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Old 06-01-2012
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Question A 30-year-old woman has no symptoms other than fatigue

A 30-year-old woman is evaluated during a routine appointment. She has no symptoms other than fatigue, which she attributes to long work hours. She denies daytime somnolence and a history of snoring. She is a lawyer and, owing to stress at work, she finds it difficult to eat healthy foods and get exercise. She gained 9.1 kg (20 lb) with the birth of her first child last year and has been unable to lose the weight. The patient had gestational diabetes. She states that her menstrual periods are normal. She is taking no medications. Vital signs are normal. She is 177.8 cm (70 in) tall. BMI is 32. Her thyroid examination is normal. She has normal hair distribution and normal skin color with no evidence of striae. In addition to a fasting plasma glucose, lipid panel, and thyroid-stimulating hormone assay, which of the following should be done next?

A 24-Hour urine cortisol
B Pelvic ultrasonography
C Serum insulin-like growth factor 1 (IGF-1) concentration
D Waist circumference measurement
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Originally Posted by Novobiocin View Post
A 30-year-old woman is evaluated during a routine appointment. She has no symptoms other than fatigue, which she attributes to long work hours. She denies daytime somnolence and a history of snoring. She is a lawyer and, owing to stress at work, she finds it difficult to eat healthy foods and get exercise. She gained 9.1 kg (20 lb) with the birth of her first child last year and has been unable to lose the weight. The patient had gestational diabetes. She states that her menstrual periods are normal. She is taking no medications. Vital signs are normal. She is 177.8 cm (70 in) tall. BMI is 32. Her thyroid examination is normal. She has normal hair distribution and normal skin color with no evidence of striae. In addition to a fasting plasma glucose, lipid panel, and thyroid-stimulating hormone assay, which of the following should be done next?

A 24-Hour urine cortisol
B Pelvic ultrasonography
C Serum insulin-like growth factor 1 (IGF-1) concentration
D Waist circumference measurement
no idea...but still D....
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no idea...but still D....
yea actually for metabolic synd (>40 inches in male, 35 in female) --> abd obesity
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Old 06-02-2012
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D Waist circumference measurement
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yea actually for metabolic synd (>40 inches in male, 35 in female) --> abd obesity
I also thought about metabolic syndrome ...so picked D.......
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The evaluation of the patient with an initial diagnosis of overweight or obesity should include measurement of waist circumference and a review of eating and exercise habits. Higher levels of abdominal obesity are associated with increased risk of coronary artery disease, type 2 diabetes mellitus, dyslipidemia, and hypertension. In adults with a BMI of 25 to 34.9, a waist circumference greater than 102 cm (40 in) for men and 88 cm (35 in) for women is associated with greater risk than that determined by BMI alone. In patients with a BMI of 35 or greater, the measurement is less helpful, as nearly all these patients have abdominal obesity. In Asian populations, a male waist circumference greater than 90 cm (35 in) and a female waist circumference greater than 80 cm (32 in) are considered abnormal.
Patients should also be screened for diseases that are caused or worsened by obesity, including hyperlipidemia, diabetes mellitus, hypertension, and obstructive sleep apnea, particularly in patients who complain of unrefreshing sleep, daytime somnolence, or have a history of snoring.
Screening for Cushing syndrome may be indicated in patients with truncal obesity, plethora, wide purple striae, hypertension, or hirsutism, but these findings are absent in this patient. Measurement of 24-hour cortisol is, therefore, not necessary. The regularity of her menstrual periods, her ability to conceive, and absence of androgen excess make polycystic ovary syndrome unlikely, and pelvic ultrasonography is unnecessary. A patient with growth hormone deficiency and obesity would be expected to have short stature, but this patient is relatively tall, and an insulin-like growth factor 1 (IGF-1) concentration in not indicated.
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Originally Posted by Novobiocin View Post
In Asian populations, a male waist circumference greater than 90 cm (35 in) and a female waist circumference greater than 80 cm (32 in) are considered abnormal.
what r u saying man....my waist is 36 inches.....that means its abnormal....m scared.....
I think I need to join a gym .....!!!
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Originally Posted by K06100 View Post
what r u saying man....my waist is 36 inches.....that means its abnormal....m scared.....
I think I need to join a gym .....!!!
I am not sure what the word "Asian" means but in US it is mainly used for Chinese people.
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Originally Posted by Novobiocin View Post
I am not sure what the word "Asian" means but in US it is mainly used for Chinese people.

Indians r also Asians man.....anyone that lives in Asia is an asian......!!!!
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Old 06-03-2012
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Quote:
Originally Posted by Novobiocin View Post
A 30-year-old woman is evaluated during a routine appointment. She has no symptoms other than fatigue, which she attributes to long work hours. She denies daytime somnolence and a history of snoring. She is a lawyer and, owing to stress at work, she finds it difficult to eat healthy foods and get exercise. She gained 9.1 kg (20 lb) with the birth of her first child last year and has been unable to lose the weight. The patient had gestational diabetes. She states that her menstrual periods are normal. She is taking no medications. Vital signs are normal. She is 177.8 cm (70 in) tall. BMI is 32. Her thyroid examination is normal. She has normal hair distribution and normal skin color with no evidence of striae. In addition to a fasting plasma glucose, lipid panel, and thyroid-stimulating hormone assay, which of the following should be done next?

A 24-Hour urine cortisol
B Pelvic ultrasonography
C Serum insulin-like growth factor 1 (IGF-1) concentration
D Waist circumference measurement

D. has association with high mortelty rate in obese pt.
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Originally Posted by K06100 View Post
Indians r also Asians man.....anyone that lives in Asia is an asian......!!!!
Of course but in US Asian is typically used for people from China/Korea etc. For example, American is automatically taken as being from USA not Canada, Mexico, Brazil or Argentina but we all know that they all live in America.
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Originally Posted by Novobiocin View Post
Of course but in US Asian is typically used for people from China/Korea etc. For example, American is automatically taken as being from USA not Canada, Mexico, Brazil or Argentina but we all know that they all live in America.
ok ok......
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