MCQ bank · 8 questions · free
Surgical nutrition MCQs with answers
8 single-best-answer questions on refeeding syndrome, enteral and parenteral nutrition, and fistulas. Try each one, then open the answer to see the explanation, why the other options are wrong, and the guideline or trial behind it.
A 45-year-old with oesophageal cancer has eaten almost nothing for 2 weeks and has a BMI of 15. Feeding is about to start. What is the main risk and how is it reduced?
- Overfeeding is safe: give full calories on day 1
- Give glucose before thiamine
- Refeeding syndrome: start feeding slowly (about 10 kcal/kg/day), give thiamine and B vitamins before feeding, and monitor and replace phosphate, potassium and magnesium
- Stop all electrolytes
- No risk; feed normally
Show the answer and explanation
Answer: C. Refeeding syndrome: start feeding slowly (about 10 kcal/kg/day), give thiamine and B vitamins before feeding, and monitor and replace phosphate, potassium and magnesium. After starvation, carbohydrate stimulates insulin, driving phosphate, potassium and magnesium into cells. Severe hypophosphataemia can cause heart failure, arrhythmias, respiratory failure and death. High-risk patients start feeding slowly with careful electrolyte monitoring and replacement, and thiamine is given to prevent Wernicke’s encephalopathy.
Why not the others? Hypophosphataemia is the hallmark of refeeding syndrome.
References
A patient will be unable to eat for at least 7 days after major surgery but has a working gut. Which route of feeding is preferred?
- Intravenous 5% glucose only
- Enteral feeding (for example via a nasogastric or nasojejunal tube)
- No feeding until he can eat
- Parenteral nutrition for every patient
- Oral water only
Show the answer and explanation
Answer: B. Enteral feeding (for example via a nasogastric or nasojejunal tube). Enteral nutrition maintains the gut barrier, is cheaper and has fewer infectious complications than parenteral nutrition. Parenteral nutrition is used when the gut cannot be used or enteral feeding cannot meet needs.
Why not the others? 5% glucose provides very few calories and no protein.
References
A ventilated trauma patient on parenteral nutrition has rising CO₂, blood glucose of 16 mmol/L and abnormal liver tests. Her calorie intake exceeds her estimated needs. What should be changed?
- Reduce the total calories, especially dextrose, to avoid overfeeding, and control glucose
- Stop all nutrition permanently
- Increase dextrose to improve healing
- Add more lipid
- Give more insulin and keep the same feed
Show the answer and explanation
Answer: A. Reduce the total calories, especially dextrose, to avoid overfeeding, and control glucose. Overfeeding, particularly with excess glucose, increases CO₂ production (making weaning from the ventilator harder), causes hyperglycaemia and fatty liver. Critically ill patients are fed to measured or estimated needs, often below full targets in the first days.
Why not the others? More calories are not always better in critical illness.
References
Roughly how much energy and protein does a stable adult surgical patient need per day?
- Protein is not needed after surgery
- 5 kcal/kg/day and no protein
- About 25–30 kcal/kg/day and 1.2–1.5 g/kg/day of protein
- 10 kcal/kg/day only
- 60 kcal/kg/day and 4 g/kg/day protein
Show the answer and explanation
Answer: C. About 25–30 kcal/kg/day and 1.2–1.5 g/kg/day of protein. These simple estimates guide nutritional support. Protein needs rise with surgery, trauma and sepsis to support healing and preserve muscle. Indirect calorimetry can be used in critical care.
Why not the others? Obesity and critical illness need adjusted targets.
References
Five days after a percutaneous gastrostomy was placed, the tube falls out. What should be done?
- Push a new tube in at the bedside and start feeding immediately
- Close the hole with a suture
- Start feeding through the hole
- Do not blindly reinsert it through the immature tract; stop feeding, and arrange endoscopic or radiological replacement because of the risk of intraperitoneal placement
- Leave it and discharge
Show the answer and explanation
Answer: D. Do not blindly reinsert it through the immature tract; stop feeding, and arrange endoscopic or radiological replacement because of the risk of intraperitoneal placement. The tract between stomach and skin takes about 2–4 weeks to mature (longer in malnourished patients). Before that, the stomach can fall away from the abdominal wall, and a blindly replaced tube can enter the peritoneal cavity, causing peritonitis when feeding starts. After maturation, a new tube can usually be placed through the tract promptly.
Why not the others? A leak around a gastrostomy is managed by stabilising the tube, not by inserting a larger one.
References
Gastric fluid is leaking around a surgical gastrostomy tube, and the skin is becoming excoriated. What is the correct management?
- Increase feeding rate
- Remove the tube permanently
- Replace it with a much larger tube
- Apply a tight dressing only
- Stabilise the tube (check the external bumper position and avoid side-to-side movement), protect the skin, and consider acid suppression; do not insert a larger tube
Show the answer and explanation
Answer: E. Stabilise the tube (check the external bumper position and avoid side-to-side movement), protect the skin, and consider acid suppression; do not insert a larger tube. Leaks are usually caused by tube movement that enlarges the tract. Upsizing the tube enlarges the tract further and worsens the leak. Stabilising the tube, skin protection and treating any infection or gastric outlet problems allow the tract to tighten.
Why not the others? A tube that is too tight can cause buried bumper syndrome.
References
Which tool is used on admission to screen adult inpatients for malnutrition risk?
- Haemoglobin
- No screening is needed
- Height alone
- Serum albumin alone
- A validated screening tool such as MUST (BMI, unintentional weight loss, acute illness effect)
Show the answer and explanation
Answer: E. A validated screening tool such as MUST (BMI, unintentional weight loss, acute illness effect). Malnutrition is common and often missed in surgical patients. Screening with a validated tool on admission and regularly identifies those needing dietitian assessment and nutritional support. Albumin is mainly a marker of inflammation, not nutrition.
Why not the others? Unintentional weight loss is a strong predictor of complications.
References
Two weeks after a laparotomy with small bowel resection, a patient has small bowel content draining through the wound (enterocutaneous fistula, 600 mL/day). He is septic from an abscess. What is the order of priorities?
- Antibiotics only
- Control sepsis, then optimise nutrition and fluids, protect the skin, define the anatomy with imaging, and plan definitive surgery after several months
- Close the skin over the fistula
- Feed orally and ignore the output
- Immediate laparotomy to close the fistula
Show the answer and explanation
Answer: B. Control sepsis, then optimise nutrition and fluids, protect the skin, define the anatomy with imaging, and plan definitive surgery after several months. Enterocutaneous fistulas are managed step by step (often remembered as SNAP: sepsis, nutrition, anatomy, protection of skin, then planned surgery). Many low-output fistulas close spontaneously. Early reoperation in a hostile abdomen leads to further fistulas.
Why not the others? Definitive repair is usually delayed 3–6 months or more.
References