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Nutrition 1

front 1

A pediatrician reviewing global health data defines malnutrition as which process?
A. Excess adiposity impairing mobility
B. Deficient nutrient supply impairing health
C. Appetite loss after infection
D. Weight loss from dehydration

back 1

B. Deficient nutrient supply impairing health

front 2

An adult with chronic illness has a BMI of 18.2. Which threshold defines being underweight and at risk for malnutrition?
A. BMI below 20.0
B. BMI below 17.0
C. BMI below 19.0
D. BMI below 18.5

back 2

D. BMI below 18.5

front 3

A toddler’s weight-for-age and BMI-for-age fall below which percentile, prompting closer evaluation for malnutrition?
A. 5th percentile
B. 10th percentile
C. 15th percentile
D. 25th percentile

back 3

A. 5th percentile

front 4

Marasmus most directly reflects failure to meet which dietary requirement?
A. Iron and folate
B. Water and sodium
C. Fat and vitamins
D. Calories and protein

back 4

D. Calories and protein

front 5

Which finding best supports marasmus rather than kwashiorkor?
A. Generalized edema and apathy
B. Dermatitis with hair changes
C. Marked wasting with fat loss
D. Hypoalbuminemia with edema

back 5

C. Marked wasting with fat loss

front 6

Kwashiorkor is best described as which nutritional deficit?
A. Predominant protein deficiency
B. Exclusive vitamin deficiency
C. Total caloric deficiency
D. Isolated carbohydrate deficiency

back 6

A. Predominant protein deficiency

front 7

A child has edema, irritability, dermatitis, hypopigmented hair, and low albumin. What is the most likely diagnosis?
A. Marasmus
B. Kwashiorkor
C. Cachexia
D. Food insecurity

back 7

B. Kwashiorkor

front 8

Both marasmus and kwashiorkor commonly lead to which consequence?
A. Enhanced immune surveillance
B. Preserved daily functioning
C. Reduced infection risk
D. Functional decline with weakness

back 8

D. Functional decline with weakness

front 9

Which group is particularly prone to malnutrition?
A. Children, older adults, hospitalized patients
B. Athletes, students, commuters
C. Travelers, teachers, executives
D. Adolescents, smokers, laborers

back 9

A. Children, older adults, hospitalized patients

front 10

In developing countries, malnutrition is associated with approximately what share of deaths among children under 5?
A. 20%
B. 35%
C. 50%
D. 70%

back 10

C. 50%

front 11

In 2011, roughly how many under-5 children in developing countries were underweight?
A. 75 million
B. 99 million
C. 120 million
D. 150 million

back 11

B. 99 million

front 12

Underweight prevalence in children under 5 in developing countries changed from which 1990 value to which 2011 value?
A. 25% to 15%
B. 20% to 10%
C. 17% to 28%
D. 28% to 17%

back 12

D. 28% to 17%

front 13

Worldwide, vitamin and mineral deficiencies affect approximately:
A. One in three
B. One in eight
C. One in six
D. One in ten

back 13

A. One in three

front 14

Malnutrition affects what proportion of preschool children?
A. One in eight
B. One in six
C. One in four
D. One in two

back 14

C. One in four

front 15

In developing countries, approximately what proportion of infants are born at low birth weight?
A. One in ten
B. One in six
C. One in three
D. One in two

back 15

B. One in six

front 16

Malnutrition has been reported in up to what proportion of nursing home residents?
A. 15%
B. 30%
C. 40%
D. 50%

back 16

D. 50%

front 17

Which patient profile carries the greatest malnutrition risk?
A. Chronic disease, polypharmacy, poverty
B. Exercise, full pantry, employment
C. Good mobility, family meals
D. Adequate income, no disease

back 17

A. Chronic disease, polypharmacy, poverty

front 18

Food insecurity is best defined as:
A. Poor diet quality without hunger
B. Voluntary restriction for finances
C. Financially limited access to food
D. Inadequate vitamins despite satiety

back 18

C. Financially limited access to food

front 19

Hungry households are best characterized by:
A. Temporary shortages without hunger
B. High food costs, normal intake
C. Child pickiness causing skipped meals
D. Regular hunger with adult restriction

back 19

D. Regular hunger with adult restriction

front 20

In 2011, about what percentage of American households experienced food insecurity?
A. 12%
B. 15%
C. 20%
D. 8%

back 20

B. 15%

front 21

Which household best fits a high-risk pattern for food insecurity?
A. Married professionals, no children
B. Retired couple above poverty line
C. Minority single parent
D. Dual-income suburban homeowners

back 21

C. Minority single parent

front 22

Many eligible low-income working families do not use federal assistance primarily because of:
A. Shift from welfare to work
B. Excess program availability
C. Universal employer meal coverage
D. Decreased food prices nationwide

back 22

A. Shift from welfare to work

front 23

Obesity-related conditions account for more than what share of preventable deaths yearly?
A. 25%
B. 33%
C. 40%
D. 50%

back 23

D. 50%

front 24

A malnourished child first shows falling weight-for-age, later stunted height, and eventually plateaued head growth. Which progression is most accurate?
A. Height → weight → head size
B. Weight → height → head size
C. Head size → BMI → height
D. BMI → head size → weight

back 24

B. Weight → height → head size

front 25

In an older adult, which added feature further increases malnutrition risk?
A. Homebound, poor support, depression
B. Employed with meal delivery
C. Ambulatory with exercise group
D. Strong cooking skills, transportation

back 25

A. Homebound, poor support, depression

front 26

Which household pattern is also associated with especially high food insecurity rates?
A. Married couple above poverty line
B. Single adults without children
C. Minority family near poverty line
D. Retired homeowners with savings

back 26

C. Minority family near poverty line

front 27

Which social or behavioral factor also raises malnutrition risk?
A. Formal nutrition counseling
B. Alcohol misuse, poor nutrition knowledge
C. Daily shared family meals
D. Reliable grocery assistance

back 27

B. Alcohol misuse, poor nutrition knowledge

front 28

A cohort study compares BMI categories with normal-weight adults. Which group is not associated with excess mortality?
A. Overweight and Class I obesity
B. Underweight and overweight
C. Class II and Class III obesity
D. Central obesity and sarcopenia

back 28

A. Overweight and Class I obesity

front 29

Severe obesity is associated with significantly increased mortality relative to normal BMI. In that comparison, which group has the larger relative increase?
A. Females
B. Adolescents
C. Males
D. Older children

back 29

C. Males

front 30

Which is considered a biological factor contributing to obesity?
A. Restaurant meal frequency
B. Resting energy expenditure
C. Sedentary commuting patterns
D. Sugary beverage access

back 30

B. Resting energy expenditure

front 31

Which pair best represents environmental contributors to obesity?
A. High intake, low activity
B. FTO variant, diabetes risk
C. Large adipocytes, low REE
D. Pregnancy, adolescence

back 31

A. High intake, low activity

front 32

The FTO gene may account for up to what proportion of obesity cases?
A. 10 percent
B. 15 percent
C. 30 percent
D. 22 percent

back 32

D. 22 percent

front 33

The FTO gene shows a strong association with which condition?
A. Hypertension
B. Diabetes
C. Asthma
D. Osteoporosis

back 33

B. Diabetes

front 34

A child has one overweight parent. What is the approximate chance of becoming overweight in adulthood?
A. 20 percent
B. 40 percent
C. 60 percent
D. 80 percent

back 34

B. 40 percent

front 35

If both parents are overweight, that child’s approximate adult overweight risk becomes:
A. 80 percent
B. 50 percent
C. 60 percent
D. 30 percent

back 35

A. 80 percent

front 36

During infancy, adolescence, and pregnancy, adipose tissue normally increases primarily in:
A. Density
B. Size
C. Number
D. Distribution

back 36

C. Number

front 37

With modest weight gain, adipocytes typically increase in:
A. Number only
B. Size only
C. Surface tension
D. Lipase activity

back 37

B. Size only

front 38

With significant weight gain, adipocytes generally increase in:
A. Size and number
B. Number only
C. Size only
D. Insulin response

back 38

A. Size and number

front 39

After weight loss, adipocytes typically decrease in:
A. Number, not size
B. Size, not number
C. Neither size nor number
D. Number and size

back 39

B. Size, not number

front 40

Rising calorie consumption in many populations is partly attributed to:
A. Fewer snacks and fasting
B. Smaller meals at home
C. More activity and commuting
D. Larger portions and dining out

back 40

D. Larger portions and dining out

front 41

Which populations are less likely to meet physical activity guidelines?
A. Men and retirees
B. Women and minorities
C. Children and athletes
D. Smokers and immigrants

back 41

B. Women and minorities

front 42

In overweight or obese patients who have already lost weight, the single best predictor of long-term weight control is:
A. Daily calorie counting
B. Regular physical activity
C. Intermittent fasting
D. Low-carbohydrate dieting

back 42

B. Regular physical activity

front 43

In 2009–2010, what proportion of U.S. adults were obese?
A. About one sixth
B. About one fourth
C. More than one third
D. More than one half

back 43

C. More than one third

front 44

Over the past decade in the United States, obesity prevalence increased significantly among:
A. Women and girls
B. Men and boys
C. Girls only
D. Women only

back 44

B. Men and boys

front 45

For children and adolescents, overweight is defined as BMI above which percentile?
A. 75th percentile
B. 95th percentile
C. 90th percentile
D. 85th percentile

back 45

D. 85th percentile

front 46

For children and adolescents, obesity is defined as BMI:
A. Above the 90th percentile
B. Below the 5th percentile
C. Greater than 95th percentile
D. At the 85th percentile

back 46

C. Greater than 95th percentile

front 47

A patient with obesity loses 10% of body weight. Which improvement is expected?
A. Lower pressure, glucose, lipids
B. Higher HDL, lower calcium
C. Lower albumin, lower insulin
D. Higher hemoglobin, lower LDL

back 47

A. Lower pressure, glucose, lipids

front 48

Which additional outcome may also improve after 10% weight loss?
A. Lower fracture risk
B. Reduced cancer risk
C. Reduced anemia risk
D. Lower infection risk

back 48

B. Reduced cancer risk

front 49

Intensive treatment is particularly important for an obese patient with three or more accompanying risk factors. Which option lists qualifying risk factors?
A. Smoking, hypertension, dyslipidemia
B. Asthma, eczema, myopia
C. Gallstones, gout, migraine
D. Arthritis, GERD, insomnia

back 49

A. Smoking, hypertension, dyslipidemia

front 50

Which additional factor also counts among those obesity-related treatment risk factors?
A. High ferritin level
B. Family history of diabetes
C. Vegetarian diet history
D. Normal fasting glucose

back 50

B. Family history of diabetes

front 51

A clinician asks a patient to list everything consumed during the previous day. Which dietary tool is being used?
A. Food frequency questionnaire
B. Prospective food record
C. Usual intake history
D. Twenty-four-hour recall

back 51

D. Twenty-four-hour recall

front 52

Which dietary assessment method is retrospective and asks about normal intake patterns, including amounts eaten?
A. Food record
B. Twenty-four-hour recall
C. Usual intake history
D. Calorie expenditure log

back 52

C. Usual intake history

front 53

Which dietary assessment method is best for identifying trends in usual consumption of specific foods?
A. Food frequency questionnaire
B. Twenty-four-hour recall
C. Seven-day weighed record
D. Prospective meal diary

back 53

A. Food frequency questionnaire

front 54

Which dietary assessment tool is completed prospectively?
A. Diet history
B. Food record
C. Intake recall
D. Frequency survey

back 54

B. Food record

front 55

On exam, which site should be checked closely for muscle wasting?
A. Deltoid insertion
B. Patellar tendon
C. Temporalis muscle
D. Parotid gland

back 55

C. Temporalis muscle

front 56

Which hand muscle region is specifically examined for wasting in nutritional assessment?
A. Lumbricals
B. Thenar eminence
C. Flexor retinaculum
D. Palmar fascia

back 56

B. Thenar eminence

front 57

Serum albumin has which approximate half-life?
A. 2–3 days
B. 8–9 days
C. 12–14 days
D. 18–20 days

back 57

D. 18–20 days

front 58

Serum transferrin has which approximate half-life?
A. 8–9 days
B. 18–20 days
C. 2–3 days
D. 30–40 days

back 58

A. 8–9 days

front 59

Serum prealbumin has which approximate half-life?
A. 18–20 days
B. 8–9 days
C. 5–6 days
D. 2–3 days

back 59

D. 2–3 days

front 60

Evidence of a nutrition disorder should be labeled primary when it occurs in a patient with:
A. Severe organ failure
B. No other etiology
C. Chronic inflammation
D. Multiple comorbid causes

back 60

B. No other etiology

front 61

A child with cystic fibrosis develops weight loss from pancreatic insufficiency and fat malabsorption. This is best classified as:
A. Primary nutrition disorder
B. Starvation-related marasmus
C. Secondary nutrition problem
D. Isolated protein deficiency

back 61

C. Secondary nutrition problem

front 62

Resting energy expenditure is best defined as the energy required to:
A. Maintain vital function at rest
B. Digest food after a meal
C. Sustain exercise over hours
D. Build new adipose tissue

back 62

A. Maintain vital function at rest

front 63

Basal metabolic rate is the minimum calorie requirement measured under which condition?
A. Fasting, controlled environment
B. Exercise, thermoneutral environment
C. Feeding, room temperature
D. Stress, postabsorptive state

back 63

A. Fasting, controlled environment

front 64

Clinically, REE is mainly used to estimate:
A. Lean body mass
B. Basal metabolic rate
C. Activity thermogenesis
D. Respiratory quotient

back 64

B. Basal metabolic rate

front 65

Approximately what fraction of daily energy expenditure is due to REE?
A. 35%
B. 50%
C. 80%
D. 65%

back 65

D. 65%

front 66

Total energy expenditure is best estimated by:
A. REE plus nitrogen balance
B. REE times activity factor
C. BMR minus exercise losses
D. Protein intake times BMI

back 66

B. REE times activity factor

front 67

Average protein requirement for a healthy adult is closest to:
A. 0.3–0.5 g/kg
B. 0.8–1.0 g/kg
C. 1.8–2.0 g/kg
D. 2.5–3.0 g/kg

back 67

B. 0.8–1.0 g/kg

front 68

Malnutrition is best defined as a nutrient supply that is:
A. Excessive and growth-promoting
B. Deficient but asymptomatic
C. Suboptimal and health-impairing
D. Protein-poor but calorie-rich

back 68

C. Suboptimal and health-impairing

front 69

Genetics accounts for no more than what proportion of body-weight variance?
A. One half
B. One quarter
C. Two thirds
D. One third

back 69

D. One third

front 70

A hospitalist teaching interns about nutrition says nearly all hospitalized patients are what, to some degree?
A. Obese
B. Cachectic
C. Malnourished
D. Sarcopenic

back 70

C. Malnourished

front 71

The major biochemical consequence of excessive alcohol consumption is:
A. Respiratory alkalosis
B. Metabolic acidosis
C. Metabolic alkalosis
D. Respiratory acidosis

back 71

B. Metabolic acidosis

front 72

Alcohol-induced metabolic acidosis occurs largely because alcohol interferes with:
A. Glycolysis in erythrocytes
B. Acetyl-CoA oxidation in TCA
C. Ketone use in muscle
D. Urea synthesis in liver

back 72

B. Acetyl-CoA oxidation in TCA

front 73

In the Western world, the most common cause of malnutrition is:
A. Chronic alcoholism
B. Crohn disease
C. Chronic pancreatitis
D. Poverty alone

back 73

A. Chronic alcoholism

front 74

Alcohol provides how many kilocalories per gram?

back 74

7

front 75

High alcohol concentrations can directly disrupt which mucosal surfaces?
A. Esophageal and colonic
B. Jejunal and ileal
C. Gastric and duodenal
D. Oral and rectal

back 75

C. Gastric and duodenal

front 76

Which vitamin is routinely supplemented in patients with alcoholism?
A. Niacin
B. Pyridoxine
C. Folate
D. Thiamin

back 76

D. Thiamin

front 77

Thiamin is especially important in:
A. Fatty acid transport
B. Carbohydrate metabolism
C. Cholesterol esterification
D. Bile acid conjugation

back 77

B. Carbohydrate metabolism

front 78

Which symptom cluster best suggests thiamin deficiency?
A. Jaundice, edema, ascites
B. Hematuria, rash, fever
C. Anorexia, fatigue, irritability
D. Tremor, diarrhea, pruritus

back 78

C. Anorexia, fatigue, irritability

front 79

Chronic alcohol use is also associated with deficiency of:
A. Vitamin D
B. Vitamin B12
C. Folate
D. Vitamin E

back 79

C. Folate

front 80

Folate is required for normal biosynthesis of:
A. Purines and pyrimidines
B. Heme and globin
C. Ketones and bile salts
D. Glycogen and lactate

back 80

A. Purines and pyrimidines

front 81

A patient with vitamin B12 deficiency is mistakenly treated only with folate. Which abnormality is least likely to improve?
A. Neurologic dysfunction
B. Megaloblastic anemia
C. Low hemoglobin
D. Macrocytosis

back 81

A. Neurologic dysfunction

front 82

In chronic liver disease, hepatic production of which protein is usually preserved until end-stage disease?
A. Transferrin
B. Albumin
C. Fibrinogen
D. Prealbumin

back 82

B. Albumin

front 83

Which abnormality can respond to either folate or vitamin B12 replacement?
A. Posterior column loss
B. Paresthesias
C. Hematologic changes
D. Cognitive decline

back 83

C. Hematologic changes

front 84

A clinician asks a diabetic patient to list everything consumed yesterday. Which dietary tool is being used?
A. Three-day food record
B. Food frequency survey
C. Usual intake history
D. Twenty-four-hour recall

back 84

D. Twenty-four-hour recall

front 85

Which dietary assessment is best suited to evaluating long-term eating habits?
A. Three-day food record
B. Usual intake history
C. Calorie count sheet
D. Single-meal recall

back 85

B. Usual intake history

front 86

A patient is asked to document meals as they are eaten over three days. This method is:
A. Retrospective
B. Cross-sectional
C. Prospective
D. Qualitative

back 86

C. Prospective

front 87

In a three-day food record, patients are specifically asked to:
A. Estimate grocery spending
B. Recall favorite foods
C. Rank meal quality
D. Record their food intake

back 87

D. Record their food intake

front 88

Excess abdominal fat is most directly assessed by measuring:
A. Hip circumference
B. Body fat percentage
C. Waist circumference
D. Mid-arm circumference

back 88

C. Waist circumference

front 89

Waist circumference should be measured at the level of the:
A. Umbilicus
B. Xiphoid process
C. Greater trochanter
D. Right iliac crest border

back 89

D. Right iliac crest border

front 90

Waist circumference is an independent predictor of morbidity particularly when which variable is not markedly increased?
A. BMI
B. LDL cholesterol
C. Age
D. Blood pressure

back 90

A. BMI

front 91

Measuring waist circumference is especially recommended when BMI is less than:
A. 25
B. 30
C. 35
D. 40

back 91

C. 35

front 92

Increased waist circumference independently predicts all of the following except:
A. Diabetes
B. Dyslipidemia
C. Hypertension
D. Hypothyroidism

back 92

D. Hypothyroidism

front 93

Compared with BMR, REE is approximately:
A. 10% lower
B. 25% higher
C. Equivalent
D. 10% higher

back 93

A. 10% lower

front 94

Daily protein needs for an unstressed, well-nourished adult are closest to:
A. 0.8-1.0 g/kg
B. 1.2-1.4 g/kg
C. 1.5-2.0 g/kg
D. >2.0 g/kg

back 94

A. 0.8-1.0 g/kg

front 95

A postoperative patient generally requires which protein intake range?
A. 0.6-0.8 g/kg
B. 0.8-1.0 g/kg
C. 1.5-2.0 g/kg
D. >3.0 g/kg

back 95

C. 1.5-2.0 g/kg

front 96

A burn patient with severe infection will often need protein intake:
A. Below 1 g/kg
B. Over 2 g/kg
C. Exactly 1.5 g/kg
D. Under 0.8 g/kg

back 96

B. Over 2 g/kg

front 97

Which is a major cause of malnutrition?
A. Reduced oral intake
B. Excessive vitamin storage
C. Increased insulin sensitivity
D. Reduced sleep duration

back 97

A. Reduced oral intake

front 98

Malabsorption-related stool losses best fit which cause of malnutrition?
A. Decreased oral intake
B. Increased nutrition loss
C. Increased fat storage
D. Reduced metabolic demand

back 98

B. Increased nutrition loss

front 99

Hypermetabolic illness causing increased calorie needs is best categorized as:
A. Increased requirements
B. Increased excretion
C. Decreased intake
D. Reduced absorption

back 99

A. Increased requirements

front 100

Which is considered part of obesity etiology?
A. Adipose cell size
B. Low stomach acid
C. Iron deficiency
D. Thyroid storm

back 100

A. Adipose cell size

front 101

Which factor is a major driver of overweight and obesity?
A. Excess caloric intake
B. Excess water intake
C. High fiber intake
D. Reduced salt intake

back 101

A. Excess caloric intake

front 102

Which lifestyle pattern promotes obesity development?
A. Increased resistance training
B. Decreased physical activity
C. Greater sleep efficiency
D. Reduced eating frequency

back 102

B. Decreased physical activity

front 103

How many kilocalories does 1 gram of protein provide?

back 103

4

front 104

How many kilocalories does 1 gram of carbohydrate provide?

back 104

4

front 105

How many kilocalories does 1 gram of fat provide?

back 105

9

front 106

In the United States, obesity most disproportionately affects:
A. Asian men
B. Black women
C. White women
D. Hispanic boys

back 106

B. Black women

front 107

A patient loses 10% of body weight. Which change is expected?
A. Higher fasting glucose
B. Lower blood pressure
C. Lower hemoglobin
D. Higher cancer risk

back 107

B. Lower blood pressure

front 108

Diet history is most commonly obtained as part of the patient’s:
A. Family history
B. Surgical history
C. Social history
D. Medication history

back 108

C. Social history

front 109

Which dietary tool is especially recommended for older adults?
A. Three-day food record
B. Usual intake history
C. Single 24-hour recall
D. Snack frequency sheet

back 109

B. Usual intake history

front 110

In the United States, obesity is most prevalent in the:
A. Northeast
B. Midwest
C. West
D. South

back 110

D. South