Childhood Obesity: Model Clinical Case and Viva Q&A

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Clinical Case of Childhood Obesity

Patient: Sarah, a 10-year-old female

Chief Complaint:

Sarah's parents bring her to the pediatrician due to concerns about her weight gain over the past two years.

History of Present Illness:

Sarah has been steadily gaining weight since age 8. Her parents report that she has become increasingly sedentary, spending most of her free time watching TV or playing video games. They note that she often snacks on high-calorie foods and drinks sugary beverages throughout the day.

Past Medical History:

  • No significant past medical conditions
  • Up-to-date on vaccinations

Family History:

  • Father: Overweight, Type 2 Diabetes
  • Mother: Obese, Hypertension
  • Maternal grandmother: Type 2 Diabetes

Social History:

Sarah lives with both parents and a younger sister. She attends 5th grade at a local elementary school. The family frequently eats fast food and rarely engages in physical activities together.

Physical Examination:

  • Height: 140 cm (55th percentile)
  • Weight: 55 kg (>97th percentile)
  • BMI: 28 kg/m² (>99th percentile)
  • Blood Pressure: 118/78 mmHg (>90th percentile for age, sex, and height)
  • Skin: Acanthosis nigricans noted on the neck and axillae

Laboratory Results:

  • Fasting Blood Glucose: 102 mg/dL (slightly elevated)
  • Total Cholesterol: 210 mg/dL (elevated)
  • LDL: 130 mg/dL (elevated)
  • HDL: 38 mg/dL (low)
  • Triglycerides: 160 mg/dL (elevated)
  • ALT: 45 U/L (slightly elevated)
  • AST: 40 U/L (normal)

Assessment:

Sarah is diagnosed with childhood obesity (BMI >99th percentile for age and sex) with associated comorbidities, including pre-diabetes, dyslipidemia, and early signs of non-alcoholic fatty liver disease (NAFLD).

Plan:

  1. Comprehensive lifestyle modification program including dietary changes and increased physical activity
  2. Referral to a pediatric nutritionist for personalized meal planning
  3. Encouragement to engage in 60 minutes of moderate to vigorous physical activity daily
  4. Family-based behavioral therapy to address eating habits and sedentary behaviors
  5. Screening for depression and other psychosocial issues
  6. Follow-up in 3 months to reassess weight, BMI, and laboratory values
  7. Consider referral to pediatric endocrinology if no improvement or if comorbidities worsen


Clinical Presentations of Childhood Obesity

  1. Metabolic Syndrome Presentation

    A 14-year-old male presents with central obesity (waist circumference >90th percentile), hypertension (blood pressure >95th percentile), and acanthosis nigricans. Laboratory tests reveal elevated fasting glucose, low HDL cholesterol, and high triglycerides, indicating metabolic syndrome.

  2. Orthopedic Complications

    An 11-year-old obese female complains of knee pain and difficulty walking. Physical examination reveals genu valgum (knock-knees) and limited range of motion in the hips. X-rays show early signs of slipped capital femoral epiphysis (SCFE) in the left hip.

  3. Respiratory Issues

    A 9-year-old obese male presents with snoring, daytime sleepiness, and poor academic performance. Sleep study reveals obstructive sleep apnea. Additionally, the patient has a history of recurrent asthma exacerbations, which have worsened with weight gain.

  4. Endocrine Disorders

    A 13-year-old obese female presents with irregular menstrual cycles, hirsutism, and acne. Laboratory tests show elevated androgens and polycystic ovaries on ultrasound, consistent with polycystic ovary syndrome (PCOS).

  5. Gastrointestinal Complications

    A 12-year-old obese male complains of recurrent right upper quadrant pain. Ultrasound reveals gallstones, and liver function tests show elevated ALT and AST, suggesting non-alcoholic fatty liver disease (NAFLD).

  6. Psychosocial Issues

    A 15-year-old obese female presents with symptoms of depression, social isolation, and declining academic performance. She reports being bullied at school due to her weight and has low self-esteem.

  7. Dermatological Manifestations

    A 10-year-old obese male presents with multiple skin tags, acanthosis nigricans in the neck and axillae, and intertrigo in the skin folds. He also complains of recurrent fungal infections in the groin area.



Knowledge Check: Question and Answers for Medical Students & Professionals

This interactive quiz component covers essential viva questions and answers. It includes 30 high-yield viva questions with detailed answers.

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The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.



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