In a district hospital, a strict vegetarian woman has haemoglobin 7.2 g/dL, MCV 118 fL, hypersegmented neutrophils, a raised LDH and mild jaundice, with paraesthesia of the feet and reduced vibration sense at the ankles. Serum B12 and folate have been sent but will take five days. The resident wants to start oral folic acid 5 mg daily at once, because folate deficiency is common in the area. She is haemodynamically stable, has no heart failure and is not pregnant. Which is the most appropriate treatment while the results are awaited?

No treatment until the results return

Transfusion of two units of blood

A young adult with lifelong hyperphagia, obesity, short stature, small hands and feet, mild learning disability and hypogonadism is reviewed in the endocrine clinic. Neonatal records note severe hypotonia and poor feeding. Which genetic mechanism is most likely?

Loss of paternal 15q11-q13 expression

Loss of maternal 15q11-q13 expression

Dyslipidaemia, obesity and nutrition in medicine

45 NEET-PG practice questions on Dyslipidaemia, obesity and nutrition in medicine, part of General Medicine. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
Three years after a Roux-en-Y gastric bypass, a woman who stopped her supplements has numb feet, glossitis and a macrocytic anaemia (MCV 112 fL). Which deficiency explains this?
1. AThiamine
2. BCopper
3. CIron
4. DVitamin B12
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Answer: D · Vitamin B12
Gastric bypass excludes most of the stomach, so acid and intrinsic factor are reduced and vitamin B12 is poorly absorbed; stores last a few years, so deficiency appears late. Lifelong B12 (injections or high-dose oral), iron, calcium with vitamin D and a multivitamin are needed. Iron deficiency is also common but gives a microcytic picture. Key point: After gastric bypass, lifelong B12 supplements are needed; deficiency appears after a few years.
- A: Thiamine deficiency causes neuropathy or Wernicke encephalopathy, not macrocytic anaemia with glossitis.
- B: Copper deficiency causes myeloneuropathy with anaemia and neutropenia but is less common.
- C: Iron deficiency causes microcytic, not macrocytic, anaemia.
Question 2 · Hard
In a district hospital, a strict vegetarian woman has haemoglobin 7.2 g/dL, MCV 118 fL, hypersegmented neutrophils, a raised LDH and mild jaundice, with paraesthesia of the feet and reduced vibration sense at the ankles. Serum B12 and folate have been sent but will take five days. The resident wants to start oral folic acid 5 mg daily at once, because folate deficiency is common in the area. She is haemodynamically stable, has no heart failure and is not pregnant. Which is the most appropriate treatment while the results are awaited?
1. ANo treatment until the results return
2. BOral folic acid alone
3. CTransfusion of two units of blood
4. DIM vitamin B12 with folic acid
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Answer: D · IM vitamin B12 with folic acid
Megaloblastic anaemia with neurological signs in a strict vegetarian strongly suggests B12 deficiency. Folic acid alone corrects the anaemia but not the neurological damage, which can progress, so when the cause is not yet known B12 is given together with folate. Transfusion is not needed in a stable patient and risks circulatory overload. Key point: Megaloblastic anaemia of unknown cause, especially with neurological signs: give B12 with folate, never folate alone.
- A: Waiting five days allows the neurological damage to progress.
- B: Folate alone can let B12-related neurological damage progress.
- C: Transfusion is unnecessary in a stable patient and risks circulatory overload.
Question 3 · Medium
A young adult with lifelong hyperphagia, obesity, short stature, small hands and feet, mild learning disability and hypogonadism is reviewed in the endocrine clinic. Neonatal records note severe hypotonia and poor feeding. Which genetic mechanism is most likely?
1. ALoss of paternal 15q11-q13 expression
2. BLoss of maternal 15q11-q13 expression
3. CTrisomy of chromosome 21
4. DLeptin receptor gene mutation
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Answer: A · Loss of paternal 15q11-q13 expression
Neonatal hypotonia and poor feeding followed by hyperphagia and obesity, with short stature, small hands and feet and hypogonadism, is Prader-Willi syndrome. It results from absent paternal expression of genes on 15q11-q13, through a paternal deletion (most common), maternal uniparental disomy or an imprinting defect. Loss of the maternal copy (UBE3A) gives Angelman syndrome instead. Key point: Prader-Willi syndrome: loss of paternal 15q11-q13 (deletion or maternal UPD); hyperphagia, obesity, hypogonadism.
- B: Loss of maternal 15q11-q13 expression causes Angelman syndrome.
- C: Down syndrome has a different phenotype, with typical facies and heart defects.
- D: Leptin receptor defects cause severe early obesity but not neonatal hypotonia, small hands or learning disability.
Question 4 · Medium
Difficulty seeing at dusk for months, with dry, foamy triangular spots on the temporal conjunctiva, is the complaint of a man with chronic calcific pancreatitis and steatorrhoea. Which vitamin is deficient?
1. AVitamin E
2. BRiboflavin
3. CVitamin D
4. DVitamin A
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Answer: D · Vitamin A
Night blindness and Bitot's spots are features of vitamin A deficiency, which in adults usually comes from fat malabsorption (chronic pancreatitis, coeliac disease, cholestasis, bariatric surgery). Retinol forms rhodopsin in the rods, so dark adaptation fails first. Pancreatic enzymes and vitamin A replacement are needed. Key point: Fat malabsorption in adults can cause vitamin A deficiency: night blindness and Bitot's spots.
- A: Vitamin E deficiency causes ataxia and neuropathy, not night blindness.
- B: Riboflavin deficiency gives angular cheilitis and corneal vascularisation.
- C: Vitamin D deficiency causes osteomalacia.
Question 5 · Hard
At an NTEP treatment centre, a man ten weeks into treatment for pulmonary TB with isoniazid, rifampicin, pyrazinamide and ethambutol complains of burning feet. He is also pale: haemoglobin 8.6 g/dL, MCV 72 fL, serum ferritin 480 ng/mL (raised), and the bone marrow shows ring sideroblasts. He was given no vitamin supplement with his tablets, eats a poor diet and drinks alcohol at weekends. His sputum has converted and he has gained weight. Which vitamin deficiency explains both the anaemia and the neuropathy?
1. AFolic acid
2. BThiamine (vitamin B1)
3. CPyridoxine (vitamin B6)
4. DVitamin B12
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Answer: C · Pyridoxine (vitamin B6)
Isoniazid forms a hydrazone with pyridoxine and increases its excretion. Pyridoxal phosphate is the cofactor for ALA synthase, the first step of haem synthesis, so its deficiency causes a microcytic sideroblastic anaemia with iron loading (high ferritin, ring sideroblasts); it is also needed for neurotransmitter synthesis, so neuropathy follows. Pyridoxine supplements with isoniazid treat and prevent both. Key point: Isoniazid depletes pyridoxine, causing peripheral neuropathy and sideroblastic anaemia (ALA synthase cofactor).
- A: Folate deficiency causes megaloblastic anaemia.
- B: Thiamine deficiency causes neuropathy but not sideroblastic anaemia.
- D: B12 deficiency causes macrocytic, not microcytic sideroblastic, anaemia.
Question 6 · Hard
Six weeks after a sleeve gastrectomy, a young woman is brought to casualty after a month of persistent vomiting and very little food. She is confused and unsteady on her feet, with horizontal nystagmus and bilateral lateral rectus weakness. Capillary glucose is 62 mg/dL and BP is 104/70 mmHg. The intern has hung a bag of 25% dextrose to give first and plans to start an oral multivitamin tomorrow, once she can swallow safely. Her husband says she has barely kept down even water for the last few days. What should be done?
1. AIV thiamine before or with the dextrose
2. BOral thiamine from tomorrow
3. CDextrose first; thiamine can wait
4. DMRI brain before any treatment
Answer and explanation in LearnFree account
Question 7 · Hard
On the third day of nasogastric feeding in the medical ICU, a chronic alcoholic admitted with severe malnutrition (weight 38 kg) becomes breathless and confused, with pitting oedema, basal crackles and new muscle weakness. The feed was started at the full calculated rate of 2,000 kcal a day on admission. Results today: phosphate 0.9 mg/dL (2.5-4.5), potassium 2.8 mmol/L (3.5-5.0), magnesium 1.1 mg/dL (1.7-2.4), sodium 133 mmol/L. He received a single dose of oral thiamine on admission and no electrolyte supplements; his weight was 52 kg a year ago. Which plan is most appropriate now?
1. AStop feeding for a week and give IV saline
2. BContinue the feed and give IV furosemide
3. CSlow the feed; IV phosphate, K, Mg and thiamine
4. DIncrease the feed to reverse catabolism
Answer and explanation in LearnFree account
Question 8 · Easy
For an Asian Indian adult, which BMI marks obesity under the 2009 Indian consensus guidelines?
1. A27.5 kg/m2 or more
2. B30 kg/m2 or more
3. C23 kg/m2 or more
4. D25 kg/m2 or more
Answer and explanation in LearnFree account
Question 9 · Medium
Consider these statements about drugs for obesity: 1. Tirzepatide is a dual GIP and GLP-1 receptor agonist. 2. Orlistat acts centrally to suppress appetite. 3. Semaglutide slows gastric emptying and reduces appetite. 4. Phentermine is safe in uncontrolled hypertension. Which are correct?
1. A1, 2 and 3 only
2. B1, 3 and 4 only
3. C1 and 3 only
4. D2 and 4 only
Answer and explanation in LearnFree account
Question 10 · Medium
Biochemistry in a woman who keeps purdah and has bone pain with a waddling gait: calcium 8.0 mg/dL (8.5-10.5), phosphate 2.1 mg/dL (2.5-4.5), alkaline phosphatase 410 U/L (40-130), PTH 142 pg/mL (10-65), 25-hydroxyvitamin D 6 ng/mL. X-ray shows Looser zones in the pubic rami. What is the diagnosis?
1. APrimary hyperparathyroidism
2. BPostmenopausal osteoporosis
3. CPaget disease of bone
4. DOsteomalacia
Answer and explanation in LearnFree account
Question 11 · Medium
Consider these statements about ezetimibe: 1. It blocks the NPC1L1 sterol transporter in the small intestine. 2. It inhibits hepatic HMG-CoA reductase. 3. Added to a statin, it lowers LDL by a further 20-25%. 4. Added to simvastatin after acute coronary syndrome, it reduced cardiovascular events. Which are correct?
1. A1, 3 and 4 only
2. B1, 2 and 3 only
3. C1 and 2 only
4. D2 and 3 only
Answer and explanation in LearnFree account
Question 12 · Medium
Burning pain in the hands and feet since adolescence, clusters of dark red papules around the umbilicus and thighs, reduced sweating and proteinuria of 1.8 g/day are found in a man whose maternal uncle needed dialysis at 40. Which enzyme is deficient?
1. AGlucocerebrosidase
2. BAlpha-galactosidase A
3. CArylsulfatase A
4. DHexosaminidase A
Answer and explanation in LearnFree account
Question 13 · Medium
Weekly semaglutide 2.4 mg is being considered for a man with a BMI of 34 kg/m2 and prediabetes. Which history is a contraindication to it?
1. AMedullary thyroid cancer in his mother
2. BPapillary thyroid cancer 10 years ago
3. CGout with one attack a year
4. DWell-controlled bronchial asthma
Answer and explanation in LearnFree account
Question 14 · Medium
Lipid profile of a schoolteacher: total cholesterol 380 mg/dL, LDL 290 mg/dL, HDL 46 mg/dL, triglycerides 120 mg/dL. He has thickened Achilles tendons and his father had a heart attack at 42. Thyroid and kidney function are normal. Which defect is most likely?
1. ALDL receptor mutation
2. BABCA1 transporter defect
3. CApo E2 homozygosity
4. DLipoprotein lipase deficiency
Answer and explanation in LearnFree account
Question 15 · Medium
Severe hypophosphataemia develops two days after a starving man is given glucose-rich feeds. Which hormonal change drives the fall?
1. ACalcitriol fall reducing gut absorption
2. BInsulin release shifting phosphate into cells
3. CPTH rise increasing urinary loss of phosphate
4. DFGF-23 release from bone
Answer and explanation in LearnFree account
Question 16 · Easy
Which electrolyte abnormality is the hallmark of refeeding syndrome?
1. AHypernatraemia
2. BHyperkalaemia
3. CHypercalcaemia
4. DHypophosphataemia
Answer and explanation in LearnFree account
Question 17 · Medium
A man with coronary disease gets disabling muscle pain with three different statins, even at low doses, though his CK stays normal. His LDL remains above goal. Which oral drug, activated only in the liver, suits him?
1. AColestipol
2. BNicotinic acid
3. CGemfibrozil
4. DBempedoic acid
Answer and explanation in LearnFree account
Question 18 · Hard
Follow-up in the lipid clinic: a software engineer with heterozygous familial hypercholesterolaemia had an anterior STEMI at 41 and has a drug-eluting stent. For six months he has taken rosuvastatin 40 mg and ezetimibe 10 mg daily, with good adherence confirmed by pharmacy records. His diet is controlled and he has stopped smoking. His LDL is now 132 mg/dL; it was 310 mg/dL untreated. TSH, liver and kidney tests are normal, his BP is controlled, and he has no muscle symptoms. Which is the most appropriate next step to lower his LDL?
1. AAdd omega-3 fatty acids
2. BAdd a PCSK9 inhibitor
3. CAdd fenofibrate
4. DSwitch to atorvastatin 80 mg
Answer and explanation in LearnFree account
Question 19 · Easy
Atorvastatin lowers LDL cholesterol mainly by inhibiting which enzyme?
1. ACholesteryl ester transfer protein
2. BLipoprotein lipase
3. CHMG-CoA reductase
4. DAcyl-CoA cholesterol acyltransferase
Answer and explanation in LearnFree account
Question 20 · Easy
Oily spotting on her underwear, faecal urgency and flatulence trouble a woman two weeks after her doctor starts a weight-loss drug for a BMI of 32 kg/m2. Which drug is she most likely taking?
1. APhentermine
2. BOrlistat
3. CMetformin
4. DSemaglutide
Answer and explanation in LearnFree account
Question 21 · Easy
Bleeding gums, perifollicular haemorrhages and corkscrew hairs on the legs are seen in an elderly widower who lives alone on tea and biscuits. Which step of collagen synthesis is defective?
1. ACleavage of procollagen peptides
2. BHydroxylation of proline and lysine
3. CCross-linking of fibrils by lysyl oxidase
4. DGlycosylation of hydroxylysine
Answer and explanation in LearnFree account
Question 22 · Hard
Admitted to the surgical ward with severe colicky abdominal pain, a young woman has a soft abdomen, tachycardia, BP 160/100 mmHg, sodium 124 mmol/L and dark urine that darkens further on standing. A laparoscopy two years ago for similar pain was normal. This attack began a week after she started an oral contraceptive pill and a crash diet. Urinary porphobilinogen is markedly raised, and she is now becoming weak in the arms. Morphine has been given for the pain, and the surgeons are considering another laparoscopy. Which is the most appropriate specific treatment?
1. AIV haem arginate (hemin)
2. BIV phenobarbitone for agitation
3. COral cholestyramine
4. DRepeat diagnostic laparoscopy
Answer and explanation in LearnFree account
Question 23 · Medium
About hereditary haemochromatosis in adults: 1. Most cases are homozygous for the HFE C282Y mutation. 2. Transferrin saturation above 45% is the usual screening clue. 3. Iron chelation with deferasirox is first-line treatment. 4. Women usually present later than men. Which are correct?
1. A2, 3 and 4 only
2. B1, 2, 3 and 4
3. C1 and 3 only
4. D1, 2 and 4 only
Answer and explanation in LearnFree account
Question 24 · Easy
A daily-wage labourer from a maize-eating area has a scaly, darkly pigmented rash on sun-exposed skin, including a band around the neck, with diarrhoea and poor memory. Which vitamin is deficient?
1. AThiamine (vitamin B1)
2. BPyridoxine (vitamin B6)
3. CRiboflavin (vitamin B2)
4. DNiacin (vitamin B3)
Answer and explanation in LearnFree account
Question 25 · Medium
Facial flushing, diarrhoea and wheeze for a year, liver metastases on CT and a raised urinary 5-HIAA are known in a woman who now develops a photosensitive scaly rash and forgetfulness. Which mechanism causes her new rash?
1. AExcess histamine release
2. BZinc loss in diarrhoea
3. CDiversion of tryptophan to serotonin
4. DMalabsorption of riboflavin
Answer and explanation in LearnFree account

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Dyslipidaemia, obesity and nutrition in medicine

Three years after a Roux-en-Y gastric bypass, a woman who stopped her supplements has numb feet, glossitis and a macrocytic anaemia (MCV 112 fL). Which deficiency explains this?

A young adult with lifelong hyperphagia, obesity, short stature, small hands and feet, mild learning disability and hypogonadism is reviewed in the endocrine clinic. Neonatal records note severe hypotonia and poor feeding. Which genetic mechanism is most likely?

Difficulty seeing at dusk for months, with dry, foamy triangular spots on the temporal conjunctiva, is the complaint of a man with chronic calcific pancreatitis and steatorrhoea. Which vitamin is deficient?

For an Asian Indian adult, which BMI marks obesity under the 2009 Indian consensus guidelines?

Consider these statements about drugs for obesity: 1. Tirzepatide is a dual GIP and GLP-1 receptor agonist. 2. Orlistat acts centrally to suppress appetite. 3. Semaglutide slows gastric emptying and reduces appetite. 4. Phentermine is safe in uncontrolled hypertension. Which are correct?

Biochemistry in a woman who keeps purdah and has bone pain with a waddling gait: calcium 8.0 mg/dL (8.5-10.5), phosphate 2.1 mg/dL (2.5-4.5), alkaline phosphatase 410 U/L (40-130), PTH 142 pg/mL (10-65), 25-hydroxyvitamin D 6 ng/mL. X-ray shows Looser zones in the pubic rami. What is the diagnosis?

Burning pain in the hands and feet since adolescence, clusters of dark red papules around the umbilicus and thighs, reduced sweating and proteinuria of 1.8 g/day are found in a man whose maternal uncle needed dialysis at 40. Which enzyme is deficient?

Weekly semaglutide 2.4 mg is being considered for a man with a BMI of 34 kg/m2 and prediabetes. Which history is a contraindication to it?

Lipid profile of a schoolteacher: total cholesterol 380 mg/dL, LDL 290 mg/dL, HDL 46 mg/dL, triglycerides 120 mg/dL. He has thickened Achilles tendons and his father had a heart attack at 42. Thyroid and kidney function are normal. Which defect is most likely?

Severe hypophosphataemia develops two days after a starving man is given glucose-rich feeds. Which hormonal change drives the fall?

Which electrolyte abnormality is the hallmark of refeeding syndrome?

A man with coronary disease gets disabling muscle pain with three different statins, even at low doses, though his CK stays normal. His LDL remains above goal. Which oral drug, activated only in the liver, suits him?

Atorvastatin lowers LDL cholesterol mainly by inhibiting which enzyme?

Oily spotting on her underwear, faecal urgency and flatulence trouble a woman two weeks after her doctor starts a weight-loss drug for a BMI of 32 kg/m2. Which drug is she most likely taking?

Bleeding gums, perifollicular haemorrhages and corkscrew hairs on the legs are seen in an elderly widower who lives alone on tea and biscuits. Which step of collagen synthesis is defective?

About hereditary haemochromatosis in adults: 1. Most cases are homozygous for the HFE C282Y mutation. 2. Transferrin saturation above 45% is the usual screening clue. 3. Iron chelation with deferasirox is first-line treatment. 4. Women usually present later than men. Which are correct?

A daily-wage labourer from a maize-eating area has a scaly, darkly pigmented rash on sun-exposed skin, including a band around the neck, with diarrhoea and poor memory. Which vitamin is deficient?

Facial flushing, diarrhoea and wheeze for a year, liver metastases on CT and a raised urinary 5-HIAA are known in a woman who now develops a photosensitive scaly rash and forgetfulness. Which mechanism causes her new rash?