CNM
The College of Naturopathic & Complementary Medicine
Course: Nutrition Study Course
Semester: Year 1, Semester II exam
June 2011
Name: ______Date______
Location: ______
Telephone number: ______
Total marks: 100 Pass mark: 40%
Time allowed: 120 minutes
Exam result:______Marker:______
2nd Marker:______
Read each question carefully. Answer all questions. Your name needs to be clearly written on additional paper.
If you don’t understand a term or a question please ask your supervisor!
Always keep exam papers and clinic sheets in your file
GOOD LUCK! ALL
CNM Nutrition Year 1 Semester II
1. Ingredients listed on food labels must be listed in a particular order. How are they ordered? (1 mark)
A) In ascending order
B) Organic ingredients listed first then non-organic ingredients
C) Ingredients featured in the name of the product listed first
D) In descending order
2. When discussing Dietary Reference Values what is the definition of a safe upper level? (2 marks)
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3. Name three nutrients for which a safe upper level has been set. (3 marks)
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4. Why does table sugar have a lower glycaemic index than glucose? (4 marks)
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5. Supplemental coenzyme Q10 appears to be beneficial in cardiovascular health. Name two cardiovascular conditions in which it has been found to be of benefit, describing how it may be of help. (4 marks)
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6. Glucosamine supplementation is most associated with arthritis. Name a condition not associated with joint health where it has been found to be beneficial. (1 mark)
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7. Name two potential side effects of taking shitake mushrooms.
(2 marks)
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8. Which of the following orthomolecular nutrients has been anecdotally reported to improve the symptoms of autism? (1 mark)
A) Betaine anhydrous
B) Trimethylglycine
C) Dimethylglycine
D) Phosphatidyl serine
9. Breastfeeding is acknowledged as the best food for infants. Name three benefits of breastfeeding to mothers. (3 marks)
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10. What is the name of the name of the carbohydrate found in human breastmilk? (1 mark)
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11. Describe two ways in which breastfeeding offers immunological protection to babies. (4 marks)
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12. Young girls who consume more animal products and fewer fruits and vegetables have been found to go through puberty at an earlier age than average. Why is this of concern? (3 mark)
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13. Adolescence is a time when it is crucial that nutritional needs are met. However, teenagers do not always make decisions which confer a nutrient-dense diet. Name three factors which may influence food choice during adolescence. (3 marks)
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14. What is sarcopenia? (1 mark)
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15. Give three factors which contribute to the development of sarcopenia. (3 marks)
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16. Numerous studies have found that cancer rates in vegetarians are 50% to 75% lower than the general population. Give five factors which could help to explain this. (5 marks)
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17. Vegan diets are associated with many health benefits. However, vegans must carefully plan their nutrient intake in order to meet their bodies’ requirements. Name three nutrients vegans should consider supplementing. (3 marks)
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18. You are examining the nails of a two year old boy and notice they appear spoon shaped. His mother mentions he is a fussy eater who drinks a lot of milk. What is the most likely explanation for his spoon shaped nails? (3 mark)
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19. What is Schamroth’s sign and what can it indicate? (3 marks)
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20. Describe the concept of the TCM body clock. (3 marks)
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21. Where on the tongue would you look to assess the health of the liver and gallbladder when using tongue diagnosis? (1 mark)
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22. What is the name given to the unit of energy required to raise the temperature of 1g of water by 1C? (1 mark)
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23. List four factors which can influence the resting metabolic rate. (4 marks)
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24. Name two hormone associated with a decrease in food intake. (2 marks)
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25. DDT is a pesticide which was banned or restricted in many countries in the 1970s. This was due to several worrying effects it was observed to have on wildlife. Name one of these. (1 mark)
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26. The oral contraceptive pill (OCP) is not recommended for some women – those who are smokers and aged over 35, for example. Women who have certain conditions in their family history may be advised not to take the OCP. Name three such conditions. (3 marks)
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27. Long term use of cocaine can lead to unpleasant side effects. List three of these. (3 marks)
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28. Name two serious side effects of non-steroidal anti-inflammatory drugs. (2 marks)
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CASE STUDY – 30
Read the following case study then answer the questions below.
Jodi is a 29 year old woman who has come to you to discuss her energy levels. She feels tired all the time and has fallen asleep at her desk at work several times over the past few weeks. She also experiences constipation, only needing to pass stool twice a week. When she does have a bowel movement she needs to strain and often finds spots of bright red blood on the toilet paper. She has been to see her GP about this, who examined her and found some small anal fissures. The GP advised eating more fibre, which Jodi has been trying to do but which she says hasn’t made a difference to her constipation.
Jodi is 162 cm tall and weighs 58 kg, giving her a body mass index (BMI) of 22. She works as a receptionist in a private bank, starting work at 8am and finishing at 5pm. She plays in the bank’s netball team one evening a week and tries to go for a run on Saturday mornings, but often feels too tired to do so. She spends her weekends with her boyfriend, visiting friends, going to the cinema and catching up on housework.
Jodi’s diet:
Breakfast: Jodi has no appetite on rising and is always in a rush to get to work, as she finds it difficult to get out of bed. She buys a large coffee at the train station and adds three sugars to give her some energy for her hour long commute. She eats once she gets to work, snatching mouthfuls of breakfast cereal between phone calls. Since seeing her GP she has switched from having white toast to having a wholegrain bran cereal with skimmed milk.
Morning snack: She is very hungry by 10am, but tells you she tries to be ‘good’ by trying not to snack before lunch. However, most days she buys a chocolate croissant or a cheese toastie from the staff canteen.
Lunch: If she’s had a morning snack she is less hungry at lunch, and often has a salad from the canteen buffet. This is usually a lettuce leaf base with sliced tomato, cucumber, olives, sweetcorn and peppers. She adds some mayonnaise or salad cream.
Afternoon snack: by 3pm Jodi is feeling very tired and has recently fallen asleep at her desk. She craves something sweet to help boost her energy so often buys a large chocolate bar or a low-fat muffin as a pick-me-up. If she is still sleepy after eating this she makes herself a coffee with two sugars. Sometimes she has a green tea of peppermint tea instead.
Evening meal: Jodi lives with her boyfriend, who also works in the bank. He works longer hours than she does, so Jodi does most of the cooking during the week. She is very tired when she gets home from work, so tries to make quick and easy dinners. Some of her favourites are chicken pasta, tuna casserole and shepherd’s pie. She serves fruit-flavoured yoghurt for dessert.
Fluid intake: Jodi has made a conscious effort to increase her water intake to try to ease her constipation. She drinks a 500ml bottle on her way home from work, thinks she might drink about 500ml over the course of the day at the office. She has one or two strong coffees with two or three sugars in each. Most days she drinks one or two herbal teas, usually green or peppermint. She drinks two small glasses of wine on Friday and Saturday nights.
Jodi reports her stress level as being fairly low. She has no significant medical history, and no diagnosed medical conditions. The only prescription medication she uses is an antibiotic cream for acne, as she experiences outbreaks of painful red pimples around her mouth before her period each month. She has a copper coil for contraception.
When you examine her nails you find they are strong but feel quite rough to touch. Jodi says they grow quite slowly. Her tongue is slightly flabby and you can see teeth marks around the edges. There are fissures located down the centre, although not all the way to the tip.
List five positive things about Jodi’s diet. (5 marks)
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List five negative things about Jodi’s diet. (5 marks)
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What is your naturopathic summary of this case? Discuss possible triggers and drivers. List any red flags identified. (12 marks)
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Formulate two treatment aims based on your naturopathic summary. (4 marks)
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Would you consider referring Jodi to any other medical practitioner? Are there any tests you would like her to undertake? (4 marks)
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End of exam - Total 100 marks
Answers - Nutrition Year 1, Semester 2:
1. Ingredients listed on food labels must be listed in a particular order. How are they ordered? (1 mark)
d) In descending order
2. When discussing Dietary Reference Values what is the definition of a safe upper level? (2 marks)
The highest level of nutrient intake that is likely to pose no risk of adverse health effects in almost all individuals.
3. Name three nutrients for which a safe upper level has been set. (3 marks)
Any three of the following: vitamin A; beta carotene; calcium; copper; fluoride; iodine; iron (1 mark each)
4. Why does table sugar have a lower glycaemic index than glucose? (4 marks)
Table sugar is sucrose (1 mark), which is composed of half glucose (1 mark) and half fructose (1 mark). Fructose only causes a very small rise in blood sugar levels (1 mark)
5. Supplemental coenzyme Q10 appears to be beneficial in cardiovascular health. Name two cardiovascular conditions in which it has been found to be of benefit, describing how it may be of help. (4 marks)
Any two of the following:
Atherosclerosis – inhibits LDL oxidation and prevents monocyte recruitment
Congestive heart failure – CHF patients have been found to have lower levels of CoQ10
Myocardial infarction/heart attack – CoQ10 decreases post-infarct heart damage
Angina pectoris – CoQ10 improves exercise tolerance and reduces ECG changes
Hypertension – CoQ10 has been found to decrease both systolic and diastolic blood pressure
(1 mark per condition; 1 mark for explaining how CoQ10 may help)
6. Glucosamine supplementation is most associated with arthritis. Name a condition not associated with joint health where it has been found to be beneficial. (1 mark)
Inflammatory bowel disease (could accept Crohn’s, ulcerative colitis or juvenile IBD)
7. Name two potential side effects of taking shitake mushrooms.
(2 marks)
Any two of the following: abdominal discomfort; eosinophilia; shitake dermatitis; photosensitivity (1 mark each)
8. Which of the following orthomolecular nutrients has been anecdotally reported to improve the symptoms of autism? (1 mark)
C) Dimethylglycine
9. Breastfeeding is acknowledged as the best food for infants. Name three benefits of breastfeeding to mothers. (3 marks)
Any three of the following:
- delays return of ovulation thus lengthening birth intervals
- conserves iron stores by prolonging amennorrhoea
- may protect against breast cancer
- may protect against ovarian cancer (1 mark each)
10. What is the name of the name of the carbohydrate found in human breastmilk? (1 mark)
Lactose
11. Describe two ways in which breastfeeding offers immunological protection to babies. (4 marks)
Any two of the following:
- colostrum protects the infant from infections against which the moather has gained immunity
- - maternal antibodies in breastmilk inactivate pathogenic bacteria in the infant’s gut
- provides bifidus factors which act as prebiotics for lactobacillus bifidus, encouraging its growth
- lactoferrin binds to iron, preventing it from fuelling bacterial growth
- lactadherin fights off the virus causing most cases of infant diarrhoea (2 marks for each explanation)
12. Young girls who consume more animal products and fewer fruits and vegetables have been found to go through puberty at an earlier age than average. Why is this of concern? (3 mark)
Puberty before the age of 12 (1 mark) has been strongly associated (1 mark) with breast cancer (1 mark)
13. Adolescence is a time when it is crucial that nutritional needs are met. However, teenagers do not always make decisions which confer a nutrient-dense diet. Name three factors which may influence food choice during adolescence. (3 marks)
Any three of the following:
- increased appetite due to growth spurt
- decreased appetitie due to drug or alcohol use
- influence of peers
- concerns around body image
- media and advertising
- more independent and increased money spending
- living in food insecure households
- availability of fast/convenience foods (1 mark each)
14. What is sarcopenia? (1 mark)
The age-related loss of muscle mass, strength and function.
15. Give three factors which contribute to the development of sarcopenia. (3 marks)
Any three of the following:
- decreased activity of insulin/insulin resistance
- decreased activity of growth hormone
- decreased levels of androgens