Carbohydrate Metabolism
Lectures (1-5)
Marks’ Basic medical
biochemistry USMLE step 1 (FIRST AID)
14 questions 3 questions
Lippincott's Illustrated
review of Biochemistry
9 questions
Various sources
15 questions from:
Mutah’s past/ JUST’s past
OMC’s past/ Online resources
Link for feedback if there's any question wrong: FEEDBACK FORM
CAUTION!! There are some hard questions but with some
really good comprehensive ideas, I’ll emphasize them with the
word Hard. Focus and don’t down yourself if you get any
question wrong.
GOOD LUCK!
Q1: the facilitative transporter that is most responsible for
transporting fructose from the blood into cells is which of the
following
A) GLUT 1
B) GLUT 2
C) GLUT 3
D) GLUT 4
E) GLUT 5
ANSWER: E
Hard
Q2: patient with alcoholism developed pancreatitis that affected his
exocrine pancreatic function. He exhibited discomfort after eating
a high-carbohydrate meal. The patient most likely had a reduced
ability to digest which of the following?
A) Starch
B) Lactose
C) Fiber
D) sucrose
E) Maltose
ANSWER: A
Why? The pancreas produces α-amylase, which digests starch in the intestinal lumen. If pancreatic α-amylase cannot enter the lumen because of pancreatitis, the starch will not be
digested to a significant extent. (The salivary α-amylase begins the process, but only for the time during which the food is in the mouth, because the acidic conditions of the
stomach destroy the salivary activity.) The discomfort arises from the bacteria in the intestine digesting the starch and producing acids and gases. Lactose, sucrose, and maltose are
all disaccharides that would be cleaved by the intestinal disaccharidases located on the brush border of the intestinal epithelial cells (thus, B, D, and E are incorrect). These
activities might be slightly reduced because the pancreas would also have difficulty excreting bicarbonate to the intestine, and the low pH of the stomach contents might reduce the
activity of these enzymes. However,these enzymes are present in excess and will eventually digest the disaccharides. Fiber cannot be digested by human enzymes, so answer Cis
Hard
Q3:A patient has a genetic defect that causes intestinal epithelial
cells to produce disaccharidases of much lower activity than normal.
Compared with a normal person, after eating a bowl of oatmeal and
milk sweetened with table sugar, this patient will exhibit higher
levels of which of the following?
A) Maltose, sucrose, and lactose in the stool
B) Starch in the stool
C) Galactose and fructose in the blood
D) Glycogen in the muscles
E) Insulin in the blood
ANSWER: A
The why, Salivary and pancreatic α-amylase will partially digest starch to glucose, but maltose and disaccharides will pass through the intestine and exit with the stool as a result of the limited
activity of the brush-border enzymes. Because the amylase enzymes are working, there will only be normal levels of starch in the stool (thus, B is incorrect). Not all available glucose is entering the
blood, so less insulin will be released by the pancreas (thus, E is incorrect), which will lead to less glucose uptake by the muscles and less glycogen production (thus, D is incorrect). Because neither
lactose nor sucrose can be digested to a large extent in the intestinal lumen under these conditions, it would be difficult to have elevated levels of galactose or fructose in the blood (thus, C is
incorrect).
Q4:Glucose is the body’s universal fuel, which can be used by
virtually all tissues. A major role of glycolysis is which one of the
following?
A) To synthesize glucose
B) To generate energy
C) To produce FAD(2H)
D) To synthesize glycogen
E) To use ATP to generate heat
ANSWER: B
Q5: Glycolysis generates energy such that cells have a source of energy
to survive. Starting with glyceraldehyde 3-P and synthesizing one
molecule of pyruvate, the net yield of ATP and NADH would be which
one of the following?
A) 1 ATP, 1 NADH
B) 1 ATP, 2 NADH
C) 1 ATP, 4 NADH
D) 2 ATP, 1 NADH
E) 2 ATP, 2 NADH
F) 2 ATP, 4 NADH
G) 3 ATP, 1 NADH
H) 3 ATP, 2 NADH
I) 3 ATP, 4 NADH
ANSWER: D
Q6: Every human cell has the capacity to use glycolysis for energy
production. Which one of the following statements correctly
describes an aspect of glycolysis?
A) ATP is formed by oxidative phosphorylation.
B) Two molecules of ATP are used in the beginning of the pathway.
C) Pyruvate kinase is the rate-limiting enzyme.
D) One molecule of pyruvate and three molecules of CO2 are formed
from the oxidation of one glucose molecule.
E) The reactions take place in the matrix of the mitochondria.
ANSWER: B
Q7: Because glucose has several metabolic routes it might take
once it arrives in the cytoplasm, which one of the following
reactions would commit the glucose to following the glycolytic
pathway?
A) Glucose to glucose 1-P
B) Glucose to glucose 6-P
C) Fructose 6-P to fructose 1,6-bisP
D) Fructose 1,6-bisP to dihydroxyacetone phosphate and glyceraldehyde
3-P
E) Glucose 1-P to glucose 6-P
ANSWER: C
Q8: The red blood cells require ATP in order to maintain ion
gradients across their membrane. In the absence of these ion
gradients, the red blood cells will swell and burst, bringing about a
hemolytic anemia. Red cells generate their energy via which one of
the following?
A) Substrate-level phosphorylation
B) TCA cycle
C) Oxidative phosphorylation
D) Electron transfer to oxygen
E) Oxidation of glucose to CO2 and H2O
ANSWER: A
Q9: Under conditions of glucagon release, the degradation of liver
glycogen normally produces which one of the following?
A) More glucose than glucose 1-P
B) More glucose 1-P than glucose
C) Equal amounts of glucose and glucose 1-P
D) Neither glucose nor glucose 1-P
E) Only glucose 1-P
ANSWER: B
Q10: An adolescent patient with a deficiency of muscle phosphorylase
was examined while exercising her forearm by squeezing a rubber
ball. Compared with a normal person performing the same exercise,
this patient would exhibit which one of the following?
A) Exercise for a longer time without fatigue
B) Have increased glucose levels in blood drawn from her forearm
C) Have decreased lactate levels in blood drawn from her forearm
D) Have lower levels of glycogen in biopsy specimens from her forearm
muscle
E) Hyperglycemia
ANSWER: C
McArdle disease
Q11: In a glucose tolerance test, an individual in the basal
metabolic state ingests a large amount of glucose. If the individual
is normal, this ingestion should result in which one of the
following?
A) An enhanced glycogen synthase activity in the liver
B) An increased ratio of glycogen phosphorylase a to glycogen
phosphorylase b in the liver
C) An increased rate of lactate formation by red blood cells
D) An inhibition of PP-1 activity in the liver
E) An increase of cAMP levels in the liver
ANSWER: A
Q12: Assume that an individual carries a mutation in muscle PKA
such that the protein is refractory to high levels of cAMP.
Glycogen degradation in the muscle would occur, then, under
which one of the following conditions?
A) High levels of intracellular calcium
B) High levels of intracellular glucose
C) High levels of intracellular glucose 6-P
D) High levels of intracellular glucose 1-P
E) High levels of intracellular magnesium
ANSWER: A
Ca2+ - Calmodulin
Q13: A patient has been diagnosed with a glucagonoma, a
pancreatic tumor that independently and episodically secretes
glucagon. Which one of the following would be expected in this
patient?
A) Low serum glucose
B) Increased glycogenolysis in the liver
C) Increased glycogenolysis in muscle tissue
D) Increased glycogenesis in the liver
E) Increased glycogenesis in muscle tissue
ANSWER: B
Cytology question, but it’s good.
Q14: The mechanism through which Ras becomes an oncogenic
protein is which one of the following?
A) Ras remains bound to GAP
B) Ras can no longer bind cAMP
C) Ras has lost its GTPase activity
D) Ras can no longer bind GTP
E) Ras can no longer be phosphorylated by MAP kinase
ANSWER: C
Q15: A 6-year-old boy is brought to his pediatrician’s office by his
parents, who report that the child has been unusually thirsty for the past
week. He also has increased urinary frequency and has wet the bed three
times in the past two weeks. A random blood glucose level is 215
mg/dL. The pediatrician suspects that the child has type 1 diabetes
mellitus caused by autoimmune destruction of insulin-producing
pancreatic b cells. Which of the following is the transporter for glucose
to enter pancreatic b cells?
A) GLUT 1
B) GLUT 2
C) GLUT 4
D) Simple diffusion
ANSWER: B
Q16: Which of the following enzymes catalyzes high-energy
phosphorylation of substrates during glycolysis?
A) Pyruvate kinase
B) Phosphoglycerate kinase
C) Triose phosphate isomerase
D) Aldolase
E) Glyceraldehyde-3-phosphate dehydrogenase
ANSWER: E
High energy phosphate bonds are added to the substrates of glycolysis at three steps in the pathway. Hexokinase—or, in the case of the
liver, glucokinase— adds phosphate from ATP to glucose to form glucose-6-phosphate. Strictly speaking, this is not always considered
a step of the glycolytic pathway. Phosphofructokinase uses ATP to convert fructose-6-phosphate to fructose-1, 6-phosphate. Using
NAD+ in an oxidation-reduction reaction, inorganic phosphate is added to glyceraldehyde-3-phosphate by the enzyme
glyceraldehyde3-phosphate dehydrogenase to form 1,3-diphosphoglycerate. The enzymes phosphoglycerate kinase and pyruvate kinase
transfer substrate high-energy phosphate groups to ADP to form ATP.
Q17: Which of the following is most likely to be seen in Fasting
State?
A) A decrease in glucagon activity
B) Increased activity of cyclic AMP
C) Increase glycolytic activity
D) A decrease in insulin activity
ANSWER: B
Q18: Anaerobiosis leads to lactate formation in muscle due to
which one of the following?
A) Inhibiting hexokinase by glucose-6-phosphate
B) Providing 2,3-bisphosphoglycerate for the phosphoglycerate mutase
reaction
C) Inhibiting pyruvate kinase by pyruvate
D) Providing substrate for glyceraldehyde-3-phosphate dehydrogenase
E) Inhibiting phosphofructokinase-1 by AMP
ANSWER: D
Q19: In muscle, under anaerobic conditions, the net synthesis of
ATP starting from one mole of glucose derived from muscle
glycogen is which one of the following? (remember that glucose is cleaved from glycogen as G6P )
A) 1 mole of ATP
B) 2 moles of ATP
C) 3 moles of ATP
D) 4 moles of ATP
E) 5 moles of ATP
ANSWER: C
Q20: Under conditions of hypoglycemia, the liver is not utilizing
glucose as an energy source due to which of the following?
A) A low Km for glucokinase
B) A high Km for glucokinase
C) An inhibited, phosphorylated PFK-1
D) An activated, phosphorylated PFK-1
E) A reduction of glucose transporters in the membrane
ANSWER: B
Hard
Q21: A 3-month-old infant was brought to the pediatrician due to muscle
weakness (myopathy) and poor muscle tone (hypotonia). Physical exam revealed
an enlarged liver and heart, and heart failure. The infant had always fed poorly,
had failure to thrive, and had breathing problems. He also had trouble holding up
his head. Blood work indicated early liver failure. A liver biopsy indicated that
glycogen was present and of normal structure. A potential defect in this child is
which of the following?
A) Liver glycogen phosphorylase
B) Liver glycogen synthase
C) Liver α-(1-4) glucosidase
D) Liver debranching enzyme
E) Liver branching enzyme
ANSWER: C
REMEMBER: Pompe disease affects muscle, heart and liver. And is characterized by cardiomegaly, and compromised degradation of glycogen (3%);
therefore glycogen accumulates leading to “megaly/ enlargement”.
Q22: A 6-month-old infant was brought to the pediatrician due to fussiness and a tender
abdomen. The child seemed to do well until the time between feeding was increased to
more than 3 h. The baby always seemed hungry and irritable if not fed frequently. Upon
examination, hepatomegaly and enlarged kidneys were noted, and blood work showed
fasting hypoglycemia. Subsequent laboratory analysis demonstrated that in response to a
glucagon challenge, only about 10% of the normal amount of glucose was released into
circulation, which significantly contributed to the fasting hypoglycemia. Which enzyme
defect in the patient is the most likely?
A) Glycogen synthase
B) Branching enzyme
C) Debranching enzyme
D) Glucose-6-phosphatase
E) Fructose-1,6-bisphosphatase
ANSWER: D
Symptoms indicate that have
Von Gierke disease .
Q23: A muscle cell line has been developed with a nonfunctional
adenylate cyclase gene. Glycogen degradation can be induced in
this cell line via which of the following mechanisms?
A) Addition of glucagon
B) Addition of epinephrine
C) Increase in intracellular magnesium
D) Increase in intracellular AMP
E) Increase in intracellular ADP
ANSWER: D
Positive regulator to glycogen phosphorylase
Q24: An individual is taking a serene walk in the park when he
spots an escaped alligator from the zoo. The individual runs away
as fast as he can. Glycogen degradation is occurring to supply
glycolysis with a substrate even before epinephrine has reached the
muscle. This is due to which of the following?
A) Sudden decrease in blood glucose levels
B) Increase in sarcoplasmic calcium levels
C) Insulin binding to muscle cell receptors
D) Decline in ATP levels
E) Lactate production
ANSWER: B
Activation by epinephrine (fight or flight)
Q25: As the individual in the previous question continues to run
from the alligator, the muscle begins to import glucose from the
circulation. This occurs due to which of the following?
A) Insulin binding to muscle cells
B) Epinephrine binding to muscle cells
C) Glucagon binding to muscle cells
D) Increase in intracellular AMP levels
E) Increase in intracellular calcium levels
ANSWER: D
As AMP levels increase in the muscle due to the need for ATP for muscle contraction, and the activity of the adenylate kinase reaction, the AMP-activated protein kinase is turned on. One of the effects
of the AMP-activated protein kinase is to increase the number of GLUT4 transporters in the muscle membrane, in a process simi lar to the action of insulin. This enables muscle to take up glucose
efficiently from the circulation when internal energy levels are low. The ability of the muscle to take up glucose under these conditions is not due to an increase in epinephrine levels, an increase in
sarcoplasmic calcium levels, or insulin binding to muscle cells. Under conditions as described in the question, insulin will not be present in the circulation to bind to the muscle cells. As the muscle does
not contain glucagon receptors, there is no effect on muscle when glucagon is present in the circulation.
Not included but good to know
Q26: Streptococcus mutans, found in dental plaque, produces acids
from the metabolism of carbohydrates. Topical fluoride treatment
in the dental office can slow the production of acids, resulting in
the accumulation of which metabolite?
A) Glucose-6-phosphate
B) Fructose-1,6-bisphosphate
C) Glyceraldehyde-3-phosphate
D) 2-phosphoglycerate
E) Phosphoenolpyruvate
ANSWER: D
Q27: Which of the following is the primary stimulus for insulin
secretion?
A) Epinephrine
B) High Glucose
C) Gastric peptide
D) Glucagon
E) Low Glucose
ANSWER: B
Q28: What is the immediate trigger for the dissociation of the α
and βγ subunits of the G-protein?
A) Association with adenyl cyclase
B) Binding of GTP
C) Dissociation of GDP
D) Dissociation of hormone
E) Hydrolysis of GTP
ANSWER: B
Q29: Adenylyl cyclase:
A) Catalyzes the ADP ribosylation of proteins.
B) Catalyzes the dephosphorylation of phospho-Ser residues on
enzymes.
C) Catalyzes the hydrolysis of ATP to ADP and Pi.
D) Diffuses to the nucleus to function as a transcription factor.
E) Is regulated by protein-protein interactions.
ANSWER: E
G-proteins
Q30: Which of the following will reverse the inhibition of PFK-1?
A) AMP
B) ATP
C) Citrate
D) fructose-2,3-bisphosphate
E) More than one answer is correct
ANSWER: E
Both D+A are correct
Q31: Name the pathway for glucose synthesis by non-carbohydrate
precursors?
A) Glycogenesis
B) Glycolysis
C) Gluconeogenesis
D) Glycogenolysis
ANSWER: C
Q32: Which of the following are major sites for glycogen storage?
A) Adipose tissue
B) Bones
C) Muscle and liver
D) Kidney and liver
E) Brain and muscles
ANSWER: C
Q33: Which of the following is the precursor of glycogen?
A) Glycerol 3-phosphate
B) Malate
C) UDP-glucose
D) Leucine and lysine
ANSWER: C
Q34: Name the enzyme which is used for branching of glycogen?
A) Branching enzyme
B) Hexokinase
C) Phosphoglucomutase
D) Glycogen synthase
E) Unbranching enzyme
ANSWER: A
Q35: Erythrocytes undergo glycolysis for production of ATP. The
deficiency of ……………. enzyme leads to hemolytic anemia?
a) Glucokinase
b)Phosphofructokinase
c) Phosphoglucomutase
d) Pyruvate Kinase
ANSWER: D
Q36: Which of the following glycolytic reactions produce ATP:
A) Pyruvate kinase
B) Phosphoglycerate mutase
C) Adolase
D) hexokinase
ANSWER: A
Q37: Which of the following does NOT
activate glycogenolysis?
a) Activation of adenylyl cyclase
b) Phosphorylation of glycogen phosphorylase kinase
c) Presence of the high AMP concentrations
d) The release of Ca2+ from the sarcoplasmic reticulum
e) Activation of phosphodieastrase
ANSWER: E
Q38: In which of the following genetic glycogen storage diseases
is there an accumulation of glycogen in lysosomes due to a
deficiency in the enzyme acid α-glucosidase (acid maltase)?
A. Von Gierke disease
B. McArdle disease
C. Pompe disease
D. Cori disease
E. lipidosis
ANSWER: C
Q39: Which of the following statements about the hormonal
regulation of glycogen metabolism is INCORRECT?
A) Epinephrine stimulates glycogenolysis in both liver and muscle cells.
B) Insulin activates glycogen synthase, promoting glycogen synthesis in
the liver.
C) Glucagon acts directly on muscle cells to stimulate glycogenolysis
during fasting.
D) AMP can allosterically activate glycogen phosphorylase in muscle
tissue.
ANSWER: C
Glucagon primarily acts on the liver, not muscle, to stimulate glycogenolysis during fasting. Muscle cells are responsive to epinephrine rather than glucagon..
Q40: A 30-year-old male presents to the clinic complaining of fatigue and
weakness during prolonged periods of fasting. He reports a history of recurrent
episodes of low blood sugar levels. Laboratory tests reveal elevated serum lactate
levels during these episodes. Genetic testing confirms a diagnosis of Von Gierke
disease. Which of the following enzymes is deficient in Von Gierke disease, and
how does this deficiency contribute to the patient's symptoms?
A) Glucose-6-phosphatase; leading to impaired glucose release from
glycogen in liver tissue.
B) Glycogen synthase; resulting in excessive glycogen accumulation in liver
cells.
C) Phosphofructokinase; leading to impaired glycolysis and ATP production
in liver cells.
D) Phosphorylase kinase; impairing the activation of glycogen phosphorylase
and subsequent glycogen breakdown in liver tissue.
E) Liver glycogen phosphorylase; impairing glycogen breakdown in liver
cells, leading to limited glucose production during fasting.
ANSWER: A
Q41: A 28-year-old male presents to the emergency department with severe
muscle pain and weakness after performing strenuous exercise. He reports
experiencing similar symptoms in the past during physical activities. Laboratory
tests reveal elevated serum myoglobin levels. Genetic testing confirms a
diagnosis of McArdle disease. Which of the following best describes the
enzymatic deficiency and its clinical manifestations in McArdle disease?
A) Deficiency in liver glycogen phosphorylase, leading to fasting hypoglycemia and
hepatomegaly.
B) Deficiency in muscle glycogen synthase, resulting in excessive glycogen
accumulation in muscle cells and exercise intolerance.
C) Deficiency in glucose-6-phosphatase, impairing glucose release from glycogen
and causing fasting hypoglycemia.
D) Deficiency in muscle glycogen phosphorylase, impairing glycogen breakdown
and leading to exercise intolerance and myoglobinuria.
E) Deficiency in glycogen debranching enzyme, causing impaired glycogen
breakdown and leading to fasting hypoglycemia.
ANSWER: D
THE END
By: Mahmoud
Aljunaidi