QUIZ FEEDBACK: Prescription Foods CPD Quiz
This quiz is based on content from the TV program Prescription Kitchen broadcast on Sky in May 2011 and accompanying “Prescription Foods” handbook. All GPs who took part in the quiz received 1 hour CQI credit.
| 1. For which of the following cows’ milk protein allergy (CMPA) conditions is an amino acid formula considered a first line treatment? | Your peers | Preferred |
| GORD associated cows’ milk protein allergy | 17% |  |
| Eczema | 13% | |
| Eosinophilic oesophagitis | 60% |  |
| Proctocolitis | 14% | |
| Protein induced enterocolitis syndrome | 43% | |
Irrespective of the cause and clinical type of CMPA, cows’ milk should be removed from the diet and replaced with an elemental (extensively hydrolysed or amino acid) or soy-based formula.
Amino acid formula is the most hypoallergenic formula and is the first-line choice for infants with eosinophilic oesophagitis or anaphylaxis due to cows’ milk protein allergy (CMPA). First-line choices for infants with CMPA without these particular conditions are:
- Extensively hydrolysed formula for infants aged under six months
- Soy formula for infants aged over six months
Amino acid formula may be trialled as a second-line option if extensively hydrolysed formula has been trialled and is not tolerated.
| 2. When should a soy infant formula be used as a first line option? | Your peers | Preferred |
| Two-year-old presenting with eczema related to cows’ milk protein | 41% | |
| Three-month-old with GORD related to cows’ milk protein | 12% | |
| Seven-month-old with GORD related to cows’ milk protein | 61% | |
| One-year-old with suspected eosinophilic oesophagitis | 15% | |
Soy-based infant formula is not appropriate for infants aged under six-months as cross-reactivity or concurrent soy allergy is much higher in this group. Although soy-based formula is not subsidised it is comparably priced to standard cows’ milk formula, and is a recommended first-line option for treatment of GORD or eczema related to cows’ milk protein allergy in infants aged over six-months, provided there is no failure to thrive (in which case extensively hydrolysed formula is first-line). Infants with eosinophilic oesophagitis should be treated first-line with an amino acid formula.
| 3. What percentage of immediate reactions to CMPA resolve by three years of age? | Your peers | Preferred |
| 10% | 4% | |
| 25% | 7% | |
| 50% | 17% | |
| 80% | 75% | |
| 100% | 1% | |
The most serious form of immediate reaction to CMPA is anaphylaxis but it can also present in non-anaphylactic ways such as erythema, angioedema, acute urticaria and vomiting. Infants with CMPA are often allergic to other foods such as eggs and peanuts. Approximately 80% of cases of immediate CMPA reactions resolve by age three years.
| 4. If a person is assessed as being malnourished “Food First” should be tried for: | Your peers | Preferred |
| Two weeks | 14% | |
| Four weeks | 52% | |
| Six weeks | 20% | |
| Two months | 16% | |
A “Food First” approach – eating small but frequent, high energy, high protein snacks and meals – is the first step in the treatment of elderly people who are malnourished. In some cases this approach may be adequate to correct malnutrition, and additional supplements will not be required. However, if after four weeks of a Food First trial, improvement is not being made or is not adequate, oral nutritional supplements (ready-made sip feeds or powders which are mixed with water or milk) may be added. The prescription of oral supplements should be based on the gap between the patient’s estimated requirements and how much they are managing orally. The need for continuation of an oral nutritional supplement should be monitored regularly and adjusted as malnutrition risk reduces.
| 5. Which of the following is used to define malnutrition? | Your peers | Preferred |
| Present a balanced picture of the harms and benefits | 7% | |
| Support the patient to make the best decision for him | 39% | |
| Point out the increased risk due to age or family history | 72% | |
| Let him know that a normal result can reassure him that he is free of prostate cancer | 29% | |
The term malnutrition can mean under-nutrition, over-nutrition or deficiencies of specific nutrients. In terms of under-nutrition, a malnourished state is defined as any of the following:
- BMI < 18.5 kg/m2
- Unintentional weight loss > 10% within the last three to six months
- BMI < 20 kg/m2 and unintentional weight loss > 5% within the last three to six months
In many cases, clinical judgement is sufficient to diagnose under-nutrition, however, objective classification of a patient’s risk of malnutrition, using a screening tool such as MUST (malnutrition universal screening tool) assists in clinical decision making.
