560D CLINICAL BIOCHEMISTRY Flashcards Preview

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Flashcards in 560D CLINICAL BIOCHEMISTRY Deck (201)
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1
Q

Which of the following factors can increase likelihood of getting iron deficiency anemia?

a. All of these responses can increase the risk of getting iron deficiency anemia
b. Heavy menstruation
c. Celiac disease
d. Deficiency of copper

A

a. All of these responses can increase the risk of getting iron deficiency anemia

2
Q

Anemia of chronic disease can be caused from prolonged inflammation (IL-6, cytokines, infection), which increases level of __________________ to sequester iron in tissues so germs can’t use the iron to reproduce.

a. Hepcidin
b. Aconitase
c. Vitamin B12
d. Folic acid

A

a. Hepcidin

3
Q

What are the four conditionally essential amino acids?

a. Arg, Gln, Gly, Tau
b. Arg, Gln, Gly, Ser
c. Arg, Glu, Gly, Tau
d. Arg, Glu, Gly, Ser

A

a. Arg, Gln, Gly, Tau

4
Q

Mutations in the SN1-SN2 transporter can lead to elevations in what 3 AA?

a. Gln, Asn, His
b. Glu, Asn, His
c. Glu, Asp, His
d. Gln, Asp, His

A

a. Gln, Asn, His

5
Q

The central energy pathways begin with digestion and assimilation of fats, carbohydrates, and proteins. Long chain FA require the use of the _________________ shuttle to help them enter the mitochondrial for beta-oxidation.

a. Carnitine
b. Malate
c. Aspartate
d. Carnosine

A

a. Carnitine

6
Q

Inhibition of CoQ10 synthesis from statin drugs, will typically reveal elevations in urinary_____________________.

a. Hydroxymethylglutarate
b. Hydroxymethylbutyrate
c. Hydroxymethylpropionate
d. Hydroxymethylsuccinate

A

a. Hydroxymethylglutarate

7
Q

When considering toxic exposures, through what barriers and routes of entry can lipophilic (fat loving) toxins be absorbed?

a. All of these responses
b. Through the GI tract
c. Through the skin
d. Through the lymphatics
e. In utero

A

a. All of these responses

8
Q

One of the phthalate esters used in plastic wrap to cover foods can lead to decreased kidney function, increased cysts, increased peroxisome proliferation and even liver cancer in rats. This is a concern to humans because ________________ is used in plastic tubing for hemodialysis.

a. Di(2-ethylhexyl) phthalate (DEHP)
b. Dimethyl phthalate (DMP)
c. Diethyl phthalate (DEP)
d. Polyethylene terephthalate (PETE)

A

a. Di(2-ethylhexyl) phthalate (DEHP)

9
Q

What does the Fenton Reaction do?

A

It forms the toxic hydroxyl radical, a form of reactive oxygen species, which causes lipid peroxidation and formation of other free radicals

10
Q

What does DMT-1 transport, and what would be the impact of an excess of any of these metals?

A

DMT-1 transports iron, zinc, copper, and manganese. Excess can inhibit absorption of the other metals

11
Q

How would antacids and H2 blockers interfere with iron absorption?

A

DMT-1 requires H+, which comes from stomach acid

12
Q

Deficiency of which nutrients increase the risk of iron deficiency anemia? (2)

A

Vitamin C and copper

13
Q

What is the only active and functional porphyrin in the heme synthesis pathway?

A

Protoporphyrin IX

14
Q

A client with diagnosed iron deficiency anemia comes to you because he eats meat based protein and green leafy vegetables but his iron levels have not increased. What other nutrient is needed to properly absorb iron?

  1. ) Vitamin B12
  2. ) Folic Acid
  3. ) Intrinsic factor
  4. ) Vitamin C
A

4.) Vitamin C

15
Q

Antacids can reduce the absorption of iron and copper, leading to iron deficiency anemia because:

  1. ) Because the antacids bind the metals
  2. ) Acidic pH increases Fe3+
  3. ) DMT1 requires co-transport of H+ ions to internalize divalent cations
  4. ) Stomach acid properly degrades metals
A

3.) DMT1 requires co-transport of H+ ions to internalize divalent cations

16
Q

Which of the following factors can increase likelihood of getting iron deficiency anemia?

  1. ) Celiac disease
  2. ) All of these responses
  3. ) Heavy menstruation
  4. ) Deficiency of copper
A

2.) All of these responses

17
Q

Glucose-6-phosphate dehydrogenase is the enzyme that reduces …….(a)……. to ____(b)____ as part of the hexose monophosphate shunt pathway (ie. pentose phosphate pathway). G6PD deficiency can lead to RBC hemolysis from oxidant stress because ___(b)___ is no longer available to help recycle glutathione.

  1. ) (a) NADPH, (b) NADP+
  2. ) (a) NADH, (b) NADPH
  3. ) (a) NADP+, (b) NADPH
  4. ) (a) NAD+, (b) NADH
A

3.) (a) NADP+, (b) NADPH

18
Q

Sickle Cell Anemia is caused by a point mutation leading to a structural instability of the RBC. What conditions can create increased stress, leading to increased levels of deoxyhemoglobin and sickle cell crisis?

A: All of these responses

  1. ) Decreased pH (acidity)
  2. ) High altitude
  3. ) Increased 2,3-Bisphosphoglycerate
A

A: All of these responses

19
Q

Anemia of chronic disease can be caused from prolonged inflammation (IL-6, cytokines, infection), which increases level of __________________ to sequester iron in tissues so germs can’t use the iron to reproduce.

  1. ) Vitamin B12
  2. ) Aconitase
  3. ) Hepcidin
  4. ) Folic Acid
A

3.) Hepcidin (Is synthesized by the liver and controls iron homeostasis).

20
Q

Sideroblastic anemia is an X-linked condition where the enzyme called ____________________ is mutated, leading to excess iron in the RBC mitochondria.

  1. ) Protoporphyrin IX oxidase
  2. ) NADH methemoglobin reductase
  3. ) Delta-aminolevulinic acid synthase
  4. ) Diaphorase I
A

3.) Delta-aminolevulinic acid synthase (this is also the enzyme that controls the rate limiting step in heme synthesis)

21
Q

Copper-containing ferroxidases called Hephaestin and __________ convert Fe2+ to Fe3+ so it can be safely transported by transferrin in the bloodstream

A

A: Ferritin (this is an intracellular storage form of iron)

22
Q

Which transporter assists in uptake of iron from the intestines?

  1. ) Divalent metal transporter 1 (DMT1)
  2. ) Ferritin
  3. ) Ferrireductase duodenal cytochrome b
  4. ) Transferrin
A

1.) Divalent metal transporter 1 (DMT1)

23
Q

The Bohr effect explains that a decrease in the amount of oxygen associated with hemoglobin (Hb) due to a reduced affinity of oxygen for Hb is the result of:

  1. ) Increased pC02 and increased pH
  2. ) Increased pCO2 and decreased pH
  3. ) Decreased pC02 and decreased pH
  4. ) Decreased pC02 and increased pH
A

2.) Increased pCO2 and decreased pH

pCO2 (partial pressure of carbon dioxide)

24
Q

It is important to simultaneously check vitamin B12 and folate levels because administration of folic acid can mask vitamin B12 deficiency, leading to neurological demyelination that is often irreparable. The 2 constituents that accumulate in B12 deficiency, one of which competitively inhibits FA biosynthesis leading to increased myelin sheath turnover/degradation are:

  1. ) Succinyl CoA and Methylmalonyl CoA
  2. ) Methylmalonyl CoA and homocysteine
  3. ) Acetyl CoA and homocysteine
  4. ) Succinyl CoA and homocysteine
A

2.) Methylmalonyl CoA and homocysteine

25
Q

Elevations of FIGLU in the urine can indicate:

  1. ) Functional deficiency of vitamin B12
  2. ) Functional deficiency of histidine
  3. ) Functional deficiency of glutamate
  4. ) Functional deficiency of folic acid
A

4.) Functional deficiency of folic acid

26
Q

The folate trap occurs when there is deficient amounts of vitamin B12 and folate gets “trapped” in the form _______________.

  1. ) 5,10 Methylene-THF
  2. ) 5-Methyl-THF
  3. ) THF
  4. ) 10-Formyl-THF
A

2.) 5-Methyl-THF

27
Q

GI conjugase enzymes hydrolyze folate to the monoglutamate form. What cofactor is needed for this reaction?

  1. ) Zinc
  2. ) Vitamin C
  3. ) Copper
  4. ) Magnesium
A

1.) Zinc

28
Q

Alanine aminotransferase converts alpha-ketoglutarate into glutamate and alanine into:

  1. ) Pyruvate
  2. ) Aspartate
  3. ) Oxaloacetate
  4. ) Glutamate
A

1.) Pyruvate

29
Q

Folic Acid is composed of:

A

A: Pterin, PABA, Glutamic acid

30
Q

What cofactor assists aminotransferases like ALT and AST in their ability to transfer amino groups?

  1. ) Pyridoxal-5-Phosphate
  2. ) Vitamin B5
  3. ) Pyridoxamine Phosphate
  4. ) Vitamin C
A

1.) Pyridoxal-5-Phosphate

Pyridoxal-5-Phosphate (B6) is required by all aminotransferases, actually holds onto the amino group that gets transferred during the enzymatic process, and gets recycled for continual use in these reactions.

31
Q

How many ATP are utilized in the Gamma-glutamyl cycle to resynthesize glutathione?

  1. ) 2 ATP
  2. ) 4 ATP
  3. ) 1 ATP
  4. ) 3 ATP
A

4.) 3 ATP

32
Q

Gamma-glutamyl transpeptidase (GGT) is responsible for breaking down ……(a)…… into ____(b)____

  1. ) (a) GSH, (b) gamma-glutamylAA + cysteinylglutamate
  2. ) (a) GSH, (b) gamma-glutamylAA + cysteinyl-oxoproline
  3. ) (a) GSH, (b) gamma-glutamylAA + cysteinylglycine
  4. ) (a) GSH, (b) gamma-glutamylAA + cysteinylglutamine
A

3.) (a) GSH, (b) gamma-glutamylAA + cysteinylglycine

33
Q

Thyroperoxidase (TPO) is responsible for catalyzing the following reaction(s):

  1. ) Iodination, joining of Iodine to thyroglobulin
  2. ) Coupling of DIT with DIT to form T4
  3. ) Oxidization of Iodide to Iodine
  4. ) Coupling of MIT with DIT to form T3
  5. ) All of these responses
A

5.) All of these responses

34
Q

Which of the following interfere with Iodide uptake and utilization by the thyroid:

  1. ) Goitrogenic Foods like soy and uncooked cruciferous vegetables
  2. ) Low ATP
  3. ) Low TSH
  4. ) Competing halogens like bromide and chloride
  5. ) All of these responses
A

5.) All of these responses

35
Q

What minerals are actively symported into the thyroid follicular cell from the bloodstream for the creation of thyroid hormones?

  1. ) Iodine and Selenium
  2. ) Iodide and Sodium
  3. ) Iodide and Potassium
  4. ) Iodide and Magnesium
A

2.) Iodide and Sodium

36
Q

How can decreased levels of thyroid hormone impact vitamin A?

  1. ) Impairs function of vitamin A
  2. ) Impairs conversion of beta-carotene to vitamin A
  3. ) Impairs absorption of vitamin A
  4. ) Impairs release of vitamin A
A

2.) Impairs conversion of beta-carotene to vitamin A

37
Q

Iodothyronine deiodinase 2 converts T4 to T3. What cofactor is needed for proper function?

A

A: Selenium

38
Q

Genetic mutations deactivating leptin or its receptor lead to:

A

A: Hyperphagia and massive obesity

39
Q

Clients may be diagnosed as overweight if their BMI is:

  1. ) 30-34.9
  2. ) 18.5-24.9
  3. ) 35-39.9
  4. ) 25-29.9
A

4.) 25-29.9

40
Q

High levels of ATP in the cell indicate increased energy reserves. Hence, high levels of ATP will:

  1. ) Appear during a fasting state
  2. ) Enhance activity of glycogen phosphorylase
  3. ) Enhance activity of isocitrate dehydrogenase
  4. ) Block activity of pyruvate kinase
A

4.) Block activity of pyruvate kinase

High ATP will shut down phosphofructokinase and pyruvate kinase of glycolysis to slow production of more ATP.

41
Q

True or False: Phosphofructokinase 1, Glucokinase, and Pyruvate Kinase are all upregulated in response to insulin.

A

A: True

42
Q

Intra-abdomial (visceral/organ) fat is more dangerous than subcutaneous fat because it:

  1. ) Increases inflammatory cytokines
  2. ) May increase insulin resistance and ER stress
  3. ) All of these responses
  4. ) Increases free FA
A

3.) All of these responses

43
Q

The Cori cycle:

  1. ) All of these responses
  2. ) Converts 2 lactate into glucose
  3. ) Is upregulated in a fasting state
  4. ) Produces 2 ATP in peripheral tissues
A

1.) All of these responses

44
Q

Obesity and chronic overnutrition interrupt metabolic pathways in the following way(s):

  1. ) High NADH reduces creation of Acetyl CoA and TCA cycle
  2. ) All of these responses
  3. ) High ATP reduces glycolysis and TCA cycle
  4. ) High pyruvate and acetyl CoA increase FA
  5. ) Excess glucose converts to glycogen
A

2.) All of these responses

45
Q

The Alanine Cycle:

  1. ) Does not require ATP
  2. ) Occurs in a well-fed state
  3. ) Releases alanine from the liver
  4. ) None of these responses
A

4.) None of these responses

Alanine cycle converts 2 alanine from peripheral tissue into glucose in the liver during a fasting state, requires ATP and produces 5-7 ATP in peripheral tissues.

46
Q

Hyperglycemia can lead to glycation (glycosylation) reactions. One such glycation reaction with hemoglobin A, leads to Hemoglobin A1c, which can be measured in the bloodstream and is a marker for how much a person’s blood sugar has fluctuated over the past 3 months. What level of HbA1c is indicative of Diabetes?

  1. ) 5.7-6.4
  2. ) > or = 7.0
  3. ) < 5.7
  4. ) > or = 6.5
A

4.) > or = 6.5

47
Q

Peroxisome Proliferator Activated Receptor (PPAR) are important in FA and glucose metabolism. Nutrients and activities that can assist in activation of these receptors include:

  1. ) Exercise
  2. ) Zinc and Magnesium
  3. ) All of these responses
  4. ) Vitamin E
  5. ) PUFA and 9-cis-retinoic acid
A

3.) All of these responses

48
Q

Insulin Resistance leads to increased cardiovascular disease risks through:

  1. ) Increased PAI-1
  2. ) Increased inflammation through peroxidation
  3. ) All of these responses
  4. ) Increased TG, VLDL, and LDL
A

3.) All of these responses

49
Q

Glucagon rises in a fasting state and controls metabolism by:

A: All of these responses

  1. ) Blocking glycolytic enzymes
  2. ) Inhibiting glycogen synthase
  3. ) Increases PEP-carboxykinase
A

A: All of these responses

Glucagon blocks glycolysis, increases gluconeogenesis (PEP-carboxykinase) and decreases glycogenesis (glycogen synthase).

50
Q

Metabolic Syndrome (Syndrome X) is a combination of metabolic changes including hypertension, insulin resistance, and dyslipidemia. The dyslipidemia is characterized by:

  1. ) Decline in TG
  2. ) Decline in HDL
  3. ) Decline in VLDL
  4. ) Decline in LDL
A

2.) Decline in HDL

51
Q

During heme degradation, which degradation product of bilirubin gives urine its yellow color?

A

A: Urobilin

52
Q

One of the maladaptive responses in insulin resistance includes dyslipidemia. Increased activity of vascular lipoprotein lipase leads to increased chylomicron and VLDL release of non-esterified or:

A

A: Free-fatty acids

Non esterified fatty acids = Free FA

53
Q

The correlation of hyperinsulinemia and increases in hypertension come from the hyperinsulinemia causing:

  1. ) Increased sodium retention and uric acid retention
  2. ) Improved thermogenesis
  3. ) Increased potassium retention
  4. ) Increased blood flow to peripheral tissues
A

1.) Increased sodium retention and uric acid retention

54
Q

Difficulty losing weight with insulin resistance comes from the body’s inability to increase body heat from increased decoupling of the ETC and oxidative phosphorylation (and hence remove excess energy from carbohydrates and lipids as heat). This process is called:

  1. ) Metabolic Syndrome
  2. ) Obesity
  3. ) Thermogenesis
  4. ) Diabetes Mellitus
A

3.) Thermogenesis

55
Q

Obstruction of the bile duct from gallstones (called extrahepatic cholestasis) can cause symptoms of pale clay colored stools and dark urine upon standing. This occurs because:

  1. ) The liver regurgitates stercobilin into the blood and the decline of urobilinogen entering the GI tract
  2. ) The liver regurgitates conjugated bilirubin into the blood and the decline of conjugated bilirubin entering the GI tract
  3. ) The liver regurgitates unconjugated bilirubin into the blood and the decline of unconjugated bilirubin entering the GI tract
  4. ) The liver regurgitates biliverdin into the blood and the decline of heme entering the GI tract
A

2.) The liver regurgitates conjugated bilirubin into the blood and the decline of conjugated bilirubin entering the GI tract

56
Q

Delta-aminolevulinic acid (ALA synthase) creates delta-aminolevulinic acid from what substrates?

  1. ) Succinyl CoA and heme
  2. ) Succinyl CoA and iron
  3. ) Succinyl CoA and glycine
  4. ) Succinyl CoA and vitamin B12
A

3.) Succinyl CoA and glycine

57
Q

The reabsorption of urobiliogens from the GI to the liver so they can be resecreted into the bile is called the______________.

  1. ) Enterohepatic Urobiliogen Cycle
  2. ) Hepatosplenic Urobilinogen Cycle
  3. ) Entersplenic Urobilinogen Cycle
  4. ) Enterohepatic Stercobilin Cycle
A

1.) Enterohepatic Urobiliogen Cycle

58
Q

Hyperbilirubinemia can lead to Jaundice, yellowing of the skin, nail beds and whites of the eyes. Acute hemolytic crises found in G6PD deficiency and Sickle Cell Anemia can cause hyperbilirubinemia and jaundice from an:

  1. ) Increase in stercobilin and urobilinogen
  2. ) Increase in unconjugated bilirubin only
  3. ) Increase in conjugated bilirubin only
  4. ) Increase in unconjugated and conjugated bilirubin
A

4.) Increase in unconjugated and conjugated bilirubin

59
Q

Which enzyme in the heme biosynthesis pathways contains zinc and is located in the cytosol?

  1. ) Delta-ALA Dehydratase
  2. ) Hydroxymethylbilane Synthase
  3. ) Uroporphyrinogen Decarboxylase
  4. ) ALA Synthase
A

1.) Delta-ALA Dehydratase

This enzyme converts 2 ALA into porphobilinogen and is very sensitive to heavy metals like lead because they replace the zinc.

60
Q

How many ATP are needed to create active ALA synthase (to fold it, activate it, and transport it into the term-51mitochondria)?

  1. ) 3 ATP
  2. ) 4 ATP
  3. ) 2 ATP
  4. ) 1 ATP
A

3.) 2 ATP

61
Q

The first step in heme degradation utilizes heme oxygenase to create biliverden. What reductant is required for this pathway to function?

  1. ) GTP
  2. ) NADH
  3. ) NADPH
  4. ) ATP
A

3.) NADPH

62
Q

How can porphyrias arise from a low caloric (low glucose) diet?

  1. ) Because ALAS1 will be downregulated to push the heme biosynthesis pathway
  2. ) Because Delta-ALA dehydratase will be upregulated in the heme biosynthesis pathway
  3. ) Because ALA synthase 1 will be upregulated to push heme biosynthesis.
  4. ) Because Delta-ALA dehydratase will be downregulated in the heme biosynthesis pathway
A

3.) Because ALA synthase 1 will be upregulated to push heme biosynthesis.

Glucose inhibits ALAS1, so it is automatically upregulated in the absence of glucose. This is why glucose is given IV to people with acute porphyrias and why it is important for people with porphyrias to avoid crash dieting and low carb diets.

63
Q

What is the abbreviation for Glutamine?

  1. ) Gln
  2. ) Glt
  3. ) Glu
  4. ) Gly
A

1.) Gln

64
Q

What are the four conditionally essential amino acids?

  1. ) Arg, Gln, Gly, Ser
  2. ) Arg, Glu, Gly, Tau
  3. ) Arg, Glu, Gly, Ser
  4. ) Arg, Gln, Gly, Tau
A

4.) Arg, Gln, Gly, Tau

65
Q

List the large neutral AA:

  1. ) Trp, Tyr, Phe, Leu, Ile, Val
  2. ) Trp, Thr, Phe, Leu, Ile, Met
  3. ) Trp, Thr, Phe, Leu, Ile, Val
  4. ) Trp, Tyr, Phe, Leu, Ile, Met
A

4.) Trp, Tyr, Phe, Leu, Ile, Met

66
Q

If there is a defect in the SN1-SN2 transporter allowing Gln into the presynaptic nerve terminal, what will happen to Glu levels within the presynaptic nerve terminal?

  1. ) Glu levels will decline unless the EEAC1 receptor can compensate
  2. ) Glu levels will increase unless the EEAC1 receptor can compensate
  3. ) Glu levels will increase unless the GLAST receptor can uptake Glu into the perineuronal astrocyte
  4. ) Glu levels will decline unless the GLAST receptor can uptake Glu into the perineuronal astrocyte
A

1.) Glu levels will decline unless the EEAC1 receptor can compensate

67
Q

GS (Glutamine Synthetase) requires the use of what minerals to assist in the conversion of Glu -> Gln?

  1. ) Mg++, Se++
  2. ) Se++, Mn++
  3. ) Mg++, Zn++
  4. ) Mg++, Mn++
A

4.) Mg++, Mn++

68
Q

NH3 is ___(a)___ and acts to help buffer __(b)__ environments.

  1. ) (a) mildly basic, (b) acidic
  2. ) (a) mildly basic, (b) basic
  3. ) (a) mildly acidic, (b) basic
  4. ) (a) mildly adicic, (b) acidic
A

1.) (a) mildly basic, (b) acidic

69
Q

In the urea cycle, Citrulline combines with Aspartate to form ______________ via the enzyme ASS (argininosuccinate synthase/synthetase).

  1. ) Argininoglutarate
  2. ) Argininomalate
  3. ) Argininoaspartate
  4. ) Argininosuccinate
A

4.) Argininosuccinate

70
Q

In the urea cycle, Arginase requires what cofactor to convert Arg -> Orn + urea?

  1. ) Mn++
  2. ) Mg++
  3. ) Cu++
  4. ) Zn++
A

1.) Mn++

71
Q

A defect in the urea cycle enzyme argininosuccinate lyase, will lead to the accumulation of what substrate?

  1. ) Fumarate
  2. ) Argininosuccinate
  3. ) Arginine
  4. ) Citrulline
A

2.) Argininosuccinate

72
Q

In the urea cycle, CPS (mitochondrial carbamoyl phosphate synthase 1) converts ammonia + H2O + 2 ATP + CO2 -> ______________.

  1. ) Carbamoyl phosphate + AMP + diphosphate
  2. ) Carbamoyl phosphate + SO4, 2 ADP
  3. ) Carbamoyl phosphate + PO4 + AMP
  4. ) Carbamoyl phosphate + PO4 + 2 ADP
A

4.) Carbamoyl phosphate + PO4 + 2 ADP

73
Q

The pathway Arg -> Orn + a-KG -> -> Pro for the creation of collagen via the enzymes arginase, ornithine aminotransferase and pyrroline-5-carbosylate reductase require what nutrients for proper activity?

  1. ) Mn++, B5, retinoic acid, B3, Mg++
  2. ) Mn++, P5P, B5, B3, Mg++
  3. ) Zn++, B5, retinoic acid, B3, Mg++
  4. ) Mn++, P5P, retinoic acid, B3, Mg++
A

4.) Mn++, P5P, retinoic acid, B3, Mg++

74
Q

Arg -> ADMA via PRMT (methionine dependent protein arginine N-methyltransferase) requires what nutrient?

  1. ) SAH
  2. ) Homocysteine
  3. ) Met
  4. ) SAMe
A

4.) SAMe

75
Q

BCAA are converted to alpha-ketoacids via BCAA transaminase. This enzyme requires the cofactor:

  1. ) B3
  2. ) B6
  3. ) B5
  4. ) B2
A

BCAA are converted to alpha-ketoacids via BCAA transaminase. This enzyme requires the cofactor:

  1. ) B3
  2. ) B6
  3. ) B5
  4. ) B2
76
Q

Branched Chain Ketoacid Dehydrogenase Complex (BCKDC) attaches Coenzyme A (CoA) to alpha-ketoacids. The nutrients utilized in this reaction as either substrate or cofactors are:

1.) B2, B3, B5, Lipoic Acid
2.) B1, B3, B5, B6, Lipoic Acid
3,) B1, B2, B3, B6, Lipoic Acid
4.) B1, B2, B3, B5, Lipoic Acid

A

4.) B1, B2, B3, B5, Lipoic Acid

77
Q

Lysine does NOT undergo the initial transamination requiring B6 but downstream conversion of alpha-aminoadipic acid (a-AAA) to alpha-ketoadipate does require B6. What nutrient is required for the initial conversion of Lys -> Saccharopine?

  1. ) B2
  2. ) B12
  3. ) B5
  4. ) B3
A

4.) B3

78
Q

Phenylalanine Hydroxylase (PAH) requires what nutrients for conversion of Phe -> Tyr?

1) Copper, B2, BH4
2. ) Copper, B3, BH4
3. ) Iron, B2, BH4
4. ) Iron, B3, BH4

A

4.) Iron, B3, BH4

79
Q

What two nutrients are required by both tyrosine hydroxylase (TH) and phenylalanine hydroxylase (PAH)?

  1. ) Iron, Vitamin C
  2. ) Copper, Vitamin C
  3. ) Vitamin C, tetrahydrobiopterin
  4. ) Iron, tetrahydrobiopterin
A

4.) Iron, tetrahydrobiopterin

80
Q

Conversion of norepinephrine -> epinephrine via the enzyme Phenylethanolamine-N-Methyltransferase (PNMT) utilizes what nutrient in this reaction?

  1. ) Copper
  2. ) Iron
  3. ) SAMe
  4. ) Vitamin C
A

3.) SAMe

81
Q

Tryptophan monooxygenase (ie. tryptophan hydroxylase), like tyrosine hydroxylase and phenylalanine hydroxylase require what cofactors for proper functionality?

  1. ) Tetrahydrobiopterin, vitamin C
  2. ) Iron, tetrahydrobiopterin
  3. ) Iron, Vitamin C
  4. ) Copper, Vitamin C
A

2.) Iron, tetrahydrobiopterin

82
Q

What enzyme requiring B6 converts Glutamate -> Gamma-amino-N-butyric acid (GABA)?

  1. ) Succinate semialdehyde dehydrogenase
  2. ) Glutamic acid decarboxylase (GAD)
  3. ) Monoamine oxidase
  4. ) Catechol-O-methyltransferase
A

2.) Glutamic acid decarboxylase (GAD)

83
Q

Both Methionine Synthase (MS) and Betaine Homocysteine Methyltransferase (BHMT) can convert homocysteine to methionine with the assistance of what mineral?

  1. ) Zn++
  2. ) Fe++
  3. ) Cu++
  4. ) Mg++
A

1.) Zn++

84
Q

Heme iron, B6, betaine and SAMe assist Cystathionine Beta-Synthase (CBS) in activating the transulfuration pathway in oxidative stress to convert homocysteine + ___________ -> cystathionine.

  1. ) Serine
  2. ) Cystine
  3. ) Glycine
  4. ) Methionine
A

1.) Serine

85
Q

Homocysteine is considered the _____________ form of homocystine.

  1. ) Oxidized
  2. ) Reduced
A

2.) Reduced

86
Q

Supplementation with what vitamin raises betaine levels?

  1. ) Cobalamin
  2. ) Pantothenic acid
  3. ) Pyridoxine
  4. ) Folic acid
A

4.) Folic acid

87
Q

True/False: Oxidative stress activates the transulfuration pathway to divert sulfur-containing amino acids into the creation of Glutathione, a major antioxidant.

A

A: True

88
Q

Glutathione reductase converts GSSG -> 2 GSH. What nutrients assist this process?

  1. ) NAD, Cu++, Fe++
  2. ) FAD, Zn++, Fe++
  3. ) FAD, NAD, Cu++
  4. ) NAD, Zn++, Fe++
A

3.) FAD, NAD, Cu++

89
Q

What AA is a precursor to serine and component of glutathione?

  1. ) Tryptophan
  2. ) Glycine
  3. ) Phenylalanine
  4. ) Taurine
A

2.) Glycine

90
Q

While the Glycine Cleavage System utilizes Gly, NAD, and THF in the chain reactions to create 5,10-Methylene THF, it also contains a _________ binding domain and __________ prosthetic group.

  1. ) Fe++, Cu++
  2. ) B12, Fe++
  3. ) FAD, Cu++
  4. ) FAD, Lipoic Acid
A

4.) FAD, Lipoic Acid

91
Q

Sarcosine (aka N-methylglycine) can be a storage or buffer for excess methyl groups that are transferred from _________ to Glycine to create sarcosine.

  1. ) MET
  2. ) Homocysteine
  3. ) SAH
  4. ) SAMe
A

4.) SAMe (Via enzyme glycine-N-methyltransferase)

92
Q

What nutrients are required for the creation of connective tissue components Hydroxyproline (HPro) and Hydroxylysine (HLys)?

  1. ) Vitamin A, Iron
  2. ) Vitamin A, Copper
  3. ) Vitamin C, Copper
  4. ) Vitamin C, Iron
A

4.) Vitamin C, Iron

93
Q

In the urea cycle, Ornithine + Carbomoyl phosphate -> PO4 + Citrulline is catalyzed by what enzyme?

A

A: OTC (Mitochondrial ornithine transcarbamoylase)

94
Q

T/F: ADMA (asymmetric dimethylarginine) activates nitric oxide synthesis and angiogenesis.

A

False

95
Q

Histidine is converted to histamine via histadine decarboxylase. What cofactor is required for this reaction?

  1. ) Flavoprotein
  2. ) Nicotinamide
  3. ) Pantothenic acid
  4. ) Pyridoxal-5-phosphate
A

4.) Pyridoxal-5-phosphate

96
Q

Histamine can be degraded through hepatic (liver) diamine oxidase and aldehyde dehydrogenase OR through extra-hepatic pathways utilizing histamine N-methyltransferase. How do the nutrient requirements differ for these pathways?

  1. ) N-methyltransferase is a flavoprotein
  2. ) Diamine Oxidase is a flavoprotein
  3. ) N-Methyltransferase is copper-dependant
  4. ) Diamine Oxidase is copper-dependent
A

4.) Diamine Oxidase is copper-dependent

97
Q

Coversion of Lys -> -> -> Carnitine is important because carnitine shuttles FA into the mitochondria for Beta-oxidation. Along with Lys, what nutrients would improve enzymatic function of this pathway?

A

A: SAMe, a-KG, B3, Fe++, vitamin C

98
Q

Degradation of serotonin -> 5HIAA via monoamine oxidase (MAO) requires what two minerals for functionality?

1.) Iron, Vitamin C
2.) Copper, Zinc
3,) Iron, Zinc
4.) Copper, Iron

A

4.) Copper, Iron

99
Q

Alpha-amino-N-butyric acid (AANB) may be elevated in alcoholism. What nutrient may be deficient when AANB is elevated?

  1. ) B2
  2. ) B6
  3. ) Iron
  4. ) B3
A

2.) B6

100
Q

Methionine adenosyltransferase converts Met -> to ________ with the assistance of ATP and H2O.

  1. ) SAH
  2. ) SAMe
  3. ) Homocysteine
  4. ) Cysteine
A

2.) SAMe

101
Q

Taurine, which is utilized in skeletal muscle and bile, can be created from cysteine with the assistance of what nutrients?

  1. ) Iron, NAD, FAD, B12
  2. ) Iron, P5P, Folate, B12
  3. ) Iron, NAD, FAD, Folate
  4. ) Iron, P5P, FAD, NAD
A

4.) Iron, P5P, FAD, NAD

102
Q

Serine Hydroxymethyltransferase (SHMT) interconverts serine and glycine with the assistance of what nutrients?

  1. ) NAD, P5P, Mn++
  2. ) FAD, P5P, Mn++
  3. ) 5,10-Methylene THF, P5P, Mn++
  4. ) Cobalamin, P5P, Mn++
A

3.) 5,10-Methylene THF, P5P, Mn++

103
Q

In biochemistry, an enzyme ends with “-ase” like lactase, a sugar ends in “-ose” like lactose, and the ionized form of an organic acid ends in “____________.”

  1. ) “-ate” like butryate
  2. ) “ite” like carbonite
  3. ) “-yl” like acetyl
  4. ) “-one” like ketone
A

1.) “-ate” like butryate

104
Q

The central energy pathways begin with digestion and assimilation of fats, carbohydrates, and proteins. Carbohydrates require the use of _____________________ for conversion to acetyl-CoA and entry into the TCA cycle.

  1. ) Vitamins B1, B2, B3, B5 and B6
  2. ) Vitamins B1, B2, B3, B6, and Lipoate
  3. ) Vitamins B2, B3, B5, B6, and Lipoate
  4. ) Vitamins B1, B2, B3, B5 and Lipoate
A

4.) Vitamins B1, B2, B3, B5 and Lipoate

105
Q

The central energy pathways begin with digestion and assimilation of fats, carbohydrates, and proteins. Proteins require the use of ________________ for the conversion of ketoacids into acetyl-CoA.

  1. ) Vitamins B1, B2, B3, B5 and Lipoate
  2. ) Vitamins B1, B2, B3, B5 and B6
  3. ) Vitamins B2, B3, B5, B6 and Lipoate
  4. ) Vitamins B1, B2, B3, B6, and Lipoate
A

1.) Vitamins B1, B2, B3, B5 and Lipoate

106
Q

The conversion of alpha-ketoglutarate (a-KG) to succinyl-CoA via the enzyme a-KG dehydrogenase, is similar to other dehydrogenase complexes (like BCKDC) in that it also requires the same nutrients for functionality, ______________________.

  1. ) Vitamins B1, B2, B3, B5 and Lipoate
  2. ) Vitamins B1, B2, B3, B6, and Lipoate
  3. ) Vitamins B1, B2, B3, B5 and B6
  4. ) Vitamins B2, B3, B5, B6, and Lipoate
A

1.) Vitamins B1, B2, B3, B5 and Lipoate

107
Q

Citrate, Cis-Aconitate, and Isocitrate are located at the beginning of the TCA cycle. Elevations in cis-aconitate can indicate dysfunction of the enzyme aconitase, which requires the mineral ______________ and cysteine.

  1. ) Se++
  2. ) Zn++
  3. ) Cu++
  4. ) Fe++
A

4.) Fe++

108
Q

High MMA can inhibit the ______________ transporter, leading to elevations of it in the urine. Hence elevations in this TCA cycle intermediate can be from vitamin B12 deficiency.

  1. ) Aspartate
  2. ) Fumarate
  3. ) Carnitine
  4. ) Malate
A

4.) Malate

109
Q

Low urinary citrate levels have been associated with kidney stone formation. What type of diet may increase the risk of kidney stone formation?

  1. ) High carbohydrate, low protein
  2. ) High carbohydrate, high fat
  3. ) Low protein, high fat
  4. ) High protein, low carbohydrate
A

4.) High protein, low carbohydrate

110
Q

Asparagine (from asparagus) can be converted into aspartate. Aspartate is in a unique position to enter the TCA cycle through its conversion into the TCA cycle intermediate, __________________, via the enzyme AST (SGOT) and cofactor vitamin B6.

  1. ) Citrate
  2. ) Oxaloacetate
  3. ) Pyruvate
  4. ) Malate
A

2.) Oxaloacetate

111
Q

Inhibition of CoQ10 synthesis from statin drugs, will typically reveal elevations in urinary_____________________.

  1. ) Hydroxymethylglutarate
  2. ) Hydroxymethylpropionate
  3. ) Hydroxymethylbutyrate
  4. ) Hydroxymethylsuccinate
A

1.) Hydroxymethylglutarate

112
Q

Elevations in suberate, adipate, and ethylmalonate indicate dysfunction of _______________ metabolism.

  1. ) Carbohydrate
  2. ) Fatty acid
  3. ) Mineral
  4. ) Protein
A

2.) Fatty acid

113
Q

Elevations in lactate, pyruvate, and beta-hydroxybutyrate indicate abnormalities in _______________ metabolism.

  1. ) Protein
  2. ) Carbohydrate
  3. ) Fat
  4. ) Mineral
A

2.) Carbohydrate

114
Q

Elevations in lactate can indicate disruption of carbohydrate metabolism and the body’s need to regenerate the vitamin _____________ to keep the glycolytic pathway functional

  1. ) NADH
  2. ) NADPH
  3. ) FADH
  4. ) NAD
A

4.) NAD

115
Q

High urinary oxalates may occur from:

  1. ) GI bacteria that produce it
  2. ) Dietary ingestion of spinach, peanuts, beets, and chocolate
  3. ) Absence of Oxalobacter formigenes
  4. ) All of these responses
A

4.) All of these responses

116
Q

Beta-hydroxybutyrate is a ketone body formed in diabetes (from the failure to utilize glucose appropriately) or from a low carbohydrate diet increasing dependency on FA oxidation. Both scenarios lead to a spill over of acetyl-CoA, which gets converted into beta-hydroxybutyrate. Treatment with what two minerals can help support the action of insulin and rebalance carbohydrate metabolism?

  1. ) Magnesium and Copper
  2. ) Zinc and selenium
  3. ) Chromium and vanadium
  4. ) Manganese and iron
A

3.) Chromium and vanadium

117
Q

Elevation of the kynurenin pathway constituent 3-hydroxykynurenin leads to its side conversion into xanthurenate, which spills into the urine and can indicate insufficiency of vitamin ___________.

  1. ) B6
  2. ) B5
  3. ) B3
  4. ) B2
A

1.) B6

118
Q

Catabolism of several AA and odd-chain FA eventually yields methylmalonyl-CoA (MMA). MMA conversion via the enzyme methylmalonyl-CoA mutase requires the vitamin:

  1. ) B12
  2. ) B2
  3. ) B3
  4. ) B6
A

1.) B12

119
Q

The marker for biotin insufficiency is:

  1. ) Valine
  2. ) alpha-keto-beta-methylvalerate
  3. ) Beta-hydroxyisovalerate
  4. ) alpha-ketoisovalerate
A

3.) Beta-hydroxyisovalerate

120
Q

It is important to note that elevations in Xanthurenate indicate that you should NOT supplement with any amino acids till you have first supplemented with vitamin _______ because transamination function is impaired.

  1. ) B3
  2. ) B6
  3. ) B5
  4. ) B2
A

2.) B6

121
Q

Formiminotransferase utilizes ____________ to convert FIGLU to glutamate.

  1. ) 5,10-methylene THF
  2. ) 5-formimino-THF
  3. ) THF
  4. ) 5MTHF
A

3.) THF

122
Q

Insufficiency of vitamins B1, B2, B3, and B5 can lead to reduced enzymatic function of branched chain ketoacid dehydrogenase complex and causing increased urinary:

  1. ) All of these responses
  2. ) alpha-ketoisovalerate
  3. ) alpha-keto-beta-methylvalerate
  4. ) alpha-ketoisocaproate
A

1.) All of these responses

123
Q

High protein diets increase activity of ACMSD (alpha-amino-beta-carboxymuconate-E-semialdehyde decarboxylase), which converts 2-amino-3-carboxymuconate into the organic acid __________________ and leads to the upregulation of NO synthase, shifts Tryptophan metabolism away from B3 formation, and leads to activation of inflammatory chemokines.

  1. ) Quinolinate
  2. ) Kynurenate
  3. ) Nicotinate
  4. ) Picolinate
A

4.) Picolinate

124
Q

Copper deficiency can lead to reduced activity of dopamine beta-monooxygenase (DBM), which converts dopamine -> norepinephrine. Hence, in copper deficiency you can find elevated urinary ____(a)____ and reduced urinary ____(b)_____ .

  1. ) (a) VMA, (b) HVA
  2. ) (a) HVA, (b) 5HIAA
  3. ) (a) 5HIAA, (b) VMA
  4. ) (a) HVA, (b) VMA
A

4.) (a) HVA, (b) VMA

125
Q

Norepinephrine and epinephrine can be degraded into _________________ via the enzymes COMT and MAO.

  1. ) Quinolinate
  2. ) Hydroxyindoleacetate
  3. ) Homovanillate
  4. ) Vanilmandelate
A

4.) Vanilmandelate

126
Q

Homovanillate is the degradation product of _____________ catabolism.

  1. ) Serotonin
  2. ) Dopamine
  3. ) Epinephrine
  4. ) Norepinephrine
A

2.) Dopamine

127
Q

The ratio of kynurenate (KYNA) to quinolinate (QUIN) is important because:

  1. ) KYNA blocks NMDA receptors reducing glutamate excitotoxicity
  2. ) KYNA activates NMDA receptors leading to increased glutamate toxicity
  3. ) QUIN block NMDA receptors reducing glutamate excitotoxicity
  4. ) QUIN activates NMDA receptors leading to reduced glutamate toxicity
A

1.) KYNA blocks NMDA receptors reducing glutamate excitotoxicity

128
Q

Catechol-O-methyltransferase (COMT) utilizes _________ and _________ to degrade the catecholamines dopamine, norepinephrine, and epinephrine.

  1. ) Cu++ and Fe++
  2. ) NAD and Mg++
  3. ) NAD and P5P
  4. ) SAMe and Mg++
A

4.) SAMe and Mg++

129
Q

Homogentisate (HGA) may be elevated in urine from excess supplementation of the amino acid ______________.

  1. ) Cysteine
  2. ) Methionine
  3. ) Tyrosine
  4. ) Tryptophan
A

3.) Tyrosine

Part of tyrosine degradation pathway.

130
Q

____________ is a metabolite of Tyrosine, is a cell proliferation marker, and may indicate normal tissue growth or tumor growth.

  1. ) p-Hydroxyphenyllactate (HPLA)
  2. ) p-Hydroxyphenylpyruvate (HPP)
  3. ) Methyl-p-Hydroxyphenyllactate (MeHPLA)
  4. ) p-Hydroxyphenylacetate (HPA)
A

1.) p-Hydroxyphenyllactate (HPLA)

131
Q

High urinary _____________, a marker for phase I and II liver detoxification, may indicate exposure to pesticides, petrochemicals, alcohol and drugs.

  1. ) Pyroglutamate
  2. ) 2-Methylhippurate
  3. ) Alpha-Hydroxybutyrate
  4. ) Glucarate
A

4.) Glucarate

132
Q

When the DNA oxidative damage marker, __________________, is seen elevated in urine with high QUIN and high HPLA, this indicates sustained inflammatory responses and increased cell proliferation rates causing increased reactive oxygen species (ROS), which lead to DNA damage via oxidation.

  1. ) 8-hydroxy-2’-deoxyguanosine (8-OHDG)
  2. ) 2-Methylhippurate
  3. ) Homogentisate
  4. ) Glucarate
A

1.) 8-hydroxy-2’-deoxyguanosine (8-OHDG)

133
Q

Alpha-hydroxybutyrate appears elevated in the urine when there has been a shift from trans- ___(a)___ to trans- ___(b)___ , to increase the creation of ___(c)___ .

  1. ) (a) sulfuration, (b) methylation, (c) methionine
  2. ) (a) sulfuration, (b) methylation, (c) GSH
  3. ) (a) methylation (b) sulfuration, (c) methionine
  4. ) (a) methylation, (b) sulfuration, (c) GSH
A

4.) (a) methylation, (b) sulfuration, (c) GSH

134
Q

High ammonia levels from urea cycle dysfunction can lead to the accumulation of _ (a) . Treatment with (b) , may help the urea cycle function better and decrease urinary (a) levels.

  1. ) (a) Orotate, (b) Arginine, Mg++
  2. ) (a) Pyroglutamate, (b) NAC
  3. ) (a) Glucarate, (b) Arginine, Mn++
  4. ) (a) Sulfate, (b) NAC
A

1.) (a) Orotate, (b) Arginine, Mg++

135
Q

Deficiency of the mineral, ___________, can lead to decreased incorporation of cystine into protein, allowing sulfate to spill into the urine.

  1. ) Zinc
  2. ) Copper
  3. ) Selenium
  4. ) Iron
A

1.) Zinc

136
Q

Elevations in __(a) _ from xylene exposure may warrant supplementation with _(b) to assist cytochrome P450 oxidase enzymes and phase II conjugation reactions.

  1. ) (a) 2-Methylhippurate, (b) NAC and B3
  2. ) (a) Homogentisate, (b) NAC and P5P
  3. ) (a) 2-Methylhippurate, (b) Glycine and B5
  4. ) (a) Homogentisate, (b) Glycine and B3
A

3.) (a) 2-Methylhippurate, (b) Glycine and B5

137
Q

Elevations in benzoate and not hippurate indicate:

  1. ) Difficulty with phase II conjugation
  2. ) There is a need for Glycine
  3. ) All of these responses
  4. ) There is a need for B5
A

3.) All of these responses

138
Q

Clostridia species, like C. difficile, can lead to elevations in several microbial dysbiosis markers such as:

  1. ) Phenylpropionate
  2. ) 3,4-Dihydroxyphenylpropionate
  3. ) All of these responses
  4. ) p-Cresol
A

3.) All of these responses

139
Q

Bacterial ingestion of dietary polyphenols can lead to the creation of the intestinal dysbiosis markers _______________.

  1. ) D-Arabinitol, Dihydroxyphenylpropionate
  2. ) Cresol, Hydroxybenzoate, D-Arabinitol
  3. ) Tricarballylate, D-Lactate
  4. ) Benzoate, Hippurate, Phenylacetate, Phenylpropionate
A

4.) Benzoate, Hippurate, Phenylacetate, Phenylpropionate

140
Q

Poor absorption of the amino acid, ___(a)___, can lead to accumulation of the dysbiosis metabolite ___(b)____.

  1. ) (a) Tyrosine, (b) Tricarballylate
  2. ) (a) Tryptophan, (b) Indican
  3. ) (a) Tryptophan, (b) Tricarballylate
  4. ) (a) Tyrosine, (b) Indican
A

2.) (a) Tryptophan, (b) Indican

141
Q

High urinary D-Lactate may indicate a person:

  1. ) Is ingesting too much Lactobacillus acidophilus or L. plantarum
  2. ) Has short bowel syndrome
  3. ) Is ingesting too many carbohydrates
  4. ) All of these responses
A

4.) All of these responses

142
Q

A reaction that forms intermediates in a metabolic pathways like in the TCA cycle from precursors that are not part of the original metabolic pathway is considered a(n) ___________ reaction.

A

A: Anaplerotic reaction

143
Q

The central energy pathways begin with digestion and assimilation of fats, carbohydrates, and proteins. Long chain FA require the use of the _________ shuttle to help them enter the mitochondrial for beta-oxidation.

A

A: Carnitine

144
Q

Isocitrate dehydrogenase converts isocitrate -> a-KG with the assistance of:

A

A: Mg++, Mn++, NAD+

145
Q

Succinate is unique because it not only is one of the TCA cycle intermediates, but is can also feed electrons directly to complex II of the ETC, via succinate dehydrogenase. This enzyme requires (a)_________ to function. Low levels of (b)_________ may also raise levels of succinate and all the TCA cycle intermediates because the ETC becomes halted, causing a backup of the TCA cycle.

A

A: (a) FAD, (b) CoQ10

146
Q

High levels of suberate, adipate and ethylmalonate can be reduced with vitamin ________, which is utilized by the flavoprotein enzyme Fatty Aycl-CoA Dehydrogenase.

A

A: B2

147
Q

Breakdown of serotonin into 5-hydroxyindolacetate (5HIAA) occurs via the enzyme (a)_______, which requires (b)_________.

A

A: (a) ALD, (b) Cu++ and Fe++

148
Q

Breakdown of serotonin into 5-hydroxyindolacetate (5HIAA) occurs via the enzyme (a)_______, which requires (b)_________.

A

A: (a) ALD, (b) Cu++ and Fe++

149
Q

Elevation in urinary pyroglutamate indicates that supplementation with ________ may be beneficial.

A

A: NAC, Glycine, GSH, antioxidants, Mg++

150
Q

The Hormesis Model may be a better indicator of dose-response curves of many toxins because many substances have:

  1. ) All of the above
  2. ) Biphasic responses
  3. ) Beneficial and toxic doses
  4. ) Opposite responses dependent upon dosage
A

1.) All of the above

151
Q

The insecticide DDT, a chlorinated hydrocarbon pesticide, has been banned in the USA since the 1970s but is still causing toxic side effects today because it is:

  1. ) All of these responses
  2. ) A persistent toxin
  3. ) Bioaccumulative
  4. ) Still used overseas
A

1.) All of these responses

152
Q

Toxic insults can be addictive in nature. Which of the following could lead to synergistic effects of toxic insults?

  1. ) All of these reasons
  2. ) Reduced nutrients
  3. ) Multiple toxins
  4. ) Poor diet
  5. ) Pharmaceutical drugs
  6. ) Genetic SNPs
A

1.) All of these reasons

153
Q

Testing toxin load can be difficult depending upon the type of toxin and where it prefers to deposit. For instance, non-polar organotoxins preferentially deposit in _____(a) tissue and may require a ____ (b) because they quickly clear from blood and urine.

  1. ) (a) Adipose, (b) fat biopsy
  2. ) (a) Muscle, (b) muscle biopsy
  3. ) (a) bone, (b) bone biopsy
  4. ) (a) synovium, (b) synovial aspirate
A

1.) (a) Adipose, (b) fat biopsy

154
Q

Two major types of organotoxins are xylene and phthalates. Since both can be stored in adipose, measuring the hepatic detoxification product ________________ in the urine, can reveal that xylene is still being processed long after the initial exposure.

  1. ) 2-methylhippurate
  2. ) Hippurate
  3. ) Benzoate
  4. ) Sodium benzoate
A

1.) 2-methylhippurate

155
Q

Advanced glycation end-products (AGEs) are created when glucose reacts spontaneously with ___(a)___ on proteins to create ____(b)___ products that spontaneously and irreversibly degrade to form AGEs.

  1. ) (a) amino acids, (b) Maillard reaction
  2. ) (a) amino acids, (b) Fenton reaction
  3. ) (a) organic acids, (b) Maillard reaction
  4. ) (a) organic acids, (b) Fenton reaction
A

1.) (a) amino acids, (b) Maillard reaction

156
Q

Treatments to reduce AGEs and ALEs include:

  1. ) All of these responses
  2. ) Antioxidants to reduce oxidation
  3. ) Phase I and II detox to remove RCOs
  4. ) Activation of lysosome degradation
  5. ) Normalizing plasma glucose levels
A

1.) All of these responses

157
Q

Porphyrias can occur from prolonged fasting because low glucose intake leads to:

  1. ) upregulation of ALAS1
  2. ) downregulation of ALAS1
  3. ) upregulation of ALA dehydratase
  4. ) downregulation of ALA dehydratase
A

1.) upregulation of ALAS1

158
Q

The first step in the formation of heme (porphyrinogen pathway) involves the substrates glycine and succinyl CoA being converted to _(a)__ by the enzyme (b).

  1. ) (a) delta-aminolevulinic acid, (b) delta-aminolevulinic acid synthase
  2. ) (a) ALA, (b) ALA dehydratase
  3. ) (a) succinate, (b) succinate dehydrogenase
  4. ) (a) hydroxymethylbilane, (b) hydroxymethylbilane snythase
A

1.) (a) delta-aminolevulinic acid, (b) delta-aminolevulinic acid synthase

159
Q

ALA + ALA -> porphobilinogen via the enzyme (a) which requires (b).

  1. ) (a) delta-ALA dehydratase, (b) Zinc
  2. ) (a) ALA synthase, (b) Zinc
  3. ) (a) porphobilinogen deaminase, (b) NH3
  4. ) (a) hydroxymethylbilane synthase, (b) NH3
A

1.) (a) delta-ALA dehydratase, (b) Zinc

160
Q

The enzyme CPOX (coproporphyrinogen oxidase) converts coproporphyrinogen III to protoporphyrinogen IX and is blocked by the heavy metals.

  1. ) Lead and Mercury
  2. ) Mercury and Arsenic
  3. ) Arsenic and Cadmium
  4. ) Lead and Cadmium
A

1.) Lead and Mercury

161
Q

The heavy metal ______ causes preferential elevation in Copro I: Copro III because it blocks the early steps of UROD decarboxylation, leading to the accumulation of uroporphyrinogen I, which converts to coproporphyrinogen I.

  1. ) Arsenic
  2. ) Mercury
  3. ) Lead
  4. ) Cadmium
A

1.) Arsenic

162
Q

UROD is blocked by both ___(a)___ . The difference between the two heavy metals is that ___(b)___ causes high pentacarboxyporphyrin because it slows UROD down, making the last decarboxylation step difficult.

  1. ) (a) As and Hg, (b) Hg
  2. ) (a) As and Hg, (b) As
  3. ) (a) Hg and Pb, (b) Pb
  4. ) (a) Pb and As, (b) As
A

1.) (a) As and Hg, (b) Hg

Arsenic blocks UROD at the beginning steps while Mercury blocks the last step of UROD.

163
Q

Elevations in BUN indicate increased load of ammonia. Checking the OA profile, you find high orotate levels, which could indicate there is a genetic SNP in the enzyme _____________.

  1. ) ornithine transcarbamoylase (OTC)
  2. ) argininesuccinate synthetase (ASS)
  3. ) argininosuccinate lyase (ASL)
  4. ) arginase
A

1.) ornithine transcarbamoylase (OTC)

164
Q

AST, ALT, CPK, and _____ are all enzymes that can be indicators of liver damage, which in turn means impaired liver function.

  1. ) gamma-glutamyl transpeptidase
  2. ) gamma-glutamyl cyclotransferase
  3. ) pyroglutaminase
  4. ) GSH synthase
A

1.) gamma-glutamyl transpeptidase

165
Q

High ammonia can be from impaired degradation of proteins, impaired urea cycle, and even exercise. High ammonia can also be indicative of:

  1. ) all of these responses
  2. ) bacterial overgrowth
  3. ) excessive glutamine intake
  4. ) deficiency of arginine
A

1.) all of these responses

166
Q

Alcohol, high protein diets, high brassica diets, saturated fats, steroid hormones, charcoal-broiled meats (AGEs), oranges, exhaust fumes, pesticides, niacin and riboflavin all have the following thing in common:

  1. ) they induce CYP enzymes
  2. ) they inactivate CYP enzymes
  3. ) they increase urea cycle intermediates
  4. ) they decrease urea cycle intermediates
A

1.) they induce CYP enzymes

167
Q

Clearance of the compound _________ is used to determine activity level of phase I detoxification.

  1. ) caffeine
  2. ) acetaminophen
  3. ) acetylsalicylic acid
  4. ) benzoic acid
A

1.) caffeine

168
Q

One of the three major pathways of phase I detoxification includes:

  1. ) Hydroxylation
  2. ) Decarboxylation
  3. ) Acetylation
  4. ) Sulfation
A

1.) Hydroxylation

Other ones are oxidation and reduction.

169
Q

CYP1A2 and CYP2E1 are important to remember because these pathways are activated by:

  1. ) caffeine
  2. ) estrogen
  3. ) alcohol
  4. ) cortisol
A

1.) caffeine

Both are also activated by acetaminophen

170
Q

Phase II detoxification involves conjugation of a water soluble constituent to a functional group on the toxin. These conjugation reactions can occur:

  1. ) on carboxyl, hydroxyl or amine groups
  2. ) multiple times creating many different types of metabolites
  3. ) along different pathways depending upon substrate concentration
  4. ) all of these responses
A

4.) all of these responses

171
Q

A low rate of caffeine clearance can indicate:

  1. ) all of these responses
  2. ) loss of liver function
  3. ) low level of toxin exposure
  4. ) genetic SNPs lowering phase I detox capacity
A

1.) all of these responses

172
Q

The activated form of glucuronic acid, ____(a)____ , is used in glucuronidation reactions and is produced from the oxidation of ____(b)____ .

  1. ) (a) UDP-glucuronic acid, (b) UDP-glucose
  2. ) (a) ADP-glucuronic acid, (b) ADP-glucose
  3. ) (a) GDP-glucuronic acid, (b) GDP-glucose
  4. ) (a) TDP-glucuronic acid, (b) TDP-glucose
A

1.) (a) UDP-glucuronic acid, (b) UDP-glucose

173
Q

The major and most common route for xenobiotic phase II metabolism is ___________ and it accounts for the majority of conjugated metabolites found in urine and bile.

  1. ) glucuronidation
  2. ) sulfation
  3. ) acetylation
  4. ) GSH conjugation
A

1.) glucuronidation

174
Q

Localization of the enzyme ____(a)____ in the ER right next to the cytochrome P450 enzymes enables it to reach the phase I metabolites before other phase II detox enzymes. The isoform ____(b)____ acts on the highest number of substrates (40%), including bile, morphine, and codeine.

  1. ) (a) UDP-glucuronyl transferase, (b) UGT2B4 (=2B7)
  2. ) (a) N-acetyl-transferase, (b) NAT2
  3. ) (a) glutathione-S-transferase, (b) GSTM1
  4. ) (a) sulfotransferase, (b) SULT1
A

1.) (a) UDP-glucuronyl transferase, (b) UGT2B4 (=2B7)

175
Q

GSH can conjugate with electrophiles through the enzyme ___________ to reduce the reactivity of these harmful substances.

  1. ) glutathione-S-transferase (GST)
  2. ) glutamyl-transferase
  3. ) cysteinyl-glycinase
  4. ) acetylase
A

1.) glutathione-S-transferase (GST)

176
Q

The sulfation pathway prevails over glucuronidation when there are adequate levels of sulfate and ATP with __________ of xenobiotics.

  1. ) low levels
  2. ) high levels
  3. ) multiple types
A

1.) low levels

177
Q

There are two major types of sulfotransferases. One type is membrane-bound in the golgi apparatus and sulfates GAGs and glycoproteins, while the other is located in the __________ and conjugates steroids, catecholamines, T4, bile acids, and xenobiotics.

  1. ) cytosol
  2. ) nucleus
  3. ) smooth ER
  4. ) mitochondria
A

1.) cytosol

178
Q

The most common amino acid used in conjugation reactions is __________, which is the preferential detoxification pathway of benzoic acid.

  1. ) glycine
  2. ) glutamine
  3. ) taurine
  4. ) cysteine
A

1.) glycine

179
Q

The rate of acetylation is important in detoxification because:

  1. ) slow acetylators accumulate higher blood concentrations of active drugs
  2. ) fast acetylators accumulate higher blood concentrations of active drugs
  3. ) fast acetylators eliminate the drug more slowly
  4. ) slow acetylators eliminate drugs more quickly
A

1.) slow acetylators accumulate higher blood concentrations of active drugs

180
Q

Methylation typically works on endogenous constituents, with O-methyl metabolites have ___(a)____ activity than the original molecule. The active methyl group used in methylation reactions is ____(b)____.

  1. ) (a) greater, (b) SAMe
  2. ) (a) lesser, (b) SAMe
  3. ) (a) greater, (b) 5MHTF
  4. ) (a) lesser, (b) 5MTHF
A

1.) (a) greater, (b) SAMe

181
Q

Biomethylation to remove arsenic requires the use of ____ SAMe as a methyl donor.

  1. ) 2
  2. ) 1
  3. ) 3
  4. ) 4
A

1.) 2

182
Q

True/False: Oral challenge with aspirin reveals higher glycine conjugate than glucuronides. This is a normal interpretation.

A

A: True

183
Q

Oral challenge with acetaminophen reveals increased glutathione conjugation with low sulfate and glucuronide conjugation. This person:

  1. ) all of these responses
  2. ) would benefit from sodium sulfate and NAC
  3. ) would benefit from reduced toxin exposure
  4. ) would benefit from oleic acid (olive oil)
A

1.) all of these responses

184
Q

Alcohol can deplete numerous nutrients. Match the nutrient depletion and the type of symptom/problem that can occur when that nutrient is depleted.

  1. ) Depletion of vitamins B1 and B6 causes
  2. ) Depletion of vitamins B6 and B9 causes
  3. ) Depletion of vitamin B1 causes
  4. ) Depletion of vitamin D causes
A
  1. ) neurological symptoms
  2. ) hematological symptoms
  3. ) Wernicke-Korsakoff syndrome
  4. ) osteoporosis
185
Q

Match the pathways of alcohol degradation with the appropriate enzyme.

  1. ) ethanol + NAD+ -> acetaldehyde + NADH
  2. ) acetaldehyde + NAD+ -> acetate + NADH
  3. ) ethanol + NADPH -> acetaldehyde + NADP+
A

1.) ethanol + NAD+ -> acetaldehyde + NADH
uses alcohol dehydrogenase

  1. ) acetaldehyde + NAD+ -> acetate + NADH uses aldehyde dehydrogenase
  2. ) ethanol + NADPH -> acetaldehyde + NADP+ uses cytochrome P450 CYP2E1
186
Q

Match the appropriate detox function with the specific nutrient:

  1. ) toxic metal binding & antioxidant protection
  2. ) hepatic conjugation substrates
  3. ) glutathione regeneration
  4. ) methyl donors
  5. ) lead protection
  6. ) stimulate Phase I and Phase II detox

vitamin C

NAC, Se, Mn, Cu, Zn

Calcium

glycine, sulfate

Met, SAMe

Cruciferous

A
  1. ) vitamin C
  2. ) glycine, sulfate
  3. ) NAC, Se, Mn, Cu, Zn
  4. ) Met, SAMe
  5. ) Calcium
  6. ) Cruciferous
187
Q

The definition of ________ is: a term used when products of detoxification processes are more toxic than the original substance.

  1. ) Biotoxification
  2. ) Detoxification
  3. ) Toxicology
  4. ) Hormesis
A

1.) Biotoxification

188
Q

One of the phthalate esters used in plastic wrap to cover foods can lead to decreased kidney function, increased cysts, increased peroxisome proliferation and even liver cancer in rats. This is a concern to humans because ______ is used in plastic tubing for hemodialysis.

  1. ) Di(2-ethylhexyl) phthalate (DEHP)
  2. ) Dimethyl phthalate (DMP)
  3. ) Diethyl phthalate (DEP)
  4. ) Polyethylene terephthalate (PETE)
A

1.) Di(2-ethylhexyl) phthalate (DEHP)

189
Q

Toxins can cause cell injury by interfering with DNA regulatory mechanisms, increasing oxidative stress, and altering enzymatic function. If the damage is extensive and cannot be easily repaired, the DNA itself will be damaged, as indicated by a rise in _________.

  1. ) 8OHDG
  2. ) Pyroglutamate
  3. ) Ammonia
  4. ) Cresol
A

1.) 8OHDG

190
Q

Porphyrin accumulation indicates:

  1. ) All of these responses
  2. ) decreased ability to oxygenate cells
  3. ) decreased CYP enzymes
  4. ) decreased ability to degrade toxins
A

1.) All of these responses

191
Q

The heavy metal ______ causes preferential elevation in Copro I: Copro III because it blocks the early steps of UROD decarboxylation, leading to the accumulation of uroporphyrinogen I, which converts to coproporphyrinogen I.

  1. ) Arsenic
  2. ) Mercury
  3. ) Lead
  4. ) Cadmium
A

1.) Arsenic

192
Q

Precoproporphyrin may elevate when __________ blocks the last step of UROD, leading to the accumulation of pentacarboxyporphyrinogen, which gets converted by CPOX to precoproporphyrin.

  1. ) Mercury
  2. ) Lead
  3. ) Arsenic
  4. ) Cadmium
A

1.) Mercury

193
Q

Elevations in total bilirubin levels indicate impaired degradation of heme as seen in Gilbert’s syndrome. This indicates impaired ________, a pathway in phase II detoxification.

  1. ) Glucuronidation
  2. ) acetylation
  3. ) sulfation
  4. ) glutathione conjugation
A

1.) Glucuronidation

194
Q

Cytochrome P450 enzymes function in the hydroxylation reactions for the activation of (a)__________ and in the microsomal system located in the (b)_________ for the detoxification of xenobiotics.

  1. ) (a) vitamin D, (b) smooth ER
  2. ) (a) vitamin A, (b) peroxisome
  3. ) (a) vitamin E, (b) lysosome
  4. ) (a) vitamin C, (b) rough ER
A

1.) (a) vitamin D, (b) smooth ER

195
Q

High caffeine clearance indicates:

  1. ) upregulation of phase I detox
  2. ) downregulation of phase 1 detox
  3. ) reduction of oxidation damage
  4. ) low liver function
A

1.) upregulation of phase I detox

Can be upregulated by high protein diet, smoking, and other toxins going through CYP1A2 and CYP2E1 pathways.

196
Q

Phase II detoxification involves conjugation of a water soluble constituent to a functional group on the toxin. These conjugation reactions occur:

  1. ) All of these responses
  2. ) on carboxyl, hydroxyl, or amine groups
  3. ) multiple times creating many different types of metabolites
  4. ) along different pathways depending upon substrate concentration
A

1.) All of these responses

197
Q

Immune responses can occur from the creation of __________, like when acyl groups migrate from C1-acyl glucuronides to another protein, covalently bond this new protein, and create a substrate that is now considered foreign and antigenic to the body.

  1. ) Haptens
  2. ) immunoglobulins
  3. ) antibody-antigen complexes
  4. ) complement
A

1.) Haptens

198
Q

Amino acid conjugation requires two steps. The first step is activation of the xenobiotic carboxylic acid using the enzyme (a)________, which requires ATP and (b) ____________.

  1. ) (a) acyl synthetase, (b) B5
  2. ) (a) transacetylase, (b) B5
  3. ) (a) acyl synthetase, (b) P5P
  4. ) (a) transacetylase, (b) P5P
A

1.) (a) acyl synthetase, (b) B5

199
Q

Methylation for single carbon transfer is needed in far greater quantities for (a)________ then for (b)_____________.

  1. ) (a) detoxification, (b) catecholamine biosynthesis
  2. ) (a) telomere protection, (b) detoxification
  3. ) (a) catecholamine biosynthesis, (b) detoxification
  4. ) (a) histamine inactivation, (b) detoxification
A

1.) (a) detoxification, (b) catecholamine biosynthesis

200
Q

Elevations in Cortisol have been implicated in insulin resistance. Which of the following is NOT an action of high cortisol levels?

  1. ) Increased FA synthesis
  2. ) Increased gluconeogenesis
  3. ) Upregulation of GLUT4 receptors
  4. ) Increased glycogenolysis
A

3.) Upregulation of GLUT4 receptors

201
Q

Mutations in the SN1-SN2 transporter can lead to elevations in what 3 AA?

  1. ) Gln, Asn, His
  2. ) Glu, Asn, His
  3. ) Glu, Asp, His
  4. ) Gln, Asp, His
A

4.) Gln, Asp, His