From Core Curriculum Flashcards
Which of the following is the largest component of TEE?
a. RMR
b. thermogenic effect of food
c. physical activity
d. metabolic stress
a. RMR
Which of the following is the most commonly used method for assessing energy expenditure?
a. indirect calorimetry
b. predictive equations
c. reverse Fick equation
d. free energy balance
b. predictive equations
You are determining the energy intake for a 53yo, critically ill, male who is about to start enteral feeding. He is 170cm and 150kg, BMI of 51.9. Minute ventuilationis 12.5 L/min. Based on the 2016 ASPEN guidelines, what is the energy value you would use?
a. 1750kcal (25kcal/kg of IBW)
b. 1225kcal (70% of calculated 25kal/kg IBW)
c. 2250kcal (25kcal/kg of adjusted wt)
d. 2615kcal (Penn State)
a. 1750kcal
Which parameter is measured when using IC?
a. heat loss
b. catabolic rate
c. gas exchange
d. free energy balance
c. gas exchange
Which of the following is true about the net chemical reaction of glucose catabolism?
a. pyruvate is the final product
b. oxygen is required for ATP synthesis
c. both water and CO2 are produced
d. CO2 is produced but water is not
e. Water is produced but CO2 is not
c. both water and CO2 are produced
Which of the following incorrectly pairs a metabolic process with its site of occurance?
a. glycolysis and cytosol
b. TCA cycle and mitochondrial membrane
c. ATP phosphorylation and cytosol in mitochondira
d. electrol transport chain and mitochondrial membrane
e. oxidative decarbosylation of pyruvate and mitochondria
B TCA cycle and mitochondrial membrane
Which of the following is least likely to occur during oxygen debt?
a. buildup of lactic acid
b. buildup of pyruvate
c. decrease in pH
d. increase in fatigue
e. shortage of ATP
B. buildup of pyruvate
Which of the following statements best describes the human gut microbiota?
a. the human gut is established by the age of 3 and few factors influence it
b. trillions of bacteria comprise the microbiota
c. it is highly dependent on the host for survival but provides little benefit to the host
d. It is not influenced by the mode of infant delivery
b. trillionsof bacteria comprise the microbiota
Which of the following best describes a probiotic?
a. it is a live organism used to make yogurt
b. it is a live non pathogenic organism which when administered in adequate amounts confers a health benefit on the host
c. are generally recognized as safe and therefore can be safely provided to all humans receiving nutrition support
d. the mechanism is well known, making probiotic therapy a great addition to nutrition support therapy
b. it is a live non pathogenic organism which when administered in adequate amounts confers a health benefit on the host
which of the following best describes prebiotics?
a. all fibers are considered prebiotics
b. prebiotics are synthetic compounds
c. are dietary polysaccharides that escape digestion by the host enzymes, are fermented by the gut microbiota, and influence the gut microbiota pattern in a beneficial matter
d. all prebiotics are fermented to yield the same SCFA
c. are dietary polysaccharides that escape digestion by the host enzymes, are fermented by the gut microbiota, and ifnluence the gut microbiota pattern in a beneficial matter
which of the following is true relating to HCl and protein digestion?
a. HCl aid in the convernsion of pepsin to pepsinogen
b. HCl denatures protein structures to make them more susceptibble to enzymatic action
c. HCl is secreted by the parietal cells within the duodenum in response to dietary protein
d. HCl’s release is stimulated by the hormone insulin
b. HCl denatures protein structures to make them more susceptibble to enzymatic action
During protein metabolism, BCAA:
a. are extracted primarily by the liver after a protein-containing meal
b. are released by the skeletal muscle at a higher rate than other AA
c. serve as the primary fuel source for enterocytes
d. produce oxidative wastes during metabolism within the skeletal muscles, which are removed by alanine and glutamine
d. produce oxidative wastes during metabolism within the skeletal muscles, which are removed by alanine and glutamine
Proteins perform all the following physiological functions except:
a. major source of energy
b. maintain acid base balance
c. contribute to immune defense
d. serve as a mode of transport for substances
a. major source of energy
the rate of protein turnover in catabolic, critically ill pts:
a. does not change
b. decreases
c. increases
d. is not affected by nutrition support
c. increases
The administration of 1L NS to a normonatremic pt will increase the intravascular and interstital fluid compartments by (respectively)
a. 1000ml and 0ml
b. 0ml and 1000ml
c. 750ml and 250ml
d. 250ml and 750ml
d. 250ml and 750ml
Assuming the same wt and serum Na concentrations, which of the following pt has the greatest free water deficit?
a. 35yo man
b. 75yo man
c. 35yo woman
d. 75yo woman
a. 35yo man
A pt with severe intractable n/v is at risk for which of the acid-base disorders?
hypochloremic metabolic alkalosis
which of the following is a benefit of EN compared with PN or no nutrition?
a. maintain normal gallbladder function
b. reduce GI bacterial translocation
c. more efficient nutrition metabolism
d. all of the above
d. all the above
High protein hypocaloric EN providing 65-70% of energy needs, as determined by IC is recommended for ICU pt in which condition
obesity
risk factors for aspiration including all the following except
a. malnutrition
b. use of naso/oro feeding tube
c. bolus EN
d. supine position
a. malnutrition
A 55yoM had a fall from a ladder. A CT scan of the head showed SDH with midline shift. After admit to the ICU, the pt was intubated and sedated, with a OGT to suction with 200ml gastric content. The pt abd was soft and nondistended. Nephrology was contustuled as the pt was started on continuous venous hemodialysis. What type of formula would best meet his needs.
a. Restricted in in fluid, protein, and electrolytes
b. Not restricted in protein, but restricted in fluid and electrolytes
c. Restricted in fluid but not protein and electrolytes
d. Not restricted in fluid or protein, but restricted in electrolytes
c. Restricted in fluid but not protein and electrolytes
60yo critically ill pt has been tolerating a 1kcal/ml formula well for the past week. She begins to have diarrhea and a rectal tube was placed. What should the clinician’s next suggestion be?
a. change to peptide formula
b. determine cause of diarrhea
c. add pre and pro biotics to feeding regimen
d. change to fiber supplemented formula
b. determine cause of diarrhea
What should a clinician do when considering the use of enteral formula marketed for specific disease conditions?
Evaluate the studies used to support the use of specialty formulas and apply clinical judgement to select the appropriate product
If a nasoenteric feeding tube cannot be unclogged using water flushes, what is the next method prior to replacing the tube?
a. cola and let it sit for a few hours
b. Clog Zapper and flush within 30-60mi n
c. wait for a few hours to see whether the clog dissolves spontaneously
d. pancreatic enzymes and bicarb, allow to sit for 1-2 hrs, and then flush with warm water.
d. pancreatic enzymes and bicarb, allow to sit for 1-2 hrs, and then flush with warm water.
Which of the following action is most appropriate for enhancing gastric empyting during administration of EN?
a. Trendelenburg position
b. decrease the rate of the continuous infustion, or change from bolus to continous feeding
c. switch to a formula with higher fat content
d. switch to a formula with higher protein content
b. decrease the rate of the continuous infustion, or change from bolus to continous feeding
Which of the following is the most appropriate initial action for the management of TF associated diarrhea?
a. change the EN to have fiber
b. review the medications to determine whether hyperosmolar agents are being administered
c. change to peptide TF
d. use anti motility agent
b. review the medications to determine whether hyperosmolar agents are being administered
which of the following methods is not recommended to minimize contamination of formula?
a. washing hands and donning clean gloves before preparing formula
b. immediate use of formula from newly opened container
c. infusing reconstituted formula with added modular in 1 bag for up to 8 hrs
d. change an open system container every 24hrs
c. infusing reconstituted formula with added modular in 1 bag for up to 8 hrs
which of the following may increase the risk of phlebitis with PPN?
a. osmolarity <900mOsm
b. K more than 100mEq/L
c. Ca less than 5mEa/L
d. addition of heparin
b. K more than 100mEq/L
Which of the following will increase the solubility of Ca and Phos in a PN formulation?
a. use of Ca as Cl salt
b. use of phos as a Na salt
c. increase AA concentration
d. increase temperature
c. increase AA concentration
According to ASPEN, the amount of dextrose used in a PN is required to be listed on the label as:
Grams per day
Which of the following is the most appropriate VAD strategy for a pt requiring a long term PN therapy?
a. use of midclavicular as a cost effective measure
b. place a percutaneous non tunneled catheter to initiate PN and then replace with an implanted port
c. place a single lumen tunneled cuff catheter
d. place a triple lumen, antibiotic coated catheter to ensure adequate access for the future.
c. place a single lumen tunneled cuff catheter
thrombotic occlusions are the most commonly treated with which of the following?
thrombolytics (i.e. alteplase)
Which of the following practices has been shown to reduce the risk of CRBSIs?
a. systemic use of antimicrobial prophylaxis at the time of insertion or access
b. routine replacement of CVADs
c. use of the central line bundle
d. selection of internal jugular site as opposed to the subclavian site
c. use of the central line bundle
Which of the following is most strongly correlated with improved mortality in a TBI?
a. strict avoidance of PN
b. early initiation of nutrition
c. high protein content in nutrition formula
d. supplementation of vit C and E
b. early initiation of nutrition
Which of the following commonly used medications in TBI is not associated with reduction on measured energy expenditures?
a. propranolol
b. mannitol
c. pentobarbital
d. rocuronium
b. mannitol
Metabolic changes following SCI depend of the level of cord injury and the extent of injuries. Which of the following is true?
a. the energy expenditure following a SCI is 48% higher than a TBI
b. to accurately assess the energy for SCI, multipy the REE by 1.6 injury factor and then again by 1.2 activity
c. modified BMI proposed for SCI
d. SCI require 30-35kcal/kg depending on their physical activity
c. modified BMI proposed for SCI
which of the following regarding SAH is false?
a. high doses folic acid should be administered to reduce the likelihood of a second hemorrhagic stroke
b. energy expenditure is higher for pts with SAH than those with ischemic stroke
c. concentrated EN may be necessary if fluid intake is restricted to minimize cerebral edema
d. bedside or formal swallow studies should be preformed to confirm the pt does not have dysphagia before an oral diet is started
a. high doses folic acid should be administered to reduce the likelihood of a second hemorrhagic stroke
which of the following characterizes the current understanding of SIRS?
a. overstimulated immune system
b. mixture of immune stimulation and suppression
c. initial immune suppression followed by stimulation
d. immune suppression
b. mixture of immune stimulation and suppression
why is hemodynamic stability an important consideration before initiation of EN?
GI perfusion may be compromised
what is the best reason to conservatively prescribe energy in nutrition support pts?
a. glycemic control
b. to facilitate permissive underfeeding
c. cost containment
d to achieve goal infusion more efficiently
a glycemic control
the strategy of fluid restriction may decrease the number of days that pt is required ventilation for which disease process?
a. TBI
b. ARDS
c. Pulm Embol
d. septic shock
b. ARDS
Which of the following does not help reduce VAP?
a. elevate HOB >45 degrees
b. gastric ulcer prophylaxis and early PN
c. early mobility and decreased days on vent
d. minimizing sedation and daily sedation vacation
b. gastric ulcer prophylaxis and early PN
What is the definition of ANH?
a medical treatment that allows a person to receive nutrition and hydration when he or she is no longer able to consume them by mouth
which of following is true concerning Forest plots from a meta analysis?
a. the test of heterogeneity evaluates the similarity between patients in a study
b. the test overall treatment effect indicates whether the quality of the meta analysis is high or low
c. relative risk tends to overestimate the treatment effect
d. absolute risk reduction is determined by count the number of positive studies divided by the total number of studies in the meta analysis.
c. relative risk tends to overestimate the treatment effect
