B) Low glucose levels
C) Insulin and glucose
D) High fat intake
E) Exercise

C) Insulin and glucose

Explanation: SREBP-1c and ChREBP transcription factors are activated by insulin and glucose, promoting genes involved in lipogenesis in response to high carbohydrate intake.

p.15

Diabetic Ketoacidosis (DKA)

What are the main ketone bodies produced during ketogenesis?
A) Acetoacetate and beta-hydroxybutyrate
B) Acetyl-CoA and lactate
C) Glucose and pyruvate
D) Glycerol and fatty acids
E) Fructose and galactose

A) Acetoacetate and beta-hydroxybutyrate

Explanation: The primary ketone bodies generated during ketogenesis are acetoacetate and beta-hydroxybutyrate, which serve as alternative fuels for the body during fasting or starvation.

p.48

Nitrogen Metabolism and Urea Cycle

What happens to carbon skeletons in amino acid metabolism?
A) They are stored as fat
B) They are used in glucogenic or ketogenic processes
C) They are converted to glucose only
D) They are excreted as waste
E) They are used for energy only

B) They are used in glucogenic or ketogenic processes

Explanation: Carbon skeletons derived from amino acids can be utilized in either glucogenic or ketogenic processes, contributing to energy metabolism and the synthesis of glucose or ketone bodies.

p.49

Nitrogen Metabolism and Urea Cycle

Which of the following conditions is associated with a positive nitrogen balance?
A) Weight loss
B) Starvation
C) Pregnancy
D) Aging
E) Dehydration

C) Pregnancy

Explanation: Pregnancy is one of the conditions that leads to a positive nitrogen balance, as the body requires more nitrogen to support the growth and development of the fetus.

p.30

Regulation of Fuel Metabolism

What is Bowman’s capsule associated with in the kidney?
A) Blood filtration
B) Hormone production
C) Nutrient absorption
D) Urine storage
E) Electrolyte balance

A) Blood filtration

Explanation: Bowman’s capsule is a crucial structure in the kidney involved in the filtration of blood, serving as the initial part of the nephron where blood plasma is filtered to form urine.

p.30

Diabetes Pathology

What does thickening of Bowman’s capsule indicate?
A) Increased urine production
B) Potential kidney damage
C) Enhanced blood flow
D) Decreased blood pressure
E) Improved filtration rate

B) Potential kidney damage

Explanation: Thickening of Bowman’s capsule can be a sign of pathological changes in the kidney, often indicating potential damage or disease affecting renal function.

p.14

Lipolysis and Fatty Acid Metabolism

Which condition promotes lipolysis?
A) Fasting
B) Overeating
C) Sleep
D) Hydration
E) Resting state

A) Fasting

Explanation: Lipolysis is promoted during fasting, starvation, and trauma, as the body mobilizes fatty acids for energy in the absence of food intake.

p.13

Insulin and Glucagon Functions

What effect does glucagon have on lipogenesis?
A) Stimulates it
B) Inhibits it
C) Has no effect
D) Enhances fatty acid uptake
E) Converts fatty acids to glucose

B) Inhibits it

Explanation: Glucagon inhibits lipogenesis, counteracting the effects of insulin and promoting the breakdown of fats instead.

p.11

Lipogenesis and Lipogenesis

Which enzyme is NOT involved in lipogenesis?
A) Glucokinase
B) PDH
C) Citrate lyase
D) Acetyl-CoA carboxylase
E) Hexokinase

E) Hexokinase

Explanation: Hexokinase is not involved in lipogenesis; the other listed enzymes play critical roles in the synthesis of fatty acids and triglycerides.

p.9

Gluconeogenesis and Lipogenesis

Which enzyme is involved in the gluconeogenesis process?
A) Lactate dehydrogenase
B) Glucose-6-phosphatase
C) Hexokinase
D) Glycogen synthase
E) Aldolase

B) Glucose-6-phosphatase

Explanation: Glucose-6-phosphatase is one of the key enzymes involved in gluconeogenesis, facilitating the final step of converting glucose-6-phosphate to glucose.

p.4

Insulin and Glucagon Functions

What is the primary function of insulin in the body?
A) To increase blood glucose levels
B) To regulate blood glucose levels
C) To decrease protein synthesis
D) To stimulate fat breakdown
E) To enhance muscle contraction

B) To regulate blood glucose levels

Explanation: Insulin is a peptide hormone released by pancreatic islet beta cells in response to high blood glucose levels, effectively regulating glucose levels in the body.

p.50

Nitrogen Metabolism and Urea Cycle

What is the primary role of NH4+ produced from glutamine deamination?
A) Energy production
B) Protein synthesis
C) Acid-base balance
D) Glucose metabolism
E) Lipid metabolism

C) Acid-base balance

Explanation: NH4+ produced from glutamine deamination plays a role in acid-base balance by sequestering H+, which helps maintain pH levels in the body.

p.37

Pharmacological Treatments for Diabetes

Which of the following is classified as a biguanide antidiabetic drug?
A) Insulin
B) Metformin
C) Sulfonylureas
D) SGLT2 inhibitors
E) DPP-IV inhibitors

B) Metformin

Explanation: Metformin is the only drug listed that is classified as a biguanide, which is an important first-line treatment for type 2 diabetes mellitus (T2DM).

p.40

Pharmacological Treatments for Diabetes

How does empagliflozin enter the proximal convoluted tubule (PCT)?
A) Through active transport
B) Via glomerular filtration and tubular secretion
C) By diffusion
D) Through lymphatic drainage
E) By passive absorption

B) Via glomerular filtration and tubular secretion

Explanation: Empagliflozin enters the proximal convoluted tubule primarily through glomerular filtration and tubular secretion, which is a key aspect of its pharmacokinetics.

p.58

Exercise and Metabolic Adaptations

What happens to energy utilization with increasing exercise duration?
A) It remains constant
B) It shifts from high-energy phosphates to anaerobic metabolism, then to aerobic carbohydrate metabolism, and finally to aerobic fat metabolism
C) It only uses high-energy phosphates
D) It only uses anaerobic metabolism
E) It shifts to anaerobic metabolism and then stops

B) It shifts from high-energy phosphates to anaerobic metabolism, then to aerobic carbohydrate metabolism, and finally to aerobic fat metabolism

Explanation: As exercise duration increases, the body transitions through various energy utilization pathways, starting from high-energy phosphates, moving to anaerobic metabolism, then to aerobic carbohydrate metabolism, and finally to aerobic fat metabolism, reflecting the body's adaptation to prolonged exercise.

p.5

Insulin and Glucagon Functions

Which hormones inhibit the release of insulin?
A) CCK and incretins
B) Adrenaline and glucagon
C) Cortisol and thyroid hormones
D) Growth hormone and prolactin
E) Estrogen and testosterone

B) Adrenaline and glucagon

Explanation: The release of insulin is inhibited by adrenaline and glucagon, which are hormones that promote the mobilization of energy stores, counteracting insulin's effects.

p.53

Diabetes Pathology

What causes the inflammatory response in gout?
A) Bacterial infection
B) Uric acid crystals
C) Autoimmune reaction
D) Joint trauma
E) Viral infection

B) Uric acid crystals

Explanation: The inflammatory response in gout is triggered by the deposition of urate crystals in joint spaces, which leads to inflammation and pain.

p.36

Pharmacological Treatments for Diabetes

Under what conditions should additional antidiabetic drugs be added to the management of T2D?
A) If the patient is overweight
B) If comorbidities are present
C) If the patient is under 40 years old
D) If there is a family history of diabetes
E) If the patient is asymptomatic

B) If comorbidities are present

Explanation: The algorithm specifies that other drugs should be added to the management of T2D if comorbidities are present, reflecting a comprehensive approach to patient care.

p.23

Pharmacological Treatments for Diabetes

Which medication is suggested for treating hyperlipidaemia in metabolic syndrome?
A) Metformin
B) ACE inhibitors
C) Statins
D) ARBs
E) Insulin

C) Statins

Explanation: Statins are recommended for the treatment of hyperlipidaemia in patients with metabolic syndrome, as they help lower cholesterol levels and reduce cardiovascular risk.

p.46

Insulin and Glucagon Functions

What is a rare adverse effect of insulin analogues?
A) Hypoglycemia
B) Weight gain
C) Oedema due to fluid retention
D) Lipohypertrophy
E) Local cutaneous allergy

C) Oedema due to fluid retention

Explanation: Oedema due to extravasation of fluid to subcutaneous tissue from renal retention of sodium is a rare adverse effect associated with insulin analogues.

p.17

Metabolic Syndrome and Insulin Resistance

What effect do cytokines and stress hormones have on insulin sensitivity?
A) They enhance insulin sensitivity
B) They have no effect
C) They lead to insulin resistance and hyperglycemia
D) They decrease blood glucose
E) They promote gluconeogenesis

C) They lead to insulin resistance and hyperglycemia

Explanation: Cytokines, stress hormones, and glucagon contribute to insulin resistance and hyperglycemia, which can disrupt normal glucose metabolism and lead to various metabolic disorders.

p.2

Exercise and Metabolic Adaptations

How does exercise influence metabolic conditions?
A) It decreases insulin sensitivity
B) It promotes weight gain
C) It enhances glucose uptake by muscles
D) It increases fatigue
E) It reduces metabolic rate

C) It enhances glucose uptake by muscles

Explanation: Exercise plays a significant role in improving metabolic conditions by enhancing glucose uptake by muscles, thus helping to manage blood sugar levels effectively.

p.24

Diabetes Pathology

What does MODY stand for?
A) Maturity Onset Diabetes of the Young
B) Metabolic Obesity Diabetes of Youth
C) Multiple Organ Dysfunction in Youth
D) Mild Onset Diabetes of the Young
E) Maturity Onset Disorder of Youth

A) Maturity Onset Diabetes of the Young

Explanation: MODY stands for Maturity Onset Diabetes of the Young, which is a form of diabetes that is important to identify due to its hereditary nature and implications for family members.

p.42

Pharmacological Treatments for Diabetes

What is the recommended combination therapy for Type 2 Diabetes Mellitus (T2DM) mentioned in the text?
A) Metformin and insulin
B) Metformin and empagliflozin
C) Dulaglutide and insulin
D) Metformin and sulfonylureas
E) Metformin and glucagon

B) Metformin and empagliflozin

Explanation: The text states that the combination of Metformin and empagliflozin is a safe option for managing T2DM, highlighting its effectiveness when used together.

p.30

Regulation of Fuel Metabolism

Which of the following best describes the structure of Bowman’s capsule?
A) A muscular tube
B) A thin-walled sac
C) A solid organ
D) A network of veins
E) A thickened membrane

B) A thin-walled sac

Explanation: Bowman’s capsule is a thin-walled sac that encases the glomerulus in the kidney, allowing for efficient filtration of blood.

p.50

Nitrogen Metabolism and Urea Cycle

Which of the following enzymes is involved in the urea cycle?
A) Lactate dehydrogenase
B) Glutamine synthetase
C) Creatine kinase
D) Pyruvate carboxylase
E) Hexokinase

B) Glutamine synthetase

Explanation: Glutamine synthetase is one of the key enzymes involved in nitrogen metabolism, facilitating the conversion of glutamate and ammonia into glutamine, which is important for nitrogen balance and the urea cycle.

p.53

Diabetes Pathology

Which joint is most commonly affected by gout?
A) Shoulder joint
B) Knee joint
C) 1st MTP joint
D) Elbow joint
E) Wrist joint

C) 1st MTP joint

Explanation: The 1st metatarsophalangeal (MTP) joint is the most commonly affected joint in gout, indicating where symptoms typically manifest.

p.37

Pharmacological Treatments for Diabetes

What is the primary mechanism of action of metformin?
A) Inhibition of insulin secretion
B) Stimulation of gluconeogenesis
C) Inhibition of hepatic gluconeogenesis
D) Increase in blood glucose levels
E) Promotion of glycogen storage

C) Inhibition of hepatic gluconeogenesis

Explanation: The primary mechanism of action of metformin is the inhibition of hepatic gluconeogenesis, which helps lower blood glucose levels, particularly after meals.

p.28

Diabetes Pathology

Which diabetic complication is characterized by kidney damage?
A) Neuropathy
B) Nephropathy
C) Retinopathy
D) Accelerated atherosclerosis
E) Hyaline arteriolosclerosis

B) Nephropathy

Explanation: Diabetic nephropathy refers to kidney damage resulting from diabetes, characterized by changes in kidney function and structure, and is one of the major complications of diabetes.

p.5

Insulin and Glucagon Functions

What role do gut hormones like CCK and incretins play in insulin release?
A) They inhibit insulin release
B) They have no effect on insulin
C) They potentiate insulin release
D) They degrade insulin
E) They are produced in the liver

C) They potentiate insulin release

Explanation: Gut hormones such as CCK and incretins enhance the release of insulin, indicating their role in promoting insulin secretion in response to food intake.

p.59

Exercise and Metabolic Adaptations

What is a key effect of EPOC after exercise?
A) Decreased heart rate
B) Elevated basal metabolic rate (BMR)
C) Increased fatigue
D) Decreased muscle mass
E) Reduced oxygen demand

B) Elevated basal metabolic rate (BMR)

Explanation: EPOC results in an elevated BMR for up to 24 hours after exercise, indicating that the body continues to burn calories at a higher rate even after the workout has ended.

p.21

Pharmacological Treatments for Diabetes

What is a primary treatment for Type 1 Diabetes Mellitus (T1DM)?
A) Oral antidiabetics
B) Insulin and glucose monitoring
C) Lifestyle management
D) Dietary supplements
E) Exercise only

B) Insulin and glucose monitoring

Explanation: The primary treatment for T1DM includes insulin therapy and glucose monitoring, which are essential for managing blood sugar levels effectively.

p.16

Diabetes Pathology

What is the effect of the absence of insulin-mediated peripheral LPL activation?
A) Increased triglycerides return to the liver
B) Decreased triglycerides in the liver
C) Enhanced lipogenesis in peripheral tissues
D) Decreased fatty acid delivery to the liver
E) Increased glucose uptake in tissues

A) Increased triglycerides return to the liver

Explanation: The absence of insulin-mediated peripheral lipoprotein lipase (LPL) activation leads to triglycerides (TAGs) returning to the liver, contributing to dysregulated lipid metabolism.

p.21

Diabetes Pathology

Which of the following is a dietary tip for glycemic management in both Type 1 and Type 2 Diabetes Mellitus?
A) Skip meals to reduce calorie intake
B) Have only one piece of fruit at a time
C) Consume high-sugar snacks frequently
D) Eat meals at irregular times
E) Avoid carbohydrates altogether

B) Have only one piece of fruit at a time

Explanation: A dietary tip for glycemic management in both T1D and T2D is to have only one piece of fruit at a time, which helps in controlling carbohydrate intake and managing blood sugar levels.

p.15

Gluconeogenesis and Lipogenesis

What metabolic state is characterized by elevated ketone bodies?
A) Glycolysis
B) Anabolism
C) Ketosis
D) Gluconeogenesis
E) Lipogenesis

C) Ketosis

Explanation: Ketogenesis occurs during ketosis, a metabolic state where the body prioritizes fat metabolism over carbohydrate metabolism, resulting in increased levels of ketone bodies.

p.30

Regulation of Fuel Metabolism

What is the primary function of Bowman’s capsule?
A) Reabsorption of nutrients
B) Filtration of blood
C) Secretion of hormones
D) Regulation of electrolytes
E) Storage of urine

B) Filtration of blood

Explanation: The primary function of Bowman’s capsule is to filter blood to form a filtrate that will eventually become urine, playing a key role in kidney function.

p.14

Ketogenesis and Fatty Acid Metabolism

What happens to excess acetyl-CoA in the liver?
A) It is converted to glucose
B) It is used for lipogenesis
C) It is diverted to ketogenesis
D) It is excreted
E) It is stored as glycogen

C) It is diverted to ketogenesis

Explanation: Excess acetyl-CoA in the liver is diverted to ketogenesis, especially during states of fasting or low carbohydrate intake, leading to the production of ketone bodies.

p.19

Hypoglycemia Management

What is the recommended action before drinking alcohol for individuals with diabetes?
A) Skip meals
B) Always eat before drinking
C) Drink on an empty stomach
D) Avoid all snacks
E) Drink only water

B) Always eat before drinking

Explanation: It is recommended that individuals with diabetes always eat before drinking alcohol to help manage blood glucose levels and prevent hypoglycemia.

p.39

Pharmacological Treatments for Diabetes

Which of the following statements about metformin is true?
A) It can cause hypoglycemia
B) It is contraindicated in pregnancy
C) It promotes weight loss
D) It is not effective for T2DM
E) It should be used in severe hepatic failure

C) It promotes weight loss

Explanation: Metformin is known to promote weight loss, which is particularly beneficial for overweight patients managing Type 2 Diabetes Mellitus (T2DM).

p.14

Gluconeogenesis and Lipogenesis

What is the role of CPT1 in fatty acid metabolism?
A) Converts fatty acids to glucose
B) Activates hormone-sensitive lipase
C) Transports fatty acids into mitochondria
D) Inhibits beta-oxidation
E) Converts acetyl-CoA to malonyl-CoA

C) Transports fatty acids into mitochondria

Explanation: CPT1 (carnitine palmitoyltransferase I) is responsible for transporting activated fatty acids (fatty acyl CoA) into the mitochondria for beta-oxidation.

p.10

Gluconeogenesis and Lipogenesis

What is the role of fructose-1,6-bisphosphatase (Fru-1,6-BPase) in gluconeogenesis?
A) It promotes glycolysis
B) It promotes gluconeogenesis
C) It inhibits glycolysis
D) It converts glucose to glycogen
E) It activates PFK-1

B) It promotes gluconeogenesis

Explanation: Fru-1,6-BPase is an enzyme that plays a crucial role in promoting gluconeogenesis, which is the synthesis of glucose from non-carbohydrate precursors.

p.40

Pharmacological Treatments for Diabetes

What is the oral bioavailability of empagliflozin?
A) 50%
B) 70%
C) 90%
D) 100%
E) 30%

C) 90%

Explanation: Empagliflozin has an oral bioavailability of approximately 90%, which is unaffected by food intake, making it effective regardless of meal timing.

p.18

Hypoglycemia Management

What is the glucose threshold for defining hypoglycemia?
A) < 5.0 mmol/L
B) < 4.0 mmol/L
C) < 6.0 mmol/L
D) < 3.0 mmol/L
E) < 7.0 mmol/L

B) < 4.0 mmol/L

Explanation: Hypoglycemia is defined as having glucose levels below 4.0 mmol/L, with further classifications for mild, moderate, and severe based on lower thresholds.

p.39

Pharmacological Treatments for Diabetes

How does empagliflozin affect cardiac metabolism?
A) It promotes glucose utilization
B) It shifts cardiac metabolism to fat utilization
C) It has no effect on cardiac metabolism
D) It increases plasma glucose levels
E) It causes weight gain

B) It shifts cardiac metabolism to fat utilization

Explanation: Empagliflozin shifts cardiac metabolism to fat utilization, making it more energetically efficient due to decreased plasma glucose levels, which is beneficial for patients with cardiovascular disease.

p.42

Pharmacological Treatments for Diabetes

What is the contraindication for the combination of Metformin and empagliflozin?
A) When eGFR<60 mL/min/1.73m²
B) When eGFR<45 mL/min/1.73m²
C) When eGFR<30 mL/min/1.73m²
D) When eGFR<15 mL/min/1.73m²
E) There are no contraindications

C) When eGFR<30 mL/min/1.73m²

Explanation: The combination of Metformin and empagliflozin is contraindicated when eGFR is less than 30 mL/min/1.73m², highlighting the importance of renal function in the safety of this therapy.

p.5

Insulin and Glucagon Functions

What characterizes the biphasic release pattern of insulin?
A) Continuous release throughout the day
B) Two distinct phases: brief high and prolonged low
C) Only one phase of release
D) Release only during fasting
E) Random release without a pattern

B) Two distinct phases: brief high and prolonged low

Explanation: Insulin is released in a biphasic pattern, with a brief first phase that is higher and a second phase that is lower but prolonged, indicating a regulated response to blood glucose levels.

p.28

Diabetes Pathology

Which condition is associated with thickening of the basement membrane of blood vessels?
A) Diabetic nephropathy
B) Non-proliferative retinopathy
C) Hyaline arteriolosclerosis
D) Neuropathy
E) Accelerated atherosclerosis

C) Hyaline arteriolosclerosis

Explanation: Hyaline arteriolosclerosis is characterized by the thickening of the basement membrane of blood vessels, which affects blood flow and is a common complication in diabetes.

p.53

Diabetes Pathology

What is the second most common type of arthritis in New Zealand?
A) Osteoarthritis
B) Rheumatoid arthritis
C) Gout
D) Psoriatic arthritis
E) Ankylosing spondylitis

C) Gout

Explanation: Gout is identified as the second most common type of arthritis in New Zealand, highlighting its prevalence in the population.

p.46

Pharmacological Treatments for Diabetes

What is the purpose of the proline to aspartate substitution in insulin aspart?
A) To increase solubility
B) To enhance aggregation
C) To reduce aggregation and promote monomer formation
D) To decrease insulin clearance
E) To increase the half-life

C) To reduce aggregation and promote monomer formation

Explanation: The proline to aspartate substitution in insulin aspart (Novorapid) reduces the tendency to aggregate, promoting monomer formation and allowing for rapid diffusion.

p.51

Nitrogen Metabolism and Urea Cycle

Where does the majority of urea synthesis occur in the liver?
A) In the mitochondria
B) In the cytosol
C) In periportal hepatocytes
D) In perivenous hepatocytes
E) In the bile ducts

C) In periportal hepatocytes

Explanation: The urea cycle predominantly occurs in periportal hepatocytes, where the initial steps of urea synthesis take place.

p.19

Hypoglycemia Management

What should individuals with diabetes do if their blood glucose level is below 5.0 mmol/L before starting exercise?
A) Start exercising immediately
B) Check again later
C) Don't start exercising
D) Drink water
E) Eat a large meal

C) Don't start exercising

Explanation: Individuals should not start exercising if their blood glucose level is below 5.0 mmol/L or if they have had a severe hypoglycemic episode within the past 24 hours, to avoid the risk of further hypoglycemia.

p.4

Insulin and Glucagon Functions

Which channel is inhibited leading to insulin release?
A) Sodium channels
B) Calcium channels
C) ATP-dependent K+ channels
D) Chloride channels
E) Magnesium channels

C) ATP-dependent K+ channels

Explanation: The inhibition of ATP-dependent K+ channels leads to membrane depolarization, which is a critical step in the release of insulin from beta cells.

p.48

Nitrogen Metabolism and Urea Cycle

What are the three states of nitrogen balance?
A) Positive, negative, and neutral
B) Positive, negative, and balanced
C) Positive, negative, and excessive
D) Balanced, deficient, and excessive
E) Positive, negative, and stable

B) Positive, negative, and balanced

Explanation: The three states of nitrogen balance are positive, negative, and balanced, reflecting the body's nitrogen intake and excretion in relation to its physiological needs.

p.28

Metabolic Syndrome and Insulin Resistance

What complication is associated with accelerated atherosclerosis in diabetes?
A) Hyaline arteriolosclerosis
B) Neuropathy
C) Retinopathy
D) Nephropathy
E) All of the above

E) All of the above

Explanation: Accelerated atherosclerosis in diabetes can lead to various complications, including hyaline arteriolosclerosis, neuropathy, retinopathy, and nephropathy, affecting multiple organ systems.

p.19

Diabetes Pathology

Which of the following symptoms is typical at the diagnosis of diabetes mellitus?
A) High energy levels
B) Weakness
C) Increased appetite
D) Decreased thirst
E) Improved vision

B) Weakness

Explanation: Weakness, along with other symptoms like blurred vision, weight loss, polydipsia, polyuria, and polyphagia, is typical at the diagnosis of diabetes mellitus.

p.40

Pharmacological Treatments for Diabetes

What is the half-life (t1/2) of empagliflozin?
A) 6 hours
B) 10 hours
C) 13 hours
D) 20 hours
E) 24 hours

C) 13 hours

Explanation: Empagliflozin has a half-life of approximately 13 hours, which influences its dosing schedule and duration of action.

p.20

Diabetes Pathology

Which triad of symptoms is commonly associated with T1DM?
A) Fatigue, weight gain, and high blood pressure
B) Polydipsia, polyuria, and polyphagia
C) Nausea, vomiting, and fever
D) Blurred vision, headaches, and dizziness
E) Skin rashes, joint pain, and fatigue

B) Polydipsia, polyuria, and polyphagia

Explanation: The classic triad of symptoms for T1DM includes polydipsia (excessive thirst), polyuria (excessive urination), and polyphagia (excessive hunger).

p.58

Exercise and Metabolic Adaptations

What occurs during the rest-to-exercise transition regarding oxygen demand?
A) Oxygen supply exceeds demand
B) Oxygen demand outweighs cardiorespiratory responses to increase oxygen supply
C) Oxygen supply is constant
D) Cardiorespiratory responses are immediate
E) There is no change in oxygen uptake

B) Oxygen demand outweighs cardiorespiratory responses to increase oxygen supply

Explanation: During the rest-to-exercise transition, the demand for oxygen exceeds the body's immediate cardiorespiratory responses to supply oxygen, leading to a lag in oxygen uptake and reliance on anaerobic energy systems for ATP production.

p.48

Nitrogen Metabolism and Urea Cycle

What is the waste product of nitrogen metabolism?
A) Ammonia
B) Urea
C) Creatinine
D) Uric acid
E) Carbon dioxide

B) Urea

Explanation: Urea is the waste product of nitrogen metabolism, produced from ammonia, which is toxic. Urea is a non-toxic, soluble nitrogen molecule that the body can safely excrete.

p.17

Metabolic Syndrome and Insulin Resistance

What is the role of adipocytes in obesity related to insulin resistance?
A) They release more antihyperglycemic adiponectins
B) They increase insulin receptor synthesis
C) They release fewer antihyperglycemic adiponectins
D) They enhance tyrosine phosphorylation
E) They decrease proinflammatory cytokine release

C) They release fewer antihyperglycemic adiponectins

Explanation: In obesity, adipocytes release fewer antihyperglycemic adiponectins, which contributes to insulin resistance by impairing glucose regulation and promoting inflammation.

p.47

Pharmacological Treatments for Diabetes

Which of the following is a characteristic of sulfonylureas?
A) They are ineffective in insulin-resistant states
B) They only work in obese patients
C) They induce glucagon secretion
D) They are short-acting only
E) They have no drug interactions

A) They are ineffective in insulin-resistant states

Explanation: Sulfonylureas are ineffective if beta-cells are destroyed and in insulin-resistant states, which includes many cases of obesity.

p.9

Insulin and Glucagon Functions

How does insulin affect glucose-6-phosphatase transcription?
A) It enhances transcription
B) It has no effect
C) It inhibits transcription
D) It promotes degradation
E) It activates transcription

C) It inhibits transcription

Explanation: Insulin inhibits the transcription of glucose-6-phosphatase, which is crucial for regulating gluconeogenesis and glucose production in the liver.

p.42

Pharmacological Treatments for Diabetes

What should be done if the eGFR falls in a patient taking Metformin?
A) Increase the dose of Metformin
B) Stop Metformin immediately
C) Reduce the dose of Metformin
D) Switch to insulin therapy
E) No action is needed

C) Reduce the dose of Metformin

Explanation: According to the text, a reduction in the dose of Metformin may be required as the eGFR falls, indicating the need for careful monitoring and adjustment of medication.

p.4

Insulin and Glucagon Functions

What stimulates insulin release besides high blood glucose levels?
A) Low levels of potassium
B) Presence of alanine, arginine, and glycerol
C) Increased fatty acids
D) Decreased ATP levels
E) Low blood pressure

B) Presence of alanine, arginine, and glycerol

Explanation: Insulin release can also be stimulated by the presence of amino acids like alanine and arginine, as well as glycerol, indicating multiple pathways for its secretion.

p.58

Exercise and Metabolic Adaptations

What does VO2max represent?
A) The minimum rate of oxygen uptake
B) The maximum rate of oxygen uptake
C) The average rate of oxygen uptake
D) The rate of anaerobic metabolism
E) The rate of fat oxidation

B) The maximum rate of oxygen uptake

Explanation: VO2max is defined as the maximum rate of oxygen uptake and is an indicator of maximal aerobic capacity, which is crucial for assessing endurance performance.

p.5

Insulin and Glucagon Functions

What is the primary function of GLUT4 in insulin's action?
A) To inhibit glucose uptake
B) To facilitate glucose uptake into cells
C) To store glucose as glycogen
D) To break down fatty acids
E) To synthesize amino acids

B) To facilitate glucose uptake into cells

Explanation: GLUT4 is a glucose transporter that facilitates the uptake of glucose into adipose and muscle cells in response to insulin, playing a crucial role in glucose metabolism.

p.59

Exercise and Metabolic Adaptations

Which of the following adaptations occurs in muscles due to regular exercise?
A) Decreased capillary density
B) Increased muscle fiber size
C) Reduced blood flow
D) Decreased mitochondrial content
E) Increased fat storage

B) Increased muscle fiber size

Explanation: Regular exercise leads to muscle adaptations such as larger fiber size, especially in Type 1 fibers, which enhances blood flow and oxygen uptake.

p.45

Pharmacological Treatments for Diabetes

Which of the following is a DPP-IV inhibitor used for diabetes management?
A) Metformin
B) Vildagliptin
C) Glimepiride
D) Insulin
E) Acarbose

B) Vildagliptin

Explanation: Vildagliptin is a DPP-IV inhibitor specifically mentioned for diabetes treatment, alongside sitagliptin, highlighting its role in managing blood glucose levels.

p.6

Insulin and Glucagon Functions

What metabolic process is stimulated by glucagon?
A) Lipogenesis
B) Glycogenesis
C) Lipolysis
D) Glycogen synthesis
E) Protein synthesis

C) Lipolysis

Explanation: Glucagon stimulates lipolysis, which is the breakdown of fats in adipose tissue, contrasting with the effects of insulin that promotes fat storage.

p.53

Diabetes Pathology

Which demographic is noted to have higher average urate levels?
A) African Americans
B) Caucasians
C) Polynesians and Micronesians
D) Native Americans
E) East Asians

C) Polynesians and Micronesians

Explanation: Polynesians and Micronesians are noted to have higher average urate levels, indicating a demographic predisposition to conditions like gout.

p.18

Hypoglycemia Management

What is the recommended treatment for severe hypoglycemia?
A) Oral glucose
B) IM/SC glucagon
C) Increased physical activity
D) High-carbohydrate diet
E) Increased water intake

B) IM/SC glucagon

Explanation: For severe hypoglycemia, the recommended treatment is IM/SC glucagon, and if there is no immediate response, IV glucose may be administered.

p.5

Insulin and Glucagon Functions

What is the primary source of insulin during the first phase of its release?
A) Newly synthesized insulin
B) Insulin from the liver
C) Already synthesized and stored insulin
D) Insulin from muscle cells
E) Insulin from adipose tissue

C) Already synthesized and stored insulin

Explanation: The first phase of insulin release consists of insulin that has already been synthesized and stored, allowing for a rapid response to glucose levels.

p.28

Diabetes Pathology

What is a hallmark feature of non-proliferative retinopathy?
A) Nephropathy
B) Microaneurysms
C) Accelerated atherosclerosis
D) Neuropathy
E) Proliferative changes

B) Microaneurysms

Explanation: Microaneurysms are a hallmark feature of non-proliferative retinopathy, indicating early changes in the retinal blood vessels due to diabetes.

p.18

Hypoglycemia Management

What can cause neuroglycopenia?
A) High glucose levels
B) Low insulin levels
C) Low glucose levels in the brain
D) Increased incretin secretion
E) High fat metabolism

C) Low glucose levels in the brain

Explanation: Neuroglycopenia occurs when there is low glucose in the brain, leading to symptoms such as confusion, weakness, and in severe cases, seizures or coma.

p.48

Nitrogen Metabolism and Urea Cycle

How is nitrogen balance maintained in the body?
A) By storing excess nitrogen
B) Through continuous losses and replenishment by intake and excretion
C) By increasing protein intake only
D) By reducing waste excretion
E) Through hydration

B) Through continuous losses and replenishment by intake and excretion

Explanation: Nitrogen balance is maintained by the continuous losses of nitrogen and its replenishment through dietary intake and excretion, which can be influenced by the physiological state of the individual.

p.51

Nitrogen Metabolism and Urea Cycle

What role do perivenous hepatocytes play in nitrogen excretion?
A) They synthesize urea
B) They release ammonia
C) They clean up remaining ammonia
D) They produce alanine
E) They store excess nitrogen

C) They clean up remaining ammonia

Explanation: Perivenous hepatocytes are responsible for cleaning up any remaining ammonia after urea synthesis, helping to maintain nitrogen balance.

p.10

Insulin and Glucagon Functions

How does insulin affect the activity of PFK-2?
A) It inhibits PFK-2
B) It has no effect on PFK-2
C) It activates PFK-2
D) It activates Fru-1,6-BPase
E) It promotes gluconeogenesis

C) It activates PFK-2

Explanation: Insulin, via PP1, activates PFK-2, which increases the levels of Fru-2,6-BP, leading to the inhibition of Fru-1,6-BPase and stimulation of PFK-1, thereby blocking gluconeogenesis and promoting glycolysis.

p.41

Pharmacological Treatments for Diabetes

In which condition is the use of SGLT2 inhibitors contraindicated?
A) Type 2 Diabetes Mellitus
B) Type 1 Diabetes Mellitus
C) Hypertension
D) Hyperlipidemia
E) Gestational Diabetes

B) Type 1 Diabetes Mellitus

Explanation: SGLT2 inhibitors are contraindicated in Type 1 Diabetes Mellitus due to the high risk of ketoacidosis, particularly in carbohydrate-depleted states.

p.12

Lipogenesis and Glucokinase Functions

What is the effect of increased glucose on glucokinase?
A) Allosteric downregulation
B) No effect
C) Allosteric upregulation
D) Inhibition of synthesis
E) Decrease in activity

C) Allosteric upregulation

Explanation: Increased glucose leads to allosteric upregulation of glucokinase, enhancing its activity in the lipogenesis process.

p.39

Pharmacological Treatments for Diabetes

What is the mechanism of action (MOA) of SGLT2 inhibitors like empagliflozin?
A) Inhibition of sodium glucose co-transporter isoform 1
B) Stimulation of glucose reabsorption
C) Inhibition of sodium glucose co-transporter isoform 2
D) Promotion of insulin secretion
E) Increase in renal glucose threshold

C) Inhibition of sodium glucose co-transporter isoform 2

Explanation: SGLT2 inhibitors, such as empagliflozin, work by inhibiting sodium glucose co-transporter isoform 2 (SGLT2) in the proximal convoluted tubule (PCT), preventing glucose reabsorption and promoting glucosuria.

p.53

Diabetes Pathology

What is hyperuricaemia usually due to?
A) Increased uric acid production
B) Dysfunctional excretion
C) Excessive hydration
D) Decreased dietary purines
E) Liver failure

B) Dysfunctional excretion

Explanation: Hyperuricaemia, a condition often associated with gout, is usually due to dysfunctional excretion of uric acid, rather than excessive production.

p.56

Regulation of Fuel Metabolism

How does leptin influence basal metabolic rate (BMR)?
A) Decreases BMR
B) Has no effect on BMR
C) Increases BMR
D) Stabilizes BMR
E) Fluctuates BMR

C) Increases BMR

Explanation: Leptin not only reduces appetite but also increases basal metabolic rate (BMR), contributing to energy expenditure.

p.52

Diabetes Pathology

What are some of the symptoms associated with phenylketonuria?
A) High blood pressure and diabetes
B) Cognitive, behavioral, and neurological deficits
C) Increased appetite and weight gain
D) Skin rashes and respiratory issues
E) Excessive sweating and fever

B) Cognitive, behavioral, and neurological deficits

Explanation: Individuals with phenylketonuria can experience a range of symptoms including cognitive, behavioral, and neurological deficits due to the toxic buildup of phenylalanine and its metabolites.

p.22

Hypoglycemia Management

How often should diabetics monitor their blood glucose on a sick day?
A) Every hour
B) Every 4 hours
C) Every 6 hours
D) Once a day
E) Only when feeling unwell

B) Every 4 hours

Explanation: It is recommended that diabetics monitor their blood glucose every 4 hours during a sick day, as levels can fluctuate significantly.

p.9

Insulin and Glucagon Functions

What role does glucagon play in gluconeogenesis?
A) It inhibits gluconeogenesis
B) It has no effect
C) It increases expression of glucose-6-phosphatase
D) It decreases glucose levels
E) It promotes insulin secretion

C) It increases expression of glucose-6-phosphatase

Explanation: Glucagon increases the expression of glucose-6-phosphatase, promoting gluconeogenesis and increasing glucose availability in the blood.

p.4

Insulin and Glucagon Functions

What is the process of insulin synthesis from its precursor?
A) Preproinsulin → proinsulin → insulin
B) Proinsulin → insulin → glucose
C) Insulin → proinsulin → preproinsulin
D) Glucose → insulin → proinsulin
E) Insulin → glucose → energy

A) Preproinsulin → proinsulin → insulin

Explanation: Insulin is synthesized from its precursor preproinsulin, which is converted to proinsulin before becoming active insulin.

p.11

Lipogenesis and Lipogenesis

What role does AMPK play in lipogenesis?
A) It activates lipogenesis
B) It inhibits lipogenesis
C) It has no effect on lipogenesis
D) It converts fatty acids to glucose
E) It enhances ATP production

B) It inhibits lipogenesis

Explanation: AMPK blocks lipogenesis, and its activity is inhibited by ATP production, highlighting a regulatory mechanism in energy metabolism.

p.47

Pharmacological Treatments for Diabetes

What is a common adverse effect of sulfonylureas?
A) Increased insulin sensitivity
B) Weight loss
C) Risk of hypoglycemia
D) Hyperglycemia
E) Liver toxicity

C) Risk of hypoglycemia

Explanation: One of the common adverse effects of sulfonylureas, particularly in the elderly, is the risk of hypoglycemia, which can be dangerous.

p.53

Diabetes Pathology

What is a common characteristic of gout flares?
A) Osteophyte formation
B) Cardinal signs of inflammation
C) Chronic pain without inflammation
D) Smooth joint surfaces
E) Increased range of motion

B) Cardinal signs of inflammation

Explanation: Acute flares of gout are associated with cardinal signs of inflammation, which include redness, heat, swelling, and pain.

p.6

Insulin and Glucagon Functions

What type of receptor does insulin activate?
A) Ion channel receptor
B) G-protein coupled receptor
C) Tyrosine kinase receptor
D) Nuclear receptor
E) Ligand-gated receptor

C) Tyrosine kinase receptor

Explanation: Insulin activates a tyrosine kinase receptor, which is crucial for its signaling pathway and metabolic effects in target tissues like adipose, liver, and muscle.

p.51

Nitrogen Metabolism and Urea Cycle

Which two sources provide nitrogen/amine groups for the urea cycle?
A) Urea and creatinine
B) NH3 and aspartate
C) Glutamate and alanine
D) Lactate and pyruvate
E) Ammonium and bicarbonate

B) NH3 and aspartate

Explanation: The two sources of nitrogen for the urea cycle are ammonia (NH3) from the breakdown of glutamate and glutamine, and aspartate from the transamination of oxaloacetate and glutamate.

p.37

Pharmacological Treatments for Diabetes

What effect does metformin have on the transcription factor SREBP-1?
A) Increased expression
B) No effect
C) Reduced expression
D) Inhibition of activity
E) Activation of SREBP-1

C) Reduced expression

Explanation: Metformin reduces the expression of the transcription factor SREBP-1, which is associated with lipid metabolism and glucose regulation.

p.41

Pharmacological Treatments for Diabetes

What should be assessed before commencing treatment with SGLT2 inhibitors?
A) Blood glucose levels
B) Renal function
C) Liver function
D) Blood pressure
E) Body mass index

B) Renal function

Explanation: It is crucial to assess renal function before starting treatment with SGLT2 inhibitors and to monitor it regularly during treatment, particularly because of the potential decline in renal function.

p.51

Nitrogen Metabolism and Urea Cycle

What is the primary regulatory point of the urea cycle?
A) Urease enzyme
B) Carbamoyl phosphate synthetase
C) Glutamine synthetase
D) Arginase
E) Aspartate transaminase

B) Carbamoyl phosphate synthetase

Explanation: Carbamoyl phosphate synthetase is a key regulatory enzyme in the urea cycle, which is rapidly activated by N-acetyl-glutamate, a molecule whose concentration is influenced by arginine levels.

p.40

Pharmacological Treatments for Diabetes

In which patient population is empagliflozin not recommended?
A) Patients with mild renal impairment
B) Patients aged 85 years and older
C) Patients with normal renal function
D) Patients with diabetes
E) Patients with hepatic impairment

B) Patients aged 85 years and older

Explanation: Empagliflozin is not recommended for patients aged 85 years and older, highlighting the need for caution in older populations due to potential risks.

p.20

Diabetic Ketoacidosis (DKA)

What is a common complication of T1DM?
A) Ketoacidosis
B) Hypoglycemia
C) Hypertension
D) Hyperlipidemia
E) Peripheral neuropathy

A) Ketoacidosis

Explanation: Diabetic ketoacidosis (DKA) is much more common in T1DM due to the absence of insulin, leading to uninhibited lipolysis and increased ketone production.

p.59

Exercise and Metabolic Adaptations

What happens to hormone sensitivity as a result of regular exercise?
A) It decreases
B) It remains unchanged
C) It increases
D) It fluctuates
E) It becomes irrelevant

C) It increases

Explanation: Regular exercise increases hormone sensitivity, allowing for more effective hormonal responses to metabolic stimuli.

p.21

Diabetic Ketoacidosis (DKA)

What is an important aspect of acute management for Diabetic Ketoacidosis (DKA)?
A) Regular exercise
B) Insulin administration
C) Avoiding fluids
D) High protein diet
E) Skipping meals

B) Insulin administration

Explanation: Insulin administration is a critical component of the acute management for Diabetic Ketoacidosis (DKA), as it helps to lower blood glucose levels and correct the metabolic state.

p.13

Insulin and Glucagon Functions

What is the function of lipoprotein lipase (LPL) in relation to insulin?
A) Decreases FA uptake
B) Inhibits lipogenesis
C) Stimulates cellular FA uptake
D) Converts fatty acids to glucose
E) Increases beta-oxidation

C) Stimulates cellular FA uptake

Explanation: Insulin stimulates lipoprotein lipase (LPL), which facilitates the uptake of fatty acids by cells, promoting fat storage and lipogenesis.

p.41

Pharmacological Treatments for Diabetes

What is a key adverse reaction associated with SGLT2 inhibitors like empagliflozin?
A) Increased heart rate
B) Reduced GFR leading to decline in renal function
C) Increased blood pressure
D) Hypoglycemia
E) Liver damage

B) Reduced GFR leading to decline in renal function

Explanation: One of the notable adverse reactions of SGLT2 inhibitors is a reduction in glomerular filtration rate (GFR), which can lead to a decline in renal function, especially when used with diuretics and ACE inhibitors/ARBs.

p.47

Pharmacological Treatments for Diabetes

What metabolic pathway is involved in the metabolism of sulfonylureas?
A) CYP3A4
B) CYP2C9
C) CYP1A2
D) UGT
E) FMO

B) CYP2C9

Explanation: Sulfonylureas are metabolized by hepatic CYP2C9, and this can lead to interactions with other drugs that are also metabolized by this enzyme.

p.43

Pharmacological Treatments for Diabetes

What is the half-life (t 1/2) of dulaglutide?
A) 2 days
B) 3 days
C) 4.7 days
D) 6 days
E) 1 day

C) 4.7 days

Explanation: The half-life of dulaglutide is approximately 4.7 days, which is significant for determining dosing intervals.

p.20

Diabetes Pathology

What is the primary cause of Type 1 Diabetes Mellitus (T1DM)?
A) Insulin resistance
B) Autoimmune destruction of beta cells
C) High carbohydrate intake
D) Sedentary lifestyle
E) Viral infection

B) Autoimmune destruction of beta cells

Explanation: T1DM is characterized by the autoimmune destruction of pancreatic beta cells, leading to an absence of insulin production.

p.56

Metabolic Syndrome and Insulin Resistance

What is the primary function of leptin secreted by white adipose tissue?
A) Increase appetite
B) Reduce appetite
C) Increase fat storage
D) Decrease metabolism
E) Enhance insulin sensitivity

B) Reduce appetite

Explanation: Leptin, secreted by white adipose tissue, acts on the hypothalamus to reduce appetite, leading to decreased food intake and potential weight loss.

p.42

Insulin and Glucagon Functions

What is the mechanism of action (MOA) of the GLP1 receptor agonist, dulaglutide?
A) Increases glucagon release
B) Binds to GLP1 receptors on beta cells
C) Decreases insulin release
D) Increases gastric emptying
E) Inhibits DPP-IV degradation

B) Binds to GLP1 receptors on beta cells

Explanation: Dulaglutide's MOA involves binding to GLP1 receptors on beta cells, which increases incretin-stimulated insulin release and inhibits glucagon release, thus aiding in glycemic control.

p.5

Insulin and Glucagon Functions

What is the effect of insulin on glycogen synthesis?
A) It inhibits glycogen synthesis
B) It has no effect on glycogen synthesis
C) It promotes glycogen synthesis
D) It only promotes fat storage
E) It converts glycogen to glucose

C) It promotes glycogen synthesis

Explanation: Insulin promotes glycogen synthesis by activating glycogen synthase through dephosphorylation, which is crucial for energy storage in the liver and muscles.

p.54

Diabetes Pathology

Which of the following is NOT a precipitant of gout?
A) Dehydration
B) High purine intake
C) Low sugar intake
D) Alcohol
E) Obesity/overweight

C) Low sugar intake

Explanation: Low sugar intake is not listed as a precipitant of gout; instead, high sugar/fructose intake is noted as a contributing factor.

p.44

Pharmacological Treatments for Diabetes

What is the mechanism of action (MOA) of DPP-IV inhibitors like vildagliptin and sitagliptin?
A) Increase glucagon release
B) Inhibit DPP-IV, prolonging incretin action
C) Decrease insulin sensitivity
D) Increase liver function test indices
E) Decrease postprandial insulin release

B) Inhibit DPP-IV, prolonging incretin action

Explanation: DPP-IV inhibitors work by inhibiting the enzyme DPP-IV, which breaks down incretin hormones. This prolongs the action of incretin hormones (GLP and GIP), leading to increased insulin sensitivity and insulin levels.

p.52

Pharmacological Treatments for Diabetes

What dietary modifications are recommended for managing phenylketonuria?
A) High-protein diet
B) Low protein diet with essential amino acid supplements
C) Vegan diet
D) Ketogenic diet
E) No dietary restrictions

B) Low protein diet with essential amino acid supplements

Explanation: Management of phenylketonuria typically involves dietary modifications that include a low protein diet and supplementation with essential amino acids to prevent toxic buildup of phenylalanine.

p.56

Diabetes Pathology

What is a rare cause of obesity related to leptin?
A) Leptin overload
B) Leptin resistance
C) Leptin deficiency
D) Leptin receptor mutation
E) Leptin insensitivity

C) Leptin deficiency

Explanation: Leptin deficiency is a rare condition that can lead to monogenic obesity, indicating a direct link between leptin levels and obesity.

p.17

Metabolic Syndrome and Insulin Resistance

What is a consequence of lipotoxicity in obesity?
A) Enhanced oxidative pathways
B) Increased insulin receptor synthesis
C) Toxic oxidative intermediates
D) Reduced stress hormone levels
E) Improved gluconeogenesis

C) Toxic oxidative intermediates

Explanation: Lipotoxicity in obesity overwhelms oxidative pathways, leading to the accumulation of toxic oxidative intermediates, which can disrupt normal cellular functions and contribute to insulin resistance.

p.15

Diabetic Ketoacidosis (DKA)

What can excessive levels of ketones in the body lead to?
A) Ketosis
B) Ketonemia
C) Ketoacidosis
D) Hypoglycemia
E) Hyperglycemia

C) Ketoacidosis

Explanation: When ketone levels become excessive (ketonemia), they can overwhelm the body's oxidative abilities and pH buffering systems, leading to a condition known as ketoacidosis.

p.39

Pharmacological Treatments for Diabetes

What is a contraindication for using empagliflozin?
A) Mild renal impairment
B) Pregnancy
C) Severe renal impairment (eGFR<15 mL/min/1.73m²)
D) Overweight patients
E) Patients on atorvastatin

C) Severe renal impairment (eGFR<15 mL/min/1.73m²)

Explanation: Empagliflozin is contraindicated in patients with severe renal impairment, as indicated by an estimated glomerular filtration rate (eGFR) of less than 15 mL/min/1.73m².

p.58

Exercise and Metabolic Adaptations

What is the 'training effect' on fat metabolism attributed to?
A) High insulin levels
B) Increased carbohydrate intake
C) Low insulin levels
D) Decreased exercise duration
E) Increased anaerobic metabolism

C) Low insulin levels

Explanation: The 'training effect' on fat metabolism is primarily due to low insulin levels, which facilitates the utilization of fat as a fuel source during prolonged exercise.

p.37

Pharmacological Treatments for Diabetes

Which class of drugs is recommended for cardiovascular disease (CVD) risks in diabetes management?
A) DPP-IV inhibitors
B) SGLT2 inhibitors
C) Biguanides
D) Sulfonylureas
E) GLP-1 receptor agonists

B) SGLT2 inhibitors

Explanation: SGLT2 inhibitors are recommended for patients with diabetes who have cardiovascular disease risks, as they have shown to provide cardiovascular benefits.

p.52

Nitrogen Metabolism and Urea Cycle

What is the genetic inheritance pattern of phenylketonuria (PKU)?
A) Autosomal dominant
B) X-linked recessive
C) Mitochondrial inheritance
D) Autosomal recessive
E) Polygenic inheritance

D) Autosomal recessive

Explanation: Phenylketonuria (PKU) is inherited in an autosomal recessive manner, meaning that two copies of the mutated gene (one from each parent) are necessary for the disorder to manifest.

p.47

Insulin and Glucagon Functions

What effect do sulfonylureas have on somatostatin secretion?
A) They inhibit somatostatin secretion
B) They have no effect on somatostatin
C) They induce somatostatin secretion
D) They decrease insulin secretion
E) They increase glucagon secretion

C) They induce somatostatin secretion

Explanation: Sulfonylureas induce somatostatin secretion, which leads to inhibition of glucagon, complementing their insulin-secreting effect.

p.43

Pharmacological Treatments for Diabetes

Which condition is an exception for the renal and hepatic impairment contraindication for dulaglutide?
A) Mild renal impairment
B) Severe hepatic impairment
C) End-stage renal disease requiring dialysis
D) Moderate hepatic impairment
E) None of the above

C) End-stage renal disease requiring dialysis

Explanation: Dulaglutide is generally unaffected by renal and hepatic impairment, except in cases of end-stage renal disease requiring dialysis.

p.12

Insulin and Glucagon Functions

How does insulin affect glucokinase synthesis?
A) Decreases synthesis
B) No effect
C) Increases synthesis
D) Inhibits activity
E) Decreases activity

C) Increases synthesis

Explanation: Insulin promotes the synthesis of glucokinase, which is crucial for lipogenesis, indicating its role in metabolic regulation.

p.42

Pharmacological Treatments for Diabetes

What is one of the benefits of using dulaglutide in diabetes management?
A) It increases blood glucose levels
B) It promotes weight loss
C) It is effective in Type 1 Diabetes Mellitus
D) It decreases satiety
E) It has no effect on gastric emptying

B) It promotes weight loss

Explanation: The text notes that dulaglutide promotes weight loss, making it a beneficial option for patients with T2DM who may also be struggling with obesity.

p.56

Metabolic Syndrome and Insulin Resistance

What condition is characterized by increased levels of leptin leading to resistance?
A) Leptin deficiency
B) Leptin sensitivity
C) Leptin resistance
D) Leptin overload
E) Leptin imbalance

C) Leptin resistance

Explanation: Obesity is associated with increased adipose tissue, which leads to higher leptin levels and the phenomenon known as 'leptin resistance', where the body's response to leptin is diminished.

p.53

Diabetes Pathology

What can trigger gout flares?
A) Cold weather
B) Crystal deposition
C) High altitude
D) Excessive exercise
E) Lifestyle-related factors

E) Lifestyle-related factors

Explanation: Gout flares can be triggered by a combination of crystal deposition and lifestyle-related factors, suggesting that lifestyle plays a role in managing the condition.

p.6

Insulin and Glucagon Functions

Which of the following stimulates glucagon secretion?
A) High glucose levels
B) Insulin
C) Anoxia
D) Somatostatin
E) Growth hormone

C) Anoxia

Explanation: Glucagon secretion is stimulated by low glucose levels, anoxia, and adrenaline, indicating its role in countering low energy states.

p.12

Insulin and Glucagon Functions

What is the overall effect of insulin on lipogenesis?
A) Decreases fatty acid synthesis
B) Promotes fatty acid synthesis
C) Inhibits glucose uptake
D) Reduces acetyl-CoA production
E) Increases gluconeogenesis

B) Promotes fatty acid synthesis

Explanation: Insulin enhances the synthesis of key enzymes involved in lipogenesis, thereby promoting fatty acid synthesis and overall lipid metabolism.

p.22

Pharmacological Treatments for Diabetes

Which medication should be avoided in diabetics with nephropathy or those taking ACEi/ARB?
A) Insulin
B) Metformin
C) NSAIDs
D) Sulfonylureas
E) GLP-1 agonists

C) NSAIDs

Explanation: Diabetics with nephropathy or those taking ACE inhibitors or ARBs should avoid NSAIDs due to the risk of renal complications.

p.59

Exercise and Metabolic Adaptations

What does EPOC stand for in the context of exercise recovery?
A) Excessive Post-Exercise Oxygen Consumption
B) Excess Post-Exercise Oxygen Consumption
C) Enhanced Post-Exercise Oxygen Consumption
D) Essential Post-Exercise Oxygen Consumption
E) Extended Post-Exercise Oxygen Consumption

B) Excess Post-Exercise Oxygen Consumption

Explanation: EPOC refers to Excess Post-Exercise Oxygen Consumption, which is the amount of oxygen the body consumes after exercise to restore itself to pre-exercise levels.

p.19

Diabetes Pathology

What is one of the diagnostic criteria for diabetes mellitus?
A) Fasting glucose < 5.0 mmol/L
B) Random glucose > 11.1 mmol/L
C) HbA1c < 40 mmol/mol
D) Glucose Tolerance Test (GTT) < 7.0 mmol/L
E) Fasting glucose = 6.0 mmol/L

B) Random glucose > 11.1 mmol/L

Explanation: A random glucose level greater than 11.1 mmol/L is one of the criteria used to diagnose diabetes mellitus, indicating poor glucose regulation.

p.40

Pharmacological Treatments for Diabetes

What is the primary metabolic pathway for empagliflozin?
A) Oxidation
B) Hydrolysis
C) Glucuronidation
D) Methylation
E) Acetylation

C) Glucuronidation

Explanation: The primary metabolic pathway for empagliflozin is glucuronidation, which is important for its metabolism and clearance from the body.

p.27

Hypoglycemia Management

What role does NADPH play in the body?
A) It is a primary energy source
B) It is involved in oxidative damage prevention
C) It promotes blood clotting
D) It facilitates muscle contraction
E) It aids in oxygen transport

B) It is involved in oxidative damage prevention

Explanation: NADPH is a crucial cofactor in various biochemical reactions, particularly in the prevention of oxidative damage by acting as a reducing agent.

p.4

Insulin and Glucagon Functions

How is insulin cleared from the body?
A) Only through renal filtration
B) Only by hepatic metabolism
C) Albumin-bound insulin is cleared by cellular receptor trafficking; free insulin is cleared by renal filtration and hepatic metabolism
D) Only through muscle metabolism
E) By digestion in the stomach

C) Albumin-bound insulin is cleared by cellular receptor trafficking; free insulin is cleared by renal filtration and hepatic metabolism

Explanation: Insulin clearance involves both cellular receptor trafficking for albumin-bound insulin and renal filtration or hepatic metabolism for free insulin.

p.58

Exercise and Metabolic Adaptations

What is the relationship between VO2max and endurance capacity?
A) No correlation
B) Positive correlation
C) Negative correlation
D) Inverse correlation
E) Variable correlation

B) Positive correlation

Explanation: There is a positive correlation between VO2max and endurance capacity, indicating that higher maximal oxygen uptake is associated with better endurance performance.

p.37

Pharmacological Treatments for Diabetes

What occurs as a result of AMPK activation by metformin?
A) Increased ATP production
B) Decreased GLUT4 uptake
C) Increased fatty acid oxidation
D) Decreased glucose utilization
E) Reduced insulin sensitivity

C) Increased fatty acid oxidation

Explanation: Activation of AMPK by metformin leads to increased fatty acid oxidation, among other metabolic benefits, which helps improve insulin sensitivity and glucose control.

p.59

Exercise and Metabolic Adaptations

How do cardiorespiratory changes from exercise affect the body?
A) They decrease oxygen delivery
B) They enhance blood flow and oxygen delivery
C) They have no effect on blood flow
D) They lower heart rate and blood pressure
E) They increase resting heart rate

B) They enhance blood flow and oxygen delivery

Explanation: Cardiorespiratory changes from exercise enhance blood flow and oxygen delivery, which improves overall cardiovascular efficiency.

p.45

Pharmacological Treatments for Diabetes

What is a common adverse reaction associated with DPP-IV inhibitors?
A) Hypoglycemia
B) Respiratory tract infections
C) Weight gain
D) Nausea
E) Liver toxicity

B) Respiratory tract infections

Explanation: Respiratory tract infections are listed as a common adverse reaction to DPP-IV inhibitors, indicating potential side effects when using these medications.

p.40

Pharmacological Treatments for Diabetes

What are common adverse reactions associated with empagliflozin?
A) Nausea and vomiting
B) UTIs and genital mycotic infections
C) Hypertension
D) Weight gain
E) Liver dysfunction

B) UTIs and genital mycotic infections

Explanation: Common adverse reactions to empagliflozin include urinary tract infections (UTIs) and genital mycotic infections, necessitating patient education on hygiene and signs of infection.

p.20

Diabetes Pathology

Which of the following is a characteristic of Type 2 Diabetes Mellitus (T2DM)?
A) Autoimmune destruction of beta cells
B) Childhood onset more common
C) Insulin resistance and impaired insulin secretion
D) Ketoacidosis is always present
E) No genetic component

C) Insulin resistance and impaired insulin secretion

Explanation: T2DM is characterized by insulin resistance and impaired insulin secretion, often associated with obesity and other cardiovascular risk factors.

p.43

Pharmacological Treatments for Diabetes

Which of the following is a contraindication for using dulaglutide?
A) Mild hypertension
B) Severe renal impairment
C) Type 2 Diabetes Mellitus
D) Mild asthma
E) None of the above

B) Severe renal impairment

Explanation: Severe renal or hepatic impairment is a contraindication for the use of dulaglutide, highlighting the need for careful patient assessment before prescribing.

p.54

Pharmacological Treatments for Diabetes

What genetic association is noted with severe cutaneous adverse reactions (SCAR) in gout treatment?
A) HLA-B5801
B) HLA-A0201
C) HLA-DRB1
D) HLA-C*0602
E) HLA-DQB1

A) HLA-B*5801

Explanation: Severe cutaneous adverse reactions (SCAR) associated with gout treatment have been linked to the HLA-B*5801 allele, particularly in patients of Southeast Asian or African American descent.

p.38

Pharmacokinetics

What is the half-life (t 1/2) of metformin?
A) 1-2 hours
B) 2-4 hours
C) 4-6 hours
D) 6-8 hours
E) 8-10 hours

C) 4-6 hours

Explanation: The half-life of metformin is approximately 4-6 hours, indicating how long it remains active in the body before being cleared.

p.10

Insulin and Glucagon Functions

What effect does glucagon have on PFK-2?
A) It activates PFK-2
B) It inhibits PFK-2
C) It has no effect on PFK-2
D) It promotes glycolysis
E) It increases Fru-2,6-BP

B) It inhibits PFK-2

Explanation: Glucagon, via PKA, inhibits PFK-2, which decreases the levels of Fru-2,6-BP, leading to reduced inhibition of Fru-1,6-BPase and decreased stimulation of PFK-1, promoting gluconeogenesis.

p.52

Nitrogen Metabolism and Urea Cycle

What is the primary enzyme affected in phenylketonuria?
A) Tyrosinase
B) Phenylalanine hydroxylase (PAH)
C) Dipeptidase
D) Glutamate dehydrogenase
E) Arginase

B) Phenylalanine hydroxylase (PAH)

Explanation: The disorder is caused by a deficiency in the enzyme phenylalanine hydroxylase (PAH), which is responsible for converting phenylalanine (Phe) to tyrosine (Tyr).

p.19

Diabetic Ketoacidosis (DKA)

What condition can ketosis progress to if not managed?
A) Hypertension
B) Diabetic ketoacidosis (DKA)
C) Hyperthyroidism
D) Hypoglycemia
E) Heart failure

B) Diabetic ketoacidosis (DKA)

Explanation: Ketosis can progress to diabetic ketoacidosis (DKA), a serious condition characterized by symptoms like thirst, frequent urination, fatigue, and blurred vision.

p.43

Pharmacological Treatments for Diabetes

What is one of the common adverse reactions associated with dulaglutide?
A) Headache
B) GI discomfort
C) Insomnia
D) Rash
E) Vision changes

B) GI discomfort

Explanation: Common adverse reactions to dulaglutide include gastrointestinal discomfort, nausea, and diarrhea, which are important for patient management.

p.12

Lipogenesis and Glucokinase Functions

Which enzymes' synthesis is increased by insulin to promote lipogenesis?
A) Glucokinase and lactate dehydrogenase
B) PK and PDH
C) Glucokinase and pyruvate carboxylase
D) Citrate lyase and hexokinase
E) PK and hexokinase

B) PK and PDH

Explanation: Insulin increases the synthesis of pyruvate kinase (PK) and pyruvate dehydrogenase (PDH), which promotes acetyl-CoA production, an important step in lipogenesis.

p.43

Pharmacological Treatments for Diabetes

In which type of diabetes does dulaglutide have no therapeutic value?
A) Type 2 Diabetes Mellitus
B) Gestational Diabetes
C) Type 1 Diabetes Mellitus
D) Prediabetes
E) Maturity-Onset Diabetes of the Young

C) Type 1 Diabetes Mellitus

Explanation: Dulaglutide has no value in treating Type 1 Diabetes Mellitus, making it essential to identify suitable treatment options for patients with this condition.

p.44

Insulin and Glucagon Functions

What effect do DPP-IV inhibitors have on postprandial insulin and glucagon levels?
A) Increase glucagon release and decrease insulin release
B) No effect on insulin or glucagon levels
C) Decrease postprandial insulin release and increase glucagon release
D) Increase postprandial insulin release and reduce glucagon release
E) Decrease both insulin and glucagon levels

D) Increase postprandial insulin release and reduce glucagon release

Explanation: DPP-IV inhibitors increase postprandial insulin release while reducing glucagon release, which helps in managing blood sugar levels after meals.

p.54

Pharmacological Treatments for Diabetes

What is the first-line treatment for urate lowering therapy in gout?
A) Colchicine
B) NSAIDs
C) Low-dose allopurinol
D) Corticosteroids
E) Xanthine oxidase inhibitors

C) Low-dose allopurinol

Explanation: Allopurinol is the first-line treatment for urate lowering therapy, and it should be initiated at a low dose to manage gout effectively.

p.52

Pharmacological Treatments for Diabetes

What is the role of tetrahydrobiopterin in the treatment of phenylketonuria?
A) It increases dietary protein intake
B) It stabilizes the native structure of some mutant forms of PAH
C) It acts as a laxative
D) It enhances muscle growth
E) It reduces blood sugar levels

B) It stabilizes the native structure of some mutant forms of PAH

Explanation: Tetrahydrobiopterin supplementation is used to stabilize certain mutant forms of phenylalanine hydroxylase (PAH), which can help improve enzyme function in some patients with phenylketonuria.

p.44

Pharmacological Treatments for Diabetes

What is a key pharmacokinetic feature of DPP-IV inhibitors regarding absorption?
A) Poor oral absorption
B) Good oral absorption, slightly reduced with food
C) Immediate absorption regardless of food
D) Absorption only through injection
E) Absorption is not affected by liver function

B) Good oral absorption, slightly reduced with food

Explanation: DPP-IV inhibitors have good oral absorption, although it is slightly reduced when taken with food, which is an important consideration for dosing.

p.26

Diabetes Pathology

Which of the following is NOT a consequence of glycation and cross-linking of ECM proteins?
A) Pro-inflammatory effects
B) Pro-oxidative effects
C) Decreased vascular smooth muscle proliferation
D) Procoagulant effects
E) BM thickening

C) Decreased vascular smooth muscle proliferation

Explanation: Glycation and cross-linking of ECM proteins lead to pro-inflammatory, pro-oxidative, procoagulant effects, and BM thickening, but do not decrease vascular smooth muscle proliferation.

p.33

Diabetes Pathology

What is a potential complication of neuropathy that affects sexual function?
A) Erectile dysfunction
B) Impotence
C) Infertility
D) Decreased libido
E) Premature ejaculation

A) Erectile dysfunction

Explanation: Erectile dysfunction is a potential complication of neuropathy, as nerve damage can affect sexual function.

p.6

Insulin and Glucagon Functions

Which hormone is released by pancreatic islet alpha cells?
A) Insulin
B) Glucagon
C) Somatostatin
D) Cortisol
E) Adrenaline

B) Glucagon

Explanation: Glucagon is a peptide hormone released by pancreatic islet alpha cells, playing a key role in increasing blood glucose levels, particularly in response to low glucose levels.

p.27

Insulin and Glucagon Functions

What is a characteristic of insulin-independent tissues?
A) They require insulin for glucose uptake
B) They can utilize glucose without insulin
C) They are exclusively found in the pancreas
D) They do not metabolize glucose
E) They are resistant to all hormones

B) They can utilize glucose without insulin

Explanation: Insulin-independent tissues, such as certain muscle and brain tissues, can take up and utilize glucose without the need for insulin, especially in the presence of excess glucose.

p.10

Gluconeogenesis and Lipogenesis

Which enzyme's expression is increased by glucagon to promote gluconeogenesis?
A) PFK-1
B) PK
C) PEPCK
D) PDH
E) PFK-2

C) PEPCK

Explanation: Glucagon increases the expression of PEPCK (phosphoenolpyruvate carboxykinase), which is essential for promoting gluconeogenesis.

p.41

Pharmacological Treatments for Diabetes

What is a potential benefit of SGLT2 inhibitors in patients with Type 2 Diabetes Mellitus?
A) Increased hypoglycemic risk
B) Diuresis
C) Weight gain
D) Insulin dependence
E) Liver toxicity

B) Diuresis

Explanation: SGLT2 inhibitors, such as empagliflozin, promote diuresis, which can be beneficial in managing fluid retention and contributes to weight loss in patients with Type 2 Diabetes Mellitus.

p.5

Insulin and Glucagon Functions

What is the role of insulin in protein synthesis?
A) It inhibits protein synthesis
B) It has no role in protein synthesis
C) It promotes amino acid uptake, leading to protein synthesis
D) It converts proteins to glucose
E) It breaks down proteins

C) It promotes amino acid uptake, leading to protein synthesis

Explanation: Insulin facilitates the uptake of amino acids into cells, promoting protein synthesis, which is essential for growth and repair.

p.54

Diabetes Pathology

What is considered the gold standard for diagnosing gout?
A) Blood urate levels
B) Presence of monosodium urate crystals in synovial fluid
C) Imaging studies
D) Patient symptoms
E) Family history of gout

B) Presence of monosodium urate crystals in synovial fluid

Explanation: The gold standard for diagnosing gout is the identification of monosodium urate crystals in synovial fluid during a flare.

p.10

Gluconeogenesis and Lipogenesis

What is the relationship between Acetyl CoA and gluconeogenesis during fasting?
A) Acetyl CoA inhibits gluconeogenesis
B) Acetyl CoA activates PDH
C) Acetyl CoA activates PC and inhibits PDH
D) Acetyl CoA has no effect on gluconeogenesis
E) Acetyl CoA promotes glycolysis

C) Acetyl CoA activates PC and inhibits PDH

Explanation: During fasting, Acetyl CoA produced from glycolysis and beta-oxidation inhibits PDH and activates pyruvate carboxylase (PC), thus promoting gluconeogenesis.

p.56

Diabetes Pathology

What genetic factors are suggested to influence obesity?
A) Thrifty genes
B) Lean genes
C) Active genes
D) Fast metabolism genes
E) Growth genes

A) Thrifty genes

Explanation: 'Thrifty genes' are genetic links that predispose individuals to increased energy storage, providing a survival advantage during times of food scarcity, which can contribute to obesity.

p.26

Regulation of Fuel Metabolism

What role does VEGF play in vascular health?
A) It promotes LDL trapping
B) It inhibits neutrophil functions
C) It stimulates angiogenesis
D) It causes BM thickening
E) It reduces protein synthesis

C) It stimulates angiogenesis

Explanation: Vascular Endothelial Growth Factor (VEGF) is crucial for promoting angiogenesis, which is the formation of new blood vessels.

p.38

Pharmacokinetics

How is metformin primarily excreted from the body?
A) Hepatic metabolism
B) Renal clearance via OCT-1 and OCT-2
C) Bile secretion
D) Sweating
E) Fecal excretion

B) Renal clearance via OCT-1 and OCT-2

Explanation: Metformin is primarily excreted unchanged through renal clearance, utilizing organic cation transporters (OCT-1 and OCT-2) in the proximal convoluted tubule (PCT).

p.38

Pharmacokinetics

What rare but serious condition can occur with high doses of metformin?
A) Hypoglycemia
B) Lactic acidosis
C) Renal failure
D) Hyperkalemia
E) Anemia

B) Lactic acidosis

Explanation: Lactic acidosis is a rare but serious adverse reaction that can occur with high doses of metformin, especially in cases of renal impairment or other contraindications.

p.10

Gluconeogenesis and Lipogenesis

What is the effect of fasting on gluconeogenesis?
A) It inhibits gluconeogenesis
B) It has no effect on gluconeogenesis
C) It promotes gluconeogenesis
D) It promotes glycolysis
E) It converts glucose to glycogen

C) It promotes gluconeogenesis

Explanation: Fasting conditions promote gluconeogenesis, as the body relies on this process to generate glucose from non-carbohydrate sources when glucose levels are low.

p.52

Nitrogen Metabolism and Urea Cycle

Which of the following is a common physical characteristic of individuals with phenylketonuria?
A) Dark skin and hair
B) Musty odor
C) Overly tall stature
D) Blue eyes
E) Increased muscle mass

B) Musty odor

Explanation: A characteristic symptom of phenylketonuria is a musty odor in the breath and urine, often attributed to the accumulation of phenylalanine.

p.56

Obesity

What is one of the negative regulators of leptin mentioned in the content?
A) Insulin
B) SOCS-3
C) Ghrelin
D) Cortisol
E) Adiponectin

B) SOCS-3

Explanation: Increased leptin levels can lead to the upregulation of negative regulators such as SOCS-3, which can impair leptin signaling.

p.45

Insulin and Glucagon Functions

What does a basal-bolus regimen consist of?
A) Only long-acting insulin
B) Only short-acting insulin
C) Long-acting insulin for background levels and short-acting insulin for meals
D) Oral medications only
E) Insulin pumps only

C) Long-acting insulin for background levels and short-acting insulin for meals

Explanation: A basal-bolus regimen includes long-acting insulin to maintain background insulin levels and short-acting insulin to manage postprandial glucose levels.

p.26

Regulation of Fuel Metabolism

Which type of collagen is primarily found in vascular basement membranes?
A) Collagen type I
B) Collagen type II
C) Collagen type III
D) Collagen type IV
E) Collagen type V

D) Collagen type IV

Explanation: Collagen type IV is specifically associated with vascular basement membranes, playing a crucial role in maintaining vascular integrity.

p.45

Insulin and Glucagon Functions

Where can insulin be administered subcutaneously?
A) Only in the abdomen
B) Only in the thighs
C) Buttocks, arms, thighs, abdomen
D) Only in the arms
E) Only in the hands

C) Buttocks, arms, thighs, abdomen

Explanation: Insulin can be administered subcutaneously in various sites including the buttocks, arms, thighs, and abdomen, allowing for flexibility in administration.

p.44

Diabetes Pathology

What is the clinical significance of DPP-IV inhibitors in Type 1 Diabetes Mellitus (T1DM)?
A) They are first-line treatment options
B) They have no value in T1DM
C) They are used to replace insulin
D) They are effective for weight loss
E) They are used as monotherapy

B) They have no value in T1DM

Explanation: DPP-IV inhibitors are not effective in treating Type 1 Diabetes Mellitus, as they primarily enhance insulin secretion in response to glucose, which is not applicable in T1DM.

p.33

Diabetes Pathology

What symptom involves abnormal sensations such as tingling or pins-and-needles?
A) Dysesthesia
B) Numbness
C) Loss of pain
D) Postural hypotension
E) Erectile dysfunction

A) Dysesthesia

Explanation: Dysesthesia refers to abnormal sensations, which can include tingling or pins-and-needles feelings, commonly experienced in neuropathy.

p.6

Insulin and Glucagon Functions

What effect does insulin have on glycogen phosphorylase?
A) Activation
B) Deactivation
C) No effect
D) Inhibition of lipolysis
E) Stimulation of ketogenesis

B) Deactivation

Explanation: Insulin promotes the dephosphorylation of glycogen phosphorylase, leading to its inactive form, which inhibits gluconeogenesis and promotes glycogen storage.

p.40

Pharmacological Treatments for Diabetes

What should patients do to prevent dehydration while taking empagliflozin?
A) Limit fluid intake
B) Drink plenty of fluids
C) Avoid water
D) Increase caffeine consumption
E) Eat more salt

B) Drink plenty of fluids

Explanation: Patients taking empagliflozin are advised to drink plenty of fluids to prevent dehydration, which is a potential side effect of the medication.

p.44

Pharmacological Treatments for Diabetes

What is the recommended dosage for DPP-IV inhibitors like vildagliptin and sitagliptin?
A) 10 mg once a day
B) 50 mg 1-2 times a day
C) 100 mg twice a day
D) 200 mg once a day
E) 25 mg three times a day

B) 50 mg 1-2 times a day

Explanation: The recommended dosage for DPP-IV inhibitors is 50 mg taken 1-2 times a day, with or without food, which allows for flexibility in administration.

p.6

Insulin and Glucagon Functions

What is the primary effect of glucagon compared to insulin?
A) Both promote glycogen storage
B) Glucagon decreases blood glucose, insulin increases it
C) Glucagon increases blood glucose, insulin decreases it
D) Both have no effect on blood glucose levels
E) Glucagon promotes lipogenesis, insulin promotes lipolysis

C) Glucagon increases blood glucose, insulin decreases it

Explanation: The effects of glucagon are opposite to those of insulin; glucagon increases blood glucose levels while insulin lowers them.

p.26

Metabolic Syndrome and Insulin Resistance

What is a consequence of increased protein synthesis relative to protein degradation in blood vessels?
A) Decreased vessel stiffness
B) Stiffer vessels and endothelial injury
C) Enhanced LDL clearance
D) Reduced atherosclerosis risk
E) Improved neutrophil functions

B) Stiffer vessels and endothelial injury

Explanation: An increase in protein synthesis compared to degradation leads to stiffer vessels, which can result in endothelial injury and other vascular complications.

p.26

Metabolic Syndrome and Insulin Resistance

What effect does collagen type I have on large vessel walls?
A) It decreases stiffness
B) It promotes vessel elasticity
C) It traps albumin in capillaries
D) It contributes to vessel stiffness
E) It inhibits ECM synthesis

D) It contributes to vessel stiffness

Explanation: Collagen type I is found in large vessel walls and contributes to increased stiffness, which can have detrimental effects on vascular function.

p.41

Diabetic Ketoacidosis (DKA)

What is a significant risk factor for SGLT2 inhibitor-induced euglycemic ketoacidosis?
A) High carbohydrate intake
B) Excessive exercise
C) Volume depletion and reduced serum glucose
D) Increased insulin production
E) Low blood pressure

C) Volume depletion and reduced serum glucose

Explanation: The combination of volume depletion and reduced serum glucose increases the glucagon/insulin ratio, leading to increased lipolysis and more acetyl-CoA production for ketogenesis, which can result in euglycemic ketoacidosis.

p.26

Metabolic Syndrome and Insulin Resistance

What is the effect of glycation and cross-linking of ECM proteins on blood vessels?
A) It leads to increased elasticity
B) It results in leaky vessels
C) It reduces protein synthesis
D) It prevents endothelial injury
E) It decreases LDL trapping in vessels

B) It results in leaky vessels

Explanation: Glycation and cross-linking of extracellular matrix (ECM) proteins contribute to the formation of leaky blood vessels, which can lead to various vascular complications.

p.20

Diabetic Ketoacidosis (DKA)

What metabolic process is inhibited in T2DM, leading to reduced ketogenesis?
A) Lipolysis
B) Beta-oxidation
C) Gluconeogenesis
D) Lipogenesis
E) Glycolysis

B) Beta-oxidation

Explanation: In T2DM, insulin still stimulates acetyl-CoA carboxylase (ACC), leading to increased malonyl-CoA, which inhibits carnitine palmitoyltransferase 1 (CPT1) and thus inhibits beta-oxidation, reducing the availability of acetyl-CoA for ketogenesis.

p.44

Diabetes Pathology

In which condition should DPP-IV inhibitors be avoided?
A) Mild renal impairment
B) Severe heart failure with raised liver function test indices
C) Type 2 Diabetes Mellitus
D) Type 1 Diabetes Mellitus
E) Obesity

B) Severe heart failure with raised liver function test indices

Explanation: DPP-IV inhibitors should be avoided in patients with severe heart failure and raised liver function test indices, as these conditions may be exacerbated by the medication.

p.38

Pharmacokinetics

What is the primary mechanism of absorption for metformin in the body?
A) Via plasma protein binding
B) Through organic cation transporter 1 (OCT-1)
C) By passive diffusion
D) Through active transport via OCT-2
E) Via the lymphatic system

B) Through organic cation transporter 1 (OCT-1)

Explanation: Metformin is absorbed primarily through hepatocytes and skeletal muscle via the organic cation transporter 1 (OCT-1), which facilitates its entry into the portal circulation, although food slightly delays this process.

p.22

Diabetic Ketoacidosis (DKA)

What should a diabetic do if their blood glucose level exceeds 15 mmol/L?
A) Ignore it
B) Check ketones
C) Increase insulin dosage
D) Eat more carbs
E) Drink less fluid

B) Check ketones

Explanation: If blood glucose levels exceed 15 mmol/L, diabetics should perform a ketone check to assess for diabetic ketoacidosis (DKA).

p.33

Diabetes Pathology

Which of the following disturbances can neuropathy cause?
A) Enhanced appetite
B) Disturbances in bladder and bowel function
C) Increased muscle strength
D) Heightened reflexes
E) Improved coordination

B) Disturbances in bladder and bowel function

Explanation: Neuropathy can lead to disturbances in bladder and bowel function due to nerve damage affecting the autonomic nervous system.

p.12

Lipogenesis and Glucokinase Functions

What role does citrate lyase play in lipogenesis?
A) Converts glucose to glycogen
B) Produces acetyl-CoA from citric acid cycle
C) Breaks down fatty acids
D) Converts pyruvate to lactate
E) Inhibits glucokinase activity

B) Produces acetyl-CoA from citric acid cycle

Explanation: Citrate lyase, which is synthesized in response to insulin, plays a crucial role in producing acetyl-CoA from the citric acid cycle, facilitating lipogenesis.

p.59

Exercise and Metabolic Adaptations

What is the effect of exercise on GLUT4 transporters?
A) Fewer GLUT4 transporters for a given stimulus
B) More GLUT4 transporters for a given stimulus
C) No change in GLUT4 transporters
D) GLUT4 transporters become inactive
E) GLUT4 transporters are destroyed

B) More GLUT4 transporters for a given stimulus

Explanation: Exercise leads to an increase in the number of GLUT4 transporters, enhancing glucose uptake in response to contraction and insulin.

p.54

Pharmacological Treatments for Diabetes

When is allopurinol recommended for the first flare of gout?
A) For any flare
B) Only if kidney stones are present
C) In all cases of hyperuricaemia
D) For flares without symptoms
E) Only if the patient is underweight

B) Only if kidney stones are present

Explanation: Allopurinol is recommended for the first flare of gout only if there are kidney stones, chronic kidney disease stage > 3, or severe hyperuricaemia.

p.45

Insulin and Glucagon Functions

What is a limitation of subcutaneous insulin injections?
A) They mimic the rapid rise and fall of endogenous insulin
B) They are the only method of insulin delivery
C) They do not mimic the rapid rise and fall of endogenous insulin
D) They are not effective in Type 2 Diabetes
E) They require oral administration

C) They do not mimic the rapid rise and fall of endogenous insulin

Explanation: Subcutaneous injections do not replicate the rapid changes in insulin levels that occur naturally in response to glucose, which can affect blood glucose control.

p.33

Diabetes Pathology

Which of the following is NOT a symptom associated with neuropathy?
A) Loss of pain
B) Numbness
C) Increased sensitivity to touch
D) Paresthesia
E) Dysesthesia

C) Increased sensitivity to touch

Explanation: Neuropathy is characterized by symptoms such as loss of pain, numbness, paresthesia, and dysesthesia, but increased sensitivity to touch is not typically associated.

p.38

Pharmacokinetics

Which of the following is a common adverse reaction associated with metformin?
A) Hypertension
B) GI discomfort, nausea, diarrhoea
C) Liver toxicity
D) Heart failure
E) Weight gain

B) GI discomfort, nausea, diarrhoea

Explanation: Common adverse reactions of metformin include gastrointestinal discomfort, nausea, and diarrhoea, which can be exacerbated by taking the medication without food.

p.22

Diabetic Ketoacidosis (DKA)

What type of monitoring is often required for diabetics in intensive care?
A) Only blood glucose
B) Frequent labs including pH, glucose, and electrolytes
C) Just vital signs
D) Daily weight checks
E) Weekly blood tests

B) Frequent labs including pH, glucose, and electrolytes

Explanation: Close monitoring in intensive care units often includes frequent laboratory tests for pH, glucose, and electrolytes to manage the patient's condition effectively.

p.56

Obesity

What is the relationship between childhood obesity and adult obesity?
A) Childhood obesity has no impact on adult obesity
B) All obese children become obese adults
C) Childhood obesity increases the likelihood of adult obesity
D) Adult obesity prevents childhood obesity
E) Childhood obesity is irrelevant to adult health

C) Childhood obesity increases the likelihood of adult obesity

Explanation: Childhood obesity is associated with an increased likelihood of adult obesity, although not all obese adults were obese as children.

p.33

Diabetes Pathology

What is characterized by a 'glove-and-stocking' distribution of sensory symptoms?
A) Osteoarthritis
B) Neuropathy
C) Rheumatoid arthritis
D) Fibromyalgia
E) Gout

B) Neuropathy

Explanation: The 'glove-and-stocking' distribution refers to the pattern of sensory symptoms commonly seen in neuropathy, where symptoms are experienced in the hands and feet.

p.38

Pharmacokinetics

What should be done in cases of renal impairment for patients taking metformin?
A) Increase dosage
B) Maintain the same dosage
C) Reduce dosage if GFR > 30 mL/min
D) Stop the medication entirely
E) Switch to a different medication

C) Reduce dosage if GFR > 30 mL/min

Explanation: In patients with renal impairment, it is important to reduce the dosage of metformin if the glomerular filtration rate (GFR) is greater than 30 mL/min to prevent potential complications.

p.22

Diabetic Ketoacidosis (DKA)

What is the primary treatment for correcting insulin deficit during a diabetic emergency?
A) Oral antidiabetics
B) IV fluids
C) Continuous insulin infusion
D) Increased carbohydrate intake
E) NSAIDs

C) Continuous insulin infusion

Explanation: In a diabetic emergency such as DKA, insulin is administered via continuous infusion to correct the insulin deficit effectively.

p.22

Diabetic Ketoacidosis (DKA)

What is the recommended action if a diabetic is unable to keep fluids down?
A) Increase carbohydrate intake
B) Visit the emergency department (ED)
C) Stop all medications
D) Self-medicate with NSAIDs
E) Wait for symptoms to improve

B) Visit the emergency department (ED)

Explanation: If a diabetic is unable to keep fluids down, it is crucial to go to the emergency department for further evaluation and treatment.

p.22

Hypoglycemia Management

What condition should be monitored closely in diabetics during a sick day?
A) Hyperkalemia
B) Hypokalaemia
C) Hypertension
D) Hyperglycemia
E) Hypoglycemia

B) Hypokalaemia

Explanation: During a sick day, diabetics should watch for hypokalaemia, which may require potassium supplementation, such as KCl.

p.2

Regulation of Fuel Metabolism

What is the primary focus of the regulation of fuel metabolism in diabetes?
A) Increasing insulin resistance
B) Maintaining normal glucose levels
C) Decreasing physical activity
D) Enhancing fat storage
E) Reducing protein intake

B) Maintaining normal glucose levels

Explanation: The regulation of fuel metabolism in the context of diabetes primarily aims to maintain normal glucose levels, which is crucial for preventing complications associated with the disease.

Study Smarter, Not Harder

Metabolism Study Buddy Revision

Created by Bwwongy

Explanation

What is the primary goal of energy homeostasis?A) To increase blood pressureB) To maintain blood glucose within relatively narrow limitsC) To decrease body temperatureD) To enhance muscle growthE) To improve digestion

Which of the following is a criterion for diagnosing muscle loss?A) High muscle strengthB) Low muscle strength (probable)C) Increased physical performanceD) Increased muscle quantityE) High protein intake

What happens to the utilization of fats as exercise intensity increases?A) Fats are used more than carbohydratesB) Fats are converted into carbohydratesC) Fats are not used at allD) Fats are stored in the bodyE) Fats are converted into proteins

What is a key characteristic of peripheral tissues in relation to insulin in the context of Type 2 Diabetes Mellitus (T2DM)? A) Increased sensitivity to insulin B) Insensitivity to insulin C) Complete insensitivity to glucose D) Enhanced insulin secretion E) Normal insulin function

What process occurs during the fed state?A) GlycogenolysisB) LipolysisC) Glycogen synthesisD) Ketone synthesisE) Proteolysis

What is a characteristic feature of diabetic microangiopathy affecting endoneurial vessels?A) Increased blood flowB) Endoneurial arteriole thickeningC) Decreased nerve conduction velocityD) Axonal regenerationE) Increased oxygen supply

Where does lipogenesis primarily occur in the body?A) Brain and lungsB) Muscle and kidneyC) Liver and adipose tissueD) Heart and pancreasE) Spleen and intestines

When should insulin be initiated in the management of Type 2 Diabetes (T2D) according to the updated NZSSD algorithm?A) If HbA1c is ≥ 40 mmol/mol B) If HbA1c is ≥ 50 mmol/mol C) If HbA1c is > 80 mmol/mol D) If HbA1c is < 50 mmol/mol E) Only in emergencies

Which of the following is a risk associated with neovascularization?A) Increased vision clarityB) Intraocular hemorrhageC) Decreased eye pressureD) Improved retinal healthE) Enhanced color perception

Which of the following is a symptom that diabetes management aims to prevent?A) Hyperglycaemia symptomsB) Increased energy levelsC) Weight lossD) DehydrationE) Increased appetite

What compensatory mechanism occurs in response to insulin resistance? A) Decreased insulin production B) Beta-cell hyperfunction C) Increased insulin sensitivity D) Decreased glucose levels E) Enhanced peripheral tissue response

What happens to insulin effects in Type 1 Diabetes Mellitus (T1DM)? A) Insulin effects are enhancedB) Insulin effects are lost entirelyC) Insulin effects are partially preservedD) Insulin effects are normalE) Insulin effects are reversed

What occurs during the fasting state?A) Glycogen synthesisB) LipogenesisC) Fuel mobilizationD) Protein synthesisE) Cellular uptake

What is the primary organ responsible for gluconeogenesis?A) HeartB) MuscleC) LiverD) PancreasE) Spleen

What is a common risk factor for individuals with diabetes?A) Decreased infection susceptibilityB) Increased physical enduranceC) Infection susceptibilityD) Improved visionE) Enhanced kidney function

Which process is NOT stimulated by glucagon?A) KetogenesisB) Fatty acid oxidationC) Glycogen synthesisD) GluconeogenesisE) Glycogenolysis

Which of the following can result from missing meals while on insulin?A) Weight lossB) Weight gainC) OedemaD) Increased appetiteE) Improved glycemic control

What is the primary effect of adrenaline on adipose tissue?A) LipogenesisB) Glycogen synthesisC) LipolysisD) GlycogenolysisE) Gluconeogenesis

What happens to circulating fuels as exercise intensity rises?A) They decrease in availabilityB) They are prioritized for muscle glycogen storesC) They are converted to fatD) They become less effectiveE) They are completely consumed

What is the primary function of glucagon in the liver?A) Glycogen synthesisB) LipogenesisC) GlycolysisD) GluconeogenesisE) Fatty acid synthesis

What is the recommended approach to prevent muscle loss in older adults?A) Decrease protein intakeB) Engage in resistance exercisesC) Increase sedentary behaviorD) Focus solely on aerobic exercisesE) Avoid physical activity altogether

What physiological change contributes to the increased catabolism and decreased anabolism in older adults?A) Increased muscle strengthB) Enhanced aerobic capacityC) Age-associated changes in body compositionD) Higher levels of physical activityE) Decreased water retention

What is a common adverse effect of insulin analogues?A) HypoglycemiaB) Increased energy levelsC) Weight lossD) Enhanced insulin sensitivityE) Improved kidney function

What should be done if HbA1c is ≥ 50 mmol/mol in the management of T2D?A) Start insulin therapy B) Continue current management C) Add other drugs to management D) Refer to a specialist E) Increase physical activity

Which process is NOT stimulated by adrenaline in the liver?A) GlycogenolysisB) GluconeogenesisC) LipolysisD) KetogenesisE) Glycogen synthesis

What role does adrenaline play in muscle tissue?A) Promotes glycogen synthesisB) Stimulates fatty acid oxidationC) Increases insulin sensitivityD) Enhances lipogenesisE) Reduces gluconeogenesis

Which metabolic process is primarily associated with cortisol?A) Glycogen synthesisB) LipogenesisC) Insulin resistanceD) Fatty acid oxidationE) Glycogenolysis

What is a key characteristic of metabolic syndrome according to the provided criteria?A) Central adiposityB) Low blood sugarC) Elevated physical activityD) Decreased triglyceridesE) Low body mass index (BMI)

What is carnitine primarily made from in the body?A) Glucose and fructoseB) Lysine and methionineC) Alanine and serineD) Leucine and isoleucineE) Tyrosine and phenylalanine

What is a consequence of axonal degeneration in diabetic microangiopathy?A) Improved nerve functionB) Increased myelinationC) Nerve conduction impairmentD) Enhanced sensory perceptionE) Decreased blood sugar levels

What is the recommended weight loss target for managing metabolic syndrome?A) 10%B) 2%C) 5%D) 15%E) 20%

What role does glucagon play in fatty acid metabolism?A) It inhibits fatty acid oxidationB) It promotes fatty acid oxidationC) It stimulates fatty acid synthesisD) It has no role in fatty acid metabolismE) It converts fatty acids to glucose

Which of the following is NOT a precursor for gluconeogenesis?A) AlanineB) LactateC) GlycerolD) FructoseE) Pyruvate

Which gene is specifically mentioned as being involved in T2DM?A) InsulinB) GlucokinaseC) AmylinD) LeptinE) Ghrelin

What stimulates de novo lipogenesis from excess glucose in diabetes? A) Increased insulin levelsB) Decreased glucose availabilityC) Insulin-mediated processesD) Absence of insulinE) Insulin still stimulates it despite resistance

What does VEGF production lead to in the context of neovascularization?A) ApoptosisB) AngiogenesisC) Cell necrosisD) FibrosisE) Inflammation

What complication is associated with microvascular damage in diabetes?A) Heart attackB) StrokeC) RetinopathyD) HypertensionE) Osteoporosis

What pathway disturbance is associated with diabetic microangiopathy?A) Glycolytic pathwayB) Polyol pathwayC) Krebs cycleD) Fatty acid synthesisE) Urea cycle

Which of the following processes does glucagon promote in the liver?A) GlycogenolysisB) GlycolysisC) LipogenesisD) Protein synthesisE) Fatty acid synthesis

Which hormone inhibits lipolysis?A) GlucagonB) AdrenalineC) CortisolD) InsulinE) TNF-alpha

What is the consequence of uninhibited lipolysis in diabetes? A) Decreased fatty acid delivery to the liverB) Increased fatty acid delivery to the liverC) Decreased hepatic lipogenesisD) Increased glucose utilizationE) Enhanced insulin sensitivity

What type of arteriolosclerosis is accelerated in diabetes? A) Hyaline arteriolosclerosis B) Atherosclerotic arteriolosclerosis C) Fibromuscular arteriolosclerosis D) Calcific arteriolosclerosis E) Medial arteriolosclerosis

What is the primary effect of disturbances in the polyol pathway in diabetes?A) Increased insulin sensitivityB) Enhanced glucose metabolismC) Accumulation of sorbitolD) Decreased fat storageE) Improved renal function

What are potential consequences of retinal detachment due to neovascularization?A) Improved visionB) Impairment and blindnessC) Color blindnessD) Increased peripheral visionE) No consequences

What is the primary cause of T2DM in teens and young adults (MODY)? A) ObesityB) Mutations in genes involved with insulin production and glucose metabolismC) Sedentary lifestyleD) High sugar dietE) Viral infections

In Type 2 Diabetes Mellitus (T2DM), how are insulin effects altered? A) Insulin effects are enhancedB) Insulin effects are lost entirelyC) Insulin effects are lost only peripherallyD) Insulin effects are normalE) Insulin effects are reversed

What is the main function of lipolysis?A) To store fatsB) To synthesize proteinsC) To break down fatsD) To create glucoseE) To produce ketones

What are the consequences of carnitine deficiency?A) Increased muscle strengthB) Muscle fatigue, hypoglycemia, and fatty liverC) Enhanced metabolismD) Improved brain functionE) Weight loss

What is a common consequence of negative nitrogen balance?A) Increased muscle massB) Decrease in lean massC) Improved immune functionD) Enhanced metabolic rateE) Increased energy levels

Which condition might lead to thickening of Bowman’s capsule?A) DehydrationB) Diabetes mellitusC) HypertensionD) HyperthyroidismE) Anemia

What role does glucagon play in lipolysis?A) Inhibits hormone-sensitive lipaseB) Activates hormone-sensitive lipaseC) Converts glycerol to glucoseD) Stimulates insulin releaseE) Promotes lipogenesis

What is the mechanism of action (MOA) of sulfonylureas like gliclazide?A) Increases insulin resistanceB) Blocks K+ ATP channels on beta cellsC) Inhibits glucagon secretion directlyD) Stimulates glucagon releaseE) Increases glucose absorption in the intestines

What is a key factor contributing to reduced muscle quality and quantity in older adults?A) Increased hydration levelsB) Age-associated changes in body compositionC) Higher aerobic capacityD) Increased flexibilityE) Reduced caloric intake

What type of fat increases with age and contributes to muscle quality decline?A) Subcutaneous fatB) Intramuscular fatC) Brown fatD) Essential fatE) Saturated fat

Which hormone primarily regulates fuel storage during the fed state?A) GlucagonB) InsulinC) CortisolD) AdrenalineE) Thyroxine

What is a macrovascular complication of diabetes?A) RetinopathyB) NeuropathyC) Infection susceptibilityD) Accelerated atherosclerosisE) Microangiopathy

How does chronic alcoholism affect gluconeogenesis?A) It enhances gluconeogenesisB) It has no effect on gluconeogenesisC) It impairs gluconeogenesisD) It increases pyruvate levelsE) It converts lactate to pyruvate efficiently

What is a notable characteristic of T2DM in teens and young adults?A) It always requires insulin therapyB) It is often asymptomaticC) It often doesn’t require insulinD) It is only found in adultsE) It is reversible with diet alone

What happens to glucose production after 2 days of fasting?A) It increases significantlyB) It stops completelyC) It provides all glucoseD) It remains the sameE) It decreases gradually

Which metabolite is involved in TAG synthesis from fatty acids?A) Acetyl-CoAB) Glycerol-3-PC) GlucoseD) CitrateE) Pyruvate

Where does urea synthesis primarily occur in the body?A) KidneysB) BrainC) LiverD) MuscleE) Pancreas

What modification is made in long-acting insulin glargine?A) Addition of two prolinesB) Addition of two argininesC) Removal of beta-chainD) Substitution of aspartate for prolineE) Increased solubility

What happens to beta-cells as they compensate for insulin resistance over time? A) They become more efficient B) They exhaust and fail C) They increase in number D) They produce less insulin E) They become more sensitive to glucose

What are the products of lipolysis from triacylglycerols (TAGs)?A) Glycerol and glucoseB) Glycerol and free fatty acids (FFAs)C) Acetyl-CoA and malonyl-CoAD) Fatty acids and ketonesE) Glycerol and amino acids

What is the first committed step of lipogenesis mediated by Acetyl-CoA?A) Acetyl-CoA → Fatty AcidsB) Acetyl-CoA → Malonyl-CoAC) Acetyl-CoA → GlycerolD) Acetyl-CoA → GlucoseE) Acetyl-CoA → Cholesterol

What is the primary substrate for fatty acid synthesis in lipogenesis?A) GlucoseB) Acetyl-CoAC) GlycerolD) LactateE) Pyruvate

What is glucotoxicity associated with in diabetes?A) Increased insulin productionB) Damage to beta cellsC) Enhanced incretin secretionD) Increased exercise toleranceE) Weight loss

What role does glucagon play in energy metabolism?A) It promotes fuel storageB) It stimulates anabolic pathwaysC) It regulates fuel mobilizationD) It inhibits protein synthesisE) It increases fat storage

Which condition is associated with increased gluconeogenesis?A) AlcoholismB) TraumaC) Genetic diseasesD) ObesityE) Insulin resistance

What area of metabolism is related to the breakdown of amino acids?A) LipogenesisB) GlycolysisC) Nitrogen metabolismD) GluconeogenesisE) Ketogenesis

What type of diabetic eye disease is characterized by microaneurysms? A) Proliferative retinopathy B) Non-proliferative retinopathy C) Diabetic nephropathy D) Diabetic neuropathy E) Accelerated atherosclerosis

What role does Malonyl-CoA play in fatty acid oxidation?A) Stimulates CPT1B) Inhibits CPT1C) Converts fatty acids to glucoseD) Enhances beta-oxidationE) Inhibits lipogenesis

Which tissues primarily release amino acids for the urea cycle?A) Muscle and skinB) Brain and liverC) Alanine and glutamineD) Fat and boneE) Heart and lungs

What happens to beta-oxidation during the fed state due to insulin release?A) It is stimulatedB) It is inhibitedC) It has no effectD) It increases cellular FA uptakeE) It converts glucose to fatty acids

Which process is stimulated by glucagon in adipose tissue?A) GlycolysisB) LipogenesisC) LipolysisD) GlycogenolysisE) Gluconeogenesis

What is the effect of adrenaline on glycogen stores in muscle?A) Increases glycogen storesB) Decreases glycogen storesC) No effect on glycogen storesD) Converts glycogen to glucose for blood releaseE) Stimulates fatty acid synthesis from glycogen

Which of the following is NOT a criterion for diagnosing metabolic syndrome?A) Raised triglycerides (>1.7mmol/L)B) Reduced HDL cholesterolC) Elevated fasting plasma glucose (>5.6mmol/L)D) Increased physical activityE) Raised blood pressure (systolic >135mm Hg, diastolic >80mm Hg)

What is the primary goal of energy homeostasis?
A) To increase blood pressure
B) To maintain blood glucose within relatively narrow limits
C) To decrease body temperature
D) To enhance muscle growth
E) To improve digestion

Which of the following is a criterion for diagnosing muscle loss?
A) High muscle strength
B) Low muscle strength (probable)
C) Increased physical performance
D) Increased muscle quantity
E) High protein intake

What happens to the utilization of fats as exercise intensity increases?
A) Fats are used more than carbohydrates
B) Fats are converted into carbohydrates
C) Fats are not used at all
D) Fats are stored in the body
E) Fats are converted into proteins

What is a key characteristic of peripheral tissues in relation to insulin in the context of Type 2 Diabetes Mellitus (T2DM)?
A) Increased sensitivity to insulin
B) Insensitivity to insulin
C) Complete insensitivity to glucose
D) Enhanced insulin secretion
E) Normal insulin function

What process occurs during the fed state?
A) Glycogenolysis
B) Lipolysis
C) Glycogen synthesis
D) Ketone synthesis
E) Proteolysis

What is a characteristic feature of diabetic microangiopathy affecting endoneurial vessels?
A) Increased blood flow
B) Endoneurial arteriole thickening
C) Decreased nerve conduction velocity
D) Axonal regeneration
E) Increased oxygen supply

Where does lipogenesis primarily occur in the body?
A) Brain and lungs
B) Muscle and kidney
C) Liver and adipose tissue
D) Heart and pancreas
E) Spleen and intestines

When should insulin be initiated in the management of Type 2 Diabetes (T2D) according to the updated NZSSD algorithm?
A) If HbA1c is ≥ 40 mmol/mol
B) If HbA1c is ≥ 50 mmol/mol
C) If HbA1c is > 80 mmol/mol
D) If HbA1c is < 50 mmol/mol
E) Only in emergencies

Which of the following is a risk associated with neovascularization?
A) Increased vision clarity
B) Intraocular hemorrhage
C) Decreased eye pressure
D) Improved retinal health
E) Enhanced color perception

Which of the following is a symptom that diabetes management aims to prevent?
A) Hyperglycaemia symptoms
B) Increased energy levels
C) Weight loss
D) Dehydration
E) Increased appetite

What compensatory mechanism occurs in response to insulin resistance?
A) Decreased insulin production
B) Beta-cell hyperfunction
C) Increased insulin sensitivity
D) Decreased glucose levels
E) Enhanced peripheral tissue response

What happens to insulin effects in Type 1 Diabetes Mellitus (T1DM)?
A) Insulin effects are enhanced
B) Insulin effects are lost entirely
C) Insulin effects are partially preserved
D) Insulin effects are normal
E) Insulin effects are reversed

What occurs during the fasting state?
A) Glycogen synthesis
B) Lipogenesis
C) Fuel mobilization
D) Protein synthesis
E) Cellular uptake

What is the primary organ responsible for gluconeogenesis?
A) Heart
B) Muscle
C) Liver
D) Pancreas
E) Spleen

What is a common risk factor for individuals with diabetes?
A) Decreased infection susceptibility
B) Increased physical endurance
C) Infection susceptibility
D) Improved vision
E) Enhanced kidney function

Which process is NOT stimulated by glucagon?
A) Ketogenesis
B) Fatty acid oxidation
C) Glycogen synthesis
D) Gluconeogenesis
E) Glycogenolysis

Which of the following can result from missing meals while on insulin?
A) Weight loss
B) Weight gain
C) Oedema
D) Increased appetite
E) Improved glycemic control

What is the primary effect of adrenaline on adipose tissue?
A) Lipogenesis
B) Glycogen synthesis
C) Lipolysis
D) Glycogenolysis
E) Gluconeogenesis

What happens to circulating fuels as exercise intensity rises?
A) They decrease in availability
B) They are prioritized for muscle glycogen stores
C) They are converted to fat
D) They become less effective
E) They are completely consumed

What is the primary function of glucagon in the liver?
A) Glycogen synthesis
B) Lipogenesis
C) Glycolysis
D) Gluconeogenesis
E) Fatty acid synthesis

What is the recommended approach to prevent muscle loss in older adults?
A) Decrease protein intake
B) Engage in resistance exercises
C) Increase sedentary behavior
D) Focus solely on aerobic exercises
E) Avoid physical activity altogether

What physiological change contributes to the increased catabolism and decreased anabolism in older adults?
A) Increased muscle strength
B) Enhanced aerobic capacity
C) Age-associated changes in body composition
D) Higher levels of physical activity
E) Decreased water retention

What is a common adverse effect of insulin analogues?
A) Hypoglycemia
B) Increased energy levels
C) Weight loss
D) Enhanced insulin sensitivity
E) Improved kidney function

What should be done if HbA1c is ≥ 50 mmol/mol in the management of T2D?
A) Start insulin therapy
B) Continue current management
C) Add other drugs to management
D) Refer to a specialist
E) Increase physical activity

Which process is NOT stimulated by adrenaline in the liver?
A) Glycogenolysis
B) Gluconeogenesis
C) Lipolysis
D) Ketogenesis
E) Glycogen synthesis

What role does adrenaline play in muscle tissue?
A) Promotes glycogen synthesis
B) Stimulates fatty acid oxidation
C) Increases insulin sensitivity
D) Enhances lipogenesis
E) Reduces gluconeogenesis

Which metabolic process is primarily associated with cortisol?
A) Glycogen synthesis
B) Lipogenesis
C) Insulin resistance
D) Fatty acid oxidation
E) Glycogenolysis

What is a key characteristic of metabolic syndrome according to the provided criteria?
A) Central adiposity
B) Low blood sugar
C) Elevated physical activity
D) Decreased triglycerides
E) Low body mass index (BMI)

What is carnitine primarily made from in the body?
A) Glucose and fructose
B) Lysine and methionine
C) Alanine and serine
D) Leucine and isoleucine
E) Tyrosine and phenylalanine

What is a consequence of axonal degeneration in diabetic microangiopathy?
A) Improved nerve function
B) Increased myelination
C) Nerve conduction impairment
D) Enhanced sensory perception
E) Decreased blood sugar levels

What is the recommended weight loss target for managing metabolic syndrome?
A) 10%
B) 2%
C) 5%
D) 15%
E) 20%

What role does glucagon play in fatty acid metabolism?
A) It inhibits fatty acid oxidation
B) It promotes fatty acid oxidation
C) It stimulates fatty acid synthesis
D) It has no role in fatty acid metabolism
E) It converts fatty acids to glucose

Which of the following is NOT a precursor for gluconeogenesis?
A) Alanine
B) Lactate
C) Glycerol
D) Fructose
E) Pyruvate

Which gene is specifically mentioned as being involved in T2DM?
A) Insulin
B) Glucokinase
C) Amylin
D) Leptin
E) Ghrelin

What stimulates de novo lipogenesis from excess glucose in diabetes?
A) Increased insulin levels
B) Decreased glucose availability
C) Insulin-mediated processes
D) Absence of insulin
E) Insulin still stimulates it despite resistance

What does VEGF production lead to in the context of neovascularization?
A) Apoptosis
B) Angiogenesis
C) Cell necrosis
D) Fibrosis
E) Inflammation

What complication is associated with microvascular damage in diabetes?
A) Heart attack
B) Stroke
C) Retinopathy
D) Hypertension
E) Osteoporosis

What pathway disturbance is associated with diabetic microangiopathy?
A) Glycolytic pathway
B) Polyol pathway
C) Krebs cycle
D) Fatty acid synthesis
E) Urea cycle

Which of the following processes does glucagon promote in the liver?
A) Glycogenolysis
B) Glycolysis
C) Lipogenesis
D) Protein synthesis
E) Fatty acid synthesis

Which hormone inhibits lipolysis?
A) Glucagon
B) Adrenaline
C) Cortisol
D) Insulin
E) TNF-alpha

What is the consequence of uninhibited lipolysis in diabetes?
A) Decreased fatty acid delivery to the liver
B) Increased fatty acid delivery to the liver
C) Decreased hepatic lipogenesis
D) Increased glucose utilization
E) Enhanced insulin sensitivity

What type of arteriolosclerosis is accelerated in diabetes?
A) Hyaline arteriolosclerosis
B) Atherosclerotic arteriolosclerosis
C) Fibromuscular arteriolosclerosis
D) Calcific arteriolosclerosis
E) Medial arteriolosclerosis

What is the primary effect of disturbances in the polyol pathway in diabetes?
A) Increased insulin sensitivity
B) Enhanced glucose metabolism
C) Accumulation of sorbitol
D) Decreased fat storage
E) Improved renal function

What are potential consequences of retinal detachment due to neovascularization?
A) Improved vision
B) Impairment and blindness
C) Color blindness
D) Increased peripheral vision
E) No consequences

In Type 2 Diabetes Mellitus (T2DM), how are insulin effects altered?
A) Insulin effects are enhanced
B) Insulin effects are lost entirely
C) Insulin effects are lost only peripherally
D) Insulin effects are normal
E) Insulin effects are reversed

What is the main function of lipolysis?
A) To store fats
B) To synthesize proteins
C) To break down fats
D) To create glucose
E) To produce ketones

What are the consequences of carnitine deficiency?
A) Increased muscle strength
B) Muscle fatigue, hypoglycemia, and fatty liver
C) Enhanced metabolism
D) Improved brain function
E) Weight loss

What is a common consequence of negative nitrogen balance?
A) Increased muscle mass
B) Decrease in lean mass
C) Improved immune function
D) Enhanced metabolic rate
E) Increased energy levels

Which condition might lead to thickening of Bowman’s capsule?
A) Dehydration
B) Diabetes mellitus
C) Hypertension
D) Hyperthyroidism
E) Anemia

What role does glucagon play in lipolysis?
A) Inhibits hormone-sensitive lipase
B) Activates hormone-sensitive lipase
C) Converts glycerol to glucose
D) Stimulates insulin release
E) Promotes lipogenesis

What is the mechanism of action (MOA) of sulfonylureas like gliclazide?
A) Increases insulin resistance
B) Blocks K+ ATP channels on beta cells
C) Inhibits glucagon secretion directly
D) Stimulates glucagon release
E) Increases glucose absorption in the intestines

What is a key factor contributing to reduced muscle quality and quantity in older adults?
A) Increased hydration levels
B) Age-associated changes in body composition
C) Higher aerobic capacity
D) Increased flexibility
E) Reduced caloric intake

What type of fat increases with age and contributes to muscle quality decline?
A) Subcutaneous fat
B) Intramuscular fat
C) Brown fat
D) Essential fat
E) Saturated fat

Which hormone primarily regulates fuel storage during the fed state?
A) Glucagon
B) Insulin
C) Cortisol
D) Adrenaline
E) Thyroxine

What is a macrovascular complication of diabetes?
A) Retinopathy
B) Neuropathy
C) Infection susceptibility
D) Accelerated atherosclerosis
E) Microangiopathy

How does chronic alcoholism affect gluconeogenesis?
A) It enhances gluconeogenesis
B) It has no effect on gluconeogenesis
C) It impairs gluconeogenesis
D) It increases pyruvate levels
E) It converts lactate to pyruvate efficiently

What is a notable characteristic of T2DM in teens and young adults?
A) It always requires insulin therapy
B) It is often asymptomatic
C) It often doesn’t require insulin
D) It is only found in adults
E) It is reversible with diet alone

What happens to glucose production after 2 days of fasting?
A) It increases significantly
B) It stops completely
C) It provides all glucose
D) It remains the same
E) It decreases gradually

Which metabolite is involved in TAG synthesis from fatty acids?
A) Acetyl-CoA
B) Glycerol-3-P
C) Glucose
D) Citrate
E) Pyruvate

Where does urea synthesis primarily occur in the body?
A) Kidneys
B) Brain
C) Liver
D) Muscle
E) Pancreas

What modification is made in long-acting insulin glargine?
A) Addition of two prolines
B) Addition of two arginines
C) Removal of beta-chain
D) Substitution of aspartate for proline
E) Increased solubility

What happens to beta-cells as they compensate for insulin resistance over time?
A) They become more efficient
B) They exhaust and fail
C) They increase in number
D) They produce less insulin
E) They become more sensitive to glucose

What are the products of lipolysis from triacylglycerols (TAGs)?
A) Glycerol and glucose
B) Glycerol and free fatty acids (FFAs)
C) Acetyl-CoA and malonyl-CoA
D) Fatty acids and ketones
E) Glycerol and amino acids

What is the first committed step of lipogenesis mediated by Acetyl-CoA?
A) Acetyl-CoA → Fatty Acids
B) Acetyl-CoA → Malonyl-CoA
C) Acetyl-CoA → Glycerol
D) Acetyl-CoA → Glucose
E) Acetyl-CoA → Cholesterol

What is the primary substrate for fatty acid synthesis in lipogenesis?
A) Glucose
B) Acetyl-CoA
C) Glycerol
D) Lactate
E) Pyruvate

What is glucotoxicity associated with in diabetes?
A) Increased insulin production
B) Damage to beta cells
C) Enhanced incretin secretion
D) Increased exercise tolerance
E) Weight loss

What role does glucagon play in energy metabolism?
A) It promotes fuel storage
B) It stimulates anabolic pathways
C) It regulates fuel mobilization
D) It inhibits protein synthesis
E) It increases fat storage

Which condition is associated with increased gluconeogenesis?
A) Alcoholism
B) Trauma
C) Genetic diseases
D) Obesity
E) Insulin resistance

What area of metabolism is related to the breakdown of amino acids?
A) Lipogenesis
B) Glycolysis
C) Nitrogen metabolism
D) Gluconeogenesis
E) Ketogenesis

What type of diabetic eye disease is characterized by microaneurysms?
A) Proliferative retinopathy
B) Non-proliferative retinopathy
C) Diabetic nephropathy
D) Diabetic neuropathy
E) Accelerated atherosclerosis

What role does Malonyl-CoA play in fatty acid oxidation?
A) Stimulates CPT1
B) Inhibits CPT1
C) Converts fatty acids to glucose
D) Enhances beta-oxidation
E) Inhibits lipogenesis

Which tissues primarily release amino acids for the urea cycle?
A) Muscle and skin
B) Brain and liver
C) Alanine and glutamine
D) Fat and bone
E) Heart and lungs

What happens to beta-oxidation during the fed state due to insulin release?
A) It is stimulated
B) It is inhibited
C) It has no effect
D) It increases cellular FA uptake
E) It converts glucose to fatty acids

Which process is stimulated by glucagon in adipose tissue?
A) Glycolysis
B) Lipogenesis
C) Lipolysis
D) Glycogenolysis
E) Gluconeogenesis

What is the effect of adrenaline on glycogen stores in muscle?
A) Increases glycogen stores
B) Decreases glycogen stores
C) No effect on glycogen stores
D) Converts glycogen to glucose for blood release
E) Stimulates fatty acid synthesis from glycogen

Which of the following is NOT a criterion for diagnosing metabolic syndrome?
A) Raised triglycerides (>1.7mmol/L)
B) Reduced HDL cholesterol
C) Elevated fasting plasma glucose (>5.6mmol/L)
D) Increased physical activity
E) Raised blood pressure (systolic >135mm Hg, diastolic >80mm Hg)

Which of the following complications is associated with diabetes?
A) Hypertension
B) Retinopathy
C) Osteoporosis
D) Asthma
E) Arthritis

What is a consequence of pre-term babies having underdeveloped livers?
A) Increased gluconeogenesis
B) High glycogen stores
C) Impaired gluconeogenesis
D) Enhanced lactate production
E) Normal glucose metabolism

Which hormone stimulates lipogenesis?
A) Glucagon
B) Cortisol
C) Insulin
D) Adrenaline
E) Somatostatin

What is the risk associated with T2DM in teens and young adults?
A) Low blood sugar episodes
B) High risk of heart disease
C) Risk of transmission in relatives
D) Increased risk of stroke
E) Increased risk of kidney failure