CBE CBE Metabolic and Comorbidity Management 1 — Questions and Answers
Question 1: Which comorbidity shows the most rapid improvement or remission following Roux-en-Y gastric bypass (RYGB)?
- Type 2 diabetes mellitus (Correct answer)
- Osteoarthritis
- Chronic kidney disease
- Hypothyroidism
Correct answer: Type 2 diabetes mellitus
Type 2 diabetes often remits within days of RYGB, even before significant weight loss, due to gut hormone changes including increased GLP-1 secretion.
Question 2: A bariatric patient with pre-existing hypertension is 3 months post-surgery and has lost 50 lbs. What medication adjustment is most likely needed?
- Antihypertensive doses may need to be reduced or discontinued (Correct answer)
- Antihypertensive doses should be doubled
- No medication changes are warranted until 1 year post-op
- Diuretics should be added to manage fluid retention
Correct answer: Antihypertensive doses may need to be reduced or discontinued
Significant weight loss after bariatric surgery frequently leads to blood pressure normalization, requiring reduction or elimination of antihypertensive medications to prevent hypotension.
Question 3: Which metabolic marker is most directly used to monitor type 2 diabetes remission after bariatric surgery?
- Hemoglobin A1c (HbA1c) (Correct answer)
- Total cholesterol
- Serum albumin
- C-reactive protein
Correct answer: Hemoglobin A1c (HbA1c)
HbA1c reflects average blood glucose over 2–3 months and is the standard metric for determining if type 2 diabetes is in remission following bariatric surgery.
Question 4: Obstructive sleep apnea (OSA) is a common comorbidity in bariatric patients. After significant weight loss, what follow-up is required?
- Repeat sleep study to reassess CPAP/BiPAP needs (Correct answer)
- Permanent continuation of current CPAP settings
- Discontinuation of all sleep therapy without testing
- Referral to a cardiologist only
Correct answer: Repeat sleep study to reassess CPAP/BiPAP needs
Weight loss substantially reduces upper airway fat deposits, so CPAP pressure requirements often change or OSA resolves entirely, requiring a repeat sleep study for adjustment.
Question 5: Which lipid abnormality most commonly improves after bariatric surgery?
- Hypertriglyceridemia (Correct answer)
- Low LDL cholesterol
- High HDL cholesterol
- Normal total cholesterol
Correct answer: Hypertriglyceridemia
Elevated triglycerides are strongly associated with obesity and insulin resistance, both of which improve dramatically after bariatric surgery, leading to triglyceride normalization.
Question 6: A bariatric educator is counseling a patient with GERD pre-surgery. Which procedure should the educator explain may worsen GERD symptoms?
- Sleeve gastrectomy (Correct answer)
- Roux-en-Y gastric bypass
- Adjustable gastric banding
- Biliopancreatic diversion
Correct answer: Sleeve gastrectomy
Sleeve gastrectomy can worsen GERD because it removes the gastric fundus (reducing the angle of His) and may increase intragastric pressure, pushing acid into the esophagus.
CBE CBE Metabolic and Comorbidity Management 1
Which comorbidity shows the most rapid improvement or remission following Roux-en-Y gastric bypass (RYGB)?