DURATION: 3 HOURS TOTAL MARKS: 165 External Examiner: Ms C Biggs Internal Examiner: Dr K Pillay NOTE: THIS EXAM PAPER CONSISTS OF SIX (6) PAGES PLUS A MULTIPLE CHOICE QUESTIONNAIRE (MCQ) ANSWER BOOKLET (8 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 QUESTION 1 MULTIPLE CHOICE QUESTIONS See separate booklet (30 MARKS) SECTION B SHORT QUESTIONS (100 MARKS) SECTION C CASE STUDY (35 MARKS) PLEASE ANSWER ALL OF THE QUESTIONS BELOW AND START EACH QUESTION ON A NEW PAGE SECTION B QUESTION 2 2.1 Discuss the role of vitamin B6 in amino acid metabolism. [5] 2.2 What criteria must be met in order for a substance to be classified as a vitamin. [3] 2.3 Discuss the role of vitamin A in growth and development. [7] 2.4 List five (5) functions of Vitamin C. [1 X 5 = 5] TOTAL = 20 MARKS 1
QUESTION 3 3.1 What was the aim of the National Food Consumption Survey (NFCS)-Fortification Baseline (2005)? [3] 3.2 Give the food fortification recommendations that were made after the National Food Consumption Survey (NFCS) of 1999. [10] 3.3 You are given the following hypothesis on magnesium: When magnesium is removed from the diet it causes a lack of muscle coordination. This suggests that magnesium is needed for muscle contraction. When enough magnesium is added to the diet again, muscle control returns. The requirement for magnesium is determined to be the amount of magnesium needed to return muscle control to normal. 3.3.1 What type of study can be used to test this hypothesis? [1] 3.3.2 Explain how this type of study is conducted. [5] 3.4 Name the instrument used to measure skinfold thickness. [1] QUESTION 4 4.1 Discuss the diurnal variation in weight. [7] TOTAL = 20 MARKS 4.2 Discuss the factors that affect the absorption of calcium in the body. [9] 4.3 Explain the difference between cross-sectional data and longitudinal data. [4] TOTAL = 20 MARKS 2
QUESTION 5 5.1 Discuss the strengths and limitations of using the food frequency questionnaire method of dietary assessment. [9] 5.2 A newborn preterm infant presents with the following: Jaundice, muscle weakness and peripheral neuropathy, raised bilirubin levels and reduced red blood cell levels. 5.2.1 What nutritional condition does this infant most likely have? [1] 5.2.2 Is the condition from a toxicity or deficiency? [1] Name the nutrient that is involved. [1] 5.2.3 Explain the cause of the condition. [3] 5.2.4 Explain why preterm infants are more susceptible to having this condition. [3] 5.2.5 With both jaundice and hypercarotenaemia the skins appears yellow/orange. Explain how you would be able to tell the difference between hypercarotenaemia and jaundice. [2] QUESTION 6 TOTAL = 20 MARKS 6.1 A passenger on an aircraft is flying for the first time and wants to avoid having to use the bathroom on the aircraft. As a result she decides not to consume any fluids at all during the 8 hour flight. 6.1.1 What advice would you give to the passenger regarding her fluid intake? [4] 6.1.2 Explain how the kidney will respond to her decision to not consume any fluids for the duration of the flight. [7] 3
6.1.3 This passenger continues to avoid fluids and becomes severely dehydrated. List two (2) signs that would indicate to you that she requires immediate treatment. [2] 6.2 For each of the following nutrients listed below, indicate one laboratory test that could be used to assess nutritional status. [1 X 5 = 5] Carbohydrate Fat Vitamin D Vitamin K Iron 6.3 Explain how water can be treated if it is suspected to be contaminated with bacteria in settings where no electricity is available. [2] TOTAL = 20 MARKS END OF SECTION B 4
SECTION C 35 MARKS QUESTION 7 Mr A, a 55 year old African male was admitted into hospital with the following complaints: Difficulty swallowing, loss of appetite and mild dehydration. Clinically, he appears pale and weak. His anthropometric measurements on admission are as follows: Weight = 89 kg Height = 165 cm Waist circumference = 130 cm Hip circumference = 125 cm His biochemical tests revealed the following: Haemoglobin 10.9 g/dl (12.3-17 g/dl) Haematocrit (Hct) 32% (36-50%) Red Blood Cells (RBC) 2.5 X 10 12 / L (4-5.7 X 10 12 / L) After thorough medical investigations the doctors have diagnosed Mr A with cancer of the oesophagus and iron deficiency anaemia. 7.1 Carry out a complete anthropometric assessment on Mr A, based on all the information that you have been given. [8] 7.2 Identify possible nutritional risk factors in this case. [4] 7.3 Mr A has been experiencing difficulty swallowing due to the cancer of the oesophagus. Explain how the brain would respond if he continued to have difficulty swallowing fluids. [5] 7.4 What are the possible causes of the iron deficiency anaemia in this case? [2] 7.5 The doctor has decided to put Mr A onto an iron supplement. 7.5.1 Which route should be used to supply the iron given his difficulty with swallowing? [1] 5
7.5.2 Explain why using this route would be more effective than dietary intervention in this particular case? [3] 7.5.3 After receiving treatment Mr A is managing to eat a soft diet. Complete a diet plan for Mr A using the dietary prescription given below. [12] Total energy = 6340 kj Carbohydrate = 50% of total energy (TE) Fat = 30% of TE Protein = 20% of TE Please make use of all of the following exchanges: Low fat milk Vegetables Fruit Starch Lean meat Medium fat meat Fat Sugar END OF SECTION C 6
STUDENT NUMBER: SECTION A: MULTIPLE CHOICE QUESTIONS (8 Pages) (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 most stable? A. Thiamin B. Niacin C. Riboflavin D. Folate 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. Irreversible nerve damage can be caused by intakes of at levels of 2-6 g/day for a period of over 2 months. A. Vitamin B6 B. Folate C. Vitamin C D. Riboflavin 7
4. Which one of the following statements on vitamin C is false? A. Vitamin C is the most easily destroyed vitamin B. Oxidation of vitamin C is inhibited by an acid environment C. Ascorbic acid is the reduced active form of vitamin C and dehydroascorbic acid is the oxidised active form of vitamin C D. Vitamin C is able to donate electrons to oxidising agents thus becoming reduced and hereby prevents oxidation 5. All of the following are good sources of vitamin D except: A. Oily fish B. Breast milk C. Egg yolk D. Liver 6. The plant version of vitamin D is also known as: A. Cholecalciferol B. Ergocalciferol C. 7-dehydrocholesterol D. Lumisterol 7. The bioavailability of Vitamin A is enhanced by the presence of? A. Vitamin C B. Vitamin D C. Vitamin E D. Vitamin K 8
8. According to the National Department of Health s Preventive Supplementation Programme what dose of Vitamin A is given to infants between 6-11 months of age? A. 10 000 IU B. 50 000 IU C. 100 000 IU D. 200 000 IU 9. A deficiency can result from a reduced intake of dietary protein. A. Vitamin D B. Niacin C. Vitamin K D. Biotin 10. Which one of the following statements on vitamin K is false? A. The form of vitamin K which is produced from intestinal bacterial synthesis is Menaquinone B. During the conversion of active prothrombin to inactive prothrombin CO 2 is added to glutamic acid yielding gamma-carboxyl glutamic acid C. The addition of CO 2 to glutamic acid imparts calcium binding potential to bone D. Newborn infants are given a single dose of vitamin K (0.5-1.0 mg) within 6 hours of birth because they are born with a sterile gastrointestinal tract Water & Minerals (1 X 10) 11. Which one of the following statements on temperature regulation is correct? A. Water has a low specific heat or heat capacity B. Each 1 litre of perspiration evaporated from the skin represents 600 kj of energy C. Evaporation of perspiration occurs more readily when humidity is low D. Energy requirements are reduced during fever 9
12. With which nutrient would you associate the condition Wilson s disease? A. Chromiun B. Zinc C. Selenium D. Copper 13. Frequent, prolonged vomiting is most likely to cause a deficiency of? A. Sodium B. Potassium C. Chloride D. Magnesium 14. Hair loss, garlic-odour on breath, nausea, diarrhoea, fatigue, rashes and liver cirrhosis are symptoms associated with toxicity. A. Selenium B. Chromium C. Iodide D. Copper 15. Identify the incorrect statement on zinc. A. About 2-3g of zinc is found in the human body B. Zinc from animal sources are better absorbed than zinc from plant sources C. Excess amounts of zinc (5-20 X RDA) can inhibit copper absorption and reduce HDL D. A person with iron deficiency is unlikely to have a zinc deficiency at the same time 10
16. Which diet would be most effective in preventing and treating hypertension? A. A diet low in sodium B. A diet low in sodium and high in potassium C. A diet low in potassium D. A diet high in sodium and low in potassium 17. Which one of the following factors does not increase calcium absorption? A. Dietary glucose and lactose B. A ph < 6 in the jejunum C. Infancy D. Parathyroid hormone 18. Both pyruvate carboxylase and superoxide dismutase require as a cofactor. A. Selenium B. Copper C. Zinc D. Manganese 19. Which one of the following minerals is found abundantly in chlorophyll and functions in respiration? A. Zinc B. Chromium C. Magnesium D. Phosphorus 11
20. Which of the following is not a consequence of high intakes of chromium? A. Increased LDL (low density lipoprotein) levels B. Liver damage C. Cancer D. Inhibits copper absorption Nutritional assessment (1 X 5) 21. The Waterlow classification considers the following: A. Weight for Height and Height for Age B. Height for Age C. Weight for Height and Weight for Age D. Weight for Age 22. Which of the following factors is likely to have the greatest influence on weight measurements during the day? A. Time of day B. Menstruation C. Genetics D. Hydration status 23. Which dietary intake assessment method would provide information on the trends of food consumption in a country? A. 24 hour recalls B Food balance sheets C. Food frequency questionnaire D. Diet history 12
24. Which of the following statements on biochemical assessment is incorrect? A. Biochemical assessment information is compared to reference values B. All biochemical assessment values reflect short term nutritional status only C. Biochemical assessment is reflective of the body s chemistry D. Biochemical tests can be repeated for confirmation of results 25. Which of the following dietary assessment methods does not involve using a recall? A. 24 hour recall B. Food frequency questionnaire C. Food record D. Diet history Nutrition in South Africa (1 X 5) 26. 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 27. According to the National Food Consumption Survey (NFCS) Fortification Baseline of 2005 the number of children with poor vitamin A status was: A. 1 in 3 B. 2 in 5 C. 1 in 4 D. 2 in 3 13
28. According to the South African Vitamin A Consultative Group (SAVACG) Study, the number of children in South Africa that were stunted was: A. 1 in 10 B. 1 in 4 C. 1 in 3 D. 1 in 5 29. According to the South African National Nutrition Survey Study (SANNSS) there was a high prevalence of obesity in: A. Black women B. Coloured women C. Black and Coloured women D. Black, Coloured and Indian women 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 14