Diabetes mellitus and other metabolic diseases

Question 1

What is body mass index?
A) (body height – 100) + 10%
B) body height – 100
C) body weight (kg) divided by the square of body height expressed in meters
D) the body weight of the general population divided by that of the individual
E) none of the listed

Answer 1

C) body weight (kg) divided by the square of body height expressed in meters

Question 2

Which categories may patient belong to, according the body mass index?
A) underweight – normal weight – overweight – obese – extreme obese
B) obese – thin
C) normal weight – abnormal weight
D) android obese – gynoid obese
E) none of the listed

Answer 2

A) underweight – normal weight – overweight – obese – extreme obese

Question 3

Complications of extreme obesity include
A) sudden death, sleep apnea, daytime hypoventilation, somnolence, polycythemia, cor pulmonale
B) congestive heart failure
C) renal vein thrombosis
D) immobility that impedes daily activity
E) all of the listed

Answer 3

E) all of the listed

Question 4

Apart from binge eating, bulimia nervosa is characterized by…
A) consuming high-energy food which is easily absorbed
B) binge eating is followed by abdominal pain, sleep and purging by vomiting
C) repeated attempts to lose weight using severe caloric restrictions, self-induced vomiting, and laxative or diuretic abuse
D) body weight fluctuates by more than 4.5 kg
E) all of the listed

Answer 4

E) all of the listed

Question 5

Anorexia nervosa is characterized by the following:
A) fear from gaining weight despite actual weight loss
B) disturbed body image
C) at least 25% loss of original body weight and rejection of reaching normal weight
D) exclusion of other potential reasons of weight loss
E) all of the listed

Answer 5

E) all of the listed

Question 6

The normal daily protein requirement of a healthy adult is:
A) 100 g
B) 10 g/body weight kg
C) 1 g/body weight kg
D) 0.8 g/body weight kg
E) none of the listed

Answer 6

D) 0.8 g/body weight kg

Question 7

A patient suffering from hypertension and ischemic heart disease takes thiazide diuretics regularly. One day this patient wakes up with a swollen and extremely painful right knee. His skin is warm and red above the joint. After some shivering, he took his body temperature, which was 37.7°C. What is the most probable diagnosis?
A) deep venous thrombosis of the lower extremity
B) arterial embolisation of the lower extremity
C) acute gout attack
D) septic arthritis
E) none of the listed

Answer 7

C) acute gout attack

Question 8

Secondary gout is most often caused by:
A) cytostatic treatment of a malignant tumor
B) diuretic treatment
C) large dose of acetylsalicylic acid
D) renal failure
E) none of the listed

Answer 8

B) diuretic treatment

Question 9

Allopurinol (Milurit) was initiated to treat the hyperuricemia of a patient with gout. He is receiving 3x200mg daily, but hyperuricemia still persists. How would you decrease hyperuricemia further?
A) Urinary acidifiers should be used to prevent kidney stone formation.
B) 24-hour urine urate output should be measured, and a uricosuric medication should be started in case of a low value.
C) A non-steroid anti-inflammatory drug has to be given to relieve symptoms
D) Start colchicine treatment
E) Diuretics should be given to promote the excretion of uric acid.

Answer 9

B) 24-hour urine urate output should be measured, and a uricosuric medication should be started in case of a low value.

Question 10

The most common cause of idiopathic, primary gout:
A) decreased renal elimination of uric acid
B) Lesch–Nyhan syndrome
C) urate overproduction of unknown origin
D) increased activity of the hypoxanthine-guanine phosphoribosyltransferase enzyme
E) none of the listed

Answer 10

A) decreased renal elimination of uric acid

Question 11

Urate crystal formation is promoted by:
A) decreased pH
B) decreased temperature
C) high urate level of the solution
D) all of the listed above
E) none of the listed

Answer 11

D) all of the listed above

Question 12

The most important step in acute gout attack treatment:
A) 0.5mg colchicin administered hourly until symptoms resolve or gastrointestinal toxicity appears, or a large-dose non-steroid anti-inflammatory drug (such as 2x100 mg indomethacin or 2x550 mg naproxen)
B) large-dose allopurinol
C) large-dose uricosuric agent
D) low-dose acetylsalicylic acid
E) low-purine diet

Answer 12

A) 0.5mg colchicin administered hourly until symptoms resolve or gastrointestinal toxicity appears, or a large-dose non-steroid anti-inflammatory drug (such as 2x100 mg indomethacin or 2x550 mg naproxen)

Question 13

Differential diagnosis of an acute gout attack must include:
A) septic arthritis
B) reactive arthritis
C) traumatic arthritis
D) CPPD- (calcium pyrophosphate dihydrate) arthropathy
E) all of the listed

Answer 13

E) all of the listed

Question 14

A potential cause of hypertriglyceridemia:
A) hyperchylomicronemia
B) VLDL-overproduction
C) decreased LPL-activity
D) alcohol consumption
E) all of the listed

Answer 14

E) all of the listed

Question 15

Apart from diet and alcohol abstinence, the treatment of hypertriglyceridemia may include:
A) nicotinic acid and its derivatives (such as acipimox)
B) fibrates
C) fish oil
D) drug combinations
E) all of the listed

Answer 15

E) all of the listed

Question 16

Apart from diet, the treatment of hypercholesterolemia may include:
A) inhibition of cholesterol absorption by ezetimibe (inhibitor of Niemann-Pick protein in the bowel mucosa)
B) bile acid sequestrant resins
C) statins
D) drug combinations
E) all of the listed

Answer 16

E) all of the listed

Question 17

Marfan-syndrome is characterized by:
A) connective tissue disorder of autosomal dominant inheritance
B) arachnodactyly
C) partial lens dislocation
D) potentially fatal aortic dissection
E) all of the listed

Answer 17

E) all of the listed

Question 18

Which of the disorders is characterized by dark discoloration of the sclera and the earlobes, darker urine, and accelerated arthrosis?
A) Wilson’s disease
B) porphyria
C) hemochromatosis
D) ochronosis
E) hepatolenticular degeneration

Answer 18

D) ochronosis

Question 19

The following signs and symptoms appear in diabetes mellitus due to the renal threshold of glucose being exceeded:
A) polyuria
B) polydipsia
C) polyphagia
D) weight loss
E) all of the listed

Answer 19

E) all of the listed

Question 20

The prevalence of type 1 (insulin-dependent) diabetes mellitus in the general population:
A) 2%
B) 10%
C) 0.2%
D) 0.02%
E) 1%

Answer 20

C) 0.2%

Question 21

When does type 1 diabetes mellitus become manifest?
A) once 75% of pancreatic β-cells are lost
B) once 50% of pancreatic β-cells are lost
C) once 25% of pancreatic β-cells are lost
D) once all pancreatic β-cells are lost
E) none of the listed

Answer 21

A) once 75% of pancreatic β-cells are lost

Question 22

What does Latent Autoimmune Diabetes in Adults (LADA) mean?
A) a latent disorder of the carbohydrate metabolism in adults, which does not manifest as diabetes
B) a disorder the clinical picture of which starts as a non-insulin dependent diabetes, and which becomes later insulin dependent owing to the islet cell damage of autoimmune origin
C) a slowly developing diabetes in adults
D) a slowly developing type 2 diabetes
E) none of the listed

Answer 22

B) a disorder the clinical picture of which starts as a non-insulin dependent diabetes, and which becomes later insulin dependent owing to the islet cell damage of autoimmune origin

Question 23

Predicting type 1 diabetes mellitus would require the analysis of the following factors:
A) genetic factors (primarily identifying MHC genes that make someone resistant to diabetes)
B) immunologic abnormalities (mainly islet-cell antibodies (ICA), antibodies to glutamic acid decarboxylase (GAD), ICA 512)
C) first-phase insulin secretion during iv. glucose load
D) all of the listed
E) none of the listed

Answer 23

D) all of the listed

Question 24

Type 2 diabetes mellitus is characterized by:
A) high plasma glucose and insulin levels
B) impaired pancreatic β-cell function, lack of first phase insulin secretion, and increased and prolonged second phase insulin release
C) insulin cannot properly increase the glucose uptake of skeletal muscle cells and decrease the hepatic glucose production
D) insulin cannot increase hepatic glucose uptake
E) all of the listed

Answer 24

E) all of the listed

Question 25

Aims of oral antidiabetic therapy in type 2 diabetes mellitus, except:
A) increase in insulin sensitivity (metformin)
B) increase in insulin secretion (GLP1 effect promoters, sulfonylureas)
C) increase in peripheral glucose use (metformin, insulin)
D) retardation of carbohydrate absorption (α-glucosidase inhibitors), promotion of glucose elimination through the kidneys (SGLT2-inhibitors)
E) inhibition of carbohydrate absorption (α-glucosidase inhibitors)

Answer 25

E) inhibition of carbohydrate absorption (α-glucosidase inhibitors)

Question 26

Which is the first step in providing an optimal diet for a diabetic individual?
A) determine energy need
B) determine lipid need
C) determine protein need
D) determine vitamin need
E) determine carbohydrate need

Answer 26

A) determine energy need

Question 27

How energy intake should be distributed between nutrients in the optimal diet for a diabetic individual?
A) 50-60% carbohydrates, 10-20% proteins and 20-30% lipids (with less than 1/3 saturated fat)
B) 40% carbohydrates, 30% proteins, 30% lipids
C) 30% carbohydrates, 30% proteins, 40% lipids
D) 20% carbohydrates, 30% proteins, 50% lipids
E) 10% carbohydrates, 30% proteins, 60% lipids

Answer 27

A) 50-60% carbohydrates, 10-20% proteins and 20-30% lipids (with less than 1/3 saturated fat)

Question 28

Which is the optimal approach to start treating type 2 diabetes mellitus?
A) Start with and adhere to a diet that has optimal distribution of nutrients and provides adequate energy intake, increase physical activity and take metformin. In case of suboptimal carbohydrate metabolism, drugs that promote GLP1 effects, sulfonylureas, drugs that retard carbohydrate absorption, drugs that promote renal elimination of glucose or insulin can be added to the therapy.
B) Start with appropriate diet and intensive conservative insulin treatment
C) Start with appropriate diet and sulfonylurea in maximal dose, then, in case of suboptimal carbohydrate metabolism, add biguanide in maximal dose, and lastly, switch quickly to insulin
D) Start with the combination of appropriate diet, oral antidiabetic agents and insulin
E) Start with appropriate diet and low-dose sulfonylurea, then apply maximal dose sulfonylurea, then maximal dose biguanide, and lastly, a long-acting insulin once a day.

Answer 28

A) Start with and adhere to a diet that has optimal distribution of nutrients and provides adequate energy intake, increase physical activity and take metformin. In case of suboptimal carbohydrate metabolism, drugs that promote GLP1 effects, sulfonylureas, drugs that retard carbohydrate absorption, drugs that promote renal elimination of glucose or insulin can be added to the therapy.

Question 29

How large is the daily insulin secretion of a healthy adult?
A) 20–40 U
B) 10–20 U
C) 40–60 U
D) over 100 U

Answer 29

A) 20–40 U

Question 30

What is the distribution of prandial and basal insulin need?
A) 60% prandial, 40% basal
B) 40% prandial, 60% basal
C) 50% prandial, 50% basal
D) none of the listed

Answer 30

A) 60% prandial, 40% basal

Question 31

What does the term “intensive conservative insulin treatment” stand for?
A) basal insulin need is supplemented by intermediate-acting insulin once or twice a day or by ultra-long-acting insulin analogue, whereas prandial need is covered by short-acting insulin or by ultra-short-acting insulin analogue administered before meals
B) measurement of blood glucose hourly and adjusting short-acting insulin dose accordingly
C) administration of short-acting insulin every 6 hours (starting from 8:00 AM) in the ratio of 4:2:3:1
D) intravenous insulin treatment

Answer 31

A) basal insulin need is supplemented by intermediate-acting insulin once or twice a day or by ultra-long-acting insulin analogue, whereas prandial need is covered by short-acting insulin or by ultra-short-acting insulin analogue administered before meals

Question 32

What are the principal aims of the treatment in diabetic ketoacidosis?
A) administration of insulin because of absolute insulin deficiency
B) infusion of physiologic saline because of the absolute water and electrolyte deficiency
C) potassium supplementation because of potassium deficiency
D) glucose administration to replenish glycogene stores
E) all of the listed

Answer 32

E) all of the listed

Question 33

How should be administered insulin in diabetic ketoacidosis?
A) intravenously
B) intramuscularly
C) subcutaneously
D) intraportally

Answer 33

A) intravenously

Question 34

Characteristic feature(s) of hypoglycemia:
A) symptoms appear rapidly
B) initially sympathetic hyperactivity, then cerebral dysfunction appears
C) skin turgor is normal
D) blood pressure is not decreased
E) all of the listed

Answer 34

E) all of the listed

Question 35

When do you think of an unnoticed nighttime hypoglycemia?
A) the patient wakes up with a headache
B) the patient complains about nightmares
C) the patient complains about night sweats
D) normal nighttime breathing becomes disturbed and snoring appears
E) all of the listed above
F) none of the listed

Answer 35

E) all of the listed above

Question 36

What kind of insulin treatment can be applied in type 1 diabetes mellitus?
A) intensive conservative treatment
B) premix insulin applied twice a day, before breakfast and dinner
C) short- and intermediate-acting insulin applied twice a day, before breakfast and dinner
D) three times daily insulin: premix insulin before breakfast and dinner and short-acting insulin before lunch
E) any of the listed above
F) none of the listed

Answer 36

A) intensive conservative treatment

Question 37

What kind of insulin treatment can be applied in type 2 diabetes mellitus if a patient requires insulin?
A) intensive conservative treatment
B) bedtime insulin treatment (insulin applied before going to bed) and sulfonylurea
C) twice daily insulin treatment using premix insulin
D) three times daily insulin: premix insulin before breakfast and dinner and short-acting insulin before lunch
E) any of the listed above
F) none of the listed

Answer 37

E) any of the listed above

Question 38

Which of the following drives the bedtime insulin dose in a patient with type 2 diabetes?
A) morning fasting blood glucose level
B) blood glucose level before dinner
C) blood glucose level after dinner
D) the amount of carbohydrate consumed for dinner
E) none of the listed

Answer 38

A) morning fasting blood glucose level

Question 39

An alcoholic and diabetic patient develops hypoglycemia. Select the treatment which is not suggested!
A) oral glucose
B) intravenous glucose
C) glucagon
D) none of the listed

Answer 39

C) glucagon

Question 40

A patient taking α-glucosidase inhibitor develops hypoglycemia. Select the treatment which is not suggested!
A) oral glucose
B) intravenous glucose
C) sugar cubes, coffee sugar, granulated sugar, food containing complex carbohydrates
D) none of the listed

Answer 40

C) sugar cubes, coffee sugar, granulated sugar, food containing complex carbohydrates

Question 41

How many units (U) of insulin can be found in one ml of an insulin vial (distributed in Hungary)?
A) 100 U
B) 50 (U)
C) 40 (U)
D) none of the listed

Answer 41

C) 40 (U)

Question 42

How many units (U) of insulin can be found in one ml of an insulin penfill (distributed in Hungary)?
A) 100 U
B) 50 U
C) 40 U
D) none of the listed

Answer 42

A) 100 U

Question 43

What is gestational diabetes?
A) diabetes that develops during pregnancy and ceases after delivery
B) type 1 diabetes that develops during pregnancy
C) type 2 diabetes that develops during pregnancy
D) none of the listed

Answer 43

A) diabetes that develops during pregnancy and ceases after delivery

Question 44

Which is the antihypertensive drug of first choice in a hypertensive and diabetic individual?
A) β-blocker
B) ACE-inhibitor
C) calcium channel blocker
D) α-receptor inhibitor
E) none of the listed

Answer 44

B) ACE-inhibitor

Question 45

First-degree relatives of patients with type 1 diabetes of autoimmune origin more often suffer from the following disorders as compared to the general population
A) autoimmune thyroid disorders
B) pernicious anemia
C) rheumatoid arthritis
D) Addison’s disease
E) all of the listed

Answer 45

E) all of the listed

Question 46

Pathogenesis of type 2 diabetes mellitus includes:
1) genetic factors
2) environmental factors (obesity, too high calorie, carbohydrate and lipid intake, and too low fiber intake)
3) advancing age
4) autoimmune processes
5) climatic factors

A) answers 1, 2 and 3 are correct
B) all of the answers are correct
C) none of the answers are correct
D) answers 4 and 5 are correct
E) answers 3, 4 and 5 are correct

Answer 46

A) answers 1, 2 and 3 are correct

Question 47

Select the correct statistical data about type 2 diabetes mellitus!
1) 75% of all diabetic individuals have type 2 diabetes
2) most type 2 diabetic patients are > 60 years old
3) 2/3 of the patients affected are overweight or obese
4) 40% of the patients have positive family history as regards diabetes mellitus
5) the male-to-female ratio is 3:2

A) answers 1, 2 and 3 are correct
B) all answers are correct
C) none of the answers is correct
D) answers 1, 3 and 5 are correct
E) answers 1, 2, 3 and 4 are correct

Answer 47

B) all answers are correct

Question 48

Type 2 diabetes can be discovered:
1) based on signs and symptoms of diabetes (53%)
2) as an accidental finding (29%)
3) in the background of an infection (16%)
4) in the background of a diabetic complication (2%)
5) during screening

A) answers 1,4 and 5 are correct
B) all answers are correct
C) none of the answers is correct
D) answers 1, 3 and 4 are correct
E) answers 2 and 5 are correct

Answer 48

B) all answers are correct

Question 49

Select the correct statements about the screening of type 2 diabetes mellitus!
1) population at risk is worth screening
2) when applied for screening, sensitivity of postprandial glycosuria varies between 16-64%
3) measurement of HgbA1 or fructosamine (glycated proteins) is too expensive
4) the well-performed oral glucose tolerance test (OGTT) is the gold standard method
5) population at risk has to be screened every third year, while others have to be screened every fifth year

A) answers 1, 3 and 5 are correct
B) all answers are correct
C) none of the answers is correct
D) answers 2 and 4 are correct
E) answers 3, 4 and 5 are correct

Answer 49

B) all answers are correct

Question 50

The appropriate execution of oral glucose tolerance test necessitates the following:
1) at least 150 g carbohydrates has to be consumed for 3 days before the test
2) the last meal before the morning test should be consumed not later than 8 PM; water can be consumed ad-libitum
3) the patient should not be under hormonal treatment, should be afebrile and stressors have to be minimized.
4) 75 g glucose dissolved in 3 dl water has to be consumed in 5 minutes
5) blood has to be drawn every 30 minutes for 2 hours

A) answers 1, 3 and 5 are correct
B) all answers are correct
C) none of the answers is correct
D) answers 2 and 4 are correct
E) answers 3, 4 and 5 are correct

Answer 50

B) all answers are correct

Question 51

People at risk for type 2 diabetes include:
1) the obese
2) the hypertensive
3) people with positive family history of type 2 diabetes
4) patients with gout, hyperuricemia or hyperlipoproteinemia
5) patients with vascular disease (peripheral, cerebrovascular or cardiovascular)

A) answers 1, 3 and 5 are correct
B) all answers are correct
C) none of the answers is correct
D) answers 2 and 4 are correct
E) answers 3, 4 and 5 are correct

Answer 51

B) all answers are correct

Question 52

Associate parameters with their definitions!
A) waist to hip ratio > 1.0 in men or > 0.8 in women in obese individuals
B) waist to hip ratio < 1.0 in men or < 0.8 in women in obese individuals
C) body mass index over 40
D) body mass index between 30 and 40
E) body mass index between 25 and 30

INT - 12.58 - extreme obesity
INT - 12.59 - obesity
INT - 12.60 - android obesity
INT - 12.61 - gynoid obesity
INT - 12.62 - being overweight

Answer 52

58- C
59- D
60- A
61- B
62- E

Question 53

Associate the disorder with a characteristic substance!
A) Wilson’s disease
B) hemochromatosis
C) porphyria
D) Hartnup disease
E) von Gierke disease

INT - 12.63 - neutral amino acids
INT - 12.64 - hem
INT - 12.65 - copper
INT - 12.66 - glycogen
INT - 12.67 - iron

Answer 53

63- D
64- C
65- A
66- E
67- B

Question 54

Insulin is the activator of LPL, therefore, insulin deficiency (such as diabetic ketoacidosis) may result in profound hypertriglyceridemia.
A) the statement and the explanation are both correct, and there is causative relationship between them
B) the statement and the explanation are both correct, without any causative relationship between them
C) the statement is correct but the explanation is false
D) the statement is false but the explanation in itself is correct
E) the statement and the explanation are both false

Answer 54

A) the statement and the explanation are both correct, and there is causative relationship between them

Question 55

Diabetic patients may experience temporary blurred vision, because hyperglycemia results in the swelling of the lens.
A) the statement and the explanation are both correct, and there is causative relationship between them
B) the statement and the explanation are both correct, without any causative relationship between them
C) the statement is correct but the explanation is false
D) the statement is false but the explanation in itself is correct
E) the statement and the explanation are both false

Answer 55

A) the statement and the explanation are both correct, and there is causative relationship between them

Question 56

Hyperglycemia always derives from insulin deficiency, because in diabetes β-cells do not produce insulin.
A) the statement and the explanation are both correct, and there is causative relationship between them
B) the statement and the explanation are both correct, without any causative relationship between them
C) the statement is correct but the explanation is false
D) the statement is false but the explanation in itself is correct
E) the statement and the explanation are both false

Answer 56

E) the statement and the explanation are both false

Question 57

The prevalence of type 1 diabetes decreases from north to south in Europe, therefore, prevalence in Hungary is the average of the extremes.
A) the statement and the explanation are both correct, and there is causative relationship between them
B) the statement and the explanation are both correct, without any causative relationship between them
C) the statement is correct but the explanation is false
D) the statement is false but the explanation in itself is correct
E) the statement and the explanation are both false

Answer 57

A) the statement and the explanation are both correct, and there is causative relationship between them

Question 58

Autoimmune processes resulting in type 1 diabetes mellitus may persist for years, therefore, it is feasible to intervene and delay the complete damage of beta cells in early stage of the disease.
A) the statement and the explanation are both correct, and there is causative relationship between them
B) the statement and the explanation are both correct, without any causative relationship between them
C) the statement is correct but the explanation is false
D) the statement is false but the explanation in itself is correct
E) the statement and the explanation are both false

Answer 58

A) the statement and the explanation are both correct, and there is causative relationship between them

Question 59

Appearance of islet-cell antibodies (ICA) and/or glutamic acid decarboxylase antibodies (GAD) is a marker of β-cell damage, therefore, patients positive for islet-cell antibodies always become diabetic.
A) the statement and the explanation are both correct, and there is causative relationship between them
B) the statement and the explanation are both correct, without any causative relationship between them
C) the statement is correct but the explanation is false
D) the statement is false but the explanation in itself is correct
E) the statement and the explanation are both false

Answer 59

C) the statement is correct but the explanation is false

Question 60

Type 1 diabetes is also called juvenile diabetes mellitus, therefore, every diabetes that manifests in older age is a type 2, non-insulin dependent diabetes.
A) the statement and the explanation are both correct, and there is causative relationship between them
B) the statement and the explanation are both correct, without any causative relationship between them
C) the statement is correct but the explanation is false
D) the statement is false but the explanation in itself is correct
E) the statement and the explanation are both false

Answer 60

C) the statement is correct but the explanation is false

Question 61

In type 1 diabetes insulin secretion is completely absent, therefore, the aim of the treatment is insulin replacement.
A) the statement and the explanation are both correct, and there is causative relationship between them
B) the statement and the explanation are both correct, without any causative relationship between them
C) the statement is correct but the explanation is false
D) the statement is false but the explanation in itself is correct
E) the statement and the explanation are both false

Answer 61

A) the statement and the explanation are both correct, and there is causative relationship between them

Question 62

In type 1 diabetes insulin is administered into the peripheral tissues, not intraportally as it was physiological, therefore, peripheral hyperinsulinism and hepatic hypoinsulinism is achieved.
A) the statement and the explanation are both correct, and there is causative relationship between them
B) the statement and the explanation are both correct, without any causative relationship between them
C) the statement is correct but the explanation is false
D) the statement is false but the explanation in itself is correct
E) the statement and the explanation are both false

Answer 62

A) the statement and the explanation are both correct, and there is causative relationship between them

Question 63

In type 1 diabetes it is not possible to imitate physiologic insulin secretion using exogenous insulin, therefore, strict dietary regulations have to be applied to adjust diet to the non-physiologic insulin absorption.
A) the statement and the explanation are both correct, and there is causative relationship between them
B) the statement and the explanation are both correct, without any causative relationship between them
C) the statement is correct but the explanation is false
D) the statement is false but the explanation in itself is correct
E) the statement and the explanation are both false

Answer 63

A) the statement and the explanation are both correct, and there is causative relationship between them

Question 64

Food containing large amount of non-absorbable fibers is advantageous in diabetes, because fiber content retard the absorption other carbohydrates.
A) the statement and the explanation are both correct, and there is causative relationship between them
B) the statement and the explanation are both correct, without any causative relationship between them
C) the statement is correct but the explanation is false
D) the statement is false but the explanation in itself is correct
E) the statement and the explanation are both false

Answer 64

A) the statement and the explanation are both correct, and there is causative relationship between them

Question 65

Retarding the absorption of carbohydrates is beneficial in both forms of diabetes, because in type 2 diabetes first-phase insulin secretion is absent, whereas in type 1 diabetes exogenous insulin concentrations rise too slowly and their fall is prolonged.
A) the statement and the explanation are both correct, and there is causative relationship between them
B) the statement and the explanation are both correct, without any causative relationship between them
C) the statement is correct but the explanation is false
D) the statement is false but the explanation in itself is correct
E) the statement and the explanation are both false

Answer 65

A) the statement and the explanation are both correct, and there is causative relationship between them

Question 66

Diabetic individuals must avoid alcohol consumption, because alcohol shifts the metabolism towards ketosis, increases the risk of lactic acidosis in case of biguanide treatment and worsens the adaptation to hypoglycemia.
A) the statement and the explanation are both correct, and there is causative relationship between them
B) the statement and the explanation are both correct, without any causative relationship between them
C) the statement is correct but the explanation is false
D) the statement is false but the explanation in itself is correct
E) the statement and the explanation are both false

Answer 66

A) the statement and the explanation are both correct, and there is causative relationship between them

Question 67

Type 1 diabetic patients with high blood glucose levels should avoid physical exercise, because exercise shifts the increased metabolism towards ketosis in case of insulin deficiency.
A) the statement and the explanation are both correct, and there is causative relationship between them
B) the statement and the explanation are both correct, without any causative relationship between them
C) the statement is correct but the explanation is false
D) the statement is false but the explanation in itself is correct
E) the statement and the explanation are both false

Answer 67

A) the statement and the explanation are both correct, and there is causative relationship between them

Question 68

High blood glucose levels in a type 2 diabetic patient can be decreased by physical exercise, because physical exercise decreases insulin resistance.
A) the statement and the explanation are both correct, and there is causative relationship between them
B) the statement and the explanation are both correct, without any causative relationship between them
C) the statement is correct but the explanation is false
D) the statement is false but the explanation in itself is correct
E) the statement and the explanation are both false

Answer 68

A) the statement and the explanation are both correct, and there is causative relationship between them

Question 69

Secondary prevention of myocardial infarction includes the treatment of hypercholesterolemia, because hypercholesterolemic patients tend to have a more severe coronary arteriosclerosis.
A) the statement and the explanation are both correct, and there is causative relationship between them
B) the statement and the explanation are both correct, without any causative relationship between them
C) the statement is correct but the explanation is false
D) the statement is false but the explanation in itself is correct
E) the statement and the explanation are both false

Answer 69

A) the statement and the explanation are both correct, and there is causative relationship between them

Question 70

Measurement of HgbA1-levels is sufficient four times yearly, when it is used to assess carbohydrate metabolism in a diabetic patient, because the average lifespan of red blood cells in the circulation is approx. 120 days.
A) the statement and the explanation are both correct, and there is causative relationship between them
B) the statement and the explanation are both correct, without any causative relationship between them
C) the statement is correct but the explanation is false
D) the statement is false but the explanation in itself is correct
E) the statement and the explanation are both false

Answer 70

A) the statement and the explanation are both correct, and there is causative relationship between them

Question 71

Hypertensive patients should be screened for diabetes, because hypertension often causes diabetes.
A) the statement and the explanation are both correct, and there is causative relationship between them
B) the statement and the explanation are both correct, without any causative relationship between them
C) the statement is correct but the explanation is false
D) the statement is false but the explanation in itself is correct
E) the statement and the explanation are both false

Answer 71

C) the statement is correct but the explanation is false

Question 72

Hypertension often develops in type 2 diabetic individuals, because hyperinsulinemia may cause hypertension via multiple mechanisms.
A) the statement and the explanation are both correct, and there is causative relationship between them
B) the statement and the explanation are both correct, without any causative relationship between them
C) the statement is correct but the explanation is false
D) the statement is false but the explanation in itself is correct
E) the statement and the explanation are both false

Answer 72

A) the statement and the explanation are both correct, and there is causative relationship between them

Question 73

Diabetic individuals often suffer from a “silent” myocardial infarction, because diabetes may cause autonomic neuropathy.
A) the statement and the explanation are both correct, and there is causative relationship between them
B) the statement and the explanation are both correct, without any causative relationship between them
C) the statement is correct but the explanation is false
D) the statement is false but the explanation in itself is correct
E) the statement and the explanation are both false

Answer 73

A) the statement and the explanation are both correct, and there is causative relationship between them

Question 74

Diabetic individuals often display sinus tachycardia at rest, because one of the chronic complications of diabetes is autonomic neuropathy.
A) the statement and the explanation are both correct, and there is causative relationship between them
B) the statement and the explanation are both correct, without any causative relationship between them
C) the statement is correct but the explanation is false
D) the statement is false but the explanation in itself is correct
E) the statement and the explanation are both false

Answer 74

A) the statement and the explanation are both correct, and there is causative relationship between them

Question 75

In diabetic individuals, trophic ulcers typically develop over the heels, the proximal interphalangeal joint of a hammertoe, the sole or on the dorsum of the foot, because diabetic trophic ulcers usually appear at the site of pressure.
A) the statement and the explanation are both correct, and there is causative relationship between them
B) the statement and the explanation are both correct, without any causative relationship between them
C) the statement is correct but the explanation is false
D) the statement is false but the explanation in itself is correct
E) the statement and the explanation are both false

Answer 75

A) the statement and the explanation are both correct, and there is causative relationship between them

Question 76

In diabetic patients Charcot joint may develop, because diabetic neuropathy is one of the chronic complications of diabetes mellitus.
A) the statement and the explanation are both correct, and there is causative relationship between them
B) the statement and the explanation are both correct, without any causative relationship between them
C) the statement is correct but the explanation is false
D) the statement is false but the explanation in itself is correct
E) the statement and the explanation are both false

Answer 76

A) the statement and the explanation are both correct, and there is causative relationship between them

Question 77

Physical exercise increases insulin effect via decreasing insulin resistance, therefore, increasing physical activity in type 2 diabetes represents causative treatment.
A) the statement and the explanation are both correct, and there is causative relationship between them
B) the statement and the explanation are both correct, without any causative relationship between them
C) the statement is correct but the explanation is false
D) the statement is false but the explanation in itself is correct
E) the statement and the explanation are both false

Answer 77

A) the statement and the explanation are both correct, and there is causative relationship between them

Question 78

Which disorders should the differential diagnosis include?
A middle-aged patient had participated in a pigsticking before Christmas, he had been eating a lot of meat and offal and he had drunk some wine. Some days later he became febrile, and he was having right-sided lower abdominal pain for some days. Abdominal pain vanished spontaneously, but after a week, he noticed subfebrility, or fever on some occasions, and his left knee became swollen, painful and red. Similar symptoms appeared in the left ankle, and he was hardly able to walk. Examination of the joints revealed fluid accumulation in the joint space, whereas laboratory investigations suggested inflammation (high ESR, leukocytosis, left shift of WBCs).
1) acute gout attack
2) reactive arthritis (induced by Yersinia enterocolitica)
3) septic arthritis
4) rheumatoid arthritis
5) Bechterew’s disease

A) answers 1, 2 and 3 are correct
B) answers 1, 4 and 5 are correct
C) answers 1, 2, 3 and 4 are correct
D) all answers are correct
E) none of the answers is correct

Answer 78

A) answers 1, 2 and 3 are correct

Question 79

Which complementary investigations have to be performed?
A middle-aged patient had participated in a pigsticking before Christmas, he had been eating a lot of meat and offal and he had drunk some wine. Some days later he became febrile, and he was having right-sided lower abdominal pain for some days. Abdominal pain vanished spontaneously, but after a week, he noticed subfebrility, or fever on some occasions, and his left knee became swollen, painful and red. Similar symptoms appeared in the left ankle, and he was hardly able to walk. Examination of the joints revealed fluid accumulation in the joint space, whereas laboratory investigations suggested inflammation (high ESR, leukocytosis, left shift of WBCs).
1) investigation of the synovial fluid from the knee to detect urate crystals
2) culture of the synovial fluid from the knee
3) a smear of the synovial fluid sediment and investigation of cellular elements and screening for the presence of bacteria using Gram stain
4) serologic investigation of Yersinia enterocolitica
5) measurement of serum urate levels

A) all answers are correct
B) answers 1, 2 and 3 are correct
C) only answer 4 is correct
D) only answer 5 is correct
E) none of the answers is correct

Answer 79

A) all answers are correct