Medical faculty 2- d course Module 4 General principles of metabolism 1. A new-born child suffers from diarrhea, vomiting and cataract. Disorder of synthesis of what enzyme caused this disease? A. Glucose - 6 phosphatase B. Hexokinase C. Glycogen synthase D. Glucose phosphate isomerase E. Galactose – 1 – phosphate uridyl transferase ANSWER: E 2. Most enzymes are composed of. A. Lipids B. Carbohydrates C. Proteins D. Phosphates E. Vitamins ANSWER: C 3. A competitive inhibitor of an enzyme is usually: A. A highly reactive compound B. A metal ion such as Hg2+ or Pb2+ C. Structurally similar to the substrate D. Water insoluble E. A poison ANSWER: C 4. What is the area of an enzyme called where the chemical reactions occur? A. The Cytoplasm B. The Active Site C. The Catalyst D. The Nucleus E. A substrate ANSWER: B 5. When considering the features of an exergonic reaction, exergonic reactions: A. Release energy B. Are spontaneous reactions C. Have an equilibrium constant greater than 1 D. Can be coupled to energonic reactions E. All statements are true. ANSWER: A 6. Zinc is present in which of the following enzymes A. Cytochrome oxidase B. Arginase C. Hexokinase D. Alcoholdehydrogenase E. Catalase ANSWER: D 7. Lactate dehydrogenase is a A. Coenzyme B. Isoenzyme C. Zymogen D. Abzyme E. Prostetic group ANSWER: B 8. Isoenzymes are generally separated by A. Ion exchange chromatography B. Gel filtration chromatography C. Paper chromatography D. Electrophoresis E. Selective adsorbtion ANSWER: D 9. A person having deficiency of lactase cannot digest A. Proteins B. Milk C. Starch D. Fats E. Potatos ANSWER: B 10. The product(s) of lactate dehydrogenase under anaerobic conditions is (are) A. Pyruvic acid B. TPP C. NADH D. Propionate E. Lactate ANSWER: E 11. What component is not included in the structure of holoenzymes? A. Apoenzyme B. Coenzyme C. Cofactor D. Prostetic group E. Izoenzyme ANSWER: E 12. Which vitamin does not serve as a coenzyme? A. B1 B. B2 C. B5 D. С E. B12 ANSWER: D 13. How many active centers can have enzymes? A. 1 B. 3 C. 2 D. Depends on the amount of subunits of enzyme E. 10 ANSWER: D 14. Allosteric centers serve as: A. The place of the effect on the enzyme different regulators B. The place relation of enzyme with substrate C. Catalytic area D. Contact area E. The area of the spatially united amino acid residues separation ANSWER: A 15. What is not a type of enzymes specificity? A. Relative B. Absolute C. Conformational D. Stereospecificity E. Both C and D ANSWER: C 16. The Fischer's lock and key theory of enzyme specificity view the _______ as the lock and _______ as the key. A. Enzyme; substrate B. Substrate; enzyme C. Enzyme; transition state D. Transition state; enzyme E. Substrate; transition state ANSWER: A 17. What from the below mentioned enzymes is a polyenzyme complex? A. Pyruvate dehydrogenase B. Transketolase C. Succinate dehydrogenase D. Aldolase E. Glucose-6-phosphatase ANSWER: A 18. Which property is common for enzymes and inorganic catalysts? A. Specificity B. Dependence from temperature C. Catalysis only thermodynamically possible reactions D. Dependence from рН E. High catalytic activity ANSWER: C 19. According to the international classification there are six classes of enzymes in such order: A. Oxidoreductases, hydrolyses, ligases, lyases, transferases, isomerases. B. Transferases, hydrolyses, oxidoreductase, isomerases, lyases, ligases. C. Hydrolyses, oxidoreductase, transferases, lyases, isomerases, ligases. D. Oxidoreductase, transferases, hydrolyses, isomerases, ligases, lyases. E. Oxidoreductase, transferases, hydrolyses, lyases, isomerases, ligases. ANSWER: E 20. The laboratory test allows to diagnose myocardium infarction. The increase of what enzyme in blood proves it? A. LDH4,5 B. Arginase C. Pyruvate dehydrogenase D. AsAT E. ALAT ANSWER: D 21. NAD+, FAD, and FMN are all cofactors for: A. Oxidoreductases B. Transferases C. Hydrolases D. Lyases E. Ligases ANSWER: A 22. How is nonprotein part of enzyme called? A. Holoenzyme. B. Apoenzyme. C. Cofactor. D. Apoprotein. E. None of the above ANSWER: C 23. How many classes of enzymes are there? A. 4. B. 5. C. 6. D. 7. E. 2 ANSWER: C 24. What pathology is developed in the absence of phenylalanine 4-monooxygenase? A. Phenylketonuria. B. Alkaptonuria C. Galactosemia. D. Hyperglycemia. E. Achilia ANSWER: A 25. What is the cause of primary enzymo-pathologies? A. Liver diseases. B. Genetic disorders. C. Trauma. D. Ischemia. E. All of these ANSWER: B 26. A substance that is Not a coenzyme is A. ATP B. NAD+ C. NADPH D. FAD E. Pyrydoxal phosphate ANSWER: A 27. Pyruvate dehydrogenase complex and ?-ketoglutarate dehydrogenase complex require the following for their oxidative decarboxylation: A. CoASH and Lipoic acid B. NAD+ and FAD C. CoASH and TPP D. CoASH, TPP,NAD+,FAD, Lipoate E. A and C ANSWER: D 28. The number of ATP produced in the succinate dehydrogenase step is A. 1 B. 2 C. 3 D. 4 E. 5 ANSWER: B 29. There are such three enzymes in pyruvate dehydrogenase complex: A. Pyruvate carboxylase, lactate dehydrogenase, citrate synthase B. Pyruvate dehydrogenase, dihydrolipoyl acetyl transferase, dihydrolipoyl dehydrogenase. C. Ketoglutarate dehydrogenase, acetyltransferase, aconitase D. NАDН2- dehydrogenase E. Succinate dehydrogenase, aldehyde dehydrogenase. ANSWER: B 30. There are 4 main functions of Krebs cycle, except: A. Oxidation of acetic acid into СО2 і Н2О B. Donator of hydrogen atoms for respiratory chain C. Oxidation of lactate into pyruvate D. Formation of ATP E. Supplying substrates for heme synthesis ANSWER: C 31. Name the common product of the second stage of catabolism of carbonhydratess, lipids and amino acids. A. Acetyl-CoA. B. Pyruvate C. Citric acid. D. Acyl-CoA. E. ATP ANSWER: A 32. Central intermediate product of metabolism is: A. Acetyl-CoA B. Succinyl-CoA C. Oxaloacetate D. Pyruvate E. Citrate ANSWER: A 33. ubstrates of the respiratory chain are all the below mentioned, except one: A. Isocitrate B. Malate C. C-кеtoglutarate D. Succinate E. Lactate ANSWER: E 34. Pyruvate can be form from all substrates, except one: A. Lactate B. Glycerol C. Glucose D. Fatty acids E. Glycogen ANSWER: D 35. There are ____ enzymes in the pyruvate dehydrogenase complex and ____ coenzymes: _______________________________________________. A. 5; 5: TPP, lipoamide, HS-CoA, FAD+, NAD+ B. 3; 5: TPP, lipoamide, HS-CoA, FAD+, NAD+ C. 3; 5: PLP, lipoamide, HS-CoA, FAD+, NADP+ D. 4; 5: PLP, lipoamide, HS-CoA, FAD+, NADP+ E. 5; 5: PLP, lipoamide, HS-CoA, FAD+, NADP+ ANSWER: B 36. All enzymes and coenzymes of the pyruvate dehydrogenase complex are located in: A. Cytoplasm; B. Matrix of mitochondria; C. Lysosomes; D. Partially in cytoplasm, partially in mitochondrial matrix. E. All of the above ANSWER: B 37. The citric acid cycle is the _________________________________________. A. Final common pathway for the catabolism of fuel molecules — carbohydrates, fatty acids and amino acids; B. The anabolic pathway in which macromolecules are synthesized from monomers; C. The biochemical pathway in which glucose is oxidized to acetyl CoA; D. The biochemical pathway in which glucose is synthesized from noncarbohydrate components. E. Final common pathway for the catabolism of carbohydrates; ANSWER: A 38. Which cofactor is not used by the pyruvate dehydrogenase complex? A. Lipoamide B. Thiamine pyrophosphate C. FAD D. QH2 E. HS-CoA ANSWER: D 39. Which is not produced by the citric acid cycle? A. NADH B. FMN C. CO2 D. FADH2 E. All of the above ANSWER: B 40. Which enzyme catalyzes the citrate synthesis? A. Aldolase B. Citrate synthase C. Citrate isomerase D. Aconitase E. Citrate dehydrogenase ANSWER: B 41. NAD-dependent malate dehydrogenase A. Catalyzes the oxidation of malate to regenerate oxaloacetate B. Catalyzes the conversion of fumarate to malate C. Catalyzes a reaction which results in the formation of an FADH molecule D. All of the above E. None of the above ANSWER: A 42. All of the following are intermediates of citric acid cycle except A. Oxalosuccinate B. Oxaloacetate C. Pyruvate D. Fumarate E. ?-Ketoglutarate ANSWER: C 43. The coenzyme electron carriers produced in the Krebs cycle are A. ATP and ADP B. Pyruvate and acetyl CoA C. FADH2 and NADH D. NAD and NADH E. NADH and ATP ANSWER: C 44. The decarboxylation of pyruvate produces A. NADH B. Acetyl CoA C. CO2 D. ATP E. All of these ANSWER: E 45. Most CO2 produced during aerobic cellular respiration is released during A. Oxidative phosphorylation B. Lactate fermentation. C. The Kreb’s cycle D. Electron transport E. Glycolysis. ANSWER: C 46. A deficiency in thiamin causes the disease beriberi. Which might you expect to have a higher than normal blood concentration in an individual with this condition? A. Isocitrate B. Pyruvate C. Oxaloacetate D. Acetyl CoA E. Malate ANSWER: B 47. Compounds like succinate, fumarate and а-ketoglutarate have a catalytic effect on the consumption of oxygen in a cell suspension. The rate of oxygen consumption is far more than that required for their own oxidation. This is evidence that ________. A. They are intermediates in glycolysis B. They act as enzymes to cause the oxidation of other compounds C. They are involved in a cyclic pathway D. They must be cofactors for enzymes that are oxidoreductases E. All of these ANSWER: C 48. Substrate-level phosphorylation differs from oxidative phosphorylation in that: A. Substrate-level phosphorylation involves the transfer of electrons B. Substrate-level phosphorylation only occurs in the cytosol C. Oxidative phosphorylation only occurs in the cytosol D. Oxidative phosphorylation involves the transfer of electrons E. GTP is always involved in substrate-level phosphorylation ANSWER: D 49. The high toxity of ammonia for the neurons of CNS is predetermined by inhibition of TCA and, as a result, decline of the tissue respiration, oxidative phosphorylation, ketonemia. The reason is a binding of ammonia to the following component(s) of cycle: A. Alfa - ketoglutarate B. Isocitrate C. Succinate D. Fumarate E. Oxaloacetate ANSWER: A 50. The coenzymes NAD and FAD carry electrons to the A. Nucleus B. Citric Acid cycle C. Plasma membrane D. Electron transport system E. Lysosoms ANSWER: D 51. When a phosphate is transferred from a high-energy molecule of ADP to form ATP it's referred to as _____. A. Photophosphorylation B. Substrate-level phosphorylation C. Oxidative phosphorylation D. Citric cycle E. Decarboxilation of pyruvat ANSWER: C 52. Which of the following statements about the chemiosmotic theory is false? A. Electron transfer in mitochondria is accompanied by an asymmetric release of protons on one side of the inner mitochondrial membrane. B. Energy is conserved as a transmembrane pH gradient. C. Oxidative phosphorylation cannot occur in membrane-free preparations. D. The effect of uncoupling reagents is a consequence of their ability to carry protons through membranes. E. The membrane ATPase, which plays an important role in other hypotheses for energy coupling, has no significant role in the chemiosmotic theory. ANSWER: E 53. Uncoupling of mitochondrial oxidative phosphorylation: A. Allows continued mitochondrial ATP formation, but halts O2 consumption. B. Halts all mitochondrial metabolism. C. Halts mitochondrial ATP formation, but allows continued O2 consumption. D. Slows down the citric acid cycle. E. Slows the conversion of glucose to pyruvate by glycolysis. ANSWER: C 54. 2,4-Dinitrophenol and oligomycin inhibit mitochondrial oxidative phosphorylation. 2,4Dinitrophenol is an uncoupling agent; oligomycin blocks the ATP synthesis reaction itself. Therefore, 2,4-dinitrophenol will: A. Allow electron transfer in the presence of oligomycin. B. Allow oxidative phosphorylation in the presence of oligomycin. C. Block electron transfer in the presence of oligomycin. D. Diminish O2 consumption in the presence of oligomycin E. Do none of the above. ANSWER: A 55. Several prosthetic groups act as redox centers in Complex I, including: A. FMN, ubiquinone, iron-sulfur clusters, heme. B. FMN, iron-sulfur clusters. C. Heme, ubiquinone, iron-sulfur clusters. D. All of the above E. None of the above ANSWER: B 56. Which of the following statements are true about oxidative phosphorylation? A. Electron transport provides energy to pump protons into the intermembrane space. B. An electrochemical gradient is formed across the inner mitochondrial membrane. C. Potassium and sodium ions form an ionic gradient across the inner mitochondrial membrane. D. A and B E. A, B, and C ANSWER: D 57. In the electron transport chain, the hydrogen ions enter the inner compartment of mitochondria through special channels formed by A. ATP synthase. B. Coenzyme A C. Acetyl CoA. D. Oxygen. E. Water ANSWER: A 58. The movement of protons through ATP synthase occurs from the A. Matrix to the intermembrane space. B. Matrix to the cytoplasm. C. Intermembrane space to the matrix. D. Intermembrane space to the cytoplasm. E. Cytoplasm to the intermembrane space. ANSWER: C 59. The FADH2 formed during the TCA cycle enters the electron transport system at which site? A. NADH dehydrogenase B. Cytochrome a C. Coenzyme Q D. ATP synthase E. Cytochrome c1 ANSWER: C 60. ATP synthase complexes can generate _______ATP(s) for each NADH that enters electron transport. A. 1 B. 2 C. 3 D. 4 E. 8 ANSWER: C 61. All of the following processes produce ATP, except: A. Lactic acid formation B. Oxidative phosphorilation C. Glycolysis D. The Krebs cycle E. The electron transport chain ANSWER: A 62. The coenzyme electron carriers produced in the Krebs cycle are A. ATP and ADP B. Pyruvate and acetyl CoA C. FADH2 and NADH D. NAD and NADH E. NADH and ATP ANSWER: C 63. Chemiosmotic generation of ATP is driven by A. Phosphate transfer through the plasma membrane B. Sodium, potassium pump C. A difference in H+ concentration on the two sides of the mitochondrial membrane D. Osmosis of macromolecules E. Large quantities of ADP ANSWER: C 64. A process common to all living organisms, aerobic and anaerobic, is A. Glycolysis B. Fermentation C. The Krebs cycle D. Electron transport chain reactions E. Pyruvate oxidation ANSWER: A 65. The oxygen utilized in cellular respiration finally shows up as A. CO2 B. ATP C. New O2 D. H2O E. Part of a sugar ANSWER: D 66. The electron transport chain consists all of the following except A. NADH dehydrogenase B. Cytochrome complex C. Oxygenase D. Cytochrome c oxidase E. Ubiquinone, Q ANSWER: C 67. Which of the following would be considered one of a cell's electron carriers? A. ATP B. NADH C. FAD D. All of the above E. More than one of the above, but not ANSWER: B 68. The notion that ATP is generated by a proton gradient existing across a membrane is called A. Proton motion. B. Chemiosmotic theory C. Cytochromic flow D. Lactate reduction E. A and D ANSWER: B 69. Which of the following takes place during oxidative phosphorilation in mitochondria A. Protons are pumped from the matrix to the intermembrane space B. Protons are translocated from the intermembrane space to the matrix C. Electrons are pumped from the matrix to the intermembrane space D. Electrons are pumped from the intermembrane space to the matrix E. NADP is pumped from the matrix to the intermembrane space ANSWER: B 70. In the mitochondria NADH and QH2 are oxidized by ____________. A. Carbon dioxide B. Hydrogen peroxide C. Ozone D. Oxygen E. Water ANSWER: D 71. The protonmotive force is a result of _______________________. A. The flow of electrons from the matrix to the inner membrane space B. A combination of an electrical potential and a chemical potential C. The flow of protons within the inner mitochondrial membrane D. All of the above E. None of the above ANSWER: B 72. The synthesis of one molecule of ATP from ADP requires _________ to be translocated across the inner mitochondrial membrane. A. One proton B. About three protons C. Hundreds of protons D. 1 mole of protons E. 10 protons ANSWER: B 73. Which molecule is an electron carrier that is carrying electrons? A. NaCl B. NAD+ C. NADH D. NH4 E. (NH4)2SO4 ANSWER: C 74. Which of the following is true for all exergonic reactions? A. A net input of energy from the surroundings is required for the reactions to proceed. B. The products have more total energy than the reactants. C. The reactions are nonspontaneous. D. The reaction proceeds with a net release of free energy. E. The reactants have more total energy than the products ANSWER: D 75. Carrier molecules in the cell membrane and metabolic energy are required for: A. Osmosis B. Facilitated diffusion C. Active transport D. All the above E. B & C only ANSWER: C 76. In cellular metabolism, ATP provides energy by: A. Releasing heat upon hydrolysis B. Acting as a catalyst in chemical reactions C. Stealing electrons from glucose and it’s intermediates D. Releasing a terminal phosphate group E. Oxidizing helper molecules ANSWER: D 77. Which of the following statements are true about oxidative phosphorylation? A. Electron transport provides energy to pump protons into the intermembrane space. B. An electrochemical gradient is formed across the inner mitochondrial membrane. C. Potassium and sodium ions form an ionic gradient across the inner mitochondrial membrane. D. All of these E. It needs ATP ANSWER: B 78. Which sequence illustrates the order of the steps from food to biochemically useful energy? A. Acetyl-SCoA production, digestion, ATP production, electron transport. B. Digestion, acetyl-SCoA production, citric acid cycle, electron transport, ATP production, C. Digestion, ATP production, acetyl-SCoA production, citric acid cycle D. Citric acid cycle, digestion, ATP production, acetyl-SCoA production, electron transport E. Digestion, citric acid cycle, acetyl-SCoA production, electron transport, ATP production ANSWER: B 79. A third class of inhibitors - hydrogen cyanide, hydrogen sulfide, and carbon monoxide block electron transport from: A. Cytochrom c to CO2 B. Cytochrome aa3 to oxygen C. Cytochrom b to c D. Cytochrom b to aa3 E. NADH to Fe-S proteins ANSWER: B 80. The formation of ATP from ADP and phosphate at the expense of the energy yielded by electron transport to oxygen is called: A. Oxidative phosphorylation B. Substrate-level phosphorylation. C. Tissue respiration D. Peroxidation E. Krebs cycle ANSWER: A 81. How many reactions of substrate-level phosphorylation are in an organism? A. 2. B. 3. C. 4. D. 5. E. 12 ANSWER: B 82. Cyanide, oligomycin, and 2,4-dinitrophenol (DNP) are inhibitors of mitochondrial aerobic phosphorylation. Which of the following statements correctly describes the mode of action of the three inhibitors? A. Cyanide and 2,4-dinitrophenol inhibit the respiratory chain, and oligomycin inhibits the synthesis of ATP. B. Cyanide inhibits the respiratory chain, whereas oligomycin and 2,4-dinitrophenol inhibit the synthesis of ATP. C. Cyanide, oligomycin, and 2,4-dinitrophenol compete with O2 for cytochrome oxidase (Complex IV). D. Oligomycin and cyanide inhibit synthesis of ATP; 2,4-dinitrophenol inhibits the respiratory chain. E. Oligomycin inhibits the respiratory chain, whereas cyanide and 2,4-dinitrophenol prevent the synthesis of ATP. ANSWER: B 83. Which group of organic compounds includes the enzymes? A. Starches B. Carbohydrates C. Lipids D. Nucleic acids E. Proteins ANSWER: E 84. The inherited genetic defects results in disorder of some enzymes synthesis in the human organism. The defect of which enzyme results in disorders of splitting of lactose: A. Maltase B. Sucrase C. Amylase D. Peptidase E. Lactase ANSWER: E 85. A patient has disorder of liver functions. Which from the below mentioned biochemical indexes in blood is used for the estimation of the liver state? A. LDH1 B. Creatin phosphokinase C. Aldolase D. Lipase E. AlAT ANSWER: E 86. A patient complains about pain on the left side in breast, weakness and tachycardia. What from the transferred enzymes is it necessary to define in blood for confirmation of diagnosis of myocardium infarction? A. AlAT, aldolase, LDH-4 B. Amylase, alkaline phosphatase , ALAT C. Acidic phosphatase, LDH-5, LDH-4 D. fetoprotein, aldolase, CK E. AsAT, CPK MB, LDH-1 ANSWER: E 87. Acute pancreatitis of the patient was diagnosed. Determination of which from the below mentioned enzymes in blood can be a diagnostic criteria? A. LDH B. Aldolase C. Creatin kinase D. Alanine amino peptidase E. Amylase ANSWER: E 88. A 47-years-old man was delivered to the hospital with the diagnosis – myocardium infarction. What factions of LDH will prevail in the blood serum during the first two days of disease? A. LDH3 B. LDH7 C. LDH4 D. LDH5 E. LDH1 ANSWER: E 89. It was determine high activity of amylase in urine of a patient. How properly interpret this analysis? A. Pathology of liver. B. This analysis testifies disorders of gastrointestinal tract. C. It is possible at nephropathies D. This analysis testifies disorders of carbohydrate metabolism in an organism. E. It is possible acute pancreatitis, parotitis. ANSWER: E 90. The patient with cyanide poisoning was delivered to clinic. What is immediately used for the improvement of his state? A. Glucose B. Ascorbic acid C. Vitamin B1 D. Nicotine amide E. Cytochromoxidase ANSWER: E 91. A two year old child was delivered to the hospital with symptoms of mental and physical underdevelopment, frequent vomiting after meal. In urine found out phenyl-pyruvic acid. Disorder of what substances metabolism causes this pathology? A. Phosphorus-calcium metabolism B. Water-salt metabolism C. Carbohydrates metabolism D. Lipids metabolism E. Metabolism of amino acids ANSWER: E 92. In a stomach of new-born takes place transformation of soluble of milk proteins - caseins into insoluble protein - paracasein with participation of calcium ions and enzyme. What enzyme takes part in this process? A. Pepsin B. Gastrin C. Secretin D. Lipase E. Rennin ANSWER: E 93. In poison of some snakes there is an enzyme which in a human organism can result in formation of substances with a hemolytic action. Choose it. A. Lipase A1 B. Lipase C C. Phospho lipase D D. Phospho lipase B E. Phospho lipase A2 ANSWER: E 94. At treatment of bleeding wounds with 3% hydrogen peroxide a foam is formed due to decomposition of hydrogen peroxide with enzyme of blood. Choose this enzyme: A. Monoaminooxidase B. Carboanhydrase C. Cytochromoxidase D. Lactate dehydrogenase E. Catalase ANSWER: E 95. It was determined high activity of amylase in a patient’s saliva . How properly interpret this analysis? A. Pathology of liver. B. This analysis testifies disorders of gastrointestinal tract. C. It is possible at nephropathies D. This analysis testifies disorders of carbohydrate metabolism in an organism. E. Parotitis is possible. ANSWER: E 96. For treatment of dermatitis, wounds and ulcers coenzyme preparations of flavin mononucleotide and flavinate are used. The active forms of what vitamin are they? A. B1 B. B5 C. B3 D. C E. B2 ANSWER: E 97. For treatment of the patient with acute pancreatitis a doctor prescribed a trasilol. For what purpose this preparation is used? A. For the improvement of fats digestion B. For the improvement of proteins digestion C. For the increase of insulin secretion D. All above are correct E. To avoid of autolysis of pancreas ANSWER: E 98. Which enzyme cleaves proteins in the stomach? A. Trypsin B. Chymotrypsin C. Carboxypeptidase D. Enterokinase E. Pepsin ANSWER: E 99. At the inspection of patient was diagnosed alkaptonuria. The deficiency of what enzyme causes this pathology? A. Phenylalanine hydroxylase B. Thyrosinase C. Thyroxin hydroxylase D. Mono amino oxidase E. Oxidase of homogentisic acid ANSWER: E 100. Hairs, skin and eyes of a patient do not have a pigment. A diagnosis – albinism was set. The deficiency of what enzyme does take place? A. Arginase B. Carbanhydrase C. Histidin decarboxylase D. Aldolase E. Tyrosinase ANSWER: E