,Q1 ANALYZE METABOLIC PATHWAYS AND THEIR REGULATION IN RESPONSE TO DIETARY
INTAKE AND PHYSIOLOGICAL STATES
In a fasting state, which coordinated hormonal and metabolic response ensures
glucose supply to the brain while sparing muscle protein?
A. Increased insulin and decreased glucagon, promoting glycogen synthesis and lipogenesis
B. Increased glucagon and cortisol, enhancing gluconeogenesis while increasing fatty acid
oxidation and ketogenesis CORRECT
C. Decreased glucagon and increased insulin, stimulating glucose uptake by muscle and
adipose tissue
D. Increased epinephrine and decreased cortisol, promoting glycogenolysis without affecting
protein breakdown
RATIONALE: During fasting, glucagon and cortisol rise, promoting gluconeogenesis (using amino
acids and glycerol) and ketogenesis to spare glucose. Insulin is low, reducing peripheral glucose
uptake. Increased insulin (A, C) is the fed-state response; epinephrine (D) is acute stress, not
prolonged fasting.
Q2 ANALYZE METABOLIC PATHWAYS AND THEIR REGULATION IN RESPONSE TO DIETARY
INTAKE AND PHYSIOLOGICAL STATES
A patient with chronic kidney disease has a serum phosphorus of 6.2 mg/dL and
intact PTH of 450 pg/mL. Which dietary modification is most appropriate to
manage hyperphosphatemia while minimizing vascular calcification risk?
A. Increase dietary calcium intake to bind phosphate in the gut
B. Restrict dietary phosphate and avoid phosphate additives, using phosphate binders with
meals CORRECT
C. Supplement vitamin D to enhance intestinal phosphate absorption
D. Increase protein intake to promote phosphate excretion via urea generation
RATIONALE: Restricting dietary phosphate and avoiding additives is first-line; phosphate binders
reduce absorption. Increasing calcium (A) may worsen vascular calcification; vitamin D (C)
increases phosphate absorption; high protein (D) increases phosphate load and uremia.
Page 2
,Q3 ANALYZE METABOLIC PATHWAYS AND THEIR REGULATION IN RESPONSE TO DIETARY
INTAKE AND PHYSIOLOGICAL STATES
A patient with suspected malabsorption has a fecal fat of 15 g/day and a normal
D-xylose test. Which condition is most consistent with these findings?
A. Celiac disease
B. Tropical sprue
C. Chronic pancreatitis CORRECT
D. Lactose intolerance
RATIONALE: Normal D-xylose indicates intact small intestinal mucosal absorption, pointing to
pancreatic insufficiency (chronic pancreatitis) as cause of fat maldigestion. Celiac disease (A)
and tropical sprue (B) cause mucosal damage and abnormal D-xylose; lactose intolerance (D)
does not cause steatorrhea.
Q4 ANALYZE METABOLIC PATHWAYS AND THEIR REGULATION IN RESPONSE TO DIETARY
INTAKE AND PHYSIOLOGICAL STATES
Which combination of findings best indicates vitamin B12 deficiency rather than
folate deficiency?
A. Elevated homocysteine and macrocytic anemia
B. Elevated methylmalonic acid and normal folate levels CORRECT
C. Low serum folate and elevated homocysteine
D. Normal methylmalonic acid and elevated homocysteine
RATIONALE: Methylmalonic acid is elevated in B12 deficiency but not folate deficiency, as B12 is
required for MMA conversion. Homocysteine is elevated in both (A, C, D), so MMA distinguishes.
Normal folate rules out folate deficiency.
Page 3
, Q5 ANALYZE METABOLIC PATHWAYS AND THEIR REGULATION IN RESPONSE TO DIETARY
INTAKE AND PHYSIOLOGICAL STATES
In a patient receiving total parenteral nutrition, which refeeding complication is
most likely if severe hypophosphatemia develops within 48 hours?
A. Hyperglycemia
B. Hypertriglyceridemia
C. Respiratory failure CORRECT
D. Hypercalcemia
RATIONALE: Refeeding syndrome causes hypophosphatemia leading to ATP depletion and
respiratory muscle weakness, potentially respiratory failure. Hyperglycemia (A) and
hypertriglyceridemia (B) are metabolic complications but not directly due to hypophosphatemia;
hypercalcemia (D) is not typical.
Q6 ANALYZE METABOLIC PATHWAYS AND THEIR REGULATION IN RESPONSE TO DIETARY
INTAKE AND PHYSIOLOGICAL STATES
A 45-year-old woman with a BMI of 32 kg/m² and waist circumference 102 cm has
a fasting glucose of 118 mg/dL and triglycerides of 210 mg/dL. Which dietary
change is most evidence-based to reduce her cardiometabolic risk?
A. Replace saturated fats with refined carbohydrates
B. Increase intake of omega-6 polyunsaturated fatty acids
C. Adopt a Mediterranean-style diet with moderate fat intake CORRECT
D. Increase dietary cholesterol intake to improve lipid profile
RATIONALE: Mediterranean diet improves glycemic control and triglycerides, reducing
cardiometabolic risk. Refined carbs (A) worsen glucose and triglycerides; omega-6 (B) is not
specifically indicated; dietary cholesterol (D) is not beneficial.
Page 4
INTAKE AND PHYSIOLOGICAL STATES
In a fasting state, which coordinated hormonal and metabolic response ensures
glucose supply to the brain while sparing muscle protein?
A. Increased insulin and decreased glucagon, promoting glycogen synthesis and lipogenesis
B. Increased glucagon and cortisol, enhancing gluconeogenesis while increasing fatty acid
oxidation and ketogenesis CORRECT
C. Decreased glucagon and increased insulin, stimulating glucose uptake by muscle and
adipose tissue
D. Increased epinephrine and decreased cortisol, promoting glycogenolysis without affecting
protein breakdown
RATIONALE: During fasting, glucagon and cortisol rise, promoting gluconeogenesis (using amino
acids and glycerol) and ketogenesis to spare glucose. Insulin is low, reducing peripheral glucose
uptake. Increased insulin (A, C) is the fed-state response; epinephrine (D) is acute stress, not
prolonged fasting.
Q2 ANALYZE METABOLIC PATHWAYS AND THEIR REGULATION IN RESPONSE TO DIETARY
INTAKE AND PHYSIOLOGICAL STATES
A patient with chronic kidney disease has a serum phosphorus of 6.2 mg/dL and
intact PTH of 450 pg/mL. Which dietary modification is most appropriate to
manage hyperphosphatemia while minimizing vascular calcification risk?
A. Increase dietary calcium intake to bind phosphate in the gut
B. Restrict dietary phosphate and avoid phosphate additives, using phosphate binders with
meals CORRECT
C. Supplement vitamin D to enhance intestinal phosphate absorption
D. Increase protein intake to promote phosphate excretion via urea generation
RATIONALE: Restricting dietary phosphate and avoiding additives is first-line; phosphate binders
reduce absorption. Increasing calcium (A) may worsen vascular calcification; vitamin D (C)
increases phosphate absorption; high protein (D) increases phosphate load and uremia.
Page 2
,Q3 ANALYZE METABOLIC PATHWAYS AND THEIR REGULATION IN RESPONSE TO DIETARY
INTAKE AND PHYSIOLOGICAL STATES
A patient with suspected malabsorption has a fecal fat of 15 g/day and a normal
D-xylose test. Which condition is most consistent with these findings?
A. Celiac disease
B. Tropical sprue
C. Chronic pancreatitis CORRECT
D. Lactose intolerance
RATIONALE: Normal D-xylose indicates intact small intestinal mucosal absorption, pointing to
pancreatic insufficiency (chronic pancreatitis) as cause of fat maldigestion. Celiac disease (A)
and tropical sprue (B) cause mucosal damage and abnormal D-xylose; lactose intolerance (D)
does not cause steatorrhea.
Q4 ANALYZE METABOLIC PATHWAYS AND THEIR REGULATION IN RESPONSE TO DIETARY
INTAKE AND PHYSIOLOGICAL STATES
Which combination of findings best indicates vitamin B12 deficiency rather than
folate deficiency?
A. Elevated homocysteine and macrocytic anemia
B. Elevated methylmalonic acid and normal folate levels CORRECT
C. Low serum folate and elevated homocysteine
D. Normal methylmalonic acid and elevated homocysteine
RATIONALE: Methylmalonic acid is elevated in B12 deficiency but not folate deficiency, as B12 is
required for MMA conversion. Homocysteine is elevated in both (A, C, D), so MMA distinguishes.
Normal folate rules out folate deficiency.
Page 3
, Q5 ANALYZE METABOLIC PATHWAYS AND THEIR REGULATION IN RESPONSE TO DIETARY
INTAKE AND PHYSIOLOGICAL STATES
In a patient receiving total parenteral nutrition, which refeeding complication is
most likely if severe hypophosphatemia develops within 48 hours?
A. Hyperglycemia
B. Hypertriglyceridemia
C. Respiratory failure CORRECT
D. Hypercalcemia
RATIONALE: Refeeding syndrome causes hypophosphatemia leading to ATP depletion and
respiratory muscle weakness, potentially respiratory failure. Hyperglycemia (A) and
hypertriglyceridemia (B) are metabolic complications but not directly due to hypophosphatemia;
hypercalcemia (D) is not typical.
Q6 ANALYZE METABOLIC PATHWAYS AND THEIR REGULATION IN RESPONSE TO DIETARY
INTAKE AND PHYSIOLOGICAL STATES
A 45-year-old woman with a BMI of 32 kg/m² and waist circumference 102 cm has
a fasting glucose of 118 mg/dL and triglycerides of 210 mg/dL. Which dietary
change is most evidence-based to reduce her cardiometabolic risk?
A. Replace saturated fats with refined carbohydrates
B. Increase intake of omega-6 polyunsaturated fatty acids
C. Adopt a Mediterranean-style diet with moderate fat intake CORRECT
D. Increase dietary cholesterol intake to improve lipid profile
RATIONALE: Mediterranean diet improves glycemic control and triglycerides, reducing
cardiometabolic risk. Refined carbs (A) worsen glucose and triglycerides; omega-6 (B) is not
specifically indicated; dietary cholesterol (D) is not beneficial.
Page 4
