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Simmons NURP 503 Exam 4 > 12: Eating Disorders > Flashcards

12: Eating Disorders Flashcards

1
Q

Anorexia or bulimia?

Frequency of episodes: 1 time/week.

A

Bulimia

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2
Q 
What do labs look like in anorexia?
Hemoglobin?
BUN?
Potassium?
pH?
Electrolytes?
Cholesterol?
A 
Hemoglobin = Falsely elevated
BUN = Elevated or low
Potassium = Hypokalemia
pH = Acidosis
Electrolytes = Normal when purging stops
Cholesterol = Elevated
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3
Q

What screening is used for eating disorders?

A

SCOFF
Sick - Do you make yourself sick because you feel uncomfortably full?
Control - Do you worry you lost control of over how much you eat?
One - Have you recently lost 1 stone (14 pounds) in a 3-month period?
Fat - Do you think you’re fat when others say you’re thin?
Food - Does food dominate your life?

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4
Q

What hormone is produced in the fat cells and is involved in satiety signaling?

A

Leptin. Current research disproves that there is an abnormality in leptin receptors for anorexics.

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5
Q

What neurological complications can occur with anorexia (5)?

A
  1. Seizures
  2. Cognitive and memory dysfunction
  3. Depression
  4. Anxiety
  5. Abnormal EEG
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6
Q

Which electrolytes will be off with bulimia?

A
  1. Low calcium
  2. Low sodium
  3. Low chloride
  4. Metabolic acidosis (loss of stomach acid)
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7
Q

What BMI indicates anorexia?

A

Below 17.5

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8
Q

A ROS with anorexia may reveal what symptoms (7)?

A
  1. Dizziness, blackout, weakness
  2. Pallor, easy bruising
  3. Cold intolerance
  4. Hair loss, dry skin
  5. Vomiting, diarrhea, bloating, abdominal pain
  6. Muscle cramps, joint pains, chest pains
  7. Menstrual irregularities
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9
Q

What type of food is usually involved in binging?

A

High calorie, high carb

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10
Q

Majority of bulimics meet criteria for at least 1 personality disorder. Which 3 are most common?

A
  1. OCD
  2. Borderline personality disorder
  3. Depression
    They often also have a hx of substance abuse, sexual conflicts, impulsive behaviors, promiscuity, and self-mutilation.
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11
Q

Anorexia or bulimia?

Cycles of binge eating.

A

Bulimia

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12
Q

_____ can be present on PE if using ipecac for vomiting.

A

Cardiomyopathy

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13
Q

What percentage of bulimics have a full recovery within 2 years?

A

50%

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14
Q

What are physical s/sx of bulimia (5)?

A
  1. Russell’s sign (calluses or scars on backs of hands from inducing vomiting)
  2. Parotid swelling (bilateral)
  3. Loss of dental enamel (and bruises, lacerations of palate and post-pharynx)
  4. GERD
  5. Constipation
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15
Q

T/F Healthy People 2020 includes eating disorders in their goals.

A

True. Goal is to reduce proportion of adolescents with eating disorders from 14% to 10%.

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16
Q

Are eating disorders more common with males or females?

A

Females

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17
Q

How is refeeding syndrome prevented?

A

Refeed patient slowly. Start with 500 calories above what the patient eats. Add 200-300 calories q 3-4 days.

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18
Q

What physical findings and complications can be present in bulimia (11)?

A
  1. Electrolyte imbalances
  2. EKG (QTc prolongation)
  3. Pancreatitis
  4. Constipation
  5. Loss of gag reflex (GERD)
  6. Parotid enlargement
  7. Dental enamel erosion
  8. Seizures
  9. Cognitive/memory dysfunctions
  10. Depression
  11. Anxiety
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19
Q

What psychiatric s/sx may be present with bulimia (3)?

A
  1. Suicidal ideation
  2. Depression
  3. Anxiety
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20
Q

Anorexia or bulimia?

Restriction of energy intake.

A

Anorexia

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21
Q

Anorexia or bulimia?

Intense fear of weight gain even though underweight.

A

Anorexia

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22
Q

What is perhaps the most dangerous complication of anorexia?

A

Refeeding syndrome. Hypophosphatemia and eventual cardiac decompensation b/c the sudden high caloric intake leads to possibility of HF.

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23
Q

What percentage of the population meets DMS criteria for eating disorder?

A

1%

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24
Q

What are 5 clues for anorexia?

A
  1. Rapid/severe weight loss
  2. Dieting, taboo foods, calorie counting
  3. Excessive exercise
  4. Focus on body image
  5. Symptoms such as weakness/fatigue
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25
Q

What hormone is low in anorexia?

A

Serotonin (mood, stress response, eating behaviors) (specifically 5-hydroxyindoleacetic acid is low)

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26
Q

What is the best way to detect bulimia (85%)?

A

Serum electrolyte screening panel combined with examination of teeth, hands, and salivary glands.

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27
Q

What are some social risk factors for eating disorders (3)?

A
  1. Obesity
  2. Media impact on body image norms
  3. Modeling or specific sports
28
Q

What are clues to bulimia (3)?

A
  1. Weight cycles (gain/loss)
  2. Trips to bathrooms after meals
  3. Vomiting, laxatives, enemas, excessive exercise
29
Q

What hematologic complications can occur with anorexia (4)?

A
  1. Easy bruising
  2. Leukopenia
  3. Anemia
  4. Thrombocytopenia
30
Q

Which ethnicity has the most eating disorders?

A

Caucasion

More than 90% female. 95% Caucasian. More than 75% are adolescents at first occurrence.

31
Q

T/F Severe dieters are more likely to develop an eating disorder.

A

True. It is a mild variant on the eating disorder spectrum and can become full-blown. Need to be monitored.

32
Q

T/F Labs are performed in suspected anorexia to make a diagnosis.

A

False. Diagnosis is clinical. Labs are needed for baseline.

33
Q

What supplements should be given during anorexia recovery (2)?

A
  1. Calcium 12-1500 mg daily (3-4 glasses of milk)

2. Multivitamin 400 IU daily

34
Q

What percentage of anorexics become bulimic?

35
Q

What is the common starting point for eating disorders?

A

Dieting. Other hypotheses include familial transmission, biochemical factors, family functioning, and avoidance of sexual pressure.

36
Q

T/F Bulimia patients have BMIs less than 17.5.

A

False. Anorexics do. Bulimics often present at normal weight.

37
Q

What is the general management for anorexia (3)?

A
  1. Work as a team
  2. Involve family
  3. Consider medication (low priority)
38
Q

When is the usual onset of eating disorders?

39
Q

What cardiac complications can occur with anorexia (5)?

A
  1. Bradycardia
  2. Hypotension
  3. EKG abnormalities
  4. Syncope
  5. MVP
40
Q

What is the mortality rate of anorexia?

41
Q

What is the mean duration of bulimia before diagnosis?

42
Q

What is the nutrition goal for BMI?

A

Help patient regain BMI of at least 16 or above.

43
Q

T/F Anorexia is usually treated inpatient.

A

False. Usually outpatient, but may require initial or periodic hospitalizations.

44
Q

What are protein/fat goals for anorexia recovery?

A 
Protein = 2-3 servings
Fat = 30-50 grams/day
45
Q

What triggers binging (2)?

A
  1. Dysphoric mood state

2. Lack of control

46
Q

What MSK complications can occur with anorexia (5)?

A
  1. Muscle wasting
  2. Loss of sub-Q fat tissue
  3. Low weight
  4. Low BMI/bone density
  5. Pathologic/stress fractures
47
Q

T/F Esophageal rupture is an emergency that can occur in bulimia.

48
Q

Binging usually occurs in less than _____.

49
Q

What is the mortality rate of bulimia?

50
Q

What routine tests are performed with anorexia (6)?

A
  1. CBC with diff
  2. ESR
  3. Electrolytes
  4. UA
  5. Serum protein
  6. Albumin
51
Q

What are indications for hospitalization in anorexia (7)?

A
  1. BP below 85/50
  2. Severe malnutrition
  3. Dehydration
  4. Electrolyte imbalances
  5. EKG abnormalities
  6. Sinus bradycardia
  7. Suicidality
52
Q

What metabolic/endocrine complications can occur with anorexia (5)?

A
  1. Cold intolerance
  2. Hypothermia
  3. Amenorrhea
  4. Delayed puberty
  5. Hypoglycemia
53
Q

What are some psychological risk factors of eating disorders (4)?

A
  1. Psych diagnoses
  2. Concerns about self-control, low self-esteem, or self-efficacy
  3. Stress from developmental tasks
  4. Hx of abuse
54
Q

What is a reasonable weight gain goal during recovery for outpatients?

A

0.5-4 pounds/week until minimum goal is met.

55
Q

Anorexia nervosa and bulimia nervosa are serious disturbances in eating that include concerns about body shape and weight. The DSM-5 added what 2 categories?

A
  1. Binge-eating disorder

2. Avoidant/restrictive food intake disorder

56
Q

T/F There is speculation that anorexia is a biological condition.

A

True. Investigating disruptions in pituitary, hypothalamus, and neurotransmitters.

57
Q

Anorexia or bulimia?

Recurrent inappropriate compensatory behaviors to prevent weight gain.

58
Q

What are some family and biological risk factors for eating disorders (4)?

A
  1. Obesity
  2. Affective disorders
  3. Serotonin dysfunction
  4. Onset of puberty
  5. Family hx of disordered eating or alcoholism
59
Q

T/F There are pro-eating disorder groups on the internet who view them as alternative lifestyles and offer support and encouragement.

A

True. Must be aware of this as it presents a challenge to helping those with eating disorders.

60
Q

Who is at increased risk for eating disorders (3)?

A
  1. Athletes
  2. Diabetics
  3. Obese
61
Q

What is a reasonable weight gain goal during recovery for inpatients?

A

0.5 pound/day

62
Q

When is the peak onset for anorexia and bulimia?

A
  1. Anorexia = 15-19

2. Bulimia = 18-23 (may arise from anorexia)

63
Q

What GI complications can occur with anorexia (3)?

A
  1. Hypomotility/constipation
  2. Abdominal pain
  3. Elevated liver enzymes
64
Q

Anorexia or bulimia?

Distortion in body weight/shape experience.

65
Q

Why would you order T4, TSH, stool, HIV, pregnancy, PPD, EKG, CXR, or bone density in anorexia?

A

To r/o other DDx and to check for s/sx (bone density).

66
Q

What is the main characteristic of bulimia?

A

Binge eating

67
Q

What are the common features between anorexia and bulimia (7)?

A
  1. Dysfunctional eating patterns
  2. Underlying pysch issues
  3. Low self-esteem
  4. Depression
  5. Family dynamics
  6. Body image disturbance
  7. Weight changes/fluctuations

Simmons NURP 503 Exam 4 (17 decks)

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