Biochem

TEST QUESTIONS IN BIOCHEMISTRY
NUTRITION - 30
I. Given patient data, determine the metabolic pathways and processes involved.
1.
A two year old boy, short for his age, presented with leg edema and abdominal swelling. He
was weaned from breast milk at one year of age, because of the coming of another baby. He
was fed rice or lugaw everyday mixed with condensed milk. The edema is caused by:
A.
lack of protein in his diet
B.
excessive intake of water
C.
kidney failure
D.
presence of intestinal parasites
Recall
Answer: A. lack of protein in his diet
Reference: Harper's Illustrated Biochemistry 27th ed., Murray, Granner & Rodwell
2006 The MacGraw-Hill Companies, Inc., p. 241, par. 1, p. 487, par. 3
2.
Catabolism of amino acids requires the participation of transaminase enzymes. What

coenzyme form of vitamin B is an important participant in this reaction?
A.
thiamin pyrophosphate
B.
nicotinamide adenine dinucleotide
C.
tetrahydrofolic acid
D.
pyridoxal phosphate
Recall
Answer: D. pyridoxal phosphate
Reference: Harper's Illustrated Biochemistry 27th ed., p. 247 par. 2 , p. 498 - 499
3.
In marasmus, the affected person has very little fat reserves and there is wasting of
muscles. The person is said to be in :
A.
positive nitrogen balance
B.
negative nitrogen balance
C.
nitrogen balance
D.
equilibrium
Recall
Answer: B. negative nitrogen balance
Reference: Harper's Illustrated Biochemistry 27th ed., p. 487 par. 3
4.
Persons who consume large amounts of unleavened whole-wheat products may

experience calcium deficiency because:
A.
wheat is poor in calcium
B.
wheat contains phytic acid which prevents calcium absorption
C.
the wheat is deficient in vitamin D
D.
absorbable form of calcium is not generated
Application
Answer: B. wheat contains phytic acid which prevents calcium absorption
5.
An elderly woman is believed to be suffering from vitamin B12 deficiency. Which of the
following can be the basis for this statement?
A.
she has been diagnosed to be deficient in cobalt
B.
she is a vegan
C.
she has methylmalonic aciduria
D.
any of the above
Application
Answer: D. any of the above
Reference: Harper's Illustrated Biochemistry 27th ed., p. 499-500
6.
The patient was in coma. Since diabetes was ruled out, how does one explain the condition?
A.
patient has ammonia intoxication because of the liver pathology
B.
coma is due to marked ketosis
C.
acid-base balance of the patient is disturbed
D.
there is increase urea production
Application
Answer: A. patient has ammonia intoxication because of the liver pathology
7.
The obese matron was instructed by her physician to alter her diet and eat only protein foods
to bring down her weight. The matron was afraid however that the absence of carbohydrates
in her meals will cause hypoglycemia and give her more problems. The physician was certain
she does not have to worry about this because:
A.
she's going to cheat on her diet anyway
B.
the excess body fat will be converted to glucose
C.
amino acids in excess are converted to glucose
D.
she has a lot of glycogen slores
Application
Answer: C. amino acids in excess are converted to glucose
Reference: Harper's Illustrated Biochemistry 27th ed., p. 172 par. 2, p. 175 summary,
p. 269 summary
II.
Given a patient with a nutritional deficiency, give the expected clinical manifestation
8.
Deficiency of iron results in which of the following?

A.
failure to metabolize proteins
B.
heme-containing enzymes remain inactive
C.
there is liver dysfunction
D.
individual goes into ATP production using fats
Recall
Answer: B. heme-containing enzymes remain inactive
Reference:
Harper's Illustrated Biochemistry 27th ed., p. 504 Table
9.
An infant with genetic deficiency of glucose-6-phosphatase also known as von Gierke's

disease will exhibit this clinical sign:
A.
poor exercise tolerance
B.
muscle dystrophy
C.
hypoglycemia & lactic acidemia
D.
glycogen with few branch points
Recall
Answer: C. hypoglycemia & lactic acidemia
Reference:
Harper's Illustrated Biochemistry 27th ed., p. 166 Table
10.
In the absence of creatine kinase enzymes, an athlete would have problem in:
A.
oxidizing creatine
B.
releasing ATP from biological oxidation
C.
aerobic glucose oxidation
D.
generating ATP reserves for muscle contraction
Recall
Answer: D. generating ATP reserves for muscle contraction
Reference:
Harper's Illustrated Biochemistry 27th ed., p. 583 par. 1-3
11.
A young woman already in her fifth month of a carbohydrate and lipid-free diet was advised by
her physician to increase the amount of fats in her diet because she appears to be suffering
from vitamin A deficiency despite her regular vitamin intake. Which of the following complaints
presented by the woman supports the diagnosis?
A.
she has lesions of the corner of the mouth
B.
her wounds take longer time to heal
C.
she finds it hard to see in the dark when in a movie theater
D.
she has this sensation of "burning feet".
Application
Answer: C. she finds it hard to see in the dark when in a movie theater
Reference: Harper's Illustrated Biochemistry, 27th edition, p. 491, par. 4, line 3
12.
Tests done on a two month-old baby showed deficiency in enzymes of the Uronic Acid
Pathway. What clinical manifestation may be observed?
A.
elevated urinary glucuronic acid
B.
yellow coloration of the skin
C.
high direct-reacting bilirubin in plasma
D.
accumulation of heme
Application
Answer: B. yellow coloration of the skin
Reference: Harper's Illustrated Biochemistry, 27th edition, p. 289 par. 2, p. 290 par. 2
13.
A 35 year old Muntinlupa inmate was confined to 6 weeks of isolation because of bad
behavior. Although he was given regular meals, he stayed in the underground cell for the
duration of the 6 weeks. If the prisoner became deficient in vitamin D because of this, what
signs should the attending physician look for? in the inmate:
A.
there may be kidney stones formation
B.
the inmate may complain of tiredness
C.
he can easily be fractured
D.
serum calcium will be extremely low
Application
Answer: C. he can easily be fractured
Reference: Harper's Illustrated Biochemistry, 27th edition, p. 492 - 493
14.
Thiamine deficiency can result in Wernicke- Korsakoff's syndrome. The absence of the
vitamin prevents the conversion of pyruvate to acetyl CoA on a high carbohydrate diet. Which
compound would be found to be high in concentration in the plasma?
A.
glucose
B.
lactate & pyruvate
C.
acetyl CoA
D.
alcohol
Application
Answer: B. lactate & pyruvate
Reference: Harper's Illustrated Biochemistry, 27th edition, p. 496- 497
III.
Given a laboratory finding, identify the involved biochemical mechanism
15.
Important in the synthesis of collagen, this vitamin serves as cofactor of the mixed function
oxygenase enzymes, proline & lysine hydroxylases:
A.
vitamin B1
B.
vitamin B2
C.
vitamin C
D.
folic acid
Recall
Answer: C. vitamin C
Reference:
Harper's Illustrated Biochemistry 27th ed., p. 242 par. 3, line 9
16.
Unlike other vitamins, niacin is a semi-essential vitamin because it can be synthesized from
this amino acid:
A.
proline
B.
phenylalanine
C.
tryptophan
D.
histidine
Recall
Answer: C. tryptophan
Reference:
Harper's Illustrated Biochemistry 27th ed., p. 498, par. 1
17.
Activity of the aldose reductase enzyme in the lens of the eye increases in the presence of
high concentration of glucose. This initiates the conversion of glucose to a compound that has
been linked to osmotic damage and cataract formation. What compound is this?
A.
mannitol
B.
galactitol
C.
ribitol
D.
sorbitol
Recall
Answer: D. sorbitol
Reference:
Harper's Illustrated Biochemistry 27th ed., p. 185 last par.
18.
A patient was tested for transketolase activity of the erythrocyte lysate. Results showed
markedly low activity of the enzyme, consistent with the physicians impression of deficiency of
this vitamin:
A.
vitamin B2
B.
vitamin B3
C.
vitamin B5
D.
vitamin B1
Application
Answer: D. vitamin B1
Reference:
19.
Inorganic iron is best absorbed by the body in the ferrous form. What is the rationale behind
the addition of vitamin C in many iron preparations?
A.
vitamin C can take the place of iron
B.
absorption of other minerals is prevented
C.
vitamin C chelates iron
D.
vitamin C keeps the iron in reduced (ferrous) state
Application
Answer: D. Vitamin C keeps the iron in reduced (ferrous) state
Reference: Harper's Illustrated Biochemistry 27th ed., p. 485 - 486
20.
In a routine medical check up, an executive showed elevated plasma levels of lactic acid
dehydrogenase enzymes 1 & 2 and low levels of LDH 5. This prompted his physician to refer
him to a cardiologist because:
A.
low levels of LDH 5 indicated a clogged vessel
B.
it is part of the medical check up
C.
increase levels of LDH 1 & 2 is indicative of myocardial infarction
D.
angioplasty was needed
Application
Answer: C. increase levels of LDH 1 & 2 is indicative of myocardial infarction
Reference: Harper's Illustrated Biochemistry 27th ed., p. 57
21.
A tourist from the Caribbean fell ill and was diagnosed to have malaria. He was given
primaquine upon admission to the hospital and was thought to be recuperating when he
showed signs of hemolytic anemia. Tests showed he had glucose 6- phosphatase deficiency.
What is the biochemical explanation for the hemolysis?
A.
the malarial parasite had invaded the rbc
B.
inactivity of the Hexose Monophosphate Shunt prevented the NADPH - reduction of
membrane glutathione
C.
the drug oxidized membrane proteins
D.
absence of G6PD initiated release of peroxides
Application
Answer: B. inactivity of the Hexose Monophosphate Shunt prevented the NADPH reduction of membrane glutathione
Reference: Harper's Illustrated Biochemistry 27th ed., p. 177 par. 2, p. 183 par. 2
V.
Given patient data, formulate an appropriate nutritional plan
22.
Metabolic screening of a newborn showed absence of galactose uridyltransferase enzyme.

What should be the dietary recommendation?
A.
Galactose should not be included in the diet
B.
Galactose - free and lactose -free milk should be given
C.
Newborn should be breastfed
D.
Liquid protein preparation instead of milk should be given
Recall
Answer: B. galactose-free and lactose -free milk should be given
23.
A born-again vegetarian was diagnosed to be suffering from vitamin B12 deficiency. Which
of the following suggestions should be followed?
A.
the vegetarian should include meat in the diet
B.
he should be tested for pernicious anemia
C.
the born-again can take in vitamin B12 preparation to meet the requirement
D.
intrinsic factor should be released from bonding
Recall
Answer: C.
the born-again can take in vitamin B12 preparation to meet the

requirement
24.
A woman had just given birth by ceasarean section. For fast recuperation she should be
advised to:
A.
eat nutritious and protein-rich foods
B.
rest in bed until the incision heals
C.
include more carbohydrates in the diet
D.
drink a lot of water
Recall
Answer: C. eat nutritious and protein-rich foods
5
25.
A 50 year old male is suffering from gout because of his tendency to over eat. He should be
told to:
A.
eat moderately
B.
stay away from nuclei-rich foods like nuts, beans, meat
C.
drink plenty of water
D.
all of the above
Recall
Answer: D. drink plenty of water
Reference: Harper's Illustrated Biochemistry 27th ed., p. 307 par. 2 & 3
Questions # 26-28
A 32 year old married woman consulted at the OPD because of increasing thirst and frequent
urination. She is 5 feet 2 inches tall and weighs 168 lbs.
26.
Which of the following statements best described the metabolic status in this patient?
A.
Her energy expenditure is greater than food intake hence she is diuresing
B.
She is obese and she has increased mortality
C.
The (BMR) basal metabolic rate of this patient is higher compared to a man of the
same body weight
D.
She is frequently urinating because she has increased protein reserves
Application
Answer: B. She is obese and she has increased mortality
27.
The BMI of the patient is:

A.
25
B.
27
C.
29
D.
31
Application
Answer: D. 29
28.
You want to give this patient a 1,500 cal/day diet because you want her to lose weight. How
do you formulate an appropriate plan for this patient?
A.
Carbohydrate - 55% Fats = 35%
Protein = 10%
B.

Protein = 50%
C.

Protein = 60%
D.

Protein = 20%
Application
Answer: A. Carbohydrate - 55% Fats = 35%
Protein = 10%
29.
The edema of a patient with kwashiorkor should respond best when prescribed with:
A.
diet rich in protein
B.
diuretics
C.
bed rest
D.
virgin coconut oil
Application
Answer: A. diet rich in protein
6
30.
A 32 year old physician suffered a 3rd degree burn. He stayed in the hospital for almost one
month. What can be said of his metabolic condition
A.
the excretion of nitrogenous compounds is less than the dietary intake
B.
negative nitrogen balance
C.
positive nitrogen balance
D.
there is net retention of the nitrogen in the body as protein
Application
Answer: B. negative nitrogen balance
METABOLISM - 40
I.
31.
Given patient data, determine the metabolic pathways and processes involved.
The human body, even at rest, uses up energy. This amount of energy expenditure is termed
as:
A.
Respiratory Quotient
B.
Basal Metabolic Rate
C.
Respiratory Burst
D.
Body Mass Index
Recall
Answer: B. Basal Metabolic Rate
Reference:
Harper's Illustrated Biochemistry 27th ed.,
32.
p. 486
Uptake of glucose in these tissues is controlled by the hormone insulin:

A.
liver & kidneys
B.
adipose tissue & muscle
C.
muscle & intestines
D.
liver & rbc
Recall
Answer: B. adipose tissue & muscle
Reference: Harper's Illustrated Biochemistry 27th ed., p. 140, par. 3, line 1
33.
Between meals, the blood glucose concentration of the body is maintained through
these metabolic pathways:
A.
glycolysis & gluconeogenesis
B.
glycogenesis & glycogenolysis
C.
glycolysis & glycogenolysis
D.
glycogenolysis & gluconeogenesis
Recall
Answer: D. glycogenolysis & gluconeogenesis
Reference: Harper's Illustrated Biochemistry 27th ed., p. 134, par. 4, line 8
34.
During continuous anaerobic physical activity, e.g. when working out in a gym, this metabolic
pathway is used by the muscles
A.
gluconeogenesis
B.
glycolysis
C.
Hexose Monophosphate Shunt
D.
glycogenesis
Recall
Answer: B. glycolysis
Reference: Harper's Illustrated Biochemistry 27th ed., p. 151, p. 158
35.
When tested, a young woman, complaining of fatigability and poor exercise tolerance was
found to have only one sixth the amount of carnitine found in others who had no muscle
disease. This means that the above symptoms she is experiencing is due to:
A.
inability of the body to synthesize lipids
B.
inhibition of ATP production
C.
failure of fatty acids to enter - oxidation
D.
impairment of the mitochondria
Recall
Answer: C. failure of fatty acids to enter - oxidation
36.
Newborn infants can generate more heat needed by the body because they contain
thermogenin, an uncoupling protein. This protein exerts its effect by:
A.
increasing the amount of substrate oxidized
B.
preventing heat loss
C.
dissociating respiratory chain oxidation from ATP synthesis (phosphorylation)
D.
activating respiratory chain enzymes
Application
Answer: C. dissociating respiratory chain oxidation from ATP synthesis
(phosphorylation)
Reference: Harper's Illustrated Biochemistry 27th ed., p. 107, par. 4, p. 228 - 229
37.
Erythrocytes are hemolyzed when there is impairment of the Pentose Phosphate Pathway
and this is manifested in a person as hemolytic anemia. This defect is due to:
A.
lack of NADPH from the Pentose Phosphate Pathway
B.
non-synthesis of ATP
C.
failure to release ribose
D.
defect in the membrane transport
Application
Answer: A. lack of NADPH from the Pentose Phosphate Pathway
Reference: Harper's Illustrated Biochemistry 27th ed., p. 183- 184, par. 1
38.
A 30 year old patient was diagnosed to be suffering from a mitochondrial disease that
specifically involves defect in mitochondrial energy transduction.
Which of the following signs/symptoms will be evident?
A.
High body mass index (BMI), hyperactivity, increased appetite
B.
Hyperventilation, clammy sweat
C.
Muscle weakness, excessive perspiration, and elevated BMR (Basal metabolic
rate)
D.
lack of appetite, hypoventilation
Application
Answer: C. Muscle weakness, excessive perspiration, and elevated BMR (Basal
metabolic rate)
Reference: Harper's Illustrated Biochemistry 27th ed., p. 100, par. 2
39.
A newborn infant tested positive in the phenylketonuria screening. The attending pediatrician
ordered a change in the infant milk to one which contains negligible amount of:
A.
lactose
B.
proteins
C.
fats
D.
glucose
Application
Answer: B. proteins
40.
A drug used as an adjunct in the treatment of obesity inhibits pancreatic lipase. Following its
intake, which of the following is expected to be excreted in great amount in the feces?
A.
cholesterol
B.
triacylglycerols
C.
free fatty acids
D.
bile salts
Application
Answer: B. triacylglycerols
Reference: Harper's Illustrated Biochemistry 27th ed., p. 483, par. 4, p. 484 diagram
II.
Given a patient with a nutritional deficiency, give the expected clinical manifestation
41.
In the mucopolysaccharidoses, glycosaminoglycans are not degraded due to the absence of

lysosomal hydrolases. Individuals suffering from this can be identified because of:
A.
excessive accumulation and urinary excretion of the proteoglycans
B.
presence of enzyme fragments in the urine
C.
release of the core proteins in urine
D.
increase turnover of affected cells
Recall
Answer: A. excessive accumulation and urinary excretion of the proteoglycans
42.
In the rare disease, analbuminemia, there is complete lack of serum albumin. The affected
individual presents with this:
A.
extreme edema
B.
edema & presence of free fatty acids
C.
accumulation of triglycerides
D.
elevated plasma cholesterol
Recall
Answer: B. edema & presence of free fatty acids
Reference: Harper's Illustrated Biochemistry 27th ed., p. 592 par. 1, p. 187 par. 3
p. 711 Clinical Correlation , Textbook of Biochemistry, 5th ed., Thomas Devlin,
editors, 2002 Wiley-Liss
43.
Metabolic screening was requested for a week-old newborn because the grandmother had
noticed the dark stains on the wet diaper whenever she attended the infant. Tests identified
the condition as alkaptonuria. What urinary metabolic should the physician request in the
laboratory tests?
A.
tryptophan
B.
tyrosine
C.
homogentisic acid
D.
melanin
Recall
Answer: C. homogentisic acid
Reference: Harper's Illustrated Biochemistry 27th ed., p.259 par. 2
Textbook of Biochemistry, 5th ed., Thomas Devlin, p. 801, Clinical Correlation
44.
Skeletal muscles do not have the enzyme glucose-6-phosphatase. This means:

A.
they cannot degrade glucose
B.
glucose cannot be synthesized
C.
ATP cannot be generated
D.
glycogen is stored in big amount
Recall
Answer: B. glucose cannot be synthesized
Reference: Harper's Illustrated Biochemistry 27th ed., p. 161, p. 167
9
45.
L-xylulose reductase catalyzes the reduction of xylulose to xylitol. In affected individuals,

absence of this enzyme results in:
A.
formation of cataracts
B.
failure to synthesize nucleic acids
C.
excretion of large amounts of urinary pentose
D.
presence of skeletal deformities
Recall
Answer: C. excretion of large amounts of urinary pentose
46.
When there is restricted intake of carbohydrates as in starvation and uncontrolled diabetes

mellitus, ketosis results because of:
A.
change in pH of the body
B.
failure to oxidize glucose
C.
mobilization of fatty acids
D.
inactivity of buffer systems
Application
Answer: C. mobilization of fatty acids
Reference:
Harper's Illustrated Biochemistry, 27th ed., p. 194 last par. , p.195 , 2nd par.
(summary)
47.
Measurement of HbA1c or glycosylated hemoglobin provides valuable information for the

management of diabetes mellitus because it:
A.
is elevated in diabetes mellitus
B.
reflects the mean glucose concentration over the preceding 6 - 8 weeks
C.
is formed by reaction with HbA
D.
is released when rbc dies
Application
Answer: B. reflects the mean glucose concentration over the proceeding 6 - 8 weeks
Reference: Harper's Illustrated Biochemistry 27th ed., p. 48, par.1
48.
Inherited enzyme deficiencies of the Krebs-Henseleit cycle always present with this
observation:
A.
increase urea production
B.
formation of organic metabolites
C.
ammonia intoxication
D.
depletion of citrulline
Application
Answer: C. ammonia intoxication
Reference:
49.
The urine-soaked diaper of a week old baby was noted by the mother to smell like burnt sugar.
Her concern turned into worry when the pediatrician told her the baby may be suffering from
maple syrup urine disease. To confirm this, activity of the keto acid decarboxylase complex
has to be measured. Which amino acids will have increased concentration in plasma and
urine?
A.
serine, threonine & hydroxyproline
B.
cysteine, cystine, methionine
C.
valine, leucine & isoleucine
D.
glycine, alanine & asparagine
Application
Answer: C. valine, leucine & isoleucine
Reference:
10
50.
Calcium deficiency manifestations may also be seen in people who consume:

A.
large amounts of unleavened whole wheat products
B.
high concentrations of fatty acids
C.
high amounts of oxalates
D.
all of the above
Application
Answer: A.
Reference:
large amounts of unleavened whole wheat products

III.
Given a laboratory finding, identify the involved biochemical mechanism
51.
Milk intolerance, common among Asian populations and characterized by an osmotic

type of diarrhrea following the intake of milk is attributed to deficiency of:
A.
pancreatic amylase
B.
lactase
C.
sucrase
D.
maltase
Recall
Answer: B. lactase
Reference:
52.
p. 483, par. 1, line 3
Rate-limiting reaction in cholesterol synthesis which is inhibited by the "statins" group of

drugs is catalyzed by this enzyme:
A.
cholesterol esterase
B.
squalene cyclase
C.
mevalonate kinase
D.
beta hydroxyl-beta methyl glutaryl CoA reductase
Recall
Answer: D. beta hydroxyl-beta methyl glutaryl CoA reductase
Reference:
53.
All the carbon atoms of cholesterol are synthesized from this common metabolite:
A.
alanine
B.
acetyl CoA
C.
glucose
D.
palmitate
Recall
Answer: B. acetyl CoA
Reference:
54.
p. 230, par. 3
Carbohydrates, lipids & proteins can be oxidized to acetyl CoA or specific metabolites
intermediates using a final common pathway. The pathway functions in gluconeogenesis,
lipogenesis and interconversion of amino acids. This pathway is known as:
A.
Glycolysis
B.
Hexose Monophosphate Shunt
C.
Citric Acid Cycle
D.
Glucuronic Acid Pathway
Recall
Answer: C. Citric Acid Cycle
Reference:
11
55.
In the capillaries, hemoglobin releases oxygen and accepts carbon dioxide. The process
generates protons e which can then lower the blood pH. The buffering action of hemoglobin
will prevent this from taking place. What amino acid residues in hemoglobin are most
important in this shift in pH buffering effect at normal blood pH?
A.
arginine
B.
lysine
C.
histidine
D.
glutamate
Recall
Answer: C. histidine
Reference:
Harper's Illustrated Biochemistry 27th ed., p. 43
56.
The highest number of energy released as ATP is obtained by complete oxidation of this
compound to carbon dioxide and water
A.
an amino acid
B.
a triglyceride
C.
glucose
D.
a nucleic acid
Application
Answer: B. a triglyceride
Reference: Harper's Illustrated Biochemistry 27th ed.,
57.
p. 142, table 16-1, p.189, par.1
Laboratory tests done on a 3 year old boy showed excessive nucleic acid bases in the urine
and negligible activity of HGPRTase. Which statement explains the results obtained?
A.
purine bases are very insoluble
B.
low enzyme activity is due to feedback inhibition
C.
Salvage pathway of synthesizing nucleotides is inactive
D.
young cells utilize the in vivo method for synthesis
Application
Answer:
C. Salvage pathway of synthesizing nucleotides is inactive
58.
In myocardial infarction where a major coronary artery is occluded, ischemia results and a
lowered oxygen supply diminishes the amount of ATP available in the cell. This effect on
cellular energy is due to:
A.
release of enzymes
B.
lack of oxygen which slows down the mitochondrial electron transport chain
C.
inhibition of substrate level phosphorylation
D.
kind of occlusion
Application
Answer: B. lack of oxygen which slows down the mitochondrial electron
transport chain
Reference: Textbook of Biochemistry, 5th ed., Thomas Devlin, p. 591, Clinical Correlation
59.
The patient was diagnosed to be suffering from megaloblastic anemia. Results of urinary
tests showed 10 mg of formiminoglutamic acid (FIGLU), making the physician conclude that
the patient has folic acid deficiency. Which statement explains the diagnosis given?
A.
megaloblastic anemia is a unique feature of folic acid deficiency
B.
transfer of formimino group of histidine to tetrahydrofolate does not take place and figlu
is excreted
C.
figlu is a metabolite of folate
D.
one carbon compounds are carried by folic acid
Application
Answer: B. transfer of formimino group of histidine to tetrahydrofolate does not take
place and figlu is excreted
12
60.
In the glycogen storage disease, McArdle's disease, muscle phosphorylase is absent.

Patients who suffer from this will therefore show the following signs:
A.
inability to perform strenuous exercise because glycogen cannot be degraded
B.
there is no increase in plasma lactic acid
C.
no energy supply for the muscles
D.
all of the above
Application
Answer: D. all of the above
Reference:
Harper's Illustrated Biochemistry 27th ed., p. 582,
Textbook of Biochemistry, 5th ed., Thomas Devlin editors, 2002 Wiley-Liss
p. 647
V.
Given patient data, formulate an appropriate nutritional plan
61.
A person is suffering from gouty arthritis. What foods should not be included in his
daily meals?
A.
peas, legumes and beans family
B.
meat and internal organs
C.
strawberries, cauliflower, broccoli
D.
all of the above
Recall
Answer:
62.
What foods, cheap but rich in proteins, can the physician suggest to patients from the low
income group?
A.
pork ribs and pork legs
B.
milk and cheese
C.
anchovies, bean sprouts, mung beans
D.
instant noodles
Recall
Answer:
63.
C. anchovies, bean sprouts, mung beans
Patient has been found to be deficient in vitamin E. Which of the following should he included
in his market list as source of vitamin E?
A.
salmon fish
B.
beans
C.
alfalfa
D.
oats
Recall
Answer:
64.
D. all of the above
C. alfalfa
An elderly woman insists that the house help cook sweetened oatmeal, with milk, every
morning for her breakfast, without fail. This makes the elderly woman feel good and it is a
complete food according to her because it has:
A.
protein
B.
fiber for her constipation
C.
sugar as energy source
D.
all of the above
Recall
Reference: Textbook of Biochemistry, 5th ed., Thomas Devlin, p. 1127
13
65.
What advice can a physician give to someone who has problems with bowel movement and is
always constipated.
A.
drink plenty of water
B.
eat foods rich in fiber e.g. whole wheat , bran, oats
C.
include vegetables with high fiber
D.
all of the above
Recall
Answer: C. include vegetables with high fiber
66.
A mother brought her 8 month old, 6 kg baby to a Health Center because of diarrhea of one
day duration which occurred 4 times. The baby had been breast-fed since birth and "lugaw"
with fish and vegetables were started at 5 months. Breast feeding was stopped at the onset
of the diarrhea and the baby was given "am" with sugar instead. What suggestion can be
given to the mother to improve the overall condition of her child?
A.
meat and more solid foods can be given
B.
giving "am" with sugar, and a little salt can be used for diarrhea
C.
breastfeeding should continued even when there is diarrhea
D.
all of the above
Application
67.
p. 436 par. 4
What is the so called oral rehydration therapy for cases of diarrhea developed by the World
Health Organization?
A.
daily ingestion of 8 glasses of water
B.
oral isotonic NaCl solution
C.
intake of a NaCl and glucose oral mixed preparation
D.
daily intake of sucrose solution
Application
Answer: C. intake of a NaCl and glucose oral mixed preparation
Reference:
Harper's Illustrated Biochemistry 27th ed., p. 436, last paragraph
68 - 70 After an all night drinking spree with friends, 45 year old Juan woke up with pain all over, but
mainly of the lower extremeties. His arthritis worsens everytime he goes drinking. Earlier he
had been advised by his physician to take thiamine because he seems to be exhibiting
symptoms of the Wernicke-Korsakoff syndrome.
68.
What is the importance of taking thiamine in this case?

A.
ensures complete metabolism of carbohydrates and the alcohol
B.
the arthritic pain will be relieved
C.
this is a cure for the symptoms of the syndrome
D.
thiamine is a cofactor of alcohol dehydrogenase
Application
Answer: A. ensures complete metabolism of carbohydrates and the alcohol
Reference:
Harper's Illustrated Biochemistry 27th ed., p. 496 par. 2
69.
What enzyme of carbohydrate metabolism is activated by vitamin B1?

A.
alcohol dehydrogenase
B.
pyruvate dehydrogenase
C.
pyruvate kinase
D.
phosphoenol pyruvate kinase
Application
Answer: B. pyruvate dehydrogenase
Reference:
Harper's Illustrated Biochemistry 27th ed., p. 496
14
70.
To alleviate the arthritic pain, what suggestion on dietary habits should the physician give
Juan in addition to staying away from alcohol?
A.
eat plenty of fats for energy source
B.
take hypouricemic drugs, eat minimal amount of meat, and drink a lot of water
C.
stay away from fruits and vegetables
D.
include nucleic acid rich foods in the meals
Application
Answer: B. take hypouricemic drugs, eat minimal amount of meat, and drink
a lot of water
GENETICS - 15
I.
Given patient data, determine the metabolic pathways and processes involved
71.
Patients with hyperuricemia experience pain because of the insolubility of uric acid.
Physicians prescribe allopurinol, a structural analog of purines. Levels of uric are lowered
through this mechanism:
A.
non-competitive inhibition of purines
B.
allopurinol increases solubility of uric acid
C.
uric acid is degraded in the presence of allopurinol
D.
competitive inhibition of xanthine oxidase
Recall
Answer: D. competitive inhibition of xanthine oxidase
Reference: Harper's Illustrated Biochemistry 27th ed., p. 298 par. 4 line 11
72.
Cytosine arabinoside is an anti metabolite used in the treatment of some forms of cancer. It is
a structural analog of dCTP. Its effectivity as an anti-cancer compound is due to the following:
A.
competes with dCTP for incorporation to DNA
B.
inhibits DNA polymerase
C.
binds to ribose sugars
D.
degrades cancer cells
Recall
Answer: A. competes with dCTP for incorporation to DNA
Reference: Harper's Illustrated Biochemistry 27th ed., p. 298 par. 4 line 13
Textbook of Biochemistry, 5th ed., Thomas Devlin, p. 854 par. 6
73.
Methotrexate, an anti cancer drug, is a structural analog of folic acid. Its effective anti-cancer
action is attributed to its:
A.
inhibiting DNA elongation
B.
complexing with thymine
C.
inhibition of the dihydrofolate reductase enzyme
D.
precipitation of DNA
Application
Answer: C. inhibition of the dihydrofolate reductase enzyme
74.
In one type of hemoglobin structure, base A of a codon was changed to base U. What
possible results can happen?
A.
newly formed codon may dictate the same amino acid
B.
the new hemoglobin is a mutant
C.
oxygen carrying capacity of hemoglobin may change
D.
all of the above
Application
Textbook of Biochemistry, 5th ed., Thomas Devlin, p. 238 Clinical Correlation
15
75.
The thalassemias involve defects in the synthesis of globin chains, involving either genetic
deletion or frameshift mutation in the synthesis of the messenger RNA. Which of the following
will not be an effect of the genetic defect?
A.
reading frame of DNA chain will change
B.
a functional globin chain will be coded
C.
change in code carried by mRNA
D.
individual will present with anemia
Application
Answer: B. a functional globin chain will be coded
Textbook of Biochemistry, 5th ed., Thomas Devlin, p. 224 Clinical Correlation
IV.
Given a clinical condition, identify the genetic/immunologic processes involved
76. .
Xeroderma pigmentosa is a genetic disease characterized by the individual's marked

sensitivity to sunlight. The defect lies on:
A.
mutant helicases
B.
DNA ligase
C.
nucleotide-excission repair process
D.
the DNA polymerase
Recall
Answer: C. nucleotide-excision repair process
77.
Sickle cell disease is a classic example of a point mutation causing a structure abnormality of
the - globin gene. This results in this amino acid change:
A.
valine instead of glutamic acid
B.
leucine instead of glycine
C.
lysine instead of aspartate
D.
tyrosine instead of alanine
Recall
Answer: A. valine instead of glutamic acid
78.
The tetracycline drugs work by preventing the binding of amino acyl tRNAs to the A site of
the bacterial ribosome. This will result in:
A.
inhibition of bacterial replication
B.
bacterila cell lysis
C.
activation of transcription
D.
inhibition of protein synthesis
Recall
Answer: D. inhibition of protein synthesis
Reference:
79.
p. 413
p. 378, par. 2
A newly-launched antibiotic, is credited with inhibiting the DNA helicase which then stops the
synthesis of proteins in bacterial systems. At what stage of protein synthesis does the
antibiotic act?
A.
replication
B.
transcription
C.
translation
D.
reverse transcription
Recall
Answer: A. replication
Reference:
16
p. 334, 336
80.
Menke's disease has been identified to be linked to mutation in the ATP7A gene. This gene
codes for?
A.
a protease inhibitor
B.
an iron transporter
C.
a copper- binding P-type ATPase
D.
cytochrome oxidase
Recall
Answer:
C. a copper-binding P-type ATPase
81.
Mutation in ATP7B gene affects the copper binding P-type ATPase. This is known as Wilson's
disease. Individuals that carry this mutated gene present will all of the following signs except
one. Which one is the exception?
A.
copper is not excreted in the bile
B.
accumulation of fibrillar proteins
C.
deposition of copper ion in liver and other organs
D.
copper toxicosis
Application
Answer: B. accumulation of fibrillar proteins
Reference:
82.
p. 596
p. 597
Deficiency of 1- antiproteinase (1- antitrypsin) is associated with emphysema. In smokers,

progress to emphysema becomes faster because:
A.
smoking destroys the methionine of 1- antitrypsin impairing binding to protease
B.
smoking releases polyaromatic hydrocarbons that bind 1- antitrypsin
C.
smokers carry mutant genes for the enzyme
D.
oxygen facilitates conversion of enzyme to inactive form
Application
Answer: A. smoking destroys the methionine of 1- antitrypsin impairing binding
to protease
83.
In one genetic disease, molecular studies showed that there is premature termination of the
transcription process. This should result in:
A.
failure to have an mRNA code
B.
there will be deficiency of the protein
C.
RNA will be non-functional
D.
all of the above
Application
Reference:
84.
p. 351
In one type of cancer, the normal gene was mutated and transformed into a cancer-inducing
gene or oncogene. Since the gene coded for an enhancer that binds DNA polymerase, what
is the mechanism for the proliferation of cells in the cancer?
A.
presence of excessive substrates
B.
increase synthesis of DNA
C.
cellular transformatioin
D.
lack of DNA binding site
Application
Answer: B. increase synthesis of DNA
Reference:
17
p. 342
85.
A newly-discovered genetic disease presents with premature aging of the affected individual.
It was noted in initial studies that activity of the enzyme telomerase was quite low. What
mechanism explains the above observation?
A.
some proteins disappear with time
B.
replication at telomeres is absent
C.
DNA chains shorten with time
D.
all of the above
Application
Reference:
p. 326
IMMUNOLOGIC - 15
I.
Given patient data, determine the metabolic pathways and processes involved.
86.
A highly atopic individual wil have elevated levels of:

A.
Ig A
B.
Ig G
C.
Ig M
D.
Ig E
Recall
Answer: D. Ig E
Reference:
87.
Patients with bronze diabetes have:

A.
diabetes mellitus
B.
excessive storage iron in tissues
C.
mutations in the HFE gene
D.
all of the above
Recall
Reference:
88.
p. 601, Table 149 - 9
p. 594 - 595 par. 10
In a 52 year old congestive heart failure patient presenting with edema, which of the
following statements is TRUE:
A.
The hydrostatic pressure in the arterioles and in the veins are the same
B.
The hydrostatic pressure in the veins is greater than that of the arterioles
C.
The oncotic pressure in the arterioles is greater than that of the veins
D.
Edema results when fluid accumulates in the extravascular tissue spaces
Application
Answer: D. Edema results when fluid accumulates in the extravascular tissue spaces
89.
After a massive incompatible blood transfusion, the patient complained of abdominal pain and
"bloody urine". Which of the following biochemical processes is TRUE of this patient?
A.
The "bloody urine" is due to the Hb-Hp complex
B.
The urine is due to the free hemoglobin passing thru the glomerulus
C.
The haptoglobin is elevated in this patient
D.
All of the above
Application
Answer: B. The urine is due to the free hemoglobin passing thru the glomerulus
Reference: Harper's Illustrated Biochemistry 27th ed., p. 592 par.3
18
90.
In a patient with chronic liver disease, which of the following biochemical processes is TRUE?
A.
albumin production is decreased
B.
erythropoietin is elevated
C.
haptoglobins are elevated
D.
nuclear factor kappa- (NFKB) is stimulated
Application
Answer: A. albumin production is decreased
Reference: Harper's Illustrated Biochemistry 27th ed., p. 591 par. 2 - 4
IV.
Given a clinical condition, identify the genetic/immunologic processes involved
91.
A pregnant woman most likely will transmit this immunoglobulin to her baby:
A.
Ig G
B.
Ig A
C.
Ig M
D.
Ig E
Recall
Answer: A. Ig G
Reference: Harper's Illustrated Biochemistry 27th ed., p. 601, Table 49-9
92.
A patient with emphysema may have a deficiency in:

A.
albumin
B.
1 - antitrypsin
C.
2 - macroglobulin
D.
ceruloplasmin
Recall
Answer: B. 1 - antitrypsin
Reference:
93.
Which organ is seriously affected in patients with multiple myeloma?

A.
liver
B.
kidneys
C.
intestines
D.
brain
Recall
Answer: B. kidneys
94.
Patient with agammaglobulinemia is a serious immunodeficiency disease of:

A.
Ig M
B.
Ig G
C.
Ig A
D.
Ig E
Recall
Answer: B. Ig G
95.
Which protein is deposited in large amounts in brain tissues in patients with alzheimer's
disease
A.
C - reactive protein
B.
C - peptide
C.
Amyloid
D.
2 macroglobulin
Recall
Answer: C. Amyloid
19
96.
On a routine physical examination, a first year nursing student was told by the examining
physician that he has golden pigment ring around his cornea of both eyes. Which of the
following laboratory results yield abnormal results?
A.
serum copper
B.
serum calcium
C.
urinary creatinine
D.
urine sodium
Application
Answer: A. serum copper
97.
A medical student came to the emergency room because of difficulty of breath and rashes all
over her body after attending a birthday party. The resident on duty gave her a shot of
hydrocortisol which provided a dramatic relief to the student. The relief is due to:
A.
stimulation of the JAK-STAT pathway
B.
inhibition of NF-KB
C.
regulation of nuclear receptor family
D.
stimulation of tyrosine kinase activity
Application
Answer: B. inhibition of NF-KB
98.
Patient's with Crohn's disease may die because of:

A.
infection
B.
hypoalbuminemia
C.
protein losing gastroenteropathy
D.
all of the above
Application
99.
Which statement is TRUE of a patient with recurrent respiratory tract infections:

A.
Circulating immunoglobulins are decreased
B.
Cell-mediated immunity is decreased
C.
T cells are involved
D.
All of the above
Application
Answer: A. Circulating immunoglobulins are decreased
100.
A kidney transplant patient developed graft rejection reactions on the 7th day post transplant.
Which statement is TRUE of this patient:
A.
Plasma cells are the primary culprint
B.
This is hormonal response
C.
This is T cell-mediated immunologic response
D.
Bone marrow transplant is a must for this patient
Application
Answer: C. This is T cell-mediated immunologic response
20

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TEST QUESTIONS IN BIOCHEMISTRY

Catabolism of amino acids requires the participation of transaminase enzymes. What

Persons who consume large amounts of unleavened whole-wheat products may

Deficiency of iron results in which of the following?

An infant with genetic deficiency of glucose-6-phosphatase also known as von Gierke's

Given a laboratory finding, identify the involved biochemical mechanism

Given patient data, formulate an appropriate nutritional plan

Metabolic screening of a newborn showed absence of galactose uridyltransferase enzyme.

the born-again can take in vitamin B12 preparation to meet the

The BMI of the patient is:

Carbohydrate - 30% Fats = 20%

Carbohydrate - 0% Fats = 40%

Carbohydrate - 40% Fats = 40%

Uptake of glucose in these tissues is controlled by the hormone insulin:

In the mucopolysaccharidoses, glycosaminoglycans are not degraded due to the absence of

Skeletal muscles do not have the enzyme glucose-6-phosphatase. This means:

L-xylulose reductase catalyzes the reduction of xylulose to xylitol. In affected individuals,

When there is restricted intake of carbohydrates as in starvation and uncontrolled diabetes

Measurement of HbA1c or glycosylated hemoglobin provides valuable information for the

Calcium deficiency manifestations may also be seen in people who consume:

large amounts of unleavened whole wheat products

Given a laboratory finding, identify the involved biochemical mechanism

Milk intolerance, common among Asian populations and characterized by an osmotic

p. 483, par. 1, line 3

Rate-limiting reaction in cholesterol synthesis which is inhibited by the "statins" group of

p. 142, table 16-1, p.189, par.1

In the glycogen storage disease, McArdle's disease, muscle phosphorylase is absent.

Given patient data, formulate an appropriate nutritional plan

C. anchovies, bean sprouts, mung beans

D. all of the above

What is the importance of taking thiamine in this case?

What enzyme of carbohydrate metabolism is activated by vitamin B1?

Given a clinical condition, identify the genetic/immunologic processes involved

Xeroderma pigmentosa is a genetic disease characterized by the individual's marked

Deficiency of 1- antiproteinase (1- antitrypsin) is associated with emphysema. In smokers,

A highly atopic individual wil have elevated levels of:

Patients with bronze diabetes have:

p. 601, Table 149 - 9

p. 594 - 595 par. 10

Given a clinical condition, identify the genetic/immunologic processes involved

A patient with emphysema may have a deficiency in:

Which organ is seriously affected in patients with multiple myeloma?

Patient with agammaglobulinemia is a serious immunodeficiency disease of:

Patient's with Crohn's disease may die because of:

Which statement is TRUE of a patient with recurrent respiratory tract infections:

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