Weight Gain

Question 1

What key history would you obtain for a patient who complains of weight gain?

Answer 1

Amount
Duration
Timing (relation to medication changes, smoking cessation, depression)
Diet history
Hypothyroid symptoms (fatigue, constipation, skin/hair/nail changes)
Menstrual irregularity
Past medical history
Alcohol and drug use

Question 2

What key physical exams would you perform for a patient who complains of weight gain?

Answer 2

Vital signs
Complete exam including signs of Cushing’s syndrome (hypertension, central obesity, moon face, buffalo hump, supraclavicular fat pads, purple abdominal striae)

Question 3

44 yo F present with a weight gain of over 11 kg over the past two months. She quit smoking three months ago and is on amitriptyline for depression. She also reports cold intolerance and constipation. Differentials?

Answer 3

Smoking cessation
Drug side effect
Hypothyroidism
Cushing's syndrome
Polycystic ovary syndrome
Diabetes mellitus
Atypical depression

Question 4

44 yo F present with a weight gain of over 11 kg over the past two months. She quit smoking three months ago and is on amitriptyline for depression. She also reports cold intolerance and constipation. Differentials: smoking cessation, drug side effect, hypothyroidism, Cushing’s syndrome, polycystic ovary syndrome, diabetes mellitus, atypical depression. Workup?

Answer 4

CBC, electrolytes
Glucose
TSH
24-hour urine free cortisol
Dexamethasone suppression test