560E Nutr Assesment - my tests Flashcards
Which of the government guidelines is the nutrient intake level sufficient to meet the nutrient requirements of approximately 97% of people in a given sex/age group?
Recommended Dietary Allowance (RDA)
What measurement allows the nutritional quality of foods to be easily evaluated?
Nutrient density
What phenotypes have been identified with specific genetic polymorphisms?
Bone loss
Blood pressure
Inflammation
DRI’s were developed to address…
Chronic disease risk
Name 3 major themes in the 2010 Dietary Guidelines for Americans
Balancing calories to manage weight
Foods and nutrients to increase
Foods and food components to reduce
What is the most accurate statement describing the impact of single gene polymorphisms (SNPs) on phenotype?
Nutrients may alter the action of SNPs.
The primary purpose of the food exchange system is
To control energy consumption.
The New American Plate was developed by the American Institute for Cancer Research and the World Cancer Research Fund to emphasize ___________.
Plant foods
The UL for a particular nutrient describes…
the level above which the nutrient has a risk of adverse effects.
Nutritional Assessment methods include:
“ABCs”
Anthropometric
Biochemical
Clinical
Name 3 techniques for measuring dietary intake:
24-hour recall
Food diary
Diet History
A problem with the 24-Hour Recall is that
underreporting and/or overreporting can occur
An advantage of the Food Record over the 24-Hour Recall is that
it does not depend on memory
A limitation of Food Frequency Questionnaires is that
it may not represent usual foods or portion sizes chosen by respondents
A strength of the Diet History is that
it assesses usual nutrient intake
A well-known biological marker for verifying reported protein intake is
an analysis of nitrogen in a 24-hour urine specimen
True or False: An accurate dietary assessment can be the sole criterion on which to base nutritional recommendations for an individual.
FALSE
The fact that some nutrients are missing from the USDA database used in computerized dietary analysis systems
can result in falsely low nutrient values when evaluating dietary intake
Most high-quality computerized dietary analysis systems contain food composition data from
USDA plus non-USDA sources
The generally accepted normal range for BMI is
18.5-24.9
A waist circumference of 38 inches in an adult female
indicates an increased risk for type 2 diabetes
A disadvantage of assessing weight with BMI is that
BMI can be elevated for reasons other than excess fat
A tricep skinfold measures
subcutaneous fat
A disadvantage of Bioelectrical Impedance is
• electrical current is transmitted most rapidly by fat.
• dehydration will overestimate fat mass.
• it is invasive to the patient.
• it is a slow procedure.
dehydration will overestimate fat mass.
3 factors that contribute to total energy expenditure are
• REE, physical activity, thermic effect of food.
• BMR, REE, physical activity.
• BMR, REE, adaptive thermogenesis.
• BMR, RMR, physical activity.
• REE, physical activity, thermic effect of food.
In the article, Fat: an evolving issue, Speakman and O’Rahilly, cite evidence that
• obesity is primarily a result of decreased physical activity.
• genetics has no impact on obesity.
• interactions between genes and environment complicate the understanding of causes of obesity.
• positive energy balance is the only explanation required to explain the increase in obesity.
interactions between genes and environment complicate the understanding of causes of obesity.
Determination of body density by under-water weighing allows estimation of • BMR. • bone mass. • BMI. • body fat.
body fat.
According to the article, Inflammation as a link between obesity, metabolic syndrome and type 2 diabetes, which of the following is an accurate statement?
• Insulin resistance is an autoimmune condition.
• Obesity induces inflammation.
• Obesity is a result of inflammation.
• Obesity results in a marked decrease of tumor necrosis factor alpha (TNFalpha).
Obesity induces inflammation.
Which of the following assessments would not be indicated on an initial assessment of the obese patient? • lipid profile • blood pressure measurement • fasting blood glucose • serum calcium measurement
serum calcium measurement
T/F: Clinical findings are extremely important in nutritional assessment because, when present, they are specific for a particular nutrient deficiency.
FALSE
The most probable cause of edema in an individual would be • calcium deficiency. • vitamin A deficiency. • vitamin C deficiency. • protein deficiency.
protein deficiency.
A decrease in taste sensation would most likely indicate a deficiency of • zinc. • protein. • vitamin C. • vitamin K.
zinc
During a medical history, Martha indicates that she is a vegan and that she does not take supplements because she cannot swallow pills. What would be the most likely nutrient deficiency for her to have? • vitamin C • vitamin B12 • folic acid • magnesium
vitamin B12
What is the most likely explanation for a low level of all essential amino acids in a blood specimen? • toxicity from chemicals • inadequate protein digestion • steroid use • vitamin B6 deficiency
inadequate protein digestion
Which of the following would not be an indication of bulimia?
• eating small amounts of food several times a day
• eating a very large amount of food in a discrete period of time
• dental erosion
• asymmetrical parotid gland enlargement
eating small amounts of food several times a day
Assessment of the aromatic amino acids phenylalanine, tyrosine, and tryptophan can provide information regarding • neurotransmitter metabolism. • muscle catabolism. • collagen synthesis. • glutathione synthesis.
neurotransmitter metabolism.
Which of the following is true about serum albumin levels?
• Its short half-life allows for rapid response to nutritional changes.
• Protein status is the only factor that affects serum concentration.
• It must be measured in the fasting state.
• Dehydration results in increased serum concentration.
Dehydration results in increased serum concentration.
A "flag-sign" observed in the hair would be most likely associated with • vitamin C deficiency. • protein deficiency. • vitamin D deficiency. • essential fatty acid deficiency.
protein deficiency.
The most likely nutrient deficiency to be observed in an alcoholic is • sodium. • fat. • iron. • thiamin.
thiamin
Urine is primarily • urea. • uric acid. • water. • solute.
water.
Which of the following would be expected to decrease the pH of urine?
• allowing the specimen to sit for several hours at room temperature
• ingesting large quantities of meat
• ingesting large quantities of fruits and vegetables
• ingesting antacids
ingesting large quantities of meat
The most sensitive indicator of kidney malfunction is • specific gravity. • nitrites. • crystals. • protein.
protein
Ketonuria would be most likely found in • a dilute urine. • an individual on the Atkins diet. • an individual with renal disease. • an individual with well-controlled Type II diabetes.
an individual on the Atkins diet.
Microscopic exam of urine sediment provides the most useful information about • the urinary system. • metabolic acidosis. • dietary intake. • recent drug use.
the urinary system.
Which of the following is present in filtrate, but is normally reabsorbed through the renal tubules so is not present in urine? • uric acid • potassium ions • hydrogen ions • amino acids
amino acids
Urine that is pale and nearly colorless would be most likely observed • in a first morning specimen. • when glucose is positive. • when bilirubin is positive. • when leukocyte esterase is positive.
when glucose is positive.
Which of the following best describes an organic acid?
• product of metabolism that can be used to identify nutrient deficiencies
• essential nutrient
• toxin that must be excreted
• compound synthesized in the GI tract that is necessary for digestion
product of metabolism that can be used to identify nutrient deficiencies
The best assessment of glomerular filtration rate is • urea nitrogen • examination of urinary sediment • serum creatinine • nitrates
serum creatinine
In which area has urinary organic acid assessment been the most useful? • diagnosing cancer • detecting a kidney infection • confirming a heart attack • detecting dysbiosis
detecting dysbiosis
An increase in expired hydrogen after an oral dose of lactose indicates • a lack of pancreatic lipase. • a lack of intrinsic factor. • a lack of intestinal lactase. • a lack of intestinal peptidase.
a lack of intestinal lactase.
Gastric colonization with \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ is strongly correlated with duodenal and gastric ulcers. • E. coli • Staph aureus • Helicobacter pylori • Bifidus regularis
Helicobacter pylori
Bacterial overgrowth in the small intestine could be diagnosed by
• bacterial count of at least 103/ml in an intestinal fluid aspirate.
• achlorhydria.
• positive AGA antibodies.
• excess exhalation of 14CO2 after an oral dose of 14C-xylose.
excess exhalation of 14CO2 after an oral dose of 14C-xylose.
Bacterial fermentation in the large intestine produces beneficial • glycoproteins. • pectins. • short-chain fatty acids. • branched-chain amino acids.
short-chain fatty acids.
Digestive enzymes most likely to be diminished in the presence of small intestine mucosal inflammation are • disaccharidases. • amylase. • lipase. • pepsin.
disaccharidases
Which symptom would be least likely to occur in an individual with malabsorption? • steatorrhea • weight loss • weight gain • anemia
weight gain
The most common test used to confirm malabsorption assesses • serum gastrin. • fecal fat. • exhaled hydrogen. • serum B12.
fecal fat.
Medium-chain triglycerides (MCTs) can be helpful in nourishing those with inflammatory bowel disease because
• MCTs are absorbed through the stomach.
• MCTs are absorbed directly into portal blood.
• MCTs reach the lymphatic system rapidly.
• MCTs are prebiotics.
MCTs are absorbed directly into portal blood.
A decreased fecal elastase is most strongly correlated with • celiac disease. • lactose intolerance. • pernicious anemia. • pancreatic insufficiency.
pancreatic insufficiency.
A positive anti-gliadin antibody (AGA) and anti-endomysial antibody (EMA) are nearly 100% diagnostic of • bacterial overgrowth. • celiac disease. • Crohn's disease. • Zollinger-Ellison syndrome.
celiac disease.
Consistent blood glucose control in diabetes
• delays the onset and slows the progression of complications.
• is primarily appropriate for Type 1 diabetes.
• offers no advantage over less stringent control in terms of delaying or slowing complications.
• is primarily appropriate for Type 2 diabetes.
delays the onset and slows the progression of complications.
T/F: Autoantibodies are most commonly associated with type 1 diabetes.
TRUE
The best screening test for diabetes is • measurement of urine glucose. • measurement of fasting plasma glucose. • a 5 hour glucose tolerance test. • measurement of urine ketones.
measurement of fasting plasma glucose.
A fasting plasma glucose value greater than 100 mg/dl, but less than 126 mg/dl indicates • a normal blood glucose. • Type 1 diabetes. • Type 2 diabetes. • impaired fasting glucose.
impaired fasting glucose.
The major benefit of measuring glycosylated hemoglobin is
• it gives information about glucose levels at the precise moment the blood specimen is drawn.
• it is only elevated in Type 1 diabetes.
• it reflects average blood glucose levels during the past 8 to 12 weeks.
• it is only elevated in Metabolic Syndrome.
it reflects average blood glucose levels during the past 8 to 12 weeks.
Nutritional recommendations for individuals with diabetes
• follow strict guidelines developed by the American Diabetes Association.
• should include a large amount of simple sugar to prevent hypoglycemia during treatment.
• should exclude all simple carbohydrates from the diet.
• should be based on nutritional assessment of each individual.
should be based on nutritional assessment of each individual.
A BMI greater than 25 would most likely be observed
• in a Type 1 diabetic.
• in a Type 2 diabetic.
• in all diabetics.
• when fasting plasma glucose levels are greater than 200 mg/dl.
in a Type 2 diabetic.
Ketosis is more likely to be observed • in a Type 1 diabetic. • in a Type 2 diabetic. • in Syndrome X. • when glycosylated hemoglobin is below 7%.
in a Type 1 diabetic.
The lack of insulin in Type 1 diabetes is associated with all of the following except • increased protein catabolism. • glycosuria. • increased glucose use. • dehydration.
increased glucose use.
Hyperinsulinemia • is observed in type 1 diabetes. • is associated with weight gain. • is associated with weight loss. • is extremely rare.
is associated with weight gain.
Every lipoprotein contains all of the following except • triglyceride. • cholesterol. • enzymes. • protein.
enzymes.
As an individual’s HDL increases, their risk of myocardial infarction
• remains constant.
• increases.
• decreases.
decreases
According to the most recent report by the National Cholesterol Education Program (Adult Treatment Panel III or ATP III), presence of major CHD risk factors should
• lower the value for LDL cholesterol goals.
• raise the value for LDL cholesterol goals.
• lower the value for HDL cholesterol goals.
• raise the value for HDL cholesterol goals.
lower the value for LDL cholesterol goals.
T/F: According to “The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure”, individuals with a systolic blood pressure of 120-139 mmHg or a diastolic blood pressure of 80-89 mmHg should be considered as prehypertensive and require health-promoting lifestyle modifications to prevent CVD.
TRUE
A fasting specimen is most important for accurate measurement of • cholesterol. • triglyceride. • HDL. • C-reactive protein.
triglyceride
According to the article, A New Perspective on Cardiovascular Disease,
• current ATP III are the best strategy for identifying cardiovascular risk.
• cardiovascular disease is a result of a normal protective response to an insult to endothelium.
• the most effective strategy for decreasing risk of cardiovascular disease is to raise HDL.
• there are between 3 and 5 stressors that can increase risk of cardiovascular disease.
cardiovascular disease is a result of a normal protective response to an insult to endothelium.
Which of the following is not a clinical determinant of the metabolic syndrome? • high-risk waist circumference • elevated serum triglyceride level • elevated serum HDL-C level • elevated plasma glucose level
elevated serum HDL-C level
Initiation of the atherogenic process may begin in response to some form of endothelial injury. This injury is most likely to result from • reduced LDL particles. • oxidized LDL particles. • reduced HDL particles. • large LDL particles.
oxidized LDL particles.
According to ATP III, major coronary heart disease risk factors include all of the following except
• hypertension
• diabetes mellitus
• current cigarette smoking
• high levels of chylomicrons in the blood.
high levels of chylomicrons in the blood.
A relationship has been demonstrated between large VLDL size, small LDL size, small HDL size and • decreased caloric intake. • decreased saturated fat intake. • increased fiber intake. • insulin resistance.
insulin resistance.
Which condition would be expected to cause the largest increase in alanine aminotransferase (ALT)? • cirrhosis • hepatitis • pancreatitis • obstructive jaundice
hepatitis
T/F: An elevation of aspartate aminotransferase (AST) is specific for liver disease.
FALSE
In patients with jaundice, direct hyperbilirubinemia would most likely occur with • gallstones • hepatitis • Tylenol overdose • hemolysis
gallstones
Cirrhosis of the liver can cause an increased APTT because
•cirrhosis causes an increased production of heparin.
•cirrhosis causes decreased absorption of vitamin K.
•cirrhosis causes decreased platelet production.
•cirrhosis causes decreased production of coagulation factors.
cirrhosis causes decreased production of coagulation factors.
Increased blood ammonia levels correlate most closely with
• decreased alanine aminotransferase (ALT).
• increased alanine aminotranserase (ALT).
• decreased alkaline phosphatase (ALP).
• decreased gamma-glutamyl transpeptidase (GGT).
increased alanine aminotranserase (ALT).
The most sensitive indicator of chronic alcohol ingestion is • GGT • AST • ALT • ALP
GGT
Of the following choices, the serum elevation most specific for liver dysfunction is • AST. • ALT. • ALP. • bilirubin.
ALT.
When jaundice is observed in an individual, it is important to differentiate whether the jaundice is primarily a result of direct (conjugated) or indirect (unconjugated) bilirubin. The best explanation for this is
• When liver cells are damaged, they lose the ability to conjugate.
• When unconjugated bilirubin is increased, this rules out red blood cell damage.
• When unconjugated bilirubin is increased, this confirms obstruction of the extrahepatic ducts.
• Only cirrhosis causes an increase in unconjugated bilirubin.
When liver cells are damaged, they lose the ability to conjugate.
Elevated pyroglutamate in urine may indicate depletion of • vitamin K. • Phase I activity. • glutathione. • glucaric acid.
glutathione
When Phase I and Phase II liver detoxification pathways are actively working to rid the body of toxins, the most likely observation would be • high urinary orotate. • low urinary orotate. • high urinary glucarate. • low urinary glucarate.
high urinary glucarate.
In a normally functioning hypothalamus-pituitary-adrenal (HPA) system, it is expected that increasing cortisol levels would result in ______________.
• a negative feedback that increases ACTH
• a negative feedback that increases CRH
• a negative feedback that decreases ACTH
• a positive feedback that increases ACTH
a negative feedback that decreases ACTH
An elevated TSH would most likely indicate • a hyperactive thyroid. • a hypoactive thyroid. • hyperactive adrenals. • hypoactive adrenals.
a hypoactive thyroid.
Which of the following conditions would be MOST LIKELY to be associated with decreased activity of the hypothalamic-pituitary-adrenal (HPA) axis? • Cushing syndrome • Diabetes mellitus • Chronic fatigue syndrome • Hyperthyroidism
Chronic fatigue syndrome
The most appropriate interpretation of a salivary cortisol is obtained___________.
• from a specimen that has been collected in the early morning
• from a specimen that has been collected between 11:00PM and midnight
• from a specimen collected at noon
• from specimens collected throughout the day
from specimens collected throughout the day
Chronic stress can result in all of the following EXCEPT: • increased salivary cortisol. • insulin resistance. • visceral obesity. • increased TSH.
increased TSH.
Which nutritional deficiency is most often associated with hypothyroidism? • vitamin B12 • iodine • copper • calcium
iodine
The most biologically active thyroid hormone is • T3. • free T3. • T4. • free T4.
free T3.
The MOST APPROPRIATE interpretation of a normal TSH, normal T4, decreased T3 is:
• Hypothyroidism
• Decreased conversion of T4 to T3 due to extra-thyroidal factors
• Compensated hyperthyroidism
• Lab error
Decreased conversion of T4 to T3 due to extra-thyroidal factors
Antithyroid peroxidase antibodies are closely linked with • poor conversion of T4 to T3. • decreased TSH. • hypothyroidism. • iodine deficiency.
hypothyroidism.
All of the following are appropriate strategies to suggest to someone with chronically high cortisol levels that appear to be the result of chronic stress EXCEPT
• maintain a healthy diet.
• engage in regular moderate activity.
• engage in strenuous activity.
engage in strenuous activity.
The best measurement to assess cellular stores of vitamin C is • plasma vitamin C level. • leukocyte vitamin C level. • urinary vitamin C level. • erythrocyte vitamin C level.
leukocyte vitamin C level.
According to Cannell and Hollis, which statement is true regarding vitamin D status?
• Vitamin D deficiency should only be suspected in those with symptoms of rickets.
• Only children are at risk for vitamin D deficiency.
• Virtually everyone has a chronic vitamin D deficiency.
• Only the elderly are at risk for vitamin D deficiency.
Virtually everyone has a chronic vitamin D deficiency.
Which of the following nutrients would have the LEAST effect on a TBARS level? • vitamin C. • vitamin E. • Coenzyme Q. • vitamin B6.
vitamin B6.
Which test result would you most expect in an individual that presents with bleeding gums and easy bruising? • decresased plasma ascorbate • increased plasma ascorbate • decreased pyridoxal phosphate • increased pyridoxal phosphate
decresased plasma ascorbate
Measurement of urinary xanthurenate would best assess \_\_\_\_\_. • thiamin • niacin • riboflavin • vitamin B6
vitamin B6
The level of serum vitamin A
• is never measured.
• is never an accurate reflection of A status.
• is an accurate reflection of a toxic excess of vitamin A.
• is only accurate when performed on a fasting specimen.
is an accurate reflection of a toxic excess of vitamin A.
Functional tests which assess oxidative changes in lipids may be used to assess vitamin \_\_\_\_\_\_ status. • A • D • E • K
E
Which of the following conditions or diseases are known to be caused by a deficiency of the same nutrient?
• osteomalacia and rickets
• xerophthalmia and breath pentane release
• kwashiorkor and fibrocystic breast disease
• hemolytic anemia and megaloblastic anemia
osteomalacia and rickets
Plasma concentration of \_\_\_\_\_\_\_\_ seems to offer the best index of vitamin D status. • 1,24,25-(OH)3 D3 • 1,25-(OH)2 D3 • 25-OH D3 • cholecalciferol
25-OH D3
Morphological changes in epithelial cells would most likely indicate a deficiency of vitamin • A. • D. • E. • K.
A
Which of the following activities is shared by vitamin B12 and folate?
• Both are required for nucleic acid synthesis.
• Both are considered problem nutrients for strict vegetarians.
• Both are found in significant amounts in green leafy vegetables.
• Both require intrinsic factor for their release from food proteins.
Both are required for nucleic acid synthesis.
It is especially important for women of child-bearing age to consume adequate folate because
• they are a high risk group for developing anemia.
• it can decrease the risk of hemolysis in a fetus.
• it can decrease the risk of spina bifida in a fetus.
• it can decrease the risk of pernicious anemia in a fetus.
it can decrease the risk of spina bifida in a fetus.
Which of the following is required for the absorption of dietary vitamin B12? • bile • lipase • intrinsic factor • folate
intrinsic factor
What is the most common treatment for pernicious anemia?
• injection of cobalamin
• topical administration of liver extract
• oral supplements of B-vitamin complex
• a diet high in liver and green leafy vegetables
injection of cobalamin
It is important to detect pernicious anemia early because
• it can lead to birth defects.
• it can lead to irreversible neuropathy.
• it can lead to blindness.
• it can lead to a dangerous increase in xanthurenic acid.
it can lead to irreversible neuropathy.
An expected MCV for pernicious anemia would be
• below normal.
• normal.
• above normal.
above normal.
Folate supplements may mask the anemia due to a vitamin B12 deficiency.
TRUE
Serum folate levels reflect • folate tissue status. • liver folate stores. • bone marrow folate levels. • recent dietary intake.
recent dietary intake.
Which statement is the most accurate?
• It is almost impossible to differentiate B12 and folate deficiency.
• There is an inverse relationship between vitamin B12 and methylmalonic acid.
• There is an inverse relationship between folate and methylmalonic acid.
• Measurement of homocysteine is a more specific indicator of B12 status than methylmalonic acid.
There is an inverse relationship between vitamin B12 and methylmalonic acid.
The most common cause of B12 deficiency is • inadequate intake. • atrophic gastritis. • multiple pregnancies. • oral contraceptive use.
atrophic gastritis.
The association between serum calcium levels and dietary calcium intake can best be described as
• a strong positive correlation.
• a strong negative correlation.
• virtually no correlation.
virtually no correlation.
A low serum calcium level can best be explained by
• hyperparathyroidism.
• hypoalbuminemia.
• failure to include dairy products in the diet.
• excessive intake of vitamin D.
hypoalbuminemia
When measuring serum magnesium,
• lysis of red blood cells will cause a falsely low result.
• lysis of red blood cells will cause a falsely high result.
• lysis of red blood cells will have no effect on the result.
• lysis of red blood cells is desirable because magnesium is primarily an intracellular ion.
lysis of red blood cells will cause a falsely high result.
The correct test to perform to determine physiologically active calcium is • ionized calcium. • fasting calcium. • total calcium. • protein-bound calcium.
ionized calcium.
The only way to diagnose osteoporosis and determine risk of future fractures is
• 2-3 serum calcium measurements performed on different days.
• a calcium level determined on a 24-hour urine specimen.
• measurement of serum PTH.
• bone mineral density test.
bone mineral density test.
Zinc deficiency is most likely present if
• urinary zinc levels are lower than expected.
• serum zinc levels are lower than expected.
• serum zinc and metallothionen are both below expected levels.
• serum zinc is below expected levels, but metallothionen is above expected levels.
serum zinc and metallothionen are both below expected levels.
Evaluating taste acuity can help to assess \_\_\_\_\_ status. • zinc • magnesium • calcium • general mineral
zinc
Which of the following population groups is least susceptible to iron deficiency anemia? • older infants • children 2-10 years of age • women of childbearing age • men 20-45 years of age
men 20-45 years of age
What is erythrocyte protoporphyrin? • an iron storage protein • an immature red blood cell • an iron binding protein • a precursor for hemoglobin synthesis
a precursor for hemoglobin synthesis
Which of the following would be an expected result in an individual with iron-deficiency anemia? • decreased TIBC • increased MCV • decreased erythrocyte protoporphyrin • decreased transferrin saturation
decreased transferrin saturation
