Your Name: Ruvandhi Nathavitharana

Theme: Obesity and Cardiovascular disease

OPTION LIST

A	BMI quantification	I	Urine dipstick
B	Chest X ray	J
C	Cortisol measurement	K
D	Exercise tolerance test	L
E	Genetic testing	M
F	Lipid profile	N
G	Ovarian ultrasound	O
H	Thyroid autoantibodies	P

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

1. A 15 year old overweight schoolgirl presents to her GP complaining of oligomenorrhoea. She is very self conscious and concerned about acne and excessive facial hair. Tests reveal raised serum LH and androgen concentrations.

2. A 54 year old businessman comes to you with a wound in his foot that has failed to heal over a few weeks. You notice various other minor lesions on both feet and he tells you that he has recently ‘lost feeling’ in his legs. His BMI is 31 and his blood pressure is 145/95.

3. A 38 year old secretary presents with a 3 month history of increasing fatigue and lethargy. She says that her muscles ‘don’t seem to work any more’ and you note slow relaxing reflexes on neurological examination. She complains of weight gain and seems very depressed.

4. A 3 year old child is brought in by his parents who are concerned about his development, both physically and behaviourally. Her mother complains that he is continually eating, despite some feeding difficulties present in early infancy. On examination, you note some mild mental retardation, distinctive facial features and hypogonadism.

5. A 60 year old ex-RAF pilot presents with breathlessness on exercise. Questioning reveals that he has difficulty sleeping and requires 3/4 pillows. He is wheezy but puts that down to a lifetime of smoking (40 pack years). Further examination reveals ankle oedema, crepitations and a displaced apex beat.

ANSWERS

1. G

2. I

3. H

4. E

5. B