Minicase - Wt Loss and Gain

Question 1

Ddx for weight loss (6)

Answer 1

1. hyperthyroidism
2. cancer
3. HIV
4. dieting/diet drugs
5. anorexia nervosa
6. malabsorption

Question 2

Ddx for wt gain (7)

Answer 2

1. smoking cessation
2. drug SFX
3. hypothyroidism
4. Cushing syndrome
5. PCOS
6. insulinoma
7. pregnancy
   (also reactive postprandial hypoglycemia that you would test with a GTT)

Question 3

W/u for wt loss (6)

Answer 3

1. TSH, free T4
2. CBC
3. BMP
4. HIV antibody
5. Utox
6. Age-appropriate cancer screenings

Question 4

W/u for wt gain (7)

Answer 4

1. CBC
2. BMP, glucose
3. TSH
4. 24-hour urine free cortisol
5. dexamethasone suppression text
6. urine B-hCG
7. plasma insulin after induced hypoglycemia

Question 5

44yo F presents with wt gain of >25lbs within past 2 months. Quit smoking 3 months ago and is on amitriptyline for depression. Also reports cold intolerance and constipation. (3)

Answer 5

1. smoking cessation
2. drug SFX (TCA)
3. hypothyroidism

Question 6

30 yo F presents with wt gain over past 3 months. Tremor, palpitations, anxiety and hunger that is relieved by eating. Proximal muscle weakness and easy bruising. (3)

Answer 6

1. insulinoma
2. reactive postprandial hypoglycemia
3. Cushing syndrome

Question 7

Wt gain exam (3)

Answer 7

1. complete exam (ALL of them, which is impossible)
2. so look for Cushing syndrome (moon facies, central obesity, purple abdominal striae)
3. LE edema from water retention in renal disease

Question 8

Wt loss exam (3)

Answer 8

1. all of them
2. skin
3. MSK

Question 9

Wt loss history (9)

Answer 9

1. amount
2. duration
3. intention
4. body image
5. anxiety, depression
6. constitutional symptom, hx of cancer
7. hyperthyroid symptoms
8. HIV risk factors
9. medication and drug use

Question 10

Wt gain history (8)

Answer 10

1. amount
2. duration
3. timing (when did it start: meds, smoking cessation, depression)
4. diet history
5. hypothyroid symptoms
6. menstrual irregularity
7. hirsutism
8. sexual history