CASE 39 - Weight Gain

Question 1

I want to go back to smoking because I have started gaining weight since I quit.

Answer 1

I understand that controlling your weight is important to you, but the health risks of smoking far outweigh those associated with weight gain.

We also need to determine if something else is contributing to your weight gain and, if so, discuss strategies to deal with it.

Question 2

Specific Qs:

Answer 2

None specific.

Question 3

PEx:

Answer 3

1. Head exam ==> Inspected conjunctivae, mouth, and throat.
2. Neck exam ==> Palpated lymph nodes, thyroid gland.
3. CV ==> A.
4. Chest ==> A.
5. Abdo ==> A + P + P.
6. Extr ==> Edema, checked DTRs.

Question 4

DDx:

Answer 4

1. Hypothyroidism.
2. Smoking cessation.
3. Li-related weight gain.
4. Familial obesity.
5. Pregnancy.
6. Cushing’s syndrome.

Question 5

Workup:

Answer 5

1. TSH.
2. Serum Li level.
3. Fasting glucose, cholesterol, TGs.
4. Urine hCG.
5. Dexa suppression test.
6. 24h urine free cortisol.