CSOWM Practice Exam Review Questions and
Answers
Question 1
Which of the following syndromes may occur in association with the postoperative development of thiamine
deficiency in patients who have had the Roux-en-Y gastric bypass?
a. Pickwickian
b. Wernicke-Korsakoff
c. Dumping
d. Metabolic
Correct Answer
Answer: B. Wernicke-Korsakoff
Question 2
According to the ADA Guidelines, which race/ethnicity demographic has lower BMI cutoffs?
African American/Black
White
Asian
Latino/a
Native Hawaiian/Pacific Islander
Correct Answer
Answer: Asian
Question 3
A 52-‐year-‐old man presents to your clinic with a chief concern of having difficulty with weight loss. He has a
6 year history of hypertension that is well controlled with medication management. Which of the following
medications is most likely to explain a 5%-‐10% reduction of total energy expenditure for this man?
1. Enalapril
2. Losartan
3. Carvedilol
4. Metoprolol
Correct Answer
Answer: 4. Metoprolol
Question 4
Results from the SURMOUNT-1 trial investigating tirzepatide in patients who were overweight or obese, 15
mg weekly doses of tirzepatide demonstrated what amount of weight loss compared to placebo?
a. 5%
b. 10%
Page 1 of 211
,c. 15%
d. >/= 20%
Correct Answer
Answer: The Correct Answer is D. The pivotal, phase III, double-blind, randomized, controlled SURMOUNT-1
trial investigated tirzepatide treatment in individuals with obesity or overweight who did not have diabetes.
Results demonstrated that at 5 mg, 10 mg, and 15 mg of once-weekly tirzepatide resulted in weight reduction
in participants. At the highest dose, this resulted in 20.9% weight loss compared to placebo. Semaglutide at
2.4 mg demonstrated 14.9% weight loss compared to placebo.
Reference: Wilding, J, et al. New England Journal of Medicine 384, 989-1002; Jastreboff AM, Aronne LJ, Ahmad
NN, et al. N Engl J Med. 2022;387(3):205-216
Question 5
Which of the following procedures is being used increasingly in the US as definitive treatment for severe
obesity (eg, in patients with a body mass index [BMI] > 60)?
a. Sleeve Gastrectomy
b. Roux-en Y Gastric Bypass
c. Adjustable Gastric Banding
d. Vertical Banded Gastroplasty
Correct Answer
Answer: A: Sleeve gastrectomy; because this procedure causes substantial and sustained weight loss, it is
being used increasingly in the US as definitive treatment for severe obesity. Part of the stomach is removed,
creating a tubular stomach passage. The procedure does not involve anatomic changes to the small intestine.
B: Nonetheless, Roux-en-Y gastric bypass surgery accounts for about 80% of bariatric procedures in the US. C:
Use of adjustable gastric banding has dramatically decreased in the US. D: Vertical banded gastroplasty is no
longer commonly done because complication rates are high and the resulting weight loss is insufficient.
Question 6
Which of the following effects are hypothesized to be mediated via activation of glucose-dependent
insulinotropic polypeptide (GIP) receptors, leading to ongoing development of agents targeting GIP to treat
obesity?
a. Increased insulin secretion and delayed gastric emptying
b. Increased adipose tissue blood flow and adipocyte metabolism
c. Delayed gastric emptying and suppression of postprandial glucagon
d. Increased glucagon secretion and modulation of dopaminergic signaling in the limbic system
Correct Answer
Answer: B. Increased adipose tissue blood flow and adipocyte metabolism
Explanation: GIP receptor agonists in clinical development for the treatment of patients with obesity are
associated with a variety of physiological effects leading to weight loss, including increases in adipose tissue
blood flow, adipocyte metabolism, and insulin secretion. Increased insulin secretion, delayed gastric emptying,
and reductions in glucagon are associated with both GLP-1 agonists currently approved for the treatment of
obesity (ie, liraglutide and semaglutide) and amylin receptor agonists that are in development. In addition,
amylin receptor agonists are hypothesized to have direct effects in the CNS via the hypothalamus and
dopaminergic neurons projecting from the ventral tegmental area to the limbic system, thereby altering
reward and motivation associated with food.
Page 2 of 211
,Gjermeni E et al. Obesity: An update on the basic pathophysiology and review of recent therapeutic advances.
Biomolecules. 2021;11:1426.
Jastreboff AM, Kushner RF. New frontiers in obesity treatment: GLP-1 and nascent nutrient-stimulated
hormone-based therapeutics. Ann Rev Med. 2023;74:125-39.
Lempesis IG et al. The catcher in the gut: tirzepatide, a dual incretin analog for the treatment of type 2
diabetes mellitus and obesity. Metab Open. 2022;16:100220.
Question 7
A 48-‐year-‐old woman with class III obesity who underwent Roux-‐en-‐Y obesity surgery six weeks ago
presents to the emergency department. She has a history of poorly controlled type 2 diabetes, hypertension,
depression, and hyperlipidemia. Since obesity surgery, she has had very poor tolerance of food and fluid and
has required intravenous hydration. Review of systems reveals nausea, vomiting, edema, numbness, a new
painful tingling in her feet and legs, and complaints of brain fog. Which of the following nutritional
deficiencies is the MOST likely cause of her symptoms?
1. Folate deficiency
2. Thiamine deficiency
3. Vitamin B12 deficiency
4. Iron deficiency anemia
Correct Answer
Answer: 2. Thiamine deficiency
Question 8
A laparoscopic Roux-‐en-‐Y gastric bypass was converted to an open procedure due to limited exposure
caused by increased intra-‐abdominal pressure. The procedure lasted six hours and the patient was
transferred to the intensive care unit postoperatively. The next morning, highly concentrated dark urine is
noted and urine output has steadily decreased to less than 10 mL/hr. The patient's abdomen is soft and
significant generalized edema is appreciated. Review of lab results indicates hyperkalemia, elevated creatinine,
and markedly elevated CPK levels. Which of the following is the most likely explanation for this patient's
developing acute renal failure?
1. Hypovolemia
2. Rhabdomyolysis
3. Acute myocardial infarction
4. Abdominal compartment syndrome
Correct Answer
Answer: 2. Rhabdomyolysis
Question 1
While of the following fits in with nutrition recommendations from the American Academy of Pediatrics?
a) increased consumption of fast food
b) Increased high-fat foods
c) Timely, regular meals
d) Decreased saturated fat intake for children >2 years
Correct Answer
c) Timely, regular meals
Page 3 of 211
, Question 2
Patients with obesity are at risk for which of the following micronutrients?
a) Vitamin B12, folate, D, Zinc, Iron
b) Vitamins A,E,D,K
c) Vitamin B12, B1, B6, and D
d) They are not at risk because patients with obesity are over nourished
Correct Answer
a) Vitamins B12, folate, D, zinc and iron
Question 3
A patient's surgeon wants her to lose weight before surgery. The patient's surgery is scheduled in one month;
why does the surgeon want her to lose weight prior to the procedure?
a) to reduce abdominal adipose tissue stores
b) to reduce liver volume
c) to prove she can follow instructions and adhere to the diet
d) all of the above
Correct Answer
b) To reduce the volume of her liver.
Question 4
Which is true of the pediatric assessment that differs from adult assessment?
a) Pediatric assessment must be longer
b) Pediatric assessment should include adults caregiver
c) Pediatric assessment isn't possible in the clinic setting
d) None of the above
Correct Answer
b) Pediatric assessment should include adults caregiver
Question 5
When reviewing a pediatric patients' weight, what is most important to review?
a) Weight relative to height (BMI)
b) Weight history of parents
c) Weight changes in the past week
d) Weight of siblings
Correct Answer
a) Weight relative to height (BMI)
Question 6
Self-monitoring is important for adherence because it:
a) allows the client to track information
Page 4 of 211
Answers
Question 1
Which of the following syndromes may occur in association with the postoperative development of thiamine
deficiency in patients who have had the Roux-en-Y gastric bypass?
a. Pickwickian
b. Wernicke-Korsakoff
c. Dumping
d. Metabolic
Correct Answer
Answer: B. Wernicke-Korsakoff
Question 2
According to the ADA Guidelines, which race/ethnicity demographic has lower BMI cutoffs?
African American/Black
White
Asian
Latino/a
Native Hawaiian/Pacific Islander
Correct Answer
Answer: Asian
Question 3
A 52-‐year-‐old man presents to your clinic with a chief concern of having difficulty with weight loss. He has a
6 year history of hypertension that is well controlled with medication management. Which of the following
medications is most likely to explain a 5%-‐10% reduction of total energy expenditure for this man?
1. Enalapril
2. Losartan
3. Carvedilol
4. Metoprolol
Correct Answer
Answer: 4. Metoprolol
Question 4
Results from the SURMOUNT-1 trial investigating tirzepatide in patients who were overweight or obese, 15
mg weekly doses of tirzepatide demonstrated what amount of weight loss compared to placebo?
a. 5%
b. 10%
Page 1 of 211
,c. 15%
d. >/= 20%
Correct Answer
Answer: The Correct Answer is D. The pivotal, phase III, double-blind, randomized, controlled SURMOUNT-1
trial investigated tirzepatide treatment in individuals with obesity or overweight who did not have diabetes.
Results demonstrated that at 5 mg, 10 mg, and 15 mg of once-weekly tirzepatide resulted in weight reduction
in participants. At the highest dose, this resulted in 20.9% weight loss compared to placebo. Semaglutide at
2.4 mg demonstrated 14.9% weight loss compared to placebo.
Reference: Wilding, J, et al. New England Journal of Medicine 384, 989-1002; Jastreboff AM, Aronne LJ, Ahmad
NN, et al. N Engl J Med. 2022;387(3):205-216
Question 5
Which of the following procedures is being used increasingly in the US as definitive treatment for severe
obesity (eg, in patients with a body mass index [BMI] > 60)?
a. Sleeve Gastrectomy
b. Roux-en Y Gastric Bypass
c. Adjustable Gastric Banding
d. Vertical Banded Gastroplasty
Correct Answer
Answer: A: Sleeve gastrectomy; because this procedure causes substantial and sustained weight loss, it is
being used increasingly in the US as definitive treatment for severe obesity. Part of the stomach is removed,
creating a tubular stomach passage. The procedure does not involve anatomic changes to the small intestine.
B: Nonetheless, Roux-en-Y gastric bypass surgery accounts for about 80% of bariatric procedures in the US. C:
Use of adjustable gastric banding has dramatically decreased in the US. D: Vertical banded gastroplasty is no
longer commonly done because complication rates are high and the resulting weight loss is insufficient.
Question 6
Which of the following effects are hypothesized to be mediated via activation of glucose-dependent
insulinotropic polypeptide (GIP) receptors, leading to ongoing development of agents targeting GIP to treat
obesity?
a. Increased insulin secretion and delayed gastric emptying
b. Increased adipose tissue blood flow and adipocyte metabolism
c. Delayed gastric emptying and suppression of postprandial glucagon
d. Increased glucagon secretion and modulation of dopaminergic signaling in the limbic system
Correct Answer
Answer: B. Increased adipose tissue blood flow and adipocyte metabolism
Explanation: GIP receptor agonists in clinical development for the treatment of patients with obesity are
associated with a variety of physiological effects leading to weight loss, including increases in adipose tissue
blood flow, adipocyte metabolism, and insulin secretion. Increased insulin secretion, delayed gastric emptying,
and reductions in glucagon are associated with both GLP-1 agonists currently approved for the treatment of
obesity (ie, liraglutide and semaglutide) and amylin receptor agonists that are in development. In addition,
amylin receptor agonists are hypothesized to have direct effects in the CNS via the hypothalamus and
dopaminergic neurons projecting from the ventral tegmental area to the limbic system, thereby altering
reward and motivation associated with food.
Page 2 of 211
,Gjermeni E et al. Obesity: An update on the basic pathophysiology and review of recent therapeutic advances.
Biomolecules. 2021;11:1426.
Jastreboff AM, Kushner RF. New frontiers in obesity treatment: GLP-1 and nascent nutrient-stimulated
hormone-based therapeutics. Ann Rev Med. 2023;74:125-39.
Lempesis IG et al. The catcher in the gut: tirzepatide, a dual incretin analog for the treatment of type 2
diabetes mellitus and obesity. Metab Open. 2022;16:100220.
Question 7
A 48-‐year-‐old woman with class III obesity who underwent Roux-‐en-‐Y obesity surgery six weeks ago
presents to the emergency department. She has a history of poorly controlled type 2 diabetes, hypertension,
depression, and hyperlipidemia. Since obesity surgery, she has had very poor tolerance of food and fluid and
has required intravenous hydration. Review of systems reveals nausea, vomiting, edema, numbness, a new
painful tingling in her feet and legs, and complaints of brain fog. Which of the following nutritional
deficiencies is the MOST likely cause of her symptoms?
1. Folate deficiency
2. Thiamine deficiency
3. Vitamin B12 deficiency
4. Iron deficiency anemia
Correct Answer
Answer: 2. Thiamine deficiency
Question 8
A laparoscopic Roux-‐en-‐Y gastric bypass was converted to an open procedure due to limited exposure
caused by increased intra-‐abdominal pressure. The procedure lasted six hours and the patient was
transferred to the intensive care unit postoperatively. The next morning, highly concentrated dark urine is
noted and urine output has steadily decreased to less than 10 mL/hr. The patient's abdomen is soft and
significant generalized edema is appreciated. Review of lab results indicates hyperkalemia, elevated creatinine,
and markedly elevated CPK levels. Which of the following is the most likely explanation for this patient's
developing acute renal failure?
1. Hypovolemia
2. Rhabdomyolysis
3. Acute myocardial infarction
4. Abdominal compartment syndrome
Correct Answer
Answer: 2. Rhabdomyolysis
Question 1
While of the following fits in with nutrition recommendations from the American Academy of Pediatrics?
a) increased consumption of fast food
b) Increased high-fat foods
c) Timely, regular meals
d) Decreased saturated fat intake for children >2 years
Correct Answer
c) Timely, regular meals
Page 3 of 211
, Question 2
Patients with obesity are at risk for which of the following micronutrients?
a) Vitamin B12, folate, D, Zinc, Iron
b) Vitamins A,E,D,K
c) Vitamin B12, B1, B6, and D
d) They are not at risk because patients with obesity are over nourished
Correct Answer
a) Vitamins B12, folate, D, zinc and iron
Question 3
A patient's surgeon wants her to lose weight before surgery. The patient's surgery is scheduled in one month;
why does the surgeon want her to lose weight prior to the procedure?
a) to reduce abdominal adipose tissue stores
b) to reduce liver volume
c) to prove she can follow instructions and adhere to the diet
d) all of the above
Correct Answer
b) To reduce the volume of her liver.
Question 4
Which is true of the pediatric assessment that differs from adult assessment?
a) Pediatric assessment must be longer
b) Pediatric assessment should include adults caregiver
c) Pediatric assessment isn't possible in the clinic setting
d) None of the above
Correct Answer
b) Pediatric assessment should include adults caregiver
Question 5
When reviewing a pediatric patients' weight, what is most important to review?
a) Weight relative to height (BMI)
b) Weight history of parents
c) Weight changes in the past week
d) Weight of siblings
Correct Answer
a) Weight relative to height (BMI)
Question 6
Self-monitoring is important for adherence because it:
a) allows the client to track information
Page 4 of 211
