Past Papers | Clinical Nutrition | Cmt Nta 4 | Clinical Medicine First Year

 Past Papers | Clinical Nutrition | Cmt Nta 4 | Clinical Medicine First Year

1. There are five 5 food groups which are:

Ø Cereals, Green Bananas, Roots and Tubers

Ø  Pulses, Nuts and Foods of Animal Origin

Ø Fruits

Ø Vegetables

Ø Fats and Oils, Sugars, Honey

2. Dietary fibre is a food component that cannot be fully broken down by digestive enzymes. Food high in dietary fibre helps to enhance bowel function and as a result it can prevent and sometimes treat constipation.

3. Balanced meal is a meal which contains a mixture of foods from all food groups



4. Digestion: is the process by which food is broken down into simple chemical compounds that can be absorbed and used as nutrients

5. Absorption: Is the process of liquid, gas  or other substance (final products of digestion) being taken into the blood stream through villi in the small intestine

6. Carbohydrates: is any of a large group of organic compounds occurring in foods and living tissues and including sugars, starch, and cellulose. They contain compounds of carbon, hydrogen and oxygen atoms

7. Fat/Lipids: is a substance such as oil or wax dissolved in alcohol but not in water  

8. Villi: are the smallest finger like projection which are found all over the mucous layer of small intestine. Their functions are to absorb the amino acid, glucose, fatty acid and glycerol, water, mineral salts and vitamins after digestion has been completed

9. Anaemia: deficiency/reduction of number of red blood cells in the body which decreases oxygen capacity of the blood.

10. Ant-nutrients: Substances in food that are natural poisons or toxins e.g. (the poison in bitter cassava) or that interfere with digestion, absorption or use of nutrients in the body

11. Antioxidants: Molecules, which can either be nutrients or enzymes and sometimes both, which mop up damaging fundamental nature in our bodies.

12. Balanced Diet: A diet which provides adequate amount of all nutrients required by the body.

13. Bio-availability: The degree to which a nutrient is absorbed or becomes available at the site of physiological activity after intake.

14. Body Mass Index: Weight (kg) divided by height (m2). 

15. Calorie: A measure of energy content in foods.

16. Complementary Feeding: The child receives solid (or semi-solid) foods in addition to breast milk or suitable breast milk substitute after six months of age.

17. Complementary Foods: Foods or liquids whether manufactured or locally prepared, given to a baby in addition to breast milk or infant formula after six months to satisfy their nutritional requirements.

18. Dietary Fibres:The non-digestible carbohydrates and lignin found intact in plants. It facilitates the emptying of the bowel.

19. Enzymes:These are chemical substances proteins in nature found in the body that speed up the rate of chemical reactions but are not changed in the process 

20. Essential Nutrient: A nutrient which is necessary for life and cannot be synthesized by the body therefore it must be included in the diet. 

21. Exclusive Breastfeeding:Giving a baby only breast milk but no other food or drink not even water (with the exception of medicines and vitamin or mineral drops prescribed by doctor; suckling directly from the breast, expressed breast milk is also permitted

22. Exclusive Replacement Feeding: Breastfeeding is completely replaced with suitable breast milk substitute and no other foods, liquids or solids, not even water (with the exception of medicines and vitamins or mineral drops or syrups prescribed by a medical personnel).

23. Fermented Foods: Foods that have been subjected to processing, involving the action of yeasts or bacteria for example, yoghurt (mtindi), togwa and fermented porridge.  

24. Germinated Foods: Foods made from seeds that have started to sprout for example kimea. It can be from millet, maize, beans or legumes.

25. Health Diet: A diet with appropriate types and adequate amounts of foods and drinks to supply nutrient for maintenance of body cells, tissues, and organs, and to support normal growth and development

26. Healthy Eating: Eating patterns, which involve a variety of culturally acceptable foods, balanced by a moderation intake of each food from all food groups, to provide sufficient nutrients that are required for growth, development, physical activity as well as for the maintenance and restoration of health.

27. Healthy Lifestyle: A way an individual or a community, practices good social, physical, mental, spiritual health, and in harmony with internal and external environment.

28. Lactation: The process of synthesizing and secreting breast milk.

29. Malnutrition: An abnormal physiological condition caused by deficiencies, excesses or imbalance of energy and nutrients in the body.

30. Metabolism: A chemical process within cells whereby energy is produced enabling the body to maintain life.

31. Mother-to-Child Transmission (MTCT): Transmission of HIV from mother to her child during pregnancy; at the time of labour and birth or through breastfeeding.

32. Nutrients: Substances found in foods that provide energy, enhance growth, help repair body tissues and regulate body functions.

33. Nutrition: The way our bodies take in and use food 

34. Nutritional Assessment: The measurement of nutritional status. It is based on anthropometric (scientific study of measurement) and biochemical data, and a dietary history. 

35. Nutrition Status:Is the state (Grade) of health produced by the balance between requirement and intake of nutrients.

36. Nutritional Supplements: These are the products taken in by mouth and contain dietary ingredients, which may include vitamins, minerals or amino acids, as well as other substances such as enzymes

37. Obesity: A condition of being ‘too fat’. In adults it means having a BMI of 30 and above.

38. Overweight: A condition of having a weight that is ‘too high’ in relation to a person’s height. In adults it means having a BMI of 25 – 29.9. When a person is overweight, usually energy intake by the body is higher than energy expenditure.

39. Replacement Feeding: Feeding infants (who are receiving no breast milk) with a diet that provide all the nutrients the child need until the child can be fully fed on family foods. During the first six months of life, replacement feeding should be a suitable breast milk substitute.

40. Osteoporosis: A condition characterised by progressive decrease in bone density. The bones become fragile and more likely to break. If left untreated, osteoporosis can progress painlessly until a bone breaks.

41. Under nutrition, occurs when nutrients intake does not meet nutrients needs.Stores are then used up and health declines.

42. Over nutrition, is a prolonged consumption of more nutrients than the body needs, can lead to over nutrition. In the short run, for instance a week or two, over nutrition may cause a few symptoms such as GI tract distress from excess dietary fibre or iron intake. But if kept up some nutrients may increase to toxic amount which can lead to serious disease.

43. Common micro-nutrient deficiencies

Ø Nutritional anaemia

Ø Iodine Deficiency Disorders (IDD)

Ø Vitamin A deficiency


· Causes of malnutrition including severe malnutrition causes can be described into three categories

Ø Immediate causes

Ø Underlying causes

Ø  Basic causes


· Metabolism: Is a term used to describe all the changes which are concerned with the use of food once it is absorbed in the alimentary canal

· Catabolism: Is the breakdown of complex molecules in living organisms to form simpler ones, together with the release of energy.

· Anabolism: is a process in which the liver creates new proteins from digested nutrients.

· Carbohydrate metabolism: A general term for any metabolic activity—e.g., breakdown of starches and sugars into smaller units—to be used for energy, or the storage. E.g. glycogen storage in the liver.

· Once the glucose reaches the liver the following may occur:

Ø It can be used to provide energy to the liver itself

Ø The liver may give back the glucose to the blood stream to maintain the level of blood sugar

Ø Can be converted into glycogen then stored in the liver for later use

Ø It can be converted into fats

Ø If the glucose needed for energy and heat production it is first changed into a form which is called: LACTIC ACID (is a compound produced when glucose is broken down and oxidized


· Polysaccharides: are called complex carbohydrates, are chemically the most complicated carbohydrates. It contains large number of monosaccharides, are combined

· Disaccharides: Is a type of simple sugar formed, when two monosaccharides are joined.

· Monosaccharides: These are the simplest form (unit) of sugar.

· Glycolysis: is the process that allows the simple sugar glucose, which comes from your food, to be broken down into usable energy.

· Gluconeogenesis: Is the formation of glucose, especially by the liver, from non-carbohydrate sources, such as amino acids and the glycerol portion of fats

· Pentose phosphate pathway Is a series of biochemical reactions in which glucose is converted into other molecules such as those needed to synthesize nucleic acids

· Pentose: is carbohydrate with five-carbon sugar

· Protein metabolism: is the process whereby protein foods are used by the body to make tissue proteins, together with the process of breakdown of tissue protein in the production of energy.

· The nitrogen cycle describes how nitrogen moves between plants, animals, bacteria, the atmosphere (the air), and soil in the ground.

· Nitrogen is found in the amino acids and it plays a role in the nucleic acids. These acids make proteins that we need in our body. Nitrogen is an important element to all life on Earth

· Amino acid is subdivided into main groups;

Ø Essential amino acid and

Ø Non-essential amino acid

· Fats deposits are:

Ø Greater omentum

Ø Around the kidney

Ø In the breast

Ø Buttocks and

Ø Hips

· Anaemia is classified according to causes and mechanism of its development:

Ø Haemorrhagic anaemia

Ø Haemolytic anaemia

Ø Hypo plastic/Aplastic anaemia

Ø Nutritional anaemia

· Signs and Symptoms of Iron Deficiency Anaemia (IDA)

Ø Tiredness and fatigue

Ø Dizziness and/or headaches

Ø Palpitations     

Ø Difficulty in breathing on exertion

Ø Inadequate temperature regulations

Ø Mild degree of splenomegaly

Ø Pallor of the mucous membrane and beneath the nail.

Ø Brittle finger nail (sometimes spoon shaped-koilonychias)


· The following are the major complications of anaemia.

Ø Heart failure

Ø Reduced mental capacity.

Ø Anaemia negatively affects school performance

Ø Reduced immune competence, leading to high incidences of diseases

Ø Poor pregnancy outcomes (low birth weight, spontaneous abortion, premature delivery)

Ø Failure of mothers to withstand blood loss at delivery and hence increased risk of maternal deaths

· Groups with High Risk for Anaemia are:

Ø Women, especially during pregnancy or soon after delivery

Ø Babies who are low birth weight or not breast fed

Ø Premature babies

Ø Young children especially if they are malnourished

Ø Sickle cell disease patients

Ø Adolescents, who are growing fast, especially girls

Ø Older men and women, especially if they are poor


· Strategies for prevention and control of anaemia

Ø Promotion of consumption of iron- and vitamin-rich foods

Ø Prevention and treatment of anaemia-related diseases (malaria, worm infestation)

Ø Iron and folic acid supplementation to the most at risk groups (children, pregnant women, sickle cell disease patients)

Ø Building up of foods with relevant nutrients (iron, folic acid)



· Iodine Deficiency Disorders (IDD);isdeficiency of iodine in the body.

· Hyperthyroidism:Is an increased production of thyroid hormone,

· Hypothyroidism:is a deficiency of thyroid activities (which is low production of thyroid hormone)

· How to examine and classify goitre

Ø Stand or sit facing the person

Ø Place your two thumbs on either side of the person’s trachea, several centimetres below the larynx (voice box)

Ø Roll your thumbs gently over the thyroid (which lies next to the trachea). This is called palpation.

Ø If each lobe of the thyroid is smaller than the end joint of the person’s thumb, there is no goitre.

Ø If one or both lobes are larger than the end joint of the person’s thumb, then there is goitre.

Ø Ask the person to bend their head back and look upward. Try to see the goitreAsk the person to look straight forward, and try to see the goitre again.



· Iodine classification;


Ø Grade 0 No goitre lobes smaller than

end joint of thumb

Ø Grade 1A Thyroid lobes larger than ends

of thumbs

Ø Grade 1B Thyroid gland visible with

head bent back

Ø Grade 2 Thyroid gland visible with head

in normal position

Ø Grade 3 Thyroid gland visible from

about ten meters 


· A person who is hypothyroid:

Ø Feels cold easily

Ø Moves slowly and lacks energy

Ø Think slowly and appear unconcerned

Ø May be sleepy

Ø Has a dry skin

Ø May be constipated

· Women who are hypothyroid during pregnancy may also have;

Ø Miscarriage or still birth

Ø Low birth weight babies

Ø Babies with congenital deformities,

Ø Babies with cretinism


· Cretinism: poor physical & mental development, there are two types of cretinism;

Ø Neurological cretinism

Ø  Hypothyroid cretinism


· The effect of Neurological cretinism;

Ø Squint (eyes are not held straight)

Ø Weakness and stiffness especially of the legs

Ø Severe mental handicap (defect)

Ø Deafness and mutism (the child cannot speak)


· Various medicinal preparations are administeredfor control of iodine deficiency, such as:

Ø Injectable iodized oil

Ø Iodinated oil capsules

Salt iodation’s

· VITAMINS. Are essential organic substances needed in small amounts in the diet for normal function, growth, and maintenance of body tissues

· Vitamins are classified into two groups:

Ø water-soluble

Ø fat-soluble.


· Fat soluble vitamins have the following general properties:

Ø They consist only carbon, hydrogen and oxygen

Ø  They are soluble in fats

Ø   They are relatively stable (compared to water soluble vitamins during processing, preservation and preparation of foods

· There are a total of ninewater-soluble vitamins:

Ø Thiamine (vitamin B1)

Ø Riboflavin (vitamin B2)

Ø Niacin or Nicotinic acid (vitamin B3)

Ø Biotin (Vitamin B7)

Ø Pantothenic acid (Vitamin B5)

Ø Focalin (folic acid) (Vitamin B9)

Ø Cobalamin (vitamin B12)

Ø Pyridoxine (vitamin B6) – which functions as co-enzyme in the synthesis and breakdown of amino acids. It is therefore important in the metabolism of protein

Ø Ascorbic acid (vitamin C) – involved in the formation of collagen. Also enhances absorption of iron in the gut. 



· Vitamin A It plays important roles in the body including;

Ø Vision

Ø Maintenance of epithelial tissue

Ø Synthesis of mucous secretion

Ø Formation of bones

Ø Growth and development,

Ø Immune function and

Ø Reproduction

Ø Also works as an antioxidant and fighting cell damage



· The common symptoms and signs Vitamin A deficiency include:

Ø Night blindness: Reduced ability to see in dim light.

Ø Conjunctival neurosis: Drying of the conjunctival, patches of neurosis give the appearance of sandbanks at receding tide. The conjunctiva loses its bright and shiny and often becomes thickened, wrinkled and sometimes pigmented.

Ø Bigot’s spot: Triangular-shaped, raised whitish plaques that occur in both eyes

Ø Corneal neurosis: Drying of the cornea surface, appears unclear and then rough on simple examination

Ø Exophthalmic fundus: Sometimes seen early in the disease, the retina has white dots around the periphery of fundus. They disappear following treatment.




· Complications of Vitamin A deficiency include:

Ø Corneal ulceration: Following cornea neurosis, the cornea is softening with ulceration, and areas of necrosis

Ø Keratomalacia: Perforation of the cornea prolapsed of the iris, loss of ocular contents and perhaps destruction of the eye. Total blindness often occurs following keratomalacia.

Ø Corneal scar: Occurs when treatment is introduced, when a corneal ulcer is still small and it is healed.

· VitaminsB; Are a class of water-soluble vitamins that play important roles in cell metabolism

· Roles of Vitamin B1;


Ø All B vitamins help the body change food (carbohydrates) into fuel (glucose), which the body uses to produce energy

Ø  Also help the body metabolize fats and protein.

· Complications of vitamin B1 (thiamine) deficiency;

Ø Thiamine deficiency causes beriberi.

Ø It occurs when people consume highly milled polished rice or maize, and starchy roots such as cassava, which are removal of thiamine content. 

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