Nutritional requirements and disorders Practice Questions

Question 1

A 61-year-old woman presents for a routine health visit. She complains of generalized fatigue and lethargy on most days of the week for the past 4 months. She has no significant past medical history and is not taking any medications. She denies any history of smoking or recreational drug use but states that she drinks "socially" approx. 6 nights a week. She says she also enjoys a "nightcap," which is 1–2 glasses of wine before bed every night. The patient is afebrile, and her vital signs are within normal limits. On physical examination, there is significant pallor of the mucous membranes. Laboratory findings are significant for a mean corpuscular volume (MCV) of 72 fL, leukocyte count of 4,800/mL, hemoglobin of 11.0 g/dL, and platelet count of 611,000/mL. Stool guaiac test is negative. She is started on oral ferrous sulfate supplements. On follow-up, her laboratory parameters show no interval change in her MCV or platelet level, and she reports good compliance with the medication. Which of the following is the best next step in the management of this patient?

Accepted Answer

Administer iron intravenously

Answer

Transfuse the patient with whole blood

Answer

Administer folate

Answer

Continue oral ferrous sulfate and supplement with omeprazole

Answer

Continue oral ferrous sulfate and supplement with ascorbic acid

Question 2

A 5-month-old boy is brought to the pediatrician by his parents, who began noticing that the infant was not able to hold his head upright when sitting or in a prone position. Upon examination, the infant has a musty odor, fair skin with patches of eczema, and blue eyes. The pediatrician orders laboratory tests and prescribes a special diet. Which of the following amino acids becomes essential and must be supplemented in this patient's condition?

Accepted Answer

Tyrosine

Answer

Thiamine

Answer

Large neutral amino acids

Answer

Arginine

Answer

Phenylalanine-free amino acid formula

Question 3

A 1-year-old male presents to his pediatrician for a well-child visit. Through a history from the mother and physical examination, the pediatrician learns that the baby babbles non-specifically, takes several steps independently, and picks up his cereal using two fingers. His weight is currently 22 lbs (birth-weight 6 lbs, 9 oz), and his height is 30 inches (birth length 18 inches). Are there any aspects of this child's development that are delayed?

Accepted Answer

Language delay

Answer

Fine motor skill delay

Answer

Inadequate growth

Answer

Gross motor skill delay

Answer

There are no developmental concerns

Question 4

A 12-month-old boy presents with pallor, fatigue, and conjunctival pallor. Examination reveals a grade II systolic ejection murmur. Labs show: Leukocytes 6,500/mm^3, Hemoglobin 6.4 g/dL, Platelets 300,000/mm^3, MCV 71 µm^3, Reticulocytes 2.0%, Serum iron 34 mcg/dL, Ferritin 6 ng/mL (normal 7-140 ng/mL), TIBC 565 mcg/dL (normal 240-450 mcg/dL). Peripheral smear shows microcytosis and hypochromia. In addition to starting iron supplementation, what dietary modification is most important to address the underlying cause?

Accepted Answer

Limit milk intake

Answer

Administer deferoxamine

Answer

Echocardiogram

Answer

Measure lead level

Answer

Iron supplementation

Question 5

A 55-year-old woman presents with fatigue. She says her symptoms are present throughout the day and gradually started 4 months ago. Her past medical history is significant for rheumatoid arthritis–treated with methotrexate, and diabetes mellitus type 2–treated with metformin. The patient is afebrile, and her vital signs are within normal limits. A physical examination reveals pallor of the mucous membranes. Initial laboratory tests show hemoglobin of 7.9 g/dL, hematocrit of 22%, and mean corpuscular volume of 79 fL. Which of the following is the best next diagnostic step in this patient?

Accepted Answer

Serum ferritin and soluble transferrin receptor levels

Answer

Serum ferritin level and total iron-binding capacity (TIBC)

Answer

Serum ferritin and serum iron levels

Answer

Serum iron level

Answer

Serum ferritin level

Question 6

A 70-year-old male presents to his primary care physician for complaints of fatigue. The patient reports feeling tired during the day over the past 6 months. Past medical history is significant for moderately controlled type II diabetes. Family history is unremarkable. Thyroid stimulating hormone and testosterone levels are within normal limits. Complete blood cell count reveals the following: WBC 5.0, hemoglobin 9.0, hematocrit 27.0, and platelets 350. Mean corpuscular volume is 76. Iron studies demonstrate a ferritin of 15 ng/ml (nl 30-300). Of the following, which is the next best step?

Accepted Answer

Colonoscopy

Answer

Blood transfusion

Answer

MRI abdomen

Answer

CT abdomen

Answer

Gel electrophoresis

Question 7

A 5-year-old boy presents to the pediatrician for a well child visit. He is meeting his developmental milestones and is in the 15th percentile for height and 70th percentile for weight. His parents report that he complains of fatiguing easily and having trouble participating in sports. They are concerned he is not getting enough sleep and state that sometimes they hear him snore. The patient has a past medical history of a supracondylar fracture of the humerus, which was appropriately treated. He is doing well in school but is sometimes bullied for being small. The patient eats a balanced diet of milk, fruit, and some vegetables. His parents have been trying to get him to drink more milk so he can grow taller. His temperature is 99.5°F (37.5°C), blood pressure is 90/48 mmHg, pulse is 100/min, respirations are 19/min, and oxygen saturation is 98% on room air. On physical exam, the patient appears well. HEENT exam is notable for conjunctival pallor and a unilateral clear middle ear effusion. Cardiac exam reveals a benign flow murmur. Pulmonary exam is clear to auscultation bilaterally. The patient's gait is stable and he is able to jump up and down. A full set of labs are ordered as requested by the parents including a serum vitamin D level, B12 level, and IGF level. A selection of these lab values are seen below.

Serum:
Na+: 139 mEq/L
Cl-: 100 mEq/L
K+: 4.3 mEq/L
HCO3-: 25 mEq/L
BUN: 20 mg/dL
Glucose: 99 mg/dL
Creatinine: 1.1 mg/dL
Ca2+: 9.9 mg/dL
AST: 12 U/L
ALT: 10 U/L

Which of the following would you expect to find in this patient?

Accepted Answer

Increased RDW and TIBC

Answer

Decreased IGF levels

Answer

Decreased oxygen saturation when the patient sleeps

Answer

Increased MCV

Answer

Decreased vitamin D level

Question 8

An 11-month-old boy presents with the recent loss of appetite and inability to gain weight. His diet consists mainly of cow’s milk and fruits. Family history is unremarkable. Physical examination shows conjunctival pallor. Laboratory findings are significant for the following:
Hemoglobin 9.1 g/dL
Mean corpuscular volume 75 μm3
Mean corpuscular hemoglobin 20 pg/cell
Red cell distribution width 18%
The patient is presumptively diagnosed with iron deficiency anemia (IDA) and ferrous sulfate syrup is prescribed. Which of the following laboratory values would most likely change 1st in response to this treatment?

Accepted Answer

↑ reticulocyte count

Answer

↓ Mentzer index

Answer

↑ mean corpuscular hemoglobin

Answer

Normalization of hemoglobin

Answer

↓ Anisocytosis

Question 9

A 28-year-old gravida 1 para 1 woman is being seen in the hospital for breast tenderness. She reports that both breasts are swollen and tender. She is also having difficulty getting her newborn to latch. The patient gave birth 4 days ago by uncomplicated vaginal delivery. During her pregnancy, the patient developed gestational diabetes but was otherwise healthy. She took folate and insulin. She attended all her pre-natal appointments. Upon examination, the patient has a low grade fever, but all other vital signs are stable. Bilateral breasts appear engorged and are tender to palpation. There is no erythema, warmth, or induration. A lactation nurse is brought in to assist the patient and her newborn with more effective breastfeeding positions. The patient says a neighbor told her that breastmilk actually lacks in nutrients, and she asks what the best option is for the health of her newborn. Which of the following components is breastmilk a poor source of?

Accepted Answer

Vitamin D

Answer

Whey protein

Answer

Lysozymes

Answer

Phosphorus

Answer

Immunoglobulin A

Question 10

A 5-month-old male presents to the pediatrician with his mother for a well visit. The patient was born at 35 weeks gestation to a 30-year-old gravida 2 via vaginal delivery. The pregnancy and labor were uncomplicated. The patient required no resuscitation after delivery and was discharged from the hospital on day two of life. His mother now reports that the patient has been exclusively breastfed since birth, and she says that feedings have been going well, and that the patient appears satisfied afterwards. The patient feeds for 30 minutes every two hours and urinates 8-10 times per day. The patient’s mother reports that she eats a varied diet that includes animal products, but she worries that the patient is not meeting his nutritional needs with breastmilk alone. The patient’s height and weight at birth were in the 15th and 20th percentile, respectively. His height and weight are now in the 20th and 25th percentile, respectively. His temperature is 98.1°F (36.7°C), blood pressure is 58/46 mmHg, pulse is 128/min, and respirations are 34/min. On physical exam, the patient appears well-developed and well-nourished. He has mild conjunctival pallor.

Which of the following is the most appropriate guidance regarding this patient’s nutritional needs?

Accepted Answer

Supplement his diet with iron and vitamin D

Answer

Add cow's milk to his diet

Answer

Supplement his diet with formula

Answer

No changes are necessary to his diet

Answer

Add pureed foods to his diet

Nutritional requirements and disorders

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Infant feeding recommendations

Breastfeeding support and counseling

Formula selection and preparation

Introduction of complementary foods

Childhood nutrition requirements by age

Nutritional assessment methods

Micronutrient deficiencies

Vitamin D deficiency and rickets

Iron deficiency and anemia

Feeding disorders in children

Malnutrition management

Food allergies and intolerances

Special diets in pediatric conditions

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