Section 1: Clinical Nutrition

1. The Dietary Reference Intakes provide information regarding:

a. Recommended Dietary Allowance (RDA)
b. Estimated average requirement (EAR)
c. Adequate intake (AI)
d. All of the above

2. The cut off for waist circumference that indicates increased risk for CVD and DM in
South Asian women is:
a. 37 inches (94 cm)
b. 35 inches (88cm)
c. 33 inches (84 cm)
d. 31 inches (79 cm)

3. The cut off for total serum cholesterol in children 2-19 years is:
a. 150 mg/dl
b. 170 mg/dl
c. 200 mg/dl
d. No cut off has been set for children.

4. Overweight hypertensive individuals should not consume more than

a. 300 mg cholesterol/day
b. 200 mg cholesterol/day
c. 15% of calories from fat
d. 60 gm carbohydrates/day

5. The Dash diet is a:

a. Low fat eating plan
b. A low fat eating plan high in fruits and vegetables and low in dairy products
c. A low fat eating plan high in fruits and vegetables, high in protein and dairy
products
d. A low fat eating plan high in fruits and vegetables, low in animal protein
and high in low fat dairy products

6. Mr. Khan has steatorrhea and has been prescribed a low fat diet (<25 g fat/day) which is
the most appropriate dietary intake for him:
a. 4 oz lean meat or substitute and 2 fat exchanges
b. 6 oz lean meat or substitute and 4 fat exchanges
c. 8 oz lean meat or substitute and 2 fat exchanges
d. 5 oz lean meat or substitute and 3 fat exchanges

7. What is the most important factor in prevention of urolithiasis?

a. Avoiding tomato soup
b. Avoiding spinach
c. Increased fluid intake
d. Use of lemonade

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8. Mrs. Shah has Hb of 7 mg/dl. She can afford to cook meat only occasionally. Which of
the options below is not appropriate nutritional advice for her?
a. Eat an apple at least 2-3 times/week
b. Use small amounts of meat mixed with vegetables or dals 2-3 times a week
rather than cooking a larger amount of meat occasionally
c. Decrease consumption of tea
d. Include a vegetable such as a raw tomato with her meals whenever possible

9. Nutrition therapy for pernicious anemia includes:

a. A high protein diet
b. A diet high in green leafy vegetables
c. Frequent use of liver
d. All of the above

10. Which of these foods does not need to be avoided in a child with Gluten sensitivity?
a. Suji kheer
b. Homemade chapatti
c. Rice kheer
d.
e. Spaghetti

11. The most important advice for a patient with peptic ulcers is to:
a. Avoid all spices
b. Drink small amounts of milk whenever they have discomfort
c. Avoid large meals
d. Take a relatively fat free diet

12. How many calories/kg/day are adequate to preserve protein reserves in a patient with
Nephrotic syndrome?
a. 25
b. 35
c. 45
d. 55

13. Individuals with chronic liver disease need ___ gm/kg body weight/per day to maintain
nitrogen balance.
a. 0.8 gm protein
b. 1 gm protein
c. 1.2-1.5 gm protein
d. >1.5 gm protein

14. Individual who exhibit the Somogyi effect may need to:
a. Have their Blood pressure checked
b. Have their night Insulin dose reduced
c. Exercise late in the evening
d. Have a high protein diet

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15. Mrs. Khan has come to you for the nutritional management of her dyslipidemia.
According to the Stages of Change Model you would expect her to be in the:
a. Denial phase
b. The pre-contemplation phase
c. Contemplation phase
d. The active change phase

16. Individuals with type 2 diabetes

a. Should be counseled to avoid table sugar completely
b. Should be counseled to use honey as a sweetener instead of sugar
c. May consume 5% of their total caloric intake as sugar
d. The percentage of sugar they can consume depends on their total caloric
requirement

17. Individuals with the metabolic syndrome will benefit from a diet that:
a. Provides 35% of the calories from fats
b. Is low in saturated fats
c. Is low in trans fats
d. All of the above

18. The most appropriate advice for an individual with low HDL levels is:
a. Consume foods with low glycemic index
b. Maintain saturated fat intake to 7-10 % of caloric intake
c. Engage in brisk exercise regularly
d. All of the above

19. Supplementation with ________in individuals with homocysteinemia generally results in

a lowering of homocysteine levels.
a. Vitamin A
b. Vitamin B
c. Vitamin C
d. Vitamin D

20. In order to reduce thirst in patients who are fluid restricted one can advise them to
a. Carefully restrict their salt intake
b. Suck on few chips of ice
c. Suck on cold sliced fruit
d. All of the above

21. A child with galactosemia should:

a. Avoid all milk and milk products
b. Avoid all products containing lactose
c. Restrict intake of fruits such as dates and watermelons
d. All of the above

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22. One liter of a 10% dextrose solution provides ________ calories.
a. 170
b. 340
c. 400
d. 650

23. An isotonic solution of glucose contains ________% glucose.

a. 2.5
b. 5
c. 7.5
d. 10

24. Guidelines for prevention of cancer include:

a. Choose a diet rich in plant based foods
b. Maintain a healthy weight
c. Be physically active
d. All of the above

25. In individuals with cancer:

a. There is decreased ability to eat as the day progresses
b. There is an increased ability to eat as the day progresses
c. Ability to eat is not related to the time of the day
d. Late night feedings are well tolerated

Section 2: Nutrition Science

1. An apple has approximately 65 Kcal. How many Kj is this equal to?
a. 3.5
b. 4.2
c. 5
d. 5.8

2. Soluble fibers help in decreasing the absorption of cholesterol from the gut. Which one
of these is a soluble fiber?
a. Cellulose
b. Hemicellulose
c. Pectin
d. Collagen

3. Trans fats are most likely to be formed in:

a. Saturated fats
b. Poly unsaturated fats
c. Monounsaturated fats
d. Partially hydrogenated fat

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4. If water contains more __________, it is termed "hard".
a. Sodium
b. Potassium
c. Calcium and potassium.
d. Calcium and magnesium

5. Antioxidant vitamins are reported to reduce risk of NCDs. Which of the following two
vitamins are known to be antioxidants?
a. Vitamin B6 and B12
b. Vitamin C and E
c. Vitamin D and C
d. Vitamin E and K

6. Measurement of serum _______level is an excellent indicator of the size of the body’s

storage iron pool In healthy adults.
a. Transferrin
b. Ferritin
c. Hemoglobin
d. Total iron binding capacity

7. Mrs Shah has a Hb of 7 mg/dl. She would be considered:

a. Normal
b. Mildly anemic
c. Moderately anemic
d. Severely anemic

8. The elderly (age 80+) are reported to be at risk of pernicious anemia. Which of the
following is not a symptom of pernicious anemia?
a. Low serum folate levels
b. Koilonychias (cup like depressions on finger nails
c. Neuropsychiatric changes
d. Paresthesia (numbness and tingling in hands and feet)

9. Which snack has the least cholesterol?

a. Handful of cashew nuts
b. 1 cup fruit yogurt
c. 1 plate chicken salad
d. 1 roast beef sandwich

10. Which of the following is the most appropriate choice for cooking Pakistani foods if one
wants to use heart friendly oil?
a. Coconut oil as it is high in medium chain triglycerides
b. Canola oil as it has a relatively high content of MUFA
c. Corn oil as it is high in PUFA
d. Olive oil as it has the highest % of MUFA of the available oils

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11. To increase potassium intake one should consume a snack of:
a. A bowl of cereal with milk and 1 tbsp raisins
b. A bowl of fruit “chaat”
c. Some biscuits, a cup of tea and an apple
d. A cheese sandwich and a small bunch of grapes

12. The kidneys respond to respiratory acidosis by:

a. Increasing the excretion of sodium
b. Exchanging sodium for calcium
c. Increasing retention of bicarbonates
d. Exchanging potassium for hydrogen

13. Which of the following amino acid is a precursor of serotonin?

a. Phenylalanine
b. Methionine
c. Tryptophan
d. Tyrosine

14. The major functions of cholcystokinin are:

a. Stimulate the pancreas to secrete enzymes
b. Stimulate gallbladder contraction
c. Slow gastric emptying
d. All of the above

15. What percentage of protein and fat can be converted to glucose in the body?
a. 58% protein and 10% fat
b. 10% protein and 60% fat
c. 30% protein and 30% fat
d. 20% protein and 40% fat

16. During the metabolism of glucose lactate is formed:

a. When glucose is broken down under anaerobic conditions
b. When glucose is broken down under aerobic conditions
c. When there is not enough fat to provide energy
d. During sleep

17. A very high protein intake can lead to:

a. Increased urea production
b. Increased loss of calcium from the bones
c. Increased intake of cholesterol
d. All of the above

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18. Iron deficiency secondary to insufficient erythropoietin production is common in
patients of?
a. Renal disease
b. Cardiovascular disease
c. Hypertension
d. Liver disorders

19. The deficit of __________ calories is required to mobilize 1 kg of body fat.

a. 3500 Kcal
b. 5000 Kcal
c. 7700 kcal
d. 12000 Kcal

20. Very low calorie diets can result in:

a. Decrease in basal metabolic rate
b. Increased risk of gallstones
c. Increased serum uric acid levels
d. All of the above

21. Calcium requirement is influenced by _____________ In the diet.

a. Animal protein
b. Sodium
c. Oxalate
d. All of the above

22. Which of the following is the best food source of Zinc?

a. Milk
b. Beef
c. Green leafy vegetables
d. Beans

23. One retinol equivalent is equal to _________ β carotene

a. 1 mg
b. 3 mg
c. 6 mg
d. 12 mg

24. The active form of Vitamin D is:

a. Cholecalciferol
b. 25 Hydrodxy Vitamin D
c. 125 Di Hydroxy Vitamin D
d. Calcitorol

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 25. The glycemic index of a food is influenced by the:
a. Fiber
b. Particle size
c. Cooking method
d. All of the above

Section 3: Public Health Nutrition

1. According to National Health Survey of Pakistan the prevalence of anemia in women
between 15 to 44 years is about:
a. 43 to 47% of rural and 35 to 41% of urban
b. 45 to 50% of rural and 35 to 41% of urban
c. 43 to 47% of rural and 30 to 40% of urban
d. 50 to 55% of rural and 20 to 25% of urban

2. The burden of hypertension in Pakistani adults aged 40 years or above is:

a. one in six adults
b. one in five adults
c. one in four adults
d. one in three adults

3. The National Nutrition Survey of Pakistan (2001-2) presents malnutrition estimates of

less than -2 SD z-scores in under five years of age. Which of the following figures is
true?
a. Wasting 13%
b. Wasting 20%
c. Stunting 20%
d. Stunting 30 %

4. According to UNICEF State of the World’s Children data 2003-2008 the prevalence of
Low Birth Weight in the country is:
a. 25%
b. 20%
c. 30%
d. 32%

5. By the age of one year a baby should be:

a. Double the birth weight
b. Triple the birth weight
c. Four times the birth weight
d. It depends on the birth weight and cannot be predicted

6. The energy requirement of a toddler per kg body weight is:

a. 60-70 kcal/kg
b. 75-85 kcal/kg
c. 85-90 kcal/kg
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 d. 90-100 kcal/kg
7. Which of these foods should not be given to a 7 month old infant?
a. Egg yolk
b. Egg white
c. Banana
d. Biscuits

8. Recommended weight gain during pregnancy for Pakistani female who is 60 inches
(152 cm) tall and is underweight is:
a. At least 15 lbs (7kg)
b. 15-20 lbs (7-9 kg)
c. 20-25 lbs (9-11 kg)
d. 28-30 lbs (12.5-13.5kg)

9. The infant mortality rate in Pakistan is X this means that:

a. Out of 1000 mothers who are pregnant X give birth to live babies
b. Out 1000 live births x infant die in the first week of life
c. Out of 1000 live births X infants die in the first month of life
d. Out of 1000 live births X infants die in the first year of life

10. The maternal mortality is high in Pakistan because a large % of primeparas are:
a. Under 18 years of age
b. Anemic
c. Involved in physically demanding work during pregnancy
d. All of the above

11. According to Barker’s hypothesis the risk of NCD’s is increased in those infants who:
a. Have birth weights > 2500 gm
b. Are born to mothers over the age of 30 years
c. Are anemic at birth
d. Low birth weight

12. The GOP MOH does not have a program to target which micronutrient deficiency?
a. Iodine
b. Iron
c. Vitamin A
d. Vitamin D

13. Vitamin A supplementation has been reported to result in:

a. Increased infant mortality
b. Decreased maternal mortality
c. Decreased stunting in children
d. Decreased CVD risk

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14. Iodine Deficiency is prevalent:
a. Only in the Northern Areas of Pakistan
b. In the Northern Areas and in some areas of Sindh
c. In the Northern Areas, in some areas of Sindh and Baluchistan
d. No area of Pakistan is free of iodine deficiency

15. One of the major hurdles to many of the GOPs nutrition programs such as salt
iodination, iron fortification:
a. Accessibility for remote populations
b. Lack of trust in the GOPs intentions
c. Lack of distribution systems
d. Change in taste of fortified products

16. In order to decrease the incidence of neural tube defects women of child bearing age
must have an adequate intake of:
a. Energy
b. Vitamin A
c. Folic acid
d. Iron

17. As a Public Health Nutritionist you wish to study the usual intake of women of child
bearing age in the population you work with. The most feasible tool to use would be:
a. 24 Hour dietary recalls
b. Food frequency questionnaires
c. Food diaries
d. Observation of food intake in the homes

18. The limiting amino acid in the wheat based diet of the average Pakistani is:
a. Tryptophan
b. Methionine
c. Lysine
d. Phenylalanine

19. The Lady Health Worker (LHW) is important for improving child survival and
decreasing morbidity. Which of these is not a function performed by the LHW?
a. Ensuring that mothers initiate breast feeding as soon as possible after delivery
b. Growth monitoring
c. Teaching mothers to prepare and give ORS in diarrhea
d. Food distribution to undernourished children

20. The Tawana Pakistan Project:

a. Provided school lunch to children in rural primary schools
b. Provided school lunch to girls in rural primary schools
c. Distributed food to rural households
d. Distributed cooking oil to encourage girls to attend school

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 Section 4: Food Science
1. The formation of a green ring (iron sulfide) around the yolk of hard-cooked eggs may
be prevented by:
a. Cooking the eggs slowly for 45minutes.
b. Cooking eggs in rapidly boiling water for a short time.
c. Plunging the hard-cooked egg into cold water.
d. Pricking the egg with a pin.

2. There are several different ways of preventing the formation of lumps in starch
granules when making a starch-thickened food product. Which method is not
recommended?
a. Make a roux to coat the starch granules with an equal amount of fat.
b. Mix hot water into the starch to separate the granules.
c. Blend the starch with sugar.
d. Blend the starch with cold water to make a slurry.

3. Which of the following is not a good test for doneness in roasted chicken?
a. Lose joints
b. Internal temperature
c. Clear and translucent juices
d. Tender breast when pierced with fork.

4. Why do egg whites beat easier at room temperature?

a. The pH is increased
b. The protein is denatured
c. There is a lower surface tension
d. The surface tension is higher

5. Aside from sweetness, sugar influences which of the following characteristics of baked
products?
a. Volume
b. Moistness
c. Color
d. All of the above

6. Identify the correct order of steps, from beginning to end, for preparing most types of
candy.
a. Cooling, beating, heating, creating a syrup solution.
b. Creating a syrup solution, heating, cooling, beating
c. Beating , heating, cooling, creating a syrup solution
d. Creating a syrup solution, heating, beating, cooling

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7. Which pigment does not change color in an acid or alkaline medium?
a. Anthocyanin
b. Chlorophyll
c. Carotene
d. Flavone

8. Cured meat such as hunter beef is pink due to:

a. High salt content
b. Caramelized sugar
c. Vinegar added for preservation
d. Nitrates

9. Adding baking soda to garbanzo beans (cholley) while boiling will cause a loss of:
a. Fiber
b. Protein
c. Riboflavin
d. Iron

10. The leavening agent in yeast bread is:

a. Air
b. Steam
c. Carbon dioxide
d. Oxygen

11. A recipe for a cake calls for 30 gm piece of unsweetened cooking chocolate. You do
not have chocolate on hand. An appropriate substitution would be:
a. 3 Tbs cocoa and 1Tb butter
b. 3 Tbs cocoa and 2 Tb butter
c. 3 Tbs cocoa and 3 Tb butter
d. Just 3 Tbs cocoa

12. A recipe call for the following spices mustard seeds, fenugreek and cumin. You need to
send for:
a. Rye, methi and zeera
b. Rye, kalongi and zeera
c. Methi, sauf, zeera
d. Rye, methi, sauf

13. A dessert recipe that serves 20 people calls for 2 pints of milk. You need to make
dessert for 50 people. How many liters of milk do you need?
a. 1 ½ liters
b. 2 liters
c. 2 ½ liters
d. 3 liters

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14. Adding tamarind to a spinach bhujia will result in:
a. Bright green color
b. Loss of the green color
c. Loss of vitamin C
d. Make the iron in spinach unavailable

15. Milling of flour results in the loss of almost ______% of the pantothenic acid in grains.
a. 10
b. 20
c. 40
d. 50

Section 5: Food Service

1. A facility establishes a productivity standard of 3.75 labor minutes per meal for 4500
meals. The normal work schedule of each employee is 8 hours per day. The minimum
daily staffing need for the facility, state the full time equivalents (FTEs), would be
approximately:
a. 7
b. 28
c. 35
d. 56

2. Which temperature range represents what is called “the temperature danger zone” for
consumers in food safety?
a. Between -7 degree C and 27 degree C
b. Between 27 degree C and 82 degree C
c. Between 4 degree C and 60 degree C
d. Between 16 degree C and 71 degree C

3. How many pounds of coffee will you need in order to give 800 people 2 cups of coffee 1600/141
each if a pound of coffee has yield of 141 cups per pound of coffee?
a. 20 pounds
b. 25 pounds
c. 12.5 pounds
d. 2.5 pounds

4. A recipe for Stir Fried Chicken that uses 2 kg chicken breast and 4 tablespoons of soya
sauce yields 15 servings. How many kilograms of chicken and ml of soy sauce would be
needed for 325 people?
a. 70 kg and 1650 ml
b. 60 kg and 1450 ml
c. 54 kg and 1380
d. 44 kg and 1000 ml

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5. For the food service system in a large nursing home, the food is placed in bulk form in
carts and taken to a pantry for each wing where it is served on trays setup in the
pantry. This is an example of the:
a. Centralized food service system
b. Assembly/serve system
c. Ready-prepared system
d. Decentralized food service system

6. The management cycle consists of five functions which revolve and interrelate. The
functions usually occur in the following sequence:
a. Controlling, evaluation, standards, planning, organization
b. Directing, staffing, controlling, organizing and planning
c. Controlling, directing, staffing, organizing and planning
d. Planning, organizing, staffing, directing, and controlling

7. Which of the following statements is NOT true about the process of delegating
authority and responsibility?
a. Once the dietary manager delegates the responsibility for a task, he or she is
no longer responsible for it.
b. Authority is the power one needs to command and act.
c. The administrator delegates responsibilities to the supervisors of each
department in the facility.
d. A job analysis should be done with the help of each employee and the job
descriptions should be developed in consultation with the concerned
employee.

8. Both the supervisor and employee complete the annual performance evaluation form.
In two areas the supervisor rates the employee’s performance as poor while the
employee rates them as good. At the evaluation interview, the supervisor needs to:
a. Discuss the observations she has made on these poor ratings with the
employee.
b. Discuss disciplinary problems from previous years.
c. Not allow the employee to give any explanation about the problem areas.
d. Put the employee on probation until improvements are made.

9. A manager observes a new employee operating the meat slicer in an unsafe manner.
The manager’s first reaction should be to:
a. Stop the employee from operating the meat slicer.
b. Find out who trained the employee.
c. Go and get the equipment operating instructions.
d. Ask another employee to complete the slicing job.

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10. After taking the proper course of action in Question # 9, the supervisor decides the
next step(s) is:
a. Re-evaluate the department training procedure.
b. Present an in service on the proper use and care of the meat slicer.
c. Only let older, more experienced employees operate the” dangerous”
equipment.
d. Both A and B.

11. One measure of quality control standards is customer satisfaction. As a dietary

manager, the feedback instrument should include:
a. Food temperatures
b. Portion control
c. Sanitation checklists or reviews
d. All of the above

12. The dietary department uses an average of 84 hours labor per day and produces and 84* 60
serves 475 meals per day. What is the department’s “minutes of labor per meal 5040/475
served?” =
a. 1.6 minutes 10.6mins
b. 5.3 minutes
c. 10.6 minutes
d. 15.9 minutes

13. The dietary manager discusses problems related to the cleaning schedule with the
employees at a meeting, asks for suggestions, and then writes new procedures and a
new cleaning schedule. This is an example of a:
a. Domineering leader
b. Autocratic leader
c. Democratic leader
d. Laissez- faire leader

14. To motivate employees, a dietary manager must consider the different personal needs
which employees have. Which needs are important motivators for the “team
concept?”
a. Physiological needs
b. Esteem and ego needs
c. Safety and security needs
d. Social and belonging needs

15. The nasal passages of foodservice workers are frequently associated with this
enterotoxin:
a. Salmonella
b. Eschericbia coli
c. Campylobacter jejuni
d. Staphylococcus aureus

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