Obesity Medicine and Metabolic Disorders Review

Flashcard study set generated from lecture notes covering obesity medicine, genetic syndromes, bariatric surgical complications, nutrition, and pharmacological management.

What mnemonic is used to remember the key clinical features of Alström Syndrome (ALMS)?

A: Autosomal recessive with ALMS1 mutation, Anosmia; L: Loss of vision with retinal dystrophy; M: CardioMyopathy (dilated) leading to heart failure; S: Sensorineural hearing loss, Short stature.

What is the Recommended Dietary Allowance (RDA) of fiber for men and women aged $19\text{--}50$\,years old?

For men (aged $14\text{--}50$\,years old), it is $38$\,grams per day; for women (aged $19\text{--}50$\,years old), it is $25$\,grams per day.

How does exogenous testosterone replacement lead to reduced fertility in men?

Exogenous testosterone suppresses GnRH ($1^{st}$ step), which results in decreased LH and FSH ($2^{nd}$ step), thereby decreasing testicular testosterone and spermatogenesis ($3^{rd}$ step).

Which specific nutrient deficiencies are commonly associated with Proton pump inhibitors and Metformin?

Proton pump inhibitors cause deficiencies in Vitamin $B_{12}$, magnesium, and calcium. Metformin causes deficiency in Vitamin $B_{12}$.

How is weight assessed in children under $2$\,years of age?

Weight assessment in those under $2$\,years old is done by evaluating weight-for-length using World Health Organization (WHO) charts, taking into account sex and age.

What increased risk for childhood obesity is associated with having one versus both parents affected by obesity?

Having $1$ parent with obesity leads to a $3\times$ risk, whereas having both parents with obesity leads to a $10\times$ risk.

What are the key drug interactions and contraindications for Naltrexone/Bupropion ER (Contrave®)?

Contraindicated with MAOIs (do not take within $14$\,days), chronic or acute opioid use, uncontrolled hypertension, and seizure disorders. Bupropion inhibits CYP2D6 and is metabolized by CYP2B6.

What physical features and clinical manifestations are characteristic of Fragile X syndrome?

Large ears, testicular enlargement (macroorchidism post-puberty) with normal function, elongated and narrow face with broad prominent forehead, prominent jaw, strabismus, hypotonia, joint hyperlaxity, and developmental/cognitive delays.

What are the diagnostic criteria for Metabolic Syndrome in adults aged $\ge 19$\,years old?

Requires $3$ of $5$ criteria: Triglycerides $\ge 150$\,mg/dL, HDL $<40$\,mg/dL (men) or $<50$\,mg/dL (women), Fasting glucose $\ge 100$\,mg/dL, Waist circumference $\ge 102$\,cm ($40$\,in) in men or $\ge 88$\,cm ($35$\,in) in women, and Blood pressure $\ge 130/85$\,mmHg.

What are the mechanisms of action and contraindications for Phentermine/Topiramate ER (Qsymia®)?

Phentermine stimulates the hypothalamus to release norepinephrine to decrease appetite. Topiramate ER enhances GABA activity and $\text{Na}^+$ channels. Contraindicated in pregnancy, glaucoma, hyperthyroidism, concurrent MAOI use, and hypersensitivity.

What is the difference between Fat-Free Mass (FFM) and Lean Body Mass (LBM)?

FFM is total body mass minus all adipose tissue (excluding all fat). LBM includes essential non-adipose fat found in organs, bone marrow, and the central nervous system (typically $2\text{--}3\%$ of FFM in men, $10\text{--}12\%$ in women).

How do symptoms, diagnostic tools, and treatments differ between Anastomotic Ulcer and Stricture?

Ulcers present with localized pain, nausea, vomiting, and bleeding risk; diagnosed by EGD; treated with PPIs and sucralfate. Strictures present with dysphagia, solid food intolerance, and weight loss; diagnosed by Upper GI barium or EGD; treated with balloon dilation.

What are the four core communication components of the OARS framework in Motivational Interviewing?

O: Open-ended questions; A: Affirmations; R: Reflective listening; S: Summarizing.

What are the specific Respiratory Quotient (RQ) values for carbohydrates, proteins, and fats?

Carbohydrates = $1.0$, Proteins = $0.8$, Fats = $0.7$ (Mixed diet = $0.8$).

What post-operative complication of gastric banding is illustrated here, and what symptoms does it produce?

Band Slippage; occurs when the gastric band shifts position, allowing the stomach to prolapse upward. It leads to an enlarged gastric pouch, causing progressive nausea, vomiting, reflux, dysphagia, or obstruction.

What surgical complication following Roux-en-Y gastric bypass is shown in this diagram?

Internal Hernia; protrusion of a segment of small intestine through a mesenteric defect (most commonly at the jejunojejunostomy or Petersen's space), presenting with crampy postprandial abdominal pain, nausea, and risk of bowel ischemia.

How do physical examination signs (Stemmer's sign and Cuff sign) differentiate Lipedema from Lymphedema?

Lipedema features a negative Stemmer's sign (ability to pinch skin at the base of the second toe) and positive Cuff sign (feet are spared). Lymphedema features a positive Stemmer's sign (cannot pinch skin due to fibrosis) and negative Cuff sign (swelling involves the feet).

What minimally invasive procedure is depicted, and what is its clinical purpose?

Transoral Outlet Reduction (TORe); an endoscopic procedure that reduces the size of a dilated gastrojejunal anastomosis to restore restriction in patients experiencing weight regain following Roux-en-Y gastric bypass.

What cumulative Adverse Childhood Experiences (ACEs) score is associated with an increased adult risk of obesity?

A cumulative ACEs score of $\ge 4$ is associated with a $2\text{--}3\times$ higher risk of obesity and metabolic syndrome in adulthood due to persistent HPA-axis activation and behavioral pathways.

Which anti-hypertensive class is considered first-line for controlling blood pressure in patients with obesity?

Renin-angiotensin-aldosterone system (RAAS) inhibition, using either angiotensin receptor blockers (such as losartan) or angiotensin-converting enzyme inhibitors.

What is the most common monogenic etiology of obesity and what are its key features?

Melanocortin 4 receptor (MC4R) deficiency; presenting with hyperphagia, normal development, hyperinsulinemia, and increased linear growth (tall stature as adults).