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Metabolic Syndrome — MRCPsych Paper B MCQ

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ModerateSchizophrenia & PsychosisMetabolic SyndromeMRCPsych Paper B

A 45-year-old White British man with chronic schizophrenia attends annual physical health monitoring. He has no symptoms of hyperglycaemia and no previous diagnosis of diabetes. His waist circumference is 98 cm, fasting triglycerides are 1.9 mmol/L, HDL cholesterol is 1.2 mmol/L, blood pressure is 128/86 mmHg, and fasting plasma glucose is 6.2 mmol/L. Which single diagnosis best captures this cardiometabolic cluster?

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Correct answer: D — Metabolic syndrome

The correct answer is D, metabolic syndrome. Under the harmonised definition, at least three of five abnormalities are required. This man has increased waist circumference for a White European man, raised triglycerides, raised diastolic blood pressure and raised fasting glucose. His HDL cholesterol is not reduced, but four qualifying components are present. A fasting glucose of 6.2 mmol/L does not meet the diagnostic threshold for type 2 diabetes, so A is incorrect. Although the glucose is in the non-diabetic hyperglycaemia range, C fails because the abnormality is not isolated. Likewise, central obesity and hypertriglyceridaemia are present, but D and E do not account for the wider cluster. NICE recommends systematic monitoring of these cardiometabolic measures in people receiving antipsychotics.

Reference: Lam DW, LeRoith D. Metabolic Syndrome. Endotext, Harmonized Definition section, updated 11 February 2019. https://www.nice.org.uk/guidance/cg178/chapter/recommendations