Obesity is an incredibly complex disease, requiring a multi-disciplinary approach, with many patients being stigmatised due to their weight. Test your understanding of this multi-faceted disease on this set of questions.
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Stem 1, question 1 of 4
Diane, a 56 year old woman, presents to her GP following a recent weight gain
What is the definition of obesity?
An imbalance between energy intake and expenditure
A chronic condition caused by an excessive energy intake
A chronic condition characterised by an inadequate caloric expenditure
A chronic adverse condition caused by excessive appetite
A chronic adverse condition due to an excess amount of body fat
Question 1 Explanation:
Obesity is condition surrounded in stigma so it is very important to understand the definitions. It is reductionist to state that obesity is caused by excessive energy intake and/or inadequate energy expenditure as there are a number of complex interacting metabolic processes.
Stem 1, question 2 of 4Leptin, a hormone, is released by adipocytes. What is the action of leptin?
Acts as a hunger signal to promote appetite and decrease substrate utilisation, acting through the hypothalamus
Acts as a satiety signal to inhibit appetite and increase substrate utilisation, acting through the hypothalamus
Acts as a satiety signal to inhibit appetite and increase substrate utilisation, acting through the thalamus
Acts through the vagus nerve on the hypothalamus to increase appetite
Acts on the hypothalamus to decrease appetite and causes gallbladder contraction
Question 2 Explanation:
Leptin is a hormone secreted by adipose when substrate is plentiful and acts as a satiety signal to inhibit appetite and increase substrate utilisation and acts through the hypothalamus. People who are obese may be an a state of relative leptin resistance and do not respond adequately to an increased leptin level.
Stem 1, question 3 of 4On examination, Diane has central obesity, facial round, thinning of the skin and proximal muscle weakness. What is the most common cause of this presentation?
Adrenocorticotropic hormone secreting pituitary adenoma
Question 3 Explanation:
This is a bit trickier so hopefully this explanation will help make sense. The question is describing Cushing's syndrome, which is the clinical manifestation of pathological hypercortisolism. This can be caused by endogenous or exogenous corticosteroids. An example of pathological endogenous corticosteroids would be a adrenocorticotropic hormone secreting pituitary adenoma. However, the most common cause of Cushing's syndrome is exogenous corticosteroids, therefore is prednisolone. Hypothyroidism, sodium valproate and clozapine can all cause weight gain, but will not result in Cushing's syndrome.
Stem 1, question 4 of 4Diane also describes waking up several times a night, not feeling refreshed from sleep and is diagnosed with sleep apnoea. How can obesity cause sleep apnoea?
Decreased tissue mass when relaxed can cause partial or complete airway obstruction
Increased tissue mass when relaxed can cause partial or complete airway obstruction
Increased airway resistance leads to wheezing
Increased tissue mass when relaxed can cause partial or complete airway dilation
Increased laxity of ligaments due to a higher circulating volume of relaxin
Question 4 Explanation:
Sleep apnoea is often, but not always, associated with obesity. Due to the increased tissue mass, when the muscles relax during sleep this can lead to a partial or complete airway obstruction, this can cause apnoeic periods or ineffective ventilation. This will result in individuals not feeling refreshed after sleep and/or waking multiple times a night. Poor sleep is linked to an increased appetite and thus sets up a vicious cycle
Stem 2, question 1 of 5
Oscar, a 34 year old man, presents with recurrent episodes of upper right quadrant pain. Oscar has a BMI of 31.1 kg.m^2
What is the link between gall bladder disease and obesity?
Higher levels of fat mean more cholecystokinin must be produced which overwhelms the capacity of the gallbladder
Decreased metabolism leading to cholestasis and thus stone formation
Higher levels of fat mean fewer bile salts must be produced which underwhelms the capacity of the gallbladder
Higher levels of fat mean more bile salts must be produced which overwhelms the capacity of the gallbladder
Higher levels of fat mean more bile salts must be produced which underwhelms the capacity of the gallbladder
Question 5 Explanation:
Obesity results in higher levels of fat so the body must produce more bile salts, this can overcome the ability of the gall bladder. In addition there is an increased association with gallbladder stones which results in obstructive jaundice. Remember that gall bladder issues can be incredibly painful so ensure patients receive adequate analgesia for their pain!
Stem 2, question 2 of 3Which of the following cancers is obesity NOT a risk factor for?
Question 6 Explanation:
Obesity and cancer has a well documented associated and obesity is now an acknowledged risk factor for: breast (post menopausal), endometrial, colon, kidney and oesophagus cancers. This must be approached in a sensitive manner as it is not as simple as "eat less and move more".
Stem 2, question 3 of 5Oscar takes an anti-depressant. Which one of the following anti-depressants does not cause weight gain as a side effect?
Question 7 Explanation:
Many anti-depressants can result in weight gain, with mirtazapine notorious for causing weight gain. Bupropion is an anti-depressant that is not associated with weight gain as a side effect. Remember the BNF is always a great resource to look at!
Stem 2, question 4 of 5By what mechanism do anti-psychotics cause weight gain?
Inhibits H1 and 5HT receptors resulting in increased appetite
Stimulation H2 and noradrenaline receptors resulting in increased appetite
Acts via the vagus nerve on the hypothalamus to increase appetite
Stimulate H1 and D2 receptors resulting in increased appetite
Inhibits H1 and D2 receptors resulting in increased appetite
Question 8 Explanation:
Anti-psychotics inhibit the H1 and 5HT receptors which results in an increase in appetite. In the central nervous system, serotonin (5HT) suppresses appetite (so its inhibition would stop this suppression). Olanzapine and clozapine are well known to result in weight gain.
Stem 2, question 5 of 5What is the neural centre for the control of appetite?
Question 9 Explanation:
The hypothalamus is the centre processing unit which receives input from hormones, peripheral neural input and the cerebral cortex and is responsible for controlling appetite. This is proven in cases of damage to the hypothalamus that result in poor appetite control
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