Exam questions Flashcards
(24 cards)
Is blood and urine testing for neurotransmitters and their breakdown metabolites likely to be a highly accurate indicator for nervous health? Why/ why not? (2 marks)
No, most blood and urine testing can be inaccurate (1 mark) due to the fact that they will often show peripheral instead of central nervous system activity (1 mark).
What is the hepatic first pass effect? What does this mean for drug concentration? Name two ways pharmaceutical drugs can be administered in order to avoid the first pass effect? (4 marks)
If drugs are administered orally they are absorbed into the portal circulation and go directly to the liver. (1 mark) This means drug concentration is often drastically reduced as the liver will detoxify the drug before it reaches general circulation (1 mark) The first pass effect can be bypassed via: Injections, inhaled, topical and sublingual administration.(1 mark each, max 2 marks)
Leslie (65 years old) comes to see you as she is suffering from epigastric pain 2-3 hours post meals (described as burning or gnawing pain). She suffers from heartburn that wakes her at night; she mentions that her stools are often very dark brown to black. Her symptoms are relieved by eating or antacids which she needs to take daily. What could Leslie be suffering from? Which pathogen would you want to test for? Name 2 things Leslie can increase or decrease in her diet which may help ease her symptoms. (4 marks)
Peptic Ulcers (1 mark) H.Pylori (1 mark) (1 mark each, max 2 marks). Add Cabbage juice, slippery elm powder, licorice, bananas. Avoid hot spicy foods, coffee, tea, sugar. 4
The immune system attacks microbes via a multilayered approach using the Innate and Acquired Immune System. Describe 4 differences between these two systems. (4 marks)
(1 mark for each difference, max 4 marks) Innate: non specific, response is antigen independent, immediate maximal response, non-antigen specific, exposure results in no immunological memory.
Acquired: specific, response is antigen dependent, time lag in maximal response, antigen specific, exposure results in immunological memory
During a consult Hayley mentions she is going through a highly stressful period at work. Which salivary test might you choose for this client? Name 3 nutrients (not foods or herbs) that may be beneficial for supporting Hayley’s adrenals during this time? (4 marks)
Adrenal stress index (1 mark) (1 mark each, max 3 marks) Vit C, Vit K, Omega 3, Mg, B5, B6, Tyrosine, Taurine, Vit E
During the consult you talk to Hayley about the role of cortisol in the stress response. Aside from emotional stress, what are two physical threats that could increase cortisol release? (2 mark)
(1 mark each, max 2 mark) Physical trauma, infection, extreme heat and cold, exercise to the point of exhaustion.
Paula comes to see you for care during her pregnancy. She is drinking a lot of herbal teas at the moment but you notice that many of them are contraindicated in pregnancy. Circle below the three (3) herbal teas which are safe for Paula to drink whilst she is pregnant. (3 marks) - Rhubarb root - Chamomile - Thyme - Cascara - Green Tea - Fennel tea - Blue Cohosh
Chamomile, Green Tea, Fennel Tea
People are often told not to consume grapefruit with certain prescription medication. Which enzyme is affected and where does this occur? (2 marks)
Grapefruit inhibits CYP 3A4 enzyme, (1 mark) in the gut wall. (1 mark)
Angelina (70 years old) has come to see you as she has recently started to exercise with a personal trainer and wants some dietary advice. During the consult you find out she is on glyceryl trinitrate medication for her Angina. Which amino acid would you NOT
3
prescribe her that may interact with this medication. Explain. (3 marks)
L-arginine.(1 mark) L-arginine converts to nitric oxide which causes endothelium-derived relaxation factor and causes vasodilation. (1 mark)Therefore L-arginine and glyceryl trinitrate may have an additive effect. (1 mark)
Do high levels of insulin increase or decrease the following metabolic pathways? (6 marks)
Increase: Glucose uptake in muscle and adipose tissue. Glycolysis Glycogen synthesis Protein synthesis Uptake of ions (esp K+ and P03)
Decrease: Gluconeogenesis Glucogenolysis Lypolysis Ketogenesis Proteolysis
.Quercetin is used as an anti-inflammatory nutrient. Which of the following statements are correct. (1 mark)
inhibits phospholipase A2 and lipoxygenase enzymes
Are the following statements True or False. (3 marks)
(a) Maitake mushroom (Grifola frondosa) is hypoglycaemic in action as well as an immune enhancer.
(b) White button mushrooms (Agaricus bisporus) has been shown to increase IgM in research trials.
(c) Shiitake mushrooms (Lentinula edodes) has shown immunomodulatory effects in HIV and genital herpes when used along side conventional medicine.
(a) T
(b) F
(c) T
Name 2 markers that can be tested to measure and monitor blood sugar levels. (2 marks)
(1 mark each, max 2 marks) blood glucose, haemoglobin A1C, insulin
Explain 3 practical ways you can encourage an overweight client to decrease their food intake. (3 marks)
(1 mark each, max 3 marks) smaller serves, eat from a side plate, include protein with every meal/snack, chew food well 30 times, enjoy the ritual of food, turn off ‘stimulators’ whilst eating
Chloe (26 years old) comes to see you as she wants to go on a nutritionally sound detox program. Name 4 common signs or symptoms of suboptimal detoxification that Chloe could be experiencing. (4 marks)
(1 mark each, max 4 marks) Bowel – halitosis, bitter taste, bloating, fatty stools, constipation, diarrhoea, intolerance to fatty foods, tender swollen liver, gallbladder problems. Immune – food allergies, skin issues, asthma.Hormonal – stress, infertility, PMS, overweight, depression. Nervous system – headaches, dementia, poor memory and concentration. Recurrent headaches, Muscle aching and weakness, Paraesthesias and neuralgia, Recurrent infections, Infertility, Adverse reactions / sensitivity to environmental chemicals, odours &/or nutritional supplements, Chronic fatigue and lethargy, Depression, anxiety &/or mood swings, Poor short term memory and concentration, Anaemia
Barry 68 years old comes to see you as he has recently been diagnosed with hypertension (145/90). His doctor wanted to put him on pharmaceutical medication, however he has asked the doctor for 8 weeks to see if he can reduce his blood pressure through diet and lifestyle modifications. What are 5 dietary interventions Barry could try which may help reduce his high blood pressure? (5 marks)
(1 mark each, max 5 marks) Add celery, add garlic, add magnesium rich foods, add oats, increase cold water fish into diet. Possible, vit C, arginine, EPA/DHA, Taurine. DASH diet, lower sodium, increase potassium:sodium ratio.
Barry says he has read up on a hormone which is involved in the following; activates sympathetic nervous system (SNS), oxidative stress and inflammation, vasoconstrictor, vascular smooth muscle cell proliferation, collagen production, platelet aggregation and thrombosis, stimulates leukocyte migration, stimulates aldosterone production. Which hormone is he referring to? (2 marks)
Angiotensin II (2marks) (Angiotensin I has no biological activity)
Barry has read on the internet that homocysteine levels are important in cardiovascular disease. What nutrients could you advise Barry to take to promote healthy homocysteine levels? Name 3 of these. (3 marks)
(1 mark each, max 3 marks) B6, B9, B12, Betaine and Choline 16
Complete the following table using the options below. Please note there are more options than are required (4 marks)
Acetylcholine, serotonin, dopamine, GABA, adrenalin, noradrenalin
Neurotransmitter Functions related to GABA:Sleep, Anxiety
Noradrenalin: Cognitive, Emotional Status, Mood, Fine Motor Function
Serotonin: Sleep, Mood, Brain Activity Dopamine: Cognitive Arousal, Emotional Status, Mood, Fine Motor Function
Inflammatory Bowel Diseases are said to be autoimmune in origin, more specifically a dominance of T helper 1 cells. Name 2 substances which may be used to balance out a Th1 immune dominance. (2 marks)
(1 mark each, max 2 marks) Curcumin, fish oils, vitamin E, D, bromelain, glycine and L. acidophilus, vit D.
What is Leptin?Where is it produced? What is its action in the body? (4 marks)
Leptin is a satiety hormone (1 mark) produced by the adipocyte (1 mark). It decreases hunger (1 mark) and increases thermogenesis (1 mark).
Lisa (36 years old) comes to see you as she is suffering from abdominal bloating, flatulence and bad breath. When you asked about the rest of her digestive system, she mentions that she is sometimes constipated and sometimes experiences diarrhoea. You would like to put her on the ‘The Four R Program’. Explain 2 of the steps in this program and what each step involves. (4 marks)
2 of the following – step and explanation must match up. Max 4 marks
Remove (1 mark)– remove pathogens (virus, bacteria, fungi, parasites, food allergens) (1 mark)
Replace (1 mark) – digestive enzymes, HCl (1 mark)
Re-inoculate (1mark) – reintroduce probiotics (1 mark)
Repair (1 mark) – Direct nutritional support for the structure and function of the intestinal wall structure (1 mark)
Restore/ retain (1mark)– supportive measures to retain the health and function such as stress managementetc (1 mark) also an option as it has recently been added to make a 5th R
Lisa comes back to see you 6 weeks later as she is suffering from a lack of energy. During the consult you find out she has recently been put on Proton - Pump inhibitors by her doctor. Name 3 nutrients that could be affected whilst Lisa is taking proton-pump inhibitors. (3 marks)
(1 mark each, max 3 marks) Beta-carotene, Calcium, Chromium, Folic Acid, Vitamin B12, Vitamin C, Zinc – all minerals acceptable.
Your friend Emily asks your advice about supplementation for her father Alfred (84 years old). Alfred has Parkinson’s Disease and is on Levodopa. Emily has given her father vitamin B6 as she read on the internet that it is good for Parkinson’s patients. Should supplemental B6 be given to a person on Levodopa? Why or Why not? (6 marks)
No (2 marks)
Supplemental B6 increases levodopa metabolism into dopamine in the peripheries (2 mark) and it cannot cross the blood brain barrier into the CNS site of action (1 mark). It also inhibits further absorption of levodopa in the GI tract. (1 mark)
