Return to Diagnosis ListShow Learning Points most relevant to Phase 1:


Clinical Discipline(s)/Organ System(s)
Digestive System, Endocrinology, Gastroenterology & Hepatology, General Practice, General Surgery
Progress Test Topic(s)
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 2
Applied 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
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
Personal and Professional Skills 
   - 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
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
Conditions to be considered relating to this scenario
non-alcoholic fatty liver disease, metabolic syndrome, obstructive sleep apnoea, diabetes mellitus, impaired glucose tolerance, dyslipidaemia, essential hypertension, PCOS
ectopic ACTH from malignancy, Cushing's syndrome