eating disorders

Question 1

DSM criteria for Anorexia Nervosa

Answer 1

refusal to maintain 85% IBW
intense fear of gaining weight
body image disturbance, or denaial of seriousness of low weight
amenorrhea for 3 months

Question 2

DSM criteria for Bulemia Nervosa

Answer 2

recurrent binge episodes
recurrent use of inappropriate behaviors to prevent weight gain
binging and [urging occur 2x weekly for 3 months
self0evaluation unduly influenced by weight/shape
does not meet the criteria for AN

Question 3

how non purging bulemics prevent weight gain

Answer 3

excess exercise

Question 4

ways of purging in bulemia

Answer 4

vomiting, abusing laxatives, abusing diuretics

Question 5

russells sign is:

Answer 5

callouses on back of hand from rubbing the skin over incisors

Question 6

perimyolysis is

Answer 6

decalcification of back of the teeth from vomiting

Question 7

facial sign of bulemia

Answer 7

salivary gland hypertrophy

Question 8

clinical signs of anorexia

Answer 8

hypercarotenemia, lanugo hair

Question 9

CV coplications of anorexia

Answer 9

brdycardia, decreased LV mass, arrythmias

Question 10

causes of arrythmias in anorexia

Answer 10

decreased LV mass+ electrolyte imbalances+ SSRIs

Question 11

GI consequences of anorexia

Answer 11

GERD, constipation, delayed gastric emptying, colon hypofunction

Question 12

treatment for delayed gastric emtpying

Answer 12

metoclopramide and PPI
Walking after meals
possible jejunal feedings or gastric pacing

Question 13

how to treat constipation in anorexia

Answer 13

increase fluid intake, fiber/stool softener, polyethylene glycol

Question 14

how NOT to treat constipation in anorexia

Answer 14

avoid stimulant laxitives

Question 15

endocrine issues with anorexia

Answer 15

euthyroid sick syndrome, amenorrhea, osteopenia/osteoporosis

Question 16

primary marker of health in anorexia

Answer 16

menses

Question 17

factors contributing to low bone density in AN

Answer 17

hypogonadism, undernutrition, low IGF levels, excessive exercise

Question 18

treatment for low bone density in AN

Answer 18

primary restoration of health and weight

Question 19

purgative that can cause

Answer 19

IPECAC syrup

Question 20

GI consequenses of purging

Answer 20

esophagitism GERD, mellory-weiss tears, laxative toxicity

Question 21

long term consequenses of laxative abuse

Answer 21

constipation, nerve damage

Question 22

initial workup for eating disorder

Answer 22

HX, with substance abuse, sexual abuse, PTSD screenning, family dynamics, dietary habits
weighing
baseline ECG, electrolytes and CBC

Question 23

treatment for eatingdisorder

Answer 23

prompt weight restoration (1200-1500 kCal)
weekly office visits
manage the medical complications
CBT

Question 24

SSRI approved for Bulemia

Answer 24

Fluoxetine

Question 25

SSRI approved for anorexia

Answer 25

NONE

Question 26

admission criteria for eating disorders

Answer 26

HR < 40
symptomatic hypoglycemia
arrythmias
rapid weight loss
dehydration

Question 27

electrolyte involved in refeeding syndome

Answer 27

Phosphorus, K, Mg

Question 28

sign of refeeding syndrome

Answer 28

tachycardia

Question 29

weight gain caloric standards to prevent refeeding syndome

Answer 29

1200-1500 kcal/day increase by 500 kcal every 4 days