a. The IRS is a newly recognized disease which, when detected, should be treated with an insulin sensitizing agent.

b. The IRS should be considered a new term for the pre-diabetic state, and when detected should lead to the initiation of glucose-lowering medication.

c.  The IRS represents an interrelated set of conditions, which, when detected, should lead to heightened awareness of the potential for development of a variety of related and seemingly unrelated disease states, including diabetes, dyslipidemia, hypertension, cardiovascular disease (CVD), non-alcoholic fatty liver disease (NAFLD), polycystic ovary syndrome (PCOS), Alzheimer’s disease, sleep apnea syndrome, and a number of malignancies.

2.   Problems with the diagnosis of IRS include:

a. the profusion of proposed diagnostic criteria, all identifying different populations of individuals with the syndrome
b. lack of evidence-that any proposed diagnostic criteria are actually associated with CVD
c. the failure of any of the proposed definitions to lead to identification of persons at increased risk of diabetes.
d. all of the above
e. none of the above

 

3.  AMP kinase is:

a. activated by elevations in intracellular ATP
b. activated by elevations in intracellular AMP
c. the enzyme which catalyzes the production of cyclic AMP from ATP

 

4. AMP activation:

a. is associated with caloric restriction and exercise
b. can be induced pharmacologically with metformin, thiazolidinediones, alpha-lipoic acid, estrogen, and polyphenols such as those found in red wine.
c. decreases the inhibitory effect of malonyl co-A on mitochondrial fatty acid metabolism
d. all of the above
e. none of the above

 

5. 11 β OH steroid dehydrogenase (11 βHSD)-type 2 converts cortisol to cortisone in the kidney, placenta, and colon, while 11 βHSD-type 1 has the opposite effect, by catalyzing conversion of cortisone to cortisol. All of the following are true about 11 βHSD1 EXCEPT:

a. a. is expressed in adipose tissue
b. is preferentially expressed in visceral as compared to subcutaneous adipose tissue
c. increases intracellular cortisol levels
d. is decreased by a high fat diet
e. is downregulated in type 2 diabetes

 

6. Peroxisome proliferator-activated receptor (PPAR) γ Coactivator (PGC)-1, which also coactivates PPARα and hepatic nuclear factor-4, is reduced in all of the following EXCEPT:

a. administration of thiazolidinediones and metformin
b. type 2 diabetes
c. insulin resistance in non-diabetic persons
d. low levels of physical activity
e. high fat feeding, particularly of saturated fats

 

7.  Leptin acts in the brain to reduce food intake, while states of low circulating leptin are associated with appetite stimulation. What is the relationship of insulin levels to appetite regulation?

a. a. insulin stimulates appetite, increasing food intake
b. insulin reduces appetite, decreasing food intake
c. insulin has no effect at normal and high glucose levels on food intake, only playing a role in appetite regulation under circumstances of hypoglycemia

 

8. Insulin resistance is associated with the following CNS abnormalities:

a. reduced effect of insulin in stimulating food intake
b. reduced effect of insulin in suppressing food intake
c. neurodegenerative disorders such as Alzheimer’s disease
d. all of the above
e. “b” and “c” only

9.  Hibernating mammals exhibit insulin resistance as a means of:

a. regulating temperature
b. storing vast deposits of fat
c. decreasing metabolic rate

 

10.  True of False:  The nuclear regulatory factor rev-erbα is inversely related to PPARγ receptor activation.

a. True
b. False

11.  Disruption of normal sleep-wake cycles is associated with:

a. increased energy expenditure, resulting in excessive weight loss
b. improvement in sleep-related disorders such as obstructive sleep apnea
c. obesity, diabetes, dyslipidemia, and hypertension