Q.1 A 62-year-old man with sepsis is receiving enteral nutrition. Which laboratory marker is LEAST reliable for assessing short-term changes in nutritional status during acute inflammation?
Prealbumin concentration
Transferrin concentration
Retinol-binding protein
C-reactive protein level
Explanation - Transferrin has a relatively long half-life and is strongly affected by inflammation, iron status, and liver function, making it a poor marker of short-term nutritional changes in critically ill patients.
Correct answer is: Transferrin concentration
Q.2 A patient with chronic kidney disease stage 4 not on dialysis requires dietary protein management. What is the most appropriate protein prescription according to standard clinical nutrition recommendations?
0.3 g/kg/day
0.6–0.8 g/kg/day
1.2–1.5 g/kg/day
2.0–2.5 g/kg/day
Explanation - For CKD stage 3–5 not on dialysis, protein intake of approximately 0.6–0.8 g/kg/day is recommended to slow progression while maintaining nutritional adequacy.
Correct answer is: 0.6–0.8 g/kg/day
Q.3 In a severely malnourished patient started on nutrition support, which electrolyte abnormality is most characteristic of refeeding syndrome?
Hypercalcemia
Hypernatremia
Hypophosphatemia
Hypermagnesemia
Explanation - Refeeding syndrome is characterized by a rapid intracellular shift of phosphate following carbohydrate administration, leading to hypophosphatemia, along with potassium and magnesium depletion.
Correct answer is: Hypophosphatemia
Q.4 A 70-year-old stroke patient has a functional gastrointestinal tract but cannot safely swallow. What is the preferred route for nutrition support?
Total parenteral nutrition
Peripheral parenteral nutrition
Enteral tube feeding
Intravenous dextrose infusion
Explanation - When the gastrointestinal tract is functional, enteral nutrition is preferred because it maintains gut integrity, reduces infectious complications, and is more physiologic.
Correct answer is: Enteral tube feeding
Q.5 Which formula best estimates basal energy expenditure in hospitalized adults and is commonly used in clinical nutrition practice?
Benedict–Harris equation
Cockcroft–Gault equation
MDRD equation
Child–Pugh score
Explanation - The Harris–Benedict equation estimates basal energy expenditure and has historically been widely used in clinical nutrition assessment.
Correct answer is: Benedict–Harris equation
Q.6 A patient with acute pancreatitis is hemodynamically stable. According to current evidence, when should enteral nutrition ideally be initiated?
After complete pain resolution
Within 24–48 hours
After serum amylase normalizes
Only if oral intake fails for 7 days
Explanation - Early enteral nutrition within 24–48 hours is associated with reduced infectious complications and improved outcomes in acute pancreatitis.
Correct answer is: Within 24–48 hours
Q.7 Which anthropometric measure is most useful for identifying sarcopenia risk in older adults when advanced imaging is unavailable?
Waist circumference
Calf circumference
Hip circumference
Neck circumference
Explanation - Calf circumference is a practical bedside indicator of muscle mass and is commonly used in screening for sarcopenia in older adults.
Correct answer is: Calf circumference
Q.8 A patient receiving warfarin asks about dietary vitamin K. Which advice is most appropriate?
Avoid all green vegetables permanently
Consume large vitamin K loads weekly
Maintain a consistent vitamin K intake
Replace vegetables with supplements
Explanation - The key recommendation is consistency of vitamin K intake rather than complete avoidance, allowing stable anticoagulation management.
Correct answer is: Maintain a consistent vitamin K intake
Q.9 In liver cirrhosis with hepatic encephalopathy, what is the preferred nutritional approach regarding protein intake?
Complete protein restriction
Moderate to high protein intake
Exclusive intravenous amino acids
Protein-free carbohydrate feeding
Explanation - Current guidelines recommend avoiding prolonged protein restriction; adequate protein intake is important to prevent muscle wasting and support recovery.
Correct answer is: Moderate to high protein intake
Q.10 A critically ill ventilated patient has indirect calorimetry unavailable. Which weight-based energy target is commonly recommended initially?
10–15 kcal/kg/day
20–25 kcal/kg/day
35–40 kcal/kg/day
45–50 kcal/kg/day
Explanation - An initial target of approximately 20–25 kcal/kg/day is commonly used in critically ill adults when indirect calorimetry is not available.
Correct answer is: 20–25 kcal/kg/day
Q.11 Which nutrient deficiency is most strongly associated with megaloblastic anemia after long-term use of proton pump inhibitors and gastric surgery?
Vitamin C deficiency
Vitamin B12 deficiency
Vitamin D deficiency
Vitamin K deficiency
Explanation - Reduced gastric acid and intrinsic factor availability can impair vitamin B12 absorption, leading to megaloblastic anemia.
Correct answer is: Vitamin B12 deficiency
Q.12 A patient with obesity and type 2 diabetes is hospitalized. Which enteral formula characteristic is most appropriate?
High simple sugar content
High glycemic carbohydrate blend
Diabetes-specific lower glycemic formula
Protein-free elemental formula
Explanation - Diabetes-specific formulas with lower glycemic carbohydrate profiles may improve glycemic control during enteral feeding.
Correct answer is: Diabetes-specific lower glycemic formula
Q.13 Which finding is included in the Subjective Global Assessment (SGA) of nutritional status?
Serum sodium level
Recent weight loss history
Arterial blood gas value
Serum troponin level
Explanation - SGA incorporates history of weight loss, dietary intake, gastrointestinal symptoms, functional capacity, and physical examination findings.
Correct answer is: Recent weight loss history
Q.14 A patient with severe burns covering 40% of body surface area is hypermetabolic. Which macronutrient strategy is generally appropriate?
Low protein and low carbohydrate
High protein with adequate carbohydrate
Protein restriction with high fat
Exclusive lipid-based nutrition
Explanation - Burn patients have markedly increased protein requirements and benefit from adequate carbohydrate to support wound healing and reduce protein catabolism.
Correct answer is: High protein with adequate carbohydrate
Q.15 Which electrolyte should be monitored most closely during initiation of nutrition in a patient with prolonged starvation?
Calcium
Phosphate
Chloride
Bicarbonate
Explanation - Phosphate depletion is a hallmark of refeeding syndrome and can lead to respiratory failure, arrhythmias, and neuromuscular complications.
Correct answer is: Phosphate
Q.16 A postoperative patient has a functioning gut and expected inadequate oral intake for 5 days. Which nutrition strategy is preferred?
No nutrition intervention
Enteral nutrition support
Central parenteral nutrition
Peripheral dextrose only
Explanation - If the gut is functional and oral intake is inadequate, enteral nutrition is preferred over parenteral nutrition.
Correct answer is: Enteral nutrition support
Q.17 Which micronutrient deficiency is classically associated with Wernicke encephalopathy in malnourished patients?
Thiamine deficiency
Niacin deficiency
Riboflavin deficiency
Pyridoxine deficiency
Explanation - Thiamine deficiency can cause Wernicke encephalopathy and should be corrected before carbohydrate administration in high-risk patients.
Correct answer is: Thiamine deficiency
Q.18 In parenteral nutrition, which complication is most specifically associated with excessive glucose infusion rates?
Hypothermia
Hyperglycemia
Hypocalcemia
Metabolic alkalosis
Explanation - Excessive glucose delivery in parenteral nutrition commonly leads to hyperglycemia and increased infectious risk.
Correct answer is: Hyperglycemia
Q.19 A patient with short bowel syndrome develops chronic diarrhea and weight loss. Which nutrition intervention is often beneficial?
High insoluble fiber only
Small frequent nutrient-dense meals
Large high-fat meals twice daily
Complete fluid restriction
Explanation - Small frequent nutrient-dense meals improve tolerance and absorption in patients with short bowel syndrome.
Correct answer is: Small frequent nutrient-dense meals
Q.20 Which clinical parameter best reflects improvement in protein-energy malnutrition over several weeks?
Single serum albumin value
Daily serum sodium level
Trend in body weight and function
One-time cholesterol measurement
Explanation - Functional improvement and weight trends are more meaningful than isolated laboratory values in assessing recovery from malnutrition.
Correct answer is: Trend in body weight and function
Q.21 A patient with chronic obstructive pulmonary disease and hypercapnia requires enteral feeding. Which formula composition may reduce carbon dioxide production?
High carbohydrate formula
Very low protein formula
Lower carbohydrate, higher fat formula
Protein-free elemental formula
Explanation - Lower carbohydrate and relatively higher fat formulations may reduce respiratory quotient and carbon dioxide production in selected COPD patients.
Correct answer is: Lower carbohydrate, higher fat formula
Q.22 Which nutrition-related complication is most likely after Roux-en-Y gastric bypass if supplementation is inadequate?
Vitamin A toxicity
Vitamin B12 deficiency
Copper overload
Hypervitaminosis K
Explanation - Roux-en-Y gastric bypass can impair vitamin B12 absorption, making deficiency a common long-term concern.
Correct answer is: Vitamin B12 deficiency
Q.23 In oncology nutrition, which factor most strongly contributes to cancer cachexia?
Simple caloric restriction alone
Inflammatory cytokine-mediated catabolism
Excess dietary protein intake
Isolated vitamin deficiency
Explanation - Cancer cachexia is driven by systemic inflammation and cytokine-mediated metabolic alterations causing muscle wasting.
Correct answer is: Inflammatory cytokine-mediated catabolism
Q.24 A patient receiving continuous enteral nutrition develops diarrhea. Which intervention should be considered first?
Immediate cessation for 7 days
Evaluate medications and feeding rate
Switch directly to parenteral nutrition
Add unrestricted fruit juice
Explanation - Medication review, feeding rate assessment, formula osmolality, and infectious causes should be evaluated before discontinuing enteral nutrition.
Correct answer is: Evaluate medications and feeding rate
Q.25 Which recommendation is most appropriate for protein intake in a stable patient receiving maintenance hemodialysis?
0.4 g/kg/day
0.6 g/kg/day
1.0–1.2 g/kg/day
2.5–3.0 g/kg/day
Explanation - Hemodialysis patients generally require higher protein intake, approximately 1.0–1.2 g/kg/day, to compensate for dialysis-related losses and maintain nutritional status.
Correct answer is: 1.0–1.2 g/kg/day