Practice Exam-Unit 3

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Practice Exam-Unit 3 Powered By Docstoc
					                                                                                   Dan Feldman

        Note: I wrote up these questions using our lecture slides from last year. While they are
very similar—and often identical—to the ones used this year, some may vary slightly, so a
couple of the questions on here might not have been covered in your lectures. If you find any
errors, please let me know. Note also that the VAST majority of the questions from Dr.
Dignam and Dr. Smith on this exam will be clinical vignettes. Unfortunately, this is not
reflected in this practice test because I have not yet become proficient at writing clinical
vignettes…but you should still keep this in mind.

   1. What is the leading cause of permanent premature disability in the United States labor
      a. Diabetes
      b. Coronary Heart Disease
      c. Stroke
      d. Mental Illness
      e. None of these
   2. Consider two patients, A and B. Patient A is 37 years old and in good health. Patient B is
      32 years old and obese. How much greater is the life expectancy for patient A compared
      to patient B?
      a. 3 years
      b. 6 years
      c. 9 years
      d. 12 years
      e. 15 years
   3. Which of these would you not expect to see in an individual with a BMI of 42, as
      compared to an individual with a BMI of 24?
      a. High GnT-4a activity
      b. High TNFα levels
      c. High IL-6 levels
      d. Increased activation of AKT-1
      e. None of these
   4. The rate of which type of cancer is 10x higher in industrialized areas?
      a. Stomach cancer
      b. Oral cancer
      c. Liver cancer
      d. Colorectal cancer
      e. Pancreatic cancer
   5. Which of the following is a factor that increases salt sensitivity?
      a. Old age
      b. Male
    c. Caucasian
    d. Two of the above
    e. All of the above
6. For men ages 25-65, the recommended daily intakes of calcium and Vitamin D,
    respectively, are:
    a. 1000 mg and 400-800 IU
    b. 1500 mg and 400-800 IU
    c. 1000 mg and 800-1000 IU
    d. 1500 mg and 800-1000 IU
    e. 1000 mg and 1000-1500 IU
7. You have an obese patient with a co-morbidity and a BMI of 37. Which of these
    treatment options are viable for the patient to treat their obesity?
    a. Diet and exercise
    b. Pharmacotherapy
    c. Surgery
    d. A and B
    e. A, B, and C
8. Which of these accurately describes the levels of urinary ammonia in a patient with
    progressive starvation-induced Protein-Energy Malnutrition (PEM)?
    a. Levels consistently remain high.
    b. Levels consistently remain low.
    c. Levels initially rise, and then gradually drop.
    d. Levels initially drop, and then gradually rise.
    e. Levels oscillate between high and low (i.e. constant cycles of rising and falling).
9. Which of these would you not expect to see in a patient with Acute Catabolic Insult-
    Induced PEM?
    a. Decreased insulin sensitivity
    b. Increased glucagon
    c. Increased cortisol
    d. Hypometabolism
    e. All of these would be expected with this patient.
10. What is the approximate protein content of a food item that contains 3.4 grams of
    a. 15.6 g
    b. 21.3 g
    c. 35.8 g
    d. 42.4 g
    e. 56 g
11. You are treating a patient with PEM who has lost 10 kg. Approximately how much
    protein would it be appropriate to give this patient as treatment?
    a. 15 g
    b. 25 g
    c. 35 g
    d. 45 g
    e. 55 g
12. A patient comes to you with nystagmus and photosensitivity. After conducting a
    thorough patient history and running all the necessary tests, you diagnose the patient with
    Hartnup’s disease, and explain that it is caused by a genetic defect in the uptake of which
    amino acid?
    a. Tryptophan
    b. Niacin
    c. Tyrosine
    d. Phenylalanine
    e. Serine
13. Dermatitis, dementia, diarrhea, and death, collectively known as the “4 D’s,” are
    symptomatic of a deficiency in which vitamin?
    a. A
    b. B
    c. C
    d. D
    e. E
14. Choose the correct statement.
    a. Broccoli is a better source of vitamin B12 than are eggs.
    b. A deficiency in cyanocobalmin is more likely to be seen in a vegan than in someone
        with a diet consisting of meats and fish.
    c. 4 grams per day of Vitamin C is considered an appropriate amount.
    d. α-tocopherol is the most abundant and active form of Vitamin K.
    e. Coumadin, also known as Warfarin, is an antagonist of Vitamin E that is often used
        clinically to inhibit blood coagulation.
15. Which of the following is not a risk factor for Metabolic Syndrome?
    a. A triglyceride level of 164 mg/dL
    b. A fasting glucose level of 125 mg/dL
    c. A blood pressure of 135/90
    d. An abdominal girth of 30 inches
    e. An HDL cholesterol level of 35 g/dL
16. Which statement is true?
    a. Metformin is a Biguanide that activates AMP-activated protein kinase to down-
        regulate insulin targets.
    b. Repaglinide is a Sulfonylurea agent that inhibits the ATP-dependent potassium
    c. Meglitinides are the most widely used anti-diabetic drugs.
    d. Pioglitazone is a Thiazolidinedione (TZD) that decreases peripheral insulin
    e. Both Repaglinide and Glyburide increase insulin secretion from pancreatic beta cells.
17. Compared to a patient with normal weight, an obese patient would be expected to have
    ______ levels of Adiponectin and ______ levels of TNFα.
    a. Higher; Higher
    b. Lower; Lower
    c. Higher; Lower
    d. Lower; Higher
    e. Equal; Higher
18. Which statement is false about the Ca2+/Phosphoinositide signal pathway?
    a. Diacylglycerol and Inositol Triphosphate are both produced via the cleavage of PIP2
        by Protein Kinase C.
    b. IP3 triggers Calcium release from intracellular stores, which leads to the
        Ca2+/Calmodulin cascade.
    c. Phospholipase C is activated by a protein called Gq
    d. Drugs such as calcium ionophores mimic the actions of IP3.
    e. None of the above.
19. Compared to peptides and proteins, catecholamines have
            I.The same mechanism of secretion. II. A longer half-life in blood. III. Stronger
            binding to plasma proteins. IV. A longer time course of action.
        a. I only
        b. I, II, and IV only
        c. II and III only
        d. III and IV only
        e. I, II, III, and IV
20. The role of Thrombin in extrinsic coagulation is to accelerate the activation of which
    clotting factors? Choose all correct answers!
    a. Factor V
    b. Factor VII
    c. Factor VIII
    d. Factor IX
    e. Factor X
    f. Factor XI
    g. Factor XIII
21. Activated protein C (APC) proteolytically inactivates which of the following clotting
    a. Factor V and VIIa
    b. Factors V and VIIIa
    c. Factors VIIa and VIIIa
    d. Factors V and IX
    e. Factors VIIa and IX
22. Which of the following occurs in the intrinsic coagulation pathway? Note that  means
    a. Factor Xa+ThrombinFactor XII
    b. Factor VIIIFactor Xa
    c. Factor XII+HMWKFactor IXFactor XI
    d. Factor XII+HMWKFactor XIFactor IX
    e. Factor VIII+ThrombinFactor Xa
23. For the amino acids Isoleucine, Tyrosine, and Phenylalanine, identify each as essential,
    conditionally essential, or nonessential.
        a. Isoleucine-essential, Tyrosine-essential, Phenylalanine-conditionally essential
        b. Isoleucine-nonessential, Tyrosine-conditionally essential, Phenylalanine-essential
        c. Isoleucine-essential, Tyrosine-nonessential, Phenylalanine-conditionally essential
        d. Isoleucine-nonessential, Tyrosine-conditionally essential, Phenylalanine-essential
        e. Isoleucine-essential, Tyrosine-nonessential, Phenylalanine-nonessential
24. Which statement is true about the Urea Cycle?
    a. The first three reactions occur in the mitochondria, while the last two occur in the
    b. Ammonia is used in both the first and second steps of the cycle.
    c. The enzyme that catalyzes the final step of the cycle is absent in the kidney.
    d. In one of the steps of the cycle, argininosuccinate and fumarate are formed from
    e. Ornithine is produced in the mitochondria and then transported to the cytosol where
        the remaining reactions of the cycle occur.
25. Which of these glucogenic amino acids is metabolized to fumarate?
    a. Valine
    b. Tryptophan
    c. Methionine
    d. Tyrosine
    e. Lysine
26. A patient presents to you with joint inflammation and reddish tints in his skin. In
    addition, when his urine is exposed to oxygen, it turns black. The disorder that the patient
    most likely has results from insufficient production of:
    a. Maleylacetoacetid acid
    b. Homogentisate
    c. p-Hydroxyphenylpyruvate
    d. Homocysteine
    e. S-adenosylmethionine
27. Which of the following diseases results from a defective Na+ dependent anionic amino
    acid transporter?
    a. Imino glycinuria
    b. Cystinuria
    c. Hartnup disorder
    d. Dicarboxylic aminoaciduria
    e. Alkaptonuria
28. Which of these is a viable treatment for a patient with Cystinuria?
    a. Increasing protein in the diet
    b. Treatment with cystine
    c. Decreased water intake
    d. Decreased dietary methionine
    e. Decreased dietary Isoleucine
29. Which of the following symptoms would you expect to see in a breast-fed infant with
    Lysinuric Protein Intolerance?
    a. An enlarged spleen
    b. Diarrhea
    c. Episodic hyperammonemia
    d. Muscular hypotonia
    e. None of the above
30. Ketamine can be used as a treatment for which of the following disorders?
    A. Cystinuria
    B. Nonketotic Hyperglycinemia
    C. Alkaptonuria
    D. Maple Syrup Disease
    E. Methylmalonic Acidemia
31. Neither the muscle nor the brain can synthesize glucose from lactate, because neither has
    the enzyme
    a. Glucose-6-phosphatase
    b. Glucose-3-phosphatase
    c. Acetyl-CoA Carboxylase
    d. Propionyl-CoA Carboxylase
    e. Pyruvate Carboxylase
32. Consider the process of glycogen metabolism. Which glycosidic bond is hydrolyzed by
    the transferase enzyme?
    a. α (14)
    b. α (16)
    c. β (14)
    d. β (16)
    e. None of these
33. Compared to a patient with untreated diabetes, a healthy patient would have increased:
            a. Fatty acid oxidation
            b. Mitochondrial uptake of fatty acids
            c. Malonyl-CoA production
            d. Acetyl-CoA diverted to Acetoacetate
            e. None of the above
34. What enzyme catalyzes the conversion of diacylglycerol to triacylglycerol in
    triacylglycerol biosynthesis?
    a. Phosphatidate Phosphatase
    b. Diglyceride Acyltransferase
    c. Glycerol-3-Phosphate Acyltransferase
    d. 1-Acyl-Glycerol-3-Phosphate Acyltransferase
    e. Thiolase
35. Which class of Eicosanoids plays a role in decreasing platelet aggregation?
    a. Thromboxanes
    b. Leukotrienes
    c. Prostacyclins
    d. Both B and C
    e. All of the above
36. Which of these is the correct sequence of intermediates in the cholesterol synthesis
    pathway in mammalian cells?
    a. Isopentyl-PP, Farnesyl-PP, Geranyl-PP, Squalene, Cholesterol
    b. Mevalonate, Isopentyl-PP, Squalene, Farnesyl-PP, Cholesterol
    c. Geranyl-PP, Farnesyl-PP, Isopentyl-PP, Squalene, Cholesterol
    d. Mevalonate, Isopentyl-PP, Farnesyl-PP, Geranyl-PP, Squalene
    e. Isopentyl-PP, Geranyl-PP, Farnesyl-PP, Squalene, Cholesterol
37. Which statement is true?
    a. Most fat absorption occurs in the lower third of the small intestine.
    b. Orlistat is a drug which inhibits the enzyme that catalyzes to conversion of 1-
        monoacylglycerol to fatty acid and glycerol.
    c. Chylomicrons enter the venous system through the right subclavian vein.
    d. A and B are true.
    e. B and C are true.
38. Which statement is false?
    a. LDLs contain more proteins than lipids.
    b. HDLs contain more phospholipids than triacylglycerol.
    c. VLDLs contain more free cholesterol than chylomicrons.
    d. Apolipoprotein A-II is found in HDLs and chylomicrons, but not in LDLs or VLDLs.
    e. Apolipoprotein B-48 is found in chylomicrons, but not in HDLs or LDLs.
39. Triacylglycerol is the major core lipid of which apolipoprotein(s)?
    a. HDLs and Chylomicrons
    b. VLDLs and HDLs
    c. HDLs and LDLs
    d. VLDLs and LDLs
    e. VLDLs and Chylomicrons
40. Insulin _____ fatty acid release from human adipocytes by ______ glycolysis and ______
    hormone-sensitive lipase.
    a. Stimulates; Increasing; Inhibiting
    b. Inhibits; Decreasing; Stimulating
    c. Inhibits; Increasing; Inhibiting
    d. Stimulates; Decreasing; Stimulating
    e. Inhibits; Increasing; Stimulating
41. Which statement is true?
    a. Ezetimibe is a drug that increases cholesterol transport into intestinal cells.
    b. Soluble fibers decrease the conversion of cholesterol to bile acids.
    c. Phytosterols increase cholesterol incorporation into micelles
    d. Statins inhibit 7-α-hydroxylase.
    e. None of these.
42. Lipoprotein a is
    a. Present in HDLs
    b. Synthesized in the small intestine
    c. Covalently linked to apo B-100 in LDLs
    d. Expected to be present in lower amounts in a patient at risk for CVD (as opposed to
        one who is not at risk)
    e. None of these
43. Which of these is defined as “localized necrosis due to loss of blood supply?”
    a. Infarction
    b. Ischemia
    c. Arteriosclerosis
    d. Atherosclerosis
    e. Angina
44. Increased hepatic triglyceride syntheses will increase the number of….
    a. Small, dense HDL but not LDL
    b. Small, dense LDL, but not HDL
    c. Both small, dense LDL and small, dense HDL
    d. Neither small dense LDL, nor small, dense HDL
    e. None of the above
45. What would be the triacylglycerol level of a patient with LDL of 150, and HDL of 50,
    and a total cholesterol level of 250?
    a. 180
    b. 120
    c. 50
    d. 250
    e. 100
46. Choose the incorrect statement about fibrates.
    a. Fibrates increase HDL cholesterol.
    b. Fibrates have very little of no effect on LDL cholesterol.
    c. Fibrates have very little or no effect on triacylglycerol.
    d. Fibrates may increase morbidity.
    e. Fibrates are agonists for a transcription factor involved in lipid metabolism.
47. Which of these is a phenotype for Familial Defective Apo B-100?
    a. LDL-C levels increased 1.5 to 2-fold.
    b. LDL-C levels increased 4-fold.
    c. LDL-C levels greater than 190 mg/dl.
    d. CHD 3x to 4x general population.
    e. Widespread severe atherosclerosis.
48. Choose the incorrect statement about glutathione.
    a. The enzyme glutamyl cysteine synthetase is involved in its synthesis.
    b. It is involved in the reduction of oxidized protein thiols.
    c. It is involved in the detoxification of hydrogen peroxide.
    d. It is made directly from γ-glutamyl cysteine and glycine.
    e. It is responsible for the oxidation of Hb (Fe2+) to MetHb (Fe2+).
49. Which of these pathological states will result in an increase of 2,3-BPG?
    a. Cystic fibrosis
    b. Hyperthyroidism
    c. Anemia
    d. Obstructive pulmonary disease
    e. None of these.
50. Which statement is false about the anion exchange protein I-Band 3?
    a. It is electroneutral
    b. It is a dimer
    c. It contains 12 membrane spanning helices
    d. It associates with G-6-P dehydrogenase
    e. It exchanges Cl- for HCO3-
51. An individual with a terminal fucose and N-acetylgalactosamine side-chain will have
    which blood type?
    a. A
    b. B
    c. AB
    d. O
    e. None of the above.
52. Which statement is false about iron uptake?
    a. The enzyme ferric reductase is located on the apical surface of the enterocyte.
    b. The Divalent metal transporter 1 (DMT1) is the proton-coupled transporter of Fe3+
    c. Hepcidin inhibits iron absorption
    d. Ceruloplasmin is involved in the delivery of iron to various tissues
    e. Hephaestin is an integral membrane protein on the basolateral surface
53. Which of these dietary factors promotes iron uptake?
    a. Phytate
    b. Histidine
    c. Oxalic acid
    d. Non-cellulose fiber
    e. Bicarbonate
54. Which of these is a laboratory indicator of stage 2 iron deficiency?
    a. Decrease in hemoglobin
    b. Increase in mean corpuscular volume
    c. Decrease in mean corpuscular volume
    d. Increase in small hypochromic erythrocytes
    e. Decrease in serum ferritin
55. The rate controlling step in porphyrin biosynthesis
    a. Is catalyzed by alanine synthase
    b. Occurs in the cytosol
    c. Requires pyridoxal phosphate
    d. A and C only
    e. A, B, and C
56. Uroporphyrinogen decarboxylase catalyzes the formation of
    a. Uroporphyrinogen III
    b. Coproporphyrinogen III
    c. Uroporphyrinogen I
    d. Protoporphyrinogen III
    e. Protoporphyrin III
57. Choose the correct statement regarding the regulation of globin synthesis by heme.
    a. Iron levels have no effect on the synthesis of globin
    b. Increased ALAS2 activity inhibits heme synthesis
    c. Decreased heme levels activate a protein kinase
    d. When iron is low, IRE-BP stimulates the translation of ALAS2 mRNA
    e. A-D are all false.
58. Which of the following proteins is synthesized in the liver?
    a. Haptoglobin
    b. Albumin
    c. Hemopexin
    d. All of the above
    e. None of the above
59. Jaundice can result from all of the following except
    a. Increased bilirubin production
    b. Blockage of bile flow
    c. Increased hepatic uptake of bilirubin
    d. Decreased conjugation of bilirubin
    e. Decreased transport of bilirubin conjugates into bile
60. Which enzyme catalyzes the rate-limiting step in bilirubin conjugation?
    a. UDP-glucuronosyl transferase
    b. UDP-Glucose dehydrogenase
    c. Heme oxygenase
    d. Heme transferase
    e. Biliverdin reductase

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