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EXAMINATION AUGUST 2024
FIRST MBBS
BIO-CHEMISTRY (PAPER - I) (NEW) - LEVEL 3
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[Time: As Per Schedule]
[Max. Marks:100 ]
Instructions:
Seat No:
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1. Fill up strictly the following details on your answer booka. Name of the Examination: FIRST MBBS
b. Name of the Subject: BIO-CHEMISTRY (PAPER - I) (NEW) -
LEVEL 3
c. Subject Code No: 2406000101030701
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2. Sketch neat and labelled diagram wherever necessary.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)20x1=20
1) A known diabetic patient went for the consultation, his clinician asked
him to go for the analysis of HbA1c. He visited clinical laboratory
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with requisition slip. The duty technician collected blood sample into avacutainer. What was that vacutainer.
a) sodium fluoride containing
b) sodium oxalate containing
c) Both sodium fluoride and oxalate containing
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d) EDTA containing2) A 35-year male was brought to emergency in an unconscious state. He
was a habitual drinker. When his blood sample was analyzed, blood
glucose levels were found to be low (48mg/dl). Blood glucose levels
were low due to:
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a) Increase in the catabolism of blood glucoseb) Increased availability of NAD+
c) Decreased availability of pyruvate and oxaloacetate
d) Increased availability of NADPH
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[1 of 8]3) A 40-year-old chronic alcoholic enters the hospital because of a
variety of symptoms, including loss of feeling in his hands and feet,
nystagmus, and difficulty with his balance when walking. This patient
would have difficulty catalyzing which one of the following reactions?
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a) -Ketoglutarate dehydrogenaseb) Pyruvate carboxylase
c) Succinate dehydrogenase
d) Fumarase
4) Which one of the following statements concerning dietary lipid is
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correct?a) Corn oil and soybean oil are examples of fats rich in saturated fatty
acids.
b) Triacylglycerols obtained from plants generally contain less
unsaturated fatty acids than those from animals.
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c) Fatty acids containing double bonds in the trans configuration,unlike the naturally occurring cis isomers, raise plasma cholesterol
levels.
d) Coconut and palm oils are rich in polyunsaturated fats.
5) A 32-year-old poorly controlled diabetic pregnant lady is undergoing
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amniocentesis at 36 weeks for fetal lung maturity prior to having acesarean delivery. Which of the following laboratory tests results on
the amniotic fluid would best indicate that the fetal lungs are mature?
a) Phosphatidylglycerol is present
b) Lecithin/sphingomyelin (L/S) ratio of 1:1
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c) Cephalin is presentd) Phosphatidylinositol is present
6) A final MBBS student represented marathon events in the
interuniversity sports event. Prior to participation he prepared himself
with shifting of his diet to carbohydrates with high starch content.
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What will be products which are sequentially formed by the action ofpancreatic amylase.
a) Amylose, amylopectin, and maltose
b) Limit dextrin, maltotriose and maltose
c) Maltotriose, maltose and glucose
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d) Amylose, maltotriose and maltose2406000101030701
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7) Defective enzyme in Hereditary fructose intolerance is
a) Fructokinase
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b) Aldolase Bc) Phosphofructokinase
d) Fructose 1,6 bisphosphatase
8) Which one of the reactions listed replenishes a TCA cycle
intermediate?
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a) Heme Synthesisb) Carboxylation of pyruvate
c) Transamination of oxaloacetate
d) carboxylation of acetyl CoA
9) 52-year-old man suddenly collapsed at work. He was diagnosed with
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acute myocardial infarction. Tissue plasminogen activator wasadministered to the patient, but further damage to the affected organ
resulted from this treatment. This may have happened owing to which
one of the following?
a) Elevated lactic acid levels
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b) Increased generation of oxygen-derived radicalsc) Release of cytochrome a from the mitochondria
d) Inhibition of the TCA cycle due to plasminogen activator
administration
10) A woman develops severe abdominal cramps and flatulence whenever
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she eats dairy products, so she has decided to eliminate all suchproducts from her diet. Which one of the following is an accurate
statement concerning sugar metabolism in this woman?
a) She cannot produce mucopolysaccharides that contain galactose.
b) She cannot produce lactose during lactation.
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c) She can eat curd in the dairy products.d) She is likely to have high levels of galactose-1-phosphate.
11) A person with Type 1 diabetes went on a trip and ran out of insulin.
after 4 days she felt lethargic, nauseous, and had difficulty standing.
After appropriate treatment, which one of the following liver enzymes
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would be reduced in activity as compared to before treatment?a) Phosphofructokinase-2
b) Pyruvate dehydrogenase
c) Pyruvate kinase
d) Fructose 1,6-bisphosphatase
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12) A man presents to the emergency room with an elevated temperature,sweats, and increased rate of breathing. He had been spraying
insecticide and accidentally inhaled some of the poison. Using the
insecticide on cultured cells, it was demonstrated that the rate of
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[3 of 8]oxygen consumption by the cells was much greater than in the absence
of the compound. Identify the most likely causative agent from below:
a) Carbon monoxide.
b) Dintrophenol
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c) Rotenoned) Cyanide
13) A 4-year-old boy has had a history of skin infections, pneumonia,
nausea, vomiting, and abdominal pain. He has been on antibiotics
prophylactically for the past year, but still contracts various sort of
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infections, both bacterial and fungal. The boy most likely has inheriteda mutation that prevents which one of the following reactions?
a) Oxidized glutathione to reduced glutathione
b) The formation of superoxide
c) Hydrogen peroxide conversion to hydroxyl radicals
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d) Superoxide conversion to hydrogen peroxide and oxygen14) A 50-years old female obese was recently diagnosed with coronary
artery disease was advised to increase green leafy vegetables intake in
her diet. All of the following are the beneficial effects of that diet,
EXCEPT
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a) Dietary fibers increase glycemic index.b) Dietary fibers decrease absorption of bile acids and increase
production of bile acids.
c) Sitosterol present in the diet decreases cholesterol absorption
d) Dietary fibers retain water in feces and increase stomach fullness.
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15) A medical student has been studying for exams, and neglects to eatanything for 12 hours. At this point, the student opens a large packet of
potato chips and eats every one of them in a short period. Which one
of the following is elevated in his plasma?
a) Chylomicrons
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b) Glucagonc) Acetolactate
d) Free fatty acids
16) A lab technician has collected the blood sample of a patient in a plain
vacuum cleaner for glucose estimation. The sample was analyzed four
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hours after sample collection. The lab in charge observed that thevalue of serum glucose was lower than the actual value. So he advised
the lab technician to collect blood samples in which of the following
containing vacutainer for glucose estimation to have accurate results.
a) Sodium Qxalate
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b) Ethylenediamine tetra acetatec) Sodium fluoride (EDTA) d) Heparin
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17) Leptin is a hormone secreted by adipose tissue which regulates energy
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intake and expenditure. It regulates appetite bya) Inhibiting Melanocyte stimulating hormone
b) Inhibiting Neuropeptide Y
c) Increasing secretion of Insulin
d) Increasing secretion of orexin
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18) A baby boy 10-month-old comes with vomiting severe jaundice,hepatomegaly and features of irritability on starting weaning with fruit
juice. Which of the following enzymes is defective?
a) Fructokinase
b) Aldolase B
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c) Galactose 1 Phosphate Uridyl transferased) Medium chain fatty acyl CoA dehydrogenase
19) Hemolyzed sample is not suitable for estimation of which parameter?
a) Potassium
b) Calcium
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c) Chlorided) Sodium
20) A diabetic patient develops paresthesia and loss of sensations in
lower limbs. This has resulted from which one of the following?
a) Reduced glucose levels in the blood
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b) Elevated glucagon levelsc) Elevated LDL levels in the blood
d) Increased sorbitol levels in Schwann cells
Section B
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Q.2 Long Answer Questions (2 out of 3)
2x10=20
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1) Describe the metabolism of alcohol.3
Describe and explain biochemical alterations that occur during
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alcoholism.
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Describe the effects of chronic alcoholism on the liver, central
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nervous system, and heart.
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Enumerate biochemical markers for monitoring of alcoholism.1
2) Describe the electron transport chain and oxidative phosphorylation.
5+3
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What are uncouplers and explain them by giving suitable examples.2
3) Describe at least six risk factors for Atherosclerosis.
3
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Describe LDL-cholesterol metabolism.3
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Describe the causes of primary familial hypercholesterolemia.
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2Explain the basis of using the 'Statin' group of drugs to reduce
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cholesterol levels.
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Q.3 Short Answer Questions (10 out of 11)10x2=20
1) Explain why excess lipoprotein (a) is atherogenic.
2) Why cataracts and hepatomegaly are seen in galactosemia?
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3) Write at least four differences between hexokinase and glucokinase.4) Explain why fasting hypoglycemia and hyperuricemia are seen in
type-1 glycogen storage disease.
5) Draw the Cori's cycle and write its significance.
6) Write types of vesicular transport mechanisms with suitable
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examples.7) Why are premature babies prone to acute respiratory distress
syndrome?
8) Calcium level in blood is increased by parathyroid hormone.
Explain.
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9) Iron is conserved in our body. Explain.10) Write any four phase-II detoxification reactions with suitable
examples.
11) Oral iron treatment should be supplemented with ascorbate and
tocopherol. Why?
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Section C
Q.4 Short Answer Questions (4 out of 5)
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4x5=201) Describe protein energy malnutrition.
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2) Describe the liver enzyme profile with significance.
3) Describe the synthesis and clinical significance of Prostaglandins
(2+3)
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4) Describe the roles and responsibilities of a physician in the health-
care system.
5) Describe the functions of NADPH.
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Q.5 Clinical Cases (2 out of 2)2x10=20
1) A 32-year-old man from a rural area was admitted to the hospital with
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chief complaints and clinical features of fatigue, jaundice, and dark
urine. His pertinent laboratory findings included normocytic and
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normochromic anemia, elevated serum unconjugated bilirubin, anddecreased hemoglobin levels. When blood was analyzed, there were
very low levels of Glucose-6- Phosphate Dehydrogenase (G6PD). The
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diagnosis of intravascular hemolysis was attributed to G6PD
deficiency.
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1. In which metabolic pathway G6PD is required, describe the step on2
which it acts
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2. Which coenzyme is required for the action of this enzyme and give2
two functions of an altered form of coenzyme
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3. Why the deficiency of this enzyme leads to hemolysis and2
jaundice?
4. Which form of bilirubin do you expect to be increased in this
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2deficiency and why it is so?
5. Do the subjects of G6PD are protected against malaria? If so,
2
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explain the mechanism.2) A 55-year-old person was brought to the hospital in a confused and
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semiconscious state. He had a low BP and a feeble pulse. His breathhad a fruity odor. His random blood sugar was 800 mg/dl. Urine sugar
was 4+ and urine ketone bodies were 3+. His blood pH was 7.1 (7.35-
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7.45). Plasma bicarbonate (HCO3) was 12 mmol/l (24-30 mmol/l) and
carbonic acid was 1.2 mmol/l (1-2 mmol/l). It was diagnosed as
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diabetic ketoacidosis.1) What is diabetic ketoacidosis? The main problems in
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Diabetic ketoacidosis are hyperglycemia, hyperketonemia,and metabolic acidosis. Explain why these are observed in
Diabetic ketoacidosis.
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2) What is the rationale behind rapid infusion of normal saline,
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2administration of insulin and potassium, and correction of
acidosis?
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3) What is metabolic acidosis? Write at least four causes of it.
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4) What are compensatory mechanisms and which organs are2
involved in this mechanism and why it is important
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5) Enlist other acid-bases disorders.2
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