DURATION: 3 HOURS TOTAL MARKS: 160 External Examiner: Dr N Wiles Internal Examiner: Dr K Pillay NOTE: THIS EXAM PAPER CONSISTS OF FIVE (5) PAGES PLUS AN ANSWER BOOKLET (11 PAGES), WHICH MUST BE HANDED IN. PLEASE MAKE SURE THAT YOU HAVE ALL PAGES. PLEASE ANSWER SECTIONS A, B AND C. PLEASE WRITE LEGIBLY AND ANSWER ALL QUESTIONS IN INK. ANSWERS WRITTEN IN PENCIL WILL NOT BE MARKED. SECTION A SECTION B SECTION C 50 MARKS 80 MARKS 30 MARKS PLEASE ANSWER ALL OF THE QUESTIONS BELOW. START EACH QUESTION ON A NEW PAGE SECTION B QUESTION 2 2.1 Discuss the strengths and limitations of using the food frequency questionnaire method of dietary assessment. [9] 2.2 Explain the difference between a case control study and a human intervention study. [5] 2.3 Explain what problems could be seen with high intakes (>2g/day) of vitamin C. [5] 2.4 Give the name of the anthropometric equipment used to measure height. [1] 1 TOTAL = 20 MARKS
QUESTION 3 3.1 Discuss the limitations of the South African National Nutrition Survey Study (SANNSS). [7] 3.2 A 20 year old male patient who is on the drug Roaccutane goes to the blood bank to donate blood. At the blood bank he is informed that they will not take his blood as he is on Roaccutane. 3.2.1 Explain why the patient was not allowed to donate blood while on the drug Roaccutane. [3] 3.2.2 The patient also had a blood test done which showed increased levels of cholesterol and triglycerides. He is concerned that he may be at increased risk for heart disease. Should he be concerned? Explain why? [4] 3.3 Explain how a household survey can be used to measure food intake. [3] 3.4 List three (3) reactions that are dependent on biotin. [1X3=3] TOTAL = 20 MARKS QUESTION 4 4.1 A patient is admitted into hospital with a body temperature of 39.1 ºC. The cause of the fever is unknown and the patient has no other medical problems. 4.1.1 Explain how the body will respond to the raised body temperature. [4] 4.1.2 A patient with fever needs a modification to their energy requirements. Explain what modification is required. [1] 4.1.3 Explain why this modification is needed. [3] 4.1.4 Explain why patients with fever should wear minimal clothing. [2] 4.2 Using the correct number of subjects is very important when designing an experiment. Explain why it is important to do this and how it can be achieved. [4] 2
4.3 Outline the steps in the visual cycle. [6] TOTAL = 20 MARKS QUESTION 5 5.1 For each of the body areas listed below give two (2) clinical signs of good nutrition and two (2) clinical signs of malnutrition. Please tabulate your answer. [8] Eyes Gums Skin Nails 5.2 Discuss the findings of the National Food Consumption Survey (NFCS) of 1999 in terms of macronutrients only. [10] 5.3 Give the criteria that must be met in order for a substance to be classified as a vitamin. [2] END OF SECTION B TOTAL = 20 MARKS 3
SECTION C 30 MARKS QUESTION 6 Miss J is a 19 year old full-time University student. She recently went to the doctor as she has been feeling very tired and finding it difficult to concentrate on her studies. Clinically she appears pale and has shortness of breath on exertion. She was diagnosed with a gastric ulcer and iron deficiency anaemia. Her anthropometric measurements are as follows: Weight = 52 kg Height = 1.65m Waist circumference = 50 cm Hip circumference = 65 cm Her biochemical assessment revealed the following: Haemoglobin 10.7 g/dl (12.3-17 g/dl) 6.1 Carry out a complete anthropometric assessment on Miss J based on all the information that you have been given. [6] 6.2 Identify possible nutritional risk factors in this case. [4] 6.3 If you were to carry out a clinical examination on Miss J specifically looking at her finger nails what clinical signs of iron deficiency would you expect to see? [2] 6.4 What is the most likely cause of the iron deficiency anaemia in this case? [1] 6.5 The Doctor has decided to put Miss J onto an iron supplement. What dosage of iron is used to treat iron deficiency anaemia and for how long is it given. [2] 6.6 Although Miss J is not a vegetarian she tends to eat more plant foods than animal foods. Offer Miss J practical dietary advice in order to increase the absorption of non-haem iron from foods sources. [3] 4
6.7 Complete a diet plan for Miss J using the dietary prescription given below. [12] Total energy = 6750 kj Carbohydrate = 58% of total energy (TE) Fat = 30% of TE Protein = 12% of TE Please make use of all of the following exchanges: Low fat milk Vegetables Fruit Starch Medium fat meat Fat Sugar END OF SECTION C 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 one of the vitamins listed below is the least stable? A. Thiamin B. Vitamin B12 C. Riboflavin D. Vitamin C 2. In the citric acid cycle the oxidation of succinate to fumarate requires an enzyme which contains. A. Riboflavin B. Thiamin C. Niacin D. Vitamin B6 3. also functions as a decarboxylase in the metabolism of branched chain amino acids. A. Flavin mononucleotide B. Thiamin pyrophosphate C. Pyridoxal phosphate D. Tetrahydrofolic acid 4. was first officially recorded in 1735 by Gaspar Casal. 6
A. Beri-Beri B. Pellagra C. Scurvy D. Ariboflavinosis 5. The synthesis of niacin from tryptophan also requires: A. Riboflavin and vitamin B6 B. Vitamin B12 and folate C. Vitamin B6 and thiamin D. Folate and riboflavin 6. Coenzyme A forms when pantothenic acid combines with a derivative of ADP and part of the amino acid. A. Leucine B. Histidine C. Cysteine D. Tryptophan 7. Primary deficiency can be confirmed using a. A. Diet history B. Health history C. Laboratory tests D. Physical examination 8. 120 IU of vitamin D is equal to µg cholecalciferol. 7
A. 3 B. 4800 C. 40 D. 13 9. Which of the following coenzymes is formed through phosphorylation reactions? A. Thiamin pyrophosphate B. Pyridoxal phosphate C. Tetrahydrofolic acid D. Methylcobalamin 10. Which of the following is the active ingredient in Retin A? A. 13 cis retinoic acid B. Transthyretin C. Tretinoin D. 13 cis retinal Water & Minerals (1 X 10) 11. What volume of water is normally produced as a by product of metabolism? A. 1.4 litres B. 150 ml C. 0.5 litres D. 350 ml 12. Which of the following minerals is found abundantly in chlorophyll and functions in respiration? A. Magnesium 8
B. Chromium C. Zinc D. Phosphorus 13. Which is the major extracellular cation? A. Phosphorus B. Sodium C. Potassium D. Chloride 14. What is the approximate volume of blood plasma in the human body? A. 14 litres B. 17 litres C. 3 litres D. 7 litres 15. Mottling is associated with excessive intake of? A. Fluoride B. Chromium C. Copper D. Zinc 16. In South Africa what percentages of households obtain their table salt from typical food stores selling iodised salt? A. 37% B. 8% 9
C. 78% D. 95% 17. Which condition is treated with binding agents such as penicillamine? A. Acrodermatitis enteropathica B. Wilson s disease C. Hyperkalaemia D. Hartnup s disease 18. Identify the incorrect statement: A. The iodisation of salt in South Africa is mandatory B. It is not mandatory for the salt used in the production of processed foods to be iodised C. Coarse salt contains more iodine than fine salt D. ½ a teaspoon of iodised salt provides the RDA for iodine 19. A deficiency of chromium may be related to. A. Type 2 diabetes B. Liver damage C. Lung cancer D. Low blood cholesterol and triglyceride levels 20. Which of the following sources contributes the most to sodium intake? A. Salt added to food products by the food manufacturer B. Salt added during cooking C. The natural sodium content in foods D. Salt added to beverages 10
Nutritional assessment (1 X 5) 21. is an example of a field method used to estimate body fat? A. Total body water B. Near infrared interactance C. Density D. Dual photon absorptiometry 22. 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 23. Which of the following is a long term indicator of nutritional status? A. Stunting B. Weight for height C. Weight for age D. Wasting 24. assessment is the least subjective method used to assess nutritional status. A. Anthropometric B. Biochemical C. Clinical D. Dietary 11
25. Which of the following body types is most associated with developing osteoporosis? A. Endomorph B. Mesomorph C. Ectomorph D. Mendomorph Nutrition in South Africa (1 X 5) 26. According to the National Food Consumption Survey (NFCS) of 1999 children were underweight. A. 1 in 5 B. 1 in 10 C. 1 in 4 D. 1 in 6 27. According to the National Food Consumption Survey (NFCS)-Fortification Baseline (FB) (2005) households were at risk of hunger. A. 1 out of 2 B. 1 out of 4 C. 1 out of 3 D. 1 out of 5 28. According to the South African Vitamin A Consultative Study (SAVACG) of 1994, one year old children had an immunisation card. A. 9 out of 10 B. 6 out of 10 C. 5 out of 10 D. 8 out of 10 12
29. The South African National Nutrition Survey Study (SANNSS) provides the results of a metaanalysis of South African dietary data since. A. 1975 B. 1994 C. 1979 D. 1999 30. According to the South African Vitamin A Consultative Group (SAVACG) Study, the number of children in South Africa that were underweight was : A. 1 in 10 B. 1 in 4 C. 1 in 3 D. 1 in 5 END OF MULTIPLE CHOICE QUESTIONS 13
SHORT QUESTIONS 20 MARKS QUESTION 2 2.1 What is the ideal ratio of vitamin E: PUFA (polyunsaturated fatty acids)? [1] 2.2 Which form of vitamin K is given to newborn babies at birth? [1] 2.3 Give the name of the principal ingredient in Retin-A [1] 2.4 What dosage of vitamin B6 is used to treat nausea during pregnancy? [1] 2.5 Folate consists of three (3) parts. Name all of the parts. [½ x 3=1½] 2.6 Vitamin B12 is required for two (2) enzymatic reactions. List both reactions. [1 x 2=2] 14
2.7 List four (4) functions of calcium. [½ x 4=2] 2.8 Manganese acts as a cofactor for certain enzymes. List two (2) of these enzymes. [½ x 2=1] 2.9 What are anatomical landmarks? [2] 2.10 Give the name of two (2) novel methods used to estimate body fat. [½ x 2=1] 2.11 List the five (5) steps (in the correct sequence) involved when carrying out research using the Scientific Method. [½ x 5=2½] 15
2.12 According to the South African Vitamin A Consultative Group (SAVACG) Study of 1994, how many children had a visible BCG scar? [1] 2.13 Which two (2) dietary questionnaires were used to gather dietary data in the National Food Consumption Survey (NFCS) of 1999? [1 x 2=2] 2.14 Which two (2) groups were surveyed in the National Food Consumption Survey (NFCS) - Fortification Baseline (FB) (2005)? [½ x 2=1] END OF SHORT QUESTIONS 16