Differential & Work-up: Wt Loss, Wt Gain, Nausea & Vomiting

Question 1

42 yo F presents with a 15.5~lb (7 ~kg) weight loss within the past 2 months. She has a fine tremor, and her pulse is 112.

Answer 1

1. Hyperthyroidism
2. Cancer
3. HIV infection
4. Dieting/ diet drugs
5. Anorexia nervosa
6. Malabsorption

Question 2

WORK UP FOR:

1. Hyperthyroidism
2. Cancer
3. HIV infection
4. Dieting/ diet drugs
5. Anorexia nervosa
6. Malabsorption

Answer 2

1. TSH, FT4
2. CBC
3. BMP
4. HIV antibody
5. Urine toxicology
6. Age-appropriate cancer screenings

Question 3

44 yo F presents with a weight gain of >25lbs (11.3kg) within the past 2 months. She quit smoking 3 months ago and is on amitriptyline for depression. She also reports cold intolerance and constipation.

Answer 3

1. Smoking cessation
2. Drug side effect
3. Hypothyroidism
4. Cushing syndrome
5. Polycystic ovary syndrome
6. Diabetes mellitus
7. Atypical depression

Question 4

WORK UP FOR:

1. Smoking cessation
2. Drug side effect
3. Hypothyroidism
4. Cushing syndrome
5. Polycystic ovary syndrome
6. Diabetes mellitus
7. Atypical depression

Answer 4

1. CBC
2. BMP, glucose
3. TSH
4. 24-hour urine free cortisol
5. Dexamethasone suppression test

Question 5

30 yo F presents with weight gain over the past 3 months. She also reports tremor, palpitations, anxiety, and hunger that are relieved by eating. She exhibits proximal muscle weakness and easy bruising.

Answer 5

1. Insulinoma
2. Reactive postprandial hypoglycemia
3. Cushing syndrome
4. Pregnancy

Question 6

WORK UP FOR:

1. Insulinoma
2. Reactive postprandial hypoglycemia
3. Cushing syndrome
4. Pregnancy

Answer 6

1. Blood glucose
2. Plasma insulin after induced hypoglycemia
3. Glucose tolerance test
4. 24-hour urine free cortisol
5. Urine B-hCG

Question 7

20 yo F presents with nausea, vomiting (especially in the morning), fatigue, and polyuria. Her last menstrual period was 6 weeks ago. She is sexually active with her boyfriend, and they use condoms for contraception.

Answer 7

1. Pregnancy
2. Hypercalcemia
3. Diabetes mellitus
4. Gastritis/GERD
5. UTI
6. Depression/ eating disorder
7. Substance use ( eg, alcohol)

Question 8

WORK UP FOR:

1. Pregnancy
2. Hypercalcemia
3. Diabetes mellitus
4. Gastritis/GERD
5. UTI
6. Depression/ eating disorder
7. Substance use ( eg, alcohol)

Answer 8

1. Urine hCG
2. Pelvic exam
3. U/S-transvaginal
4. CBC
5. Electrolytes, calcium, glucose, liver function tests
6. UA, urine culture