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Biochem 46

front 1

A CNS-resident cell phagocytoses pathogens after meningitis. Which cell type is primarily responsible?
A. Astrocyte
B. Microglia
C. Oligodendrocyte
D. Ependymal cell

back 1

B. Microglia

front 2

The main interface between brain parenchyma and the CSF compartment is formed by:
A. Astrocytes
B. Microglia
C. Ependymal cells
D. Oligodendrocytes

back 2

C. Ependymal cells

front 3

Structurally, neurotransmitters are divided into:
A. Small nitrogen molecules and neuropeptides
B. Small steroid molecules and purines
C. Amino acids and lipids
D. Ions and peptides

back 3

A. Small nitrogen molecules and neuropeptides

front 4

Small nitrogen-containing neurotransmitters are generally synthesized in the:
A. Postsynaptic density
B. Nucleus
C. Myelin sheath
D. Presynaptic terminal

back 4

D. Presynaptic terminal

front 5

Small nitrogen-containing neurotransmitters are synthesized mainly from:
A. Fatty acids and cholesterol
B. Amino acids and glycolysis intermediates
C. DNA bases and ribose
D. Heme and bilirubin

back 5

B. Amino acids and glycolysis intermediates

front 6

Serotonin is synthesized from:
A. Tryptophan
B. Tyrosine
C. Serine
D. Glutamine

back 6

A. Tryptophan

front 7

Glutamate (and its derivative GABA) is derived from the TCA intermediate:
A. Oxaloacetate
B. Citrate
C. Alpha-ketoglutarate
D. Succinate

back 7

C. Alpha-ketoglutarate

front 8

In the brain, glycine is synthesized from:
A. Alanine
B. Glycine cleavage products
C. Tryptophan
D. Serine

back 8

D. Serine

front 9

After global cerebral ischemia, which process most directly amplifies neuronal injury in many regions?
A. Reduced synaptic vesicle fusion
B. Glutamate excitotoxicity
C. Decreased nitric oxide formation
D. Lower intracellular calcium

back 9

B. Glutamate excitotoxicity

front 10

A neurodegenerative disorder is linked to oxidative damage. Which pair is emphasized in pathogenesis?
A. Lactate and ketones
B. Chloride and bicarbonate
C. Free radicals and nitric oxide
D. Phosphate and sulfate

back 10

C. Free radicals and nitric oxide

front 11

During CNS development, which glial cell guides neuronal migration and helps form a stabilizing matrix?
A. Astrocyte
B. Microglia
C. Schwann cell
D. Oligodendrocyte

back 11

A. Astrocyte

front 12

A cell population lines the ventricles and can be specialized to secrete CSF. Which cells are these?
A. Microglia
B. Oligodendrocytes
C. Astrocytes
D. Ependymal cells

back 12

D. Ependymal cells

front 13

Impaired ventricular ciliary beating would most directly disrupt:
A. Neuronal action potentials
B. CSF circulation efficiency
C. Myelin compaction
D. Synaptic cleft reuptake

back 13

B. CSF circulation efficiency

front 14

Glucose crosses brain capillary endothelium primarily via facilitated diffusion through:
A. GLUT3
B. GLUT4
C. GLUT1
D. SGLT1

back 14

C. GLUT1

front 15

Neurons take up glucose from extracellular fluid primarily via:
A. GLUT3
B. GLUT2
C. GLUT5
D. GLUT4

back 15

A. GLUT3

front 16

An infant has seizures and a low CSF glucose despite normal serum glucose. This CSF finding is called:
A. Hyperglycorrhachia
B. Hyperglycemia
C. Glycosuria
D. Hypoglycorrhachia

back 16

D. Hypoglycorrhachia

front 17

Large neutral amino acids enter CSF rapidly via:
A. Multiple peptide transporters
B. A single amino-acid transporter
C. Passive diffusion only
D. Vesicular transcytosis

back 17

B. A single amino-acid transporter

front 18

High levels of one LNAA can reduce transport of others across the BBB via:
A. Competitive inhibition
B. Noncompetitive inhibition
C. Allosteric activation
D. Irreversible blockade

back 18

A. Competitive inhibition

front 19

Untreated PKU causes cognitive impairment; one proposed mechanism is reduced BBB entry of other amino acids due to excess:
A. Phenylalanine
B. Glycine
C. Tryptophan
D. Histamine

back 19

A. Phenylalanine

front 20

In maple syrup urine disease, impaired CNS amino-acid balance is most linked to excess blood:
A. Aromatic amino acids
B. Branched-chain amino acids
C. Sulfur amino acids
D. Acidic amino acids

back 20

B. Branched-chain amino acids

front 21

A patient started on reserpine later reports severe anhedonia and suicidal thoughts. The drug’s relevant primary action is:
A. Blocks dopamine receptors
B. Stimulates serotonin reuptake
C. Inhibits MAO activity
D. Blocks catecholamine vesicular uptake

back 21

D. Blocks catecholamine vesicular uptake

front 22

Which adverse psychiatric outcome was historically observed in a subset of patients taking reserpine?
A. Depression and suicidality
B. Mania and insomnia
C. Hallucinations and delusions
D. Euphoria and agitation

back 22

A. Depression and suicidality

front 23

The first and rate-limiting step in catecholamine synthesis from tyrosine is catalyzed by:
A. Dopamine beta-hydroxylase
B. COMT
C. Tyrosine hydroxylase
D. MAO

back 23

C. Tyrosine hydroxylase

front 24

Tyrosine hydroxylase requires which cofactor for activity?
A. NADPH oxidase
B. Tetrahydrobiopterin
C. Thiamine pyrophosphate
D. Biotin

back 24

B. Tetrahydrobiopterin

front 25

The immediate product of tyrosine hydroxylase is:
A. L-DOPA
B. Dopamine
C. Norepinephrine
D. Epinephrine

back 25

A. L-DOPA

front 26

The conversion of L-DOPA to dopamine requires which cofactor?
A. FAD
B. Biotin
C. THF
D. Pyridoxal phosphate

back 26

D. Pyridoxal phosphate

front 27

Epinephrine synthesis depends on adequate vitamin support to generate SAM, specifically:
A. Vitamin C and vitamin K
B. Vitamin B12 and folate
C. Thiamine and riboflavin
D. Niacin and biotin

back 27

B. Vitamin B12 and folate

front 28

Conversion of tyrosine to L-DOPA and L-DOPA to dopamine occurs in the:
A. Synaptic vesicle lumen
B. Mitochondrial matrix
C. Cytosol
D. Lysosome

back 28

C. Cytosol

front 29

Reserpine was historically used clinically primarily as a(n):
A. Antipsychotic and anxiolytic
B. Antiparkinson and antiemetic
C. Analgesic and antipyretic
D. Antihypertensive and antiepileptic

back 29

D. Antihypertensive and antiepileptic

front 30

Which set lists only major small nitrogen-containing neurotransmitters from the provided material?
A. Glutamate, GABA, glycine, histamine
B. Glutamate, histamine, oxytocin, GABA
C. Glycine, endorphin, dopamine, histamine
D. Acetylcholine, serotonin, insulin, GABA

back 30

A. Glutamate, GABA, glycine, histamine

front 31

A vesicular monoamine transporter shares homology with bacterial drug-resistance transporters. Which example fits this family?
A. P-glycoprotein
B. GLUT1
C. Dopamine transporter
D. Na+/K+ ATPase

back 31

A. P-glycoprotein

front 32

Vesicle transporters for monoamines typically span the membrane with how many transmembrane domains?
A. 4
B. 7
C. 12
D. 24

back 32

C. 12

front 33

Catecholamines are concentrated inside storage vesicles by a mechanism best described as:
A. Primary active transport
B. Secondary active transport
C. Simple diffusion
D. Channel-mediated influx

back 33

B. Secondary active transport

front 34

The catecholamine vesicular uptake process is ultimately driven by a:
A. Proton pump gradient
B. Sodium gradient
C. Chloride gradient
D. Calcium gradient

back 34

A. Proton pump gradient

front 35

In storage vesicles, catecholamines most characteristically exist complexed with:
A. Albumin and calcium
B. ATP and chromogranins
C. GTP and tubulin
D. Heme and ferritin

back 35

B. ATP and chromogranins

front 36

When chromogranins are released, they can be proteolytically processed into:
A. Inactive waste products
B. Neurotoxic aldehydes
C. Bioactive peptides
D. Membrane phospholipids

back 36

C. Bioactive peptides

front 37

A patient has episodic headaches, sweating, palpitations, and severe hypertension (pheochromocytoma). Which circulating marker may be elevated in this tumor type?
A. Chromogranins
B. C-reactive protein
C. Troponin I
D. Myoglobin

back 37

A. Chromogranins

front 38

Two major enzyme systems mediating catecholamine inactivation include:
A. AChE and GABA-T
B. COMT and MAO
C. CYP3A4 and UGT1A1
D. Renin and ACE

back 38

B. COMT and MAO

front 39

MAO is located primarily on the:
A. Inner mitochondrial membrane
B. Outer mitochondrial membrane
C. Nuclear envelope
D. Rough ER lumen

back 39

B. Outer mitochondrial membrane

front 40

MAO catalysis oxidizes the amino-bearing carbon to an aldehyde and releases:
A. Sulfate ion
B. Bicarbonate
C. Ammonium ion
D. Chloride ion

back 40

C. Ammonium ion

front 41

A drug selectively inhibiting MAO-A would most directly reduce deamination of:
A. Dopamine and histamine
B. Norepinephrine and serotonin
C. Acetylcholine and GABA
D. Glutamate and glycine

back 41

B. Norepinephrine and serotonin

front 42

MAO-B has relatively broader activity against:
A. Phenylethylamines
B. Purines
C. Peptides
D. Steroids

back 42

A. Phenylethylamines

front 43

A child with hypopigmentation is suspected to have albinism due to impaired tyrosine-to-melanin conversion. A potentially defective enzyme is:
A. Tryptophan hydroxylase
B. Copper-dependent tyrosine hydroxylase
C. Lactate dehydrogenase
D. Dopamine beta-hydroxylase

back 43

B. Copper-dependent tyrosine hydroxylase

front 44

COMT inactivates catecholamines by transferring a methyl group from:
A. NADPH
B. FAD
C. SAM
D. CoA

back 44

C. SAM

front 45

CSF homovanillylmandelic acid (HVA) is an indicator of:
A. Dopamine degradation
B. Serotonin synthesis
C. GABA recycling
D. Histamine storage

back 45

A. Dopamine degradation

front 46

Reduced CSF HVA would be most consistent with neuronal changes seen in:
A. Huntington disease
B. Alzheimer disease
C. ALS
D. Parkinson disease

back 46

D. Parkinson disease

front 47

A patient develops headaches, palpitations, nausea, vomiting, and high blood pressure after ingesting large amounts of aged foods. The culprit amine is:
A. Histamine
B. Serotonin
C. Tyramine
D. GABA

back 47

C. Tyramine

front 48

Tyramine is normally detoxified primarily by:
A. COMT
B. MAO-A
C. MAO-B
D. Acetylcholinesterase

back 48

B. MAO-A

front 49

A patient on an MAO inhibitor eats aged cheese and develops a hypertensive crisis. The key immediate mechanism is:
A. Tyramine releases norepinephrine
B. COMT blocks dopamine synthesis
C. VMAT blocks vesicle loading
D. MAO generates excess ammonium

back 49

A. Tyramine releases norepinephrine

front 50

Free cytosolic catecholamines downregulate tyrosine hydroxylase by competing for the enzyme’s:
A. Pyridoxal phosphate site
B. Heme binding pocket
C. Pterin cofactor binding
D. Acetyl-CoA docking site

back 50

C. Pterin cofactor binding

front 51

Which acute event in a nerve terminal activates tyrosine hydroxylase?
A. Hyperpolarization
B. Depolarization
C. Myelin loss
D. Axonal transport block

back 51

B. Depolarization

front 52

With prolonged sympathetic firing, increased transcription of tyrosine hydroxylase and dopamine β-hydroxylase occurs mainly in neuronal:
A. Synaptic clefts
B. Axon terminals
C. Nodes of Ranvier
D. Neuronal Perikarya

back 52

D. Neuronal Perikarya

front 53

The synthesis pathway of serotonin from tryptophan is most similar in logic to norepinephrine synthesis from tyrosine because both begin with:
A. Oxidation then phosphorylation
B. Hydroxylation then decarboxylation
C. Transamination then reduction
D. Glycosylation then cleavage

back 53

B. Hydroxylation then decarboxylation

front 54

In addition to catecholamines, serotonin is inactivated by:

A. COMT
B. AChE
C. MAO
D. DBH

back 54

C. MAO

front 55

The activity of several antipsychotic drugs is described here as being based on inhibiting:
A. MAO
B. COMT
C. VMAT
D. GLUT3

back 55

A. MAO

front 56

Melatonin is synthesized from the amino acid precursor:
A. Tyrosine
B. Serine
C. Tryptophan
D. Glycine

back 56

C. Tryptophan

front 57

A patient develops thrombocytopenia and thrombosis after heparin exposure due to antiheparin antibodies. This antibody-driven platelet activation is associated with release of:
A. Dopamine
B. Serotonin
C. Histamine
D. GABA

back 57

B. Serotonin

front 58

Within the brain, histamine is produced by:
A. Astrocytes and oligodendrocytes
B. Microglia and ependyma
C. Mast cells and neuronal fibers
D. Endothelium and pericytes

back 58

C. Mast cells and neuronal fibers

front 59

Histaminergic neuronal cell bodies in humans are concentrated in the:
A. Locus coeruleus
B. Dorsal raphe nucleus
C. Tuberomammillary nucleus
D. Substantia nigra

back 59

C. Tuberomammillary nucleus

front 60

The tuberomammillary nucleus lies within the:
A. Posterior basal hypothalamus
B. Anterior hypothalamus
C. Dorsal midbrain
D. Ventral medulla

back 60

A. Posterior basal hypothalamus

front 61

Histamine synthesis from histidine is catalyzed by:
A. Histamine N-methyltransferase
B. Tyrosine hydroxylase
C. DOPA decarboxylase
D. Histidine decarboxylase

back 61

D. Histidine decarboxylase

front 62

Histidine decarboxylase requires which cofactor?
A. Tetrahydrobiopterin
B. Pyridoxal phosphate
C. Biotin
D. FAD

back 62

B. Pyridoxal phosphate

front 63

The catalytic mechanism of histidine decarboxylase most resembles:
A. Tryptophan hydroxylase
B. Tyrosine hydroxylase
C. DOPA decarboxylase
D. Dopamine β-hydroxylase

back 63

C. DOPA decarboxylase

front 64

A serotonergic anorexigen decreases appetite via receptors on:
A. POMC neurons
B. Orexin neurons
C. GnRH neurons
D. CRH neurons

back 64

A. POMC neurons

front 65

The POMC neurons mediating Redux hypophagia are in the:
A. Paraventricular nucleus
B. Arcuate nucleus
C. Suprachiasmatic nucleus
D. Ventromedial nucleus

back 65

B. Arcuate nucleus

front 66

A drug that raises synaptic serotonin most directly promotes:
A. Hunger signaling
B. Anhedonia symptoms
C. Panic symptoms
D. Satiety signaling

back 66

D. Satiety signaling

front 67

Chronically low serotonin is associated with:
A. Increased appetite
B. Fixed satiety
C. Reduced appetite
D. Decreased thirst

back 67

A. Increased appetite

front 68

Redux raised synaptic serotonin by SSRI action plus:
A. Reduced vesicle fusion
B. Increased MAO activity
C. Increased serotonin secretion
D. Increased COMT activity

back 68

C. Increased serotonin secretion

front 69

After neuronal release, histamine is thought to activate:
A. Postsynaptic only
B. Pre and postsynaptic
C. Glial only
D. Extrasynaptic only

back 69

B. Pre and postsynaptic

front 70

Relative to many transmitters, histamine shows little:
A. Presynaptic recycling
B. Calcium-triggered release
C. Vesicular storage
D. Enzymatic synthesis

back 70

A. Presynaptic recycling

front 71

Major CNS uptake/inactivation of histamine is attributed to:
A. Microglia
B. Oligodendrocytes
C. Neurons
D. Astrocytes

back 71

D. Astrocytes

front 72

A first-generation antihistamine most commonly causes:
A. Euphoria
B. Tremor
C. Drowsiness
D. Mydriasis

back 72

C. Drowsiness

front 73

“Nondrowsy” antihistamines minimize sedation mainly due to:
A. Poor BBB penetration
B. Higher H2 selectivity
C. Rapid CSF clearance
D. Increased histamine release

back 73

A. Poor BBB penetration

front 74

Peripheral antihistamine effects primarily counter histamine-driven:
A. Platelet aggregation
B. Vasodilation permeability
C. Cardiac contractility
D. Insulin secretion

back 74

B. Vasodilation permeability

front 75

A proposed contributor to neurologic findings in B12 deficiency is impaired:
A. Choline synthesis
B. GABA synthesis
C. Melatonin synthesis
D. Dopamine synthesis

back 75

D. Dopamine synthesis

front 76

The key reaction supplying acetyl-CoA for acetylcholine synthesis is:
A. Citrate lyase
B. Ketone cleavage
C. Pyruvate dehydrogenase
D. Fatty acid synthase

back 76

C. Pyruvate dehydrogenase

front 77

Pyruvate dehydrogenase is located in the:
A. Mitochondria
B. Cytosol
C. Nucleus
D. ER lumen

back 77

A. Mitochondria

front 78

Lecithin (phosphatidylcholine) supplementation has been used for:
A. Myasthenia gravis
B. Parkinson disease
C. Alzheimer dementia
D. Tardive dyskinesia

back 78

D. Tardive dyskinesia

front 79

The highest physiologic demand for choline is in the:
A. Elderly adult
B. Neonate
C. Adolescent
D. Middle-aged adult

back 79

B. Neonate

front 80

Glutamate dehydrogenase forms glutamate by incorporating:
A. Carbon dioxide
B. Sulfate
C. Ammonia
D. Glucose

back 80

C. Ammonia

front 81

An alternative major route to glutamate from α-ketoglutarate uses:
A. Transamination
B. Phosphorylation
C. Glycosylation
D. Beta-oxidation

back 81

A. Transamination

front 82

The CNS recycling pathway conserving glutamate and GABA is the:
A. Cori cycle
B. Urea cycle
C. Malate-aspartate
D. GABA shunt

back 82

D. GABA shunt

front 83

A patient with epilepsy is given a drug that blocks GABA reuptake:
A. Vigabatrin
B. Gabapentin
C. Tiagabine
D. Diazepam

back 83

C. Tiagabine

front 84

Which amino acid cannot cross the BBB?
A. Alanine
B. Aspartate
C. Serine
D. Glycine

back 84

B. Aspartate

front 85

Nitric oxide (NO) is synthesized from which amino acid substrate?
A. Histidine
B. Arginine
C. Tyrosine
D. Serine

back 85

B. Arginine

front 86

A patient’s ABG shows PaO2 = 18 mm Hg during acute hypoxia. Most likely clinical state?
A. Somnolence
B. Confusion
C. Seizures
D. Coma

back 86

D. Coma

front 87

A shared metabolic consequence of all forms of hypoxia is:
A. Decreased neurotransmitter synthesis
B. Increased myelin synthesis
C. Increased CSF glucose
D. Enhanced synaptic recycling

back 87

A. Decreased neurotransmitter synthesis

front 88

Which enzyme represents a major anaplerotic reaction for the TCA cycle?
A. Pyruvate dehydrogenase
B. Citrate synthase
C. Pyruvate carboxylase
D. Malate dehydrogenase

back 88

C. Pyruvate carboxylase

front 89

Valine and isoleucine degradation replenishes the TCA cycle by producing:
A. Succinyl-CoA
B. Acetyl-CoA
C. Citrate
D. Oxaloacetate

back 89

A. Succinyl-CoA

front 90

A peroxisome biogenesis disorder (e.g., Refsum) injures brain cells largely due to failed metabolism of:
A. Ketones and lactate
B. Glucose and glycogen
C. Cholesterol and bile acids
D. VLCFAs and branched-chain AAs

back 90

D. VLCFAs and branched-chain AAs

front 91

Which lipid class is ~16% of myelin lipid and largely absent from other membranes?
A. Phosphatidylcholine
B. Cerebrosides
C. Triacylglycerols
D. Gangliosides

back 91

B. Cerebrosides

front 92

Galactosylcerebroside is best described as having:
A. Two sugars on glycerol
B. Phosphate headgroup on ceramide
C. Single sugar on sphingosine OH
D. Sulfate on cholesterol ring

back 92

C. Single sugar on sphingosine OH

front 93

Myelin lamellae are stabilized primarily by:
A. Protein–lipid and protein–protein
B. Disulfide bridges only
C. Ionic bonds only
D. Hydrogen bonds only

back 93

A. Protein–lipid and protein–protein

front 94

Two proteins comprising ~60–80% of CNS myelin protein are:
A. MAG protein and PMP22
B. P0 protein and PMP22
C. Myelin P2 and P0
D. Proteolipid protein and Myelin basic proteins

back 94

D. Proteolipid protein and Myelin basic proteins

front 95

What may help to stabilize the structure from within the membrane?

A. Proteolipid protein
B. P0 protein
C. Myelin basic protein
D. Myelin-associated glycoprotein

back 95

C. Myelin basic protein

front 96

Pre-op management to mask catecholamine-excess signs in pheochromocytoma most classically uses:
A. Propranolol then phenoxybenzamine
B. Phenoxybenzamine then propranolol
C. Propranolol only
D. Phenoxybenzamine only

back 96

B. Phenoxybenzamine then propranolol

front 97

Multiple sclerosis incidence is described as:
A. Near nil at Equator
B. Highest near Equator
C. Uniform worldwide distribution
D. Only tropical latitudes

back 97

A. Near nil at Equator

front 98

Modern MS treatment is now based mainly on blocking the:
A. Adrenergic system blockade
B. Glutamatergic system blockade
C. Immune system blockade
D. Cholinergic system blockade

back 98

C. Immune system blockade

front 99

Inherited mutations in P0 (major PNS myelin protein) most directly cause:
A. Multiple sclerosis
B. ALS
C. Guillain-Barré syndrome
D. Charcot-Marie-Tooth disease

back 99

D. Charcot-Marie-Tooth disease

front 100

The inheritance pattern classically described for Charcot-Marie-Tooth is:
A. Autosomal recessive
B. Autosomal dominant
C. X-linked recessive
D. Mitochondrial inheritance

back 100

B. Autosomal dominant

front 101

A PLP mutation in CNS myelin is associated with which leukodystrophy?
A. Krabbe disease
B. Metachromatic leukodystrophy
C. Pelizaeus-Merzbacher disease
D. Adrenoleukodystrophy

back 101

C. Pelizaeus-Merzbacher disease

front 102

The enzyme catalyzing NO formation from arginine is:
A. Nitric oxide synthase
B. Tyrosine hydroxylase
C. Histidine decarboxylase
D. DOPA decarboxylase

back 102

A. Nitric oxide synthase

front 103

Which branched-chain amino acids contribute succinyl-CoA via degradation?
A. Leucine and lysine
B. Valine and isoleucine
C. Phenylalanine and tyrosine
D. Tryptophan and serine

back 103

B. Valine and isoleucine

front 104

Mutations in the major CNS myelin protein can cause Pelizaeus-Merzbacher and X-linked spastic paraplegia type 2. The protein is:
A. P0 protein
B. Myelin basic protein
C. Myelin-associated glycoprotein
D. Proteolipid protein

back 104

D. Proteolipid protein