Monday, October 22, 2012

plasma protein


1- The deficiency of which plasma protein is responsible for Wilson’s disease ?

 (Ceruloplasmin)

2-Which immunoglobulin is pentameric in structure?                  

(Ig M)

3-Which plasma protein is a transporter of free fatty acids?

(Albumin)

4-Which protein acts as reservoir of oxygen?                      

(Myoglobin)

5-What is the normal level of Fibrinogen in the blood?    

(300mg %)

6-Which Immunoglobulin is present at the mucosal surfaces?

( IgA)

7-Complement activation is a function of which part of the Immunoglobulin?

(Fc segment)

8-Which antibody is the first to be synthesized in a fetus ?

(Ig M)

9-What is the function of Hinge region of an immunoglobulin?

(The hinge region confers flexibility and allows both Fab arms to move independently, thus helping them to bind to antigenic sites that may be variable distances apart (eg, on bacterial surfaces).)

10-Name the storage protein of iron                          

(Ferritin)

11-Name a plasma protein that binds extra corpuscular Hb      

(Haptoglobin)

12- γ Globulins are synthesized in the plasma cells- State true or false

(True)

13-What is the nature of apoprotein present in HDLc?                

(α1- globulin)

14-What is specified by CL   in the structure of immunoglobulin?

(Constant region of light chain)

15-What are the consequences of α1- Antitrypsin deficiency?

(Emphysema and cirrhosis of liver)

16-Name a plasma protein which acts as a transporter of Iron

(Transferrin)

17-Maximum contribution to the buffering capacity of plasma proteins is by- ?

(Albumin- due to the presence of histidine residues )

18-Maximum contribution to the viscosity of plasma is by—–?

(Fibrinogen- Since it is an elongated molecule)

19-What is Analbuminemia?

( Congenital absence of Albumin in the plasma)

20- The plasma level of gamma globulins is decreased in chronic liver  diseases True or false ?

(False- The level of gamma globulins is increased in chronic liver diseases)

21-What is the clinical significance related with Alpha feto protein?

  (Its plasma level is increased in liver cell carcinoma and teratoblastomas)

22-What is the function of Alpha 1 acid Glycoprotein?

( Acute phase protein and transporter of Progesterone)

23- What is the significance of the variable region of the immunoglobulins and why is it so-called variable region?

( It is variable in amino acid sequence and is involved in antigen binding)

24- Which plasma protein is a transporter of bilirubin?  

(Albumin)

25- What is meant by acute phase proteins?

(Acute phase proteins are those proteins, the synthesis and thus the plasma level of which are increased in response to inflammation or tissue damage.)

26–What is the difference between plasma and serum?

(Plasma contains clotting factors, while serum lacks them)

27-Out of Albumin, hemoglobin and immunoglobulin, which one has the least molecular weight?                                            

(Hemoglobin)

28-What is the difference between Haemopexin and hemoglobin?

(Haemopexin binds free haem while Haptoglobin binds free hemoglobin.)

29-What is the function of IgD?

(It acts as a receptor on the surface of B lymphocytes)

30-Name the Acute phase proteins

(Alpha 1 Antitrypsin, Alpha 1 acid glycoprotein, Haptoglobin, C-reactive protein)

31-What is the actual meaning of C-reactive protein, what does C mean?

(CRP, so-named because it reacts with the C polysaccharide of pneumococci)

32-Out of lipoproteins, immunoglobulins and Albumin, which one  is a simple protein ?    

(Albumin)

33-Name the plasma proteins involved in the clotting of blood?

(Fibrinogen and clotting factors)

34-Name the defense proteins of plasma

(Immunoglobulins, complement proteins and Beta 2 microglobulin)

35-How is copper transported in the blood?

(It is transported complexed with ceruloplasmin and Albumin)

36-Kayser-Fleischer ring is diagnostic of which disease?

(Wilsondisease)

37-What types of enzyme activities are associated with ceruloplasmin ?

(It has copper dependent Ferro- oxidase activity, it oxidizes iron  from ferrous to ferric form

38-Out of the following proteins which protein has mainly alpha helical structure-

(Collagen, immunoglobulin, myoglobin)              

(Myoglobin)

39-What is the chemical nature of Bence jone’s proteins?

(Light chain of immunoglobulins)                            

40-Name the commonly occurring haemoproteins

(Hemoglobin, Myoglobin, Cytochromes, Peroxidase and Tryptophan Pyrrolase)

41-How does smoking inactivate the Alpha 1 Antitrypsin protein?

(Smoking oxidizes this methionine to methionine sulfoxide and thus inactivates it. As a result, affected molecules of alpha 1-antitrypsin no longer neutralize proteases.)

42-Name three conditions of hyperproteinemia

(Hemoconcentration, chronic infections and malignancies)

43-What is the significance of M band , where is it located ?

(M band is present between beta and gamma globulin regions on electrophoresis of plasma proteins and is diagnostic of Multiple myeloma)

44- How many polypeptides are present in the structure of globin part of hemoglobin ?

(4)

45-Which amino acid contributes maximally to the structure of collagen molecule?

(Glycine)

46- Which immunoglobulin has the cytophilic property?

( Ig E)

47-The number of antibody secreting  plasma cells are decreased in Multiple myeloma that is why there is impaired humoral immune response . True or false?

(False- The number of plasma cells secreting antibodies are increased but these are abnormal and useless antibodies not targeted against any antigen, but the actual humoral response against a specific antigen is decreased.)

48- Which antibody is considered the most potent agglutinating antibody?

(IgM)

49-Which protein is precipitated by full saturation with Ammonium sulphate?

  (Albumin)

50-What is Pre albumin? Why is to so named? Is it a precursor of Albumin?

( Ii is a plasma protein and not a precursor, it is so named because of its faster electrophoretic migration in the electric field).


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major proteins of plasma


1- Name the major proteins of plasma.

(Albumin, Globulin and Fibrinogen)

2-Name the transport proteins

(Albumin, Lipoproteins, Prealbumin, Transthyretin, Retinol Binding protein, Thyroxin binding Globulin)

3-How many copper atoms can bind to one molecule of ceruloplasmin?

(6-8)

4-What is A: G ratio, what is its range in the normal health?                

(1.2:1 to 1.5:1)

5-What is the most significant sign of hypoproteinemia?

 (Edema)

6-Almost all proteins except Globulins are synthesized in the liver, True or false?

(True)

7-Name the negative phase proteins

(Albumin, Transthyretin, Transferrin etc.)

8-What are the different types of light chains?

( Kappa and Lambda)

9-Which immunoglobulin is the major antibody of primary immune response

 (IgM)

10-What is the function of the secretory piece of the IgA?

(It protects the antibody from proteolytic digestion)

11-What is the actual meaning of Fc and Fab ?

(These are the two portions of immunoglobulins produced after proteolytic cleavage of immunoglobulin. Fc denotes fragment crystallisable and Fab denotes antigen binding fragment)

12-Which form of Ig M – monomeric or polymeric acts as a receptor on the surface of B lymphocytes.

( Monomeric form)

13-Which form (Alpha helical, Beta pleated sheet or triple helical) predominates in the structure of collagen?                                  

(Triple helical)

14-What are the different types of heavy chains present in different types if immunoglobulins?

(α, β,γ,δ, Σ)

15-What types of globin chains  are present in Fetal Hemoglobin?

(Two alpha and 2 Gamma)

16-What is methaemoglobin?

( Hb in which iron is in the oxidized form(Ferric form )

17-25 % of the structure of hemoglobin is in the alpha helical form- state true or false?

(False- 75% is in the alpha helical form)

18-Name the beta globulins of biological significance

(Transferrin, Haemopexin, Complement etc)

19-What is the nature of ceruloplasmin?

(Alpha 2 globulin)

20-What is the function of Transferrin?

(Transfer of iron)

21-What is the function of fibrinogen?

(Blood clotting and viscosity)

22-What is the clinical significance of C- reactive protein ?

(Acute phase protein, activates complement, also helps in the formation of haem)

23-What is meant by opsonization?

(Coating the surface of antigen by antibodies)

24-What is the difference between monoclonal and polyclonal antibodies?

(Monoclonal means antibodies of only one specificity while polyclonal means antibodies of different specificities)

25-Hepato lenticular degeneration is observed due to deficiency of which plasma protein?

(Ceruloplasmin)

26-What is the function of complement protein ?

(These are defense molecules present in the plasma in the inactive form, required for pathogenic killing)

27-Enumerate the causes of hypo Albuminemia?

(Hypovolemia, mal nutrition, cirrhosis of liver, losses from the body ),

28-Give two causes of hyperproteinemia

(Hemoconcentration, malignancies, chronic infections)

29-What is class switching?

(The switch from one class of immunoglobulin to another class is called class switching)

30-How are the light chain and heavy chains linked together?

 ( By disulphide linkages)

31-What is the function of carbohydrate in the structure of immunoglobulins?

( It is required for the secretion of antibodies by the plasma calls)

32-Which antibody is called as the mucosal barrier?

( Ig A)

33-Which antibody is called as the Millionaire molecule?

 ( Ig M )

34-How is the rate of catabolism of Ig G affected by its serum concentration?

( It is a direct relationship, more the concentration more is the rate  of catabolism

 35- How many polypeptide chains are present in the structure of myoglobin?

(One)

36-Which out of the two (Myoglobin and hemoglobin) has more affinity for Oxygen?

(Myoglobin)

37-Name two proteins that bind thyroid hormone

(Thyroxin binding protein and Transthyretin)

38-What will be the effect of excessive vomiting on plasma protein concentration ?

( It will result in hyperproteinemia due to hemoconcentration)

39-In a chronic alcoholic patient plasma protein concentration should be lower than normal or higher?

(Lower than normal)

40- What is the function of Transcobalamine?

(Transporter of B12)

41-What are Bence jone’s proteins?

These are light chain Immuno globulins excreted in the urine of a patient suffering from multiple myeloma.

 42- What are the clinical features observed in a patient of multiple myeloma ?

(Weight loss, punched out lesions, anemia , increased frequency of infections)

43-What are the component chains in HbA1?

( 2 alpha and 2 delta)

 44 What is the cause of emphysema in alpha 1 anti trypsin deficiency?

(Inactivated Elastase which causes damage to the lung tissues)






------------------------------------------ Best Wishes: Dr.Ehab Aboueladab, Tel:01007834123 Email:ehab10f@gmail.com,ehababoueladab@yahoo.com ------------------------------------------

Immunoglobulin


DEFINITION 
Immunoglobulin (Ig) 
Immunoglobulins are glycoprotein molecules that function as antibodies and are produced by plasma cells in response to an immunogen. The immunoglobulins derive their name from the finding that they migrate in the region of globulins when antibody-containing serum is placed in an electrical field.









Figure- 1-showing the  Electrophoretic separation of plasma proteins 
BASIC STRUCTURE OF IMMUNOGLOBULINS
Although different immunoglobulins differ structurally but they all are built from the same basic units.(Figure-2)
A. Heavy and Light Chains 
All immunoglobulins have a four chain structure as their basic unit. They are composed of two identical light chains (23kD) and two identical heavy chains (50-70kD)
B. Disulfide bonds
1. Inter-chain disulfide bonds - The heavy and light chains and the two heavy chains are held together by inter-chain disulfide bonds and by non-covalent interactions .The number of inter-chain disulfide bonds varies among different immunoglobulin molecules.
2. Intra-chain disulfide binds - Within each of the polypeptide chains there are also intra-chain disulfide bonds.
C. Variable (V) and Constant (C) Regions 
Both the heavy and light chain can be divided into two regions based on variability in the amino acid sequences. These are the
1. Light Chain – VL (110 amino acids) and CL (110 amino acids)
2. Heavy Chain – VH (110 amino acids) and CH (330-440 amino acids)
D. Hinge Region 
This is the region at which the arms of the antibody molecule form a Y. It is called the hinge region because there is some flexibility in the molecule at this point.
E. Domains 
Three dimensional images of the immunoglobulin molecule show that it is not a straight molecule rather, it is folded into globular regions each of which contains an intra-chain disulfide bond (figure-2). These regions are called domains.
1. Light Chain Domains – VL and CL
2. Heavy Chain Domains – VH, CH1,CH2CH3 (or CH4)
F. Oligosaccharides 
Carbohydrates are attached to the CH2 domain in most immunoglobulins. However, in some cases carbohydrates may also be attached at other locations.















Figure-2- showing the general structure of Immunoglobulin
GENERAL FUNCTIONS OF IMMUNOGLOBULINS
A. Antigen binding 
Immunoglobulins bind specifically to one or a few closely related antigens. Each immunoglobulin actually binds to a specific antigenic determinant. Antigen binding by antibodies is the primary function of antibodies and can result in protection of the host.  The valency of antibody refers to the number of antigenic determinants that an individual antibody molecule can bind. The valency of all antibodies is at least two and in some instances more.














Figure-3- Showing the general structure of Immunoglobulin and  structure of antigen binding cleft. Antigenic determinants are present on the surface of  antigen while the antigen binding sites are present in the antigen binding cleft made by both light chain and heavy chain
B. Effector Functions 
Frequently the binding of an antibody to an antigen has no direct biological effect. Rather, the significant biological effects are a consequence of secondary “effector functions” of antibodies. The immunoglobulins mediate a variety of these effector functions. Not every immunoglobulin will mediate all effector functions. Such effector functions include:
1. Fixation of complement - This results in lysis of cells and release of biologically active molecules
2. Binding to various cell types – Phagocytic cells, lymphocytes, platelets, mast cells, and basophils have receptors that bind immunoglobulins. This binding can activate the cells to perform some function.














Figure-4 showing the receptors present on the surface of macrophages to bind the antigen antibody complex

Some immunoglobulins also bind to receptors on placental trophoblasts, which results in transfer of the immunoglobulin across the placenta. As a result, the transferred maternal antibodies provide immunity to the fetus and newborn.

















Figure- 5 showing the functions of different regions of the immunoglobulins

IMMUNOGLOBULIN FRAGMENTS: STRUCTURE/FUNCTION RELATIONSHIPS
Immunoglobulin fragments produced by proteolytic digestion -
A.  Fab 
Digestion with papain breaks the immunoglobulin molecule in the hinge region before the H-H inter-chain disulfide bond Figure 6. This results in the formation of two identical fragments that contain the light chain and the VH and CH1 domains of the heavy chain.


















Figure-6 showing the  site of action of Papain (a proteolytic enzyme).  Fab and Fc are the two fragments obtained by proteolytic cleavage.
Antigen binding - These fragments are  called the Fab fragments because they contained the antigen binding sites of the antibody. Each Fab fragment is monovalent whereas the original molecule was divalent. The combining site of the antibody is created by both VH and VL
B. Fc 
Digestion with papain also produces a fragment that contains the remainder of the two heavy chains each containing a CH2 and CH3 domain. This fragment was called Fc because it was easily crystallized.
Effector functions - The effector functions of immunoglobulins are mediated by this part of the molecule. Different functions are mediated by the different domains in this fragment (figure 5). 

















Figure-7- showing the site of action of Pepsin on Immunoglobulin.
C. F(ab’)2 
Treatment of immunoglobulins with pepsin results in cleavage of the heavy chain after the H-H inter-chain disulfide bonds resulting in a fragment that contains both antigen binding sites (figure 7). This fragment is called F(ab’)2because it is divalent. The Fc region of the molecule is digested into small peptides by pepsin. The F(ab’)2binds antigen but it does not mediate the effector functions of antibodies.
HUMAN IMMUNOGLOBULIN CLASSES, SUBCLASSES, TYPES AND SUBTYPES
A. Immunoglobulin classes 
The immunoglobulins can be divided into five different classes, based on differences in the amino acid sequences in the constant region of the heavy chains. All immunoglobulins within a given class will have very similar heavy chain constant regions. 
1. IgG – Gamma  heavy chains
2. IgM – Mu  heavy chains
3. IgA – Alpha heavy chains
4. IgD – Delta  heavy chains
5. IgE – Epsilon  heavy chains
Immunoglobulin Subclasses 
The classes of immunoglobulins can de divided into subclasses based on small differences in the amino acid sequences in the constant region of the heavy chains. All immunoglobulins within a subclass will have very similar heavy chain constant region amino acid sequences. 
1. IgG Subclasses
a) IgG1 – Gamma 1  heavy chains
b) IgG2 – Gamma 2  heavy chains
c) IgG3 – Gamma 3  heavy chains
d) IgG4 – Gamma 4  heavy chains
2. IgA Subclasses
a) IgA1 – Alpha 1  heavy chains
b) IgA2 – Alpha 2  heavy chains
 Immunoglobulin Types 
Immunoglobulins can also be classified by the type of light chain that they have. Light chain types are based on differences in the amino acid sequence in the constant region of the light chain. 
1. Kappa light chains 
2. Lambda light chains 
 STRUCTURE AND SOME PROPERTIES OF IG CLASSES AND SUBCLASSES
A.  IgG
1. Structure
 All IgG’s are monomers (7S immunoglobulin). The subclasses differ in the number of disulfide bonds and length of the hinge region.
2. Properties
IgG is the most versatile immunoglobulin because it is capable of carrying out all of the functions of immunoglobulin molecules.
a) IgG is the major Ig in serum – 75% of serum Ig is IgG
b) IgG is the major Ig in extra vascular spaces
c) Placental transfer – IgG is the only class of Ig that crosses the placenta. Transfer is mediated by a receptor on placental cells for the Fc region of IgG. Not all subclasses cross equally well; IgG2 does not cross well.
d) Fixes complement – Not all subclasses fix equally well; IgG4 does not fix complement
e) Binding to cells – Macrophages, monocytes and neutrophils and some lymphocytes have Fc receptors for the Fc region of IgG.  A consequence of binding to the Fc receptors on such cells  is that the cells can now internalize the antigen better. The antibody prepares the antigen for killing by the phagocytic cells. The term opsonin is used to describe substances that enhance phagocytosis. (Coating of the surface of pathogen by antibody is called opsonization).IgG is a good opsonin. Binding of IgG to Fc receptors on other types of cells results in the activation of other functions.















Figure-8- showing the structure of Ig G 
IgM
1. Structure
 IgM normally exists as a pentamer (19S immunoglobulin) but it can also exist as a monomer. In the pentameric form all heavy chains are identical and all light chains are identical. Thus, the valence is theoretically 10. IgM has an extra domain on the mu chain (CH4) and it has another protein covalently bound via a S-S bond called the J chain. This chain functions in polymerization of the molecule into a pentamer.
2. Properties
a) IgM is the third most common serum Ig.
b) IgM is the first Ig to be made by the fetus and the first Ig to be made by a virgin B cells when it is stimulated by antigen.
c) As a consequence of its pentameric structure, IgM is a good complement fixing Ig. Thus, IgM antibodies are very efficient in leading to the lysis of microorganisms.
d) As a consequence of its structure, IgM is also a good agglutinating Ig . Thus, IgM antibodies are very good in clumping microorganisms for eventual elimination from the body.
e) IgM binds to some cells via Fc receptors.
f) B cell surface Ig 
Surface IgM exists as a monomer and lacks J chain but it has an extra 20 amino acids at the C-terminus to anchor it into the membrane . Cell surface IgM functions as a receptor for antigen on B cells.















 Figure-9- showing the structure of Ig M 
IgA
1. Structure
Serum IgA is a monomer but IgA found in secretions is a dimer as presented in Figure 10. When IgA exits as a dimer, a J chain is associated with it.
When IgA is found in secretions is also has another protein associated with it called the secretory piece or T piece; sIgA is sometimes referred to as 11S immunoglobulin. Unlike the remainder of the IgA which is made in the plasma cell, the secretory piece is made in epithelial cells and is added to the IgA as it passes into the secretions . The secretory piece helps IgA to be transported across mucosa and also protects it from degradation in the secretions.


















Figure-10- showing the structure of Ig A 
2. Properties
a) IgA is the 2nd most common serum Ig.
b) IgA is the major class of Ig in secretions – tears, saliva, colostrum, mucus. Since it is found in secretions secretory IgA is important in local (mucosal) immunity.
c) Normally IgA does not fix complement, unless aggregated.
d) IgA can binding to some cells – PMN’s and some lymphocytes.

IgD
1. Structure
 IgD exists only as a monomer.
2. Properties
a) IgD is found in low levels in serum; its role in serum  is uncertain.
b) IgD is primarily found on B cell surfaces where it functions as a receptor for antigen.
 c) IgD does not bind complement.











Figure-11- showing the structure of Ig D 
E. IgE
1. Structure

IgE exists as a monomer and has an extra domain in the constant region.
2. Properties
a) IgE is the least common serum Ig since it binds very tightly to Fc receptors on basophils and mast cells even before interacting with antigen.
b) Involved in allergic reactions – As a consequence of its binding to basophils and mast cells, IgE is involved in allergic reactions. Binding of the allergen to the IgE on the cells results in the release of various pharmacological mediators that result in allergic symptoms.
c) IgE also plays a role in parasitic helminth diseases. Since serum IgE levels rise in parasitic diseases, measuring IgE levels is helpful in diagnosing parasitic infections. Eosinophils have Fc receptors for IgE and binding of eosinophils to IgE-coated helminths results in killing of the parasite.
d) IgE does not fix complement.












Figure-12- showing the structure of Ig E


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Lipid metabolism


1.  Describe the role of bile salts in the digestion and absorption of lipids.
2.  What is steatorrhea? What are the conditions that can cause it and what is the outcome?
3.  Discuss the steps of beta oxidation of a fatty acid with 16 carbon atoms. What will be the net energy yield per mole upon its complete oxidation?
4.  How is fatty acid oxidation switched off when the active synthesis of fatty acid is in process?
Or
5.  Discuss the regulation of fatty acid oxidation.
6.  Which process out of fatty acid synthesis or fatty acid oxidation would predominate during starvation? Discuss the steps,energetics and regulation of that pathway?
7.  Give a brief account of Alpha oxidation of fatty acids. What is its biological or clinical significance?
8. If a person fails to metabolize Phytanic acid which is a normal component of dairy products and green vegetables, what could be the possible defect? What would be the clinical manifestations and how can this defect be treated?
or
9.  Discuss the causes, consequences,laboratory diagnosis and treatment of Refsum disease.
10. What is the role played by Carnitine in mitochondrial oxidation of long chain fatty acids?
11. What is the cause of non ketotic hypoglycemia in Carnitine deficiency?
12. Discuss the causes, consequences and laboratory diagnosis of-
 i)Jamaican sickness ii) Sudden cot death syndrome iii) Zellwegar syndrome
13.-What is ketosis ? Outline the steps of formation and utilization of ketone bodies.
14.- Why it is said that ketone bodies are synthesized in liver and utilized in the peripheral tissues?
15- Give a flow chart representation of biochemical basis of ketosis in starvation and Diabetes mellitus.
16. What are the clinical features,laboratory findings and possible treatment of Ketosis?
17-Discuss the steps of de novo biosynthesis of fatty acids. How is this pathway regulated?
18- Give a diagrammatic representation of fatty acid synthase complex.
19- Discuss the regulation of fatty acid synthesis in the presence of i) Excess of citrate ii) Palmitic acid and describe the  long term control of  fatty acid synthesis if a person has  developed a compulsive urge to eat carbohydrate rich diet.
20- De novo Fatty acid synthesis is a cytoplasmic process while its precursor Acetyl co A is present in  the mitochondrion,how is that transported out in to the cytoplasm ?
21- “Fatty acid oxidation is not simply a reversal of fatty acid synthesis”, justify the statement giving the details of differences.
22- Discuss the steps and regulation of denovo synthesis of cholesterol.
23- Discus the significance of reactioncatalyzed by HMG Co A reductase.
24- What is the normal level of serum total cholesterol? What are the different conditions in which variations of serum total cholesterol level are observed?
25 Differentiate between LCAT (LecithinCholesterol Acyl Transferase) and ACAT (Acyl cholesterol acyl transferase) by giving at least three points of differences.
26- Discuss the steps of formation of bile acids. How is this pathway regulated?
27- How do bile acid sequestrants help in lowering serum total cholesterol levels?
28- Why it is said that equimolar amount of bile salts and phospholipids are needed during excretion of cholesterol in bile? What will happen if the bile salts or phospholipids are deficient?
29- What do you understand by cholelithiasis? What is the biochemical defect and what are the clinical manifestations in the affected patients?
30- What are lipoproteins? Discuss the general structure and classification of lipoproteins.
31- Discuss the functions of different apo-proteins giving examples.
32- What is meant by down regulation of LDLreceptors? What is the clinical significance associated with it?
33- Discuss the role of lipoprotein lipase in the metabolism of lipoproteins. What is clearing factor? What will be the clinical outcome if lipoprotein lipase is deficient?
34- Give a detailed account of hyperlipidemia. What is the possible line of treatment for this group of disorders?
35.- Discuss the central role of Acetyl coA  giving the details of its sources andchannels of utilization.
36- Give a brief account of hypolipidemic drugs.
37- How do polyunsaturated fatty acids help in lowering serum total cholesterol levels?
38- Give a brief account of metabolism of HDL highlighting the process of reverse cholesterol transport.
39- Why is LDL called a bad cholesterol while HDL a good cholesterol?
40- What is Lp (a) ? Discuss its clinicalsignificance?
41- Outline the reaction catalyzed by each of the following enzymes-
i)     Acetyl co A carboxylase
ii)     HMG Co A reductase
iii)    Thiokinase
iv)    Thiophorase
v)     Thiolase
vi)   7-Alpha hydroxylase
vii)   Acyl co A dehydrogenase
42-What is fatty liver? Enlist the causes and discuss the role of lipotropic agents.
43- What is the product of oxidation of a fatty acid with odd number of carbon atoms?
44- Why it is partly correct to say that fats can not be converted to glucose?
45- What is Atherosclerosis? Discuss in detail the causes, pathogenesis, laboratory findings and its possible treatment. 


------------------------------------------ Best Wishes: Dr.Ehab Aboueladab, Tel:01007834123 Email:ehab10f@gmail.com,ehababoueladab@yahoo.com ------------------------------------------