Past Quiz Questions

Question 1

in a patient with iron deficiency anemia, a clinician would expect which biochemical markers to be low?

Answer 1

ferritin
transferrin saturation

Question 2

a patient with low hematocrit, high MCV, and normal cobalamin concentration has …

Answer 2

macrocytic anemia

Question 3

which micronutrient has a sensitive biomarker, meaning the concentration in blood, serum, or plasma is reflective of total body pools?

Answer 3

folate

Question 4

you are interested in evaluating the calcium intake and status of your patient
what biochemical marker would be most appropriate to measure

Answer 4

24-hour urinary calcium excretion

Question 5

what marker would you use to help evaluate folate status in a woman with questionable folate intake who is trying to become pregnant?

Answer 5

erythrocyte folate concentration

Question 6

erythrocyte transketolase activity coefficient is considered the best marker of

Answer 6

thiamin status

Question 7

what is the best way to assess niacin status

Answer 7

by measuring urinary end products of niacin metabolism

Question 8

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

Answer 8

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

Question 9

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”.

Answer 9

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.

Question 10

what is the best biochemical marker of vitamin D status

Answer 10

serum 25(OH)D

Question 11

pale conjunctivae is associated with a deficiency of

Answer 11

iron

Question 12

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?

Answer 12

riboflavin and calcium

Question 13

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 …

Answer 13

fiber and magnesium

Question 14

perifollicular hemorrhages or petechiae may be a sign of

Answer 14

vitamin C deficiency

Question 15

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

Answer 15

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.

Question 16

what is the bioavailable form of niacin

Answer 16

NADH

Question 17

what is the bioavailable form of vitamin B6

Answer 17

pyrodoxal phosphate

Question 18

what is the bioavailable form of vitamin E

Answer 18

alpha tocopherol

Question 19

what is the bioavailable form of pantothenic acid

Answer 19

coenzyme A

Question 20

what is the bioavailable form of riboflavin

Answer 20

FADH

Question 21

what is the bioavailable form of folate

Answer 21

tetrahydrofolate

Question 22

__ 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

Answer 22

oxalates

Question 23

dermatitis, diarrhea, and dementia are signs of a

Answer 23

niacin deficiency

Question 24

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 __

Answer 24

pharmacodynamics, pharmakinetics

Question 25

chelation reactions between certain drugs and medications cause

Answer 25

decreased amount of mineral available for absorption decreased absorption and action of the drug/medication

Question 26

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

Answer 26

b) Tetracycline is more likely to be ineffective in teenagers who drink a lot of milk

Question 27

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

Answer 27

C) The medication should be taken in the morning on an empty stomach, about 30-60 minutes before breakfast

Question 28

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_____.

Answer 28

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

Question 29

Patients on the Parkinson's drug Levodopa should be instructed to __, particularly in the more advanced stages of this disease

Answer 29

consume protein mostly in the evening meal to ensure optimal absorption of the medication

Question 30

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 ___.

Answer 30

May be at risk for drug toxicity

Question 31

GFR is lower in women compared to men. These physiological difference can account for sex-related differences in drug clearance. T/F?

Answer 31

true

Question 32

Please list two other differences between men and women that may account for sex-related differences in drug metabolism and/or drug distribution

Answer 32

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.

Question 33

What is the purpose of cytochrome P450 tests? what is the significance of being a porr metabolizer and an ultrarapid metabolizer?

Answer 33

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.

Question 34

A well recognized nutritional side effect of the lipid lowering drug cholestyramine is __.

Answer 34

its inhibition of the absorption of vitamins A, D, E, K and vitamin B12

Question 35

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)

Answer 35

reduced pharmacological effects of the drug

Question 36

a patient taking a loop diuretic such as Lasix for management of edema may be at risk __

Answer 36

for hyponatremia if older

Question 37

the cancer chemotherapeutic agent methotrexate acts as an antagonist of which vitamin

Answer 37

folate

Question 38

proton pump inhibitors are known to decrease absorption of ___

Answer 38

calcium, zinc, iron, and vitamin B12

Question 39

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

Answer 39

a MAO inhibitor hypertensive crisis

Question 40

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?

Answer 40

fermented and aged foods

Question 41

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?

Answer 41

the patient may be excreting sodium via the kidney that is resulted in increased drug excretion and "therapeutic failure"

Question 42

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

Answer 42

avoiding black pepper when undergoing cancer treatment with the drug Tomoxifen

Question 43

Buffer, binder, fillers, flavors, preservatives, coatings, and suspension agents found in medications tablets and pills are terms ___

Answer 43

excipients

Question 44

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.

Answer 44

thiazide diuretics

Question 45

People on certain medications should avoid potassium containing salt substitutes. What medications are these

Answer 45

k-sparing diuretics ACE inhibitors beta blockers

Question 46

what is term for physician induced?

Answer 46

iatrogenic

Question 47

what micronutrients are known to be particularly important for wound healing?

Answer 47

zinc, vitamin C

Question 48

symmetrical, scaley dermititis with hyperpigmentation, desquamation and sharp margination on the skin exposed to sunlight is characteristic of a deficiency of __

Answer 48

niacin

Question 49

what do you expect in a patient with nephrotic syndrome

Answer 49

protein urea

Question 50

combining measurement of the mid-upper arm circumference with the triceps skin fold thickness provides the dietitian with information to assess

Answer 50

possible compromised nutritional status

Question 51

which of the following statements about waist and hip circumferences is not true?

Answer 51

waist circumference is of little value in patients who are Asian

Question 52

a female has a 34" waist and a 40" hip measurement she is at particular risk for ...

Answer 52

nothing

Question 53

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.

Answer 53

- helps determine risk factors - very good for overarching populations - does not account for body fat percentage - does not account for different ethnicities

Question 54

which biochemical markers are classically elevated in patients with liver damage or liver disease?

Answer 54

alkaline phosphatase, alanine amino transferase (ALT), aspartate amino transferase (AST)

Question 55

which biochemical markers are expected to be elevated in a patient with poor renal function?

Answer 55

BUN, creatinine

Question 56

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)

Answer 56

CK, LDH, ALT, AST, alkaline phosphatase

Question 57

a serum sodium concentration of 150 mEq/L may be due to

Answer 57

dehydration

Question 58

what marker is an indicator of average plasma glucose concentration over previous months?

Answer 58

hemoglobin A1c

Question 59

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

Answer 59

the liver is not able to excrete bilirubin due to obstruction in bile passage

Question 60

serum concentrations of this enzyme is elevated with pancreatitis, bowel obstruction, and perforated ulcer it is also commonly elevated in patient with bulimia

Answer 60

amylase

Question 61

elevated concentrations of __ in blood (serum) can lead to cardiac abnormalities including heart palpitations, and cardiac arrest

Answer 61

potassium

Question 62

the general carbohydrate recommendations for adults with diabetes are

Answer 62

200 grams per day

Question 63

neuropathy can affect

Answer 63

cardiac nerve impulses

Question 64

which of the following would be an initial good educational approach to an inpatient with diabetes?

Answer 64

basic information on carbohydrate counting

Question 65

what is an example of the rule of 15 for treatment of hypoglycemia

Answer 65

drink 1/2 cup regular (non diet) soda

Question 66

which is an example of basal insulin

Answer 66

lantus

Question 67

in an emergency situation, where would you instruct a patient to inject insulin to ensure it reaches circulation as rapidly as possible?

Answer 67

the stomach

Question 68

macrovascular disease is a complication related to diabetes. Which of the following problem is associated with macrovascular disease?

Answer 68

cerebrovascular disease

Question 69

which of the following is not an action of insulin

Answer 69

decreases lipogenesis

Question 70

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?

Answer 70

55 grams

Question 71

why can better glycemic control in a patient with diabetes lead to weight gain?

Answer 71

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

Question 72

which is an example of bolus insulin

Answer 72

humulin R

Question 73

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

Answer 73

increase morning NPH insulin

Question 74

direct calorimetry measures

Answer 74

head production

Question 75

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

Answer 75

2304 kcal/day

Question 76

what is the biggest predictor of resting metabolism

Answer 76

fat-free mass

Question 77

energy is stored within the bonds of foodstuff including fat, sugar, and starches is an example of __ energy

Answer 77

chemical

Question 78

list four additional and specific factors that can impact REE in a hospital patient

Answer 78

medications, burn or trauma, hormones (thyroid, testosterone), surgical procedures

Question 79

which of the following best describes the interchange of energy from foodstuffs to skeletal muscle to allow muscle movement

Answer 79

stored chemical energy is used to produce mechanical energy and ultimately heat energy

Question 80

what substrate has the highest thermic effect of food

Answer 80

protein

Question 81

what is the thermic effect of food

Answer 81

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

Question 82

what is the RQ of arachidic acid C20H40O2

Answer 82

0.6897