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EXAMINATION AUGUST 2024
FIRST MBBS
BIO-CHEMISTRY (PAPER - II) (NEW) - LEVEL 3
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[Time: As Per Schedule][Max. Marks: 100]
Instructions:
Seat No:
1. Fill up strictly the following details on your answer book
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a. Name of the Examination: FIRST MBBSb. Name of the Subject: BIO-CHEMISTRY (PAPER - II) (NEW) -
LEVEL 3
c. Subject Code No: 2406000101030702
2. Sketch neat and labelled diagram wherever necessary.
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3. Figures to the right indicate full marks of the question.4. All questions are compulsory.
Student's Signature
SECTION A
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Q.1 Multiple choice questions: (20 out of 20)
20*1=20
1. A 19-year-old male patient was suffering from Wilson's disease.
His ceruloplasmin level was low and liver enzymes were elevated.
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Which of the following mineral is useful in the treatment?a) Zinc b) Copper
c) Iron d) Molybdenum
2. Enzyme A digests proteins in the stomach (environment with a pH
of 2). Enzyme B digests proteins in the small intestine (environment
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with a pH of 8). Which of the following is NOT true:a) Enzyme A would be denatured in the small intestine.
b) Enzyme A works best in acidic conditions.
c) Enzyme A can also work in the small intestine.
d) Enzyme A helps in the hydrolysis of proteins
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3. A newborn does well with breast feeding. Two days later, the
mother brought the infant to emergency as the baby was bleeding
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from umbilical cord and nostrils. The most likely cause is:a) Deficiency of vitamin C due to a citrus poor diet during
pregnancy
b) Deficiency of vitamin K because disseminated intravascular
coagulation
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c) Deficiency of vitamin K because infant intestines are sterile.d) Deficiency of vitamin E due to maternal malabsorption during
pregnancy.
4. A 42 years old man comes to OPD with complaints of frequent
bleeding nose and easy bruisability. For past 1 month. He was
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treated with prolong antibiotic therapy for chronic diarrhea. Whichof the following laboratory finding is most likely?
a) Elevated fibrinogen level
b) Elevated Prothrombin time
c) Elevated Platelet count
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d) Elevated bleeding time5. A 40 years old male came to OPD with complaints of anorexia,
listlessness and numbness of legs. Examination shows loss of
sensation on legs and edema was observed. He was suspected of
suffering from Beriberi. Which of the following tests will confirm
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the diagnosis?a) FIGLU excretion test
b) Methylmalonic acid in urine
c) Kynureninase activity
d) Erythrocyte transketolase activity
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6. A 2 years old boy was brought to OPD with complaints of rashsurrounding mouth and nose and diarrhea. What supplementation
should be given to the child?
a) Vitamin C b) Zinc
c) Folic acid d) Copper
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7. Adenosine deaminase deficiency leads to severe Combined immune
deficiency because of accumulated dATP inhibits which of the
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following enzyme?a) Adenosine Phosphoribosyltransferase
b) Ribonucleotide Reductase
c) Orotate Phosphoribosyltransferase
d) CTP Synthetase
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8. Which one of the following is the toxin-based vaccine?a) Polio b) Diphtheria
c) MMR d) Rabies
9. 48-year-old man presents to your office complaining of generalized
weakness and increased pain on left side of chest & both thighs.
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Physical examination reveals muscle strength of 4 out of 5 in allextremities as well as pain on palpation of the fifth and sixth ribs on
his left side. The x-ray films reveal several healed rib fractures as
well as diffuse radiolucency with thinning of the cortical bone of his
femur. Which serum enzyme level will increase in this case?
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a) Acid phosphataseb) Alanine amino transferase
c) Aspartate amino transferase
d) Alkaline phosphatase
10. 1. A child with short stature, brittle bone and blue sclera is found to
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have mutation in collagen. Which of the following is the recurringamino acid is the most likely to be altered in mutation that distort
collagen molecule?
a) Glycine b) Lysine
c) Proline d) Tryptophan
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11. A 45 years old male suffering from diabetes mellites for 8 years. Hewas presented with erectile dysfunction. He was prescribed
Sildenafil Citrate. What is the mechanism of action of this drug?
a) Activates Guanylate cyclase
b) Activates Nitric Oxide synthase
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c) Inhibits Phosphodiesterase type 5d) Activates Adenyl cyclase
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12. A 72 years old man diagnosed with Alzheimer's disease. In this
patient Amyloid precursor protein's normal alpha helical structure
gets disrupted due to mutation. The following mutational change
affects alpha helical structure of mutant protein.
a) Methionine to Proline b) Valine to Alanine
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c) Glutamate to Aspartate d) Lysine to Arginine13. A woman has been complaining of a sore throat and cough, and a
sputum culture demonstrated a bacterial infection. The physician
placed the woman on erythromycin. Erythromycin will be effective
in eliminating the bacteria because it interferes with which one of
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the following processes?a) DNA replication
b) Elongation of protein synthesis
c) Initiation of protein synthesis
d) RNA synthesis
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14. A pathologist, while doing an autopsy of a patient who died fromCreutzfeldt-Jakob syndrome, accidentally cut himself while
examining the brain. The pathologist became very concerned for his
well-being. The precipitating event in the patient's brain that led to
this disease is which one of the following?
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a) Infection of the brain with a virusb) Proteolytic cleavage of an existing brain protein
c) An altered secondary and tertiary structures for an existing brain
protein
d) Altered gene expression
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15. 34-year-old female has a history of intermittent episodes of severeabdominal pain. She has had multiple abdominal surgeries and
exploratory procedures with no abnormal findings. Her urine
appears dark during an attack and gets even darker if exposed to
sunlight. This patient most likely has difficulty in synthesizing
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which of the following?a) Heme b) Methionine
c) Creatine Phosphate d) Urea
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16. A 42 years old man comes to OPD with complaints of frequent
bleeding nose and easy bruisability. For past 1 month. He was
treated with prolong antibiotic therapy for chronic diarrhea. Which
of the following laboratory finding is most likely?
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a) Elevated fibrinogen level b) Elevated bleeding timec) Elevated Platelet count d) Elevated Prothrombin time
17. Which one of the following occurs in the urea cycle?
a) Carbamoyl phosphate is derived directly from glutamine and
CO2.
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b) The a-amino group of arginine forms one of the two nitrogen ofurea.
c) N-acetylglutamate is a positive allosteric effector of ornithine
transcarbamoylase.
d) Ornithine directly reacts with carbamoyl phosphate to form
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citrulline.18. A 40 years old female presented to the emergency center with
complaints of nausea, vomiting and abdominal pain. Her pain was
located in the mid epigastric area and right upper quadrant. Lab
investigation shows high serum lipase levels. What is the probable
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diagnosis?a) A cute pancreatitis b) Viral hepatitis
c) A cute gastritis d) Gall stone
19. Membrane bound and secretory forms of Immunoglobulin are
created due to which of the following process?
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a) m RNA editing b) Alternative mRNA splicingc) Gene amplification d) Gene rearrangement
20. Which of the following is NOT True about PCR?
a) Thermostable enzyme Taq Polymerase is.used
b) Annealing comes after denaturation
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c) Specific primers are requiredd) The extension step is performed at 50?C temperature for 30
seconds.
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SECTION B
Q.2 Long Answer Questions (2 out of 3)
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2*10=201. Describe the pathway (location, steps, energetics, and regulation)
through which ammonia is finally disposed of from our body
(1+2+1+2). Write a note on disorders of this pathway (4).
2. Describe gene expression regulation in prokaryotes (6). Write a
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note on cell cycle and its checkpoints (4).3. Describe the general structure of immunoglobulin (2). Describe the
functions and significance of immunoglobulins (5). Describe
principles of vaccine development (3).
Q.3 Short Answer Questions (10 out of 11)
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10*2=201. The salvage pathway is more economical than the de-novo
synthesis of purine nucleotide. Explain.
2. Edema develops when the albumin level is decreased. Why?
3. Enumerate types of blotting techniques with their significance.
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4. Write at least two products formed from glycine with theirsignificance.
5. Write the biological and clinical significance of the transamination
reaction.
6. What is a folate trap? Explain by drawing reactions.
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7. Why night blindness may be seen in patients with post-hepaticjaundice?
8. Explain why barbiturates precipitate an attack of porphyria and why
administration of glucose alleviates symptoms of porphyria.
9. Write the principle of electrophoresis. Draw a normal
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electrophoretogram of plasma proteins.2406000101030702
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10. Vitamin B12 deficiency leads to neurological manifestations.
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Justify.11. Write any two post-transcriptional modifications with significance.
SECTION C
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Q.4 Short Answer Questions (4 out of 5)
4*5=20
1. Describe mechanisms of regulation of enzyme activity.
2. Describe steps and clinical applications of DNA recombinant
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technology (3+2)3. Describe at least ten tumor markers with their clinical significance.
4. Enumerate cardiac biomarkers in the order of their earliest rise in
myocardial infarction. What is a flipped pattern? Describe cardiac
biomarkers that are not enzymes. (1+1+3)
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5. Describe the mechanisms of action of hormones.Q.5 Clinical Cases (2 out of 2)
2*10=20
1. A 40 years-old male, with a history of smoking cigarettes (a pack a
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day), who developed a chronic progressive condition of shortness ofbreath and incapability of sustaining any physical activity, was
referred to a respiratory physician. After a physical examination and
laboratory investigations, a diagnosis of emphysema without any
evidence of cancer arrived. The serum alpha-1 antitrypsin levels
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were very low.1. What is alpha-1 antitrypsin? (1)
2. Why is it also called a protease inhibitor and what is its
mechanism of action? (2)
3. What is the effect of smoking on alpha-1 antitrypsin and why
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the deficiency of this protein also may lead to liver disease? (2)2406000101030702
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4. What do you mean by positive acute phase proteins and give
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two examples (apart from one mentioned in the case) and theirimportance. (2)
5. Write any two negative acute phase proteins. (1)
6. What are the functions of haptoglobin and why do decreased
levels of this protein lead to hemolyticanemia? (2)
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2. A 30-year-old man has recurrent arthritic attacks. On examinationsigns of inflammation were present in several joints. Serum uric
acid was grossly elevated, as was the urinary excretion of this
compound. Further investigation revealed the deposition of urate
crystals in the inflamed joints and tissues. Treatment was started
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with allopurinol at a daily dose of 50 mg twice a day. For 2-3weeks, the dose was gradually increased to 400 mg per day.
Ibuprofen was added to control pain and inflammation.
1. What is the biochemical reason behind the development of
inflammation around the joints? (2)
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2. Write two primary and two secondary causes for raised uric acidlevels in our body. (2)
3. What is the rationale behind treating this patient with
allopurinol? Write the mechanism of action of allopurinol. (2)
4. Alcohol precipitates an attack of Gout. Why? (2)
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5. Write the normal blood level of uric acid in males and females.(2)
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