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NTR 604: ADVANCED CLINICAL
NUTRITION & SUPPORT – 115 QUESTIONS
WITH VERIFIED ANSWERS REAL EXAM
2026 UPDATE FREE PDF
1. What is the primary metabolic response to injury or stress
(e.g., surgery, trauma, sepsis)?
A) Decreased resting energy expenditure (REE)
B) Increased protein catabolism and nitrogen loss
C) Increased glycogen synthesis
D) Decreased gluconeogenesis
Answer: B
Rationale: The stress response is characterized by
hypermetabolism and hypercatabolism. Counter-regulatory
hormones (cortisol, glucagon, catecholamines) increase, leading to
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accelerated proteolysis (muscle breakdown), increased
gluconeogenesis, and negative nitrogen balance .
2. The ebb phase of the stress response is characterized by:
A) Hypermetabolism and hyperdynamic circulation
B) Hypometabolism, decreased cardiac output, and hypovolemia
C) Anabolic recovery and tissue repair
D) Increased insulin sensitivity
Answer: B
Rationale: The ebb phase occurs immediately after injury (first
24-48 hours) and is a period of shock with decreased metabolic
rate, reduced cardiac output, and hypovolemia. It is followed by
the flow phase, which is catabolic and hypermetabolic .
3. Which of the following is a marker of visceral protein
status?
A) Albumin
B) Hemoglobin
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C) Creatinine height index
D) Triceps skinfold thickness
Answer: A
Rationale: Visceral proteins are synthesized by the liver and
include albumin, prealbumin (transthyretin), transferrin, and
retinol-binding protein. Albumin is a commonly used marker,
though its long half-life (20 days) makes it less responsive to
acute changes compared to prealbumin .
4. Which inflammatory cytokine is primarily responsible for
promoting muscle catabolism during critical illness?
A) Interleukin-10 (IL-10)
B) Tumor necrosis factor-alpha (TNF-α)
C) Transforming growth factor-beta (TGF-β)
D) Interleukin-4 (IL-4)
Answer: B
Rationale: TNF-α is a pro-inflammatory cytokine released during
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stress that promotes muscle proteolysis, insulin resistance, and
fever. It is a key mediator of the hypercatabolic state seen in
critical illness .
5. What is the nitrogen balance formula?
A) Nitrogen intake (g) – (Urinary urea nitrogen + 4)
B) (Urinary urea nitrogen + 4) – Nitrogen intake (g)
C) Nitrogen intake (g) / (Urinary urea nitrogen + 4)
D) (Urinary urea nitrogen + 4) / Nitrogen intake (g)
Answer: A
Rationale: Nitrogen balance = Nitrogen intake (g) – Nitrogen
output (g). Nitrogen output is estimated as 24-hour urinary urea
nitrogen (UUN) + 4 (to account for non-urinary losses such as
feces, skin, and miscellaneous). A positive balance indicates
anabolism; negative indicates catabolism .
6. Which of the following best defines the term "refeeding
syndrome"?
NTR 604: ADVANCED CLINICAL
NUTRITION & SUPPORT – 115 QUESTIONS
WITH VERIFIED ANSWERS REAL EXAM
2026 UPDATE FREE PDF
1. What is the primary metabolic response to injury or stress
(e.g., surgery, trauma, sepsis)?
A) Decreased resting energy expenditure (REE)
B) Increased protein catabolism and nitrogen loss
C) Increased glycogen synthesis
D) Decreased gluconeogenesis
Answer: B
Rationale: The stress response is characterized by
hypermetabolism and hypercatabolism. Counter-regulatory
hormones (cortisol, glucagon, catecholamines) increase, leading to
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accelerated proteolysis (muscle breakdown), increased
gluconeogenesis, and negative nitrogen balance .
2. The ebb phase of the stress response is characterized by:
A) Hypermetabolism and hyperdynamic circulation
B) Hypometabolism, decreased cardiac output, and hypovolemia
C) Anabolic recovery and tissue repair
D) Increased insulin sensitivity
Answer: B
Rationale: The ebb phase occurs immediately after injury (first
24-48 hours) and is a period of shock with decreased metabolic
rate, reduced cardiac output, and hypovolemia. It is followed by
the flow phase, which is catabolic and hypermetabolic .
3. Which of the following is a marker of visceral protein
status?
A) Albumin
B) Hemoglobin
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C) Creatinine height index
D) Triceps skinfold thickness
Answer: A
Rationale: Visceral proteins are synthesized by the liver and
include albumin, prealbumin (transthyretin), transferrin, and
retinol-binding protein. Albumin is a commonly used marker,
though its long half-life (20 days) makes it less responsive to
acute changes compared to prealbumin .
4. Which inflammatory cytokine is primarily responsible for
promoting muscle catabolism during critical illness?
A) Interleukin-10 (IL-10)
B) Tumor necrosis factor-alpha (TNF-α)
C) Transforming growth factor-beta (TGF-β)
D) Interleukin-4 (IL-4)
Answer: B
Rationale: TNF-α is a pro-inflammatory cytokine released during
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stress that promotes muscle proteolysis, insulin resistance, and
fever. It is a key mediator of the hypercatabolic state seen in
critical illness .
5. What is the nitrogen balance formula?
A) Nitrogen intake (g) – (Urinary urea nitrogen + 4)
B) (Urinary urea nitrogen + 4) – Nitrogen intake (g)
C) Nitrogen intake (g) / (Urinary urea nitrogen + 4)
D) (Urinary urea nitrogen + 4) / Nitrogen intake (g)
Answer: A
Rationale: Nitrogen balance = Nitrogen intake (g) – Nitrogen
output (g). Nitrogen output is estimated as 24-hour urinary urea
nitrogen (UUN) + 4 (to account for non-urinary losses such as
feces, skin, and miscellaneous). A positive balance indicates
anabolism; negative indicates catabolism .
6. Which of the following best defines the term "refeeding
syndrome"?
