CSOWM PRACTICE QUESTION
COMPILATION WITH COMPLETE
SOLUTIONS
Which hormone is most directly responsible for increased appetite following weight loss
due to caloric restriction?
A. GLP-1
B. Leptin
C. Peptide YY
D. Cholecystokinin - Correct Answers -B. Leptin
Leptin is produced by adipose tissue and signals satiety. After weight loss, leptin levels
drop, which increases hunger and decreases energy expenditure, making it harder to
maintain weight loss.
A patient 6 months post-Roux-en-Y gastric bypass presents with fatigue, glossitis, and
elevated MCV. Which deficiency is most likely?
A. Vitamin D
B. Iron
C. Thiamin
D. Vitamin B12 - Correct Answers -D. Vitamin B12
Post-Roux-en-Y patients are at high risk for B12 deficiency due to reduced intrinsic
factor and decreased absorption in the terminal ileum, leading to macrocytic anemia,
glossitis, and neurologic symptoms.
Which mechanism best explains the rapid improvement of type 2 diabetes following
bariatric surgery before significant weight loss occurs?
A. Increased insulin receptor sensitivity from fat loss
B. Decreased hepatic gluconeogenesis from calorie restriction alone
C. Incretin hormone changes (GLP-1 increase, GIP modulation)
D. Increased skeletal muscle glucose uptake from exercise - Correct Answers -C.
Incretin hormone changes
Bariatric surgery rapidly improves glucose control largely due to increased GLP-1
secretion and altered gut hormone signaling, improving insulin secretion and sensitivity
even before major weight loss.
Which micronutrient deficiency is most associated with post-biliopancreatic diversion
procedures?
A. Vitamin K
B. Fat-soluble vitamins (A, D, E, K)
C. Vitamin C
,D. Folate - Correct Answers -B. Fat-soluble vitamins (A, D, E, K)
Biliopancreatic diversion causes significant fat malabsorption, making deficiencies of
fat-soluble vitamins the most common and clinically significant long-term complication.
A patient presents with Wernicke's encephalopathy after bariatric surgery. What is the
most appropriate immediate treatment?
A. Oral thiamin with glucose
B. IV thiamin before any carbohydrate administration
C. Oral multivitamin only
D. High-dose vitamin B12 injection - Correct Answers -B. IV thiamin before any
carbohydrate administration
Giving glucose without thiamin can worsen Wernicke's encephalopathy. Thiamin must
be given immediately IV to prevent irreversible neurologic damage.
What is the primary physiological effect of sleeve gastrectomy contributing to weight
loss?
A. Malabsorption of fats
B. Increased ghrelin suppression due to fundus removal
C. Bile acid malabsorption
D. Pancreatic enzyme inhibition - Correct Answers -B. Increased ghrelin suppression
due to fundus removal
The gastric fundus produces ghrelin (hunger hormone). Sleeve gastrectomy reduces
ghrelin levels, decreasing appetite significantly.
Which lab marker is most useful for assessing iron deficiency in a bariatric patient with
inflammation?
A. Serum iron
B. Hemoglobin
C. Ferritin
D. Transferrin saturation alone - Correct Answers -C. Ferritin
Ferritin reflects iron stores and is the best indicator in inflammatory states, though it can
be elevated in inflammation, making interpretation context-dependent.
A patient 2 weeks post-op bariatric surgery is vomiting and cannot tolerate oral intake.
What deficiency is most time-sensitive to prevent neurologic damage?
A. Vitamin D
B. Thiamin
C. Calcium
D. Vitamin A - Correct Answers -B. Thiamin
Thiamin stores deplete quickly (within weeks). Post-op vomiting dramatically increases
risk of Wernicke-Korsakoff syndrome, making it the most urgent deficiency.
Which condition is most associated with long-term hypoglycemia after Roux-en-Y
gastric bypass?
A. Dumping syndrome
B. Nesidioblastosis
,C. Reactive hyperlipidemia
D. Insulin resistance - Correct Answers -B. Nesidioblastosis
Post-gastric bypass hypoglycemia is often due to beta-cell hyperplasia
(nesidioblastosis) causing excessive insulin secretion.
What is the recommended protein intake range for post-bariatric surgery patients?
A. 0.5-0.8 g/kg/day
B. 0.8-1.0 g/kg/day
C. 1.0-1.5 g/kg ideal body weight/day
D. 2.5-3.0 g/kg/day - Correct Answers -C. 1.0-1.5 g/kg ideal body weight/day
Post-bariatric patients need higher protein intake to prevent muscle loss, typically based
on ideal body weight rather than actual weight.
What is the primary cause of dumping syndrome?
A. Delayed gastric emptying
B. Rapid delivery of hyperosmolar food into the small intestine
C. Excess bile secretion
D. Pancreatic insufficiency - Correct Answers -B. Rapid delivery of hyperosmolar food
into the small intestine. This causes fluid shifts into the gut → symptoms like nausea,
diarrhea, dizziness, and tachycardia.
Which lab abnormality is most likely in copper deficiency?
A. Hypercalcemia
B. Microcytic anemia with neutropenia
C. Macrocytic anemia only
D. Elevated ferritin - Correct Answers -B. Microcytic anemia with neutropenia
Copper deficiency can mimic iron deficiency anemia but also causes neurologic
symptoms and neutropenia, making it distinctive
Which surgical procedure has the highest risk for malabsorption?
A. Sleeve gastrectomy
B. Adjustable gastric band
C. Biliopancreatic diversion with duodenal switch
D. Endoscopic sleeve gastroplasty - Correct Answers -C. Biliopancreatic diversion with
duodenal switch
This is the most malabsorptive bariatric procedure, with the highest risk of micronutrient
deficiencies.
Which mechanism explains increased satiety after bariatric surgery?
A. Decreased vagal nerve signaling only
B. Increased GLP-1 and PYY secretion
C. Increased ghrelin secretion
D. Reduced leptin sensitivity - Correct Answers -B. Increased GLP-1 and PYY secretion
These gut hormones increase satiety and improve insulin response, contributing
significantly to post-surgical appetite reduction and metabolic changes.
, Which change is primarily responsible for early improvement in insulin sensitivity after
Roux-en-Y gastric bypass?
A. Increased fat oxidation
B. Caloric restriction alone
C. Increased GLP-1 secretion
D. Increased physical activity - Correct Answers -A post-bariatric patient presents with
bone pain and elevated PTH. What is the most likely cause?
A. Vitamin K deficiency
B. Vitamin D deficiency
C. Vitamin C deficiency
D. Excess calcium intake
Which bariatric surgery has the highest risk of dumping syndrome?
A. Sleeve gastrectomy
B. Adjustable gastric band
C. Roux-en-Y gastric bypass
D. Endoscopic sleeve gastroplasty - Correct Answers -C. Roux-en-Y gastric bypass
Why: Food rapidly enters small intestine → osmotic fluid shifts + hormone release →
dumping syndrome
Which hormone is most associated with hunger suppression after bariatric surgery?
A. Ghrelin
B. Insulin
C. GLP-1
D. Cortisol - Correct Answers -C. GLP-1
Increases satiety
Slows gastric emptying
Improves insulin response Ghrelin decreases, but GLP-1 increase is the key tested
driver
A patient has macrocytic anemia and neuropathy after bariatric surgery. Which lab
abnormality is most expected?
A. Elevated ferritin
B. Low vitamin B12
C. High serum iron
D. Low calcium - Correct Answers -B. Low vitamin B12
Classic combo:
Macrocytic anemia
Neuropathy Due to loss of intrinsic factor + reduced absorption
Which bariatric procedure is both restrictive and malabsorptive?
A. Gastric band
B. Sleeve gastrectomy
C. Roux-en-Y gastric bypass
D. Intragastric balloon - Correct Answers -C. Roux-en-Y gastric bypass
Why:
COMPILATION WITH COMPLETE
SOLUTIONS
Which hormone is most directly responsible for increased appetite following weight loss
due to caloric restriction?
A. GLP-1
B. Leptin
C. Peptide YY
D. Cholecystokinin - Correct Answers -B. Leptin
Leptin is produced by adipose tissue and signals satiety. After weight loss, leptin levels
drop, which increases hunger and decreases energy expenditure, making it harder to
maintain weight loss.
A patient 6 months post-Roux-en-Y gastric bypass presents with fatigue, glossitis, and
elevated MCV. Which deficiency is most likely?
A. Vitamin D
B. Iron
C. Thiamin
D. Vitamin B12 - Correct Answers -D. Vitamin B12
Post-Roux-en-Y patients are at high risk for B12 deficiency due to reduced intrinsic
factor and decreased absorption in the terminal ileum, leading to macrocytic anemia,
glossitis, and neurologic symptoms.
Which mechanism best explains the rapid improvement of type 2 diabetes following
bariatric surgery before significant weight loss occurs?
A. Increased insulin receptor sensitivity from fat loss
B. Decreased hepatic gluconeogenesis from calorie restriction alone
C. Incretin hormone changes (GLP-1 increase, GIP modulation)
D. Increased skeletal muscle glucose uptake from exercise - Correct Answers -C.
Incretin hormone changes
Bariatric surgery rapidly improves glucose control largely due to increased GLP-1
secretion and altered gut hormone signaling, improving insulin secretion and sensitivity
even before major weight loss.
Which micronutrient deficiency is most associated with post-biliopancreatic diversion
procedures?
A. Vitamin K
B. Fat-soluble vitamins (A, D, E, K)
C. Vitamin C
,D. Folate - Correct Answers -B. Fat-soluble vitamins (A, D, E, K)
Biliopancreatic diversion causes significant fat malabsorption, making deficiencies of
fat-soluble vitamins the most common and clinically significant long-term complication.
A patient presents with Wernicke's encephalopathy after bariatric surgery. What is the
most appropriate immediate treatment?
A. Oral thiamin with glucose
B. IV thiamin before any carbohydrate administration
C. Oral multivitamin only
D. High-dose vitamin B12 injection - Correct Answers -B. IV thiamin before any
carbohydrate administration
Giving glucose without thiamin can worsen Wernicke's encephalopathy. Thiamin must
be given immediately IV to prevent irreversible neurologic damage.
What is the primary physiological effect of sleeve gastrectomy contributing to weight
loss?
A. Malabsorption of fats
B. Increased ghrelin suppression due to fundus removal
C. Bile acid malabsorption
D. Pancreatic enzyme inhibition - Correct Answers -B. Increased ghrelin suppression
due to fundus removal
The gastric fundus produces ghrelin (hunger hormone). Sleeve gastrectomy reduces
ghrelin levels, decreasing appetite significantly.
Which lab marker is most useful for assessing iron deficiency in a bariatric patient with
inflammation?
A. Serum iron
B. Hemoglobin
C. Ferritin
D. Transferrin saturation alone - Correct Answers -C. Ferritin
Ferritin reflects iron stores and is the best indicator in inflammatory states, though it can
be elevated in inflammation, making interpretation context-dependent.
A patient 2 weeks post-op bariatric surgery is vomiting and cannot tolerate oral intake.
What deficiency is most time-sensitive to prevent neurologic damage?
A. Vitamin D
B. Thiamin
C. Calcium
D. Vitamin A - Correct Answers -B. Thiamin
Thiamin stores deplete quickly (within weeks). Post-op vomiting dramatically increases
risk of Wernicke-Korsakoff syndrome, making it the most urgent deficiency.
Which condition is most associated with long-term hypoglycemia after Roux-en-Y
gastric bypass?
A. Dumping syndrome
B. Nesidioblastosis
,C. Reactive hyperlipidemia
D. Insulin resistance - Correct Answers -B. Nesidioblastosis
Post-gastric bypass hypoglycemia is often due to beta-cell hyperplasia
(nesidioblastosis) causing excessive insulin secretion.
What is the recommended protein intake range for post-bariatric surgery patients?
A. 0.5-0.8 g/kg/day
B. 0.8-1.0 g/kg/day
C. 1.0-1.5 g/kg ideal body weight/day
D. 2.5-3.0 g/kg/day - Correct Answers -C. 1.0-1.5 g/kg ideal body weight/day
Post-bariatric patients need higher protein intake to prevent muscle loss, typically based
on ideal body weight rather than actual weight.
What is the primary cause of dumping syndrome?
A. Delayed gastric emptying
B. Rapid delivery of hyperosmolar food into the small intestine
C. Excess bile secretion
D. Pancreatic insufficiency - Correct Answers -B. Rapid delivery of hyperosmolar food
into the small intestine. This causes fluid shifts into the gut → symptoms like nausea,
diarrhea, dizziness, and tachycardia.
Which lab abnormality is most likely in copper deficiency?
A. Hypercalcemia
B. Microcytic anemia with neutropenia
C. Macrocytic anemia only
D. Elevated ferritin - Correct Answers -B. Microcytic anemia with neutropenia
Copper deficiency can mimic iron deficiency anemia but also causes neurologic
symptoms and neutropenia, making it distinctive
Which surgical procedure has the highest risk for malabsorption?
A. Sleeve gastrectomy
B. Adjustable gastric band
C. Biliopancreatic diversion with duodenal switch
D. Endoscopic sleeve gastroplasty - Correct Answers -C. Biliopancreatic diversion with
duodenal switch
This is the most malabsorptive bariatric procedure, with the highest risk of micronutrient
deficiencies.
Which mechanism explains increased satiety after bariatric surgery?
A. Decreased vagal nerve signaling only
B. Increased GLP-1 and PYY secretion
C. Increased ghrelin secretion
D. Reduced leptin sensitivity - Correct Answers -B. Increased GLP-1 and PYY secretion
These gut hormones increase satiety and improve insulin response, contributing
significantly to post-surgical appetite reduction and metabolic changes.
, Which change is primarily responsible for early improvement in insulin sensitivity after
Roux-en-Y gastric bypass?
A. Increased fat oxidation
B. Caloric restriction alone
C. Increased GLP-1 secretion
D. Increased physical activity - Correct Answers -A post-bariatric patient presents with
bone pain and elevated PTH. What is the most likely cause?
A. Vitamin K deficiency
B. Vitamin D deficiency
C. Vitamin C deficiency
D. Excess calcium intake
Which bariatric surgery has the highest risk of dumping syndrome?
A. Sleeve gastrectomy
B. Adjustable gastric band
C. Roux-en-Y gastric bypass
D. Endoscopic sleeve gastroplasty - Correct Answers -C. Roux-en-Y gastric bypass
Why: Food rapidly enters small intestine → osmotic fluid shifts + hormone release →
dumping syndrome
Which hormone is most associated with hunger suppression after bariatric surgery?
A. Ghrelin
B. Insulin
C. GLP-1
D. Cortisol - Correct Answers -C. GLP-1
Increases satiety
Slows gastric emptying
Improves insulin response Ghrelin decreases, but GLP-1 increase is the key tested
driver
A patient has macrocytic anemia and neuropathy after bariatric surgery. Which lab
abnormality is most expected?
A. Elevated ferritin
B. Low vitamin B12
C. High serum iron
D. Low calcium - Correct Answers -B. Low vitamin B12
Classic combo:
Macrocytic anemia
Neuropathy Due to loss of intrinsic factor + reduced absorption
Which bariatric procedure is both restrictive and malabsorptive?
A. Gastric band
B. Sleeve gastrectomy
C. Roux-en-Y gastric bypass
D. Intragastric balloon - Correct Answers -C. Roux-en-Y gastric bypass
Why:
