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A 50-year-old female presents to the GP with concerns about her weight. She has a body mass index (BMI) of 31 and you are concerned about a diagnosis of metabolic syndrome. Which of the following is one of the diagnostic criteria for this?

4 things

Metabolic syndrome is a clustering of cardiovascular disease risk factors. The underlying pathophysiology is related to insulin resistance and visceral/central obesity.

There is great variation in the diagnostic criteria for this condition. In 2009 the International Diabetes Federation (IDF) and American Heart Association (AHA) defined their own criteria which are commonly used. It is diagnostic if three or more of the criteria are present. These are;
- Increased waist circumference (dependent on ethnicity) or a BMI >30
- Dyslipidaemia with raised triglycerides >150 mg/dL or reduced HDL-cholesterol
- Hypertension
- Impaired glucose tolerance


physiological: normal in puberty
syndromes with androgen deficiency: Kallman's, Klinefelter's
testicular failure: e.g. mumps
liver disease
testicular cancer e.g. seminoma secreting hCG
ectopic tumour secretion

common causes of what



Gynaecomastia describes an abnormal amount of breast tissue in males and is usually caused by an increased oestrogen:androgen ratio. It is important to differentiate the causes of galactorrhoea (due to the actions of prolactin on breast tissue) from those of gynaecomastia

common drug causes of this

spironolactone (most common drug cause)
GnRH agonists e.g. goserelin, buserelin
oestrogens, anabolic steroids


In patients with multiple endocrine neoplasia type IIb which of the following clinical appearances is the patient most likely to display?

marfanoid features
Medullary thyroid cancer, phaeochromocytoma, marfanoid body habitus - multiple endocrine neoplasia type IIb


A 56-year-old man has long standing chronic pancreatitis and develops pancreatic insufficiency. Which one of the following will be absorbed normally?

folic acid

Pancreatic lipase is required for digestion of fat, Proteases facilitate protein and B12 absorption. Folate digestion is independent of the pancreas.


hypospadias characteristics

Hypospadias is characterised by
a ventral urethral meatus
a hooded prepuce
chordee (ventral curvature of the penis) in more severe forms
the urethral meatus may open more proximally in the more severe variants. However, 75% of the openings are distally located.

Hypospadias most commonly occurs as an isolated disorder. However, associated conditions include cryptorchidism (present in 10%) and inguinal hernia.

once hypospadias has been identified, infants should be referred to specialist services
corrective surgery is typically performed when the child is around 12 months of age
it is essential that the child is not circumcised prior to the surgery as the foreskin may be used in the corrective procedure
in boys with very distal disease, no treatment may be needed



An undescended testicle