Diagnoses - Eating disorders

Question 1

Episodes of unrestrained eating w/o compensatory behaviors of bulimia. Dx? (5x)

Answer 1

BINGE-EATING DISORDER

Question 2

Metabolic abnormality commonly found w anorexia nervosa/purging subtype? (4x)

Answer 2

DECREASED SERUM POTASSIUM

Question 3

Dehydrated bulimic w/ BP 100/60 and orthostasis HR 60. Stat lab test: (3x)

Answer 3

POTASSIUM

Question 4

What med has shown some efficacy in reducing binging and purging in bulimia nervosa? (x3)

Answer 4

FLUOXETINE

Question 5

A plastic surgeon asks the psychiatrist to evaluate a 15 yo pt who is requesting rhinoplasty. The surgeon is willing to perform the operation but is concerned by the pt’s young age. The pt is with her parents. The pt explains “I broke my nose playing hockey 2 years ago and it has bothered me ever since” On exam, her nose is noticeable asymmetrical. Patient shows no obvious psychological distress other than concern for her appearance. Pt states “I just want to look normal again”. Parents report child has had poor self esteem since the injury and they are hoping the operation will help her self confidence. Which of the following is the most likely psychological outcome for this pt following cosmetic surgery? (x2)

Answer 5

AN IMPROVEMENT IN QUALITY OF LIFE

Question 6

Complication of anorexia nervosa LEAST likely to resolve after restoring weight is? (2x)

Answer 6

OSTEOPOROSIS

Question 7

A diagnosis of anorexia nervosa requires that the patient has maintained a weight below what percentage of a minimally normal weight for age and height? (2x)

Answer 7

85%

Question 8

Pt with significant medical hx admitted to inpatient psych unit. Labs show: low K and Cl, elevated HCO3 and amylase, and normal lipase. Dx: (2x)

Answer 8

BULIMIA NERVOSA, PURGING TYPE

Question 9

23 y/o pt w/ excessive preoccupation with body shape. Pt is in no apparent distress, but admits to binge eating episodes followed by purging twice weekly for past 6 months, Body weight: normal. Dx: (x2)

Answer 9

BULIMIA NERVOSA

Question 10

Enlarged parotid glands in a pt being treated for anorexia nervosa would suggest which of the following? (2x)

Answer 10

SELF-INDUCED VOMITING

Question 11

During the acute initial refeeding phase of tx for pt w/ severe anorexia nervosa, which is most helpful focus of psychotherapeutic interventions with the pt? (2x)

Answer 11

COACHING, SUPPORT, AND POSITIVE BEHAVIORAL REINFORCEMENT

Question 12

Risk factor for developing bulimia?

Answer 12

CHILDHOOD SEXUAL ABUSE

Question 13

During the acute initial refeeding phase of treatment for a patient with severe anorexia nervosa, which of the following is the most helpful focus of psychotherapeutic interventions with the patient?

Answer 13

COACHING, SUPPORT, AND POSITIVE BEHAVIORAL REINFORCEMENT

Question 14

What differentiates bulimia from binge eating disorder?

Answer 14

HISTORY OF LAXATIVE ABUSE

Question 15

13 yo seen for therapy has lost weight and is now 20th %ile for weight and 60th %ile for hight. Decided to eat healthy, wants to lose 5-10 lbs, spending time researching food. Diagnosis?

Answer 15

ANOREXIA NERVOSA

Question 16

Abdominal pain, diarrhea, hypokalemia, weight loss, steatorrhea, skin pigmentation. Possible laxative abuse. Measure:

Answer 16

PHENOLPHTHALEIN (over the counter laxative)

Question 17

Patient with anorexia nervosa is admitted to inpatient unit and has begun treatment with high caloric oral feedings; 2 days after admission an EKG shows ventricular tachycardia. Which tests would best determines the likely cause of arrhythmia?

Answer 17

PHOSPHATE

Question 18

The primary focus of behavior therapy in the treatment of anorexia nervosa is to :

Answer 18

RESTORE WEIGHT

Question 19

Bulimia is comorbid with:

Answer 19

MDD

Question 20

Frequently a medical sx/sign in pts with anorexia:

Answer 20

REPRODUCTIVE HORMONE DYSFUNCTION

Question 21

What electrolyte abnormality is most seen in bulimics?

Answer 21

HYPOCHLOREMIC ALKALOSIS WITH HYPOKALEMIA

Question 22

32 y/o pt reveals a long-standing preoccupation with the shape of her mouth and teeth, though she says that her friends and spouse have assured her that her feelings are inappropriate. Pt reports that she often spends an hour cleaning her teeth, so that the abnormality will be less noticeable. At times she avoids social contact, fearing that people will silently criticize the appearance of her mouth. She has no other obsessions on cleaning rituals. Best dx for pt’s long-standing preoccupation?

Answer 22

BODY DYSMORPHIC DISORDER

Question 23

25-year-old pt with no previous psych history has a new preoccupation with imagined defects in appearance, which is a cause of excessive concern. The pt has a normal medical workup and, other than the distress over appearance, the pt does not have other psych sx. Which of the following meds is most appropriate?

Answer 23

FLUOXETINE

Question 24

In overcoming the resistance to treatment often encountered with patients who have anorexia nervosa, what is it most useful for the psychiatrist to emphasize?

Answer 24

EMPHASIZE HOW TREATMENT WILL ALLOW THE PATIENT TO FOCUS ENERGY ON OTHER MATTERS.

Question 25

Bulimia and depression. Contraindicated:

Answer 25

BUPROPION

Question 26

What is associated with flattening of T waves and development of U waves on EKG?

Answer 26

PURGING BEHAVIOR

Question 27

What test findings are associated with anorexia and bulimia?

Answer 27

BRADYCARDIA, AMENORRHEA, HYPOKALEMIA, AND ELEVATED SERUM AMYLASE

Question 28

Bulimia nervosa presents in which personality d/o?

Answer 28

BORDERLINE

Question 29

Which enzymes can be increased in serum of pt’s with bulimia?

Answer 29

AMYLASE

Question 30

At 30 years after presentation for treatment, mortality rates for anorexia nervosa are:

Answer 30

0.20%

Question 31

EKG finding in pt with bingeing and purging bx:

Answer 31

QT AND T WAVE CHANGES

Question 32

Psychotherapy that has been shown to be effective in bulimia nervosa:

Answer 32

CBT