Must follow ____ free diet in celiac disease

gluten

Diet rich in whole ____ can be useful across spectrum of most GI symptoms

grains

Carb digestion requires ____ to convert starches into disaccharides

amylase

____ absorbed through diffusion or active transport

Monosaccharides

Symptoms:
o Bloating
o Abdominal pain
o Flatulence
o Borborygmi
o Nausea
o Diarrhea
o Cons0pa0on

Lactose Intolerance

The most common form of carbohydrate malabsorption worldwide is:
A. Fructose intolerance
B. Lactose intolerance
C. Sucrase deficiency
D. Glucose-galactose malabsorption

B. Lactose intolerance

Lactose intolerance affects approximately what proportion of the world population?
A. 10–15%
B. 25–30%
C. 45–50%
D. 70–75%

D. 70–75%

Lactose must be hydrolyzed by lactase into:
A. Fructose and galactose
B. Glucose and galactose
C. Glucose and fructose
D. Maltose and glucose

B. Glucose and galactose

The primary biochemical defect in most lactose intolerance is:
A. Sucrase deficiency
B. Pancreatic lipase deficiency
C. Suboptimal lactase activity
D. Glucose transporter loss

C. Suboptimal lactase activity

A teenager reports bloating and diarrhea after ice cream but tolerates small amounts of yogurt. The most likely diagnosis is:
A. Celiac disease
B. Lactose intolerance
C. Tropical sprue
D. Pancreatic insufficiency

B. Lactose intolerance

Which test can help confirm lactose intolerance?
A. D-xylose absorption test
B. Schilling test
C. Lactose hydrogen breath test
D. Fecal occult blood test

C. Lactose hydrogen breath test

Another accepted test for confirming lactose intolerance is:
A. Lactose tolerance test
B. Secretin stimulation test
C. Sweat chloride test
D. Urea breath test

A. Lactose tolerance test

Lactase production typically changes with age by:
A. Increasing after puberty
B. Remaining constant lifelong
C. Falling with age
D. Rising in older adults

C. Falling with age

Reduced lactase production is most appropriately described as:
A. Always normal in infancy
B. Usually normal in infants
C. Pathologic in adults usually
D. Pathologic in infants sometimes

D. Pathologic in infants sometimes

In most teens and adults, decreased lactase production is:
A. Usually normal
B. Always pathologic
C. Due to pancreatitis
D. Due to infection

A. Usually normal

Which factor increases predisposition to lactose intolerance?
A. High protein intake
B. Genetic predisposition
C. Vitamin D excess
D. Low fiber intake

B. Genetic predisposition

Severity of lactose intolerance symptoms is often most related to:
A. Daily fat intake
B. Lactose dose consumed
C. Meal temperature
D. Protein source eaten

B. Lactose dose consumed

A major nutritional goal in lactose malabsorption is prevention of:
A. Iron overload
B. Secondary bone disease
C. Hyperphosphatemia
D. Folate deficiency

B. Secondary bone disease

To help prevent skeletal complications, patients with lactose issues are encouraged to:
A. Avoid all supplements
B. Restrict calcium entirely
C. Use calcium supplementation
D. Take iron daily

C. Use calcium supplementation

Even with lactose malabsorption, dietary guidance encourages:
A. No dairy ever
B. Three low-fat dairy servings
C. Only high-fat dairy
D. Total carbohydrate avoidance

B. Three low-fat dairy servings

Which dairy products may improve tolerance because they contain lactic acid bacteria?
A. Heavy cream products
B. Sweetened condensed milk
C. Fermented dairy products
D. Butter-based products

C. Fermented dairy products

Which food is most likely to be better tolerated in lactose malabsorption?
A. Yogurt
B. Whey powder
C. Buttermilk
D. Non-fat milk solids

A. Yogurt

Some patients with lactose intolerance may benefit from:
A. Probiotics
B. Loop diuretics
C. Bile acid resins
D. Pancrelipase

A. Probiotics

A patient with lactose malabsorption wants to maintain calcium intake while limiting symptoms. The best recommendation is:
A. Avoid all fortified foods
B. Use calcium-fortified foods
C. Eliminate calcium completely
D. Take phosphate binders

B. Use calcium-fortified foods

If supplementation is needed for lactose intolerance, the notes recommend:
A. 250 mg calcium daily
B. 500 mg calcium twice weekly
C. 1000 mg calcium daily
D. 2000 mg calcium twice daily

C. 1000 mg calcium daily

A patient avoids milk but tolerates fermented cheese. The best explanation is:
A. Cheese lacks protein
B. Cheese contains lactase
C. Lactic acid bacteria help
D. Calcium blocks lactose uptake

C. Lactic acid bacteria help

Who has this diet?

Encouraged to consume 6-11 servings whole grain or enriched gluten-free grains and 3 servings gluten-free dairy foods per day

celiac disease

Perform LFT, serum iron and ferri0n, RBC folate, vitamin B12, calcium, Vitamin D tests ordered for what patients?

celiac disease

Symptoms:
o Weight loss
o Failure to thrive
o Osteomalacia
o Bone pain
o Infertility
o Dysmenorrhea
o Amenorrhea

fat malabsorption

Associated with _____
o Poor quality of sleep
o Regular use of NSAIDs
o Heavy alcohol intake
o Irregular dietary habits
o H pylori

GERD

Foods that can cause _____
o Spicy foods
o Acidic foods
o High fat foods
o Chocolate
o Mint
o Caffeine

GERD

A 24-year-old woman has chronic diarrhea, bloating, and iron deficiency anemia that worsens after bread and pasta. Which dietary antigen most likely drives her disease?
A. Casein
B. Gliadin
C. Lactose
D. Albumin

B. Gliadin

A patient with suspected celiac disease undergoes endoscopy. Which biopsy pattern most strongly supports the diagnosis?
A. Goblet cell hyperplasia
B. Transmural granulomas
C. Pseudopolyps with crypt abscesses
D. Villous atrophy with crypt hyperplasia

D. Villous atrophy with crypt hyperplasia

Celiac disease is defined by chronic inflammation involving which site?
A. Small bowel mucosa
B. Gastric antrum
C. Colonic submucosa
D. Pancreatic ducts

A. Small bowel mucosa

A patient has positive celiac serologies. What is the most appropriate next diagnostic step?
A. Lactose breath test
B. Gluten challenge only
C. Small bowel biopsy
D. Stool elastase testing

C. Small bowel biopsy

Which serologic pair is most appropriate when screening for celiac disease?
A. ANA and RF
B. TTG and EMA
C. ASCA and pANCA
D. AMA and ANCA

B. TTG and EMA

A patient with untreated celiac disease is most likely to have which deficiency pattern?
A. Iron, folate, and B12
B. Copper, zinc, and vitamin C
C. Vitamin K and niacin
D. Vitamin E and selenium

A. Iron, folate, and B12

Longstanding untreated celiac disease may contribute to which skeletal complication?
A. Gout and nephrolithiasis
B. Osteopetrosis and sclerosis
C. Hyperparathyroid bone disease
D. Osteoporosis or osteomalacia

D. Osteoporosis or osteomalacia

Which intake pattern is specifically associated with many gluten-free diets?
A. Excessive medium-chain triglycerides
B. Increased fermented dairy intake
C. Concentrated sweets and soft drinks
D. Markedly increased dietary fiber

C. Concentrated sweets and soft drinks

Nutritional monitoring is important in celiac disease because most gluten-free products are:
A. Non-fortified
B. Protein-enriched
C. Lactose-free
D. Iron-overloaded

A. Non-fortified

Beyond malabsorption, untreated celiac disease may also present with:
A. Nephrotic syndrome
B. Portal vein thrombosis
C. Hyperaldosteronism
D. Infertility

D. Infertility

Which laboratory abnormality may occur in untreated celiac disease?
A. Hyperamylasemia
B. Elevated transaminases
C. Severe hypercalcemia
D. Marked polycythemia

B. Elevated transaminases

A patient with celiac disease develops gait instability without weakness. Which neurologic manifestation is specifically associated with this disorder?
A. Hemiballismus
B. Aphasia
C. Ataxia
D. Myoclonus

C. Ataxia

Which patient is at highest risk for celiac disease?
A. Patient with nephrotic syndrome
B. Patient with hereditary spherocytosis
C. Patient with chronic pancreatitis
D. Patient with type 1 diabetes

D. Patient with type 1 diabetes

Which additional condition is specifically listed as a high-risk setting for celiac disease?
A. Turner syndrome
B. Klinefelter syndrome
C. Marfan syndrome
D. Neurofibromatosis

A. Turner syndrome

Which family history most strongly increases pretest probability for celiac disease?
A. Relative with colon cancer
B. Relative with ulcerative colitis
C. Relative with celiac disease
D. Relative with gallstones

C. Relative with celiac disease

Which broad comorbidity category should prompt increased suspicion for celiac disease?
A. Plasma cell dyscrasias
B. Autoimmune endocrinopathies
C. Chronic hemolytic disorders
D. Inherited myopathies

B. Autoimmune endocrinopathies

Which disorder is best classified as a protein malabsorption syndrome in this context?
A. Celiac disease
B. Lactose intolerance
C. Achalasia
D. Diverticulosis

A. Celiac disease

A patient asks which foods should be removed to treat celiac disease. What is the core dietary target?
A. High-fructose foods
B. Dairy products
C. Gluten-containing wheat products
D. High-fat meats

C. Gluten-containing wheat products

Which statement best explains why micronutrient deficiencies may persist even after adopting a gluten-free diet?
A. Gluten-free foods block absorption
B. Many products lack fortification
C. Gliadin remains in vegetables
D. EMA antibodies destroy vitamins

B. Many products lack fortification

A patient with bulky, greasy, foul-smelling stools most likely has which type of malabsorption syndrome?
A. Protein malabsorption
B. Fat malabsorption
C. Iron malabsorption
D. Carbohydrate malabsorption

B. Fat malabsorption

Fat malabsorption often occurs when there is impaired:
A. Luminal transport of digested products
B. Colonic sodium absorption
C. Hepatic glycogen storage
D. Gastric acid secretion

A. Luminal transport of digested products

A patient with diffuse small-intestinal injury develops fat malabsorption. Which mechanism best explains this?
A. Excess pancreatic bicarbonate
B. Increased gastric emptying
C. Widespread mucosal injury
D. Isolated esophageal dysmotility

C. Widespread mucosal injury

Which disorder can cause fat malabsorption through widespread mucosal injury?
A. Celiac disease
B. Achalasia
C. Appendicitis
D. Diverticulosis

A. Celiac disease

Which inflammatory disorder is specifically listed as a cause of fat malabsorption?
A. Chronic gastritis
B. Peptic ulcer disease
C. Ulcerative proctitis
D. Inflammatory bowel disease

D. Inflammatory bowel disease

Small-bowel bacterial overgrowth may cause fat malabsorption primarily because it can:
A. Raise lactase activity
B. Injure absorptive mucosa
C. Stimulate pancreatic lipase
D. Increase micelle formation

B. Injure absorptive mucosa

A patient with chronic pancreatitis develops greasy stools. The most direct cause is:
A. Villous hyperplasia
B. Excess bile salt synthesis
C. Lipase deficiency
D. Accelerated gastric emptying

C. Lipase deficiency

Fat malabsorption in cystic fibrosis most commonly reflects:
A. Excess gastric acid
B. Colonic inflammation
C. Lactase deficiency
D. Maldigestion

D. Maldigestion

A patient with cholestatic disease develops steatorrhea despite normal pancreatic enzymes. The best explanation is:
A. Lack of emulsification
B. Crypt hyperplasia
C. Increased intestinal motility
D. Renal vitamin wasting

A. Lack of emulsification

Which condition can cause steatorrhea because of bile salt deficiency?
A. Achalasia
B. Gastroparesis
C. Cholestatic biliary disease
D. Hiatal hernia

C. Cholestatic biliary disease

Which mechanism best distinguishes maldigestion from mucosal fat malabsorption?
A. Impaired enterocyte turnover
B. Defective intraluminal breakdown
C. Autoimmune villous destruction
D. Reduced intestinal surface area

B. Defective intraluminal breakdown

Fat malabsorption can also be seen in which wasting syndrome?
A. HIV wasting
B. Marfan syndrome
C. Turner syndrome
D. Nephrotic syndrome

A. HIV wasting

A patient with chronic steatorrhea is most at risk for deficiency of:
A. Water-soluble vitamins
B. Vitamin B12 alone
C. Iron and copper
D. Fat-soluble vitamins

D. Fat-soluble vitamins

To increase caloric intake in fat malabsorption, the diet can be supplemented with:
A. Long-chain triglycerides
B. Complex starch polymers
C. Medium-chain triglycerides
D. Branched-chain amino acids

C. Medium-chain triglycerides

Medium-chain triglycerides are especially useful because they do not require:
A. Enteropeptidase activation
B. Bile salts or micelles
C. Colonic fermentation
D. Intrinsic factor binding

B. Bile salts or micelles

The caloric content of medium-chain triglycerides is approximately:
A. 115 calories per teaspoon
B. 60 calories per teaspoon
C. 200 calories per tablespoon
D. 40 calories per gram

A. 115 calories per teaspoon

A patient with pancreatic insufficiency and fat malabsorption should receive:
A. Gluten restriction
B. Calcium carbonate
C. Bile acid sequestrants
D. Pancreatic enzyme supplementation

D. Pancreatic enzyme supplementation

Which patient most clearly has steatorrhea from maldigestion rather than mucosal injury?
A. Untreated celiac disease
B. Bacterial overgrowth syndrome
C. Chronic pancreatitis
D. Crohn ileitis flare

C. Chronic pancreatitis

Based on population data, GERD affects approximately what proportion of people?
A. About 2%
B. About 8%
C. Up to 20%
D. Nearly 50%

C. Up to 20%

Which risk factor from history is most strongly associated with GERD?
A. Obesity
B. High protein intake
C. Low sodium diet
D. Increased hydration

A. Obesity

Which mechanism best explains why obesity increases GERD risk?
A. Reduced gastric acid output
B. Increased bile salt secretion
C. Increased intestinal transit
D. Increased intra-abdominal pressure

D. Increased intra-abdominal pressure

In addition to elevated intra-abdominal pressure, obesity promotes GERD by increasing:
A. Pyloric contraction
B. LES relaxation
C. salivary bicarbonate
D. duodenal motility

B. LES relaxation

Which dietary feature most likely contributes to his GERD?
A. High saturated fat intake
B. High lean protein intake
C. High water content
D. High calcium intake

A. High saturated fat intake

High-fat meals worsen GERD in part because they:
A. Increase fiber fermentation
B. reduce pepsin secretion
C. delay gastric emptying
D. block intestinal glucose uptake

C. delay gastric emptying

A patient asks which dietary change may help lower reflux risk over time. Which recommendation is most supported by the material provided?
A. Increase saturated fat intake
B. Increase dietary fiber intake
C. Eliminate all carbohydrates
D. Drink more acidic beverages

B. Increase dietary fiber intake

these foods _____ gastric acid secretions: coffee, tea, colas, alcohol

increase

these foods are poorly tolerated in _____ _____ disease:
o coffee
o orange juice
o fried foods
o spicy foods
o fruits

peptic ulcer

A patient with epigastric pain is found to have a duodenal ulcer. Most gastric and duodenal ulcers are primarily caused by:
A. Excess pancreatic enzyme release
B. Gastric mucosal damage
C. Colonic bacterial overgrowth
D. Distal ileal ischemia

B. Gastric mucosal damage

A patient with chronic dyspepsia develops a gastric ulcer after years of daily analgesic use. Which pair includes the most common causative agents of peptic ulcer disease?
A. Alcohol and caffeine
B. Bile salts and stress
C. Steroids and tobacco
D. H pylori and NSAIDs

D. H pylori and NSAIDs

A college student develops 2 days of watery diarrhea after a viral illness. Most cases of diarrhea are due to:
A. Self-limited infection
B. Pancreatic insufficiency
C. Chronic malabsorption
D. Endocrine neoplasia

A. Self-limited infection

A patient reports loose stools for more than 4 weeks. This is best classified as:
A. Secretory diarrhea
B. Acute dysentery
C. Chronic diarrhea
D. Functional constipation

C. Chronic diarrhea

Chronic diarrhea affects approximately what proportion of the population?
A. Less than 1%
B. Up to 5%
C. About 15%
D. Nearly 25%

B. Up to 5%

A patient develops diarrhea after drinking milkshakes and eating ice cream. Which malabsorptive disorder best explains this?
A. Chronic pancreatitis
B. Bile salt deficiency
C. Peptic ulcer disease
D. Lactose intolerance

D. Lactose intolerance

A patient with chronic diarrhea, iron deficiency, and villous injury most likely has which malabsorptive cause?
A. Celiac disease
B. Achalasia
C. Diverticulosis
D. Appendicitis

A. Celiac disease

A patient with chronic diarrhea and intestinal inflammation has transmural bowel disease. Which listed malabsorptive disorder can cause diarrhea?
A. Peptic ulcer disease
B. Cholelithiasis
C. Inflammatory bowel disease
D. Gastroparesis

C. Inflammatory bowel disease

A patient develops diarrhea after ingesting a nonabsorbed solute. This mechanism is most consistent with:
A. Exudative diarrhea
B. Osmotic diarrhea
C. Motility diarrhea
D. Infectious dysentery

B. Osmotic diarrhea

A patient chewing large amounts of sugar-free gum develops diarrhea. Which substance most likely caused it?
A. Lactase
B. Gliadin
C. Butyrate
D. Sorbitol

D. Sorbitol

A patient taking a saline cathartic develops osmotic diarrhea. Which ingested agent best fits this mechanism?
A. Magnesium sulfate
B. Calcium citrate
C. Sodium bicarbonate
D. Potassium chloride

A. Magnesium sulfate

Ingestion of which poorly absorbed substance may also cause osmotic diarrhea?
A. Inulin
B. Cellulose
C. Phosphate
D. Casein

C. Phosphate

A patient with diarrhea feels worse after increasing bran cereal and other roughage. Which fiber type is most likely aggravating symptoms?
A. Fermentable fiber
B. Insoluble fiber
C. Viscous fiber
D. Soluble fiber

B. Insoluble fiber

A patient with diarrhea is advised to increase a fiber type that forms a gel within the intestinal lumen. Which is most likely to help?
A. Wheat bran fiber
B. Corn hull fiber
C. Insoluble cereal fiber
D. Soluble fiber

D. Soluble fiber

Which dietary approach is most consistent with using functional foods to help diarrhea?
A. Live active cultures
B. High saturated fat
C. Added simple sugars
D. Strict lactose loading

A. Live active cultures

Which recommendation best matches the provided material for helping some patients with diarrhea?
A. Eliminate all bacteria
B. Avoid fermented foods
C. Use yogurt or probiotics
D. Increase insoluble fiber

C. Use yogurt or probiotics

Which exposure is a classic peptic ulcer risk factor?
A. NSAID overuse
B. Excess soluble fiber
C. Probiotic intake
D. Sugar alcohol avoidance

A. NSAID overuse

A patient with a newly diagnosed duodenal ulcer has no NSAID exposure. Which organism is a common causative agent?
A. Giardia lamblia
B. Clostridioides difficile
C. Escherichia coli
D. H pylori

D. H pylori

Definition=less than 2-3 bowel movements per week

conspitation

Dietary sources of ______ fats include fatty fish, walnuts, soy, flaxseed, canola oil, and in small amounts, certain leafy greens

omega-3

Which demographic pattern is most associated with constipation risk?
A. Young men
B. Older women
C. Adolescent boys
D. Middle-aged men

B. Older women

A patient has constipation due to impaired stool propulsion within the colon, without medication or endocrine triggers. This is best classified as:
A. Functional diarrhea
B. Osmotic constipation
C. Secondary constipation
D. Primary constipation

D. Primary constipation

A patient develops constipation after starting an anticholinergic medication for bladder symptoms. This mechanism is most consistent with:
A. Secondary constipation
B. Colonic pseudo-obstruction
C. Primary constipation
D. Pelvic floor trauma

A. Secondary constipation

Which outpatient recommendation is most appropriate for uncomplicated constipation?
A. Abruptly double daily fiber
B. Restrict all oral fluids
C. Increase fluids and fiber gradually
D. Begin bowel rest immediately

C. Increase fluids and fiber gradually

Inflammatory bowel disease is best defined as including:
A. Celiac disease and IBS
B. Crohn disease and ulcerative colitis
C. Diverticulitis and colitis
D. Gastritis and enteritis

B. Crohn disease and ulcerative colitis

A patient with patchy transmural intestinal inflammation has disease involving the terminal ileum and perianal region. Which disorder can affect any part of the digestive tract?
A. Crohn disease
B. Ulcerative colitis
C. Microscopic colitis
D. Celiac disease

A. Crohn disease

A patient has continuous inflammatory disease limited to the large intestine. Which diagnosis best fits disease confined to the colon?
A. Crohn disease
B. Celiac sprue
C. Ulcerative colitis
D. Tropical sprue

C. Ulcerative colitis

Which nutritional problem is common in IBD?
A. Protein malnutrition
B. Iron overload
C. Hypervitaminosis D
D. Copper toxicity

A. Protein malnutrition

Which cytokine profile most directly contributes to protein malnutrition in inflammatory bowel disease?
A. IL-4, IL-5, IL-13
B. IFN-beta, IL-2, IL-12
C. IL-10, TGF-beta, IL-22
D. IL-1, IL-6, TNF-alpha

D. IL-1, IL-6, TNF-alpha

Beyond cytokine effects, which intestinal change contributes to malnutrition in inflammatory bowel disease?
A. Increased gastric acid output
B. Accelerated bile synthesis
C. Decreased absorptive surface area
D. Enhanced colonic fermentation

C. Decreased absorptive surface area

A patient undergoes ileal resection for Crohn disease and later develops fat malabsorption. Which deficiency most directly explains this complication?
A. Lactase deficiency
B. Bile salt deficiency
C. Intrinsic factor deficiency
D. Pancreatic amylase deficiency

B. Bile salt deficiency

A patient with IBD is treated with prednisone for a severe flare. Which metabolic effect is expected?
A. Reduced calcium absorption
B. Increased calcium absorption
C. Decreased protein breakdown
D. Enhanced bile recycling

A. Reduced calcium absorption

High intake of which dietary fat is associated with increased risk of ulcerative colitis?
A. Oleic acid
B. Alpha-linolenic acid
C. Palmitic acid
D. Linoleic acid

D. Linoleic acid

aka omega-6

The increased ulcerative colitis risk associated with linoleic acid is partly due to its conversion into:
A. Eicosapentaenoic acid
B. Arachidonic acid
C. Docosahexaenoic acid
D. Lactic acid

B. Arachidonic acid

Which dietary pattern most increases linoleic acid exposure?
A. Fruit, rice, legumes
B. Yogurt, oats, beans
C. Red meat, oils, margarine
D. Fish, eggs, potatoes

C. Red meat, oils, margarine

Which dietary pattern is associated with increased ulcerative colitis risk?
A. High soluble fiber intake
B. High fermented dairy intake
C. High calcium-fortified intake
D. High animal protein intake

D. High animal protein intake

A patient is hospitalized, placed on bowel rest, and is not expected to resume oral repletion for 7 days. Which nutritional support should be considered?
A. Total parenteral nutrition
B. Clear liquid diet
C. Lactose restriction
D. Fiber supplementation

A. Total parenteral nutrition

_____ show promise as an adjunctive treatment for mild-to-moderate ulcerative colitis

Probiotics

______ are specialized, non-digestible plant fibers that pass through the small intestine undigested to reach the colon. There, they act as fuel, selectively stimulating the growth of beneficial gut bacteria to improve digestive and overall health.

Prebiotics

A patient with active inflammatory bowel disease has ongoing diarrhea and malabsorption. Which diet is most appropriate to help control symptoms?
A. Low fat, low fiber, low lactose
B. High fat, high fiber, low lactose
C. Low protein, high fiber, low fat
D. High lactose, low fat, low fiber

A. Low fat, low fiber, low lactose

A patient with inflammatory bowel disease reports worsening cramping after large meals. Which feeding pattern is most appropriate?
A. One large evening meal
B. Alternate-day feeding
C. Small, frequent feedings
D. Liquid-only weekends

C. Small, frequent feedings

A patient with inflammatory bowel disease develops urgent diarrhea soon after certain beverages. Which trigger pair is most likely?
A. Water and tea
B. Milk and juice
C. Broth and soup
D. Alcohol and caffeine

D. Alcohol and caffeine

A patient with chronic diarrhea asks which sweetener type commonly causes bloating and loose stools. Which is most likely?
A. Sugar alcohols
B. Table sugar
C. Corn starch
D. Glucose syrup

A. Sugar alcohols

A patient with active inflammatory bowel disease and complications is losing weight. How should caloric intake generally change?
A. Decrease to reduce stooling
B. Increase to meet higher needs
C. Remain unchanged
D. Stop calories temporarily

B. Increase to meet higher needs

A severely malnourished patient with inflammatory bowel disease is starting nutrition support. What is the safest initial approach?
A. Begin aggressive refeeding
B. Start a high-fat diet
C. Add fiber immediately
D. Begin cautiously to avoid refeeding

D. Begin cautiously to avoid refeeding

A patient with active inflammatory bowel disease is started on prednisone during a flare. How should protein intake generally change?
A. Increase, especially with prednisone
B. Decrease during steroid therapy
C. Stay unchanged during flares
D. Restrict until diarrhea resolves

A. Increase, especially with prednisone

A patient with inflammatory bowel disease develops nausea, constipation, and abdominal cramping after starting supplementation. Which supplement is most likely responsible?
A. Folate
B. Vitamin D
C. Oral iron
D. Calcium carbonate

C. Oral iron

A patient with iron deficiency from inflammatory bowel disease is not responding well to oral iron alone. What addition may improve absorption?
A. Magnesium
B. Ascorbic acid
C. Vitamin K
D. Zinc sulfate

B. Ascorbic acid

Ascorbic acid helps oral iron therapy mainly by:
A. Binding intestinal bile salts
B. Slowing gastric emptying
C. Chelating dietary oxalate
D. Converting ferric to ferrous

D. Converting ferric to ferrous

A patient with inflammatory bowel disease asks where orally administered iron is mainly absorbed. Which site is most relevant?
A. Duodenum
B. Jejunum
C. Ileum
D. Colon

A. Duodenum

A patient with inflammatory bowel disease is treated with sulfasalazine. Which supplement should routinely be considered?
A. Vitamin C
B. Potassium
C. Folate
D. Vitamin A

C. Folate

A patient with Crohn disease is treated with methotrexate. Which additional supplement is typically recommended?
A. Iron
B. Folate
C. Zinc
D. Riboflavin

B. Folate

Which deficiency pattern is especially common in both children and adults with inflammatory bowel disease?
A. Vitamin K excess
B. Copper overload
C. Vitamin E toxicity
D. Vitamin D deficiency

D. Vitamin D deficiency

A patient with Crohn disease has a narrowed bowel segment and intermittent obstructive symptoms. Which diet is most appropriate?
A. Low-fiber diet
B. High-fiber diet
C. Raw vegetable diet
D. Seed-enriched diet

A. Low-fiber diet

Which dietary approach should generally be avoided in a patient with Crohn disease and bowel strictures?
A. Small, frequent meals
B. Low-lactose intake
C. Personalized food choices
D. Fiber-rich diet

D. Fiber-rich diet

A patient with fat malabsorption is using medium-chain triglyceride oil. How should it be introduced?
A. In small amounts at a time
B. In large bolus servings
C. Only with insoluble fiber
D. Only during fasting periods

A. In small amounts at a time

A patient with Crohn disease undergoes ileal resection and later develops kidney stones. Which stone type is most likely?
A. Struvite
B. Uric acid
C. Cystine
D. Calcium oxalate

D. Calcium oxalate

A patient with Crohn disease has undergone ileal resection and diverting ileostomy. What postoperative problem increases the risk of the typical kidney stones seen in this setting?
A. Lactase deficiency
B. Pancreatic enzyme excess
C. Reduced gastric acid
D. Bile salt malabsorption

D. Bile salt malabsorption

characterized by abdominal pain, altered bowel motility, and bloating or abdominal distension

IBS

Irritable Bowel Syndrome (IBS) is a common, chronic functional disorder of the ____ ____ causing chronic abdominal pain, bloating, and diarrhea or constipation

large intestine

_____ malabsorption may precipitate symptoms of IBS

Carbohydrate

A patient undergoing colon evaluation is found to have diverticulosis. Which location is most commonly involved?
A. Sigmoid colon
B. Transverse colon
C. Ascending colon
D. Rectum

A. Sigmoid colon

An older adult is counseled about diverticulosis risk. Which age-related change is recognized as a contributing factor?
A. Pancreatic fibrosis
B. Changes in the colonic wall
C. Esophageal dysmotility
D. Hepatic steatosis

B. Changes in the colonic wall

A patient with diverticulosis asks about a proposed mechanism behind the formation of diverticula. Which process is implicated?
A. Reduced bile production
B. Excess gastric acid secretion
C. Increased colonic intraluminal pressure
D. Accelerated small-bowel transit

C. Increased colonic intraluminal pressure

Which additional colonic abnormality may contribute to diverticulosis?
A. Villous atrophy
B. Lactase deficiency
C. Bile salt wasting
D. Motor dysfunction

D. Motor dysfunction

A patient wants to reduce future diverticulosis risk through diet. Which pattern is most associated with increased risk?
A. Inadequate fiber intake
B. High calcium intake
C. Increased omega-3 intake
D. Frequent fermented dairy intake

A. Inadequate fiber intake

A patient asks who is more likely to develop diverticulosis over time. Which factor increases risk?
A. High protein intake
B. Older age
C. Daily yogurt use
D. Regular hydration

B. Older age

Which food pattern best supports dietary treatment of diverticulosis?
A. Refined grains and processed meats
B. Full-liquid diet only
C. High-fat dairy and sweets
D. Whole grains, fruits, vegetables

D. Whole grains, fruits, vegetables

A patient with diverticulosis wants one practical long-term plan. Which is best?
A. Reduce fluids and fiber
B. Use bowel rest indefinitely
C. Emphasize fiber-rich foods and hydration
D. Rely mainly on high-protein foods

C. Emphasize fiber-rich foods and hydration

Which counseling statement best reflects management of uncomplicated diverticulosis?
A. Treatment centers on lactose restriction
B. Management requires pancreatic enzymes
C. Therapy focuses on reducing omega-6 fats
D. Diet and hydration are key measures

D. Diet and hydration are key measures

______ is the presence of small, harmless pouches (diverticula) in the colon wall, while ______ occurs when these pouches become inflamed or infected, causing symptoms like fever and severe abdominal pain

Diverticulosis

diverticulitis

Biopsy showing hepatic steatosis with minimal inflammation. Which subtype is most consistent with this finding?
A. Alcoholic hepatitis
B. Nonalcoholic fatty liver
C. Fulminant hepatic failure
D. Nonalcoholic steatohepatitis

B. Nonalcoholic fatty liver

Biopsy findings of steatosis, inflammation, hepatocyte ballooning, and fibrosis. Which subtype best fits?
A. Cholestatic liver disease
B. Alcoholic fatty liver
C. Nonalcoholic fatty liver
D. Nonalcoholic steatohepatitis

D. Nonalcoholic steatohepatitis

A patient with fatty liver disease asks which subtype has greater risk of progression to advanced cirrhosis and end-stage liver disease. Which is most concerning?
A. Nonalcoholic steatohepatitis
B. Nonalcoholic fatty liver
C. Gilbert syndrome
D. Isolated cholestasis

A. Nonalcoholic steatohepatitis

Which associated condition pattern is most consistent with nonalcoholic fatty liver disease?
A. Hyperthyroidism and asthma
B. COPD and nephrolithiasis
C. Obesity and type 2 diabetes
D. Celiac disease and anemia

C. Obesity and type 2 diabetes

A clinician is counseling a patient newly diagnosed with nonalcoholic fatty liver disease. Which overall weight-loss approach is most appropriate?
A. Gradual weight loss
B. Rapid crash dieting
C. Prolonged fasting
D. High-fat bulking diet

A. Gradual weight loss

A patient with nonalcoholic fatty liver disease asks which dietary change is part of treatment. Which recommendation is most appropriate?
A. Increase saturated fat intake
B. Eliminate all carbohydrates
C. Increase sugar-sweetened drinks
D. Reduce calorie and fat intake

D. Reduce calorie and fat intake

A patient with nonalcoholic fatty liver disease wants a nutrition change beyond reducing fat intake. Which additional recommendation is most appropriate?
A. Restrict all plant foods
B. Increase dietary fiber
C. Avoid physical activity
D. Increase alcohol intake

B. Increase dietary fiber

A patient with nonalcoholic fatty liver disease asks which lifestyle intervention should accompany dietary treatment. Which is most appropriate?
A. Strict bed rest
B. Night-only eating
C. Increase physical activity
D. High-protein overfeeding

C. Increase physical activity

A patient with biopsy-proven nonalcoholic steatohepatitis asks which histologic feature helps distinguish it from simple fatty liver. Which finding supports steatohepatitis?
A. Iron deposition only
B. Bile duct loss
C. Portal vein thrombosis
D. Cellular ballooning

D. Cellular ballooning

A patient with simple nonalcoholic fatty liver asks how it differs from steatohepatitis. Which statement is most accurate?
A. It has minimal inflammation
B. It always causes cirrhosis
C. It requires alcohol use
D. It is marked by ballooning fibrosis

A. It has minimal inflammation

A patient with advanced cirrhosis has marked muscle wasting and poor oral intake. Why is protein-calorie malnutrition clinically important in liver disease?
A. It mainly causes constipation
B. It reliably improves prognosis
C. It is a negative prognostic factor
D. It only affects early disease

C. It is a negative prognostic factor

Which complication is associated with poor nutritional status in cirrhosis?
A. Hepatorenal syndrome
B. Nephrotic syndrome
C. Acute pancreatitis
D. Diverticulosis

A. Hepatorenal syndrome

Which additional complication is linked to protein-calorie malnutrition in cirrhosis?
A. Achalasia
B. Celiac sprue
C. Hyperthyroidism
D. Refractory ascites

D. Refractory ascites

A patient with cirrhosis and worsening nutritional status is at increased risk for which major bleeding complication?
A. Mallory-Weiss tear
B. Variceal hemorrhage
C. Hemorrhoids
D. Ischemic colitis

B. Variceal hemorrhage

A patient with decompensated cirrhosis has severe malnutrition. Which infectious complication is associated with poor nutritional status?
A. Spontaneous bacterial peritonitis
B. Viral gastroenteritis
C. Clostridioides difficile colitis
D. Acute cholangitis

A. Spontaneous bacterial peritonitis

A patient with cirrhosis asks about everyday dietary choices to support liver health. Which recommendation is most appropriate?
A. Emphasize sweets over grains
B. Avoid all carbohydrates
C. Increase whole grains and limit sweets
D. Eliminate all dietary fat

C. Increase whole grains and limit sweets

A patient with cirrhosis has anorexia and significant malnutrition. Which nutritional strategy is most appropriate?
A. Restrict calories until appetite returns
B. Increase calories with energy-dense foods
C. Avoid fat completely
D. Limit meals to once daily

B. Increase calories with energy-dense foods

A patient with cirrhosis but no encephalopathy is worried about protein intake. Which guidance is most appropriate?
A. Protein should always be avoided
B. Protein should stay very low
C. Protein is never needed
D. Adequate protein is needed to prevent catabolism

D. Adequate protein is needed to prevent catabolism

A patient with cirrhosis develops acute hepatic encephalopathy. How should protein intake be handled during this period?
A. Protein should be increased sharply
B. Protein should remain unchanged
C. Temporary protein restriction may be used
D. Protein must be eliminated indefinitely

C. Temporary protein restriction may be used

A patient with cirrhosis and acute encephalopathy is having protein adjusted. Which principle is most appropriate?
A. Avoid making protein excessively low
B. Remove all oral nutrition
C. Use sweets as the main calories
D. Start raw seafood for protein

A. Avoid making protein excessively low

A patient with cirrhosis asks which food should be specifically avoided because of infection risk. Which is most important to avoid?
A. Whole grains
B. Cooked legumes
C. Refined cereals
D. Raw shellfish

D. Raw shellfish

A patient with cirrhosis develops clinically significant ascites. Which dietary approach is most appropriate?
A. High-sodium intake
B. Sodium restriction with fluid limitation
C. High-fiber loading only
D. Unlimited fluids for renal support

B. Sodium restriction with fluid limitation

A middle-aged woman presents with biliary colic and is found to have gallstones. Which mechanism most directly contributes to cholelithiasis?
A. Lithogenic bile and gallbladder stasis
B. Pancreatic lipase excess
C. Small-bowel villous atrophy
D. Colonic motor dysfunction

A. Lithogenic bile and gallbladder stasis

A patient with symptomatic gallstones asks which stone type is most common overall. Which is the best answer?
A. Pigment stones
B. Calcium oxalate stones
C. Cholesterol stones
D. Uric acid stones

C. Cholesterol stones

A pregnant patient asks why her clinician is more concerned about gallstones during pregnancy. Which statement is most accurate?
A. Pregnancy lowers bile cholesterol
B. Pregnancy is a risk factor
C. Pregnancy prevents gallbladder stasis
D. Pregnancy reduces biliary crystallization

B. Pregnancy is a risk factor

An older patient with obesity develops recurrent postprandial right upper quadrant pain and is found to have gallstones. Which additional factor is a recognized risk factor?
A. Male sex
B. High dietary fiber
C. Young age
D. Female sex

D. Female sex

A patient loses weight rapidly on a very restrictive diet and then develops gallstones. Which statement best explains this association?
A. Rapid weight loss increases risk
B. Weight loss prevents crystallization
C. Weight loss improves gallbladder emptying
D. Weight loss lowers biliary stasis

A. Rapid weight loss increases risk

A patient with new gallstones asks which dietary pattern likely contributed most. Which is the best answer?
A. High polyunsaturated fat intake
B. High saturated fat and refined sugars
C. High whole-grain intake
D. High monounsaturated fat intake

B. High saturated fat and refined sugars

Which additional contributor is specifically associated with increased gallstone risk?
A. Certain medications
B. Probiotic use
C. Calcium supplementation
D. Soluble fiber intake

A. Certain medications

Lower gallstone risk?
A. Trans fats and monounsaturated fats
B. Polyunsaturated and monounsaturated fats
C. Hydrogenated and monounsaturated fats
D. Short-chain saturated and monounsaturated fats

B. Polyunsaturated and monounsaturated fats

fat female forty fertile fair

gallstones

Bowel rest is often indicated with gradual diet advancement in (Diverticulitis/Diverticulosis)

Diverticulitis