Diabetes mellitus may be associated with many genetic syndromes, all of the following associations are true except:

1.   ?    Myotonia dystrophica
2.   ?    Down syndrome
3.   ?    lipodystrophy
4.   ?    Friedriech's ataxia
5.   ?    nesidiolastosis

Type I diabetes mellitus, all are true except:

1.   ?    it is a T cell mediated immunological disease
2.   ?    there is a mononuclear cell infiltration of the pancreas causing insulinitis
3.   ?    there is an association with HLD B8/DR3 DR4
4.   ?    concordance rate in monozygotic twins is almost 100%
5.   ?    The disease can be induced to enter a remission by immune suppressed.

Type II diabetes mellitus, all are true except

1.   ?    about 70% of patients are above the age of 50 years at the time of diagnosis
2.   ?    about 10% of the whole population above the age of 65 years has type II diabetes mellitus
3.   ?    about 80% of females with a history of gestational diabetes will ultimately develop type II diabetes
4.   ?    overeating, obesity and under-activity are risk factors for the future development of type II diabetes
5.   ?    Concordance rate in monozygotic twins is around 50%

Type 2 diabetes mellitus has been to be associated with many single gene mutations, all of the following gene mutations are autosomal dominant except:

1.   ?    mutation in hepatocyte nuclear factor 4alpha gene
2.   ?    Mutation in hepatocyte nuclear factor 1alpha gene
3.   ?    muatiaon in glucokinase gene
4.   ?    muation in insulin gene
5.   ?    mutation in mitochondrial DNA

Action of insulin, all are true except

1.   ?    decreases lipolysis
2.   ?    enhances the action of lipoprotein lipase
3.   ?    enhances potassium and amino acid entry into cells
4.   ?    enhances glycogensis and glycolysis
5.   ?    enhances fatty acid synthesis by the liver

Oral glucose tolerance test, all are true except:

1.   ?    is not used in the routine diagnosis of diabetes mellitus
2.   ?    there should be unrestricted carbohydrate diet 3 days before the test
3.   ?    the patient may be allowed to smoke during the test
4.   ?    the patient should fast overnight
5.   ?    if the 2 hours plasma glucose is between 7.8-11.1 mmol /L it is called impaired glucose tolerance test

Diagnosis of diabetes mellitus, all are true except

1.   ?    glycated hemoglobin is not used for the diagnosis
2.   ?    the presence of glycosuria should warrant further investigation and should not be used as a diagnostic test per se
3.   ?    ketonuria per se is not pathognomonic for diabetes and may found in normal people after prolonged fasting or exercise
4.   ?    the fasting blood glucose is always preferred over the random one in the diagnosis
5.   ?    the random blood glucose of more than 11.1 mmol/L on 2 or more occasions is diagnostic for diabetes mellitus

Dietary Management of diabetes, all are true except:

1.   ?    50% of type II diabetes will respond initially to diet alone
2.   ?    the total dietary fat better no to exceed 10% of total energy intake
3.   ?    alcohol should be avoided
4.   ?    salt restriction is advised
5.   ?    encourage regular exercises

Effects of anti-diabetic agents, all are true except

1.   ?    sulphonylureas have no effect on lipid profile
2.   ?    insuline does not reduce post prandial glycemia
3.   ?    acarbose has no hypoglycemic effect
4.   ?    glitazones do not raise serum insulin
5.   ?    metformin does not increase body weight

Side effects of anti-diabetic agents, all are true except

1.   ?    metformin carries a risk of lactic acidosis
2.   ?    chlopropamide may cause SIADH
3.   ?    glitazones may cause prominent fluid retention
4.   ?    insulin may cause peripheral edema
5.   ?    acarbose causes constipation

Severe hypoglycemia in diabetics may cause all of the followings except

1.   ?    vitrous hemorrhage
2.   ?    cardiac dysrrhythmia
3.   ?    hyperthermia
4.   ?    risks of accidents
5.   ?    stroke

Causes of hypoglycemia in diabetics, all are true except

1.   ?    no daily exercise
2.   ?    unrecognised other endocrine diseases like Addison's disease
3.   ?    missed, delayed or inadequate meal
4.   ?    gastrparesis
5.   ?    factitious and deliberately induced

Diabetic ketoacidosis, all are true except

1.   ?    caused by severe and absolute insulin deficiency
2.   ?    averge fluid loss is 6 liters and potassium loss is 350 meq/ L
3.   ?    any sudden impairment in consciousness during treatment should alert you to possibility of brain edema
4.   ?    sudden gastric dilatation may occur
5.   ?    leukocytosis indicates infection

Complications of diabetic ketoacidosis , all are true except

1.   ?    DIC is common
2.   ?    confusion, drowsiness and coma is seen up to 10%
3.   ?    thromboembolism
4.   ?    acute circulatory failure
5.   ?    ARDS

Non ketotic hyperosmolar coma, all are true

1.   ?    Acidosis is not a prominent part of the picture
2.   ?    Hyperosmolarity is a must
3.   ?    thromboembolic complications are common
4.   ?    10% mortality rate
5.   ?    the condition usually affects elderly with previously undiagnosed diabetes

Diabetic retinopathy, all are true except:

1.   ?    microaneurysms is the first ophthalmologic sign
2.   ?    hard exudates are characteristic
3.   ?    prominent soft exudates indicates an advanced retinopathy state or an associated hypertension
4.   ?    IRMAs (intra-retinal micro vascular abnormalities) mainly indicate a pre-proliferative stage
5.   ?    venous loops and beadings are seen mainly in proliferative stage

Diabetic peripheral neuropathy, all are true except

1.   ?    variable combination of axonopathy and demyelination and thickening Shwann cell basal lamina
2.   ?    overall seen in 50 % of cases and usually not that symptomatic
3.   ?    may be associated with Charcot joints
4.   ?    mainly motor and is irreversible
5.   ?    may cause trophic ulceration in the feet

Diabetic nephropathy, all are true except

1.   ?    occurs in 30-35% of type I diabetes but 10-20% of type II diabetes
2.   ?    50% of diabetic nephropathy patients are type II
3.   ?    hypertension is very common and may accelerate the course
4.   ?    the nodular glomeruloscleorsis type is much more common than the diffuse type
5.   ?    ACE inhibitors are effective at reducing the rate of progression even in the absence of hypertension

Diabetes and pregnancy, all are true except

1.   ?    ideally, all patients should have pre-pregnancy counseling
2.   ?    ideally, diabetes should be controlled before pregnancy rather than during the course of pregnancy
3.   ?    the objective of good diabetic control is to decrease the fetal congenital anomalies
4.   ?    oral hypoglycemic are useful in the management
5.   ?    isulin requirement vaies through out the course of pregnancy

Surgery and diabetes, all are true about preoperative evaluation, except

1.   ?    Pre-operative cardiovascular and renal assessments are very important
2.   ?    preoperatively, check signs of neuropathy and especially autonomic one
3.   ?    assess the over all glycemic control by HbA1c
4.   ?    revew the overall treatment and stop metformin and long acting sulphonylureases
5.   ?    no need for hospitalization and as the assessment can be done as an outpatient basis