Domain 2 Flashcards
In community surveys, a frequent symptom of malnutrition is:
a. scurvy
b. rickets
c. low serum albumin
d. low hemoglobin
d. low hemoglobin
Low hemoglobin- common cause is malnutrition. Nutritional deficiencies directly affect the hemoglobin count, for example, vitamin deficiency, especially deficiency of vitamins B6, B12, and folate.
It is also often seen that in pregnancy, women suffer from low hemoglobin, if they are not careful to follow a proper diet, and include adequate folic acid, vitamin, and mineral supplements in it.
Hgb: Men 14-17 gm/dl; women 12-15 mg/dl;
pregnant >= 11 gm/dl
Which is the least common symptom in the elderly?
a. osteomalacia
b. osteoporosis
c. obesity
d. hypertension
a. osteomalacia
Osteomalacia in adults- Rickets in children
Osteomalacia refers to a marked softening of your bones, most often caused by severe vitamin D deficiency. The softened bones of children and young adults with osteomalacia can lead to bowing during growth, especially in weight-bearing bones of the legs.
What is included in the study of demographics? I. age of individuals II. population statistics III. sex of individuals IV. socioeconomic factors
a. I only
b. all of the above
c. II, III
d. I, II, III
d. I, II, III ( age, population statistics, sex)
Demographics is the study of a population, based on factors such as age, race, sex, education, income, and employment.
** socioeconomic status- YES, factors, NO
Athletes should receive:
a. salt pills only during the summer months
b. extra protein
c. carbohydrate loading two weeks prior to an event
d. water during an event to replace lost fluids
d. water during an event to replace lost fluids
** this is the most basic need. deciding on other factors would require additional information before making the recommendation
How many grams of protein would you receive on a 1500 calorie diet which is 20% protein?
a. 70
b. 75
c. 64
d. 300
b. 75
1500 x .20= 300 cal of protein
300 cal pro divided 4 cal/gm of pro= 75 gm protein for 1500 calorie diet
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 the fluid intake
d. decrease the intake of saturated fats
a. increase fluid intake
A high protein diet increases the risk of dehydration, may place increased strain on the kidneys and liver and does not improve muscle bulk,
increased protein consumption requires an increase in urea excretion — hence, more frequent urination during a high-protein diet. Increased Risk of Dehydration
Nutritional prescription for a patient with cardiac cachexia includes:
a. < 1 liter fluid, low sodium
b. low sodium, low saturated fat, low cholesterol, high calorie
c. restricted calorie, .8 g pro/kg, fluid restriction
d. normal protein, follow DASH diet
b. low sodium, low saturated fat, low cholesterol, high calorie
Cardiac- low sodium, low saturated fat, low cholesterol, DASH or Mediterranean Diet
CACHEXIA- Need high calories
Cardiac cachexia is a condition that can happen to people who have heart failure. It means you lose a serious amount of body fat, muscle, and bone. Doctors often call this “body .”.
Cachexia is loss of fat AND muscle mass- commonly seen in cancer patients
Which infant is at the greatest risk?
a. 20 lbs Hemoglobin 10
b. 22 lbs hemoglobin 10.5
c. 19 lbs hemoglobin 11
d. 30 lbs hemolgobin 9
d. 30 lbs hemolgobin 9
low hemoglobin levels associated with increased risk of mortality.
What is the normal hemoglobin range for infants?
Adults?
Hgb infants: 9.5-13 gm/dl
Hgb women: 12-15 gm/dl; Men: 14-17 gm/dl
Pregnant: >= 11 gm/dl
The normal HgB range for infants is between 9.5 -13 gm/dl. hemoglobin is a protein found in red blood cells that carries oxygen.
An alcoholic patient has a low serum albumin, low hemoglobin, high ammonia, abnormal liver function tests, and ascites. Why is he on a 500 mg sodium diet? a. secondary renal failure b. hypoaldosteronism c. hypoalbuminemia d. hyperammonemia
c. hypoalbuminemia
low hemoglobin--> sign of malnutrition. nutritional deficiencies (B6, B12, folate) Low albumin (hypoalbuninemia)--> common in malnourished, liver damage. edema due to hypoalbuminemia
high ammonia–> abnormal liver function tests–> liver disease
ascites–> fluid accumulation. Ascites happens when pressure builds up in the veins of your liver and it doesn’t work as it should. These two problems usually are caused by another condition – cirrhosis, heart or kidney failure, cancer, or an infection. The pressure blocks blood flow in the liver, which over time keeps your kidneys from removing excess salt from your body.
Which of the following should the patient in the above question have for lunch?
a. 4 ounces cottage cheese
b. 1 ounce cheddar cheese
c. 1 ounce roast beef
d. 1 ounce cold cuts
c. 1 ounce roast beef
cheese, cold cuts and cottage cheese HIGH in sodium
Which of the following should be included in the diet for celiac disease? I. decrease intake of eggs II. use potato and rice flour III. IM vitamin B12 and iron IV. low calorie, high fat, high protein
a. II, III
b. III, IV
c. I, II, IV
d. II, IV
a.
II. use potato and rice flour
III. IM vitamin B12 and iron
There are a variety of nutritional deficiencies associated with celiac disease, primarily caused by the inability of the damaged small intestine to properly absorb enough of the nutrients our bodies need. People recently diagnosed with celiac disease are commonly deficient in fiber, iron, calcium, magnesium, zinc, folate, niacin, riboflavin, vitamin B12, and vitamin D, as well as in calories and protein.
celiac disease: immune reaction to the gliadin part of gluten. Must avoid gluten products
GLUTEN-FREE flours include rice, potato, corn, teff, buckwheat, soy, chickpea, and pure oat flours
Who is most at risk for gestational diabetes?
a. BMI <30
b. age < 25, overweight
c. BMI> 30, history of GDM
d. conception within 10 months of last pregnancy
c. BMI> 30, history of GDM (these are the risk factors)
GDM: temporary (in most cases) form of diabetes in which the body does not produce adequate amounts of insulin to regulate sugar during pregnancy.
Gestational diabetes raises your risk of high blood pressure, as well as preeclampsia — a serious complication of pregnancy that causes high blood pressure and other symptoms that can threaten the lives of both mother and baby. Future diabetes. If you have gestational diabetes, you’re more likely to get it again during a future pregnancy.
A child is lethargic, irriatable with diarrhea. The cause may be:
a. zinc toxicity
b. lead poisoning
c. iron overload
d. vitamin A toxicity
b. lead poisoning
paint, toys
How many calories are in 300 ml of 5% dextrose solution?
a. 51
b. 60
c. 15
d. 200
a. 51
300 ml x .05= 15 gm dextrose
15 gm dextrose x 3.4 cal/ gm of dextrose= 51 cal
A single 19 year old female is 6 months pregnant. She has not gained any weight and has not seen a physciian. Hemoglobin is 9. Hematocrit is 30. What is the most important recommendation for her?
a. see a physiciain immediately
b. apply for WIC immediately
c. join a teenage pregnancy support group
d. begin taking iron supplements
a. see a physiciain immediately.
Rationale: no weight gain, hasnt seen a doctor. hemoglobin and hematocrite is below normal
Hgb normal for pregnant- >= 11
Hct normal for pregnant- 33%
A female, 5’7” tall, weights 115 lbs. Six months ago she weighed 130 lbs. What is her percent of ideal body weight?
a. 85%
b. 83%
c. 81%
d. 87%
a. 85%
% IBW: current wt/IBW x 100 IBW: Females- 100 lbs + 5 x every pound over 5 ft IBW: 100 + 35= 135 lbs current wt: 115 lbs % IBW= 115/ 135 x 100 = 85%
A vegan is allergic to milk. Which nutrients would you expect might be deficient in her intake?
a. protein, calories
b. vitamin B12, D
c. vitamin C, calcium
d. vitamin A, D
b. vitamin B12, D
Vegan= no dairy, no meat
A patient with Crohn’s disease needs the following diet:
I. high fat, high calorie, high protein
II. low fat only with steatorrhea, vitamin C, B12
III. calories according to current BMI, high protein
IV. high residue, low fat, fat soluble vitamins
V. low calorie, low residue, fat soluble vitamins, B12
a. I
b. II, III
c. III, IV
d. V
b. II, III
b.
II. low fat only with steatorrhea, vitamin C, B12
III. calories according to current BMI, high protein
Crohn’s Disease: type of inflammatory bowel disease (IBD)
affects ileum- weight loss, anorexia, diarrhea
B12 deficiency leading to megaloblastic anemia
iron deficiency anemia due to blood loss, decreased absorption
Treatment:
- maintain fluid/electrolyte balance (antidiarrhea agent)
- acute Crohns flare ups= bowel rest, parenteral nutrition or minimal residue
- energy needs based on BMI, limit fat only with steaorhea; water soluble and fat soluble vitamins: iron, folate
- assess Ca, Mg, Zn
- MCT oil, watch lactose, frequent feedings
- high fat may improve energy balance
Which of the following diets is appropriate for reactive hypoglycemia?
a. reduce intake of concentrated carbohydrates, 5-6 meals
b. increased complex carbohydrate, low fat, high protein
c. decreased complex carbohydrate, low fat
d. high protein, high fat, high carbohydrate
a. reduce intake of concentrated carbohydrates, 5-6 meals
Reactive hypoglycemia:
low blood sugar reaction after meals. Result of too much insulin being produced and released by the pancreas after a LARGE, carbohydrate-based meal.
common after bariatric surgery.
TREATEMENT is the DIET
Which patient has marasmus? Patient A (male) serum albumin 3.5 transferrin 275 triceps skinfold 3 MAMC 15 TLC
Patient B (female) serum albumin 2.6 transferrin 125 triceps skinfold 16.8 MAMC 24.1 TLC 1000
Patient C (male) serum albumin 4.0 transferrin 450 triceps skinfold 17 MAMC 28.1 TLC 3500
a. A
b. B
c. C
d. A, B
a. A
Patient A (male)
serum albumin 3.5 (normal=3.5-5)
transferrin 275 (normal= > 200 mg/dl)
**triceps skinfold 3 (measures BODY FAT reserves)
TSF Male: 12.5 mm; female 16.5 mm
**MAMC 15 (measures skeletal muscle mass)
MAMC Male: 25.3 cm; female 23.2 cm
TLC
The primary symptom of marasmus is an acute loss of body fat and muscle tissues, leading to an unusually low body mass index (BMI). Marasmus is a type of wasting. In a child, the main symptom of marasmus is a failure to grow, known as stunted growth.
MAMC: mid-arm muscle circumference (body fat reserves)
TSF: triceps skinfold (skeletal muscle mass)
When assessing nutritional status, which would be the most beneficial?
a. 24-hour recall, history of weight changes
b. medical history, diet order, socioeconomic status
c. clinical observation, weight status, cultural habits
d. diet intake info, clinical data, laboratory data
d. diet intake info, clinical data, laboratory data
The first function of the public health nutritionist is:
a. assess the needs of the community
b. counsel patientw with special dietary needs
c. write pamphlets for educational purposes
d. expand the role of Dietitians
a. assess the needs of the community
The elderly need how many ml of water per KG?
a. 35-40
b. 45
c. 25-30
d. 25
c. 25-30
is this less than adults??
What nutrients most affect the renal solute load?
a. protein and carbohydrate
b. sodium and carbohydrate
c. protein and sodium
d. sodium and fat
c. protein and sodium
The renal solute load (RSL) is the sum of the materials that must be excreted via the urine.
According to the Diabetic Exchange Lists, when substituting 2% milk for fat-free milk, you must omit how many fat exchanges?
a. 1/2
b. 1
c. . 1- 1/2
d. 2
b. 1
If a man normally consuming 2600 calories per day reduces his intake to 1500 calories per day, how much weight will he lose in one week?
a. 05. kg
b. 1.0 kg
c. 1.5 kg
d. 2.0 kg
b. 1.0 kg
2600-1500=1100 calorie 1100 cal x 7 days= 7700 cal 3500 cal= 1 lb 7700/3500=2.2 lbs convert to kg: 2.2/2.2= 1.0 kg
For which of the following diseases is diet therapy the primary treatment?
a. peptic ulcer
b. diabetes
c. Wilsons disease
d. galactosemia
d. galactosemia
galactosemia: due to missing enzyme that would have converted galactose-1-PO4 into glucose-1-PO4
treated solely by diet: galactose and lactose free
NO: organ meats (have galactose), MSG extenders, milk, lactose, galactose, whey, casein, dry milk solids, curds, calcium or sodium caseinate, dates, bell peppers
OKAY: soy, hydrolyzed casein, lactate, lactic acid, lactalbumin, pure MSG
Which of the following best reflects protein status?
a. serum albumin
b. serum transferrin
c. retinaol-binding protein
d. prealbumin
d. prealbumin
PAB: 16-40 mg/dl
short half-life. picks up changes in protein status quickly
during inflammation, liver synthesizes CRP at expense of PAB
Following a Billroth II, steatorrhea often results. What is the likely cause?
a. bacterial overgrowth in the remaining loop
b. lack of pancreatic secretion due to less duodenal hormone secretion
c. a diet restricting simple carbohydrates
d. rapid absorption of simple carbohydrates
b. lack of pancreatic secretion due to less duodenal hormone secretion
Steatorrhea= consequence of malabsorption
Billroth II: gastrojejunostomy. attaches it to the jejunum. When food bypasses the duodenum, the secretion of secretin and pancreozymin by the duodenum is reduces. These hormones normally stimulate the pancrease, so there is now little pancreatic secretion. Affects CALCIUM and IRON absorption
Meats cured with whey wont be tolerated by someone with: I. lactose intolerance II. diabetes III. post-gastrectomy of 3 months IV. duodenectomy
a. I, II, III
b. II, III, IV
c. I
d. I, III, IV
c. I (lactose intolerance)
Chemically defined formulas are used for:
a. short bowel syndrome
b. post chemotherapy treatment
c. hypermetabolism
d. galactosemia
a. short bowel syndrome
Elemental formulas (also known as monomeric, hydrolyzed, or chemically defined formulas) are different from standard formulas because their macronutrients have already been partly or fully broken down for those patients who have compromised digestive systems or nutrient absorption problems. This allows the body to digest and absorb what it needs from the formula more easily. J tube patients usually eat elemental formulas.
A PEG feeding would be useful in a patient with:
a. head or neck cancer, who will not be able to eat normally for weeks
b. short bowel syndrome
c. duodenal ulcers
d. pancreatitis
a. head or neck cancer, who will not be able to eat normally for weeks
PEG: inserts tube into stomach through abdominal wall. used when needed for more that 3-4 weeks
A patient with hepatitis needs a high protein intake. Besides helping the liver to regenerated, what other purpose is served?
a. it helps increase iron absorption
b. it restores glycogen reserves
c. it helps prevent a fatty liver
d. it helps prevent necrosis of the liver
c. it helps prevent a fatty liver
Purpose of high protein intake with hepatitis:
- help regenerate liver
- prevent fatty liver (provide lipotropic agents to convert fat into lipoproteins for removal from the liver)
The additive influence of foods and constituents which when eaten have a beneficial effect on health refers to:
a. nutracueticals
b. food synergy
c. positive corollaries
d. medical foods.
b. food synergy
“Food Synergy” or foods that work better together, than apart, is an excellent way to get the maximum amount of nutrients out of the foods you eat.
Ex: tomatoes with avocado
tomatoes have lycopene (antioxidant-fight CVD and cancer) which is best absorbed with good fat
Which foods are most likely to cause an allergic reaction:
a. shellfish, peanuts, wheat
b. wheat, chocolate, rice
c. citrus fruits, milk, corn
d. chocolate, milk, corn
a. shellfish, peanuts, wheat
Top allergens: Dairy, wheat, fish, shellfish, treenuts, peanuts, soy, and eggs
Which set of conditions is most commonly seen in American children?
a. obesity, dental caries, anemia
b. hypertension, dental caries, rickets
c. hyperkinesis, anemia, dental caries
d. diabetes, obesity, anemia
a. obesity, dental caries, anemia
A 1500 calorie diabetic diet with 45% of the calories from carbohydrate is prescribed. One-third of the carbohydrate grams is met with 1/2 cup orange juice, 1 cup milk, and:
a. 1 slice toast
b. 2 slices of toast
c. 2 slices toast and 1/2 cup oatmeal
d. 1/2 slice toast
b. 2 slices of toast
b. 2 slices of toast
1500 cal x 45%= 675 cal divided by 4 cal/gram= 168.75 gm
168.75 x 1/3= 56.25 gm
( 15 + 12+ x= 56.25= 29.25)
1/2 cup orange juice= 15 gram
1 cup milk= 12 gram
toast= 15 gram
1/2 cup oatmeal= 15 gram
Which of the followins is a medium fat protein?
a. peanut butter
b. tuna packed in oil
c. corned beef
d. chicken without skin
b. tuna packed in oil
chicken without skin: lean meat
corned beef and peanut butter: high fat
Which government agency would you contact regarding food distribution?
a. USDA
b. FDA
c. HHS
d. FTC
a. USDA
USDA’s food distribution programs support consumers and American agricultural producers through purchases of 100% American-grown and -produced foods for use by schools and institutions.
