Sample Paper 2 Flashcards
(20 cards)
Q1. Detail TWO long-term side effects associated with PPI’s use. In your answer refer to the
mechanism of each (2 marks)
Pharm 61
* Increased risk of GI infections (e.g., Clostridium difficile) and SIBO. Alkaline gastric pH
allows bacterial survival.
* Increased fracture risk: Reduced calcium absorption leads to decreased bone mineral
density, possible inhibition of osteoclast activity.
* Vitamin B12 deficiency: Gastric acid is needed for release of vit. B12 from proteins to help
intestinal absorption.
* Low blood magnesium due to decreased intestinal absorption.
* Also reduced iron absorption (= possible iron deficiency anaemia).
Q2. Identify FOUR signs and/or symptoms that you may observe when conducting a
physical examination of a client with suspected low thyroid function (2 mark)
Endo; slide 19. Thyroid gland enlargement, dry skin, nail beading, thinning eyebrows, hair loss,
low blood pressure, bradycardia (< 60 BPM)
Q3. Describe a benefit and downside to organic acid testing in clinical practice (2 marks)
Slide 59 A&D. 1 mark for a benefit and 1 mark for downside.
Q4. Name TWO herbal actions associated with the reproductive system. In your answer
state the mechanism of action, and an example of each (3 marks)
Slide 65 Herbal Medicine. 2 x ½ per action, ½ mark per MOA & ½ per example:
* Hormone modulators: Regulate and balance hormonal activity e.g., chaste berry.
* Emmenagogue: Promotes menstruation e.g., Dong quai.
* Galactagogue: Promotes breast milk production e.g., fennel seeds.
* Reproductive tonic: Promotes reproductive health and fertility e.g., shatavari.
* Anti-prostatic: Reduces symptoms form the prostate gland e.g., saw palmetto.
Q5, Name TWO natural antifungals and ONE biofilm disrupter that might be used as part of
a Gastrointestinal protocol. Why is it advisable to go slow with this protocol? (2 marks)
Slide 54 Gastro. 2 x ½ marks natural antifungals. ½ marks biofilm disruptor. ½ marks - Start slow,
build up slowly to prevent die-off symptoms
Q6. Sophie has been struggling with diarrhoea, provide FOUR natural ways to help alleviate
it (2 marks)
Gastro; slide 80. 1/5 mark for each
* ↑ soluble fibre to help bulk stool e.g. apple pectin.
* Enteric-coated peppermint oil.
* Digestive enzymes.
* S. boulardii (↑ sIgA).
* Electrolyte replacement, juices and broths to account for fluid / electrolyte losses.
* Marshmallow root, slippery elm, meadowsweet (powder).
Q7. Isla has recently been diagnosed with type 2 diabetes. Explain how berberine
supplementation may support someone with this condition (2 marks)
Endo; slide 82
* Decreases gluconeogenesis and facilitates GLUT4 translocation.
* ↓ expression of proinflammatory genes (incl. that which is LPS induced) e.g., TNF-alpha, IL1beta, IL-6. Berberine ↓ hs-CRP.
* ↑ AMPK activity of islet cells = insulin secretion. * Modulates the microbiome — a likely antidiabetic mechanism. Thought to reduce circulating LPS load (a factor associated with insulin
resistance).
Q8. Compare the pathophysiology that you would expect to see in two different clients
presenting with PMS-D (depression) and PMS-H (hyperhydration) (2 marks)
Women;s 37
*PMS-D (depression): Low oestrogen:progesterone ratio (0.5 marks) and neurotransmitter
imbalances (e.g., low serotonin) (0.5 marks)
*PMS-H (hyperhydration): ↑ water retention secondary to ↑ aldosterone (excess salt intake,
excess oestrogen, (0.5 marks) stress or magnesium deficiency) (0.5 marks)
Q9. Describe Two mechanisms involved in calorie restriction that influence weight loss (2
marks)
Obesity 30
* ↓ leptin levels during weight loss signals to the brain ↑ feeding and ↓ energy expenditure.
* Pre-adipocyte proliferation occurs, ↑ fat storage capacity.
* Changes occur in the circulating levels of several gut hormones involved in the homeostatic
regulation of body weight.
Q10. Describe ONE mechanistic reason for prescribing B6 to a client who is experiencing
high levels of stress. What dose would be suitable? (2 marks)
Stress – 29. 1 mark for ONE of the following. 1 mark for dose
* Exerts modulatory effects on GABA and serotonin, neurotransmitters that regulate aniety,
depression and pain perception.
* Downregulates activity of glucocorticoid receptors, ↓ the physiological impact of corticosteroid
release
* Dosage: 50-100 mg / day
Q11. Describe the corresponding amino acids that support healthy Serotonin and GABA
metabolism (1 mark)
Nervous Slide 27. 0.5 x 2 – amino acids
Tryptophan and Glutamine
Q12. Define what a xenobiotic is and provide TWO examples (2 marks)
Nutri; slide 34. Foreign substances (typically synthetic) found in the body that are not derived from
a normal diet or produced endogenously e.g., pesticides, food additives, heavy metals
pharmaceutical drugs, industrial chemicals.
Q13. What is the rationale for taking digestive enzymes at the beginning of a meal or
during? (1 mark)
Gastro; Slide 12.
*The rationale is to mimic endogenous secretion whereby enzyme secretion increases as more
food is ingested
Q1. Your new client Wendy comes to see you in clinic to discuss support for Bulimia
Nervosa. Outline some of the signs and symptoms which might be present in a client
presenting with an eating disorder. What key aims would you consider to be appropriate as
part of their treatment in nutritional therapy, and what other clinical considerations would
be appropriate when working 1:1 with a client of this nature (15 marks)
Obesity 79/87/92. 5 marks S&S. 5 marks aims. 5 marks key considerations
S&S – 1 mark any of the following, up to 5 marks
- Most often normal weight to slightly overweight — difficult to detect from appearance.
- Binge eating large amounts of food.
- Often follows anorexia or previous episodes of dieting.
- Associated depression, anxiety and tension.
- Periods of fasting and / or laxative abuse.
- Erratic menstrual periods.
- Frequent weight changes.
- Disappearing to the toilet after meals.
- Periods of relapse and episodic purging.
- Sore throat, tooth erosion and swollen parotid glands.
- Reluctant to socialise where food is involved.
Aims – 1 mark any of the following, up to 5 marks.
- To reduce the number of binges by attending to any blood sugar imbalances and increase
insulin receptor sensitivity. - To encourage healthy eating patterns and dispel any food myths.
- To increase inhibitory neurotransmitter levels.
- BN, specifically, fosters harm minimisation and prevents the use of purging techniques.
- Eating regular meals, even if a binge has occurred, is extremely important.
- Mindfulness programmes can help to facilitate healthy eating patterns again¹, as listening to
body signs of hunger and giving the body what it needs can help to break the binge-purgestarve cycle.
Key clinical considerations – 1 mark any of the following, up to 5 marks
- Empathy and non-judgemental style key to success.
- ED clients are frequently ashamed of behaviour and feel judged when disclosing.
- Be direct but non-judgmental; ‘what do you need help with?’
- Do not collude with ED behaviours.
- Therapy needs to focus on behaviour before any weight loss issues can be addressed.
- You must be confident you can work with the client — otherwise refer on.
- Dangerously underweight individuals must be referred on / guided to medical care.
Q2. On reviewing your client’s case history, you notice several signs that indicate early
menopause transition, including vasomotor symptoms. Discuss the factors affecting early
menopause transition. What specific naturopathic recommendations (diet, lifestyle and
supplements) would you make for a client suffering from vasomotor symptoms associated
with menopause? (15 marks)
Slide 86/89/90/91/92 Women’s
Factors affecting transition – 5 marks = 0.5 marks per point, 0.5 marks per explanation.
* Obesity — can exacerbate menopausal symptoms.
* Smoking — linked to an earlier onset. It can be hypoestrogenic.
* Chronic stress (HPA axis) — associated with menstrual irregularity.
* Long term lead exposure — associated with early menopause.
* Gut microbiome changes (the ‘oestrobolome’).
* Lead — a long-term cumulative exposure to lead is associated with early menopause.
* Family history — women whose mothers entered menopause at an early age are at a high risk
of early onset menopause.
* Hypertension — at an earlier age is linked to an early menopause.
Naturopathic plan – 10 marks = 1 mark per correct point related to vasomotor symptoms
- Increase phytoestrogen foods and herbs, e.g., flaxseeds, sage, fermented soy (non-GM). Red
clover. - Sage home remedy — 6 sage leaves soaked in lemon juice overnight in the fridge. Strain and
drink lemon juice in water. - Reduce weight and focus on balancing blood glucose levels — hypoglycaemia increases hot
flushes. - Acupuncture has been shown to reduce VMS.
- EPO (attributed to GLA content).
- Avoid smoking, alcohol and caffeine.
- Herbal medicines (see later).
- ↓ fracture risk (support bone density) — calcium, vitamin C, D, K2, magnesium, black cohosh.
Weight-bearing exercise (promotes osteoblasts). - Manage stress / anxiety — yoga, acupuncture, breathing exercises, L-theanine, B vitamins,
magnesium, ashwagandha. Bach flowers. - Improve sleep — poor sleep negatively affects eating patterns. Remove stimulants. Use
passionflower, valerian, magnesium etc. - GU health — use organic natural lubricants (close to vaginal secretions pH); oral or local
probiotics (lactobacillus based). - Optimise intestinal microbiome (also for vitamin K2).
- Black cohosh — oestrogen-modulating (isoflavone content) and energetically cooling. Reduces
hot flushes and supports BMD. - Shatavari — reproductive tonic (testosterone-like effects) and adaptogen. Relieves vaginal
symptoms incl. vaginal dryness. - Valerian root, passionflower and chamomile — nervines.
- St. John’s wort extract — reduces hot flashes, improves sleep, mood and relieves anxiety.
- Liquorice root — mildly oestrogenic (isoflavones).
- Maca — improves libido, sleep, mood and hot flushes. Appears to interfere with androgen
receptors.
Q3. Discuss in detail SNPs relating to the
a. VDR gene
b. Essential fatty acid genes
c. Inflammation genes
In your answer detail the pertinent points for each one above, including clinical
associations with SNPs and any naturopathic recommendations you would make for
clients who present with these SNPs in general practice (15 marks)
Genomics 16/17/18
5 marks each – ie: 1. VDR, 2. essentially fatty acid SNPs or 3. Inflammation SNP’s – MUST
COVER ALL THREE GENE AREAS.
Gene: VDR gene ― codes for the Vitamin D Receptor.
* the A allele is associated with reduced bone density risk while the G allele is associated with a
decreased risk of osteoporosis – 1 mark
* Vitamin D deficiency symptoms: Rickets and osteomalacia, osteoporosis, immune dysfunction
(↑ infections, autoimmunity, allergies, asthma). 2 marks
* Recommendations: Ensure optimal vitamin D levels with regular testing, sun exposure, food
sources (e.g. mushrooms, oily fish, eggs) and supplementation 2 marks
Genes: Fatty acid desaturase 1 and 2 (FADS 1 and 2) ― involved in essential fatty acid
(EFA) conversion.
the G allele is associated with poor conversion of ALA to EPA and DHA. 1 mark
* GG individuals are low converters (approx. 30% less efficient conversion relative to normal
converters). 1 mark
* AG individuals are approx. 19% less efficient. 1 mark
* Recommendations: Consider increasing EPA and DHA from fish oils or algae over flaxseed
oils 2 marks
Other types of SNPs ― inflammation:
* Gene example: The TNF gene codes for the production of the pro-inflammatory cytokine
(protein). 1 mark
* the A allele is associated with ↑ TNF and is associated with an ↑ risk of asthma, RA, psoriasis
and cancer. 2 marks
* Recommendations: Extra focus on ↓ pro-inflammatory foods (e.g. sugar, dairy, fried foods, high
omega-6
foods), processed meats, alcohol.1 mark
* Increase anti-inflammatory foods / herbs ― turmeric, catechins (green tea), echinacea, omega3 rich foods (‘SMASH’, flax). 1 mark
