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ART_MRCPSYCH_B_MENTOR > 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
Q

NICE guidelines

Adults with anorexia nervosa

A

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
Q

NICE guidelines
what if CBT-ED,SSCM, MANTRA did not work?

A

Eating-disorder-focused focal psychodynamic therapy (FPT)

27
Q

NICE guidelines
for children and young (0-18) with AN

A

Anorexia-Nervosa-Focused family therapy (FT-AN)

28
Q

NICE guidelines
for children and young (0-18) with AN
If FT-AN is unsuitable

A

consider CBT-ED & AFP-AN (adolescent focused psychotherapy)

29
Q

can medication be offered as sole treatment for anorexia nervosa

A

Nope!

30
Q

NICE guidelines
For adults with bulimia nervosa

A

First step: offer guided self-help programmes

31
Q

NICE guidelines
For adults with bulimia nervosa
if guided self-help programmes was not suitable or helpful for 4 weeks

A

CBT-ED

32
Q

NICE guidelines
For children with bulimia nervosa

A

First step: Anorexia-Nervosa-Focused family therapy (FT-AN)

33
Q

if FT-AN is not suitable or working

A

consider CBT-ED

34
Q

can medication be offered as sole treatment for Bulimia Nervousa

A

Nope!!! again

35
Q

NICE guidelines
For adults with BED

A

First step: guided self-help programme

36
Q

NICE guidelines
For adults with BED
if guided self-help programme was not suitable or helpful

A

CBT-ED

37
Q

NICE guidelines
For young children with BED

A

same as adult

38
Q

can medication be offered as sole treatment for Bulimia Nervousa

A

Nope nope nope no medication offered as sole treatment

39
Q

what will patient with purging (vomitting) be advised to do after vomitting?

A
  • Don’t brush teeth
    -Don’t eat acidic food and drinks
    -Wash mouth with non-acidic mouth wash
40
Q

what will patient who use laxatives and diuretics be advised about?

A

diuretics and laxatives do not reduce calorie absorption and weight loss

41
Q

What is refeeding syndrome?

A

Refeeding syndrome occurs when a malnourished person resumes feeding. Rapid reintroduction of food may lead to severe complications.

42
Q

why refeeding syndrome happens?

A
  • rapid shift electrolytes back into cells which they had been leached out during starvation
43
Q

what electrolyte is involved with refeeding syndrome?

A

phosphate <2.5 mmol/L
potassium <0.32 mmol/L
magnesium <0.5 mmol/L

44
Q

what are concequenses of refeeding syndrome?

A

cardiovascular and neurological complications

45
Q

onset of refeeding syndrome

A

within 72 hours of beginning refeeding (1-5 days)

46
Q

Most serious complication in refeeding syndrome?

A

cardiac

47
Q

Features of refeeding syndrome

A

Low electrolytes
peripheral oedema
disturbance to respiration, cardiac liver transaminases, pulmonary oedema

48
Q

Risk for refeeding sydnrome

A
  • BMI<13
  • Little/no intake >4 days
    -Low electrolytes
    -Low white blood cell(<3.8)
  • Low thiamine
    -Medical comorbidities
49
Q

can physical therapy be offered to eating disorders?

A

No (no yoga, no TMS, no acupuncture or no weight trainings…)

50
Q

When should bone mineral density scan be done in children and young people

A

1 year of underweight

if they have bone pain or recurrent fractures

51
Q

When should bone mineral density scan be done in adults

A

2 years

52
Q

when should bone mineral density scan indicated?

A

if they have bone pain or recurrent fractures

53
Q

Is oestronge therapy routinely (oral or transdermal) recommended to treat low bone mineral desity in children and yougn people with AN?

A

no

54
Q

Rx for women >18 with AN, long-term low body weight and low bone density

A

Biphosphonates

55
Q

Biphosphonates indications

A

women >18 with AN,
long-term low body weight
low bone density

56
Q

Pharma Rx for young women 13-17 with delayed puberty, long-term low eight and low bone desity

A

Incremental physiological doses oestrogen

57
Q

Incremental physiological doses oestrogen indication

A

Pharma Rx for women 13-17 with delayed puberty, long-term low eight and low bone desity (bone age >15)

58
Q

Pharma Rx for young women 13-17 with long-term low eight and low bone desity (bone age over 15)

A

Transdermal 17-B- estradiol (with cyclic progesterone)

ART_MRCPSYCH_B_MENTOR (38 decks)

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