Good Questions Flashcards
A 14 yo breast fead neonate fails to gain weight during infancy but mother continues ot breastfeed , the infant developes catarics an enlarged liver and a very funny retardation, galactosemia, and has high levels of galactose in the urine
What enzyme is defficent?
What food stuff is causing this for the baby?
Galactokinase defficency is causing galactose to build up in the urine
The lactose in the breast milk is beind degraded to glucose and galactose which is contributing to the problem
God forgive me for the retard joke
4 month old w hepatomegaly jaundice hypoglycemia and septic infection
What enzyme is deffective?
Galactose 1 phosphate udriyltransferase. These are classical symptoms of galactosemia
- Jaundice is due to the livers inability to produce bilirubin
- Galactose 1 phosphate inactivation of phosphoglucomutase contributes to hypoglycemia
- Septic infection is common with G6P-UDT
An east african presents with jaundice and splenomegaly after eating flava beans, a blood smear reveals hemolysis,
What is the inactive enzyme and explain the symptoms
G6PDH catalyzes the oxidatie portion of the pentos phosphate pathway generating NADPH.
NADPH is required to mantain a reduced store of Glutathione which prevents oxidative damage to the red blood cells. (hemolysis)
Jaundice is from excess heme from the lysis of RBC’s being converted to bilirubin and overwhelming the liver
Otherwise healthy child with 3x glucose in urine on a dipstick test
What hexose metabolism enzyme could be defective?
Fructose Kinase defficency results in fructose buildup in the urine which will make a glucose urine dipstick test show positive.
Healthy male has cataracts and galactosemia?
What is-a this?
Galactokinase defficency will result in galactose buildup in the blood and is converted in the eye developing cataracts.
Healthy patient is put on Primaquine (a drug known for inducing oxidative stress) he then developes sevire fatigue and experiences hemolysis. What is the problem?
He has defficent G6P UDT which prevents NADPH generation to mantain a stock of reduced glutathionine to combat oxidative stress.
What enzyme converts glucose to sorbitol?
Aldose reductase
34 year old with central obesity blood gluose is 258 mg/dl on OGTT and she has excess cortisol in her blood, what is causing her hyperglycemia?
Cushings syndrome
PEPCK is transcriptionally regulated so increased circulating glucocorticoids will result in increased PEPCK gene expression. This will cause an increase in the conversion of OAA to PEP.
This is the commitment step of gluconeogenesis.
Which of the following would be indacitative of diabetes?
- single random glucose level of 190mg/dl
- Presence of reduced sugar in the urine
- A fasting blood glucose level of 160mg/dl
- A 2 hour oral glucose tolerance test of 210 mg/dl
- A single fasting blood glucose level of 110 mg/dl
The only one that renders a diagnosis fo diabetes in a single episode is a 2 hour OGTT yielding blood glucose of 200mg/dl
Fasting glucose levels over 126 have to be observed atleast more than once for a diagnosis
Two fasting levels between 100- 125 indicate impared glucose tolerance.
Which gluconeogenesis enzyme requires biotin?
Pyruvate carboxylase
Pyruvate —–> Oxaloacetate
Needs ATP
When does insulin level peak after an injection?
Peaks at 4 hours and is absent after 8 hours
After 12 hours of not eating describe the body’s metabolic state
We will be in Glycogenolysis because the liver glycogen stores will not yet be depleated.
Glucagon will be circulating and levels of cAMP and PKA will be elevated phosphorylating glycogen synthase (inactivating it) phosphorylase kinase (activating it) and glycogen phosphorylase (activating it)
What are the two unique steps of the glyoxylate cycle?
Isocitrate lyase
Malate synthetase
Give an example of a futile cycle
After the pyruvate carboxylase and PEPCK reactions if Pyruvate kinase is not inactivated the PEP will be turned into pyruvate and form a futile cycle.
Presence of glucagon will increase cAMP and cause the phosphorylation of Pyruvate kinase inactivating it to prevent this shit show
What inhibits PFK-1
Low levels of F23BP, presence of ATP and Citrate
What inhibits pyruvate dehydrogenase?
Acetyl CoA from FA oxidation
Caffine inhibits cAMP phosphodiestrase. If caffine and glucagon are administered together what will be the result?
A large increase in cAMP with no way to degrade it. This will initiate the Gluconeogenesis cascade
Pyruvate Kinase will be phosphorylated and inhibited
Glycogen synthase will the +Pi and inhibited
Phosphorylase Kinase will be +Pi and activated
Glycogen Phosphorylase will be +Pi and activated.
After an overnight fast the patient has glycogen in the urine with short branches (4 units) what enzyme is defficent?
What if the branches were one glucose unit long?
4:4 Transferase is the debranching enzyme and its inhibition will leave 4 glucose unit branches on glycogen
If they were 1 glucose branches then 1:6 Glucosidase would be inhibited
What is the energy gain from dietary carbs versus carbs generated from glycogen stores In anaerobic conditions
In anaerobic conditions we are creating lactate
2 ATP from Pyruvate to Lactate
Remember when glycogen is broken down to glucose 1 Phosphate you do not need Hexokinase to begin glycolysis so you will invest one less ATP to utilize glycogen.
What causes F23BP release from the liver?
F23BP’s objective is to cause glycolysis in the liver for the synthesis of FA. So high blood glucose will cause its release. Glucagon and Epinephrine will inhibit its release.
What are the 4 different pyruvate metabolic pathways
- (Alanine) carries amino groups to the liver from muscle
- (Oxaloacetate) can replenish TCA cycle or be used for gluconeogenesis
- (Acetyl CoA) Transition from glycolysis to the TCA cycle
- (Lactate) End of anaerobic glycolysis