Each question below contains five suggested responses. Choose the one best response to each question.
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1 | |
A patient who is being screened for vitamin B12 deficiency undergoes a Schilling test, 1 mg of cobalamin administered intramuscularly 1 h after the administration of radiolabeled cobalamin. A normal Schilling test, excretion of >10% of the labeled cobalamin in a 24-h urine specimen, would be most likely in which of the following situations? |
| | A) | Intrinsic factor deficiency |
| | B) | Chronic pancreatitis |
| | C) | Surgically absent terminal ileum |
| | D) | Achlorhydria |
| | E) | Celiac sprue |
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2 | |
A 23-year-old woman presents for a routine physical examination. The patient gives a history of trying to diet, but she also admits to binge intake and extensive use of laxatives. The physical examination discloses a woman of normal height and weight and is unremarkable except for chipping and erosion of the front teeth. This patient is likely to |
| | A) | have disrupted menstrual cycles |
| | B) | experience a normal life span |
| | C) | have osteopenic bones |
| | D) | have elevated serum anti-goblet cell antibodies |
| | E) | be unconcerned about body shape and weight |
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3 | |
Which of the following personality traits is most likely to describe a young woman with anorexia nervosa? |
| | A) | Depressive |
| | B) | Borderline |
| | C) | Anxious |
| | D) | Perfectionist |
| | E) | Impulsive |
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4 | |
Which of the following therapies is most effective for a patient with anorexia nervosa who is 70% of ideal body weight? |
| | A) | Tricyclic antidepressant |
| | B) | Serotonin uptake antagonist antidepressant |
| | C) | Supervised oral re-feeding in the hospital |
| | D) | Total parenteral nutrition |
| | E) | Oral re-feeding with outpatient psychiatric treatment |
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5 | |
A strain of obese mice homozygous for a mutation in the ob gene has a failure to elaborate normal amounts of the peptide leptin. Which of the following statements about leptin is correct? |
| | A) | Leptin is secreted by cells in the hypothalamus |
| | B) | Overproduction causes increased energy expenditure. |
| | C) | Aberrant leptin physiology has never been shown to be a cause of obesity in humans. |
| | D) | Obese people have normal levels of serum leptin. |
| | E) | Patients with nongenetic causes of obesity do not respond to exogenous leptin. |
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6 | |
A 32-year-old obese woman presents to you for advice regarding weight loss. She has no significant medical problems at this time. She requests a pill to help her lose weight. You should |
| | A) | tell her that a low-calorie diet and exercise are the best ways to lose weight |
| | B) | prescribe phentermine |
| | C) | prescribe fenfluramine |
| | D) | prescribe a combination of phenylpropanolamine plus fenfluramine |
| | E) | prescribe L-thyroxine |
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7 | |
A 65-year-old man with a known history of prostatism develops a fever of 39.5°C (103°F), shaking chills, and progressive deterioration. He is brought to the emergency room where his systolic blood pressure is 60 mmHg. He is given intravenous fluids and pressors and is intubated. Although his gram-negative sepsis is brought under control with antibiotics, he remains intubated for another 5 days to recover from diffuse lung injury. During this time he is not given any nutrition. How does the patient cope metabolically with the stress imposed by his acute illness? |
| | A) | Conversion of body fat into ketones |
| | B) | Conversion of body fat into protein |
| | C) | Conversion of glucose to glycogen |
| | D) | Conversion of skeletal muscle to amino acids |
| | E) | Conversion of glycogen to glucose |
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8 | |
You are evaluating a 45-year-old homeless individual with known chronic schizophrenia. He appears to be generally malnourished with decreased temporal and proximal extremity muscle mass. Which of the following immunologic/hematologic abnormalities is most likely to be found in this situation? |
| | A) | Depressed absolute lymphocyte count |
| | B) | Depressed absolute monocyte count |
| | C) | Depressed absolute granulocyte count |
| | D) | Hypogammaglobulinema |
| | E) | Microcytic red cells |
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9 | |
Dietary deficiency of thiamine produces which of the following clinical syndromes? |
| | A) | Loss of proprioception |
| | B) | Peripheral neuropathy |
| | C) | Color blindness |
| | D) | Osteoporosis |
| | E) | Bruising |
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10 | |
Why do patients with the carcinoid syndrome develop pellagra (loss of appetite, generalized weakness, abdominal pain, vomiting, stomatis and bright red glossitis, and a skin rash that is pigmented and scaling in sunlight- exposed areas)? |
| | A) | Failure to elaborate serotonin |
| | B) | Vitamin B12 deficiency |
| | C) | Thiamine deficiency |
| | D) | Niacin deficiency |
| | E) | Pyridoxine deficiency |
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11 | |
Why is it necessary to coadminister vitamin B6 (pyridoxine) together with isoniazid? |
| | A) | Vitamin B6 requirements are higher in tuberculosis patients. |
| | B) | Isoniazid causes decarboxylation of ? carboxyl groups in vitamin K-dependent enzymes. |
| | C) | Isoniazid interacts with pyridoxal phosphate. |
| | D) | Isoniazid causes malabsorption of vitamin B6. |
| | E) | Isoniazid causes a conversion of homocysteine to cystathionine. |
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12 | |
A 50-year-old chronic alcoholic has bruising, inflamed and bleeding gums, and painful joints. The platelet count and prothrombin time are normal. The most likely cause for this clinical scenario is deficiency of which of the following vitamins? |
| | A) | Vitamin A |
| | B) | Vitamin B1 |
| | C) | Vitamin B12 |
| | D) | Vitamin C |
| | E) | Vitamin K |
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13 | |
A 23-year-old individual who believes in megavitamin therapy develops severe headaches. Ophthalmologic examination discloses papilledema. The cause for this problem is |
| | A) | vitamin A intoxication |
| | B) | vitamin B6 intoxication |
| | C) | vitamin D intoxication |
| | D) | vitamin E intoxication |
| | E) | not likely related to vitamin excess |
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14 | |
Which of the following patients is LEAST likely to benefit from nutritional support? |
| | A) | A 50-year-old female malnourished alcoholic about to undergo lumpectomy for lung cancer |
| | B) | A 23-year-old patient hospitalized for management of severe burn injury |
| | C) | A 50-year-old man with malnourishment due to pancreatic cancer |
| | D) | A 38-year-old woman undergoing allogeneic bone marrow transplantation |
| | E) | A 45-year-old man with advanced liver failure due to autoimmune hepatitis awaiting liver transplantation |
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15 | |
A 65-year-old woman complains of a 20-lb weight loss over the past 6 months. She is of average build and has not been on a diet. She states that she has just not been very hungry. Physical examination is unrevealing. Complete blood count is normal, as is urinalysis, multiphased chemical screen, thyroid-stimulating hormone, chest x-ray, and stool for blood. The next most appropriate study would be |
| | A) | abdominal CT |
| | B) | serum protein electrophoresis |
| | C) | colonoscopy |
| | D) | blood cultures |
| | E) | short ACTH test |
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16 | |
A 35-year-old obese woman presents with irregular menses. A pregnancy test is negative. What is the most likely cause of oligomenorrhea in this individual? |
| | A) | Glucagon resistance |
| | B) | Excess production of tumor necrosis factor by adipocytes |
| | C) | Polycystic ovarian syndrome |
| | D) | Elevated leptin levels |
| | E) | Anatomic impairment of menstrual flow |
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17 | |
Which of the following endocrinologic abnormalities is typical of patients with anorexia nervosa? |
| | A) | Increased gonadotropin-releasing hormone levels |
| | B) | Depressed serum cortisol levels |
| | C) | Elevated thyroid stimulating hormone levels |
| | D) | Increased insulin-like growth factor levels |
| | E) | Increased growth hormone |
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18 | |
A 45-year-old truck driver is involved in a serious motor vehicle accident. He has fractured multiple bones and sustained a pneumothorax and a hepatic laceration requiring emergency surgery. In order to maintain energy balance, what must this patient receive per day? |
| | A) | 2000 kcal |
| | B) | 2500 kcal |
| | C) | 3500 kcal |
| | D) | 4500 kcal |
| | E) | 5500 kcal |
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19 | |
Which of the following statements concerning the measurement of serum albumin to assess the degree of malnutrition in a patient is correct? |
| | A) | A low serum albumin indicates malnutrition. |
| | B) | The half-life of serum albumin is about 3 weeks. |
| | C) | Circulating tumor necrosis factor is required for albumin synthesis. |
| | D) | Measurement of a longer-lived circulating protein such as transferrin gives a better indication of the nutritional state. |
| | E) | Albumin levels are unaffected by changes in extracellular volume. |
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20 | |
A 50-year-old man with recent acute pancreatitis receiving his third week of nutritional support via a central venous catheter might be expected to develop which of the following complications at this time? |
| | A) | Zinc deficiency |
| | B) | Osteomalacia |
| | C) | Microcytic anemia |
| | D) | Hyperosmolar coma |
| | E) | Hypophosphatemia |
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