Past Papers of 2002-2007 as they relate to

BIOCHEMISTRY SYLLABUS (Class of 2012)

Recommended books: Lippincott; Marks’ Basic Medical Biochemistry; Harper’s Illustrated
Biochemistry; Lecture handouts when made available.

CELL MODULE (CLM 021) – 8 MCQ +

Eukaryotes vs Prokaryotes (comprehensive table in Chatterjee; Table 1.1)
1. Draw a labeled diagram of nucleosomes. (4)
pH and Buffers
2. How is the pH regulated in body fluids? (3)
3. Write differences between metabolic and respiratory acidosis. (2)
4. Write a short note on buffers. (3)
5. **Define buffers. What are the main buffers in plasma? (3)
6. Enumerate body buffers. How do these help in buffering volatile acids? (2.5)
7. *Enumerate important buffer systems of the human body indicating their specific site of action. (2)
8. Define buffers. Why does Histidine act as a buffer at physiological pH? (2)
Calculations pH and pK
9. Write differences between pH and pKa. (2)
10. *Define pH. What is the normal pH range of the blood? (2)
11. What would be the pH of gastric juice which has [H+??] 0.001?? moles/liter? (2)
Nucleic Acids (structure only, DNA replication etc is for 2nd year)
12. *What are the functions of nucleotides? (2)
13. Define the following terms by giving examples: a. Nucleotides (1); b. Nucleosides (1)
14. What is the structure of DNA? (2)
15. Draw the schematic diagram of double-stranded DNA and label its different components
(structures not necessary). (2)
16. Write the properties of DNA double helix in terms of base pairing and direction of the two strands.
(2)
17. What are the different forms of DNA? Give on salient feature of each form. (2)
18. The green algae Classiferous moronish store its genetic information in the form of double-stranded
DNA. When denatured single stranded DNA was isolated from this organism it was found that it
consists of 20% thymine. Calculate the percentage of adenine, guanine and cytosine from this
information. (2)
19. Compare the structure of DNA with that of RNA? (4)
20. **Write differences between (the structures of) DNA and RNA.(2)
21. What are the different types of RNA? (2)
22. Enumerate the different types of RNA present in the cell. What is the function of each? (2)
23. What are the three types of RNA? How is each related to the transfer of genetic information? (2)
24. *What is the role of ribonucleotide reductase in the biosynthesis of deoxyribonucleotides? (2)
25. A region of one strand of DNA has the sequence of “ACGTAACC”. What will be the sequence of
the complementary region on the other strand? (2)
26. Write differences between AG and AGY (??AGT, AGV). (2)
27. What are mutations? List various types. (2)
Amino acids (Chapter 1 and table 20.2 (pg262) in Lippincott)
28. What are amino acids? Draw their general structure. (2)
29. Define and enumerate essential amino acids. (2)
30. Classify amino acids on the basis of their chemical nature. (4)
31. *Classify amino acids on the basis of (the nature of) their side chains (R-groups) (2)
32. By giving at least one example in each case, classify amino acids according to their side chains. (2)
33. Write any four derivatives of tyrosine. (2)
34. List ketogenic and glucogenic aminoacids (1)
35. **List the essential amino acids for humans. Why are they considered to be essential? (3)
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Protein Structure
36. By giving examples, classify proteins on the basis of structure, shape and functions. (6)
37. What is meant by the primary, secondary and tertiary structure of a protein? (3)
38. Define the primary, secondary, tertiary & quaternary structure of proteins? What types of forces/
bonds are involved in maintaining these structures? (2)
39. How is the secondary structure of proteins formed? (2)
40. Define the following term by giving examples: Tertiary structure of proteins (1)
41. *What is meant by the structure of proteins?
Discuss by comparing myoglobin and hemoglobin. (4)
42. *Differentiate between the structure of hemoglobin and myoglobin (3)
43. *Describe various levels of protein structures.
What level of protein structures would be present in Myoglobin?(2)
44. What are the forces responsible for various levels of protein structures? Show with a diagram. (2)
45. List the functions of proteins in the body. (2)
46. How do the proteins play their role in various biological processes? (2)
47. *What factors influence the folding of protein? (2)
48. What is a random coil? How is it different from α-helical coil? (4)
49. What is denaturation and renaturation of proteins? (2)
50. What is the effect of temperature and pH on the structure and function of protiens?
51. What are the characteristics of a peptide bond? (2)
52. Why is the length of a peptide bond shorter than C—N single bond? (2)
53. Why do most amino acids in polypeptide chains exist in trans- configuration rather than a cis-
configuration? (2)
54. Define sterioisomers and describe their importance. (2)
55. What is meant by protein quality? (1)
56. Discuss at least one method, which can be used to determine the nutritional quality of proteins. (2)
57. How can the nutritional quality of vegetable proteins be improved? (2)
58. Which is the major protein which appears in urine?
59. Describe the functions of albumin considering the following points: a. Carrier (4); b. Fluid balance
(2); c. Buffer (2); d. Energy (2)
60. A patient with nephrotic syndrome was losing large quantities of albumin in his urine. His plasma
albumin fell to 1.0 gm/dl (normal 3.5-5 gm/dl). He subsequently developed edema. Give a brief
explanation.
61. Define isotonic, hypotonic and hypertonic solutions. (1.5)
Enzymes
62. What are enzymes? (1)
63. What is their mechanism of action? (2)
64. What are allosteric enzymes and how does their kinetics differ from the non-allosteric enzymes?
(2)
65. Define and classify enzymes giving an example of each class. (3)
66. How are enzymes classified? Enlist properties of enzymes. (4)
67. *Differentiate between competitive and non-competitive enzyme inhibitors. (2)
68. What are the various types of enzyme inhibitors? Discuss how they alter Km and Vmax by giving
examples in each case. (4)
69. Define the terms Km and Vmax. (2)
70. What is meant by Km and Vmax? By giving examples, discuss how do the competitive inhibitors
affect these characteristics of an enzyme? (3)
71. What is Michaelis-Menton equation? (1)
72. In enzymes which follow Michaelis-Menton kinetics, what would be the initial velocity (vo) of an
enzyme which has a Km of 0.5mM and the [S] varies as follows? (3)
a. [S] = 0.05mM
b. [S] = 0.5mM
c. [S] = 5mM

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73. Discuss briefly how enzymes are regulated. (3)
74. Enumerate the various ways in which enzyme activity can be regulated. (3)
75. Briefly explain enzyme inhibition. (2)
76. Define the following terms and give at least one example:
***Epimers; *Enantiomers, Anomeric carbons (Anomers); Mutarotations; Chiral carbon. (5)
Enzymes of Medical Importance
77. What is the diagnostic significance of enzymes? (3)
78. **Which enzymes in the serum would be useful if you were to investigate damage to bone, heart
and pancreas? Or, Name the diagnostic enzymes for: myocardial infarction, hepatitis (or hepatic
damage), muscle damage, bone disease, prostate cancer, pancreatitis (3)
79. Which organ’s damage is indicated by elevated levels of the following enzymes in serum obtained
from a patient? Comment on the specificity of each. (3) a. Alkaline phosphatase; b. Amylase; c.
Creatine kinase.
80. A 55 year old male was brought to the emergency room with history of severe chest pain while
lying in bed early morning. Pain was radiating to his left arm and jaw. He had a cold sweat and
began to feel weak. Which blood tests would you request to diagnose his condition?
Carbohydrates
81. Classify carbohydrates using a flow chart diagram. (4)
82. Classify carbohydrates by giving examples in each case. (3)
83. Classify different carbohydrates. What are the main dietary carbohydrates? (2)
84. Name four monosaccharides and list one key function of each in the body? (2)
85. Which test is performed in the laboratory to measure the quantity of glucose present in the urine?
What is the biochemical principle of the test? (2)
86. Define and give one example for each of the following:
a. Reducing sugars (1)
b. Amino sugars (1)
c. Glycosidic bond (1)
87. Differentiate between:
a. Monosaccharides and polysaccharides (1)
b. Starch and glycogen (1)
88. Explain the lubricant property of saliva on the basis of your knowledge of biochemistry. (2)
Lipids
89. *Define lipids. Classify lipids and give a few examples of each class. (4)
90. Classify lipids and write down the functions of each. (3)
91. Classify lipids according to their structure. (3)
92. Classify lipids by giving their chemical components. (3)
93. By giving examples, list the functions of lipids in the body. (3)
94. List the functions of the following: a. Fatty acids; b. Phospholipids; c. Bile salts; d. Steroids. (2)
95. Write differences between oils and fats. (2)
96. How do lipids get re-esterfied in the mucosal cells? (2)
97. Define fatty acids. Classify them with examples. (3)
98. List the following: Essential fatty acids (1)
99. Define the following term by giving examples: Essential fatty acids. (1)
100. *Name essential fatty acids and describe their importance (why are they essential). (1)
101. Compare and contrast fatty acid oxidation and fatty acid biosynthesis. (3)
102. What are the phospholipids? What is their function in the body? (2)
103. Write down the function of phospholipids and clinical importance of
dipalmitoylphosphotidylcholine (DPPC) or lecithin. (3)
104. What are the various types of phospholipases? A phospholipid was hydrolyzed by an enzyme.
The products obtained were below: Name the phospholipase in each (2)
a. Free fatty acid and Lysophosphatidylcholine
b. Diacylglycerol and phosphocholine
105. Draw the structure of cholesterol. *Enlist its biochemical functions. (2)

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106. What is the main regulatory enzyme for the biosynthesis of cholesterol from acetyl CoA? How
is this enzyme regulated? (2)
107. You are aware of the structure of: The following molecules are present in
a. DNA, which of these structures? (10)
b. RNA, a. Ribose
c. Nucleoside, b. Deoxyribose
d. Nucleotide, c. Pyrimidine
e. Peptide, d. Glycerol
f. Starch, e. Phosphate
g. Cellulose, f. Fatty acids
h. Glycogen, g. Amino acids
i. Phospholipids and h. Inositol
j. Fats. i. Maltose

Skin and Musculoskeletal System (SMS-03) – 4 MCQ +

Collagen Structure, Classification and Functions
Glycosaminoglycans and Proteoglycans
108. Differentiate between: Glycoproteins and proteoglycans (1)
109. Define the following terms and give at least one example: (2)
Glycosoid?; Glycosaminoglycans

Cardiovascular system (CVS 051)

Lipoprotein Metabolism (look up Coffee for this as well)
Cholesterol Metabolism (look up Coffee for this as well)
1. An obese person with shortness of breath and chest pain was brought into the OPD clinic at Shifa
Community Health Center. His lipid profile showed raised cholesterol and triglyceride levels.
Angina was diagnosed. He was advised to lose weight and modify his diet. The patient was
discharged from the hospital after treatment.
a. Define lipids. (2)
b. Enumerate the essential fatty acids. Why are these considered essential? (2)
c. What are sphingolipids? What is their function in the body? (2)
2. Enumerate the important functions of sphingolipids.
3. How are they produced and metabolized? (3) (I don’t know where this question belongs.)

HEMATOLOGY (HEM 061) – 5 MCQ +

Hemoglobin Synthesis
1. Draw the various steps of Heme synthesis? (3) (See also iron in microminerals.)
2. Exemplify heme-proteins.
3. Which amino acid is required for the synthesis of heme?
4. Which vitamin is required for the synthesis of heme? Which enzyme requires the vitamin in its
cofactor form?
5. Which enzyme is regulated in the synthesis of heme?
6. Can RBCs synthesize heme?
7. **What is the clinical importance of determining HbA 1c level? (1)
Heme Degradation
8. *A 44 year old female (or a 54 year old male) presented to the Medical OPD (or to his internist),
complaining of right hypochondrial pain (or gradual yellow discoloration of his skin and eyes).
Physical examination revealed yellow skin & eyes (or was inconclusive.). Her (or his) lab results
were as follows:
Serum ALT 100 IU/L Normal <35 IU/L
Serum AST 94 IU/L Normal <35 IU/L
Serum Alkaline Phosphate 800 IU/L Normal <100 IU/L
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Serum Total bilirubin 8 mg/dL Normal < 0.2 – 1.2 mg/dL
Serum Direct bilirubin 5.9mg/dL Normal <0.1 – 1.4 mg/dL
Serum Indirect bilirubin 2.1mg/dL Normal <0.1 – 0.7 mg/dL
Prothrombin time 19 seconds Normal 11 – 15 seconds
a. Based on the information above, what kind of jaundice does the patient have? Give
adequate reasons to support your answer. (2)
b. List two possible causes that can account for the above patient’s condition. (1)
9. ***A neonate has developed physiological jaundice soon after birth. Predict how the following
lab values will be altered in this child. (You may use ‘very high’, ‘high’, ‘normal’, ‘low’, ‘very
low’, to indicate the lab values.) (or increased, decreased or normal in the serum of this infant.) (4)
a. AST
b. Serum alanine aminotransferase (ALT)
c. Serum alkaline phosphatase
d. Serum γ-glutamyl transpeptidase (GGT)
e. Total bilirubin
f. Direct bilirubin
g. Indirect bilirubin
10. What is the biochemical basis of physiological jaundice? How can it be treated? (2)
11. A 36 year old man was admitted to a hospital following episodes of nausea, vomiting, and general
malaise. His urine was darker that usual. Upon examination it was discovered that his liver was
enlarged and tender to palpation. Liver function tests were abnormal, plasma ALT = 1500 IU/L
(normal = 40 IU/L) and plasma total bilirubin = 9.0 mg/dl (normal = 1 mg/dl).
a. What is the diagnosis? (2)
b. Which other enzymes might have been elevated in the plasma? (3)
c. How does total bilirubin relate to direct and indirect bilirubin? (5)
12. What is the normal serum bilirubin level? Enumerate various types of jaundice. (2)
13. List the liver function tests. (2)
14. Which biochemical tests would you perform to assess the functions of liver? (3)
Plasma Proteins
15. Define plasma protein. What is the normal total protein level? (2)
16. Give some of the major classes of plasma proteins with examples. (1)
17. What are the main proteins in plasma? Describe the functions of each. (3)
18. Classify plasma proteins and give examples of each class. What are the functions of each? (5)
19. What is the normal level of plasma proteins? (1)
Hemoglobinopathies
20. List the various forms of Thalassemias and the biochemical defects in each.
21. Can α and β-thalassemia, either or both, manifest in fetus? Rationalize your response. (2)
22. Compare β-thalassemia and sickle cell anemia in terms of biochemical defect and hemoglobin
structure. (4)
23. What is the difference between thalassemia and sickle cell anemia? Which one of the two is more
prevalent in Pakistan? (3)
24. Based on the arrangement of side chains around porphyrin structure, porphyrins are named as
a. Types I, II, III, or IV porphyrins
b. Uro-, copro-, or proto-porphyrinogens
c. Porphyrinogen or porphyrin
25. Based on the variations in side chains attached to porphyrin structure, porphyrins are named as
a. Types I, II, III, or IV porphyrins
b. Uro-, copro-, or proto-porphyrinogens
c. Porphyrinogen or porphyrin
26. Which one of the two is colored?
a. Porphyrinogen
b. Porphyrin
27. Rationalize why photosensitivity and dark-colored urine occurs in porphyrias. (2)

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Allergy, Immunology, Rheumatology (AIR 071) – 2 MCQ +
Prostaglandins
Leukotrines
1. *A 20 (or 19) year old boy was admitted to the hospital with pneumonia. One of his younger
sisters had previously died of emphysema. The α1 globulin concentration was below the normal
level and its electrophoretic mobility was abnormally slow. The patient was treated with antibiotics
and his pneumonia cleared up (or resolved). He was advised to quit smoking and was discharged
from the hospital.
a. Name the different plasma proteins and list their key functions in the body. (4)
b. What is the biochemical defect in the above case? (1)
c. Why was he advised to quit smoking? (1)
2. Genetic deficiency of which of the globulins leads to emphysema. (1)
3. By using a flow chart, show the two main pathways for the synthesis of eicosanoids. (4)
4. Which single inhibitor would you use to inhibit both pathways and why? (1)
5. What do you understand by Opsonization? (2)
6. What are the structural differences between IgG and IgM? (2)
7. Enumerate immunoglobulin and their percentage in plasma. (2)
8. Name the deficient enzymes/proteins and biochemical abnormalities of the following diseases:
a. Fructosemia (2)
b. Severe combined immunodeficiency syndrome (SCID) (2)

Gastrointestinal Tract (GIT 081) – 8 MCQ + 2 SEQ

Digestion of Carbohydrates
1. Write salient features of carbohydrate digestion in human GIT. (3)
2. List the enzymes involved in the digestion of carbohydrates. Write down their functions and
specific characteristics. (3)
3. How is glucose absorbed from the intestine? (2)
4. Classify different carbohydrates. What are the main dietary carbohydrates? (2)
5. List the main carbohydrates present in our diets. (2)
6. What are the various dietary sources for carbohydrates? What is the dietary carbohydrate
requirement in a balanced diet? (2)
7. Give the chemistry of sucrose and lactose. (2)
8. What are the various dietary sources of carbohydrates? What is the dietary carbohydrate
requirement in a balanced diet? (2)
9. A 22 year old hostelite came to the medical OPD with the complaints of abdominal cramps,
flatulence and diarrhea after having breakfast. Last week he was admitted in the hospital for the
treatment of acute gastroenteritis. Since then whenever he consumes ice cream and a glass of milk
he develops these symptoms. What is the most likely biochemical defect and what modification
would you recommend in his diet? (4)
10. A previously healthy 20 year old female presented to the ER with signs and symptoms of acute
gastroenteritis. After complete recovery she noted abdominal bloating, camps and intermittent
diarrhea, especially after intake of dairy products.
a. What is the most likely diagnosis? (2)
b. What is the biochemical defect in the above case and how would you explain the above
symptoms? (2)
c. Which tests(s) would you like to perform to confirm the diagnosis? (1)
11. Explain the biochemical basis for lactose intolerance and what modification you would
recommend in a patient’s diet? (4)
12. What is the biochemical defect in lactose intolerance and how would you explain the above
symptoms? (2)
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13. What tests would you perform to confirm the diagnosis of lactose intolerance? (1)
14. What is lactose intolerance? (2)
Digestion of Proteins
15. You went to Eid Milan party and consumed pizza with chicken tikka toppings. Discuss how the
carbohydrates and proteins from this meal will be digested. (4)
16. Discuss how the carbohydrates and proteins from a pizza with chicken meal will be digested. (4)
17. What are ketone bodies? (1)
18. *Draw a flowchart showing the various biochemical steps whereby alanine is converted to glucose.
Which of these are the regulatory steps? (4)
19. Name the enzymes involved in protein digestion. (2)
20. Name the enzymes, along with their function, involved in protein digestion. (4)
21. What is the role of hydrochloric acid present in the stomach in protein digestion? (1)
22. What is achlorhydria? What are its consequences? (1)
23. Explain why a deficiency of trypsin would be more crucial than a deficiency of any other digestive
protease? (2)
24. Give the chemical composition and functions of pancreatic juice. (3)
25. Discuss briefly the consequences of dietary protein deficiency, including their signs and
symptoms. (3)
26. In a flow chart diagram show how proteins are digested and amino acids are absorbed in the
gastrointestinal tract. (3)
27. Name any two disorders associated with defective amino acid transport. (2)
28. What is Cystinuria and Hartnup disease? Why do these patients have a hyperaminoaciduria? (2)
29. What are the biochemical defects and the metabolites that will accumulate in the following
metabolic disorders?
a. Phenylketonuria (2)
b. Maple syrup disease (2)
c. Cystinuria (1)
Digestion of Lipids
30. Classify lipids & write down functions of each. (3)
31. *What are the main dietary lipids? (1)
32. Describe the digestion and intestinal absorption of lipids. (3)
33. Discuss the importance of lipids in the human body. (3)
34. How are chylomicrons formed? What is their significance in lipid transport? (2)
35. What is steatorrhea? How can obstruction to bile flow cause steatorrhea? (3)
36. Discuss the digestion and absorption of dietary triglycerides. (2)
37. You have two triglycerides (tripalmitoylglycerol and trihexanoylglycerol). How would their
digestion and absorption differ in a patient who has an obstruction of the bile duct? (4)
38. List the following: Bile salts (1)
39. Enumerate bile salts. What is their function? (2)
40. What are bile salts? (1)
41. How do they aid in the digestion of dietary fats? (2)
42. Define each of the following terms; what is their role in lipid metabolism? (10)
a. Chylomicrons; b. Emulsification; c. HDL; d. Bile acids; e. Ketone bodies.
Microminerals and Macrominerals
43. Differentiate between macrominerals and trace elements. Give four examples of each. (2)
44. Differentiate between macro- and microminerals? (1)
45. A 30 year old female from the Northern areas of Pakistan presented to the OPD with a large
swelling (goiter) on the anterior aspect of the neck, which has gradually increased in size over the
past five years. She also had complaints of lethargy, fatigue and hoarseness of voice.
a. How would you explain the swelling in the neck? (3)
b. How can you prevent it? (2)
46. How would you explain goiter and how can you prevent it? (5)
47. *Why is iodine important for our body? (2)

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48. Deficiency of fluoride would result in which disease? (1)
49. Enumerate the functions and effects of deficiency associated with each of the following minerals:
a. Iron (2); b. Iodine (2), c. Zinc (2)
50. What is hyperkalemia? What are the sources and functions of the micronutrient associated with
this condition? (3)
51. A 20 year old student living in a hostel was brought to the ER by her roommate with a history of
several episodes of diarrhea, vomiting and listlessness for the past few days. She was complaining
of cramps in her legs with painful walking and palpiations. The baseline ECG was done which
showed only downward deviations of the T waves.
a. What appropriate blood test would you order based on her history? (1)
b. Discuss briefly the biochemical rationale for her complaints? (2)
52. What are the dietary sources of phosphorus? (1)
53. Why is zinc considered to be an essential mineral (3)
54. Why does a diet rich in whole grains decrease the absorption of zinc, iron and calcium? (1)
55. What do you understand by dietary fiber? Why is an increased consumption of fiber useful for
health? (3)
Calcium
56. List the factors which affect the absorption of dietary calcium? Write down the RDA for a 20 year
old male and the normal serum Ca levels. (2)
57. Draw a flow chart diagram for Calcitrol biosynthesis showing various sites of biochemical
reactions. (3)
58. List four important functions of calcium. (2)
59. What would be the consequences of hypocalcemia on the body?(1)
60. Enumerate the factors influencing serum calcium levels? (2)
61. Discuss the role of calcium in maintaining homeostasis. (2)
Iron and Anemia
62. Write a short note on iron deficiency anemia. (3)
63. In what forms is iron stored in the body? (2)
64. Deficiency of which trace element is most likely the cause of hypochromic microcytic red cells?
Which blood tests would you do to confirm your diagnosis? (2)
65. What are the other functions of the above nutrient in the body? (2)
66. A 25 year old woman came to you with complaints of palpitation on exertion and general
weakness. Her Hemoglobin = 8 g/dl, MCV = 65 fl (normal 78-100fl) and MCH = 20 pm (normal
27-31 pg). Examination of her peripheral blood smear revealed hypochromic microcytic red cells.
a. Deficiency of which trace element is the most likely cause of these findings? Which
blood tests would you do to confirm your diagnosis? (2)
b. What are the other functions of the above nutrient in the body? (3)
67. A 65 year old man complains of progressive generalized fatigue. He is unable to walk long
distances without becoming fatigued and developing shortness of breath. He also complains of
tingling in his legs and a feeling of coldness that he has attributed to “poor circulation”. His dietary
habits include fresh fruits and leafy vegetables. His blood anaylysis showed Hb 10gm/dL and a
MCV of 118fL. What is the most probable nutritional deficiency in the above case? What dietary
modification would you advise?
68. What is the most probably nutritional deficiency in having less dietary fresh fruits & vegetables
with Hb of 10gm/dL? What dietary modification would you advise? (2)
69. What are the factors which affect the intestinal absorption of heme & non-heme dietary iron? (3)
70. Give the dietary sources of iron. (1)
71. Enlist the factors affecting absorption of iron from GIT. (2)
72. What are the factors which affect the intestinal absorption of heme and non-heme dietary iron? (3)
73. List symptoms and signs of iron deficiency. (1)
74. What would be the consequences of prolonged iron deficiency? (3)

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75. An 8-month old boy who presented with generalized weakness and lethargy was found to have
hypochromic microcytic anemia. He also has a history of seizures and convulsions. The physician
suspected him to have iron deficiency anemia but his serum iron and ferritin levels were normal.
a. What causes of hypochromic microcytic anemia would you consider? (2)
b. What further lab investigation would you recommend to confirm your diagnosis? (1)
Fat soluble Vitamins
76. A mother from Dera Ismael Khan was worried about her 4 year old son who was having difficulty
to see in dim light. He had a history of diarrhea and repeated chest infections during the past six
months. On examination his skin and hair were dry and rough, finger nails were broken. What is
the most likely biochemical basis of his condition? Discuss the other consequences if this patient
is not properly treated? 93)
77. ****What are the different forms of vitamin A? Discuss the function of each. (4)
78. What are the different sources of vitamin A? (1)
79. Describe briefly how vitamin A deficiency manifests in different body systems. (4)
80. What are the deficiency symptoms of vitamin A? (2)
81. Why should an overdose of vitamin A be avoided in pregnancy? (1)
82. *What are the consequences of vitamin A deficiency in children? (2)
83. *Describe the biosynthesis of active form of vitamin D, naming the intermediates, enzymes and
the sites of synthesis. (6)
84. Describe the synthesis and activation of vitamin D, with the help of a flow chart, including the
sites of each metabolic process. (3)
85. *How is vitamin D converted into its active form? What are the effects of vitamin D deficiency in
children and adults? (3)
86. What is the active form of vitamin D? By using a flow chart diagram, show how it is synthesized
in the body. (4)
87. *What are the various functions of vitamin E and vitamin K? (2)
Water-soluble Vitamins
88. *Name the coenzymes of folic acid and niacin. Give an example of a biochemical reaction in each
case. (2)
89. *Name the coenzyme for each of the following vitamins and one biochemical reaction in which
they are involved: thiamine, cyanocobalamin, riboflavin, pyridoxine. (4)
90. What are the coenzyme forms of the following vitamins: thiamin, pyridoxine, cobalamin, niacin,
riboflavin? (5)
91. What are the active forms of the following vitamins: thiamin, cobalamin, niacin, riboflavin? (2)
92. List two biochemical functions and deficiencies of each of the following vitamins: thiamin, folic
acid, vitamin K. (9)
93. A newborn was brought to the emergency with active bleeding from the site of circumcision,
which was performed by a local barber. He was delivered three days back by an untrained
midwife (dai) at home and was alright at birth. Discuss the various causes that can account for this
increased bleeding tendency? (2)
Vitamin C
94. What are free radicals and how are they harmful for the body? What is the role of vitamins in
preventing free radical induced damage? (3)
95. Scurvy is the result of deficiency of which micronutrient? Write down the biochemical defect
involved. (2)
96. What advice would you give a patient with scurvy? (2)
97. Describe any four biochemical functions of vitamin C. (2)
98. Enumerate at least 4 functions of vitamin C. Write down the biochemical reactions associated with
each function. (4)
99. What is the RDA and sources of vitamin C? (2)
100. Briefly describe why primates are not able to synthesize vitamin C. (1)
101. It is August 1472; Captain Joao Vas Cortez, a Portuguese explorer, has been at the sea for the
last 6 months now, in search of what is now known as Newfoundland. He has lost 14 of his crew

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 members to some cursed ailment. They start off by bleeding from the mouth and the nose, become
very pale; the joints become painful and swollen. Their teeth fall off. They become sick and bleed
to death. Eleven more are on the verge of death.
a. What biochemical defect would most likely result in these clinical features? (1)
b. Correlate the clinical features with the biochemical defect. (2)
102. A widower old man presented in CHC Shifa with the formation of large bruises on legs,
swollen joints, bleeding from gums and lack of healing of wound, which he got while cooking one
week ago.
a. Name the possible diagnosis. (1)
b. What is the biochemical defect in case? (3)
c. What advice would you give to this patient? (2)
Folate, B12 and Anemia
103. What are the causes of folic acid deficiency and how does it manifest itself? (2)
104. Anti-folates are anti-cancer agents, explain why? (2)
105. Write down the biochemical reactions which require vitamin B12 as a coenzyme. (2)
106. What are the biochemical functions and the deficiency symptoms of vitamin B12?(2)
107. A 26 year old male patient with pernicious anemia has macrocytic erythrocytes and
hyperhomocysteinemia. Explain the reasons for these abnormalities? (2)
108. What are the biochemical functions and deficiency symptoms of vitamin B12? (2)
109. Explain the biochemical defect of vitamin B12 deficiency during gastrectomy. What is the
possible treatment? Give sources of this bio-molecule. (3)
110. A strict vegetarian recently underwent gastrectomy. Thereafter, he developed progressive
generalized weakness, and easy fatigability. He was anemic and his blood film showed large
immature red blood cells (RBCs):
a. What dietary deficiency would you expect? (1)
b. What will be the biochemical effects of this deficiency? (1)
c. What is the possible treatment? (1)
d. Give sources of this bio-molecule? (1)
111. What is the biochemical basis of a baby with neural tube defect? What other biochemical
changes would be observed in the mother? What would you advise the mother in order to prevent
such birth defects in the future? (3)
112. A malnourished woman delivered a baby with swelling over his back and small head, with
some exposed brain tissue. She had history of giving birth to babies with neural tue defects.
a. What is the biochemical basis of this defect? What other biochemical changes would be
observed in this patient. (2)
b. What would you advise the mother in order to prevent such birth difects in future? (1)
113. A 26 year old married lady came to the gynecological OPD after she had missed her menstrual
period along with complaints of weakness and breathlessness on exertion. Investigation revealed
that her urinary hCG was elevated suggesting pregnancy. The hemoglobin was decreased to 8.4
g/dl (normal 12-16 g/dl) and the mean cell volume (MCV) was increased to 128 fl (normal 80-100
fl). The past history revealed that she conceived an anencephalic baby 5 months back who failed
to survive.
a. Name the biochemical defect leading to such a disorder. (1)
b. What is the biochemical rationale for the above defect? (2)
c. What advice should be given before planning her next pregnancy? (1)

Next term ??:

1. Write down the components of : (3)
a. Ceramide
b. Cerebroside
c. Ganglioside
2. Define Gangliosides

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3. Describe the biochemical defect in Tay-Sachs and Niemann-Pick Disease and how would these
biochemical defects manifest themselves clinically?
4. Which biochemical tests would you perform to assess the functions of kidney? (4)
5. In pathological conditions, what could be the abnormal constituents of urine? (3)

6. *Calculate the caloric value of one liter of 25% (or 5%) dextrose (glucose) solution. (3)
7. *Calculate the BMR of a person whose weight is 65 (or 75) kilograms.
8. A female weighing 60 kg comes to you for nutritional advice. Calculate her BMR.
9. What are the functions of each of the following metabolic pathways?
a. Citric Acid cycle
b. Hexose monophosphate shunt
c. Cori cycle
d. Gluconeogenesis (2)
10. What are the important features of chemiosmotic theory of oxidative phosphorylation? (3)
11. List the names of the enzymes, substrates and products involved in irreversible steps of glycolysis?
(4)
12. What are the functions of Hexose Monophosphate Shunt? (3)
13. A 2 year old girl, resident of katchi abadi, presented in Falahi Clinic with generalized edema,
failure to thrive, distended abdomen, and skin and hair pigmentation. What is the probably
nutritional deficiency of this condition? (1)
14. Name the enzymes of the urea cycle. Where are they present in the Eukaryotic cells? (2)
15. Which is the rate-limiting step in urea synthesis? (1)
16. Explain the biochemical role of allopurinol in the treatment of gout. (2)
17. A two year old village boy was brought to the hospital. He was mentally retarded. On clinical
investigations, his urine showed increased levels of an aromatic amino acid and ketones. The
conclusion was made for an abnormality of amino acid metabolism.
a. What is the possible diagnosis? (2)
b. What is the biochemical basis of this diagnosis? (5)
c. What advice will you give to this patient? (3)
18. What is the enzymatic/metabolic defect in each of the following diseases? Name the
metabolite(s) which accumulates in the tissues.
a. Tay Sachs Disease (2)
b. Gout (2)
c. Cysteinuria (2)
d. Sickle Cell anemia (2)
e. Von Gierkes Disease (2)
19. Why does an ATP molecule give more energy than an ADP molecule on hydrolysis? (2)
20. Define High-Energy Biomolecules. (2)
21. Name the various components of the electron transport chain. (4)
22. Name two uncouplers of electron transport chain and oxidative phosphorylation. What is their
mechanism of action? (4)
23. What is the effect of Cyanide on the electron transport chain? (3)
24. A patient was brought to the hospital by the request of junior high school teacher who complained
that the youngster had seizures, appeared weak and tired. Physical exam showed the Kayser-
Fleischer rings in the eyes and hepatomegaly. On the basis of these findings a diagnosis was made
and penicillamine therapy was promptly instituted. What is the diagnosis? (2) What is the
biochemical defect? (3)
25. *A baby boy was born prematurely after 32 weeks of gestation (or 28 weeks). He had difficulty in
breathing and was diagnosed to have Acute Respiratory Distress Syndrome. What could be the
underlying Biochemical basis of this syndrome (or defect in this case)? (3)
a. What biochemical test would you recommend? (1)

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