Practice Questions

Question 1

What is diabetes mellitus?

Answer 1

Diabetes Mellitus refers to a group of metabolic disorders in which persistent hyperglycaemia (random plasma glucose- the oral glucose tolerance test- more than 11 mmol/L or the fasting glucose is 7 mmol/l or more) is caused by deficient insulin secretion, resistance to the action of insulin, or both.

Insulin deficiency and insulin resistance lead to the abnormalities of carbohydrate, fat, and protein metabolism that are characteristic of diabetes mellitus.

Question 2

What is a health belief?

Answer 2

A health belief is a idea or concept held by an individual which may not have a factual basis to it.

EG) Although they are overweight they are not as bad as other people

EG) They have stressful lives and deserve to enjoy their food

Question 3

What are the Zola’s triggers for consultation?

Answer 3

1. The occurrence of an interpersonal crisis: like divorce/death
2. Perceived interference with social or personal relations: can’t play golf anymore
3. Perceived interference with vocational or physical activity: can’t do job
4. “Temporalising” - setting a personal deadline.
5. “Sanctioning” - pressure from other people to consult.

Question 4

Risk factors for type 2 diabetes?

Answer 4

• age – being over the age of 40
• ethnicity- the risk increases from over 25 for people of south Asian, Chinese, African-Caribbean or black African origin
• genetics – having a close relative with the condition, such as a parent, brother or sister
• weight – being overweight or obese
• women who have had gestational diabetes during pregnancy also have a greater risk of developing diabetes later in life.
• women who have polycystic ovarian syndrome ( PCOS)

Question 5

Briefly outline the pathophysiology that leads to polydipsia and polyuria in diabetes?

Answer 5

Worsening symptoms of thirst and needing to pass urine all the time. This is because her kidneys can’t remove all the excess glucose from the blood and then reabsorb it again. This means the excess glucose is excreted in the urine, as glucose leaves it makes water leave too due to osmosis. The excess water removed causes excess urine and thirst. She felt tired a lot of the time:this may be due to dehydration, and duet to the body’s inability to use the sugar in the blood. Vaginal thrush twice in the last month: high levels of glucose in the urine may help yeast to grow causing vaginal infection.

Question 6

How does Metformin work? What are the most common side effects experienced by patients?

Answer 6

Metformin works in two ways:

It helps to stop the liver producing new glucose

It helps to overcome insulin resistance by making insulin carry glucose into muscle cells more effectively.

Most common side effects of this medication include:

• Nausea and vomiting
• Diarrhoea
• Unusual taste, lack of appetite, abdominal pain

Question 7

Briefly explain the pathophysiology of the micro and microvascular damage caused by diabetes.

Answer 7

Uncontrolled hyperglycaemia induces changes to the microvascular system affecting the retina, nerves, kidney by the following mechanisms:

• extracellular protein matrix synthesis
• thickening of the basement membrane
• advanced glycation end products
• oxidative stress
• low grade inflammation

Damage to the macrovascular system is mainly through the process of atherosclerosis, but it is thought that microangiopathy of the vasa vasorum accelerates the development of atherosclerosis.

Question 8

19-year-old male presents to the emergency department after suffering from diarrhoea and vomiting for the past three days and has been unable to tolerate any oral intake for the past 24 hours. Despite this he is still passing lots of urine. He feels weak and tired. He looks unwell, dehydrated and there is a sweet, fruity smell to his breath. What is the class of diabetic medication that this could be a rare but major side effect of.

Answer 8

Dipeptidylpeptidase-4 inhibitors

Glucagon-like peptide-1 receptor agonists

Sodium glucose co-transporter 2 inhibitors

Sulfonylureas

Thiazolidinedione

Question 9

A 19-year-old man with type I diabetes visits the GP. He is concerned about his recent blood glucose measurements, which over the last three days have been between 12-13mmol/L. He normally has well-controlled diabetes, and his blood glucose normally measures between 6-8mmol/L. Other than his diabetes, he has significant past medical history. He self-administers insulin, and takes no other medication.The patient is found to have an upper respiratory tract infection. The GP explains that illness can cause blood glucose measurements to become more difficult to control.Please select the most appropriate temporary measure that the GP could recommend to the patient, until his illness subsides.

1. Decrease insulin dose
2. Decrease sugar intake
3. Increase insulin dose
4. Increase sugar intake
5. Stop taking insulin

Answer 9

1. Decrease insulin dose
2. Decrease sugar intake
3. Increase insulin dose
4. Increase sugar intake
5. Stop taking insulin

Question 10

A number of diseases are associated with deficiencies in the enzymes involved in glycolysis. Select the enzyme directly involved in glycolysis whose deficiency is linked to enzyme-deficient haemolytic anaemia.

1. Glucokinase
2. Glucose-6-phosphate dehydrogenase
3. Glycerol kinase
4. Pyruvate dehydrogenase
5. Pyruvate Kinase

Question 11

Aldolase B deficiency is a serious defect of fructose metabolism. Select the symptom that is NOT normally associated with Aldolase B deficiency.

1. Fructosuria
2. Hepatomegaly
3. Kidney failure
4. Nausea
5. Severe hypoglycaemia

Answer 11

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Question 12

An 8-year-old boy was brought to the emergency department with drowsiness, vomiting, abdominal pain, increased thirst and high volume urine output. He is normally fit and well and takes no regular medication. His physical examination was unremarkable, however the examining doctor noted the patient’s sweet-smelling breath. On investigation, his blood glucose was found to be 19mmol/L with high levels of ketones in his urine. Select the mechanism most likely to be responsible for this patient’s condition.

1. Deficiency in the production of endogenous insulin
2. Increased elimination of endogenous insulin by the liver
3. Increased production of endogenous insulin
4. Insensitivity of normal insulin receptors to endogenous insulin
5. Presence of abnormal insulin receptors

Answer 12

1. Deficiency in the production of endogenous insulin
2. Increased elimination of endogenous insulin by the liver
3. Increased production of endogenous insulin
4. Insensitivity of normal insulin receptors to endogenous insulin
5. Presence of abnormal insulin receptors

Question 13

​Appetite is controlled is in a number of ways. Importantly hormones can signal states of hunger, inducing feeding, or satiety, suppressing feeding. Select the hormone that is inhibited by a full (stretched) stomach.

1. Cholecystokinin (CCK)
2. Ghrelin
3. Insulin
4. Leptin
5. Peptide YY

Answer 13

1. Cholecystokinin (CCK)
2. Ghrelin
3. Insulin
4. Leptin
5. Peptide YY

Question 14

Assuming optimal conditions, what is the number of NADH that will be produced by complete oxidation of one glucose molecule by glycolysis, oxidative decarboxylation and the TCA / Krebs cycle.

Answer 14

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Question 15

Fatty acid oxidation defects such as medium chain acyl CoA dehydrogenase deficiencies (MCADD) can lead to severe hypoglycaemia. Select a metabolic explanation of this phenomenon in MCADD.

1. Beta-oxidation of fatty acids provide excess ATP meaning that glucose is converted to glycogen
2. Gluconeogenesis is inhibited by a build of medium chain fatty acid derivatives that inhibit gluconeogenic enzymes
3. Ketoacidosis inhibits the production of glucose by gluconeogenesis
4. Ketones bodies are overproduced meaning that glucose is not required
5. The lack of fatty acid oxidation results in increased glycogenesis

Answer 15

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Question 16

Fructose 2,6, bisphosphate is a potent activator of glycolysis in the liver. Select the enzyme it acts upon.

• Glucokinase
• Hexokinase
• Phosphofructokinase
• Pyruvate kinase
• Pyruvate dehydrogenase

Answer 16

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Question 17

In classical phenylketonuria excess phenylalanine can be detrimental to health therefore levels of phenylalanine need to be maintained at close to or below normal levels by limiting intake. As a result of this, select the non-essential amino acid that now needs to be supplemented in the diet.

1. Arginine
2. Asparagine
3. Glutamine
4. Serine
5. Tyrosine

Answer 17

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Question 18

Ketoacidosis is a complication of poorly controlled type 1 diabetes. Ketones are produced in the liver following catabolism of fatty acids that have been released by adipocytes. Select the enzyme activated by an absence of insulin and the presence of glucagon and epinephrine that leads to increased fatty acids concentrations in the blood.

Answer 18

1. Acetyl CoA carboxylase
2. Acyl CoA dehydrogenase
3. Fatty acid synthase
4. Hormone sensitive lipase
5. Lipoprotein lipase

Question 19

Select a metabolic process that is stimulated by insulin.

1. Hydrolysis of triacylgycerides in adipocytes to fatty acids and glycerol
2. Glycogenolysis in the liver
3. Glycolysis in the liver
4. Gluconeogenesis
5. Ketogenesis in the liver

Answer 19

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Question 20

Select the alternative fuel the brain can adapt to use during fasting.

1. Amino acids
2. Fatty acids
3. Fructose
4. Glucose
5. Ketone bodies

Answer 20

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Question 21

Select the best description of a health promotion activity.

1. A taxation on sugary drinks
2. Bariatric surgery for obesity
3. Doctors monitoring a patient’s BMI
4. Enabling people to increase control over and improve their health
5. The Government delivering a TV advert campaign on healthy eating

Answer 21

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Question 22

Select the best description of an activity that falls into the ‘client focused’ model of health education and health promotion.

1. Addressing a person’s priorities, concerns and interests so as the person sets their own health promotion agenda
2. Encouraging people to reduce their calorie consumption
3. High risk individuals taking up screening services e.g. cholesterol testing
4. Increasing a person’s understanding of the health risks of obesity so that the person can make their own informed choice
5. Making political and legislative changes to make it easier for a person to choose healthy options

Answer 22

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Question 23

Select the correct end product of oxidative decarboxylation.

1. Acetyl CoA
2. Glucose 6 Phosphate
3. Lactate
4. Phosphoenolpyruvate
5. Pyruvate

Answer 23

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Question 24

Select the description of substrate level phosphorylation.

1. The formation of ATP by the transfer of electrons from NADH to ADP
2. The formation of ATP by the ATP synthase and the proton motive force
3. The formation of ATP by transfer of a phosphate to ADP from another phosphorylated molecule
4. The formation of ATP by the transfer of electrons from FADH2 to ADP
5. The formation of ATP by the transfer of protons through Thermogenin 1

Answer 24

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Question 25

elect the effect of glucagon in the liver during fasting state. 1. Glycogenesis 2. Glycogenolysis and gluconeogenesis 3. Oxidation of glucose to produce ATP through glycolysis 4. Synthesis of fatty acids from excess dietary glucose 5. Transport of dietary amino acids into muscle cells

Answer 25

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Question 26

Select the enzyme that is NOT a component of the mitochondrial electron transport chain. 1. ATP synthase 2. Cytochrome Bc1 complex 3. Cytochrome C oxidase 4. NADH dehydrogenase 5. Succinate dehydrogenase

Answer 26

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Question 27

Select the glycolytic enzyme that catalyses the conversion of Fructose 6-Phosphate to Fructose 1,6 Bis-Phosphate. 1. Enolase 2. Glucokinase 3. Phosphofructokinase-1 4. Phosphoglycerate kinase 5. Pyruvate kinase

Answer 27

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Question 28

Select the group of compounds that are produced by the catabolism of fatty acids in the liver and can be utilised by the brain during prolonged periods of starvation. 1. Branched chain amino acids 2. Disaccharides 3. Ketone bodies 4. Starches 5. Trigacylycerides

Answer 28

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Question 29

Select the mechanism of carbon monoxide (CO) inhibition of the electron transport chain. 1. CO competes with oxygen at the oxygen binding site of haemoglobin 2. CO inhibits substrate level phosphorylation of ADP 3. CO inhibits the ATP synthase 4. CO inhibits the transfer of electrons to the final electron acceptor oxygen 5. CO uncouples the proton motive force

Answer 29

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Question 30

Select the metabolic disorder that hypoglyceamia and hypoketonuria are typically associated with. 1. Fructosuria 2. Glycogen synthase deficiency 3. Lysosomal storage disorders 4. Medium-chain acyl-CoA dehydrogenase deficiency 5. Phenylketonuria

Answer 30

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Question 31

Select the metabolic pathway inhibited by insulin. 1. Fatty acid synthesis 2. Glycolysis (in the liver) 3. Glycogenesis 4. Gluconeogenesis 5. Lipolysis

Answer 31

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Question 32

Select the most appropriate reason for inclusion of patients and the public in decisions about health service provision and development. 1. All patients want a say in their health care and they have a right to a voice in decisions about health care services 2. Decisions about health care are complex and therefore responsibility for these decisions should rest with patients and the public 3. In a consumer society, patients and the public expect responsive health care services 4. In an increasingly litigious culture, responsibility for decision making should rest with patients and the public 5. Patients have a right to be involved in decision making about health care, and their involvement should lead to more appropriate health services and better health outcomes

Answer 32

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Question 33

Select the most correct statement regarding Type 2 diabetes. 1. Diagnosis usually depends upon an oral glucose tolerance test 2. It does not occur in people less than 35 years of age 3. It never requires insulin treatment 4. It is more common in people from South Asia than in white Europeans 5. Sulphonylurea medication is the first drug of choice

Answer 33

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Question 34

Select the net output from the complete oxidation of one molecule of Acetyl CoA by the Krebs Cycle. * 3 x NADH / 1 x FADH2 / 1 x GTP * 4 x NADH / FADH2 / 1 x GTP * 6 x NADH / 2 x FADH2 / 2 x GTP * 9 x NADH / 2 x FADH2 / 2 x GTP * 18 NADH / 9 x FADH2 / 6 x GTP

Answer 34

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Question 35

elect the statement that best describes the enzyme hexokinase. 1. It has a low Km (high affinity) for glucose 2. It has a narrow substrate range and can only phosphorylate glucose 3. It is indirectly inhibited by fructose-6-phosphate 4. It is the predominant enzyme involved in the phosphorylation of glucose in liver parenchymal cells 5. Its Vmax for phosphorylation of glucose is only reached when blood glucose concentrations are well in excess of normal fasting blood glucose concentration

Answer 35

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Question 36

Select the statement that describes the oxidative decarboxylation of pyruvate. 1. It converts phosphoenolpyruvate to pyruvate and generates ATP by substrate level phosphorylation 2. It converts pyruvate to oxaloacetate during gluconeogenesis 3. It is an aerobic reaction that takes place in the cytosol that yields 2 Acetyl CoA and 1 NADH for each pyruvate 4. It is an anaerobic reaction that yields 2 Acetyl CoA and 2 NADH for every pyruvate 5. It takes place after export of pyruvate to the mitochondria and yields 1 Acetyl CoA and 1 NADH for each pyruvate

Answer 36

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Question 37

The level of blood glucose must be maintained at a satisfactory level, in order to provide metabolic fuel for the brain, central nervous system and erythrocytes. Select the process used during the initial period of fasting to maintain blood glucose. 1. Glycogenesis in liver 2. Gluconeogenesis and glycogenolysis in skeletal muscle 3. Gluconeogenesis in skeletal muscle 4. Glycogenolysis in skeletal muscle 5. Glycogenolysis in liver

Answer 37

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