DURATION: 3 HOURS TOTAL MARKS: 170. External Examiner: Ms C Biggs Internal Examiner: Mrs K Pillay

Transcription

1 DURATION: 3 HOURS TOTAL MARKS: 170 External Examiner: Ms C Biggs Internal Examiner: Mrs K Pillay NOTE: THIS EXAM PAPER CONSISTS OF FOUR (4) PAGES PLUS A MULTIPLE CHOICE QUESTIONNAIRE (MCQ) ANSWER BOOKLET (7 PAGES), WHICH MUST BE HANDED IN. PLEASE MAKE SURE THAT YOU HAVE ALL PAGES. PLEASE ANSWER SECTIONS A, B AND C. SECTION A QUESTION 1 MULTIPLE CHOICE QUESTIONS See separate booklet (30 MARKS) SECTION B SHORT QUESTIONS (100 MARKS) PLEASE ANSWER ALL OF THE QUESTIONS BELOW AND START EACH QUESTION ON A NEW PAGE QUESTION 2 The Recommended Dietary Allowances (RDA) were first published in 1943 and have now been replaced by the Dietary Reference Intakes (DRIs). 2.1 Explain why the DRIs have replaced the original RDAs. [5] 2.2 Explain what the DRIs are and give a detailed explanation of each of the nutrient based reference values that make up the DRIs. [15] QUESTION 3 TOTAL = 20 MARKS 3.1 Discuss the stability of vitamin E. [5] 3.2 List three (3) common forms of calcium supplements and give the amount of calcium found in each form. [1X3=3] 3.3 List ten (10) factors that can affect the absorption of vitamin B 12. [1 X 10=10] 1

2 3.4 What are the consequences of inadequate maternal intake of iodine during pregnancy? [2] TOTAL = 20 MARKS QUESTION Outline the process by which 1,25 dihydroxy vitamin D 3 is able to regulate blood calcium levels in the body. [8] 4.2 Give a detailed explanation of how the visual cycle occurs. [10] 4.3 Explain why athletes may require riboflavin in amounts higher than the Recommended Dietary Allowance (RDA). [2] QUESTION 5 TOTAL = 20 MARKS 5.1 Explain the difference between a single blind study and a double blind study. [4] 5.2 List five (5) limitations of using the diet history method of dietary assessment. [1 X 5 = 5] 5.3 Explain what is meant by somatotyping and discuss the three body types. [10] 5.4 List the two (2) enzymes that require molybdenum for optimal functioning. [2 X ½ =1] QUESTION 6 TOTAL = 20 MARKS 6.1 Define the Scientific Method of Enquiry and outline the steps involved in the correct sequence. [4½] 6.2 Outline the biochemical findings of the South African National Nutrition Survey Study (SANNSS) of [6] 6.3 Explain how a household survey can be used to measure food intake. [2½] 6.4 Explain the difference between haemochromatosis and haemosiderosis. [7] 2 TOTAL = 20 MARKS

3 SECTION C CASE STUDY 40 MARKS QUESTION 7 PLEASE READ THE FOLLOWING CASE STUDY AND ANSWER ALL THE QUESTIONS THAT FOLLOW Miss S is 42 years old and works as a cleaner at a local school. She weighs 89 kg and is 1.61m tall. She has been complaining of weakness, fatigue and shortness of breath on exertion. Clinically she appears pale but is otherwise well. Her biochemical results are as follows: Haemoglobin (Hb) 10 g/dl ( g/dl) Haematocrit (Hct) 32% (36-50%) Red Blood Cells (RBC) 2.5 X / L (4-5.7 X / L) A diet history was obtained from Miss S and revealed the following: Breakfast (6:30 am) 2 slices brown bread 2 teaspoons margarine 1 cup tea (no milk) 2 teaspoons white sugar Snack (9:30 am) 1 cup tea (no milk) 2 teaspoons white sugar 1 small apple Lunch (12:30 pm) 2 cups cooked white rice 2 cups boiled cabbage 1 cup tea (no milk) 2 teaspoons white sugar 2 Romany Creams Snack (3:30 pm) 1 cup tea (no milk) 2 teaspoons white sugar 1 packet Simba chips (30g) Supper (8:00 pm) 2 cups cooked samp 1 cup cooked sugar beans 3

4 1 cup cooked carrots 1 cup tea (no milk) 2 teaspoons white sugar A dietary prescription was formulated for Miss S and her nutritional requirements are as follows: Energy = 6300 kj Carbohydrate = 204 g Protein = 56 g Fat = 50 g 7.1 Using the information provided carry out a complete nutritional assessment on Miss S and draw a conclusion regarding her overall nutritional status. [10] 7.2 What practical dietary advice can you offer to Miss S in order to improve her current condition? [10] 7.3 Using the information provided complete a diet plan for Miss S using the exchange system. [14] Please make use of the following exchanges only: Low fat milk Starch Medium fat meat Vegetable Fruit Fat Sugar 7.4 A follow up blood test found that Miss S has low calcium levels and she has been prescribed both an iron and a calcium supplement (calcium carbonate) to take orally. Advise her on when and how she should take these supplements. [6] TOTAL = 40 MARKS END OF SECTION C 4

5 STUDENT NUMBER: SECTION A: MULTIPLE CHOICE QUESTIONS (1 X 30 = 30 MARKS) QUESTION 1 Indicate your answer to each question by placing a circle over the appropriate letter. Mark allocation as follows: 0 marks of no answer is given 1 mark for each correct answer - ½ mark for each incorrect answer Vitamins (1 X 10) 1. Which of the following statements on vitamins is false? A. Many fat soluble vitamins require protein carriers for transport in the blood. B. Fat soluble vitamins are more likely to reach toxic levels when consumed from supplements. C. Fat soluble vitamins are required in frequent doses of every 1-3 days. D. Fat soluble vitamins are absorbed directly into the blood. 2. is an important component of Co-enzyme A which is needed for metabolism of carbohydrate, fat and protein. A. Vitamin B6 B. Niacin C. Pantothenic acid D. Biotin 3. The conversion of carotenoids to the retinoid form is dependent on the enzyme. A. Hydroxylase B. Dioxygenase C. Catalse D. Carboxylase 5

6 4. Which of the following is not a function of vitamin B6? A. Participates in the conversion of tryptophan to niacin. B. Facilitates the conversion of linolenic acid to arachidonic acid. C. Required for the production of hydrochloric acid. D. Synthesis of key neurotransmitters. 5. A deficiency of is unlikely to result in high levels of homocysteine. A. Niacin B. Folate C. Vitamin B6 D. Vitamin B12 6. What dose of vitamin A is given to infants (6-11 months) as part of the Preventive Supplementation Protocol? A IU B IU C IU D IU 7. All of the following are non-essential vitamins, except: A. Biotin B. Folate D. Niacin C. Vitamin K 8. Which vitamin is also known as the anti-scorbutic vitamin? A. Vitamin E B. Folate C. Riboflavin D. Vitamin C 6

7 9. Which of the following statements on vitamin E is false? A. The structure of alpha tocopherol was established by Fernholz in 1938 B. Vitamin E is needed for the maintenance of nervous tissue and iron metabolism C. Megadoses of vitamin E can interfere with blood clotting action D. Vitamin E acts as a redox agent, donating an electron to oxidising agents and thus becomes reduced 10. Pteroglutamic acid is an alternative name for: A. Pantothenic acid B. Folic acid C. Pyridoxine D. Biotin Minerals (1 X 10) 11. The greatest amount of insensible losses of water takes place via the? A. Faeces B. Urine C. Lungs D. Skin 12. A deficiency of phosphorus could also contribute to. A. Microcytic, hypochromic anaemia B. Pernicious anaemia C. Haemolytic anaemia D. Megaloblastic anaemia 13. Which of the following is a function of zinc? A. Important for the storage, release and function of insulin B. Part of enzymes that synthesise norepinephrine and dopamine C. Needed for the formation and maintenance of myelin D. Important for blood clotting and bone development 7

8 14. All of the following are known to enhance calcium absorption, except? A. Lactose B. Pregnancy C. Oxalic acid D. Stomach acid 15. Which of the following statements on Type 1 (postmenopausal) osteoporosis is true? A. Affects women aged 50 to 70 years and involve both cortical and trabecular bone B. Affects women 70 years and older and involved trabecular bone only C. Affects women 70 years and older and involves trabecular bone only D. Affects women 50 to 70 years old and involves trabecular bone only 16. Wilson s disease is a genetic condition in which there is an accumulation of in the liver, brain, kidney and cornea. A. Iron B. Copper C. Zinc D. Selenium 17. Which of the following statements on iron is incorrect? A. Absorption from food is approximately 10-20% in iron deficient individuals B. Consumption of haem iron and non-haem iron together increases the absorption of haem iron C. Ferrous iron is better absorbed than ferric iron D. Consumption of pica is a potential cause of iron deficiency anaemia 8

9 18. Which is the major intracellular cation? A. Potassium B. Sodium C. Phosphorus D. Chloride 19. Which of the following minerals hardens and stabilises the crystals of teeth and makes the enamel resistant to decay? A. Calcium B. Phosphorus C. Fluoride D. Chloride 20. Which of the following is not a trace mineral? A. Fluoride B. Iodide C. Manganese D. Chloride Nutritional assessment (1 X 5) 21. Which dietary intake assessment method would provide information on the trends of food consumption in a country? A. Food balance sheets B 24 hour recall C. Food frequency questionnaire D. Diet history 22. Which of the following statements on weight is false? A. It is best to carry out a weight measurement in the morning after voiding B. Weight can be influenced by genetics and the environment C. Weight indicates current nutritional status and recent nutritional intake D. Weight is the sum of lean tissue, bone and fat 9

10 23. Which of the following statements on biochemical assessment is incorrect? A. Biochemical assessment information is compared to standard values B. Biochemical assessment tells us about the body s chemistry C. All biochemical values reflect short tern nutritional status only D. Biochemical tests can be repeated for confirmation of results 24. Which of the following increases disease risk? A. BMI of 22.4kg/m 2 B. Waist: Hip ratio < 0.8 in women C. Android obesity D. Waist: Hip ratio < 1 in men 25. A child with a low weight for height can be considered to be: A. Wasted B. Overweight C. Stunted D. Underweight Nutrition in South Africa (1 X 5) 26. According to the South African National Nutrition Survey Study (SANNSS) of 1995, which statement on macronutrient intake in Black South African adults is false? A. Rural Blacks obtained ⅔ of their protein from plant sources B. Rural Blacks had the highest intake of carbohydrates C. Rural Blacks had the highest intake of sugar D. Rural Blacks had a fat intake of < 30% 27. According to the SAVACG Study of 1994, the number of children in South Africa with marginal vitamin A status was: A. 1 in 3 B. 1 in 5 C. 1 in 10 D. 1 in 4 10

11 28. According to the National Food Consumption Survey (NFCS) of 1999, which were the most commonly consumed food items? A. Maize, white sugar, meat and beans B. Maize, white sugar, tea, whole milk and brown bread C. Maize, white sugar, tea, whole milk, and rice D. Maize, white sugar, fish and brown bread 29. According to the NFCS Fortification Baseline 2005, the number of women with a poor vitamin A status was: A. 1 in 2 B. 1 in 3 C. 1 in 4 D. 1 in According to the NFCS Fortification Baseline 2005, the number of children with a poor iron status was: A. 1 in 3 B. 1 in 5 C. 1 in 4 D. 1 in 7 END OF MULTIPLE CHOICE QUESTIONS 11