CSOWM PRACTICE TEST EXAM 2025/2026 ALL QUESTIONS
AND SOLUTIONS GRADED A+ TIP
✔✔Look AHEAD Trial - ✔✔Assessed long-term health consequences of intentional wt
loss. Showed feasibility of achieving and maintaining long-term (13.5 years) weight loss
in patients with type II DM.
Participants randomly
assigned to the intensive lifestyle
group achieved equivalent risk factor
control but required fewer glucose-,
blood pressure-, and lipid-lowering
medications than those randomly assigned
to standard care. Other improvements included increased mobility, physical and sexual
functioning, and health-related quality of life
(did NOT show reduced CVD events in diabetics & overweight/obesity)
✔✔DM meds that can promote weight loss - ✔✔Metformin
Alpha-glucosidase inhibitors
SGLT-2 inhibitors
GLP-1 agonsits
Amylin mimetics (Pramlintide)
✔✔Metabolic Surgery for Type II DM - ✔✔BMI >/= 35 (Asian Americans >/= 32.5)
Pts who do not achieve durable weight loss and improvement in comorbidities with
nonsurgical methods
Can be considered with BMI of >/= 30 (Asians of >/= 27.5) who do not achieve durable
weight loss & improvement in comorbidities with tested efficacious nonsurgical methods
✔✔Adverse Effects of Metabolic Surgery - ✔✔Dumping Syndrome
Vitamin and Mineral deficiencies
Anemia
Osteoporosis
Rarely- hypoglycemia, which is more likely to occur in RYGB patients (cause unknown)
✔✔Phentermine and Diethylpropion - ✔✔Sympathomimetic agents that can increase
BP and pulse
FDA approved for short-term (3 months)
Do not use for pt's with uncontrolled HTN, h/o heart disease, or with CVD
✔✔Lorcaserin or Orlistat - ✔✔Orlistat is good medication for patients with CVD
(Lorcaserin discontinued in 2020)
,✔✔Medications that cause weight gain - ✔✔Antidepressants (tricyclic) (Paroxetine,
Amitriptyline)
Antipsychotics (Olanzapine)
Anticonvulstants (Gabapentin, Valproic acid)
Glucocorticoids
Injectable contraceptives
Sulfonylureas
Glitazones
Beta Blockers
Antiretroviral therapy
sedating antihistamines (potentially)
✔✔Endocrine related causes of weight gain - ✔✔Hypothyroidism
Cushing Syndrome
GH deficiency
Pseudohypoparathyroidism
✔✔Genetic causes of Obesity - ✔✔POMC deficiency
Leptin deficiency
Melanocortin-4 receptor mutation
✔✔Ghrelin - ✔✔A hunger-arousing hormone secreted by an empty stomach
Orexigenic
✔✔Leptin - ✔✔Secreted from adipose tissue, circulating levels are proportional to fat
mass (Obesity = high levels)
Anorectic hormone that activates POMC & cocaine amphetamine neurons in arcuate
nucleus
Results in decreased intake and increased energy expenditure (satiety)
✔✔Gut Hormones - ✔✔Signal satiety
Peptide YY (ileum and colon)
CCK (duodenum)
K cells ( duodenum and jejunum)
GLP-1 (ileum); response to glucose and promote insulin release and satiety
✔✔Phentermine and Diethylpropion - ✔✔Noradrenergic sympathomimetic amine
(norepinephrine-releasing agents)
Inexpensive
Short-term use (3 months )
, Contraindicated in pts with anxiety disorders, h/o heart disease, uncontrolled HTN,
seizure, h/o drug abuse, pregnancy and breastfeeding
✔✔Lorcaserin (Belviq) - ✔✔Serotonin agent
Discontinued in 2020 due to increased cancer risk
Do not use in patients on SSRI and SNRI due to the potential for serotonin syndrome or
if pt is pregnant or breastfeeding
✔✔Phentermine/Topiramate (Qsymia) - ✔✔sympathomimetic that decreases appetite +
antiseizure/neurostablizer
can cause Teratogen, constipation, dry mouth/taste changes with carbonated
beverages, tingling
FDA-approved for chronic weight management
Contraindicated in pregnancy and breastfeeding, hyperthyroidism, etc
✔✔Bupropion (Wellbutrin) - ✔✔dopamine and norepinephrine reuptake inhibitor that
stimulates POMC neurons
✔✔Bupropion/Naltrexone (Contrave) - ✔✔Reuptake inhibitor of dopamine &
norepinephrine (antidepressant) + naltrexone is an opioid antagonist
Suppresses appetite and curbs cravings
May cause C/D, increased BP and heart rate
FDA-approved for chronic management
Contraindicated in uncontrolled HTN, seizure disorders, eating disorders, drug or
alcohol withdrawal
✔✔Orlistat (Xenical or Alli) - ✔✔Blocks 25-30% of fat absorption
FDA-approved for chronic management (Adults, kids over 12)
can decrease the absorption of fat-soluble vitamins and cause diarrhea, gas, and oily
stool
Contraindicated with Cyclosporine, chronic malabsorption, cholestasis, pregnancy and
breastfeeding
✔✔Pharmacotherapy - ✔✔BMI >/= 27 + comorbidity
BMI >/= 30
as adjunctive therapy to behavioral modifications
✔✔Comorbidities in Obesity - ✔✔T2DM
Dyslipidemia
AND SOLUTIONS GRADED A+ TIP
✔✔Look AHEAD Trial - ✔✔Assessed long-term health consequences of intentional wt
loss. Showed feasibility of achieving and maintaining long-term (13.5 years) weight loss
in patients with type II DM.
Participants randomly
assigned to the intensive lifestyle
group achieved equivalent risk factor
control but required fewer glucose-,
blood pressure-, and lipid-lowering
medications than those randomly assigned
to standard care. Other improvements included increased mobility, physical and sexual
functioning, and health-related quality of life
(did NOT show reduced CVD events in diabetics & overweight/obesity)
✔✔DM meds that can promote weight loss - ✔✔Metformin
Alpha-glucosidase inhibitors
SGLT-2 inhibitors
GLP-1 agonsits
Amylin mimetics (Pramlintide)
✔✔Metabolic Surgery for Type II DM - ✔✔BMI >/= 35 (Asian Americans >/= 32.5)
Pts who do not achieve durable weight loss and improvement in comorbidities with
nonsurgical methods
Can be considered with BMI of >/= 30 (Asians of >/= 27.5) who do not achieve durable
weight loss & improvement in comorbidities with tested efficacious nonsurgical methods
✔✔Adverse Effects of Metabolic Surgery - ✔✔Dumping Syndrome
Vitamin and Mineral deficiencies
Anemia
Osteoporosis
Rarely- hypoglycemia, which is more likely to occur in RYGB patients (cause unknown)
✔✔Phentermine and Diethylpropion - ✔✔Sympathomimetic agents that can increase
BP and pulse
FDA approved for short-term (3 months)
Do not use for pt's with uncontrolled HTN, h/o heart disease, or with CVD
✔✔Lorcaserin or Orlistat - ✔✔Orlistat is good medication for patients with CVD
(Lorcaserin discontinued in 2020)
,✔✔Medications that cause weight gain - ✔✔Antidepressants (tricyclic) (Paroxetine,
Amitriptyline)
Antipsychotics (Olanzapine)
Anticonvulstants (Gabapentin, Valproic acid)
Glucocorticoids
Injectable contraceptives
Sulfonylureas
Glitazones
Beta Blockers
Antiretroviral therapy
sedating antihistamines (potentially)
✔✔Endocrine related causes of weight gain - ✔✔Hypothyroidism
Cushing Syndrome
GH deficiency
Pseudohypoparathyroidism
✔✔Genetic causes of Obesity - ✔✔POMC deficiency
Leptin deficiency
Melanocortin-4 receptor mutation
✔✔Ghrelin - ✔✔A hunger-arousing hormone secreted by an empty stomach
Orexigenic
✔✔Leptin - ✔✔Secreted from adipose tissue, circulating levels are proportional to fat
mass (Obesity = high levels)
Anorectic hormone that activates POMC & cocaine amphetamine neurons in arcuate
nucleus
Results in decreased intake and increased energy expenditure (satiety)
✔✔Gut Hormones - ✔✔Signal satiety
Peptide YY (ileum and colon)
CCK (duodenum)
K cells ( duodenum and jejunum)
GLP-1 (ileum); response to glucose and promote insulin release and satiety
✔✔Phentermine and Diethylpropion - ✔✔Noradrenergic sympathomimetic amine
(norepinephrine-releasing agents)
Inexpensive
Short-term use (3 months )
, Contraindicated in pts with anxiety disorders, h/o heart disease, uncontrolled HTN,
seizure, h/o drug abuse, pregnancy and breastfeeding
✔✔Lorcaserin (Belviq) - ✔✔Serotonin agent
Discontinued in 2020 due to increased cancer risk
Do not use in patients on SSRI and SNRI due to the potential for serotonin syndrome or
if pt is pregnant or breastfeeding
✔✔Phentermine/Topiramate (Qsymia) - ✔✔sympathomimetic that decreases appetite +
antiseizure/neurostablizer
can cause Teratogen, constipation, dry mouth/taste changes with carbonated
beverages, tingling
FDA-approved for chronic weight management
Contraindicated in pregnancy and breastfeeding, hyperthyroidism, etc
✔✔Bupropion (Wellbutrin) - ✔✔dopamine and norepinephrine reuptake inhibitor that
stimulates POMC neurons
✔✔Bupropion/Naltrexone (Contrave) - ✔✔Reuptake inhibitor of dopamine &
norepinephrine (antidepressant) + naltrexone is an opioid antagonist
Suppresses appetite and curbs cravings
May cause C/D, increased BP and heart rate
FDA-approved for chronic management
Contraindicated in uncontrolled HTN, seizure disorders, eating disorders, drug or
alcohol withdrawal
✔✔Orlistat (Xenical or Alli) - ✔✔Blocks 25-30% of fat absorption
FDA-approved for chronic management (Adults, kids over 12)
can decrease the absorption of fat-soluble vitamins and cause diarrhea, gas, and oily
stool
Contraindicated with Cyclosporine, chronic malabsorption, cholestasis, pregnancy and
breastfeeding
✔✔Pharmacotherapy - ✔✔BMI >/= 27 + comorbidity
BMI >/= 30
as adjunctive therapy to behavioral modifications
✔✔Comorbidities in Obesity - ✔✔T2DM
Dyslipidemia
