Free Pediatric Nutrition Practice Test
1. Which of the following are the most commonly seen symptoms of a cow's milk allergy in an infant? (Choose 4 options)
- Atopic dermatitisc
- Blood in the stool
2. Which of the following foods are not allowed on a wheat-free diet? (Choose 4 options)
3. The diet of an adolescent in the United States is most likely to be deficient in which of the following nutrients? (Choose 4)
- Vitamin C
- Calcium and vitamin D
- Vitamins B6 and B12
- Vitamins A and E
4. A 6-month-old infant weighs 7 kg and is 62 cm in length. He is at the 90% weight for his length. Following GI surgery he is receiving TPN solution consisting of 15% dextrose and 2.5% TrophAmine at 27.7 mL/hr, with 1.5 mL/hr of 20% Intralipid. Which of the following is correct regarding total fluid intake, calories, amino acids, and lipid intake?
- 100 cc/kg, 68 kcal/kg, 2.4 g/kg amino acids, 1.1 g/kg lipids
- 95 cc/kg, 68 kcal/kg, 2.5 g/kg amino acids, 1.1 g/kg lipids
- 100 cc/kg, 82 kcal/kg, 2.4 g/kg amino acids, 0.55 g/kg lipids
- 95 cc/kg, 76 kcal/kg, 2.5 g/kg amino acids, 1.1 g/kg lipids
5. A malnourished patient showing signs of the refeeding syndrome may have which of the following symptoms? (Choose 5)
- Low serum magnesium levels
- Elevated serum magnesium levels
- Cardiac arrhythmias
Answers & Explanations
1. B, C, E, F: An allergy to cow's milk protein can present in the first 4 months of an infant's life. The most commonly seen symptoms are the presence of blood in the stool, diarrhea, vomiting or gagging, and colic. Infants may also develop skin reactions such as atopic dermatitis, hives, or eczema. Respiratory issues such as asthma may occur. Anaphylaxis is rarely seen with cow's milk protein allergy. This is seen more often with allergic reaction to peanuts or tree nuts. Constipation is not a common symptom. Sometimes lactose intolerance is suspected but it is very rare for an infant to have lactose intolerance. Lactose intolerance is a result of an enzyme issue whereas an allergy to cow's milk is an immunologic response. Infants can develop a cow's milk protein allergy while on a cow's-milk-based formula or breast milk.
2. A, E, F, H: Wheat is a difficult ingredient to remove from the diet. With a suspected wheat allergy, it is important to obtain a detailed diet history as well as food frequency questionnaire to determine usual dietary intake patterns. Wheat is found in many products, including baked goods, snack foods, cereals, pastas, soups, and other types of processed foods. Some foods that are not allowed on a wheat free diet include bulgur, couscous, durum, farina, flour, hydrolyzed wheat proteins, pastas, semolina, and triticale. Any ingredient that contains wheat bran, wheat germ, wheat protein isolate, or wheat berries should be avoided. Foods that do not contain wheat include flours made from arrowroot, barley, buckwheat, oats, potato, rye, quinoa, and rice.
3. A, C, F, H: The nutrients that are most likely to be deficient in the diet of an adolescent in the United States are vitamins A, D, C, E, calcium, and magnesium. Deficiencies are more likely to occur in areas where the average income is lower, in families that are homeless or have limited access to food, and in Native Americans, but can occur in other areas as well. Calcium and vitamin D deficiency is especially dangerous for this population because peak bone mass occurs during adolescence. Many families will supplement their child's diet with multivitamins; however, the families that supplement are often the ones that do not need supplementation. Additionally, many multivitamins do not contain calcium, which is an important mineral that should be supplemented in many cases.
4. A: Based on a weight of 7 kg, the TPN solution would provide 27.7 mL/hour + 1.5 mL/hour = 29.2 mL/hour or 700.8 cc per day, to provide 100 mL/kg. The total dextrose intake would be 27.7 mL/hour * 24 hours = 664.8 total mL * 0.15= 99.7 grams of dextrose. There are 3.4 kcal/gram of dextrose or 339 kcal. TrophAmine at 2.5% in 664.8 cc total volume would provide 16.6 grams of amino acids or 2.4 g/kg. There are 4 kcal/gram of amino acids so this would provide 66.5 kcals. At 1.5 mL/hour of Intralipid, there would be a total volume of 36 mL. There are 0.2 g/mL of fat in 20% Intralipid and this would provide 7.2 g of lipids or 1.1 g/kg. There are 10 kcal/g of Intralipid to provide 72 kcal. To convert this to per-kilogram units, total calories would be 339 kcal from dextrose + 66.5 from amino acids + 72 from lipids= 477.5/7 kg= 68 kcal/kg.
5. B, D, E, G, I: Refeeding syndrome can occur when initiating aggressive nutrition support in a patient with malnutrition. Essentially the body goes into a shock state when excessive calories are provided, causing an increase in insulin release. The increase in insulin release causes an alteration in glucose metabolism because of the increased uptake of glucose at the cellular level. Hypophosphatemia is the hallmark of the refeeding syndrome, which can lead to changes in both cardiac and respiratory function. Other metabolic changes that can occur include hypokalemia, which can also cause cardiac disturbances, and low serum magnesium levels, which can contribute to cardiac arrhythmias and changes in GI function. As the shift of electrolytes into the intracellular space and the shift of glucose into the cells for oxidation occur, there is a decrease in sodium and fluid excretion, causing the potential for fluid imbalance in the body putting an additional strain on the body.
Last Updated: 04/18/2018