BIOCHEMISTRY-Metabolism Flashcards

1
Q

These are the two sites where the metabolism takes place

A

Mitochondria and Cytoplasm

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2
Q

These three process take place in the mitochondria and the cytoplasm

A

Heme synthesis, Urea cycle, Gluconeogenesis

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3
Q

Name the processes that take place in the mitochondria

A

Fatty acid oxidation (β oxidation)
Acetyl CoA production, TCA cycle
Oxidative phosphorylation

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4
Q

Which processes take place in the cytoplasm?

A
Glycilysis
Fatty acid synthesis
HMP shunt
Protein synthesis
Steroid synthesis
Cholesterol synthesis
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5
Q

What does Glucokinase catalyzes?

A

Catalyzes the phosphorylation of glucose using a molecule of ATP

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6
Q

What is the function of Kinase?

A

Uses ATP to add high energy phosphate group onto substrate

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7
Q

This enzyme adds inorganic phosphate onto substrate without using ATP

A

Phosphorylase

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8
Q

What does the Phosphatase does to the substrate?

A

removes phosphate group

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9
Q

This enzyme catalyzes oxidation reduction reactions

A

Dehydrogenase

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10
Q

What does Hydroxylase does to the substrate?

A

Adds hydroxyl group (-OH)

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11
Q

Which is the effect of Carboxylase?

A

Transfers CO2 groups with help of biotin

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12
Q

This enzyme relocates a functional group within a molecule

A

Mutase

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13
Q

This enzyme manages the glycolysis

A

Phosphofructokinase-1 (PFK-1)

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14
Q

Who are the positive regulators of PFK-1

A

AMP +

Fructose- 2, 6- biphosphate +

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15
Q

These are the negative regulators of PFK-1

A

ATP -

citrate -

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16
Q

Which process is fructose-1,6 biphosphatase related?

A

Gluconeogenesis

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17
Q

ATP and acetyl-CoA which kind of regulators are for fructose-1,6 biphosphatase?

A

positive regulators

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18
Q

These are the negative regulators for fructose-1,6 biphosphatase

A

AMP -

Fructose- 2, 6- biphosphate -

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19
Q

Which are the alternative names for Citric acid cycle?

A

Tricarboxylic acid cycle (TCA) or Krebs cycle

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20
Q

This enzyme has a great importance on TCA cycle

A

Isocitrate dehydrogenase

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21
Q

This is the positive regulator in Citric acid cycle

A

APD+

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22
Q

Who are the negative regulators in Krebs cycle?

A

ATP- and NADH

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23
Q

This enzyme manages the glycogenesis

A

Glycogen synthase

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24
Q

These are positive regulators in glycogenesis

A

Glucose-6-phosphate
Insulin
Cortisol

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25
Q

Epinephrine and glucagon are negative regulators in this process

A

Glycogenesis

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26
Q

Which process is managed by glycogen phosphorylase?

A

Glycogenolysis

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27
Q

Glucose-6-phosphate, Insulin and ATP are negative regulators for this process

A

Glycogenolysis

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28
Q

Who are positive regulators in Glycogenolysis?

A

AMP, Epinephrine and glucagon

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29
Q

This enzyme is related to hexose monophosphate shunt…

A

Glucose-6-phosphate dehydrogenase (G6PD)

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30
Q

Is NADP a positive or negative regulator in pentose phosphate pathway?

A

Positive

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31
Q

It´s an alternative name for hexose monophosphate shunt…

A

Pentose phosphate pathway

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32
Q

Is NADPH a positive or negative regulator in hexose monophosphate shunt?

A

Negative

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33
Q

Which process is Carbamoyl phosphate synthetase II related to?

A

De novo pyrimidine synthesis

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34
Q

This enzyme is related to De novo purine synthesis

A

Glutamine-phosphoribosylpyrophosphate (PRPP) amidotransferase

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35
Q

These are negative regalutors in De Novo purine synthesis

A

AMP, IMP, GMP

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36
Q

The carbamoyl phosphate synthetase I is related to this process

A

Urea Cycle

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37
Q

The N-acetylglutamate is a positive regulator in this process

A

Urea cycle

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38
Q

Which enzyme is related to fatty acid oxidation?

A

Carnitine acyltransferase I

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39
Q

Who is a negative regulator in Fatty acid synthesis?

A

Glucagon and palmitoyl-CoA

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40
Q

Act as an enzyme in the Fatty acid synthesis

A

Acetyl CoA carboxylase (ACC)

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41
Q

Insulin and citrate are postive regulators in fatty acid oxidation or fatty acid synthesis

A

In the fatty acid synthesis

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42
Q

Which process has HMG- CoA synthase as an enzyme?

A

Ketogenesis

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43
Q

Which enzyme acts in Cholesterol synthesis?

A

HMG- CoA reductase

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44
Q

Insulin and Thyroxine are positive regulators in this process

A

Cholestherol synthesis

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45
Q

Which are the negative regulators in Cholestherol synthesis?

A

Glucagon, cholesterol

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46
Q

How many ATP are produced in the aerobic metabolism via malate aspartate shuttle?

A

32 net ATP

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47
Q

Which organs are related to aerobic metabolism via malate aspartate shuttle?

A

Heart and liver

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48
Q

How many ATP are produced in the aerobic metabolism via glycerol 3 phosphate?

A

30 net ATP

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49
Q

Which tissue is related to aerobic metabolism via glycerol 3 phosphate?

A

Muscle

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50
Q

How many ATP are produced in the anaerobic glycolysis?

A

2 net ATP per glucose molecule

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51
Q

Can ATP hydrolysis be coupled to energetically favorable reactions?

A

False, ATP hydrolysis can be coupled to energetically unfavorable reactions

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52
Q

Which element causes glycolysis to produce zero net ATP?

A

Arsenic

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53
Q

From which pathway is NADPH produce?

A

HMP shunt

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54
Q

Where is used NADPH?

A

Anabolic processes
Respiratory burst
Cytochrome P450 system
Glutathione reductase

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55
Q

In which processes is NAD+ generally used?

A

Catabolic processes

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56
Q

During the catabolic processes which is the function for NAD+ ?

A

To carry reducing equivalents away as NADH

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57
Q

In which processes is NADPH generally used?

A

Anabolic processes

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58
Q

These are examples of anabolic processes

A

Steroid and fatty acid synthesis

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59
Q

During the anabolic processes which is the function for NADPH?

A

As a supply of reducing equivalents

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60
Q

Which is the first step of glycolysis?

A

Phophorylation of glucose to yield glucose 6-P

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61
Q

In which other process Phophorylation of glucose to yield glucose 6-P is the first step?

A

Glycogen synthesis in the liver

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62
Q

Which enzyme catalyses Phophorylation of glucose to yield glucose 6-P?

A

Hexokinase or glucokinase depending in the tissue

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63
Q

At low glucose concetrations who sequesters glucose in the tissue?

A

Hexokinase

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64
Q

When there is high glucose concentration, who stores glucose excess?

A

The liver

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65
Q

These are the location of action of the Glucokinase

A

Liver, β cells of pancreas

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66
Q

Which are the location of action of the Hexokinase?

A

Most tissues, but not Liver nor β cells of pancreas

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67
Q

What is the difference in Km between Hexokinase and Glucokinase

A

Hexokinase has lower Km but ↑ affinity

and Glucokinase has Higher Km but ↓ affinity

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68
Q

For the Glucokinase what does it meas that has Higher Km but ↓ affinity?

A

This means that it operates only when serum glucose levels are high.

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69
Q

If tissues need to use glucose at lower serum levels which enzyme is used?

A

Use the higher affinity (lower Km) hexokinase

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70
Q

How is the Vmax in the Hexokinase

A

Lower and decrease Capacity

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71
Q

Higher V max with increase capacity…. Glucokinase or Hexokinase?

A

Glucokinase

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72
Q

Feedback inhibited by glucose 6 P….Glucokinase or Hexokinase?

A

Hexokinase

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73
Q

Gene mutation associated with maturity onset diabetes of the young… Glucokinase or Hexokinase?

A

Glucokinase

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74
Q

Which is the equation in the net glycolysis?

A

Glucose+ 2Pi+ 2ATP+ 2 NAD→ 2 pyruvate+ 2 ATP+ 2 NADH+ 2 H+ 2 H2O

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75
Q

Is the equation in the net glycolysis balanced?

A

Not balanced chemically

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76
Q

On what depends the exact balance equation in the net glycolysis?

A

Ionization state of reactants and products

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77
Q

For the glucose conversion to glucose 6 phosphate is needed the hexokinase/glucokinase, what else is required?

A

ATP

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78
Q

For the fructose 6 P conversion to fructose 1,6 BP is required ATP, wich enzyme catalyzes this reaction?

A

Phosphofructokinase

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79
Q

Which processes produces ATP during the glycolysis?

A

1,3 BPG→ 3PG

Phosphoenolpyruvate → Pyruvate

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80
Q

Which enzyme catalyzes the conversion from Phosphoenolpyruvate → Pyruvate?

A

Pyruvate kinase

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81
Q

Which enzymes manages the conversion from fructose 2, 6 biphosphate to Fructose 6 phosphate?

A

Fructose biphosphatase 2 (FBPase2)

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82
Q

When does Fructose biphosphatase 2 (FBPase2) is activated?

A

Activated in fasting state

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83
Q

Which enzymes manages the conversion from Fructose 6 phosphate to fructose 2, 6 biphosphate?

A

Phosphofructokinase-2 (PFK 2)

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84
Q

When does Phosphofructokinase-2 is activated?

A

Activated during fed state

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85
Q

This enzymes are the same bifunctional enzyme whose function is reversed by phosphorylation by protein kinase A

A

Phosphofructokinase-2 (PFK 2) and Fructose biphosphatase 2 (FBPase2)

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86
Q

During the Fasting state which process is increase, Glycolysis or Gluconeogenesis

A

Gluconeogenesis

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87
Q

Who is primary increase during the fasting state?

A

Increase Glucagon

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88
Q

The increase of Glucagon during fasting state increases cAMP, after this… who is increased?

A

↑ protein kinase A

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89
Q

If the protein Kinase A is increased during fasting, which enzyme is increased and which one decreased?

A

Fructose biphosphatase 2 (FBPase2) is increased

Phosphofructokinase-2 (PFK 2) is decreased

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90
Q

Who is primary increase during the fed state?

A

Increase Insulin

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91
Q

The increase of insulin during fed state decreases cAMP, after this… who is decreased?

A

↓ protein kinase A

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92
Q

If the protein Kinase A is decreased during feeding, which enzyme is increased and which one decreased?

A

Fructose biphosphatase 2 (FBPase2) is decreased

Phosphofructokinase-2 (PFK 2) is increased

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93
Q

This mitochondrial enzyme complex links the glycolysis and TCA cycle?

A

Pyruvate dehydrogenase complex

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94
Q

When does the Pyruvate dehydrogenase complex is activated?

A

Active in fed state

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95
Q

Which is the reaction catalyzed by Pyruvate dehydrogenase complex?

A

pyruvate+ NAD+ CoA→ acetyl-CoA+CO2 + NADH

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96
Q

In the mitochondrial enzyme complex which links the glycolysis and TCA cycle, how many enzymes and cofactors it contains?

A

Contains 3 enzymes that require 5 cofactors

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97
Q

Which are the 5 cofactors in the Pyruvate dehydrogenase complex?

A
Pyrophosphate (B1 thiamine; TPP)
FAD (B2 riboflavin)
NAD (B3 NIacin)
CoA (B5 pantothenate)
Lipoic Acid
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98
Q

What happens to NAD/ NADH ratio, ADP and Ca2+ during exercise in the Pyruvate dehydrogenase complex?

A

They´re increased

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99
Q

The Pyruvate dehydrogenase complex to which complex is it similar?

A

α ketoglutarate dehydrogenase complex

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100
Q

In the TCA cycle what is the final product of α ketoglutarate

A

Succinyl CoA

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101
Q

Which elemet inhibits lipoic acid?

A

Arsenic

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102
Q

During the inhibition caused by Arsenic to lipoic acid which symptoms are common?

A

Vomiting, rice watter stools, garlic breath

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103
Q

If there is a Pyruvate dehydrogenase complex deficiency, which would be the consequences?

A

Causes a buildup of pyruvate that gets shunted to lactate (via LDH) and alanine (via ALT)

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104
Q

Which are the only purely ketogenic aminoacids?

A

Lysine and Leucine

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105
Q

Which findings are common during the Pyruvate dehydrogenase complex deficiency?

A

Neurologic defects, lactic acidosis, increase alanine starting in infancy

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106
Q

This is the treatment for Pyruvate dehydrogenase complex deficiency

A

Increase intake of ketogenic nutrients (high content or increase lycine and leucine)

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107
Q

From Glucose we can get pyruvate, but from pyruvate what do we get?

A

Alanine
Oxaloacetate
Acetyl CoA
Lactate

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108
Q

Which pyruvate product is related to Cahill cycle?

A

Alanine

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109
Q

This pyruvate product is the result of Cori cycle

A

Lactate

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110
Q

Which enzyme and cofactor helps during the pyruvate metabolic pathway in order to get Alanine?

A

Alanine aminotransferase (B6 as a cofactor)

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111
Q

What is the importance of alanine?

A

It carries amino groups to the liver from muscle

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112
Q

Which enzyme and cofactor helps during the pyruvate metabolic pathway in order to get Oxaloacetate?

A

Pyruvate carboxylase (biotin as cofactor)

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113
Q

What is the importance of Oxaloacetate?

A

Can replenish TCA cycle or be used in gluconeogenesis

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114
Q

Which enzyme and cofactor helps during the pyruvate metabolic pathway in order to get Acetyl CoA?

A

Pyruvate dehydrogenase (B1, B1, B3, B5, lipioc acid)

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115
Q

What is the importance of Pyruvate dehydrogenase?

A

Transition from glycolysis to the TCA cycle

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116
Q

Which enzyme and cofactor helps during the pyruvate metabolic pathway in order to get Lactate?

A

Lactic acid dehydrogenase (B3)

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117
Q

End of anaerobic glycolysis

A

Lactate

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118
Q

This is the step preview to entering the Kreb cycle

A

Pyruvate→ Acetyl Co’A

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119
Q

During the transition from pyruvate → Acetyl CoA in the TCA cycle, what is produce?

A

1 NADH and 1 CO2

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120
Q

Where does the Krebs cycle takes place?

A

Mitochondria

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121
Q

Which are the results from the TCA cycle?

A

3 NADH, 1 FADH2, 2 CO2, 1 GTP per acetyl CoA

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122
Q

How much ATP is needed for each acetyl CoA?

A

10

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123
Q

Who requires the same cofactors as the pyruvate dehydrogenase complex?

A

α ketoglutarate

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124
Q

Which cofactors does α ketoglutarate needs?

A

B1, B2, B3, B5, lipoic acid

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125
Q

Which is the mnemonic for the Krebs cycle?

A

Citrate Is Krebs Starting Substrate For Making Oxaloacetate

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126
Q

Which enzyme is required for Acetyl CoA to get to Citrate?

A

Citrate synthase

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127
Q

Which enzyme is required for Oxalatoacetate to get to Citrate?

A

Citrate synthase

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128
Q

Which enzymes are irreversible during Krebs cycle?

A

Citrate synthase
Isocitrate dehydrogenase
α KG dehydrogenase

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129
Q

Which are the substrates from TCA cycle?

A
Citrate
Isocitrate
α Ketoglutarate
Succinyl CoA
Succinate
Fumarate
Malate
Oxaloacetate
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130
Q

The NADH electrons produce from glycolysis, where do they go?

A

Thet enter the mitochondria

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131
Q

How does the NADH electrons produce from glycolysis enter the mitochondria?

A

Via the malate aspartate or glycerol 3 phosphate shuttle

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132
Q

Where are transfered the FADH2 electrons in the mitochondria?

A

To complex II

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133
Q

In the mitochondria, who is transfered at lower energy the FADH2 or NADH electrons?

A

FADH2

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134
Q

What is the result of the passage of electrons in the mitochondria?

A

Results in the formation of proton gradient

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135
Q

What is the result of proton gradient coupled to oxidative phosphorylation?

A

Production of ATP

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136
Q

On what consists the complex II?

A

Succinate dehydrogenase

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137
Q

Who inhibits the complex IV in the mitochondria?

A

Cyanide

CO

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138
Q

Antimycin A inhibits this complex in the mitochondria

A

Complex III

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139
Q

Rotenone inhibits Mitochondria complex V

A

False Rotenone inhibits Compex I

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140
Q

Who inhibits Mitochondria Complex V?

A

Oligomycin

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141
Q

What is produce by Mitochondria complex I, III, IV and V?

A

H+

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142
Q

Acts as a proton ionophore, an agent that can shuttle protons (hydrogen cations) across biological membranes. It defeats the proton gradient across mitochondria and chloroplast membranes.

A

2,4 Dinitrophenol

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143
Q

By which enzyme is ATP produce?

A

ATP synthase

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144
Q

How many ATP are produce for each NADH?

A

2.5 ATP

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145
Q

By each FADH2 how many ATPs are produce?

A

1.5 ATP

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146
Q

This poisoning directly inhibit electron transport, causing a ↓ proton gradient and block of ATP synthesis

A

Rotenone
Cyanide
Antymicin A
CO

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147
Q

Directly inhibit mitochondrial ATP synthase, causing an ↑ proton gradient

A

Oligomycin

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148
Q

Why it isn´t produce any ATP by Olygomycin?

A

Electron transport stops

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149
Q

Produces heat. Increase permeability of memebrane, causing a decrease proton gradient and increase O2 consumption

A

2, 4 Dinitriphenol
Aspirin
Thermogenin

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150
Q

With the 2, 4 Dinitriphenol how is the ATP synthesis and the electron transport?

A

ATP synthesis stops

Electron transport continues

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151
Q

Which is the illicitly use for 2, 4 Dinitriphenol?

A

For weight loss

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152
Q

Which is a common secondary effect of aspirin after an overdose?

A

Fever

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153
Q

Where do we find thermogenin?

A

In brown fat

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154
Q

Which are the irrevesible enzymes during the gluconeogenesis?

A

Pyruvate Carboxylase
Phosphoenolpyruvate carboxykinase
Fructose 1,6 bisphosphatase
Glucose 6 phosphate

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155
Q

In the gluconeogenesis, where does the pyruvate→ oxaloacetate is performed?

A

In mitochondria

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156
Q

In the gluconeogenesis, which enzymes catalyzes pyruvate→ oxaloacetate?

A

Pyruvate carboxylase

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157
Q

In the gluconeogenesis, which cofactors does pyruvate carboxylase needs to catalyze pyruvate→ oxaloacetate?

A

Biotin

ATP

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158
Q

Who activates Pyruvate carboxylase?

A

Acetyl CoA

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159
Q

In the gluconeogenesis, where does the oxaloacetate → Phosphoenolpyruvate is performed?

A

In Cytosol

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160
Q

In the gluconeogenesis, which enzymes catalyzes oxaloacetate → Phosphoenolpyruvate?

A

Phosphoenolpyruvate carboxykinase

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161
Q

In the gluconeogenesis, what does Phosphoenolpyruvate carboxykinase needs to catalyze oxaloacetate → Phosphoenolpyruvate

A

Requires GTP

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162
Q

In the gluconeogenesis, where does the Fructose 1,6 BP→ Fructose 6 phosphate is performed?

A

In cytosol

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163
Q

In the gluconeogenesis, which enzymes catalyzes Fructose 1,6 BP→ Fructose 6 phosphate?

A

Fructose 1-6 biphosphatase

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164
Q

In the gluconeogenesis, which cofactors positively stimulates Fructose 1-6 biphosphatase to catalyze Fructose 1,6 BP→ Fructose 6 phosphate

A

Citrate

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165
Q

In the gluconeogenesis, which cofactors inhibits Fructose 1-6 biphosphatase to catalyze Fructose 1,6 BP→ Fructose 6 phosphate

A

Fructose 2,6 biphosphate

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166
Q

In the gluconeogenesis, where does the Glucose 6 P→ Glucose?

A

In Endoplasmic Reticulum

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167
Q

In the gluconeogenesis, which enzymes catalyzes Glucose 6 P→ Glucose?

A

Glucose 6 phosphatase

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168
Q

Primarily where does the gluconeogenesis happens? What is it purpose?

A

Occurs primarily in the liver, serves to mantain euglycemia during fasting.

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169
Q

Which other organs can we find the irrevesible enzymes of the Gluconeogenesis?

A

Kidney, intestinal ephithelium.

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170
Q

What happens if there is a deficiency of the key glucogenic enzymes?

A

Hypoglicemia

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171
Q

Why can´t the muscle participate in gluconeogenesis?

A

Because it lacks glucose 6 phosphatase

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172
Q

Which other route serves as glucose source?

A

Odd chain fatty acids yield 1 propionyl CoA during metabolism, which can enter the TCA cycle (as succinyl CoA) undergo gluconeogenesis

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173
Q

Why can´t the Even chain fatty acids produce new glucose?

A

Since they yield only acetyl CoA equivalents

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174
Q

Provides a source if NADPH from abundantly avaible glucose 6-P

A

HMP shunt (pentose phosphate pathway)

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175
Q

What is required for the reductive reactions?

A

NADPH

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176
Q

This are examples of reductive reactions that need NADH

A

Glutathione reduction inside RBCs, fatty acid and cholesterol biosynthesis

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177
Q

What else does the HMP shunt yields?

A

Yields ribose for nucleotide synthesis and glycolytic intermediates

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178
Q

Which are the distinctic phases in the pentose phosphate pathway

A

Oxidative and nonoxidative

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179
Q

Where do the oxidative and nonoxidative phases of the HMP shunt occurs?

A

cytoplasm

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180
Q

How many ATPs are produced and used during the HMP shunt?

A

No ATP is used or produced

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181
Q

These are the sites where the pentose phosphate pathway take place

A

Lacting mamary glands, liver, adrenal cortex (sites of fatty acid or steroid synthesis) RBCs

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182
Q

In the oxidative and nonoxidative reactions in the HMP shunt, Which one is irreversible?

A

Oxidative

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183
Q

In the oxidative reaction in the pentose phosphate pathway, this is the start point

A

Glucose 6 Phosphate

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184
Q

These two metabolic pathways have Glucose 6 phosphate as the start point

A

Glycolysis and pentose phosphate pathway

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185
Q

Which are the products from the oxidative phase in the HMG shunt?

A

CO2
2 NADPH
Ribulose 5 P

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186
Q

Glucose 6 P dehydrogenase is one of the main enzymes in which metabolic process?

A

pentose phosphate pathway

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187
Q

Who stimulates and who inhibits the oxidative phase in the HMG shunt?

A

NAPD stimulates

NADPH exces inhibits

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188
Q

This is the end point of the oxidative reaction, but also the start point in the nonoxidative reaction in the pentose phosphate pathway

A

Ribulose 5 P

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189
Q

Which are the final products of the nonoxidative phase with the Ribulose 5 P?

A

Ribose 5 P
G3P
F6P

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190
Q

Which enzyme is needed for Ribulose 5 P to get to the final products?

A

Phosphopentose isomerase transketolases

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191
Q

Which cofactor is required for Ribulose 5 P to get to the final products?

A

Requires B1

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192
Q

In the Respiratory burst what does it involves?

A

Involves the activation of the phagocyte NADPH oxidase complex

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193
Q

What other name does the respiratory burst receives?

A

Oxidative burst

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194
Q

During the Respiratory burst, which is the substrate for the phagocyte NADPH oxidase complex?

A

O2

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195
Q

These cells are example of phagocyte NADPH oxidase complex

A

Neutrophils, monocytes

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196
Q

What is the importance of the respiratory burst?

A

Plays an important role in the immune response→ rapid release of reactive oxygen species

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197
Q

Who plays an important role in the creation and neutralization of Reactive Oxigen Species (ROS)?

A

NADPH

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198
Q

Who gives the blue green heme containing pigment to the sputum?

A

Myeloperoxidase

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199
Q

Which disease has NADPH oxidase deficiency?

A

Chronic granulomatous disease (CGD)

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200
Q

What happens to the phagocytes of patients with Chronic Granulomatous disease (CGD)?

A

Phagocytes can utilizr H2O2generated by invading organism and convert it to ROS

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201
Q

The CGD patients are at higher risk for infection, from whom ?

A

Catalase + species

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202
Q

Which benefit Catalase + species have against phagocytes?

A

Catalase + species are capable of neutralizing their own H2O2, leaving phagocytes without ROS for fighting infections

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203
Q

Which bacterias are examples of catalase + species?

A

S. Aureus

Aspergillus

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204
Q

Can P. aeruginosa kill competing microbes? How?

A

Pyocyanine of P. aeruginosa functions to generate ROS to kill competing microbes

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205
Q

This protein inhibits microbial growth via iron chelation

A

Lactoferrin

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206
Q

Where do we find Lactoferrin?

A

In secretory fluids and neutrophils

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207
Q

What is the relationship between NADPH and glutathione?

A

NADPH is necessary to keep glutathione reduced

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208
Q

What repercussion has that NADPH reduces glutathione?

A

Detoxifies free radicals and peroxides

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209
Q

What happens to the RBC if there is a decrease in NADPH?

A

Leads to an hemolytic anemia due to poor RBC defence agianst oxidizing agents

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210
Q

Give examples of oxidizing agents that can lead to hemolytic anemia?

A

Fava beans, sulfonamides, primaquine, antituberculosis drugs

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211
Q

What else can precipitate hemolysis and it´s worst if there is a decrease of NADPH?

A

Infection

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212
Q

How does infection can lead to hemolysis?

A

Free radicals generated via inflamatory response can diffuse into RBCs and cause oxidative damage

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213
Q

If there is a Glucose 6 phosphate dehydrogenase deficiency, which would be the results?

A

A lack of NADPH, and with that a glutathione increased resulting in increased radicals and peroxides

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214
Q

Which kind of genetic disorder is Glucose 6 phosphate dehydrogenase deficiency?

A

X linked recessive disorder

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215
Q

Which is the most common human enzyme deficiency?

A

Glucose 6 phosphate dehydrogenase deficiency

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216
Q

In whom is the glucose 6 phosphate dehydrogenase deficiency more prevalent?

A

Among blacks

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217
Q

How is related the glucose 6 phosphate dehydrogenase deficiency to the malaria?

A

Increases malarial resistance

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218
Q

What is the product of the Glucose 6 phosphate after 6 phosphate dehydrogenase catalazes it?

A

6 phosphogluconate and NADH

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219
Q

Oxidized Hemoglobin precipitaed within RBCs

A

Heinz bodies

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220
Q

Result from the phagocytic removal of Heinz bodies by splenic macrophages

A

Bite cells

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221
Q

Are consider Disorders of fructose metabolism

A

Essential fructosuria

Fructose intolerance

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222
Q

Involves a defect in fructokinase

A

Essential fructosuria

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223
Q

The essential fructosuria, which kind of mode of inheritance does it follows?

A

Autosomal recessive

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224
Q

Clinically, how is consider the Essential fructosuria?

A

A benign, asymptomatic condition

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225
Q

Why is the essential fructosuria a benign asymptomatic condition?

A

Because fructose isn´t trapped in cells

226
Q

Which would be the findings in Essential fructosuria?

A

Fructose in blood and urine

227
Q

Which disorder of the metabolism causes less severe symptoms… Fructose or Galactose disoder?

A

Disorders of the fructose metabolism cause milder symptoms than analogous disorder of galactose metabolism

228
Q

Which is the cause of hereditary fructose intolerance?

A

Hereditary deficiency of aldolase B

229
Q

The fructose intolerance, which kind of mode of inheritance does it follows?

A

Autosomal recesive

230
Q

Where is carried the fructose metabolism?

A

Liver

231
Q

If there is a lack of aldolase B, who is accumulated?

A

Fructose 1 P

232
Q

What happens if there is a Fructose 1 P accumulation?

A

Decrease in avaible phosphate

233
Q

Which cycles are inhibited if there is a lack in phosphate due to Fructose 1 P accumulation?

A

Glycogenolysis

Gluconeogenesis

234
Q

When do the symptoms present in the fructose intolerance?

A

Following consumption of fruit, juice or honey

235
Q

How do we expect the urine dipstick be in Fructose intolerance?

A

Negative (test for glucose urine only)

236
Q

Which are the symptoms found in Fructose intolerance

A

Hypoglicemia
Jaundice
Cirhosis
Vomiting

237
Q

For fructose intolerance the treatment is just decrease the intake of fructose

A

Decrease the intake of fructose and sucrose

238
Q

Which are the compounds of sucrose?

A

Glucose + fructose

239
Q

Which are the disorders of galactose metabolism?

A

Galactokinase deficiency

Classic galactosemia

240
Q

In order to get Galactose 1 P from Galactose which enzyme is needed?

A

Galactokinase

241
Q

If we have a Galactokinase deficiency and still continue having galactose in our diet, Who is going to accumulate?

A

Galactitol

242
Q

Which mode of inheritance does Galactokinase deficicency follows?

A

Autosomal Recessice

243
Q

Which findings can be expected from Galactokinase deficicency?

A

Galactose appears in blood and urine, infantile cataracts

244
Q

Initially how are manifested the infantile cataracts in the Galactokinase deficicency?

A

Failure to track objects or to develop a social smile

245
Q

Which is the cause of the classic galactosemia?

A

Absence of Galactose 1 phosphate uridyltransferase

246
Q

Which mode of inheritance does classic galactosemia follows?

A

Autosomal recessive

247
Q

How is the damaged caused in classic galactosemia?

A

By Accumulation of toxic substances (including galactitol, which accumulates in the lens of the eye)

248
Q

Failure to thrive, jaundice hepatomegaly, infantile caracts, intellectual disability are symptoms of which kind of metabolism disorder

A

Classic galactosemia

249
Q

What kind of diet does the Classic galactosemia patient needs to follow?

A

Exclude galactose and lactose

250
Q

Which are the compounds of lactose?

A

(galactose + glucose)

251
Q

Where does the most serious defect can leads in classic galactosemia?

A

It can lead to PO4 depletion

252
Q

The classic galactosemia which kind of infection can lead in neonates?

A

E. Coli Sepsis in neonates

253
Q

An alternative method of trapping glucose in the cell is to convert it to its alcohol counterpart, How is named this alcohol counterpart?

A

Sorbitol

254
Q

Which is the enzyme that catalizes the convertion from glucose to sorbitol?

A

Aldose reductase

255
Q

Which is the substrate form by sorbitol after Sorbitol dehydrogenase catalyzes it?

A

Fructose

256
Q

Which tissues have aldose reductase and sorbitol dehydrogense?

A

Liver, ovaries, and seminal vesicles have both enzymes

257
Q

What happens if there is an insufficient amount of aldose reductase and sorbitol dehydrogense in some tissues?

A

Sorbitol accumulates, causing osmotic damage

258
Q

Which symptomps are seen with sorbitol accumulation?

A

Cataracts, retinopàthy and peripheral neuropathy seen with chronic hyperglycemia in diabetes

259
Q

Aldose reductase in which metabolic pathways is related?

A

Glucose → Sorbitol

Galactose → Galacitol

260
Q

Which tissues just have Aldose reductase?

A

Schwann cells, retinam and kidneys

261
Q

Where does the lactase functions to digest lactose?

A

On the brush border

262
Q

Lactase digests lactose in which compounds?

A

Glucose and galactose

263
Q

In what consists primary lactase deficiency?

A

Age dependent decline after childhood (absence of lactase persistent allele)

264
Q

In which kind of people is common the lactase deficiency?

A

Asian, African or Native American descent

265
Q

What happens in the secondary lactase deficiency?

A

Loss of brush border due to gastroenteritis (rotavirus), autoimmune disease

266
Q

Which are the causes of Lactase deficiency?

A

Primary
Secondary
Congenital

267
Q

What does the lactase deficency demonstrate in the stools?

A

↓ pH

268
Q

What does the lactase deficency shows breath?

A

↑ Hydrogen content with lactose tolerance test

269
Q

What does intestinal biopsy reveals in Lactase intolerance?

A

Normal mucosa in patients with lactose intolerance

270
Q

Bloating, cramps, flatulence, osmotic diarrhea are the main symptomps of which metabolic disorder?

A

Lactase deficiency

271
Q

Which is the management of Lactase deficiency?

A

Avoid dairy products or add lactase pills to diet; lactose free milk

272
Q

Which kind of aminoacids are found in proteins?

A

Only L form amino acids

273
Q

Which is the classification of essential aminoacids?

A

Glucogenic, Glucogenic/ketogenic, and ketogenic

274
Q

These essential aminoacid are Glucogenic

A

Methionine, Valine, Histidine

275
Q

These essential aminoacids are consider glucogenic/ ketogenic aminoacids

A

Isoleucine, phenylalanine, threonine, thypthophan

276
Q

Which are examples of Ketogenic aminoacids?

A

Leucine, Lysine

277
Q

Which are the three types of Amino acids?

A

Essential
Acidic
Basic

278
Q

Give examples of acidic amino acids

A

Aspartic acid and glutamic acid

279
Q

Which is the characteristic of the acidic aminoacids?

A

Nagatively charged at body pH

280
Q

These are examples of basic amino acids

A

Arginine, lysine and histidine

281
Q

Which of the three basic amino acids is the most basic?

A

Arginine

282
Q

Which of the three basic amino acids has no charge at body pH?

A

Histidine

283
Q

Which basic amino acids are required during periods of growth?

A

Arginine and histidine

284
Q

Which basic amino acids are increased in histones? Why are they important?

A

Arginine and Lysine, which bind negatively charged DNA

285
Q

Which amino acids need to be supplied in diet?

A

All essential amino acids

286
Q

Why is it important the amino acid catabolism?

A

Results in the formation of common metabolites (pyruvate, acetyl CoA) which serve as metabolic fuels

287
Q

What happens to the excess nitrogen (NH3) generated by Amino acid catabolism?

A

Is converted to urea and excreted by the kidneys

288
Q

What is the name of the process where the excess nitrogen (NH3) is converted to urea and excreted by the kidneys?

A

Urea cycle

289
Q

During the Urea cycle from the Starting point NH3 + CO2, which is the next step? and which enzyme is used? which is the cofactor required?

A

Carbamoyl phosphate is the substrate
Carbamoyl phosphate synthetase I is the enzyme
N acetylglutamate the cofactor

290
Q

Where are realized the first step of the Urea cycle?

A

Mitochondria

291
Q

Which substrate is formed thanks to Carbamoyl phosphate and Ornithine by Ornithine transcarbamylase?

A

Citruline

292
Q

Which are the substrate of Urea cycle?

A
Ornithine
Carbamoyl phosphate
Citruline
Asoartate
Argininosuccinate
Fumarate
Arginine
Urea
293
Q

Who transports amonia?

A

Alanine and glutamate

294
Q

Is the Hyperammonemia acquired or hereditary?

A

Both

295
Q

How does Hyperammonemia can be aquired?

A

By liver disease

296
Q

This is an example of how you get hereditary hyperammonemia

A

Urea cycle deficiencies

297
Q

Results in excess NH4 which depletes α ketoglutarate

A

Hyperammonemia

298
Q

Which cycle is inhibited by Hyperammonemia ?

A

The Excess of NH4 which depletes α ketoglutarate leads to inhibition of TCA cycle

299
Q

Which diet is recomended in hypermmonemia?

A

Limit protein in diet

300
Q

Which medicines may decrease amonia levels?

A

Benzoate and phenylbutyrate

301
Q

How does Benzoate and phenylbutyrate decrease amonia levels?

A

Both bind amino acid and lead to excretion

302
Q

What helps to acidify the GI tract and trap NH4 for excretion?

A

Lactulose

303
Q

Which symptomps are seen in Amonia intoxication?

A

Tremor (asterixis), slurring of speech, somnolenc, vomiting, cerebral edema, blurring vision

304
Q

Required cofactor for carbamoyl phosphate synthetase I?

A

N acetylglutamate

305
Q

The absence of N acetylglutamate in which disease can it end?

A

Hyperammonemia

306
Q

N acetylglutamate deficiency presention is identical to which other deficiency?

A

Carbamoyl phosphate synthetase I deficiency

307
Q

How can you differentiate N acetylglutamate deficiency and Carbamoyl phosphate synthetase I deficiency?

A

↑ ornithine with normal urea cycle enzymes suggest hereditary N acetyl glutamate deficiency

308
Q

Which is the most common urea cycle disorder?

A

Ornithine transcabamylase deficiency

309
Q

Which mode of inheritance does Ornithine transcabamylase deficiency follows?

A

X linked recessive

310
Q

With what does the Ornithine transcabamylase deficiency interferes in the body?

A

Interferes with body´s ability to eliminate ammonia

311
Q

Who transports amonia?

A

Alanine and glutamate

312
Q

Is the Hyperammonemia acquired or hereditary?

A

Both

313
Q

How does Hyperammonemia can be aquired?

A

By liver disease

314
Q

This is an example of how you get hereditary hyperammonemia

A

Urea cycle deficiencies

315
Q

Results in excess NH4 which depletes α ketoglutarate

A

Hyperammonemia

316
Q

Which cycle is inhibited by Hyperammonemia ?

A

The Excess of NH4 which depletes α ketoglutarate leads to inhibition of TCA cycle

317
Q

Which diet is recomended in hypermmonemia?

A

Limit protein in diet

318
Q

Which medicines may decrease amonia levels?

A

Benzoate and phenylbutyrate

319
Q

How does Benzoate and phenylbutyrate decrease amonia levels?

A

Both bind amino acid and lead to excretion

320
Q

What helps to acidify the GI tract and trap NH4 for excretion?

A

Lactulose

321
Q

Which symptomps are seen in Amonia intoxication?

A

Tremor (asterixis), slurring of speech, somnolenc, vomiting, cerebral edema, blurring vision

322
Q

Required cofactor for carbamoyl phosphate synthetase I?

A

N acetylglutamate

323
Q

The absence of N acetylglutamate in which disease can it end?

A

Hyperammonemia

324
Q

N acetylglutamate deficiency presention is identical to which other deficiency?

A

Carbamoyl phosphate synthetase I deficiency

325
Q

How can you differentiate N acetylglutamate deficiency and Carbamoyl phosphate synthetase I deficiency?

A

↑ ornithine with normal urea cycle enzymes suggest hereditary N acetyl glutamate deficiency

326
Q

Which is the most common urea cycle disorder?

A

Ornithine transcabamylase deficiency

327
Q

Which mode of inheritance does Ornithine transcabamylase deficiency follows?

A

X linked recessive

328
Q

With what does the Ornithine transcabamylase deficiency interferes in the body?

A

Interferes with body´s ability to eliminate ammonia

329
Q

When is evident the ornithine transcarbamylase deficiency?

A

Often evident in the first few days of life, but may present with late onset

330
Q

If there is an excess of carbamoyl phosphate in what is it converted?

A

Orotic Acid

331
Q

Which pathway is orotic acid related?

A

Part of the pyrimidine synthesis pathway

332
Q

↑ Orotic Acid in blood and urine, ↓ BUN, symptoms of hyperammonemia

A

Which are the findings in ornithine transcabamylase deficiency?

333
Q

This finding helps to diferentiate ornithine transcabamylase deficiency and Orotic Aciduria

A

No megaloblastic anemia in ornithine transcabamylase deficiency

334
Q

Which is the chain of derivatives from the amino acid Phenylalanine?

A

Phenylalanine→ Tyrosine → Dopa → Dopamine→ NE→ Epi

335
Q

Which other derivative does Tyrosine has, apart from Dopa?

A

Thyroxine

336
Q

What other derivative does Dopa has, other than Dopamine?

A

Melanin

337
Q

The amino acid tryptophan has two derivatives, who are they?

A

Niacin

Serotonin

338
Q

Which products can Niancin could have?

A

NAD+/ NADP+

339
Q

Melatonin is the derivative of whom?

A

Serotonin

340
Q

Which amino acid is the precursos of Histamine?

A

Histidine

341
Q

This aminoacid is important in the Heme synthesis

A

Glycine

342
Q

What is the result of Glycine after B6 works as a cofactor

A

Porphyrin

343
Q

Glutamate can have two dericatives, who are they?

A

GABA

Glutathione

344
Q

This three are the derivatives if Arginine

A

Creatinine
Ura
Nitric Oxide

345
Q

Which enzyme catalyzes the reaction from Phenylalanine to tyrosine

A

Phenylalanine hydroxylase

346
Q

If there is a deficiency in Phenylalaline hydroxylase which disease can be caused?

A

Phenylketonuria

347
Q

Who is the precursor of Homogentisic acid?

A

Tyrosine

348
Q

After Homogentisate oxidase catalyzes Homogentisic acid, Who is the result?

A

Maleylacetoacetic acid

349
Q

Which disease is caused if there is a deficiency in Homogentisate oxidase?

A

Alkaptonuria

350
Q

Which cycle is Maleylacetoacetic acid precursor?

A

TCA cycle

351
Q

From Tyrosine to DOPA which enzyme acts?

A

Tyrosine hydroxylase

352
Q

What is the meaning of DOPA?

A

Dihydroxyphenylalanine

353
Q

If Melanin is a derivate of DOPE, which enzyme is affected in albinism in this conversion?

A

Tyrosinase

354
Q

Which enzyme acts in the catalization from DOPA to Dopamine?

A

Dopa decarboxylase

355
Q

Which medicine inhibits Dopa decarboxylase in the conversion of dopamie from DOPA?

A

Carbidopa

356
Q

Which cofactor is needed to get Norepinephrine from Dopamine

A

Vitamin C

357
Q

In the catecholamine synthesis, S adenosyl Methionine is needed to obtain…

A

Norepinephrine → Epinephrine

358
Q

This suprarenal cortex product stimulates positively the conversion from Norepinephrine to Epinephrine

A

Cortisol

359
Q

Methanephrine is the direct result of Norepinephrine or Epinephrine?

A

Epinephrine results in Metanephrine

Norepiephrine results in Normetanephrine

360
Q

Which is the common result of Metanephrine

and Normetanephrine?

A

Vanillylmandelic acid

361
Q

Homovanilic acid comes from?

A

Dopamine

362
Q

Which are the causes of Phenylketonuria?

A

Due to ↓ phenylalanine hydroxylase or ↓ tetrahydrobiopterin cofactor

363
Q

Which is consider the malignant PKU?

A

↓ tetrahydrobiopterin cofactor

364
Q

What is increase in the urine thanks to the increase of phenylalanine?

A

Phenylketones in urine

365
Q

Which are the findings in PKU?

A

Intellectual disability, growth retardation , seizures, fair skin, eczema, musty body odor

366
Q

What is the treatment in PKU patients?

A

↓ Phenylalanine and ↑ Tyrosine in diet

367
Q

What kind of inheritance pattern does PKU follows?

A

Autosomal recessive

368
Q

Which would be the incidence of PKU?

A

1: 10, 000

369
Q

After birth when does the neonate has to be screen in PKU?

A

Screened 2-3 days after birth

370
Q

Why the PKU neonates are normal at birth?

A

Because of maternal enzyme during fetal life

371
Q

Which kind of artificial sweetner does the PKU patients must avoid?

A

Artificial sweetner aspartame, which contains phenylalanine

372
Q

This is the cause of maternal PKU?

A

Lack of proper dietary therapy during pregnancy

373
Q

Microcephaly, intellectual disability, growth retardation, congenital heart defects are findings of?

A

Maternal PKU

374
Q

Give the explanation of Alkaptonuria

A

Congenital deficiency of homogentisate oxidase in the degradative pathway of tyrosine to fumarate

375
Q

This is mode of inheritance in Alkaptonuria

A

Autosomal recessive

376
Q

Which other names doers Alkaptonuria receives?

A

Ochronosis

377
Q

The alkaptonuria, is it a benign or malignant disease?

A

Benign disease

378
Q

How is made the cystine?

A

Made of 2 cysteines connected by a disulfide bond

379
Q

The homocystinuria follows this mode of inheritance

A

Autosomal recessive

380
Q

Name the three types of homocystinuria

A
Cystathionine synthase deficiency
↓ Affinity of cystathionine synthase for pyridoxal phosphate
Homocysteine methyltransferase (methionine synthase) deficiency
381
Q

The treatment of this homocysteine type is ↓ methionine, ↑ cysteine, ↑B12 and folate in diet

A

Cystathionine synthase deficiency

382
Q

In this kind of Homocystinuria, Which is the treatment in ↓ Affinity of cystathionine synthase for pyridoxal phosphate?

A

↑↑ B6 and ↑ cysteine in diet

383
Q

The treatment in this Homocysteine type is just to increase Methionine in diet

A

Homocysteine methyltransferase (methionine synthase) deficiency

384
Q

What is the result of each type of homocystinuria?

A

All forms result in excess homocysteine

385
Q

Which findins are expected in homocystinuria?

A

↑↑ homocysteine in urine, intellectual disability, osteoporosis, tall statur, kyphosis, lens subluxation, thrombosis, and atherosclerosis (stroke and MI)

386
Q

Methionine is the result from homocysteine but which is the enzyme and cofactors that manage it?

A

Homocysteine methyltransferase and B12

387
Q

Cystathione synthase and vitamin B6 are required for getting Cystathinine, but Which are the substrate required to get it?

A

Homocysteine and Serine

388
Q

Which is the product of Cystathionine?

A

Cysteine

389
Q

Which is the explantion of cystinuria?

A

Hereditary defect of renal PCT and intestinal amino acid transporter for Cysteine, Ornithine, Lysine and Arginie (COLA)

390
Q

Which could be the result of excess cystine in the urine?

A

Can lead to precipitation of hexagonal cystine stones

391
Q

This is the inheritance mode of cystinuria

A

Autosomal recessive

392
Q

How common the cystinuria?

A

Common 1: 7000

393
Q

Which is the diagnostic tool of cystinuria?

A

Urinary cyanide nitroprusside test is diagnostic

394
Q

Which is the treatment for cystinuria?

A

Urinary alkalinization and chekating agents increase solubility of cystine stones
Good hydration

395
Q

Which is the mnemonic of glycogen storage disease types?

A

Very Poor Carbohydrate Metabolism

396
Q

How is made the cystine?

A

Made of 2 cysteines connected by a disulfide bond

397
Q

Which is the principle of the maple syrup urine disease?

A

Blocked degradation of branched amino acids due to ↓ α Ketoacid dehydrogenase (B1)

398
Q

What does the Blocked degradation of branched amino acids due to ↓ α Ketoacid dehydrogenase (B1) causes?

A

Causes ↑ α Ketoacids in blood, especially those of leucine

399
Q

Clinically what does the maple syrup urine disease causes?

A

Severe CNS defects, intellectual disability and death

400
Q

The maple syrup urine disease is a autosomal dominant or autosomal recessive disease?

A

Autosomal Recessive

401
Q

Why does the maple syrup urine disease has that name?

A

Because the urine smells like maple syrup/burnt sugar

402
Q

Which are the three branched aminoacids?

A

Isoleucine
Leucine
Valine

403
Q

Which are the restriction in diet in the Maple syrup urine disease? and what would you supplement?

A

Restriction of Leucine, isoleucine and valine in diet

Supplementation of Thiamine

404
Q

In the glycogen structure how are the branches and linkage composed?

A

Branches have α- (1,6) bonds; linkages have α-(1,4) bonds

405
Q

These tissues have high reserves of glycogen

A

Skeletal muscle

Hepatocytes

406
Q

In the skeletal muscle the glycogen is rapidly metabolized, so which is the process of glycogenolysis

A

Glycogen → glucose 1 phosphate → Glucose 6 P

407
Q

What realationship does the Glycogen has with the liver?

A

Glycogen is stored and undergoes glycogenolysis to maintain blood sugar at appropiate levels

408
Q

Which is the process of Glycogenoslysis?

A

Glycogen phosphorylase cleaves glucose 1 P residues off branched glycogen until four remain befora a branch point. Then 4 α-D- glucanotransferase moves three glucose 1 Ps from the branch to the linkage. Then α- 1,6 glucosidase cleaves off the last glucose 1 P on the branch

409
Q

During the glycogenolysis which are consider debranching enzymes?

A

4 α-D- glucanotransferase

α- 1,6 glucosidase

410
Q

A small amount of glycogen is degraded in lysosomes by which enzyme?

A

α- 1,4 glucosidase (Acid Maltase)

411
Q

How many Glycogen storage diseases exist?

A

12 types

412
Q

Which are the four most common types of Glycogen storage disease?

A
Von Gierke disease (Type I)
Pompe disease (Type II)
Cori disease (Type III)
McArdle disease (Type V)
413
Q

Which is the only X Recessive disease in the Sphingolipidoses?

A

Fabry disease, The other are Autosomal Recessive

414
Q

What kind of inheritance pattern follows all the glycogen storage disease?

A

Autosomal recessive

415
Q

What are the Gaucher cells?

A

Lipid laden macrophages resembling crumpled tissue paper

416
Q

Which enzyme is deficient in Von Gierke disease?

A

Glucose 6 phosphate

417
Q

Which would be the management of Von Gierke disease?

A

Frequent oral glucose / cornstarch; avoidance if fructose and galactose

418
Q

This glycogen storage disease has Lysosomal α 1, 4 glucosidase (acid maltase) deficiency

A

Pompe disease (Type II)

419
Q

Which findings are common in Pompe disease?

A

Cardiomyopathy and systemic findings leading to early death

420
Q

This is a milder form type I Glycogen storage disease but with normal blood lactate

A

Cori disease (Type III)

421
Q

How is the gluconeogenesis in Cori disease?

A

Is intact

422
Q

Which enzyme is related to Cori disease?

A

α 1,6 glucosidase

423
Q

In which tissue is McArdle disease (Type V) more related? and with which enzyme?

A

Skeletal muscle glycogen phosphorylase (myophosphorilase)

424
Q

How is the glycogen in the muscle in McArdle disease?

A

↑ glycogen in muscle, but cannot break it down

425
Q

So… if there is ↑ glycogen in muscle, but cannot be broken down in McArdle disease, which are the clinical manifestations during strenous excercise?

A

Painful muscle cramps, myoglobinuria (red urine)

426
Q

Which other anormalities can be found in McArdle disease?

A

Arrythmia from electrolyte abnormalities

427
Q

Name the two type of Lysosomal storage disease

A

Sphingolipidoses and Mucopolysaccharidoses

428
Q

Which are the shingolipidoses seen in the Lysosomal storage disease?

A
Fabry disease
Gaucher disease
Niemann Pick disease
Tay Sachs disease
Krabbe disease
Metachromatic leukodystrophy
429
Q

The findings in this sphingolipidoses is peripheral neuropathy of hands/feet, angiokeratomas, cardivascular/renal disease

A

Fabry disease

430
Q

Which enzyme is deficient and which substrate is accumulated in Fabry disease?

A

α galactosidase A deficiency

Ceramide trihexiside is accumulated

431
Q

Which is the only X Recessive disease in the Sphingolipidoses?

A

Fabry disease

432
Q

This is the most common lysosomal storage disease and is part of the sphingolipidoses

A

Gaucher disease

433
Q

What are the Gaucher cells?

A

Lipid laden macrophages resembling crumpled tissue paper

434
Q

These are the posible findings in Gaucher disease

A

Hepatosplenomegaly, pancytopenia, aseptic necrosis of Femur, bone crises, Gaucher cells

435
Q

Which enzyme is deficient in Gaucher disease, which also is the treatment…

A

Glucocerebrosidase (β- glucosidase)

436
Q

In Gaucher disease if Glucocerebrosidase is the deficent enzyme… Who is the accumulated substrate?

A

Glucocerebroside

437
Q

Progressive neurodegeneration, hepatosplenomegaly, cherry red spot on macula, and foam cells… which lysosomal storage disease is?

A

Niemann Pick disease

438
Q

What are the foam cells?

A

Lipid laden macrophages seen in Niemman Pick disease

439
Q

Sphingomyelinase is the deficient enzyme and sphingomyelin the accumulated substrate

A

Niemann Pick disease

440
Q

Which sphingolipidose disease is clinically similar to Niemann Pick?

A

Tay Sachs disease

441
Q

Clinically which are the similitudes and difference between Niemman Pick and Tay-Sachs disease?

A

Similitudes is the progressive neurodegeneration, developmental delay, cherry red spot on macula
Difference, on Tay Sachs there is no hepatosplenomegaly (vs Niemman Pick)

442
Q

Which is the accumulated substrate in Tay Sachs disease?

A

GM2 ganglioside

443
Q

Hexoaminidase A is the deficient enzyme in this lysosomal storage disease

A

Tay Sachs disease

444
Q

So… if there is a Carnitine deficiency which would be the expected findings?

A

Causes weakness, hypotonia, and hypoketotic hypoglicemia

445
Q

This sphingolipidose disease has two accumulated substrates due to Galactocerebrosidase deficiency

A

Krabbe disease

446
Q

Which are the two accumulated substrates in Krabe disease?

A

Galactocerebroside, psychosine

447
Q

Peripheral neuropathy, developmental delay, optic atrophy are characteristics of this lysosomal storage disease

A

Krabbe disease

448
Q

How are the cells in Krabbe disease?

A

Globoid cells

449
Q

These findings are seen in Metachromatic leukodystrophy

A

Central and peripheral demyelination with ataxia, dementia

450
Q

Arylsulfatase A is the deficient enzyme on this sphingolipidose disease

A

Metachromatic leukodystrophy

451
Q

If Arylsulfatase A is the deficient enzyme on Metachromatic leukodystrophy, which is the accumulated substrate

A

Cerebroside sulfate

452
Q

Hurler and Hunter syndrome what kind of Lysosomal storage diease are they consider?

A

Mucopolysaccharidoses

453
Q

On this Mucopolysaccharidose disease Heparan sulfate and dermatan sulfate are the substrates accumulated but the deficient enzyme is α L iduronidase

A

Hurler syndrome

454
Q

Which findings are common in Hurler syndrome?

A

Developmental delay, gargolysm, airway obstruction, corneal clouding, hepatosplenomegaly

455
Q

Which are the accumulated substrates in both Hurler and Hunter syndrome?

A

Dermatan sulfate and heparan sulfate

456
Q

Clinically how are diffent Hurler and Hunter syndrome?

A

Hunter is a mild Hurler + aggressive behavior, no croneal clouding in Hunter disease

457
Q

This is the deficient enzyme in Hunter disease

A

Iduronate sulfatase

458
Q

Genetically which difference do Hunter and Hurler disease have?

A

Hunter syndrome is X linked recessive

Hurler syndrome is Autosomal recessive

459
Q

Which lysosomal storage diseases have an increased incidence in Askenazi Jews?

A

Tay Sachs, Niemann Pick and some forms of Gaucher disease

460
Q

What does the long chain fatty acid degradation requires?

A

Carnitine - deoendent transport into the mitochondrial matrix

461
Q

Is β hydroxybutyrate detected in urine test for ketones?

A

No, is not detected

462
Q

So… if therer is a Carnitine which would be the expected findings?

A

Causes weakness, hypotonia, and hypoketotic hypoglicemia

463
Q

Who is increased and who is descreased during the Acyl CoA dehydrogenase deficiency?

A

↑ dicarboxylic acids

↓ glucose and ketones

464
Q

What role does Acetyl CoA plays with pyruvate carboxylase?

A

Acetyl CoA is + allosteric regulator of pyruvate carboxylase in gluconeogenesis

465
Q

Which is the repercussion if ↓ Acetyl CoA?

A

↓ Fasting Glucose

466
Q

Which substrate is the beginning for the Fatty acid synthesis?

A

Citrate

467
Q

Where do we find citrate?

A

Mitochondria matrix

468
Q

Where does the ATP citrate lyase catalyzes citrate in order to have Acetyl CoA?

A

Cell cytoplasm

469
Q

How many Carbons does palmitate has?

A

16 C

470
Q

Which are the results of the degradation of Fatty acis?

A

Ketone bodies

TCA cycle

471
Q

Fatty acids and aminoacids where are they metabolized?

A

In the liver

472
Q

Which are metabolized products of Fatty acids and aminoacids?

A

Acetoacetate and β hydroxybutyrate

473
Q

Which tissues use Acetoacetate and β hydroxybutyrate?

A

Muscle and brain

474
Q

Which metabolite is depleted in prolonged starvation and diabetic ketoacidosis?

A

Oxaloacetate

475
Q

During which metabolic process is oxaloacetate depleted in prolonged starvation and diabetic Ketoacidosis?

A

Gluconeogenesis

476
Q

What happens to oxaloacetate in alcoholism?

A

Excess NADH shunts oxaloacetate to malate

477
Q

If there is a build up of Acetyl CoA during Prolonged starvation, diabetic ketoacidosis and alcoholism, what is the result?

A

Acetyl CoA shunts glucose and FFA toward the production of ketone bodies

478
Q

If there is an excess of Ketone bodies, how is it clinically manifested?

A

Smells like acetone (fruit odor)

479
Q

Is β hydroxybutyrate detected in urine test for ketones?

A

No, is not detected

480
Q

How many calories per gram does the protein or carbohydrates give?

A

1g protein or carbohydrate= 4 kcal

481
Q

1 gram of Fat how many calories does is gives?

A

9 kcal per 1 g fat

482
Q

These calories you get per 1 g of alcohol

A

1 g alcohol= 7 kcal

483
Q

During excercise the percentage of maximal energy at the begining is 100% but decreases rapidly, which is the first source of energy used that is burned in 2 seconds?

A

Stored ATP

484
Q

This metabolism manages % of maximal energy for the largest periods

A

Aerobic metabolism

485
Q

During fasting and starvation which are the priorities?

A

Are to supply sufficient glucose to the brain and RBCs and to preserve proteins

486
Q

During fed state (after a meal) which metabolic states are present?

A

Glycolisis and aerobic respiration

487
Q

During fed state (after a meal) what happens to insulin?

A

Insulin stimulates storage of lypids, protein and glycogen

488
Q

These are the three main metabolic pathways that occur during Fasting (between meals)

A

Hepatic glycogneolysis

Hepatic gluconeogenesis and adipose release of FFA

489
Q

Which is the major metabolic event that happens in Fasting?

A

Hepatic glycogneolysis

490
Q

These are the minor metabolic events that happens in Fasting?

A

Hepatic gluconeogenesis and adipose release of FFA

491
Q

During fasting, they stimulate use of fuel reserves

A

Glucagon

Adrenaline

492
Q

During the 1-3 day of starvation, how are the blood glucose levels mantained?

A

Hepatic glycogenolysis
Adipose release of FFA
Muscle and liver, which shift fuel use from glucose to FFA
Hepatic gluconeogenesis from peripheral tissue lactate and alanine, and from adipose tissue glycerol and propionyl CoA

493
Q

Which are the only triacylglycerol components that contribute to gluconeogenesis?

A

From odd chain FFA

494
Q

After starvation in how many days the glycogen reserves are depleted?

A

After day 1

495
Q

Can the RBCs use ketones?

A

No, because they lack mitochondria

496
Q

If you were to last 8 weeks of starvation, in which order the source of energy will be depleated?

A

Carbohydrates depleted in less than 3 days
Fat in 8 weeks
Protein the 8 weeks and more, Vital protein degradation

497
Q

After day 3 of starvation which is the next main source of energy for the brain?

A

Adipose stores- Ketones bodies become the main source of energy to the brain

498
Q

After the ketones bodies are depleted during starvation, what is next?

A

Vital protein degradation accelerates , leading to organ failure and death

499
Q

During starvation after day 3 what determines the survival time?

A

Amount of excess stores

500
Q

In the cholesterol synthesis which enzyme converts HMG- CoA to mevalonate?

A

HMG- CoA reductase

501
Q

Who induces HMG CoA reductase in the cholesterol synthesis?

A

Insulin

502
Q

Who esterifies 2/3 of plasma cholesterol?

A

Lecithin-cholesterol acyltransferase (LCAT)

503
Q

Which is the effect of statins?

A

Competitively and reversibly inhibit HMG- CoA reductase

504
Q

Who manages the degradation of dietary triglycerides in the small intestine?

A

Pancreatic lipase

505
Q

What is the function of Lipoprotein lipase (LPL)?

A

Degradation of Triglycerides circulating in chylomicrons and VLDLs

506
Q

Where can we find Lipoprotein lipase?

A

Found on vascular endothelial surface

507
Q

Its function is the degradation of Triglycerides remaining in IDL

A

Hepatic Triglyceride Lipase (HL)

508
Q

Which is the effect of Hormone sensitive lipase?

A

Degradation of TG stored in adipocytes

509
Q

Catalyzes esterification of cholesterol

A

Lecitin Cholesterol Acyl Transferase (LCAT)

510
Q

Who mediates transfer of cholesterol esters to other lipoprotein particles?

A

Cholesterol ester transfer protein (CETP)

511
Q

Which organs produce Nascent HDL

A

Liver and intestine

512
Q

Which enzyme is required for nascent HDL to become mature HDL?

A

LCAT- Lecitin Cholesterol Acyl Transferase

513
Q

From Mature HDL which enzyme is required to form the transfer cholesterol esters to VLDL, IDL, LDL?

A

CETP- Cholesterol ester transfer protein

514
Q

Proteins that bind lipids to form lipoproteins, they transport the lipids through the lymphatic and circulatory system

A

Apolipoprotein

515
Q

Which apolipoprotein mediates remnant uptake?

A

Apo E

516
Q

Where can we find ApoE?

A

In every kind of lipoprotein except LDL

517
Q

What is the function of Apo A I?

A

Activates LCAT

518
Q

This apolipoprotein is just found in Chylomicron and HDL

A

Apo A I

519
Q

It´s consider a Lipoprotein lipase cofactor

A

Apo C II

520
Q

Where do we find Apo C II?

A

Chylomicron, VLDL and HDL

521
Q

Found in Chylomicrons and chylomicrons remnant and mediates chylomicron secretion

A

Apo B 48

522
Q

This Apoliporpotein binds LDL receptor

A

Apo B 100

523
Q

These are the lipoproteins where we can find Apo B 100

A

VLDL, IDL, LDL

524
Q

Which is the composition of Lipoproteins?

A

Cholesterol
Triglycerides
Phospholipids

525
Q

Which lipoprotein carry most cholesterol?

A

HDL and LDL

526
Q

Which is the direction that LDL transports cholesterol?

A

From liver to Tissues

527
Q

This is the direction that HDL transports cholesterol

A

Periphery to Liver

528
Q

What is the work for chylomicrons related to the triglycerides?

A

Delivers dietary triglycerides to peripheral tissue

529
Q

This lipoprotein delivers cholesterol to liver?

A

Chylomicron remnants

530
Q

This kind of chylomicron is mostly depleted of their triacylglycerols

A

Chylomicron remnants

531
Q

Who secretes chylomicrons?

A

Intestinal epithelial cells

532
Q

DElivers hepatic triglycerides to peripheral tissue

A

VLDL

533
Q

Where is secreted the VLDL?

A

In the liver

534
Q

Formed in the degradation of VLDL

A

IDL

535
Q

Which is the function of IDL?

A

Delivers Triglycerides and cholesterol to liver

536
Q

How does LDL is formed?

A

Formed by hepatic lipase modification of IDL in the peripheral tissue

537
Q

Delivers hepatic cholesterol to peripheral tissues

A

LDL

538
Q

How does the target cells take up the LDL?

A

Via receptor mediated endocytosis

539
Q

Which is the function of HDL?

A

Mediates reverse cholesterol transport from periphery to liver

540
Q

Acts as a repository for apoC and apoE (which are needed for chylomicron and VLDL metabolism)

A

HDL

541
Q

Who secretes HDL?

A

Liver and intestine

542
Q

Which is the relationship between alcohol and HDL?

A

Alcohol increases HDL synthesis

543
Q

In this familial dyslipidemia type I, Who is increased in the blood level?

A

Chylomicrons, Tryglicerides, cholesterol

544
Q

Which other name does the Familial dyslipidemia type I receives?

A

Hyperchylomicronemia

545
Q

What kind of mode of inheritance is seen in Familial dyslipidemia type I?

A

Autosomal recessive

546
Q

What is the problem in Familial dyslipidemia Hyperchylomicronemia?

A

Lipoprotein lipase deficiency or altered apolipoprotein C II

547
Q

Which can be the consequences of Familial dyslipidemia type 1?

A

Pancreatitis , hepatosplenomegaly, and eruptive/ pruritic xanthomas

548
Q

How is the risk of atherosclerosis in Familial dyslipidemia type 1?

A

No increased risk for atherosclerosis

549
Q

In this kind of familial Dyslipidemia the LDL receptors are abscent or defective

A

Familial dyslipidemia type IIa

550
Q

Familial hypercholesterolemia also knowns as?

A

Familial dyslipidemia type IIa

551
Q

What is increased in blood in the Familial hypercholesterolemia?

A

LDL and cholesterol

552
Q

This is the inheritance mode of Familial dyslipidemia type IIa

A

Autosomal Dominant

553
Q

Which is the incidence of Familial hypercholesterolemia heterozygote?

A

1: 500

554
Q

Which are the expected levels of cholesterol seen in an heterozygote Familial hypercholesterolemia patient?

A

300 mg/ dL

555
Q

The homozygotes Familial hypercholesterolemia patients are very rare, but which levels of cholesterol would you expect to see?

A

700 mg/ dL

556
Q

How is the risk of atherosclerosis in Familial dyslipidemia type IIa?

A

Acelerated atherosclerosis (may have MI before 20)

557
Q

Which clinical findings can be seen in Familial dyslipidemia type IIa?

A

Tendon (Achiles) xanthomas and corneal arcus

558
Q

In this familial dyslipidemia, VLDL and triglycerides are increased in blood levels

A

Type IV or hypertriglyceridemia

559
Q

Which is the cause of Familial hypertriglyceridemia?

A

Hepatic overproduction of VLDL

560
Q

Familial dyslipidemia type IV Is it Autosomal Dominant or Autosomal recessive?

A

Autosomal dominant

561
Q

Which is the possible finding in Familial hypertriglyceridemia?

A

Pancreatitis