Review Questions to practice for CSOWM 2026-2027
ACTUAL EXAM Newest 2026-2027 Complete 70
Questions and Correct Detailed Answers (Verified
Answers) Already Graded A+ Brand New Version!!
A 12-‐year-‐old girl presented as a new patient for well child care with BMI for age and gender
at the 98th percentile. At the first visit, the patient was counseled about appropriate weight loss
strategies and appeared motivated to make changes to diet and physical activity. Four weeks
later, the patient has lost 12 lb (5.4 kg), which she attributes to dietary changes, and states that
her activity level was not increased. Which of the following is the most appropriate next step in
management?
1. Develop a physical activity program
2. Evaluate for excessive caloric restriction
3. Discuss her unwillingness to start exercising
4. Schedule a follow-‐up visit in another four weeks - CORRECT ANSWER: Answer: 2.
Evaluate for excessive caloric restriction
A 28 year old female, BMI 30 kg/m2, has been following the commercial Weight Watchers
program online for the past 4 months. Based on her current and desired goal weight, she was
assigned 30 points per day which she has faithfully followed. Since fruits and vegetables are not
assigned points, she has been consuming 6 additional servings of fruit per day. She presents
frustrated since she has only lost 3 lbs. On average, how many additional calories is she
consuming daily from fruit that she is not counting toward her dietary intake?
1. 120 kcal
2. 240 kcal
3. 360 kcal
4. 480 kcal - CORRECT ANSWER: Answer: 3. 360 kcal
A 32 year old patient with a BMI of 38 kg/m2 is placed on a low calorie diet and successfully
loses 12% of her body weight over 5 months. However, she is experiencing an increase in hunger
,that is making it hard for her to continue to adhere to the dietary regimen. What are the
underlying biological mechanisms that explain her increased hunger?
1. increased GLP-‐1 and ghrelin levels leading to increased POMC release in the hypothalamus
2. decreased GLP-‐1 and leptin levels leading to reduced POMC release in the hypothalamus
3. decreased PYY and ghrelin levels leading to increased NPY release in the hypothalamus
4. increased ghrelin and leptin levels leading to increased NPY release in the hypothalamus -
CORRECT ANSWER: Answer: 2. decreased GLP-‐1 and leptin levels leading to reduced POMC
release in the hypothalamus
A 32-‐year-‐old woman is considering a weight loss program but is somewhat ambivalent. She
acknowledges that her weight is causing negative medical consequences. According to
Prochaska's Stages of Change model, what is her current stage of change?
1. Action
2. Preparation
3. Contemplation
4. Precontemplation - CORRECT ANSWER: Answer: 3. Contemplation
A 38-‐year-‐old man with type 2 diabetes, glycosylated hemoglobin (HbA1c) of 7.8%, is placed
on metformin XR 500 mg per day by his primary care physician. The patient noted an initial
weight loss of six pounds (2.72 kg) but developed frequent diarrhea. His medication was
switched to glyburide 10 mg per day, and he gained 18 pounds (8.16 kg) in two months. The
patient presents to the obesity medicine physician's office concerned about the weight gain.
Repeat HbA1c is 7.4%. After discontinuing glyburide, which of the following medications would
be most beneficial to add to this patient's regimen?
1. Insulin
2. Liraglutide
3. Pioglitazone
4. Phentermine - CORRECT ANSWER: Answer: 2. Liraglutide
, A 39-‐year-‐old man in good health who engages in an average amount of physical activity
consumes 2,200 kcalories/day. Approximately how many of this man's daily kcalories are
expended in post-‐prandial thermogenesis?
1. 110
2. 220
3. 330
4. 440 - CORRECT ANSWER: Answer: 2. 220
A 39-year-old male with type 2 diabetes for the past 3 years presents for a follow-up visit. His
body mass index is 43 kg/m2 and he has recently joined a gym and is working with a registered
dietitian. His HbA1c is 8.3% and he is interested in treatment options that will help him with
weight loss as well as glycemic control. Which of the following incretin-based therapies has
shown the greatest glucose-lowering efficacy, with greatest potential for weight loss?
a. Semaglutide once weekly
b. Liraglutide once daily
c. Tirzepatide once weekly
d. Exenatide once weekly - CORRECT ANSWER: Answer: C. Tirzepatide once weekly
Explanation: In a head-to-head study comparing semaglutide 1.0 mg weekly with tirzepatide 5,
10, or 15 mg weekly, superior HbA1c reduction was demonstrated with all 3 doses of tirzepatide
(-2.30% vs 1.86% for tirzepatide 15 mg vs semaglutide 1 mg, estimated treatment difference of -
0.45% [95% CI, -0.57 to -0.32; P<0.001]). In addition, evidence from the trial suggests that
patients treated with tirzepatide 5, 10, or 15 mg weekly showed a greater change from baseline in
body weight vs semaglutide 1 mg. Although head-to-head studies among the highest doses of
once weekly semaglutide (2.0 mg), dulaglutide (4.5 mg), and tirzepatide (15 mg weekly) are not
available, these GLP-1 receptor agonists and the dual agonist of GLP-1 and GIP are considered
to have the highest efficacy and demonstrate greater HbA1c reductions than other GLP-1
receptor agonists, including exenatide once weekly and liraglutide.
Frías JP, Davies MJ, Rosenstock J et al. Tirzepatide versus semaglutide once weekly in patients
with type 2 diabetes. N Engl J Med. 2021;385(6):503-15.
ACTUAL EXAM Newest 2026-2027 Complete 70
Questions and Correct Detailed Answers (Verified
Answers) Already Graded A+ Brand New Version!!
A 12-‐year-‐old girl presented as a new patient for well child care with BMI for age and gender
at the 98th percentile. At the first visit, the patient was counseled about appropriate weight loss
strategies and appeared motivated to make changes to diet and physical activity. Four weeks
later, the patient has lost 12 lb (5.4 kg), which she attributes to dietary changes, and states that
her activity level was not increased. Which of the following is the most appropriate next step in
management?
1. Develop a physical activity program
2. Evaluate for excessive caloric restriction
3. Discuss her unwillingness to start exercising
4. Schedule a follow-‐up visit in another four weeks - CORRECT ANSWER: Answer: 2.
Evaluate for excessive caloric restriction
A 28 year old female, BMI 30 kg/m2, has been following the commercial Weight Watchers
program online for the past 4 months. Based on her current and desired goal weight, she was
assigned 30 points per day which she has faithfully followed. Since fruits and vegetables are not
assigned points, she has been consuming 6 additional servings of fruit per day. She presents
frustrated since she has only lost 3 lbs. On average, how many additional calories is she
consuming daily from fruit that she is not counting toward her dietary intake?
1. 120 kcal
2. 240 kcal
3. 360 kcal
4. 480 kcal - CORRECT ANSWER: Answer: 3. 360 kcal
A 32 year old patient with a BMI of 38 kg/m2 is placed on a low calorie diet and successfully
loses 12% of her body weight over 5 months. However, she is experiencing an increase in hunger
,that is making it hard for her to continue to adhere to the dietary regimen. What are the
underlying biological mechanisms that explain her increased hunger?
1. increased GLP-‐1 and ghrelin levels leading to increased POMC release in the hypothalamus
2. decreased GLP-‐1 and leptin levels leading to reduced POMC release in the hypothalamus
3. decreased PYY and ghrelin levels leading to increased NPY release in the hypothalamus
4. increased ghrelin and leptin levels leading to increased NPY release in the hypothalamus -
CORRECT ANSWER: Answer: 2. decreased GLP-‐1 and leptin levels leading to reduced POMC
release in the hypothalamus
A 32-‐year-‐old woman is considering a weight loss program but is somewhat ambivalent. She
acknowledges that her weight is causing negative medical consequences. According to
Prochaska's Stages of Change model, what is her current stage of change?
1. Action
2. Preparation
3. Contemplation
4. Precontemplation - CORRECT ANSWER: Answer: 3. Contemplation
A 38-‐year-‐old man with type 2 diabetes, glycosylated hemoglobin (HbA1c) of 7.8%, is placed
on metformin XR 500 mg per day by his primary care physician. The patient noted an initial
weight loss of six pounds (2.72 kg) but developed frequent diarrhea. His medication was
switched to glyburide 10 mg per day, and he gained 18 pounds (8.16 kg) in two months. The
patient presents to the obesity medicine physician's office concerned about the weight gain.
Repeat HbA1c is 7.4%. After discontinuing glyburide, which of the following medications would
be most beneficial to add to this patient's regimen?
1. Insulin
2. Liraglutide
3. Pioglitazone
4. Phentermine - CORRECT ANSWER: Answer: 2. Liraglutide
, A 39-‐year-‐old man in good health who engages in an average amount of physical activity
consumes 2,200 kcalories/day. Approximately how many of this man's daily kcalories are
expended in post-‐prandial thermogenesis?
1. 110
2. 220
3. 330
4. 440 - CORRECT ANSWER: Answer: 2. 220
A 39-year-old male with type 2 diabetes for the past 3 years presents for a follow-up visit. His
body mass index is 43 kg/m2 and he has recently joined a gym and is working with a registered
dietitian. His HbA1c is 8.3% and he is interested in treatment options that will help him with
weight loss as well as glycemic control. Which of the following incretin-based therapies has
shown the greatest glucose-lowering efficacy, with greatest potential for weight loss?
a. Semaglutide once weekly
b. Liraglutide once daily
c. Tirzepatide once weekly
d. Exenatide once weekly - CORRECT ANSWER: Answer: C. Tirzepatide once weekly
Explanation: In a head-to-head study comparing semaglutide 1.0 mg weekly with tirzepatide 5,
10, or 15 mg weekly, superior HbA1c reduction was demonstrated with all 3 doses of tirzepatide
(-2.30% vs 1.86% for tirzepatide 15 mg vs semaglutide 1 mg, estimated treatment difference of -
0.45% [95% CI, -0.57 to -0.32; P<0.001]). In addition, evidence from the trial suggests that
patients treated with tirzepatide 5, 10, or 15 mg weekly showed a greater change from baseline in
body weight vs semaglutide 1 mg. Although head-to-head studies among the highest doses of
once weekly semaglutide (2.0 mg), dulaglutide (4.5 mg), and tirzepatide (15 mg weekly) are not
available, these GLP-1 receptor agonists and the dual agonist of GLP-1 and GIP are considered
to have the highest efficacy and demonstrate greater HbA1c reductions than other GLP-1
receptor agonists, including exenatide once weekly and liraglutide.
Frías JP, Davies MJ, Rosenstock J et al. Tirzepatide versus semaglutide once weekly in patients
with type 2 diabetes. N Engl J Med. 2021;385(6):503-15.
