Answers and exploitations

Q-1(B)

Secondary causes of obesity among children and adolescents are rare (less than 1%), However, they should be considered if there is any finding suggesting underlying cause such as sudden weight gain, short stature, dysmorhic features, chronic headache, dry skin, skin hyperpigmentation and developmental delay.

Q-2(A)

In this lady, skin dryness, fall of hair, constipation, sad mood, fatigue could indicate secondary cause such hypothyroidism. High blood pressure and high glucose and high lipid could be a part of metabolic syndrome in this lady rather than manifestations of secondary cause.

Q-3(D)

This child most likely to have obesity as a result of intake of imbalanced diet and physical inactivity, however, physician should look for the clinical manifestations of secondary cause of obesity. It is not recommended to ask for further investigations such as (TSH, Growth hormone, calcium or cortisol) unless there is suggesting or secondary cause of obesity (dsymorphic features, dry skin, developmental delay, short stature, skin striae). In this child blood glucose should checked to rule out associated diabetes.

Q-4(E)

This lady with obesity should be assessed thoroughly by taking comprehensive history and complete physical examination and to ask for further tests in the case of having manifestations of secondary causes (severe and chronic headache, visual disturbance, severe fatigue, dry skin, hair fall, voice tone changes, neck swelling, skin striae, skin hyperpigmentation, menstrual cycle disturbance.

Q-5(C)

This patient should be assessed using step by step approach including : detail history with exploring the idea, concern and expectation of this lady, reasons for visit and then conducting complete physical examination to look for secondary cause of obesity and co-morbidities . As obesity in adults may associated with diabetes and dyslipidemia, blood glucose and lipid profile should be requested. Regarding asking for thyroid function test, we can ask for it if there is any symptom or sign suggesting such condition, however, it is not routinely recommended.

Resources

Allen G. Secondary Causes of Obesity. American Family Physician 2011;83(8):972-973

Karam GJ, McFarlane SI. Secondary causes of obesity Review. Therapy 2007;4(5):641-650