Question 1

For which condition might a ketogenic diet be used in treatment?

Accepted Answer

The ketogenic diet, which is set up to create and maintain a state of ketosis, has been used to effectively control seizure activity in children with epilepsy.The diet focuses on providing a fat-to-protein and carbohydrate ratio of 4:1 calories.For myasthenia gravis, nutrition therapy is focused on ensuring intake despite chewing and swallowing difficulties.For migraine headaches, nutrition therapy eliminates foods that seem to trigger migraines while maintaining adequate fluid for rehydration.For patients who develop GBS, high calorie and protein intakes are necessary to counter the hypercatabolism associated with the condition.

Question 2

Which of the following is NOT true of head-injured patients?

Accepted Answer

Head injury results in hypermetabolism evidenced by increased energy expenditure and profound urinary nitrogen loss.Correlations between the severity of brain injury as measured by the Glasgow Coma Scale and energy requirements have been shown.

Question 3

Which of the following is the inability to perform purposeful, complex movements, although no sensory or motor impairment is evident?

Accepted Answer

Lesions in the central portion of the frontal lobe may present with apraxia, the inability to execute purposeful movements.Aphasia is an impaired or absent comprehension or communication because of a lesion of the dominant cerebral hemisphere.Anosmia is the loss or impairment of smell caused by a lesion near the base of the brain.Agnosia is a loss of comprehension that is associated with Alzheimer disease.

Question 4

Pyrazole curcumin is being actively researched for treatment for

Accepted Answer

An experimental dietary protocol based on pyrazole curcumin is being investigated to reestablish membrane integrity in traumatic brain injury.Omega-3 fat and ketogenic diets are also actively being researched for this condition.

Question 5

The Frazier free water protocol is used for patients with

Accepted Answer

The Frazier free water protocol allows patients with swallowing impairment (dysphagia) to safely drink unthickened water between meals.Water is the least likely liquid to cause aspiration pneumonia when provided in the atmosphere of good oral hygiene.Wernicke-Korsakoff, brain trauma, and multiple sclerosis patients would only use the Frazier free water protocol if they also had dysphagia.

Question 6

On the Dysphagia Outcome and Severity Scale, at what level is total assistance for the patient necessary?

Accepted Answer

Patients rated at Level 3 have moderate dysphagia that requires total assistance, supervision, or strategies to ensure that they do not choke or aspirate on oral intake.Level 7 is associated with no dysphagia, and the patient can consume a normal diet.At Level 5, the patient has mild dysphagia that may need one diet consistency modification, but the patient does not require constant or direct supervision or assistance.A person with severe dysphagia who is unable to tolerate any oral intake safely is rated at Level 1.

Question 7

A patient with amyotrophic lateral sclerosis (ALS) has a rating of 3 or 4 on the swallowing severity scale.Which of the following interventions would be recommended in the medical nutrition therapy plan?

Accepted Answer

Patients with amyotrophic lateral sclerosis who rate 3 or 4 on the swallowing severity scale need supplemental tube feedings because intake by oral means is not adequate (i.e., roughly 50% to 59% of estimated needs).An ALS swallowing score of 10 is associated with normal swallowing ability.A swallowing score of 7 calls for an adjustment to small, frequent feedings.Scores of 5 and 6 indicate that the patient should be provided with a liquefied diet and a soft diet, respectively.A score of 2 or less indicates that the patient should be provided no oral intake.

Question 8

Sensory deficits of limbs on the opposite of the body that result from an occlusion of the middle cerebral artery on one side of the brain are known as

Accepted Answer

Hemiparesis is a weakness or deficit of sensation on one side of the body that is associated with damage or impairment of the brain on the opposite side.Hemiplegia is a condition of paralysis associated with half of the body.Hemianopsia is blindness in one eye that causes a person to only see half of the visual field.Hemi-inattention is the neglect of one side of the body because the patient is not able to sense that side of the body.

Question 9

Which of the following can result from thiamin deficiency?

Accepted Answer

Thiamin deficiency is the primary cause of Wernicke-Korsakoff syndrome.This is a potential side effect of alcoholism, and the syndrome manifests with encephalopathy, involuntary movement of the eyeballs, and impaired gait.Pernicious anemia is associated with vitamin B₁₂ deficiency and manifests with general weakness and tingling in the hands and feet.Pellagra results from niacin deficiency and is associated with dementia.Adrenomyeloleukodystrophy is a congenital enzyme deficiency that results in the accumulation of very-long-chain fatty acids.This disorder manifests with dementia, aphasia, apraxia, dysarthria, and blindness.

Question 10

The guideline for use of a percutaneous endoscopic gastrostomy (PEG) in patients with neurologic disease or disorders is to use

Accepted Answer

In patients with neurologic conditions, PEG placement is reserved for those whose swallowing is so affected that adequate nutritional intake cannot occur.Dysphagia places patients at risk for aspiration, so use of enteral nutrition is usually a temporary means of providing adequate nutrition while swallowing ability is reestablished.This may take several weeks to months to occur.However, because PEG feeding provides enteral formula to the stomach, appropriate positioning of the patient is necessary to prevent potential reflux and aspiration.

Question 11

Because of potential drug-nutrient interactions, it would be more beneficial to provide the majority of their dietary protein to patients with Parkinson disease

Accepted Answer

L-Dopa is given to patients with Parkinson disease to help control the tremors, rigidity, and bradykinesia associated with the disease.However, large neutral amino acids compete with L-dopa for absorption, and this is thought to alter the rate of entry of L-dopa into the circulation and its uptake into the brain.To reduce the presence of symptoms during the day when the patient is most active, dietary protein should be minimized at breakfast and lunch and added with the evening meal.This improves mobility of the patient during the day.

Question 12

What is dysphagia?

Accepted Answer

Dysphagia is a difficulty in swallowing that may be caused by various neuromuscular conditions.Inhalation of a foreign object into the lungs results in aspiration.Dysgeusia is an alteration or impairment in taste.Dysarthria is an impairment of the tongue or other muscles essential to speech that results in a person's having difficulty speaking.

Question 13

How may phenobarbital, used for anticonvulsant therapy, interfere with the intestinal absorption of calcium?

Accepted Answer

Phenytoin, phenobarbital, and primidone increase the metabolism of vitamin D in the liver.The result is that dietary calcium absorption is impaired.Long-term use of these medications places children at risk for rickets and adults at risk for osteomalacia.To prevent this, vitamin D supplementation is recommended.

Question 14

Which of the following requires the greatest coordination and control in order to swallow?

Accepted Answer

Impairments in swallowing make the intake of thin liquids dangerous because the swallowing of these cannot be controlled.Aspiration of liquids may result.To improve swallowing of liquids, thickening agents are added to provide consistency that is easier to control.Solid foods or soft foods with high water content are easier to control than liquids; however, this ease depends on factors such as texture and the ability to form a bolus.

Question 15

Damage to which of the following cranial nerves will likely affect the ability to eat food?

Accepted Answer

The glossopharyngeal or IX cranial nerve controls swallowing and the gag reflex, and it is involved with palatal, glossal, and oral sensations.The olfactory nerve affects the sensation of smell but has no control of motor function in relation to eating.The abducens nerve affects eye movement.The vagus nerve controls gastrointestinal (GI) activity and sensation of taste on the posterior third of the tongue; however, stimulation of GI activity depends on eating.

Question 16

During which phase of swallowing does bolus formation occur?

Accepted Answer

During the oral phase, food is formed into a bolus by the tongue.In the early pharyngeal phase, the bolus is propelled past the faucial arches.In the middle pharyngeal phase, the bolus is propelled down the pharynx.When the bolus passes the epiglottis, the bolus enters the esophageal phase of swallowing.

Question 17

What is the guideline for accepted weight adjusted for quadriplegia?

Accepted Answer

Loss of muscle tone caused by skeletal muscle paralysis below the point of spinal cord injury leads to decreased metabolic activity.An initial weight loss is expected; however, this weight level should be maintained to prevent further complications such as osteoporosis or obesity.For people with quadriplegia, the recommended guideline is to aim for maintaining weight 15 to 20 lb less than the ideal weight as dictated by BMI standards.The Hamwi formula does not account for levels of IBW associated with overall health and disease risk.

Question 18

Which of the following is characterized by a cholesterol plaque within an artery that ruptures and promotes platelet aggregation to clog an already narrowed artery?

Accepted Answer

The thrombotic stroke involves platelet aggregation leading to occlusion of an artery.Intracranial hemorrhage accounts for about 15% of all strokes and results from a blood vessel rupturing inside the brain.An embolic stroke happens when a cholesterol plaque is dislodged from a proximal vessel and travels to the brain to block an artery.Transient ischemic attacks are brief attacks of cerebral dysfunction that are of vascular origin with no persistent neurologic defect.TIAs may be characterized as "mini" strokes.

Question 19

Which of the following can occur with impaired swallowing?

Accepted Answer

Aspiration pneumonia is a concern in regard to dysphagia because poor control of swallowing can allow food or liquid to pass into the trachea and end up in the lungs.Hemiparesis is weakness on one side of the body, which is common in patients who have had a stroke.Hemiparesis can contribute to the possibility of aspiration.Dysgeusia is a loss of or impaired taste that can be neurologic in origin or can be affected by medication use.Comminution is a type of skull fracture that involves splintering of the bone.

Question 20

Which of the following foods is easiest to swallow for patients experiencing difficulty swallowing?

Accepted Answer

Swallowing is improved by improving the taste, texture, and temperature of the food.Thin liquids cannot be controlled during the swallowing process.By providing texture and adding sauce or gravy, foods can form a bolus, which is easier to control during swallowing.Additionally, cool and cold items are better tolerated in regard to swallowing.

Quiz 40: Medical Nutrition Therapy for Neurologic Disorders