CSOWM EXAM 1 TEST PAPER 2025/2026 ALL QUESTIONS
AND SOLUTIONS GRADED A+ TIP
✔✔Frequency of follow-up for bariatric patients is determined by... - ✔✔procedure
performed & severity of comorbids
✔✔RYGB & BPD/DS patients with postprandial hypoglycemic symptoms who have not
responded to nutritional manipulation should be evaluated to differentiate... -
✔✔noninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS) from factitious or
iatrogenic causes (ie. dumping syndrome & insulinoma)
✔✔How should noninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS) be
treated? - ✔✔* dietary changes- low carb
* octreotide
* acarbose
* diazoxide,
* calcium channel antagonists,
* gastric restriction
* reversal procedures with partial or total pancreatectomy in rare recalcitrant cases
✔✔In RYGB & BPD/DS patients, treatment with what should be used to prevent or
minimize hyperparathyroidism w/o inducing hypercalciuria - ✔✔"oral calcium citrate &
vitamin D (ergocalciferol, D 2 ; or cholecalciferol, D 3 )
*In severe cases, doses may need to be as high as 50,000 IU 1-3x daily or weekly &
more recalcitrant cases may require oral calcitrol"
✔✔________________ is usually d/t vitamin D deficiency. What supplementation
should be provided for mild-moderate cases? - ✔✔Hypophosphatemia; oral phosphate
treatment
✔✔What med may be considered in bariatric patients w/ osteoporosis only after calcium
& vitamin D supplementation prove insufficient? What evaluation should be done & in
what form should it be treated? - ✔✔Bisphosphonates.
Eval serum PTH, total calcium, phosphorus, 25-hydroxyvitamin D & 24-hr urine calcium
levels.
If indicated IV form should be used.
✔✔Management of oxalosis & calcium oxylate stones includes: - ✔✔* avoidance of
dehydration
* low oxylate meal plan
* oral calcium & potassium citrate therapy
,✔✔What probiotic strains have been shown to improve renal oxylate excretion &
improve saturation levels? - ✔✔Oxalobacter formigenes
✔✔Which deficiency presents as ocular complications? Which bariatric pts should be
routine screened? What is the treatment? - ✔✔Vitamin A deficiency; BPD/DS patients
screened; vitamin A supplementation alone or with fat-soluble vitamins (E, D, & K) to
treat
✔✔When should K1 level be considered? - ✔✔established fat-soluble vitamin
deficiency w/ hepatopathy, coagulopathy, or osteoporosis
✔✔What patients should be monitored for iron status? - ✔✔All bariatric patients; anemia
w/o evidence of blood loss warrants eval of nutritional deficiencies as well as age
appropriate causes
✔✔Iron treatment - ✔✔oral ferrous sulfate, fumarate, or gluconate up to 150-200 mg of
elemental iron daily; vitamin C enhances absorption; IV iron infusion with ferric
gluconate or sucrose may be needed with severe intolerance to oral iron or refractory
deficiency d/t malabsorption
✔✔Malabsorptive bariatric procedures may result in what nutritional deficiencies? -
✔✔Vitamin B12, folate, protein, copper, selenium, & zinc
✔✔Routine screening for what mineral deficiency should occur after malabsorptive
procedures? Who should receive routine supplementation? - ✔✔zinc deficiency; BP/DS
require supplementation
✔✔What mineral deficiency presents as hair loss, pica, significant dysgeusia, or in male
patients with hypogonadism or erectile disfunction? - ✔✔Zinc deficiency
✔✔When being treated for zinc deficiency or using supplemental zinc for hair loss, what
other supplement should be taken? - ✔✔1mg copper for every 8-15mg zinc (zinc
replacement can cause copper deficiency)
✔✔Which type of stools after BPD/DS should prompt evaluation for nutrient
deficiencies? - ✔✔steatorrhea
✔✔NSAIDs should be completely avoided after bariatric surgery as they can lead to... -
✔✔anastomic ulcerations/ perforations
,✔✔Who may benefit from a revisional procedure? - ✔✔RYGB w/ nonpartioned stomach
who developed gastric fistula or herniation w/ symptoms of weight regain, marginal
ulcer, stricture, or GERD.
✔✔What should be used to evaluate patients w/ Upper Right Quadrant Pain? What can
be the cause? How is it treated? - ✔✔Ultrasound for cholecystitis; prophylactic
cholecystectomy for RYGB patients or oral ursodeoxycholic acid > 300mg daily in
divided doses can significantly decrease gallstone formation
✔✔For antibiotic resistant cases of bacterial overgrowth, what probiotic therapy may be
considered? - ✔✔Lactobacillus plantarum 299v & Lactobacillus GG
✔✔When to repair abdominal wall hernias if asymptomatic? if symptomatic? -
✔✔"Asymptomatic - deferred until weight loss has stabilized & nutritional status
improved (12-18 mo)
Symptomatic - prompt surgical eval- abdominal or pelvic CT, exploratory laparotomy or
laparoscopy if suspected of internal hernia"
✔✔What are the criteria for hospital admission after bariatric surgery? - ✔✔"* severe
malnutrition- initiation & formulation of enteral (tube feeding) or parenteral nutrition
* if not dehydrated- endoscopic stomal dilation for stricture as outpatient procedure
* reversal or revision when serious complications related to previous bariatric surgery
cannot be managed medically"
✔✔BED, night eating syndrome, grazing & other loss-of-control eating patterns are
quite common in bariatric surgery candidates, however only what eating disorder is
considered a contraindication? - ✔✔Bulimia nervosa
✔✔Tx:
BMI > 25kg/m 2" - ✔✔diet, exercise, & behavior modification
✔✔Tx:
BMI > 27 kg/m 2 with comorbid or BMI > 30 kg/m 2 - ✔✔diet, exercise, & behavior
modification + pharmacotherapy
✔✔Tx:
BMI > 35 kg/m 2 w/comorbidity or BMI >40 kg/m 2 - ✔✔bariatric surgery as adjuncts to
behavior modification to reduce food intake & increased PA. Drugs may amplify
adherence to behavior change & may improve physical function making PA easier.
✔✔Who is a candidate for weight loss medication? - ✔✔Hx unsuccessful weight loss or
maintain weight,
BMI > 27 kg/m 2 & > 1 comorbid (i.e. HTN, T2DM, dyslipidemia, OSA) or
, BMI > 30kg/m 2
✔✔Which weight loss meds are NOT recommended for uncontrolled HTN or Hx of heart
disease? - ✔✔sympathomimetic agents: phentermine & diethylpropion
✔✔When should WL meds be assessed for efficacy & safety? - ✔✔at least monthly for
first 3 months, then every 3 months
✔✔effective responce to WL medication - ✔✔weight loss > 5% BW at 3 mo
✔✔How should medication be prescribed for chronic obesity management? -
✔✔adjunctive to comprehensive lifestyle intervention & initiated with dose escalation
based on efficacy and tolerability
✔✔"Which of the following is NOT recommended as first-line therapy for HTN in
patients with T2DM who are obese?
a) ACE inhibitors
b) ARBs
c) B-Adrenergic blockers
d) calcium channel blockers" - ✔✔"c. Beta blockers are NOT rec'd as first line therapy.
(Beta blockers can cause weight gain).
(a) (b) & (d) ARE recommended 1st."
✔✔Side-effects of Antipsychotics - ✔✔"Metabolic Syndrome (2nd-gen antipsychotics)
* increased BP, increased insulin levels, excess body fat around waist or abnormal
cholesterol levels
* increased risk for developing CVD, stroke, & T2D
* Tx: consider switching to 1st-gen antipsychotic or more ""weight-neutral"" 2nd-gen
antipsychotic such as aripiprazole or ziprasidone"
✔✔In women with a BMI > 27 kg/m w/ comorbidities or >30 kg/m seeking contraception,
suggest what form of contraceptives? - ✔✔oral contraceptives over injectable
medications d/t weight gain with injectables
✔✔monitor weight & WC in patients on antiretroviral therapy (HIV) d/t - ✔✔unavoidable
weight gain, weight redistribution, & associated CVD risk; HIV lipodystrophy is a
common cause of acquired partial lipodystrophy
(fat proliferation)
AND SOLUTIONS GRADED A+ TIP
✔✔Frequency of follow-up for bariatric patients is determined by... - ✔✔procedure
performed & severity of comorbids
✔✔RYGB & BPD/DS patients with postprandial hypoglycemic symptoms who have not
responded to nutritional manipulation should be evaluated to differentiate... -
✔✔noninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS) from factitious or
iatrogenic causes (ie. dumping syndrome & insulinoma)
✔✔How should noninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS) be
treated? - ✔✔* dietary changes- low carb
* octreotide
* acarbose
* diazoxide,
* calcium channel antagonists,
* gastric restriction
* reversal procedures with partial or total pancreatectomy in rare recalcitrant cases
✔✔In RYGB & BPD/DS patients, treatment with what should be used to prevent or
minimize hyperparathyroidism w/o inducing hypercalciuria - ✔✔"oral calcium citrate &
vitamin D (ergocalciferol, D 2 ; or cholecalciferol, D 3 )
*In severe cases, doses may need to be as high as 50,000 IU 1-3x daily or weekly &
more recalcitrant cases may require oral calcitrol"
✔✔________________ is usually d/t vitamin D deficiency. What supplementation
should be provided for mild-moderate cases? - ✔✔Hypophosphatemia; oral phosphate
treatment
✔✔What med may be considered in bariatric patients w/ osteoporosis only after calcium
& vitamin D supplementation prove insufficient? What evaluation should be done & in
what form should it be treated? - ✔✔Bisphosphonates.
Eval serum PTH, total calcium, phosphorus, 25-hydroxyvitamin D & 24-hr urine calcium
levels.
If indicated IV form should be used.
✔✔Management of oxalosis & calcium oxylate stones includes: - ✔✔* avoidance of
dehydration
* low oxylate meal plan
* oral calcium & potassium citrate therapy
,✔✔What probiotic strains have been shown to improve renal oxylate excretion &
improve saturation levels? - ✔✔Oxalobacter formigenes
✔✔Which deficiency presents as ocular complications? Which bariatric pts should be
routine screened? What is the treatment? - ✔✔Vitamin A deficiency; BPD/DS patients
screened; vitamin A supplementation alone or with fat-soluble vitamins (E, D, & K) to
treat
✔✔When should K1 level be considered? - ✔✔established fat-soluble vitamin
deficiency w/ hepatopathy, coagulopathy, or osteoporosis
✔✔What patients should be monitored for iron status? - ✔✔All bariatric patients; anemia
w/o evidence of blood loss warrants eval of nutritional deficiencies as well as age
appropriate causes
✔✔Iron treatment - ✔✔oral ferrous sulfate, fumarate, or gluconate up to 150-200 mg of
elemental iron daily; vitamin C enhances absorption; IV iron infusion with ferric
gluconate or sucrose may be needed with severe intolerance to oral iron or refractory
deficiency d/t malabsorption
✔✔Malabsorptive bariatric procedures may result in what nutritional deficiencies? -
✔✔Vitamin B12, folate, protein, copper, selenium, & zinc
✔✔Routine screening for what mineral deficiency should occur after malabsorptive
procedures? Who should receive routine supplementation? - ✔✔zinc deficiency; BP/DS
require supplementation
✔✔What mineral deficiency presents as hair loss, pica, significant dysgeusia, or in male
patients with hypogonadism or erectile disfunction? - ✔✔Zinc deficiency
✔✔When being treated for zinc deficiency or using supplemental zinc for hair loss, what
other supplement should be taken? - ✔✔1mg copper for every 8-15mg zinc (zinc
replacement can cause copper deficiency)
✔✔Which type of stools after BPD/DS should prompt evaluation for nutrient
deficiencies? - ✔✔steatorrhea
✔✔NSAIDs should be completely avoided after bariatric surgery as they can lead to... -
✔✔anastomic ulcerations/ perforations
,✔✔Who may benefit from a revisional procedure? - ✔✔RYGB w/ nonpartioned stomach
who developed gastric fistula or herniation w/ symptoms of weight regain, marginal
ulcer, stricture, or GERD.
✔✔What should be used to evaluate patients w/ Upper Right Quadrant Pain? What can
be the cause? How is it treated? - ✔✔Ultrasound for cholecystitis; prophylactic
cholecystectomy for RYGB patients or oral ursodeoxycholic acid > 300mg daily in
divided doses can significantly decrease gallstone formation
✔✔For antibiotic resistant cases of bacterial overgrowth, what probiotic therapy may be
considered? - ✔✔Lactobacillus plantarum 299v & Lactobacillus GG
✔✔When to repair abdominal wall hernias if asymptomatic? if symptomatic? -
✔✔"Asymptomatic - deferred until weight loss has stabilized & nutritional status
improved (12-18 mo)
Symptomatic - prompt surgical eval- abdominal or pelvic CT, exploratory laparotomy or
laparoscopy if suspected of internal hernia"
✔✔What are the criteria for hospital admission after bariatric surgery? - ✔✔"* severe
malnutrition- initiation & formulation of enteral (tube feeding) or parenteral nutrition
* if not dehydrated- endoscopic stomal dilation for stricture as outpatient procedure
* reversal or revision when serious complications related to previous bariatric surgery
cannot be managed medically"
✔✔BED, night eating syndrome, grazing & other loss-of-control eating patterns are
quite common in bariatric surgery candidates, however only what eating disorder is
considered a contraindication? - ✔✔Bulimia nervosa
✔✔Tx:
BMI > 25kg/m 2" - ✔✔diet, exercise, & behavior modification
✔✔Tx:
BMI > 27 kg/m 2 with comorbid or BMI > 30 kg/m 2 - ✔✔diet, exercise, & behavior
modification + pharmacotherapy
✔✔Tx:
BMI > 35 kg/m 2 w/comorbidity or BMI >40 kg/m 2 - ✔✔bariatric surgery as adjuncts to
behavior modification to reduce food intake & increased PA. Drugs may amplify
adherence to behavior change & may improve physical function making PA easier.
✔✔Who is a candidate for weight loss medication? - ✔✔Hx unsuccessful weight loss or
maintain weight,
BMI > 27 kg/m 2 & > 1 comorbid (i.e. HTN, T2DM, dyslipidemia, OSA) or
, BMI > 30kg/m 2
✔✔Which weight loss meds are NOT recommended for uncontrolled HTN or Hx of heart
disease? - ✔✔sympathomimetic agents: phentermine & diethylpropion
✔✔When should WL meds be assessed for efficacy & safety? - ✔✔at least monthly for
first 3 months, then every 3 months
✔✔effective responce to WL medication - ✔✔weight loss > 5% BW at 3 mo
✔✔How should medication be prescribed for chronic obesity management? -
✔✔adjunctive to comprehensive lifestyle intervention & initiated with dose escalation
based on efficacy and tolerability
✔✔"Which of the following is NOT recommended as first-line therapy for HTN in
patients with T2DM who are obese?
a) ACE inhibitors
b) ARBs
c) B-Adrenergic blockers
d) calcium channel blockers" - ✔✔"c. Beta blockers are NOT rec'd as first line therapy.
(Beta blockers can cause weight gain).
(a) (b) & (d) ARE recommended 1st."
✔✔Side-effects of Antipsychotics - ✔✔"Metabolic Syndrome (2nd-gen antipsychotics)
* increased BP, increased insulin levels, excess body fat around waist or abnormal
cholesterol levels
* increased risk for developing CVD, stroke, & T2D
* Tx: consider switching to 1st-gen antipsychotic or more ""weight-neutral"" 2nd-gen
antipsychotic such as aripiprazole or ziprasidone"
✔✔In women with a BMI > 27 kg/m w/ comorbidities or >30 kg/m seeking contraception,
suggest what form of contraceptives? - ✔✔oral contraceptives over injectable
medications d/t weight gain with injectables
✔✔monitor weight & WC in patients on antiretroviral therapy (HIV) d/t - ✔✔unavoidable
weight gain, weight redistribution, & associated CVD risk; HIV lipodystrophy is a
common cause of acquired partial lipodystrophy
(fat proliferation)
