I85PREP
⌘ K
ABPS Integrative Medicine study materials
ABPS Integrative Medicine study resources

ABPS Integrative Medicine practice questions

One question at a time. Build your ABPS Integrative Medicine understanding.

First 50 of 200 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

Continue in the practice tool above to load more questions, 50 at a time.

Question 1Foundations of Integrative Medicine

Which statement best describes the defining premise of integrative medicine?

  1. It prioritizes cost reduction over individual patient preference
  2. It combines conventional and complementary approaches in a coordinated, patient-centered plan Correct answer.
  3. It replaces conventional care with traditional healing systems
  4. It restricts treatment to evidence-based pharmacotherapy alone

Explanation

Integrative medicine is defined by the deliberate combination of conventional and complementary modalities within a coordinated, whole-person plan of care. It does not discard conventional medicine but situates it alongside other approaches selected for the individual patient.

Question 2Foundations of Integrative Medicine

The biopsychosocial model differs from the traditional biomedical model chiefly because it:

  1. Treats psychological and social factors as active contributors to health Correct answer.
  2. Relies exclusively on patient-reported outcomes for diagnosis
  3. Excludes environmental exposures from clinical reasoning
  4. Explains disease solely through measurable biochemical pathways

Explanation

The biopsychosocial model treats biological, psychological, and social dimensions as interacting determinants of health and illness. The biomedical model, by contrast, centers on biological mechanisms.

Question 3Foundations of Integrative Medicine

In the placebo response, which element is most directly attributable to the patient-provider relationship and expectations?

  1. The pharmacologic half-life of the substance
  2. The contextual and expectancy effects surrounding treatment Correct answer.
  3. The randomization scheme of the trial
  4. The inert chemical structure of the tablet

Explanation

Placebo effects arise largely from contextual factors such as expectation, conditioning, and the quality of the therapeutic relationship. These are distinct from the intrinsic pharmacology of any agent.

Question 4Foundations of Integrative Medicine

A clinician uses a shared decision-making process with a patient choosing among treatment options. Which feature is essential to this process?

  1. Presenting the clinician's preferred option as the default
  2. Withholding uncertain information to reduce patient anxiety
  3. Eliciting patient values and discussing trade-offs transparently Correct answer.
  4. Deferring the entire decision to the patient without guidance

Explanation

Shared decision-making requires transparent discussion of options and their trade-offs combined with explicit elicitation of the patient's values and preferences. The clinician contributes expertise while the patient contributes goals and priorities.

Question 5Foundations of Integrative Medicine

Which concept best captures the integrative principle that the body has an inherent capacity to self-repair?

  1. Iatrogenesis
  2. Reductionism
  3. Homeostasis
  4. Vis medicatrix naturae Correct answer.

Explanation

Vis medicatrix naturae, the healing power of nature, is a foundational principle holding that the body possesses intrinsic self-healing capacity that clinicians should support. Homeostasis refers to physiological stability rather than this healing principle.

Question 6Foundations of Integrative Medicine

Which of the following best exemplifies a whole-systems research design as used in integrative medicine?

  1. A comparative trial of two complete multi-component treatment protocols Correct answer.
  2. A dose-ranging pharmacokinetic study
  3. A randomized trial of a single isolated herbal compound
  4. A cross-sectional survey of supplement use

Explanation

Whole-systems research evaluates complete, multi-component care models as they are actually practiced rather than isolating single ingredients. This design suits integrative modalities that are delivered as bundled interventions.

Question 7Foundations of Integrative Medicine

A patient reports improvement after starting a supplement but also began a new exercise program and improved sleep in the same period. Which reasoning error should the clinician most guard against?

  1. Attributing the improvement solely to the supplement Correct answer.
  2. Concluding that no intervention was effective
  3. Overestimating the reliability of objective measures
  4. Assuming the patient is misreporting symptoms

Explanation

When several changes occur simultaneously, isolating one as the cause is a post hoc attribution error. Integrative assessment considers the combined and interacting contributions of concurrent interventions.

Question 8Foundations of Integrative Medicine

Which term describes treatments used alongside conventional care that are not yet supported by strong evidence but are biologically plausible?

  1. Alternative
  2. Complementary Correct answer.
  3. Integrative
  4. Investigational

Explanation

Complementary therapies are used together with conventional care, in contrast to alternative therapies used in place of it. Integrative medicine describes the coordinated combination of both, while investigational refers to research-stage interventions.

Question 9Foundations of Integrative Medicine

Which statement about the relationship between integrative medicine and evidence-based practice is most accurate?

  1. Integrative medicine rejects evidence hierarchies in favor of tradition
  2. Integrative medicine applies evidence standards to all modalities, conventional and complementary Correct answer.
  3. Evidence standards apply only to pharmaceutical interventions
  4. Integrative medicine relies on anecdotal reports as its primary evidence base

Explanation

Integrative medicine holds all modalities, whether conventional or complementary, to comparable standards of evidence and safety. This consistency is central to its credibility and to informed patient choice.

Question 10Foundations of Integrative Medicine

A clinician wants to assess a patient's readiness to adopt lifestyle changes. Which approach aligns best with motivational principles used in integrative care?

  1. Setting a fixed protocol regardless of patient goals
  2. Waiting until the patient requests a specific intervention
  3. Confronting the patient about the risks of inaction
  4. Exploring the patient's own reasons for change without pressure Correct answer.

Explanation

Motivational approaches elicit the patient's own reasons and values for change rather than imposing them. This autonomy-supportive stance improves engagement and aligns with patient-centered integrative care.

Question 11Foundations of Integrative Medicine

Which best describes the role of the therapeutic alliance in integrative medicine outcomes?

  1. It substitutes for accurate diagnosis
  2. It only matters in mental health settings
  3. It is irrelevant once a biologically active treatment is chosen
  4. It is a nonspecific factor that can independently influence outcomes Correct answer.

Explanation

The therapeutic alliance is a nonspecific but powerful contributor to outcomes across conditions and specialties. Recognizing this helps clinicians understand why context and relationship matter in integrative care.

Question 12Foundations of Integrative Medicine

Which of the following is the best example of a reductionist versus a holistic approach to a chronic pain patient?

  1. Referring to a specialist versus managing in primary care
  2. Ordering an MRI versus performing a physical exam
  3. Prescribing opioids versus recommending physical therapy
  4. Evaluating only the affected joint versus assessing biological, psychological, and social contributors Correct answer.

Explanation

Reductionism narrows focus to a single component, whereas holism integrates multiple interacting domains of the patient's experience. The other pairings describe differences in modality or setting, not in conceptual framing.

Question 13Foundations of Integrative Medicine

The concept of 'salutogenesis' in integrative health refers to:

  1. The classification of symptoms
  2. The study of disease causation
  3. The origins of health and factors supporting well-being Correct answer.
  4. The process of medical diagnosis

Explanation

Salutogenesis, associated with Antonovsky, focuses on the origins of health and the resources that support well-being rather than on disease causation. It complements the integrative emphasis on resilience and health promotion.

Question 14Foundations of Integrative Medicine

Which best explains why integrative medicine emphasizes patient narrative and values alongside objective data?

  1. Narrative accounts replace laboratory testing
  2. Objective data are generally unreliable
  3. Illness meaning and context shape treatment response and adherence Correct answer.
  4. Values are irrelevant to clinical outcomes

Explanation

The meaning a patient assigns to illness and their values influence adherence, satisfaction, and response to care. Integrative practice integrates this narrative information with objective findings rather than replacing one with the other.

Question 15Foundations of Integrative Medicine

A clinician is considering a complementary therapy with plausible mechanism but limited human trials. Which action best reflects responsible integrative practice?

  1. Reject it outright without discussion
  2. Discuss the uncertainty, potential risks, and monitor outcomes Correct answer.
  3. Recommend it only if the patient does not mention it
  4. Recommend it as proven to reassure the patient

Explanation

Responsible practice involves transparent discussion of the evidence level, potential harms, and ongoing monitoring. This respects autonomy while maintaining safety and honesty.

Question 16Foundations of Integrative Medicine

Which statement best characterizes how integrative medicine views the placebo response in clinical care?

  1. It can be ethically leveraged through honest, positive context and rapport Correct answer.
  2. It should be eliminated from practice
  3. It proves that treatments are ineffective
  4. It requires deception to be effective

Explanation

Integrative practice recognizes that context, expectation, and rapport can enhance outcomes and seeks to use them honestly. This does not require deception and does not undermine the value of specific treatments.

Question 17Foundations of Integrative Medicine

Which of the following best defines 'patient-centered care' as used in integrative medicine?

  1. Care that respects and responds to individual patient preferences, needs, and values Correct answer.
  2. Care that avoids involving family members
  3. Care limited to the patient's stated chief complaint
  4. Care organized around the clinician's schedule and preferences

Explanation

Patient-centered care organizes treatment around the individual's preferences, needs, and values and ensures patient values guide clinical decisions. It is a defining commitment of integrative practice.

Question 18Foundations of Integrative Medicine

A researcher wants to compare an integrative multi-modality program to usual care in a real-world setting. Which design feature is most important to preserve the integrity of the intervention?

  1. Standardizing and documenting the full treatment protocol Correct answer.
  2. Restricting participants to a single diagnosis subtype
  3. Isolating a single active ingredient
  4. Eliminating practitioner variability entirely

Explanation

Whole-systems interventions must be standardized and thoroughly documented so the full multi-component protocol can be described and replicated. Isolating ingredients would defeat the purpose of evaluating the system as practiced.

Question 19Foundations of Integrative Medicine

Which statement about the historical development of integrative medicine is most accurate?

  1. It originated as a government-mandated reimbursement program
  2. It began as a single traditional healing tradition
  3. It developed partly in response to patient demand and dissatisfaction with fragmented care Correct answer.
  4. It emerged as a rejection of scientific method

Explanation

Integrative medicine grew in part from patient demand and concerns about fragmented, depersonalized care, while retaining scientific standards. It is not a rejection of science nor a single tradition.

Question 20Foundations of Integrative Medicine

Which best describes the concept of 'contextual effects' in integrative clinical practice?

  1. Effects that cannot influence clinical outcomes
  2. Effects arising from the circumstances and meaning of treatment delivery Correct answer.
  3. Effects attributable only to active drug molecules
  4. Effects that occur only in controlled trials

Explanation

Contextual effects arise from the circumstances of care, including setting, ritual, expectation, and relationship, and can meaningfully influence outcomes. They are distinct from the pharmacologic action of an agent.

Question 21Nutrition, Dietary Supplements, and Botanicals

Which vitamin is synthesized in the skin upon exposure to ultraviolet B radiation?

  1. Vitamin B12
  2. Vitamin K
  3. Vitamin C
  4. Vitamin D Correct answer.

Explanation

Ultraviolet B light converts 7-dehydrocholesterol in the epidermis into previtamin D3, which isomerizes to vitamin D3. This makes sunlight exposure the principal endogenous source of the vitamin. Vitamins C, K, and B12 must be obtained from diet or gut flora.

Question 22Nutrition, Dietary Supplements, and Botanicals

A patient asks which mineral is required for thyroid hormone synthesis. Which mineral should be identified?

  1. Iodine Correct answer.
  2. Zinc
  3. Iron
  4. Selenium

Explanation

Iodine is incorporated into thyroglobulin to form the iodothyronines T3 and T4, making it essential for thyroid hormone production. Deficiency leads to goiter and impaired neurodevelopment. Iron, zinc, and selenium support other enzymatic functions but are not structural components of thyroid hormone.

Question 23Nutrition, Dietary Supplements, and Botanicals

Which botanical is commonly associated with hepatotoxicity when taken as a concentrated extract?

  1. Chamomile
  2. Peppermint
  3. Ginger
  4. Comfrey Correct answer.

Explanation

Comfrey contains pyrrolizidine alkaloids, which are metabolized to reactive pyrroles that damage hepatic sinusoidal cells and can cause veno-occlusive disease. Internal use of comfrey preparations is therefore restricted. Peppermint, chamomile, and ginger are not associated with this pattern of liver injury.

Question 24Nutrition, Dietary Supplements, and Botanicals

Which dietary pattern is most characteristic of the Mediterranean diet?

  1. High intake of red meat with refined grains
  2. Predominance of olive oil, legumes, and fish Correct answer.
  3. Strict exclusion of all dietary fats
  4. Reliance on dairy as the primary protein source

Explanation

The Mediterranean pattern emphasizes olive oil as the main fat, abundant legumes, vegetables, fruits, whole grains, and moderate fish, with limited red meat. It is not a low-fat or dairy-dominant diet. These features underlie its cardiovascular benefit in trials such as PREDIMED.

Question 25Nutrition, Dietary Supplements, and Botanicals

Which supplement form provides the active coenzyme form of vitamin B6?

  1. Cyanocobalamin
  2. Pyridoxal-5-phosphate Correct answer.
  3. Pyridoxine hydrochloride
  4. Thiamine mononitrate

Explanation

Pyridoxal-5-phosphate is the phosphorylated coenzyme form of vitamin B6 that participates in transamination and decarboxylation reactions. Pyridoxine is a precursor requiring hepatic conversion. Cyanocobalamin and thiamine are different B vitamins entirely.

Question 26Nutrition, Dietary Supplements, and Botanicals

Which food source is richest in long-chain omega-3 fatty acids?

  1. Salmon Correct answer.
  2. Walnuts
  3. Flaxseed oil
  4. Soybean oil

Explanation

Fatty fish such as salmon supply preformed eicosapentaenoic acid and docosahexaenoic acid directly. Plant sources like flaxseed, walnuts, and soybean oil provide alpha-linolenic acid, which requires inefficient conversion to the longer-chain forms.

Question 27Nutrition, Dietary Supplements, and Botanicals

A patient on warfarin asks about starting a vitamin K supplement. What is the main concern?

  1. Vitamin K antagonizes warfarin's anticoagulant effect Correct answer.
  2. Vitamin K causes hyperkalemia with warfarin
  3. Vitamin K increases warfarin metabolism
  4. Vitamin K inhibits warfarin absorption

Explanation

Warfarin acts by blocking vitamin K epoxide reductase, so supplemental vitamin K can directly oppose its anticoagulant effect and lower the INR. Patients are usually advised to keep vitamin K intake consistent rather than to add supplements. The interaction is pharmacodynamic, not absorptive.

Question 28Nutrition, Dietary Supplements, and Botanicals

Which dietary component most strongly promotes non-heme iron absorption when consumed in the same meal?

  1. Tannins
  2. Vitamin C Correct answer.
  3. Calcium
  4. Phytic acid

Explanation

Ascorbic acid reduces ferric iron to the more absorbable ferrous form and chelates it, enhancing non-heme iron uptake. Calcium, phytates, and tannins inhibit absorption. Pairing plant iron sources with vitamin C–rich foods is a standard strategy.

Question 29Nutrition, Dietary Supplements, and Botanicals

A patient reports muscle pain and weakness while taking a statin and asks about coenzyme Q10. What is the rationale for this supplement?

  1. CoQ10 directly lowers LDL cholesterol
  2. CoQ10 reverses statin-induced liver injury
  3. CoQ10 prevents statin absorption
  4. Statins inhibit the mevalonate pathway shared by cholesterol and CoQ10 synthesis Correct answer.

Explanation

The mevalonate pathway produces both cholesterol and coenzyme Q10, so statin inhibition can reduce endogenous CoQ10. This provides a mechanistic rationale for supplementation in statin-associated muscle symptoms, though trial evidence is mixed. CoQ10 does not lower LDL or block statin absorption.

Question 30Nutrition, Dietary Supplements, and Botanicals

Which laboratory marker best reflects long-term iron stores?

  1. Hemoglobin
  2. Serum iron
  3. Ferritin Correct answer.
  4. Total iron-binding capacity

Explanation

Ferritin is an acute-phase protein that stores iron and correlates with body iron reserves, making it the preferred indicator of iron status. Serum iron and TIBC fluctuate diurnally and with recent intake. Hemoglobin falls only after stores are depleted.

Question 31Nutrition, Dietary Supplements, and Botanicals

A vegan patient has elevated homocysteine. Which nutrient deficiency is most likely contributory?

  1. Fluoride
  2. Vitamin A
  3. Vitamin E
  4. Vitamin B12 Correct answer.

Explanation

Vitamin B12 is a cofactor for methionine synthase, which remethylates homocysteine to methionine. Vegans are at risk of deficiency because B12 occurs naturally almost exclusively in animal foods. Folate deficiency can also raise homocysteine, but B12 is the key concern in this population.

Question 32Nutrition, Dietary Supplements, and Botanicals

Which herbal supplement is most likely to increase bleeding risk in a patient taking an anticoagulant?

  1. Ginkgo biloba Correct answer.
  2. Echinacea
  3. Saw palmetto
  4. Valerian

Explanation

Ginkgo biloba inhibits platelet-activating factor and has been associated with bleeding events, so it warrants caution with anticoagulants and antiplatelets. Echinacea, valerian, and saw palmetto are not recognized antiplatelet agents. Counseling should include bleeding precautions.

Question 33Nutrition, Dietary Supplements, and Botanicals

A patient with hypertension asks about potassium supplementation. Which concurrent medication most increases the risk of hyperkalemia?

  1. Amlodipine
  2. Lisinopril Correct answer.
  3. Furosemide
  4. Hydrochlorothiazide

Explanation

ACE inhibitors such as lisinopril reduce aldosterone-mediated potassium excretion, so adding potassium supplements can cause hyperkalemia. Thiazide and loop diuretics increase potassium loss, and amlodipine has little effect on potassium balance. Monitoring is essential with renin-angiotensin blockade.

Question 34Nutrition, Dietary Supplements, and Botanicals

Which dietary fiber type is most effective for lowering LDL cholesterol?

  1. Insoluble cellulose
  2. Resistant starch alone
  3. Wheat bran
  4. Soluble viscous fiber such as beta-glucan Correct answer.

Explanation

Soluble viscous fibers like beta-glucan bind bile acids and increase their fecal excretion, forcing hepatic cholesterol use and lowering LDL. Insoluble fibers such as cellulose and wheat bran primarily add bulk. Resistant starch has less consistent LDL-lowering effect.

Question 35Nutrition, Dietary Supplements, and Botanicals

A patient taking levothyroxine asks about calcium supplements. What timing advice is appropriate?

  1. Take calcium one hour after levothyroxine
  2. Separate calcium from levothyroxine by at least four hours Correct answer.
  3. Stop calcium entirely while on levothyroxine
  4. Take calcium and levothyroxine together for convenience

Explanation

Calcium binds levothyroxine in the gut and reduces its absorption, so doses should be separated by at least four hours. This is a chelation-type interaction, not a reason to abandon calcium. Similar separation applies to iron and aluminum antacids.

Question 36Nutrition, Dietary Supplements, and Botanicals

Which supplement is the standard first-line pharmacologic treatment for vitamin D deficiency?

  1. Vitamin D-fortified milk alone
  2. Calcitriol
  3. Ergocalciferol or cholecalciferol Correct answer.
  4. Calcium carbonate

Explanation

Vitamin D deficiency is corrected with ergocalciferol (D2) or cholecalciferol (D3), which raise 25-hydroxyvitamin D stores. Calcitriol is the active hormone reserved for specific conditions such as renal failure. Fortified milk alone rarely provides enough to correct deficiency.

Question 37Nutrition, Dietary Supplements, and Botanicals

Which botanical is best supported by evidence for mild-to-moderate depression?

  1. Feverfew
  2. St. John's wort Correct answer.
  3. Garlic
  4. Echinacea

Explanation

St. John's wort has been studied extensively for mild-to-moderate depression with results suggesting benefit, though it has significant drug interactions via CYP3A4 and P-glycoprotein induction. Garlic, echinacea, and feverfew address different indications. Its interaction profile requires careful medication review.

Question 38Nutrition, Dietary Supplements, and Botanicals

A patient on a proton pump inhibitor has low magnesium. What is the most likely mechanism?

  1. PPIs directly chelate magnesium
  2. PPIs increase renal magnesium excretion
  3. PPIs reduce dietary magnesium intake
  4. Reduced gastric acid impairs intestinal magnesium absorption Correct answer.

Explanation

Gastric acid facilitates the solubilization and absorption of magnesium, so prolonged acid suppression can lower serum magnesium. This is a recognized class effect requiring periodic monitoring. PPIs do not chelate magnesium or directly increase renal losses.

Question 39Nutrition, Dietary Supplements, and Botanicals

Which preparation method best preserves water-soluble vitamins in vegetables?

  1. Boiling in large volumes of water
  2. Steaming until tender-crisp Correct answer.
  3. Deep-frying at high heat
  4. Prolonged soaking before cooking

Explanation

Steaming minimizes leaching and heat exposure, preserving water-soluble vitamins such as vitamin C and folate. Boiling in large volumes leaches these vitamins into the cooking water, and prolonged soaking also causes loss. Deep-frying adds fat and degrades heat-sensitive nutrients.

Question 40Nutrition, Dietary Supplements, and Botanicals

A patient with chronic kidney disease asks about a high-potassium salt substitute. What is the main risk?

  1. Hypocalcemia
  2. Metabolic alkalosis
  3. Hyperkalemia Correct answer.
  4. Hyponatremia

Explanation

Salt substitutes replace sodium chloride with potassium chloride, so patients with impaired renal potassium excretion can develop dangerous hyperkalemia. This is especially concerning with concurrent ACE inhibitors or potassium-sparing diuretics. Sodium restriction should be achieved through other means.

Question 41Nutrition, Dietary Supplements, and Botanicals

Which nutrient is most commonly deficient in patients after bariatric surgery?

  1. Vitamin K
  2. Vitamin B12 Correct answer.
  3. Fluoride
  4. Vitamin C

Explanation

Reduced gastric acid and intrinsic factor production after bariatric surgery impair vitamin B12 absorption, making deficiency common; iron and other micronutrients are also affected. Lifelong monitoring and supplementation are standard. Vitamin C, fluoride, and vitamin K are less consistently implicated.

Question 42Nutrition, Dietary Supplements, and Botanicals

A patient with a history of calcium oxalate stones asks about vitamin C supplementation. What is the concern?

  1. Vitamin C increases urinary oxalate Correct answer.
  2. Vitamin C binds dietary calcium
  3. Vitamin C causes hypercalcemia
  4. Vitamin C reduces citrate excretion

Explanation

High-dose vitamin C can be metabolized to oxalate, raising urinary oxalate and increasing calcium oxalate stone risk in susceptible patients. Modest dietary intake is generally acceptable. The concern is metabolic conversion, not calcium binding or citrate effects.

Question 43Nutrition, Dietary Supplements, and Botanicals

Which mechanism explains why grapefruit juice raises serum levels of certain medications?

  1. Induction of hepatic CYP3A4
  2. Inhibition of intestinal CYP3A4 Correct answer.
  3. Increased gastric pH
  4. Enhanced renal tubular secretion

Explanation

Furanocoumarins in grapefruit juice inhibit intestinal CYP3A4, reducing first-pass metabolism and increasing systemic exposure to susceptible drugs. This is an inhibition, not induction, and occurs primarily in the gut wall. The effect can persist for hours to days after ingestion.

Question 44Nutrition, Dietary Supplements, and Botanicals

A patient on a strict ketogenic diet develops fatigue and constipation. Which nutritional consideration best explains these symptoms?

  1. Overhydration with sodium loss
  2. Inadequate fiber and fluid intake with electrolyte shifts Correct answer.
  3. Excessive carbohydrate intake
  4. Excess dietary protein

Explanation

Very-low-carbohydrate diets often reduce fiber-rich foods and cause natriuresis with electrolyte loss, leading to constipation and fatigue. Adequate nonstarchy vegetables, fluids, and electrolytes mitigate these effects. Excess carbohydrate would contradict ketosis, and overhydration is not typical.

Question 45Nutrition, Dietary Supplements, and Botanicals

A patient taking warfarin wants to use fish oil for triglycerides. What is the main pharmacodynamic concern?

  1. Induction of vitamin K synthesis
  2. Additive antiplatelet effect increasing bleeding risk Correct answer.
  3. Inhibition of CYP2C9
  4. Reduction of warfarin absorption

Explanation

High-dose omega-3 fatty acids can reduce platelet aggregation and, combined with warfarin, may increase bleeding risk. The concern is additive pharmacodynamic effect rather than altered warfarin pharmacokinetics. Monitoring for bleeding and INR stability is prudent.

Question 46Nutrition, Dietary Supplements, and Botanicals

Which vitamin is synthesized in the skin upon exposure to ultraviolet B (UVB) radiation from sunlight?

  1. Vitamin D Correct answer.
  2. Vitamin C
  3. Vitamin A
  4. Vitamin K

Explanation

UVB radiation converts 7-dehydrocholesterol in the skin to previtamin D3, which isomerizes to vitamin D3. Vitamins A, C, and K are not synthesized in the skin in response to sunlight.

Question 47Nutrition, Dietary Supplements, and Botanicals

A patient with a history of calcium oxalate kidney stones asks about taking a high-dose vitamin C supplement. Which concern is most relevant?

  1. Vitamin C increases urinary oxalate excretion Correct answer.
  2. Vitamin C increases intestinal calcium absorption
  3. Vitamin C reduces urinary citrate levels
  4. Vitamin C directly precipitates calcium in the kidneys

Explanation

Vitamin C (ascorbic acid) is metabolized to oxalate, and high doses can increase urinary oxalate, raising the risk of calcium oxalate stone formation. It does not directly precipitate calcium or increase intestinal calcium absorption.

Question 48Nutrition, Dietary Supplements, and Botanicals

Which B vitamin is required as a cofactor for the conversion of homocysteine to methionine?

  1. Thiamine
  2. Folate Correct answer.
  3. Riboflavin
  4. Pantothenic acid

Explanation

Folate, in the form of 5-methyltetrahydrofolate, donates a methyl group to homocysteine to regenerate methionine, a reaction also requiring vitamin B12. Thiamine, riboflavin, and pantothenic acid are not directly involved in this methylation cycle.

Question 49Nutrition, Dietary Supplements, and Botanicals

A patient with type 2 diabetes asks about using cinnamon to improve glycemic control. Which statement best reflects the evidence?

  1. Cinnamon is contraindicated in diabetes because it raises blood glucose.
  2. Cinnamon reliably lowers HbA1c by at least 1% in most patients.
  3. Cinnamon has no effect on blood glucose in any form.
  4. Cinnamon may modestly lower fasting glucose, but evidence is inconsistent and it should not replace medication. Correct answer.

Explanation

Clinical trials of cinnamon in diabetes have shown inconsistent and generally modest effects on fasting glucose and HbA1c, with heterogeneity in preparations and doses. It is not a substitute for pharmacologic therapy, and safety data support its use as a supplement with caution.

Question 50Nutrition, Dietary Supplements, and Botanicals

A patient with chronic kidney disease and hyperkalemia asks about using a salt substitute containing potassium chloride. What is the primary concern?

  1. It may cause hyperkalemia and cardiac arrhythmias. Correct answer.
  2. It may cause hypokalemia due to renal wasting.
  3. It may increase sodium retention and worsen hypertension.
  4. It may impair absorption of fat-soluble vitamins.

Explanation

Potassium chloride salt substitutes can significantly increase potassium intake. In patients with impaired renal potassium excretion, this can precipitate hyperkalemia and dangerous arrhythmias. They do not cause hypokalemia, are not a source of sodium, and do not affect fat-soluble vitamin absorption.