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

A 7-year-old boy is brought to the physician by his mother for a 2-day history of vomiting and sluggishness. He has been drinking a lot and using the bathroom frequently for the past couple of weeks. His glucose is 458 mg/dL. Which of the following is most likely to be seen in this patient?

A) Decreased β-hydroxybutyrate
B) Decreased serum sodium
C) Decreased urinary potassium
D) Increased glucokinase activity
E) Increased total body potassium

A 24-year-old medical student is investigating the mechanisms of programmed cell death secondary to cell injury. Which of the following is most likely to be observed by this student?

A) Apoptosome assembly via cytochrome c and Apaf-1
B) Bax and Bak activation of caspase 9
C) Cytochrome c activation of caspases 3 and 7
D) Release of cytochrome c by damaged rough endoplasmic reticulum
E) Recruitment of caspase 9 by caspases 3 and 7

A 4-year-old boy is brought to the physician for a follow-up appointment. He is at the 3rd percentile for height and weight and has a history of 3 pneumonias since birth. He was conceived via IVF since his biologic father “had no sperm” in a sample, but sperm were retrieved using percutaneous epididymal sperm aspiration (PESA). Which of the following is most likely to be seen in this patient?

A) Autosomal dominant inheritance
B) Chromosome 5 mutation
C) Decreased unmineralized osteoid
D) Endocrine pancreatic insufficiency
E) Increased ENaC activity

A 67-year-old man with a long history of COPD is hospitalized following an acute exacerbation. Which of the following sets of arterial blood gas findings are most likely to be seen in this patient?

A) 7.58 pH; 58 mmHg CO2; 34 mEq/L HCO3^–
B) 7.52 pH; 56 mmHg CO2; 21 mEq/L HCO3^–
C) 7.49 pH; 31 mmHg CO2; 29 mEq/L HCO3^–
D) 7.47 pH; 28 mmHg CO2; 21 mEq/L HCO3^–
E) 7.33 pH; 80 mmHg CO2; 30 mEq/L HCO3^–
F) 7.31 pH; 57 mmHg CO2; 20 mEq/L HCO3^–
G) 7.12 pH; 29 mmHg CO2; 45 mEq/L HCO3^–
H) 6.99 pH; 26 mmHg CO2; 12 mEq/L HCO3^–

A 25-year-old woman partakes in a research study in which she performs complete fasting from food for 36 hours. She only consumes water during this time. Which of the following is most likely to be seen in this patient during the course of her fasting?

A) Decreased activity of pyruvate carboxylase
B) Decreased renal gluconeogenic activity
C) Glucose release by skeletal muscle
D) Increased ratio of glucokinase to hexokinase activity
E) Phosphorylation of glycogen phosphorylase