62. Loss of Weight (2%)

Question 1

Recherchez une cause sous-jacente à la perte de poids inexpliquée d’un patient, comment ? (3)

Answer 1

• en notant les antécédents
• en faisant un examen physique (y compris le poids)
• en effectuant les investigations adéquates.

Question 2

Maintenez un dossier ouvert du poids du patient afin de déterminer avec exactitude le moment où la perte de poids s’est produite.

Question 3

Chez un patient dont la perte de poids est persistante sans cause diagnostiquée, faites quoi ? (2)

Answer 3

• faites un suivi
• réévaluez la situation de façon périodique afin de décider si des mesures s’imposent.

Question 4

Describe unexplained weight loss in % weight loss over how long

Answer 4

Loss of ≥5% weight over 6-12 months

Question 5

Name DDX : Weight loss (8)

Answer 5

• Malignancy
• GI (PUD, celiac, IBD)
• Psychiatric (depression, eating disorders)
• Endocrine (hyperthyroidism, diabetes, adrenal insufficiency)
• Infectious (HIV, viral hepatitis, tuberculosis, parasite)
• Chronic disease (heart failure, renal failure, autoimmune)
• Neuro (stroke, dementia)
• Medications/substances

Question 6

Name history : Weight loss (9)

Answer 6

• Document weight loss
• Pattern of weight loss
• Intentional vs. Unintentional (r/o eating disorder)
• Dietary history
• GI symptoms (N/V/D, dysphagia, abdominal pain, early satiety)
• Malignancy (fever, fatigue, chills, night sweats)
• Psychiatric (depression, mood)
• Medication, Alcohol, Drugs
• Social (Income, Activity) and Function (Dementia)

Question 7

Describe physical exam : Weight loss (7)

Answer 7

• Vital signs (Tachycardia), Temperature
• Weight, Height (BMI)
• Lymphadenopathy (r/o malignancy)
• Breast exam
• GI : Oral Cavity, Dentition, Abdominal exam (r/o masses), Rectal exam
• Thyroid
• Cardiac, Respiratory, Neuro

Question 8

Describe labs : Weight loss (11)

Answer 8

• CBC (Hb, WBC)
• Chem (Creat, Calcium)
• Glucose, A1C
• TSH
• LFT (Alk Phos), Albumin
• ESR/CRP, LDH
• UA
• Fecal occult blood test
• CXR
• Consider : PPD (TB), HIV, Hep C, Abdominal ultrasound
• Age-appropriate cancer screening

Question 9

Describe management : Weight loss (4)

Answer 9

• Limited evidence for nutritional and pharmacological agents
• Treat underlying cause. Consider Mirtazapine in Depression
• Watchful waiting 3-6 months
• Can consider exercise and nutritional supplements at meal times

Question 10

Name 5 investigations for unexplained weight loss

Answer 10

• Weight
• Height
• Serum Hb
• Serum Na, K, eGFR
• Serum Urea and Creat
• serum PSA
• Fecal Ocult Blood
• RXP
• Chest, abdomen, pelvis CT

Question 11

Name 5 SERUM investigations for unexplained weight loss

Answer 11

• Serum Hb
• Serum Na, K, eGFR
• Serum urea and Creat
• Serum PSA