5 Practice MCQ for ethanol and xenobiotic metabolism with explanations

Q#1: A 52-year-old women is finishing her meal on a Friday night with four to five
alcoholic drinks in order to relax. Which metabolic changes will occur in her liver during
the night?
A. Inhibition of acetoacetate formation
B. Inhibition of 3-hydroxybutyrate formation
C. Inhibition of glycogen degradation
D. Increased synthesis of triacylglycerol
E. Increased gluconeogenesis

Q#2: A 19-year-old woman is having a healthy dinner and finishes with four to five
alcoholic drinks. Which of the following hepatic enzymes will lack its coenzyme during
her overnight fasting due to her ethanol metabolism?
A. Alanine aminotransferase
B. Lactate dehydrogenase
C. Mitochondrial malate dehydrogenase
D. Glutamine deaminase
E. Glycerol kinase

Q#3: A 28-year-old healthy student celebrates the end of a successful semester.

Normally he does not drink alcohol but when he meets with his friends he consumes
many alcoholic drinks in a short time with some snacks. The next morning he is chosen
for a random blood test. From the choices given what would be most likely found in his
lab data?
A. Elevated levels of VLDL
B. Very low levels of -hydroxybutyrate
C. High levels of alkaline phosphatase
D. Low albumin levels
E. Elevated glucose levels
Q#4. A 57-year-old man has hypercholesterolemia and is treated with statins. His
physician advises him not to drink grapefruit juice when he is on medication. Which of
the following enzymes metabolizes most of the statins and is inhibited by a substance in
grapefruit juice?
A. Cytochrome P450 reductase
B. UDP-glucuronyl transferase
C. Sulfatase
D. CYP 2E1
E. CYP 3A4

Q#5: A 55-year-old woman is brought by her neighbor to the ER. She had taken a toxic
overdose of Tylenol because she wanted to end her life but then had changed her mind
and asked for help. The physician administers acetadote. What is the action of this drug?
A. It activates formation of acetaminophen glucuronate
B. It activates formation of acetaminophen sulfate
C. It inhibits CYP2E1
D. It activates glutathione S-transferase
E. It prevents formation of NADPQI

Key next page

Key: 1 D, 2 B, 3 A, 4 E, 5 D
Explanations for practice MCQ for DM 51 Ethanol and xenobiotic metabolism

Q#1: A 52-year-old women is finishing her meal on a Friday night with four to five
alcoholic drinks in order to relax. Which metabolic changes will occur in her liver during
the night?
A. Inhibition of acetoacetate formation no: high levels of mitochondrial NADH favor
ketone body formation
B. Inhibition of 3-hydroxybutyrate formation no: this reaction is favored at high
NADH levels in mitochondria
C. Inhibition of glycogen degradation no: this is independent of the NADH/NAD+
ratio in cytosol and is stimulated by glucagon

D. Increased synthesis of triacylglycerol Correct! The high levels of cytosolic

NADH favor formation of glycerol 3-P for TAG synthesis.

E. Increased gluconeogenesis no: this pathway is reduced at high NADH/NAD+

ratio due to reduced usage of lactate, alanine, glycerol and glutamine provided
via the blood.

Q#2: A 19-year-old woman is having a healthy dinner and finishes four to five alcoholic
drinks. Which of the following hepatic enzymes will lack its coenzyme during her
overnight fasting due to her metabolism of ethanol?
A. Alanine aminotransferase no: it uses PLP

B. Lactate dehydrogenase Correct! It needs NAD+ in order to form pyruvate from

lactate. Ethanol metabolism leads to a high NADH level and a low NAD+ level in
cytosol.

C. Mitochondrial malate dehydrogenase no: during gluconeogenesis this enzyme

used NADH to form malate from oxaloacetate in mitochondria. It is the cytosolic
malate dehydrogenase which needs NAD+ and is lacking its coenzyme.

D. Glutamine deaminase no: this enzyme does not need a coenzyme

E. Glycerol kinase no this enzyme does not need a coenzyme, it uses ATP and
glycerol as substrates.
Q#3: A 28-year-old healthy student celebrates the end of a successful semester.
Normally he does not drink alcohol but when he meets with his friends he consumes
many alcoholic drinks in a short time with some snacks. The next morning he is chosen
for a random blood test. From the choices given what would be most likely found in his
lab data?
A. Elevated levels of VLDL Correct! High ethanol levels lead in hepatocytes to
TAG synthesis and release of VLDL. Glycerol 3-P is formed from DHAP and
also from free glycerol. The fatty acids are taken up from the blood and are
activated to fatty acyl CoA and used for TAG synthesis.

B. Very low levels of -hydroxybutyrate no: they would be very likely normal or even
slightly elevated.

C. High levels of alkaline phosphatase no: ethanol abuse can lead in the late phase
of liver cirrhosis to increased ALP levels due to the irritation of the intrahepatic
bile ducts. He is a healthy student and a one time high ethanol intake does not
lead to increased levels of ALP.

D. Low albumin levels no: this can be seen after prolonged ethanol abuse which
would already indicate liver damage. He is a healthy individual who normally
does not drink alcohol.

E. Elevated glucose levels no: he has most likely normal fasting blood glucose
levels as his liver is healthy and glycogen degradation is not reduced. If he would
be a chronic alcoholic he could be hypoglycemic.

Q#4. A 57-year-old man has hypercholesterolemia and is treated with statins. His
physician advises him not to drink grapefruit juice when he is on medication. Which of
the following enzymes metabolizes most of the statins and is inhibited by a substance in
grapefruit juice?

A. Cytochrome P450 reductase no: this is an enzyme working together with

CYP450 and uses NADPH.

B. UDP-glucuronyl transferase no: this enzyme is part of phase II detoxification and

this enzyme is not inhibited by grapefruit juice.

C. Sulfatase no: this is an enzyme of phase II detoxification and it is not inhibited by

grapefruit juice
 D. CYP 2E1 no: this enzyme metabolizes mainly ethanol and is not inhibited by
grapefruit juice.

E. CYP 3A4 Correct: This enzyme metabolizes many drugs, including statins and
this enzyme in intestinal mucosal cells is inhibited by grapefruit juice which acts
via down regulation of CYP3A4 synthesis. It is now known that the drug
metabolism of at least many drugs is affected and drugs have to be tested
whether their metabolism is affected by grapefruit juice.

Q#5: A 55-year-old woman is brought by her neighbor to the ER. She had taken a toxic
overdose of Tylenol because she wanted to end her life but had changed her mind and
asked for help. The physician administers acetadote. What is the action of this drug?

A. It activates formation of acetaminophen glucuronate no: this is not the action of

acetadote

B. It activates formation of acetaminophen sulfate no: this is not the action of

acetadote

C. It inhibits CYP2E1no: this enzyme is not inhibited by acetadote

D. It activates glutathione S-transferase Correct! Acetadote stimulates the

synthesis of GSH and activates the binding of glutathione to NADPQI. It can also
bind to NADPQI instead of GSH and make the molecule more water soluble for
detoxification.

E. It prevents formation of NADPQI no: it stimulates the detoxification of NADPQI

for excretion.