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Psychiatry Week 3 2018/19 > 6: Eating disorders > Flashcards

6: Eating disorders Flashcards

1
Q

What are the two most common eating disorders?

A

Anorexia nervosa

Bulimia nervosa

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2
Q

What are the five ICD-10 criteria for anorexia nervosa?

A

BMI < 17.5

Self-induced weight loss

Body image disturbance

Fear of fatness

Amenorrhoea

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3
Q

A BMI below what is diagnostic of anorexia?

A

17.5

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4
Q

How do anorexic patients behave re: food portions?

A

Obsession with portion sizes

Portion sizes themselves are tiny

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5
Q

How do anorexic patients encourage their own weight loss?

A

Overexercise

Self-induced vomiting

Laxatives

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6
Q

Anorexic patients obsess over their ___ ___.

A

body weight

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7
Q

What are some of the physical features of anorexia nervosa?

A

Significant weight loss and muscle atrophy

Dry skin

Lanugo hair

Swollen salivary glands

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8
Q

Why do patients with anorexia develop dry, cracked skin?

A

Dehydration

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9
Q

What is lanugo hair?

Which disease does it present in?

A

Fine, soft, unpigmented hair which sheds - usually seen in newborns

Anorexia nervosa

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10
Q

Patients with anorexia often present with jaundice - true or false?

A

Yellow skin pigmentation

but NOT jaundice

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11
Q

Which pigment is responsible for yellow skin decolouration seen in anorexia nervosa?

A

Beta-carotene

Hypercarotenaemia

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12
Q

Why do some anorexic patients present with hypercarotenaemia?

A

Excess of beta carotene

Diet consisting of excess veg

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13
Q

Which bilateral structures hypertrophy in anorexia nervosa?

A

Parotid and submandibular glands

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14
Q

The physical features of anorexia nervosa are

widespread ___

___ skin

___ hair

hypertrophy of the ___ glands.

A

widespread atrophy

dry skin

lanugo hair

hypertrophy of the salivary glands

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15
Q

Eating disorders often co-exist or precipitate other psychiatric conditions. Can you name some?

A

Mood disorders - depression, bipolar

Anxiety - e.g OCD

Psychosis

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16
Q

Which chronic disease may anorexic patients mismanage on purpose to lose weight?

A

Diabetes mellitus

Patients may omit insulin injections to lose weight (hyperglycaemia)

17
Q

A BMI < ___ or rapid weight loss are red flags for poorly managed anorexia nervosa.

A

BMI < 13

Rapid weight loss

18
Q

Which arrhythmia may anorexic patients develop?

A

Prolonged QT interval

19
Q

As muscles atrophy in anorexia nervosa, they become weaker.

How is muscle weakness assessed?

A

Sit up squat stand test

Some patients won’t be able to do it

20
Q

What investigations should you ask for in anorexic patients and why?

A

FBC - anaemia

U&Es - electrolyte abnormalities

ECG - arrhythmias

LFTs - hepatocellular autophagy in starvation

DEXA scan - osteopenia/porosis

21
Q

Which test is used to assess muscle weakness in anorexia nervosa?

A

Sit up squat stand test (SUSS)

22
Q

Patients with extreme anorexia nervosa may present with ___ impairment.

A

cognitive impairment

23
Q

What is an extreme form of electrolyte imbalance which may be seen when managing an anorexic patient?

A

Refeeding syndrome

24
Q

How is refeeding syndrome avoided?

A

Feed patient slowly

Monitor their U&Es closely

25
Q

Can a patient with an eating disorder be detained against their will?

A

Yes, under the MHA (anorexia and bulimia are classed as mental disorders)

If that patient is posing significant risk to themselves

26
Q

Which guidelines explain how to manage anorexia nervosa?

A

MARSIPAN guidelines

27
Q

Which AHP has a crucial role in the management of patients with anorexia?

A

Dietician

28
Q

What are the five ICD-10 criteria for diagnosing bulimia nervosa?

A

Persistent preoccupation with food

Irresistible food cravings

Binges

Compensatory behaviour (starving, overexercise, purging)

Fear of fatness

29
Q

What is Russell’s sign?

A

Callused knuckles

caused by self-induced vomiting

30
Q

Which structures hypertrophy in both anorexia and bulimia?

A

Parotid and submandibular glands

31
Q

Which electrolyte disturbance is caused by repeated vomiting?

A

Hypokalaemia

32
Q

The management of bulimia nervosa is largely the same as that of anorexia (psychological therapy, AHP input).

Which class of drug can be given to patients to help reduce food cravings?

A

SSRIs

Psychiatry Week 3 2018/19 (9 decks)

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