De La Salle Health Institute

College of medicine
Department of Biochemistry

Intern’s review, March 2020

Name: _________________________________

1. ____ Which of the following macronutrients is not directly absorbed by the portal system?
A. Triacylglycerol C. Amino acids
B. Short chain fatty acids D. Monosaccharides

2. ____A patient with lactose intolerance asks you about a new product called AMYLASE
which contains alpha amylase for improved carbohydrate digestion. He asks you if he
can take fresh milk together with this product. You would:
A. Highly recommend that he take the product to avoid the signs and symptoms of
lactose intolerance
B. Tell him that he can take the fresh milk even without the amylase supplement
C. Advise against taking the amylase for lactose intolerance
D. Prescribe another drug for lactose intolerance that contains PEPSIN as the active
Ingredient

3. ____ A new chemical was discovered and found to specifically block the GLUT 2 receptor of
the cells of the small intestine. What would be the most probable effect of this chemical?
A. Accumulation of glucose in the intestinal cell
B. Impaired glucose entry into the intestinal cell
C. Inability of insulin to facilitate entry of glucose into the capillaries
D. Stimulation of gluconeogenesis in the intestinal cell

4. _____ The skin of an apple contains a substance called pectin, which contains galacturonic
acid subunits linked together by alpha-1,4 glycosidic bonds. Which of the following
statements is true of this compound?
A. It provides the body with an easily digestible source of energy for ATP production
B. It cannot be broken down into its monosaccharide components in humans
C. It acts as an emulsifier of fats just like bile
D. It has no nutritional value in the human diet and is considered as junk food

5. _____ A certain dietary protein contains a large amount of neutral branch chain amino acids.
Which of the following enzymes would be most active in the digestion of this protein?
A. Trypsin C. Chymotrypsin
B. Pepsin D. Proelastase

6. _____The amount of polyunsaturated fatty acid in the diet is one of the factors that determine
the level of intake of this vitamin
A. vitamin A
B. vitamin D
C. vitamin E
D. vitamin K

7. _____Which of the following statements is TRUE about basal metabolic rate (BMR)?
A. BMR is not related to the surface area
B. BMR is directly proportional to the age of the individual
C. Males and females have similar age-related BMR
D. BMR is increased in people suffering from hyperthyroidism

8. _____Why is ammonia is toxic to the brain?

A. depletion of glutamine in the brain
B. shifts glutamate dehydrogenase equilibrium towards alpha ketoglutarate
C. shifts glutamate dehydrogenase equilibrium towards glutamate & depletes the brain
of alpha ketoglutarate
D. it favors increase synthesis of the inhibitory neurotransmitter – GABA
9. _____A 4-month old child has been experiencing vomiting and convulsions. Laboratory
results showed hyperammonemia and orotic aciduria. Which of the following enzyme
defect is likely to be present?
A. glutaminase
B. arginase
C. argininosuccinate synthase
D. ornithine transcarbamoylase

10. _____A newly isolated antibiotic interferes with the ability of the 70s ribosome to move.
What would the effect of exposure to this antibiotic have on bacterial cell be?
A. protein synthesis will not be affected
B. the protein synthesized will have different sequence of amino acids
C. the protein synthesized will be longer than the normal
D. no protein will be produced

11. _____A 65 year old man was given coumadin, 4 weeks after taking the medication there
was noted gum bleeding. Which of the following laboratory test will you request to
monitor cousin treatment?
A. Thrombin Time
B. Prothrombin Time
C. activated Partial Thromboplastin Time
D. Fibrin Dimer

12. _____A 45 year old woman was complaining of on and off right upper quadrant pain for 2
weeks and yellowing of the skin and eyes. Her urine was noted to be tea colored for the
last 5 days. On ultrasound of the hepatobiliary tree there was noted multiple stones in
the biliary tract, and gallbladder. Which of the following statement will describe the
patients condition?
A. Unconjugated bilirubin will be elevated since the patient has yellowing of the skin and
sclerae and obstruction of the secretion of bile
B. Indirect bilirubin will predominantly be elevated because of the reduced uptake of
bilirubin because of multiple stones blocking the exit
C. Direct bilirubin is high because it cannot be excreted in the urine
D. High level of conjugated bilirubin because of the interference with secretion due to
obstruction and seen in the urine because it is readily filtered in the glomerulus

13. _____Which of the following describes bilirubin?

A. Has a high water solubility
B. Rapidly cleared by the liver because of its strong binding to albumin
C. Mostly excreted in sweat glands
D. Bound ton serum albumin with an association constant of 102

14. _____The importance of methotrexate in cancer treatment is attributed to its capacity to

inhibit this enzyme in actively dividing cells:
A. aspartate transcarbamylase
B. Dihydrofolate reductase
C. HGPRTase
D. PRPP synthase

15. _____Urea Cycle is:

A. stimulated with PRPP acting as the allosteric activator of CPS I
B. initiated in the cytosol of the liver
C. used to dispose ammonia through the formation of urea
D. inhibited during starvation by repression of the urea cycle enzymes

16. _____What vitamin is needed to activate glycine to condense with succinyl-Coa in the first
step in heme biosynthesis?
A. Thiamine
B. Riboflavin
C. Niacin
D. Pyridoxal Phosphate
17. _____A 25 year old male taking Antiretroviral medication ( Tenofovir, Lamivudine and
Lopinavir/ritonavir) for 8 months already. He was diagnosed recently with tuberculosis
and started on RIF PZA EMB and INH. What will happen to antiretroviral medication of
this patient?
A. Decrease level of tenofovir
B. Decrease level of lamivudine
C. Decrease level of Lopinavir/ritonavir
D. Nothing will happen..

18. _____This enzyme of the Kreb’s Cycle is the only one that requires vitamin B2:
A. citrate synthase
B. succinate dehydrogenase
C. α-ketoglutarate dehydrogenase
D. fumarase

19. _____This form of vitamin B6 is the one used in the transamination of amino acids:
A. pyridoxine
B. pyridoxamine
C. pyridoxal PO4
D. all of the choices

20. _____Polymerase chain reaction is a technique for

A. amplification of DNA in vivo
B. amplification of DNA in vitro
C. amplification of RNA
D. amplification of protein

21. _____A 56 year old man taking coumadin was given herbal medication St John’s wort. 4
hours after he noted gum and nose bleeding. What could explain the situation?
A. Grapefruit juice is know to cause nose and gum bleeding
B. Underdose of coumadin causes bleeding
C. Grapefruit juice is an inhibitor of CYP hence increase level of coumadin that
predisposes patient to bleed
D. Coumadin inhibits grapefruit juice metabolism causing toxicity and bleeding

22. _____In transamination, this α-keto acid/amino acid pair is frequently utilized to transfer
amino groups:
A. oxaloacetic acid/aspartic acid
B. pyruvic acid/alanine
C. α-ketoglutaric acid/glutamic acid
D. α-ketobutyric/threonine

23. _____A 21 year old medical student took 750ml bottle of wine after 6-7 hours he took
paracetamol for headache. patient after wards complaint of abdominal pain and on
laboratory test note increase of liver function test. What is the reason for this?
A. Increase production of NAPQI
B. Paracetamol is a substrate of CYP 2D19
C. Increase side effect from alcohol
D. Occurrence of hepatitis infection

24. _____Rigor mortis is caused by which of the following?

A. Detachment of the cross bridging of actin to myosin in a continuous cycle
B. Lack of ATP causes permanent attachment of actin to myosin head.
C. Release of inorganic phosphate followed by ADP
D. Presence of ATP in the S1 myosin

25. _____This important tumor suppressor gene commits a cell to apoptosis if the defects or
damage in DNA is too extensive to repair. Germline mutations lead to a familial cancer
syndrome called Li-Fraumeni syndrome.
A. pRB
B. p21
C. p16
D. p53
26. _____A 3 day old newborn was noted to have yellowing of the skin and sclerae. On
laboratory work up the baby was diagnosed to have a low level of UGT1A1. Which of the
following bilirubin will be elevated?
A. Conjugated bilirubin
B. Unconjugated bilirubin
C. Direct Bilirubin

27. _____In terms of cell communication, what do bacterial pathogens such as cholera and
anthrax have in common?
A. They destroy the receptors for key signaling molecules
B. They prevent the production of key signaling molecules
C. They alter the chemical structure of key signaling molecules
D. They block the normal functioning of signal transduction mechanisms

28. _____A 26 year old 4th year medical student was exposed to a person with chicken pox. He
couldn't remember if he had it during childhood. He was expecting to acquire the disease
but to his surprise after 2 weeks he is still healthy and never gotten the disease.
Assuming he had chicken pox before what is explanation for this scenario?
A. His Memory B cell works and recognize the antigen readily and produce
immunoglobulin against chicken pox
B. His IgE is so active at that time he got immune instantly
C. IgM is produce as early as 2 days hence he did not contract the disease
D. The IgD express in the membrane bound B cells is highly active against chicken pox
and after post translational encrypting producing IgA hence got immune to disease

29. _____If a mutation in DNA caused a “stop” codon to be created on the coding strand
between
the TATA box and the transcription start site, what would be the most likely outcome?
A. a shorter protein C. no effect
B. a nonfunctional protein D. abnormal splicing

30. _____Ten minutes after eating pancake a 5 year old boy suddenly developed rashes,
angioedema and difficulty of breathing. What is the drug that should be given to the
patient immediately?
A. Epinephrine B. Steroids
C. Salbutamol D. Penicillin

31. ____A 55-year old man previously diagnosed with cirrhosis developed signs and symptoms
of ammonia intoxication. Treatment included administration of an intestinal antibiotic.
What has to be supplemented to avoid the development of complication secondary to
the treatment?
A. Vitamin B complex
B. Vitamin C
C. Vitamin E
D. Vitamin K

32. _____A human disorder thought to be due to a mutation eliminating or reducing DNA repair
activity is ____
A. Lesch Nyhan Syndrome
B. Xeroderma pigmentosum
C. Tay Sach’s disease
D. Albinism

33. _____A patient is hyperthyroid, with elevated T3 and T4 levels, but low TSH levels. In
which scenario/s would one expect this to occur?
A. Pregnancy
B. Graves’ disease
C. Functional TSH-secreting tumor (adenoma) in the pituitary
D. Acute thyroid inflammation
E. Graves’ disease and acute thyroid inflammation

34. _____A two year old boy is exhibiting developmental delay and started to bite his lips and
fingers. An “orange” colored sand is found on his diapers. The child has inability to
metabolize which one of the following molecules?
A. uric acid
B. adenine
C. thymine
D. hypoxanthine
35.____ A 4 yo presents to a pediatric clinic with megaloblastic anemia and failure to thrive.
Enzyme measurement of the white blood cells reveals a deficiency of orotate
phosphoribose transferase and abnormally high activity of aspartate transcarbamoylase.
Which of the following treatment will reverse all symptoms?
A. blood transfusion
B. dietary supplement of PRPP
C. Oral thymidine
D. Oral Uridine

36. _____A 24 year old woman was started on unfractionated heparin, after 24 hours there was
noted gum and nose bleeding. Which of the following medication are you going to give to
stop the bleeding?
A. ASA
B. Protamine Sulfate
C. Coumadin
D. Clopidogrel

37. _____Which one of following statements occurs during prolonged fasting?

A. The muscle can take up glucose for use as a metabolic fuel because glucose
transport in muscle is stimulated in response to glucagon.
B. There is decreased secretion of glucagon in response to increased glucose in the
portal blood.
C. Plasma glucose is maintained by gluconeogenesis from amino acids.
D. There is an increase in metabolic rate in the fasting state.

38. _____Vitamin D plays an essential role in the metabolic regulation of which minerals?
A. Calcium and fluoride
B. Phosphorus and chloride
C. Calcium and phosphorus
D. Manganese and cobalt

39. _____Which one of the following would be characteristic of the postabsorptive state which
occurs late in the morning, late in the afternoon or early in the morning before breakfast?
A. Glucose enters cells and is either used or stored as glycogen or fat.
B. Lactic acid is produced and then converted to glucose in the liver.
C. Fatty acids and glycerol combine to form fat, and is deposited in adipose tissue.
D. Amino acids are used in protein synthesis

40. _____Which of the following sets of amino acids are catabolized via succinyl CoA of the
TCA cycle?
A. phenylalanine and tyrosine
B. methionine and valine
C. asparagines and aspartate
D. praline and histidine

41. _____Cholera toxin results in chronic phosphorylation and activation of CFTR channels
through which process?
A. ADP-ribosylation of Gi
B. Phosphodiesterase inhibition
C. Protein kinase inhibition
D. ADP-ribosylation of Gs

42. _____Receptor tyrosine kinases without intrinsic protein kinase activity borrow this lacking
kinase activity from which cytosolic protein?
A. IRS-1
B. JAK
C. SMAD
D. PI3K

43._____ A 68-yo-man complains of urinary frequency, especially at night. The urologist

diagnosed him to have benign prostatic hypertrophy (BPH) and placed him on a 5-alpha-
reductase inhibitor.This drug would decrease which of the following?
A. Conversion of testosterone to dihydrotestosterone
B. Release of calcium from the endoplasmic reticulum
C. Prostaglandin synthesis
D. Conversion of angiotensin I to angiotensin II
44. _____The rate-limiting step in catecholamine synthesis involves which of the following
enzymes?
A. Tyrosine hydroxylase
B. Dopamine beta-hydroxylase
C. Phenylethanolamine N-methyltransferase
D. Phenylalanine hydroxylase

45. _____ Which of the following statements about the formation of uric acid is correct?
A. Uric acid levels are reduced by a deficiency of hypoxanthine-guanine phosphoribosyl
transferase (HGPRT)
B. Uric acid levels are increased by a deficiency of hypoxanthine-guanine
phosphoribosyl transferase (HGPRT)
C. Uric acid levels are reduced by increasing the activity of the de novo pathway
D. Uric acid levels are increased by increasing the activity of the salvage pathway

46. _____Deficiency of which enzyme causes porphyria cutanea tarda?

A. Uroporphyrinogen Synthase I
B. Uroporphyrinogen Synthase III
C. Uroporphyrinogen Decarboxylase
D. Coproporphyrinogen Oxidase

47. _____A 54 year old worker in automobile batteries and a house painter came to your clinic
for anemia, peripheral neuropathy, hypertension, and declining mental status. you initial
impression is heavy metal poisoning. Which of the heavy metals can cause this
symptoms?
A. Cadmium
B. Iron
C. Lead
D. Magnesium

48. _____Amine hormones are derived from which amino acid?

A. Phenylalanine
B. Histidine
C. Tryptophan
D. Tyrosine

49. _____Puberty is initiated by binding of this hormone to GPR54 receptors on GnRH neurons.
A. Dopamine
B. GABA
C. Dihydrotestosterone
D. Kisspeptin

50. _____Prolactin-inhibiting factor is otherwise known as

A. Dopamine
B. Norepinephrine
C. Epinephrine
D. Acetylcholine

51. _____During the G1 to S phase, the CKI p21 is complexed to S-phase Cdk-cyclin. When
p21 is degraded by G1-phase Cdk-cyclin just prior to initiation of S-phase, what
immediately happens next?
A. Phosphorylation of pRb by S-phase Cdk-cyclin
B. The trigger protein ATM dissociates from DNA
C. The tumor suppressor gene, p53, is activated
D. E2F becomes tightly complexed with pRb

52. _____A patient with gum bleeding and poor wound healing may have poor intake of which
food group?
A. Citrus fruits and leafy vegetables
B. Lean pork and dairy products
C. Cereals and non polished rice
D. Beans, nuts and legumes

53. _____Which is the correct risk factor-deficiency syndrome pair?

A. Chronic alcoholism: beri-beri
B. Isoniazid therapy: pellagra
C. Vegan diet: sideroblastic anemia
D. Hartnup syndrome: neural tube defects
54. _____A patient with large intakes of raw egg whites would likely suffer problems in which
process?
A. Entry of propionyl coA into the TCA cycle as succinyl coA
B. Synthesis of deoxythymidylate from deoxyuridylate
C. Oxidative decarboxylation of pyruvate to acetyl coA
D. Transfer of an amino group from glutamate to pyruvate

55. _____An otherwise healthy infant is born with cataracts. The defect may be BEST
accounted for by mutations in genes that code for which protein?
A. Collagen
B. Crystallin
C. Scotopsin
D. Transducin

56. _____Compared to anaerobic metabolism, aerobic metabolism is more advantageous

because
A. it yields the harmless carbon monoxide as by-product
B. all cells in the body can metabolize fuels aerobically
C. it protects the body from oxidative stress
D. more energy is generated in the form of ATP

57. _____Which one of following statements about the fed and fasting metabolic states is
correct?
A. In the fed state muscle can take up glucose for use as a metabolic fuel because
glucose transport in muscle is stimulated in response to glucagon.
B. In the fed state there is decreased secretion of glucagon in response to increased
glucose in the portal blood.
C. Plasma glucose is maintained in starvation and prolonged fasting by gluconeogenesis
from ketone bodies.
D. There is an increase in metabolic rate in the fasting state.

58. _____The major iron storage compound in humans:

A. Transferrin
B. Hemosiderin
C. Apoferritin
D. Ferritin

59. _____A patient who receives albumin infusion also benefits from the buffering action of the
protein in plasma via its
A. histidine residues
B. disulfide bridges
C. hydrophobic clefts
D. anionic acidic residues

60. _____Which type of metabolic fuel is utilized for generating glucose under conditions of
severe starvation?
A. Glycogen
B. Fats
C. Starch
D. Amino acids

61. _____An infant presents with fractures at multiple stages of healing. Ruling out child abuse,
the attending physician arrived at a tentative diagnosis of osteogenesis imperfecta- a
congenital defect in which protein?
A. Collagen
B. Elastin
C. Fibrillin
D. Laminin

62. _____A diabetic patient presents with a protein of 3+ on urinalysis. The charge selectivity of
the glomerular barrier, which appears to be defective in this case, is made possible
through the presence of which ECM component?
A. type I collagen
B. laminin
C. heparan sulfate
D. fibronectin
63. _____Which vitamin commonly found in everyday food forms part of co-enzyme A?
A. Ascorbic acid
B. Folic acid
C. Nicotinic acid
D. Pantothenic acid

64. _____Which vitamin is essential due to the absence of L gulonolactone oxidase in humans?
A. Ascorbic acid
B. Biotin
C. Cobalamin
D. Nicotinic acid

65. _____A patient with chronic liver disease is expected to have an albumin-globulin ratio that
is
A. decreased due to enhanced globulin production
B. decreased due to depressed albumin synthesis
C. increased due to albumin leakage into blood
D. increased due to faster globulin clearance

66. _____On newborn screening, an infant tested positive for deficiency in glucose-6-phosphate
dehydrogenase. G6PD is the rate limiting enzyme of the pentose phosphate pathway,
and is classified as a/n
A. hydrolase
B. ligase
C. oxidoreductase
D. transferase

67._____An acetylcholine antagonists derived from atropa belladona that blocks muscarinic Ach
receptor:
A. atropine C. botulinus toxin
B. D-tubocurarine D. nicotine

68. _____The rate-limiting step in adrenal steroid hormone synthesis involves which enzyme?
A. Cholesterol side-chain cleavage enzyme
B. 11-beta-hydroxylase
C. 18-hydroxysteroid dehydrogenase
D. 21-beta-hydroxylase
E. 17-alpha-hydroxylase

69. _____An obese woman in her forties is suspected to have acute pancreatitis. Elevated
levels of which enzyme in the serum would confirm this diagnosis?
A. alanine aminotransferase
B. alkaline phosphatase
C. amylase
D. lipase

70. _____A diabetic patient tested positive for ketone bodies in the blood. These ketone bodies
come from the liver but cannot be used by the organ due to the absence of succinyl-coA-
acetoacetate coA transferase. This phenomenon exemplifies which regulatory
mechanism?
A. Compartmentation
B. Covalent modification
C. Feedback inhibition
D. Substrate level control

71. _____Which of the following enzymes is common to both glycolysis and gluconeogenesis?
A. Pyruvate carboxylase
B. Hexokinase
C. Phosphoglycerate kinase
D. Fructose 1,6-bisphosphatase

72. _____A liver biopsy of a child with a very enlarged liver reveals glycogen with an abnormal,
amylopectin- like structure with long outer chains.Which of the following enzymes
would most likely be deficient?
A. Glycogen synthase
B. Glycogen phosphorylase
C. Amylo-alpha(1,6)-glucosidase
D. Alpha-glucan-branching glycosyltransferase
73. _____Vanillylmandelic acid (VMA), a major metabolite of catecholamine metabolism, is
mainly used as a marker for
A. Astrocytomas
B. Carcinoid tumors
C. Neuroblastomas
D. Malignant pheochromocytomas

74. _____Which of the following statements about the use of the pentose phosphate pathway in
red blood cells is correct?
A. Mature red blood cells do not need the pentose phosphate pathway since they do
not divide.
B. Mature red blood cells do not need the pentose phosphate pathway since they do
not synthesize fat.
C. Mature red blood cells need the pentose phosphate pathway to oxidize the glucose-
6-phosphate.
D. Mature red blood cells need the pentose phosphate pathway for the production of
NADPH

75. _____Rashes on sun exposed areas, loose watery stools and cognitive deficits constitute
the classic triad of
A. Scurvy
B. Wernicke-Korsakoff syndrome
C. Pellagra
D. Beri-beri

76. _____As a form of rescue therapy, leucovorin or folinic acid may be given to patients who
are being given
A. methotrexate as a chemotherapeutic agent
B. nicotinic acid as management for dyslipidemia
C. isoniazid as part of the regimen for tuberculosis
D. folic acid as prophylaxis for neural tube defects

77. _____Blocking of receptors for this excitatory neurotransmitter during instances such as
traumatic brain injury (TBI) or brain ischemia (as with post-cardiac arrest) is thought to
prevent or reduce the degree of neurotoxicity.
A. Glycine
B. Acetylcholine
C. Dopamine
D. Glutamate

78. _____Which of the following statements is CORRECT concerning protein-energy

malnutrition (PEM)?
A. The diagnosis of marasmus is based on fat and muscle wastage resulting from
prolonged calorie deficiency and/or inflammation.
B. Kwashiorkor has been considered the end result of a long-term deficit of dietary
energy, resulting from prolonged protein-poor diet
C. Marasmus occurs mainly in connection with acute, life-threatening illnesses such as
trauma and sepsis.
D. The major sine qua non of marasmus is severe reduction of levels of serum proteins
such as albumin and transferrin.

79. _____How does chronic kidney disease lead to hypoalbuminemia?

A. From being ellipsoidal, albumin becomes linear and passes through glomeruli.
B. Charge repulsion is lost as uremic toxins render albumin more positive.
C. More fluid is retained in blood causing albumin concentration to fall.
D. Disruption of glycosaminoglycans in glomeruli allows albumin to be filtered.

80. _____Which of the following statements concerning dietary lipids is correct?

A .Corn oil and soybean oil are examples of fats rich in saturated fatty acids
B. Triacylglycerols obtained from plants generally contain more unsaturated fatty acids
than those from animals
C. Olive oil is rich in polyunsaturated fats
D. Unsaturated fatty acids in our body are usually trans
81. _____Which of the following does NOT occur during apoptosis?
A. Activation of caspases and endonucleases
B. Induction of an inflammatory response
C. Chromatin condensation or pyknosis
D. Formation of cytoplasmic blebs and apoptotic bodies

82. _____This important tumor suppressor gene commits a cell to apoptosis if the defects or
damage in DNA is too extensive to repair. Germline mutations lead to a familial cancer
syndrome called Li-Fraumeni syndrome.
A. pRB
B. p21
C. p16
D. p53

83. _____Which of the following statements regarding energy metabolism is TRUE?

A. Adipose tissue does not contribute to basal metabolic rate (BMR).
B. Resting metabolic rate is the energy expenditure of the body when asleep.
C. Differences in physical activity represent the largest source of variability in energy
requirements.
D. The energy cost of physical activity can be determined by measuring respiratory
quotient (RQ) during the activity

84. _____ A child is noted to have recurrent respiratory infections that necessitate
hospitalization. He is diagnosed to have severe combined immunodeficiency syndrome.
Which of the following would most likely be observed in his laboratory tests?
A. a decrease in T cells and B cells
B. a decrease in dATP
C. an increase in T cells
D. a decrease in B cells

85. _____A 54 year old man was complain of chest pain 4 hours prior to consult to emergency
room, 12 Lead ECG was done and showed acute ST segment elevation myocardial
infarction. Vital Signs are stable. Which of the following medication has been proven to
significantly reduced mortality rate from coronary artery thrombosis?
A. Streptokinase
B. Coumadin
C. Dabigatran
D. RIvaroxaban

86. _____A hypertensive woman treated with amiloride presents with altered taste perception.
One class of receptors in taste buds that is specifically susceptible to amiloride inhibition
is that which
A. transduces sweet taste
B. allows sodium influx
C. interacts with protons
D. responds to glutamate

87. _____An elderly patient who is taking megadoses of vitamin E for its anti-oxidant effects
should be warned about the increased risk of
A. spinal cord demyelination
B. lung cancer
C. cardiovascular disease
D. age-related macular degeneration

88. _____A patient with megaloblastic anemia and methylmalonic acidemia is likely to be
deficient in
A. Folic acid
B. Biotin
C. Pyridoxine
D. Cobalamin

89. _____A double stranded RNA genome isolated from a virus in the stool of a child with
gastroenteritis was found to contain 15% uracil. What is the percentage of guanine in
this genome?
A. 15
B. 25
C. 35
D 75
90. _____The oxidation product/s of fatty acids with odd number of carbon atoms:
A. Acetyl CoA
B. Acetyl CoA and Propionyl CoA
C. Acetyl CoA and Succinyl CoA
D. Propionyl CoA and Succinyl CoA

91. _____Which of the following statements best describes KETOGENESIS which may occur in
diabetes?
A. Increased lipolysis due to absence of inhibitors of insulin is the most important factor
increasing ketogenesis
B. Acetoacetate is converted to acetone by a dehydrogenase which is present in blood
and urine.
C. Ketogenesis occurs only in instances when alternative sources of fuel (like glucose)
cannot be utilized.
D. Incomplete beta-oxidation of fatty acids occurs because of failure to replenish
intermediates of the TCA cycle
 
92. _____An alternative pathway for fatty acid oxidation involving removal of one carbon from
the carboxyl end and utilizes “mixed function oxidase”:
A. α-oxidation
B. β-oxidation
C. ω-oxidation
D. peroxisomal fatty acid oxidation

93. _____A 40-year-old female presents to her physician with a goiter. On physical exam, the
physician notes coarse oily skin, a large tongue, prognathism, and a prominent
supraorbital ridge of the face. The patient’s hands were noted to have thick fingers.
Which of the following should be the initial (screening) hormonal diagnostic
investigation?
A. Insulin levels
B. GH levels
C. Arginine levels
D. GHRH levels
E. IGF-1 levels

94. _____An elderly woman has recently been noticing increasing bouts of bloatedness,
abdominal discomfort, and diarrhea every time she eats dairy products in the morning.
She is flummoxed because consuming milk products is something she has been doing
for a long time. The most likely enzyme she acquired a deficiency of is
A. α-glucosidase
B. β-galactosidase
C. sucrose-α-glucosidase
D. α-amylase

95. _____Of the three groups of proteins that carry or translocate medium- to long-chain fatty
acids across the cell membrane, which one has a variety of other functions besides FA
translocation?
A. FATPs
B. FATs (CD36)
C. FABPs
D. All of the above

96. _____A 14- yr old high school student is brought to the doctor by his parents due to exercise
intolerance.His muscles become stiff and weak during exercise.Sometimes his urine is
reddish-brown after exercise.An exercise test indicates very low lactate
production.Which one of the following enzymes is potentially defective?
A. Muscle glucose-6-phosphatase
B. Muscle glycogen phosphorylase
C. Liver PFK-1
D. Liver glycogen phosphorylase
97. _____ A 3-month-old girl with developing cataracts is shown to contain a reducing sugar in
her urine, but the glucose oxidase test was negative. She has had no problems eating,
and her growth curve is at the 60th percentile. Fasting blood glucose tests show normal
levels of circulating glucose. A likely enzyme deficiency is which of the following?
A. Fructokinase
B. Galactokinase
C. Hexokinase
D. Aldolase

98. _____ A patient is diagnosed with an enzyme deficiency of glucose 6-phosphatase. This
enzyme is normally only expressed in which of the following?
A. Liver and muscle
B. Liver and kidney
C. Liver and adipose tissue
D. Liver and brain
E. Erythrocytes

99.______A patient presents with signs of hypothyroidism. To investigate the matter, you
measure the levels of T4 and TSH. If the patient suffers from iodine deficiency, you can
expect the following results:
A. T4 reduced, TSH reduced
B. T4 elevated, TSH reduced
C. T4 elevated, TSH elevated
D. T4 reduced, TSH elevated

100____ Which of the following is TRUE of respiratory quotient (RQ)?

A. High glucose intakes increase RQ because they increase CO2 production
B. The RQ value for fatty acid oxidation is 0.1
C. High intake of saturated fatty acids increases RQ
D. RQ is the volume of oxygen consumed divided by the volume of carbon dioxide
produced
 

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