Case 15 Questions 1-16

Question 1

Which of these is not one of the four types of undernutrition?

1. Stunting
2. Wasting
3. Micronutrient imbalance
4. Underweight
5. Vitamin and mineral deficiency

Micronutrient imbalance – this is incorrect as it could be an overnutrition imbalance

Micronutrient imbalance – this is incorrect as it could be an overnutrition imbalance

Stunting – this presents with low height-for-age

Wasting – this presents with low weight-for height

Underweight – low weight for age

Vitamin and mineral deficiency – this is a micronutrient deficiency

Question 2

Which is the best definition for malnutrition?

1. Not enough vitamins and minerals in the diet
2. Imbalanced in a person’s diet
3. Lack of proper nutrition caused by eating the wrong foods
4. Deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients
5. Too much fatty food in the diet

Deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients

Deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients – this is the most comprehensive answer

Not enough vitamins and minerals in the diet – incorrect because sometimes there can be too many vitamins or minerals

Imbalanced in a person’s diet – this is correct but not the best answer because it doesn’t refer to excesses or deficiencies

Lack of proper nutrition caused by eating the wrong foods – again correct but not the best answer here

Too much fatty food in the diet – this can cause malnutrition, but it is not the only cause

Question 3

Which of these nutritional requirements is not required with pregnancy?

1. Increase vitamin A intake
2. Folate supplementation
3. Vitamin C
4. Caffeine decrease
5. Increase calorie intake by 200 kcal per day

Increase vitamin A intake

Increase vitamin A intake – this is incorrect, it should be decreased to avoid teratogenic effects

Folate supplementation – to avoid neural tube defects

Vitamin C – to prevent against scurvy

Caffeine decrease – consuming high levels has been linked to pregnancy complications, such as low birth weight, miscarriage and stillbirth

Increase calorie intake by 200 kcal per day – to provide the extra nutrition needed for the foetus

Question 4

Which of these is not a consequence of vitamin C deficiency?

1. Scurvy
2. Night blindness
3. Anaemia
4. Gingivitis
5. Skin haemorrhages

Night blindness

Night blindness – this is from vitamin A deficiency

Scurvy – a common disease resulting from vitamin C deficiency

Anaemia – occurs as a result of too little vitamin C

Gingivitis – an early symptom of scurvy

Skin haemorrhages – another symptom of scurvy

Question 5

Which of these is not one of the main types of malnutrition?

1. Specific
2. Long-standing
3. Sudden
4. Recurrent
5. Protein-energy malnutrition

Protein-energy malnutrition

Protein-energy malnutrition – this is not one of the four main types which are listed above

Specific – this is a deficiency of a particular nutrient

Long-standing – this is the clinical appearance of energy and nutrient deficiencies after a period of inadequate eating often linked to general neglect

Sudden – results from a sudden marked change in food intake, often following a significant disruptive life event such as a fall or bereavement

Recurrent – this is existing inadequate nutritional status followed by a period of illness and subsequent malnutrition leading to repeated cycles of illness

Question 6

Name the function of vitamin B12?

1. A structural component of membranes, used for myelination
2. Synthesises and regulates neurotransmitters
3. Building and maintaining bones and teeth
4. Involved in conversion of propionyl CoA to succinyl CoA and homocysteine to methionine
5. Involved in synthesis of DNA and RNA and protein metabolism

Involved in conversion of propionyl CoA to succinyl CoA and homocysteine to methionine

Involved in conversion of propionyl CoA to succinyl CoA and homocysteine to methionine – this is the correct answer

A structural component of membranes, used for myelination – this is for fatty acids

Synthesises and regulates neurotransmitters – this is vitamin B1

Building and maintaining bones and teeth – this is calcium

Involved in synthesis of DNA and RNA and protein metabolism – this is zinc

Question 7

Which of these factors does not affect the body composition and thereby the link to nutritional needs?

1. Economic class
2. Ethnicity
3. Genetics
4. Disease and illness
5. Social class

Economic class

Economic class – this does not necessarily influence body composition

Ethnicity – this influences body composition

Genetics – this influences body composition

Disease and illness – this influences body composition

Social class – this influences body composition

Question 8

Which of these statements about assessing nutritional status is incorrect?

1. The indirect method involves anthropometry and bioelectrical impedance analysis
2. The atomic and cellular method involves neutron activation, isotope dilution, total body counting
3. The only criteria is densitometry
4. Nutritional screening is a rapid, simple, general procedure done at first contact with subject to detect risk of malnutrition
5. Nutritional assessment is a detailed, more specific, in depth evaluation of subject’s nutritional status

The only criteria is densitometry

The only criteria is densitometry – incorrect as the criterion are densitometry and imaging

Question 9

Which of the following diets carry a risk of nondiabetic ketoacidosis?

1. Low-carb diet
2. Veganism
3. HCG diet
4. Paleo diet
5. Atkin’s diet

Low-carb diet

Low-carb diet – this is the correct answer

Veganism – risks include vitamin deficiencies including B12

HCG diet – can cause muscle loss

Paleo diet – risks include eliminating healthy nutrients in legumes

Atkin’s diet – the high protein of a low-carbohydrate diet could lead to hyperuricemia (leading to joint pain and gout) and hypercalciuria (leading to kidney stones, hypocalcaemia, and osteoporosis).

Question 10

Which of these is not an essential plant micronutrient?

1. Zinc
2. Vitamin D
3. Iron
4. Magnesium
5. Copper

Vitamin D

Vitamin D – this is not one of the 7 essential plant micronutrients

Zinc – this is an essential plant micronutrient

Iron – this is an essential plant micronutrient

Magnesium – this is an essential plant micronutrient

Copper – this is an essential plant micronutrient

Question 11

A 40 year old female presents to the GP with a tingling in her hands and feet that has gradually come on over the last month or so. She has also noticed she has been more fatigued than usual.

On examination you find normal power but a partial loss of sensation in her hands and feet. All other examination findings are normal.

A full blood count shows:

• Haemoglobin (g/l): 95 (115-160)
• Mean corpuscular volume (fL): 107 (78-100)

What deficiency is likely causing this presentation?

1. Vitamin B1 deficiency
2. Vitamin B12 deficiency
3. Iron deficiency
4. Copper deficiency
5. Vitamin K

Vitamin B12 deficiency

B12 deficiency can lead to a macrocytic anaemia (as shown here with a low Hb and large MCV) in addition to peripheral neuropathy in severe deficiency (which is known as subacute combined degeneration of the spinal cord).

1- Vitamin B 1 (thiamine) deficiency is associated with beriberi which typically presents with cardiovascular pathology as well as psychiatric dysfunction alongside peripheral neuropathy

3- This typically presents with a microcytic, hypochromic anaemia (i.e. leading to fatigue, shortness of breath etc).

4- Copper deficiency commonly causes fatigue, weight loss, osteoporosis and cold sensitivity

5- Vitamin K is involved in the formation of the clotting factors, deficiency of which leads to a hypo-coagulability causing easy bruising and prolonged bleeding.

Question 12

A 83 year old lady is found to have osteoporosis and is deficient of vitamin D. She however is adamant that she does not want to take vitamin D tablets and asks if there is a dietary alternative she can use instead.

What foods from the list below would increase her vitamin D intake?

1. Cheese, milk, liver pate
2. Peas, oranges, nuts
3. Broccoli, spinach, vegetable oils
4. Red meat, kidney beans, chickpeas
5. Fortified cereals, eggs, oily fish

Fortified cereals, eggs, oily fish

Fortified cereals, eggs, oily fish are all good sources of vitamin D

1- These are sources of vitamin A

2- These are sources of the B vitamins

3- These are the sources of vitamin K

4- These are the sources of iron

Source : https://www.nhs.uk/conditions/vitamins-and-minerals/

Question 13

Which of the following is NOT typically a clinical consequence of malnutrition?

1. Anaemia
2. Obesity
3. Rickets
4. Thick nail growth
5. Atypical pneumonia

Thick nail growth

Malnutrition is defined as an imbalance (either deficiency or excess) of energy or nutrient intake.

Thick nail growth (onychauxis) is not typically associated with malnutrition.

Anaemias (iron deficiency or B 12/9 deficiency), obesity (increased calorie intake), rickets (vitamin D deficiency) and atypical pneumonias (particularly in severe vitamin D and C deficiency) can all be caused by malnutrition.

Question 14

Kallmann’s syndrome results in the loss of pulsatile GnRH secretion. What effect will this have on the following hormones in females?

1. Normal FSH, Normal LH, Low oestrogen, Low progesterone
2. Low FSH, Low LH, Low oestrogen, Low progesterone
3. High FSH, High LH, High oestrogen, High progesterone
4. Low FSH, Low LH, Normal oestrogen, Normal progesterone
5. Low FSH, Low LH, High oestrogen, High testosterone

Low FSH, Low LH, Low oestrogen, Low progesterone

Loss of pulsatile GnRH secretion from the hypothalamus leads to the loss of stimulation to the anterior pituitary gonadotrophic hormones (FSH/LH). This in turn leads to the loss of oestrogen and progesterone secretion.

Question 15

Describe the response of the hypothalamus to in response to dehydration

1. ADH secretion
2. CRH secretion
3. ADH inhibition
4. ACTH secretion
5. OXT secretion

ADH secretion

ADH (antidiuretic hormone) leads to peripheral vasoconstriction an aquaporin insertion in the distal tubule of the nephron. This means its secretion increases water reabsorption in response to dehydration.

Question 16

Which best describes the mechanism of action of anthracyclines in chemotherapy?

1. Inhibition of purine synthesis
2. Inhibition of mechanisms to release DNA torsion
3. Addition of alkyl groups to guanine nucleotides in DNA
4. Inhibition of spindle formation in mitosis
5. Direct tyrosine kinase receptor inhibition

Inhibition of mechanisms to release DNA torsion

Anthracyclines (e.g. doxorubicin) function by antagonism of topoisomerase 2. This leads to the inability to release tension in DNA leading to DNA fragmentation and apoptosis.

Describes the mechanism of antimetabolites such as methotrexate

3- this describes the mechanism of alkylating agents

4- This describes the action of the vinca-alkaloids

5- This describes the action of tyrosine kinase inhibitors (aka protein kinase inhibitors) such as imatinib in leukemia.