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MRCPSYCH Paper B _ Mainly general Adult (mentor&more) > Eating Disorder - 2 > Flashcards

Eating Disorder - 2 Flashcards

1
Q

Cardiac Medical Emergencies in Eating disorders (mnemonic)

A
  • HArT POBD
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2
Q

Cardiac Medical Emergencies in Eating disorders (mnemonic)

A
  • HArT POBD

Hypotension
Arrhythmia
Tachycardia, ventricular
Prolonged QT interval
Oedema, peripheral
Bradycardia
Death

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3
Q

Skeletal Medical Emergecy in Eating disorder

A

osteoporesis

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4
Q

Haematological medical emergencies in eating disorders

A

Anemia
Leukopenia
Thrombocytopenia

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5
Q

Reproductive Medical emergencies in eating disorders

A

Amenorhae
Premature Birth
Low LH & FSH

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6
Q

GIT Medical emergencies in eating disorders

A

Constipation
Delayed emptying
Pancreatitis

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7
Q

Dermatological Medical emergencies in eating disorders

A
  • Lanugo (picture)
  • hypercarotenemia
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8
Q

Items on assessment risk checklist?

A
  • Weight Loss & BMI & Weight
    -Heart Rate & Cardiovascular Health & ECG
    -Hydration & Temperature
    -Muscular function
    -Biochemical abnormality & haematology
    -Disordered eating behaviours
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9
Q

Muscular Function in risk assessment in eating disorders

A

SUSS test
Hand Grip strength
MUAC

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10
Q

Levels of risk in risk assessments of eating disorders

A

RED: impending risk to life
Amber: High concern for impending…
Green: low impending risk

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11
Q

RISK Assessment (eating disorder) RED [amber]: impending risk to life for weight loss on

A

Rapid loss ≥1kg for 2 consec. weeks [amber: .5-1kg/week]

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12
Q

RISK Assessment (eating disorder) RED [amber]: impending risk to life for BMI

A

Under 18
BMI<70% [amber:70-80%]
Above 18
BMI<13 [amber: 13-14.9]

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13
Q

RISK Assessment (eating disorder) RED [amber]: impending risk to life for Heart Rate

A

40 [amber: 40-50]

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14
Q

RISK Assessment (eating disorder) RED [amber]: impending risk to life for dehydration

A

Fluid refusal [amber: fluid restrictio]
no skin turgor [amber:normal skin turgor]
severe dehydration signs [amber: moderate dehydration]

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15
Q

RISK Assessment (eating disorder) RED [amber]: impending risk to life for suss test

A

unable to seat up from lying flat or squat at all, score 0 or 1 [amber: able to seat up but with difficulty, score 2)

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16
Q

RISK Assessment (eating disorder) RED [amber]: impending risk to life for MUAC
(Mid-Upper-Arm-Circumference)

A

<18 cm [amber: 18-20 cm]

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17
Q

RISK Assessment (eating disorder) RED [amber]: impending risk to life for Hand grip strenght

A

Male : <30.5 kg, 3rd percentile[amber: <38 kg 5th percentile]
Female: <17.5 kg [amber: <23 kg}

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18
Q

RISK Assessment (eating disorder) RED [amber]: impending risk to life for ECG abnormality

A

<18 years QTC
>460 females [amber:>460]
450 males [amber: 450]
>18 years QTC
>450 females [amber the same]
430 males
Any other ECT abnormality [amber: no other abnormality]

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19
Q

what is suss test?

A

look for muscle wasting and assess muscle strength: Scores of 2 or less (especially if scores are falling) on the Sit up–Squat–Stand (SUSS) test are a red flag.
The sit up test — the person lies flat on a firm surface such as the floor and has to sit up without, if possible, using their hands

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20
Q

RISK Assessment (eating disorder) RED : impending risk to life for Biochemical abnormality

A

Hypo-
phosphataemia
kalemia (<2.5 mmol/L)
albuminaemia
glycemia
natraemia
calcaemia (<3mmol/L)
Transaminases x3 times normal rage
diabetes mellitus HbA1C>10

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21
Q

RISK Assessment (eating disorder) RED : impending risk to life for HAEMATOLOGY

A

LOW WHITE CELL COUNT
HAEMOGLOBIN <10G/L

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22
Q

RISK Assessment (eating disorder) RED : impending risk to life for DISORDERED EATING BEHAVIOURS

A

ACUTE FOOD REFUSAL OR ESTIMATED CALORIE INTAKE <500 CALORIES FOR 2+ DAY

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23
Q

RISK Assessment (eating disorder) RED [amber]: impending risk to life for Temperature

A

<35.c tympanic 35 axilllary [ amber: <36 celcius]

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24
Q

suss scoring

A

0 unable to stand up
1 with hand
2 with difficulty
3 no problemo

25
NICE guidelines Adults with anorexia nervosa
either one of 1- individual eating disorder-focused CBT (CBT-ED) 2- Maudsley Anorexia Nervosa Treatment for Adults (MANTRA) 3- Specialist Supportive clinical management (SSCM)
26
NICE guidelines what if CBT-ED,SSCM, MANTRA did not work?
Eating-disorder-focused focal psychodynamic therapy (FPT)
27
NICE guidelines for children and young (0-18) with AN
Anorexia-Nervosa-Focused family therapy (FT-AN)
28
NICE guidelines for children and young (0-18) with AN If FT-AN is unsuitable
consider CBT-ED & AFP-AN (adolescent focused psychotherapy)
29
can medication be offered as sole treatment for anorexia nervosa
Nope!
30
NICE guidelines For adults with bulimia nervosa
First step: offer guided self-help programmes
31
NICE guidelines For adults with bulimia nervosa if guided self-help programmes was not suitable or helpful for 4 weeks
CBT-ED
32
NICE guidelines For children with bulimia nervosa
First step: Anorexia-Nervosa-Focused family therapy (FT-AN)
33
if FT-AN is not suitable or working
consider CBT-ED
34
can medication be offered as sole treatment for Bulimia Nervousa
Nope!!! again
35
NICE guidelines For adults with BED
First step: guided self-help programme
36
NICE guidelines For adults with BED if guided self-help programme was not suitable or helpful
CBT-ED
37
NICE guidelines For young children with BED
same as adult
38
can medication be offered as sole treatment for Bulimia Nervousa
Nope nope nope no medication offered as sole treatment
39
what will patient with purging (vomitting) be advised to do after vomitting?
- Don't brush teeth -Don't eat acidic food and drinks -Wash mouth with non-acidic mouth wash
40
what will patient who use laxatives and diuretics be advised about?
diuretics and laxatives do not reduce calorie absorption and weight loss
41
What is refeeding syndrome?
Refeeding syndrome occurs when a malnourished person resumes feeding. Rapid reintroduction of food may lead to severe complications.
42
why refeeding syndrome happens?
- rapid shift electrolytes back into cells which they had been leached out during starvation
43
what electrolyte is involved with refeeding syndrome?
phosphate <2.5 mmol/L potassium <0.32 mmol/L magnesium <0.5 mmol/L
44
what are concequenses of refeeding syndrome?
cardiovascular and neurological complications
45
onset of refeeding syndrome
within 72 hours of beginning refeeding (1-5 days)
46
Most serious complication in refeeding syndrome?
cardiac
47
Features of refeeding syndrome
Low electrolytes peripheral oedema disturbance to respiration, cardiac liver transaminases, pulmonary oedema
48
Risk for refeeding sydnrome
- BMI<13 - Little/no intake >4 days -Low electrolytes -Low white blood cell(<3.8) - Low thiamine -Medical comorbidities
49
can physical therapy be offered to eating disorders?
No (no yoga, no TMS, no acupuncture or no weight trainings...)
50
When should bone mineral density scan be done in children and young people
1 year of underweight if they have bone pain or recurrent fractures
51
When should bone mineral density scan be done in adults
2 years
52
when should bone mineral density scan indicated?
if they have bone pain or recurrent fractures
53
Is oestronge therapy routinely (oral or transdermal) recommended to treat low bone mineral desity in children and yougn people with AN?
no
54
Rx for women >18 with AN, long-term low body weight and low bone density
Biphosphonates
55
Biphosphonates indications
women >18 with AN, long-term low body weight low bone density
56
Pharma Rx for young women 13-17 with delayed puberty, long-term low eight and low bone desity
Incremental physiological doses oestrogen
57
Incremental physiological doses oestrogen indication
Pharma Rx for women 13-17 with delayed puberty, long-term low eight and low bone desity (bone age >15)
58
Pharma Rx for young women 13-17 with long-term low eight and low bone desity (bone age over 15)
Transdermal 17-B- estradiol (with cyclic progesterone)

MRCPSYCH Paper B _ Mainly general Adult (mentor&more) (90 decks)

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