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CCN


CNCB Certified Clinical Nutritionist 2025


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Question: 453


A patient with a history of metabolic syndrome shows elevated levels of organic acids in the urine, particularly succinic and fumaric acids. What metabolic dysfunction might these findings suggest?


  1. Impaired beta-oxidation of fatty acids

  2. Mitochondrial dysfunction

    utathione deficiency er: B

    nation: Elevated succinic and fumaric acids can indicate mitochondrial dysfunction, as they a ediates in the citric acid cycle, which may be impaired in this metabolic condition.


    ion: 454


    inical setting, a patient is suspected of having heavy metal toxicity. Which of the following tory tests would be most appropriate to confirm the presence of lead in the body?


    um creatinine

    hour urine lead excretion test um calcium

    mplete blood count er: B

    nation: The 24-hour urine lead excretion test is the most specific test for assessing lead expos xicity, as it measures the amount of lead being excreted from the body.

    Increased ethanol metabolism

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Question: 455


In a comprehensive assessment of a patient with osteoporosis, which combination of vitamins and minerals should be evaluated through laboratory testing to ensure optimal bone health and what specific tests would you recommend?


  1. Vitamin K and calcium; Serum calcium and prothrombin time

  2. Vitamin D and magnesium; Serum 25-hydroxyvitamin D and serum magnesium levels

  3. Vitamin C and iron; Serum ascorbic acid and serum ferritin

  4. Vitamin A and phosphorus; Serum retinol and serum phosphorus levels Answer: B

Explanation: Vitamin D and magnesium are crucial for bone health. Serum 25-hydroxyvitamin D and magnesium levels should be assessed to evaluate their status.


Question: 456


year-old woman presents with severe premenstrual syndrome (PMS) symptoms, including m bloating, and breast tenderness. Which of the following dietary interventions may help alle

mptoms? (Select All That Apply)


reasing omega-3 fatty acid intake

ducing refined carbohydrate consumption pplementing with vitamin D

reasing caffeine consumption er: A, B, C

nation: Research suggests that omega-3 fatty acids can reduce inflammation and improve mo educing refined carbohydrates can help stabilize blood sugar levels. Vitamin D is linked to tion and may alleviate PMS symptoms. Caffeine can exacerbate anxiety and bloating, so its se is not recommended.


ion: 457


of the following lipoproteins is primarily responsible for transporting dietary triglycerides fr ne to peripheral tissues?


w-density lipoprotein (LDL)

y low-density lipoprotein (VLDL)

A 35- ood

swings, viate

her sy


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  2. Re

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while r mood

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Which om the

intesti


  1. Lo

  2. Ver

  3. High-density lipoprotein (HDL)

  4. Chylomicrons Answer: D

Explanation: Chylomicrons are the lipoproteins responsible for transporting dietary triglycerides from the intestines to peripheral tissues after a meal.

Question: 458

In assessing a patient for food allergies, which of the following testing methods is considered the most reliable for IgE-mediated reactions? (Select All That Apply)


  1. Skin prick tests

  2. Serum specific IgE testing

  3. Elimination diet followed by food challenge

  4. IgG food sensitivity testing Answer: A, B, C

nation: Skin prick tests and serum specific IgE testing are reliable for identifying IgE-mediat es. An elimination diet followed by a food challenge can confirm food allergies. IgG testing versial and not considered reliable for diagnosing food allergies.


ion: 459


atient with chronic stress and digestive issues, which herbal remedies could be considered to both the nervous and digestive systems? (Select All That Apply)


mon Balm sionflower amomile ndelion


er: A, B, C


nation: Lemon Balm and Passionflower are known for their calming effects on the nervous sy hamomile can soothe digestive disturbances. Dandelion is more focused on liver health and ectly impact stress or anxiety.


ion: 460

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Quest


In a study on the effects of dietary fats on cardiovascular health, researchers measured the impact of omega-3 fatty acids on inflammation. Which biochemical mechanism explains how omega-3 fatty acids exert their anti-inflammatory effects?


  1. They compete with arachidonic acid for incorporation into cell membranes, reducing pro- inflammatory eicosanoid production.

  2. They increase the synthesis of leukotrienes from arachidonic acid.

  3. They enhance the production of inflammatory cytokines.

  4. They inhibit the absorption of cholesterol in the intestines.

Answer: A


Explanation: Omega-3 fatty acids compete with arachidonic acid, leading to the production of less inflammatory eicosanoids, thereby reducing overall inflammation.


Question: 461


changes may be recommended based on recent research? (Select All That Apply)


ducing artificial food colorings reasing processed food intake ding more whole foods

miting sugar-sweetened beverages er: A, C, D

nation: Reducing artificial food colorings and limiting sugar-sweetened beverages can help m symptoms, while increasing whole foods supports overall health. Processed food intake is lly discouraged.


ion: 462


year-old female with chronic digestive issues undergoes testing for dysbiosis. Which of the ing results would likely indicate the presence of opportunistic pathogens?


gh Lactobacillus Firmicutes

h Clostridia

anced gut microbiota

A child diagnosed with ADHD is being evaluated for dietary interventions. Which of the following dietary


  1. Re

  2. Inc

  3. Ad

  4. Li


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ADHD

genera


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A 40-

follow


  1. Hi

  2. Low

  3. Hig

  4. Bal Answer: C

Explanation: An increased presence of Clostridia is often associated with dysbiosis and can indicate the proliferation of opportunistic pathogens in the gut.


Question: 463


In a case study involving a patient with anxiety and digestive issues, which of the following homeopathic

remedies could be considered for their dual effect? (Select All That Apply)


  1. Argentum Nitricum

  2. Phosphorus

  3. Lycopodium

  4. Kali Phosphoricum Answer: A, C

tory issues, and Kali Phosphoricum is a nerve tonic but less specific for this case.


ion: 464


ent with a history of recurrent digestive issues undergoes a food allergy assessment. Which of ing results would most likely indicate a non-IgE mediated reaction?


vated serum IgE itive skin prick test

reased IgG levels for specific foods rmal histamine levels


er: C


nation: Elevated IgG levels indicate a non-IgE mediated immune response, often associated w ntolerances or sensitivities.


ion: 465


of the following lifestyle modifications should a clinical nutritionist recommend for a patie ted in detoxification, particularly concerning heavy metal exposure? (Select All That Apply)

Explanation: Argentum Nitricum is known for addressing both anxiety and digestive complaints, while Lycopodium may help with digestive issues linked to stress. Phosphorus is primarily for respiratory and circula


Quest


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Quest


Which nt

interes


  1. Regular exercise

  2. Saunas or steam baths

  3. High-fiber diets

  4. Increased alcohol consumption Answer: A, B, C

Explanation: Regular exercise helps with overall detoxification processes, saunas can promote sweating and toxin elimination, and high-fiber diets support digestive health. Increased alcohol consumption would

be counterproductive to detoxification.


Question: 466


A patient with chronic exposure to environmental toxins is evaluated for detoxification capacity. Which of the following findings would most likely indicate a compromised detoxification system?


  1. High levels of phase II metabolites

    vated liver enzymes rmal bilirubin levels


    er: B


    nation: Low levels of phase I enzymes suggest compromised detoxification ability, as these es are critical for converting fat-soluble toxins into water-soluble forms for elimination.


    ion: 467


    ager with ADD is experiencing challenges with focus and attention. Which of the following components may support cognitive function in this case? (Select All That Apply)


    mega-3 fatty acids h sugar snacks

    mplex carbohydrates cessed foods


    er: A, C


    nation: Omega-3 fatty acids and complex carbohydrates support cognitive function, while hig nacks and processed foods can lead to energy crashes and negatively impact focus.

    Low levels of phase I enzymes

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Question: 468

In evaluating a patient for potential metabolic disorders, which urinary marker would be most indicative of impaired carbohydrate metabolism?


  1. Hydroxybutyric acid

  2. Acetoacetate

  3. Urobilinogen

  4. 2-Hydroxybutyric acid

Answer: A


Explanation: Hydroxybutyric acid is a ketone body that indicates fat metabolism when carbohydrate metabolism is impaired. Its presence suggests potential metabolic dysfunction, particularly in states of insulin resistance.