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1. A cardiovascular researcher is conducting a study to evaluate the relationship between folate levels and cardiovascular disease. The results of the study show that persons with lower folate levels have twice the risk of cardiovascular disease mortality than do those with higher folate levels. Which of the following enzymes is most closely related to the role of folate in lowering the risk of cardiovascular disease? A.Dihydrofolate reductase B .Glycinamide ribonucleotide transformylase C.Homocysteine methyltransferase D.Ribonucleotide reductase E. Thymidylate synthase 2. Ammonia,one of the principal products of nitrogen metabolism, is normally converted to urea, in the liver, by a series of enzymatic reactions. Liver disease and congenital or acquired defects in the urea cycle may cause elevations in the blood ammonia concentration .Ammonia is highly neurotoxic and, along with other factors, undoubtedly contributes to the development of encephalopathy and coma that is often a terminal event in patients with severe liver disease .Because the concentration of ammonia in hepatic portal vein blood is normally 5-10 times greater than in mixed venous blood, the gastrointestinal tract is presumed to be the site of most ammonia production . Much of the ammonia in the hepatic portal system is metabolized by the liver,. Q:Which enzymes are responsible for producing the direct donors of nitrogen into the pathway producing urea? A. Arginase and argininosuccinate lyase B. Xanthine oxidase and guanine deaminase C. Glutamate dehydrogenase and glutaminase D. Argininosuccinate synthetase and ornithinc transcarbamoylase E. Aspartate aminotransferase and carbamoyl phosphate synthetase 3. A newborn becomes progressively lethargic after feeding and increases his respiratory rate. He becomes virtually comatose, responding only to painful stimuli, and exhibits mild respiratory alkalosis. Suspicion of a urea cycle disorder is aroused and evaluation of serum amino acid levels is initiated. In the presence of hyperammonemia, production of which of the following amino acids is always increased? a. Glycine b. Arginine c. Proline d. Histidine e. Glutamine 4. A person exhibiting lead poisoning would be expected to show decreases in the activity of which enzymes involved in porphyrin metabolism? A. -aminolevulinic dehydrase and ferrochelatase B. -aminolevulinic synthase and ferrochelatase C. -aminolevulinic synthase and uroporphyrinogen I synthase D. Ferrochelatase and heme oxidase E. Coproporphyrinogen oxidase and uroporphyrinogen I decarboxylase

5. A 5-year-old male is being evaluated for cognitive impairment, behavioral problems and mild anemia. He lives in an 80-year-old house. Which of the following enzymes would be most sensitive to environmental toxic exposure in this patient? A. -Aminolevulinate synthase B. -Aminolevulinate dehydratase C. Uroporphyrinogen I synthase D. Uroporphyrinogen decarboxylase E. Bilirubin glucuronyl transferase 6. A 30-year-old woman had severe abdominal pain, nausea, vomiting and diarrhea. Evaluations including upper and lower endoscopies did not establish any intestinal infection. She gradually improved and was discharged after 2 weeks. 2 years later she was admitted to a psychiatric unit with acute mental changes and hallucinations, she had to be transferred to the emergency department due to abdominal pain, a grand mal seizure and hyponatremia. Her pulse was 120 and BP 174/114 mm Hg. She was disoriented but had no focal neurological signs. MRI showed sub cortical abnormalities, and the spinal fluid was normal. After cholecystectomy for a distended gallbladder, she was discharged but she stayed with a family member in another city because her symptoms were worse and muscle weakness had developed. She was hospitalized and progressed to quadriparesis, respiratory failure and aspiration pneumonia. Urinary porphobilinogen (PBG) was reported as 44 mg/24 hours (reference range 0-4). Q:Which form of porphyria is inherited as a genetically disorder? A. Acute intermittent porphyria B. Congenital erythropoietic porphyria C. Hereditary coproporphyria D. Porphyria cutanea tarda E. Variegate porphyria 7. Microsomal heme oxygenase system catalyzes the first step in the degradation of heme, converting it to A. Protoporphyrin III B. Porphin C. Bilirubin D. Biliverdin E. Bilirubin diglucuronide

8. Which of the following intermediates of hemoglobin degradation is excreted with bile into the small intestine? A. Urobilin B. Bilirubin glucuronide C. Bilirubin D. Biliverdin E. Heme 9. A 35-year-old woman is evaluated for jaundice in an emergency department. For several days, the patient has had mild flu-Iike symptoms of anorexia, nausea and vomiting, fatigue, Iow-grade fever, and malaise. This morning, she noted that her urine was brown in color, and she has also today developed moderate, steady, pain of the right upper quadrant of her abdomen. She has not had any similar episodes in the past.On physical examination, the patient is noted to be jaundiced and to have an enlarged, tender liver. BIood chemistry studies are notable for alanine aminotransferase (ALT) of 15,000 mIU/L, aspartate aminotransferase (AST) of 11,000 mIU/L, and alkaline phosphatase of 100 U/L. / / / / Q:This patient's dark urine is due to the presence of which of the following? A. Bacteria B. Bilirubin C. Hemosiderin D. Ketone bodies E. Melanin 10. Routine physical examination of a 19-year-old man demonstrates mild jaundice and scleral icterus. On questioning, the patient reports he feels welI. He says he occasionally gets a slightly yellowish tinge to his skin and eyes, but the yellow seems to go away spontaneously after several days. Screening chemistry studies are remarkable only for serum bilirubin of 2 mg/dL. On further evaluation, this bilirubin is found to be predominately unconjugated. Liver enzymes are not elevated, and a complete blood count (CBC) is within normal limits. On questioning, the man says he does not use alcohoI, has not had unprotected sex, and does not feel ilI. Liver biopsy is unremarkable Q;Which of the following is the most likely diagnosis? / A. Acute viral hepatitis / B. Chronic viral hepatitis / C. Gilbert syndrome D. Hemochromatosis E. Wilson disease 11. The cellular event NOT damaged by free radicals : A.Lipids B.Proteins CCarbohydrates D.DNA E.Host defense acute phase (bactericidal) 12. Which of the following vitamins or enzymes is unable to protect against free radical damage? A.Glutathione peroxidase B.Superoxide dismutase C.Vitamin B D.Vitamin C E. Vitamin E

/ /

13. Some energy producing processes produce reactive oxygen species (free radicals)that can cause damage to cells. Which of the following is NOT a mechanism of free radical generation? a.Absorption of radiant energy b.Enzymatic metabolism of exogenous chemicals or drugs c. During creation of ATP via glycolysis d. Free electron donation from transition metals (e.g. copper, iron) e. Reduction-oxidation reactions during normal metabolic processes 14. A. A 20-year-old woman ingests 100 tablets (500 mg per tablet) of acetaminophen in a suicide attempt; she does not lose consciousness. She seems healthy for the next 2 days and then develops massive hepatic failure. Q;Which of the following is the primary mechanism responsible for the hepatic failure? A.Depletion of intracellular reduced glutathione B.Formation of excessive superoxide in the hepatocytes C. Inhibition of adenylyl cyclase D. Inhibition of ATPase-dependent transport E. Stimulation of cytochrome oxidase 15. A term infant is born at home and does well with breast-feeding. Two days later, the mother calls frantically because the baby is bleeding from the umbilical cord and nostrils. The most likely cause is a. Deficiency of vitamin C due to a citrus-poor diet during pregnancy b. Hypervitaminosis A due to ingestion of beef liver during pregnancy c. Deficiency of vitamin K because infant intestines are sterile d. Deficiency of vitamin K because of disseminated intravascular coagulation (disseminated clotting due to infantile sepsis) e. Deficiency of vitamin E due to maternal malabsorption during pregnancy 16. A 43-year-old man with chronic renal failure who requires hemodialysis complains of generalized bone pain. Physical examination shows bowing of the legs and a sallow complexion. When the mans blood pressure is taken, his thumb flexes into his palm. A radiograph of the bones shows generalized osteopenia. The patient most likely has a deficiency of which of the following vitamins? A. Niacin B. Thiamine C. Vitamin A D. Vitamin D E. Vitamin K

17. A friend asks you to check on his 85-year-old grandmother who resides in a nursing home. He tells you that she rarely gets outside, eats almost no dairy products, and has aching bones. It is likely that his grandmother has a specific vitamin deficiency. Synthesis of the vitamin in question is dependent on ultraviolet radiation. This ultraviolet radiation is required for the specific step that converts A. 7-dehydrocholesterol to cholecalciferol B. 25-hydroxycholecalciferol to 1, 25-dihydroxy-vitamin D3 D. 7-dehydrocholesterol to cholesterol C. cholecalciferol to calcitroic acid E. calcitroic acid to 7-dehydrocholesterol

18. Transamination is one of the important reactions of the amino acids that involve participation of keto acids. B6P (PLP) is a coenzyme in this reaction. The reaction shown below, which of the following are the products, X and Y? Oxaloacetate X Glutamate Y A. Alanine, a-ketoglutarate B. Glutamate, a-ketoglutarate C. Pyruvate,alanine D. Pyruvate, aspartate E. Asparate, -ketoglutarate 19. The whites of an egg contain a protein called avidin. If someone ate a large quantity of raw egg whites, which of the following reactions would be expected to be inhibited by the avidin? A. Pyruvate oxaloacetate B. Glucose 6-phosphate ribulose 5-phosphate C. Malate oxaloacetate D. Pyruvate lactate E. Phosphoenolpyruvate pyruvate 20. A 30-year-old pregnant woman complains to her physician of feeling very tired during her pregnancy. A complete blood count with differential reveals a hematocrit of 30%, with hypersegmented neutrophils and large, hypochromic red cells. Deficiency of which of the following would be most likely to produce these findings? A. Ascorbic acid B. Calcium C. Copper D. Folate 21. A 48-year-old man, who was born and raised in Mexico, complains of chronic diarrhea. His diet consists mainly of corn and corn-related products. He has a raised, hyper pigmented rash around his neck and on the back of both hands and forearms. Which of the following vitamins is most likely deficient in this patient? A. Niacin B. Pyridoxine C. Thiamine D. Vitamin A E. Vitamin C 22. In parts of the world where rice is the main component of the diet, a disease called "beriberi" is common. The addition of a vitamin to the diet can reverse the disease. Which of the following vitamins should be added to the diet of someone with beriberi? A. Vitamin C B. Thiamin C. Folic acid D. Vitamin B12
E. Riboflavin 23. A 79-year-old female presents to your office with leg pain and fatigue. She lives alone and has little money to spend on food. The patient has tibial subperiosteal hematomas and painful gums,perifollicular hemorrhages, and loose teeth. Which of the following nutrient deficiencies is most likely responsible for this patients symptoms? A. Vitamin B1 B. Vitamin B2 C. Pyridoxine D. Folio acid E. Ascorbic acid

24. A 2-year-old girl, the daughter of an African immigrant, is admitted to the pediatric ward due to an increase in abdominal girth and failure to thrive. She recently arrived in the U.S. from her home country. She was breast-fed until one year of age, at which time her mother ran out of milk. She is apathetic and irritable and has been having frequent episodes of a diarrhea, dehydration, loss of muscle and weight loss. Labs:CBC: anemia; lymphopenia. Hypoalbuminemia. Lytes: hypokalemia, hypomagnesemia. Q:Which form of form of malnutrition caused by this condition : A.Selenium B.Marasmus C. Vitamin C D.Copper E.Fluoride 25. What is the BMR for an average 70kg person A.70 * 1 = 70 kcal/day B.70 * 12 = 840 kcal/day C. 70 * 24 = 1,680 kcal/day D.70 * 36 = 2,520 kcal/day E.70 * 72 = 5,040 kcal/day 26. A 23-year-old presents for a consult about weight reduction. She works as a corporate sales consultant for popular womens clothing. At 5 feet 7 inches tall, she weighs 99 lbs and is very afraid she could weight over 100 lbs. Her daily exercise routine includes one hour of jogging every morning and one hour of walking every evening. Which of the following is the most likely problem afflicting this patient? A.Anorexia B.Depression C.Obesity D.Malnutrition E.Hypothyroidism 27. Malnutrition is assessed reliably by increased A. Transferrin levels B. Total lymphocyte count C. Erythrocyte volume D. Albumin level E. None of the above 28. An analysis of a patients diet shows that he ate 90g carbohydrate, 10g protein, and 10g fat each day. Approximately how many calories did this patient consume in one day? A.440 B. 470 C. 490 D.740 E. 940

29. Overweight and obesity are major risk factors for diseases such as A. Colin Cancer D. Thyroid Cancer B.Diabetes/CVD E. None of the Above C. Lung disease

30. A 46-year-old woman with rheumatoid arthritis complains to her physician of having a bad taste in her mouth and a rash near her mouth. The rash has resisted treatment with topical hydrocortisone. She recently had a basal cell carcinoma surgically removed from her face, and the wound is not healing properly. Q:The patient most likely has a deficiency of which of the following nutrients? .A.Chromium B. Copper C.Vitamin C D.Vitamin E E.Zinc 31. A 15-month-old Eskimo boy is brought to the pediatric clinic by his parents because of delayed dentition, poor growth and development, frequent crying, weakness, and constipation.The infant's diet is deficient in eggs and dairy products, and he spends most of his time indoors (i.e., he has no exposure to sunlight. Defective mineralization of osteoid, excess amount of uncalcified bone at junction of cartilage;bone stretched and pulled out of shape by gravity; increased osteoid seams; osteopenia; frontal bossing of skull; pigeon breast deformity. Lab analysis shows: Serum calcium normal or slightly low; decreased serum phosphorus; increased alkaline phosphatase Q:The patient most likely to have: A.Rickets B.Flurosis C.Motling D.Osteomalacia E.Caries 32. Which is the most common cause of microcytic hypochromic anemia in American women aged 20 to 50 years? a.Autoimmune hemolysis b.Iron deficiency c. Vitamin B12 deficiency d. Thalassemia minor e. Viral infection 33. A 32-year-old, vegetarian female in mid-pregnancy complains of lack of energy and says she becomes easily fatigued. Upon any strenuous movement, her heart pounds rapidly and she becomes short of breath. Nutritional supplement of what mineral may alleviate the female's symptoms? A. Mg2+ B. Ca2+ C. Fe2+ D. Cu2+ E. Zn2+ 34. 24.A4-month-old boy has matted, depigmented hair that appears "kinky" He also has major facial deformities including sagging cheeks and ears, a depressed nasal bridge, and a high arched palate. His parents report that he exhibits frequent seizure-like activity On physical examination, he fails to achieve major developmental milestones. The transport of which of the following ions is most likely defective in this child?

Menkes kinky

hair syndrome
A. calcium B. Copper C. Iron D. Potassium E. Sodium

35. In mitochondrial electron transport, the final electron transfer from cytochrome oxidase to molecular oxygen is inhibited by A. Carbon monoxide B. Antimycin A C. Hydrogen peroxide D. Carbon dioxide E. Amytal 36. Which of the following inhibitors of the mitochondrial electron transport chain acts earliest in the sequence of electron transfers? A. Rotenone B. Antimycin A C. Molecular oxygen D. Carbon monoxide E. Azide 37. Pairs of electrons carried in the form, FADH2 and NADH+H, collectively contain enough free energy to rephosphorylate: A. 6 ATP B.5 ATP C.4 ATP D. 3 ATP E. n 38. Which of the following is the only compound of the electron transport chain that is NOT protein bound?one of the above are correct a.NADH dehydrogenase b. Succinate dehydrogenase c.Coenzyme Q d. Cytochrome b-c1 complex e.Cytochrome c oxidase 39. A 25-year-old female presents with chronic fatigue. A series of blood tests are ordered, and the results suggest that her red blood cell count is low because of iron deficiency anemia. Such a deficiency would lead to fatigue because of which of the following? a.Her decrease in Fe-S centers is impairing the transfer of electrons in the electron transport chain b.She is not producing as much H2O in the electron transport chain, leading to dehydration, which has resulted in fatigue c. Iron forms a chelate with NADH and FADH2 that is necessary for them to donate their electrons to the electron transport chain d. Iron acts as a cofactor for _-ketoglutarate DH in the TCA cycle, a reaction required for the flow of electrons through the electron transport chain e.Iron accompanies the protons that are pumped from the mitochondrial matrix to the cytosolic side of the inner mitochondrial membrane. Without iron, the proton

gradient cannot be maintained to produce adequate ATP. 40. Which of the following would be expected for a patient with an OXPHOS disease? a.A high ATP:ADP ratio in the mitochondria b.A high NADH:NAD+ ratio in the mitochondria c.A deletion of the X chromosome d.A high activity of complex II of the election transport chain e. A defect in the integrity of the inner mitochondrial membrane 41. As electrons are received and passed down the transport chain shown below, the various carriers are first reduced with acceptance of the electron and then oxidized with loss of the electron. A patient poisoned by which of the following compounds has the most highly reduced state of most of the respiratory chain carriers? a. Antimycin A b. Rotenone c. Carbon monoxide d. Puromycin e. Chloramphenicol