Past Quiz Questions Flashcards
in a patient with iron deficiency anemia, a clinician would expect which biochemical markers to be low?
ferritin
transferrin saturation
a patient with low hematocrit, high MCV, and normal cobalamin concentration has …
macrocytic anemia
which micronutrient has a sensitive biomarker, meaning the concentration in blood, serum, or plasma is reflective of total body pools?
folate
you are interested in evaluating the calcium intake and status of your patient
what biochemical marker would be most appropriate to measure
24-hour urinary calcium excretion
what marker would you use to help evaluate folate status in a woman with questionable folate intake who is trying to become pregnant?
erythrocyte folate concentration
erythrocyte transketolase activity coefficient is considered the best marker of
thiamin status
what is the best way to assess niacin status
by measuring urinary end products of niacin metabolism
briefly outline/describe the three stages of iron deficiency
list at least two markers that will be low, normal, or elevated for each of the three stages
tissue depletion: decreased ferritin
functional deficiency without anemia: decreased serum ferritin, decreased transferrin saturation, increased erythrocyte protoporphyrin/ZPP, increased serum transferrin receptor
microcytic anemia: decreased hemoglobin and hematocrit, decreased MCV
A physician is concerned about zinc status of a recently admitted patient. The physician asks you if serum zinc is a sensitive marker of zinc status. What do you tell him/her? In your answer, provide a brief definition of what is meant by “sensitive”.
Serum zinc is not a sensitive marker. A sensitive marker is able to correctly reflect the stores that are in the body. In the case of serum zinc, when zinc levels in the body are so low that a deficiency is present, it will be reflected in the labs. However, if the labs are within normal levels but slightly high or low, it is not super reflective of the body stores.
For this reason, a 24-hour urinary collection would be a better indicator of zinc status to determine body stores.
what is the best biochemical marker of vitamin D status
serum 25(OH)D
pale conjunctivae is associated with a deficiency of
iron
a patient with a history of lactose intolerance reports he has been trying to follow a ketogenic diet. He eats a lot of red meat and chicken plus a variety of vegetables including peppers and leafy green vegetables. He also eats nuts and uses butter and vegetable oils liberally. He reports he does not eat bread or other grains, dairy, fruit or fish. Based on this dietary pattern, the patient could be deficient in which of the following nutrients?
riboflavin and calcium
a patient who follows an overly processed American diet that contains red and white meats, processed breads and cereals, cheese and fruit juice with little whole grains, nuts, legumes, vegetables, and fish/seafood might have suboptimal status of …
fiber and magnesium
perifollicular hemorrhages or petechiae may be a sign of
vitamin C deficiency
comment on while it is important to assess the food matrix and cooking techniques when assessing the status of calcium, zinc, iron, and other minerals
It is important to ask your client what methods they are using to prepare and cook their foods, as different methods can change the absorption of micronutrients.
For example, soaking and sprouting certain foods can help increase the absorption of zinc.
what is the bioavailable form of niacin
NADH
what is the bioavailable form of vitamin B6
pyrodoxal phosphate
what is the bioavailable form of vitamin E
alpha tocopherol
what is the bioavailable form of pantothenic acid
coenzyme A
what is the bioavailable form of riboflavin
FADH
what is the bioavailable form of folate
tetrahydrofolate
__ are found in nuts, whole grains, and certain vegetables including swiss chard, spinach, beet greens, sweet potato, and cocoa
they bind many divalent ions including calcium, magnesium, and iron and decrease their absorption
oxalates
dermatitis, diarrhea, and dementia are signs of a
niacin deficiency
the physiological and biochemical effects of a drug or a combination of drugs are termed __ whereas the movement of a drug through the body by absorption, distribution, and excretion is termed __
pharmacodynamics, pharmakinetics
chelation reactions between certain drugs and medications cause
decreased amount of mineral available for absorption
decreased absorption and action of the drug/medication
which of the following is not an example of pharmacogenomics?
a) Those with glucose-6-phosphate dehydrogenase deficiency are sensitive to hemolytic anemia after consuming fava beans, aspirin or high doses of vitamins C and K
b) Tetracycline is more likely to be ineffective in teenagers who drink a lot of milk
c) Asian Individuals are more likely to have low activity of hepatic acetyl transferase than Caucasians
d) Different activities of cytochrome P450 enzymes can influence drug effectiveness or risk of side effects
e) all of the above are examples
f) None of the above are example
b) Tetracycline is more likely to be ineffective in teenagers who drink a lot of milk
which statement is true concerning the anti-osteoporosis drug Fosamax (and other bisphosphatates)?
A) The medication should not be taken with milk or mineral water because it decreases its action
B) The medication should not be taken with iron supplements because it prevents iron from being absorbed
C) The medication should be taken in the morning on an empty stomach, about 30-60 minutes before breakfast
D) The medication must be taken with folacin, the reduced form of folic acid, to prevent macrocytic anemia
C) The medication should be taken in the morning on an empty stomach, about 30-60 minutes before breakfast
Grapefruit juice cannot be taken with a number of specific medications including certain central-nervous system drugs, immunosuppressants, cardiovascular drugs and lipid-lowering medications. The reason for this is because a component (furanocoumarin) in grapefruit and Seville oranges_____.
inhibits a specific CYP450 isoenzyme in the intestinal wall that decreases metabolism of these drugs and leads to increased blood concentrations of the drug and possibly toxic effects
Patients on the Parkinson’s drug Levodopa should be instructed to __, particularly in the more advanced stages of this disease
consume protein mostly in the evening meal to ensure optimal absorption of the medication
A hospital patient had a serum albumin concentration of 2.9 mg/dL. The patient is stabilized and adequately hydrated. If the physician prescribes Warfarin at the standard dose, this patient ___.
May be at risk for drug toxicity
GFR is lower in women compared to men. These physiological difference can account for sex-related differences in drug clearance. T/F?
true
Please list two other differences between men and women that may account for sex-related differences in drug metabolism and/or drug distribution
Women typically have lower body weight/fat and volume distribution. This means that at the same dosage, the woman might have higher concentrations when compared to a male because she is smaller in general. This could lead to drug toxicity or stronger effects than predicted.
Women also have decreased activity of cytochrome CYP450 enzymes, specifically CYP3A4. This means that they do not have as many active enzymes to metabolize the drug and inactivate it in the GI tract. This could lead to higher concentrations in the blood, and it could result in toxicity.
What is the purpose of cytochrome P450 tests? what is the significance of being a porr metabolizer and an ultrarapid metabolizer?
Cytochrome P450 tests allow us to tell which individuals have high or low activation of these enzyme complexes. This can help us understand how they will metabolize a drug.
A poor metabolizer will have less active CYP450 enzymes. This leads to less inactivation of these particular drugs, and they will have a higher risk for toxicity, since more of the drug will cross their GI tract without being deactivated.
An ultrarapid metabolizer will have more active CYP450 enzymes. This leads to more inactivation of these particular drugs, and they will have a higher risk for therapeutic failure, since more of the drug will cross their GI tract being deactivated.
If we know a patient is a poor metabolizer or an ultrarapid metabolizer, we can work with the pharmacists to appropriately adjust dosage rates so the patient is getting the intended affect without harmful consequestions.
A well recognized nutritional side effect of the lipid lowering drug cholestyramine is __.
its inhibition of the absorption of vitamins A, D, E, K and vitamin B12
A patient with probable malnutrition is admitted to the hospital because of a recent history of seizures. The admission lab work reveals low serum albumin and elevated creatinine concentrations. The nutrition screening reveals poor food intake X 3 months. If this patient were started on medication/drug therapy all of the following could be expected EXCEPT:
A) reduced pharmacological effects of the drug
B) reduced metabolism of the drug in the liver by the cytochrome P-450 enzyme system
C) increased free fraction of the drug in the blood
D) increased risk of side-effects/drug toxicity (unless the prescribed dose if reduced)
reduced pharmacological effects of the drug
a patient taking a loop diuretic such as Lasix for management of edema may be at risk __
for hyponatremia if older
the cancer chemotherapeutic agent methotrexate acts as an antagonist of which vitamin
folate
proton pump inhibitors are known to decrease absorption of ___
calcium, zinc, iron, and vitamin B12
you are covering a psychiatric ward of a hospital
a newly admitted patient is placed on a Tyramine restricted diet
most likely this patient is on ___ which may result in __ if too much tyramine is consumed
a MAO inhibitor
hypertensive crisis
In question immediately above, what foods/beverages should be avoided on a Tyramine restricted diet?
Please suggest in general what types of foods should be avoided?
fermented and aged foods
A patient on anti-manic drug lithium carbonate is stabilize on a 2300 mg sodium diet consisting of minimally processed foods. The patient feels to feel “off” while traveling for a week and eating mostly high-sodium fast foods. What is the probable explanation?
the patient may be excreting sodium via the kidney that is resulted in increased drug excretion and “therapeutic failure”
a dietitian could expect to counsel a patient on all the listed potential drug and food/nutrient interactions EXCEPT
Monitoring vitamin D status when taking anticonvulsants including phenytoin and phenobarbital
Avoiding coffee when taking the thyroid medication levothyroxine
Maintaining a consistent intake of dietary vitamin K when taking Warfarin (coumadin)
Avoiding black pepper when undergoing cancer treatment with the drug Tomoxifen
avoiding black pepper when undergoing cancer treatment with the drug Tomoxifen
Buffer, binder, fillers, flavors, preservatives, coatings, and suspension agents found in medications tablets and pills are terms ___
excipients
You are giving a cooking demonstration to a group of older women at risk for osteoporosis. You would like to suggest that the women who do not drink milk or consume other dairy products consider a calcium supplement. However, in making this recommendation you should caution those taking __ against calcium supplementations because this medication reduces calcium excretion in the distal kidney.
thiazide diuretics
People on certain medications should avoid potassium containing salt substitutes. What medications are these
k-sparing diuretics
ACE inhibitors
beta blockers
what is term for physician induced?
iatrogenic
what micronutrients are known to be particularly important for wound healing?
zinc, vitamin C
symmetrical, scaley dermititis with hyperpigmentation, desquamation and sharp margination on the skin exposed to sunlight is characteristic of a deficiency of __
niacin
what do you expect in a patient with nephrotic syndrome
protein urea
combining measurement of the mid-upper arm circumference with the triceps skin fold thickness provides the dietitian with information to assess
possible compromised nutritional status
which of the following statements about waist and hip circumferences is not true?
waist circumference is of little value in patients who are Asian
a female has a 34” waist and a 40” hip measurement
she is at particular risk for …
nothing
BMI can be useful anthropometric marker specifically in relation to disease risk, but it has a number of limitations. As discussed in the lecture recording, provide two reasons BMI is useful and two known shortcomings or limitations.
- helps determine risk factors
- very good for overarching populations
- does not account for body fat percentage
- does not account for different ethnicities
which biochemical markers are classically elevated in patients with liver damage or liver disease?
alkaline phosphatase, alanine amino transferase (ALT), aspartate amino transferase (AST)
which biochemical markers are expected to be elevated in a patient with poor renal function?
BUN, creatinine
which of the following biochemical markers would be expected to be elevated in a patient with muscle damage that could include a recent MI or recent bout of very strenuous exercise (likely with muscle soreness)
CK, LDH, ALT, AST, alkaline phosphatase
a serum sodium concentration of 150 mEq/L may be due to
dehydration
what marker is an indicator of average plasma glucose concentration over previous months?
hemoglobin A1c
an elevated conjugated bilirubin (direct) concentration typically indicates
alcoholism
the liver is not able to conjugate bilirubin
the liver is not able to excrete bilirubin due to obstruction in bile passage
hemolysis
the liver is not able to excrete bilirubin due to obstruction in bile passage
serum concentrations of this enzyme is elevated with pancreatitis, bowel obstruction, and perforated ulcer
it is also commonly elevated in patient with bulimia
amylase
elevated concentrations of __ in blood (serum) can lead to cardiac abnormalities including heart palpitations, and cardiac arrest
potassium
the general carbohydrate recommendations for adults with diabetes are
200 grams per day
neuropathy can affect
cardiac nerve impulses
which of the following would be an initial good educational approach to an inpatient with diabetes?
basic information on carbohydrate counting
what is an example of the rule of 15 for treatment of hypoglycemia
drink 1/2 cup regular (non diet) soda
which is an example of basal insulin
lantus
in an emergency situation, where would you instruct a patient to inject insulin to ensure it reaches circulation as rapidly as possible?
the stomach
macrovascular disease is a complication related to diabetes. Which of the following problem is associated with macrovascular disease?
cerebrovascular disease
which of the following is not an action of insulin
decreases lipogenesis
a lunch includes the following
sandwich: 2 slices of wheat bread, 3 oz low sodium turkey, 1/8 avocado, 1 oz low fat cheese; side salad (1 cup lettuce, 1/2 cup cooked asparagus, 1 tbsp olive oil, 1 tbsp vinegar); small apple with 2 tsp natural peanut butter
what is the carbohydrate count using the exchange list for diabetes meal planning?
55 grams
why can better glycemic control in a patient with diabetes lead to weight gain?
in simple terms, with better control cells can not take up and use glucose and amino acids
that cells are taking the glucose up for usage instead of storing it as body fat
which is an example of bolus insulin
humulin R
a patient with type 1 diabetes is taking NPH and regular insulin before his morning and evening meal
his blood sugar levels before meals reveal: breakfast (9 am) 128 g/dL, lunch (12pm) 122 g/dL, dinner (5pm) 275 g/dL
which of the following should be recommended
increase morning NPH insulin
direct calorimetry measures
head production
you are working with a physician who would like to start a critically ill patient on enteral feeding. the physician first requests a RMR. during the procedure, however, the cart malfunctions and is only recording oxygen consumption and not CO2 production.
the average oxygen consumption is 320 ml of oxygen per minute. without any additional information, estimate the daily resting metabolism of the patient
2304 kcal/day
what is the biggest predictor of resting metabolism
fat-free mass
energy is stored within the bonds of foodstuff including fat, sugar, and starches is an example of __ energy
chemical
list four additional and specific factors that can impact REE in a hospital patient
medications, burn or trauma, hormones (thyroid, testosterone), surgical procedures
which of the following best describes the interchange of energy from foodstuffs to skeletal muscle to allow muscle movement
stored chemical energy is used to produce mechanical energy and ultimately heat energy
what substrate has the highest thermic effect of food
protein
what is the thermic effect of food
the thermic effect of food is the amount of energy it takes to digest, absorb, metabolize, store, and excrete the different macro- and micronutrients that we consume
what is the RQ of arachidic acid
C20H40O2
0.6897
