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The CSO exam has 150 questions and runs 3 hours.
These 10 free CSO questions are organized by exam domain, so you can see how each part of the Certified Specialist in Oncology Nutrition blueprint is tested. Reveal the answer and explanation under each question.
During a telephone nutrition visit, a patient receiving an immune checkpoint inhibitor blames a new protein shake for diarrhea. Over 48 hours, bowel movements have increased from one formed stool daily to nine watery stools daily, with new abdominal cramping and blood in the stool. What takes priority over changing the shake?
Correct answer: A - Arrange urgent oncology assessment for possible immune-mediated colitis.
Twenty minutes into an irinotecan infusion, a patient develops abdominal cramping, a loose stool, marked sweating, and increased salivation. There is no urticaria, wheezing, or hypotension, and the infusion nurse is assessing the patient. This combination is most characteristic of which treatment effect?
Correct answer: B - An acute cholinergic syndrome triggered by irinotecan
A 59-year-old with ovarian cancer weighed 96 kg without fluid retention four months ago. She now weighs 92 kg with substantial ascites; the treating team documents an estimated dry weight of 84 kg. The weight loss has been unintentional. Her dry-weight BMI is 31 kg/m², and intake has averaged 45% of estimated requirements for three weeks. Which assessment correctly combines her weight history with GLIM diagnostic and severity criteria?
Correct answer: D - 12.5% weight loss; GLIM stage 2 malnutrition despite a BMI above 30.
A completed Patient-Generated Subjective Global Assessment (PG-SGA) has a numerical score of 12. The global A, B, or C rating has not yet been recorded. A colleague asks whether the number alone establishes severe malnutrition. How should the dietitian interpret it?
Correct answer: C - It indicates critical intervention needs; the global category requires a separate assessment judgment.
A head and neck cancer survivor has continued taking 100 mg of elemental zinc daily for nine months after self-treating taste changes. He now has anemia, neutropenia, progressive distal numbness, and gait unsteadiness. Which deficiency best links the supplement exposure with this combination of hematologic and neurologic findings?
Correct answer: D - Copper
After treatment of pneumonia in a patient receiving chemotherapy, serum albumin rises from 2.1 to 3.3 g/dL over ten days while C-reactive protein falls from 118 to 9 mg/L. Intake remains approximately 55% of estimated requirements, and the nutrition-focused examination still shows muscle depletion. The team asks whether the albumin change demonstrates nutritional recovery. Which interpretation fits the findings?
Correct answer: A - Resolving inflammation can explain the albumin rise without demonstrating nutritional recovery.
Six weeks after pancreaticoduodenectomy for pancreatic cancer, a patient continues to lose weight and pass oily, difficult-to-flush stools. Her pancrelipase prescription provides 60,000 lipase units per meal and 30,000 per snack. She takes every dose, but waits until 90 minutes after eating because she believes the capsules work better on an empty stomach. Which change should be tried first?
Correct answer: B - Take the prescribed enzymes during each meal and snack.
A patient receiving chemoradiation for oropharyngeal cancer has started gastrostomy feeding because eating enough is too painful. A speech-language pathologist's instrumental assessment confirms that small amounts of soft food and thin liquids can be swallowed safely. The patient asks, 'Now that I have the tube, should I stop swallowing food until treatment is over?' Which plan best supports nutrition and swallowing function?
Correct answer: C - Continue safe oral intake as tolerated, with tube feeding covering the nutritional shortfall.
An adult with esophageal cancer has a BMI of 15.6 kg/m² and has consumed negligible nutrition for ten days. A feeding jejunostomy is ready for use. Baseline phosphorus, potassium, and magnesium are within the laboratory reference ranges; no carbohydrate-containing IV fluids have been given. Which initial order is consistent with ASPEN's adult refeeding-syndrome recommendations?
Correct answer: B - Give 100 mg thiamin before feeding, start at 15 kcal/kg/day, and check phosphorus, potassium, and magnesium every 12 hours.
An adult recovering from an allogeneic stem-cell transplant remains neutropenic. The caregiver proposes a meal of commercially packaged yogurt made from pasteurized milk, a whole apple washed under running water, and toast topped with raw alfalfa sprouts. Applying FDA food-safety guidance for immunocompromised people, which change addresses the specific hazard in this meal?
Correct answer: A - Replace the raw sprouts with thoroughly cooked vegetables.
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