Exam problems.

Problem 1.

Amylase is an enzyme splitting starch. Conditions for amylase

optimal activity are pH=6,8; topt = 37C. How will enzyme activity
changeif:

a) pH of incubation medium is decreased till 5,0

b) t of incubation is increased till 70C.

Explain the reason for activity changes.

Problem 2.

Salivary gland peroxidase manifests maximum activity at pH 5,0

6,0. How will enzyme activity change at optimal pH in saliva = 6,
8? For the answer:

a) draw the graphof enzyme activity dependence on saliva pH;

b) point out the maximum activity and activity at pH 6,8 on the

graph

c) explain the change of peroxidase activity at optimal pH of

saliva;

d) point our - what ion increase concentration (H + or OH-) in

saliva induce peroxidase activity increasing?

Problem 3.

Examine the reaction: DOPA Dopamine + CO2

a) specifythe class of enzyme catalyzing the reaction;

b) point out coenzyme of enzyme;

c) calculate the specific activity of the enzyme if 1 mg of the

enzyme catalyses 80 M formation of DOPamine at optimal
condition (pH = 8.0 and opt t = 37C) during 60sec;

d) describe the reason of enzyme activity change if pH of

incubation medium is decreased till 5,0 ( draw the
appropriate graph).
Problem 4

Optimal conditions for salivary lysozyme (hydrolysinf

glycoproteins of bacterial waal) are 37C - temperature and pH is
5.2. explain the decrease in enzyme activirty if temperature rises
till 60C and pH changing to 8.0. thereto:

a) Draw the graf of velicity dependency on temperature and pH;

b) Calculate relative enzyme activity if 10mg of lysozyme

catalyses the formation of 5-- M of product per 2 minutes.

Problem 5

Tow patient suffering depression saw a doctor psychiatrist. Its

known that the reason of depression is deficiency of
neurotransmitter in synaptic gap in some cases. Brain cells
contaib enzymes monoaminooxidases (MAO) which degrade
neurotramsmiyyers released to synaptic gap. First patient was
prescribed pyrlindon( structural analogous of serotonin). Second
nilamide which can covalentlynbind to active site of MAO.

Characterize the influence of these madicines on MAO. Point our

thediference in mechanism of interaction with enzyme. Deu to
mechanism explain which of medicine has more prolomged
influence on organism and why.

Problem 6

Glycogen synthase may exist in two forms with deferent activity:

as simple protein (active) and phosphoprotein (inactive). Why
transition of one form to anither is accompanied by change in
enzyme activity? For the answer:

a) Draw the scheme of glucogen synthase regulation;

b) Draw amino acid structures which are modified I the way of

regulation;
 c) Specifi enzymes activating and inactivating glycogen
synthese< their class;

d) Explain why this miodification changes enzyme activity?

Problem 7

Scheme of reactions:

ATP cAMP AMP

E1 E2

Describe metabolism cAMP and its function in cells. Thereto:

a) Specifi E1 and E2 and class of enzymes

b) Name enzyme activity of which is regulated by cAMP

c) Draw the strucutureog this enzyme, describe it structure-

functional peculiarity

Problem 8

Pepsinogen (inactive form of an enzyme) is formed in chiff cells of

stomach has M mass 42000D. in stomach juice pepsinogen is
convertee to active pepsin and M mass is reduced till 35000D.
exp;ain mechanism of this regulation. Thereto:
a) draw the scheme of pepsin activity regulation;

Namr the calsass of enzyme converting pepsinogen topepsin;

What level of structural organization are changedin this mode of

activation

Porblem 9

In bone marrow heme in synthesized:

Glycine + cuccinyl-CoA P1 P2 P3 P4 ..Heme

E1 E2 E3 E4 En
Inhemeamf HB concentration increasing in sinthesi in completed.
Explain the mode of regulation. Thereto:

a) Name ther chain of ibtercaonvertions leading to final product

formation

b) List the features of regulatoery reactions and specifi what

enzymes are regulatory in givedchaib?

c) Draw the structure of regulatory enzyme and describe it

stricrital-fucctionalpecyliarutues;

d) Point out whar ligands can interreact with this enzume;

e) Specifi the mode of this enzyme regulation

10

1. Student investigated the effect of ATP and ADP different concentrations on

the rate of isocitratedehydrogenasereaction.This reaction is the slowest in
citric acid cycle the pathway having energetic importance (ATP synthesis)
and found in all cells of organism. Teacher asked the student to explain
why does increased ATP concentration lead to descent of the reaction rate,
but ADP increasing has opposite effect. In answer he suggested to student:

a) Submit a scheme of isocitratedehydrogenase structure and describe the

mechanism of ATP and ADP influence on it activity;

b) Note the peculiarities of this mode of metabolic pathways regulation.

11

1. Food proteins are digested (hydrolyzed)by stomach juice enzyme pepsin. pH

optimum for pepsin is 1,5-2,0. Why in patients with hypoacidic gastritis (in
which pH of stomach juice is increased) stomach protein digestion is
deteriorated? In answer:

a) Sing what food protein bonds are split by pepsin? Note the class of pepsin;

b) Draw the pepsin activity dependence graph on pH. Explain whethernative or

denatured proteins will be digested quicker in gastro-intestinal tract?

Problem 12
In short-duration outside surgical procedure or plastic surgery in stomatology
hexanal anesthesia is often used. Explain narcotic effect of hexanal (hexobarbital
sodium). Thereto:

a) Draw the scheme of process reduced by barbiturate;

b) Sign the component undergoing barbiturate action on the scheme;

c) Note P/O ration change under narcosis.

Problem 13

Indirect anticoagulant dicumarol is used for prevention and treatment of

thrombosis and thromboembolism. This compound is able to cumulation
accumulation in organism in high concentration and at the same time it gains the
property of uncoupler of electron transport chain. Medical applications of this
medicine lead to the following symptoms: increased body temperature and high
blood pressure, appearance of shortness of breath, severe weight loss; and in some
cases to fatal outcome.
Explain mechanism of side effects of the medicine. Thereto:
a) Point out why increased temperature and weight loss did occur in some
patients?
b) Draw the scheme of ETC;
c) Explain the mechanism of oxidative phosphorylation;
d) Sign how P/O ration is changed in these patients?
e) Name another compounds uncouplers.

Problem 14

To patient complaining of muscular pain induced by excessive physical load doctor

recommended to use heating ointment. One of medical effect of this drug is based
on uncouplers presence. Explain the action mechanism of this medicine. Draw the
scheme of process which is disturbed and answer the questions:
a) What is the chemical nature of uncouplers?
b) What processes are dissociated in participation of these compounds?
c) Why medicine containing such compound may be used as heating?
Problem 15

Hystotoxic hypoxia is oxygen insufficiency due to disturbed

function of enzymatic systems catalyzing biological oxidation in
tissues. Such disturbances appear in cytochromoxidasedamage.
What structural peculiarities are conditioned the action of in this
enzyme structure? For task solution:

a) Draw the electron transportscheme and substantiate the

name of the enzyme;

b) To what class the enzyme is belonged to?

c) Point out the final electron acceptor in electron transport

chain;

d) Name the cytochromoxidase inhibitors;

e) Describe the difference of cytocromoxidase from other

electron transport chain components.

Problem16

The rate of intercellular matrix protein synthesis is increased in osteoblasts at the

stage of mineralization. Oxygen and glucose consumption are enhanced alsoin the
cells. Call the process activation of which in osteoblasts leads to increased oxygen
consumption. Explain its biological function. Thereto:

a) Draw the scheme of ATP formation process occurring with oxygen

consumption;

b) Sign its localization in cells.

Problem 17

Cocarboxylase drug (containing thiamine diphosphate) injections are prescribed

in cardiac insufficiency. Explain the mechanism of it therapeutic action. Thereto:

a) Note what is the function of TDP

b) Draw the reaction with TDP participation, enumerate enzymes and

coenzymes
 c) Sign the process which is accelerated in myocardium in the cocarboxylase
injection and it physiological significance

Problem 18

Niacin containing vitamin PP is prescribed for energetic metabolism

improvement in parodentiumpathology. Explain expediency of this prescription.
Thereto:

a) Name vitamin PP derivatives formed in organism and point out their

biological function

b) Give examples of reaction with these derivatives

c) Explain the importance of these reactions for cells

Problem 19

Enzyme biotinasedamages the link between biotin and protein

releasing it. Free biotin (vitamin H) may participate in the work of
biotin-dependent enzymes. In inherited deficiency of biotinase
symptoms characteristic for H hypovitaminosis are developed:
hypoenergetic state, fatigability, muscular pain, seizure
(convulsive attack), anemia, dermatitis, and hair loss. Explain the
reason of hypoenergetic state development in these patients.
Thereto:

a) What is the function of biotin in the organism;

b) Draw the reaction in which biotin is a participant;

c) Point out the importance of this reaction for organism.

Problem 20

Medicine Ubiquinone (coenzyme Q) is used as an antioxidant providing

antihypoxic effect. It is used in the treatment of ischemic cardiac disorder and
myocardial infarction to increase the tolerance to physical load. Coenzyme Q is
also prescribed to sportsmen for restorative function and tissue energetic
maintenance. Explain the action mechanism of this medicine. Thereto:
a) Draw the scheme of metabolic pathway providing ATP for working
muscles;
b)on the scheme Sign the reactions the rate of which depends on oxygen
inflow;
 d) Name the process in which ubiquinone is taking place and point out
how it rate is changed in hypoxia?

Problem 21.
Inherited defect of pyruvatecarboxylase was revealed in patient. What are
the consequences which the damage structure of this enzyme can lead to? To
answer the question:
a) Draw the reaction catalyzed by the enzyme; name coenzyme;
b) Present the scheme of process in which product of the reaction
participates;
c) Explain the energetic importance of the process making an appropriate
calculation.
Problem 22.
The predominance of refined cereals or bread cooked from extra-flour in food can
lead to B1hypovitaminosis. Explain vitamin B1 function in organism. Thereto:
a) Name coenzyme which composition B1 enter and enzymes function for
which this vitamin is obligatory.
b) Draw the process in which these enzymes are taking place. How the rate
of the process have been changed in B1 deficiency?
Problem 23.
Hypovitaminosis conditioned by decreased amount of B1, B2, PP is developed in
people in spring. The most characteristic symptoms are: drowsiness, weakness, and
increased fatigability.
a)
b) give the example of reactions in which these coenzymes participate and explain
the role of these reactions in energetic metabolism
c) give another reasons for hypoenenrgetic states.
Problem 24.

Sportsmen have glucose concentration in blood about 7 mM/L

before important tournament. Assess the result of blood
 sample and explain the reason of blood glucose level change in
comparison with physiological norm. Thereto:

a) Sign blood glucose level on an empty stomach in norm

b) Describe hormone status changes in sportsmen under these

circumstances and action mechanism of the hormone in
target cells.

c) draw the scheme of process acceleration of which led to

changes of blood glucose level

problem 25.

1. Man had eaten 200gr of carbohydrates and then did not eat anything during
24 hours. Describe glycogen turnover in 1 hour after meal and in 14 hours,
draw inappropriate schemes. Explain hormone regulation of these processes.
Point out the difference of glycogen mobilization in the liver and muscular
tissue.
Problem 26

1. Man is performing urgent work (for example running from any danger) in 30
minutes after dinner (dinner contained mainly carbohydrates). What process
is flowing in skeletal muscles under this condition: glycogen synthesis or
degradation? Draw the scheme of chosen process and explain:
a) What hormone does switch glycogen turnover pathways in described
situation?
b) Illustrate by scheme the mechanism of hormone action on the process.
Problem 27

The main significance of glycogen synthesis and degradationregulation in the liver

is to maintain constant blood glucose level. What is the blood glucose
concentration in normal state? Explain the role of hormones in regulation of key-
enzymes of glycogen metabolism. Illustrate with an appropriate schemes.

Problem 28.

During examination student blood glucose level was 7mM/L. To explain this
result:
a) Point out physiological blood glucose level;
b) Note what hormone blood level is increased in blood of student?
c) Draw the scheme of the process the changed rate of which led to glucose
level increasing.
Problem 29.

Two runners on the distance: sprinter has been finishing the hundred-meter
distance; long-distance runner has been running 10 kilometer. Point out the
difference in energy supplying of muscles in these runners. Draw metabolic
pathway schemes which are energy source for work in sprinter and long-distance
runner.

Problem 30.
What is the purpose for lactatedehydrogenase presence in erythrocytes? What does
occur with erythrocyte at the presence of inhibitor of lactatedehydrogenase?
Corroborate your answer. Thereto:
a) Draw the reaction catalyzed by lactatedehydrogenase;
b) Present the scheme of process in which the reaction flow. Point out
physiological importance of this process for erythrocytes.

Problem 31.

Some tissues,for example cardiac muscle, can use lactate as energetic substrate.
How many ATP is formed in full lactate oxidation to CO2 and H2O? For the answer
draw the reaction scheme of full lactate oxidation. Point out enzymes and
coenzymes participating in the process.

Problem 32.

Crystalline lens and cornea refract light because their cells do not contain
mitochondria. What is the process for ATP synthesis is present in these tissues? For
the answer:
a) Point out the known mechanisms of phosphorylation;
b) Draw the scheme of process which provide ATP synthesis without
mitochondria respiratory chain participation and estimate it energetic effect.
Problem 33
Man is performing intense physical work. What direction reactions catalyzed by
lactatedehydrogenase are displaced in skeletal muscle and the liver? Corroborate
the answer:
a) Draw the reaction catalyzed by lactatedehydrogenase;
b) Draw the scheme of processes in which this reaction flow in skeletal
muscles and liver;
c) Sign physiological importance of these processes
Problem 34.

Medicines containing digestive enzymes penzitalor festal are

prescribed to patients with digestion disturbances in
enzymotherapy. Penzital components are enzymes of pancreatic
juice. Festal composition besides these enzymes includes bile
acids (bile components). What medicine among these ones
necessary to recommend to patient with digestion disturbance
which was caused by gallstone disease and accompanied by
steatorrhea? For the answer:
a) Describe stages of edible fats assimilation;
b) Draw the reactions occurring in fat digestion, sign enzyme
and its activator;
c) List bile acid functions and biological importance of
enterohepatic circulation.

35
Medicines containing digestive enzymes penzitalorfestal are
prescribed to patients with digestion disturbances in
enzymotherapy. Penzital components are enzymes of pancreatic
juice. Festal composition besides these enzymes includes bile
acids (bile components). What medicine among these ones
necessary to recommend to patient with digestion disturbance
which was caused by gallstone disease and accompanied by
steatorrhea? For the answer:
d) Describe stages of edible fats assimilation;
e) Draw the reactions occurring in fat digestion, sign enzyme
and its activator;
f) List bile acid functions and biological importance of
enterohepatic circulation.

36
In the course of genetic examinationof child it was determined
the damage of apoprotein C- gene structure. The level of TAG
in blood exceeds the norm in several times. It was
foundxanthomaon the skin. Explainthe reason of
hypertriacylglycerolemiain this case. Thereto:
 a) Describe structure and maturation of lipoproterins
transported edible fats;
b) Point out the role of apoprotein C- in absorption of edible
fats by tissues;
c) Name all possible reasons of hypertriacylglycerolemiaof
type.

37.
Friend recommended to girl with overweight to use xenical to
reduce weight. The reactant of this medicine is orlistat which has
structural resemblance with TAG and inhibits pancreatic lipase. It
is recommendedhypo caloric diet to patients receiving the
medicine. Girl excluded fats but did not reduce carbohydrates
from the diet. Duration of treatment was calculated for 6 months
but on the expiry of half of this time she understood that did not
lose weight butcontrariwisea little put on weight. That is why
doctor recommendedto reduce dietary carbohydrates. Explain
doctor recommendation, thereto:
a) Draw the scheme of metabolic pathways activation of which
lead to put on weight.
b) Sign hormone accelerating these metabolic pathways, explain
it mechanism, sing reactions on the scheme which are
activated by this hormone.

38

1. Prolonged antibiotic therapy inducesdeath of intestinal

microflora (disbacteriosis) as a result of which vitamin H
deficiency can be developed. That is accompanied by rapid
fatigability, drowsiness and depression. Explain the reason of
this condition. Thereto:
a) specify biotin biological function, list enzymes coenzyme of
which is biotin;
b) draw the scheme of processes (energetic metabolism and
lipid metabolism) which will be damaged in vitamin H
deficiency.
 39.

After severe trauma bed rest was prescribed for patient. Afraid
of putting on weight patient excluded lipids from diet but did
not restrict sweets. Woman put on 4 kilogram during the
following month. Why weight is gained? For substantiation the
answer:
a) Draw the schemes of pathways activation of which led to put on
weight;
b) Name the hormone which is responsible for this and explain it
mechanism of action;
c) Point out the enzymes induction of which is increased by this
hormone.

40
People eating fast-food usually has inclination to corpulence.
What changes of metabolism leads to obesity under this
condition? For the answer to:
a) name hormone, concentration of which is increased in blood
of such people;
b) explain how this hormone influence the entrance of glucose
and fatty acids into adipose tissue;
c) draw the schemes of metabolic pathways which are
increased in adipose tissue;
d) draw the scheme of origin of substrates for fatty acids and
TAG synthesis, sign regulatory enzymes.

41

The man ate 250 gram of carbohydrates and two hours did
not do any physical work. What process of lipid metabolism
will be activated in 2 hours after meal? For the answer:
a) present the process in which initial substrate for lipid
metabolism is formed from glucose in the liver (specify
enzymes, coenzymes, reactions coupled with usage and
formation of ATP)
 b) draw the reaction of this compound carboxylation and its
participation in fatty acid metabolism (the scheme)
c) what hormone stimulates this metabolic pathway.

42
Young man was admitted to hospital with mandibular bone fracture on
Friday evening. Duty doctor applied a splint to mandibular bone but did not
explain that patient has to eat through the special tube. On Monday on the
round patient complained of weakness, dizziness and acetone smell
fromthe mouth. Urgent blood examination revealed low blood glucose level
and increased level of ketone bodies. How to explain these results? For the
answer:
a) Specify which hormones amount are increased in patent blood who
did not eating during three days? Explain the action mechanism of
one of them on target cells;
b) Draw the scheme of lipid metabolism processes which are activated
by the hormone in target cells;
c) Explain the reason of acetone smell;
d) Point out the place of synthesis of compounds producing this acetone
smell and their role in metabolism;
e) Suppose what are the following doctor activities after acquaintance
with results of analysis?

43
Cresophene is used as anti-inflammatory remedy for preparation of root
canals in pulpitis and periodontitis treatment. It contains structural
analogous of glucocorticoid dexamethasone. Explain the anti-
inflammatory mechanism of dexamethasone action. Thereto:
a) Draw the reaction scheme flowing in tooth and periodontium tissue
cells suppressed (inhibited) by this remedy;
b) Draw the scheme of this reaction product conversionto local
hormone;
c) Point out functions of these compounds in tissues.
44
Some drugs caffeine and theophilline - repress (inhibit) enzyme
phosphodiesterase. How is fatty acid bloodconcentration changed in these
medicines administration? In the answer present:
a) thescheme of the reaction which is reduced in phosphodiesterase
inhibition;
b) the system of transmembrane signal transduction which will keep high
activity in these drug administration;
c) reactions actively flowing in adipose tissue under these conditions;
d) processes where one of the products is oxidized to CO 2. Present the
formula for calculation of energetic balance of the process.

45
Explain the difference in lipid metabolism in two people: one of them had a
supper and lied to have a rest. Another overweight man did not eat three
days and each evening had a jogging. Thereto:
a) Characterize hormonal status of these men;
b) Draw the reactions which are active in adipose tissue in starving
man;
c) Present the scheme of hormone-sensitive enzyme regulation of this
metabolic pathway;
d) Describe the fate of products which are removed from the liver and
present appropriate process.

46
Patient A received high caloric diet during several days; patient B
received low caloric diet. Draw the difference in metabolism of these men.
Thereto:
a) Specify who of patients has high insulin/glucagon relation during the
day?
b) Explain who of patients has amount of acetyl-CoA-carboxylase higher
and why (draw the scheme of reaction and regulation of the enzyme);
 c) Draw the schemes of metabolic processes which are activated by the
hormone the level of which is increased in patient A.

47
During hemodialysis patients lose large amount of carnitine which is
excreted from organism in the conjugated with organic acids form. After
that patients suffer from hypoglycemia attacks. Alsohigh free fatty acid
concentration is revealed in blood. Why loss of large carnitine leads to
change of glucose concentration and fatty acids in patient blood?
For the answer:
a) describe carnitine function and draw the appropriate scheme;
b) explain - why hypoglycemia occurs in patients with loss of carnitine?
(for this remind the process which participate to maintenance of blood
glucose level, draw the scheme and point out the dependence on
energetic status of cell);
c) draw the scheme of fatty acid oxidation to CO 2 (specific pathway and
CAC) flowing in the liver the rate of which is reduced after
hemodialysis.

48
What is the sequence of energy sources usage in muscular tissue in
running from first seconds of work to finishing of 10 km distance? For the
answer:
a) Draw the scheme of process which provides muscles with energy at
first minutes of work (in O2 insufficiency).
b) Draw the metabolic pathway schemes which would provide energy
for muscles in 10-15 minutes after start. Explain regulation of
processes.

49
4-years old boy has decreased ability to do physical work. In examination
of muscular biopsy material it was revealed that tissue includes four times
less carnitine. Also lipid vacuoles were found in cytosol of muscles. What
are the reasons of this condition? For the answer:
a) Explain the role of carnitine in energetic metabolism (draw the
scheme);
b) Draw the metabolic reactions which are damaged in this patient;
 c) Present the scheme of this product oxidation to CO 2

50

To ascertainment the risk of atherosclerosis development

besides the assessment of the blood crude cholesterol level
atherogenic coefficient is calculated additionally. Draw the
scheme of cholesterol synthesis and formula for atherogenic
coefficient calculation and explain:

a) Why is necessary to take into account HDL level in blood in

the coefficient calculation?

b) LDL and HDL metabolism (synthesis and interaction with

other lipoproteins etc).

51

After introduction of glucose containing tagged carbon atom

(14C) to animal it was found that mark has been appeared in
isopentylpyrophosphate and then in bile acids structure. How it
does occur? For the answer:

a) Explain in what process isopentylpyrophosphate is an

intermediate metabolite and would be this radioactive mark
remained in the final product?

b) Draw the scheme of 14C incorporation into bile acids

composition and specify organ in which it does occur;

c) Point out would bile acids tagged carbon atom ( 14 C)be found
in animal organism in a month after stopping of marked
glucose introduction?

52

To patients with fatty liver and hypercholesterolemia vitamin B

4 (choline) is recommended to take in. Its known that choline is
used for synthesis of acetylcholine, phosphatidylcholine,
sphingomyelin. Why the formation of one of these compounds can
ease the state of patient. For the answer:

a) Draw the formula of choline and acetylcholine;

b) Name the lipoproteins formation of which have to be

increased due to treatment;

c) Specify the anti-atherogenic lipoproteins;

d) Draw the scheme of metabolism of these lipoproteins;

e) Explain the lecithin role in anti-atherogenic activity of these

lipoproteins

53

Prophylactic factors of hypercholesterolemia and atherosclerosis

are carbohydrate reducing and enough amount of vitamin C, E, A
in the diet. Explain the possible mechanisms of vitamin action and
dietary recommendations. Thereto:

a) draw the scheme of origin of substrate for cholesterol

synthesis. Point out the link between carbohydrate content in diet
and activity of this steroid synthesis;

b) what are other reasons of hypercholesterolemia besides

hyper caloric diet?

c) describe the role of vitamins C, E, A in hypercholesterolemia

prophylaxis;

d) name other ways to hypercholesterolemia prevention.

54

What is the difference in cholesterol metabolism in vegetarians

and men with large amount of meat, milk, eggs, carbohydrate in
diet? For the answer:

a) draw the scheme of cholesterol synthesis. Specify

cholesterol concentration in blood in the norm;
 b) present the scheme of this process regulation;

c) explain the origin of substrates for cholesterol synthesis;

d) draw cholesterol usage in human body.

55

Patient took fluvastatin (inhibitor of cholesterol synthesis) during

prolonged time. This patient needed a surgical operation and
doctor canceled fluvastatinmedicine before operation and for
convalescence (recovery) period. Why doctor canceled the
prescription? For the answer:

a) Specify cholesterol concentration in blood and atherogenic

coefficient;

b) Name the enzyme inhibited by fluvastatin;

c) Draw the scheme of process with this enzyme;

d) Draw the pathways for usage of final product of this process

and what way will be increased in patient after operation?

56

Two patients have equal blood level of cholesterol 6,5mM/L. May

it possible to say about equal predisposition to atherosclerosis?
For the answer:

a) Draw the scheme of process which is actively flowing in the

liver of these patients;

b) Name lipoprotein containing the most quantity of cholesterol

and its esters, and describe it metabolism (formation,
interaction with other lipoproteins, change in composition and
etc);

c) Explain receptor-endocytosis of these particles by tissue cells;

 d) Calculate atherogenic coefficient if its known that HDL
cholesterol is 0,5mM/L in patient A; HDL cholesterol in patient
B is 1mMl/L.

57

People who are regularly and often eating in fast-food usually

inclined to corpulence and obesity. What changes in metabolism
lead to obesity in people on this diet? For the answer to the
question:

a) Specify hormone concentration of which is increased on blood

of people eating much fats and carbohydrates;

b) Explain the influence of this hormone on glucose and fatty

acids entering the adipose tissue;

c) Describe the mechanism of hormone signal transduction to

target-tissues;

d) Draw the schemes of metabolic pathways which are increased

by this hormone in adipose tissue. Point out the regulatory
reactions.

------------------------------------

58

Patient came to stomatologiston the occasion of tooth

extraction. He did not suffer from diabetes mellitus or steroid
diabetes but blood glucose level was 7,5mMol/L in post absorptive
state. Explain the reason of blood glucose level change. For the
answer:

a) Specify hormone concentration of which is increased in

patients blood, its site of synthesis and target-tissues;

b) Describe the mechanism of signal transduction of this

hormone of target-tissues;

c) Draw the scheme of metabolic pathway acceleration that led

to change of blood glucose level.
59

Glucagon is counter (antagonist) insulin hormone. Give

arguments in favor of the statement. Thereto:

a) Describe the mechanisms of signal transduction by insulin

and glucagon to target-tissues;

b) Present schemes of metabolic pathways which are increased

by glucagon but reduced by insulin in target tissues;

c) Specify the influence of each hormone on blood glucose level.

60

In blood of patient who complained of impairment of wound

healing, osteoporosis, and periodontitis concentration of blood
glucose was 8mMol/L, ketone bodies 2mg/dl, urea 10mMol/L,
insulin and C-peptide level was in the norm. At the same time
urea content and 17-ketosteroids are increased in twenty-four-
hour urine. Explain the reason of hyperglucosemia and azotemia
(uremia) in this case. Explain the cause of listed symptoms. Name
the disorder patient suffer from. For the answer:

a) Point out the site of hormone synthesis which

hyperproduction is observed in patient;

b) Describe the mechanism of this hormone synthesis and

secretion regulation and present the scheme of hormone
signal transduction to the cell metabolism;

c) Draw the scheme of metabolic pathways which rate was

changed and led to hyperglucosemia and azotemia, specify
regulatory reactions.

61.
 For sportsmen-body builders building up muscular mass trainers
prohibithardload. Explain the reason of this recommendation.
Thereto:

a) Specify hormone increased secretion of which in intensive

long-term work outs induce reduction of muscle bulk;

b) Describe the mechanism of hormone action in target tissues;

c) List the processes the rate of which is changed under the

action of this hormone.

62

To hospital admitting office lost consciousness girl was admitted.

Patient relatives explained that she suffered from anorexia and
refuse taking meal during 5 weeks. Examination revealed that
blood glucose level was 55mg/dl (3,3mM/L), ketone bodies 20
mg/dl, blood pH 7,1. Explain the reason of these data change
which led to loss of consciousness. Thereto:

a) Specify blood glucose level, ketone bodies concentration and

blood pH in the norm;

b) Present the schemes of processes accelerating of which led to

ketonemia;

c) List substrates which are used by brain, muscles, liver in

prolonged starvation;

d) Draw the scheme of metabolic pathway explaining the role of

ketone bodies in organism.

63

Decrease glucose tolerance in diabetes mellitus patients is

ascertained with sugar load. For this glucose level is determined
on an empty stomach, then patient drinks glucose solution
(accounting 1 gr per 1 kg of body mass). Glucose concentration is
measured each 30 minutes during 3 hours. Present graphs in
normal state and in glucose intolarance. Explain these curves.

64

Woman suffering from diabetes mellitus went to stomatologist

for consultation about implantation with the following dental
prosthetics. But stomatologist explained to her that in diabetes
mellitus this technique is not recommended. Explain the reason
for contraindication of dental prosthetics in diabetes mellitus
patient. Explain the late complications in diabetes mellitus.

65

In patient treated with glyclaside (secretogen - sulfaurea

derivative) hypoglycemia occurred. These drugs stimulate insulin
secretion. Explain the mechanism of glucose level reducing in
treatment with insulin secretogens.

a) Describe insulin secretion regulation by glucose;

b) Point out the role of the hormone in glucose entrance to

insulin-dependent tissues;

c) Draw the scheme of metabolic pathways accelerating of

which under insulin influence lead to decrease blood glucose
level.

66

Patient was admitted to hospital with weakness and diarrhea. It

was diagnosed choleras. Explain:

a) Present the scheme of liquid volume restoration in organism;

b) Describe all stages of this system functioning;

c) Name hormones maintaining water-salt balance in organism;

d) Describe mechanism and effects of these hormones.

 67

Patient saw a doctoron the occasion of enamel defects and

progressing caries. Doctor found out that she had operation of
parathyroid gland removing. Blood Ca/P coefficient is
decreased. Doctor recommended diet reach with calcium salts
and vitamin D3. Explain the reason of Ca/P coefficient change
and thevalidity of doctor recommendationThereto:

a) Name hormone the level of which is decreased after

operation. Describe the role of the hormone in calcium
and phosphate metabolism;

b) Present the scheme explaining the role of vitamin D 3 in

calcium metabolism;

c) Describe how the prescribed treatment and diet must

improve patient condition.

68

Pregnant womanwas prescribed Calcium Advance drag by the

doctor; the medicine includes vitamin D3, magnesium and etc.
Explain why did doctor prescribe the medicine? For the answer
specify:

a) The reason of increased needs in calcium in pregnancy;

b) Hormones providing maintenance of calcium level in blood;

c) What are the sources for calcium concentration maintenance?

d) Why vitamin D3 and magnesium are essential components

prescribed to pregnant woman?