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An RDN observes angular cheilosis, glossitis, and a smooth red tongue in an 85-year-old vegetarian. Which deficiency is MOST likely?

Vitamin B12

Vitamin C

Selenium

Vitamin K

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2026 Statistics

Key Facts: CSG Exam

150

Total Items

125 scored + 25 pretest

3 hrs

Time Limit

CDR

41%

Largest Domain Weight

Nutrition Assessment

2,000 hrs

Required Experience

Gerontological nutrition within 5 years

$350

US Exam Fee

$475 international

5 years

Certification Validity

CDR

The CSG (Board Certified Specialist in Gerontological Nutrition) exam is administered by CDR. The exam consists of 150 multiple-choice items (125 scored + 25 pretest) over 3 hours. The fee is $350 US / $475 international. Eligibility requires an active RD/RDN credential plus 2,000 hours of gerontological nutrition practice within the past 5 years. Nutrition Assessment is the largest domain at 41%. Year-round PSI testing. Mastery of MNA-SF, GLIM, EWGSOP2 sarcopenia, NPIAP pressure injury MNT, and CMS F-tag regulations is essential.

Sample CSG Practice Questions

Try these sample questions to test your CSG exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1An 82-year-old community-dwelling woman scores 9 on the MNA-SF. According to the validated cutoffs, how should the RDN interpret this score?

A.Normal nutritional status, no further action needed

B.At risk of malnutrition; proceed to a full nutrition assessment

C.Malnourished; initiate enteral nutrition immediately

D.Score is invalid because the patient is community-dwelling

Explanation: MNA-SF score interpretation per Nestle Nutrition Institute: 12-14 normal, 8-11 at risk of malnutrition, 0-7 malnourished. A score of 9 places this patient in the 'at risk' category, triggering completion of the full MNA or another comprehensive nutrition assessment. The MNA-SF is a screening tool, not a diagnostic tool, so enteral nutrition would not be initiated based on this score alone.

2Which screening tool was specifically developed and validated for use across all care settings (community, hospital, and long-term care) and uses BMI, unplanned weight loss, and acute disease effect?

A.MNA-SF

B.MUST (Malnutrition Universal Screening Tool)

C.SARC-F

D.NRS-2002

Explanation: MUST was developed by BAPEN for use in any adult care setting and uses three independent criteria: BMI score, unplanned weight loss score, and acute disease effect score. Total score categorizes risk as low (0), medium (1), or high (>=2). MNA-SF is geriatric-specific, SARC-F screens for sarcopenia, and NRS-2002 was developed primarily for hospitalized patients.

3An RDN screens a 78-year-old man in a primary care clinic using SARC-F. He scores 5. What does this score indicate?

A.Normal muscle function

B.Suggestive of sarcopenia; further evaluation with strength and muscle mass measurement is warranted

C.Definitive diagnosis of severe sarcopenia

D.Frailty per Fried criteria

Explanation: SARC-F (Strength, Assistance walking, Rise from chair, Climb stairs, Falls) scores >=4 are predictive of sarcopenia and adverse outcomes. It is a screening tool, not diagnostic. Per EWGSOP2, a positive SARC-F should trigger assessment of muscle strength (e.g., grip strength or chair stand), then muscle quantity/quality, then physical performance to confirm and stage sarcopenia.

4Per the EWGSOP2 algorithm, which finding is required to confirm a diagnosis of sarcopenia in an older adult?

A.Low gait speed alone

B.Low handgrip strength alone

C.Low muscle strength PLUS low muscle quantity or quality

D.Body mass index below 22 kg/m^2

Explanation: EWGSOP2 (2019) updated criteria: low muscle strength (probable sarcopenia) is the primary parameter; sarcopenia is confirmed by additionally demonstrating low muscle quantity or quality (e.g., DXA, BIA, CT). Severe sarcopenia is diagnosed when low physical performance is also present. BMI is not part of the diagnostic criteria.

5Using the GLIM criteria, malnutrition diagnosis in an older adult requires the presence of at least one phenotypic criterion AND at least one etiologic criterion. Which of the following is a GLIM phenotypic criterion?

A.Reduced food intake or assimilation

B.Inflammation related to acute disease/injury

C.Reduced muscle mass

D.Inflammation related to chronic disease

Explanation: GLIM phenotypic criteria are: (1) non-volitional weight loss, (2) low BMI, and (3) reduced muscle mass. Etiologic criteria are: (1) reduced food intake or assimilation and (2) disease burden/inflammation (acute or chronic). GLIM has been validated in older adult populations across care settings.

6Which anthropometric measurement is MOST appropriate when an older adult cannot stand for height measurement due to severe kyphosis?

A.Wrist circumference

B.Knee height with Chumlea equation

C.Self-reported height from 30 years ago

D.Skip height; use weight only

Explanation: Knee height measurement combined with the Chumlea equation provides a validated estimate of stature in older adults who cannot stand or have spinal deformities such as kyphosis. Self-reported peak adult height overestimates current height (older adults lose ~1 cm per decade after 40), and weight alone cannot calculate BMI or estimate energy needs.

7An 80-year-old long-term-care resident has a BMI of 21 kg/m^2. According to ESPEN guidelines on nutrition in the elderly, how should this BMI be interpreted?

A.Normal, no concern

B.Low for an older adult; ESPEN suggests BMI <22 kg/m^2 indicates increased risk

C.Overweight by geriatric standards

D.Severely obese

Explanation: ESPEN guidelines on clinical nutrition and hydration in geriatrics suggest the BMI cutoff for low body weight in older adults is <22 kg/m^2 (vs. <18.5 in younger adults). Lower BMIs in older adults are associated with higher mortality. GLIM also uses age-adjusted BMI cutoffs (<22 if age >=70).

8Which nutrition-focused physical exam (NFPE) finding is consistent with severe muscle wasting in the temporalis region?

A.Rounded, well-defined temple

B.Hollowing/scooping above the cheekbone with prominent bony arch

C.Visible orbital fat pad

D.Smooth supraclavicular contour

Explanation: Severe temporal wasting is characterized by hollowing/depression in the temple area with the zygomatic arch becoming prominent. NFPE muscle exam sites include temple, clavicle, shoulder (deltoid), scapula, dorsal hand (interosseous), thigh (quadriceps), and calf (gastrocnemius). NFPE is one of six characteristics in the AND/ASPEN adult malnutrition diagnostic criteria.

9A nursing home resident has bilateral pitting edema to the knees. How does this affect nutritional assessment using AND/ASPEN malnutrition criteria?

A.Edema cannot be considered in malnutrition diagnosis

B.Generalized fluid accumulation is one of the six criteria and may mask weight loss

C.Edema confirms overnutrition

D.Edema only matters in pediatric assessment

Explanation: The AND/ASPEN consensus statement lists six characteristics for malnutrition diagnosis: insufficient energy intake, weight loss, loss of muscle mass, loss of subcutaneous fat, localized/generalized fluid accumulation that may mask weight loss, and diminished functional status (handgrip strength). Fluid accumulation can hide weight loss and should be documented during NFPE.

10An RDN observes angular cheilosis, glossitis, and a smooth red tongue in an 85-year-old vegetarian. Which deficiency is MOST likely?

A.Vitamin C

B.Vitamin B12

C.Vitamin K

D.Selenium

Explanation: Glossitis (smooth, beefy red tongue), angular cheilosis, and pallor are classic findings in vitamin B12 deficiency, which is common in older adults due to atrophic gastritis (~30% prevalence after age 60), reduced intrinsic factor, PPI use, metformin, and vegetarian/vegan diets. The Institute of Medicine recommends adults >50 obtain B12 from fortified foods or supplements due to absorption issues.

About the CSG Exam

Specialty certification for Registered Dietitians providing nutrition care to older adults across community, ambulatory, hospital, post-acute, long-term care, and hospice settings. The CSG validates expertise in geriatric nutrition assessment (sarcopenia, frailty, malnutrition with GLIM), evidence-based interventions for the complex comorbidities of aging (dementia nutrition with comfort-feeding for advanced disease, CKD-elderly individualized protein, pressure injury MNT, T2DM with relaxed A1c targets), foodservice operations, and the unique regulatory environment of long-term care (CMS F-tags, MDS 3.0).

Questions

150 scored questions

Time Limit

3 hours

Passing Score

Scaled

Exam Fee

$350 US / $475 international (CDR)

CSG Exam Content Outline

41%

Nutrition Assessment

MNA-SF/MNA, GLIM, sarcopenia (EWGSOP2/SARC-F), frailty, NFPE, pressure injury staging

37%

Nutrition Interventions

Sarcopenia (PROT-AGE protein), dementia comfort feeding, dysphagia/IDDSI, CKD-elderly, pressure injury, dehydration

22%

Foodservice & Food Safety

LTC regulations (CMS F-tags), MDS 3.0, FDA Food Code, OAA Title III programs

How to Pass the CSG Exam

What You Need to Know

Passing score: Scaled
Exam length: 150 questions
Time limit: 3 hours
Exam fee: $350 US / $475 international

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

CSG Study Tips from Top Performers

1Master MNA-SF: 6 items, total score ≤11 indicates risk for malnutrition, score ≥12 normal nutritional status. Full MNA adds 12 items for diagnostic confirmation

2Memorize EWGSOP2 sarcopenia algorithm: SARC-F screen → measure muscle strength (grip <27 kg men / <16 kg women) → if low, measure muscle quantity (DXA, BIA) → if low quantity = sarcopenia → measure physical performance (gait speed ≤0.8 m/s = severe)

3Know ESPEN PROT-AGE protein: 1.0-1.2 g/kg/d healthy older adult, 1.2-1.5 g/kg/d acute illness, up to 2.0 g/kg/d severe illness/wounds; distribute evenly with leucine-rich sources

4Understand IDDSI framework: Levels 0-7 (0 = thin liquid, 1-4 = thickened liquids slightly to extremely, 3-7 = liquidised to regular solids); flow test for liquids, fork-pressure test for foods

5Know NPIAP pressure injury MNT: 30-35 kcal/kg, 1.25-1.5 g/kg protein, supplement vit C and zinc only if deficient, arginine-enriched ONS for stage 3-4, hydration

6Master CMS LTC F-tags: F692 (nutrition/hydration), F812 (food safety), F806 (resident choice of foods); MDS 3.0 weight loss thresholds 5%/30 days, 7.5%/90 days, 10%/180 days = significant

Frequently Asked Questions

Who is eligible for the CSG exam?

You need an active CDR Registered Dietitian (RD or RDN) credential held for at least 2 years plus a minimum of 2,000 hours of documented gerontological nutrition practice within the past 5 years. The exam is offered year-round through PSI test centers.

What is the most heavily weighted CSG domain?

Nutrition Assessment carries the largest weight at 41%. This domain emphasizes geriatric-specific screening tools (MNA-SF with ≤11 = at risk, full MNA), GLIM criteria (phenotypic + etiologic, validated for older adults), sarcopenia screening (SARC-F) and EWGSOP2 algorithm (low strength → low quantity → low function = severe), Fried frailty phenotype (5 criteria), dehydration assessment, and NPIAP pressure injury staging.

What protein recommendations apply to older adults?

Per ESPEN PROT-AGE: 1.0-1.2 g/kg/d in healthy older adults; 1.2-1.5 g/kg/d in acute illness; up to 2.0 g/kg in severe illness or wounds. For CKD-elderly, individualize — KDIGO suggests 0.6-0.8 g/kg in CKD non-dialysis but balance against sarcopenia risk. Distribute protein evenly across meals (~25-30 g per meal) with leucine-rich sources (whey protein, HMB) for sarcopenia management.

Should advanced dementia patients get tube feeding?

No — major US geriatric and palliative organizations (AGS, AAHPM, ASPEN, AMDA) recommend AGAINST tube feeding in advanced dementia. Evidence shows tube feeding does NOT prolong life, prevent aspiration pneumonia, or improve pressure injury healing in this population. Comfort feeding (assisted oral feeding focused on pleasure and quality of life) is preferred. This is a heavily tested CSG topic.

How should I study for the CSG exam?

Plan 60-100 hours over 8-12 weeks. Focus heavily on Nutrition Assessment (41%) and Nutrition Interventions (37%) — together 78% of the exam. Master MNA-SF and full MNA, GLIM criteria, EWGSOP2 sarcopenia algorithm, Fried frailty, ESPEN PROT-AGE protein recommendations, AGS/AAHPM advanced dementia comfort feeding, IDDSI dysphagia framework, NPIAP pressure injury MNT, and CMS LTC F-tag regulations.