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560D Clinical Biochem Additional Info > 560D > Flashcards

560D Flashcards

1
Q

Which of the following factors can increase likelihood of getting Iron def. Anemia?

a. All of these responses can increase the risk of getting IDA
b. Heavy menstruation
c. Celiac disease
d. Deficiency of Copper

A

A) All of these responses can increase the risk of getting IDA

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2
Q
  1. Anemia of chronic disease can be caused from prolonged inflammation (IL-6, Cytokines, infection), which increases level of _____________ to sequester iron in tissues so germs can’t use the iron to reproduce.

a. Hepcidin (synthesized by the liver and controls iron homeostasis)
b. Aconitase
c. B-12
d. Folic Acid

A

a. Hepcidin (synthesized by the liver and controls iron homeostasis)

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3
Q
  1. What are the four conditionally essential amino acids?

a. Arg, Gln, Gly, Tau
b. Arg, Gln, Gly, Ser
c. Arg, Glu, Gly, Tau
d. Arg, Glu, Gly, Ser

A

a. Arg, Gln, Gly, Tau

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4
Q
  1. Mutations in the SN1-SN2 transporter can lead to elevations in what 3 AA?

a. Gln, Asn, His
b. Glu, Asn, His
c. Glu, Asp, His
d. Gln, Asp, His

A

a. Gln, Asn, His

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5
Q
  1. The central energy pathways begin with digestion and assimilation of fats, carbohydrates, and proteins. Long chain FA require the use of the _________________ shuttle to help them enter the mitochondrial for beta-oxidation.

a. Carnitine
b. Malate
c. Aspartate
d. Carnosine

A

a. Carnitine

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6
Q
  1. Inhibition of CoQ10 synthesis from statin drugs, will typically reveal elevations in urinary_____________________.

a. Hydroxymethylglutarate
b. Hydroxymethylbutyrate
c. Hydroxymethylpropionate
d. Hydroxymethylsuccinate

A

a. Hydroxymethylglutarate

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7
Q
  1. When considering toxic exposures, through what barriers and routes of entry can lipophilic (fat loving) toxins be absorbed?

a. All of these responses
b. Through the GI tract
c. Through the skin
d. Through the lymphatics
e. In utero

A

a. All of these responses

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8
Q
  1. One of the phthalate esters used in plastic wrap to cover foods can lead to decreased kidney function, increased cysts, increased peroxisome proliferation and even liver cancer in rats. This is a concern to humans because ________________ is used in plastic tubing for hemodialysis.

a. Di(2-ethylhexyl) phthalate (DEHP)
b. Dimethyl phthalate (DMP)
c. Diethyl phthalate (DEP)
d. Polyethylene terephthalate (PETE

A

a. Di(2-ethylhexyl) phthalate (DEHP)

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9
Q
  • A client with diagnosed IDA comes to you because he eats meat-based protein and green leafy vegetables but his iron levels have not increased. What other nutrient is needed to properly absorb iron?
  • Vitamin C
  • B-12
  • Folic Acid
  • Intrinsic Factor
A

Vitamin C

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10
Q
  • Which of the following factors increase likelihood of getting IDA?
  • All of these responses can increase the risk of getting IDA
  • Heavy menstruation
  • Celiac Disease
  • Deficiency of Copper
A

All of these responses can increase the risk of getting IDA

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11
Q
  • It is important to differentiate IDA from Thalassemia because…
  • Blood transfusion in Thalassemia can lead to iron overload
  • ID can cause Thalassemia
  • ID can cause hemolytic anemia
  • Thalassemia can cause Iron Deficiency
A

Blood transfusion in Thalassemia can lead to iron overload

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12
Q
  • Sideroblastic anemia is an X-linked condition where the enzyme called __________ is mutated, leading to excess iron in the RBC mitochondria.
  • Delta-aminolevulinic acid synthase (this is also the enzyme that controls the rate limiting step in heme synthesis)
  • Protoporphyrin IX oxidase
  • NADH methemoglobin reductase
  • Diaphorase I
A

Delta-aminolevulinic acid synthase (this is also the enzyme that controls the rate limiting step in heme synthesis)

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13
Q
  • Glucose-6-Phosphate dehydrogenase is the enzyme that reduces (A) to (B) as part of the hexose monophosphate shunt pathway (pentose phosphate pathway. G6PD deficiency can lead to RBC hemolysis from oxidant stress because (B) is no longer available to help recycle glutathione.
  • (A) NADP+, (B) NADPH
  • (A) NADPH, (B) NADP+
  • (A) NAD+, (B) NADH
  • (A) NADH, (B) NAD+
A

(A) NADP+, (B) NADPH

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14
Q
  • What symptoms if Iron Deficiency Anemia block hepcidin expression, leading to increased ferroportin and iron availability?
  • Hypoxia and Erythropoiesis
  • Fatigue and dizziness
  • Pale skin and weakness
  • Low blood pressure and palpitations
A

Hypoxia and Erythropoiesis

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15
Q
  • Methemoglobin differs from hemoglobin by its inability to bind to oxygen because:
  • The iron has been oxidized to Fe3+
  • The iron has been reduced to Fe2+
  • It has a zinc bound instead of an iron molecule
  • It has a cobalt bound to it instead of an iron molecule
A

The iron has been oxidized to Fe3+

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16
Q
  • It is important to simultaneously check vitamin B12 and folate levels because administration of folic acid can mask vitamin B12 deficiency, leading to neurological demyelination that is often irreparable. The 2 constituents that accumulate in B12 deficiency, one of which competitively inhibits FA biosynthesis leading to increased myelin sheath turnover/degradation are:
  • Methylmalonyl Coa and homocysteine
  • Succinyl CoA and homocysteine
  • Acetyl CoA and homocysteine
  • Succinyl CoA and Methylmalonyl CoA
A

Methylmalonyl Coa and homocysteine

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17
Q
  • A client with diagnosed pernicious anemia does not have the ability to produce intrinsic factor. What nutrient binds to intrinsic factor to be properly absorbed and where is it absorbed in the GI tract?
  • Vitamin B12, Ileum
  • Folic Acid, Ileum
  • Iron, Duodenum
  • Vitamin B12, Duodenum
A

b12, ileum

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18
Q
  • GI conjugase enzymes hydrolyze folate to the monoglutamate form. What cofactor is needed for this reaction?
  • Zinc
  • Magnesium
  • Copper
  • Vitamin C
A

Zinc

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19
Q
  • Vitamin B12 is composed of ___________________, which can have hydroxy-, methyl-, or deoxyadenosyl- groups attached to it.
  • Corrin ring with cobalt
  • Corrin ring with iron
  • Corrin ring with Zinc
  • Corrin ring with magnesium
A

Corrin ring with cobalt

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20
Q
  • The reabsorption of urobilinogens from the GI to the liver so they can be resecreted into the bile is called
    the _________________.
  • Enterohepatic Urobilinogen cycle
  • Enterosplenic Urobillinogen Cycle
  • Hepatosplenic Urobillinogen cycle
  • Enterohepatic Stercobillin cycle
A

Enterohepatic Urobilinogen cycle

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21
Q
  • How can porphyrias arise from a low caloric (low glucose) diet
  • Because ALA synthase 1 will be upregulated to puse heme biosynthesis (Glucose inhibits ALAS1, so it is automatically upregulated in the absence of glucose. This is why glucose is given IV to people with acute porphyrias and why it is important for people with porphyrias to avoid crash dieting and low-carb diets).
  • Because ALAS1 will be downregulated to push the heme biosynthesis pathway
  • Because Delta-ALA dehydratase will be upregulated in the heme biosynthesis pathway
  • Because Delta-ALA dehydratase will be downregulated in the heme biosynthesis pathway
A

Because ALA synthase 1 will be upregulated to puse heme biosynthesis (Glucose inhibits ALAS1, so it is automatically upregulated in the absence of glucose. This is why glucose is given IV to people with acute porphyrias and why it is important for people with porphyrias to avoid crash dieting and low-carb diets).

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22
Q
  • Obstruction of the bile duct from gallstones (called extrahepatic cholestasis) can cause symptoms of pale clay colored stools and dark urine upon standing. This occurs because:
  • The liver regurgitates conjugated bilirubin into the blood and the decline of conjugated bilirubin entering the GI tract
  • The liver regurgitates unconjugated bilirubin in the blood and the decline of unconjugated bilirubin entering the GI tract
  • The liver regurgitates stercobilin into the blood and the decline of urobilinogen entering the GI tract
  • The liver regurgitates biliverdin into the blood and the decline of heme entering the GI tract
A
  • The liver regurgitates conjugated bilirubin into the blood and the decline of conjugated bilirubin entering the GI tract
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23
Q
  • Hyperbilirubinemia can lead to Jaundice, yellowing of the skin, nail beds and whites of the eyes. Acute hemolytic crises found in G6PD deficiency and Sickle Cell Anemia can cause hyperbilirubinemia and jaundice from an:
  • Increase in unconjugated and conjugated bilirubin
  • Increase in unconjugated bilirubin only
  • Increase in conjugated bilirubin only
  • Increase in stercobilin and urobilinogen
A

Increase in unconjugated and conjugated bilirubin

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24
Q
  • Which enzyme in the heme biosynthesis pathways contains zinc and is located in the cytosol?
  • Hydroxymethylbilane synthase
  • Uroporphyrinogen Decarboxylase
  • Delta-ALA-Dehydratase (this enzyme converts 2 ALA into porphobilinogen and is very sensitive to heavy metals like lead because they replace the zinc)
  • ALA synthase
A

Delta-ALA-Dehydratase (this enzyme converts 2 ALA into porphobilinogen and is very sensitive to heavy metals like lead because they replace the zinc)

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25
Q
  • How is a porphyrin different from a porphyrinogen?
  • Porphyrins are functional intermediates of heme synthesis
  • Porphyrins are reduced forms of porphyrinogens
  • Porphyrins are the colorless form of porphyrinogens
  • Porphyrins are oxidized forms of porphyrinogens
A
  • Porphyrins are oxidized forms of porphyrinogens
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26
Q
  • During heme degradation, which degradation product of bilirubin gives urine its yellow color?
  • Urobilin
  • Stercobilin
  • Bilirubin diglucuronide
A

Urobilin

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27
Q
  • Alanine aminotransferase converts alpha-ketoglutarate into glutamate and alanine into:
  • Aspartate
  • Pyruvate
  • Oxaloacetate
  • Glutamate
A

Pyruvate

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28
Q
  • What cofactor assists aminotransferases like ALT and AST in their ability to transfer amino groups?
  • Pyridoxamine Phosphate
  • Vitamin B5
  • P5P
  • Vitamin C
A

Pyridoxal-5-Phosphate (Pyridoxal-5-Phosphate (B6) is required by all aminotransferases, actually holds onto the amino group that get transferred during the enzymatic process, and gets recycled for continual use of these reactions).

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29
Q
  • Gamma-glutamyl transpeptidase (GGT) is responsible for breaking down (A) into (B)
  • (A) GSH, (B) Gamma-glutamylAA + Cysteinylglycine
  • (A) GSH, (B) Gamma-glutamylAA + Cysteineglutamate
  • (A) GSH, (B) Gamma-glutamylAA + Cysteineglutamine
  • (A) GSH, (B) Gamma-glutamylAA + Cysteineloxoproline
A

(A) GSH, (B) Gamma-glutamylAA + Cysteinylglycine

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30
Q
  • How many ATP are utilized in the gamma-glutamyl cycle to resynthesize glutathione?
  • 4 ATP
  • 3 ATP
  • 1 ATP
  • 2 ATP
A

3 ATP

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31
Q
  • How can decreased levels of thyroid hormone impact vitamin A?
  • Impairs conversion of beta-carotene to Vitamin A
  • Impairs function of Vitamin A
  • Impairs release of Vitamin A
  • Impairs absorption of Vitamin A
A

Impairs conversion of beta-carotene to Vitamin A

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32
Q
  • The insulin receptor is activated when active chromodulin binds it. What mineral does chromodulin required to be functionally active?
  • Biotin
  • Vanadium
  • Chromium
  • Copper
A

Chromium (Requires 4 Cr3+ bound to it to become active)

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33
Q
  • Genetic mutations deactivating leptin or its receptor leads to:
  • Better insulin sensitivity
  • Increased satiety
  • Hyperphagia and massive obesity
  • Reduced inflammation
A

Hyperphagia and massive obesity

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34
Q
  • High levels of ATP in the cell indicate increased energy reserves. Hence, high levels of ATP will:
  • Block activity of pyruvate kinase
  • Appear during a fasting state
  • Enhance activity of glycogen phosphorylase
  • Enhance activity of isocitrate dehydrogenase
A

Block activity of pyruvate kinase

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35
Q
  • Intraabdominal (visceral/organ) fat is more dangerous than subcutaneous fat because
  • Increases free FA
  • Increases inflammatory cytokines
  • May increase insulin resistance and ER stress
    All of these responses
A

All of these responses

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36
Q
  • Obesity and chronic overnutrition interrupt metabolic pathways in the following way(s):
  • High ATP reduces glycolysis and TCA cycle
  • High pyruvate and acetyl CoA increase FA
  • High NADH reduces creation of Acetyl CoA and TCA cycle
  • Excess glucose converts to glycogen
    All of these responses
A

All of these responses

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37
Q
  • Glucagon rises in a fasting state and controls metabolism by:
  • Blocking glycolytic enzymes
  • Increases PEP-carboxykinase
  • Inhibiting glycogen synthase
    All of these responses
A

All of these responses (Glucagon blocks glycolysis, Increases gluconeogenesis (PEP carboxykinase), and decreases glycogenesis (glycogen synthase).

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38
Q
  • The Alanine cycle:
  • Occurs in a well-fed state
  • Releases alanine from the liver
  • Does not require ATP
  • None of these
A

None of these responses (Alanine cycle converts 2 alanine from peripheral tissue into glucose in the liver during a fasting state, requires ATP and produces 5-7 ATP in peripheral tissues).

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39
Q
  • Insulin’s effect on target tissue include all of the following EXCEPT:
  • Increased protein degradation
  • Increased cell uptake of glucose
  • Increased glycogen synthesis
  • Increased FA synthesis
  • Increased potassium uptake
A

Increased protein degradation (Protein degradation is decreased with increased food consumption/insulin, while protein synthesis will increase.

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40
Q
  • Insulin resistance leads to increased CVD risks through:
  • Increased PAI-1
  • Increased inflammation through peroxidation
  • Increased TG, VLDL, and LDL
  • All of these responses
A

All of these responses

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41
Q
  • Adiponectin assists in:
  • Decreased fat accumulation
  • Increased glucose uptake
  • Decreased Inflammation
  • All of these responses
A

All of these

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42
Q
  • Hyperglycemia can lead to glycation (glycosylation) reactions. One such glycation reaction with hemoglobin A, leads to Hemoglobin A1c, which can be measured in the bloodstream and is a marker for how much a person’s blood sugar has fluctuated over the past 3 months. What level of HbA1c is indicative of Diabetes?
  • > or = 6.5
  • 5.7-6.4
  • < 5.7
  • > or = 7.0
A

> or = 6.5

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43
Q
  • One of the maladaptive responses in insulin resistance includes dyslipidemia. Increased activity of vascular lipoprotein lipase leads to increased chylomicron and VLDL release of non-esterified or ______.
  • HDL
  • Free Fatty Acids (Non-esterified FA = Free FA)
  • Alpha-Glycerol phosphate
  • Glucose
A

Free Fatty Acids (Non-esterified FA = Free FA)

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44
Q
  • Activation of the “thrifty” gene during maternal under- or over-nutrition may lead to under- or overweight babies, which causes an:
  • Increased risk of DM, CVD, and Obesity
  • Decreased risk of DM, CVD, and Obesity
  • No change in risk of DM, CVD, and Obesity
A

Increased risk of DM, CVD, and Obesity

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45
Q
  • List the basic AA?
  • His, Lys, Arg
  • His, Lys, Asp
  • His, Leu, Arg
  • His, Leu, Asp
A

His, Lys, Arg

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46
Q
  • GFAT is the rate-limiting enzyme in the creation of what?
  • Glucosamine, Chondroitin, Sialic Acid
  • GLucosamine, Galactosamine, Hyaluronic Acid,
  • Glucosamine, Chondroitin, Hyaluronic Acid
  • Glucosamine, Galactosamine, Sialic Acid
A

Glucosamine, Galactosamine, Sialic Acid

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47
Q
  • Periportal hepatic cells respond to increased local acidity by transporting ___(a)__ through the SNI-SN2 transporter to cleave it into __(b)__, which buffers the acidity.
  • (A) Gln, (B) Glu + NH3
  • (A) Gln + NH3, (B) Glu
  • (A) Glu, (B) Gln + NH3
  • (A) Glu + NH3, (B) Gln
A

(A) Gln, (B) Glu + NH3 (Glutamine gets broken down into Glutamate & NH3. NH3 is alkaline in nature and helps buffer acidity)

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48
Q
  • Gln can be cleaved to Glu + NH3 via PDG. This process is used in the __ to help regulate/buffer acidic pH.
  • Brain
  • Liver
  • Kidney
  • All of these responses
A

All of these responses

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49
Q
  • In the urea cycle, Ornithine + Carbamoyl phosphate > PO4 _ Citrulline is catalyzed by what enzyme?
  • OTC (mitochondrial ornithine transcarbamoylase)
  • CPS (mitochondrial carbamoyl phosphate synthetase 1)
  • Arginase
  • Argininosuccinate Synthase
A

OTC (mitochondrial ornithine transcarbamoylase)

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50
Q
  • In the Urea cycle, Arginase requires what cofactor to convert Arg > Orn + urea?
  • Mn++
  • Mg++
  • Zn++
  • Cu++
A

Mn++

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51
Q
  • The pathway Arg > Orn + a-KG&raquo_space; Pro for the creation of collagen via the enzymes arginse, ornithine aminotransferase and pyrroline-5-carboxylate reductase require what nutrients for proper activity?
  • Mn++, B5, Retinoic acid, B3, Mg++
  • Zn++, B5, Retinoic acid, B3, Mg++
  • Mn++, P5P, Retinoic acid, B3, Mg++
A

Mn++, P5P, Retinoic acid, B3, Mg++

52
Q
  • Arg > ADMA via PRMT (methionine dependent protein arginine N-methyltransferase) requires what nutrient?
  • SAMe
  • Met
  • SAH
  • Homocysteine
A

SAMe

53
Q
  • BCAA are converted to alpha-ketoacids via BCAA transaminase. This enzyme requires the cofactor:
  • B6
  • B5
  • B2
  • B3
A

B6

54
Q
  • Conversion of threonine > alpha-ketobutyrate + NH3 > Propionyl CoA requires the use of what 2 enzymes?
  • Threonine Dehydratase, Branched Chain alpha-Ketoacid Dehydrogenase Complex (BCKDC)
  • Threonine Aldolase, Branched Chain alpha-Ketoacid Dehydrogenase Complex (BCKDC)
  • Threonine Dehydratase, Threonine Aldolase
  • Threonine Aldolase, Threonine Dehydrogenase
A

Threonine Dehydratase, Branched Chain alpha-Ketoacid Dehydrogenase Complex (BCKDC)

55
Q
  • Histidine is converted to histamine via histidine decarboxylase. What cofactor is required for this reaction?
  • Pantothenic acid
  • P5P
  • Flavoprotein
  • Nicotinamide
A

P5P

56
Q
  • Histamine can be degraded through hepatic (liver) diamine oxidase and aldehyde dehydrogenase OR through extra-hepatic pathways utilizing histamine N-methyltransferase. How do the nutrient requirements differ for these pathways?
  • Diamine Oxidase is copper-dependent
  • Diamine Oxidase is flavoprotein
  • N-methyltransferase is copper-dependent
  • N-methyltransferase is a flavoprotein
A

Diamine Oxidase is copper-dependent

57
Q
  • Lysine does NOT undergo the initial transamination requiring B6 but downstream conversion of alpha-aminoadipic acid (a-AAA) to alpha-ketoadipate does require B6. What nutrient is required for the initial conversion of Lys -> Saccharopine?
  • B3
  • B2
  • B5
  • B12
A

B3

58
Q
  • Conversion of Lys ->->-> Carnitine is important because carnitine shuttles FA into the mitochondria for Beta-oxidation. Along with Lys, what nutrients would improve enzymatic function of this pathway?
  • SAMe, a-KG, B3, Cu++, Vitamin C
  • SAMe, a-KG, B3, Mg++, Vitamin C
  • SAMe, a-KG, B3, Fe++, Vitamin C
  • SAMe, a-KG, B3, Zn++, Vitamin C
A

SAMe, a-KG, B3, Fe++, Vitamin C

59
Q
  • Phenylalanine Hydroxylase PAH requires what nutrients for conversion of Phe>Tyr?
  • Iron, B3, BH4
  • Copper, B2, BH4
  • Iron, B2, BH4
  • Copper, B3, BH4
A

Iron, B3, BH4

60
Q
  • What 2 nutrients required by both tyrosine hydroxylase (TH) and phenylalanine hydroxylase PAH?
  • Iron, Vitamin C
  • Vitamin C, Tetrahydrobiopterin
  • Copper, Vitamin C
  • Iron, Tetrahydrobiopterin
A

Iron, Tetrahydrobiopterin

61
Q
  • Conversion of norepinephrine -> epinephrine via the enzyme Phenylethanolamine-N-Methyltransferase (PNMT) utilizes what nutrient in this reaction?
  • SAMe
  • Vitamin C
  • Copper
  • Iron
A

SAMe

62
Q
  • Tryptophan monooxygenase (ie. tryptophan hydroxylase), like tyrosine hydroxylase and phenylalanine hydroxylase require what cofactors for proper functionality?
  • Iron, Vitamin C
  • Copper, Vitamin C
  • Iron, Tetrahydrobiopterin
  • Tetrahydrobiopterin, Vitamin C
A

Iron, Tetrahydrobiopterin

63
Q
  • Degradation of serotonin&raquo_space; 5HIAA via monoamine oxidase (MAO) requires what 2 minerals for functionality?
  • Iron, Copper
  • Copper, Zinc
  • Iron, Zinc
  • Iron, Vitamin C
A

Iron, Copper

64
Q
  • Methionine adenosyltransferase converts Met > to ______ with the assistance of ATP and H2O.
  • Homocysteine
  • Cysteine
  • SAMe
  • SAH
A

SAMe

65
Q
  • True/False: Oxidative Stress activates the transsulfuration pathway to divert sulfur-containing amino acids into the creation of Glutathione, a major antioxidant.
A

True

66
Q
  • What AA is a precursor to serine and component of glutathione?
  • Glycine
  • Taurine
  • Phenylalanine
  • Tryptophan
A

Glycine

67
Q
  • Serine Hydroxymethyltransferase (SHMT) interconverts serine and glycine with the assistance of what nutrients?
  • Cobalamin, P5P, Mn++
  • FAD, P5P, Mn++
  • 5,10-Methylene THF, P5P, Mn++
  • NAD, P5P, Mn++
A

5,10-Methylene THF, P5P, Mn++

68
Q
  • Isocitrate dehydrogenase converts isocitrate > a-KG with the assistance of:
  • Mg++, Cu++, FAD+
  • Mg++, Mn++, NAD+
  • Mg++, Cu++, NAD+
  • Mg++, Mn++, FAD+
A

Mg++, Mn++, NAD+

69
Q
  • Succinate is unique because it not only is one of the TCA cycle intermediates, but it can also feed electrons directly to complex II of the ETC, via succinate dehydrogenase. This enzyme requires ____(a) to function. Low levels of (b) may also raise levels of succinate and all the TCA cycle intermediates because the ETC becomes halted, causing a backup of the TCA cycle.
  • (a) FAD, (b) CoQ10
  • (a) NAD, (b) Fe++
  • (a) Mg++, (b) CoQ10
  • (a) Fe++, (b) CoQ10
A

(a) FAD, (b) CoQ10

70
Q
  • Norepinephrine and epinephrine can be degraded into _________________ via the enzymes COMT and MAO.
  • Hydroxyindoleacetate
  • Homovanillate
  • Vanilmandelate
  • Quinolinate
A

VMA

71
Q
  • Elevations in benzoate and not hippurate indicate:
  • There is a need for B5
  • All of these responses
  • There is a need for glycine
  • Difficulty with phase II conjugation
A

All responses

72
Q
  • Bacterial ingestion of dietary polyphenols can lead to the creation of the intestinal dysbiosis markers
  • Benzoate, Hippurate, Phenylacetate, Phenylpropionate
  • D-Arabinitol, Dihydroxyphenyl Propionate
  • Cresol, Hydroxybenzoate, D-Arabinitol
  • Tricarballylate, D-Lactate
A

Benzoate, Hippurate, Phenylacetate, Phenylpropionate

73
Q
  • Testing toxin load can be difficult depending upon the type of toxin and where it prefers to deposit. For instance, non-polar organic toxins preferentially deposit in ___(a)__tissue and may require a ___(b)__ because they quickly clear from blood and urine.
  • (A) Muscle, (B) Muscle biopsy
  • (A) Adipose, (B) fat biopsy
  • (A) Synovium, (B) synovial aspirate
  • (A) Bone, (B) bone biopsy
A

(A) Adipose, (B) fat biopsy

74
Q
  • Phthalates are found in plastics, cosmetics and many convenience items found in developed countries. Phthalates are considered “steroid hormone disruptors” because:
  • Have increasing estrogenic potency when multiple phthalates are combined
  • They impair male reproductive development
  • Have low estrogenic potency
  • All of these
A

All of these

75
Q
  • Porphyrias can occur from prolonged fasting because low glucose intake leads to
  • Downregulation of ALA dehydratase
  • Downregulation of ALAS1
  • Upregulation of ALAS1
  • Upregulation of ALA dehydratase
A

Upregulation of ALAS1

76
Q
  • The 4 concurrent decarboxylation steps in the porphyrinogen pathway convert (A) to coproporphyrinogen III via the enzyme (B).
  • (A) uroporphyrinogen III, (B) Uroporphyrinogen decarboxylase
  • (A) pentacarbon porphyrinogen, (B) uroporphyrinogen decarboxylase
  • (A) ketosis coproporphyrin, (B) coproporphyrinogen oxidase
  • (A) heptacarboxyl porphyrinogen, (B) UROD
A

(A) uroporphyrinogen III, (B) Uroporphyrinogen decarboxylase

77
Q
  • The enzyme CPOX (coproporphyrinogen oxidase) converts coproporphyrinogen III to protoporphyrinogen IX and is blocked by the heavy metals.
  • Lead and Cadmium
  • Mercury and Arsenic
  • Arsenic and Cadmium
  • Lead and Mercury
A

Lead and Mercury

78
Q
  • Phase II detoxification involves conjugation of a water soluble constituent to a functional group on the toxin. These conjugation reactions can occur:
  • Multiple times creating many diff. Types of metabolites
  • Along different pathways depending upon substrate concentration
  • On Carboxyl, hydroxyl or amine groups
  • All of these
A

All of these

79
Q
  • The major and most common route for xenobiotic phase II metabolism is _____________ and it accounts for the majority of conjugated metabolites found in urine and bile
  • Glucuronidation
  • GSH conjugation
  • Acetylation
  • Sulfation
A

Glucuronidation

80
Q
  • GSH can conjugate with electrophiles through the enzyme ___________ to reduce the reactivity of these harmful substances.
  • Glutamyl-transferase
  • Cysteinyl-Glycinase
  • Acetylase
  • Glutathione-S-Transferase (GST)
A

Glutathione-S-Transferase (GST)

81
Q
  • The sulfation pathway prevails over glucuronidation when there are adequate levels of sulfate and ATP with ________ of xenobiotics.
  • Low levels
  • Multiple types
  • High levels
A

Low

82
Q
  • In order for AA conjugation to occur, ____(a)_____ toxins, must be activated to their ___(b) form.
  • (a) organic acid, (b) PAPS
  • (a) amino acid, (b) CoA
  • (a) carboxylic acid, (b) PAPS
  • (a) carboxylic acid, (b) CoA
A

(a) carboxylic acid, (b) CoA

83
Q
  • Methylation typically works on endogenous constituents, with O-methyl metabolites have ___(a)____ activity than the original molecule. The active methyl group used in methylation reactions is ____(b)____.
  • (a) lesser, (b) 5MTHF
  • (a) greater, (b) 5MHTF
  • (a) greater, (b) SAMe
  • (a) lesser, (b) SAMe
A

(a) greater, (b) SAMe

84
Q
  • Oral challenge with acetaminophen reveals increased glutathione conjugation with low sulfate and glucuronide conjugation. This person:
  • would benefit from oleic acid (olive oil)
  • would benefit from sodium sulfate and NAC
  • would benefit from reduced toxin exposure
  • all of these responses
A

All

85
Q
  • Match the pathways of alcohol degradation with the appropriate enzyme.
  • Ethanol + NAD+ > acetaldehyde + NADH
  • Acetaldehyde + NAD+ > acetate + NADH
  • Ethanol + NADPH > acetaldehyde + NADP+
         a. alcohol dehydrogenase
     b. cytochrome P450 CYP2E1
     c. aldehyde dehydrogenase
A

alcohol dehydrogenase
aldehyde dehydrogenase
cytochrome P450 CYP2E1

86
Q

Antacids can reduce the absorption of iron and copper, leading to iron deficiency anemia because:

Because the antacids bind the metals
Acidic pH increases Fe3+
DMT1 requires cotransport of H+ ions to internalize divalent cations
Stomach acid properly degrades metals

A

DMT1 requires cotransport of H+ ions to internalize divalent cations

87
Q

Glucose-6-phosphate dehydrogenase is the enzyme that reduces …….(a)……. to ____(b)____ as part of the hexose monophosphate shunt pathway (ie. pentose phosphate pathway). G6PD deficiency can lead to RBC hemolysis from oxidant stress because ___(b)___ is no longer available to help recycle glutathione.

(a) NADP+, (b) NADPH
(a) NADPH, (b) NADP+
(a) NADH, (b) NAD+
(a) NAD+, (b) NADH

A

(a) NADP+, (b) NADPH

88
Q

How many ATP are utilized in the Gamma-glutamyl cycle to resynthesize glutathione?

4 ATP
3 ATP
2 ATP
1 ATP

A

3

89
Q

Clients may be diagnosed as overweight if their BMI is:

35-39.9
25-29.9
18.5-24.9
30-34.9

A

25-29.9

90
Q

The Cori cycle:

Produces 2 ATP in peripheral tissues
Converts 2 lactate into glucose
All of these responses
Is upregulated in a fasting state

A

All of these

91
Q

Obesity and chronic overnutrition interrupt metabolic pathways in the following way(s):

Excess glucose converts to glycogen
All of these responses
High NADH reduces creation of Acetyl CoA and TCA cycle
High ATP reduces glycolysis and TCA cycle
High pyruvate and acetyl CoA increase FA

A

All

92
Q

True or False: Phosphofructokinase 1, Glucokinase, and Pyruvate Kinase are all upregulated in response to insulin.

A

True

93
Q

diponectin assists in:

Increased glucose uptake
All of these responses
Decreased fat accumulation
Decreased inflammation

A

All

94
Q

The correlation of hyperinsulinemia and increases in hypertension come from the hyperinsulinemia causing:

Increased potassium retention
Increased sodium retention and uric acid retention
Improved thermogenesis
Increased blood flow to peripheral tissues

A

Increased sodium retention and uric acid retention

95
Q

Activation of the “thrifty” gene during maternal under- or over-nutrition may lead to under- or over-weight babies, which causes an:

Decreased risk of DM, CVD, and Obesity
No answer text provided.
No change in risk of DM, CVD, and Obesity
Increased risk of DM, CVD, and Obesity

A

Increased risk of DM, CVD, and Obesity

96
Q

The reabsorption of urobiinogens from the GI to the liver so they can be resecreted into the bile is called the _________________.

Hepatosplenic Urobilinogen Cycle
Enterohepatic Urobilinogen Cycle
Enterohepatic Stercobilin Cycle
Enterosplenic Urobilinogen Cycle

A

Enterohepatic Urobilinogen Cycle

97
Q

How is a porphryin different from a porphyrinogen?

Porphyrins are oxidized forms of porphyrinogens
Porphyrins are functional intermediates of heme synthesis
Porphryins are the colorless form of porphyrinogens
Porphyrins are reduced forms of porphyrinogens

A

Porphyrins are oxidized forms of porphyrinogens

98
Q

Delta-aminolevulinic acid (ALA synthase) creates delta-aminolevulinic acid from what substrates?

Succinyl CoA and iron
Succinyl CoA and glycine
Succinyl CoA and vitamin B12
Succinyl CoA and heme

A

Succinyl CoA and glycine

99
Q

Lead can inhibit certain enzymes of the heme biosynthesis pathway causing elevations of ALA and decline of protoporphyrin IX (leading to elevations in coproporphyrin III). Which three enzymes in this pathway are inhibited by lead?

Ferrochelatase, Uroporphyrinogen Decarboxylase, and Hydroxymethylbilane Synthase
ALA Synthase, Delta- ALA Dehydratase, and Hydroxymethylbilane Synthase
Delta-ALA Dehydratase, Coproporphyrinogen oxidase, and Ferrochelatase
ALA Synthase, Porphyrobilinogen Deaminase, and Uroporphyrinogen III synthase

A

Delta-ALA Dehydratase, Coproporphyrinogen oxidase, and Ferrochelatase

100
Q

What are the essential amino acids?

His, Ile, Leu, Lys, Met, Phe, Thr, Trp, Val
His, Ile, Leu, Met, Phe, Thr, Tyr, Val
His, Ile, Leu, Met, Phe, Ser, Thr, Trp, Val
His, Ile, Leu, Met, Pro, Ser, Thr, Trp, Val

A

His, Ile, Leu, Lys, Met, Phe, Thr, Trp, Val

Remember: PVT TIM HaLL (no “a”)

101
Q

If there is a defect in the SN1-SN2 transporter allowing Gln into the presynaptic nerve terminal, what will happen to Glu levels within the presynaptic nerve terminal?

Glu levels will increase unless the GLAST receptor can uptake Glu into the perineuronal astrocyte.

Glu levels will decline unless the EEAC1 receptor can compensate

Glu levels will increase unless the EEAC1 receptor can compensate.

Glu levels will decline unless the GLAST receptor can uptake Glu into the perineuronal astrocyte.

A

Glu levels will decline unless the EEAC1 receptor can compensate

EEAC1 can take Glu directly up into presynaptic nerve terminal. The GLAST receptor will uptake Glu into the perineuronal astrocyte for recycling into Gln but that will not help improve levels of Glu within the presynaptic nerve terminal because it is a different cell.

102
Q

Periportal hepatic cells respond to increased local acidity by transporting ___(a)__ through the SNI-SN2 transporter to cleave it into __(b)__, which buffers the acidity.

(a) Gln + NH3, (b) Glu
(a) Glu + NH3, (b) Gln
(a) Gln, (b) Glu + NH3
(a) Glu, (b) Gln + NH3

A

(a) Gln, (b) Glu + NH3

Glutamine gets broken down into Glutamate and NH3. NH3 is alkaline in nature and helps buffer acidity.

103
Q

In the urea cycle, Ornithine + Carbamoyl phosphate -> PO4 + Citrulline is catalyzed by what enzyme?

CPS (mitochondrial carbamoyl phosphate synthase 1)
Arginase
OTC (mitochondrial ornithine transcarbamoylase)
Argininosuccinate Synthase

A

OTC (mitochondrial ornithine transcarbamoylase)

104
Q

In the urea cycle, CPS (mitochondrial carbamoyl phosphate synthase 1) converts ammonia + H2O + 2 ATP + CO2 -> ______________.

Carbamoyl phosphate + SO4 + 2 ADP
Carbamoyl phosphate + PO4 + AMP
Carbamoyl phosphate + PO4 + 2 ADP
Carbamoyl phosphate + AMP + diphosphate

A

Carbamoyl phosphate + PO4 + 2 ADP

105
Q

Arginine conversion into Agmatine via the enzyme arginine decarboxylase requires what cofactor?

P5P
Zn++
Mg++
Mn++

A

P5P

106
Q

The enzyme DDAH, which breaks ADMA down into citrulline + dimethylamine, is upregulated with the assistance of what nutrients?

Vitamin A, Vitamin C, Vitamin E, Mg++
Vitamin A, Vitamin C, Vitamin E, Zn++
Vitamin A, Vitamin C, Vitamin D, Zn++
Vitamin A, Vitamin C, P5P, Zn++

A

Vitamin A, Vitamin C, Vitamin E, Zn++

107
Q

BCAA are converted to alpha-ketoacids via BCAA transaminase. This enzyme requires the cofactor:

B5
B3
B2
B6

A

B6

108
Q

Histidine is converted to histamine via histidine decarboxylase. What cofactor is required for this reaction?

Pyridoxal-5-phosphate
Pantothenic acid
Flavoprotein
Nicotinamide

A

P5P

109
Q

Conversion of Lys ->->-> Carnitine is important because carnitine shuttles FA into the mitochondria for Beta-oxidation. Along with Lys, what nutrients would improve enzymatic function of this pathway?

SAMe, a-KG, B3, Fe++, vitamin C
SAMe, a-KG, B3, Mg++, vitamin C
SAMe, a-KG, B3, Cu++, vitamin C
SAMe, a-KG, B3, Zn++, vitamin C

A

SAMe, a-KG, B3, Fe++, vitamin C

110
Q

Phenylalanine Hydroxylase (PAH) requires what nutrients for conversion of Phe -> Tyr?

Copper, B3, BH4
Copper, B2, BH4
Iron, B3, BH4
Iron, B2, BH4

A

Iron, B3, BH4

111
Q

What two nutrients are required by both tyrosine hydroxylase (TH) and phenylalanine hydroxylase (PAH)?

Copper, vitamin C
Iron, tetrahydrobiopterin
Iron, vitamin C
Vitamin C, tetrahydrobiopterin

A

Iron, tetrahydrobiopterin

112
Q

Conversion of norepinephrine -> epinephrine via the enzyme Phenylethanolamine-N-Methyltransferase (PNMT) utilizes what nutrient in this reaction?

Vitamin C
SAMe
Copper
Iron

A

SAMe

113
Q

Alpha-amino-N-butyric acid (AANB) may be elevated in acoholism. What nutrient may be deficient when AANB is elevated?

B3
B2
B6
Iron

A

B6

114
Q

Serine Hydroxymethyltransferase (SHMT) interconverts serine and glycine with the assistance of what nutrients?

FAD, P5P, Mn++
5,10-Methylene THF, P5P, Mn++
Cobalamin, P5P, Mn++
NAD, P5P, Mn++

A

5,10-Methylene THF, P5P, Mn++

115
Q

Asparagine (from asparagus) can be converted into aspartate. Aspartate is in a unique position to enter the TCA cycle through its conversion into the TCA cycle intermediate, __________________, via the enzyme AST (SGOT) and cofactor vitamin B6.

Pyruvate
Malate
Oxaloacetate
Citrate

A

Oxaloacetate

116
Q

High ammonia levels from urea cycle dysfunction can lead to the accumulation of _ (a) . Treatment with (b) , may help the urea cycle function better and decrease urinary (a) levels.

(a) Glucarate, (b) Arginine, Mn++
(a) Orotate, (b) Arginine, Mg++
(a) Sulfate, (b) NAC
(a) Pyroglutamate, (b) NAC

A

(a) Orotate, (b) Arginine, Mg++

117
Q

____________ is a metabolite of Tyrosine, is a cell proliferation marker, and may indicate normal tissue growth or tumor growth.

Methyl-p-Hydroxyphenyllactate (MeHPLA)
p-Hydroxyphenylacetate (HPA)
p-Hydroxyphenyllactate (HPLA)
p-Hydroxyphenylpyruvate (HPP)

A

p-Hydroxyphenyllactate (HPLA)

118
Q

The definition of ________________ is: a term used when products of detoxification processes are more toxic than the original substance.

Hormesis
Toxicology
Detoxification
Biotoxification

A

Biotoxification

119
Q

Porphyrias can occur from prolonged fasting because low glucose intake leads to:

downregulation of ALAS1
downregulation of ALA dehydratase
upregulation of ALA dehydratase
upregulation of ALAS1

A

upregulation of ALAS1

120
Q

ALA + ALA -> porphobilinogen via the enzyme (a) which requires (b) .

(a) porphobilinogen deaminase, (b) NH3
(a) ALA synthase, (b) Zinc
(a) delta-ALA dehydratase, (b) Zinc
(a) hydroxymethylbilane synthase, (b) NH3

A

(a) delta-ALA dehydratase, (b) Zinc

121
Q

High ammonia can be from impaired degradation of proteins, impaired urea cycle, and even exercise. High ammonia can also be indicative of:

bacterial overgrowth
excessive glutamine intake
all of these responses
deficiency of arginine

A

All

122
Q

Cytochrome P450 enzymes function in the hydroxylation reactions for the activation of (a) and in the microsomal system located in the (b) for the detoxification of xenobiotics.

(a) vitamin D, (b) smooth ER
(a) vitamin E, (b) lysosome
(a) vitamin A, (b) peroxisome
(a) vitamin C, (b) rough ER

A

(a) vitamin D, (b) smooth ER

123
Q

CYP1A2 and CYP2E1 are important to remember because these pathways are activated by:

estrogen
cortisol
caffeine
alcohol

A

caffeine (also acetaminophen)

124
Q

There are two major types of sulfotransferases. One type is membrane-bound in the golgi apparatus and sulfates GAGs and glycoproteins, while the other is located in the __________ and conjugates steroids, catecholamines, T4, bile acids, and xenobiotics.

cytosol
smooth ER
nucleus
mitochondria

A

cytosol

125
Q

True/False: Oral challenge with aspirin reveals higher glycine conjugate than glucuronides. This is a normal interpretation.

A

True

560D Clinical Biochem Additional Info (1 decks)

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