CBE CBE Metabolic and Comorbidity Management 2 — Questions and Answers
Question 1: Nonalcoholic fatty liver disease (NAFLD) is common in bariatric surgical candidates. What is the pre-surgery dietary recommendation primarily used to reduce liver size?
- A low-calorie, low-carbohydrate liver-shrinking diet for 2–4 weeks (Correct answer)
- A high-fat ketogenic diet for 8 weeks
- An all-liquid protein diet for 6 months
- Fasting for 72 hours pre-operatively
Correct answer: A low-calorie, low-carbohydrate liver-shrinking diet for 2–4 weeks
A short-term low-calorie, low-carbohydrate liver-shrinking diet is prescribed before bariatric surgery to reduce liver glycogen and fat stores, improving surgical access and safety.
Question 2: Which micronutrient deficiency is uniquely associated with metabolic bone disease risk after bariatric surgery?
- Vitamin D and calcium (Correct answer)
- Vitamin C and iron only
- Zinc and vitamin A only
- B vitamins exclusively
Correct answer: Vitamin D and calcium
Vitamin D and calcium malabsorption after bariatric surgery (especially bypass procedures) leads to secondary hyperparathyroidism and metabolic bone disease if not corrected with lifelong supplementation.
Question 3: Which bariatric procedure is most associated with dumping syndrome as a metabolic complication?
- Roux-en-Y gastric bypass (RYGB) (Correct answer)
- Sleeve gastrectomy
- Adjustable gastric banding
- Laparoscopic cholecystectomy
Correct answer: Roux-en-Y gastric bypass (RYGB)
RYGB bypasses the pyloric valve, allowing rapid gastric emptying of high-sugar foods into the small intestine, triggering early or late dumping syndrome.
Question 4: A patient 2 years post-RYGB reports new-onset polydipsia and polyuria. What should the CBE suspect and recommend?
- Recurrence or new-onset diabetes — refer for HbA1c and fasting glucose testing (Correct answer)
- Normal post-surgical symptoms — reassure the patient
- Urinary tract infection only — recommend antibiotics
- Excess vitamin C intake — reduce supplements
Correct answer: Recurrence or new-onset diabetes — refer for HbA1c and fasting glucose testing
Polydipsia and polyuria are classic symptoms of hyperglycemia; diabetes can recur after bariatric surgery, so prompt blood glucose and HbA1c evaluation is essential.
Question 5: Which cardiovascular risk factor remains elevated in bariatric patients despite significant weight loss if not managed?
- LDL cholesterol, particularly in patients with familial hypercholesterolemia (Correct answer)
- Resting heart rate
- Blood viscosity
- Cardiac output
Correct answer: LDL cholesterol, particularly in patients with familial hypercholesterolemia
Familial hypercholesterolemia is a genetic condition that does not resolve with weight loss, and LDL may remain elevated requiring ongoing statin therapy even after successful bariatric surgery.
Question 6: What is the relationship between bariatric surgery and polycystic ovary syndrome (PCOS) in female patients?
- Weight loss after surgery often reduces androgen levels and improves menstrual regularity in women with PCOS (Correct answer)
- Bariatric surgery has no effect on hormonal conditions like PCOS
- Surgery worsens PCOS by causing hormonal imbalance
- PCOS is a contraindication to bariatric surgery
Correct answer: Weight loss after surgery often reduces androgen levels and improves menstrual regularity in women with PCOS
Significant weight loss reduces insulin resistance and androgen excess in women with PCOS, frequently improving menstrual irregularity, fertility, and hormonal profiles.
CBE CBE Metabolic and Comorbidity Management 2
Nonalcoholic fatty liver disease (NAFLD) is common in bariatric surgical candidates.
What is the pre-surgery dietary recommendation primarily used to reduce liver size?