Eating Disorders

Question 1

What is DSM-5 CRITERIA-Anorexia Nervosa?

Answer 1

Restriction of energy intake relative to requirements, leading to:
-a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.

Question 2

DSM-5 CRITERIA-Anorexia Nervosa

1. Fear of what?
2. Severe body image disturbance in which body image affected how?

Answer 2

1. Fear of weight gain

2. predominant measure of self-worth with denial of the seriousness of the illness

Question 3

Subtypes of Anorexia Nervosa

2

Answer 3

1. Restricting

2. Binge eating/purging

Question 4

Describe the following subtypes of Anorexia Nervosa:

1. Restricting?
2. Binge eating/purging?
   - When is it considered anorexic?

Answer 4

1. Restricting
   - Restriction of intake to reduce weight
2. Binge eating/purging
   - May binge and/or purge to control weight
   - Considered anorexic if she is 15% below ideal body weight

Question 5

Signs and Symptoms

21

Answer 5

1. Dry skin
2. Cold intolerance
3. Blue hands and feet
4. Constipation
5. Bloating
6. Delayed puberty
7. Primary or secondary amenorrhea
8. Fainting
9. Orthostatic hypotension
10. Lanugo hair
11. Scalp hair loss
12. Early satiety
13. Weakness, fatigue
14. Short stature
15. Osteopenia
16. Breast atrophy
17. Atrophic vaginitis
18. Pitting edema
19. Cardiac murmurs
20. Sinus brady
21. hypothermia

Question 6

DSM-V CRITERIA- Bulimia

5

Answer 6

1. Recurrent of binge eating.
2. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting: misuse of laxatives, diuretics, or other meds; fasting; or excessive exercise.
3. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
4. Self-evaluation is unduly influenced by body shape and weight.
5. The disturbance does not occur exclusively during periods of anorexia nervosa.

Question 7

An episode of binge eating is characterized by what?

2

Answer 7

1. Eating in a discrete period of time, an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
2. A sense of lack of control over eating during the episode.

Question 8

Bulimia-signs and symptoms

15

Answer 8

1. Mouth sores
2. Pharyngeal trauma
3. Dental caries
4. Heartburn, chest pain
5. Esophageal rupture
6. Impulsivity
7. Muscle cramps
8. Weakness
9. Bloody diarrhea
10. Bleeding or easy bruising
11. Irregular periods
12. Fainting
13. Swollen parotid glands
14. Hypotension
15. Russell’s Sign (calluses on the back of the hands from self induced vomiting)

Question 9

Impulsivity symptoms of Bulmia?

3

Answer 9

1. Stealing
2. Alcohol abuse
3. Drugs/tobacco

Question 10

Binge Eating Disorder…
Criteria
3

Answer 10

1. Eating, in a discrete period of time, an amount of food that is larger than most people would eat in a similar period
2. Occurs 2 days per week for a six month duration
3. Associated with a lack of control and with distress over the binge eating

Question 11

Binge eating disorder: Must have at least 3 of the 5 criteria?

Answer 11

1. Eating much more rapidly than normal
2. Eating until uncomfortably full
3. Eating large amounts of food when not feeling physically hungry
4. Eating alone because of embarrassment
5. Feeling disgusted, depressed or very guilty over overeating

Question 12

Eating Disorder,NOS…. DSM-5 Criteria

5

Answer 12

1. All criteria for anorexia nervosa except has regular menses
2. All criteria for anorexia nervosa except weight still in normal range
3. All criteria for bulimia nervosa except binges less than twice a week or for less than 3 months
4. Patients with normal body weight who regularly engage in inappropriate compensatory behavior after eating small amounts of food (ie, self-induced vomiting after eating two cookies)
5. A patient who repeatedly chews and spits out large amounts of food without swallowing

Question 13

Associated Psychiatric Conditions

with eating disorders? 4

Answer 13

1. anxiety disorders
2. obsessive-compulsive disorder
3. personality disorders
4. substance abuse.

Question 14

Screening Tools:
SCOFF Questionnaire
Which questions are involved in this?
5

Answer 14

1. Do you make yourself Sick because you feel uncomfortably full?
2. Do you worry you have lost
   Control over how much you eat?
3. Have you recently lost more than 14 pounds or 6.35 kg (One stone) in a three month period?
4. Do you believe yourself to be Fat when others say you are too thin?
5. Would you say that Food dominates your life?

Question 15

Screening Tool: Eating Disorder Screen for Primary Care (ESP)
5 questions

Answer 15

1. Are you satisfied with your eating patterns? (No is abnormal)
2. Do you ever eat in secret? (Yes is abnormal)
3. Does your weight affect the way you feel about yourself? (Yes is abnormal)
4. Have any members of your family suffered with an eating disorder? (Yes is abnormal)
5. Do you currently suffer with or have you ever suffered in the past with an eating disorder? (Yes is abnormal)

Question 16

What do we want to ask on the history?

6

Answer 16

1. Maximum height and weight
2. Exercise habits: intensity, hours per week
3. Stress levels
4. Habits and behaviors: smoking, alcohol, drugs, sexual activity
5. Eating attitudes and behaviors
6. Review of systems

Question 17

PE for anorexia?

Answer 17

1. Vital signs to include orthostatics
2. Skin and extremity evaluation
3. Cardiac exam
4. Abdominal exam
5. Neuro exam
   - -Evaluate for other causes of weight loss or vomiting (brain tumor)

Question 18

Anorexia PE:
1. Skin findings? 3

2. Cardiac Exam? 3

Answer 18

1. • Dryness,
   • bruising,
   • lanugo
2. • Bradycardia,
   • arrhythmia,
   • MVP (heart muscle shrinks but the valves do not)

Question 19

Additional PE findings for bulimia?

2

Answer 19

1. Parotid gland hypertrophy

2. Erosion of the teeth enamel

Question 20

Laboratory Assessement

11

Answer 20

1. CBC: anemia
2. Electrolytes,
3. BUN/Cr
4. Mg, K+, Calcium
5. Albumin, serum protein
6. B-HCG
7. UA: specific gravity
8. Thyroid function tests
9. Serum prolactin
10. FSH
11. Bone density

Question 21

Differential Diagnosis

6

Answer 21

1. New onset diabetes
2. Adrenal insufficiency
3. Primary depression with anorexia
4. Inflammatory bowel disease
5. Abdominal masses
6. Central nervous system lesions

Question 22

Complication: Fluid and electrolyte imbalances

7

Answer 22

1. Hypokalemia
2. Hyponatremia
3. Hypochloremic alkalosis
4. Elevated BUN
5. Inability to concentrate urine
6. Decreased GFR
7. Ketonuria

Question 23

Osteopenia:
One of the most severe complications
-Difficult to reverse

Treatment? 4

Answer 23

1. Weight gain
2. 1200-1500 mg/day of elemental calcium
3. Multivitamin with 400 IU vitamin D
4. Consider estrogen/progesterone replacement

Question 24

Secondary 1.________ affects more than 90% of patients with anorexia
2. Caused by low levels of what? 2

Answer 24

1. amenorrhea

2. FSH and LH

Question 25

Menses resumes within how long of achieving 90% IBW?

Answer 25

6 months

Question 26

Cardiac Changes | 2

Answer 26

1. MVP | 2. Long QT

Question 27

1. Risk of heart failure is greatest when?

Answer 27

1. the first 2 weeks of refeeding

Question 28

Risk of heart failure is greatest in the first 2 weeks of refeeding 1. What causes this? 2 2. How should we proceed then? 3

Answer 28

1. Reduced cardiac contractility and refeeding edema 2. - Slow refeeding, - repletion of K+, - avoidance of sodium intake

Question 29

Anorexia treatment? | 2

Answer 29

1. Cognitive behavioral therapy 2. Interdisciplinary care team - Medical provider - Dietician with experience in Eating Disorders - Mental health professional

Question 30

Medications Overall, disappointing results Effective only for treating co-morbid conditions of depression and OCD But two medications that may be helpful? 2

Answer 30

1. Anxiolytics may be helpful before meals to suppress the anxiety associated with eating 2. Case reports in the literature supporting the use of olanzapine (Zyprexa)… atypical antipsychotic

Question 31

When should we hospitalize eating disorder pts? | 9

Answer 31

1. Severe malnutrition (

Question 32

1. Nutrition goal for eating disorder pts? | 2. Inpatient treatment varies by facility. But usually includes what? 4

Answer 32

1. Goal: regain to goal of 90-92% of IBW 2. - Oral liquid nutrition - Nasogastric tube feedings - Gradual caloric increase with “regular” food - Parenteral nutrition (IV feeding) rarely indicated

Question 33

Bulimia treatments? | 5

Answer 33

1. Cognitive behavioral therapy is effective Pharmacotherapy—high success rate 2. Fluoxetine (Prozac) SSRI—studies reveal up to a 67% reduction in binge eating and a 56% reduction in vomiting 3. TCAs 4. Topiramate (Topamax) reduced binge eating by 94% and average wt. loss of 6.2 kg 5. Ondansetron (Zofran) 24 mg/day

Question 34

Binge Eating Disorder treatment consists of what? | 2

Answer 34

1. Cognitive behavioral therapy | 2. Pharmacotherapy

Question 35

What is The Female Athlete Triad? 3 Who is at risk? 2

Answer 35

The Triad 1. Eating Disorders 2. Stress Fractures 3. Amenorrhea At risk 1. Appearance Related Sports 2. High Performance Sports

Question 36

The Female Athlete Triad What to look for? 7

Answer 36

1. Weight 2. Heart Rate of 40-50 3. Hypotension 4. Hypothermia 5. Parotid swelling 6. Poor dentition 7. Overuse injuries, especially stress fractures

Question 37

The Female Athelete Triad Treatment plan? | 6

Answer 37

Treatments—multidisciplinary effort 1. Estrogen Replacement 2. Decrease energy expenditure 3. Nutritional consultation 4. Calcium with vitamin D 5. Psychological counseling. 6. Avoid NSAIDs

Question 38

Who should recieve estorgen replacement therapy? | 2

Answer 38

1. 3 years post-menarche and older than 16 years old | 2. Or, if history of stress fracture