USMLE Step 1 Question 303

Question:

An angry group of medical students go on a hunger strike to protest the increase in their tuition. After 4 to 5 hours, which of the following occurs in their bodies?

Correct Answer: E.  Increased cyclic AMP, increased liver glycogenolysis

In the presence of low blood glucose, epinephrine or norepinephrine interacts with specific receptors to stimulate adenylate cyclase production of cyclic AMP (Answer E). Cyclic AMP activates protein kinase, which catalyzes phosphorylation and activation of phosphorylase kinase. Activated phosphorylase kinase activates glycogen phosphorylase, which catalyzes the breakdown of glycogen. Phosphorylase kinase can be activated in two ways. Phosphorylation leads to complete activation of phosphorylase kinase. Alternatively, in muscle, the transient increases in levels of Ca²⁺ (Answer D) associated with contraction lead to a partial activation of phosphorylase kinase. Ca²⁺ binds to calmodulin, which is a subunit of phosphorylase kinase. Calmodulin regulates many enzymes in mammalian cells through Ca²⁺ binding.