FMGE 2025 - Biochemistry Practice Questions

Q: Which of the following acts as a major intracellular antioxidant and helps in detoxifying reactive oxygen species?

Glutathione. ***Glutathione (Correct Answer)*** - **It is the most abundant non-enzymatic intracellular antioxidant**, found in high concentrations in nearly all cells. - It detoxifies **reactive oxygen species (ROS)**, particularly **hydrogen peroxide** and lipid hydroperoxides, through the **glutathione redox cycle**. - As a **tripeptide molecule** (not an enzyme), it directly acts as the major intracellular antioxidant. *Catalase (Incorrect)* - This is an **enzyme** responsible for the rapid decomposition of two molecules of **hydrogen peroxide (H₂O₂)** into water and oxygen. - While crucial for detoxification in peroxisomes, it is an enzyme, not the primary non-enzymatic antioxidant molecule like glutathione. *Superoxide dismutase (Incorrect)* - This is a **metalloenzyme** that catalyzes the dismutation of the highly reactive **superoxide radical (O₂⁻·)** into less reactive **hydrogen peroxide (H₂O₂)**. - It initiates the antioxidant defense but does not complete the neutralization of H₂O₂, which is handled by catalase or **glutathione peroxidase**. *Peroxidase (Incorrect)* - This is a general class of **enzymes** (e.g., **glutathione peroxidase**) that primarily use substrates like glutathione to reduce **hydrogen peroxide** or lipid peroxides to water or harmless alcohols. - It is an enzyme that works *with* antioxidants like glutathione, rather than being the major intracellular antioxidant molecule itself.

Q: A 6-month-old infant is brought to the emergency department with lethargy, vomiting, and poor feeding. The episode occurred after prolonged fasting. Laboratory results reveal hypoglycemia, low ketone levels (hypoketosis), and mild hepatomegaly. These findings suggest a defect in fat metabolism. Which of the following is the most likely underlying disorder?

Medium-chain acyl-CoA dehydrogenase (MCAD) deficiency. ***Medium-chain acyl-CoA dehydrogenase (MCAD) deficiency*** - This disorder is the most common defect of **fatty acid oxidation** and is characterized by the inability to break down medium-chain fatty acids during fasting, leading to severe **hypoglycemia**. - The hallmark finding is **hypoketosis** (low ketones), as the inability to generate acetyl-CoA from fatty acid breakdown means the substrate required for **ketogenesis** is unavailable. *Hers disease* - This is **Glycogen Storage Disease type VI**, involving a deficiency in **liver glycogen phosphorylase**, leading to impaired glycogenolysis and fasting hypoglycemia. - However, GSD type VI does not impair **beta-oxidation**; hence, patients usually maintain the ability to produce adequate **ketone bodies** during periods of fasting. *Hereditary fructose intolerance* - This disorder is a defect of **aldolase B** and causes symptoms (vomiting, lethargy, hypoglycemia) only after the introduction of **dietary fructose** or sucrose. - The acute symptoms are due to **phosphate trapping** and subsequent inhibition of gluconeogenesis, which is dependent on dietary exposure rather than prolonged fasting alone. *Glycogen storage disease type I (Von Gierke disease)* - This condition, caused by a deficiency of **glucose-6-phosphatase**, leads to profound fasting hypoglycemia, significant hepatomegaly, and **lactic acidosis**. - Unlike MCAD deficiency, Von Gierke disease primarily causes defects in glucose release but generally maintains or even increases **ketone body production** (hyperketosis) because fat breakdown is often accelerated.

Q: A 2-month-old infant presents with poor feeding, vomiting, and lethargy. Laboratory studies show hyperammonemia and elevated levels of orotic acid in the urine. Which of the following is the most likely enzyme deficiency?

Ornithine transcarbamylase (OTC) deficiency. ***Ornithine transcarbamylase (OTC) deficiency*** - **Most common X-linked urea cycle disorder** presenting in infancy with hyperammonemia - **Classic triad:** Hyperammonemia + elevated urinary orotic acid + low blood urea nitrogen - **Biochemical mechanism:** OTC converts carbamoyl phosphate + ornithine → citrulline. When deficient, carbamoyl phosphate accumulates and spills into the pyrimidine synthesis pathway, producing excess orotic acid - Clinical features: poor feeding, vomiting, lethargy, seizures, developmental delay *Carbamoyl phosphate synthetase I (CPS I) deficiency* - Also causes hyperammonemia but **NO orotic aciduria** (defect occurs before OTC step) - Carbamoyl phosphate is not formed, so cannot enter pyrimidine pathway - Cannot be distinguished clinically from OTC deficiency without measuring orotic acid *Argininosuccinate lyase deficiency* - Causes hyperammonemia with elevated **argininosuccinate** in blood/urine - Does not cause orotic aciduria (defect is downstream of OTC) - May present with trichorrhexis nodosa (brittle hair) *Orotidine 5′-phosphate decarboxylase deficiency* - Causes hereditary **orotic aciduria** but **NO hyperammonemia** (not a urea cycle disorder) - Defect in de novo pyrimidine synthesis pathway - Presents with megaloblastic anemia, growth retardation, responds to uridine supplementation

Q: A patient whose diet mainly consists of pulses and rice presents with bowed legs. Which of the following vitamins could have prevented this condition?

Vitamin D. ***Vitamin D*** - This vitamin is essential for the absorption of **calcium** and **phosphate**, minerals necessary for bone mineralization. - A deficiency results in **Rickets** (softening and weakening of bones in children), leading to classic deformities like **bowed legs (genu varum)**. *Vitamin A* - Vitamin A deficiency primarily affects vision, causing **night blindness** and **xerophthalmia**. - It is crucial for cell differentiation and immune function, but its deficiency does not cause **rickets** or bowed legs. *Vitamin B₁₂* - Deficiency leads to **megaloblastic anemia** and often **peripheral neuropathy** (subacute combined degeneration). - While essential for cell division and nerve function, it is not directly involved in the calcium homeostasis required to prevent bone deformities. *Vitamin C* - Vitamin C deficiency causes **scurvy**, characterized by impaired **collagen synthesis**, leading to bleeding gums and poor wound healing. - It is not the primary factor preventing defective bone mineralization (rickets) that causes **bowed legs**.

Question 1

Which of the following acts as a major intracellular antioxidant and helps in detoxifying reactive oxygen species?

Accepted Answer

Glutathione

Answer

Superoxide dismutase

Answer

Peroxidase

Answer

Catalase

Question 2

A 6-month-old infant is brought to the emergency department with lethargy, vomiting, and poor feeding. The episode occurred after prolonged fasting. Laboratory results reveal hypoglycemia, low ketone levels (hypoketosis), and mild hepatomegaly. These findings suggest a defect in fat metabolism. Which of the following is the most likely underlying disorder?

Accepted Answer

Medium-chain acyl-CoA dehydrogenase (MCAD) deficiency

Answer

Glycogen storage disease type I (Von Gierke disease)

Answer

Hers disease

Answer

Hereditary fructose intolerance

Question 3

A 2-month-old infant presents with poor feeding, vomiting, and lethargy. Laboratory studies show hyperammonemia and elevated levels of orotic acid in the urine. Which of the following is the most likely enzyme deficiency?

Accepted Answer

Ornithine transcarbamylase (OTC) deficiency

Answer

Orotidine 5′-phosphate decarboxylase deficiency

Answer

Carbamoyl phosphate synthetase I deficiency

Answer

Argininosuccinate lyase deficiency

Question 4

A patient whose diet mainly consists of pulses and rice presents with bowed legs. Which of the following vitamins could have prevented this condition?

Accepted Answer

Vitamin D

Answer

Vitamin A

Answer

Vitamin B₁₂

Answer

Vitamin C

FMGE 2025 — Biochemistry