A 22-year-old man comes to the physician for a routine physical examination. He feels well. He has no history of major medical illness and takes no medications. His vital signs are within normal limits. Examination shows no abnormalities. Laboratory studies, including a complete blood count and a standard electrolyte panel, are within normal limits. Urine dipstick is negative for glucose; a reducing substance test result of the urine is positive. Which of the following is the most appropriate dietary recommendation for this patient?
AEliminate galactose and lactose
BEliminate fructose and sucrose
CIncrease intake of ketogenic amino acids
DDecrease purine intake
ENo changes needed
A 3-day-old female infant presents with poor feeding, lethargy, vomiting after feeding, and seizures. Labs revealed ketoacidosis and elevated hydroxypropionic acid levels. Upon administration of parenteral glucose and protein devoid of valine, isoleucine, methionine, and threonine, and carnitine, the infant began to recover. Which of the following enzymes is most likely deficient in this infant?
ABranched-chain ketoacid dehydrogenase
BPropionyl-CoA carboxylase
CCystathionine synthase
DPhenylalanine hydroxylase
EHomogentisate oxidase
On a medical trip to Nicaragua, you observe a sweet odor in the cerumen of a 12-hour-old female newborn. Within 48 hours, the newborn develops ketonuria, poor feeding, and a sweet odor is also noticed in the urine. By 96 hours, the newborn is extremely lethargic and opisthotonus is observed. In order to prevent a coma and subsequent death, which of the following amino acids is one of those that should be withheld from this newborn's diet?
AMethionine
BValine
CPhenylalanine
DThreonine
ETyrosine
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