CSOWM COMPREHENSIVE EXAM 2025/2026 ALL
QUESTIONS AND SOLUTIONS GRADED A+ TIP
✔✔Bupropion (Wellbutrin) - ✔✔Dopamine + norepinepherine reuptake inhibitor
Stimulates POMC neurons
✔✔Sibutramine (Meridia) - ✔✔Discontinued-
Norepinephrine, Serotonin, and Dopamine Reuptake Inhibitor Anorectic
Approved for use in adolescents >/=16
✔✔Orlistat - ✔✔blocks absorption of 25-30% of fat calories
✔✔SLGT-2 inhibitors (best for T2DM patients)- ex. Invokana - ✔✔promote weight loss
by preventing the reabsorption of glucose as well as water
✔✔Band name: Victoza/Sandexa - ✔✔Liraglutide
✔✔Liraglutide (Victoza/Sandexa) - ✔✔Injectable, long acting GLP-1 receptor agonist
✔✔Diethylpropion - ✔✔Anorexiants, Sympathomimetic Amine Anorectic
✔✔Cautions with use of Phentermine and Diethylpropion - ✔✔may elevate mean BP
and pulse
Do not use with pts. with hx of CVD
Monitor patient with HTN
Caution with: HTN, cardiac arrhythemia, seizures
Better choice: Lorcaserin (Seratonin receptor angonist)
✔✔cautions with Obese patients on SSRI/SNRI - ✔✔Do not use LORCASERIN
(seratonin syndrome)
Better choice- phentermine/topiramate (Qysemia) or phentermine alone or Orlistat
✔✔Appetite suppressant to avoid before/during pregnancy - ✔✔Topiramate
✔✔Medication recs for CVD - ✔✔Lorcacserin or Orlistat
,✔✔Behavioral treatment of Obesity - ✔✔Weekly: 4-6 months, then bi-weekly
Group: 10-15 participants
60-90 minutes
Private measurements of weight
Participants provide brief report of his/her success with goals
New weight mgmt skill taught each session
Goal: 0.5-1 kg/wk, ultimate goal 10%
✔✔Look Ahead structure - ✔✔3 group + 1 indiv. session for 6 months
2 group + 1 indv. session for months 7-12
year 2-4: individual monthly + contact by phone or email and opt. group sessions
✔✔Leading causes of death in obese patients - ✔✔Ischemic heart disease
Diabetes
Respiratory disease
Cancer: liver, kidney, breast, endometrial, prostate, colon
✔✔AHA/ACC/TOS weight loss guidelines - ✔✔3-5% loss is likely to result in clinically
meaningful reductions in TG, BG, A1c, and DM risk
Women- 1200-1500
Men- 1500-1800
High intensity counseling >/=14 sessions in 6 months
weight loss maintenance - monthly visits monitor:
1. 200-300 minutes/wk activity
2. body weight
3. reduced calorie diet
✔✔Pre-op nutrient lab tests (recommended) - ✔✔Iron
B12
Folic Acid
25-vitamin D
(Vit A and E optional)
✔✔Bariatric surgery patient pre-op requirements - ✔✔Labs (nutrients)
, History and Physical
Lab tests (FBS, lipid, kidney, liver, PT/INR, CBC)
OSA screening
ECG/CXR/Echo
GI eval (H. pylori, gallbladder, upper GI- endo)
Endocrine (A1c, TSH, androgens, Cushings)
Nutr. Assessment
Psych Assessment
Doc. letter of necessity
Informed consent
Financial
Pre-op weight loss
Stable BS
Pregnancy counseling
Smoking cessation
CA screening
✔✔Post-op tests/screenings - ✔✔Bone density @ 2 years
B12 annually
Folic acid, iron, 25-vitamin D, PTH
Vitamin A (initially and then q6-12 mo)
Copper, zinc, selenium
Thiamine
✔✔Protein needs- surgical - ✔✔60 grams minimum, 1.5g/kg IBW
✔✔Management of oxalosis + calcium oxalate stones - ✔✔Avoid dehydration
Low oxalate meal plan
Oral calcium
Potassium citrate therapy
✔✔Iron deficiency treatment - ✔✔Ferrous sulfate, fumerate, gluconate
150-200mg elemental iron daily + vit C
✔✔Selenium deficiency markers - ✔✔Unexplained anemia/fatigue, persistant diarrhea,
cardiomyopathy, metabolic bone disease
✔✔Signs of zinc def. - ✔✔Hair loss
Pica / taste changes
Significant dysgeusia
male patients with hypogonadism or erectile dysfunction
Patients being treated for zinc deficiency or using supplemental zinc should receive
1mg of copper for each 8-15 mg zinc
QUESTIONS AND SOLUTIONS GRADED A+ TIP
✔✔Bupropion (Wellbutrin) - ✔✔Dopamine + norepinepherine reuptake inhibitor
Stimulates POMC neurons
✔✔Sibutramine (Meridia) - ✔✔Discontinued-
Norepinephrine, Serotonin, and Dopamine Reuptake Inhibitor Anorectic
Approved for use in adolescents >/=16
✔✔Orlistat - ✔✔blocks absorption of 25-30% of fat calories
✔✔SLGT-2 inhibitors (best for T2DM patients)- ex. Invokana - ✔✔promote weight loss
by preventing the reabsorption of glucose as well as water
✔✔Band name: Victoza/Sandexa - ✔✔Liraglutide
✔✔Liraglutide (Victoza/Sandexa) - ✔✔Injectable, long acting GLP-1 receptor agonist
✔✔Diethylpropion - ✔✔Anorexiants, Sympathomimetic Amine Anorectic
✔✔Cautions with use of Phentermine and Diethylpropion - ✔✔may elevate mean BP
and pulse
Do not use with pts. with hx of CVD
Monitor patient with HTN
Caution with: HTN, cardiac arrhythemia, seizures
Better choice: Lorcaserin (Seratonin receptor angonist)
✔✔cautions with Obese patients on SSRI/SNRI - ✔✔Do not use LORCASERIN
(seratonin syndrome)
Better choice- phentermine/topiramate (Qysemia) or phentermine alone or Orlistat
✔✔Appetite suppressant to avoid before/during pregnancy - ✔✔Topiramate
✔✔Medication recs for CVD - ✔✔Lorcacserin or Orlistat
,✔✔Behavioral treatment of Obesity - ✔✔Weekly: 4-6 months, then bi-weekly
Group: 10-15 participants
60-90 minutes
Private measurements of weight
Participants provide brief report of his/her success with goals
New weight mgmt skill taught each session
Goal: 0.5-1 kg/wk, ultimate goal 10%
✔✔Look Ahead structure - ✔✔3 group + 1 indiv. session for 6 months
2 group + 1 indv. session for months 7-12
year 2-4: individual monthly + contact by phone or email and opt. group sessions
✔✔Leading causes of death in obese patients - ✔✔Ischemic heart disease
Diabetes
Respiratory disease
Cancer: liver, kidney, breast, endometrial, prostate, colon
✔✔AHA/ACC/TOS weight loss guidelines - ✔✔3-5% loss is likely to result in clinically
meaningful reductions in TG, BG, A1c, and DM risk
Women- 1200-1500
Men- 1500-1800
High intensity counseling >/=14 sessions in 6 months
weight loss maintenance - monthly visits monitor:
1. 200-300 minutes/wk activity
2. body weight
3. reduced calorie diet
✔✔Pre-op nutrient lab tests (recommended) - ✔✔Iron
B12
Folic Acid
25-vitamin D
(Vit A and E optional)
✔✔Bariatric surgery patient pre-op requirements - ✔✔Labs (nutrients)
, History and Physical
Lab tests (FBS, lipid, kidney, liver, PT/INR, CBC)
OSA screening
ECG/CXR/Echo
GI eval (H. pylori, gallbladder, upper GI- endo)
Endocrine (A1c, TSH, androgens, Cushings)
Nutr. Assessment
Psych Assessment
Doc. letter of necessity
Informed consent
Financial
Pre-op weight loss
Stable BS
Pregnancy counseling
Smoking cessation
CA screening
✔✔Post-op tests/screenings - ✔✔Bone density @ 2 years
B12 annually
Folic acid, iron, 25-vitamin D, PTH
Vitamin A (initially and then q6-12 mo)
Copper, zinc, selenium
Thiamine
✔✔Protein needs- surgical - ✔✔60 grams minimum, 1.5g/kg IBW
✔✔Management of oxalosis + calcium oxalate stones - ✔✔Avoid dehydration
Low oxalate meal plan
Oral calcium
Potassium citrate therapy
✔✔Iron deficiency treatment - ✔✔Ferrous sulfate, fumerate, gluconate
150-200mg elemental iron daily + vit C
✔✔Selenium deficiency markers - ✔✔Unexplained anemia/fatigue, persistant diarrhea,
cardiomyopathy, metabolic bone disease
✔✔Signs of zinc def. - ✔✔Hair loss
Pica / taste changes
Significant dysgeusia
male patients with hypogonadism or erectile dysfunction
Patients being treated for zinc deficiency or using supplemental zinc should receive
1mg of copper for each 8-15 mg zinc
