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Nutrition — Step 1 practice questions
11 questions in this area, with an explanation for every answer choice.
Three samples below, free and without an account.
How this shows up on Step 1
Vitamin and mineral deficiencies, presented as clinical syndromes. A small section, but the questions are unusually answerable when the deficiency states are known, which makes it efficient to revise.
Sample questions
Sample question 1
A 2-month-old exclusively breastfed infant is brought for a well-child visit. Which of the following supplements is routinely recommended, and why?
Explanations
A. Vitamin D, because breast milk contains insufficient amounts to prevent rickets · correct
Breast milk is nutritionally optimal but is low in vitamin D, so supplementation of 400 IU daily is recommended from the first days of life to prevent rickets. Iron stores from gestation suffice until roughly 4–6 months, after which supplementation or iron-rich complementary foods are needed — breast milk iron is low in quantity but highly bioavailable. Vitamin K is given ONCE intramuscularly at birth to prevent hemorrhagic disease of the newborn, since gut flora are not yet established.
B. Vitamin K daily, because breast milk lacks it entirely after the newborn period
Vitamin K is a single injection at birth, not a daily supplement.
C. No supplementation is needed in any exclusively breastfed infant
Vitamin D supplementation is specifically recommended.
D. Iron beginning at birth, because breast milk contains no iron
Iron supplementation begins around 4–6 months rather than at birth.
E. Fluoride from birth regardless of water supply
Fluoride begins around 6 months and depends on water fluoridation.
Sample question 2
A 68-year-old woman who underwent gastrectomy years ago develops progressive gait unsteadiness worse in the dark, tingling in the feet, and memory difficulties. Examination shows loss of vibration and proprioception, hyperreflexia, and extensor plantar responses. Her hemoglobin is normal. Which of the following is the most appropriate treatment?
Explanations
A. Vitamin E
Vitamin E deficiency can mimic this pattern but is rare and unrelated to gastrectomy.
B. Thiamine
Thiamine deficiency causes Wernicke encephalopathy or wet beriberi.
C. Pyridoxine
Pyridoxine deficiency (isoniazid) causes peripheral neuropathy and sideroblastic anemia, not dorsal column signs.
D. Oral folate
Folate corrects the megaloblastic anemia but NOT the neurologic disease, and can mask B12 deficiency while the cord degenerates.
E. Parenteral vitamin B12 (cobalamin) · correct
Loss of intrinsic factor after gastrectomy causes B12 deficiency; demyelination of the dorsal columns, lateral corticospinal tracts, and spinocerebellar tracts produces subacute combined degeneration — sensory ataxia (worse without visual cues), UMN signs, and cognitive change. Neurologic disease can precede or occur without anemia, so a normal hemoglobin does not exclude it. Give parenteral B12 (deficits may be irreversible if treatment is delayed); check methylmalonic acid, which is elevated in B12 but not folate deficiency.
Sample question 3
A 5-year-old's body mass index has been rising since age 4 after reaching its nadir at age 3. Which of the following best describes this pattern?
Explanations
A. Evidence of an underlying endocrine disorder in most cases
Endocrine causes are uncommon and usually accompanied by short stature.
B. BMI should decline continuously through childhood
BMI normally rises after the rebound.
C. Early adiposity rebound, which normally occurs around age 5–7 and when it happens earlier predicts increased risk of later obesity · correct
Body mass index normally falls through the preschool years, reaching a nadir around age 5–7 before rising again — the ADIPOSITY REBOUND. When this rebound occurs EARLY, it predicts substantially increased risk of adolescent and adult obesity, making it a useful early marker for intervention. Importantly, most childhood obesity is EXOGENOUS: such children are typically TALL for age, whereas endocrine causes (hypothyroidism, Cushing syndrome, growth hormone deficiency) cause obesity with SHORT stature and slowed linear growth.
D. Expected only in children with excessive caloric intake
Rebound is a normal developmental phenomenon whose timing varies.
E. A normal finding of no prognostic significance
The timing carries real prognostic weight.
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