CNSC DISEASE SPECIFIC EXAM WITH COMPLETE
SOLUTIONS
/. Est. energy needs increased by how much in 2nd & 3rd trimester? - Answer-✅BMI <
18.5 - 42-50 kcal/kg pregravid wt. BMI 18.5-24.5 - 40-45 kcal/kg. BMI > 25 - 30-35
kcal/kg
/.What is "accelerated starvation" - Answer-✅Prolonged nutrient deprivation during
pregnancy with increased rate of turnover of maternal metabolic fuels. Higher fasting
plasma concentrations of free FA, TG & increased predisposition for fasting ketones.
/.Iron needs during pregnancy - Answer-✅30 mg
/.multiple gestation energy requirements - Answer-✅20% protein, 40% fat, 40% from
carbs
/.Recommended wt gain during pregnancy - Answer-✅12.5-18 kg (27.5-40#)
underweight
11.5-16 kg (25-35#) normal weight
7-11.5 kg (15-25#) overweight
5-9 kg (11-20#) obese
/.twin pregnancy wt gain - Answer-✅<0.85 lb/week before 24 wks is associated with
decreased intrauterine growth & higher morbidity
-17-25 kg (37-55#) normal wt
-14-23 kg (31-51#) in overweight
- 11-19 kg (24-42#) for obese
/.glucose goal during pregnancy - Answer-✅<90 mg/dL fasting
<120 mg/dL 2 hour postprandial
/.DRI for carb during pregnancy - Answer-✅>175 g/day
/.DRI for protein during pregnancy - Answer-✅1.1 g/kg/d or +25 g/day of non-pregnancy
needs
/.albumin decreased in late pregnancy because of ? - Answer-✅a shift ingamma-globlin
to alpha- & beta-globulins & a dilutional effect due to plasma expansion.
, /.1st line drug therapy for hyperemesis gravidarum - Answer-✅Promethazine
(Phenergan) & pyridoxine (Vitamin B6)
/.arginine is a precursor of what AA? - Answer-✅Proline - a building block of collagen &
precursor for nitric oxide & stimulates release of insulin, HGF & anabolic hormones &
insulin-like growth factors.
/.Glutamine functions - Answer-✅improves the killing ability of neurophils, stimulates
the release of growth hormone, & provide fuels for lymphocytes, epithelial cells,
fibroblasts & macrophages. May also help preserve lean muscle mass as an
anticatabolic agent
/.kcal needs for wound healing - Answer-✅30-35 kcal/kg
35-40 kcal/kg for underweight or losing weight
/.Protein needs for pressure ulcer - Answer-✅1.25-1.5 g/kg
/.Needs for TBI pt - Answer-✅140% of harris benedict
1.3-2.5
supp with zinc & IGF-1 have been shown to improve outcome after TBI
omega 3, vit c & E should be considered
/.Max dosage for glutanine - Answer-✅0.57 g/kg/day
/.kcal needs for those with spinal cord injuries - Answer-✅20-22 kcal in quadriplegic.
22-24 kcal for paraplegic.
Aim for a modified BMI of 18-22
/.Needs for spinal cord injury - Answer-✅No injury factor. Metabolic rate is ~6-10%
lower than HBE
An adjusted BMI of 18-22 should be used.
Obese pt should be calculated based on IBW
- Protein 1.5-2 g/kg
/.Proinflammatory cytokines during sepsis - Answer-✅Catabolic hormones: glucogon,
catecholamines, cortisol - stimulates glycogenolysis & gluconeogenesis to mobilize
glucose
/.Protein metabolism during sepsis - Answer-✅Net flux of AA away from peripheral to
the liver. Increase in ureagenesis, creatinine, uric acid, ammonia. Nitrogen loss may
>30g/day
/.Fat metabolism during sepsis - Answer-✅- catabolic hormones: epinephrine,
norepinephrine & glucogon stimulates hydrolysis of stored TG (lipolysis).
SOLUTIONS
/. Est. energy needs increased by how much in 2nd & 3rd trimester? - Answer-✅BMI <
18.5 - 42-50 kcal/kg pregravid wt. BMI 18.5-24.5 - 40-45 kcal/kg. BMI > 25 - 30-35
kcal/kg
/.What is "accelerated starvation" - Answer-✅Prolonged nutrient deprivation during
pregnancy with increased rate of turnover of maternal metabolic fuels. Higher fasting
plasma concentrations of free FA, TG & increased predisposition for fasting ketones.
/.Iron needs during pregnancy - Answer-✅30 mg
/.multiple gestation energy requirements - Answer-✅20% protein, 40% fat, 40% from
carbs
/.Recommended wt gain during pregnancy - Answer-✅12.5-18 kg (27.5-40#)
underweight
11.5-16 kg (25-35#) normal weight
7-11.5 kg (15-25#) overweight
5-9 kg (11-20#) obese
/.twin pregnancy wt gain - Answer-✅<0.85 lb/week before 24 wks is associated with
decreased intrauterine growth & higher morbidity
-17-25 kg (37-55#) normal wt
-14-23 kg (31-51#) in overweight
- 11-19 kg (24-42#) for obese
/.glucose goal during pregnancy - Answer-✅<90 mg/dL fasting
<120 mg/dL 2 hour postprandial
/.DRI for carb during pregnancy - Answer-✅>175 g/day
/.DRI for protein during pregnancy - Answer-✅1.1 g/kg/d or +25 g/day of non-pregnancy
needs
/.albumin decreased in late pregnancy because of ? - Answer-✅a shift ingamma-globlin
to alpha- & beta-globulins & a dilutional effect due to plasma expansion.
, /.1st line drug therapy for hyperemesis gravidarum - Answer-✅Promethazine
(Phenergan) & pyridoxine (Vitamin B6)
/.arginine is a precursor of what AA? - Answer-✅Proline - a building block of collagen &
precursor for nitric oxide & stimulates release of insulin, HGF & anabolic hormones &
insulin-like growth factors.
/.Glutamine functions - Answer-✅improves the killing ability of neurophils, stimulates
the release of growth hormone, & provide fuels for lymphocytes, epithelial cells,
fibroblasts & macrophages. May also help preserve lean muscle mass as an
anticatabolic agent
/.kcal needs for wound healing - Answer-✅30-35 kcal/kg
35-40 kcal/kg for underweight or losing weight
/.Protein needs for pressure ulcer - Answer-✅1.25-1.5 g/kg
/.Needs for TBI pt - Answer-✅140% of harris benedict
1.3-2.5
supp with zinc & IGF-1 have been shown to improve outcome after TBI
omega 3, vit c & E should be considered
/.Max dosage for glutanine - Answer-✅0.57 g/kg/day
/.kcal needs for those with spinal cord injuries - Answer-✅20-22 kcal in quadriplegic.
22-24 kcal for paraplegic.
Aim for a modified BMI of 18-22
/.Needs for spinal cord injury - Answer-✅No injury factor. Metabolic rate is ~6-10%
lower than HBE
An adjusted BMI of 18-22 should be used.
Obese pt should be calculated based on IBW
- Protein 1.5-2 g/kg
/.Proinflammatory cytokines during sepsis - Answer-✅Catabolic hormones: glucogon,
catecholamines, cortisol - stimulates glycogenolysis & gluconeogenesis to mobilize
glucose
/.Protein metabolism during sepsis - Answer-✅Net flux of AA away from peripheral to
the liver. Increase in ureagenesis, creatinine, uric acid, ammonia. Nitrogen loss may
>30g/day
/.Fat metabolism during sepsis - Answer-✅- catabolic hormones: epinephrine,
norepinephrine & glucogon stimulates hydrolysis of stored TG (lipolysis).
