Total Points: 100
Since it is a take home exam, you may use notes/references.
Section I – Metabolic & Neurological Disorders (32pts)
- In general, what are the medical nutrition therapy goals for metabolic disorders? (4pts)
Medical nutrition therapy goals entail controlling the body weight of the patient, encouraging physical exercises to increase cardiovascular endurance and strength, maintaining favorable of both low and high density lipoprotein cholesterol, watching and maintaining favorable blood pressure and glucose level.
- Which amino acid is a patient with the phenylketonuria (PKU) unable to synthesize since phenylalanine cannot be metabolize? What role does this amino acid play in the body? (5pts)
The hepatic enzyme phenylalanine hydroxylase is unable to metabolize the amino acid phenylalanine and convert it into the tyrosine amino acid. Phenylalanine is a building block for protein in the body. It is found in foods. They are of three types: the L-phenylalanine, the D-phenylalanine, and the DL-phenylalanine (a combination of the first two types). Phenylalanine is necessary for making proteins, chemicals of the brain, and thyroid hormones. Deficiency of phenylalanine leads to energy deficiency, poor concentration and memory, lack of appetite, and depression (Swiller 1).
- What foods (provide examples) does a patient with PKU need to avoid and why? (4pts)
A patient with PKU need food with low phenylalanine (Phe). Therefore, they should avoid foods with large amounts of Phe. These foods are those with high amount of protein and they include chicken, eggs, fish, meat, milk, dairy products, nuts, and beans. These foods increases Phe levels that is not necessary for people with PKU.
- What barriers could affect a patient’s compliance with the PKU diet? (Give a minimum of 4 examples) (4pts)
Social status affects the dietary compliance of people with PKU. Foods a patient can financially afford will determines what he or she eats. A patient with adequate financial support will be able to control his or her diet that a patient who has poor financial support and has limited choice in the foods to eat.
Emotional support from family members and friends affects the dietary compliance of the patient. A patient who receives support from family and friend will find it easy to adhere to the required diet.
Peer pressure affects patients’ compliance with diet. It mostly affects school children and teenagers. In a school, for instance, a student diagnosed with PKU will find it hard to avoid peer pressure and eat a special food different from the rest.
Personal discipline of the patient will also determine his or her compliance with the PKU diet. Dedicated patients will comply with the diet while not loyal ones will go away from the required diet.
- What are the nutritional concerns for a patient with MSUD? What types foods should they avoid (give examples)? (4pts)
A patient with MUSD has increased levels of amino acid in his/her blood stream because his/her body cannot break them down. This patient should avoid foods with high proteins such as fish, meat, milk, chicken, nuts, and beans.
- Describe five warning signs a patient exhibit if they have an oral/eating problem? (5pts)
Weight loss is the first sign of an eating disorder. An individual suffering from this problem avoids certain foods and drinks so as to stay thin.
A patient thinks that he/she is fat but in the real sense they are thin. He/she will not be confident about his/her weight.
A patient will do anything to avoid gaining weight. For instance, some will make themselves vomit after eating so as not to gain weight.
The patient reports of feeling dizzy and headaches. It is due to energy deficiency in his/her system.
The patient experiences hair loss and has pale/green patches on the skin. It is due to lack of nutrients that are responsible for proper hair growth and fighting pathogens. Due to this, the patient will also report being sick frequently.
- There are three phases of swallowing. List two problems along with the medical nutrition therapy associated with: (6pts)
Section II – Eating Disorders (68pts)
- Which eating disorder is considered to be compensatory? (2pts) Why are the disorders classified as compensatory? (4pts)
Compensatory eating disorders are those that the patient tries to undo eating. A patient will induce vomiting, avoid calorie intake, use diet pills, spit food after chewing, or over-exercise so as to relieve him/herself of the guilt associated with consuming “a lot of ” calories. Compensatory eating disorders are Anorexia nervosa and Bulimia nervosa.
- Please explain the female athlete triad. (8pts)
Female Athlete Triad is a condition where an individual is diagnosed with an eating disorder, has decreased bone mineral density, and has amenorrhoea all at the same time. It is common in female who take part in sports and insist on maintaining a low body weight. With an increase in the number of women getting into sports, the number of this syndrome recorded has been on the rise. Females who take part in sports may fail to balance their calories intake with the calories they burn due to low self-esteem and family stress hence
- How would one assess a patient with ED?
- General ED assessment: (6pts)
Assessing Eating Disorder (ED) involves carrying out physical exams, urine and blood test, and psychological evaluation for the patient. To be diagnosed with an eating disorder, the patient must prove to eat large amount of food and has no control over it. This eating may occur when the patient is not hungry, is embarrassed, guilty, or disgusted. The patient shows concerns about his/her eating habits but does not do extreme action e.g. induce vomiting to kill the guilt.
- Explain the difference in assessments between AN, BN and BED. (14pts)
- What is the appropriate protocol for treatment of AN and BN? (i.e. who is involved in the treatment of ED and what are their roles) (10pts)
In treating Anorexia Nervosa, it is important to check for important signs such as level of hydration, level of electrolytes, and physical conditions. In extreme cases, the patient can be fed through tubes before giving the required therapy. However, the first goal is to make the patient gain weight to the required level. It happens with the help of a psychologist or dietitian. Individual, family-based, or group therapy will also help the patient make sound decisions and make proper eating patterns. There is no a discovered medication for Anorexia Nervosa (Minuchin 124).
In treating Bulimia Nervosa a combination of antidepressants and psychotherapy works best. Treatment through psychotherapy entails the patient sharing his/her condition with a mental specialist. The mental specialist helps the patient deal with the condition. The specialist help them differentiate between unhealthy and healthy beliefs, help them make good relationships and maintain them through communication, and to learn important life skills such as how to tolerate stress and control emotions. Antidepressants such as fluoxetine and serotonin inhibitors work along well with the therapies. Education about nutrition will help the patient to recover from underweight (Herzog 829).
In treating eating disorders, mental specialists and medical practitioners work together. The mental specialists make the patient change perception about him/herself. The medical practitioner administers medication to the patient.
- What is the appropriate MNT for AN and BN? (14pts)
- What are some potential physiological and psychological side effects a patient with AN can suffer from post-MNT? (10pts)
For a post-MNT patient, the physiological side effects include an increase in body weight. Due to consumption of adequate nutrients, the patient also gains a strong immune system. He/she does not experience frequent illness or exhibit signs of other illnesses.
- Psychological/ psychosocial
A post- Anorexia Nervosa patient will show an increase on self-esteem. He/she gets a new perception about him/herself. They begin to form new and lasting relationships with other people.
Herzog, David B., et al. "Recovery and relapse in anorexia and bulimia nervosa: a 7.5-year follow-up
study." Journal of the American Academy of Child & Adolescent Psychiatry 38.7 (1999): 829-837.
Minuchin, Salvador, et al. Psychosomatic families: Anorexia nervosa in context. Harvard University
Swiller, Michael J., and DACBN CCN. "Nutritional Considerations in the Diagnosis and Treatment of
Attention Deficit Disorder." NUTRITIONAL PERSPECTIVES: 30.