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Home , Aldolase B, Retinal isomerase

Біохімія Biochemistry Catalyse Catalytic activity Isoenzyme Multienzyme Koenzyme Nomenclature Substrate + ase

Substrate + reaction + ase

Enzyme activity – IU and katal

2 alcohol dehydrogenase, lactate dehydrogenase, xanthine oxidase, glutathione reductase, -6-phosphate dehydrogenase aspartate and (AST/ALT), , phosphoglucomutase, hexose-1-phosphate uridiltransferase, Ornithine carbamoyl glucose-6-phosphatase, pepsin, trypsin, esterases, glycoside hydrolases fumarase, arginosuccinase, UDP-glucose, epimerase, retinal , racemases, triosephosphate isomerase alanyl-t. RNA synthetase, glutamine synthetase, DNA ligases. 3

Regulation of Enzyme’s activity • phosphorylation - dephosphorylation

glycogen phosphorylase / glycogen synthase

• partial proteolysis = limited proteolysis

HCl / pepsinogen / pepsin / enterokinase / trypsinogen / trypsin

5 Inhibitors of Enzyme activity A. Competitive : Malonate / Succinate /Succinate dehydrogenase Prozerine / Acetylcholine / Acetylcholine esterase Sulfanilamide / para aminobenzoic acid / folic acid Dicoumarine / Vitamin K / gamma glutamyl carboxylase Methotrexate / dihydrofolate reductase Allopyrinol / xanthine oxidase Statins / HMG-CoA-reductase B. Non competitive Organic phosphorus / Acetylcholine esterase 6 Blood test of the patient revealed albumine content of 20 g/l and increased

activity of lactate dehydrogenase isoenzyme 5 (LDH5). These results indicate disorder of the following organ: Аналіз крові пацієнта показав вміст альбуміну 20 г / л та підвищену активність ізоферменту лактатдегідрогенази 5 (LDH5). Ці результати свідчать про порушення такого органу A. Liver B. Kidneys C. Heart D. Lungs E. Spleen For biochemical diagnostics of myocardial infarction it is necessary to measure activity of a number of and their isoenzymes. What best to prove or disprove the diagnosis of infarction in the early period after the chest pain is detected? A. Creatine kinase isoenzyme CK-MB B. Creatine kinase isoenzyme CK-MM C. LDH1 lactate dehydrogenase isoenzyme D. LDH2 lactate dehydrogenase isoenzyme E. Aspartate aminotransferase cytoplasmic isoenzyme Malaria is treated with structural analogs of vitamin B2 (riboflavin). These drugs disrupt the synthesis of the following enzymes in plasmodium: A. FAD-dependent dehydrogenase B. Cytochrome oxidase C. Peptidase D. NAD-dependent dehydrogenase E. Aminotransferase

A 50-year-old woman diagnosed with cardiac infarction has been delivered into an intensive care ward. What enzyme will be the most active during the first two days? A.Aspartate aminotransferase B.Alanine aminotransferase C.Alanine aminopeptidase D.LDH4 E.LDH5 During gastric resection the patient received mixed anesthesia with tubocurarin chloride muscle relaxant; to restore spontaneous respiration the patient received proserin. What pharmacological group does this drug belong to? A. Cholinesterase inhibitors B. Angiotensin-converting-enzyme inhibitors C. Calcium channel blockers D. Muscarinic antagonists E. Muscarinic agonists

It has been determined that one of a pesticide components is sodium arsenate that blocks lipoic acid. Enzyme activity can be impaired by this pesticide. Name this enzyme: A.Pyruvate dehydrogenase complex B.Microsomal oxidation C.Methemoglobin reductase D.Glutathione peroxidase E.Glutathione reductase A patient suffering from gout was prescribed allopurinol. What pharmacological property of allopurinol provides therapeutic effect in this case?

A. Competitive inhibition of xanthine oxidase B. Acceleration of nitrogen-containing substances excretion C. Acceleration of pyrimidine nucleotides catabolism D. Deceleration of pyrimidine nucleotides salvage E. Acceleration of nucleic acids synthesis

Pancreas is known as a mixed gland. Endocrine functions include production of insulin by beta cells. This hormone affects of . What is its effect on the activity of glycogen phosphorylase (GP) and glycogen synthase (GS)? A. It inhibits GP and activates GS B. It activates both GP and GS C. It inhibits both GP and GS D. It activates GP and inhibits GS E. It does not affect the activity of GP and GS Tissue Respiration. Biological Oxidation

• Pyruvate Dehydrogenase Complex • The Krebs Cycle (TCA Cycle) • Mitochondrial Electron Transport Chain / ETC / respiratory chain • Oxidative Phosphorylation

11 • Pyruvate dehydrogenase complex (PDH complex) is a multienzyme complex containing 3 enzymes, 5 coenzymes and other proteins.

Enzymes: E1 = pyruvate dehydrogenase E2 = dihydrolipoyl acetyltransferase E3 = dihydrolipoyl dehydrogenase Coenzymes: TPP (thiamine pyrophosphate), lipoamide, HS-CoA, FAD+, NAD+.

TPP is a prosthetic group of E1; lipoamide is a prosthetic group of E2; and FAD is a prosthetic group of E3. 12 8 key molecules and 8 enzymes in the Krebs Cycle • Citrate • Citrate Synthase • Isocitrate • Aconitase • α-Ketoglutarate • Isocitrate dehydrogenase • Succinyl-CoA • Ketoglutarate • Succinate dehydrogenase complex • Fumarate • Succinyl-CoA synthetase • Malate • Succinate dehydrogenase • Oxaloacetate • Fumarase • Malate dehydrogenase

“Can I Keep Selling Substances For Money, Officer?” Regulation of the citric acid cycle

- NADH, ATP, succinyl CoA, citrate Inhibitors of Electron Transport Chain Complex-I: Rotenon; Amobarbital (amytal) Complex-III: Antimycin A

Complex-IV: Cyanide, CO, H2S, Azide Complex-II: Malonate (competitive inhibitor of succinate dehydrogenase)

• Oxidative Phosphorylation H+ ATP-synthase / Inhibitor Olygomycin • Uncouplers of Oxidative Phosphorylation

Thyroxine; 2,4-dinitrophenol (2,4-DNP) 15 Inhibitors of ETC • ETC inhibitors prevent: 1. The reduction of oxygen to water, 2. The build-up of the H+-gradient and 3. Finally the synthesis of ATP Those organisms which in the process of evolution failed to develop protection from H2O2 can exist only in anaerobic conditions. Which of the following enzymes can break hydrogen peroxide down? A. Peroxidase and catalase B. Oxygenase and hydroxylase C. Cytochrome oxidase, cytochrome B5 D. Oxygenase and catalase E. Flavin-dependent oxidase

The process of metabolism in the human body produces active forms of oxygen, including superoxide anion radical O−2 . This anion is inactivated by the following enzyme: A. Superoxide dismutase B. Catalase C. Peroxidase D. Glutathione peroxidase E. Glutathione reductase Cytochrome oxidase is a hemeprotein that is an end component of the mitochondrial respiratory chain. What reaction is catalyzed with this enzyme? A. Transfer of reduced equivalents to molecular oxygen B. Cytochrome synthesis C. Transfer of reduced equivalents to ubiquinone D. Cytochrome splicing E. Adenosine triphosphate synthesis

Cyanide is a poison that causes instant death of the organism. What enzymes found in mitochondria are affected by cyanide? A. Cytochrome oxidase (aa3) B. Flavin enzymes C. Cytochrome _5 D. NAD+-dependent dehydrogenase E. Cytochrome P-450

Carbohydrates • Glucose, , , , sucrose, glycogen, starch • Pyruvic Acid (Pyruvate), Lactic Acid (Lactate), Citric Acid Cycle (Krebs’ Cycle), acetyl-CoA • ; Glycogenesis; ; • Hexose Monophosphate (HMP) Shunt = Pentose phosphate pathway

• Glycosylation 20 The fate of glucose molecule in the cell

Glucose Pentose phosphate Glycogenogenesis pathway supplies (synthesis of the NADPH for lipid glycogen) is Glucose-6- synthesis and activated in well pentoses for nucleic fed, resting state phosphate acid synthesis

Ribose, Glycogen NADPH

Pyruvate Glycolysis is activated if energy is required Regulation of Glycolysis Stimulation 1) AMP and fructose 2,6- bisphosphate (F2,6BP) relieve the inhibition of PFK-1 by ATP 2) F1,6BP stimulate the activity of

Inhibition 1) PFK-1 is inhibited by ATP and citrate 2) Pyruvate kinase is inhibited by ATP and alanine 3) Hexokinase is inhibited by excess glucose 6- phosphate Alanine The Role of Pentose Phosphate Pathway • Synthesis of NADPH (for reductive reactions in biosynthesis of fatty acids and steroids) • Synthesis of Ribose 5-phosphate (for the biosynthesis of ribonucleotides (RNA, DNA) and several cofactors) • Pentose phosphate pathway also provides a means for the metabolism of “unusual sugars”, 4, 5 and 7 carbons • Pentose phosphate pathway does not function in the production of high energy compounds like ATP. 23 Gluconeogenesis – synthesis of glucose from noncarbohydrate precursors • Liver and kidney are major sites of glucose synthesis • Main precursors: lactate, pyruvate, glycerol and some amino acids • Under fasting conditions, gluconeogenesis supplies almost all of the body’s glucose • Insulin deficiency / glucose intolerance = Impaired glucose tolerance / Diabetes mellitus • Glycogen Storage Disease = glycogenosis Enzyme Deficiency GSD I (von Gierke's disease) / Glucose-6-phosphatase GSD V (McArdle disease)/ Muscle glycogen phosphorylase GSD 0 / Glycogen synthase

• Mucopolysaccharidosis / lysosomal enzymes (β-glucuronidase, hyaluronidase)

• , fructosemia / hepatic • Hereditary fructose intolerance / Aldolase B / fructose- 1-phosphate • Galactosemia /galactose-1-phosphate uridyl transferase

26 Human red blood cells contain no mitochondria. What is the main pathway for ATP production in these cells? A. Anaerobic glycolysis B.Aerobic glycolysis C.Oxidative phosphorylation D.Creatine kinase reaction E.Cyclase reaction

Inherited diseases, such as mucopolysaccharidoses, manifest in metabolic disorders of connective tissue, bone and joint pathologies. The sign of this disease is the excessive urinary excretion of the following substance: A. Glycosaminoglycans B. Amino acids C. Glucose D. Lipids E. Urea A 40-year-old woman with Cushing’s disease presents with steroid diabetes. On biochemical examination she has hyperglycemia and hypochloremia. What process activates in the first place in such patients? A. Gluconeogenesis B. Glycogenolysis C. Glucose reabsorption D. Glucose transportation into a cell E. Glycolysis

It is known that pentose-phosphate pathway actively functions in the erythrocytes. What is the main function of this metabolic pathway in the erythrocytes? A. Counteraction to lipid peroxidation B. Activation of microsomal oxidation C. Neutralization of xenobiotics D. Oxidation of glucose into lactate E. Increase of lipid peroxidation When investigating human saliva it is necessary to assess its hydrolytic properties. What substance should be used as a substrate in the process? A. Starch B. Proteins C. Fats D. Fiber E. Amino acids

Diseases of respiratory system and circulatory disorders impair the transport of oxygen, thus causing hypoxia. Under these conditions the energy metabolism is carried out by anaerobic glycolysis. As a result, the following substance is generated and accumulated in blood: A. Lactic acid B. Pyruvic acid C. Glutamic acid D. Citric acid E. Fumaric acid Fructosuria is known to be connected with inherited deficiency of fructose 1- phosphate aldolase. What product of fructose metabolism will accumulate in the organism resulting in toxic action? A. Fructose 1-phosphate B. Glucose 1-phosphate C. Glucose 6-phosphate D. Fructose 1,6-biphosphate E. Fructose 6-phosphate

When blood circulation in the damaged tissue is restored, lactate accumulation stops and glucose consumption accelerates. These metabolic changes are caused by activation of the following process: A. Aerobic glycolysis B. Anaerobic glycolysis C. Lipolysis D. Gluconeogenesis E. Glycogen biosynthesis A child with point mutation presents with absence of glucose 6-phosphatase, hypoglycemia, and hepatomegaly. What pathology are these signs characteristic of? A. Von Gierke’s disease (Glycogen storage disease type I) B. Cori’s disease (Glycogen storage disease type III) C. Addison’s disease (Primary adrenal insufficiency) D. Parkinson’s disease E. McArdle’s disease (Glycogen storage disease type V)

Characteristic sign of glycogenosis is muscle pain during physical work. Blood examination usually reveals hypoglycemia. This pathology is caused by congenital deficiency of the following enzyme: A. Glycogen phosphorylase B. Glucose 6-phosphate dehydrogenase C. α-amylase D. γ-amylase E. Lysosomal glycosidase Lipids • Fatty Acid, Acyl Glycerols, Sphingolipids, Phospholipids, Cholesterol • Lipoproteins – Low Density (LDL) / High Density (HDL) • Lipolysis / Lipogenesis • Ketone Body Formation (Ketogenesis) • HMG-CoA reductase / statin / mevalonate • triacylglycerol lipase; fatty acids synthase • sphingomyelinase

32 Stages of fatty acid oxidation

(1) Activation of fatty acids takes place on the outer mitochondrial membrane acyl-CoA synthetase (ATP dependent)

(2) Transport into the mitochondria carnitine-shutle

(3) Degradation to two-carbon fragments (as acetyl CoA) in the mitochondrial matrix (b- oxidation pathway) Three stages of fatty acid synthesis: A. Transport of acetyl CoA into cytosol citrate transport system B. Carboxylation of acetyl CoA Acetyl CoA carboxylase is the regulatory enzyme biotin(coenzyme)

C. Assembly of fatty acid chain. Five separate stages: (1) Loading of precursors via thioester derivatives (2) Condensation of the precursors (3) Reduction (4) Dehydration (5) Reduction Lipoproteins help to transport lipids • Chylomicrons (CM) • Very low density Lipoprotein (VLDL) • Low density Lipoprotein (LDL) • High density Lipoprotein (HDL) Cholesterol Metabolism Pathway Ketogenesis Pathway (ketosis)

Regulation of Lipid metabolism

+ insulin • Atherosclerosis / hypercholesterolemia / • LDL / HDL - dyslipidemia • Obesity • Sphingolipidoses = lipid storage disorders • Niemann–Pick disease / Sphingomyelinase • Tay-Sachs disease / Hexosaminidase A

Сholelithiasis / bile acids deficiency

40 During examination of a teenager with xanthomatosis the family history of hypercholesterolemia is revealed. What transportable lipids are increased in concentration in case of such a disease? A. Low-density lipoproteins B. Chylomicrons C. Very low-density lipoproteins D. High-density lipoproteins E. Intermediate-density lipoproteins

A 67-year-old man consumes eggs, pork fat, butter, milk and meat. Blood test results: cholesterol - 12,3 mmol/l, total lipids - 8,2 g/l, increased low-density lipoprotein fraction (LDL). What type of hyperlipoproteinemia is observed in the patient? A. Hyperlipoproteinemia type IIa B. Hyperlipoproteinemia type I C. Hyperlipoproteinemia type IIb D. Hyperlipoproteinemia type IV E. Cholesterol, hyperlipoproteinemia One of the factors that cause obesity is the inhibition of fatty acids oxidation due to: A. Low carnitine content B. Impaired phospholipid synthesis C. Excessive consumption of fatty foods D. Choline deficiency E. Lack of carbohydrates in the diet

The key reaction of fatty acid synthesis is production of malonyl-CoA. What metabolite is the source of malonyl-CoA synthesis? A. Acetyl-CoA B. Succinyl-CoA C. Acyl-CoA D. Malonate E. Citrate A dry-cleaner’s worker has been found to have hepatic steatosis. This pathology can be caused by disruption of synthesis of the following substance: A. Phosphatidylcholine B. Tristearin C. Urea D. Phosphatidic acid E. Cholic acid

Blood of the patients with diabetes mellitus shows increased content of free fatty acids. Name the most likely cause of this: A. Increased activity of adipose triglyceride lipase B. Accumulation of palmitoyl-CoA in cytosol C. Activation of ketone bodies utilization D. Activation of apoА1, apoА2, and apoА4 apolipoprotein synthesis E. Decreased activity of plasma phosphatidylcholine-cholesterolacyltransferase Amino acids. Proteins • Essential / Non-Essential amino acids • Transamination, deamination, decarboxylation • Urea formation: Carbomoyl-phosphate, Citrulline, Ornithine, Argininosuccinate, Glutamine • Creatine, creatinine • Biogenic amines

The general ways of amino acids degradation: Ø Deamination L-Glutamate dehydrogenase Ø Transamination pyridoxal phosphate (PLP) Aspartate transaminase – myocardium Alanine transaminase - liver Ø Decarboxilation decarboxylases, pyridoxal phosphate (PLP) Tyrosine • Tyramine Tryptophan • Tryptamine, Melatonin Histidine • Histamine Glutamic acid • γ-amino butyric acid(GABA) Phenylalanine (DOPA) • Dopamine • Cadaverine Ornithine • Putrescine Urea Cycle Phenylalanine & tyrosine amino acid metabolism phenylalanine hydroxylase

tyrosine hydroxylase

homogentisate 1,2-dioxygenase Nitrogen is being excreted from the body mainly as urea. When activity of a certain enzyme in the liver is low, it results in inhibition of urea synthesis and nitrogen accumulation in blood and tissues. Name this enzyme: A. Carbamoyl phosphate synthetase B. Aspartate aminotransferase C. Urease D. Amylase E. Pepsin

An unconscious patient was delivered by ambulance to the hospital. On objective examination the patient was found to have no reflexes, periodical convulsions, irregular breathing. After laboratory examination the patient was diagnosed with hepatic coma. Disorders of the central nervous system develop due to the accumulation of the following metabolite: A. Ammonia B. Urea C. Glutamine D. Bilirubin E. Histamine A 7-year-old child in the state of allergic shock caused by a bee sting has been delivered into an emergency ward. High concentration of histamine was observed in blood. Production of this amine was the result of the following reaction: A.Decarboxylation B.Hydroxylation C.Dehydrogenation D.Deaminization E.Reduction

Prescription of penicillin G sodium salt has caused development of neurotoxic effects (hallucinations, convulsions). Such reaction is the result of antagonism with the following neurotransmitter: A. GABA B. Dopamine C. Serotonin D. Adenosine E. Acetylcholine Depression and emotional disturbances result from the lack of noradrenaline, serotonin, and other biogenic amines in the brain. Their content in the synapses can be increased through administration of antidepressants that inhibit the following enzyme: A. Monoamine oxidase B. Diamine oxidase C. L-amino acids oxidase D. D-amino acid oxidase E. Phenylalanine 4-monooxygenase

A traumatology unit received a patient with crushed muscular tissue. What biochemical indicator of urine will be raised in this case? A. Creatinine B. Total lipids C. Glucose D. Mineral salts E. Uric acid Molecular Biology. Protein Synthesis • Nucleic Acids (DNA, RNA), Nucleotides, Nucleosides, Nucleoproteins, Purines / Pyrimidines • Uric Acid, Hyperuricemy / Gout • Xanthine oxidase / allopurinol • Replication, transcription, translation, ribosomes • Mutation, DNA reparation, expression • Polymerase Chain Reaction / DNA

52 • Hyperuricemia: Gout – inherited disease accompanied with hyperuricemia and crystallization of uric acid and its salts in joints, cartilages and kidneys. Lesch-Nyhan Syndrom: is a inherited disorder caused by a deficiency of the enzyme hypoxanthine-guanine phosphoribosyltransferase. OROTACIDURIA inherited disorder of pyrimidine synthesis caused by a deficiency of the enzyme of orotate- phosphoribosyltransferase and decarboxylase. adenosine deaminase (ADA) deficiency

53 Replication Enzymes: Primase; Helicase; Topoisomerase; DNA-polymerases

54 Transcription / RNA-polymerase Translation or Protein Synthesis Replication inhibitors Afidikolin (antitumor antibiotic) - blocks all DNA polymerases Quinolones - block the DNA-gyrase

Transcription inhibitors Amanitin is an inhibitor of RNA polymerase II Rifampicin, rifamycin - block the binding of nucleotides to RNA polymerase Actinomycin D - blocks the interaction of RNA polymerase with the DNA matrix Interferons: induce synthesis of cAMP depending protein kinase →inactivation of eIF-2 (translation initiation factor) by phosphorylation

Diphtheria toxin ADP-ribosylation of elongation factor еЕF- 2

A 65-year-old man suffering from gout complains of pain in his kidneys. Ultrasonic examination revealed kidney stones. A certain substance in increased concentration can cause kidney stones formation. Name this substance: A. Uric acid B. Cholesterol C. Bilirubin D. Urea E. Cystine

A 52-year-old man presents with fever and pain in the joints. Both of his first metatarsophalangeal articulations are deformed, swollen, and reddened. Blood urea is high. The patient is diagnosed with gout. What is the main developmental factor in the pathogenesis of this disease? A. Hyperuricemy B. Argininosuccinic aciduria C. Hyperazotemia D. Hyperaminoacidemia E. Citrullinuria T-lymphocytes are determined to be affected with HIV. In this case viral enzyme reverse transcriptase (RNA-dependent DNA-polymerase) catalyzes the synthesis of: A. DNA based on the viral RNA matrix B. Viral RNA based on the DNA matrix C. Viral protein based on the viral RNA matrix D. Viral DNA based on the DNA matrix E. Informational RNA based on the viral protein matrix A patient has decreased concentration of magnesium ions that are required for ribosomes connection to granular endoplasmic reticulum. This condition is known to disturb the process of protein biosynthesis. Disturbance occurs at the following stage: A. Translation B. Transcription C. Replication D. Amino acids activation E. Processing During cell division DNA replication occurs after a signal is received from the cytoplasm, then a certain portion of the DNA helix unwinds and splits into two individual strains. What enzyme facilitates this process? A. Helicase B. RNA polymerase C. D. Restrictase E. DNA polymerase

Hepatitis B is diagnosed through laboratory tests that determine the presence of HBA-DNA in blood serum of the patient. What reference method is applied for this purpose? A. Polymerase chain reaction B. Hybridization method C. Hybridization signal amplification method D. Ligase chain reaction method E. ELISA diagnostic method Vitamins. Hormones • Fat-soluble Vitamins – retinol (A) , tocopherol (E), cholecalciferol (D3), naphthoquinone = menadione (K3) • Water-soluble Vitamins – ascorbic acid; thiamine; riboflavin; nicotinamide; pyridoxine; pantothenic acid; biotin; folic acid; cobalamin • Deficiency manifestation – scurvy; pellagra; beriberi; rickets

63 Vitamin deficiency manifestation ascorbic acid / scurvy / collagen / hydroxyproline / proline hydroxylase nicotinamide / pellagra thiamine / beriberi / pyruvate 2+ cholecalciferol (D3)/ rickets / Ca naphthoquinone = menadione (K3)/ hemorrhages folic acid; cobalamin / anemia

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Classification of hormones according to chemical nature

1. Proteins: hormones of anterior pituitary (except ACTH), insulin, parathyroid hormone. 2. Peptides: ACTH, calcitonin, , vasopressin, oxytocin, hormones of hypothalamus (releasing factors and statins). 3. Derivatives of amino acids: catecholamins (epinephrine and norepinephrine), thyroxin, triiodthyronin, hormones of epiphysis. 4. Steroid (derivatives of cholesterol): hormones of the cortex of epinephrine lands, sex hormones. 5. Derivatives of polyunsaturated fatty (arachidonic) acids: prostaglandins. A pregnant woman with several miscarriages in anamnesis is prescribed a therapy that includes vitamin preparations. What vitamin facilitates carrying of a pregnancy? A. Alpha-tocopherol B. Folic acid C. Cyanocobalamin D. Pyridoxal phosphate E. Rutin

A patient, who has been subsisting exclusively on polished rice, has developed polyneuritis due to thiamine deficiency. What substance is an indicator of such avitaminosis, when it is excreted with urine? A. Pyruvic acid B. Malate C. Methylmalonic acid D. Uric acid E. Phenyl pyruvate

A 30-year-old woman developed the signs of virilism (body hair growth, balding temples, disturbed menstrual cycle). What hormone can cause this condition when hyperproduced? A. Testosterone B. Estriol C. Relaxin D. Oxytocin E. Prolactin

On examination the patient is found to have low production of adrenocorticotropic hormone. How would this affect production of the other hormones? A. Decrease adrenocorticotropic hormone synthesis B. Decrease hormone synthesis in the adrenal medulla C. Decrease insulin synthesis D. Increase sex hormones synthesis E. Increase thyroid hormones synthesis During removal of the hyperplastic thyroid gland of a 47-year-old woman, the parathyroid gland was damaged. One month after the surgery the patient developed signs of hypoparathyroidism: frequent convulsions, hyperreflexia, laryngospasm. What is the most likely cause of the patient’s condition? A. Hypocalcemia B. Hyponatremia C. Hyperchlorhydria D. Hypophosphatemia E. Hyperkalemia

During regular check-up a child is determined to have interrupted mineralization of the bones. What vitamin deficiency can be the cause? A. Calciferol B. Riboflavin C. Tocopherol D. Folic acid E. Cobalamin Blood, Hemoglobin Delta-aminolevulinate synthase Ferrochelatase Bilirubin /Jaundice •conjugated /unconjugated •stercobilin - in the feces and urine •UDP-glucuronyl transferase Porphyria •erythropoietic porphyria (Gunther’s disease) •deficiency of uroporphyrinogen III cosynthase • Hemolytic – unconjugated bilirubin↑, ALT,AST,ALP, bilirubin in urine, urobilinogen in urine↑ • Obstructive - conjugated bilirubin, ALT,AST,ALP, urobilinogen in urine↑ • Hepatic

71 Plasma proteins • albumins - 55-65% • α1-globulins - 2-4% • α2- globulins - 6-12% • β- globulins - 8-12% • γ- globulins -12-22% • Albumins – Maintenance of osmotic pressure; transport of • fatty acids, bilirubin, bile acids, steroid hormones, pharmaceuticals and inorganic ions. • Transferrin – transport of Fе3+ • Haptoglobin – binding of Hb • Ceruloplasmin – binding of Cu (90% in plasma). Deficiency is Wilson's disease • C-reactive protein – acute phase protein Hb types Hb functional

S НbA1 (2α2β) - 96% S НbН – deoxy-Нb S S НbA2 (2α2δ) - 2% НbО2 – oxy-Нb S НbF (2α2γ) S НbСО – carboxy-Hb S НbСО – carb-Hb S НbE (2α2ε) 2 S Met-Нb (Fe2+→ Fe3+) Pathological forms S НbS (Glu6 β →Val6 β)

S Glycosylated НbA1с < 6% RBC pathology S glucose-6-phosphate dehydrogenase deficiency → lack of NADPН2 → ↑Н2О2 → hemolysis S pyruvate kinase deficiency → lack of АТP → + Na and Н2О retention → hemolysis S Spectrin and anquirin deficiency → microspherocytes → hemolysis A 46-year-old woman suffering from cholelithiasis developed jaundice. Her urine became dark yellow, while feces are lightcolored. What substance will be the most increased in concentration in the blood serum in this case? A. Conjugated bilirubin B. Unconjugated bilirubin C. Biliverdine D. Mesobilirubin E. Urobilinogen

A patient with jaundice has high total bilirubin that is mainly indirect (unconjugated), high concentration of stercobilin in the feces and urine. The level of direct (conjugated) bilirubin in the blood plasma is normal. What type of jaundice can be suspected? A. Hemolytic B. Parenchymal (hepatic) C. Mechanical D. Neonatal E. Gilbert’s disease Along with normal hemoglobin types there can be pathological ones in the organism of an adult. Name one of them: A. HbS B. HbF C. HbA1 D.HbA2

E. HbO 2

A 53-year-old male patient complains of acute pain in the right hypochondrium. Objective examination revealed scleral icterus. Laboratory tests revealed increased ALT activity, and stercobilin was not detected in the stool. What disease is characterized by these symptoms A. Cholelithiasis B. Hemolytic jaundice C. Hepatitis D. Chronic colitis E. Chronic gastritis An infant born prematurely 2 days ago presents with yellow coloring of skin and mucosa. Such a condition in the infant is caused by temporary deficiency of the following enzyme: A. UDP-glucuronyl transferase B.Aminolevulinate synthase C.Heme oxygenase D.Heme synthetase E.Biliverdine reductase

Patients with erythropoietic porphyria (Gunther’s disease) have teeth that fluoresce with bright red color when subjected to ultraviolet radiation; their skin is light-sensitive, urine is red-colored. What enzyme can cause this disease, when it is deficient? A. Uroporphyrinogen III cosynthase B. Uroporphyrinogen I synthase C. Delta-aminolevulinate synthase D. Uroporphyrinogen decarboxylase E. Ferrochelatase . Mucin aggregates retain water, which results in their viscosity and protective action. It is possible because mucin structure contains: A. Glycosaminoglycans B. Homopolysaccharides C. Disaccharides D. Oligosaccharides E. Glucose

. A patient with glossitis presents with disappearance of lingual papillae, reddening and burning pain in the tongue. Blood test: erythrocytes 2,2 · 1012/l, hemoglobin - 103 g/l, color index - 1,4. What type of anemia is it? A. B12 folate-deficient B. Iron deficiency C. α-thalassemia D. β-thalassemia E. Iron refractory . The patient’s saliva has been tested for antibacterial activity. What saliva component has antibacterial properties? A. Lysozyme B. Amylase C. Ceruloplasmin D. Parotin E. Cholesterol

To assess the rate of collagen disintegration during certain connective tissue disturbances, it is necessary to measure the urine content of the following: A. Oxyproline B. Ornithine C. Proline D. Lysine E. Urea During tooth brushing it is not uncommon for oral mucosa to be injured. However, bleeding quickly stops on its own. What substances in saliva quickly staunch the flow of blood during oral injuries? A. Procoagulants B. Lipolytic enzymes C. Amylolytic enzymes D. Mineral substances E. Lysozyme and mucin

A doctor has made a diagnosis of gingivitis and recommended the patient to rinse the oral cavity with an oxidizing agent. Specify this agent: A. Hydrogen peroxide B. Boric acid C. Salicylic acid D. Phenol E. Brilliant green Periodontitis induces development of lipid peroxidation in the periodontal tissues, as well as increase in malondialdehyde and hydrogen peroxide concentration in the oral cavity. Which of the following enzymes provides antioxidant protection? A. Catalase B. Amylase C. Maltase D. Lactase E. Invertase

Osteolaterism is charcterized by a decrease in collagen strength caused by significantly less intensive formation of cross-links in collagen fibrils. This phenomenon is caused by the low activity of the following enzyme: A. Lysyl oxidase B. Monoamine oxidase C. Prolyl hydroxylase D. Lysyl hydroxylase E.Collagenase . Calcification of dental tissues is significantly influenced by osteocalcin protein that can bind calcium ions due to the presence of the following modified amino acid residues in the polypeptide chain: A. γ-carbon glutamine B. Alanine C. γ-aminobutyric D. Carboxy aspargine E. δ-aminopropionic

A 36-year-old patient under went tooth extraction at a dental clinic. After two weeks the stratified squamous epithelium regenerated at this site. What organelles were involved in the restoration of the mucous membrane? A. Ribosomes B. Centrosomes C. Postlysosomes D. Smooth EPR E. Mitochondria Good Lack!

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