1. Major cause of death in diabetes is

Cardiovascular

Renal

Diabetic Ketoacidosis

Hypoglycemia on treatment

2. Which of the following facts are correct regarding insulin

Alpha chain contains 30 aminoacids

Beta chain contains 21 aminoacids

Alpha and Beta chains are linked by 2 disulphide bonds

Proinsulin includes insulin and peptide

3. Which of the following are correct regarding type I diabetes mellitus?

Results from Beta cell destruction by autoimmune process

Associated with HLA DR3 and DR4

Commonly manifests for the first time in adults

Ketoacidosis is less common

4. Which of the following statements is correct regarding maturity onset diabetes mellitus of the young? (MODY)

They have a mutation in glucokinase gene

Develop type II diabetes mellitus in 2nd or 3rd decade

Inherited as autosomal recessive trait

Diabetes mellitus is existent in parents and siblings

5. Which of the following statements is correct regarding screening for gestational diabetes mellitus?

Done at 24-28 weeks of gestation

No need for fasting and can be done at any time of the day

Glucose load of 75 gms is given

A 2 hour post glucose value of more than 140 mg% requires the performance of Oral Glucose Tolerance Test (OGTT)

6. Which of the following are correct regarding hypoglycemia?

Common with renal dysfunction

Sympathetic stimulation leads to tremors, sweating and palpitation

Counter regulatory hormones suppress gluconeogenesis

Elderly may present with neuroglycopenic symptoms

7. Which of the following is correct regarding diabetic ketoacidosis

Brain is unable to utilize glucose due to severe insulin deficiency

Increased lipolysis results in excessive ketone production

Osmotic diuresis results in dehydration and electrolyte imbalance

Glucagon levels are low

8. Management of diabetic ketoacidosis includes:

Correction of dehydration and electrolyte imbalance

Normalise hyperglycemia with insulin

Correct acidosis by bicarbonate

Identify and treat precipitating cause

9. Which of the following are correct regarding hyperosmolar nonketotic coma?

Carries a mortality of 10%

Bicarbonate levels <25 mEq/L

Occurs in elders living alone

Following diuretic and phenytoin treatment

10. Which of the following statements are correct

Increased prevalence of hypertension in diabetics is related to hyperinsulinemia

Diabetic nephropathy potentiates tendency for hypertension

Isolated systolic hypertension is very rare in diabetics

Autonomic neuropathy can precipitate orthostatic hypotension

11. Which of the following statements are correct

Neuropathic foot is cold with impalpable pulses

Veins of the dorsum of the foot are often distended

Neuro ischaemic foot has painful ulcers

Claudication is rare in neuro ischaemic foot

12. Which of the following are correct with respect to diabetic micro vascular complications

Thickening of the basement membrane of capillary is a hall mark of capillary changes

Related to duration of diabetes mellitus

Correction of hyperglycemia does not prevent micro-vascular complications

Intense diabetes treatment does not cause regression of micro-vascular lesions

13. Which of the following statements are correct regarding diabetic retinopathy?

Increase in number of pericytes

Development of microaneurysms

Increased vascular permeability

Newly formed retinal vessels are not fragile

14. Which of the following statements are correct

Cotton wool spots represents local retinal ischaemia

Dot hemorrhages are due to leakage of blood into deeper layers of retina

Diabetic maculopathy is common in type I diabetes mellitus

Focal vascular leakage of plasma at the fovea leads to macular star

15. Which of the following statements are correct regarding diabetic neuropathy?

Hyperglycemia affects nerves throughSorbitol and advanced glycosylation end products

Involvement of vasanervosum can also result in neuropathy

Neuropathic arthropathy is a common complication of diabetic neuropathy

Sensory or sensory motor distal poly neuropathy is the least common type of diabetic neuropathy

16. Which of the follOWing statements are correct regarding diabetic amyotrophy?

Presents with severe pain in thighs often at nights

Weakness and wasting of iliopsoas and quadriceps muscles

Sensory perception is markedly decreased in lower limbs

Knee jerk is often brisk

17. Diabetic cystopathy

Leads to atonic bladder

Overflow incontinence

Painful retention of urine

Managed by continuous bladder drainage

18. Which of the following are correct regarding sexual dysfunction of diabetes mellitus?

Erectile dysfunction is secondary to sympathetic nerve involvement

The blood vessels of corpora cavernosa are unable to dilate

Sildanefil is useful

Sildanefil can be used along with nitrates

19. Which of the following are correct regarding diabetic nephropathy

Urinary albumin excretion of more than 300 mg/24 hours

Urinary albumin by creatinine ratio of more than 3.5 mg/mMol

Not related to duration of diabetes mellitus

Micro-albuminuria is a sign of cardiovascular disease

20. Which of the following statements are correct

Metformin decreases hepatic glycogenolysis

Gliptizide is an insulin secretogogue

Pioglitazone increases serum triglyceride levels

Acarbose does not cause hypoglycemia

21. Which of the following are correct regarding cardiovascular changes during pregnancy?

The average increase in blood volume is 75%

Blood volume increase is more in multigravida and multiple pregnancy

Estrogen suppresses Renin Angiotensin Aldosterone system

Increase in hemoglobin concentration

22. Which of the following are correct with respect to cardiovascular changes during pregnancy?

There is a greater fall in diastolic blood pressure

Pulse pressure widens

Maximum fall occurs just before term

Low resistance placental circulation reduces vascular tone

23. Which of the following clinical signs during pregnancy are abnormal?

Mid systolic murmur in pulmonary area radiating to left side of neck

Continuous murmur heard over right supraclavicular fossa

Early diastolic murmur in lower left sternal border

Short mid diastolic murmur heard over the apex

24. Which of the following changes occur during pregnancy?

Gastric and Intestinal motility is decreased leading to increased absorption of drugs

Higher loading dose of drugs is required

More free drug is available with respect to highly protein bound drugs

Hepatic and renal banding of drugs is unaffected

25. Which of the following statements are correct

Beta blockers do not cross placental barrier

Relaxation of uterus is mediated by beta 2 receptors

Labetolol is used to treat pregnancy associated hypertension

Beta blockers are contraindicated in pregnant women with hereditary long QT syndrome

26. Which of the following statements are correct

Lidocaine is a widely used anti-arrhythmic agent in pregnancy

Propafenone crosses placental barrier

Amiodarone can cause fetal hypothyroidism and neuro developmental problems

Verapamil is contraindicated during pregnancy for treatment of supraventricular tachycardia

27. Which statement is more likely with cardiovascular disease in diabetes?

Males suffer more than females

Females suffer more than males

Males and females suffer equally

Males suffer more after 70 years than female

28. Which of the following statements are correct

Use of Warfarin in first trimester can result in embryopathy

Warfarin can lead to placental hemorrhage

Does not cause increased bleeding tendency in the new born

Warfarin embryopathy does not affect bones

29. Which of the following are correct regarding preeclampsia

It is a disorder of endothelial dysfunction with vasospasm

Low dose Aspirin after 12th week of gestation is useful

Wi11lead to chronic hypertension after delivery

There is abnormal placental development or placental damage

30. Which of the following statements are correct

Intravenous Magnesium Sulphate is superior to Phenytoin in Eclampsia

Diuretics may suppress lactation

A lady with preeclampsia is unlikely to have recurrence of hypertension in subsequent pregnancies

ECG in preeclampsia often shows left ventricular hypertrophy

31. The best choice of antihypertensive therapy in diabetes is

ACIE and ARB

Ca channel blockers

13 blockers

Diuretics

32. Which of the following statements are correct

A normal chest X-ray rules out diagnosis of pulmonary embolism

A normal ECG does not exclude pulmonary embolism

Echocardiography offers risk statisfication in pulmonary embolism

A normal pulse oximetry excludes pulmonary embolism

33. Which of the following patients with pulmonary embolism are candidates for thrombolysis?

Recurrence of pulmonary embolism while on heparin therapy.

Patient with massive pulmonary embolism in hemodynamic collapse.

Patient with doppler proven deep vein thrombosis.

Patient with submassive pulmonary embolism with RV dysfunction on echocardiogram.

34. Which of the following statements are correct regarding usage during pregnancy

Digoxin belongs to category C use in pregnancy

Safety of levosemindan during pregnancy is not established

Dobutamine belongs to category C for use in pregnancy

Dopamine belongs to category B for use in pregnancy

35. A lady with 36 weeks of gestation presents with pedal edema and blood pressure of 160/110 mmHg. She complains of visual disturbance and upper abdominal pain. Which of the following are appropriate

Immediate delivery must be done

Vaginal delivery is preferred if possible

Oral Methyldopa 500 mg thrice daily must be started

Magnesium sulphate to be used if convulsions occur

36. A lady with preeclampsia and 32 weeks of pregnancy is on methyl dopa 500 mg 6th hourly. Blood pressure is 160/110 mmHg. Obstetrician after examining the lady diagnosed intrauterine growth retardation and foetal distress. Which of the following are appropriate?

Increase the dose of methyldopa

Start intravenous Hydrallazine

Immediate delivery must be planned

Orallabetalol can be added

37. Which of the following differentiate preeclampsia from chronic hypertension?

Common in multigravida

Left ventricular hypertrophy is common

Onset is after 20 weeks of gestation

Proteinuria is common

38. A lady with mitral valve area of 1.1 sq cm comes with 10 weeks of pregnancy. Which of the following are appropriate

Beta blocker

Digoxin

Immediate mitral valvuloplasty

Oral diuretic

39. Choice of drug in obese diabetics is

Pioglitazone

Insulin

Metformin

Celi benc1amide

40. Glycosylated hemoglobin HBAIC indicates average glycemic value of

6 months

9 months

1 month

3 months

41. Which of the following statements about pulmonary hypertension is correct?

PA pressure is more than 30/20 mmHg

Secondary forms of pulmonary hypertension are more common than primary

High altitude pulmonary hypertension does not improve with relocation to sea level

Conditions causing pulmonary venous hypertension lead to secondary pulmonary hypertension

42. Which of the following are appropriate in management of secondary pulmonary hypertension

Endothelin receptor antegonists should be given to all patients.

If secondary to hypoventilation oxygen therapy will be useful.

LV dysfunction should be treated with ACE inhibitor and diuretics.

Closure of defect should be done in all shunt lesions.

43. Which of the following features occur in primary pulmonary hypertension

Can be easily recognized in early stages itself.

Exertional dyspnoea and angina can occur.

Can result in sudden death.

X-ray chest shows RV enlargement in all patients.

44. Which one of the following inotropes is not adrenergic against?

Dopamine

Dobutamine

Norepinephrine

Amrinone

45. " Which of the following conditions can lead to Corpulmonale

Pneumoconiosis

Diffuse bronchiectasis

Pulmonary stenosis

Obstructive sleep apnoea

46. Which of the following statements are correct

Fasting sugar of more than 126 mg indicates diabetes

Fasting sugar levels of 110 -125 mg with 2 hours post prandial sugar values of 140 -200 indicates impaired glucose tolerance

2 hours post prandial values of 140 mg% -200 mg% indicates non diabetic state

Fasting blood sugar value of more than 110 mg% with post prandial values of less than 140 mg% indicates impaired fasting glucose

47. Which of the following statements regarding Insulin secretions are correct

Increased glucose concentration in Beta cell closes calcium channels

Entry of calcium ions into beta cell causes the release of insulin

Pancreas secretes about 18 -32 units per 24 hours

Meals stimulated insulin release is slow and constant

48. Which of the following are correct regarding type II diabetes mellitus?

Common in lean individuals

Both insulin resistance and relative insulin deficiency are present

Insulin resistance is at receptor and post receptor levels

Forms 50 of diabetic population

49. Which of the following is true regarding gestational diabetes mellitus?

Diabetes mellitus detected for the first time in the pregnancy stage

Diabetic state disappears after delivery

Includes known diabetes mellitus who become pregnant

Undetected type II diabetes mellitus cannot be mistaken as gestational diabetes mellitus

50. Which of the following is correct regarding diagnosis of gestational diabetes?

With 100 gm oral glucose load, plasma glucose of >165 mg% after 2 hours

With 100 gm oral glucose load, plasma glucose of >145 mg% after 3 hours

Fasting glucose of 125 mg%

With 75 gm oral glucose load, 2 hours post glucose plasma glucose of >150 mg%

51. Which of the follOWing are correct

In every unconscious patient hypoglycemia should be excluded

An IV bolus of 20 mL of 25% glucose to be given

10% glucose drip for 4 hours will correct hypoglycemia induced by oral hypoglycemic drugs

Those only on insulin should receive IV glucose infusion for 48 hours

52. Which of the follOWing is correct regarding diabetic ketoacidosis?

Accompanied by increased gluconeogenesis

Should be suspected in any diabetic patient with vomiting and abdominal pain

Rothera's test in urine is often negative

Blood glucose is >350 mg%

53. Hyperosmolar nonketotic coma should be suspected in the following situations

Serum osmolarity is 290 mOsm/kg

After a cerebrovascular accident

Plasma glucose of >600 mg%

Arterial pH of <7.3

54. Which of the following statements are correct?

Diabetic macro vascular complications are aggravated by smoking and hypertension

Perfect control of diabetes alone does not always prevent macro vascular complications

Diabetic dyslipidemia includes high triglycerides and HDL cholesterol

Small dense LDL particles are more atherogenic than usual LDL particles

55. Which of the following statements are correct

In a diabetic, hemorrhagic strokes are more common than lacunar infarcts

Aortoiliac and femorotibial arteries are the usual sites of diabetic peripheral vascular disease

Ankle -brachial systolic pressure ratio of 1 occurs in peripheral vascular disease

Extracranial carotid arteries are rarely affected in diabetes

56. Which of the following are correct regarding neuropathic foot?

Curling up of the toes occur

Callosities form on the plantar surface of metatarsal heads

Skin is dry and atrophic

Once infected there is poor healing

57. Which of the following statements are correct

Hyperglycemia leads to intracellular accumulation of sorbitol

Myoinositol uptake is decreased

Myelin sheath of peripheral nerves are resistant to sorbitol

HbA1C is an indicator of long term average glycemic control

58. Which of the following are not features of background retinopathy?

Microaneurysms

Cotton wool spots

Neovascularisation

Shunts between venules and capillaries

59. Which of the following statements about complications of diabetes are correct

Fourth cranial nerve is commonly involved by diabetes

When diabetes mellitus involves 3rd cranial nerve, pupil is unaffected

Rubeosis Iridis is secondary to new vessel proliferation

Risk of retinopathy is not related to duration of diabetes mellitus

60. Which of the following regarding diabetic mononeuropathy are correct

Can be due to occlusion vasonervosum

Can be secondary to mechanical entrapment

Extraocular nerves are rarely involved

Ischaemic damage of optic nerve head can happen

61. Which of the following are manifestations of autonomic neuropathy

Postural hypotension

Fixed increased heart rate

Ischaemia of optic nerve head

Sudden cardiac standstill during anaesthesia

62. Which of the following are not manifestations of autonomic neuropathy

Diabetic gastroparesis

Gustatory sweating

Carpal tunnel syndrome

Diabetic amyotrophy

63. Which of the following are not features of diabetic nephropathy

Proteinuria of more than 500 mg%/24 hours

Hyperkalemia

Reduction in size of kidney (by Ultrasound Imaging)

Presence of red cell casts in urine

64. Which of the following are part of correct prescription for a diabetic with an ideal body weight of 60 kg doing only sedentary activity

Caloric content 1320 calories/day

Protein content of 50 grams

Fiber content of 40 grams

Fat content contributing to 40% of calories/day

65. Which of the following statements are correct

When an over weight person is detected to have a post prandial blood glucose of 150 Metformin should be prescribed

When a patient of Metformin continues to have post prandial blood sugar of more than 200 Sulphonylurea can be added

Pioglitazone can be added as a third drug when blood sugar control with combination of Sulphonylurea and Metformin is not adequate

Diet and weight reduction alone are not sufficient in impaired glucose tolerance

66. Which of the following are correct regarding Cardiovascular changes during pregnancy?

Heart rate at rest increases during pregnancy by 10 -20 beats/minute

Maximum increase in cardiac output is achieved by 24 -28 weeks of pregnancy

In early pregnancy, increase in cardiac output is mainly by increase in heart rate

In third trimester, increase in cardiac output is due to increase in stroke volume

67. Which of the following are correct with respect to cardiovascular changes during pregnancy?

Supine hypotensive syndrome occurs in about 11 of pregnant women

Compression of inferior vena cava by enlarged uterus occurs in supine posture

Maximum increase in cardiac output occurs in first stage of labour

Venous return of heart decreases postpartum

68. Which of the following are normal ECG changes during pregnancy?

Left axis deviation

Deep Q waves in II, III, aVF

Sinus tachycardia

ST, T changes in precardialleads without wall motion abnormalities in Echocardiogram

69. Which of the following statements are correct

Protein bound drug cannot cross placental barrier

Lipid soluble molecules can easily reach fetal circulation

Most of the drugs reaching fetal circulation do not reach the fetal heart and brain

Drugs entering fetal circulation are metabolized by fetal liver

70. Whicl1 of the following statements regarding Digoxin are correct

Does not cross placental circulation

Is excreted in milk and can affect the lactating baby

Can be used to treat heart failure in pregnancy

Is useful for fetal supraventricular tachycardia

71. Which one is a thiazide diuretic

Torsemide

Ethacrynic acid

Bumetanide

Metalozone

72. Which Of the following statements are correct regarding use of Aspirin during pregnancy?

Low dose Aspirin after 12th week of gestation prevents preeclampsia

"CLASP study" evaluated the usefulness of Aspirin in preeclampsia

Aspirin given during pregnancy had no effect on fetal growth

Aspirin caused 75% reduction in premahlre delivery

73. Which of the following statements are true about gestational hypertension?

Hypertension develops in last trimester of pregnancy

Proteinuria is absent

If severe, leads to high rates of premature delivery

Fetal growth is unaffected

74. Which of the following statements are correct regarding treatment of Preeclampsia?

Antihypertensive drug therapy does not improve perinatal outcomes

Oral Methyldopa is preferred because of its safety record

It is better to avoid Labetalol and Nifedipine

Parenteral drugs to be used if delivery is likely to occur within a few hours

75. Which of the following statements are correct

If a pregnant lady has supraventricular tachycardia, it is likely to be atrial tachycardia

Atrial fibrillation during pregnancy often occurs in presence of structural heart disease or endocrine abnormality

Intravenous Adenosine is to be avoided during pregnancy

Ventricular tachycardia is rare in pregnancy

76. Which of the following statements are correct

D dimer testing has good negative predictive ability

Normal CT pulmonary angiogram rules out pulmonary embolism

Negative venous doppler excludes pulmonary embolism

Computed tomographic venography is the best imaging_ pulmonary embolism

77. The commonest presenting feature of pulmonary embolism is: .

Acute chest pain

Acute right heart failure

Hemoptysis and fever

Acute unexplained dyspnoea with sinus tachycardia

78. Which of the following statements regarding preeclampsia are correct

Modest rise in blood pressure is often asymptomatic and requires no treatment.

Most cases worsen with time

Delivery is the appropriate therapy for the mother

Treatment alters underlying pathophysiology of the disease

79. Which of the following are features of chronic hypertension with superimposed preeclampsia

New onset of proteinuria in woman with hypertension after 20 weeks of gestation

Elevated liver enzymes

Persisting proteinuria beyond 12 weeks postpartum

Increase in platelet count

80. A 30 yrs old hypertensive lady with initial blood pressure of 150/90mm Hg is well controlled on thiazide diuretic. She reports with 6 weeks of pregnancy. Which of the following measures are correct

Continue the same drug

Restrict sodium intake to 2 gms/day

Discourage alcohol use

Encourage Weight reduction

81. Which of the following statements are wrong regarding mitral stenosis complicated by pregnancy?

Increased blood volume aggravates transmitral gradient

Colloid osmotic pressure decreases and favours pulmonary congestion

Atrial arrhythmias are uncommon

Foetal growth is unaffected

82. Which of the following are true regarding pregnancy complicating mitral regurgitation

Regurgitant lesions are not well tolerated during pregnancy

Hydralazine will be useful

Surgery is indicated if there is significant LV dysfunction

Foetal outcome is unaffected by surgery

83. All beta blockers in pregnancy can cause intrauterine growth retardation except:

Metoprolol

Labetalol

Atenolol

Propranolol

84. Which of the followink' about peripartum cardiomyopathy are correct

More than 90% of patients recover completely

Presents in early postpartum period

It is a diagnosis by exclusion

Recurrence in subsequent pregnancies is less common

85. Which of the following statements about pulmonary hypertension are correct?

Loud 52 does not occur in all cases.

Prominent IAI wave in jugular vein.

Doppler evaluation of tricuspid regurgitation is useful to quantify pulmonary hypertension.

Cardiac catheterization is a must for confirmation.

86. Following are the potassium sparing agent except

Amiloride

Triamterene

Hydrochlorothiazide

Spironolactone

87. Which of the following are true regarding pulmonary hypertension in pregnancy?

Primary pulmonary hypertension carries a high maternal mortality.

Clinical deterioration occurs in later part of pregnancy.

Fetal morbitidy and mortality is unaffected.

Complications do not occur after delivery.

88. Which of the following are correct regarding Epoprostenol

It is a metabolite of arachidonic acid

A pulmonary vasodilator

Promotes platelet aggregation

Inhibits vascular smooth muscle proliferation

89. Eclampsia is characterised by all except:

Hypertension

Seizures

Hypoglycemia

Proteinuria

90. All are causes for Cor Pulmonale except

Chronic Bronchitis

Bullous Emphysema

Bronchial Asthma

Low Altitude Dwellers