Name: Richard Hutchinson

Theme: Diseases associated with obesity

OPTION LIST

A	Alcohol excess	I	Prader-Willi Syndrome
B	Cushing’s disease	J	Pregnancy
C	Cushing’s syndrome	K	Type I diabetes
D	De Quervain’s thyroiditis	L	Type II diabetes
E	Hashimoto’s thyroiditis	M	Simple Obesity
F	Long-term insulin use	N	Steroid abuse
G	Menopause	O
H	PCOS	P

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

1. An overweight 35-year old shop-assistant visits her GP complaining of debilitating tiredness. Her periods have also become infrequent in this time. Despite it being a warm day, she wears a coat and jumper inside. On examination, she has a symmetrical painless lump on her neck. The patient has a history of well-controlled SLE.

2. A 14-year old boy visits his GP with his mother, having been recommended to by the school nurse, following an inability to attend PE lessons, due to his weight. Both seem generally unconcerned, with his mother stating that she never makes him do exercise at home anyway. The boy describes McDonalds and Playstation as his favourite hobbies. As a precaution, the GP performs a blood sample, which showed no endocrine abnormalities, but a raised cholesterol.

3. A 29-year old, clinically obese accountant presents with a relapsing of her acne, which had disappeared in her teens. On further questioning, she admits to infrequent periods over the last year, and a greater than normal growth of hair on her face. Blood tests show an elevated serum testosterone.

4. A 33-year old overweight man complains of headaches and visual disturbances which he blames for two car accidents he has been involved in the last month. He has a ruddy appearance, and the GP notes that his weight is mainly concentrated in a ‘pot belly’. The man’s blood pressure is 150/100, and following a 48hr low –dose dexamethasone test, the patient has a cortisol of 500nm/L, and after a 48hr high-dose dexamethasone test, the cortisol was 250nmol/L

5. A 65-year old overweight Indian gentleman presents to his GP, complaining of problems with his eyesight, which has become blurred recently, despite 20/20 vision for the rest of his life. On further questioning, he admits to increased urinary frequency, which he put down to his age, though recalls that he has been drinking more recently. On dip-sticking the urine, glucose was +++, and following a blood test, the blood sugar was 18mmol/L.

ANSWERS

1. E

2. M

3. H

4. B

5. L