Nutritionist-Dietitian Licensure Examination

Which vitamin forms the TPP cofactor that directly catalyzes the initial decarboxylation of pyruvate in the pyruvate dehydrogenase complex?

• AThiamine (vitamin B1)
• BRiboflavin (vitamin B2)
• CNiacin (vitamin B3)
• DPyridoxine (vitamin B6)

Which lipoprotein is primarily responsible for transporting dietary cholesterol and triglycerides from the intestine to peripheral tissues?

• AChylomicrons
• BVery-low-density lipoprotein (VLDL)
• CLow-density lipoprotein (LDL)
• DHigh-density lipoprotein (HDL)

In patients with phenylketonuria (PKU), which amino acid must be restricted in the diet?

• APhenylalanine
• BTyrosine (para-hydroxyphenylalanine)
• CTryptophan (indole-propionic amino acid)
• DMethionine (sulfur-bearing amino acid)

Which enzyme catalyzes the rate-limiting step of cholesterol biosynthesis and is the target of statin medications?

• AHMG-CoA reductase
• BAcetyl-CoA carboxylase
• CFatty acid synthase
• DLipoprotein lipase

A hospitalized patient with pneumonia has serum albumin 2.5 g/dL and a total lymphocyte count of 800 cells/mm³. No intake, weight-loss, or physical examination data are available. What is the appropriate nutritional interpretation?

• AThese nonspecific results require a comprehensive nutrition assessment
• BThese results establish severe protein-energy malnutrition by themselves
• CNormal body weight would exclude malnutrition despite these results
• DThe albumin result measures the patient's skeletal muscle protein mass

Which principle is appropriate when planning medical nutrition therapy for an adult with type 2 diabetes?

• AIndividualize carbohydrate amount and distribution within a balanced eating plan
• BUse high-fructose drinks routinely to reduce the need for insulin
• CEliminate all carbohydrate regardless of preferences or medication
• DProvide unlimited protein without considering kidney status or energy needs

A hospitalized adult has acute kidney injury without dialysis and is catabolic because of sepsis. Which principle should guide the protein prescription?

• AIndividualize protein to catabolic state rather than restrict it to delay dialysis
• BUse a fixed low-protein diet regardless of illness severity or muscle loss
• CExclude all dietary protein until serum urea returns to its reference range
• DUse the stable chronic kidney disease allowance without reassessment

An adult with COPD is mechanically ventilated in the ICU for acute respiratory failure. The gut is usable and no special formula indication is present. Which feeding strategy is appropriate?

• AUse a standard polymeric formula and avoid excessive total energy delivery
• BRoutinely use a pulmonary formula solely to reduce respiratory quotient
• CDeliver extra carbohydrate above energy needs to spare respiratory muscles
• DSelect a branched-chain amino acid formula solely because COPD is present

Kwashiorkor is clinically differentiated from marasmus primarily by which feature?

• ABilateral pitting nutritional edema
• BSevere muscle wasting without nutritional edema
• CPreserved muscle mass without weight change
• DMacrocytic anemia as the defining feature

A patient with newly diagnosed celiac disease requires dietary counseling. Which of the following grains must be completely avoided?

• AWheat, barley, and rye
• BMilled white rice and yellow corn
• CWhole-grain quinoa and amaranth seeds
• DPure rolled oats certified gluten-free

Which vitamin deficiency is characterized by night blindness (nyctalopia) and Bitot's spots on the conjunctiva?

• AVitamin A deficiency
• BVitamin B12 deficiency
• CVitamin D deficiency
• DVitamin E deficiency

The respiratory quotient (RQ) of pure fat oxidation is approximately:

• A0.7
• B1.0
• C0.85
• D1.3

A patient with hepatic encephalopathy requires a modified diet. Which amino acid group is typically increased in the plasma of these patients and may worsen neurological symptoms?

• AAromatic amino acids (phenylalanine, tyrosine, tryptophan)
• BBranched-chain amino acids (leucine, isoleucine, and valine)
• CSulfur-containing amino acids (methionine, homocysteine, cysteine)
• DBasic positively charged amino acids (lysine, arginine, histidine)

Which type of dietary fiber is most effective in lowering serum LDL cholesterol by binding bile acids in the gut?

• ASoluble viscous fiber (e.g., beta-glucan, pectin)
• BInsoluble structural fiber (e.g., cellulose, hemicellulose, wheat bran)
• CRetrograded resistant starch granules from cooled legumes
• DNon-viscous short-chain oligofructose and inulin fructans

When nutrition support (total parenteral nutrition or concentrated enteral feeding) is initiated after prolonged starvation, an abrupt insulin surge drives glucose and electrolytes into cells for ATP and 2,3-bisphosphoglycerate synthesis. Which serum electrolyte abnormality is the hallmark biochemical feature of the resulting refeeding syndrome?

• AHypophosphatemia
• BHyperkalemia (elevated serum potassium)
• CHypernatremia (elevated serum sodium)
• DHypercalcemia (elevated serum calcium)

Which pair comprises the long-chain omega-3 fatty acids supplied directly by marine fish oils?

• AEicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)
• BPlant-derived alpha-linolenic acid (ALA) extracted from flaxseed oil
• CMembrane-bound arachidonic acid (AA, 20:4n-6) from animal tissues
• DEssential linoleic acid (LA, 18:2n-6) from safflower and corn oils

In a patient without inflammation, which listed blood marker most directly reflects body iron stores?

• ASerum ferritin
• BHemoglobin concentration
• CMean corpuscular volume (MCV)
• DSerum transferrin saturation