a = new Array(140);
var f = "<FONT FACE=ARIAL SIZE=2>"
a[0] = ""
a[1] = f + "(A) Incorrect. Marasmus is total calorie deprivation with lack of many nutrients, and body weight is <60% of normal, with generalized wasting."
a[2] = f + "(B) Incorrect. Scurvy is a deficiency of vitamin C that can lead to bone abnormalities in children."
a[3] = f + "(C) Incorrect. Vitamin A toxicity leads to CNS edema."
a[4] = f + "(D) Incorrect. Niacin (vitamin B3) deficiency leads to pellagra marked by diarrhea, dermatitis, and dementia."
a[5] = f + "(E) CORRECT. Kwashiorkor occurs with protein-calorie deprivation. Lack of mainly protein in the diet leads to hypoalbuminemia and fatty liver. Throughout human history obtaining sufficient protein in the diet has been a struggle. Children are most affected because they are at the bottom of the food chain, so to speak, in most human societies."
a[6] = f + "(A) Incorrect. Thiamine is a water-soluble vitamin not significantly affected by fat malabsorbtion."
a[7] = f + "(B) CORRECT. Vitamin D is a fat-soluble vitamin. However, about 80% of the needed amount can be manufactured in the body from sunlight exposure; the rest must come from the diet. He has findings of cystic fibrosis, an autosomal recessive condition that leads to pancreatic insufficiency and decreased lipase for fat digestion."
a[8] = f + "(C) Incorrect. Iron is absorbed in the small intestine, mainly duodenum, and is not affected by steatorrhea."
a[9] = f + "(D) Incorrect. Calcium absorbtion is not significantly affected by steatorrhea."
a[10] = f + "(E) Incorrect. Folate is a water soluble vitamin not affected by fat malabsorbtion."
a[11] = f + "(A) Incorrect. Vitamin A deficiency would lead to problems with epithelia, particularly squamous (either thin or stratified) with keratomalacia and xerophthalmia. It would not explain the dementia."
a[12] = f + "(B) Incorrect. Deficiency of vitamin B1 is associated with neurologic problems (Wernicke disease or Wernicke-Korsakoff syndrome) and with cardiac problems ('wet' beri-beri)."
a[13] = f + "(C) CORRECT. These findings are typical of pellagra with niacin deficiency."
a[14] = f + "(D) Incorrect. Vitamin B6 (pyridoxine) deficiency can have manifestations of dermatitis and peripheral neuropathy, but not dementia."
a[15] = f + "(E) Incorrect. Deficiency of vitamin E is quite rare and leads to spinocerebellar tract degeneration."
a[16] = f + "(A) Incorrect. Lack of vitamin D in a child will lead to rickets with failure of bone mineralization."
a[17] = f + "(B) Incorrect. Vitamin E deficiency may be associated with neuropathy, but it is not associated with bone disease."
a[18] = f + "(C) CORRECT. This is scurvy. Vitamin C is needed for the osteoid matrix production, which includes collagen."
a[19] = f + "(D) Incorrect. Niacin deficiency leads to pellagra with diarrhea, dermatitis, and dementia. Bone is not affected."
a[20] = f + "(E) Incorrect. Vitamin B6 deficiency may lead to diarrhea and peripheral neuropathy. Bone is not affected."
a[21] = f + "(A) CORRECT. Folate deficiency in pregnant women leads to a greater incidence of neural tube defects."
a[22] = f + "(B) Incorrect. This defect is seen most often with other anomalies, sometimes with chromosomal anomalies."
a[23] = f + "(C) Incorrect. A poor overall diet could lead to low birth weight, but this is not the result of a specific nutrient deficiency."
a[24] = f + "(D) Incorrect. CMV infection is not linked to nutritional deficiencies."
a[25] = f + "(E) Incorrect. Perinatal and pediatric tumors are not linked to nutritional deficiencies."
a[26] = f + "(A) Incorrect. Vitamin A has its primary effect upon maintaining epithelia, but it does not enhance iron absorbtion."
a[27] = f + "(B) Incorrect. Thiamine does not have an effect upon iron absorbtion."
a[28] = f + "(C) CORRECT. Vitamin C (ascorbic acid) enhances the absorption of iron in the small intestine, primarily in the duodenum."
a[29] = f + "(D) Incorrect. Vitamin D has its main effect upon calcium metabolism."
a[30] = f + "(E) Incorrect. Vitamin E is mainly an antioxidant."
a[31] = f + "(A) Incorrect. Vitamin A deficiency could lead to eye problems (xerophthalmia, keratomalacia)."
a[32] = f + "(B) CORRECT. Thiamine deficiency leads to beri-beri with high output congestive heart failure from peripheral vasodilation, not anemia."
a[33] = f + "(C) Incorrect. B2 deficiency can lead to non-specific neurologic problems, glossitis, and anemia."
a[34] = f + "(D) Incorrect. Vitamin K is needed by the liver for synthesis of clotting factors 2, 7, 9, and 10. These proteins require carboxylation of glutamate residues for functional activity. Hemorrhagic disease of the newborn can occur because neonatal endogenous production of vitamin K is limited due to minimal establishment of intestinal bacterial flora that produce this nutrient. Vitamin K may also be involved with formation of factor V and the anticoagulant proteins C and S."
a[35] = f + "(E) Incorrect. Vitamin D is involved in calcium and phosphorus metabolism."
a[36] = f + "(A) Incorrect. Deficiency of vitamin A leads to problems with epithelia, such as keratomalacia."
a[37] = f + "(B) CORRECT. Thiamine deficiency in chronic alcoholism leads to neurologic problems with Wernicke disease."
a[38] = f + "(C) Incorrect. A deficiency of vitamin C leads to scurvy."
a[39] = f + "(D) Incorrect. A deficiency of vitamin D leads to problems with calcium and bone metabolism."
a[40] = f + "(E) Incorrect. The theory is that vitamin E counters the effects of free radical formation."
a[41] = f + "(A) Incorrect. Folic acid deficiency may lead to a macrocytic anemia, but there are no accompanying neurologic problems."
a[42] = f + "(B) Incorrect. Vitamin B12 deficiency may result in subacute combined degeneration of the spinal cord as well as macrocytic anemia."
a[43] = f + "(C) CORRECT. The iron is necessary to produce heme that goes into production of RBC's. Iron deficiency is most likely to affect women (because of menstruation), pregnant women (iron needed for two people), and children. Iron deficiency leads to hypochromic, microcytic anemia."
a[44] = f + "(D) Incorrect. Calcium is mainly involved in bone metabolism and does not have a bearing on hematopoiesis."
a[45] = f + "(E) Incorrect. Niacin deficiency may lead to findings of pellagra (diarrhea-dermatitis-dementia)."
a[46] = f + "(A) Incorrect. The increased weight stresses large joints such as knees and hips."
a[47] = f + "(B) Incorrect. There is an increased risk for gallstones in obese persons."
a[48] = f + "(C) CORRECT. Dementia of the Alzheimer type is not related to body mass index. Some vascular dementias are related to thromboembolic events or hypertension that can be consequences of increased cardiovascular disease in obese persons."
a[49] = f + "(D) Incorrect. About 80% of persons with type II diabetes mellitus are obese."
a[50] = f + "(E) Incorrect. Persons who are obese have a greater risk for development of hypertension."
a[51] = f + "(A) Incorrect. Alcoholic beverages have no protective effect in preventing cancer, and chronic alcoholism leading to cirrhosis will increase the risk for hepatocellular carcinoma."
a[52] = f + "(B) Incorrect. Chocolate is quite fatty, and fats have no cancer prevention role."
a[53] = f + "(C) CORRECT. More fruits and vegetables in the diet help to reduce the risk for cancer. Even vegemite, mate!"
a[54] = f + "(D) Incorrect. Smoked and pickled products may increase the risk for carcinoma."
a[55] = f + "(E) Incorrect. Cheese products are fatty, and fats have no cancer prevention role."
a[56] = f + "(A) Incorrect. Fruits and vegetables have little sodium (celery has the most) compared to processed and packaged foods."
a[57] = f + "(B) Incorrect. Bread is made with a small amount of salt."
a[58] = f + "(C) CORRECT. Even a small can of soup may have a gram of sodium, and a couple of grams is as much as you should have a day. Virtually all canned and packaged food products have a lot of sodium. The salt is a good preservative, and enhances the flavor. Unfortunately, people are getting used to having a lot of salt, and want it to give the taste they have come to expect."
a[59] = f + "(D) Incorrect. Milk doesn't have that much sodium, but it is a good source of calcium."
a[60] = f + "(E) Incorrect. Cereals are packaged, but don't tend to have a lot of sodium, compared with canned products."
a[61] = f + "(A) Incorrect. Thiamine can be deficient in alcoholics and can play a role in the development of Wernicke's disease."
a[62] = f + "(B) Incorrect. Vitamin C can be deficient in alcoholics with a poor diet, and can lead to easier bleeding from soft tissues, but does not explain the prolonged prothrombin time."
a[63] = f + "(C) Incorrect. Niacin does not play a role in coagulation disorders."
a[64] = f + "(D) CORRECT. The vitamin K dependent coagulation factors (II, VII, IX, X) are made in the liver, and a decrease in these factors is first manifested by a prolonged protime."
a[65] = f + "(E) Incorrect. Folate is often lacking in the diet of alcoholics, and leads to macrocytic anemia."
a[66] = f + "(A) Incorrect. Milk is a better source for calcium and vitamin D."
a[67] = f + "(B) Incorrect. Bread can be a good source for calcium, B vitamins, and fiber."
a[68] = f + "(C) Incorrect. Meat is a good source for protein, heme, and vitamin B12."
a[69] = f + "(D) Incorrect. Beer, like all alcoholic beverages, represents 'empty' calories. Alcohol has about 7 calories per gram of carbohydrate, and little else."
a[70] = f + "(E) CORRECT. Carrots and other vegetables that are yellow and orange have a lot of carotenes, a good source of vitamin A."
a[71] = f + "(A) CORRECT. Vitamin B2 deficiency by itself is uncommon, and cheilosis may also appear with vitamin B6 deficiency."
a[72] = f + "(B) Incorrect. Vitamin C deficiency may lead to scurvy, with bleeding gums."
a[73] = f + "(C) Incorrect. Folate deficiency predisposes to megaloblastic anemia."
a[74] = f + "(D) Incorrect. Iron deficiency predisposes to a microcytic anemia."
a[75] = f + "(E) Incorrect. Niacin deficiency may lead to pellagra with a dermatitis involving sun-exposed skin."
a[76] = f + "(A) Incorrect. Excessive intake of calcium does not lead to serious problems. In fact, some antacid medications include a lot of calcium."
a[77] = f + "(B) Incorrect. Too much fluoride can lead to hypomineralization of tooth enamel in a process known as fluorosis. Virtually all cases are of the mild variety with no visible changes, although in severe cases there can be seen irregular brown-stained teeth."
a[78] = f + "(C) CORRECT. These are findings of vitamin A toxicity. The fat soluble vitamins can be stored in the body, and vitamin A is stored in the liver. The neurologic manifestations resemble those of a brain tumor with mass effect."
a[79] = f + "(D) Incorrect. The tocopherols are a form of vitamin E preparation. The most serious side effect of increased consumption is loss of monetary savings."
a[80] = f + "(E) Incorrect. Taking a lot of niacin can lead to vasodilation with flushing and headaches, but not papilledema."
a[81] = f + "(A) Incorrect. Some fad diets may predispose to vitamin deficiencies over a long time frame, but episodic dieting is unlikely to lead to nutrient deficiencies."
a[82] = f + "(B) Incorrect. She is unlikely to have a signficant enough vitamin D or calcium deficiency to affect bone mass."
a[83] = f + "(C) Incorrect. Staying on a diet could have this benefit, but not episodic dieting."
a[84] = f + "(D) CORRECT. Her body becomes more efficient at utilizing calories while on the diet, and she gains weight more readily when she goes off the diet each time."
a[85] = f + "(E) Incorrect. Persons with this psychiatric disorder have an abnormal body image that drives them to lose weight excessively."
a[86] = f + "(A) CORRECT. The retinol compounds, which collectively constitute what is known as vitamin A, contribute to differentiation and maintenance of mucus-secreting epithelia."
a[87] = f + "(B) Incorrect. Thiamine is more important in preventing peripheral neuropathy, cardiomyopathy, and Wernicke's disease."
a[88] = f + "(C) Incorrect. Pyridoxine helps to prevent peripheral neuropathy."
a[89] = f + "(D) Incorrect. Cobalamin is important in preventing megaloblastic anemia and subacute combined degeneration of the cord."
a[90] = f + "(E) Incorrect. Vitamin K is important for production of clotting factors manufactured in the liver."
a[91] = f + "(A) Incorrect. Ochratoxin in moldy grain acts as a nephrotoxin."
a[92] = f + "(B) CORRECT. Aflatoxin produced by <I>Aspergillus flavus</I> growing in moldy peanuts and grains can induce hepatocellular carcinomas, primarily through mutations in p53, when there is liver regeneration from injury with chronic viral infection."
a[93] = f + "(C) Incorrect. Ergotism with subsequent neurologic manifestations and death was more common in the Middle Ages when bread was more commonly made from rye."
a[94] = f + "(D) Incorrect. MSG is found as an additive in many foods and a small number of persons have adverse reactions to it, sometimes bordering on anaphylaxis."
a[95] = f + "(E) Incorrect. Nitrates are associated with risk for development of gastric carcinomas."
a[96] = f + "(A) Incorrect. Abuse should be suspected, but only a single bruise does not raise that many suspicions, since abuse usually includes multiple episodes of trauma."
a[97] = f + "(B) CORRECT. The baby is wasting away from total calorie deprivation, and is only 60% of body weight, which is markedly low and much lower than would be expected from any single nutritional deficiency."
a[98] = f + "(C) Incorrect. Decreased calcium should produce tetany, not listlessness, and does not account for marked wasting."
a[99] = f + "(D) Incorrect. Even babies born prematurely will catch up growth significantly in infancy with a normal diet."
a[100] = f + "(E) Incorrect. Easy bruising is a feature of scurvy, but does not account for marked wasting."
a[101] = f + "(A) Incorrect. Folate deficiency can also produce a megaloblastic anemia, but not neurologic deficits. Hence, both B12 and folate should be tested together."
a[102] = f + "(B) Incorrect. Vitamin C is involved with collagen synthesis to maintain vascular and soft tissue and bone integrity, not megaloblastic changes."
a[103] = f + "(C) Incorrect. Iron deficiency leads to diminished synthesis of heme, and erythropoiesis is modified by 'downsizing' the RBCs with less hemoglobin."
a[104] = f + "(D) CORRECT. Vitamin B12 deficiency is a cause for megaloblastic anemia, as is folic acid deficiency. However, the lack of B12 can lead to subacute combined degeneration of the spinal cord. Hence, both B12 and folate should be tested together."
a[105] = f + "(E) Incorrect. Vitamin B6 is not involved with megaloblastic changes in the marrow or peripheral blood."
a[106] = f + "(A) Incorrect. Niacin deficiency leads to pellagra with diarrhea, dermatitis, and dementia."
a[107] = f + "(B) Incorrect. Magnesium is an electrolyte that has functions that work in concert with calcium and phosphorus."
a[108] = f + "(C) Incorrect. Calcium deficiency leads to weakened bones. If serum ionized calcium cannot be maintained, then tetany occurs."
a[109] = f + "(D) Incorrect. A lack of vitamin K may occur in newborns because their intestinal flora has not been well-established to produce an endogenous source for this vitamin needed for hepatic synthesis of coagulation factors."
a[110] = f + "(E) CORRECT. The blood loss leads to iron deficiency. There are about 250 mg of iron in a unit of blood."
a[111] = f + "(A) Incorrect. Breast and endometrial cancers are related to obesity, but the relationship to other cancers is not well established."
a[112] = f + "(B) CORRECT. This patient has morbid obesity. The BMI should not be higher than 24, or a variety of complications are more likely to occur, particularly diabetes mellitus type II."
a[113] = f + "(C) Incorrect. The cause for Alzheimer's disease is not known. Obesity does not play a role, though morbidly obese persons might not live long enough to develop Alzheimer's."
a[114] = f + "(D) Incorrect. Type I diabetes mellitus is not related to obesity; type II diabetes is."
a[115] = f + "(E) Incorrect. Gout results from disordered uric acid metabolism not related to obesity."
a[116] = f + "(A) Incorrect. Folate deficiency leads to macrocytic anemia but not neuropathy."
a[117] = f + "(B) Incorrect. Niacin deficiency may produce a dermatitis, particularly in sun exposed areas such as hands, but not neuropathy."
a[118] = f + "(C) CORRECT. Pyridoxine (vitamin B6) deficiency can be a complication of isoniazid therapy, particularly in persons who are slow acetylators of this drug. Giving pyridoxine concurrently with isoniazed will help to reduce the incidence of peripheral neuropathy."
a[119] = f + "(D) Incorrect. Riboflavin deficiency can lead to neuropathy, but not in the setting of isoniazid therapy."
a[120] = f + "(E) Incorrect. Thiamine deficiency can lead to beri beri and to Wernicke disease. The 'dry' beri beri includes peripheral neuropathy, but this does not occur in the setting of isoniazid therapy."
a[121] = f + "(A) Incorrect. Diminished exercise increases the risk for obesity, but this is not related to dental caries."
a[122] = f + "(B) CORRECT. Supplementation of drinking water with fluoride will diminish the incidence of dental caries. Curiously, this issue has remained controversial in the U.S. for decades, with opponents of fluoridation touting everthing from conspiracy theories to lack of personal choice."
a[123] = f + "(C) Incorrect. Dental caries are not related to metabolic gene defects."
a[124] = f + "(D) Incorrect. Bulimia is an eating disorder. Episodes of vomiting could increase dental caries through increased exposure to gastric acid in the oral cavity."
a[125] = f + "(E) Incorrect. Sunlight exposure helps to increase vitamin D manufacture, which helps to build strong bone, but this is not a key factor in tooth decay."
a[126] = f + "(A) Incorrect. Vitamin A deficiency could lead to eye problems (xerophthalmia, keratomalacia)."
a[127] = f + "(B) Incorrect. Thiamine deficiency leads to beri-beri."
a[128] = f + "(C) Incorrect. B2 deficiency can lead to non-specific neurologic problems, glossitis, and anemia."
a[129] = f + "(D) Incorrect. Vitamin D is involved in calcium and phosphorus metabolism."
a[130] = f + "(E) CORRECT. Vitamin K is needed by the liver for synthesis of clotting factors 2, 7, 9, and 10. These proteins require carboxylation of glutamate residues for functional activity. Hemorrhagic disease of the newborn can occur because neonatal endogenous production of vitamin K is limited due to minimal establishment of intestinal bacterial flora that produce this nutrient. Vitamin K may also be involved with formation of factor V and the anticoagulant proteins C and S."
a[131] = f + "(A) Incorrect. Vitamin A deficiency has a major effect upon epithelia, particularly skin and respiratory tract and cornea."
a[132] = f + "(B) Incorrect. Vitamin B1 (thiamine) deficiency can lead to beri-beri with peripheral neuropathy or Wernicke's disease."
a[133] = f + "(C) Incorrect. Vitamin C deficiency leads to scurvy."
a[134] = f + "(D) Incorrect. Vitamin D deficiency at his age could lead to osteomalacia (similar findings to osteoporosis)."
a[135] = f + "(E) CORRECT. Vitamin E is touted as having anti-oxidant effects. A rare deficiency state can lead to a mild ataxia with impaired proprioception along with diminished to absent deep tendon reflexes and diminished sensation to pain and vibration sense bilaterally in the extremities."
a[136] = f + "(A) Incorrect. Folate deficiency can lead to a macrocytic anemia, but not to the neurologic problems."
a[137] = f + "(B) CORRECT. B12 deficiency explains both the macrocytic anemia as well as the neurologic problems from subacute combined degeneration of the spinal cord."
a[138] = f + "(C) Incorrect. Iron deficiency leads to a hypochromic microcytic anemia without paresthesias."
a[139] = f + "(D) Incorrect. Calcium deficiency affects bone metabolism."
a[140] = f + "(E) Incorrect. A deficiency of nicotinic acid (niacin) can lead to pellagra with diarrhea, dermatitis, and dementia."