CSOWM Practice Question
Compilation with correct answers
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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 Answer 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 Answer 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 Answer 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 Answer 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 Answer 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 Answer 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 Answer 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 Answer 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 Answer 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 Answer 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 Answer 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 Answer B. Microcytic anemia with neutropenia
Compilation with correct answers
100%
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 Answer 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 Answer 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 Answer 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 Answer 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 Answer 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 Answer 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 Answer 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 Answer 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 Answer 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 Answer 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 Answer 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 Answer B. Microcytic anemia with neutropenia
