Basic Concepts

Question 1

Slipped capital femoral epiphysis is significant for…

Answer 1

Instability of the growth plate of the proximal femur - mostly commonly from fat mass disease (mechanical overload)

SGFE Pnemonic
S: Surgery urgently required
G: Growth plate of the proximal femur is unstable
F: Fat mass disease is the common cause
E: External rotated limb with walking (new onset) due to resistance to internal rotation of the hip.

Question 2

Marasmus is characterized by…

Answer 2

Total calorie deficit. Emaciated, irritable, thin sparse Hair, Low weight, no edema.

Question 3

What are essential amnio acids vs non-essential amino acids

Answer 3

Essential amino acids:
TRY THIS VIP MaLL
TRY: tryptophan
THIS: threonine, histidine
VIP: Valine, Isoleucine, Phenylalanine
MaLL: Methionine, Lysine, Leucine

Question 4

POMC gene mutations lead to

Answer 4

Adrenal crisis in neonatal life due to ACTH deficiency, which is produced from POMC (hypothalamus) as well as alpha-melanocyte-stimulating hormone, which is involved in reducing food intake

Question 5

Whats Respiratory Quotient for carbs,protein, fats?

Answer 5

RQ: vol of co2 evolved/vol of o2 consumed
Carbs: high intensity, sprinting: 1
Protein: 0.8
Fats: jogging, marathon: 0.7

Question 6

Ghrelin is secreted by

Answer 6

fundus of the stomach

Question 7

Legg-calve-perthes disease

Answer 7

idiopathyic avascular necrosis of the femoral head and can be similarly to SCFE; affects younger patients and impairs internal rotation

Question 8

Prader Willi

Answer 8

It is the most common syndromal cause of genetic obesity.

Not inherited, there is loss of function on chromosome 15.
Hyperphagia, short stature, hypotonia, almond shaped eyes.

Question 9

Borgeson-Forssman-Lehmann syndrome
is?

Answer 9

X-linked males.
Seizures, large earlobes, short toes, gynecomastia, and small genitals.

Question 10

Cohen syndrome is?

Answer 10

Autosomal recessive.
Small head size, narrow hands and feet, joint hypermobility, “open mouth” expression, low white blood count, retinal dystrophy, thick hair and eyebrows.

Question 11

Albright, hereditary osteodystrophy

Answer 11

Short stature, round face, pseudohypoparathyroidism, shortened fourth and fifth metacarpal’s (seen on xray - shorter digits), intellectual disability, impaired olfaction.

Pseudohypoparathyrodism ⇒ leading to hypocalcemia, hyperphosphatemia and elevated PTH level

Question 12

Bardet-biedl syndrome is…

Answer 12

characterized by microorchidism (men), retinal dystrophy, polydactyl, Renal malformations, polyuria, and polydipsia. Also has obesity and intellectual disability.

Setmelanotide is approved for the treatment of BBS.

Autosomal recessive

Question 13

What action does adiponectin have directly on coronary vasculature?

Answer 13

Inhibition of monocyte adhesion to endothelial cells, which reduces atherosclerosis.

Question 14

Adiponectin pearls

Answer 14

• Produced by white adipose tissue
• Increases insulin sensitivity
• Anti-inflammatory
• Decreases hunger
• Increases energy expenditure

Question 15

What is the obesity paradox?

Answer 15

Patient with overweight or obesity may have lower cardiovascular mortality than patients with normal BMI.

Question 16

Fat mass disease vs Sick fat disease

Answer 16

Fat mass disease: complications of mechanics and physical stress brought on by extra pounds of weight and force. Ex: OSA, obesity hypoventilation, joint pain, tissue friction.

Sick fat disease: metabolic derangements (abnormal endocrine and immune responses) that often occur as a complication of the disease process of obesity. Ex: Metabolic syndrome, HyperTg, impaired fasting glycemia)

Question 17

How does b12 deficiency occur after a sleeve gastrectomy?

Answer 17

80% of the stomach is resected in a SG and the majority of the parietal cells are also resected, thus decreasing intrinsic factor production.

B12 is absorbed in the terminal ileum with cofactor intrinsic factor.

Question 18

what are factors that decrease ghrelin?

Answer 18

• stretching of stomach
• post meals
• status vagotomy or sleeve gastrectomy
• weight gain
• leptin
• carbohydrates fast (rebound)
• protein (prolonged suppression)

Question 19

What are factors that increase ghrelin levels?

Answer 19

Empty stomach, fasting, weight loss, stress sleep deprivation, Prader Willi syndrome.

Question 20

What happens with SHBG levels as we age?

Answer 20

increases

Question 21

How much energy would it take to raise 1 kilogram of water by 1 degree celsius?

Answer 21

it would take 1000 calories = 1 Calorie = 1 kilocalorie = 4.184 kilojoules of energy

Question 21

What are characteristics of Beckwith-Wiedemann Syndrome?

Answer 21

Fetal overgrowth syndrome presents with enlarged organs (hepatomegaly, splenomegaly, nephromegaly, and macroglossia) and predisposes the patient to tumor growth such as Wilms tumors and hepatoblastoma. Needs frequent surveillance with abdominal ultrasound and tumor markers are necessary.

Question 22

What is associated with Chromosome 11p15.5 dysregulation?

Answer 22

Beckwith-Wiedemann Syndrome

Question 23

What early onset obesity syndromes are inherited in an
Autosomal recessive pattern?

Answer 23

Bardet-biedl syndrome, POMC deficiency, congenital leptin deficiency, cohen syndrome (8q22 mutation)

Question 24

What happens to SHBG levels after bariatric surgery (weight loss)?

Answer 24

Increase

Question 25

What is the orexegenic pathway?

Answer 25

Question 26

What is the anorexegenic pathway?

Answer 26

Question 27

What is obesity class 1, 2, and 3?

Answer 27

Question 28

How does decreasing body fat percentage affect VO2max?

Answer 28

Vo2 max = volume of oxygen consumed (VO2) is a marker of oxygen utilization, with higher levels indicating increased efficiency.

• Decreasing body fat percentage increases levels

• Levels decrease with age
• Athletes have higher levels

Question 29

Estimated average requirements vs recommended dietary allowance

Answer 29

• Estimated average requirements (EAR) refers to the amount of a nutrient that is estimated to meet the requirement of half of all healthy individuals in the population
• Recommended dietary allowance (RDA): this is the average daily dietary intake of a nutrient that is sufficient to meet the requirements of nearly all healthy persons within a particular population (age, gender, pregnancy, elderly, etc.)