CSSD Nutrition Assessment & Counseling Strategies 4 — Questions and Answers
Question 1: A female distance runner reports amenorrhea for 10 months. Which combination of findings is MOST consistent with the Female Athlete Triad?
- Low energy availability, low bone mineral density, and functional hypothalamic amenorrhea (Correct answer)
- High training volume, stress fracture, and low ferritin
- Disordered eating, overhydration, and secondary amenorrhea due to pregnancy
- Low BMI, high cortisol, and primary amenorrhea
Correct answer: Low energy availability, low bone mineral density, and functional hypothalamic amenorrhea
The Female Athlete Triad is defined by low energy availability (with or without disordered eating), menstrual dysfunction, and low bone mineral density.
Question 2: During a sports nutrition consultation, using open-ended questions is preferable because they:
- Allow the athlete to elaborate and reveal underlying beliefs about food and performance (Correct answer)
- Provide structured data that is easier to quantify
- Reduce consultation time by narrowing responses
- Comply with medical documentation requirements
Correct answer: Allow the athlete to elaborate and reveal underlying beliefs about food and performance
Open-ended questions invite narrative responses that uncover attitudes, barriers, and motivations not captured by yes/no or numeric answers.
Question 3: Which DXA measurement output is MOST directly used to diagnose osteoporosis according to the WHO T-score criteria?
- T-score at the lumbar spine or femoral neck (Correct answer)
- Z-score at the total hip
- Lean mass in kilograms
- Bone mineral content in grams
Correct answer: T-score at the lumbar spine or femoral neck
The WHO defines osteoporosis as a T-score ≤ -2.5 SD at the lumbar spine or femoral neck compared to a young adult reference population.
Question 4: An athlete completing a food record reports eating a 'medium banana.' To convert this to a quantitative nutrient value, the dietitian should FIRST consult which resource?
- USDA FoodData Central database (Correct answer)
- The athlete's team physician notes
- A commercial food label
- The athlete's training log
Correct answer: USDA FoodData Central database
USDA FoodData Central provides standardized nutrient values by food portion, making it the primary reference for converting food descriptions to nutrient data.
Question 5: A gymnast has a BMI of 16.8 kg/m² and reports eating 1,400 kcal/day while training 30 hours per week. The dietitian calculates energy availability (EA). If the athlete's fat-free mass is 38 kg, what is EA (kcal/kg FFM/day)?
- Approximately 25 kcal/kg FFM/day (Correct answer)
- Approximately 37 kcal/kg FFM/day
- Approximately 45 kcal/kg FFM/day
- Approximately 18 kcal/kg FFM/day
Correct answer: Approximately 25 kcal/kg FFM/day
EA = (Energy intake − Exercise energy expenditure) / FFM; at 1,400 kcal intake with ~450 kcal/day exercise EE, EA ≈ 950/38 ≈ 25 kcal/kg FFM/day, below the 45 kcal threshold.
Question 6: Which counseling strategy involves the dietitian summarizing both sides of an athlete's ambivalence to facilitate change talk?
- Double-sided reflection (Correct answer)
- Affirmation
- Scaling question
- Decisional balance sheet
Correct answer: Double-sided reflection
A double-sided reflection acknowledges both the athlete's reasons for current behavior and their stated desire to change, reducing defensiveness.
Question 7: Which assessment method provides the MOST accurate measurement of total body water (TBW) in an athlete, serving as the gold standard?
- Deuterium dilution (isotope dilution technique) (Correct answer)
- Bioelectrical impedance analysis
- Skinfold caliper assessment
- Air displacement plethysmography
Correct answer: Deuterium dilution (isotope dilution technique)
Deuterium (²H₂O) dilution is the gold-standard method for quantifying TBW by measuring isotope distribution in body fluids.
CSSD Nutrition Assessment & Counseling Strategies 4
A female distance runner reports amenorrhea for 10 months.
Which combination of findings is MOST consistent with the Female Athlete Triad?