\ 1) The most common autoantibody found in type 1DM is directed against: A. GAD 6S B. IAP-2 nT8 D. Insulin 2) All of the following statements regarding type 1 DM Istrue except? Vitamin D has protective effect. Cows milk predisposes to diabetes. Time of onset is unpredictable. Most common presentation is not DKA Omega 3 fatty acids are protective. Allof the above are true. smpomP 3) Which of the following statements regarding risk factors for type 2 DM is false? Obesity is the strongest risk factor for Type 2 DM. Coffee and other caffeinated drinks are protective. Cigarette smoking increases the risk. Statins increase the risk for type 2 DM. Allof the above are correct. mOORe Icr 4) Which of the following values indicates diabetes? ‘A. FBS>126 B. FBS < 126, PPBS 140-200 .PBS« 140, PPBS > 200 D. RBS>200 5) In diabetic patients who are not at goal levels of blood glucose, HbAtc should be monitored with what frequency? ‘A. Yearly B. Every 6 months Every 3 months D. Every 6 weeks 6) Regarding Insulin therapy, the following statements are true except: ‘A. Three doses of regular insulin s excellent for glucose control in hospitalized patients, B._ Regular insulin is fast acting and safe. C._NPH can produce nocturnal hypoglycemia. D. Insulin pump uses UFA insulin 7) The first drug recommended for treatment of type 2 DM patients is A. Sulphonylurea Metformin Pioglitazone Insulin Exanetide moor 8) Which of the following is a recently recognized side effect of thiazolinediones? ‘A. Increased incidence of fractures B._ Increase in visceral fat. ._ Increased risk of hypoglycemia D._ Increased incidence of heart failure 9) Which of the following drugs is associated with weight loss?: ‘A. Sulphonylureas B. Pioglitazone Repaglinide D. Bxanetide E, Pramlintide 10) DPP-1V inhibitors are currently approved for treatment of patients with type 2 DM in all of the following settings except: ‘As monotherapy In combination with metformin Combined with pioglitazne Combined with exenatide Combined with glimepiride Poo Ee 11) Which ofthe following statements are true: ‘A. Exanetide has no risk of hypoglycemia B.Pramlintide is not useful in type 2 DM ._ Pramlintide has to be combined with insulin or OHA. D, Amylin analogues can suppress appetitie 12) A57 year old obese woman with type 2 DM for the past 13 years, is on hemodialysis for CKD. She had good glycemic control on a sulphonylurea, but was admitted in the recent past for hypoglycemia. On discharge she is taken off all OHA's. She now comes to you with FBS 114 mg% and HbA1C of 7.6%. What treatment will you recommend? ‘A. Restartthe suphonylurea B. Start sitagliptin ¢._ Start basal insulin D. Start metformin. E. Donothing. 13) A 60 year old with h/o T2DM for 12 yrs, HBP, dyslipidemia, presents with FBS 191 and HbA1C of 18.4%, She is obese, has mild pedal edema but normal ‘chest and CVS. Serum creatinine is 1.1mg%. Sh currently on ecospirin, statin, ACEI, and glimepiride/ metformin combo. Which would be the most appropriate change for optimal glycemic control? ‘A. Stop metformin, add pioglitazone B, Start detemir insulin every morning C._ Start 30/70 premixed insulin every morning. D. Startaspart insulin with each meal. 14) A511 year old woman with T2DM,HBP and dyslipidemia comes for routine follow-up. She is on metformin 1g bd and once daily morning dose of glargine. Her glucose logbook reveals the following values: FBS mean 106, pre-lunch mean 100, pre-dinner mean 110. Her PPBS values range from 275-288 mg/dl, Which one of the following would be best for improving her glycemic control? ‘A. Add NPH insulin in the morning B. Add lispro/aspart C._Add second dose of glargine at bedtimeD._ Change glargine to detemir E. Increase dose of metformin DKA 15) Which of the following fluids are useful in the treatment of DKA? ANS B. DNS C596 D. 0.45% saline 16) Ina lady with bilateral superior temporal ‘quadrantanopia and galactorrhea A. The most likely diagnosis is pituitary adenoma B, Prolactinomas are the MC adenomas in the pituitary. C. Measuring serum prolactin levels would be helpful D. Theyare detected earlier in males 17) Regarding acromegaly, the following statements are true except: ‘Patients requenty have hypoglycemia B. MC extra-pituitary cause is SCLC C. Headache is mote commonly encountered than in prolactinomas, D. Patients have increased risk of colonic malignancy. 18, The initial screening test for acromegaly is: Serum IGF-1 levels. Serum GH levels. Oral glucose tolerance test. MRI pituitary pose 19) SIADH is characterized by which of the following features: ‘A. High urine sodium, B. Low BNP levels. C. Expanded fluid volume D. Suppressed plasma renin activity. 20) Which of the following features regarding hyponatremia is true: ‘A. Hypertonic saline can correct Na in type 1 hyponatremia, NS can correct Na deficit in SIAD. NS can correct Na in cerebral salt wasting, syndrome * D. Water restriction can correct Na deficit in SIAD. B c Diabetes insipidus 21) All ofthe following cause primary diabetes insipidus except: ’ ‘A. Multiple sclerosis B. Head injury C. Histiocytosis D. Viral encephalitis 22) Choose the typical lab value in a patient with, diabetes insipidus? ‘A. Urine osmolality > 300 B, Plasma osmolality > 300 Urine SG< 1.005 D. Urine volume > 50 ml/kg/day 23) Which of the following is the earliest manifestation of Cushing's syndrome? ‘A. Loss of diurnal variation B. Increased ACTH ._ Increased plasma cortisol D. Increased urinary metabolites of cortisol Cushing's syndrome 24) A patient with cushingoid features shows no response to high dose dexamethasone suppression test. The likely diagnosis is ‘A. Drug induced Cushing's. B, Adrenal adenoma C. Calung with ectopic ACTH production D._ Pituitary macroadenoma Cushing's syndrome 25. Cushing's syndrome is not a feature of: Pancreatic islet malignancy. Prostate cancer. Bronchial carcinoid. Adenocarcinoma lung. Thymic malignancy Allof the above cause Cushing's AmpO Re Conns syndrome 26) Which of the following is not a feature of Conn’s syndrome? ‘A. Hyperkalemia B. Hypertension C. Hypernatremia D. Increased renin level 27. A 36-year-old male presents with lethargy. Examination reveals that his blood pressure of 120/72 mmig, all systems are normal. ‘Sodium 140 meq/i Potassium 2.8 meq/dl ‘S.HCO3 30 mg/dl (Creatinine 0.9 mg/dl He most likely has ‘A. Bartter's syndrome B. Con's syndrome . Cushing's syndrome D. Liddle’s syndrome 28) Glucocorticoid remediable hyper -aldosteronism is dueto ‘eNac mutation Chimeric gene CYP11B1 mutation Mutations in HSD11B2 poseConn’s syndrome 29) The initial screening test for primary hyperaldosteronism is: IV saline infusion test. Aldosterone ~renin ratio ‘Adrenal vein sampling, Fludrocortisone suppression test. pope 30) Regarding adrenal insufficiency: ‘A. MC cause in India is TB B. Hyperpigmentation is characteristic of secondary causes. C. May be associated with increased plasma renin activity. D. May be associated with hypothyroidism 31) The gold standard diagnostic test in assessing the integrity of the HPA axis is: ‘A. Midnight measurement of cortisol. B, Saline suppression of Na Insulin tolerance test. D. Cosyntropin test (ACTH stimulation test) 32, A40 year old lady is being treated for Addison's disease with daily hydrocortisone of 30 mg. Hydrocortisone is not available, but you have prednisolone. What is the dose of prednisolone you will prescribe in her? A Omg, B. 12mg c 18mg, D. 24mg Pheochromocytoma 33) Extraadrenal pheochromocytoma secretes mainly: Norepinephrine Epinephrine Metanephrine Dopamine vMA moORP 34) Which of the following are features of pheochromocytoma ?: ‘A. Tako-tsubo cardiomyopathy B. Sustained hypertension Episodic hypotension D. Hypoglycemia 35) The following image is from a patient with episodic hypertension, Which of the following would be the best test to identify pheochromocytoma in her? Urine VMA Urine fractionated metanephrine Plasma fractionated metanephrine MIBG. MRI RpORE 36) All of the following regarding treatment of. pheochromocytoma is true except: ‘A. Salt restriction is advised. B, Phenoxybenzamine is the first drug to be started. C. Alpha blockade is achieved in 24 hrs. D._Nitroprusside is used for intraoperative BP control 37) All ofthe following are features of MEN Ila except: A. Pituitary tumour B. Pheochromocytoma . Cutaneous fibroma D. Parathyroid hyperplasia MEN 38) Multiple subcutaneous neuromas are most ‘commonly associated with ‘A. Medullary Ca thyroid B, Von-hippel lindau Testicular Ca D. Pancreatic beta cell carcinoma 39) Alkaline phosphatase is elevated in all of the following conditions except: AL Rickets B. Osteomalacia . Hypoparathyroidism D. Multiple myeloma 40) The most common cause of hypercalcemia i A. Malignancy. B, Primary hyperparathyroidism. Sarcotdosis. D. Multiple myeloma. 41) A patient with raised serum alkaline phosphatase and raised PTH with low phosphate may be suffering from ‘A. Primary hyperparathyroidism B. Pagets disease Osteoporosis D. Vitamin D deficiency 42) The most common reason for hypercalcemia in Hodgkins lymphoma is: ‘A. Osteolytic metastasis B. Ectopic PTHrP . Ectopic 1,25 OH D3 D. Ectopic PTH 43) Which among the following will reduce serum calcium the fastest? Glucocorticoids Pamidronate Calcitonin, Dialysis Oral phosphate therapy moee> 44) The above patient is likely to have all of the following excep\ ‘A. Low calcium B. High phosphate C. LowPTH D. Cataract