A patient reports that swallowing does not proceed appropriately. This symptom is called:
A. Odynophagia
B. Dysphagia
C. Dyspepsia
D. Globus

B. Dysphagia

A patient has pain specifically as the food bolus traverses the esophagus. This is:
A. Odynophagia
B. Dysphagia
C. Regurgitation
D. Early satiety

A. Odynophagia

Which tissue generates the peristaltic contraction in the esophageal body?
A. Skeletal muscle
B. Cardiac muscle
C. Smooth muscle
D. Striated fascia

C. Smooth muscle

Which esophageal sphincter relaxes to allow food into the gastric fundus?
A. Upper esophageal sphincter
B. Pyloric sphincter
C. Cricopharyngeus
D. Lower esophageal sphincter

D. Lower esophageal sphincter

A Schatzki ring is best described as:
A. Distal esophageal narrowing ring
B. Proximal esophageal diverticulum
C. Gastric mucosal web
D. Distal tracheal stenosis

A. Distal esophageal narrowing ring

Schatzki rings are usually located:
A. Upper cervical esophagus
B. Mid thoracic esophagus
C. Near stomach in lower esophagus
D. At the pylorus

C. Near stomach in lower esophagus

Esophageal squamous cell carcinoma is most commonly found in the:
A. Lower third only
B. Upper and middle sections
C. Gastroesophageal junction only
D. Distal fundic cardia

B. Upper and middle sections

Esophageal adenocarcinoma is most commonly found in the:
A. Upper section
B. Middle section
C. Lower section
D. Cervical inlet

C. Lower section

A patient cannot swallow, coughs with attempts, and has hoarseness. The problem is most likely:
A. Esophageal
B. Oropharyngeal
C. Gastric
D. Colonic

B. Oropharyngeal

A patient says food gets stuck below the sternal notch. This localizes best to:
A. Oropharyngeal disease
B. Tracheal compression
C. Esophageal disease
D. Laryngeal dysfunction

C. Esophageal disease

Myasthenia gravis is which hypersensitivity type?
A. Type I
B. Type II
C. Type III
D. Type IV

B. Type II

Symptoms of myasthenia gravis are usually worst:
A. Upon awakening
B. After meals
C. Mid-morning
D. End of day

D. End of day

Deep tendon reflexes in myasthenia gravis are typically:
A. Absent
B. Brisk
C. Normal
D. Asymmetric

C. Normal

Muscle atrophy in myasthenia gravis is generally:
A. Severe and early
B. Rare
C. Universal
D. Progressive

B. Rare

Myasthenia gravis incidence classically peaks around which age in women?
A. 15
B. 25
C. 45
D. 65

B. 25

Myasthenia gravis incidence classically peaks around which age in men?
A. 25
B. 35
C. 50
D. 65

D. 65

Leather, rubber, and tire manufacturing are classic risk factors for:
A. Renal cell carcinoma
B. Transitional cell carcinoma
C. Squamous bladder carcinoma
D. Prostate adenocarcinoma

B. Transitional cell carcinoma

A patient taking rifampin notices urine discoloration. Which color is most expected?
A. Blue
B. Green
C. Reddish
D. Milky

C. Reddish

Which additional substance can also cause reddish urine?
A. Bananas
B. Blackberries
C. Spinach
D. Rice

B. Blackberries

Hematuria is more likely glomerular when accompanied by:
A. RBC casts
B. Ketone crystals
C. Bacteriuria
D. Calcium oxalate

A. RBC casts

Which finding also points toward glomerular hematuria?
A. Proteinuria
B. Dysuria
C. Frequency
D. Incontinence

A. Proteinuria

In a patient with hematuria but no clear glomerular features, the next step is:
A. Ignore transient findings
B. Start dialysis immediately
C. Perform systemic evaluation
D. Give empiric antibiotics

C. Perform systemic evaluation

In patient communication, legitimization primarily:
A. Redirects patient decisions
B. Validates patient choices
C. Obtains legal consent
D. Clarifies prognosis

B. Validates patient choices

A DNRO in Florida is best defined as:
A. Surrogate appointment form
B. Organ donation registry
C. Department-issued no-resuscitation identifier
D. Court-ordered hospice directive

C. Department-issued no-resuscitation identifier

A living will is best described as a document that:
A. Names only a proxy
B. Directs care under circumstances
C. Refuses all hospitalization
D. Grants emergency consent

B. Directs care under circumstances

Can an out-of-state DNR be used in Florida?
A. Yes, always
B. Yes, with witnesses
C. No
D. Only in hospice

C. No

Which is another name for pre-formed vitamin A?
A. Retinal
B. Retinol
C. Tocopherol
D. Calcitriol

B. Retinol

Retinol is the:
A. Least active vitamin A form
B. Most active vitamin A form
C. Storage form of vitamin D
D. Precursor to vitamin K

B. Most active vitamin A form

Retinol is found mostly in foods of:
A. Animal origin
B. Plant origin
C. Fungal origin
D. Algal origin

A. Animal origin

Beta-carotenes are cleaved to form:
A. Retinal
B. Tocotrienol
C. Retinol
D. Cholecalciferol

C. Retinol

In circulation, retinol is primarily bound to:
A. Albumin
B. Ceruloplasmin
C. Retinol-binding protein
D. Transferrin

C. Retinol-binding protein

In rod cells, all-trans retinal combines with a protein to form:
A. Iodopsin
B. Rhodopsin
C. Melanopsin
D. Retinol

B. Rhodopsin

In cone cells, all-trans retinal combines with a protein to form:
A. Rhodopsin
B. Retinoic acid
C. Iodopsin
D. Beta-carotene

C. Iodopsin

Rod photopigment is primarily required for:
A. Bright-light color vision
B. Night vision
C. Peripheral hearing
D. Depth perception

B. Night vision

Cone photopigment is most important for:
A. Night vision
B. Dark adaptation only
C. Color vision in light
D. Peripheral motion only

C. Color vision in light

A child with xerophthalmia and recurrent infections most likely lacks:
A. Vitamin D
B. Vitamin K
C. Vitamin E
D. Vitamin A

D. Vitamin A

Which skin finding is classically associated with vitamin A deficiency?
A. Pellagrous dermatitis
B. Perifollicular hyperkeratosis
C. Vesicular palm rash
D. Photosensitive plaques

B. Perifollicular hyperkeratosis

Which visual complaint is an early clue to vitamin A deficiency?
A. Diplopia
B. Cataracts
C. Night blindness
D. Tunnel vision

C. Night blindness

Xerophthalmia from vitamin A deficiency can progress to:
A. Retinal detachment
B. Corneal ulceration
C. Vitreous hemorrhage
D. Lens dislocation

B. Corneal ulceration

Severe xerophthalmia may ultimately lead to:
A. Reversible diplopia
B. Transient mydriasis
C. Irreversible blindness
D. Conductive vision loss

C. Irreversible blindness

Vitamin A deficiency impairs which immune functions?
A. Humoral and cell-mediated
B. Neutrophilic and eosinophilic
C. Innate and complement
D. Platelet and fibrinolytic

A. Humoral and cell-mediated

In developing countries, vitamin A deficiency increases mortality from:
A. Influenza
B. Tuberculosis
C. Measles
D. Rabies

C. Measles

A woman taking high-dose vitamin A for acne needs reliable contraception because vitamin A is:
A. Nephrotoxic
B. Teratogenic
C. Ototoxic
D. Cardiotoxic

B. Teratogenic

Vitamin A exposure is especially dangerous during which time?
A. Third trimester
B. Periconception only
C. First trimester
D. Postpartum period

C. First trimester

Children with sickle cell disease tend to have what serum vitamin A pattern?
A. Markedly elevated
B. Slightly lower
C. Completely normal
D. Highly variable

B. Slightly lower

Which form of vitamin D is plant- or yeast-derived?
A. Vitamin D1
B. Vitamin D2
C. Vitamin D3
D. Vitamin D4

B. Vitamin D2

Which form of vitamin D is produced in skin with sunlight?
A. Vitamin D2
B. Vitamin D1
C. Vitamin D3
D. Vitamin K2

C. Vitamin D3

Which vitamin D form is commonly used to fortify milk?
A. Vitamin D2
B. Vitamin D3
C. Vitamin A
D. Vitamin E

A. Vitamin D2

Vitamin D deficiency in children causes:
A. Osteomalacia
B. Scurvy
C. Beriberi
D. Rickets

D. Rickets

Vitamin D deficiency in adults causes:
A. Rickets
B. Osteomalacia
C. Osteopetrosis
D. Scoliosis

B. Osteomalacia

A child has bowed legs, frontal bossing, and rachitic rosary. The diagnosis is:
A. Osteomalacia
B. Marasmus
C. Rickets
D. Scurvy

C. Rickets

Delay in closure of skull bones in infancy most strongly suggests:
A. Iron deficiency
B. Vitamin D deficiency
C. Vitamin K deficiency
D. Vitamin C deficiency

B. Vitamin D deficiency

An adult with vitamin D deficiency is most likely to have:
A. Gingival bleeding
B. Bone pain, fragile bones
C. Night blindness
D. Hemolytic anemia

B. Bone pain, fragile bones

Long-term phenobarbital therapy may cause osteomalacia because it:
A. Blocks intestinal calcium
B. Increases vitamin D breakdown
C. Decreases bile salt synthesis
D. Inhibits renal phosphate loss

B. Increases vitamin D breakdown

Which anticonvulsant is also linked to osteomalacia?
A. Carbamazepine
B. Valproate
C. Phenytoin
D. Levetiracetam

C. Phenytoin

Which tocopherol has the highest biologic activity?
A. Beta-tocopherol
B. Gamma-tocopherol
C. Delta-tocopherol
D. Alpha-tocopherol

D. Alpha-tocopherol

Which tocopherol isomer is physiologically effective?
A. l-isomer
B. d-isomer
C. racemate only
D. trans-isomer

B. d-isomer

Alpha-tocopherol inhibits which enzyme?
A. Protein kinase C
B. Hexokinase
C. Adenylate cyclase
D. Xanthine oxidase

A. Protein kinase C

Vitamin E is best known as the body’s major:
A. Water-soluble antioxidant
B. Lipid-soluble antioxidant
C. Hepatic clotting cofactor
D. Mitochondrial electron carrier

B. Lipid-soluble antioxidant

Vitamin E deficiency is uncommon except in patients who cannot:
A. Absorb fat
B. Absorb glucose
C. Store glycogen
D. Metabolize purines

A. Absorb fat

Which disorder predisposes to vitamin E deficiency?
A. Achalasia
B. Cystic fibrosis
C. Nephrolithiasis
D. Hyperthyroidism

B. Cystic fibrosis

Which other condition predisposes to vitamin E deficiency?
A. Pancreatic insufficiency
B. Iron overload
C. Hyperparathyroidism
D. Nephritic syndrome

A. Pancreatic insufficiency

Vitamin E deficiency classically causes:
A. Brisk reflexes, spasticity
B. Lost reflexes, sensory loss
C. Tremor, myoclonus
D. Ptosis, diplopia

B. Lost reflexes, sensory loss

Which sensory deficit fits vitamin E deficiency?
A. Loss of smell
B. Decreased vibration sense
C. Reduced visual acuity
D. Loss of temperature sense

B. Decreased vibration sense

Premature infants given oxygen may develop retrolental fibroplasia. What may help prevent this?
A. Vitamin K
B. Vitamin C
C. Vitamin E
D. Vitamin A

C. Vitamin E

Very large doses of vitamin E may cause:
A. Hemorrhage
B. Hypercalcemia
C. Polycythemia
D. Hypertension

A. Hemorrhage

Excess vitamin E promotes bleeding mainly by interfering with:
A. Vitamin C recycling
B. Vitamin K clotting function
C. Platelet ADP signaling
D. Fibrin polymerization

B. Vitamin K clotting function

The predominant dietary form of vitamin K is:
A. Menaquinone
B. Phylloquinone
C. Menadione
D. Phytolquinone

B. Phylloquinone

Which vitamin K form is produced by gut microflora?
A. Phylloquinone
B. Menadione
C. Menaquinone
D. Calciferol

C. Menaquinone

Vitamin K is absorbed primarily in the:
A. Distal ileum
B. Stomach
C. Proximal small bowel
D. Colon

C. Proximal small bowel

Normal vitamin K absorption requires:
A. Intrinsic factor
B. Pancreatic insulin
C. Bile salts
D. Gastric acid

C. Bile salts

Which vitamin is least stable and easily destroyed during cooking?
A. Vitamin A
B. Vitamin C
C. Vitamin D
D. Vitamin K

B. Vitamin C

Vitamin C is efficiently absorbed in the:
A. Duodenum and colon
B. Stomach and jejunum
C. Jejunum and ileum
D. Ileum and colon

C. Jejunum and ileum

A patient with recurrent calcium oxalate stones should avoid high doses of:
A. Vitamin B12
B. Vitamin E
C. Vitamin C
D. Vitamin A

C. Vitamin C

High-dose vitamin C can raise urinary oxalate because it is metabolized to:
A. Uric acid
B. Oxalic acid
C. Acetoacetate
D. Homocysteine

B. Oxalic acid

Thiamin is primarily absorbed in the:
A. Duodenum
B. Jejunum
C. Ileum
D. Colon

B. Jejunum

Thiamin deficiency is especially common in alcoholics and patients with:
A. Vitamin D deficiency
B. Folate deficiency
C. Iron deficiency
D. Zinc deficiency

B. Folate deficiency

A patient with glossitis and cheilosis is found to have deficiency of which vitamin also known as vitamin B2?
A. Riboflavin
B. Niacin
C. Biotin
D. Pyridoxine

A. Riboflavin

Randy call Gill at 2!

Free riboflavin released from food is primarily absorbed by an ATP-dependent process in the:
A. Ileum
B. Duodenum
C. Jejunum
D. Colon

C. Jejunum

A malnourished patient has diarrhea, sun-exposed dermatitis, and confusion. Which deficiency is most likely?
A. Biotin deficiency
B. Niacin deficiency
C. Folate deficiency
D. Riboflavin deficiency

B. Niacin deficiency

3 Ds- dementia, dermatitis, diarrhea

If untreated, severe pellagra classically progresses to:
A. Paralysis
B. Renal failure
C. Death
D. Blindness

C. Death

Pantothenic acid is a precursor of:
A. ATP
B. Heme
C. NADPH
D. CoA

D. CoA

Biotin

B7

Folate

B9

Niacin

B3

Riboflavin

B2

Cobalamin

B12

Thiamin

B1

Pantothenic acid

B5

A patient with dermatitis, alopecia, myalgias, nausea, and mental changes most likely has deficiency of:
A. Thiamin
B. Biotin
C. Niacin
D. Folate

B. Biotin

BAD MNM

Which additional finding is associated with biotin deficiency?
A. Low cholesterol
B. Increased appetite
C. High hemoglobin
D. High cholesterol

D. High cholesterol

Vitamin B6 deficiency can occur with use of:
A. Metformin
B. Isoniazid
C. Vancomycin
D. Propranolol

B. Isoniazid

Which other drug may also precipitate vitamin B6 deficiency?
A. Penicillamine
B. Rifampin
C. Digoxin
D. Furosemide

A. Penicillamine

A patient with pyridoxine deficiency is most likely to have:
A. Pellagra-like dermatitis
B. Night blindness
C. Gingival bleeding
D. Leg bowing

A. Pellagra-like dermatitis

Which neuropsychiatric feature may occur in vitamin B6 deficiency?
A. Euphoria
B. Depression
C. Mania
D. Aphasia

B. Depression

Long-term proton pump inhibitor use may predispose to deficiency of:
A. Vitamin C
B. Folate
C. Vitamin B12
D. Vitamin E

C. Vitamin B12

A patient has megaloblastic anemia, paresthesias, and a swollen painful red tongue. Which deficiency best explains this?
A. Folate deficiency
B. Iron deficiency
C. Vitamin B12 deficiency
D. Calcium deficiency

C. Vitamin B12 deficiency

Untreated vitamin B12 deficiency may cause irreversible injury to the:
A. Peripheral nerves and cord
B. Liver and pancreas
C. Skin and hair
D. Colon and stomach

A. Peripheral nerves and cord

A patient with B12 deficiency is most likely to develop which sensory deficit?
A. Loss of vibration sense
B. Loss of smell
C. Loss of taste
D. Loss of hearing

A. Loss of vibration sense

According to your notes, folate deficiency is associated with:
A. Low homocysteine
B. Elevated homocysteine
C. Normal methylmalonate only
D. Elevated calcium

B. Elevated homocysteine

When serum calcium rises, which hormone is released to reduce bone calcium release and promote excretion?
A. Parathyroid hormone
B. Aldosterone
C. Calcitonin
D. Calcitriol

C. Calcitonin

Calcitonin is released from which thyroid cells?
A. Follicular cells
B. Parafollicular C cells
C. Hurthle cells
D. Chief cells

B. Parafollicular C cells

A patient has paresthesias, tetany, and seizures. Which deficiency is most likely?
A. Calcium deficiency
B. Iron deficiency
C. Niacin deficiency
D. Biotin deficiency

A. Calcium deficiency

CAP TS

Osteoporosis is defined as a reduction in:
A. Bone length
B. Bone density
C. Bone turnover
D. Cartilage volume

B. Bone density

A patient with hypercalcemia is most likely to have:
A. Tetany and seizures
B. Lethargy and dehydration
C. Ataxia and dementia
D. Glossitis and diarrhea

B. Lethargy and dehydration

A premenopausal woman has chronic heavy prolonged menses and iron deficiency anemia. Which condition most likely contributes?
A. Endometriosis
B. Ovarian torsion
C. Uterine fibroids
D. Ectopic pregnancy

C. Uterine fibroids

Atrophy of the lingual papillae is a classic sign of deficiency of:
A. Iron
B. Calcium
C. Biotin
D. Vitamin D

A. Iron

A patient with microcytic anemia feels unusually:
A. Cold
B. Flushed
C. Hungry
D. Thirsty

A. Cold

A patient with iron deficiency reports compulsive ice eating. This is called:
A. Pica
B. Geophagia
C. Rumination
D. Pagophagia

D. Pagophagia

Which test is the single best noninvasive marker of iron stores?
A. Serum iron
B. TIBC
C. Serum ferritin
D. Transferrin saturation

C. Serum ferritin

A patient with chronic inflammation may have iron deficiency masked because inflammation can:
A. Lower ferritin
B. Raise ferritin
C. Raise transferrin
D. Lower protoporphyrin

B. Raise ferritin

Transferrin saturation is calculated as:
A. Ferritin divided by TIBC
B. Serum iron times ferritin
C. TIBC divided by serum iron
D. Serum iron divided by TIBC

D. Serum iron divided by TIBC

Serum iron levels are typically:
A. Higher in the p.m.
B. Equal all day
C. Higher in the a.m.
D. Lowest at midnight

C. Higher in the a.m.

Which condition tends to reduce TIBC?
A. Pregnancy
B. Nephrotic syndrome
C. Oral contraceptive use
D. Iron deficiency alone

B. Nephrotic syndrome

Which situation tends to increase TIBC?
A. Malnutrition
B. Chronic infection
C. Liver disease
D. Pregnancy

D. Pregnancy

Protoporphyrin remains elevated when:
A. Iron cannot enter hemoglobin
B. Ferritin is acutely elevated
C. TIBC is excessively high
D. Transferrin becomes saturated

A. Iron cannot enter hemoglobin

Which substance enhances iron absorption by forming soluble complexes at low pH?
A. Folate
B. Calcitriol
C. Ascorbic acid
D. Pantothenate

C. Ascorbic acid

Iron is best absorbed in which form?
A. Ferric, Fe3+
B. Ferrous, Fe2+
C. Heme-bound iron
D. Transferrin-bound iron

B. Ferrous, Fe2+

A patient taking oral iron develops constipation and GI upset. The best next step is to:
A. Stop iron permanently
B. Switch to parenteral iron
C. Reduce dose by one-half
D. Take double doses weekly

C. Reduce dose by one-half

The most serious adverse effect of parenteral iron is:
A. Constipation
B. Anaphylaxis
C. Dark stools
D. Metallic taste

B. Anaphylaxis