Condition Specific Nutrition Support

Question 1

ERAS is a care program that has been shown to improve outcomes after major surgery. The key mechanism behind ERAS effectiveness:

Answer 1

Decrease the stress of surgery and support recovery.

Question 2

What is the inpatient glycemic target for critically ill patients?

Answer 2

140-180

Question 3

Under conditions of sepsis and stress, what metabolic alterations are most likely to occur?

Answer 3

Increased glucose production and decreased glucose uptake

Question 4

What immunomodulating nutrient may be harmful in patients with sepsis/septic shock?

Answer 4

Arginine

Question 5

What best describes enteral glutamine supplementation in the critically ill?

Answer 5

Enteral GLutamine decreases nosocomial infections

Question 6

What are counter regulatory hormones responsible in the hypercatabolism observed in critically ill trauma patients?

Answer 6

Glucagon, epinephrine, cortisol

Question 7

In patinets with. burns, providing caloric support above energy exenditure has benn found to:

Answer 7

Have no effect on preservation of lean body mass

Question 8

In pulmonary insufficiency, excessive calorie administration may cause increase blood PCO2 resulting in ?

Answer 8

Respiratory acidosis

Question 9

What is true of EFAD in patients with CF?

Answer 9

EFA profiles have been shown to improve in CF patients after lung transplantation

Question 10

What has not been shown to delay weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease who are receiving EN?

Answer 10

Trophic feeds

Question 11

What is the best choice for feedings a pancreatic insufficient infant with CF?

Answer 11

Human milk

Question 12

Patients with chronic heart failure are typically on a loop diuretic. These patients are at risk for:

Answer 12

Azotemia

Question 13

A CHF patient on high dose furosemide is started on EN for inability to consume adequate oral nutrition. Despite slow advancement to goal feeding rate, he suffers from electrolyte imbalance and peripheral neuritis. Deficiency of which vitamin should be suspected?

Answer 13

Thiamin

Question 14

A patient with AKI who requires ON would most likely benefit from a solution containing what amino acid formula?

Answer 14

Essential and non essential amino acids

Question 15

What is the GFR of a patients with end stage renal disease?

Answer 15

<15 ml/mi/1.73m2

Question 16

What is the recommended maximum dietary protein intake in critically ill adult patients receiving continuous renal replacement therapy?

Answer 16

2.5 g/kg per day

Question 17

What are the protein requirements for a stable patient receiving PD?

Answer 17

1.2-1.3 g/kg/day

Question 18

Increased mortality in maintenance HD patients has been associated with?

Answer 18

Low baseline body fat percentage and low muscle mass

Question 19

Hypoglycemia, requiring dextrose infusions to maintain euglycemia, is most likely to occur in what type of liver disease?

Answer 19

Fulminant hepatic failure

Question 20

What is not a cause of PEM in a patient with liver disease?

Answer 20

Reduced energy expenditure

Question 21

In cirrhotic patients, which of the following should be implemented to assist in avoiding fasting associated starvation during the night?

Answer 21

Late evening snack

Question 22

PEM in the most common in which types of liver disease?

Answer 22

Cirrhosis

Question 23

What is an important indicator of PEM in chronic liver disease?

Answer 23

Muscle wasting

Question 24

Treatment for patients with overt hepatic encephalopathy who have impairments in cognitive and neuomuscular function does not include:

Answer 24

Low protein diet

Question 25

The highest prevalence and severity of weight loss is found in patients with what types of cancer?

Answer 25

Pancreatic and gastric

Question 26

What best describes the benefit of megestrol acetate in patients with cancer related cachexia?

Answer 26

Improves appetite and ameliorates weight loss

Question 27

In the first 1-3 months after a bone marrow transplant the nutritional needs of a patients are best met with:

Answer 27

30-35 kcals/kg/day with >=1.5 g/kg protein

Question 28

Supplementation with which nutrient is routinely restricted during the early stages following hematopoietic stem cell transplantation?

Answer 28

Iron

Question 29

What acute changes in the serum chemistry profile would be expected in a patients who is experiencing tumor lysis syndrome?

Answer 29

Hyperkalemia and hyperphosphatemia

Question 30

What best describes the treatment of diarrhea in inflammatory bowel syndrome?

Answer 30

Start antidiarrheal agents once infections etiology is ruled out

Question 31

A patient with Crohn's disease that involves the distal ileum should be closely monitored for malabsorption of:

Answer 31

B12

Question 32

What is a major contributing factor in the development of MBD in patients with IBS?

Answer 32

Corticosteroid use

Question 33

In patients with acute pancreatitis, the use of EN via NGT rather than PN is associated with:

Answer 33

A lower risk of developing infectious complications

Question 34

Gastric hypersecretions following significant small bowel resection can become problematic. What medication has been shown to be the most successful in suppressing gastric hypersecretions?

Answer 34

Proton pump inhibitors

Question 35

What metabolic complication may occur in patients with short bowel syndrome and small bowel intestinal bacterial overgrowth?

Answer 35

Metabolic acidosis

Question 36

Patients with short bowel syndrome would benefit most from octreotide injections in the presence of:

Answer 36

refractory diarrhea not controlled with diet and medication

Question 37

What diet should be recommended to patients with short bowel syndrome (ileal resection) and colon in continuity?

Answer 37

High complex carbohydrate

Question 38

Calcium oxalate nephrolithasis can occur in patients with SBS with an intact colon who:

Answer 38

Do not maintain adequate hydration

Question 39

What type of fistula will result in the greatest degree of nutritional loss?

Answer 39

Proximal high output

Question 40

A pregnant woman present with persistent N/V for the past 6 weeks associated with a 10% weight loss. Her symptoms were refractory to a 48 hour trial of antiemetics and IV fluids.A decision to made to initiate nutrition support. What vitamin should be supplemented in this patient before providing nutrition support?

Answer 40

Thiamin

Question 41

A pregnant woman present with persistent N/V for the past 6 weeks associated with a 10% weight loss. Her symptoms were refractory to a 48 hour trial of antiemetics and IV fluids.A decision to made to initiate nutrition support. What is the most appropriate initial nutrition therapy to implement?

Answer 41

EN with polymeric formula via NGT

Question 42

A critically ill hyperglycemic patient receiving continuous EN with a history of insulin dependent DM should ideally be placed on:

Answer 42

Continuous IV insulin infusion

Question 43

HIV associated lipodystrophy syndrome is most commonly associated with what class of agents used to treat HIV?

Answer 43

NRTIs

Question 44

A 51 yo female who is 10 years s/p gastric bypass for obesity presented with numbness and tingling in her distal lower extremities that had progressively worsened. She had been on an oral MV supplement. She was significantly anemia and neutropenic. Her vitamin B12, iron, ferritin and transferrin levels were all normal. What nutritional deficiency is most likely the cause of all these symptoms?

Answer 44

Copper

Question 45

What is the most appropriate feeding strategy for morbidly obese trauma patient?

Answer 45

High protein, hypocaloric feeding

Question 46

Zinc supplementation should be considered for patients:

Answer 46

with unexplained skin rashes and alopecia

Question 47

Nutrition support for solid organ transplant patients receiving cyclosporine need to be modified due to the presence of:

Answer 47

Hyperkalemia