Eating Disorders Flashcards
1
Q
Case 1: 18 yo female presents with 5 mo h/o wt loss
- she began reducing the fat in her diet - lost 22 lbs and now weighs 95 lbs
- she hardly eats has a BM 4-5 days, runs 4 miles q day and does 100 sit ups, LMP was 6 mo, not sexually active
- She constantly feels cool and is dizzy upon standing, hair is dry, feels bloated after meals, she still thinks she is too large and she doesn’t think she has a problem
- DSM 5 criteria?
A
- classic example of anorexia nervosa
- DSM-5 criteria:
restriction of energy intake relative to requirements, leading to sig. low body wt in context of age, sex, developmental trajectory and physical health - fear of wt gain
- severe body image disturbance in which body image is predominant measure of self worth with denial of the seriousness of the illness
2
Q
Subtypes of anorexia nervosa?
A
- restricting: restriction of intake to reduce wt
- binge eating/purging: may binge and/or purge to control wt
considered anorexic if she/he is 15% below ideal body wt
3
Q
Signs and sxs of anorexia nervosa?
A
- dry skin
- cold intolerance
- blue hands and feet
- constipation
- bloating
- delayed puberty
- primary or secondary amenorrhea
- fainting
- orthostatic hypotension
- lanugo hair: fine hair - body’s response to malnourishment, keeping warm
- scalp hair loss
- early satiety
- weakness, fatigue
- short stature
- osteopenia
- breast atrophy
- atrophic vaginitis
- pitting edema
- cardiac murmurs
- sinus brady
- hypothermia
4
Q
Case 2: 20 yo female - presents for eval of hematemesis - admits to self-induced vomiting for past 3 yrs, 62” tall, 140 lbs - gorges and vomits 3-5x week, uncontrollable eating binges, feels guilty, smokes 1 pack of cigs a day, gets drunk weekly - binge drinks, irregular menses, hasn’t lost wt. Characteristic of? DSM-V criteria?
A
- bulimia
A. recurrent of binge eating. An episode of binge eating is characterized by both of the following:
1. eating in a discrete period of time, an amt of food that is definitely larger than what most individuals would eat
2. a sense of lack control over eating during the episode
B. recurrent inappropriate compensatory behaviors in order to prevent wt gain, such as self-induced vomiting, misuse of laxatives, diuretics, other meds, fasting, or excessive exerciese
C. binge eating and inappropriate compensatory behaviors both occur, on average at least 1x a week for 3 months
D. self eval is unduly influenced by body shape and wt
E. the disturbance doesn’t occur exclusively during periods of anorexia nervosa
5
Q
Signs and sxs of bulimia?
A
- mouth sores
- pharyngeal trauma
- dental caries
- heartburn, chest pain
- esophageal rupture
- impulsivity: stealing, ETOH abuse, drugs/tobacco
- muscle cramps
- weakness
- bloody diarrhea
- bleeding or easy bruising
- irregular periods
- fainting
- swollen parotid glands (from overuse)
- hypotension
- russell’s sign: callouses on knuckles
6
Q
Binge eating disorder?
A
- eating, in a discrete period of time, an amt of food that is larger than most people would eat in similar period
- occurs 2 days/week for 6 month duration
- assoc with lack of control and with distress over the binge eating
7
Q
Binge eating disorder criteria?
A
must have at least 3 of 5:
- eating much more rapidly than normal
- eating until uncomfortably full
- eating large amts of food when not feeling physically hungry
- eating alone b/c of embarrassment
- feeling disgusted, depressed or very guilty about overeating
8
Q
Eating disorder, NOS - DSM-5 criteria?
A
- all criteria for anorexia nervosa except has regular menses
- all criteria for anorexia except wt still in normal range
- all criteria for bulimia except binges less than 2x a week for less than 3 months
- pts with normal body wt who regularly engage in inappropriate compensatory behavior after eating small amts of food (self induced vomiting after eating 2 cookies)
- a pt who repeatedly chews and spits out large amts of food without swallowing
9
Q
Epidemiology of eating disorders?
A
- anorexia: incidence rates have increased in past 25 years, affects 1% of adolescent females, rates for men only 10% of those for women, seen in pts as young as 6
- bulimia: occurs in 1-5% of high school girls, and as high as 19% in college women
- eating disordre NOS: occurs in 3-5% of women b/t ages 15-30 in western countries, as minority culture groups assimilate into american society - rates increase
- binge eating disorder: occurs more commonly in women, depening on pop surveryed, can vary from 3%-30%
10
Q
Assoc psych conditions with Eating disorders?
A
- anxiety disorders
- OCD
- personality disorders
- substance abuse
11
Q
Pathogenesis of eating disorders?
A
- no consensus on precise cause
- combo of psychological, biological, family, genetic, enviro and social factors
12
Q
Screening tools - SCOFF questionnaire?
A
- do you make yourself Sick b/c you feel uncomfortably full?
- do you worry you have lost Control over how much you eat?
- have you recently lost more than 14 lbs (One stone) in a 3 month period?
- Do you believe yourself to be Fat when others say you are too thin?
- Would you say that Food dominates your life?
13
Q
Screening tool - eating disorder screen for primary care (ESP)?
A
- are you satisfied with your eating patterns? (no is abnormal)
- do you ever eat in secret? (yes is abnormal)
- does your wt affect the way you feel about yourself? (yes is abnormal)
- have any members of your family suffered with an eating disorder? (yes is abnormal)
- do you currently suffer with or have you ever suffered in the past with an eating disorder? (yes is abnormal)
14
Q
Impt hx ?s to hit?
A
- max ht and wt
- exercise habits: intensity, hrs/week
- stress level
- habits and behaviors: smoking, ETOH, drugs, sexual activity
- eating attitudes and behaviors
- ROS
15
Q
PE findings in anorexia?
A
- vital signs to include orthostatics
- skin and extremity eval: dryness, bruising, lanugo
- cardiac exam: bradycardia, arrhythmia, MVP (heart muscle shrinks but valves don’t)
- abdominal exam
- neuro exam: eval for other causes of wt loss or vomiting (brain tumor)
