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A 1-year-old child is found unresponsive at home. EMS notes a bitter almond odor on breath. Arterial blood gas reveals severe lactic acidosis and normal pO₂. Antidote treatment begins immediately. Which of the following explains how nitrite contributes to this treatment?
A. Blocks cyanide entry into the mitochondria
B. Reduces cyanide to thiocyanate for renal excretion
C. Oxidizes Fe²⁺ in hemoglobin to Fe³⁺, creating methemoglobin
D. Competes with oxygen at Complex IV
E. Enhances ATP synthesis by upregulating Complex V
C
A. ❌ Cyanide can enter mitochondria passively; nitrite doesn't prevent entry.
B. ❌ That’s thiosulfate’s job: converts CN⁻ to thiocyanate for excretion.
✅ C. Nitrite oxidizes Fe²⁺ → Fe³⁺ (methemoglobin), which binds cyanide and frees Complex IV.
D. ❌ Cyanide, not nitrite, competes with oxygen at Complex IV.
E. ❌ Nitrite has no effect on Complex V activity.
A 40-year-old gardener presents with nausea, dizziness, and confusion after using a pesticide. Labs show high NADH levels and reduced ATP. Which mitochondrial complex is most likely affected?
A. Complex I
B. Complex II
C. Complex III
D. Complex IV
E. Complex V
A
✅ A. Rotenone is a pesticide that inhibits Complex I → NADH accumulates, ATP drops.
B. ❌ Complex II isn't the entry point for NADH.
C. ❌ Antimycin A inhibits Complex III, but that’s a Streptomyces-derived antibiotic, not a garden pesticide.
D. ❌ Cyanide inhibits Complex IV; different clinical picture.
E. ❌ Complex V inhibition wouldn’t elevate NADH.
A patient is undergoing metabolic testing. Their mitochondrial membranes are found to be selectively permeable to potassium but not protons. Which substance is most likely responsible for this effect?
A. Oligomycin
B. 2,4-DNP
C. Rotenone
D. Valinomycin
E. Antimycin A
D
A. ❌ Oligomycin inhibits ATP synthase (Complex V), not ion transport.
B. ❌ DNP carries protons, not potassium.
C. ❌ Rotenone inhibits Complex I — unrelated to potassium transport.
✅ D. Valinomycin is a K⁺ ionophore → disrupts membrane potential → acts as uncoupler.
E. ❌ Antimycin A inhibits Complex III, not a K⁺ transporter.