June 5th

Question 1

Pyruvate dehydrogenase cycle and cofactors

Answer 1

Glycolysis to TCA Cycle 
Requires "TLC For Nancy" 
Thiamine pyrophosphate B1
Lipoid acid 
CoA B5 
FAD B2 
NAD B3

Question 2

4 fates of pyruvate

Answer 2

Oxalacetate
Alanine
Lactate
Acetyl CoA

Question 3

3 Enzymes to know in TCA cycle and which is the RLS?

Answer 3

Citrate synthase
Isocitrate dehydrogenase (RLS)
Alpha ketoglutarate dehydrogenase (same enzymes and cofactors as pyruvate dehydrogenase)

Question 4

Inhibitors of ETC

Answer 4

Inhibits Complex 1 = MPP, Amytal, Rotenone
Inhibits Complex 3 = Antimycin A
Inhibits Complex 4 = N3-, CO, H2S, CN (cyanide)
Inhibits ATP synthase = Oligomycin A (macrolide)

Question 5

ETC Uncouplers

Answer 5

High dose aspirin
2,6 - dinitrophenol
Thermogenin

Question 6

Causes of Acute Pancreatitis

Answer 6

"BAD HITS" 
Biliary causes 
Alcohol 
Drugs (HIV Rx) 
HyperCa and Hypertriglycermia 
Idiopathic 
Trauma (ECRP) 
Scorpion sting

Question 7

Deficient enzyme in Galactokinase Deficiency and Sx

Answer 7

Galactokinase
Infantile cataracts
Galactose in blood and urine

Question 8

Deficient enzyme in Fructose intolerance and Sx

Answer 8

Aldolase B
“Bad Dz”
Inhibition of glycogenolysis and gluconeogenesis due to builup in fructose - 1- phosphate
Fasting hypoglycemia, jaundice, vomiting with consumption of fructose

Question 9

Deficient enzyme in Lactose deficiency

Answer 9

Lactase

Bloating/osmotic diarrhea due to colonic bacteria digestion of lactose

Question 10

Deficient enzyme in Classic Galactosemia and Sx

Answer 10

Galactose - 1 - phosphate uridyltransferase 
Failure to thrive 
Infantile cataracts 
Intellectual disability 
Jaundice 
Hepatomegaly 
E.coli sepsis

Question 11

Deficient enzyme in Essential Fructosuria

Answer 11

Fructokinase

Asx with fructose in blood and urine

Question 12

Causes of G6PD Deficiency Hemolysis

Answer 12

"Spleen Purges Nasty Inclusion From Damaged Cells" 
Sulfonamides 
Primaquine 
Nitrofurantoin 
Isoniazid 
Fava beans 
Dapsone 
Chloroquine

Question 13

RBC findings in G6PD Deficiency

Answer 13

Heinz bodies = denatured Hb precipitates in cells

Bite cells

Question 14

What does G6PD do?

Answer 14

Regnerates NAPH for the production of GSH (reduced glutathione) which is an important antioxidant in RBCs

Question 15

How does GSH protect against oxygen radicals? (ENZYME)

Answer 15

GSH reduces H202 to H20 through glutathione peroxidase

Question 16

What disease is NADPH oxidase deficient in? and what bacterial are they susceptible to?

Answer 16

Chronic Granulomatous disease

At risk for infection with catalase + bacteria (Staph and Strep)

Question 17

Sx of Serotonin Syndrome

Answer 17

Muscle rigidity
Hyperthermia
Cardiovascular collapse due to Autonomic instability

Question 18

Kwashiokor defect and Sx

Answer 18

Protein malnutrition 
"FLAMES" 
Fatty liver (no ApoB100 = lipid buildup) 
Anemia 
Malnutrition 
Edema 
Skin lesions

Question 19

Defect in familial hypercholesterolemia

Answer 19

LDL Receptors

Question 20

Apolipoprotein that activates LCAT

Answer 20

ApoA-1

Question 21

Apolipoprotein that mediates chylomicron secretion

Answer 21

ApoB-48

Question 22

Apolipoprotein that mediates VLDL secretion

Answer 22

ApoB-100

Question 23

Apolipoprotein that cofactor for lipoprotein lipase

Answer 23

ApoC-II

Question 24

Apolipoprotein that mediates uptake of remanent particles

Answer 24

ApoE

Question 25

Rate limiting enzyme of fatty acid synthesis

Answer 25

Acetyl CoA carboxylase

Question 26

Rate limiting enzyme of B-oxidation of fatty acids

Answer 26

Carnithine acyltransferase 1

Question 27

Rate limiting enzyme of ketone body synthesis

Answer 27

HMG CoA synthetase

Question 28

Rate limiting enzyme of cholesterol synthesis

Answer 28

HMG CoA reductase (inhibited by Statins)

Question 29

Phenylalanine derivatives

Answer 29

``` Tyrosine >> thyroxine = TH Dopa >> melanin Dopamine >> HVA NE >> VMA Epi >> Metanephrines ```

Question 30

Tryptophan derivatives

Answer 30

Uses Vit B6 Niacin >> NAD/NADH Serotonin >> Melanin

Question 31

Histidine derivatives

Answer 31

Uses Vit B6 | Histamine

Question 32

Glycine derivatives

Answer 32

Uses Vit B6 | Porphyrin >> Heme

Question 33

Glutamate derivatives

Answer 33

Uses Vit B6 >> GABA | Glutathione (antioxidant)

Question 34

Arginine derivatives

Answer 34

Urea Creatinine Nitric oxide***

Question 35

Anti-HTN safe in pregnancy

Answer 35

``` "Htn Moms Love Nifidepine" Hydralazine Methyldopa Labetalol Nifidipine ```

Question 36

``` What do these cells secrete? G cells I cells S cells D cells Parietal cells ```

Answer 36

``` Gastrin CCK Secretin Somatostatin IF and gastric acid ```

Question 37

Zinc deficiency Sx

Answer 37

``` Delayed wound healing Decreased adult hair Dysgusia (loss of taste) Anosmia Acrodermatitis enteropathica (well demarcated scaly patches in anus, eye, mouth) Anorexia & diarrhea Growth retardation Depressed mental status Impaired night vision Infertility ```

Question 38

Organs affected by excess mercury

Answer 38

Kidneys and brain

Question 39

Hypocalcemia signs

Answer 39

Tetany and neuromuscular irritability Chovestek Trousseau --> carpal pedal spasm

Question 40

Basophilic stippling and ring sideroblasts

Answer 40

Iron toxicity

Question 41

Describe bacillus anthracis skin lesion

Answer 41

Black eschar with necrosis surrounded by edematous ring (due to lethal factor and edema factor)

Question 42

Common causes of ARDS

Answer 42

``` Shock Infxn Toxic gas inhalation Heroin OD Aspiration Acute pancreatitis High O2 concentrations ```

Question 43

How can sarcoidosis cause Vit D tox?

Answer 43

Increased activation of Vit D by epithelial macrophages

Question 44

Study looking at populations

Answer 44

Ecological survey | Can only draw hypothesis

Question 45

Crytococcus neoformans meningitis tx

Answer 45

Amphoteracin B

Question 46

Tx of chronic bronchial asthma to reduce luminal inflammation

Answer 46

Corticosteroids (Flutacisone)