CBE Postoperative Care & Long-term Monitoring 3 — Questions and Answers
Question 1: A patient who has vomited often for 3 weeks after surgery develops confusion, ataxia and nystagmus. Which deficiency is most likely?
- Vitamin B12
- Folate
- Thiamine (B1) (Correct answer)
- Vitamin K
Correct answer: Thiamine (B1)
Thiamine stores run out within weeks of persistent vomiting, which can cause Wernicke encephalopathy.
Question 2: Why are patients at risk of vitamin B12 deficiency after Roux-en-Y gastric bypass?
- Excess bile acid secretion
- Bypass of the terminal ileum
- Higher renal excretion
- Less gastric acid and intrinsic factor in the pouch (Correct answer)
Correct answer: Less gastric acid and intrinsic factor in the pouch
The small pouch makes little acid and intrinsic factor, both of which are needed to release and absorb B12.
Question 3: Which instruction best improves absorption of an oral iron supplement after bariatric surgery?
- Take it with vitamin C and at least 2 hours apart from calcium (Correct answer)
- Take it together with calcium citrate
- Take it with milk to reduce GI upset
- Take it right after a high-fiber meal
Correct answer: Take it with vitamin C and at least 2 hours apart from calcium
Vitamin C improves iron absorption, while calcium competes with it, so the two should be taken separately.
Question 4: Why is calcium citrate preferred over calcium carbonate after gastric bypass?
- It has more elemental calcium per tablet
- It does not need stomach acid to be absorbed (Correct answer)
- It can be taken with iron
- It also gives full daily vitamin D needs
Correct answer: It does not need stomach acid to be absorbed
Calcium citrate absorbs well in the low-acid setting of the gastric pouch, while carbonate needs acid.
Question 5: What is the usual target serum 25-hydroxyvitamin D level for bariatric patients?
- Above 10 ng/mL
- Above 20 ng/mL only in winter
- Above 30 ng/mL (Correct answer)
- Above 150 ng/mL
Correct answer: Above 30 ng/mL
Bariatric guidelines aim for 25(OH)D above 30 ng/mL to support calcium absorption and bone health.
Question 6: Years after gastric bypass, a patient has anemia, neutropenia and gait problems, but B12 is normal. Which deficiency should be checked?
- Copper (Correct answer)
- Zinc toxicity only
- Vitamin C
- Selenium excess
Correct answer: Copper
Copper deficiency can cause anemia, neutropenia and myeloneuropathy that look like B12 deficiency.
Question 7: Which procedure carries the highest risk of fat-soluble vitamin (A, D, E, K) deficiency?
- Adjustable gastric band
- Sleeve gastrectomy
- Endoscopic sleeve gastroplasty
- Biliopancreatic diversion with duodenal switch (Correct answer)
Correct answer: Biliopancreatic diversion with duodenal switch
BPD/DS causes the most fat malabsorption, so A, D, E and K deficiencies are most likely after it.
CBE Postoperative Care & Long-term Monitoring 3
A patient who has vomited often for 3 weeks after surgery develops confusion, ataxia and nystagmus.
Which deficiency is most likely?