A 43-year old female patient came to the clinic for evaluation of a rapid onset of weight gain. In the last 3 months, she gained 12 KG without significant changes in her diet or exercise habits. Her other symptoms include easy fatigability, mood swings, and irregular menses. On physical examination, she is vitally stable, her BMI is 32. It was difficult for her to get off the chair when she was asked to go to the examination table. Central obesity was noticed, and purple stretch marks were noticed on her abdomen. What would be the next step in managing this patient?
سؤال مجاني 1 من 10 اليوم · اشترك وكمّل بدون حد
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الإجابة والشرح
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الإجابة: A. Order a 24-hours urinary free cortisol test
Rapid weight gain with central obesity, purple abdominal striae, proximal muscle weakness (difficulty rising from a chair) and menstrual irregularity strongly suggests Cushing syndrome. The next step is a screening test for hypercortisolism. A 24-hour urinary free cortisol is one of the initial screening tests, alongside late-night salivary cortisol and the low-dose dexamethasone suppression test. Starting weight-loss drugs would miss the underlying cause. Thyroid tests do not explain the striae and proximal myopathy.
ليش كل خيار صح أو غلط
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A
ليش صح
Her central obesity, striae and weakness suggest Cushing syndrome; 24-hour urinary free cortisol is an excellent screening test, with values above three times normal rare except in Cushing.
✓ Step Up To Medicine 6th Edition 2024 (Adrenal).pdf · p. 3 -
B
ليش غلط
Purple abdominal striae, muscle weakness, central obesity and menstrual irregularity are the listed signs of Cushing syndrome, whose first screening tests are cortisol-based, not TSH/free T4.
✓ Adrenal summary.pdf · p. 2 -
C
ليش غلط
Liraglutide is an obesity drug used only after dieting and exercise prove insufficient; it treats the weight, not the cause of her rapid gain with striae and proximal weakness.
✓ Step Up To Medicine 6th Edition 2024 (Obesity).pdf · p. 2 -
D
ليش غلط
Orlistat (a pancreatic lipase inhibitor) is an obesity drug for when dieting and exercise are insufficient; it does not look for the cause of her rapid gain with striae and weakness.
✓ Step Up To Medicine 6th Edition 2024 (Obesity).pdf · p. 2
- المصدر
- Adrenal summary.pdf · p. 2
Step Up To Medicine 6th Edition 2024 (Adrenal).pdf · p. 3 - المحاضرة
- Cushing's Syndrome · Endocrinology · Module B
- ظهر في
- Endo bank · MED43 ♂ Quiz B