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Kaplan Qbank USMLE



Author9 Posts
  #1

A 26-year-old man who has been homeless for 6 months is unconscious on arrival at the emergency department. His blood is positive for ketones and has a pH of 7.3. He is started on intravenous glucose and given a high carbohydrate diet after regaining consciousness. This treatment would most likely increase the activity of which enzyme?

a citrate synthase

b glucose 6 phosphatase

c HMG coA synthase

d lipoprotein lipase

e ornithin transcarbomylase


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  #2

Ill go with answer-a- citrate synthase/////as far as b -he's already getting glucose and carbos, so he doesnt need to make glucose from non carbohydrate precursors.

**Most significant- he's making a heck of lot of ATP's


Edited by mjl1717 on 07/23/06 - 06:44 PM

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  #3

A

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  #4

a-citrate synthase is a pacemaker enzyme to start Krebs cycle

b- I mentioned above

c- take you from AcetylacetylCoa to HMG CoA

d- lipoprotein lipase cleaves one FA from triacylglycerol in chylomicrons in endothelial cells

e-ornithine transcarbamylase is second enzyme in urea cycle {I forgot the actual detail}


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  #5

But in real life he'd be started on Normal IV saline with insulin and a trace of potassium assuming his glucose was 800 or 900 mg/dl? And Thiamine!/ Naloxone? {monitoring input and output and doing frequent finger sticks} Is this correct or am I losing my mind at this point??? Also Nursing should be sued for giving the wrong diet.

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  #6

ok mj, this is the explanation given.

Option D (Lipoprotein lipase) is correct. Lipoprotein lipase is increased by insulin, which would rise rapidly after refeeding following a fast. The excess carbohydrate is converted into triglycerides.

Option A (Citrate synthase) is incorrect. Citrate synthase is already increased to metabolize the acetyl CoA from fatty acid oxidation.

Option B (Glucose-6-phosphatase) is incorrect. Glucose-6-phosphatase is already increased to release glucose produced in gluconeogenesis from the liver.

Option C (Hydroxymethylglutaryl (HMG)-CoA synthase) is incorrect. To adapt to starvation, HMG-CoA synthase, the enzyme catalyzing the rate limiting-step in ketogenesis, is already maximally increased to form ketone bodies.

Option E (Ornithine transcarbamoylase) is incorrect. Ornithine transcarbamoylase is already increased to dispose of amino acid nitrogen in the urea cycle.


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  #7

vow good one mitty thanx

frequently overlooked point !!!
TCA cycle aint regulated by hormones...glycolysis is!!

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  #8

Very good q mitty- In the backof my mind Im saying "Doesnt ketone production mean there is an imbalance in fat and carbohydrate metabolism?"

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  #9

thanks for the review










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