Question 1

A 4-year-old child was born at term, with no congenital anomalies. She is now only 70% of normal body weight. On examination she shows dependent edema of the lower extremities as well as an enlarged abdomen with palpable fluid wave. Her desquamating skin shows irregular areas of depigmentation, and hyperpigmentation. Which of the following nutritional problems is most likely present in this child?

A Marasmus

B Scurvy

C Vitamin A toxicity

D Niacin deficiency

E Kwashiorkor

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Question 2

A 32-year-old man has a history of multiple and recurrent pulmonary infections since childhood. He also has noted foul smelling stools for the past 10 years. Laboratory studies show an elevated sweat chloride test. He has a quantitative stool fat of 10 g/day. A deficiency state involving which of the following nutrients is most likely to develop in this patient?

A Vitamin B1

B Vitamin D

C Iron

D Calcium

E Folic acid

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Question 3

A 45-year-old woman has developed red, roughened skin in sun-exposed areas over the past 2 years. She also has a chronic, watery diarrhea. On physical examination she exhibits memory loss with confusion. These findings are most consistent with which of the following vitamin deficiencies?

A Vitamin A

B Thiamine

C Niacin

D Pyridoxine

E Vitamin E

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Question 4

A 5-year-old child has complained of pain in his legs for the past year. On physical examination, there is bowing deformity of his lower extremities. Plain film radiographs of his lower legs shows widened epiphyses and bowing of tibiae. Bone mineral density appears normal, consistent with failure of osteoid matrix formation. Which of the following vitamin deficiencies is this child most likely to have?

A D

B E

C C

D B3

E B6

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Question 5

A clinical study of diet in pregnancy is conducted. It is observed that pregnant women who do not get a diet that includes green, leafy vegetables develop a specific nutritional deficiency that affects their developing fetuses. Which of the following abnormalities is most likely to be found with increased frequency in these fetuses?

A Anencephaly

B Diaphragmatic hernia

C Low birth weight

D Congenital cytomegalovirus

E Neuroblastoma

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Question 6

A clinical study is performed involving dietary iron metabolism in adults. It is observed that intestinal absorption of iron can be enhanced in patients with iron deficiency anemia by supplementing their diet with another nutrient. Which of the following vitamins is most likely to have this effect?

A A

B B1

C C

D D

E E

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Question 7

A 41-year-old man has had increasing dyspnea for the past year. On physical examination his temperature is 37°C, pulse 106/min, respiratory rate 20/min, and blood pressure 100/65 mm Hg. He has diffuse crackles at lung bases. A chest x-ray shows pulmonary edema and cardiomegaly. Echocardiography shows an ejection fraction of 40%. Laboratory studies show hemoglobin 14 g/dL, hematocrit 42%, and WBC count 8320/microliter. A deficiency in which of the following vitamins is most likely to produce these findings?

A A

B B1

C B2

D K

E D

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Question 8

A 49-year-old man has a 20 year history of chronic alcohol abuse. He has had worsening problems with ambulation for the past year. On physical examination his gait is ataxic. MR imaging of the brain shows diminished size of the mamillary bodies and of the cerebellar vermis. He is most likely to have a deficiency of which of the following vitamins?

A A

B B1

C C

D D

E E

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Question 9

A 34-year-old primigravida is in her 8th month of gestation. She is feeling increasingly tired and weak. Laboratory studies include a CBC which shows Hgb 9.7 g/dL, Hct 28.8%, MCV 71 fL, platelet count 289,000/microliter, and WBC count 5600/microliter. On the peripheral blood smear, the RBCs show increased variation in size and shape, with many that are hypochromic and microcytic. Which of the following dietary deficiencies is she most likely to have?

A Folic acid

B Vitamin B12

C Iron

D Calcium

E Nicotinic acid

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Question 10

A clinical study is performed to compare the risk for health problems in obese persons with a BMI >30, compared with a control group of persons with a BMI between 20 and 25. Persons in these two groups are followed for 20 years. Which of the following conditions is most likely to appear equally in both groups?

A Osteoarthritis

B Cholelithiasis

C Alzheimer disease

D Diabetes mellitus

E Hypertension

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Question 11

A study is performed involving the relationship of diet and cancer. It is observed that inclusion of certain foods in the diet is associated with a decreased risk for subsequent development of cancer. Which of the following foods is most likely to have this risk-reducing effect?

A Rum

B Chocolate bon-bons

C Apples

D Smoked meats

E Cheese

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Question 12

A dietary study is performed that assesses risks for hypertension. It is observed that increased consumption of sodium in the diet is correlated with elevated blood pressure. Of the following food items, which one has the greatest amount of sodium?

A Bundle of carrots

B Loaf of bread

C Can of soup

D Glass of milk

E Bowl of cereal

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Question 13

A 42-year-old man with a 19-year history of chronic alcohol abuse has noted during the past year that he has bruising with minimal trauma. On physical examination he has abdominal enlargement with a fluid wave. He has pitting edema to the knees. He has palmar erythema. Laboratory studies show he has a prothrombin time of 30 seconds (control 12). His hemoglobin is 13.8 g/dL, hematocrit 44.4%, MCV 94 fL, platelet count 229,000/microliter, and WBC count 6630/microliter. Which of the following nutrients is most likely to be of benefit in treating this man?

A Thiamine

B Vitamin C

C Niacin

D Vitamin K

E Folic acid

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Question 14

A study is performed to determine dietary sources of vitamin A. It is observed that some commonly available foods have more vitamin A than others. Which of the following is most likely to provide the best source for vitamin A in the diet?

A Milk

B Bread

C Meat

D Beer

E Carrots

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Question 15

A 15-year-old girl has been under a physician's care for the past year after diagnosis of anorexia nervosa. Her BMI is now 18. On physical examination she has cheilosis. Laboratory studies show hemoglobin 13.7 g/dL, hematocrit 41.0%, MCV 88 fL, platelet count 191,055/microliter, and WBC count 4930/microliter. Her serum glucose is 66 mg/dL. Which of the following nutrient deficiencies is most likely to cause her findings?

A Riboflavin

B Ascorbic acid

C Folic acid

D Iron

E Niacin

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Question 16

A 36-year-old woman goes to the health food store to buy dietary supplements that she is convinced will help her to be more healthy and live longer. Instead, a year later she has increasing headaches, joint pain, nausea, vomiting, and weight loss. On physical examination she is noted to have dryness of the oral mucosa, and a mild degree of papilledema is noted on funduscopic examination. A radiograph of her hands shows bony hyperostosis. An excessive intake of which of the following nutrients is most likely responsible for her findings?

A Calcium

B Fluoride

C Vitamin A

D Alpha-tocopherol

E Niacin

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Question 17

A 39-year-old woman has been on and off diets for the past 10 years trying to lose weight. She has had no major illnesses during this time. Her BMI has ranged from 25 to 31 over that time. Which of the following problems is her pattern of dieting most likely to cause?

A Vitamin deficiencies

B Increased risk for osteoporosis

C Decreased risk for atherosclerosis

D Greater weight gain

E Anorexia nervosa

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Question 18

A 5-year-old child develops gradual loss of vision over the past 2 years resulting in blindness. On physical examination there is bilateral keratomalacia and corneal scarring. This child's blindness is most likely to have been prevented by adequate dietary intake of which of the following vitamins?

A A

B B1

C B6

D B12

E K

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Question 19

A 45-year-old man has had increasing abdominal enlargement over the past year. On physical examination there is an abdominal fluid wave. An abdominal CT scan shows a small nodular liver with a 10 cm mass in the right lobe. Laboratory studies shown a serum albumin of 2.9 g/dL. Serologic testing is positive for hepatitis B and C. He does not abuse ethanol. Which of the following toxins is most likely to contribute to the development of this man's liver disease?

A Ochratoxin

B Aflatoxin

C Ergot

D Monosodium glutamate

E Nitrates

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Question 20

An 11-month-old infant is only 60% of ideal body weight. The baby is proportionately small in size. Upon physical examination, the baby is listless and does not respond with vocalization when touched. A small purplish contusion is noted over the right lower extremity. Which of the following is the most likely diagnosis?

A Physical abuse

B Marasmus

C Hypocalcemia

D Premature birth

E Vitamin C deficiency

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Question 21

A 65-year-old woman has felt increasingly fatigued during the past 9 months. On physical examination she has decreased sensation to touch in her lower extremities bilaterally. Laboratory studies show hemoglobin 10.1 g/dL, hematocrit 31.2%, and MCV 120 fL. Microscopic examination of her peripheral blood smear shows red blood cells that have macrocytosis and neutrophils with hypersegmentation of nuclei. Laboratory testing for which of the following nutrients is most likely to show a deficiency state?

A Folate

B Ascorbic acid

C Iron

D Cobalamin

E Pyridoxine

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Question 22

A 27-year-old woman has been having particularly heavy menstrual periods for the past year. She is becoming progressively fatigued. She then becomes pregnant. She receives no prenatal care. She delivers a term baby. During the delivery, bleeding is excessive. Which of the following nutrient deficiencies is most likely to be present in both mother and baby postpartum?

A Niacin

B Magnesium

C Calcium

D Vitamin K

E Iron

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Question 23

A 40-year-old man has a body mass index of 40. His BMI was increased, even as a child. He has deranged leptin signaling by steatocytes. Which of the following complications is he most likely to develop?

A Prostatic adenocarcinoma

B Osteoarthritis

C Alzheimer's disease

D Diabetes mellitus, type I

E Gout

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Question 24

A 23-year-old man has a positive tuberculin skin test and a chest radiograph showing upper lobe densities. He is started on antitubercular therapy with isoniazid, rifampin, and ethambutol. Over the next 4 months he develops paresthesias of his hands and feet. A deficiency of which of the following vitamins is most likely causing this complication of therapy?

A Folate

B Niacin

C Pyridoxine

D Riboflavin

E Thiamine

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Question 25

While at a family reunion, parents are talking about their children. One family unit notes that none of their children has had any dental caries, though all of the children have all had the same childhood infections and have similar dietary habits. They all brush their teeth regularly. Children in other family units have had multiple visits to the dentist for treatment of dental caries. Which of the following is most likely to account for this observation?

A Lack of regular exercise

B Fluoridation of drinking water

C An inborn error of metabolism

D Bulimia nervosa

E Reduced sunlight exposure

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Question 26

A 21-year-old G3 P2 woman gives birth at term at home. The infant has Apgar scores of 8 and 9 at 1 and 5 minutes. The newborn is initially doing well, but at 3 days of life there is bleeding from the umbilical cord stump, and ecchymoses are observed over the buttocks. This is followed by seizure activity. Which of the following vitamin deficiencies is most likely to be present in this infant?

A A

B B1

C B2

D D

E K

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Question 27

A 54-year-old man expects to halt the ravages of aging. He does a search on the internet for information about prevention of aging. He finds multiple sites recommending dietary supplements with anti-aging properties. Some of these sites also indicate that a deficiency of a particular vitamin may lead to neurologic problems similar to cobalamin (vitamin B12) deficiency, but without development of pernicious anemia. Persons with liver and biliary tract disease are also more likely to be deficient in this nutrient. Which of the following vitamins is most likely to have these properties?

A A

B B1

C C

D D

E E

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Question 28

A 56-year-old man has paresthesias of the lower extremities, worsening over the past 3 years. A CBC shows: Hgb 10.0 g/dL, Hct 30.6%, MCV 121 fL, platelets 233,000/microliter, and WBC count 8100/microliter. Examination of the peripheral blood smear shows macro-ovalocytosis of the RBCs and hypersegmentation of the neutrophils. Which of the following nutritional deficiencies is he most likely to have:

A Folic acid

B Cobalamin

C Iron

D Calcium

E Nicotinic acid

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Question 29

In a study of diet and metabolism, a substance is identified that binds to receptors in the hypothalamus to inhibit food intake. This substance is elaborated by adipocytes that have taken up fatty acids. What is this substance most likely to be?

A Adiponectin

B Ghrelin

C Leptin

D Melanocortin

E Neuropeptide Y

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Question 30

A study is performed comparing a modern diet in developed nations to the diet of persons living 5000 years ago. It is noted that dietary patterns have changed, along with modern food processing and packaging. Which of the following patterns fits best with modern diets, compared with ancient people?
ChoiceTotal Calories Salt Fiber Ascorbate Calcium
A Increased Increased Decreased Decreased Decreased
B Increased Decreased Increased Increased Decreased
C Decreased Increased Decreased Increased Increased
D Decreased Decreased Increased Decreased Increased

A A

B B

C C

D D

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