CBE Behavioral & Psychological Support 2 — Questions and Answers
Question 1: A patient 18 months after Roux-en-Y gastric bypass reports drinking wine nightly to 'unwind' and says it affects her more than before surgery. What is the most accurate educational response?
- Wine is safe after bypass because it contains no carbohydrates
- After bypass, alcohol reaches the bloodstream faster and peaks higher, raising intoxication and alcohol use disorder risk (Correct answer)
- Alcohol tolerance increases after bypass, so she should drink more slowly
- Alcohol absorption is unchanged after bypass, so the effect is likely psychological
Correct answer: After bypass, alcohol reaches the bloodstream faster and peaks higher, raising intoxication and alcohol use disorder risk
RYGB speeds alcohol delivery to the small intestine, producing faster, higher blood alcohol peaks and increased risk of alcohol use disorder.
Question 2: Which DSM-5 frequency criterion is required for a diagnosis of binge eating disorder?
- Binge episodes at least once a month for 1 year
- Binge episodes daily for 1 month
- Binge episodes at least once a week for 3 months (Correct answer)
- Binge episodes at least twice a week for 6 months
Correct answer: Binge episodes at least once a week for 3 months
DSM-5 requires binge eating at least once weekly on average for 3 months.
Question 3: A patient says, 'I know I should log my food, but I'm just too busy.' Using motivational interviewing, which response best reflects ambivalence?
- Logging is the most important predictor of success, so you must do it.
- Many patients are busy; that is not a valid excuse.
- Part of you sees the value in logging, and part of you feels your schedule makes it hard. (Correct answer)
- You need to make time if you want results.
Correct answer: Part of you sees the value in logging, and part of you feels your schedule makes it hard.
A double-sided reflection acknowledges both sides of ambivalence without confrontation.
Question 4: Which behavior pattern after sleeve gastrectomy is most associated with gradual weight regain because small portions are eaten continuously throughout the day?
- Grazing (Correct answer)
- Purging
- Night eating syndrome
- Food restriction
Correct answer: Grazing
Grazing, repetitive unplanned eating of small amounts, bypasses the restrictive effect of surgery and is linked to weight regain.
Question 5: Population studies show which risk is elevated after bariatric surgery compared with matched controls?
- Risk of suicide and self-harm (Correct answer)
- Risk of dementia
- Risk of attention-deficit disorder
- Risk of schizophrenia onset
Correct answer: Risk of suicide and self-harm
Several cohort studies show increased rates of suicide and self-harm after bariatric surgery, warranting ongoing mental health screening.
Question 6: Which tool is most appropriate for brief screening of depressive symptoms at a postoperative visit?
- PHQ-9 (Correct answer)
- Mini-Mental State Exam
- Epworth Sleepiness Scale
- AUDIT
Correct answer: PHQ-9
The PHQ-9 is a validated nine-item depression screening tool widely used in bariatric follow-up.
Question 7: A patient keeps chips in the pantry and eats them when stressed. Which behavioral strategy is best described as stimulus control?
- Writing down feelings before eating
- Removing chips from the home and storing healthy snacks in view (Correct answer)
- Rewarding herself with a movie after a week without chips
- Counting chews for each bite
Correct answer: Removing chips from the home and storing healthy snacks in view
Stimulus control modifies the environment to reduce cues that trigger unwanted eating.
