Syllabus · Historical · V4 (2023) · Nutrition and Metabolism
Nutrition and Metabolism
P.ii · Nutrition and Metabolism
Describe the physiology of fat, carbohydrate, and protein metabolism.
Written examination
SAQ history
Metabolism — Ammonia & Lactulose
1 exam appearance
Describe ammonia metabolism and excretion (70% of marks). Outline the pharmacology of lactulose (30% of marks).
37.5%
Metabolism — Carbohydrate Digestion
1 exam appearance
Metabolism — Citric Acid Cycle
1 exam appearance
Metabolism — Dietary Fat
1 exam appearance
Outline the components of dietary fat (20% of marks). Describe their possible metabolic fates (80% of marks)
21%
Metabolism — Fed State
1 exam appearance
Metabolism — Protein & Starvation
1 exam appearance
Metabolism — Triglyceride Metabolism
1 exam appearance
Metabolism — Urea
1 exam appearance
Starvation Metabolism
1 exam appearance
Outline the carbohydrate and lipid energy stores of the body (15% marks). Outline the metabolic responses to starvation under the following headings: <24 hours; 24-72 hours; and >72 hours (85% marks).
67%
Liver — Nutrient Metabolism
2 exam appearances
Outline the role of the liver in the metabolism of fat (⅓ marks), carbohydrate (⅓ marks) and proteins (⅓ marks)
54%
Outline the role of the liver in the metabolism of fat (1/3 of marks), carbohydrate (1/3 of marks) and proteins (1/3 of marks)
50%
Oral examination
VIVA history
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2026A · VIVA 4
Relevant examiner prompts
Explain the metabolic response to prolonged fasting (>16 hours).
How might the response to fasting differ in a neonate?
Following a period of starvation, why do electrolytes become deranged with reintroduction of calories?
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2025B · VIVA 7
This viva will examine metabolism and nutrition. Describe the metabolic and hormonal changes that occur during the following: (a) prolonged starvation (b) reintroduction of nutrition in a malnourished patient
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2021A · Day 1 · VIVA 7
This viva will explore your knowledge of glucose physiology and related pharmacology. Can you describe the storage of glucose in the body?
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2019B · Day 1 · VIVA 6
This viva will test your understanding of glucose metabolism. Describe how glucose is moved from the intestinal lumen to the blood.
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2016B · Day 2 · VIVA 6
This viva tested knowledge of physiology around glucose utilization and the pharmacology of insulin.
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2016A · Day 2 · VIVA 6
This viva tested knowledge of physiology around metabolic rate and went on to discuss metabolism particularly of carbohydrates and the influence of insulin.
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2015A · VIVA 6
This Viva tested knowledge on nutrition and metabolism.
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2014B · VIVA 8
This Viva tested knowledge on liver physiology and blood flow and then explored understanding of nutrition, including the changes seen with fasting and stress.
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2014A · VIVA 4
This Viva tested knowledge on glucose and lipid metabolism and went on to explore daily nutritional requirements and aspects of insulin physiology.
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2008B · VIVA 6
The initial information given to the candidates was - This viva will mostly cover pharmacology and physiology of insulin. Describe the primary function of insulin. This viva explored the candidates’ knowledge in relation to the following points Structure, mechanism of action and physiology of natural insulin Insulin preparations Pathophysiology of re-feeding syndrome Examination feedback: Candidates knowledge in relation to the physiology of insulin was good and much stronger than their knowledge in relation to the pharmacology of the different insulin preparations. It is important that candidates have a good understanding of the pharmacology of insulin preparations as well as remain up to date with changes in those preparations. Candidates also struggled with describing the basic elements, in particular the changes to electrolytes, associated with the re-feeding syndrome.
Sources: objective text from the relevant CICM syllabus; historical SAQ and VIVA wording from CICM examiner reports.