Anorexia Nervosa

Question 1

mortality rate

Answer 1

20% - highest morality of mental illness

Question 2

name methods in which weight loss is self induced

Answer 2

excessive exercise, dieting, laxative abuse, diuretics, appetite

Question 3

what effect does anorexia have on sexual development etc

Answer 3

• dec GnRH secretion from hypothalamus
• if onset is pre pubertal it can delay /arrest pubertal developments
• sexual dysfunction, amenorrhoea, infertility, loss of sexual interest

Question 4

what must weight be to meet ICD 10 criteria

Answer 4

<85% normal or BI ≤17.5

Question 5

is amenorrhoea in ICD 10 criteria

Answer 5

yes - 6 consectuive menstrual cycles absent unless on pill

Question 6

female to male ratio

Answer 6

4: 1

Question 7

what kind of traits are often present in people

Answer 7

perfectionist and obsessive traits

anxiety disorders are often seen pre-morbidly

Question 8

how does an anorexic person think of food

Answer 8

preoccupation with thoughts of food, morbid fear of fatness

Question 9

cognitive effects

Answer 9

fatigue, poor concentration, weakness, slow thinking

Question 10

hair skin and nails

Answer 10

hair thinning

dry skin

cracked nails

Question 11

what is the hair called that grows on anorexic person

Answer 11

lanugo hair

Question 12

cardiac effects

Answer 12

bradycardia and prolonged QT

Question 13

blood pressure

Answer 13

hypotension - hypovolaemia/bradycardia/low CO

Question 14

body temperature

Answer 14

low - poor insulation

pt has cold intolerance

Question 15

what is seen in the hands in cold weather

Answer 15

Raynauds

Question 16

skin goes what colour

Answer 16

yellow tinge - hypercarotenemia

Question 17

what happens to gastric emptying

Answer 17

slows down as food intake is insufficient, leads to non specific GI symptoms, eg bloating, cramping and nausea

Question 18

what does repeated vomiting do to electrolytes

Answer 18

lose stomach acid - body fluids are more alkaline

low sodium, potassium, calcium etc

Question 19

fluid balance

Answer 19

redued fluid intake, vomiting and laxative abuse leads to dehydration

Question 20

glucose level

Answer 20

typically low

Question 21

thyroid hormones

Answer 21

low T3 is common

Question 22

what problems might a patient taking ADs encounter with anorexia

Answer 22

they are not as effective when low body weight is present

Question 23

what effect does AN have on bones

Answer 23

later on in the course of the llness there is osteopenia and osteoporosis

decreased oestrogen leads to increasd OC activity and dec OB activity

there may be a dietary lack of Ca and vitamin D

Question 24

should thyroid supplementation be given for low T3

Answer 24

no

Question 25

what ECG changes does hypokalaemia show

Answer 25

flattened T waves and prominent U waves

stimulus for cardiac arrhythmias

Question 26

what investigations should be done

Answer 26

bloods and serum chemistry

TFT

LFT

urinarlysis to assess hydration status

ECG

DEXA bone scan

Question 27

what is the most effective therapy in teens

Answer 27

family based therapy

Question 28

other psychotherapies

Answer 28

CBT

Question 29

what is refeeding syndrome

Answer 29

• prolonged fasting depletes IC minerals and causes fat and protein to be used for energy instead of carbs
• BMR also decreases (20-25%)

when refeeding:

• glycaemia leads to insulin secretion and decreased glucagon secretion - stimulates fat protein and glycogen synthesis
• this all requires minerals of which there is a shortage of
• are taken up into cells and there is a deficiency of them

Question 30

what is the hallmark biochemical feature of refeeding syndrome

Answer 30

hypophosphatemia

Question 31

diet recovery

Answer 31

may restrict carbs at first and slowly increase

dietary phosphate

Question 32

what may the patient develop during refeeding due to fluid shifts

Answer 32

oedema, monitor for refeeding syndrome