Obesity approach

WIPE

WINDS +syndrome ( prader willi syndrome , Laurence Moon Biedle

Syndrome ),, tall ( simple obesity, genetic ) short ( cushing,

hypothyroid),, distribution of fat central distribution as in cushing

syndrome or not ,, glasses (LMBS), distress or not ( pickwikian)

Don't forget some points which are pass/ fail criteria in obesity sheet :

1.mentality ( decreased in syndrome )

2.BMI

3.Bl.P

4.genitalia examination and tanner staging

5.eye examination

6.bone affection in case of obesity ( tibia bowing, SCFE )

Measurement ( height, sitting height, wg, BMI ) + plot on appropriate

Centiles + assess previous measurements

Gait +exposure( SCFE…. Limping and in addition assess tibia bowing )

Back :

Low posterior hair line

Short neck

Acanthosis nigricans

Acne

Interscapular pad of fat

Spinal tenderness

Skin spine nappies

Ask patient to bend forward and touch toes

Maneuvers :

Put your arm beside yourself and your palm faces forward… cubitus

valgus….. turner syndrome

Put your arms in front each other ….. to assess asymmetry ( beckwith

wideman syndrome )

Make a fist …. Short 4th

and 5th metacarpal….. turner and

pseudohypoparathyroidism

Head to toe examination …. According to each case

Hand :

Small … P.W.S

Polydactyl or scars of extra digit… LMBS

Short 4th

and 5th metacarpals …. Turner or hypoparathyroidism

Clubbing

Hypo plastic nail, convex nail….. turner

Cold hand and dry skin …. Hypothyroidism

Simian crease, clinodactyly

3 P … pulse , blood pressure, proximal myopathy

Cubitus valgus

Axilla :

Tanner

Acanthosis nigricans

LN

Striae

Face :

Hair

Features :

1.moon face , acne, hirsutism , depigmentation (Cushing)

2.almond shaped eye , bitemporal narrowing (PW)

3.midline facial hypoplasia (GH)

4.trisomy 21 features

5. round face… pseudohypoparathyroidism

Eye, nose, mouth, palate +adenoid features

Neck :

Thyroid , LN

Chest :

RR, Gynecomastia , pigmentation ( café-aulait)

Heart :

Increase S2 , RVH

Abdomen :

Distension

Stria

Liver

Adrenal mass

Umbilicus +hernia

Lower limb :

Asymmetry

Stria

Peritibeal myxdema

Bone tenderness

Small feet , short 4th

and 5th metatarsal , polydactyl

Proximal myopathy

In order to continue examination :

1.centiles especially BMI if you did not say it you will fail + tanner and

examination of external genitalia + blood pressure and eye examination

2.according to each case : Cushing , PW, LMBS( would be discussed

later

3.ask for his diet and pattern of exercise

Then thank patient and cover him .