DBP Prep 2024 Flashcards
Criteria for Anorexia Nervosa
- restriction of energy intake relative to requirements leading to low body weight
- intense fear of gaining weight or becoming fat
- disturbance in way that person’s body weight or shape is experienced (dysmorphia, not recognizing seriousness of low body weight)
Features of inadequate energy intake/malnutrition (from anorexia nervosa)
- low resting HR (bradycardia 95%) or BP
- orthostatic increase in HR (>20 beats/min) or decrease BP (>10mmHg) when standing
- hypothermia
- flat/anxious affect
- pallor, dry sallow skin; carotenemia (yellow-orange coloring of skin due to too much carotenoids from veggies)
- cachexia: facial wasting, decreased subQ fat, decreased muscle mass
- dull, thin scalp hair (lanuogo)
- cardiac murmur (1/3 w/ mitral valve prolapse), cool extremities; acrocyanosis, poor perfusion
- stool mass LLQ
- delayed/interrupted puberty
- small breasts/vaginal dryness
- small testes
Features if purging (bulimia)
- orthostatic increase in HR (>20 beats/min), decrease in BP (>10mmHg)
- angular stomatitis (pain/red/cracked corners of mouth)
- scratches on palate; dental enamel erosion
- Russell’s sign (abrasion of callous on knuckles from self-induced emesis)
- salivary gland enlargement (parotid and submandibular)
- epigastric tenderness
- bruising/abrasions over the spine (due to excessive exercise or sit ups)
Features of excess calories
- obesity
- high BP or HTN
- acanthosis nigricans, acne, hirsutism
- hepatomegaly
- premature puberty
- MSK pain
All the effects of anorexia can be reversed except?
loss of bone mineral density
Medical Complications of Eating Disorders
A. Fluids/electrolytes
dehydration; electrolyte abnormalities (hypoKalemia, hypoNAtremia)
Medical Complications of Eating Disorders
B. psychiatric
depressed mood/mood dysregulation; OCD symptoms; anxiety
Medical Complications of Eating Disorders
C. Neurological
cerebral cortical atrophy; cognitive deficits; seizures
Medical Complications of Eating Disorders
D. Cardiac
decreased cardiac muscle mass; right axis deviation on EKG; cardiac arrhythmias; cardiac conduction delays; mitral valve prolapse; pericardial effusion; CHF; edema
Medical Complications of Eating Disorders
E. GI
delayed gastric emptying; slow GI motility; constipation; superior mesenteric artery syndrome; pancreatitis; elevated LFTs/transaminases; hypercholesterolemia
Medical Complications of Eating Disorders
F. Endocrinology
growth retardation; hypogonadotropic hypogonadism; amenorrhea; testicular atrophy; decreased libido; sick euthyroid syndrome; hypoglycemia/hyperglycemia; impaired glucose tolerance; hypercholesterol; decreased bone mineral density
Medical Complications of Eating Disorders
G. Hematology
leukopenia, anemia, thrombocytopenia, elevated ferritin, decreased ESR
Medical Complications of Vomiting (purging)
- electrolyte issues: hypoKalemia; hypoChloremia; metabolic alkalosis
- dental erosions
- GERD, esophagitis; Mallory-Weiss tears; esophageal or gastric rupture
Refeeding syndrome symptoms
night sweats; polyuria (pee lots); nocturia (pee night); refeeding syndrome (electrolyte abnormalities, edema, seizures, CHF)
electrolyte imbalance in laxative use (eating disorder)
HYPERchloremic metabolic acidosis; hypocalcemia
Bulimia Nervosa criteria
recurrent binge eating episodes + compensatory behaviors to prevent weight gain (e.g. self-induced vomiting, laxatives); happens at least 1x/week for 3 months; usually has one other psychiatric disorder (increased anxiety, depression, bipolar disorders)
Binge Eating Disorder criteria
recurrent episodes of bine eating associated with feeling of lack of control over eating and marked distress about the binge eating
no compensatory behaviors to prevent weight gain like in bulimia
bine eating episodes happen 1x/month for 3 months
commonly have another psychiatric disorder like MDD or alcohol use disorder
Common side effects of alpha-2 adrenergic receptive agonists (guanfacine/clonidine) include:
sedation, dry mouth, dizziness, constipation, abdominal pain, HA, dry mouth
Should monitor BP and HR at baseline, at dose increases, and periodically due to potential S/E like bradycardia and hypotension
guanfacine less likely to cause sedation and dizziness compared to clonidine
Avoid abrupt stopping of alpha-2 adrenergic receptor agonists (guanfacine/clonidine) because risk of:
rebound HTN
how do guanfacine/clonidine (alpha-2 adrenergic receptor agonists) work?
decrease sympathetic response and make child feel calmer
improve behavioral inhibition and child’s ability to concentrate (second line for ADHD)
Fragile X syndrome is due to what gene abnormality?
loss of function of fragile X messenger ribonucleoprotein 1 (FMR1)
FMR1 gene found on chromosome Xq27.3
repetition of CGG triplets (>200 in full mutation) and abnormal methylation of gene causes loss of Fragile X messenger ribonucleoprotein causing Fragile X syndrome
normal FMR1 genes have # of CGG triplets?
premutation?
full mutation?
normal: 5 to 44 CGG triplet repeats
premutation: 55-200 CGG repeats
full mutation: >200 CGG repeats
full mutation of FMR1 gene (Fragile X syndrome) symptoms include:
ID, autistic traits, macrocephaly, elongated face, large and prominent ears, joint hypermobility, macro-orchidism (large testes)
premutation of FMRI gene symptoms include:
doesn’t have symptoms of Fragile X syndrome but risk of FMR1-related disorders like primary ovarian insufficiency or fragile X tremor-ataxia syndrome
Females with premutation range are at risk of having kids with Fragile X syndrome
Males with premutation range don’t pass onto their children b/c fathers don’t contribute X chromosome to their sons; but their daughters will always get the premutation
Most common psychiatric condition resulting in school refusal?
anxiety disorders (separation anxiety disorder, social phobia, GAD, OCD, panic disorder)
Others include: depression, learning disabilities, lack of friends, bullying parental illness, parental separation
separation anxiety is normal for what ages?
10 months to preschool age
Separation Anxiety Disorder features?
age: beyond preschool years
child has extreme fear that something bad will happen to them or caregiver when they are separated
symptoms: behavioral outbursts, physical symptoms when anticipating separation
Social Anxiety Disorder features
most common anxiety d/o in teens
fearful of drawing attention to or embarrassing themselves especially in presence of peers
In OCD, definition of obsessions and compulsions
Obsessions: intrusive thoughts that are distressing to person
Compulsions: repetitive behaviors and rituals that when performed temporarily relieves the distress resulting from obsessions
Ex. fear of contamination and illness resulting in cleaning and washing behaviors
Ex. fear of dangers resulting in repeated checking behaviors
SSRIs approved for treating depression in adolescents?
- escitalopram
- fluoxetine
Symptoms of Major Depressive Disorder (MDD)
- persistent sadness/irritability and anhedonia (lack of enjoyment) for minimum 2 weeks causing functional impairment
Accompanying symptoms: changes in appetite/weight, sleep, activity level, concentration, feelings of guilt/worthlessness, fatigue/loss of energy, suicidal ideation
Prevalence of MDD in adolescents?
12% of adolescents by age 17 years; 2:1 ratio of females to males
Side effects of SSRIs
most common: HA, GI upset, sleep disturbance
others: behavioral activation (disinhibition, restlessness, impulsive behaviors), mood disturbance (possibly activate mania in bipolar d/o), increase in suicidation ideation or behaviors
Adverse effects bupropion?
constipation, tremor, HA, insomnia; rarely seizures
Major side effect with tricylic antidepressants (nortriptyline)
more so used in adults and not kids
significant cardiac (arrhythmias) and CNS (seizure) problems
Childhood apraxia of speech definition?
neurological disorder resulting in difficulty motor planning of speech sounds
Kid wants to say a word or sound correctly but can’t; brain cannot plan or sequence the proper sounds
Symptoms due to difficulty planning muscle movements in tongue and jaw and results in distorted sounds; often make inconsistent errors in speech (e.g. say a difficulty word correctly once but can’t again); often kids will try to say it correctly several times; may make errors in tone and rhythm causing unusual inflection
Dysarthria definition?
speech disorder characterized by muscle weakness, often due to brain injury/brain trauma (e.g. CP, multiple sclerosis, muscle dystrophy)
Treatment is ST; work on slowing down speech, building muscle strenght, using more breath to speak
