Diagnosis and evaluation

Question 1

Diagnostic criteria for metabolic syndrome

Answer 1

Need 3 out of 5 of the following
* Waist circumference: >35in (88 cm) women, >40 in (102 cm) men
* Tg >150mg/dl or use of Tg lowering medication
* HDL < 40mg/dl in men or <50mg/dl women or drug treatment for low HDL
* BP >or =130/85; or use of BP medication
* FBG over 100mg/dl or use of glucose lowering meds

Question 2

PCOS

Rotterdam Criteria for PCOS diagnosis

Answer 2

Need 2 out of 3 of the following:
* Oligomenorrhea or anovulation
* Biochemical or clinical markers of hyperandrogenism (elevated testosterone/DHEA, hirsutism)
* Polycystic ovaries by US (>12 antral follicles or ovarian volume >10cm^3/10mL)

Question 3

Pediatric obesity

How do you define overweight and obesity in children?

Answer 3

Overweight: BMI 85–94th%
Obese: BMI ≥ 95th%

Question 4

Pediatric obesity

Structured weight management recommendations
(≥ 6 years old)

Answer 4

• Offer healthy eating guidelines
• Encourage exercise ≥ 1 hour/day
• Monitor sleeping patterns
• Limit screen time

Question 5

Which is the most common comorbidity in patients with childhood obesity?

Answer 5

Dyslipidemia

Question 6

How do you diagnose Small intestine bacterial overgrowth (SIBO)?

Answer 6

carbohydrate breath test

Question 7

A patient presents after bariatric surgery with bloating, abdominal pain, watery diarrhea, B12 deficiency, D-lactic acidosis and folate excess. What is their diagnosis?

Answer 7

Small intestine bacterial overgrowth.

Question 8

Cushing syndrome

Answer 8

• Patient presents with amenorrhea, central obesity, depressive symptoms, and easy bruising
• PE: purple striae, moon face (facial adiposity), buffalo hump (increased adipose tissue in the neck and upper back), and hypertension
• Diagnosis: 24-hour urinary free cortisol, late night salivary cortisol, dexamethasone suppression test, ACTH levels
• Most common noniatrogenic cause is hypercortisolism from ACTH-secreting pituitary tumor
• If cause is pituitary tumor then it’s called Cushing disease

Question 9

After bariatric surgery, what complication would cause colicky abdominal pain, nausea, and early satiety?

Answer 9

Mesenteric defect causing an internal hernia

CT may show an internal hernia as “mesenteric swirl sign”

Question 10

What is the timing of hypoglycemia after RYGB in the setting of post-gastric bypass hypoglycemia (PGBH) vs dumping syndrome?

Answer 10

PGBH usually occurs >1 year post-op. 1-4 hours post-prandial.

Dumping syndrome hypoglycemia occurs <1 year post-op and within 15-30 minutes of meal. (late dumping syndrome may present similarly to PGBH in timing but would not cause neuroglycopenia and corrects with dietary changes alone.

Question 11

What are the diagnostic criteria for obstructive sleep Apnea?

Answer 11

Question 12

What is the most accurate fat composition measurement at a molecular level, regardless of cost?

Answer 12

Isotope dilution Hydrometry
* allows for calculation of non-fat mass, which can be subtracted from total body weight, resulting in fat mass

Question 13

What is considered the gold standard to measure body fat?

Answer 13

DXA

may not accomodate those with extreme BMI

Question 14

Describe the different stages of Edmonton Obesity Staging System

Answer 14