DBP Prep 2024 Flashcards by Jennifer Han

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)

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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

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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)

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Features of excess calories

obesity
high BP or HTN
acanthosis nigricans, acne, hirsutism
hepatomegaly
premature puberty
MSK pain

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All the effects of anorexia can be reversed except?

loss of bone mineral density

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Medical Complications of Eating Disorders
A. Fluids/electrolytes

dehydration; electrolyte abnormalities (hypoKalemia, hypoNAtremia)

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Medical Complications of Eating Disorders
B. psychiatric

depressed mood/mood dysregulation; OCD symptoms; anxiety

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Medical Complications of Eating Disorders
C. Neurological

cerebral cortical atrophy; cognitive deficits; seizures

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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

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Medical Complications of Eating Disorders
E. GI

delayed gastric emptying; slow GI motility; constipation; superior mesenteric artery syndrome; pancreatitis; elevated LFTs/transaminases; hypercholesterolemia

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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

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Medical Complications of Eating Disorders
G. Hematology

leukopenia, anemia, thrombocytopenia, elevated ferritin, decreased ESR

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Medical Complications of Vomiting (purging)

electrolyte issues: hypoKalemia; hypoChloremia; metabolic alkalosis
dental erosions
GERD, esophagitis; Mallory-Weiss tears; esophageal or gastric rupture

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Refeeding syndrome symptoms

night sweats; polyuria (pee lots); nocturia (pee night); refeeding syndrome (electrolyte abnormalities, edema, seizures, CHF)

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electrolyte imbalance in laxative use (eating disorder)

HYPERchloremic metabolic acidosis; hypocalcemia

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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?

1. escitalopram 2. fluoxetine

Symptoms of Major Depressive Disorder (MDD)

1. 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