Metabolism
Metabolism Mastery Quiz
Test your knowledge on metabolism and related genetic disorders with our comprehensive quiz. Challenge yourself with a variety of questions that cover key concepts and clinical implications surrounding glycogen storage diseases, glucose homeostasis, and more.
Whether you are a student, educator, or just a curious learner, this quiz is designed for you!
- Multiple choice questions
- Score and review your answers
- Gain insights into metabolic disorders
Symptoms of hypoglycemia in the brain:
Trembling
Sweating
Somnolent
Seizure
All answers are correct
Glycogen is formed and stored in :
Liver
Muscle
Brain
Spleen
Liver and muscle
GSDs are caused by defects in :
Glycogen synthesis
Glycolysis
Glycogen breakdown
Autosomal recessive
All answers are correct
What are the defects of glucose homeostasis?
Glycogenosis and glycogen synthase deficiency gluconeogenesis
Hereditary Fructose Intolerance
Fanconi Bickel syndrome
De Vivo – Syndrome
All answers are correct
Which one is the most form of GSD?
Glycogenosis type 1
Glycogenosis type 4
Glycogenosis type 6
Glycogenosis type 7
Glycogenosis type 5
Clinical sign of glycogenosis type 1:
Large abdomen
Small stature
Late puberty
Liver adenoma
All answers are correct
Treatment of glycogenosis type 1:
Carbohydrate rich meal
Uncooked starch
Gastric tubing over night
Frequent
All answers are correct
Treatment of GSD:
Avoidance of hypoglycemia
Soya containing milk product
Calcium supply
Allopurinal
All answers are correct
What happens to glucose and lactate in the Fasting state?
Both decreases
Increase
Glucose elevate, lactate low
Glucose low, lactate elevate
Glucose normal, lactate normal
What happens to glucose and lactate in the Fed state?
Decrease
Both increases
Glucose elevate, lactate low
Glucose low, lactate elevate
Glucose normal, lactate normal
Differential diagnosis of hypoglycemia:
Hyperinsulinism
Cortisol deficiency
Growth hormone deficiency
Carnitine deficiency
All answers are correct
In hereditary fructose intolerance (HFI): reactive hypoglycemia after fructose due to immediately functional block by:
Fructose- 1-phosphatase
Glucose-6-1-phosphatase
Glucose-6-phosphatase
Fructose-1-6-biphosphatase
Fructose-1-6-phosphatase
HFI causes defects in which organs:
Intestine
Liver
Kidney
Intestine and liver
Intestine, liver and kidney
Symptoms in chronic HFI of the infant includes:
Poor eater (a version against sweet)
Large abdomen
Slow growth
Caries free
All answers are correct
Lactose is contained in:
Milk
Yogurt
Quark
Butter, soft cheese
All answers are correct
Treatment of Fanconi-Bickel Syndrome include:
Vitamin D
Calcium
Fluid
Frequent meal
All answers are correct
Clinical signs in Fanconi-Bickel syndrome:
Normal at birth
Failure to thrive starting with 3to10 month
Hepato nephromegaly
Ricket
All answers are correct
De Vivo syndrome-GLUT 1 deficiency symptoms are:
Mental retardation starting at one year
Ataxia
Hypotonia
Acquired microcephaly
All answers are correct
Treatment in GLUT1 deficiency which one is true?
The ketogenic diet for beginner
Regular diet
Vitamin supplement
Add more glucose
Add more lactose
Take home message in metabolic crisis include:
Must be explored diagnostically as much as possible
Analyze and store blood and urines frozen
Start symptomatic therapy only thereafter
Don' t keep a child alone in a case of severe hypoglycemia
All answers are correct
Genetic counseling includes all of the following EXCEPT:
Recommendation of specific reproductive options
Discussion of available genetic testing
Discussion of available therapy
Discussion of an impact on a patient
Assessment of a recurrence risk
The family below is segregating an X-linked recessive disorder with 100% penetrance. Shaded individuals are affected with the disorder. What is the chance that the woman's next child (IV-5) is an affected son?
1/3
1/9
1/11
1/15
1/36
The family below is segregating a mutation for Duchenne Muscular Dystrophy (DMD), a lethal X-linked recessive disorder. Filled symbols represent individuals affected with DMD. Individual III-1, 5 y.o., has muscle weakness and wasting, and has an abnormal muscle biopsy. Both III-1, and her sister III-2, aged 1 y.o., have normal karyotypes. What is the risk that III-2 is a carrier for DMD?
5%
25%
50%
75%
95%
Approximately what percentage of all pregnancies result in the birth of a child with a significant genetic disease or birth defect that can cause crippling, mental retardation, or early death?
0.9%
0.01%
0.1%
3%
0.25%
You would appropriately suspect a possible collagen disorder in a patient who has any of the following symptoms except:
Multiple fracture
Joint hypermobility or laxity
Progressive neurological deterioration
Rupture of a bowel
Blue sclera
You see a previously healthy 3-day-old male infant who is very lethargic, vomiting, and had a seizure. Which of the laboratory tests would be most appropriate to obtain initially to confirm your suspicions?
A 24 hours urine homogentisic acid level
Just a plasma phenylalanine level
Plasma phenylalanine and tyrosine level
The serum ammonia levels
Ornithine transcarbamylase gene sequence
G6PD deficiency is common in African, Mediterranean, and Asiatic populations in which malaria has been endemic. Multiple different mutations have been found in different populations. This high frequency of G6PD mutations is best explained by :
A mild phenotype of G6PD deficiency
Genetic drift
Founder effect
Influence of drugs that cause hemolytic anemia.
The balanced polymorphisms
Which is true of newborn screening tests for genetic diseases? Newborns are typically screened for genetic diseases:
Which are the treatable and/or preventable of newborns
Which are fatal by one year of age
When first degree relative is known to be affected
Which are irreversible disorder
Newborn is screened for all known genetic disease
A large percentage of individuals with α1 -antitrypsin deficiency will develop chronic obstructive pulmonary disease (COPD) or emphysema. The severity of this disease will be significantly increased if the patient is:
The cigarette smokers
Heterozygous for a mutation, with one normal copy of α1 -antitrypsin gene
Homozygous for null alleles of an elastase gene
Neutropenic
Woman
Why is β -thalassemia major usually evident only after birth?
The fetal Hb persists after birth when it should have been shut off
The product of β globin pseudogene is highly expressed only after birth
The mother's normal red blood cells provide oxygen to a fetus in utero
The switch from γ gene to β gene expression occurs around the time of birth
The Hb subunits encoded by α cluster
Severe β -thalassemia may not become clinically apparent until a child is several months old because :
Elevated hemoglobin A2 compensates for a missing β globin gene
The α globin genes don't turn on until several months after birth
Overexpression of ζ globin (zeta) compensates for a missing β chain
The γ (gamma) to β globin switch is not complete until several months after the birth
The oxygen needs of a newborn are minimal
The major abnormal form of hemoglobin that accumulates in a fetus with the severe form of α - thalassemia (hydrops fetalis) is composed of:
A tetramer of 4 γ subunits (γ4)
A tetramer of 2 β subunit (β2)
A tetramer of 2 α subunit (α2)
A tetramer containing 2 δ subunit and 2 β subunit (δ2β2)
A tetramer containing 2 ζ subunit and 2 ε subunit (ζ2ε2)
For a given autosomal recessive disease, q = 0.01 (where q is the allele frequency of the mutant allele). Approximately what percentage of the population has two copies of the normal allele?
5%
15%
65%
75%
98%
Which of the following observations is the strongest evidence for an important genetic component in the causation of type-1 diabetes mellitus (IDDM)?
Pancreatic β cell autoantibodies are frequently present
Approximately 10% of affected individuals have an affected sibling
Onset of disease is usually in childhood
Concordance rate in monozygotic twins is approximately 30%.
The concordance rate in monozygotic twins is five times that in dizygotic twin
Hemophilia A and hemophilia B have nearly identical phenotypes, but they result from mutations in different genes on the X chromosome. This is an example of:
The locus heterogeneities
Variable expressivity
Heterozygosity
Double heterozygosity
Allelic heterogeneity
A disorder causing muscle weakness and epilepsy afflicts several members of the pedigree below. What is the MOST LIKELY mode of inheritance?
X linked recessive
Non genetic
Autosomal recessive
Autosomal dominant
Mitochondrial (maternal inheritance)
What is the most likely pattern of inheritance in this pedigree?
X linked recessive
X linked dominant
Y linked recessive
Autosomal dominant
Mitochondrial
To establish a successful and cost-effective screening program for detecting heterozygous carriers of an autosomal recessive disease, all of the following are essential, EXCEPT:
Disease is severe enough to be clinically significant
A high risk population can be identified
The screening test has a positive predictive value of 100%
Genetic counseling is provided with a testing
Reproductive options are available
A child is born with a cleft lip and palate. This birth defect may be associated with the following:
A healthy newborn infant
A disruption defect related to amniotic band
A chromosome disorder such as trisomy 13
Completely normal newborn infant
All answers are correct
One gene, one enzyme” is a phrase describing the concept that:
Individual metabolic steps are controlled by individual enzymes encoded by specific genes
Functional enzymes are never made up of subunits encoded by different gene
Alteration of genes by rare enzymes are a main cause of metabolic disease
Only one of a gene needs to be inactive to cause severe disease due to 50% level
Most metabolic disorders are X linked recessive
Asbjörn Følling’s 1st description called Imbecillitas phenylpyrouvica was in
1934
1939
1936
1937
1938
Horst Bickel’s therapeutic success in PKU was in
1953
1958
1955
1956
1957
Bob Guthrie’s screening method was in
1962
1969
1966
1968
1967
Progressive psychomotor retardation due to toxicity of Phe in the central nervous system at blood levels
400 µmol/l
450 µmol/l
350 µmol/l
250 µmol/l
150 µmol/l
Classification of phenotypes in PKU are
2
1
4
8
7
Mild PKU:
Phe < 100 µmol/l
Phe < 360 µmol/l
Phe 360-600 µmol/l
Phe > 600 µmol/l
Phe > 1200 µmol/l
Therapy of PKU
Vegetarian diet
Protein poor product
Amino acid mixture
Multivitamin complex
All answers are correct
Therapeutic of Homocystinuria
Vit A
Vit C
Vit D
Vit E
Vit B6
Embryo-fetopathy due to maternal PKU
Microcephaly
Small for gestational age (length, weight)
Mental retardation ad short stature
Malformation: heart, limb
All answers are correct
Hyperaminonemia in NB period
NH3 > 150 µmol/l
NH3 > 75 µmol/l
NH3 > 70 µmol/l
NH3 > 85 µmol/l
NH3 > 80 µmol/l
When will Medium Chain Acyl-CoA Dehydrogenase Deficiency (MCAD) occur?
1 year of life
First 2 years of age
After birth
First 5 year
> 5 year
What is the consequence of untreated Medium Chain Acyl-CoA Dehydrogenase Deficiency (MCAD)?
Hyoglycemia
Hypoketosis
Seizure
Hyponatremia
Coma within hours
Which organ that involve in Medium Chain Acyl-CoA Dehydrogenase Deficiency (MCAD)?
Brain
Kidney
CNS
Metabolic disease
Liver, Heart, Skeletal muscle
We can do the diagnosis of Medium Chain Acyl-CoA Dehydrogenase Deficiency (MCAD) by the following except:
Acylcarnitine in blood
Organic acid in urine
CTs Scan of the brain
Autosomal recessive
Frequent mutation
Which one of these is not the general management in Medium Chain Acyl-CoA Dehydrogenase Deficiency (MCAD)?
Avoidance of fasting for too long
Regular, carbohydrate rich meal
The regular, fatty acids-rich meals
During infections: short hospitalizations for iv glucose
Carnitine supplement: 50 mg/kg between/die per os
Acute therapeutic measure in Propionic Acidemia (PA) / Methylmalonic Aciduria (MMA) are all of the following except:
Stop protein intake
Correct acidosis
Must increase fluid intake
Forced diuresis
Coenzyme addition
All of the following are the complication in Propionic Acidemia (PA) / Methylmalonic Aciduria (MMA) except:
Neurological complication
The cirrhosis only
Progressive kidney dysfunction (MMA)
Skin and hair change
Cardiomyopathy
Cardiomyopathy:
Glycogen
Protein
Amino acid
Fatty acids
Polysaccharide
Which of these following are Branched Chain Amino Acids (BCAAs)?
Valine, Leucine, Isoleucine
Phylalanine, methionoine, threonine
Tryptophan, histidine, asparagine
Cysteine, glutamine, lysine
Alanine, arginine, proline
All of the following are the clinical course in acute neonatal Propionic Acidemia (PA) / Methylmalonic Aciduria (MMA) except
Poor sucking
Vomiting
Usually with apnea
Dehydration
Hyperpnea
These following are Chronic intermittent manifestation up to adulthood in Propionic Acidemia (PA) / Methylmalonic Aciduria (MMA) except:
Recurrent lethargy / ataxia / stupor → coma
Recurrent ketoacidosis (may be lacking!)
Focal neurological sign
Psychomotor retardation, Osteoporosis, Neuro-vegetative dysregulation
Reye syndrome
These following are Long term therapy in Propionic Acidemia (PA) / Methylmalonic Aciduria (MMA) except:
Reduction of protein intake
Increase fluid intake, Sufficient energy intake
Increase protein intake, Reduce fluid intake, Forced diuresis
L Carnitine 100 (250) mg/kg/d (po)
Biotin/Hydroxycobalamin Metronidazol 10 to 30 mg/kg/d
Which of these following is not the symptoms of Propionic Acidemia (PA) / Methylmalonic Aciduria (MMA)?
Muscular hypotonia, Lethargy
Tachypnea, Poor sucking, Vomiting
Dehydration, Seizures, Ataxia
Failure to thrive, Psychomotor retardation
No correct answers
Which of the following are the 4 main types of Organic Acidurias?
Propionic Acidemia (PA)
Isovaleric acidemia
Methylmalonic Aciduria (MMA)
Maple syrup urine disease
All answers are correct
Organic Acidurias are usually diagnosed in infancy, characterized by urinary excretion of abnormal amounts or types of:
Organic acid
Lysergic acid
Bronsted acid
Acetic acid
Lactic acid
The diagnosis of Organic Acidurias is usually made by detection an abnormal patter of organic acids in an urine sample by:
Random sample
Morning sample
Catheter sample
Gas chromatography mass spectrometry
Single random specimen
The Organic Acidurias disorder vary in their prognosis from manageable to fatal and usually affect more than one organ system, especially which one of these system?
Central nervous system
Digestive system
Cardiovasular system
Respiratory system
Lymphatic system
The Organic Acidurias generally present with
Hyperammonemia and High anion gab metabolic acidosis
Hyperglycemia, Low anion gab metabolic acidosis
Hypoammonemia
Low anion gab metabolic acidosis
Hyperammonemia, Hypoglycemia
Chorionic villus sampling for pre-natal diagnosis in Organic Acidurias is done at
8-10 weeks
15-17 weeks
11-15 weeks
11-13weeks
13-15weeks
A child presents with brawny dermatitis, somnolence hallucinations, and neurologic signs, like hyperesthesia. There is an increase in organic aciduria. He is known to have been fed raw egg-white regularly. This could result from:
Overdose of Vitamin B6
The biotin deficiencie
Niacin deficiency
Vitamin K excess
All answers are not correct
A 5-day-old term neonate presents to the ED. Her Parents report a 2 - 3day history of poor feeding and a 1-day history of increasing lethargy. She has increased anion gap metabolic acidosis and a glucose level of 24mg/dl. Urinalysis reveals the presence of large urinary ketones. Which of the following laboratory evaluations, is most likely to lead to an underlying diagnosis?
Urine organic acids
Free and total carnitine level
Very long chain fatty acid
Urine reducing substance
Urine amino acid
A 5-months-old, previously healthy infant followed in your clinic has sudden onset of hypotonia and dystonia after an intercurrent illness. She was born with macrocephaly. You have followed her in your clinic since birth without other medical problems of significance. A brain MRI is completed and show s degeneration of the caudate and putamen with frontal atrophy. Which of the following diagnostic tests is most likely to reveal the underlying diagnosis?
Galactose 1 phosphate level
Urine Organic acids
Ceruloplasmin level
Copper level
Urine mucopolysaccharide
Which disease would occur if there was a deficiency enzyme branched-chain alpha-keto acid dehydrogenase?
Maple syrup urine disease
Phenylketonuria
Tyrosemia
Galactosemia
Anemia
What group is most likely to develop MSUD (Maple syrup urine disease)?
Infants
Children
Young adult
Elderly
Men and women
Which of these following is a risk factor of Maple syrup urine disease I(MSUD)?
Smoking
Obesity
From family history
Unprotected six
Hypertension
What type of fibers are found in connective tissue matrix?
Collagen, elastic and reticular fiber
Collagen fiber
Collagen, nerve fiber
Collagen, elastic fiber
Collagen, muscle fiber
Collagen fiber is found abundantly in the followings except one?
Dermis
Tendon
Ligament
Blood vessels
Cartilag
Elastic fiber is found abundantly in the followings except one?
Artery
Heart
Ligament
Lung
Vein
Which one is the collagen disorder type 2?
Epidermolysis bullosa
The chondrodysplasias
Schimid
Ehlers Danlos Syndrome
All answers are not correct
Which one are involved in Functional Connective tissue complex?
Cell
Collagen
Elastin
Hyaluronic acid
All answers are correct
What are the important signs in vascular form of EDS 4?
Skin thin and translucent
Ecchymosis
Rupture of internal organ
Facies characteristic
All answers are correct
All of the following are typical facial appearance in EDS 4 except one?
Nose thin and sharp
Lip thin
The macrocephalia
Eyes prominent
Cheeks hallow
Which organ is the most frequent attacked by EDS 4?
Spleen
Artery vessels
Liver
Sigmoid
Kidney
Which one is the mortality cause in Marfan syndrome?
Habitus
The aneurysm of the aorta
Subluxation of the len
Positive family history
All answers are not correct
What defects are there in Heritable disorders of connective tissues?
Collagen
Microfibril
Elastin
Proteoglycan
All answers are correct
How many types are there in Osteogenesis imperfecta?
9 types
4 types
6 types
7 types
8 types
What is not type of Osteogenesis imperfecta?
Bluish scerae
Perinatal lethal form
The autosomal dominant
White sclerae
Progressive form
In Alport syndrom , which type of cllagen is involved?
Collagen type 1
Collagen type 2
Collagen type 8
Collagen type 4
Collagen type 9
. What clinical signs are in Cutis laxa?
Lax, redundant skin
Diverticulae of a bladder
CDiaphragmatic herniae
Diverticulae of intestine
All answers are correct
In Ehlers-Danlos Syndrome (EDS) , which collage types are defected?
Collagen type 1, 3, 5
Collagen type 2, 4, 6
Collagen type 4, 6, 8
Collagen type 2, 6, 8
Collagen type 4, 6, 10
What type of collagen disorder that causes Epidermolysis bullosa?
Collagen 7
Collagen 2
Collagen 4
Collagen 3
Collagen 5
What type of collagen disorder that causes Chondrodysplasia?
Collagen 2
Collagen 9
Collagen 3
Collagen 5
Collagen 6
Which one of the following pathologies is caused by Collagen disorders type 2 , type 9 and type 11 ?
Chondrodysplasia
EDS
Bethlem
Schmid
Alport syndrome
Which disease is caused by Collagen disorders type 7 and type 17?
Epidermolysis bullosa
EDS
Bethlem
Schmid
Alport syndrome
What is Ehlers-Danlos syndrome?
Heterogeneous group of disorder
Hyperextensibility of joint
Hyperelasticity of skin
Fragility of tissues (skin, internal organs)
All answers are correct
What is the etiology of EDS?
Mutation in genes coding for
Diverse collagen chain
Enzymes in metabolism of collagen
Other adhesion protein
All answers are correct
What is the clinical sign of EDS 7?
Generalized hyperlaxity of the joints and bilateral hip dislocation
Bilateral hip dislocation
Skin thin and translucent
Ecchymosis
Generalized hyperlaxity of joint
What is not diagnostic criteria of Marfan syndrome?
Habitus
The generalized ecchymosis
Luxation of len
Positive family history
Aneurysm of aorta
All the following pathologies are bases on heritable disorder of CT except one?
Osteogenesis imperfecta
The Basedow diseases
Marfan syndrome
Cutis laxa
EDS
What is Osteogenesis imperfecta?
Generalized connective tissue disorder
Affected bone: osteopenia
Affected teeth: caries , brittle
Affected soft CT: thin skin , hernia , fragile vessel
All answers are correct
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