Welcome, PharmD students, to this MCQ quiz on the Introduction to Diabetes Mellitus! Diabetes is a chronic metabolic disorder affecting millions worldwide, and pharmacists play a crucial role in its management. This quiz will test your foundational knowledge on the pathophysiology of different types of diabetes, common signs and symptoms, diagnostic criteria, basic treatment goals, and the importance of lifestyle modifications. Understanding these introductory concepts is the first step towards effectively counseling and caring for patients with diabetes. Let’s begin!
1. Diabetes Mellitus is primarily characterized by:
- a) Chronically low blood glucose levels.
- b) Defective insulin secretion, insulin action, or both, leading to hyperglycemia.
- c) Overproduction of glucagon.
- d) Excessive water retention by the kidneys.
Answer: b) Defective insulin secretion, insulin action, or both, leading to hyperglycemia.
2. Which hormone, produced by the beta cells of the pancreas, is essential for glucose uptake by most body cells?
- a) Glucagon
- b) Insulin
- c) Somatostatin
- d) Cortisol
Answer: b) Insulin
3. Type 1 Diabetes Mellitus (T1DM) is primarily caused by:
- a) Insulin resistance in peripheral tissues.
- b) Autoimmune destruction of pancreatic beta cells, leading to absolute insulin deficiency.
- c) Excessive dietary sugar intake.
- d) Normal age-related decline in insulin production.
Answer: b) Autoimmune destruction of pancreatic beta cells, leading to absolute insulin deficiency.
4. The pathophysiology of Type 2 Diabetes Mellitus (T2DM) involves a combination of:
- a) Absolute insulin deficiency from birth.
- b) Autoimmune destruction of alpha cells.
- c) Insulin resistance and a progressive decline in beta-cell insulin secretion.
- d) Viral infection of the pancreas.
Answer: c) Insulin resistance and a progressive decline in beta-cell insulin secretion.
5. Which of the following is a classic symptom of undiagnosed or poorly controlled diabetes?
- a) Polyuria (excessive urination)
- b) Polydipsia (excessive thirst)
- c) Polyphagia (excessive hunger)
- d) All of the above
Answer: d) All of the above
6. According to the American Diabetes Association (ADA), which A1c level is a diagnostic criterion for diabetes?
- a) ≥ 5.7%
- b) ≥ 6.0%
- c) ≥ 6.5%
- d) ≥ 7.0%
Answer: c) ≥ 6.5%
7. A fasting plasma glucose (FPG) level of _______ on two separate occasions is diagnostic of diabetes.
- a) ≥ 100 mg/dL (5.6 mmol/L)
- b) ≥ 110 mg/dL (6.1 mmol/L)
- c) ≥ 126 mg/dL (7.0 mmol/L)
- d) ≥ 140 mg/dL (7.8 mmol/L)
Answer: c) ≥ 126 mg/dL (7.0 mmol/L)
8. “Prediabetes” is a term used to describe individuals whose glucose levels are higher than normal but not yet high enough to be diagnosed as diabetes. An A1c range for prediabetes is:
- a) 5.0% to 5.4%
- b) 5.7% to 6.4%
- c) 6.5% to 6.9%
- d) Below 5.0%
Answer: b) 5.7% to 6.4%
9. Which of the following is a major modifiable risk factor for developing Type 2 Diabetes Mellitus?
- a) Age
- b) Family history of diabetes
- c) Ethnicity
- d) Overweight or obesity and physical inactivity
Answer: d) Overweight or obesity and physical inactivity
10. Gestational Diabetes Mellitus (GDM) is a type of diabetes that:
- a) Occurs only in elderly women.
- b) Is diagnosed for the first time during pregnancy.
- c) Is always permanent after delivery.
- d) Is a form of Type 1 diabetes.
Answer: b) Is diagnosed for the first time during pregnancy.
11. The primary goal of diabetes management is to:
- a) Eliminate all carbohydrates from the diet.
- b) Maintain blood glucose levels as close to the normal range as safely possible to prevent acute and chronic complications.
- c) Cure diabetes completely with medication.
- d) Only treat symptoms when they occur.
Answer: b) Maintain blood glucose levels as close to the normal range as safely possible to prevent acute and chronic complications.
12. Lifestyle modifications are a cornerstone of diabetes management and prevention. This typically includes:
- a) Increased intake of sugary beverages.
- b) A sedentary lifestyle.
- c) Healthy eating patterns, regular physical activity, and weight management.
- d) Smoking cessation (while important for overall health, the question focuses on core diabetes lifestyle modifications).
Answer: c) Healthy eating patterns, regular physical activity, and weight management.
13. Unexplained weight loss can be a symptom of new-onset diabetes, particularly Type 1, because:
- a) The body starts storing excess glucose as fat.
- b) Lack of insulin prevents glucose from entering cells for energy, so the body breaks down fat and muscle instead.
- c) Patients develop an aversion to food.
- d) Glucagon levels are suppressed.
Answer: b) Lack of insulin prevents glucose from entering cells for energy, so the body breaks down fat and muscle instead.
14. Which of the following is an acute and potentially life-threatening complication of Type 1 Diabetes, characterized by hyperglycemia, ketosis, and acidosis?
- a) Hypoglycemia
- b) Diabetic Ketoacidosis (DKA)
- c) Hyperosmolar Hyperglycemic State (HHS)
- d) Diabetic retinopathy
Answer: b) Diabetic Ketoacidosis (DKA)
15. Hypoglycemia (low blood glucose) is a common acute complication in patients with diabetes, especially those treated with:
- a) Metformin alone.
- b) Insulin or sulfonylureas.
- c) Acarbose.
- d) Lifestyle modification only.
Answer: b) Insulin or sulfonylureas.
16. Chronic microvascular complications of diabetes include:
- a) Stroke and heart attack.
- b) Retinopathy, nephropathy, and neuropathy.
- c) Peripheral artery disease.
- d) Hypertension.
Answer: b) Retinopathy, nephropathy, and neuropathy.
17. Regular self-monitoring of blood glucose (SMBG) is important for patients with diabetes to:
- a) Determine their daily insulin manufacturing capacity.
- b) Assess their glycemic control, guide treatment adjustments, and detect hypo- or hyperglycemia.
- c) Cure their diabetes.
- d) Only track their dietary intake.
Answer: b) Assess their glycemic control, guide treatment adjustments, and detect hypo- or hyperglycemia.
18. The A1c test reflects average blood glucose control over the preceding:
- a) 24 hours
- b) 1 week
- c) 2-3 months
- d) 1 year
Answer: c) 2-3 months
19. Insulin resistance means that:
- a) The pancreas does not produce any insulin.
- b) Body cells (e.g., muscle, fat, liver) do not respond effectively to insulin, leading to impaired glucose uptake.
- c) The body is allergic to insulin.
- d) Insulin is broken down too quickly in the bloodstream.
Answer: b) Body cells (e.g., muscle, fat, liver) do not respond effectively to insulin, leading to impaired glucose uptake.
20. The “dawn phenomenon” in diabetes refers to:
- a) A drop in blood glucose levels in the early morning.
- b) An increase in blood glucose levels in the early morning, often due to nocturnal growth hormone secretion.
- c) Hypoglycemia that occurs after exercise.
- d) The initial diagnosis of diabetes.
Answer: b) An increase in blood glucose levels in the early morning, often due to nocturnal growth hormone secretion.
21. Which diagnostic test for diabetes involves drinking a glucose-rich beverage and having blood glucose levels measured at specific intervals?
- a) Fasting Plasma Glucose (FPG) test
- b) Hemoglobin A1c test
- c) Oral Glucose Tolerance Test (OGTT)
- d) Urine ketone test
Answer: c) Oral Glucose Tolerance Test (OGTT)
22. Social determinants of health can significantly impact diabetes management. Which of the following is an example?
- a) Genetic predisposition to diabetes.
- b) Access to affordable healthy foods and safe places for physical activity.
- c) The type of insulin prescribed.
- d) The brand of glucose meter used.
Answer: b) Access to affordable healthy foods and safe places for physical activity.
23. In Type 1 Diabetes, patients require lifelong insulin therapy because:
- a) Their cells are resistant to insulin.
- b) Their pancreas produces too much glucagon.
- c) Their pancreatic beta cells are destroyed and cannot produce sufficient insulin.
- d) They cannot absorb glucose from their diet.
Answer: c) Their pancreatic beta cells are destroyed and cannot produce sufficient insulin.
24. Ketones are produced when the body breaks down _______ for energy, which can occur in uncontrolled Type 1 Diabetes.
- a) carbohydrates
- b) fats
- c) proteins
- d) nucleic acids
Answer: b) fats
25. One of the main goals for A1c in most non-pregnant adults with diabetes is generally:
- a) < 5.0%
- b) < 6.0%
- c) < 7.0%
- d) > 8.0%
Answer: c) < 7.0% (Individualized, but this is a common general target)
26. Which of the following is a macrovascular complication of diabetes?
- a) Diabetic retinopathy
- b) Coronary artery disease (CAD)
- c) Diabetic nephropathy
- d) Peripheral neuropathy
Answer: b) Coronary artery disease (CAD)
27. The “honeymoon period” in Type 1 Diabetes refers to:
- a) The first year after diagnosis where no treatment is needed.
- b) A temporary phase after diagnosis where some endogenous insulin secretion may recover, potentially reducing insulin needs for a short time.
- c) The period when patients strictly adhere to their diet.
- d) A complication-free period that lasts for life.
Answer: b) A temporary phase after diagnosis where some endogenous insulin secretion may recover, potentially reducing insulin needs for a short time.
28. Which is NOT a primary component of initial management for most patients newly diagnosed with Type 2 Diabetes?
- a) Pancreas transplant
- b) Diabetes self-management education and support (DSMES)
- c) Lifestyle modifications (diet and exercise)
- d) Consideration of metformin therapy (unless contraindicated)
Answer: a) Pancreas transplant
29.Blurred vision can be a symptom of diabetes due to:
- a) Damage to the auditory nerve.
- b) High blood glucose levels causing fluid shifts in the lens of the eye.
- c) Low blood pressure.
- d) Vitamin A deficiency.
Answer: b) High blood glucose levels causing fluid shifts in the lens of the eye.
30. The Somogyi effect in diabetes is characterized by:
- a) Consistently high morning blood glucose levels due to insufficient evening insulin.
- b) Nocturnal hypoglycemia, which triggers counter-regulatory hormones leading to rebound hyperglycemia in the morning.
- c) A rapid decrease in A1c after starting new medication.
- d) Insulin allergy.
Answer: b) Nocturnal hypoglycemia, which triggers counter-regulatory hormones leading to rebound hyperglycemia in the morning.
31. Which type of diabetes accounts for the vast majority (around 90-95%) of all diagnosed cases of diabetes?
- a) Type 1 Diabetes
- b) Type 2 Diabetes
- c) Gestational Diabetes
- d) LADA (Latent Autoimmune Diabetes in Adults)
Answer: b) Type 2 Diabetes
32. Regular foot exams are crucial for patients with diabetes primarily to detect and prevent complications related to:
- a) Retinopathy
- b) Nephropathy
- c) Neuropathy and peripheral artery disease, which can lead to foot ulcers and amputations.
- d) Gastroparesis
Answer: c) Neuropathy and peripheral artery disease, which can lead to foot ulcers and amputations.
33. The oral glucose tolerance test (OGTT) is commonly used to screen for which condition?
- a) Type 1 diabetes in children only
- b) Gestational diabetes mellitus (GDM) in pregnant women
- c) Hypoglycemia
- d) Prediabetes in all adults
Answer: b) Gestational diabetes mellitus (GDM) in pregnant women
34. What is the role of glucagon, a hormone produced by pancreatic alpha cells?
- a) It lowers blood glucose levels by promoting glucose uptake into cells.
- b) It raises blood glucose levels, primarily by stimulating glycogenolysis and gluconeogenesis in the liver.
- c) It stimulates insulin secretion.
- d) It aids in fat storage.
Answer: b) It raises blood glucose levels, primarily by stimulating glycogenolysis and gluconeogenesis in the liver.
35. Which of the following is a key aspect of diabetes self-management education (DSME)?
- a) Providing patients with pre-filled insulin syringes for life.
- b) Empowering patients with the knowledge and skills to manage their condition effectively (e.g., diet, exercise, medication use, SMBG).
- c) Discouraging patients from asking questions about their treatment.
- d) Ensuring patients only eat sugar-free foods.
Answer: b) Empowering patients with the knowledge and skills to manage their condition effectively (e.g., diet, exercise, medication use, SMBG).
36. A random plasma glucose of _______ plus classic symptoms of hyperglycemia is diagnostic of diabetes.
- a) ≥ 140 mg/dL (7.8 mmol/L)
- b) ≥ 180 mg/dL (10.0 mmol/L)
- c) ≥ 200 mg/dL (11.1 mmol/L)
- d) ≥ 250 mg/dL (13.9 mmol/L)
Answer: c) ≥ 200 mg/dL (11.1 mmol/L)
37. The development of Type 2 diabetes often has a strong ________ component.
- a) viral
- b) genetic and lifestyle
- c) purely accidental
- d) traumatic injury-related
Answer: b) genetic and lifestyle
38. Hyperosmolar Hyperglycemic State (HHS) is an acute complication more commonly seen in:
- a) Patients with Type 1 Diabetes.
- b) Patients with Type 2 Diabetes, especially older individuals, often precipitated by illness or infection.
- c) Healthy individuals without diabetes.
- d) Pregnant women without GDM.
Answer: b) Patients with Type 2 Diabetes, especially older individuals, often precipitated by illness or infection.
39. Which factor does NOT directly contribute to the diagnostic criteria for diabetes?
- a) A1c
- b) Fasting plasma glucose
- c) Symptoms of hyperglycemia with a random plasma glucose
- d) Serum insulin levels
Answer: d) Serum insulin levels (While informative, not a primary diagnostic criterion itself for defining diabetes)
40. One of the earliest signs of diabetic nephropathy is often:
- a) Gross hematuria.
- b) Microalbuminuria (small amounts of albumin in the urine).
- c) Severe kidney pain.
- d) Anuria (no urine output).
Answer: b) Microalbuminuria (small amounts of albumin in the urine).
41. “Carbohydrate counting” is a meal planning technique often taught to patients with diabetes, especially those on:
- a) No medication.
- b) Metformin only.
- c) Flexible insulin regimens (e.g., basal-bolus therapy).
- d) Thiazolidinediones.
Answer: c) Flexible insulin regimens (e.g., basal-bolus therapy).
42. Which of the following ethnic groups in the United States has a higher prevalence of Type 2 Diabetes?
- a) Non-Hispanic Whites
- b) African Americans, Hispanic/Latino Americans, American Indians/Alaska Natives, and some Asian Americans/Pacific Islanders.
- c) Only individuals of European descent.
- d) Prevalence is equal across all ethnic groups.
Answer: b) African Americans, Hispanic/Latino Americans, American Indians/Alaska Natives, and some Asian Americans/Pacific Islanders.
43. The primary difference between Type 1 and Type 2 diabetes lies in the:
- a) Age of onset (T1DM always occurs in childhood).
- b) Underlying cause and degree of insulin deficiency/resistance.
- c) Need for blood glucose monitoring.
- d) Long-term complications, which are unique to each type.
Answer: b) Underlying cause and degree of insulin deficiency/resistance.
44. Regular physical activity is beneficial for individuals with Type 2 diabetes because it can:
- a) Increase insulin resistance.
- b) Improve insulin sensitivity and help lower blood glucose levels.
- c) Eliminate the need for all medications immediately.
- d) Only help with weight loss, not glucose control.
Answer: b) Improve insulin sensitivity and help lower blood glucose levels.
45. For an individual diagnosed with prediabetes, the primary goal of intervention is to:
- a) Initiate insulin therapy immediately.
- b) Prevent or delay the progression to Type 2 Diabetes through lifestyle changes and, if appropriate, medication.
- c) Monitor A1c levels annually without any other action.
- d) Eliminate all carbohydrates from the diet.
Answer: b) Prevent or delay the progression to Type 2 Diabetes through lifestyle changes and, if appropriate, medication.
46. Diabetic neuropathy can affect:
- a) Only sensory nerves.
- b) Only motor nerves.
- c) Sensory, motor, and autonomic nerves.
- d) Only the optic nerve.
Answer: c) Sensory, motor, and autonomic nerves.
47. A common target for blood pressure control in many patients with diabetes and hypertension is:
- a) <180/110 mmHg
- b) <160/100 mmHg
- c) <140/90 mmHg or often <130/80 mmHg if achievable without undue burden.
- d) Blood pressure control is not important in diabetes.
Answer: c) <140/90 mmHg or often <130/80 mmHg if achievable without undue burden. (Targets can vary, <130/80 is often a goal for many).
48. The term “glycemic index” (GI) refers to:
- a) The amount of glucose in a food.
- b) How quickly a carbohydrate-containing food raises blood glucose levels compared to a reference food.
- c) The patient’s average blood glucose level.
- d) A type of insulin.
Answer: b) How quickly a carbohydrate-containing food raises blood glucose levels compared to a reference food.
49. Which statement best describes the initial approach to managing Type 1 Diabetes upon diagnosis?
- a) Lifestyle changes alone are usually sufficient.
- b) Oral antidiabetic medications are the first line of therapy.
- c) Insulin therapy is essential from the time of diagnosis.
- d) Pancreatic enzyme replacement is the primary treatment.
Answer: c) Insulin therapy is essential from the time of diagnosis.
50. Pharmacists play a critical role in diabetes care through:
- a) Only dispensing medications.
- b) Providing diabetes self-management education, medication therapy management, immunizations, and screening for complications.
- c) Diagnosing new cases of diabetes independently.
- d) Performing surgical procedures for complications.
Answer: b) Providing diabetes self-management education, medication therapy management, immunizations, and screening for complications.
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