Nutritional Management of Chronic Diseases — MCQs
A 35-year-old Caucasian female presents with anemia, malaise, bloating, and diarrhea. Past genetic testing revealed that this patient carries the HLA-DQ2 allele. The physician suspects that the patient's presentation is dietary in cause. Which of the following findings would definitively confirm this diagnosis?
A CKD patient develops serum K+ 7.2 mEq/L without ECG changes. Best initial management?
A 1-year-old child weighing 6 kg is suffering from acute gastroenteritis with signs of sunken eyes and skin pinch returning to normal very rapidly. What will be your management?
Patient presented with diarrhoea, poor appetite and malabsorption. His duodenal biopsy was taken which showed crypt hyperplasia, villi atrophy and infiltration of CD8+ T cells in the epithelium. What is the likely diagnosis of the patient?
A young man weighing 65 kg was admitted to the hospital with severe burns in a severe catabolic state. An individual in this state requires 40 kcal per kg body weight per day and 2 gms of protein/kg body weight/day. This young man was given a solution containing 20% glucose and 4.25% protein. If 3000 ml of solution is infused per day, which of the following statements is most accurate regarding the nutritional provision?
A diabetic patient's fasting blood glucose level is found to be $160 \mathrm{mg} / \mathrm{dL}$. What will you advise the patient regarding non-pharmacological management?
What is the daily requirement of potassium in a healthy adult?
A 6-year-old presents with developmental delay, musty body odor, and fair skin. Lab tests show high phenylalanine levels. What is the most appropriate management?
A 5-year-old has the following anthropometry findings: Weight/age < -3.2 SD, Height/age < -2.5 SD, Weight/height < -1.7 SD. What is the most likely diagnosis?
All of the following are true about anemia of chronic kidney disease except
Nutritional Management of Chronic Diseases Indian Medical PG Practice Questions and MCQs
Question 1: A 35-year-old Caucasian female presents with anemia, malaise, bloating, and diarrhea. Past genetic testing revealed that this patient carries the HLA-DQ2 allele. The physician suspects that the patient's presentation is dietary in cause. Which of the following findings would definitively confirm this diagnosis?
- A. CT scan showing inflammation of the small bowel wall
- B. Biopsy of the duodenum showing atrophy and blunting of villi (Correct Answer)
- C. Biopsy of the colon showing epithelial cell apoptosis
- D. Esophageal endoscopy showing lower esophageal metaplasia
- E. Liver biopsy showing apoptosis of hepatocytes
Explanation: ***Biopsy of the duodenum showing atrophy and blunting of villi*** - This finding is the **gold standard** for diagnosing **celiac disease**, which aligns with the patient's symptoms (anemia, malaise, bloating, diarrhea), genetic predisposition (HLA-DQ2 allele), and suspected dietary cause. - The characteristic **villous atrophy** and **crypt hyperplasia** seen in duodenal biopsies are hallmark pathological changes in celiac disease due to gluten exposure. *CT scan showing inflammation of the small bowel wall* - While a CT scan can show **inflammation**, it is not specific enough to definitively diagnose celiac disease, as many other conditions can cause small bowel inflammation. - It does not provide the **histopathological detail** necessary to confirm villous atrophy, which is key for celiac diagnosis. *Biopsy of the colon showing epithelial cell apoptosis* - **Epithelial cell apoptosis** in the colon is not a primary diagnostic feature of celiac disease, which primarily affects the **small intestine**. - This finding might be associated with other inflammatory bowel conditions or infections, not gluten-induced enteropathy. *Esophageal endoscopy showing lower esophageal metaplasia* - **Lower esophageal metaplasia**, or **Barrett's esophagus**, is a pre-cancerous condition of the esophagus, often caused by chronic acid reflux. - This finding is unrelated to celiac disease and does not explain the patient's gastrointestinal symptoms or genetic predisposition. *Liver biopsy showing apoptosis of hepatocytes* - **Apoptosis of hepatocytes** (liver cell death) would indicate liver damage or disease, such as hepatitis or drug-induced injury. - While celiac disease can sometimes have **hepatic manifestations**, liver apoptosis is not a primary or definitive diagnostic criterion for celiac disease itself.
Question 2: A CKD patient develops serum K+ 7.2 mEq/L without ECG changes. Best initial management?
- A. Emergency dialysis
- B. Sodium polystyrene
- C. Insulin with glucose
- D. Calcium gluconate (Correct Answer)
Explanation: **Calcium gluconate** - **Calcium gluconate** is the best initial management for severe hyperkalemia, particularly when the potassium level is very high (above 6.5 mEq/L) even without ECG changes [1]. It acts quickly to directly stabilize the cardiac membrane by **antagonizing the effects of potassium on myocardial excitability**, thereby preventing life-threatening arrhythmias [1]. - It provides immediate cardioprotection, buying time for other therapies to shift potassium into cells or remove it from the body. *Emergency dialysis* - While **dialysis** is the most effective way to remove potassium from the body, it is typically reserved for cases of severe, refractory hyperkalemia, or when other therapies have failed [3]. - It is not the *initial* management for immediate cardiac stabilization, especially if no ECG changes are present and calcium can be administered more rapidly. *Sodium polystyrene* - **Sodium polystyrene sulfonate (Kayexalate)** is a potassium-binding resin that works in the gastrointestinal tract to exchange sodium for potassium, thus removing potassium from the body. - Its onset of action is slow (hours to days), making it inappropriate for acute, severe hyperkalemia requiring immediate intervention. *Insulin with glucose* - **Insulin with glucose** therapy promotes the intracellular shift of potassium, temporarily lowering serum potassium levels [2]. - While effective, its onset of action is typically 15-30 minutes, and it functions as a temporary measure to redistribute potassium, not to acutely stabilize the cardiac membrane, which is the primary concern when potassium is severely elevated.
Question 3: A 1-year-old child weighing 6 kg is suffering from acute gastroenteritis with signs of sunken eyes and skin pinch returning to normal very rapidly. What will be your management?
- A. RL infusion 120 ml in the first hour followed by 360 ml in the next 5 hours
- B. RL infusion 180 ml in the first hour followed by 480 ml in the next 5 hours
- C. RL infusion 240 ml in the first hour followed by 360 ml in the next 5 hours
- D. RL infusion 180 ml in the first hour followed by 270 ml in the next 5 hours (Correct Answer)
Explanation: ***RL infusion 180 ml in the first hour followed by 270 ml in the next 5 hours*** - The child shows signs of **some dehydration** (sunken eyes, skin pinch returning very rapidly). According to **WHO Plan B**, some dehydration requires **75 ml/kg over 6 hours** for rehydration. - For a 6 kg child: **75 × 6 = 450 ml total** - **Distribution:** 30 ml/kg in first hour (180 ml) + 45 ml/kg over next 5 hours (270 ml) - This option provides exactly **450 ml (180 + 270)**, perfectly matching WHO guidelines for some dehydration *RL infusion 120 ml in the first hour followed by 360 ml in the next 5 hours* - First hour: 120 ml = only **20 ml/kg**, which is **below the recommended 30 ml/kg** initial bolus for some dehydration - Total volume: **480 ml** exceeds the required **450 ml** for a 6 kg child - Incorrect fluid distribution pattern for WHO Plan B *RL infusion 180 ml in the first hour followed by 480 ml in the next 5 hours* - First hour volume is correct at **30 ml/kg (180 ml)** - However, next 5 hours: **480 ml = 80 ml/kg**, far exceeding the recommended **45 ml/kg** - Total: **660 ml** significantly exceeds **450 ml**, risking **fluid overload** in a small child *RL infusion 240 ml in the first hour followed by 360 ml in the next 5 hours* - Initial rate: **240 ml = 40 ml/kg** is appropriate for **severe dehydration (WHO Plan C)**, not some dehydration - This child shows **some dehydration** signs, not severe (no lethargy, unconsciousness, or very slow skin pinch) - Total: **600 ml** exceeds the **450 ml** requirement, indicating overtreatment for this clinical scenario
Question 4: Patient presented with diarrhoea, poor appetite and malabsorption. His duodenal biopsy was taken which showed crypt hyperplasia, villi atrophy and infiltration of CD8+ T cells in the epithelium. What is the likely diagnosis of the patient?
- A. Celiac disease (Correct Answer)
- B. Whipple disease
- C. Environmental enteropathy
- D. Pancreatitis
Explanation: ***Celiac disease*** - The combination of **diarrhoea**, **malabsorption**, **villi atrophy**, **crypt hyperplasia**, and **CD8+ T-cell infiltration** in the duodenal epithelium is pathognomonic for celiac disease [1]. - This condition is triggered by **gluten ingestion**, leading to an immune-mediated enteropathy [1], [3]. *Whipple disease* - Characterized by **malabsorption**, fever, arthralgia, and neurological symptoms [2]. - Histologically, it shows **foamy macrophages** containing PAS-positive material (Tropheryma whipplei) in the lamina propria, not primarily CD8+ T-cell infiltration [2]. *Environmental enteropathy* - Also known as tropical enteropathy, it causes **villi atrophy** and malabsorption, particularly in individuals living in areas with poor sanitation. - However, the prominent feature is often a diffuse inflammatory infiltrate, and specific **CD8+ T-cell infiltration** in the epithelium is not as specific as in celiac disease. *Pancreatitis* - Presents with **abdominal pain**, nausea, and vomiting, and can lead to malabsorption due to pancreatic enzyme insufficiency. - Histology of the duodenum would typically be normal, as the pathology primarily involves the **pancreas**, not the duodenal mucosa itself.
Question 5: A young man weighing 65 kg was admitted to the hospital with severe burns in a severe catabolic state. An individual in this state requires 40 kcal per kg body weight per day and 2 gms of protein/kg body weight/day. This young man was given a solution containing 20% glucose and 4.25% protein. If 3000 ml of solution is infused per day, which of the following statements is most accurate regarding the nutritional provision?
- A. The protein provided exceeds the patient's requirement
- B. The protein provided is insufficient for the patient's requirement
- C. The calories provided are insufficient for the patient's needs (Correct Answer)
- D. The solution provides adequate protein and calories for the patient
Explanation: ***The calories provided are insufficient for the patient's needs*** - The patient requires 40 kcal/kg/day × 65 kg = **2600 kcal/day** - The solution provides (200 g glucose/L × 4 kcal/g) × 3 L = **2400 kcal/day**, which is 200 kcal less than required (92.3% of requirement) - This represents a **7.7% caloric deficit**, which in a severe catabolic state with burns is clinically significant *The protein provided exceeds the patient's requirement* - The patient requires 2 g/kg/day × 65 kg = **130 g protein/day** - The solution provides (42.5 g protein/L) × 3 L = **127.5 g protein/day**, which is slightly below, not exceeding, the requirement *The protein provided is insufficient for the patient's requirement* - The patient requires **130 g protein/day** - The solution provides **127.5 g protein/day** (98% of requirement) - While technically 2.5 g short, this is nearly adequate, but the more critical issue is the caloric deficit *The solution provides adequate protein and calories for the patient* - The provided calories (2400 kcal) are **insufficient** for the patient's needs (2600 kcal) - The protein (127.5 g) is very close to the requirement (130 g) at 98% adequacy - In severe catabolic states, even modest deficits can impair recovery, making this provision inadequate
Question 6: A diabetic patient's fasting blood glucose level is found to be $160 \mathrm{mg} / \mathrm{dL}$. What will you advise the patient regarding non-pharmacological management?
- A. At least 25-35 g of dietary fibre
- B. <30 % of the calories should come from fat (Correct Answer)
- C. Dietary cholesterol <300 mg per day
- D. <2.3 g sodium intake every day
Explanation: ***<30 % of the calories should come from fat*** - Reducing dietary fat intake to less than 30% of total calories is a crucial non-pharmacological strategy for diabetic patients to manage blood glucose levels and prevent cardiovascular complications [1]. - Excess dietary fat, especially saturated and trans fats, can contribute to insulin resistance and weight gain, both of which negatively impact glycemic control [1]. *At least 25-35 g of dietary fibre* - While adequate dietary fiber (typically 25-30g for adults, sometimes up to 35g for men) is beneficial for managing blood glucose, it is generally recommended as a baseline for healthy eating and not the primary or most impactful intervention to address a fasting glucose of 160 mg/dL [1]. - Fiber helps slow glucose absorption and can improve insulin sensitivity, but a specific "at least 25-35g" statement without further context on total caloric intake or other macronutrient distribution might not be the most targeted advice for this specific glucose level [1]. *Dietary cholesterol <300 mg per day* - Limiting dietary cholesterol to less than 300 mg per day is a general recommendation for cardiovascular health, which is particularly important for diabetic patients due to their increased risk of atherosclerosis [2]. - However, for directly addressing a fasting blood glucose of 160 mg/dL, focusing on overall fat intake and carbohydrate quality would have a more immediate impact on glucose control than dietary cholesterol alone. *<2.3 g sodium intake every day* - Restricting sodium intake to less than 2.3 g per day is recommended for managing hypertension and reducing cardiovascular risk, which is often comorbid with diabetes [2]. - While important for overall health in diabetic patients, this recommendation does not directly target blood glucose control and would not be the primary non-pharmacological advice for a fasting glucose of 160 mg/dL.
Question 7: What is the daily requirement of potassium in a healthy adult?
- A. 3-4 g/day
- B. 4-5 g/day (Correct Answer)
- C. 2-3 g/day
- D. 5-7 g/day
Explanation: ***4-5 g/day*** - The recommended daily intake of **potassium** for a healthy adult is approximately **3,500-4,700 mg (3.5-4.7g)**, making **4-5 g/day** the most accurate answer. - This range aligns with the **Adequate Intake (AI)** recommendations from major health organizations. - Adequate potassium is crucial for maintaining proper **fluid balance**, **nerve impulses**, **muscle contraction**, and **blood pressure regulation**. *3-4 g/day* - While this range covers the minimum requirement (3.5g), it falls short of the **optimal intake of 4.7g**. - This amount may be adequate but is lower than the recommended target for cardiovascular health benefits. *2-3 g/day* - This amount is **below the minimum recommended intake** of potassium for healthy adults. - Consistent intake at this level can lead to **hypokalemia**, potentially affecting **blood pressure regulation**, **muscle function**, and increasing risk of **cardiovascular disease**. *5-7 g/day* - This intake is higher than the typical recommended daily allowance for most healthy adults. - While high potassium intake is generally safe for individuals with **healthy kidneys**, very high levels can be a concern for those with **renal impairment** or taking certain medications.
Question 8: A 6-year-old presents with developmental delay, musty body odor, and fair skin. Lab tests show high phenylalanine levels. What is the most appropriate management?
- A. Low-phenylalanine diet (Correct Answer)
- B. Avoidance of ascorbic acid
- C. Vitamin D supplementation
- D. High-protein diet
- E. Tetrahydrobiopterin (BH4) supplementation
Explanation: ***Low-phenylalanine diet*** - The patient's symptoms (developmental delay, musty body odor, fair skin) and high **phenylalanine levels** are classic for **phenylketonuria (PKU)**. - Management primarily involves a strict **low-phenylalanine diet** to prevent further neurological damage. - This is the **cornerstone of PKU management** and must be initiated as early as possible. *Tetrahydrobiopterin (BH4) supplementation* - While **BH4 (sapropterin)** can be beneficial in some patients with **BH4-responsive PKU** (a subset of PKU cases), it is not first-line management. - BH4 testing is performed after diagnosis, but dietary restriction remains the primary treatment. - Not all PKU patients respond to BH4, and it's used as an adjunct, not a replacement for dietary management. *Avoidance of ascorbic acid* - **Ascorbic acid** (vitamin C) is generally not contraindicated in PKU and does not impact phenylalanine metabolism. - This intervention is not relevant to the management of PKU. *Vitamin D supplementation* - While vitamin D supplementation might be necessary for general health, especially in children with restricted diets, it is not the primary treatment for **phenylketonuria (PKU)**. - It does not directly address the elevated phenylalanine levels. *High-protein diet* - A **high-protein diet** would exacerbate the condition, as proteins are a major source of phenylalanine. - This would lead to even higher phenylalanine levels and worsen the symptoms of PKU.
Question 9: A 5-year-old has the following anthropometry findings: Weight/age < -3.2 SD, Height/age < -2.5 SD, Weight/height < -1.7 SD. What is the most likely diagnosis?
- A. Moderate acute malnutrition
- B. Acute malnutrition
- C. Chronic malnutrition (Correct Answer)
- D. Acute or chronic malnutrition
Explanation: ***Chronic malnutrition*** - A **Height-for-Age z-score < -2.5 SD** indicates **stunting**, which is the hallmark of **chronic malnutrition** due to long-term nutritional deprivation. - The **Weight-for-Age z-score < -3.2 SD** (severe underweight) is consistent with chronic malnutrition, as stunted children typically have low weight-for-age. - The **Weight-for-Height z-score of -1.7 SD** is **NOT indicative of wasting** (which requires WHZ < -2 SD per WHO criteria). This value is within the mild range and does not suggest acute malnutrition. - The predominant finding is **chronic malnutrition (stunting)** without evidence of acute malnutrition. *Acute or chronic malnutrition* - While stunting (chronic component) is clearly present, there is **no acute malnutrition** by standard criteria. - Acute malnutrition requires **Weight-for-Height z-score < -2 SD** (moderate) or < -3 SD (severe). - The WHZ of -1.7 SD does not meet the threshold for wasting, so this option incorrectly suggests both components are present. *Moderate acute malnutrition* - **Moderate acute malnutrition (MAM)** is defined by **Weight-for-Height z-score between -2 and -3 SD**. - The given WHZ of -1.7 SD does **not meet** this criterion and therefore does not indicate MAM. *Acute malnutrition* - **Acute malnutrition** is defined by low **Weight-for-Height z-score** (wasting), indicating recent nutritional deficit. - The WHZ of -1.7 SD is **insufficient** to diagnose acute malnutrition (requires < -2 SD). - This option fails to account for the clear evidence of chronic malnutrition (stunting).
Question 10: All of the following are true about anemia of chronic kidney disease except
- A. Normocytic normochromic anemia
- B. Dialysis worsens anemia of renal failure
- C. Erythropoietin improves the symptom
- D. Anemia is proportional to the kidney disease (Correct Answer)
Explanation: ***Anemia is proportional to the kidney disease*** - While anemia is a common complication of **CKD**, its severity doesn't always directly correlate with the degree of **kidney function decline** [1]. - Other factors like **inflammation**, **iron deficiency**, and **dialysis-related blood loss** can independently influence the severity of anemia, sometimes disproportionately [2]. *Normocytic normochromic anemia* - **Anemia of chronic kidney disease (CKD)** is typically a **normocytic normochromic anemia**, meaning the red blood cells are normal in size (normocytic) and hemoglobin content (normochromic). - This is primarily due to the **reduced production of erythropoietin** by the kidneys [3]. *Dialysis worsens anemia of renal failure* - **Dialysis** can indeed worsen anemia in patients with renal failure due to several factors including **blood loss during the dialysis procedure**, residual blood in the dialyzer, and increased **hepcidin levels** leading to **iron sequestration** [2], [3]. - Additionally, hemodialysis can induce **inflammation**, which further contributes to **hyporesponsiveness to erythropoietin**. *Erythropoietin improves the symptom* - **Erythropoietin-stimulating agents (ESAs)** are a cornerstone of treatment for anemia of CKD, as they replace the deficient **endogenous erythropoietin** and stimulate red blood cell production [3]. - While ESAs improve **hemoglobin levels** and consequently the symptoms associated with anemia, they do not cure the underlying kidney disease or address all aspects of anemia management, such as **iron deficiency** [3].
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free