1) Which of the following adrenal regions do not produce the steroid hormones?

a) Zona glomerulosa
b) Zona fasciculata
c) Zona reticularis
d) Adrenal cortex

b) Which of the following hormones are synthesized by zona glomerulosa

a) Progesterone
b) Cortisol
c) Aldosterone
d) dehydroepiandrosterone 

3) Which of the following is not the 21-carbon steroid hormones?

a) Progesterone
b) Aldosterone
c) Cortisol
d) Androstenedione

4) Cortisol or glucocorticoid is a 21-carbon steroid hormone. Identify the FALSE statement related
to glucocorticoids. 
a) Cortisol levels are highest just before waking (~8AM) and lowest in the evening (~12 midnight)
b) CRH stimulates the ACTH that in turn increases the synthesis of glucocorticoids
c) ACTH inhibits the enzyme cholesterol desmolase in the adrenal cortex
d) ACTH regulates its own recept in the adrenal cortex and increases its sensitivity

5) Which of the following statement is FALSE regarding the Dexamethasone suppression test?
a) The test is based on the ability of dexamethasone to inhibit ACTH secretion
b) The suppression of the glucocorticoid release by dexamethasone administration is
suggestive of Adrenal cortical tumors
c) The suppression of the glucocorticoid release by dexamethasone administration is suggestive of
ACTH secreting tumors
d) All of the above

6) Glucocorticoids stimulate gluconeogenesis by which of the following mechanisms?

a) Increase protein catabolism and availability of amino acids
b) Decreased glucose utilization and insulin sensitivity in adipose tissue
c) Increased lipolysis and increase the availability of glycerol pool
d) All of the above

7) Glucocorticoids possess anti-inflammatory effects by the following mechanism, EXCEPT

a) Induce the synthesis of lipocortin
b) Inhibit the production of interleukin-2 and inhibit T cell proliferation
c) Induce the release of histamine and serotonin from mast cells
d) Decrease production of prostaglandins and leukotrienes

8) Aldosterone is a hormone that increases the renal reabsorption of Na+ and increases
extracellular fluid and blood volume. 
Identify the correct statement associated with aldosterone
a) Renin-Angiotensin feedback loop decreases the synthesis of aldosterone
b) Hyperkalemia reduces the aldosterone secretion
c) ACTH increases the production of aldosterone
d)  None of the above 

9) Addison disease- a primary insufficiency of the adrenal cortex:

a) It is caused by autoimmune destruction of the adrenal cortex
b) It results in decreased glucocorticoid, androgen, and aldosterone
c) It causes increased ACTH level 
d) It causes hyperpigmentation
e) All of the above

10) Cushing's disease is caused by the excess production of glucocorticoids. 

Cushing disease is characterized
by.......................................................................................... 
a) increased cortisol, decreased ACTH, hyperglycemia, and muscle wasting
b) increased cortisol, increased ACTH, hyperglycemia, and muscle wasting
c) increased cortisol, decreased ACTH, hypoglycemia, and muscle wasting
c) increased cortisol, increased ACTH, hypoglycemia, and muscle wasting

11) Conn Syndrome is a disease caused by an aldosterone-secreting tumor resulting in an increased

aldosterone level. 
Which of the following does not accurately characterize Conn syndrome?
a) Hypertension
b) Hyperkalemia
c) Metabolic alkalosis
d) Decreased renin secretion

12) Which of the following condition does not accurately characterize the congenital adrenal
hyperplasia caused by 21 beta-hydroxylase deficiency?
a) Elevated 17-hydroxyprogesterone
b) Elevated Aldosterone
c) Hyponatremia
d) Hyperkalemia

13) Which of the following would be seen on laboratory examination of a patient suffering from
hypercortisolism?
a) Decreased plasma cortisol, decreased plasma ACTH, without hyperpigmentation
b) Decreased plasma cortisol, increased plasma ACTH, with hyperpigmentation
c) Increased plasma cortisol, increased plasma ACTH, with hyperpigmentation
d) Increased plasma cortisol, decreased plasma ACTH, without hyperpigmentation

14) Which of the following would be associated with parallel changes in aldosterone and cortisol
secretion?
a) Addison's disease
b) Cushing's disease
c) Low sodium diet
d) Administration of a converting enzyme inhibitor

15) Excess consumption of potassium results in which of the following condition?

a) Increased secretion of cortisol
b) Increased secretion of aldosterone
c) Increased secretion of ACTH
d) Decreased secretion of CRH

Answers
1-d) Adrenal cortex
2-c) Aldosterone
3-d) Androstenedione
4-c) ACTH inhibits the enzyme cholesterol desmolase in the adrenal cortex
5-b) The suppression of the glucocorticoid release by dexamethasone administration
is suggestive of Adrenal cortical tumors
6-d) All of the above
7-c) Induce the release of histamine and serotonin from mast cells
8-c) ACTH increases the production of aldosterone
9-e) All of the above
10-a) increased cortisol, decreased ACTH, hyperglycemia, and muscle wasting
11-b) Hyperkalemia
12-b) Elevated Aldosterone
13-d) Increased plasma cortisol, decreased plasma ACTH, without hyperpigmentation
14-a) Addison's disease
15-c) Increased secretion of aldosterone

1) Which of the following enzyme is not involved in galactose metabolism?

a) Glucokinase
b) Galactokinase
c) Galactose-1-Phosphate Uridyl transferase
d) UDP-Galactose 4- epimerase

2) Which of the following enzyme is defective in galactosemia- a fatal genetic disorder in infants?
a) Glucokinase
b) Galactokinase
c) Galactose-1-Phosphate Uridyl transferase
d) UDP-Galactose 4- epimerase

3) In the liver, the accumulation of which of the following metabolite attenuates the inhibitory of
ATP on phosphofructokinase?
a) Glucose-6-Phosphate
b) Citrate
c) Fructose-1,6-Bisphosphate
d) Fructose-2,6-Bisphosphate

4) Mutation in which of the following enzymes leads to a glycogen storage disease known as
Tarui’s disease?
a) Glucokinase
b)Phosphofructokinase
c) Phosphoglucomutase
d) Pyruvate Kinase

5) Erythrocytes undergo glycolysis for the production of ATP. The deficiency

of ……………........ enzyme leads to hemolytic anemia?
a) Glucokinase
b)Phosphofructokinase
c) Phosphoglucomutase
d) Pyruvate Kinase

6) Cancer cells have high energy demands for replication and division. Increased flux of glucose
into glycolysis replenishes the energy demand. 
Which of the following enzyme plays an important role in tumor metabolism?
a) Glucokinase
b)Phosphofructokinase
c) Phosphoglucomutase
d) Pyruvate Kinase M2

7) Which of the following glucose transporter (GLUT) is important in insulin-dependent glucose

uptake?
a) GLUT1
b) GLUT2
c) GLUT3
d) GLUT4

8) Which of the following glucose transporter (GLUT) is present in the beta cells of the pancreas?
a) GLUT1
b) GLUT2
c) GLUT3
d) GLUT4

9) Which of the following glucose transporter (GLUT) is important in fructose transport in the
intestine?
a) GLUT1
b) GLUT3
c) GLUT5
d) GLUT7

10) Which of the following metabolite negatively regulates pyruvate kinase?

a) Fructose-1,6-Bisphosphate
b) Citrate
c) Acetyl CoA
d) Alanine
11) In absence of oxygen, pyruvate is converted into lactate in muscle because
a) Lactate is the substrate from the downstream pathway
b) Lactate acts as a substrate for the formation of amino acid
c) during the product of lactate two ATP are produced
d) during lactate formation, NADH is reconverted into NAD.

12) Which of the following glycolytic enzyme is inhibited by the accumulation of long-chain fatty
acid in the liver?
a) Hexokinase
b) Glucokinase
c)Phosphofructokinase
d) Pyruvate kinase

13) Which of the following statement related to phosphofructokinase-I is false:

a) PFK-2 is the isoenzyme of PFK-1 that is present in the liver

b) PFK-1 is activated by AMP whereas inhibited by ATP and citrate

c) The binding of ATP to PFK-1 induces the conformation change from R to T state
d) PFK-1 is regulated by posttranslational modification such as phosphorylation

14) Which of the following statement about Phosphofructokinase-2 (PFK-2) is false?

a) PFK-2 is a bifunctional enzyme having a kinase domain, phosphatase domain, and a regulatory
domain
b) Activated protein kinase A phosphorylates PFK-2 and activates the phosphatase domain
c) PFK-2 catalyzes the conversion of fructose-6-phosphate to fructose 2-6 bisphosphate

d) PFK-2 phosphatase activity is activated by the insulin signaling pathway.

15) Which of the following hormone decreases blood glucose and increases the uptake of glucose in
various tissues like skeletal muscle, and adipose tissues?
a) Glucagon
b) Epinephrine
c) Cortisol
d) Insulin

16) Which of the following statement is true?

a) Glycolysis occurs only in mammalian cells
b) Glycolysis occurs in mitochondria
c) Glycolysis occurs in the presence and absence of oxygen
d) Glycolysis occurs when ATP concentration is high.

17) What is the rate-limiting step in glycolysis?

a) Hexokinase
b) Phosphohexose isomerase
c) Glyceraldehyde-3-phosphate dehydrogenase
d) Enolase

18) The net gain of ATP during the conversion of glucose to pyruvate is:
a) 1 ATP
b) 2 ATP
c) 1 ATP +1 GTP
d) 4 ATP

19) During the conversion of glucose to pyruvate, two NADH molecules are generated. 
Which of the following steps generates NADH?
a) Conversion of fructose-6-phosphate to fructose-1-6-bisphosphate
b) Conversion of glyceraldehydes-3-phosphate to 1-3-bisphosphoglycerate
c)Conversion of 3-phosphoglycerate to 2-phosphoglycerate
d) Conversion of phosphoenolpyruvate to pyruvate

20) What is the committed step in glycolysis?

a) Conversion of glucose to glucose-6-phosphate
b) Conversion of fructose-6-phosphate to fructose-1,6-bisphosphate
c) Conversion of glyceraldehydes-3-phosphate to 1-3-bisphosphoglycerate
d) Conversion of 3-phosphoglycerate to 2-phosphoglycerate

21) Glycolysis consists of three irreversible steps. 

Which of the following enzyme-catalyzed reaction are not irreversible steps in glycolysis?
a) Hexokinase
b) Phosphofructokinase
c) Glyceraldehyde-3-phosphate kinase
d) Pyruvate kinase

22) The following are the negative regulators of phosphofructokinase except

a) ATP
b) AMP
c) Citrate
d) pH

23) Which of the following step is inhibited by sodium fluoride?

a) Glyceraldehyde-3-phosphate dehydrogenase
b) 3-phosphoglycerate mutase
c) Enolase
b) AMP

24) Which of the following step is inhibited during arsenate poisoning?

a) Glyceraldehyde-3-phosphate dehydrogenase
b) 3-phosphoglycerate mutase
c) Enolase
d) Pyruvate kinase

25)Which of the following enzyme catalyzes the conversion of pyruvate to lactate?

a) Pyruvate reductase
b) Lactate reductase
c) Lactate dehydrogenase
d) Pyruvate dehydrogenase

26) Glucokinase is an isoenzyme of hexokinase that has high Km and Vmax. 

Which of the following organ expresses glucokinase?
a) Kidney
b) Muscle
c) Liver
d) Brain

27) Gluconeogenesis is the production of glucose from non-carbohydrate molecules. 

Which of the following is not a substrate for gluconeogenesis?
a) Lactate
b) Alanine
c) Glycerol
d) Acetyl CoA

28) Gluconeogenesis occurs in the liver and kidneys. 

Which is of the following enzyme are important for gluconeogenesis and are expressed exclusively
in these tissues?
a) Glucose-6-phosphatase
b) Fructose-1,6-Bisphosphatase
c) Phosphoenolpyruvate carboxykinase
d) Pyruvate carboxylase

29) During gluconeogenesis, the three irreversible steps of glycolysis have to be bypassed. The first
step is the conversion of pyruvate to phosphoenolpyruvate. 
Which of the following statement is false regarding the reaction step?
a) This reaction involves a two-step process catalyzed by pyruvate carboxylase and
phosphoenolpyruvate carboxykinase
b) Conversion of oxaloacetate from pyruvate occurs in mitochondria and shuttled into the cytosol.
c) Formation of phosphoenolpyruvate requires both ATP and GTP as an energy source.
d) Acetyl CoA is an activator of the enzyme pyruvate carboxylase.
30) During gluconeogenesis, the three irreversible steps of glycolysis have to be bypassed. The final
step is the conversion of glucose-6-P to glucose which is catalyzed by glucose-6-phosphatase. 
Which of the following statement is true about the reaction step?
a) Conversion of glucose-6-phosphate to glucose releases one ATP molecule
b) It is a highly active enzyme in skeletal muscle
c) Defect in glucose-6-phosphatase leads to abnormal accumulation of glycogen in
the liver
d) The reaction occurs in mitochondria

31) Which of the following statement is true about Cori Cycle?

a) The Cori cycle involves three tissues muscle, liver, and brain
b) It involves the transport of lactate from the liver to skeletal tissue for gluconeogenesis
c) It involves the transport of lactate from skeletal muscle to the liver for gluconeogenesis
d) It is active during resting stages and in well-fed condition

32) During prolong starvation, which of the following hormone is responsible for increasing
gluconeogenesis in the liver
a) Insulin
b) Glucagon
c) TSH
d) Thyroxine

Answers:
1-a) Glucokinase
2-c) Galactose-1-Phosphate Uridyl transferase
3-d) Fructose-2,6-Bisphosphate
4-b)Phosphofructokinase.
5- d) Pyruvate Kinase
6- d) Pyruvate Kinase M2
7- d) GLUT4
8- b) GLUT2
9- c) GLUT5
10- d) Alanine
11- d) during lactate formation, NADH is reconverted into NAD
12- b) Glucokinase
13- d) PFK-1 is regulated by posttranslational modification such as phosphorylation
14- b) Activated protein kinase A phosphorylates PFK-2 and activates the phosphatase domain
15-d) Insulin
16-c) Glycolysis occurs in the presence and absence of oxygen
17- a) Hexokinase
18- b) 2 ATP
19- b) Conversion of glyceraldehydes-3-phosphate to 1-3-bisphosphoglycerate
20- b) Conversion of fructose-6-phosphate to fructose-1,6-bisphosphate
21- c) Glyceraldehyde-3-phosphate kinase
22-b) AMP
23- c) Enolase
24-a) Glyceraldehyde-3-phosphate dehydrogenase
25- c) Lactate dehydrogenase
26-c) Liver
27-d) Acetyl CoA
28- a) Glucose-6-phosphatase
29-d) Acetyl CoA is an activator of enzyme pyruvate carboxylase
30- c) Defect in glucose-6-phosphatase leads to abnormal accumulation of glycogen in the liver
31-c) It involves the transport of lactate from skeletal muscle to the liver for gluconeogenesis
32-b) Glucagon

1) Pancreatic islets consist of specialized cells that produce insulin, glucagon, and somatostatin. 
Which of the following cells produce insulin?
a) Alpha cells
b) Beta cells
c) Gamma cells
d) Delta cells
2) Pancreatic islets consist of specialized cells that produce insulin, glucagon, and somatostatin. 
Which of the following cells produce glucagon?
a) Alpha cells
b) Beta cells
c) Gamma cells
d) Delta cells

3) Insulin activates cells by binding to which of the following receptor?

a) G protein Receptor
b) Tyrosine kinase Receptor
c) Nuclear receptor
d) None of the above

4) Once insulin engages with its receptor, all the following activities occur downstream, Except
a) Proteins with SH2 domains bind to the phosphotyrosine residue in the insulin receptor

b) Activation of phosphatidylinositol-3-kinase  (PI3 kinase)

c) Activation of p21ras encoded by ras gene
d) Activation of Protein Phosphorylase

5) Epinephrine prevents the secretion of which of the following hormone by inhibiting adenylate
cyclase?
a) Gastrin
b) Glucagon
c) Insulin
d) None of the above

6) Insulin is synthesized as proinsulin. Within storage granules, a connecting peptide (C peptide) is

removed by proteases to yield insulin. The C peptide is packaged and secreted along with
insulin. Which of the following statement is true regarding the C peptide?
a) C-peptide is measured for the diagnosis of diabetes mellitus

b) C-peptide is used to monitor beta-cell function in patients receiving exogenous

insulin
c) C-peptide facilitates the interaction of insulin with insulin receptor
d) All of the above

7) Which of the following factor decreases insulin secretion?

a) Epinephrine
b) Amino acids (Arginine, Lysine, Leucine)
c) Fatty Acid
d) Glucose-dependent insulinotropic peptide

8) Which of the following factor increases insulin secretion?

a) Somatostatin
b) Increased Blood glucose
c) Norepinephrine
d) All of the above

9) All the following statements are correct regarding the Insulin receptors, EXCEPT:
a) The insulin receptor is a tetramer consisting of two alpha and two beta subunits

b) The alpha subunits are located on the extracellular side and interact with insulin
c) The beta subunits span the cell membrane and have intrinsic tyrosine kinase activity
d) Binding of insulin to insulin receptors leads to dissociation of the tetrameric
complex

10) Insulin acts on the liver, adipose tissue, and muscle to decrease blood glucose
concentration. Identify the correct statements from the following:
a) Increases uptake of glucose into the target tissue by upregulating glucose transporter GLUT4. 
b) Increases promote the formation of glycogen and downregulation of glycogenolysis (glycogen
breakdown.
c) Decreases gluconeogenesis and activating glycolysis in the liver
d) All of the above

11) Which of the following hormones do not increase protein synthesis (anabolic effect )?
a) Glucagon
b) Growth Hormone
c) Insulin
d) Thyroid Hormones

12) Insulin promotes glycogen synthesis by..................................................................?

a) Increasing activity of glucokinase
b) Increasing activity of glycogen synthetase
c) Increasing uptake of glucose into the cells
d) All of the above 

13) Insulin causes a positive nitrogen balance in the body by the following mechanism, EXCEPT
a) Increasing uptake and availability of amino acid 
b) Increasing protein synthesis
c) Increasing gluconeogenesis
d) Decreasing protein breakdown

14) Select the false statement regarding the effect of insulin on lipid metabolism:
a) Insulin increases the availability of triose phosphate required for fat synthesis
b) Insulin increases the activity of hormone-sensitive lipase and enhances the uptake
of fatty acids in adipose tissues 
c) Insulin increases the activity of acetyl CoA carboxylase, a rate-limiting enzyme for the fatty acid
synthesis
d) Insulin increases the activity of lipoprotein lipase and enhances the uptake of fatty acids in
adipose tissues 

15) Identify the false statement regarding the control and secretion of insulin:
a) High blood glucose- the potent stimulator of insulin secretion, activates GLUT2
b) Increased glucose oxidation in islet cells increases intracellular ATP 
c) High Intracellular ATP opens the ATP-sensitive potassium ion channel 
d) Depolarization opens voltage-gated ion channel calcium channel
e) Increased Cytosolic Calcium ion causes exocytosis and release of insulin

16) Glucagon is a peptide hormone. It is secreted by the alpha cells of the pancreatic islets. The
primary target for glucagon action is the liver, where its action is mediated
by..............................................? 
a) cAMP
b) cGMP
c) Nuclear receptors
d) None of the above

17) Glucagon regulates blood glucose by following, EXCEPT: 

a) Increasing liver glycogenesis
b) Increasing liver gluconeogenesis 
c) Increasing liver glycolysis
d) All of the above 

18) Glucagon increases liver gluconeogenesis by which of the following mechanism?

a) It inhibits phosphofructokinase-2 (PFK-2), thereby reducing fructose 2-6 bisphosphate 
b) It enhances phosphoenolpyruvate carboxykinase
c) It stimulates glucose-6-phosphatase, thereby, releasing glucose into the blood. 
d) All of the above

19) Which of the following is not the metabolic effect of glucagon?

a) Decreased lipogenesis as a result of  inhibiting acetyl CoA carboxylase
b) Decreased ketogenesis as a result of decreasing availability of acetyl CoA
c) Increased Lipolysis as a result of the activation  of hormone-sensitive lipase
d) Increased ureagenesis 

20) Which of the following factor is a potent inhibitor of glucagon?

a) Hypoglycemia
b) Arginine
c) Lysine
d) Hyperglycemia

Answers:
1-b) Beta cells
2-a) Alpha cells
3-b) Tyrosine kinase Receptor
4-d) Activation of Protein Phosphorylase
5-c) Insulin
6)-b) C-peptide is used to monitor beta-cell function in patients receiving exogenous
insulin
7-a) Epinephrine
8-b) Increased Blood glucose
9-d) Binding of insulin to insulin receptors leads to dissociation of the tetrameric
complex
10-d) All of the above
11-a) Glucagon
12-d) All of the above 
13-c) Increasing gluconeogenesis
14-b) Insulin increases the activity of hormone-sensitive lipase and enhances the
uptake of fatty acids in adipose tissues 
15-c) High Intracellular ATP opens the ATP sensitive potassium ion channel 
16-a) cAMP
17-c) Increasing liver glycolysis
18-d) All of the above
19-b) Decreased ketogenesis as a result of decreasing availability of acetyl CoA
20-d) Hyperglycemia

Quiz on Lecture 32: Integrated Metabolism

1. Regulated metabolic pathways are:

irreversible.
committed after the first step.
usually regulated at the first step.
compartmentalized in eukaryotes.
All of the above are correct.

2. Each reaction in a metabolic pathway is:

controlled by the end product.
catalyzed by a specific enzyme.
irreversible.
reversible.
linked to at least two other pathways.

3. The hormones, glucagon and epinephrine,

stimulate glycogen breakdown to G-6-P
 directly, by binding to glycogen
phosphorylase.
indirectly, by first stimulating adenylate
cyclase to make cAMP.
only in the liver.
only in muscle cells.
using ATP as the phosphoryl donor.

4. Activation of the ___ kinase results in the

activation of ___ kinase and thereby the
phosphorylation of both glycogen
phosphorylase and glycogen synthase.
pyruvate, phosphorylase
phosphorylase, cAMP-dependent protein
cAMP-dependent protein, phosphorylase
cAMP-dependent protein, pyruvate
None of the above.

5. When it functions as a "second messenger",

cAMP
acts outside the cell to influence cellular
processes.
acts "second in importance" to AMP.
activates all cytosolic protein kinases.
activates the cAMP-dependent protein
kinase.
binds to calmodulin causing it to bind Ca2+.

6. The major free energy sources for anabolic

pathways are:
ATP and NADPH.
ATP and NADP+.
ADP and NADPH.
ADP and NADP+.
AMP or NADPH.

7. Which of the following compounds is

responsible for coordinated regulation of
glucose and glycogen metabolism?
NADH
 NAD+
acetyl-CoA
fructose 2,6 bis-phosphate
fructose 1,6 bis-phosphate

8. Opposing degradative and biosynthetic

pathways
use the same enzymes for many steps.
use different enzymes for steps that require
large energy changes.
are coordinately regulated at the steps that
use different enzymes.
are used in both directions in most
organisms.
all of the above

1) Diabetes mellitus is a disorder characterized by hyperglycemia. 

Which of the following is not the common characteristic features of type 2 diabetes
mellitus?
a) Impaired insulin secretion
b) Increased Insulin resistance 
c) Diabetic ketoacidosis
d) Excessive hepatic glucose production

2) Which of the following are the characteristic features of type 1 diabetes mellitus?
a) Type 1 diabetes is caused by an absolute deficiency of insulin.
b) Type 1 diabetes is associated with the autoimmune destruction of beta cells. 
c) Patients with type 1 diabetes present with diabetic ketoacidosis
d) All of the above
 
3) Which of the following serum measurements are not used for the diagnosis of diabetes mellitus?
a) Fasting blood glucose
d) Postprandial blood glucose 
c) Insulin 
d) Glycated Hemoglobin HbA1c

4) Which of the following are not the criteria for the diagnosis of diabetes?
a) Fasting blood glucose >126 mg/dL
b) 2-hour postprandial glucose >140 mg/dL
c) HbA1C > 6.5%
d) Random blood glucose >200 mg/dL with classical symptoms

5) Which of the following is not auto-antibodies is a marker for type 1 diabetes?

a) Antibodies to GAD65
b) Antibodies to tyrosine phosphatase IA-2 and IA-2 beta
c) Zinc transporter 8 (ZnT8)
d) None of the above

6) Prediabetes is the term used for individuals that do not meet the criteria for diabetes but are too
high to be considered normal. 
Which of the following statement accurately characterize prediabetes?
a) Fasting blood glucose from 120-180 mg/dL
b) Fasting blood glucose from 126-140 mg/dL
c) Fasting blood glucose from 110-125 mg/dL
d) All of the above

7) All of  the following drugs are oral hypoglycemic drugs, Except 

a) Metformin
b) Sulphonylureas
c) Thiazolidinediones
d) Insulin

8) Which of the following are the pharmacological effect of metformin?

a) Reduced glucose absorption from the gut
b) Facilitation of glucose entry into muscle 
c) Inhibition of gluconeogenesis in the liver 
d) All of the above

9) Sulphonylureas increase insulin secretion by beta cells. Sulphonylureas acts by binding

sulphonylurea receptor and inhibiting......................................
a) ATP-dependent K+ channel
b) Voltage-gated calcium channel
c) GLUT-2 
d) None of the above

10) Glitazones is an oral hypoglycemic drug used to treat hyperglycemia. 

Which of the following statement is not correct regarding the mechanism of action of
Glitazones drug?
a) Glitazone binds to the peroxisome-proliferating activator receptor gamma, 
b) Peroxisome-proliferating activator receptor-gamma is a cell surface receptor
found in adipocytes
c) Glitazone increases insulin sensitivity 
d) None of the above 

11) Acarbose, an alpha-glucosidase inhibitor, is a drug used to treat hyperglycemia. 

Which of the following is the correct mechanism regarding the Acarbose drug?
a) Acabarose acts in the adipose tissue
b) Acarbose increases insulin sensitivity
c) Acarbose delays absorption of starch and sucrose
d) All of the above

12) Which of the following is not the consequence of insulin deficiency in carbohydrate
metabolism?
a) Increased blood glucose concentration
b) Decreased gluconeogenesis
c) Decreased peripheral glucose utilization
d) Increased glycogen breakdown

13) Which of the following is the consequence of insulin deficiency in protein metabolism?
a) Decreased protein breakdown
b) Increased synthesis of amino acids
c) Decreased ureagenesis
d) Increased protein synthesis 

14) Which of the following is not the consequence of insulin deficiency in lipid metabolism?
a) Increased lipogenesis
b) Increased level of free fatty acids
c) Increased ketogenesis
d) Increased triglyceride breakdown

15) The acute complications of uncontrolled diabetes mellitus include hyperosmolar coma, diabetic
ketoacidosis, etc. 
Which of the following statement is false regarding the hyperglycemia hyperosmolar
coma?
a) Severe hyperglycemia shifts fluid from the intracellular to the extracellular space
b) Polyuria increases the volume of extracellular space and decreased renal blood
flow
c) The severe loss of intracellular fluid from the brain causes the coma
d) Increased serum osmolality

16) In Diabetic ketoacidosis, the lack of insulin causes increased production of ketone bodies. 
Which of the following laboratory results are likely seen in diabetic ketoacidosis?
a) Decreased arterial blood pH, increased blood glucose, decreased bicarbonate ion
concentration 
b) Decreased arterial blood pH, increased blood glucose, decreased anion gap
c) Increased arterial blood pH, increased blood glucose, decreased bicarbonate ion concentration
d) All of the above

17) The long-term complication of diabetes includes retinopathy, neuropathy, and nephropathy.
Retinopathy (cataract) is caused by the accumulation of sorbitol in the affected tissues. 
Which of the following enzyme is involved in the conversion of glucose to sorbitol?
a) Galactokinase
b) Glucokinase
c) Aldose reductase
b) Aldolase B

18) Which of the following laboratory measurement best indicate the blood glucose control over a
period of weeks?
a) Measurement of blood glucose
b) Measurement of HbA1C
c) Measurement of urinary ketone bodies
d) Measurement of insulin

19) Which of the following enzyme would be more active in diabetic patients?
a) Hormone-sensitive lipase
b) Fatty acid synthase
c) Lipoprotein lipase
d) Glucokinase

20) The therapeutic goal of managing and preventing hyperlipidemic complications of diabetes
mellitus includes.............................................
a) LDL <100 mg/dL
b) HDL> 40 mg/dL
c) Triglycerides <150 mg/dL
d) All of the above

Answers:
1-c) Diabetic ketoacidosis
2-d) All of the above
3-c) Insulin 
4-b) 2-hour postprandial glucose >140 mg/dL
5-d) None of the above
6-c) Fasting blood glucose from 110-125 mg/dL
7-d) Insulin
8-d) All of the above
9-a) ATP dependent K+ channel
10-b) Peroxisome-proliferating activator receptor-gamma is a cell surface receptor
found in adipocytes
11-c) Acarbose delays absorption of starch and sucrose
12-b) Decreased gluconeogenesis
13-d) Increased protein synthesis
14-a) Increased lipogenesis
15-b) Polyuria increases the volume of extracellular space and decreased renal blood
flow
16-a) Decreased arterial blood pH, increased blood glucose, decreased bicarbonate
ion concentration 
17-c) Aldose reductase
18-b) Measurement of HbA1C
19-a) Hormone-sensitive lipase
20-d) All of the above
1) Which of the following drug and their mechanism of
action is incorrect?
a) Sulfonylureas: promotes insulin release from the β cells of the pancreas
b) Biguanides: improves target cell response to insulin without increasing pancreatic
insulin secretion
c) Thiazolidinediones: promotes insulin release from the β cells of the pancreas
d) α-glucosidase inhibitors: reversible inhibition of membrane-bound α glucosidase
in the intestine

2) Followings are the side effects of insulin, except

a) Lipodystrophy
b) Hypoglycemia
c) Local injection site reactions
d) Anorexia

3) Following statements about type I diabetes are true,

except:
a) Shows classic symptoms of insulin deficiency such as polydipsia, polyphagia, polyuria
b) Age of onset is commonly over 35 years of age
c) Obesity is usually present
d) Absolute deficiency of insulin caused by destroyed β cells
e) a, c and d
f) a and d

4) In case of heart failure with a history of Type II diabetes,

which of the following drugs would be a poor choice in
controlling diabetes?
a) Glipizide
b) Pioglitazone
c) Metformin
d) Acarbose

5) Which of the following antidiabetic agent is least likely

to cause hypoglycemia?
a) Metformin
b) Chlorpropamide
c) Insulin
d) Glyburide

6) Which of the following statement about insulin

administration is incorrect?
a) Insulin is degraded in the gastrointestinal tract if taken orally
b) In a hyperglycemic emergency, regular insulin is injected intravenously

c) Insulin is administered by intramuscular injection

d) Insulin is administered by subcutaneous injection
7) Following are the drugs that may reduce the effects of
sulfonylureas except
a) Sulfonamides
b) Atypical antipsychotics
c) Corticosteroids
d) Diuretics

8) Which effect on glucose metabolism is exerted by

Metformin?
a) Reduction in hepatic glucose output
b) Promotes insulin secretion
c) Increases hepatic glucose uptake
d) All of the above

9) What is the mechanism of action of Pioglitazone?

a) Increase release of endogenous insulin
b) Increase Hepatic gluconeogenesis
c) Increase target tissue sensitivity to insulin
d) Decrease intestinal absorption of glucose

10) Symptoms of hypothyroidism include all of the following

except
a) Bradycardia
b) Mental slowing
c) Poor resistance to heat
d) Physical slowing

11) Goitrogens produce all of the following effects except

a) Suppress T3 & T4 secretion
b) Increase TSH levels
c) Goiter
d) Destroy thyroid tissue

12) Metyrapone is useful in testing the endocrine function

of the....................................?
a) α cells of pancreatic islets
b) β cells of pancreatic islets
c) Neurohypophysis
d) Pituitary adrenal axis

13) Toxic effect of corticosteroids includes all of the

following, except
a) Hypoglycemia
b) Osteoporosis
c) Growth inhibition
d) Cushing’s syndrome

14) All of the following are useful in the therapy of

hypercalcemia, except
a) Calcitonin
b) Glucocorticoids
c) Vitamin D
d) Parenteral infusion of phosphate

15) The mechanism of action of Methimazole

is...........................................................
.........
a) Inhibition of iodination of iodide
b) Inhibition of thyroid peroxidase
c) Inhibition of coupling of iodotyrosines
d) All of the above
e) None of the above

16) Which of the following adrenal steroids has the lowest

mineralocorticoid activity?
a) Prednisolone
b) Hydrocortisone
c) Prednisone
d) Dexamethasone

17) Which of the following is NOT an indication for the use

of adrenal steroids?
a) Acute attack of bronchial asthma
b) Angina pectoris
c) Addison’s disease
d) Acute lymphatic leukemia

18) All of the followings are the features of Cushing’s

syndrome except:
a) Buffalo torso
b) Moon face
c) Acne and hirsutism
d) All of the above

19) The mechanism of action of  I is: 131

a) Inhibition of its own transport

b) Inhibition of iodine trapping
c) Thyroid cells necrosis without damaging neighboring cells
d) Inhibition of organification of iodine

20) Which of the following statement is incorrect?

a) Ca2+ is absorbed by facilitated diffusion in the intestine
b) Calcitonin decreases Ca2+ reabsorption
c) Phenytoin increases Ca2+ absorption
d) Oxalates interfere with Ca2+ absorption
Multiple Choice Answers
1-c) Thiazolidinediones: promotes insulin release from the β cells of the pancreas 
2-d) Anorexia
3-f) a and d 
4-b) Pioglitazone 
5-a) Metformin 
6-c) Insulin is administered by intramuscular injection 
7-a) Metformin 
6-c) Insulin is administered by intramuscular injection 
7-a) Sulfonamides
8-a) Reduction in hepatic glucose output 
9)-c) Increase target tissue sensitivity to insulin
10-d) Destroy thyroid tissue 
12-d) Pituitary adrenal axis
13-a) Hypoglycemia
14-c) Vitamin D
15-d) All of the above
16-d) Dexamethasone
17-b) Angina pectoris
18-d) All of the above
19-c) Thyroid cells necrosis without damaging neighboring cells
20-b) Calcitonin decreases Ca2+ reabsorption