Pakistan Nutrition and Dietetic Society

REGISTRATION EXAM 4
Date: 22/29 SEPTEMBER 2012

KARACHI/ISLAMABAD
Write the alphabet that denotes the BEST possible answer in the right hand
column
Each question carries 1 mark
Maximum attainable marks: 100
Duration: 100 minutes

Name (in block letters): _________________________

(Please write your name as you would want printed on your certificate)

Email address: _______________________________________

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S. No. Answers
NUTRITION SCIENCE
Soluble fibers help in decreasing the absorption of cholesterol from the gut.
Which one of these is a soluble fiber?

1. a) Cellulose
b) Hemicellulose
c) Pectin
d) Collagen

____________ develops due to low level of ionized calcium in the blood.

2. a) Rickets
b) Tetanus
c) Tetany
d) Osteomalacia

Vitamin D (25,hydroxyvitamin D) deficiency can manifest as

a) Muscle weakness.
3.
b) Decreased production and excretion of parathyroid hormone
(PTH) levels.
c) Hypotension
d) Less than normal serum lipid levels

The requirement of _________ is related to the individual’s protein intake

4. a) Thiamin
b) Riboflavin
c) Niacin
d) Pyridoxine

Which of the following most affects osmolarity?

5. a) Protein
b) Sugar
c) Electrolytes
d) Ketones

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The obligatory water excretion per day to carry away waste generated by
metabolism is -------
6.
a) 0.5 litres
b) 1 litre
c) 1.5 litres
d) 2 litres
The immediate post-stress release of glucagon increases:

a) Glucose uptake into cells

7.
b) Glucose release into the bloodstream
c) Insulin release
d) Release of Free fatty acids.

The body of a trained athlete adapts to conserve all of the following

electrolytes, except ------- Therefore these electrolytes do not need to be
replenished after exercise.
8.
a) Sodium
b) Magnesium
c) Chloride
d) Potassium

The hormone leptin

9. a) Is higher in obese individuals

b) Inhibits energy intake
c) Increases energy expenditure
d) Is lower in women than in men.

During pregnancy the % increase in requirement of ----------- is the highest.

10. a) Energy
b) Protein
c) Folic acid
d) Calcium

Which of the following hormones adversely affects milk

production/secretion?
11.
a) Prolactin
b) Oxytocin
c) Adrenaline
d) Glucagon

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An apple has approximately 65 Kcal. How many Kjoules is this equal to?

12. a) 150
b) 225
c) 275
d) 300

When subjected to routine frying temperatures__________ can generate

high levels of toxic aldehyde products that promote CVD and cancer.
13.
a) PUFA
b) MUFA
c) SFA
d) SCFA

Which of these has the lowest glycemic load?

14. a) Rice
b) Banana
c) Chocolate milk
d) Popcorn

Which of the following amino acid is a precursor of niacin?

15. a) Phenylalanine
b) Methionine
c) Tryptophan
d) Tyrosine

Which of these is high in Oxalate?

16. a) Tea with biscuits

b) Guava Chaat
c) Spaghetti with meat sauce
d) Tomato soup with croutons

Sarcopenia is the age related loss of muscle mass, strength and function.
Which of the following has the most deleterious affect on sarcopenia?
17.
a) Weight loss
b) Physically strenuous work
c) Sedentary life style
d) Inadequate intake of protein

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Which of the following can lead to vitaminB12 deficiency?

18. a) Helicobacter pylori

b) Metformin
c) Liver disease
d) All of the above
Cretinism is caused by a deficiency of

a) Copper
19.
b) Selenium
c) Iodine
d) Chromium

Which of the following is the most sensitive parameter of negative iron

balance
20.
a) Hemoglobin
b) Hematocrit
c) Plasma iron
d) Plasma ferritin

The problem with the use of Food Frequency Questionnaires for dietary
assessment is that it does not provide information on
21.
a) Portion size
b) Meal patterns
c) Nutrient intake
d) All of the above

A patient presents to you with a 12% unintentional weight loss in 6

months. You would consider this a
22.
a) Mild weight loss
b) Significant weight loss
c) Severe weight loss
d) Cannot classify as it would depend on her height

During period of emotional, psychological or physiological stress the

urinary excretion of ________ increases
23.
a) Thiamin
b) Folic acid
c) Pyridoxine
d) Vitamin C

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The requirement of _______________ is increased in smokers

24. a) Vitamin A
b) Folic Acid
c) Vitamin C
d) Iron
A functional food is any food that

a) Lowers blood sugar

25. b) Acts as an antioxidant
c) Promotes a healthy GI tract
d) All of the above
CLINICAL NUTRITION

Clinical signs of zinc deficiency include

26. a) Immune deficiency

b) Delayed wound healing
c) Photophobia
d) All of the above

A child with galactosemia should:

27. a) Avoid all milk and milk products

b) Avoid all products containing lactose
c) Restrict intake of fruits such as dates and watermelons
d) All of the above

Feeding techniques that can help to prevent the complications of dysphagia

include
28.
a) Chewing on the strong side of the mouth
b) Tucking the chin and turning the head to assist closure of airways.
c) Encouraging coughing to clear food residue to minimize aspiration.
d) All of the above.

Mr. Khan has steatorrhea and has been prescribed a 25 gm/day low fat diet.
Which of these would give him 25 gm of fat:
29.
a) 4 oz lean meat or substitute and 2 fat exchanges.
b) 4 oz cheddar cheese and 2 fat exchanges.
c) 2 egg omelet and 2 fat exchanges.
d) 1 cup of yogurt and 2 fat exchanges.

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Which of the following foods can result in obstruction in a person with an

ileostomy?
30.
a) Nuts
b) Cheese
c) Broccoli
d) Shell fish
Foods that decrease LES pressure are

a) Tea
31.
b) Complex carbohydrates
c) Skim milk
d) Carbonated beverages

Faisal has just recovered from an acute bout of nausea and vomiting. You
advise a clear liquid diet. Which of these liquids should Faisal avoid
32.
a) Tea
b) Skim Milk
c) Apple juice
d) Gelatin dessert

Which of the following would NOT reliably indicate nutritional risk?

33. a) A weight loss of 5% in 3 months

b) Low serum albumin levels
c) Gluten sensitivity
d) Dysphagia

Central obesity is most associated with an increased risk of all of the

following EXCEPT________
34.
a) Glucose intolerance
b) Elevated blood pressure
c) Gout
d) Hyperlipidemia

According to the Diabetic Exchange Lists, when substituting 2% milk for

skim milk, you must omit how many fat exchanges?
35.
a) ½
b) 1
c) 1½
d) 2

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A pregnant client has undergone a glucose tolerance test. The result are 105
mg / dl fasting, 200 mg / dl – 1hr, 175 – 2 hr and 160 – 3 hrs. How would
you interpret these results?
36.
a) Glucose levels are within normal limits
b) Glucose levels indicate hypoglycemic state
c) Glucose level indicates GDM
d) Glucose levels are inconclusive and the tests need to be repeated
Which of the following would be appropriate for a hemodialysis patient on
a 60 gram protein diet, with 75% from HBV protein?

37. a) 1 egg, 2 ounce, chicken, 3 ounces beef, 1/2 cup milk

b) 1egg, 2 ounces chicken, 3 slices bread, 3 ounces beef
c) 2 eggs, 3 ounces chicken, 3 ounces beef, 1 cup milk
d) 1egg, 3 ounce chicken, 2 cups milk, 5 bread slices

Which of the following apply to diet for individuals with hypertension?

I. Low sodium
II. High potassium
III. High calcium
38.
a) I
b) I,II
c) I,III
d) I,II,III

The diet for a patient recovering from hepatic coma should contain
legumes because they are:
39.
a) low in ammonia
b) low in fat
c) high in branched chain amino acids
d) high in essential amino acids

A patient on ______________medication should not eat grapefruit

40. a) Antidepressants
b) Anticonvulsants
c) Statins
d) NSAIDS

Low levels of folate, pyridoxine and cyanocobalamin are associated with:

41.
a) Glycogen storage disease

b) Homocystinurias
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c) Phenylketonuria

d) Galactosemia

If a patient eats palak paneer for lunch which food should he also eat to
increase absorption of iron:

42. a) Chicken
b) Egg
c) Chapatti
d) Apple

Poly unsaturated fats decrease

43. a) Total Cholesterol

b) LDL Cholesterol
c) HDL Cholesterol
d) All of the above

A woman of average height and weight would need to walk at a medium

pace for ---- minutes to burn 100 calories.
44.
a) 10
b) 15
c) 20
d) 25

In individuals with cancer:

45. a) There is decreased ability to eat as the day progresses

b) There is an increased ability to eat as the day progresses
c) Ability to eat is not related to the time of the day
d) Late night feedings are well tolerated

Anti secretory drugs used to treat GERD can affect the absorption of

46. a) B1
b) B2
c) B6
d) B12

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Raised level of C- reactive protein(CRP) is a risk factor for

47. a) Diabetes
b) Hypertension
c) CHD
d) Obesity.
You have calculated that a tube fed patient requires 1800 calories. If using
a continuous drip, calculate required ml/hr to provide 1800 kcal when
using a 1.5 kcal/ml formula at full strength.
48.
a) 75 ml/hr
b) 40 ml/hr
c) 50 ml/hr
d) 112 ml/hr

__________________ is the best measure of somatic protein

49. a) Serum Albumin

b) Serum Transferrin
c) Mid-arm muscle circumference
d) Triceps skin fold

When there is plenty of oxygen and you have been involved in prolonged
exercise , the main energy source will be:
50.
a) Glucose
b) Glycogen
c) Lactic acid
d) Fatty acids
PUBLIC HEALTH

Weight for Height Z-Score of -2 indicates:

51. a) Wasting
b) Severe wasting
c) Over weight
d) Obesity

The data that is most useful in evaluating the nutritional status of children
is:
52.
a) Sex and age
b) Iron and vitamin intake
c) Energy intake and health history
d) Height and weight
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A child presents at the 65 percentile height for age. This child would be
considered
53.
a) Stunted
b) Normal height for age
c) Very tall for age
d) Small for age

Mothers who were born LBW are more likely to have infants that are born

54. a) Preterm
b) LBW
c) LBW and Preterm
d) None of the above

The inter-pregnancy interval that is most favorable for reducing risk of

LBW/preterm deliveries is:
55.
a) 10-12 months
b) 12-15 months
c) 15-18 months
d) 18-24 months

A woman who has a pre-pregnancy BMI of 30 is at risk of

56. a) preeclampsia
b) pregnancy induced hypertension
c) congenital anomalies in the fetus
d) All of the above

Breast feeding is an important child survival strategy. Which of the

following is not true regarding breast feeding practices in Pakistan?

a) More than 90% of the children born are breast fed

57. b) More than 60% of the infants are given something other than breast
milk in the first 3 days of life
c) Less than 30% of the children are breast fed within 30 minutes of
birth
d) Approximately 50% of the infants are exclusively breast fed for the
first 6 months of life

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The preconception status of ________ has the most impact on the outcome
of pregnancy

58. a) Calcium
b) Vitamin D
c) Iron
d) Folic acid
You have a postpartum mother concerned about weight loss in her newborn
infant. You tell her:

a) To increase breast feedings to every four hours until the newborn is at

birth weight
59. b) Weight loss is common in infants in the first 10 days due to loss of the
extra fluid in the body
c) To consult the midwife to check breast feeding techniques and
adequacies of milk
d) Any weight loss in newborns should be regained within ten days after
delivery

The most common strategy used in Pakistan or decreasing the prevalence

of vitamin A deficiency in children under 5 years of age is

60. a) Encouraging the use of vitamin A rich foods

b) Fortification of oil and ghee with vitamin A
c) Giving supplements of Vitamin A to the children
d) Giving an oral dose of vitamin A within 6 weeks of delivery to
mothers to enrich breast milk content of vitamin A

Many dietary components have been shown to have value in preventing a

variety of cancers. For which the following is the scientific evidence
strongest in overall cancer prevention?
61.
a) Increasing dietary fiber
b) Reducing dietary fat
c) Using antioxidants
d) Increasing fruit and vegetable intake

The burden of hypertension in Pakistani adults aged 40 years or above is:

62. a) one in six adults

b) one in five adults
c) one in four adults
d) one in three adults

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According to UNICEF State of the World’s Children data 2003-2008 the
prevalence of Low Birth Weight in the country is:
63.
a) 25%
b) 20%
c) 30%
d) 32%

By the age of one year a baby should be:

64. a) Double the birth weight

b) Triple the birth weight
c) Four times the birth weight
d) It depends on the birth weight and cannot be predicted

As a Public Health Nutritionist you wish to study the usual intake of

women of child bearing age in the population you work with. The most
feasible tool to use would be:
65.
a) 24 Hour dietary recalls
b) Food frequency questionnaires
c) Food diaries
d) Observation of food intake in the homes

The Tawana Pakistan Project:

66. a) Provided school lunch to children in rural primary schools

b) Provided school lunch to girls in rural primary schools
c) Distributed food to rural households
d) Distributed cooking oil to encourage girls to attend school

A Nutrition surveillance program is designed primarily to:

a) Verify data from other survey

67.
b) Identify the nutritional need of the population
c) Indicate the number of people at increased risk for medical
conditions.
d) Indicate the causes underlying the nutrition problems indentified.

The incidence of xerophtalemia in children between the age of 1-5 years is

5:1000 this means;
68.
a) Morbidity rate of xerophtalmia is 5 in every 1000 children age 1-5
years
b) Mortality rate of xerophtalmia is 5000 in this age group
c) Morbidity rate of xerophtalemia is 5000 in this age group
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d) Mortality rate of xerophtalmia is 5 in every 1000 in children age 1-5
years

You wish to study the distribution of ethnicity in a given population of

diabetics. The data you collect is

69. a) Ordinal data

b) Continuous data
c) Nominal data
d) Stratified data

The Z-Score lines indicate:

70. a) Mean
b) Median
c) Distance from the average
d) Average
FOOD SCIENCE

A non-nutritive substance found in vegetables that appears to have a

positive effect on health is:
71.
a) Polymer
b) Phytochemical
c) Oxalic acid
d) Lignin

Many vegetables are blanched before freezing in order to:

72. a) Kill all pathogenic mold spores

b) Inactivate spores of harmful bacteria
c) Destroy all pathogenic microorganisms
d) Destroy enzymes involved in discoloration

The formation of a green ring (ferrous sulfide) around the yolk of hard-
cooked egg may be prevented by:
73.
a) Cooking the egg slowly for 45 minutes
b) Cooking eggs in rapidly boiling water for a short time
c) Plunging the hard-cooked egg into cold water
d) Pricking the egg with a pin

Common example of filled milk would include?

74.
a) Double strength dry milk powder
b) Sweetened condensed milk
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c) Skim milk with vegetable oil
d) Evaporated milk

Less tender cuts of meat are best cooked by ______method

75. a) Pan frying

b) Roasting
c) Stewing
d) Grilling

Which of these fats has the highest smoking point

76. a) Olive oil

b) Corn oil
c) Banaspati ghee
d) Desi Ghee

A recipe calls for the following ingredients bay leaf, cinnamon and cottage
cheese. You need to send for:
77.
a) Curry pata, dal(dar) cheeni and khoya
b) Tej pata (paath), dal (dar) cheeni and paneer
c) Dhania, ilaichi and paneer
d) Podina, laung and paneer

The best food to provide the acid to react with baking soda is

78. a) Citric acid in citrus foods

b) Gluconic acid in honey
c) Lactic acid in yogurt
d) Any one of the above

Decreasing the amount of sugar in the recipe for chocolate pudding will
result in a:
79.
a) Firmer gel
b) Stronger chocolate flavor
c) Weaker gel
d) Tendency to lump when heated

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Which one of these is NOT a function of water in food preparation

80. a) A dispersing medium

b) Medium for the transfer of heat
c) Promotes chemical changes
d) Hygroscopicity
The rigidity of gels in gelatin desserts will be increased by

a) Acids that lower the pH below 4

81.
b) Increasing the amount of sugar
c) By adding chopped up fruits
d) Using milk instead of water or juice to make the gel

Which microorganism recognized in recent years is a concern because it

grows at refrigerator temperatures?
82.
a) Yersinia
b) Listeria
c) Staphylococcus
d) Salmonella

The most commonly used inhibitor of microbial growth is

83. a) Acid
b) Sulfur
c) Salt
d) Nitrites

When ingredients are listed on a product, they are listed according to:

84. a) Descending order by weight.

b) Alphabetically.
c) Dietary Guidelines for Americans.
d) Recommended Daily Allowances (RDAs).

Adding lemon juice to a spinach bhujia will result in:

85. a) A bright green color

b) Loss of green color
c) Decreasing the cooking time
d) Decreasing the availability of iron in the spinach

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 FOOD SERVICE
86. Food borne diseases occur when people eat food with:

a) Live, pathogenic microorganisms

b) Strong chemicals
c) A pH of 8.5
d) All of the above

Listeriosis is:

87. a) A virus
b) A parasite
c) An infection
d) An intoxication

Raw meats and poultry should be stored:

a) On the bottom refrigerator shelf to avoid contamination of other

88.
foods
b) In plastic wrap so that they don't touch other foods
c) At a temperature of 45 degrees or lower to preserve freshness
d) Within 3 hours of receiving, to minimize contamination

HACCP stands for

89. a) Hazard Analysis for Critical Care Patients.

b) Health And Critical Care Problems.
c) Hazard Analysis and Critical Control Points
d) Hazard Analysis Control Center Plan

Most potentially hazardous foods have a pH level between

90. a) 3.1 – 7
b) 4.6 – 10
c) 1 - 3.5
d) 10.2 – 14

Which of the following foods is NOT a high risk food?

91. a) Refrigerated catsup

b) French Toast
c) Tofu
d) Apple sauce

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 Which of the following is NOT an approved thawing method?

92. a) Under running water at 70◦F (21◦C)

b) In a refrigerator at 38◦F (3◦C)
c) In a covered sanitary pan at 75◦F (24C)
d) In a microwave, then placed immediately on a stove

Staphylococcus aureus is most often transmitted by:

93. a) Time/temperature abused crisp beef

b) Kheer
c) Unwashed bunches of grapes
d) A food handler with a sore on his hand

What is a sign that a shipment of fish is of UNACCEPTABLE quality?

94. a) The fish is packed in crushed, self-draining ice

b) The eyes are sunken
c) No fishy odor is detected
d) Fingerprint does not stay visible on the flesh

From a sanitation perspective, which are considered the most dangerous to

a foodservice establishment?
95.
a) Bees
b) Mice
c) Flies
d) Ants

Gaps between desired and actual food service operations are termed

96. a) Safety hazards

b) Nutrition hazards
c) Quality hazards
d) Bio hazards

The length of a cycle menu is determined primarily by the:

97. a) Production schedule

b) Patient length of stay
c) Food service manpower
d) Number of patients

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 What is a good method to send trays to patients so the foods are served at
the correct hot temperature?
98.
a) Cover plate with dome after placing food on heated plate
b) Cover plate with dome.
c) Cover and reheat in microwave at serving time.
d) Cover plate with plastic wrap.

A grievance procedure is best described as a process through which:

a) Management can address problem employees and take disciplinary

action.
99. b) Top management monitors the relationship between middle
management and employees.
c) Employees register problems with the employer, investigations are
conducted and objective conclusions are reached.
d) Employees register problems with the National Labor Board,
investigations are conducted and actions taken.

A facility establishes a productivity standard of 3.75 labor minutes per

meal for 4500 meals. The work scheduled for each employee is 8 hours
per day. The minimum daily staffing need in full time equivalents (FTEs)
would be approximately:
100.
a) 14
b) 28
c) 35
d) 56

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