front 1 A healthy adult finishes dinner at 7 PM. At what point does their
physiology transition into the fasting state? | back 1 D. About 2–4 hours later |
front 2 One hour after a carbohydrate-heavy meal, a student notes her
finger-stick glucose is falling from its 30-minute peak. What timing
rule-of-thumb best explains this? | back 2 A. Blood glucose begins to fall about 1 hour after a meal |
front 3 Early fasting is characterized by which hormonal shift? | back 3 C. Insulin ↓, glucagon ↑ |
front 4 A 19-year-old presents for morning labs after a 10-hour fast. The
principal hepatic mechanism sustaining euglycemia right now is: | back 4 A. Glycogenolysis |
front 5 During an overnight fast, adipocytes mobilize their stored energy.
Which pathway and products are correct? | back 5 B. Lipolysis → fatty acids, glycerol & β-hydroxybutyrate for export |
front 6 As fasting lengthens through the day, which substrate increasingly
supplies energy? | back 6 C. Fatty acids |
front 7 A healthy adult has consumed no calories since 10 PM and presents at
8 AM for testing. The major fuel currently supplying energy is: | back 7 C. Fatty acids |
front 8 Even in fasting, which tissues continue to oxidize glucose
(primary/sole)? | back 8 B. Brain and red blood cells |
front 9 After a short fast, you have increased β-oxidation. Which tissues are
directly oxidizing fatty acids in this state? | back 9 A. Skeletal muscle and liver |
front 10 After a 48-hour fast, serum β-hydroxybutyrate is elevated. Which
organ is the predominant source? | back 10 B. Liver |
front 11 Endogenous hepatic glucose production during fasting depends
primarily on: | back 11 D. Glycogenolysis and gluconeogenesis |
front 12 The process of synthesizing glucose from non-carbohydrate precursors
is termed: | back 12 C. Gluconeogenesis |
front 13 Which list correctly identifies the major carbon sources for
gluconeogenesis? | back 13 A. Lactate, glycerol, amino acids |
front 14 When amino acid carbons are used to make glucose, their nitrogen is
primarily excreted as: | back 14 B. Urea |
front 15 A clinician defines the metabolic state of “starvation” by duration
alone. Which threshold matches that definition? | back 15 B. ≥3 days without food |
front 16 During starvation, skeletal muscle continues to oxidize fatty acids
but specifically reduces its use of: | back 16 D. Ketone bodies |
front 17 As skeletal muscle spares ketone bodies, circulating levels of that
substrate: | back 17 A. Rise, allowing the brain to oxidize it for energy |
front 18 Compared with early fasting, hepatic gluconeogenesis during prolonged
starvation changes because: | back 18 D. The brain increasingly uses ketone bodies |
front 19 The degradation of stored hepatic glycogen to release glucose is
called: | back 19 C. Glycogenolysis |
front 20 After 72 hours without food, which tissue still relies exclusively on
glucose oxidation? | back 20 D. Red blood cells |
front 21 Which interval best defines the postprandial state? | back 21 B. The period following a meal |
front 22 A 64-year-old burn patient surviving on minimal calories for several
days shows a shift away from amino acid catabolism despite persistent
caloric deficit. What best describes this adaptation in
starvation? | back 22 D. Protein sparing |
front 23 What does PEM stand for? | back 23 A. Protein-energy malnutrition |
front 24 A global health program screens undernourished adults by body mass
index and assigns severity. Which statement best describes how PEM is
classified? | back 24 C. By BMI into Grades I–III |
front 25 A 29-year-old with reduced intake has BMI 17.0–18.4 kg/m². Which PEM
grade applies? | back 25 B. Grade I |
front 26 An 18-year-old with chronic food insecurity has BMI between 16.0–16.9
kg/m². What is the correct PEM grade? | back 26 D. Grade II |
front 27 A hospitalized elder presents with BMI below 16 kg/m². Which PEM
grade is most accurate? | back 27 A. Grade III |
front 28 Which statement about creatinine production is most accurate? | back 28 C. Released from muscle at a near-constant rate proportional to muscle mass |
front 29 A 56-year-old with suspected renal disease has rising serum
creatinine. Which best describes creatinine removal in normal
physiology? | back 29 D. Renal clearance with appearance in urine |
front 30 In a primary-care panel, several patients show elevated creatinine.
What does this most directly suggest? | back 30 B. Impaired renal function |
front 31 A laboratory validation study compares methods for creatinine
measurement in body fluids. Which reaction is classically used? | back 31 C. Jaffe reaction |
front 32 A neuropharmacology exam asks which substrate most neurons are
fundamentally unable to oxidize. The correct answer is: | back 32 C. Fatty acids |
front 33 A hepatology consult explains why nitrogen handling is crucial during
catabolism: the liver converts toxic ammonia primarily into which
small molecule for safe excretion? | back 33 D. Urea |
front 34 After a carbohydrate-rich meal, a healthy adult’s liver glycogen can
rise to approximately: | back 34 B. 200–300 g |
front 35 The same individual completes an overnight fast. Approximate hepatic
glycogen content now is: | back 35 A. ~80 g |
front 36 A physiology slide labeled “after an overnight fast” depicts the
canonical metabolic state at that timepoint. Which term best matches
the label? | back 36 C. Basal (postabsorptive) state |
front 37 During a 24–48 hour fast, adipose tissue provides a carbon backbone
for gluconeogenesis by releasing glycerol. This glycerol chiefly
originates from: | back 37 D. Lipolysis of adipose triacylglycerols |
front 38 A sprinter finishes repeated 400-m intervals; blood tests show
increased lactate. In routine physiology, lactate is also a major
product of glycolysis in which cells? | back 38 B. Red blood cells |
front 39 A neurologist emphasizes fuel flexibility of the brain during
prolonged fasting. Which statement is accurate? | back 39 A. Neurons can use ketone bodies to a limited extent |
front 40 A hospital lab expands specimen types for creatinine testing. In
which matrices is creatinine appropriately measured? | back 40 C. Plasma, serum, and urine |
front 41 A patient with advanced hepatic dysfunction accumulates ammonia
during catabolic stress. What hepatic process counters nitrogen
toxicity? | back 41 B. Conversion of nitrogen to urea |
front 42 As insulin falls and glucagon rises during fasting, adipose
triacylglycerols are mobilized primarily by: | back 42 D. Lipolysis |
front 43 Lipolysis of adipose triacylglycerols yields which two major
products? | back 43 C. Fatty acids and glycerol |
front 44 In prolonged fasting, most fatty acids arriving at the liver are
preferentially: | back 44 A. Converted to ketone bodies rather than fully oxidized to CO₂ |
front 45 Hepatic acetyl-CoA is converted into which ketone bodies? | back 45 D. Acetoacetate and β-hydroxybutyrate |
front 46 Which structural classification is correctly paired? | back 46 B. β-Hydroxybutyrate—reduced hydroxy acid; acetoacetate—β-ketoacid; acetone—simple ketone |
front 47 In a 4-day fast, a patient’s fruity breath odor increases. The
volatile compound arises primarily from: | back 47 D. Nonenzymatic decarboxylation of acetoacetate |
front 48 Regarding acetone handling in humans, the most accurate statement is
that it is: | back 48 C. Expired in breath and not significantly metabolized |
front 49 Which statement best describes prealbumin? | back 49 C. Liver-derived protein transporting thyroid hormone |
front 50 To screen for protein malnutrition, clinicians typically
measure: | back 50 B. Albumin and prealbumin |
front 51 Why is prealbumin more sensitive than albumin for acute changes in
protein status? | back 51 A. Albumin has a relatively long half-life |
front 52 In systemic illness (hepatic disease, renal disease, surgery), serum
albumin and prealbumin typically: | back 52 C. Decrease |
front 53 After 3–5 days of fasting, the body’s overall fuel use shifts
to: | back 53 D. Decreased ketone use with greater reliance on fatty acids |
front 54 During extended fasting, gluconeogenesis becomes the only source of
blood glucose primarily because: | back 54 A. Liver glycogen stores are depleted after ~30 hours, so glycogenolysis is no longer available |
front 55 The single biggest determinant of how long a person can survive
fasting is: | back 55 C. Amount of adipose tissue |
front 56 Another factor that influences survival time during starvation
is: | back 56 B. Body protein levels |
front 57 Which statement about fatal starvation is most accurate? | back 57 D. Death typically follows ~40% body-weight loss |
front 58 BMI thresholds associated with death by starvation are
approximately: | back 58 A. 13 for men, 11 for women |
front 59 Compared with a 24-hour fast, which change is expected in prolonged
fasting? | back 59 C. Muscle protein degradation decreases |
front 60 Compared with a 24-hour fast, hepatic gluconeogenesis during
prolonged fasting generally: | back 60 B. Decreases as the brain increases ketone use |
front 61 A 17-year-old with restrictive eating presents with BMI 15.9 kg/m²,
bradycardia, and distorted body image. Which feature is part of the
diagnostic profile of anorexia nervosa? | back 61 C. Persistent fear of gaining weight |
front 62 A 19-year-old runner with severe weight loss develops secondary
amenorrhea. In anorexia nervosa, the immediate physiologic cause is
most directly: | back 62 D. Reduced LH/FSH secretion by the anterior pituitary |
front 63 In clinical nutrition, the most widely used biochemical marker to
estimate body muscle mass is: | back 63 A. 24-hour urinary creatinine excretion |
front 64 To assess muscle mass depletion, creatinine output is normalized
to: | back 64 B. Height, yielding the Creatinine Height Index (CHI) |
front 65 A patient excretes 80-90% of the expected creatinine for a healthy
same-sex, same-height control (after multiplying by 100). What is the
CHI category? | back 65 B. Mild deficit |
front 66 A patient excretes 60–80% of the expected creatinine for a healthy
same-sex, same-height control (after multiplying by 100). What is the
CHI category? | back 66 C. Moderate deficit |
front 67 A patient excretes <60% of the expected creatinine for a healthy
same-sex, same-height control (after multiplying by 100). What is the
CHI category? | back 67 D. Severe deficit |
front 68 Post-meal endocrine changes most consistent with your notes
are: | back 68 B. Insulin ↑, glucagon ↓ |
front 69 During an overnight fast, which tissues use fatty acids as their
principal fuel? | back 69 B. Liver and skeletal muscle |
front 70 Falling blood glucose during fasting triggers release of which
hormone—and from which cells? | back 70 B. Glucagon from α-cells |
front 71 After ~3 days of fasting, the liver provides an alternative fuel for
the brain by releasing: | back 71 D. Ketone bodies |
front 72 By ~3 days of fasting, liver glycogen is depleted. Therefore, blood
glucose is supplied by: | back 72 B. Gluconeogenesis |
front 73 Glucagon stimulation of adipose tissue supplies the liver with which
gluconeogenic carbon source? | back 73 C. Glycerol |
front 74 Which are the three major carbon sources for hepatic gluconeogenesis
in your notes? | back 74 C. Lactate, amino acids, glycerol |
front 75 A 24-year-old has had no food for 4 days. Compared with a 24-hour
fast, which systemic change is expected now? | back 75 D. Brain use of ketone bodies increases |
front 76 What is a principal function of prealbumin (transthyretin) described
in your notes? | back 76 C. Transport of thyroid hormone |
front 77 During an early-morning fast, hepatocytes raise plasma glucose by
releasing it from glycogen. This process is: | back 77 D. Glycogenolysis |
front 78 A biochemist describes making glucose from glycerol and amino acids.
This pathway is called: | back 78 A. Gluconeogenesis |
front 79 In hepatic handling of amino acids during catabolism, carbons go to
_______, while nitrogens are converted to _______. | back 79 C. Glucose; urea |
front 80 A disaster victim is evaluated on day 3 without food. Which
combination best matches the starvation state? | back 80 D. ≥3 days; muscle uses fatty acids; brain uses ketone bodies |
front 81 A healthy adult completes a 12-hour fast for labs. This corresponds
to which metabolic state and hormones? | back 81 B. Basal state; low insulin, high glucagon |
front 82 After a meal, plasma glucose peaks at ~1 hour then declines; by ~2
hours it returns to the fasting range. What fasting range did your
notes specify? | back 82 A. 80–100 mg/dL |
front 83 Why are red blood cells obligately dependent on glucose? | back 83 B. No mitochondria |
front 84 What is the major energy source during fasting that supplies most
fuel to the body? | back 84 C. Adipose triacylglycerols |
front 85 In the fasting state, which fuel do the kidneys preferentially
oxidize? | back 85 A. Fatty acids |
front 86 Which half-life pairing is correct for these nutrition markers? | back 86 A. Prealbumin ≈ 2–3 days; albumin ≈ 14–20 days |
front 87 Glucagon signaling in fasting drives adipose to supply the liver’s
gluconeogenesis via which carbon source? | back 87 B. Glycerol |
front 88 After about three days of fasting when hepatic glycogen is depleted,
blood glucose is supplied primarily by: | back 88 C. Gluconeogenesis |
front 89 Which set correctly lists tissues that can oxidize ketone bodies for
energy? | back 89 A. Skeletal muscle, kidneys, nervous system |
front 90 During prolonged fasting, adipose triacylglycerol supplies fatty
acids and glycerol. These fates are correct: | back 90 D. Muscle: CO₂ + H₂O; Liver: ketone bodies |
front 91 A fasting patient has glucose 65 mg/dL with normal anion gap and no
diabetes history. Which serum/urine finding is most likely
elevated? | back 91 B. Ketone bodies |
front 92 A 19-year-old with polyuria and weight loss has very high ketones and
very high glucose. The most likely interpretation is: | back 92 D. Insulin deficiency |
front 93 The most widely used biochemical approach to estimate muscle mass
from 24-hour urinary creatinine is called the: | back 93 C. Creatinine-Height Index (CHI) |
front 94 In protein malnutrition, urinary levels of which compound fall
proportionally to muscle loss? | back 94 A. Creatinine |
front 95 Interpreting BUN: which pairing is correct? | back 95 B. Low BUN → liver dysfunction; High BUN → kidney dysfunction |
front 96 Interpreting creatinine: which pairing is correct? | back 96 A. Low creatinine → low skeletal muscle production; High creatinine → renal excretory failure |
front 97 A thin but otherwise healthy faster has high ketone bodies with
normal/low glucose. Best interpretation: | back 97 C. Starvation physiology |
front 98 After ~30 hours of fasting, hepatic glycogen is depleted. If fasting
continues, the only process providing plasma glucose is ______, and
one major carbon source is ______. | back 98 A. Gluconeogenesis; amino acids |
front 99 A patient with villous blunting, low MUAMC and CHI, low albumin and
prealbumin, and elevated ketones most likely has: | back 99 D. Protein-energy malnutrition (PEM) |
front 100 Which list correctly names the three ketone bodies produced by the
liver? | back 100 C. Acetone, acetoacetate, β-hydroxybutyrate |
front 101 During fasting, which fuel do the kidneys preferentially oxidize for
their own energy needs? | back 101 A. Fatty acids |
front 102 A prolonged faster is cognitively intact while using ketone bodies
heavily. Per your notes, the brain still needs a small amount of
glucose primarily to support: | back 102 D. Neurotransmitter carbon skeletons |
front 103 During starvation, adipose lipolysis is active. Which substrate
cannot provide net carbon for hepatic glucose production? | back 103 B. Long-chain fatty acids |
front 104 A patient presents after severe caloric restriction with plasma
glucose 65 mg/dL. Which urine finding is most expected? | back 104 A. Positive urine ketones |
front 105 In prolonged fasting, some amino acids are diverted from
gluconeogenesis because they are also needed for synthesis of: | back 105 D. Heme and neurotransmitters |
front 106 In anorexia nervosa, amenorrhea is linked to low gonadotropins and
typically appears when body fat drops to about: | back 106 C. 22% body weight |
front 107 A dietitian calculates Creatinine-Height Index (CHI). Which formula matches your notes for the CHI percentage? A. Expected/observed × 100 | back 107 B. Observed/expected × 100 |
front 108 Which best describes creatinine in your notes? | back 108 A. Muscle degradation product |
front 109 A malnourished patient has low albumin and low prealbumin. Per your
notes, this most directly indicates the body’s muscle mass cannot
provide enough amino acids to sustain: | back 109 D. Gluconeogenesis and serum proteins |