Clinical Module Exams Flashcards by Maggie R

A 50 year old patient is started on Coumadin to reduce his risk of blood clotting after minor surgery. What should the patient be advised about Coumadin?

a. Avoid intake of foods with Vitamin E
b. Avoid intake of food with Vitamin K
c. Maintain consistent intake of Vitamin E
d. Maintain consistent intake of Vitamin K

d. Maintain consistent intake of Vitamin K

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A 70 year old female is admitted for SOB related to acute exacerbation of heart failure. Past medical history includes CAD and HTN. BMI is 29 and physical exam reveals 3+ edema in her lower extremities.

What nutrition prescription is recommended?

a. 1,500 mg Sodium Diet with no fluid restriction
b. Calorie controlled meal plan to promote weight loss
c. Therapeutic Lifestyle Diet with 1500 cc fluid restriction
d. 2,000 mg Sodium Diet with < 2000 cc fluid/day

d. 2,000 mg Sodium Diet with < 2000 cc fluid/day

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A 56 year old male patient with PMH of heart failure, HTN and Type 2 diabetes mellitus is admitted for a cholecystectomy. The patient’s RBC count, hemoglobin are below standard for gender with hematocrit and iron just below standard for gender. His MCV is normal.

What do these values suggest?

a. Anemia related to B12 deficiency
b. Anemia related to folate deficiency
c. Anemia related to iron deficiency
d. Anemia related to chronic disease

d. Anemia related to chronic disease

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A 42-year-old male landscaper is admitted with acute abdominal pain and reoccurring diarrhea (2 to 3 episodes daily) for 6 weeks with occult + blood in his stools. He complains of worsening fatigue and poor appetite with intermittent nausea. Symptoms are independent of what he eats. He is 5’10 and admission weight 145 lbs, usual body weight 156 lbs (last assessed 4 months ago). Admission labs: Albumin-2.9 mg/dL, Prealbumin-17 mg/dL, K+-3.4 mg/dL, Hct- 40%, Hgb-12 g/dL, MCV- 75 mm3. He is pending a colonoscopy r/o causes.
Based on the patients presenting signs and symptoms what is the priority to evaluate?
a. Folate level
b. B12 level
c. Ferritin level
d. Iron level

c. Ferritin level

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Which of the following is important to avoid when taking beta blockers or ace inhibitors to manage Heart Failure?

a. Milk
b. Grapefruit juice
c. Coffee
d. Green tea

b. Grapefruit juice

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All of the following are known nutrition implications of taking long term corticosteroids except for which of the following?

a. Weight gain
b. Glucose intolerance
c. Hypokalemia
d. Osteoporosis

c. Hypokalemia

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A 46 year-old male is admitted with acute hepatitis. He consumes 6 to 8 beers per day and PMH reveals +EOTH use for 15 years. Height: 5’10 Weight: 142 lbs. Usual weight: 158 lbs (6 months ago).

He is found to have cirrhosis after his medical work-up. Hct- 41%, Hgb-12 g/dL, MCV- 106 mm3.

Based on the assessment information and diagnosis what are the patient’s protein requirements?

a. 0.6 to 0.8 g/kg
b. 0.8 to 1.0 g/kg
c. 1.0 to 1.2 g/kg
d. 1.2 to 1.4 g/kg

c. 1.0 to 1.2 g/kg

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Which of the following has shown to be beneficial in improving hepatic fibrosis in cirrhosis?

a. Thiamine supplementation
b. Vitamin D supplementation
c. Zinc supplementation
d. Vitamin C supplementation

c. Zinc supplementation

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A patient is admitted for acute mental status changes secondary to advanced cirrhosis. Assessment indicators reveal compromised nutritional status with a BMI of 18 and energy and protein intake less than 75% of estimated needs. Patient is started on lactulose.

What is the suggested nutrition intervention?

a. High calorie high protein meal plan
b. Provide low protein meal plan providing no greater than 50 g protein/day
c. Initially provide 0.8 g/protein per kg and advance protein to 1.0 to 1.2 g/day
d. Provide 40 g fat modified diet with MCT supplementation to increase calories

c. Initially provide 0.8 g/protein per kg and advance protein to 1.0 to 1.2 g/day

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What diet intervention may help in managing and preventing the reoccurrence of hepatic encephalopathy?

a. Diet high in soluble fiber
b. Diet high in casein or whey protein
c. Diet high in MCT oil
d. Diet high in B vitamins

a. Diet high in soluble fiber

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How many risk factors presented by the patient meets diagnostic criteria for metabolic syndrome?

a. 2
b. 3
c. 4
d. 5

c. 4

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What modification in the prescribed diet plan is suggested for this patient based on her metabolic profile?

a. Provide 30% of total calories from carbohydrate and < 25% of total calories from fat
b. Provide 40% of total calories from carbohydrate and < 25% of total calories from protein
c. Provide 50% of total calories from carbohydrate and < 35% of total calories from fat
d. Provide 60% of total calories from carbohydrate and < 30% of total calories from fat

c. Provide 50% of total calories from carbohydrate and < 35% of total calories from fat

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Based on the evidence, which of the following occurs as a result of consuming foods containing trans fatty acids?

a. Decrease LDL-cholesterol and increase HDL-cholesterol
b. Decrease LDL-cholesterol and increase Total cholesterol
c. Increase LDL-cholesterol and decrease HDL-cholesterol
d. Increase LDL-cholesterol and decrease Total cholesterol

c. Increase LDL-cholesterol and decrease HDL-cholesterol

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Which of the following provides the most significant dietary source of trans fatty acids in the American diet?

a. Butter
b. Margarine
c. Canola oil
d. Olive oil

b. Margarine

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According to the latest evidence, which of the following produces a greater increase in ratio of LDL-cholesterol and HDL-cholesterol increasing risk for coronary heart disease events?

a. Saturated fats
b. Polyunsaturated fats
c. Monounsaturated fats
d. Trans fatty acids

d. Trans fatty acids

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A dietary pattern that follows the Therapeutic Lifestyle Changes cardioprotective recommendations can reduce serum LDL-cholesterol levels by which of the following?

a. 5 to 10%
b. 10 to 15%
c. 15 to 20%
d. 20 to 25%

b. 10 to 15%

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Which of the following statements is NOT true regarding omega-3 fatty acids?

a. Consuming 1,000 mg of EPA plus DHA preferably from oily fish per day or in the form of supplements with physician supervision is advised for persons with existing CHD
b. Consuming at least 2 fish meals per week is advised for all persons for prevention of CHD
c. Consuming 1,000 mg of EPA plus DHA as fish oil supplements is a therapeutic option for hypertriglyceridemia
d. Consuming 1.5 g/day of food sources high in alpha-linolenic acid is associated with 40% to 65% reduced risk of death from cardiac events

? c. Consuming 1,000 mg of EPA plus DHA as fish oil supplements is a therapeutic option for hypertriglyceridemia

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Which of the following are recommended therapeutic options for preventing or reducing risk of coronary heart disease?
[Select all that apply]
a. Consuming 15 g soy protein daily
b. Consuming 5 oz nuts per week
c. Consuming 2 to 3 g of plant stanol or sterol ester containing foods daily
d. Consuming 300 mg vitamin E supplement daily

b. Consuming 5 oz nuts per week

c. Consuming 2 to 3 g of plant stanol or sterol ester containing foods daily

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Which of the following statements is true with regards to consuming alcohol in excess of current recommendations (2 drinks/day for men; > 1 drink/day for women)?

a. Excess alcohol can cause high blood pressure
b. Excess alcohol can reduce cardiovascular risk
c. Excess alcohol reduces triglycerides
d. Excess alcohol is cardioprotective

a. Excess alcohol can cause high blood pressure

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John would like to have guidance regarding his blood pressure. His blood pressure has steadily been increasing over the last few years and his average readings are 135/82 mm Hg. He has not exercised on a regular basis in the last 2 years due to his highly demanding job. His BMI is 26 with no other significant medical history.
What dietary guidance should be provided?
a. Recommend following the TLC diet meal plan for cardioprotection
b. Recommend following the DASH meal plan
c. Recommend following the Atkins diet for quick weight loss
d. Recommend regular physical activity at least 30 minutes daily if physician approves

b. Recommend following the DASH meal plan

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When prescribing the DASH meal plan all of the dietary modifications should be followed except for which of the following?

a. Consume at least 2,400 mg sodium each day
b. Consumes 5 to 10 servings of fruits and vegetables each day
c. Consume 2 to 3 servings of low-fat dairy foods each day
d. Consume 4 to 5 servings of nuts each week

a. Consume at least 2,400 mg sodium each day

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Based on evidence and current recommendations from Dietary Guidelines which of the following groups should target sodium intake less than 1,500 mg/day?
[Select all that apply]
African American
Adults with hypertension
Adults with diabetes mellitus
Adults 51 years and older

All of the above: 
African American
Adults with hypertension
Adults with diabetes mellitus
Adults 51 years and older

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Which of the following meal plan approaches is recommended for hospitalized patients who have diabetes mellitus?

a. 1,800 to 2,000 Kilocalorie Diabetic Exchange meal plan
b. High Protein Low Carbohydrate meal plan
c. Therapeutic Lifestyle Changes meal plan
d. Consistent Carbohydrate meal plan

d. Consistent Carbohydrate meal plan

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Which of the following laboratory values is priority to assess to determine a diagnosis of diabetes mellitus?

[Select all that apply]

a. Urine glucose
b. Plasma glucose
c. Microalbumin
d. Hemoglobin A1C

b. Plasma glucose

d. Hemoglobin A1C

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A 48 year old male is admitted to the ER with high blood pressure (195/90) and a persistent bronchial infection for 8 weeks that will not go away. Height: 5’10, current weight 145 lbs, and usual weight is 152-155 lbs. The patient has been losing weight without trying; however states his appetite remains very good. He also complains of thirst and frequent urination. The patient’s glucose comes back with a reading of 355 mg/dL and A1C test 8% confirming a diagnosis of type 1 diabetes mellitus. What medications will initially be administered? a. Metformin and insulin b. Long-acting and short-acting insulin c. Glyburide and Metformin d. Exenatide

b. Long-acting and short-acting insulin

A newly diagnosed patient is being counseled on dietary strategies for type 2 diabetes. The patient refuses to consume sugar substitutes or alternatives due to taste aversion and preference to sucrose. Which is the best advice for this patient? a. Avoid sugar as the diagnosis of diabetes mellitus is serious and sugar must be avoided b. When sugar is to be consumed, avoid consuming with meals and check blood sugar frequently c. Sugar does not have to be avoided and amount consumed can be calculated into the allowed amount of carbohydrates prescribed d. Adjust medications so sugar can be consumed as the patient desires

c. Sugar does not have to be avoided and amount consumed can be calculated into the allowed amount of carbohydrates prescribed

Patients on intensified insulin therapy are at greatest risk for which of the following? [Select all that apply] a. Hyperglycemia b. Hypoglycemia c. Weight gain d. High blood pressure

b. Hypoglycemia | c. Weight gain

What is the recommended targeted blood glucose range for hospitalized critically ill patients who have diabetes and prescribed insulin for management of hyperglycemia? a. 80 to 120 mg/dL b. 100 to 140 mg/dL c. 120 to 160 mg/dL d. 140 to 180 mg/dL

d. 140 to 180 mg/dL

All of the following food items can be suggested options used to treat mild hypoglycemia except for which of the following? a. 4 to 6 oz of fruit juice b. 2 Tbsp raisins c. 4 packets of granulated sugar d. ¼ c applesauce

d. ¼ c applesauce (should be 1/2 cup)

A patient is admitted with severe vomiting and inability to keep liquids and food down for 48 hours. The patient has type 2 diabetes managed with Metformin. Admission blood sugar is 300 mg/dL, urinalysis reveals ketones 4 mmol/L and the patient is very lethargic. Which of the following complications is the patient experiencing? a. Gastroparesis b. Diabetic Ketoacidosis c. Glycosuria d. Hyperosmolar Hyperglycemia Nonketoic Syndrome

b. Diabetic Ketoacidosis

A patient is admitted with severe vomiting and inability to keep liquids and food down for 48 hours. The patient has type 2 diabetes managed with Metformin. Admission blood sugar is 300 mg/dL, urinalysis reveals ketones 4 mmol/L and the patient is very lethargic. Based on the presenting signs and symptoms, which of the following is not a recommended intervention for this patient? a. Rehydration with IVF's b. Increase dosage of Metformin c. Check electrolytes and assess need for supplementation d. Begin insulin for management of hyperglycemia

b. Increase dosage of Metformin

What is the most important consideration for persons with diabetes prescribed Sulfonylureas class of oral glucose-lowering medications? a. Can upset stomach so food should be consumed when taking the medication b. Can cause elevation in lipid levels and triglycerides c. Can lead to weight loss so kilocalories may need to be increased d. Can cause hypoglycemia if food is not consumed every 4 to 5 hours

d. Can cause hypoglycemia if food is not consumed every 4 to 5 hours

Which of the following oral-glucose lowering medication is a suggested option for patients with type 2 diabetes requiring weight loss? a. Glipizide b. Metformin c. Acarbose d. Glyburide

b. Metformin

Which of the following indices is used to predict the later development of nephropathy and increased cardiovascular risk in persons with type 1 and type 2 diabetes? a. Microalbumin b. Blood Urea Nitrogen c. Creatinine d. Urine glucose levels

a. Microalbumin

A patient with ESLD secondary to cirrhosis is admitted with steatorrhea. What is the suggested nutritional management? a. Modify intake of long chain triglycerides to 40 g/day b. Restrict sodium 2,000 mg/day with fluid based on total output c. Supplement with medium chain triglycerides to meet calorie needs d. Provide consistent carbohydrate meal plan and supplement with MCT oil

c. Supplement with medium chain triglycerides to meet calorie needs

Which of the following is a known cause of Acute Kidney Injury (AKI)? a. Streptococcal infection b. Diabetes mellitus c. Hypertension d. Hyperlipidemia

a. Streptococcal infection

Based on evidence, which of the following is used to evaluate nutritional status in patients with chronic kidney disease who receive renal replacement therapy? a. Albumin b. Interdialytic weight gain c. C-reactive protein d. Normalized protein catabolic rate

d. Normalized protein catabolic rate

A 65 year old female with type 2 diabetes and hypertension has a GFR of 30 mL/min/1.73 m2 and is diagnosed with chronic kidney disease. She will be managed with which of the following? a. Diet and hemodialysis b. Diet and medications c. Diet and peritoneal dialysis d. Diet and continuous venovenous hemofiltration

b. Diet and medications

Which of the following renal replacement therapies can increase hyperglycemia in diabetics and hypertriglyceridemia in all patients? a. Hemodialysis b. Peritoneal dialysis c. Continuous venovenous hemofiltration d. Continuous venovenous hemodialysis

b. Peritoneal dialysis

When determining energy needs for CKD patients receiving peritoneal dialysis which of the following should the dietitian assess? a. Protein catabolic rate b. Glucose absorption from dialysate c. Urea kinetic modeling d. Resting metabolic rate

b. Glucose absorption from dialysate

A patient on hemodialysis three days/week averages an interdialytic weight gain of 6% over the last week. What is priority for the dietitian to assess? a. Intake of potassium b. Intake of fluid c. Intake of phosphorus d. Intake of sodium

b. Intake of fluid

``` Which of the following can cause hyperkalemia in patients with CKD and should be evaluated if hyperkalemia exists? [Select all that apply] a. Inadequate dialysis b. Hyperglycemia c. Diarrhea d. Gastrointestinal bleeding ```

? not a. Inadequate dialysis or a and b

Which of the following is priority for the treatment and prevention of secondary hyperparathyroidism and bone disease in CKD? a. Low phosphorus intake b. Low potassium intake c. Low calcium intake d. Low magnesium intake

a. Low phosphorus intake

Which of the following is considered a high-protein and high-phosphorus food? a. 1 oz cheese b. 1 oz beef c. 1 large egg d. 4 slices of bacon

a. 1 oz cheese

Which of the following best describes the nutritional management of persons with nephrotic syndrome? a. Provide 0.6 g protein/kg/day with emphasis on potassium and phosphorus b. Provide 0.8 g protein/kg/day with emphasis on TLC diet principles c. Provide 1.0 g protein /kg/day with emphasis on low sodium and low carbohydrate diet d. Provide 1.2 g protein/kg/day with emphasis on very low fat diet

b. Provide 0.8 g protein/kg/day with emphasis on TLC diet principles

A patient with CKD presents with normocytic, normochromic anemia. Which of the following mechanisms most likely explains the associated anemia in patients with CKD? a. Blood loss due to dialysis procedure b. Folic acid deficiency c. Decreased erythropoietin production d. Thiamine deficiency

c. Decreased erythropoietin production

A 42 year old male landscaper is admitted with acute abdominal pain and reoccurring diarrhea (2 to 3 episodes daily) for 6 weeks with occult + blood in his stools. He complains of worsening fatigue and poor appetite with intermittent nausea. Symptoms are independent of what he eats. He is 5’10 and admission weight 145 lbs, usual body weight 156 lbs (last assessed 4 months ago). Admission labs: Albumin-2.9 mg/dL, Prealbumin-17 mg/dL, K+-3.4 mg/dL, Hct- 40%, Hgb-12 g/dL, MCV- 75 mm3. He is pending a colonoscopy r/o causes. A diagnosis of mild ulcerative colitis is confirmed after a colonoscopy and imaging scans. The patient is started on mesalamine and short term course of prednisone. Which of the following diet plans is best to prescribe initially during the acute phase? a. Lactose Diet b. Low Fiber with no caffeine c. High Fiber as tolerated d. Regular as tolerated

b. Low Fiber with no caffeine

Which of the following patterns best describes the recommended dietary fat intake for patients prescribed the Therapeutic Lifestyle Changes cardioprotective diet? a. < 5% saturated fat; < 150 mg/dL cholesterol; < 25% of total calories from fat b. < 7% saturated fat; < 200 mg/dL cholesterol; < 35% of total calories from fat c. < 10% saturated fat; < 250 mg/dL cholesterol; <30% of total calories from fat d. < 7% saturated fat; < 250 mg/dL cholesterol; <25% of total calories from fat

b. < 7% saturated fat; < 200 mg/dL cholesterol; < 35% of total calories from fat

A 59 year old female is referred to the dietitian for evaluation. Referral data: Ht-5’8, Wt- 190 lbs, BMI 29, waist circumference 38 inches, BP- 129/80 mm Hg, fasting blood glucose- 108 mg/dL, triglycerides 250 mg/dL and HDL-cholesterol 45 mg/dL. Based on assessment data what is the patients suggested weight loss goal? a. 10 to 15 lbs b. 15 to 20 lbs c. 20 to 25 lbs d. 25 to 30 lbs

b. 15 to 20 lbs

A 46 year-old male is admitted with acute hepatitis. He consumes 6 to 8 beers per day and PMH reveals +EOTH use for 15 years. Height: 5’10 Weight: 142 lbs. Usual weight: 158 lbs (6 months ago). He is found to have cirrhosis after his medical work-up. Hct- 41%, Hgb-12 g/dL, MCV- 106 mm3. Which of the following best meets the patient’s kilocalories needs? a. 1800 to 2000 kcal/day b. 2100 to 2300 kcal/day c. 2400 to 2600 kcal/day d. 2500 to 2700 kcal/day

b. 2100 to 2300 kcal/day 30-35 kcal/kg (or 32-35)

An adult patient with stage 4 CKD secondary to chronic HTN has a GFR of 25 mL/minute/1.73 m2. The patient is being managed with diet and medications at this time. What is the recommended protein intake based on a standard body weight of 75 kg? a. 35 to 45 g/day b. 45 to 55 g/day c. 55 to 65 g/day d. 65 to 75 g/day

b. 45 to 55 g/day

Which of the following nutrition strategies is important for persons with type 1 and type 2 diabetes mellitus who are taking insulin? a. Avoiding sucrose and foods with sugar b. Consuming a consistent amount of total carbohydrate at regular meals and snacks c. Eating protein with each meal snack d. Limiting fat intake to < 25% of total calories

b. Consuming a consistent amount of total carbohydrate at regular meals and snacks

A 39 year old female is referred to the dietitian for evaluation. Referral data includes: BMI of 29 with fasting plasma glucose of 110 mg/dL and A1C test of 5.9%. What nutrition intervention is indicated? a. Consistent carbohydrate meal plan b. Weight loss and weight reduction meal plan c. 1600 kilocalorie diabetic exchange meal plan d. Low glycemic meal plan

b. Weight loss and weight reduction meal plan

When evaluating the diet of a patient with chronic kidney disease which of the following are most important to assess? a. Vitamin C, vitamin B6, folic acid b. Vitamin B6, vitamin E, vitamin D c. Vitamin B12, vitamin A, thiamine d. Folic acid, vitamin C, niacin

a. Vitamin C, vitamin B6, folic acid

Which of the following if presented would determine the need for iron supplementation in a male patient with CKD? a. Iron levels below standard for gender b. Hemoglobin and hematocrit below standard for gender c. Ferritin level less than 100 ng/dL d. Transferrin saturation greater than 40%

c. Ferritin level less than 100 ng/dL

``` Which hormone moves milk through the mammary ducts? prolactin progesterone estrogen oxytocin ```

oxytocin

Compared to breast milk, commercially prepared infant formula is: similar in nutrient content equivalent to human milk in nutrient content and antibodies higher in protein and iron but lacks antibodies lower in protein and iron and lacks antibodies

higher in protein and iron but lacks antibodies

``` A child has been measured several times before the age of two years. Results of the measurements were not accurate because the child was measured first thing in the morning standing up after breakfast with light clothing ```

standing up

``` A single man with two daughters age 10 and 11, is looking for aid. Which program might provide assistance? WIC SNAP Child Care Food Program Headstart ```

SNAP

``` The Prader Willi syndrome is associated with: hyperactivity deficiency of glucose-6-phospate macrocytic anemia obesity ```

obesity

``` A 2 year old child with iron-deficiency anemia has anorexia, vomiting, weight loss and restlessness. Look for: excessive milk and fruit juice intake excessive vitamin C and D intake asthma and respiratory distress pica and lead poisoning ```

pica and lead poisoning

The effectiveness of a group education program for decreasing the number of anemic pregnant women enrolled in a community nutrition program is best indicated by: improved scores on nutrition knowledge posttest improved scores on a Likert-type attitudinal scale an increase in hemotocrit or hemoglobin levels an increase in the intake of dietary iron

an increase in hemotocrit or hemoglobin levels

``` How long should a new mother breast-feed? at least 6 months at least 12 months until 6 months, then add cow’s milk until 4 months then switch to cow’s milk ```

at least 12 months

Infants born to mothers with diabetes may be: larger than normal, and be hypoglycemic shortly after birth smaller than normal and be hyperglycemic shortly after birth larger than normal and be hyperglycemic shortly after birth smaller than normal and be hypoglycemic shortly after birth

larger than normal, and be hypoglycemic shortly after birth

``` Your client’s pre-pregnancy weight was 150 lbs at 5’6”. She is currently starting her 3rd trimester of pregnancy and weighs 170 lbs. What are your weight gain recommendations for her during her last trimester? 0.5 lb/wk 1 lb/wk 1.5 lb/wk 2 lb/wk ```

1 lb/wk

``` In which of the following has the use of medical food supplements shown to minimize weight loss and is associated with fewer radiation treatment interruptions? Pancreatic cancer Head and neck cancer Colon cancer Breast cancer ```

Head and neck cancer

Which of the following statements is true regarding use of oral vitamin E supplementation in the form of alpha tocopherol in cancer patients? Vitamin E supplementation may be beneficial in breast cancer patients undergoing radiation to reduce side-effects Vitamin E should be avoided in breast or head neck cancer due to multiple adverse effects Vitamin E supplements may reduce the risk of developing a secondary cancer in head and neck cancer patients Vitamin E can be used to improve treatment outcomes in cancer patients undergoing chemotherapy

Vitamin E should be avoided in breast or head neck cancer due to multiple adverse effects

A newly diagnosed patient with stage II colon cancer is preparing for colorectal surgery for removal of the distal colon. The patient wants to learn about the use of high dose vitamin and mineral supplements to optimize his health for surgical recovery and cancer treatment. What should be advised? Acknowledge his concern for health and advise to begin a daily multiple vitamin and mineral supplement with antioxidants Validate his concerns and discuss potential side effects of taking supplements during this phase in cancer treatment Suggest he try a macrobiotic diet versus taking multiple supplements to optimize his health Suggest he avoid all processed foods and begin a vegetarian diet to provide vitamin/minerals in their natural state

Validate his concerns and discuss potential side effects of taking supplements during this phase in cancer treatment

A patient undergoing radiation treatment for reoccurrence of stage III mediastinal large cell carcinoma secondary to lung cancer has lost 6 lbs in 2 weeks. He has received 4 weeks of daily radiation with 2 weeks pending. Simultaneously he is receiving 6 rounds of chemotherapy (carboplatin/taxol). Upon assessment the patient’s worse complaint is severe acid reflux impacting his ability to tolerate foods and beverages. He is prescribed PepcidTM twice daily. Which of the following should the dietitian suggest? [Select all that apply] Suggest drinking cool medical food supplements throughout the day Use honey to reduce mucosal irritation and damage associated with reflux Reinforce the importance of using prescribed acid reducing medications Suggest small frequent meals and limit acid containing foods and spicy foods

Suggest drinking cool medical food supplements throughout the day Reinforce the importance of using prescribed acid reducing medications Suggest small frequent meals and limit acid containing foods and spicy foods

``` A cancer patient undergoing aggressive chemotherapy is experiencing anorexia and altered taste perception. Which of the following is important to evaluate? Calcium deficiency Magnesium deficiency Zinc deficiency Selenium deficiency ```

Zinc deficiency

A 45 year old female who is receiving weekly chemotherapy following surgery for breast cancer. Which of the following nutrition recommendations can help control her complaints of nausea after treatment? Consume clear or ice cold drinks Eat favorite foods to stimulate intake Eating larger meals in the middle of the day Consume adequate fiber intake

Consume clear or ice cold drinks

``` Which of the following side effects of radiation treatment is most likely to affect a patient’s nutritional status? Alopecia Pneumonia Nausea and vomiting Oral mucositis ```

Nausea and vomiting

Which of the following meal plans is currently suggested for patients undergoing hematopoietic cell transplant or chemotherapy? Neutropenic diet avoiding all raw foods High protein high calorie diet Macrobiotic diet Regular diet encouraging low-microbial foods

Regular diet encouraging low-microbial foods

``` What is the energy and protein requirement for a male patient who is 6’0 and weighs 185 lbs with hematologic malignancy undergoing allogeneic HCT? 2200 kcal; 140 g protein 2500 kcal; 160 g protein 2800 kcal; 180 g protein 3100 kcal; 200 g protein ```

2800 kcal; 180 g protein | 30-35 kcal/kg, 2.2 gm/kg protein

Which of the following nutrition parameters is the most sensitive indicator of nutritional status in cancer patients? Weight Albumin Tumor necrosis factor (TNF) CA-125

Weight

Which of the following enterally fed patient scenarios would the use of supplemental glutamine be most beneficial? Patient with chronic kidney disease and ARDS on a ventilator Patient with ascites and rupture of esophageal varices secondary to cirrhosis Patient with post-surgical ilectomy and TBI secondary to motorcycle accident Patient with acute hepatic encephalopathy secondary to end-stage liver disease

Patient with post-surgical ilectomy and TBI secondary to motorcycle accident

When a patient is prescribed pancreatic enzymes what nutrition guideline is priority to follow? Consume a low fat diet eating 6 smaller meals daily Avoid use of medications that cause reduction in gastric acid production Consume prescribed dose with meals and/or snacks Crush enteric coated pills if needed and mix with beverages

Consume prescribed dose with meals and/or snacks

``` Which medical test is considered the gold standard for confirming a diagnosis of lactase deficiency? D-xylose test Fecal fat test Breath hydrogen analysis Stool analysis for lactase ```

Breath hydrogen analysis

For a patient with confirmed secondary lactase deficiency due to inflammatory bowel disease such as Crohn’s disease which is recommended? Consume milk or dairy products in small amounts between meals Choose fat-free milk or dairy products versus whole milk products Include cheese, yogurt or ice cream in the diet Select unflavored milk or dairy products

Include cheese, yogurt or ice cream in the diet

A 48 year old male is admitted for evaluation secondary to weight loss and progressive worsening of diarrhea and abdominal pain secondary to chronic pancreatitis. The patient has a history of ETOH abuse with documented abstinence for 8 months and s/p acute pancreatitis 2 times over the course of 3 years. Medications include OTC ibuprofen PRN for pain. The patient is following a regular diet as tolerated. Biochemical data: Serum lipase 1.6 IU/mL, serum amylase 150 IU, blood glucose 115 mg/dL, TG-175 mg/dL. Fecal fat negative. What is the priority to assess for this patient, based on available data? Intake of fat, primarily long-chain fatty acid sources Use of medium chain triglyceride sources Intake of ETOH and high triglyceride foods Use of pancreatic enzyme supplementation

Use of pancreatic enzyme supplementation

``` A patient admitted with chronic pancreatitis is undergoing a 72-hour quantitative fecal fat evaluation to r/o steatorrhea. What diet should be prescribed? MCT diet with 6 meals per day Low fiber diet Diet providing 100 g fat Low fat diet providing < 40 g/fat ```

Diet providing 100 g fat

``` For patients requiring calcium supplementation due to malabsorption issues after gastric bypass surgery, which form of elemental calcium is recommended? Calcium citrate Calcium phosphate Calcium lactate Calcium gluconate ```

Calcium citrate

``` Which of the following parameters most accurately determines vitamin D status in GI related metabolic bone disease and is recommended when assessing either vitamin D deficiency or response to vitamin D therapy? 1,25-dihydroxy vitamin D Parathyroid hormone 25-hydroxy vitamin D Alkaline phosphatase ```

25-hydroxy vitamin D

``` Persons prescribed sulfasalazine to manage IBD disease should be advised to consume which of the following? Calcium supplement Folic acid supplement Iron supplement Vitamin C supplement ```

Folic acid supplement

``` A patient who has a complete ileal resection will require which of the following? MCT diet Sublingual vitamin B12 Iron supplement Low fiber diet ```

Sublingual vitamin B12

To reduce the risk of kidney stone formation secondary to fat malabsorption or following ileal resection, what nutrition intervention is currently recommended? Limit foods with a high oxalate content Consume a high fat diet Avoid supplements with calcium and phosphorus Take a probiotic daily

Limit foods with a high oxalate content

Why is the use of MCT (medium-chain triglycerides) indicated in chylous ascites or chylothorax? Absorption requires pancreatic lipase Transport does not occur through the lymphatic system rather by the portal vein Does not transport across the intestinal mucosa Bile salts are required for absorption

Transport does not occur through the lymphatic system rather by the portal vein

``` The Roux-en-Y gastric bypass procedure places patients at risk for which of the following nutrition deficiencies? Vitamin E and K Vitamin C and zinc Iron and calcium Pyridoxine and selenium ```

Iron and calcium

``` Long term, which of the following behavioral strategies is most important for patients to adhere to following gastric bypass surgery? Avoid fluids when eating meals Adhere to daily supplement program Eat 6 small meals daily Follow a low-fat sugar free diet ```

Adhere to daily supplement program

Which of the following clinical situations would indicate the need for parenteral nutrition? Patient with mild acute pancreatitis secondary to chronic ETOH and is NPO Patient with steatorrhea secondary to advanced cirrhosis Patient with small bowel resection and enterocutaneous fistula output 800ml/day Patient with ulcerative colitis status post removal of 12 inches of colon

Patient with small bowel resection and enterocutaneous fistula output 800ml/day

A 63 year-old patient is admitted to the ICU with ARDS secondary to pneumonia requiring ventilator support. The patient’s BMI is 34. The plan is to begin nasogastric feeding. Which of the following prediction formulas is suggested for assessing the patients estimated energy requirements? Harris Benedict equation with stress factor Ireton-Jones equation Penn State equation (2003 b) Modified Penn State equation (2010)

Modified Penn State equation (2010)

A patient is admitted to the ICU with TBI secondary to MVA and in a medically induced coma. The patient is hemodynamically stable with functioning gastrointestinal tract. The patient has been NPO for two days. What nutrition intervention is recommended? Suggest placement of nasogastric small bore feeding tube to start enteral feedings Suggest remain NPO until patient is extubated and breathing independently Suggest central catheter line placement to initiate total parenteral nutrition Suggest placement of percutaneous endoscopic gastrostomy (PEG) tube

Suggest placement of nasogastric small bore feeding tube to start enteral feedings

Which of the following situations would indicate a need for parenteral nutrition in the hospital setting? A patient with diagnosis of malnutrition requiring surgery in 3 days A patient with non-functioning gastrointestinal tract and NPO 7 days A patient with non-functioning gastrointestinal tract and NPO 4 days after surgery A patient with diagnosis of acute pancreatitis and NPO for 2 days

A patient with non-functioning gastrointestinal tract and NPO 7 days

A patient receiving total parenteral nutrition for the past 2 weeks has a sudden increase in temperature and complains of chills. Laboratory assessment indicates elevated white blood cell count and hyperglycemia with no history of diabetes or glucose intolerance. ``` Which of the following is most likely the cause of complications? Viral infection Urinary tract infection Catheter-related infection Respiratory infection ```

Catheter-related infection

When a patient transitions from parenteral nutrition to oral feeding, at what point should the parenteral nutrition be discontinued? When the patient is consuming 40% of estimated energy needs with good tolerance When the patient is consuming 60% of estimated energy needs with good tolerance When the patient is consuming 80% of estimated energy needs with good tolerance When the patient is consuming 100% of estimated energy needs with good tolerance

When the patient is consuming 60% of estimated energy needs with good tolerance

A critically ill patient receiving isotonic enteral nutrition feedings via small bore nasogastric tube develops sudden hypotension and abdominal distention and pain. What is recommended? Decrease rate of enteral feedings and assess risk for intestinal hypoxia Check gastric residual volume and if < 250 mL continue enteral feedings Hold enteral feedings and assess risk of intestinal hypoxia or bowel necrosis Assess bowel sounds and if active continue enteral feedings as prescribed

Hold enteral feedings and assess risk of intestinal hypoxia or bowel necrosis

A 65 year old female with history of type 2 diabetes managed by diet is admitted to ICU secondary to heart failure and pneumonia requiring ventilator support and IV antibiotics. She is receiving enteral nutrition feedings of Osmolite HN at 40 cc/hour over 24 hours. Her past 3 days of blood glucose levels averaged 205 mg/dL. What is suggested? Suggest change enteral formula to a diabetic specific formula Consult with physician regarding need for insulin therapy Hold tube feedings until blood sugar decreases to < 140 mg/dL Continue enteral feeding plan as hyperglycemia secondary to stress response

? Consult with physician regarding need for insulin therapy

Which of the following enteral formulas has demonstrated good tolerance in patient with acute pancreatitis when standard formulas are not well-tolerated? Fiber containing formula Elemental or semi-elemental formula Formula containing glutamine Formula containing branch-chain amino acids

Elemental or semi-elemental formula

Fiber containing enteral formulas containing primarily soluble fiber is shown to be beneficial in which of the following clinical situations? Tube fed critically ill patients Tube fed patients with chronic pancreatitis Tube fed patients with non-infectious diarrhea Tube fed patients with ulcerative colitis

Tube fed patients with non-infectious diarrhea

A patient is transferred to ICU with hepatorenal syndrome secondary to complications of Cirrhosis and advanced liver disease. The patient presents with ascites and mental status changes attributed to acute hepatic encephalopathy. His intake has been suboptimal during hospitalization and the physician opts to begin nasogastric tube feedings. Wt- 185 lbs, Usual wt-165 lbs (without ascites). Abnormal labs include: GFR of 25 mL/minute/1.73 m2, K+- 5.6 mEq/L, Na-132 mEq/L, Phosphorus- 6.2 mg/dL Albumin- 2.0 mg/dL. Medications include spironolactone with the plan to start lactulose. TIPS. procedure is pending. Which of the following enteral formulas should be prescribed? Standard or polymeric formula Formula contacting glutamine Formula containing branched-chain amino acids (BCAA) Renal formula

Renal formula

``` Which of the following conditions has shown to have adverse effects with the use of an immune enhancing enteral formula containing arginine? Head and neck cancer Burn patient Abdominal trauma Sepsi ```

Sepsis

Which of the following is recommended for patients with severe acute pancreatitis? Prescribe parenteral nutrition versus enteral nutrition Position enteral feeding tube tip below the Ligament of Treitz Provide intermittent infusion schedule versus continuous infusion Use a hypertonic enteral formula with higher fat content

Position enteral feeding tube tip below the Ligament of Treitz

``` What are the similarities between WIC and SNAP? I. regulated by USDA II. Have a risk criteria III. Have income criteria IV. A health exam is required ```

I. regulated by USDA | III. Have income criteria

``` Which of the following indicates stunted growth? weight for height height for age weight for age weight for length ```

height for age

Which supplements should you give to a breast-fed baby? vitamin D and fluoride fluoride vitamin D vitamin A and C

? vitamin D and fluoride

Compared to whole milk, breast milk is: lower in protein, higher in carbohydrate and fat higher in protein and fat, lower in carbohydrate lower in protein, carbohydrate and fat has the same nutrient composition

lower in protein, higher in carbohydrate and fat

``` Patients prescribed dexamethasone as an adjunct to chemotherapy should be monitored for which of the following? Hypoalbuminemia Iron deficiency Hyperglycemia Hypercalcemia ```

Hyperglycemia

When providing parenteral nutrition to critically ill patients in the intensive care unit which of the following is currently recommended? Provide 100% of patients estimated energy requirements to prevent decline in nutrition Metabolic cart evaluations should be assessed on all patients to determine energy needs appropriately Permissive underfeeding should be considered with target of meeting 80% of patient’s energy requirements Initiate dextrose at 1 mg/kg per minute for all patients and increase as tolerated every 12 to 24 hours

Permissive underfeeding should be considered with target of meeting 80% of patient’s energy requirements

``` A patient on total parenteral nutrition receiving 5 mg glucose/kg/minute and 10% lipids providing 0.5 g fat/kg/day begins to experience hyperglycemia and increased CO2 production. What is the likely cause? Excess carbohydrate Excess total calories Excess total fat Excess amino acids ```

Excess carbohydrate

A patient receiving total parenteral nutrition with stable laboratory panel has a triglyceride level of 400 mg/dL measured 4 hours after the last lipid infusion. What is recommended? Decrease dextrose infusion and increase amino acid content Hold lipid infusions and evaluate dose and length of lipid infusion time Stop lipid infusion and increase dextrose infusion Hold total parenteral nutrition until triglycerides resume to < 250 mg/dL

Hold lipid infusions and evaluate dose and length of lipid infusion time

A critically ill patient with pancreatic cancer is admitted for surgery. The patient has not been able to tolerate food or beverages for several weeks and admission albumin is 2.6 g/dL. After beginning peripheral parenteral nutrition the patient experiences low phosphorus, low potassium and low magnesium levels. What is the likely cause? Refeeding syndrome Malabsorption Pseudocyst Parenteral nutrition limited in electrolytes and minerals

Refeeding syndrome

``` Patients prescribed IV lipids as part of total parenteral nutrition prescription should be evaluated for which of the following? Allergy to soy and casein Allergy to eggs and casein Allergy to casein and gluten Allergy to soy and eggs ```

Allergy to soy and eggs

A normal pregnancy requires supplementation of:

iron and folic acid

Which is the most common following a Roux-en-Y gastric procedure:

Dumping syndrome

``` A female patient (BMI 27) has triglycerides of 550 mg/dL. Which is recommended? TLC diet CHO modified meal plan of 45-50% CHO DASH diet Very low fat diet ```

CHO modified meal plan of 45-50% CHO

``` In community surveys, a frequent symptom of malnutrition is: a. scurvy b. rickets c. low serum albumin d, low hemoglobin ```

low hemoglobin

Which is the least common symptom in the elderly? a. osteomalacia b. osteoporosis c. obesity d. hypertension

osteomalacia

What is included in the study of demographics? I, age of individuals III. sex of individuals II. population statistics IV. socioeconomic factors a. I only b. all of the above c. II, III d. I, II, III

I, II, III

A patient is on a high protein, low carbohydrate diet. What advice should you offer? a. increase fluid intake b. decrease the intake of complex carbohydrates c. decrease fluid intake d. decrease the intake of saturated fats

increase fluid intake

glucocorticoids: a. convert protein into glucose b. convert fatty acids into glucose c. convert glucose into protein d. convert glucose into fat

convert protein into glucose

what is the change strategy with encouraging client to do something, client feels better, encourage client to continue

positive reinforcement

What should a liquid have in order to foam?

low surface tension

5 principles of motivational interviewing

1) express empathy 2) develop discrepancy - compares and contrasts present and desired behaviors 3) avoid argumentation - not arguing or attempting persuasion 4) roll with resistance - affirming the client's freedom of choice and telling the client reluctance is normal 5) support self-efficacy

what can lead to vitamin D deficiency?

limited sunlight, institutionalized/homebound, medications (including antifungals, glucocorticoids, HIV/AIDS meds)

What is substitution?

When an employee puts something else in place of his or her original objective (if not promoted, seeking employment elsewhere)

When should Class K fire extinguishers be used?

To put out fires involving vegetable oil and deep fat fryers (Kitchen fires)

When should Class A fire extinguishers be used?

for ordinary combustibles

When should Class B fire extinguishers be used?

Flammable liquids such as gasoline, paints, solvents

When should Class C fire extinguishers be used?

For electrical equipment fires

When should Class D fire extinguishers be used?

fires involving metals

When investigating a software program that will eliminate unnecessary costs while providing the most usefulness, what should be conducted?

Value analysis

Potatoes contain a green pigment that may also have a toxicant resulting in N/V or death?

Solanine (glycoalkaloid poison found in nightshade family)

How is fructose absorbed?

facilitated diffusion (GLUT 5)

How are glucose and galactose absorbed?

active transport (cotransport with sodium using GLUT1)

How to use the cost plus pricing method?

Add all percentage costs, subtract from 100, divide the food cost by the desired food cost percentage to get selling price

What law shifts focus of food supply safety from responding to preventing?

FSMA (food safety modernization act of 2011)

An alcoholic patient has a low serum albumin, low hemoglobin, high ammonia, abnormal liver function tests and ascites, Why is he on a 500mg sodium diet? a. secondary renal failure b. hypoaldosteronism c. hypoalbuminemia d. hyperammonemi

c. hypoalbuminemia

Which microorganism is know as the cafeteria bug and results in symptoms of nausea, vomiting, abdominal pain and diarrhea within 8-18 hours after ingestion?

Clostridium perfringens

units for GIR?

mg/kg/min

How much weight should a normal weight woman gain during pregnancy?

25-35 lbs

How much weight should an overweight woman gain during pregnancy?

15-25 lbs

How much weight should an underweight woman gain during pregnancy?

28-40 lbs

How much weight should an obese woman gain during pregnancy?

11-20 lbs

A vegetarian consumes most of her protein in soybeans and legumes. What essential acid might she be low in?

Methionine | soybeans are low in methionine, legumes are low in methionine, cystine and tryptophan

What is the LARGEST contributor to renal solute load?

Nitrogen (other contributors include sodium (also large), uric acid, creatinine and ammonia)

Which person is LEAST likely to be at risk for foodborne illness? a. older woman b. child with dental caries c. 30 yr old obese male with type 1 diabetes d. 26 yr old healthy pregnant woman

30 yr old obese male with type 1 diabetes (groups at higher risk are older adults, pregnant women, infants and young children, immune-compromised individuals and individuals with AIDS)

If cheese is peeled off a hamburger, what has occurred?

Cross-contact (proteins of two foods have mixed, as opposed to cross-contamination which refers to bacteria or viruses getting on food) A cross-connection is a physical link between safe water and dirty water Biological contamination is when food is already contaminated by a bacteria, parasite, fungus or virus

How much water does a person lose per day due to insensible water loss?

1 L (losses through skin and breathing... sensible losses are those that can be measured)

According to French and Raven's power study, what is needed for a leader to produce compliance in followers?

Legitimate and expert

What is FOCUS - PDCA?

F: find a process to improve O: Organize to improve the process C: Clarify current knowledge (collect data and talk with those involved) U: Understand source of process variation S: Select the process improvement Plan Do Check Act

What temperature should pork beef and lamb be cooked to?

145 degrees (and rest for 3 or more minutes)

What temperature should the oven be to roast meats?

no lower than 325 degrees

``` Which should be stored (ripen best) in the refrigerator vs at room temperature? Apples Pears Avocados Bananas Mushrooms Oranges Tomatoes ```

Room temp: pears, avocados, bananas, tomatoes Refrigerator: Apples, Mushrooms Oranges

What are the MyPlate recommendations (2015-2020)?

Make half your plate fruits and vegetables Make half your grains whole grains Switch to low-fat and fat-free dairy Vary your protein routin Drink and eat less sodium, saturated fat and added sugars

Where is tyramine found?

aged, fermented, dried, pickled, cured, smoked, processed and or spoiled foods (such as hard or aged cheeses, lunch meats, sausage, yogurt, pickles, tofu)

As blood pH decreases, respiration...

increases to excrete CO2 (can lead to Kussmaul respirations)

What is a sol?

a solid in a liquid (e.g. turkey gravy)

What dietary modification is appropriate for a client with elevated T3 and T4?

High-caloric foods (hyperthyroidism)

What is the FDPIR?

Food Distribution Program on Indian Reservations - provides USDA food to income-eligible households living on Indian reservation or other specific areas

If inventory is overstated, how would cost of goods sold and net income be affected?

Cost of goods sold would be more and net income would be less

What is maltose made of?

glucose and glucose

Who is most at risk for Vitamin A toxicity due to decreased clearance from the blood?

Elderly

USDA Automated Multiple Pass Method steps

1) The Quick Step 2) The Forgotten food list 3) The Time & Occasion List 4) The Detailed Cycle 5) The Final Review

What dietary modification would be beneficial for athetoid cerebral palsy?

High calorie, high protein (vs. spastic which would require low-calorie, high fluid and high fiber diet)

Mintzberg's management roles:

10 primary roles that can categorize a manager's different functions to accomplish work

Katz's Skill Management:

three managerial skills needed: technical, human and captial

Taylor's Scientific Management:

theory that analyzes and synthesizes workflows with the main objective being to improve economic efficiency, especially labor productivity

What will prevent curdling?

Add cream to tomato sauce on the stovetop (don't add acid too quickly or overheat dairy)

How big is a 300# can?

1 3/4 cups

How big is a 10# can?

13 cups

Percent sag?

objective measure of quality used for custards... the larger the percentage of sag, the more tender the gel is... an overcooked custard will have a low percent sag

Country club management:

an employee-centered leadership style that promotes a friendly atmosphere and seeks approval and acceptance

Team management?

Focuses on both people and production and is the most desirable leadership style

Impoverished management?

minimal concern for people and production and leadership exerts minimum effort to get work done

Total quality management?

encourages employees to identify problems and find solutions to improve organization

If there is not enough oxaloacetic acid available to the TCA cycle:

acetyl CoA coming in from fat cannot be handled properly

The Schilling test:

cyanocobalamin

The toxic level of vitamin A is

10,000 IU

One orange produces

2.67 oz juice

Which amino acid is especially glucogenic?

alanine

The rate of oxidation of which BCAA increases significantly during moderate exercise?

leucine

What percentage of protein can be converted to glucose?

58%

Niacin deficiency results in

dermatitis, diarrhea, dementia, pellagra

Pie crust is moist the day after cooking. Why?

retrogradation of filling (water seeps out - syneresis)

Strict vegans may need supplements of:

Zinc

What must be reduced before it can be further transported for transportation?

Whey

Homemade rolls are crumbly and fall apart easily. why?

use of a lower-protein flower