Lipid Metabolism — MCQs

Lipid Metabolism Indian Medical PG Practice Questions and MCQs

Question 651: Which of the following is a transfatty acid?

A. Oleic acid
B. Elaidic acid (Correct Answer)
C. Stearic acid
D. Arachidonic acid

Explanation: ***Elaidic acid*** - **Elaidic acid** is a common **trans-fatty acid** found in partially hydrogenated vegetable oils. - Its chemical structure includes a **trans double bond**, which gives it properties distinct from cis-fatty acids. *Oleic acid* - **Oleic acid** is a **monounsaturated fatty acid** commonly found in olive oil and other plant fats. - It has a **cis double bond**, which causes a bend in its molecular structure. *Stearic acid* - **Stearic acid** is a **saturated fatty acid** with no double bonds in its carbon chain. - It is found in animal fats and some plant oils, and its straight chain allows for tight packing. *Arachidonic acid* - **Arachidonic acid** is a **polyunsaturated omega-6 fatty acid** with multiple cis double bonds. - It is involved in inflammation and is a precursor to eicosanoids.

Question 652: Which of the following statements about the properties of VLDL and LDL is true?

A. LDL is formed from VLDL. (Correct Answer)
B. VLDL remnants are primarily taken up by the liver.
C. LDL is formed in the liver.
D. In electrophoresis, VLDL migrates less cathodal than LDL.

Explanation: ***LDL is formed from VLDL.*** - **Very low-density lipoprotein (VLDL)** is secreted by the liver and transports **triglycerides** to peripheral tissues. As most of the triglycerides are removed by **lipoprotein lipase**, VLDL is converted into **intermediate-density lipoprotein (IDL)** and then further to **low-density lipoprotein (LDL)**. - This conversion primarily occurs in the bloodstream as VLDL loses its triglyceride content. - This statement is **unambiguously true** and represents the established metabolic pathway. *VLDL remnants are primarily taken up by the liver.* - While this statement has some truth, **VLDL remnants (IDL)** have **two major fates**: approximately **50% are taken up by the liver** via apoE-mediated endocytosis through the **LDL receptor** and **LRP**, while the remaining **50% are converted to LDL** by hepatic lipase. - The term "primarily" (meaning mostly or mainly) is thus **not entirely accurate** since both pathways are equally significant. - In contrast, **chylomicron remnants** are almost exclusively (>90%) taken up by the liver, making this statement more applicable to them. *LDL is formed in the liver.* - The liver primarily produces and secretes **VLDL**, not LDL directly. - LDL is a product of the **catabolism** of VLDL in the circulation, not formed de novo in the liver. *In electrophoresis, VLDL migrates less cathodal than LDL.* - In standard **agarose gel electrophoresis**, **VLDL** migrates in the **pre-beta** region, which is **more cathodal** (less anodic) than **LDL** which migrates in the **beta** region. - This means VLDL is more cathodal than LDL, making this statement **incorrect** (it states the opposite).

Question 653: Which of the following conditions is characterized by a lack of genetically mediated VLDL overproduction?

A. Hypoapobetalipoproteinemia (Correct Answer)
B. Familial dyslipidemic hypertension
C. LDL subclass B
D. Familial combined hyperlipidemia

Explanation: ***Hypoapobetalipoproteinemia*** - This condition is characterized by **reduced production of apolipoprotein B**, leading to abnormally low levels of **VLDL and LDL** in the blood due to genetic mutations affecting apolipoprotein B synthesis or secretion. - Unlike the other options, it explicitly involves a *lack* of VLDL overproduction, making it the correct answer. *Familial combined hyperlipidemia* - This is a common genetic disorder characterized by **overproduction of VLDL** and occasionally decreased clearance of LDL, leading to elevated total cholesterol and triglycerides. - Patients often present with **elevated LDL and VLDL levels**, directly contradicting a lack of VLDL overproduction. *Familial dyslipidemic hypertension* - This condition is associated with a cluster of metabolic abnormalities, including **elevated triglycerides** (often secondary to VLDL overproduction) and hypertension. - The dyslipidemia component involves **increased VLDL production**, contributing to hypertriglyceridemia, rather than a lack of it. *LDL subclass B* - Refers to a predominance of **small, dense LDL particles**, which are more atherogenic than large, buoyant LDL particles. - The presence of small, dense LDL is often associated with conditions like **hypertriglyceridemia** and **insulin resistance**, which can be driven by increased VLDL production, not a lack thereof.

Question 654: What is the primary defect associated with type II hyperlipidemia?

A. Apo-E
B. Lipoprotein lipase
C. LDL receptor (Correct Answer)
D. HMG-CoA reductase

Explanation: ***LDL receptor*** - A defect in the **LDL receptor** leads to type II hyperlipidemia, characterized by elevated **LDL cholesterol** levels in the blood [1]. - This condition results in increased risk for **atherosclerosis** and cardiovascular diseases due to impaired cellular uptake of cholesterol [1,2]. *Apo-E* - Deficiencies of **Apo-E** typically result in type III hyperlipidemia, associated with **remnant lipoprotein clearance** issues rather than type II. - It affects metabolism of **chylomicron remnants** and intermediate density lipoproteins (IDL), not primarily LDL. *None* - This option incorrectly suggests that there is no defect associated with type II hyperlipidemia; in reality, it is primarily linked to **LDL receptor** dysfunction [1]. - The term "none" implies a lack of specific pathology, which is inaccurate in the context of hyperlipidemia types. *Lipoprotein lipase* - Deficiency in **lipoprotein lipase** leads to type I (or V) hyperlipidemia, characterized by increased **triglyceride** levels rather than just LDL. - It primarily impairs the hydrolysis of triglycerides in chylomicrons and VLDL, which differs from the LDL receptor's function [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 157-159. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 156-157.

Question 655: Which of the following is not a glycerophospholipid?

A. Lecithin
B. Cardiolipin
C. Plasmalogens
D. Sphingomyelin (Correct Answer)

Explanation: ***Sphingomyelin*** - Sphingomyelin is a **sphingolipid**, characterized by a **sphingosine backbone** rather than a glycerol backbone. - It contains a **phosphate group** and **choline head group** attached to the sphingosine. *Lecithin* - **Lecithin** is another name for **phosphatidylcholine**, which is a **glycerophospholipid**. - It has a **glycerol backbone** esterified to two fatty acids and a phosphate group linked to choline. *Cardiolipin* - **Cardiolipin** is a **glycerophospholipid** composed of two phosphatidic acid moieties linked by another glycerol molecule. - It is unique for having **four fatty acyl chains** and is primarily found in the **inner mitochondrial membrane**. *Plasmalogens* - **Plasmalogens** are a class of **glycerophospholipids** characterized by an **ether linkage** at the sn-1 position of the glycerol backbone, instead of an ester linkage. - They also contain an **ester-linked fatty acid** at the sn-2 position and a phosphate group with a head group.

Question 656: Which of the following is increased in lipoprotein lipase deficiency?

A. VLDL
B. LDL
C. HDL
D. Chylomicrons (Correct Answer)

Explanation: ***Chylomicrons*** - **Lipoprotein lipase (LPL)** is essential for hydrolyzing triglycerides within **chylomicrons** and VLDL, allowing fatty acids to be taken up by tissues. - Deficiency in LPL leads to a significant accumulation of **chylomicrons** in the plasma, as their degradation is impaired, resulting in **hypertriglyceridemia**. *VLDL* - While LPL also breaks down **VLDL**, the primary and most dramatic accumulation in LPL deficiency is seen with **chylomicrons** due to their larger triglyceride content and direct dependence on LPL for clearance after meals. - **VLDL** levels might also be elevated, but the hallmark is the very high **chylomicron** levels. *LDL* - **LDL** is formed from the catabolism of VLDL, and its levels are generally not directly increased due to a primary LPL deficiency. - LPL's main role is in triglyceride-rich lipoprotein metabolism, not directly in **LDL** catabolism. *HDL* - **HDL** plays a role in reverse cholesterol transport and is not directly metabolized by lipoprotein lipase. - In fact, in severe hypertriglyceridemia due to LPL deficiency, **HDL** levels may sometimes be low rather than increased.

Question 657: Aromatase produces estrogen from -

A. Progesterone
B. Cortisol
C. Aldosterone
D. Androgen (Correct Answer)

Explanation: ***Androgen*** - **Aromatase** is an enzyme complex that converts **androgens** (specifically androstenedione and testosterone) into **estrogens** (estrone and estradiol, respectively). - This conversion is a key step in **estrogen biosynthesis** and occurs in various tissues, including the ovaries, placenta, brain, and adipose tissue. *Progesterone* - **Progesterone** is a precursor to androgens, but it is not directly converted to estrogen by aromatase. - It plays a primary role in the **menstrual cycle** and **pregnancy**. *Cortisol* - **Cortisol** is a **glucocorticoid hormone** produced in the adrenal cortex and is not a substrate for aromatase. - Its primary functions relate to stress response, metabolism, and immune regulation. *Aldosterone* - **Aldosterone** is a **mineralocorticoid hormone** produced in the adrenal cortex and is not involved in estrogen synthesis. - It primarily regulates **blood pressure** and electrolyte balance.

Question 658: Oxidation of very long chain fatty acids takes place in ?

A. Ribosomes
B. Cytosol
C. Mitochondria
D. Peroxisomes (Correct Answer)

Explanation: ***Peroxisomes (Correct)*** - **Very long chain fatty acids (VLCFAs)**, which have more than 20 carbon atoms, undergo initial **beta-oxidation** in peroxisomes. - This process shortens the VLCFAs before they are transported to mitochondria for further oxidation. - Peroxisomes are essential for breaking down these fatty acids that are too long for direct mitochondrial processing. *Cytosol (Incorrect)* - The cytosol is the site for **fatty acid synthesis**, not oxidation. - It also plays a role in the initial steps of **glycerol phosphorylation** in triglyceride synthesis. *Mitochondria (Incorrect)* - **Mitochondria** primarily handle the beta-oxidation of **medium and short-chain fatty acids** (typically less than 20 carbons). - While VLCFAs are eventually oxidized here after peroxisomal shortening, their initial breakdown must occur in peroxisomes. *Ribosomes (Incorrect)* - **Ribosomes** are responsible for **protein synthesis** (translation) based on mRNA templates. - They have no role in fatty acid metabolism.

Question 659: Lipoprotein involved in reverse cholesterol transport?

A. Very Low-Density Lipoprotein (VLDL)
B. Intermediate-Density Lipoprotein (IDL)
C. Low-Density Lipoprotein (LDL)
D. High-Density Lipoprotein (HDL) (Correct Answer)

Explanation: ***High-Density Lipoprotein (HDL)*** - **HDL** is often referred to as "good cholesterol" because its primary function is **reverse cholesterol transport**, which removes excess cholesterol from peripheral tissues and returns it to the liver for excretion. - It works by picking up **unesterified cholesterol** from cells and esterifying it via **lecithin-cholesterol acyltransferase (LCAT)**, increasing its lipid content. *Very Low-Density Lipoprotein (VLDL)* - **VLDL** is primarily involved in transporting **endogenous triglycerides** synthesized by the liver to peripheral tissues. - While it carries some cholesterol, its main role is not in reverse cholesterol transport but in delivering lipids. *Intermediate-Density Lipoprotein (IDL)* - **IDL** is a transient lipoprotein formed from **VLDL** after it has shed some triglycerides and apoC-II and apoE. - It can be further metabolized to **LDL** or taken up by the liver; it does not directly participate in reverse cholesterol transport. *Low-Density Lipoprotein (LDL)* - **LDL**, often called "bad cholesterol," is responsible for transporting cholesterol from the liver to peripheral tissues. - High levels of **LDL** are associated with increased risk of **atherosclerosis** due to its role in delivering cholesterol to arterial walls.

Question 660: Which of the following is the rate limiting step in cholesterol synthesis?

A. HMG CoA reductase (Correct Answer)
B. Thiokinase
C. Mevalonate kinase
D. HMG CoA synthase

Explanation: ***HMG CoA reductase*** - **HMG-CoA reductase** catalyzes the conversion of **HMG-CoA** to **mevalonate**, which is the committed and rate-limiting step in cholesterol synthesis. - This enzyme is a major target for **statins**, a class of drugs used to lower cholesterol levels by inhibiting its activity. *Thiokinase* - **Thiokinase** (or fatty acyl-CoA synthetase) is involved in activating fatty acids for metabolism, not directly in cholesterol synthesis. - It catalyzes the formation of **fatty acyl-CoA** from fatty acids and CoA, a step in fatty acid metabolism. *Mevalonate kinase* - **Mevalonate kinase** catalyzes the phosphorylation of mevalonate to **5-phosphomevalonate**. - While essential for cholesterol synthesis, this step occurs after the rate-limiting step and is not the primary regulatory point. *HMG CoA synthase* - **HMG-CoA synthase** catalyzes the condensation of **acetoacetyl-CoA** with **acetyl-CoA** to form **HMG-CoA**. - This step occurs before the reduction of HMG-CoA by HMG-CoA reductase and is not the rate-limiting enzyme in the pathway.

Practice by Chapter

Lipid Classification and Chemistry

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Fatty Acid Oxidation

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Ketone Body Metabolism

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Fatty Acid Synthesis

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Metabolism of Triacylglycerols

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Phospholipid Metabolism

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Cholesterol Metabolism and Biosynthesis

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Bile Acids and Bile Salts

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Lipoprotein Metabolism and Transport

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Dyslipidemias and Atherosclerosis

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Prostaglandins and Eicosanoids

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Fatty Liver and Lipotropic Factors

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