Eating Disorder

Question 1

Differential dx for weight loss

Answer 1

• Hypethyroidism
• Malignancy
• GI tract disease
• Chronic infectious disease
• Affective disorders (depression)

Question 2

Screening questions for psychiatric causes of eating disorders
“SCOFF”

Answer 2

• Do you make yourself Sick because you feel uncomfortably full?
• Do you worry you have lost Control over how much you eat?
• Have you recently lost more than One stone (14 pounds) in a three month period?
• Do you believe yourself to be Fat when others say you are thin?
• Would you say that Food dominates your life?

Question 3

Anorexia is more common in which gender at what age?

Answer 3

Female
18

Question 4

Deficits in dopaminergic function and serotonergic function in patient’s with eating disorder

Answer 4

• Dopamine: eating behavior, motivation and reward
• Serotonin: mood, impulse control, obsessive behavior

Question 5

Dx criteria for anorexia nervosa

Answer 5

• Restriction of energy intake that leads to low body weight
  Taking into account the sex, age, developmental trajectory, and physical health
• Intense fear of gaining weight or becoming fat or persistent behavior that prevents weight gain
• Distorted perception of body weight and shape, undue influence of weight and shape on self-worth,

Question 6

PE findings:
- Low BMI (<17.5)
- Emaciation
- Hypothermia
- Bradycardia
- Hypotension
- Hypoactive bowel sounds
- Xerosis (dry and scaly skin)
- Brittle hair and hair loss
- Lanugo body hair
- Abdominal distention

Answer 6

Anorexia Nervosa

Question 7

Bulimia nervosa is more common in which gender and at what age?

Answer 7

3x more common in women
age of onset 18

Question 8

Dx criteria for bulimia nervosa

Answer 8

• Recurrent episodes of binging and purging and inappropriate compensatory behavior to prevent weight gain
• Occurring on average at least once per week for three months

Question 9

• Self induced vomiting
• Misuse of laxatives
• Diuretic use
• Enemas
• Fasting
• Excessive exercise
  These are compensatory behaviors of?

Answer 9

Bulimia nervosa

Question 10

Features associated with Bulimia Nervosa

Answer 10

• Mild psychosocial impairment
• Body weight usually within or above normal range
• Neurocognitive functioning (decision making) impaired
• Emotional dysregulation is common
• Self-harm is often seen
• Additional psychiatric disorders are common
  Anxiety, depression, PTSD, substance abuse, ADHD, conduct disorders, personality disorders

Question 11

Clinical findings:
- Dehydration
- Menstrual irregularities
- Mallory-Weiss syndrome
- Pharyngitis
- Erosion of dental enamel
- ECG changes may occur

Answer 11

Bulimia Nervosa

Question 12

Characteristics of Binge eating disorder

Answer 12

• Uncomfortably full
• Eating when not hungry
• Feelings of embarrassment
• Feelings of disgust, depression

Question 13

What is pica?

Answer 13

Eating of nonfood substances
Chalk, dirt, hair, metal, etc.

Question 14

Characteristics of pica

Answer 14

• Inappropriate eating behavior for developmental level
• Not culturally, socially normal eating
• Associated with iron deficiency anemia

Question 15

What is rumination disorder

Answer 15

• Repeated regurgitation of food
• May be re-chewed, re-swallowed, or spit out
• The regurgitation is not due to GERD, pyloric stenosis, or another medical condition

Question 16

What labs should be obtained when managing eating disorders?

Answer 16

• CBC
• Thyroid
• Metabolic panel

Question 17

Pts with eating disorders should be referred to?

Answer 17

• Psychiatry
• Nutrition consult