Eating And Feeding Disorders

Question 1

Which term describes small appetite but eats normal range of food in small amounts?

Answer 1

Restrictive eating

Question 2

Which term describes avoidance of certain foods due to fear of choking or vomiting?

Answer 2

Functional dysphagia

Question 3

Which term describes refusal of food, drink, talk, walk and engagment in any form of self care ?

Answer 3

Pervasive refusal syndrome

Question 4

Which term describes the lack of interest in eating or food and avoidance because of color smell, texture etc?

Answer 4

Avoidant/restrictive food intake disorder

Question 5

Name 5 red flags for eating disorders

Answer 5

• menstrual irregularities
• fertility problems
• unexplained seizures
• chronic fatigue
• Callouses on hands
Loss dental enamel

Question 6

Criteria a of binge eating disorder? ( binge episode) (2)

Answer 6

Both:

1. Eating in discrete period of time an amount of food that is larger than most people would eat in similar period under similar circumstances
2. Sense of lack of control over eating during episode

Question 7

Criteria B of binge eating disorder? ( binge episode associations) (5)

Answer 7

3 or more :

1. Eat more rapid than normal
2. Until feel uncomfortably full
3. Eat large amounts when not feeling physically hungry
4. Eat alone from embarassment by how much eat
5. Feel disgusted with self, depressed or very guilty after

Question 8

Criteria D of binge eating disorder? ( binge episode frequency )

Answer 8

At least once per week for 3 months

Question 9

Criteria B of bulimia nervosa? ( behaviours )

Answer 9

Recurrent inappropriate compensatory behaviours in order to prevent weight gain eg self-induced vomiting, misuse laxatives, diuretics, fasting, excessive exercise etc

Question 10

Criteria c of bulimia nervosa? ( frequency )

Answer 10

Binge eating and inappropriate compensatory behaviours both occur at least once a week for 3 months

Question 11

Criteria D of bulimia nervosa? ( self evaluation )

Answer 11

Self-evaluation unduly influenced by body shape and weight.

Question 12

Weight of bulimic patients in general?

Answer 12

Normal - bmi > 18,5

Question 13

Classify the severity of bulimia (4)

Answer 13

• mild - 1-3 compensatory behaviours per week
• moderate: 4-7
• severe: 8-13
• extreme : 14 or more

Question 14

Name 3 associated examination signs with bulimia nervosa

Answer 14

1. Parotitis and tooth decay-excessive vomit
2. Russel sign on hand from self-induced vomiting (knuckles)
3. Hypochloraemic hypokalaemic metabolic contraction alkalosis

Question 15

Criteria A of anorexia nervosa? ( core )

Answer 15

Restriction energy intake relative to requirements, leading to significantly low body weight (<18,5) in context of age, sex, developmental trajectory, physical health

Question 16

Criteria B of anorexia nervosa? ( attitude to weight )

Answer 16

Intense fear of gaining weight or becoming fat or persistent behaviour that interferes with weight gain, even though at a significantly low weight

Question 17

Criteria c of anorexia nervosa? ( image )

Answer 17

Disturbance in way one’s body weight or shape experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of seriousness of current low body weight

Question 18

Classify severities of anorexia nervosa (4)

Answer 18

• Mild: bmi 17 or more
• moderate: 16-16,99
• severe: 15-15,99
• extreme: below 15

Question 19

Name 6 associated symptoms of anorexia nervosa

Answer 19

• Osteoporosis
• amenorrhoea
• refeeding syndrome- decreased k ( u wave ecg), mg (muscle spasm, fatigue, paraesthesias, nystagmus, tremor), p (seizure, mi)
• hypothermia
• laguna and oedema
• Leukopenia

Question 20

Name 8 features of refeeding syndrome

Answer 20

(Treatment of anorexia gone wrong)
• hypophosphataemia
• hypo mg
• Hypo k
• Gastric dilatation
• congestive heart failure
• severe oedema
• confusion
• coma and death

Question 21

Which term describes the persistent eating of non-nutritive, non-food substances for more than a month?

Answer 21

Pica

Question 22

Which disorder is described by repeated regurg of food over 1 month?

Answer 22

Rumination disorder

Question 23

Name 4 specifiers anorexia nervosa not relating to severity

Answer 23

• restricting type (in last 3 months)
• binge-eating /purging type
• In partial remission: criteria A (weight) has not been met in a while, but B (fear of gain) or C (disturbances in self perception) still met
• In full remission

Question 24

Time period pica

Answer 24

At least 1 month

Question 25

Aetiology anorexia nervosa? (4)

Answer 25

- Biological: dysfunction of hormones regulating eating behaviour (serotonin, dopamine, na); other hUmoral (tsh, corticotropin releasing factor, neuropeptide y, grh); satiety centre dysfunction - social: ballet, parental relationships etc - heritable: genetic, obsessive personality traits, anxiety - psychological, psychodynamic : independence + control

Question 26

Name 6 specifiers bulimia nervosa

Answer 26

- In partial remission - in full remission - mild: 1-3 compensatory behaviours per week - moderate: 4-7 - severe: 8 - 13 - extreme: 14 or more

Question 27

Name 6 specifiers binge eating disorders

Answer 27

- In partial remission: binge only once per week - In full remission - mild: 1-3 binges per week - moderate: 4-7 - severe: 8-13 - extreme: 14 or more

Question 28

Name 5 presentations that fall under other specified feeding or eating disorder

Answer 28

- Atypical anorexia nervosa: weight normal - bulimia nervosa of low frequency and/or limited duration - binge - eating disorder of low frequency and/or limited duration - purging disorder: no binge eating - night eating syndrome

Question 29

Which stimulant can be used to treat binge eating disorder

Answer 29

Lisdexamfetamine (vyvanse)

Question 30

Time period rumination disorder?

Answer 30

1 mo Age of onset 3-12mo

Question 31

How decide when to hospitilise anorexia (3)

Answer 31

- < 20% below expected weight for height → in patient - < 30% → psych hospitalisation 2-6 MO - malnutrition cause risk of death → compulsory admission

Question 32

InPatient treatment of anorexia? (8)

Answer 32

- Weigh daily after pee - Monitor fluid intake + output - Monitor vomiting (no access to bathroom without attendant 12h after meal) + hypoK - constipation relieved by normal eating/stool softener, discontinue laxative if diarrhoea - feeds: 1500 - 2000 calories per day over 6 equal feels - Liquid formula supplements - psychotherapy: CBT, dynamic expressive supportive therapy, family therapy - pharmacotherapy doesn't really help. Treat associated symptoms

Question 33

Name 9 clinical features of starvation/ restriction

Answer 33

- General: low bp, low hr, significant orthostatic changes + syncope, low temp, vit deficiency - endocrine: primary/secondary amenorhaea, hypothyroid - neuro: seizures due to low ca, mg, PO4 - cutaneous: dry skin, lanugo hair, hair loss/thin, brittle nails, yellow skin from high carotene - GI: constipation, gord, delayed gastric emptying - CVS: arrhythmia, CHF, - MSK: osteoporosis 2° to hypogonadism - renal: pre-renal failure (hypovolaemia), renal calculi - extremities: pedal oedema (low albumin)

Question 34

Name 9 clinical features binge-purge

Answer 34

- General: Russel's sign (knuckle callus), parotid enlarge, perioral skin irritation, periocular+palatal petechiae, loss dental enamel + caries, aspiration pneumonia, metabolic alkalosis 2° to hypok and loss acid - GI: gord, acute gastric dilation/rupture, pancreatitis, haematemesis 2° to Mallory Weiss tear - CVS: arrhythmia, cardiomyopathy (from ipecac / emetic use ), sudden cardiac death (hypok) - MSK: muscle wasting - renal: renal failure (electrolyte disturbances ) - extremities: pedal oedema (low albumin)

Question 35

Name 4 lab changes in starvation/ restriction

Answer 35

- FBC: low RBC, low wCC - gonads: low lh, FSH, oestrogen, testosterone - metabolic: high growth hormone!, high cholesterol, - kidneys : high blood urea nitrogen

Question 36

Name 2 lab changes in binge-purge

Answer 36

- electrolytes: Low na, k, cl, H, metabolic alkalosis (laxatives cause acidosis) - pancreas: high amylase

Question 37

Name 8 feeding and eating disorders

Answer 37

- Anorexia nervosa - bulimia nervosa (1 /week for 3 mo) - binge eating disorder (1 /week for 3 mo) - rumination disorder (1 mo, age onset 3-12 mo ) - pica (1 mo) - avoidant/ restrictive food intake disorder - other specified feeding/eating disorder, reason - unspecified feeding/eating disorder