Anorexia Nervosa

Question 1

2 characteristics shared by anorexia and bulimia nervosa

Answer 1

Obsession about weight
Maladaptive behaviors eg restricting/vomiting

Question 2

Management of Anorexia x5

Answer 2

Nutritional rehabilitation
Monitor for medical complications
CBT for eating disorders
Psychodynamic psychotherapy
Family psychotherapy

Question 3

Medical complications of anorexia x6

Answer 3

Fatigue
Amenorrhea
Infertility
Osteoporosis
Electrolyte imbalance
Cardiac arrhythmias

Question 4

Shared characteristics between anorexia and OCD x3

Answer 4

Obsessive thoughts
Compulsive behavior
No ‘feeling of knowing’

Question 5

DSM 5 diagnostic criteria for AN x3

Answer 5

Restriction of energy intake resulting in low BMI
Fear of gaining weight or becoming fat
Disturbed perception of body weight and shape

Question 6

Risk factors of AN x3

Answer 6

Genetic/family history
Female gender
Body dissatisfaction

Question 7

Perpetuating factors of AN x4

Answer 7

Isolation
Initial positive reinforcement
Starvation related behavior changes
Pro-ana /thinspiration

Question 8

Physical exam x3 and investigation findings in AN x4

Answer 8

Hypothermia
Bradycardia
Neutropenia
Postural hypotension
Hypo Mg, Pho, K

Question 9

Indications for admission x5

Answer 9

Suicidal
Medical complications
Severe bingeing or purging
Severe psychiatric comorbidity
Failure to respond to outpatient treatment

Question 10

Worrying signs of severe starvation x5

Answer 10

Pancreatitis
Autophonia
Hypoglycemia
Oropharyngeal dysphagia
Superior mesenteric artery syndrome

Question 11

Psychiatric comorbidities of AN x4

Answer 11

OCD
Anxiety
Depression
Substance misuse

Question 12

Electrolyte imbalance in refeeding syndrome x3

Answer 12

Hypo K, Mg, Pho

Question 13

What causes refeeding syndrome

Answer 13

A switch from fasting gluconeogenesis to carbohydrate induced insulin release

Question 14

Pharmacological management of BN

Answer 14

SSRIs - fluoxetine

Question 15

Complications of BN x4

Answer 15

Injuries to mouth teeth and esophagus
Boerhaave syndrome
Electrolyte imbalance
Kidney injury

Question 16

BOWL mnemonic for BN

Answer 16

Binge eating
Offsetting/purging
Weekly
Linked to self esteem

Question 17

UNDER mnemonic for AN

Answer 17

Underweight
Nervous about weight gain
Distorted perception
Excessive exercise
Restriction

Question 18

Difference between AN and BN in terms of self esteem

Answer 18

In BN the weight gain is linked to low self esteem, interpersonal rejection and fear of being alone

Question 19

DSM 5 for BN x4

Answer 19

Objective binge eating episode
Sense of loss of control
Attempt to compensate for the episode
Over evaluation of the importance of weight and shape

Question 20

Etiological factors of BN x5

Answer 20

Body commentary
Parental eating disorder
Thin idealization
Social pressures
Trauma

Question 21

Aims of initial stage of treatment x4 in BN

Answer 21

Psychoeducation
Engage patient in treatment and change
To derive a personalized formulation with patient
To introduce and implement collaborative weekly weighing and regular eating

Question 22

Treatment in mildly unwell patients x2 in BN

Answer 22

Dietary education
Counselling

Question 23

Key elements of CBT- GSH guided self help x5

Answer 23

Monitor eating
Regular eating and meal planning
Eliminate dieting
Changing the mindset
Learning to intervene to prevent binge eating

Question 24

Management of BN for adolescents x3

Answer 24

Family psychotherapy
CBT for BN
Adjunctive yoga

Question 25

Difference between purging disease and BN x3

Answer 25

Postprandial fullness
GIT distress after meals
Elevated postprandial cholecystokinin ie hormone involved in satiety/ hunger suppression

Question 26

Psychiatric comorbidities of purging disease x5

Answer 26

Anxiety
Depression
Suicidality
Personality disorders
Substance abuse disorders

Question 27

Role of an ED experienced physician x4

Answer 27

Provide enough calories effective for re-nourishment
Provide supplementation and nutritional counseling
Make dietary adjustments
Address metabolic changes