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Chapter 24
Diabetes Mellitus
44
Physiology
Not Applicable
11/25/2012

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Term
1) Which of the following best describes diabetes mellitus type 1?
A) its an autoimmune disease that attacks insulin receptors
B) its an autoimmune disease that attacks alpha cells of the pancreas
C) its an autoimmune disease that attacks beta cells of the pancreas
D) its a genetic disorder associated with the X chromosome
E) its a genetic disorder associated with the Y chromosome
Definition
C) its an autoimmune disease that attacks beta cells of the pancreas
Term
2) In diabetes mellitus type 1, the immune system attacks beta cell antigens. Which of the following is a potential antigen?
A) preproinsulin
B) glucose
C) glucagon
D) preproglucagon
E) ketones
Definition
A) preproinsulin
Term
3) What is the significance of Coxsackie B virus in diabetes mellitus type 1?
A) This virus attacks beta cells of the pancreas causing an immune response against these cells.
B) A person with diabetes mellitus type 1 is more susceptible to infection with Coxsackie B.
C) Coxsackie B increases the availability of lipids for energy.
D) Coxsackie B increases the availability of glucose for energy.
E) Coxsackie B increases the availability of proteins for energy.
Definition
A) This virus attacks beta cells of the pancreas causing an immune response against these cells.
Term
4) By what percentage has the incidence of diabetes mellitus type 1 increased in the United States over the last twenty years?
A) 0
B) 10
C) 25
D) 50
E) 100
Definition
50
Term
5) At what age do symptoms of diabetes mellitus type 1 first appear?
A) at conception
B) at birth
C) before age 5
D) after age 7
E) after age 40
Definition
after age 7
Term
6) Which of the following is NOT an effect of epinephrine?
A) stimulate protein synthesis
B) stimulate lipolysis
C) stimulate gluconeogenesis
D) increase blood fatty acid levels
E) increase ketone production
Definition
stimulate protein synthesis
Term
7) Which of the following is NOT a symptom of ketoacidosis?
A) dehydration
B) fruity odor to breath
C) decreased ventilation
D) polyuria
E) electrolyte imbalance
Definition
decreased ventilation
Term
8) Which of the following can NOT cause coma?
A) a person with diabetes mellitus taking too much insulin causing hypoglycemia
B) a person with diabetes mellitus type 1 taking too little insulin causing hyperglycemia
C) a blood osmolarity greater than 350 mOsm
D) a blood glucose concentration greater than 600 mg/dL
E) a partial pressure of carbon dioxide of 40 mm Hg in arterial blood
Definition
a partial pressure of carbon dioxide of 40 mm Hg in arterial blood
Term
9) Symptoms of hypoglycemia include all of the following EXCEPT ________.
A) blurred vision
B) hunger
C) tingling sensation
D) polyuria
E) anxiety
Definition
polyuria
Term
10) Which of the following chemical messengers induces the sensation of feeling full (satiety effect)?
A) insulin
B) glucagon
C) epinephrine
D) acetylcholine
E) somatostatin
Definition
insulin
Term
11) In diabetes mellitus, polydipsia is triggered by what hormone?
A) angiotensin II
B) angiotensin I
C) leptin
D) relaxin
E) glucagon
Definition
angiotensin II
Term
12) Glycosylation of what protein is used as a marker for measuring blood glucose levels?
A) insulin
B) glucagon
C) albumin
D) fibrin
E) hemoglobin
Definition
hemoglobin
Term
13) Which of the following is NOT an adverse effect of glycosylation caused by hyperglycemia?
A) delayed wound healing
B) increased capillary permeability lipolysis
C) beta cell degeneration
D) oxidative stress
E) atherosclerosis
Definition
beta cell degeneration
Term
14) What is the polyol associated with glucose?
A) aldose
B) lactose
C) sorbitol
D) ascorbic acid
E) glycerol
Definition
sorbitol
Term
15) In diabetes mellitus type 1, blood vessel damage occurs primarily through what process?
A) shear stress on the blood vessels due to elevated pressure
B) increase in nitric oxide release from endothelial cells
C) increase in carbon dioxide build up in blood
D) increase in oxygen levels in blood
E) increase in histamine production
Definition
shear stress on the blood vessels due to elevated pressure
Term
16) In diabetes mellitus type 2, blood vessel damage occurs primarily through what process?
A) shear stress on the blood vessels due to elevated pressure
B) increase in carbon dioxide levels in blood
C) decrease in nitric oxide release from endothelial cells
D) increase in histamine production
E) sclerosis of the basement membrane
Definition
decrease in nitric oxide release from endothelial cells
Term
17) Damage to the microvasculature that occurs with diabetes contributes to which of the following conditions?
A) retinopathy
B) nephropathy
C) neuropathy
D) delayed wound healing
E) all of the above
Definition
all the above
Term
18) What is a microaneurysm?
A) small leakage of blood from the microvasculature
B) large leakage of blood from the microvasculature
C) development of new blood vessels
D) weak bulges in the walls of small blood vessels
E) perforation of the basement membrane of fenestrated capillaries
Definition
weak bluges in the walls of small blood vessels
Term
19) What is angiogenesis?
A) small leakage of blood from the microvasculature
B) large leakage of blood from the large blood vessels
C) development of new blood vessels
D) weak bulges in the walls of small blood vessels
E) developments of perforations in the basement membrane of fenestrated capillaries
Definition
development of new blood vessels
Term
20) What happens when excessive angiogenesis occurs?
A) the new blood vessel walls are weak and tend to leak
B) the new blood vessel walls are stiff and tend to clog
C) the heart can no longer beat strongly
D) the heart rate increases significantly
E) hypotension occurs due to decreased total peripheral resistance
Definition
the new blood vessel walls are weak and tend to leak
Term
21) Which of the following is an early sign of diabetic nephropathy?
A) glucose in the urine
B) blood in the urine
C) systemic edema
D) proteinuria
E) frequent urinary tract infections
Definition
proteinuria
Term
22) What is end-stage renal disease?
A) the kidneys fail and dialysis or kidney transplant is essential
B) the glomerular membrane becomes leaky and proteins appear in the urine
C) infection of the kidneys causes blood loss in the urine
D) Bowman's capsule becomes leaky causing a systemic infection
E) Bowman's capsule becomes leaky and proteins appear in the urine
Definition
the kidneys fail and dialysis or kidney tranplant is essential
Term
23) What is parasthesia?
A) simultaneous activation of afferent and efferent axons to the same region of the body
B) abnormal sensation of the skin such as tingling or numbness
C) abnormal activation of motor neurons causing muscle twitches
D) unpleasant sensation produced by innocuous stimuli
E) muscle spasms
Definition
abnormal sensation of the skin such as tingling or numbness
Term
24) What is dysthesia?
A) unpleasant sensation produced by innocuous stimuli
B) numbness
C) tingling sensation
D) muscle twitches
E) muscle spasms
Definition
unpleasant sensation produced by innocuous stimuli
Term
25) Diabetic neuropathies generally affect what area of the nervous system?
A) brain
B) spinal cord
C) peripheral nervous system
D) sensory receptors
E) glial cells
Definition
peripheral nervous system
Term
26) Which of the following does NOT contribute to diabetes enhanced atherosclerosis?
A) increased lipid transport in LDLs
B) increased production of reactive oxygen species
C) increased glycosylation
D) microvascular disease
E) increased lipid transport in HDLs
Definition
increased lipid transport in HDLs
Term
27) Which of the following is characteristic of diabetic cardiomyopathy?
A) decreased stroke volume
B) decreased heart rate
C) decreased size of the heart
D) decreased likelihood of myocardial infarction
E) All of the above
Definition
decreased stroke volume
Term
28) What is silent myocardial ischemia?
A) a heart attack without pain
B) a stroke
C) a cardiac arrhythmia that decreases contractility of the atria
D) a cardiac arrhythmia that decreases contractility of the ventricles
E) a cardiac arrhythmia that shuts down the pacemaker cells of the SA node
Definition
a heart attack without pain
Term
29) Why do many diabetics have to have a foot amputated?
A) decreased blood flow to the foot causes gangrene
B) decreased blood flow to the foot causes extreme pain that can only be relieved by amputation
C) neuropathy causes intense pain that can only be relieved by amputation
D) decreased blood flow to the foot causes wounds to develop that will not heal
E) abnormal wound healing coupled to lack of sensation from the foot can lead to gangrene
Definition
abnormal wound healing coupled to lack of sensation from the foot can lead to gangrene
Term
30) What is the correct order of the three steps of wound healing?
A) inflammation - remodeling - proliferation
B) proliferation - inflammation - remodeling
C) remodeling - inflammation - proliferation
D) proliferation - remodeling - inflammation
E) inflammation - proliferation - remodeling
Definition
inflammation - proliferation - remodeling
Term
31) What two cytokines released by platelets during hemostasis promote inflammation?
A) transforming growth factor beta and platelet derived growth factor
B) interleukin 1 and thrombin
C) interleukin 2 and platelet derived growth factor
D) thrombin and leukotriene
E) prostaglandin I2 and platelet factor 3
Definition
transforming growth factor beta and platelet derived growth factor
Term
32) What cell type initiates the inflammatory response?
A) macrophages
B) neutrophils
C) eosinophils
D) fibroblasts
E) lymphocytes
Definition
macrophages
Term
33) Phagocytosis of debris in the area of wound is carried out by what cell types?
A) lymphocytes and fibroblasts
B) neutrophils and fibroblasts
C) eosinophils and neutrophils
D) basophils and eosinophils
E) macrophages and neutrophils
Definition
macrophages and neutrophils
Term
34) What cell type lays down the new extracellular matrix as a wound heals?
A) neutrophils
B) fibroblasts
C) monocytes
D) macrophages
E) megakaryocytes
Definition
fibroblasts
Term
35) What cell type secretes collagen as a wound heals?
A) neutrophils
B) monocytes
C) macrophages
D) keratinocytes
E) fibroblasts
Definition
fibroblasts
Term
36) What are epidermal cells that proliferate to cover the opening of a wound?
A) fibroblasts
B) macrophages
C) keratinocytes
D) neutrophils
E) granule cells
Definition
keratinocytes
Term
37) Collagen becomes organized and cross-linked during what phase of wound healing?
A) hemostasis
B) proliferation
C) remodeling
D) inflammation
E) angiogenesis
Definition
remodeling
Term
38) What effect does diabetes have on wound healing?
A) speeds it up by increasing angiogenesis
B) speeds it up by increasing the rate of proliferation
C) speeds it up, but in the process leads to a larger scar formation
D) slows it down by increasing inflammation
E) delays it by slowing the rate of all phases
Definition
delays it by slowing the rate of all phases
Term
39) Adequate treatment of diabetes includes maintaining fasting blood glucose levels below what value?
A) 60 mg/dL
B) 85 mg/dL
C) 100 mg/dL
D) 115 mg/dL
E) 130 mg/dL
Definition
115 mg/dL
Term
40) Dietary control of diabetes mellitus type 1 includes limiting the intake of ________.
A) carbohydrates
B) proteins
C) cholesterol
D) triglycerides
E) cellulose
Definition
carbohydrates
Term
41) What is the primary medicine for regulating diabetes mellitus type 1?
A) insulin
B) sulfonureas
C) biguanides
D) glucagon
E) glucagon inhibitors
Definition
insulin
Term
42) What diabetes medication stimulates insulin release from beta cells of the pancreas?
A) none
B) biguanides
C) thiazolidinediones
D) sulfonureas
E) alpha-glucosidase inhibitors
Definition
sulfonureas
Term
43) How do alpha-glucosidase inhibitors decrease blood glucose levels?
A) stimulating insulin release from beta cells of the pancreas
B) inhibiting gluconeogenesis in the liver
C) inhibiting glycogenesis in the liver
D) inhibiting digestion of carbohydrates in the small intestine
E) stimulating glycogenesis in the liver
Definition
inhibiting digestion of carbohydrates in the small intestine
Term
44) What medicine for the treatment of diabetes sensitizes tissue to insulin?
A) glucagon
B) sulfonureas
C) alpha-glucosidase inhibitors
D) biguanides
E) thiazolidinediones
Definition
thiazolidinediones
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