1. A 24-year-old lean patient presents with polyuria, weight loss, positive GAD antibodies, and
low C-peptide. The most likely underlying pathophysiology is autoimmune beta cell destruction
leading to absolute insulin deficiency because this defines type 1 diabetes.
A) Autoimmune beta cell destruction leading to absolute insulin deficiency
B) Progressive beta-cell loss with insulin resistance
C) Mutation in glucokinase enzyme
D) Antibodies against insulin receptors
.Rationale: Autoimmune beta cell destruction leading to absolute insulin deficiency – type 1
diabetes results from immune-mediated loss of insulin production..
2. A 52-year-old obese patient with acanthosis nigricans and elevated fasting insulin develops
slowly progressive hyperglycemia over 5 years. The best description of the underlying process is
progressive loss of beta-cell insulin secretion on a background of insulin resistance because type
2 diabetes requires both defects.
A) Isolated insulin resistance without beta-cell dysfunction
B) Absolute insulin deficiency from viral infection
C) Progressive loss of beta-cell insulin secretion on a background of insulin resistance
D) Autoimmune destruction of pancreatic alpha cells
.Rationale: Progressive loss of beta-cell insulin secretion on a background of insulin resistance –
type 2 diabetes develops when beta-cells cannot compensate for insulin resistance..
,3. A 17-year-old non-obese patient has mild fasting hyperglycemia (115-130 mg/dL), no ketosis,
and a strong three-generation family history of diabetes. Genetic testing is most likely to reveal a
mutation affecting insulin production consistent with MODY because maturity-onset diabetes of
the young presents in adolescence/young adulthood with autosomal dominant inheritance.
A) HLA-DR3/DR4 haplotypes
B) A mutation affecting insulin production consistent with MODY
C) Mitochondrial DNA mutation
D) Insulin receptor gene mutation
Rationale: A mutation affecting insulin production consistent with MODY – MODY is caused by
single gene mutations affecting beta-cell function, not autoimmunity.
4. A 45-year-old patient with a normal BMI and no family history of diabetes tests positive for
glutamic acid decarboxylase antibodies. Glucose is 210 mg/dL. The most likely diagnosis is
LADA due to autoimmune attack on pancreatic insulin-making cells because latent autoimmune
diabetes in adults presents after age 30 with autoantibodies and slow progression.
A) Type 2 diabetes with insulin resistance
B) LADA due to autoimmune attack on pancreatic insulin-making cells
C) MODY from GCK mutation
D) Secondary diabetes from chronic pancreatitis
.Rationale: LADA due to autoimmune attack on pancreatic insulin-making cells – LADA is
autoimmune but slower onset than classic type 1..
5. A 58-year-old asymptomatic patient has a routine hemoglobin A1c of 6.7%. According to
diagnostic criteria, this value is diagnostic of diabetes (≥6.5%) and should be repeated on a
separate day.
,A) Indicates prediabetes
B) Is diagnostic of diabetes (≥6.5%)
C) Is normal for age over 55
D) Requires an oral glucose tolerance test to confirm
Rationale: Is diagnostic of diabetes (≥6.5%) – A1c ≥6.5% meets diabetes diagnosis criteria per
ADA guidelines.
6. A 48-year-old with BMI 28 and hypertension has an A1c of 5.9%. This value meets criteria for
prediabetes (>5.6% to <6.5%) and warrants lifestyle intervention.
A) Is completely normal
B) Meets criteria for prediabetes (>5.6% to <6.5%)
C) Diagnoses diabetes
D) Requires immediate metformin regardless of symptoms
.Rationale: Meets criteria for prediabetes (>5.6% to <6.5%) – A1c 5.7-6.4% defines prediabetes;
5.9% falls within this range..
7. A 60-year-old with no diabetes symptoms has a fasting plasma glucose of 128 mg/dL on two
separate occasions. This value .meets the diagnostic threshold for diabetes (≥126 mg/dL). and
does not require further testing for diagnosis.
A) Is normal for age
B) .Meets the diagnostic threshold for diabetes (≥126 mg/dL).
C) Indicates prediabetes
D) Requires a 75g OGTT to confirm
, .Rationale: .Meets the diagnostic threshold for diabetes (≥126 mg/dL). – fasting glucose ≥126
mg/dL confirms diabetes when repeated..
8. A 50-year-old with BMI 29 and a first-degree relative with type 2 diabetes should undergo
diabetes screening now because the criteria include BMI >25 plus at least one additional risk
factor such as family history.
A) Age over 65 only
B) BMI >25 plus at least one additional risk factor
C) Any patient with hypertension regardless of BMI
D) Only those with prior gestational diabetes
.Rationale: BMI >25 plus at least one additional risk factor – ADA recommends screening
overweight/obese adults with one or more risk factors..
9. A 44-year-old with no diabetes risk factors and BMI 23 asks when to start routine screening.
The recommended age to begin screening in healthy adults is 45 years old regardless of other
risk factors.
A) 35 years old
B) 45 years old
C) 50 years old
D) 55 years old
Rationale: 45 years old – ADA advises screening all adults starting at age 45, even without risk
factors.
low C-peptide. The most likely underlying pathophysiology is autoimmune beta cell destruction
leading to absolute insulin deficiency because this defines type 1 diabetes.
A) Autoimmune beta cell destruction leading to absolute insulin deficiency
B) Progressive beta-cell loss with insulin resistance
C) Mutation in glucokinase enzyme
D) Antibodies against insulin receptors
.Rationale: Autoimmune beta cell destruction leading to absolute insulin deficiency – type 1
diabetes results from immune-mediated loss of insulin production..
2. A 52-year-old obese patient with acanthosis nigricans and elevated fasting insulin develops
slowly progressive hyperglycemia over 5 years. The best description of the underlying process is
progressive loss of beta-cell insulin secretion on a background of insulin resistance because type
2 diabetes requires both defects.
A) Isolated insulin resistance without beta-cell dysfunction
B) Absolute insulin deficiency from viral infection
C) Progressive loss of beta-cell insulin secretion on a background of insulin resistance
D) Autoimmune destruction of pancreatic alpha cells
.Rationale: Progressive loss of beta-cell insulin secretion on a background of insulin resistance –
type 2 diabetes develops when beta-cells cannot compensate for insulin resistance..
,3. A 17-year-old non-obese patient has mild fasting hyperglycemia (115-130 mg/dL), no ketosis,
and a strong three-generation family history of diabetes. Genetic testing is most likely to reveal a
mutation affecting insulin production consistent with MODY because maturity-onset diabetes of
the young presents in adolescence/young adulthood with autosomal dominant inheritance.
A) HLA-DR3/DR4 haplotypes
B) A mutation affecting insulin production consistent with MODY
C) Mitochondrial DNA mutation
D) Insulin receptor gene mutation
Rationale: A mutation affecting insulin production consistent with MODY – MODY is caused by
single gene mutations affecting beta-cell function, not autoimmunity.
4. A 45-year-old patient with a normal BMI and no family history of diabetes tests positive for
glutamic acid decarboxylase antibodies. Glucose is 210 mg/dL. The most likely diagnosis is
LADA due to autoimmune attack on pancreatic insulin-making cells because latent autoimmune
diabetes in adults presents after age 30 with autoantibodies and slow progression.
A) Type 2 diabetes with insulin resistance
B) LADA due to autoimmune attack on pancreatic insulin-making cells
C) MODY from GCK mutation
D) Secondary diabetes from chronic pancreatitis
.Rationale: LADA due to autoimmune attack on pancreatic insulin-making cells – LADA is
autoimmune but slower onset than classic type 1..
5. A 58-year-old asymptomatic patient has a routine hemoglobin A1c of 6.7%. According to
diagnostic criteria, this value is diagnostic of diabetes (≥6.5%) and should be repeated on a
separate day.
,A) Indicates prediabetes
B) Is diagnostic of diabetes (≥6.5%)
C) Is normal for age over 55
D) Requires an oral glucose tolerance test to confirm
Rationale: Is diagnostic of diabetes (≥6.5%) – A1c ≥6.5% meets diabetes diagnosis criteria per
ADA guidelines.
6. A 48-year-old with BMI 28 and hypertension has an A1c of 5.9%. This value meets criteria for
prediabetes (>5.6% to <6.5%) and warrants lifestyle intervention.
A) Is completely normal
B) Meets criteria for prediabetes (>5.6% to <6.5%)
C) Diagnoses diabetes
D) Requires immediate metformin regardless of symptoms
.Rationale: Meets criteria for prediabetes (>5.6% to <6.5%) – A1c 5.7-6.4% defines prediabetes;
5.9% falls within this range..
7. A 60-year-old with no diabetes symptoms has a fasting plasma glucose of 128 mg/dL on two
separate occasions. This value .meets the diagnostic threshold for diabetes (≥126 mg/dL). and
does not require further testing for diagnosis.
A) Is normal for age
B) .Meets the diagnostic threshold for diabetes (≥126 mg/dL).
C) Indicates prediabetes
D) Requires a 75g OGTT to confirm
, .Rationale: .Meets the diagnostic threshold for diabetes (≥126 mg/dL). – fasting glucose ≥126
mg/dL confirms diabetes when repeated..
8. A 50-year-old with BMI 29 and a first-degree relative with type 2 diabetes should undergo
diabetes screening now because the criteria include BMI >25 plus at least one additional risk
factor such as family history.
A) Age over 65 only
B) BMI >25 plus at least one additional risk factor
C) Any patient with hypertension regardless of BMI
D) Only those with prior gestational diabetes
.Rationale: BMI >25 plus at least one additional risk factor – ADA recommends screening
overweight/obese adults with one or more risk factors..
9. A 44-year-old with no diabetes risk factors and BMI 23 asks when to start routine screening.
The recommended age to begin screening in healthy adults is 45 years old regardless of other
risk factors.
A) 35 years old
B) 45 years old
C) 50 years old
D) 55 years old
Rationale: 45 years old – ADA advises screening all adults starting at age 45, even without risk
factors.
