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The CSP exam has 150 questions and runs 3 hours.
These 10 free CSP questions are organized by exam domain, so you can see how each part of the Certified Specialist in Pediatric Nutrition blueprint is tested. Reveal the answer and explanation under each question.
At a six-month feeding visit, an infant with mild eczema controlled by emollients is sitting with support and swallowing purees. Egg has been eaten without a reaction. The parent is comfortable introducing peanut at home but asks whether eczema makes allergy testing mandatory. What advice is consistent with peanut-allergy prevention guidance?
Correct answer: A - Introduce thinned smooth peanut butter now and continue offering it regularly.
A former 29-week infant, now at 34 weeks postmenstrual age, tolerates full enteral feeds of expressed human milk. The only enrichment is an oil supplement. The current recipe supplies 128 kcal/kg/day but just 2.2 g protein/kg/day, and weight and length gains remain below target. The prescribed fluid allowance is already being met. Which change is most likely to improve growth within the fluid allowance?
Correct answer: C - Use multinutrient human-milk fortification to increase protein and mineral delivery.
On two separate occasions, an 8-month-old develops repetitive vomiting, marked pallor, and profound lethargy about two hours after eating oat cereal. There are no hives, wheezing, or feeding-associated choking episodes. Symptoms resolve over several hours, and the infant is well between exposures. Which diagnosis most closely fits this reproducible pattern?
Correct answer: D - Food protein-induced enterocolitis syndrome
Clinic weights show that an 8-year-old with persistent nausea has fallen from a usual weight of 25.0 kg to 23.0 kg over eight weeks. Both measurements were obtained when the child was euvolemic. The current BMI-for-age z score is -1.4; inadequate intake is documented, and no other finding supports a higher severity. Applying the Academy/ASPEN pediatric undernutrition indicators, how should these findings be reconciled?
Correct answer: D - Moderate undernutrition: the 8% weight loss supports greater severity than the single BMI indicator.
An 11-year-old undergoing evaluation for poor growth, iron-deficiency anemia, and chronic loose stools eats wheat daily. Tissue transglutaminase IgA is negative, but total serum IgA is below the assay's detection limit. Which celiac-specific testing strategy addresses the limitation of these results?
Correct answer: C - Obtain IgG-based celiac serology without removing gluten from the diet.
Laboratory testing in a 10-year-old with active juvenile idiopathic arthritis shows hemoglobin 10.2 g/dL (reference 11.5-15.5), microcytosis, ferritin 68 ng/mL (reference 15-100), and C-reactive protein 38 mg/L (reference below 5). The diet provides few iron-rich foods. At case conference, someone argues that the ferritin rules out iron deficiency. Which response is justified?
Correct answer: B - Iron depletion remains possible because inflammation can raise ferritin.
A 16-year-old distance runner requests a meal plan that will allow continued training after substantial weight loss from food restriction. BMI remains near the 50th percentile. At the afternoon visit, heart rate is 44 beats/minute after ten minutes of rest, and the teenager reports dizziness when standing. What is the appropriate disposition today?
Correct answer: A - Arrange urgent same-day medical assessment for possible inpatient stabilization.
During an observed meal, the caregiver of a 7-year-old with pancreatic-insufficient cystic fibrosis crushes the prescribed enteric-coated enzyme microspheres into applesauce. The child has greasy stools and declining weight velocity despite adequate energy intake. The enzyme dose is within recommended limits. Before increasing the dose, the dietitian should recommend:
Correct answer: B - Giving the microspheres uncrushed in a little applesauce immediately before eating.
While reviewing recurrent hyperglycemia in a 20-kg child with intestinal failure, the dietitian identifies two simultaneous glucose sources. The parenteral nutrition provides 120 g of dextrose at a constant rate over 20 hours. A separate D10W infusion, containing 10 g dextrose per 100 mL, runs at 10 mL/hour during those same 20 hours. What is the combined glucose infusion rate while both infusions are running, rounded to one decimal place?
Correct answer: A - 5.8 mg/kg/minute
A 12-year-old with cerebral palsy receives all nutrition and hydration through a gastrostomy. The prescribed total water goal is 1,500 mL/day. The energy prescription is met by 1,000 mL/day of formula whose label lists 76 mL of water per 100 mL. Medication-associated water flushes already provide 140 mL/day, and there are no other water sources. How much additional water is needed each day without changing formula delivery?
Correct answer: C - 600 mL, divided into tolerated water flushes
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