A 13-year-old girl is brought to the physician by her mother for a 1-week history of fatigue. She has been drinking a lot and using the bathroom more often than usual. Her mother has rheumatoid arthritis. Which of the following is most likely to be seen in this patient?

A) Decreased hormone-sensitive lipase activity
B) Decreased glucose-6-phosphatase activity
C) Decreased glycogen phosphorylase activity
D) Increased pyruvate carboxylase activity
E) Increased tyrosine kinase activity

An 8-year-old boy is brought to the physician for a follow-up appointment. He has a history of acute lymphoblastic leukemia for which he receives 6-mercaptopurine as part of his regimen. Which of the following agents must be used carefully in this case when considering tumor lysis syndrome?

A) Allopurinol
B) Azathioprine
C) Colchicine
D) Hydroxychloroquine
E) Rasburicase

A 49-year-old woman comes to the physician for a 2-week history of progressive muscle soreness. She has a history of hypertension and dyslipidemia managed with hydrochlorothiazide, atorvastatin, and gemfibrozil. Which of the following is the most likely explanation for this patient’s presentation?

A) Decreased activation of PPAR-α
B) Decreased activation of PPAR-γ
C) Increased mevalonate
D) Increased activation of PPAR-γ
E) P-450 interaction

A 46-year-old man is brought to hospital in the winter after being found on a park bench by police. His temperature is 95.6 F. A hypothermia protocol is initiated and his tissues are rewarmed. Which of the following acute electrolyte disturbances is of greatest concern in this patient?

A) Hypercalcemia
B) Hyperkalemia
C) Hypocalcemia
D) Hypokalemia
E) Hypophosphatemia

A 15-year-old girl is brought to the physician for a 1-week history of increasing lethargy and fatigue. She has had increased thirst and urination during this time. Her mother has rheumatoid arthritis. Which of the following is most likely to be seen in this patient?

A) Decreased glomerular filtration rate
B) Hypokalemia
C) Hyponatremia
D) Increased total body potassium
E) Increased tyrosine kinase activity

A 10-year-old girl is brought to the physician by her mother for a 1-day history of severe drowsiness and fatigue. She has been complaining of severe thirst for the past two weeks and has been frequenting the toilet more than ordinary. Which of the following is most likely to be seen in this patient?

A) Cellular shift
B) Increased sodium/potassium ATPase activity
C) Increased translocation of GLUT4
D) Increased tyrosine kinase activity
E) Reduced polyubiquitination

A 51-year-old woman is evaluated in hospital. She takes a daily multivitamin. Her mom had a history of osteoporosis. Vitals are normal. Serum studies are shown.

Chloride                                         104 mEq/L
Bicarbonate                                 20 mEq/L
Sodium                                            135 mEq/L

Which of the following is the most likely explanation for this patient’s findings?

A) Aspirin toxicity
B) Diabetic ketoacidosis
C) Lactic acidosis
D) Renal insufficiency
E) Renal tubular acidosis

A 27-year-old man is brought to hospital following having been found lost in a national park for the past two weeks. He is given 0.9% NaCl. He has not yet received any caloric nutritional therapy. Which of the following combinations of molecular activities is most likely to be seen in this patient?

A) ↑ Polyubiquitination; ↑ Glycogen phosphorylase; ↑ Pyruvate carboxylase
B) ↑ Polyubiquitination; ↑ Glycogen phosphorylase; ↓ Pyruvate carboxylase
C) ↑ Polyubiquitination; ↓ Glycogen phosphorylase; ↑ Pyruvate carboxylase
D) ↑ Polyubiquitination; ↓ Glycogen phosphorylase; ↓ Pyruvate carboxylase
E) ↓ Polyubiquitination; ↑ Glycogen phosphorylase; ↑ Pyruvate carboxylase
F) ↓ Polyubiquitination; ↑ Glycogen phosphorylase; ↓ Pyruvate carboxylase
G) ↓ Polyubiquitination; ↓ Glycogen phosphorylase; ↑ Pyruvate carboxylase
H) ↓ Polyubiquitination; ↓ Glycogen phosphorylase; ↓ Pyruvate carboxylase

A 7-year-old girl is brought to the physician for a 3-day history of increasing thirst and urination. She has also had intermittent vomiting during this time. She recently recovered from an upper respiratory tract viral infection about two weeks ago. Which of the following combinations of biochemical changes is most likely to be seen in this patient?

A) ↑ Polyubiquitination; ↑ Glucokinase; ↑ Glycogen phosphorylase
B) ↑ Polyubiquitination; ↑ Glucokinase; ↓ Glycogen phosphorylase
C) ↑ Polyubiquitination; ↓ Glucokinase; ↑ Glycogen phosphorylase
D) ↑ Polyubiquitination; ↓ Glucokinase; ↓ Glycogen phosphorylase
E) ↓ Polyubiquitination; ↑ Glucokinase; ↑ Glycogen phosphorylase
F) ↓ Polyubiquitination; ↑ Glucokinase; ↓ Glycogen phosphorylase
G) ↓ Polyubiquitination; ↓ Glucokinase; ↑ Glycogen phosphorylase
H) ↓ Polyubiquitination; ↓ Glucokinase; ↓ Glycogen phosphorylase

A 14-year-old boy is brought to the physician with scleral icterus for the past 2 days.

Which of the following is most likely to be seen in this patient?

A) Dacrocytosis
B) Decreased glucose-6-phosphate
C) Decreased NADH production
D) Increased disulfide bonds
E) Reductive environment