| Show Learning Points most relevant to Phase 1: |
Obesity
| Clinical Discipline(s)/Organ System(s) Digestive System, Endocrinology, Gastroenterology & Hepatology, General Practice, General Surgery | Progress Test Topic(s) Digestive |
Description
A 42 year old NZ European woman comes for a follow-up GP visit because she recently had blood tests that have shown abnormal liver function. She is obese and complains of irregular periods and fatigue for a few months. She feels her mood is low. Her blood pressure is 156/94 mmHg and there is glucose in her urine.
Progress Test-Type Questions: Question 1 | Question 2Applied Science for Medicine
- Anatomy and physiology of the liver, pancreas, adrenal glands and upper airway
- Physiology and distribution of adipose tissue
- Glucose and cholesterol homeostasis
- Definition and pathophysiology of 'metabolic syndrome'; role in the development of atherosclerosis
- Pathophysiology of hypertension
- Physiology of the hypothalamic-pituitary-gonadal axis, including the menstrual cycle
- Pathophysiology of polycystic ovarian syndrome (PCOS); recognise the relationship between metabolic syndrome and PCOS
- Understand the steroidogenesis pathway; pathophysiology of androgen excess; pathophysiology of steroid excess
- Pharmacology of metformin, antihypertensives
- Anatomy and physiology of the liver, pancreas, adrenal glands and upper airway
- Physiology and distribution of adipose tissue
- Glucose and cholesterol homeostasis
- Definition and pathophysiology of 'metabolic syndrome'; role in the development of atherosclerosis
- Pathophysiology of hypertension
- Physiology of the hypothalamic-pituitary-gonadal axis, including the menstrual cycle
- Pathophysiology of polycystic ovarian syndrome (PCOS); recognise the relationship between metabolic syndrome and PCOS
- Understand the steroidogenesis pathway; pathophysiology of androgen excess; pathophysiology of steroid excess
- Pharmacology of metformin, antihypertensives
Clinical and Communication Skills
- History from a patient with obesity including use of the Epworth Sleepiness Scale
- Perform a general examination; recognise the signs of cortisol excess and of androgen excess
- Differential diagnosis of obesity
- Indications for ultrasound abdomen, transvaginal ultrasound (recognise the implications of obesity as a risk factor for endometrial hyperplasia/cancer), sleep studies
- Interpret investigations for causes of obesity (overnight dexamethasone suppression test, 24 hour urinary cortisol, thyroid function tests); interpret investigations for complications of obesity (liver function tests, HbA1c, urine albumin:creatinine ratio, lipid profile, serum testosterone)
- Use of appropriate communication skills for discussing obesity with patient; screening for depression
- Management of obesity, non-alcoholic fatty liver disease, metabolic syndrome, PCOS including life-style factors and role of the dietitian
- Role of bariatric surgery for treatment of obesity
- Outline the management of obesity-related sleep disorders
- Outline the management of Cushing's syndrome
- Complications and prognosis of obesity
- History from a patient with obesity including use of the Epworth Sleepiness Scale
- Perform a general examination; recognise the signs of cortisol excess and of androgen excess
- Differential diagnosis of obesity
- Indications for ultrasound abdomen, transvaginal ultrasound (recognise the implications of obesity as a risk factor for endometrial hyperplasia/cancer), sleep studies
- Interpret investigations for causes of obesity (overnight dexamethasone suppression test, 24 hour urinary cortisol, thyroid function tests); interpret investigations for complications of obesity (liver function tests, HbA1c, urine albumin:creatinine ratio, lipid profile, serum testosterone)
- Use of appropriate communication skills for discussing obesity with patient; screening for depression
- Management of obesity, non-alcoholic fatty liver disease, metabolic syndrome, PCOS including life-style factors and role of the dietitian
- Role of bariatric surgery for treatment of obesity
- Outline the management of obesity-related sleep disorders
- Outline the management of Cushing's syndrome
- Complications and prognosis of obesity
Personal and Professional Skills
- Provide advice regarding weight loss and lifestyle modification
- Reflect on personal attitudes to obesity
- Provide advice regarding weight loss and lifestyle modification
- Reflect on personal attitudes to obesity
Hauora Māori
- Awareness of differing risk profiles for Māori (and other disadvantaged populations) compared with non-Māori in NZ presenting with abnormal liver function tests
- Understanding of inequities in access to health services and quality of medical care for Māori, and application of this to clinical decision making and management
- Awareness of disproportionate impact of socioeconomic deprivation on Māori, particularly for health-related behaviours, and appropriate response
- Awareness of differing risk profiles for Māori (and other disadvantaged populations) compared with non-Māori in NZ presenting with abnormal liver function tests
- Understanding of inequities in access to health services and quality of medical care for Māori, and application of this to clinical decision making and management
- Awareness of disproportionate impact of socioeconomic deprivation on Māori, particularly for health-related behaviours, and appropriate response
Population Health
- Obesity epidemic, obesigenic environment and relationship to broader determinants of health
- Describe the global burden of obesity, risk factors and lifestyle associated with obesity
- Strategies to reduce obesity and strategies to reduce impact of obesity
- Epidemiology of non-alcoholic fatty liver disease, metabolic syndrome, PCOS
- Screening for diabetes, hypertension, dyslipidaemia
- Obesity epidemic, obesigenic environment and relationship to broader determinants of health
- Describe the global burden of obesity, risk factors and lifestyle associated with obesity
- Strategies to reduce obesity and strategies to reduce impact of obesity
- Epidemiology of non-alcoholic fatty liver disease, metabolic syndrome, PCOS
- Screening for diabetes, hypertension, dyslipidaemia
Conditions to be considered relating to this scenario
Common
non-alcoholic fatty liver disease, metabolic syndrome, obstructive sleep apnoea, diabetes mellitus, impaired glucose tolerance, dyslipidaemia, essential hypertension, PCOS
non-alcoholic fatty liver disease, metabolic syndrome, obstructive sleep apnoea, diabetes mellitus, impaired glucose tolerance, dyslipidaemia, essential hypertension, PCOS
Uncommon
ectopic ACTH from malignancy, Cushing's syndrome
ectopic ACTH from malignancy, Cushing's syndrome
Related Scenarios
[Amenorrhoea], [Infertility], [Daytime sleepiness], [Type 2 diabetes mellitus], [Childhood obesity]
[Amenorrhoea], [Infertility], [Daytime sleepiness], [Type 2 diabetes mellitus], [Childhood obesity]
