Core Questions

Question 1

The TCA cycle is the metabolic reaction of cell respiration, which occurs inside the ___.

Answer 1

eukaryotic mitochondrion

Question 2

Glycolysis occurs in the ___.

Answer 2

cytoplasm

Question 3

ATP phosphorylation occurs both during ___ (in the cytoplasm) and the ___(in the mitochondrion).

Answer 3

Glycolysis, TCA cycle

Question 4

The electron transport chain is a carrier mechanism within the
inner ___.

Answer 4

mitochondrion

Question 5

The oxidative decarboxylation of pyruvate occurs in the ___.

Answer 5

mitochondrion

Question 6

Denaturing protein structures, making them more susceptible to
enzymatic action, is a primary role of ___.

Answer 6

HCl

Question 7

How might propofol, when provided to patients within a 10% (w/v) lipid injectable emulsion
(ILE), increase risk of hypertriglyceridemia?

Answer 7

The increased presence of liposomes in the propofol ILE may interfere with chylomicron and
pseudo-chylomicron metabolism.

Question 8

HCl plays several roles in protein digestion, including
conversion of the proenzyme ___ to its active form ___.

Answer 8

Pepsinogen, pepsin

Question 9

HCl is secreted by the parietal cells within the ___

Answer 9

Stomach

Question 10

HCl secretion is stimulated by ___

Answer 10

Gastrin

Question 11

Nitrogen end products produced during BCAA oxidation within the
skeletal muscle are removed by the nitrogen carriers ___ and ___.

Answer 11

Alanine, glutamine

Question 12

BCAAs are extracted primarily by the ___

Answer 12

Skeletal muscle

Question 13

BCAAs are primarily oxidized in the ___ and are released from the muscle at a ___ rate than other amino acids.

Answer 13

Skeletal muscle, lower

Question 14

___ is used as the body’s primary buffer to maintain acid-base balance.

Answer 14

Protein

Question 15

All cells of the immune system (ie, white blood
cells, macrophages, and so on) are made up of ___.

Answer 15

Proteins

Question 16

Proteins are the primary ___ for substances such as minerals, vitamins, and hormones.

Answer 16

Carriers

Question 17

A solution of 0.9% NaCl (154 mEq/L) is ___ and, therefore, does not contribute to an osmotic gradient. Isotonic saline enters and remains in the ___.

Answer 17

Isotonic, ECF

Question 18

The administration of 1 liter 0.9% sodium chloride (NaCl) to a normonatremic patient will
increase the intravascular and interstitial fluid compartments by:

Answer 18

250 mL and 750 mL, respectively

1 liter 0.9% NaCl expands the ECF by 1 liter. The intravascular volume accounts for 25% of the ECF and will expand by 250 mL. The remaining 750 mL will be distributed to the
interstitial fluid compartment.

Question 19

Vitamin ___ and ___ are needed to convert the cardiac risk factor
homocysteine back into methionine. Alternatively, ___ may be used for this conversion.

Answer 19

B12, folate, choline

Question 20

The control mechanisms that keep iron levels stable in the body occur at the ___ phase. It is very difficult to eliminate iron except in conditions of blood loss (eg, blood donation or menstruation)

Answer 20

Absorption

Question 21

Name 4 factors that delay gastric emptying

Answer 21

1. large boluses of fluid given at one time
2. increased rate of formula infusion
3. increased fat content of the solution
4. infusion of solutions colder than room temperature.

Question 22

Cholestasis has been associated with ILE doses greater than ___ g/kg/d in adult patients receiving long-term PN

Answer 22

1

Question 23

Cyclic TPN infusion has been shown to reduce serum ___ and ___ concentrations when compared with continuous infusion.

Answer 23

Liver enzymes, conjugated bilirubin

Question 24

Propranolol, pentobarbital, and all neuromuscular antagonists have
been shown to ___ energy expenditure after administration

Answer 24

Reduce

Question 25

Systemic inflammatory response is an overstimulation of ___ and ___ responses as well as a compensatory reaction causing immune metabolic ___.

Answer 25

Metabolic, immune, suppression

Question 26

In SIRS, decreased immunity may ___, depending on the source of inflammation, the timing, and the clinical status of the patient.

Answer 26

Predominate

Question 27

In critical care populations, ___ is associated with adverse outcomes, including increased incidence of infections.

Answer 27

Hyperglycemia

Question 28

In the critically ill population, conservative ___ prescription (including a gradual increase of infusion rates to goal energy requirements), assists in controlling serum glucose levels.

Answer 28

Energy

Question 29

Negative nitrogen balance frequently occurs despite adequate energy provision because of the ___ hormones and ___ changes that occur from traumatic insult.

Answer 29

counterregulatory, cytokine

Question 30

What are the 3 hormones elevated during trauma

Answer 30

1. Epinephrine 2. Glucagon 3. Growth hormones

Question 31

Epinephrine, glucagon, and growth hormones are elevated, resulting in increased ___ and increased ___ and ___ release.

Answer 31

Lipolysis, glycerol, free fatty acid

Question 32

___ resistance is believed to be caused by the effects of the counterregulatory hormones and causes ___ regardless of nutrition provision.

Answer 32

Insulin, hyperglycemia

Question 33

By providing early EN to a patient with trauma, the cytokine storm and counterregulatory hormone secretion are attenuated. As a result, critically ill patients experience fewer ____ despite not obtaining protein and energy goals within the first few days of nutrition provision.

Answer 33

Infections

Question 34

In 6 hours on peritoneal dialysis, approximately ___ to ___ % of the instilled dextrose of the dialysate solution is absorbed.

Answer 34

75-80%

Question 35

Describe energy and protein needs after an organ transplant

Answer 35

Energy needs are only moderately elevated after transplantation unless complications such as sepsis occur. Protein requirements are significantly elevated due to an increased catabolic rate caused by surgery, stress, and corticosteroids.

Question 36

The goal of antiretroviral therapy (in patients with HIV) is to increase ____ and decrease ___

Answer 36

To increase CD4+ T lymphocytes and decrease VL

Question 37

Lipodystrophy (as seen in HIV) is characterized by ___ adipose tissue loss with ___ adipose tissue sparing or accumulation.

Answer 37

subcutaneous, visceral

Question 38

Lipodystrophic patients may also demonstrate ___ in association with the loss of subcutaneous adipose tissue.

Answer 38

Insulin resistance

Question 39

___ may occur in association with wasting disease, as an adverse effect of antiretroviral medications, in association with abdominal adiposity, or during febrile response to bacterial infection as a host defense mechanism.

Answer 39

Hypertriglyceridemia

Question 40

What is the corrected sodium equation for hyperglycemia?

Answer 40

Corrected Serum Sodium = Measured Serum Sodium + [0.016 × (Serum Glucose – 100)]. Serum sodium concentrations decrease 1.6 mEq/L for every 100 mg/dL increase in serum glucose

Question 41

What is the equation to calculate the "sensitivity factor" of insulin/blood glucose?

Answer 41

(Starting glucose - glucose after insulin given) / units of insulin If the glucose decreased 40 mg/dL (eg, from 180 to 140 mg/dL) following an injection of 5 units, the sensitivity factor is 8 (40/5 = 8).

Question 42

What is the equation for the "rule of 1800" to estimate the amount of insulin a patient will require each day?

Answer 42

the rule of 1800: divide 1800 by the sensitivity factor. Ex: if the patient has a sensitivity factor of 8, the patient will need a total daily insulin dose of 225 units (1800/8 = 225 units).

Question 43

What are the 2 ways someone could be eligible for bariatric surgery?

Answer 43

1. BMI equal to or greater than 40. 2. BMI is equal to or greater than 35 and they have weight-related comorbidities AND more conservative efforts have not resulted in adequate weight control.

Question 44

Relative ___ is calculated in the meta-analysis and does tend to overestimate the treatment effect.

Answer 44

Risk

Question 45

The absolute risk reduction is calculated by the number of ___ in both the treatment and control groups divided by the denominator in each group. The absolute risk reduction is usually ___ than the relative risk reduction.

Answer 45

Events, lower

Question 46

The test for heterogeneity looks at the similarities between ___

Answer 46

Studies

Question 47

The overall treatment effect tells whether the outcome parameter being evaluated by the meta-analysis was significantly ___ in the study group compared to controls.

Answer 47

Different