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Review Questions to practice for CSOWM
Review Questions to practice for CSOWM
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Review Questions to practice for CSOWMA 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 - ANS-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 - ANS-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 - ANS-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 - ANS-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 - ANS-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 - ANS-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 - ANS-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.
ElSayed NA, Aleppo G, Aroda VR et al. 9. Pharmacologic approaches to glycemic
treatment: standards of care in diabetes—2023. Diabetes Care. 2023;46(Suppl
1):S140-57.
A 40 year old woman is establishing care after recently moving from a different state.
She underwent a Roux-‐en-‐Y gastric bypass procedure one year ago without
complications and currently feels well. Which of the following biochemical tests should
be ordered at this time?
1. niacin, vitamin B12, and zinc
2. calcium, magnesium, and vitamin A
3. 25-‐hydroxy-‐vitamin D, intact PTH, and vitamin B12
4. intact PTH, 1,25-‐dihydroxy-‐vitamin D, and thiamin - ANS-Answer: 3.
25-‐hydroxy-‐vitamin D, intact PTH, and vitamin B12
A 40-‐year-‐old man with a BMI of 32 kg/m2, history of type 2 diabetes, kidney stones,
migraines, and depression is concerned about his weight. Which of the following
medications should be used with caution due to an increased risk for nephrolithiasis?
1. Liraglutide (Saxenda™)
2. Bupropion/naltrexone (Contrave™)
3. Lorcaserin (Belviq™)
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