CSOWM MISCELLANEOUS EXAM QUESTIONS
AND VERIFIED ANSWERS
A PCP prescribes short-term weight-loss management for an obese patient with
migraine migraines. The nurse recognizes which medication will be the most
effective for the patient.
a. Orlistat
b. Topiramate
c. Phendimetrazine - Answer: B.
Topiramate is an anticonvulsant used in conjunction with nonamphetamines such
as phentermine. It is excellent at reducing migraines and treating obesity.
The Obesity Surgery Mortality Risk Score (OS-MRS) found which five
preoperative risk variables indicated an increased risk of 30-day morbidity and
mortality following RYGB - ANSWER 1. Advanced age: > 45 years
2. "Super-obesity": BMI ≥ 50
3. HTN
4. Male gender.
5. Pulmonary Embolism (PE) or Surrogate (e.g., DVT, OSA)
Which patients should be offered bariatric surgery? - ANSWER BMI over 40
kg/m2
BMI > 35 kg/m2 with more than one severe obesity-related comorbidity (e.g.,
T2DM, HTN, OSA, NAFLD/NASH, HLD, GERD, osteoarthritis, GI problems,
heart disease).
,There is inadequate evidence to propose a bariatric surgical surgery for what
illnesses, regardless of BMI? - ANSWER: Glycemic control alone.
- Lipid-lowering alone
- CVD risk alone.
What factors should be considered when selecting the best bariatric surgical
procedure? - ANSWER 1. Individualized therapy goals
2. accessible local and regional knowledge
3. Patient's preference
4. Personalized risk stratification.
In general, ______ bariatric procedures are recommended over ___ bariatric
treatments due to reduced early post-operative _________ and _________. -
ANSWER: Laparoscopic > Open; morbidity and death
When making a recommendation, exercise prudence. BPD/DS or comparable
surgeries are associated with significant nutritional concerns and a length of
bypassed small intestine. - ANSWER: higher nutritional risks and duration.
What should be covered in the preoperative evaluation? - ANSWER - complete
medical history.
- Psychosocial Hx.
- Physical Examination
- proper lab testing to evaluate surgical risk.
How should potential bariatric surgery candidates be handled before the procedure?
- ANSWER: Preoperative assessment.
,- proven medical necessity.
- informed consent on risks and benefits, procedure options, and choice of
surgeon/medical institution.
- The requirement for long-term f/up and vitamin supplements
- supplied with financial data
- Encourage preoperative weight loss.
What should be encouraged in order to lower liver volume (which may help
improve surgical techniques in enlarged or fatty liver disease)? - ANSWER
preoperative weight loss, generally by a two-week "liver shrink diet"
Pre-op glycemic control should be maximized with a diabetes comprehensive care
plan that includes which? - ANSWER: Healthy dietary patterns.
- MNT
- PA
- Pharmacotherapy on a regular basis
Reasonable pre-op glucose control goals that may be associated with better
bariatric surgery outcomes include:
- HbA1C?
- BG when fasting?
- 2 hours PPBG? - Answer: HbA1C <6.5-7.0%.
- Fasting blood glucose <110mg/dL
- 2 hour PPBG level <140mg/dL
, NOTE: HbA1C levels of 7-8% should be evaluated in patients with microvascular
or macrovascular problems, severe comorbidities, or long-term diabetes. Use
clinical judgement when HbA1c is more than 8%.
True or false: Routine screening for primary hypothyroidism prior to bariatric
surgery is not recommended. - ANSWER True; only those at risk should have TSH
tested and treated with L-thyroxine monotherapy if hypothyroid.
True or false: A fasting lipid panel should be acquired for all obese patients. -
ANSWER: True, and treatment should be undertaken if necessary.
Candidates for bariatric surgery should prevent pregnancy before and after surgery,
and for how long? - ANSWER: 12-18 months
True or false: After bariatric surgery, all women of reproductive age should be
educated on contraception options. - The answer is true.
When should patients who become pregnant after bariatric surgery undergo
nutritional and lab screening? What deficiencies should be monitored? - Answer:
Every trimester. Monitor iron, folate, and B12 levels, as well as calcium and
fat-soluble vitamins.
True or False: Estrogen medication should be discontinued before bariatric surgery
to lower the incidence of post-operative thromboembolic events. - ANSWER True:
One cycle of oral contraceptives in premenopausal women.
Three weeks of hormone replacement therapy in postmenopausal women.
Women with PCOS should be warned that their reproductive status may be affected
post-op. - ANSWER: Improved fertility
AND VERIFIED ANSWERS
A PCP prescribes short-term weight-loss management for an obese patient with
migraine migraines. The nurse recognizes which medication will be the most
effective for the patient.
a. Orlistat
b. Topiramate
c. Phendimetrazine - Answer: B.
Topiramate is an anticonvulsant used in conjunction with nonamphetamines such
as phentermine. It is excellent at reducing migraines and treating obesity.
The Obesity Surgery Mortality Risk Score (OS-MRS) found which five
preoperative risk variables indicated an increased risk of 30-day morbidity and
mortality following RYGB - ANSWER 1. Advanced age: > 45 years
2. "Super-obesity": BMI ≥ 50
3. HTN
4. Male gender.
5. Pulmonary Embolism (PE) or Surrogate (e.g., DVT, OSA)
Which patients should be offered bariatric surgery? - ANSWER BMI over 40
kg/m2
BMI > 35 kg/m2 with more than one severe obesity-related comorbidity (e.g.,
T2DM, HTN, OSA, NAFLD/NASH, HLD, GERD, osteoarthritis, GI problems,
heart disease).
,There is inadequate evidence to propose a bariatric surgical surgery for what
illnesses, regardless of BMI? - ANSWER: Glycemic control alone.
- Lipid-lowering alone
- CVD risk alone.
What factors should be considered when selecting the best bariatric surgical
procedure? - ANSWER 1. Individualized therapy goals
2. accessible local and regional knowledge
3. Patient's preference
4. Personalized risk stratification.
In general, ______ bariatric procedures are recommended over ___ bariatric
treatments due to reduced early post-operative _________ and _________. -
ANSWER: Laparoscopic > Open; morbidity and death
When making a recommendation, exercise prudence. BPD/DS or comparable
surgeries are associated with significant nutritional concerns and a length of
bypassed small intestine. - ANSWER: higher nutritional risks and duration.
What should be covered in the preoperative evaluation? - ANSWER - complete
medical history.
- Psychosocial Hx.
- Physical Examination
- proper lab testing to evaluate surgical risk.
How should potential bariatric surgery candidates be handled before the procedure?
- ANSWER: Preoperative assessment.
,- proven medical necessity.
- informed consent on risks and benefits, procedure options, and choice of
surgeon/medical institution.
- The requirement for long-term f/up and vitamin supplements
- supplied with financial data
- Encourage preoperative weight loss.
What should be encouraged in order to lower liver volume (which may help
improve surgical techniques in enlarged or fatty liver disease)? - ANSWER
preoperative weight loss, generally by a two-week "liver shrink diet"
Pre-op glycemic control should be maximized with a diabetes comprehensive care
plan that includes which? - ANSWER: Healthy dietary patterns.
- MNT
- PA
- Pharmacotherapy on a regular basis
Reasonable pre-op glucose control goals that may be associated with better
bariatric surgery outcomes include:
- HbA1C?
- BG when fasting?
- 2 hours PPBG? - Answer: HbA1C <6.5-7.0%.
- Fasting blood glucose <110mg/dL
- 2 hour PPBG level <140mg/dL
, NOTE: HbA1C levels of 7-8% should be evaluated in patients with microvascular
or macrovascular problems, severe comorbidities, or long-term diabetes. Use
clinical judgement when HbA1c is more than 8%.
True or false: Routine screening for primary hypothyroidism prior to bariatric
surgery is not recommended. - ANSWER True; only those at risk should have TSH
tested and treated with L-thyroxine monotherapy if hypothyroid.
True or false: A fasting lipid panel should be acquired for all obese patients. -
ANSWER: True, and treatment should be undertaken if necessary.
Candidates for bariatric surgery should prevent pregnancy before and after surgery,
and for how long? - ANSWER: 12-18 months
True or false: After bariatric surgery, all women of reproductive age should be
educated on contraception options. - The answer is true.
When should patients who become pregnant after bariatric surgery undergo
nutritional and lab screening? What deficiencies should be monitored? - Answer:
Every trimester. Monitor iron, folate, and B12 levels, as well as calcium and
fat-soluble vitamins.
True or False: Estrogen medication should be discontinued before bariatric surgery
to lower the incidence of post-operative thromboembolic events. - ANSWER True:
One cycle of oral contraceptives in premenopausal women.
Three weeks of hormone replacement therapy in postmenopausal women.
Women with PCOS should be warned that their reproductive status may be affected
post-op. - ANSWER: Improved fertility
