Clinical Biochemistry Review Questions

Chapters 17, 18, and 19

MULTIPLE CHOICE: Select the BEST ANSWER for each item.

1. Which of the following statements is CORRECT?

A. Lipid digestion begins with acid-stable lipases that primarily use TAG with long to very long-
chain fatty acids as substrates.
B. Large lipid droplets are emulsified in the mouth through the act of mastication.
C. Colipase restores activity to pancreatic lipase in the presence of inhibitory bile acids.
D. The peptide hormone secretin causes the gallbladder to contract and release bile.

2. In humans, which of the following is solely responsible for adding significant quantities of ketone
bodies into the blood?
A. Liver C. Kidney
B. Heart D. Adipose tissue

3. Which of the following statements is CORRECT?

A. Dietary triacylglycerol must be completely hydrolyzed to free fatty acids and glycerol before
absorption.
B. Triacylglycerol carried by chylomicrons is degraded to free fatty acids and glycerol by lipoprotein
lipase on the endothelial surface of capillaries in muscle and adipose primarily.
C. Fatty acids that contain ten carbons or less are absorbed and enter the circulation primarily via
the lymphatic system.
D. Formation of chylomicrons is independent of protein synthesis in the intestinal mucosa.

4. Which enzyme catalyzes the principal regulatory step in the biosynthesis of bile acids?
A. HMG-CoA reductase C. 7α-hydroxylase
B. 12α-hydroxylase D. Ascorbate

5. The following are sources of NADPH for de novo lipogenesis, EXCEPT:

A. Irreversible phase of pentose phosphate pathway
B. Oxidation of malate to pyruvate, catalyzed by the malic enzyme
C. Non-oxidative phase of pentose phosphate pathway
D. Reduction of isocitrate to α-ketoglutarate, catalyzed by cytosolic isocitrate dehydrogenase

6. Which enzyme of the outer mitochondrial membrane is responsible for fatty acid activation?
A. Acyl-CoA synthetase C. Carnitine-acylcarnitine translocase
B. Carnitine palmitoyl transferase I D. Carnitine palmitoyl transferase II

7. Which enzyme catalyzes the principal regulatory step in the biosynthesis of cholesterol?
A. HMG-CoA reductase C. HMG-CoA lyase
B. HMG-CoA synthase D. Δ24-reductase

8. Which lipoprotein represents the final stage of very-low-density lipoprotein catabolism?

A. Intermediate-density lipoprotein C. High-density lipoprotein
B. Chylomicron remnant D. Low-density lipoprotein

9. Which of the following is the first ketone body produced in ketogenesis?

A. Intermediate-density lipoprotein C. High-density lipoprotein
B. Chylomicron remnant D. Low-density lipoprotein

10. Which apolipoprotein is integral to the structure of chylomicrons?

A. Apo E C. Apo B-100
B. Apo C-II D. Apo B-48

11. Which plasma lipoprotein transports dietary TAG from the small intestine to extrahepatic tissues?
A. Very-low-density lipoprotein C. Low-density lipoprotein
B. Chylomicron D. High-density lipoprotein

12. Which of the following is a primary bile acid produced from cholyl-CoA?
A. Taurocholic acid C. Glycochenodeoxycholic acid
B. Deoxycholic acid D. Lithocholic acid

13. Cholesterol is the precursor of the following hormones, EXCEPT:

A. Progesterone C. 17-β-estradiol
B. Cortisol D. Melatonin

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Clinical Biochemistry Review Questions
Chapters 17, 18, and 19

14. The ability of phospholipids to form micelles, liposomes, and emulsions is attributed to its
__________ property.
A. amphoteric C. amphibolic
B. amphipathic D. isoelectric

15. Which of the following statements about VLDL is INCORRECT?

A. It transports triacylglycerol from liver to extrahepatic tissues.
B. Apo B-48 is integrated to VLDL during its assembly inside hepatocytes.
C. It acquires most of apo C and apo E from HDL.
D. Loss of TAG in VLDL due to lipoprotein lipase activity leads to IDL formation.

16. Which of the following is the product of a series of reactions catalyzed by fatty acid synthase
multienzyme complex?
A. Malonyl-CoA C. Acetyl-CoA
B. Mevalonate D. Palmitate

17. Which of the following statements about the initial and rate-limiting step in de novo lipogenesis is
INCORRECT?
A. It involves the biosynthesis of malonyl-CoA from acetyl-CoA.
B. It occurs in the mitochondrial matrix.
C. It is catalyzed by acetyl-CoA carboxylase, a multienzyme protein complex.
D. It requires ATP, biotin, and biotin carboxyl carrier protein.

18. Which lipoprotein is responsible for reverse cholesterol transport in humans?

A. LDL C. VLDL
B. HDL D. Chylomicron

19. Hormone-sensitive lipase:

A. Active during fasting
B. Active when acetyl CoA carboxylase is active
C. Active in the presence of insulin
D. The inactive form is a protomer.

20. Which enzyme is NOT involved in ketogenesis?

A. HMG-CoA synthase C. 3-hydroxybutyrate dehydrogenase
B. HMG-CoA lyase D. HMG-CoA reductase

21. Which of the following best describes the role of carnitine in β-oxidation of fatty acids?
A. It is a cofactor for acyl CoA synthetase.
B. It prevents the breakdown of acyl CoA in the mitochondrial intermembrane space.
C. Transfer of acyl group from CoA to carnitine enables translocation to occur across the inner
mitochondrial membrane.
D. Transfer of acyl group from CoA to carnitine enables translocation to occur across the outer
mitochondrial membrane.

22. Adipose triglyceride lipase initiates TAG hydrolysis by attacking the fatty acid attached to
__________.
A. sn carbon-3 of glycerol C. sn carbon-1 of glycerol
B. sn carbon-2 of glycerol D. all three carbons of glycerol

23. The products of hydrolysis catalyzed by monoacylglycerol lipase are __________.

A. glycerol and either saturated or unsaturated fatty acid
B. 2-monoacylglycerol and either saturated or unsaturated fatty acid
C. glycerol and usually a saturated fatty acid
D. glycerol and usually an unsaturated fatty acid

24. Release of free fatty acids from adipose tissue is increased by all of the following, EXCEPT:
A. Glucagon C. Insulin
B. Norepinephrine D. Epinephrine

25. A digestive secretion that does not contain any enzyme is __________.
A. saliva C. pancreatic secretion
B. gastric secretion D. bile

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Clinical Biochemistry Review Questions
Chapters 17, 18, and 19

26. Which of the following is the main transporter of nonesterified fatty acids (NEFA) in plasma during
the fasting state?
A. Very-low-density lipoprotein C. High-density lipoprotein
B. Chylomicrons D. Albumin

27. In adipose tissue, glycerol-3-phosphate required for the synthesis of triglycerides comes mainly
from __________.
A. hydrolysis of pre-existing triglycerides
B. hydrolysis of phospholipids
C. dihydroxyacetone phosphate formed in glycolysis
D. free glycerol

28. Hormone-sensitive lipase catalyzes the hydrolysis of a fatty acid attached to which carbon of
glycerol?
A. sn carbon-3 of glycerol C. sn carbon-1 of glycerol
B. sn carbon-2 of glycerol D. all three carbons of glycerol

29. All the following statements about ketone bodies are true, EXCEPT:
A. Their synthesis increases in uncontrolled diabetes mellitus.
B. They are synthesized in the mitochondria.
C. They can deplete the alkali reserve.
D. They can be oxidized in the liver.

30. Glycerol released from adipose tissue by hydrolysis of triglycerides is mainly __________.
A. taken up by extrahepatic tissues C. reutilized in adipose tissue
B. taken up by the liver D. excreted from the body

31. Propionyl CoA is formed on oxidation of __________.

A. monounsaturated fatty acids
B. polyunsaturated fatty acids
C. fatty acids with odd number of carbon atoms
D. fatty acids with even number of carbon atoms

32. Which of the following can be used as a source of energy in extrahepatic tissues?
A. Acetoacetate C. Both A and B
B. Acetone D. Neither A nor B

33. Which of the following statements about perilipin is INCORRECT?

A. It is a protein involved in the formation of lipid droplets in adipocytes.
B. It inhibits lipolysis in basal conditions.
C. Phosphorylation of perilipin leads to lipolysis.
D. In the presence of insulin, perilipin is phosphorylated.

34. Propionyl CoA is converted to which intermediate of the TCA cycle?

A. D-methylmalonyl CoA C. Alpha-ketoglutarate
B. Succinyl CoA D. Succinate

35. When hormone-sensitive lipase and acetyl CoA carboxylase are phosphorylated, __________.
A. triacylglycerol in adipocytes is mobilized and lipogenesis is inhibited
B. lipogenesis is turned on and TAG degradation is turned off
C. ketogenesis occurs and ketolysis stops
D. ketolysis occurs and ketogenesis stops

36. Adipose tissue lacks which of the following?

A. Hormone-sensitive lipase C. Glycerol-3-phosphate dehydrogenase
B. cAMP-dependent protein kinase D. Glycerol kinase

37. Which of the following statements about bile acids (or bile salts) is INCORRECT?
A. Primary bile acids are synthesized in the liver from cholesterol.
B. Bile acids facilitate the absorption of the products of lipid digestion in the jejunum.
C. Secondary bile acids are produced by modification of primary bile acids in the liver.
D. Bile acids are recirculated between the liver and the small intestine in the enterohepatic
circulation.

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Clinical Biochemistry Review Questions
Chapters 17, 18, and 19

38. Which of the plasma lipoproteins is best described as follows: synthesized in the liver, containing a
high concentration of triacylglycerol and mainly cleared from the circulation by adipose tissue and
muscle?
A. Very-low-density lipoprotein C. Chylomicron
B. Low-density lipoprotein D. High-density lipoprotein

39. The breakdown of one molecule of a 16:0 fatty acid by β-oxidation leads to the formation of
__________.
A. 8 reduced flavin adenine dinucleotide, 7 NADH and 8 acetyl CoA molecules
B. 7 reduced flavin adenine dinucleotide, 7 NADH and 7 acetyl CoA molecules
C. 7 reduced flavin adenine dinucleotide, 7 NADH and 8 acetyl CoA molecules
D. 8 reduced flavin adenine dinucleotide, 8 NADH and 7 acetyl CoA molecules

40. Which of the plasma lipoproteins is best described as follows: formed in the circulation by removal
of triacylglycerol from very-low-density lipoprotein, contains cholesterol taken up from high-density
lipoprotein, delivers cholesterol to extrahepatic tissues?
A. Intermediate-density lipoprotein C. Chylomicron
B. Low-density lipoprotein D. High-density lipoprotein

41. Which of the following statements is INCORRECT?

A. Taurocholic acid is a primary bile acid produced from cholyl CoA.
B. HDL is responsible for reverse cholesterol transport in humans.
C. Apo B-48 is integrated to VLDL during its assembly.
D. Glycine is normally used to conjugate bile acids.

42. Inactivation of acetyl CoA carboxylase is favored when __________.

A. cytosolic citrate levels are high C. palmityl CoA levels are low
B. it is in a polymeric form D. it is dephosphorylated

43. Which of the following statements is INCORRECT?

A. Glycerol is the initial acceptor of fatty acids during triacylglycerol synthesis.
B. Perilipin inhibits lipolysis in basal conditions by preventing access of lipases to stored TAG.
C. Micelles are disk-shaped clusters of amphipathic lipids that coalesce with their hydrophobic
groups on the inside and their hydrophilic groups on the outside.
D. Deficiencies in the ability to absorb fat result in excessive amounts of chylomicrons in the blood.

44. What is the correct ordering of lipoprotein particles from the lowest to the greatest density?
A. LDL, IDL, VLDL, chylomicron C. VLDL, IDL, LDL, chylomicron
B. Chylomicron, VLDL, IDL, LDL D. Chylomicron, IDL, VLDL, LDL

45. α-Linolenic acid is considered to be nutritionally essential in humans because __________.

A. it is an omega-3 fatty acid
B. in humans, double bonds cannot be introduced into fatty acids beyond the Δ 9 position
C. in humans, double bonds cannot be introduced into fatty acids beyond the Δ 12 position
D. human tissues are unable to introduce a double bond in the Δ 9 position of fatty acids

46. Hormone-sensitive lipase is inhibited by which of the following?

A. Vasopressin C. Epinephrine
B. ACTH D. Insulin

47. Malonyl CoA is an important regulator of fatty acid metabolism because __________.
A. it prevents entry of fatty acyl groups into the matrix of the mitochondria because it is a potent
inhibitor of CPT-I
B. it prevents entry of fatty acyl groups into the matrix of the mitochondria because it is a potent
inhibitor of CPT-II
C. it inhibits the synthesis of fatty acyl CoA
D. its formation from acetyl CoA and bicarbonate by the enzyme acetyl CoA carboxylase is the
main rate-limiting step in fatty acid synthesis

48. Enzyme deficiencies in the pathway for steroid hormone synthesis may lead to disorders that are
collectively known as __________.
A. sphingolipidoses C. congenital adrenal hyperplasia
B. glycogen storage diseases D. dyslipidemias

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Clinical Biochemistry Review Questions
Chapters 17, 18, and 19

49. Which of the following statements about cholesterol synthesis is CORRECT?

A. The rate-limiting step is the formation of HMG CoA by the enzyme HMG-CoA synthase.
B. All the carbon atoms in cholesterol came from acetyl CoA.
C. Synthesis solely occurs in the cytosol of the cell.
D. Squalene is the first cyclic intermediate in the pathway.

50. Classic 21 α-hydroxylase deficiency leads to which of the following?

A. Virtually absent or deficiency of mineralocorticoids and glucocorticoids
B. Virtually no sex hormones
C. Virtually no glucocorticoids, mineralocorticoids, active androgens, or estrogens
D. Increased production of mineralocorticoids

END OF REVIEW QUESTIONS

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