Weight gain & loss

Question 1

amount of food intake is determined by:

Answer 1

1) availability
2) attractiveness
3) emotional factors
4) physical factors

Question 2

energy expenditure is determined by:

Answer 2

Basal metabolism
-- ~50% total normal energy intake
--remains fairly constant in health
Physical activity
--easily fluctuated
--major impact on body weight

Question 3

weight gain of excess caloric intake

Answer 3

Family obesity
–genetics/ “learn” to overeat
Emotional hyperphagia
–stress, anxiety, depression

Question 4

weight gain of fluid retention

Answer 4

Edema from known disorder
--nephrotic syndrome
--congestive heart fail
--cirrhosis of liver
Premenstrual edema
--transient & benign
Salt retaining medications
--Steroids
--NSAIDS
--Lithium

Question 5

weight gain of pregnancy

Answer 5

• -considered a physiological weight gain

- -postpartum weight loss is often difficult

Question 6

weight of endocrinology disorder

Answer 6

• -cushing syndrome

- -hypothyroidism

Question 7

Cushingism

[Dexamethason suppression test]

Answer 7

• -low dose at 12PM fails to suppress 8am cortisol

- -high dose at 12PM suppresses ACTH producing pituitary adenoma only

Question 8

Cushingism S&S

Answer 8

• -insomnia
• -hunger
• -muscle wasting
• -thinning skin
• -gastric ulcer
• -hypokalemia
• -acne
• -bruisability
• -immunosuppression

Question 9

Hypothyroidism

Answer 9

• -slow mind & body
• -weak heartbeat
• -constipation
• -myxedema
• -slow reflexes
• -hair thinning
• -depression “schizophrenia” irritability
• -big tongue
• -croaky voice
• -dry & cold skin

Question 10

weight gain in children

Answer 10

• -consider endocrine & genetic disorders
• -familial obesity
• -genetic predisposition
• -a learned disorder

Question 11

physical findings in the obese patient

Answer 11

Obesity of increased caloric intake = distributed evenly
–EXCEPT: ab fat, *asian
Endocrinology obesity usually displays patterned fat
–truncal = cushing
–obesity + dry hair + coarse skin + hoarse voice + “hung up” muscle stretch reflexes = hypothyroidism

Question 12

weight loss

Answer 12

–non-deliberate = serious finding = serious disease

Question 13

weight loss mechanism

Answer 13

• -decreased caloric intake
• -accelerated metabolism
• -loss of calories in urine or stool

Question 14

weight loss most any disease

Answer 14

• -decreased appetite

- -tissue wasting

Question 15

endocrinology weight loss

Answer 15

• -diabetes mellitus (type 1*)
• -thyrotoxicosis (hyperthyroidism)
• -addison disease

Question 16

diabetes mellitus (type 1*)

Answer 16

=polyuria, polydipsia (thirst), polyphagia (hunger)
1st = osmotic diuresis
later = loss of tissue

Question 17

thyrotoxicosis

hyperthyroidism

Answer 17

--weight loss due to increased metabolic rate & increase motor activity.
=graves, hot adenoma, factitious
--fine tremor
--neurotic anxiety (atrial fib)
--lid lag
--brisk reflexes
--low LDL diarrhea

Question 18

Addison disease

Answer 18

weight loss due to decreased appetite resulting from decreased cortisol secretion
= hyper pigment, mental illness, sudden death, no ACTH stimulation test

Question 19

gastrointestinal weight loss

Answer 19

Fat malabsorption
--sprue
--chronic pancreatitis
--cystic fibrosis
Inflammatory bowel disease

Question 20

infection associated weight loss

Answer 20

Usually occult infection
--TB
--systemic mycoses
--parasitic infestations
HIV disease

Question 21

renal disease associated weight loss

Answer 21

–early manifestation of uremia is anorexia

Question 22

malignancy associated weight loss

Answer 22

–MC cause of weight loss in the absence of major S&S
–any malignancy results in eventual weight loss
–mechanism of malignancy induced weight loss
Anorexia
Increase metabolic demand
Side-effects of cancer

Question 23

psychological associated weight loss

Answer 23

• -anorexia nervosa
• -conversion disorders
• -schizophrenia
• -depression

Question 24

diagnostic tests

Answer 24

• -the big 4 (CBC, UA, chem profile, ESR)
• -fasting plasma glucose
• -thyroid function test
• -amylase & lipase
• -stool analysis