WBR0987

Author	[[PageAuthor::Rim Halaby, M.D. [1] (Reviewed by Yazan Daaboul, M.D.)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Biochemistry
Sub Category	SubCategory::General Principles
Prompt	[[Prompt::A biology student collects urine samples for pH measurement and microscopic analysis for casts, crystals, and cells. The samples are obtained from healthy individuals and stored in sterile cups pending analysis. The student forgets one cup open overnight, and and are analyzed one aThe student uses a small amount of urine for the assignment and forgets the flask open. When the student is cleaning his bench a couple of hours later, he notices that the urine in the flask turned dark brown. The student gets worried and asks his professor about the cause of the change in color of his urine. The professor suspects a genetic condition caused by a deficiency in the enzyme involved in the breakdown of tyrosine. Which of the following is a long term complication of this genetic condition?]]
Answer A	AnswerA::Blindness
Answer A Explanation	[[AnswerAExp::Alkaptonuria is a benign condition that is due to a defect in the enzyme homogenistic acid oxidase. It can be associated with brown pigmenented sclera but not with blindness.]]
Answer B	AnswerB::Cancer
Answer B Explanation	[[AnswerBExp::Alkaptonuria is a benign condition that is due to a defect in the enzyme homogenistic acid oxidase. It is not associated with cancer.]]
Answer C	AnswerC::Arthralgia
Answer C Explanation	[[AnswerCExp::Alkaptonuria is a benign condition that is due to a defect in the enzyme homogenistic acid oxidase. It is associated with arthralgia due to the excessive homogentisic acid deposition and subsequent damage to the cartilage.]]
Answer D	AnswerD::Hearing loss
Answer D Explanation	[[AnswerDExp::Alkaptonuria is a benign condition that is due to a defect in the enzyme homogenistic acid oxidase. It is not associated with darkening of the ear but not hearing loss.]]
Answer E	AnswerE::Seizures
Answer E Explanation	[[AnswerEExp::Alkaptonuria is a benign condition that is due to a defect in the enzyme homogenistic acid oxidase. It is not associated with seizures.]]
Right Answer	RightAnswer::C
Explanation	[[Explanation::Alkaptonuria is a rare autosomal recessive condition that is due to a defect in the enzyme homogenistic acid oxidase, which participates in the degradation of tyrosine to fumarate. As a result, homogentisic acid and its oxide, called alkapton, accumulate in the blood and are excreted in urine in large amounts. Excessive homogentisic acid causes damage to cartilage leading to arthralgia. Alkaptonuria is often asymptomatic, but the sclera of the eyes may be pigmented, and the skin may be darkened in sun exposed areas and around sweat glands; sweat may be coloured brown. Urine may turn brown or even inky black if collected and left exposed to open air, especially when left standing for a period of time. Educational objective: Alkaptonuria is a benign autosomal recessive condition that is due to a defect in the enzyme homogenistic acid oxidase. It can be asymptomatic, but also can be associated with arthralgia, brown pigmenented sclera and darkening of the urine when left standing. References: First aid for USMLE step 1, 2013. Page 108. Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::Alkaptonuria, WBRKeyword::arthralgia
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::