EPIDEMIOLOGY
Which of the following lifestyle factors is the main cause of the continuing rise in prevalence of metabolic syndrome?
A. Genetic mutations
B. Urbanisation and Western dietary habits
C. A decline in medical standards
D. A rise in the birth rate
B. Urbanisation and Western dietary habits
Which of the following is NOT one of the four core clinical features of metabolic syndrome?
A. Abdominal obesity
B. Insulin resistance
C. Dyslipidaemia
D. Anaemia
D. Anaemia
Which of the following is a major lifestyle-related risk factor that can contribute to metabolic syndrome?
A. Physical in activity
B. Excessive intake of unhealthy foods
C. Excessive alcohol consumption
D. High intake of carbohydrate
B. Excessive intake of unhealthy foods
According to the Harmonized 2009 definition, how many of these five criteria are required for metabolic syndrome diagnosis ?
Waist circumference
Elevated triglycerides
Reduced high-density lipoprotein (HDL) cholesterol
Elevated blood pressure
Elevated fasting glucose.
A. 1
B. 3
C. 5
D. 4
B. 3
Which of the following clinical findings most strongly supports a diagnosis of metabolic syndrome when considered alongside other cardiometabolic risk factors?
A. Reduced haemoglobin concentration
B. Persistently elevated blood pressure
C. Recurrent airway obstruction
D. Reduced bone mineral density
B. Persistently elevated blood pressure
Regarding the age distribution of metabolic syndrome, which of the following statements is correct?
A. The prevalence is highest in childhood
B. The prevalence decreases with age
C. The prevalence is highest in the elderly (aged 60 and over)
D. Age has no effect on prevalence
C. The prevalence is highest in the elderly (aged 60 and over)
Which waist circumference indicates abdominal obesity in an Asian adult male?
A. ≥ 80 cm
B. ≥ 85 cm
C. ≥ 90 cm
D. ≥ 100 cm
C. ≥ 90 cm
Which type of body fat is most strongly associated with the development of metabolic syndrome?
A. Subcutaneous fat
B. Visceral fat
C. Brown fat
D. Essential fat
B. Visceral fat
Fill in the Blank
A fasting glucose level of ≥ ______ mmol/L is one of the criteria for metabolic syndrome.
5.6 mmol/L
Excessive accumulation of visceral (abdominal) fat is most directly linked to which of the following metabolic abnormalities?
A. Increased insulin resistance in peripheral tissues
B. Elevated fasting blood glucose levels
C. Increased risk of cardiovascular disease
D. Reduced sensitivity to insulin-mediated glucose uptake
D. Reduced sensitivity to insulin-mediated glucose uptake
In Malaysia, which of the following statements regarding the prevalence of metabolic syndrome among different ethnic groups is correct?
A. The prevalence is highest among Malays
B. The prevalence is higher among Chinese than among Indians
C. The prevalence is highest among Indians, and is associated with central obesity and hyperlipidaemia
D. The prevalence is the same across all ethnic groups
C. The prevalence is highest among Indians, and is associated with central obesity and hyperlipidaemia
A patient has reduced sensitivity to circulating insulin, compensatory hyperinsulinaemia and an elevated fasting blood glucose level. Which clinical feature of metabolic syndrome does this describe?
A. Dyslipidaemia
B. Insulin resistance
C. Hypertension
D. Prothrombotic state
B. Insulin resistance
How can chronic stress contribute to the development of metabolic syndrome?
A. By permanently lowering cortisol levels
B. By increasing insulin sensitivity
C. By increasing cortisol level
D. By reducing sympathetic nervous system activity
C. By increasing cortisol level
Which TWO findings fulfil the Harmonized criteria for metabolic syndrome?
I. Blood pressure 130/85 mmHg
II. Fasting glucose 5.5 mmol/L
III. Triglycerides 1.7 mmol/L
IV. HDL 1.5 mmol/L in a female
I and III
Patient with metabolic syndrome has persistently elevated blood pressure despite lifestyle modification. Which combination of findings would most strongly support the need for closer cardiovascular risk assessment before selecting an antihypertensive treatment strategy?
A. Increased waist circumference, elevated triglycerides, and reduced HDL cholesterol
B. Elevated fasting glucose, evidence of insulin resistance, and signs of target-organ involvement
C. Increased body mass index, sedentary lifestyle, and mildly elevated LDL cholesterol
D. Elevated triglycerides, increased fasting glucose, and a family history of obesity
B. Elevated fasting glucose, evidence of insulin resistance, and signs of target-organ involvement
Metabolic syndrome significantly increases the risk of a variety of diseases. Which of the following combinations correctly lists the diseases for which metabolic syndrome significantly increases the risk?
A. Type 2 diabetes and osteoporosis
B. Cardiovascular disease and chronic obstructive pulmonary disease
C. Type 2 diabetes and cardiovascular disease
D. Stroke and rheumatoid arthritis
C. Type 2 diabetes and cardiovascular disease
Which combination correctly represents the four core clinical features of metabolic syndrome described in the report?
A. Central obesity, insulin resistance, dyslipidaemia and hypertension
B. Central obesity, hyperuricaemia, microalbuminuria and anaemia
C. Insulin resistance, atherosclerosis, inflammation and hypertension
D. Dyslipidaemia, microalbuminuria, prothrombotic state and hyperuricaemia
A. Central obesity, insulin resistance, dyslipidaemia and hypertension
A patient has central obesity and chronic insulin resistance. Which mechanism best explains how excess visceral adipose tissue contributes to metabolic syndrome?
A. It decreases free fatty acid release and suppresses inflammation
B. It increases adiponectin secretion and improves insulin sensitivity
C. It releases free fatty acids and pro-inflammatory cytokines that promote insulin resistance
D. It prevents hepatic glucose production and improves glucose regulation
C. It releases free fatty acids and pro-inflammatory cytokines that promote insulin resistance
Clinical Case
A 50-year-old man comes for a routine health examination. His results are:
- Waist circumference: 118 cm
- Triglycerides: 1.8 mmol/L
- HDL: 1.1 mmol/L
- Blood pressure: 128/84 mmHg
- Fasting glucose: 5.8 mmol/L
According to the NCEP (2005) criteria, does this patient have metabolic syndrome?
No
A 52-year-old patient presents with abdominal obesity, elevated blood pressure, and impaired fasting blood glucose but does not meet the diagnostic criteria for type 2 diabetes mellitus. Which management approach would most effectively reduce the patient's overall risk of metabolic and cardiovascular complications?
A. Prioritise blood pressure control while monitoring glucose and body weight periodically
B. Focus primarily on improving glycaemic control, with lifestyle modification introduced gradually
C. Implement comprehensive lifestyle modification alongside appropriate management of blood pressure and glycaemic abnormalities
D. Monitor the metabolic abnormalities closely and initiate pharmacological treatment only if diabetes develops
C. Implement comprehensive lifestyle modification alongside appropriate management of blood pressure and glycaemic abnormalities