Eating Disorders

Question 1

Which 3 factors are needed to classify someone as having anorexia nervosa?

Answer 1

BMI<17.5, core psychopathology and amenorrhoea

Question 2

Which 3 factors are needed to classify someone as having bulimia nervosa?

Answer 2

BMI>17.5, core psychopathology, regular binge/purges (2x a week).

Question 3

How common are anorexia nervosa and bulimia nervosa in males and females?

Answer 3

AN; females 1 in 250, males 1 in 2000. BN; females 1 in 50, males 1 in 500

Question 4

What are differential diagnosis for eating disorders?

Answer 4

Depression, somatoform disorders, OCD, hypopituitariem, addisons disease, thyrotoxicosis, inflammatory bowel disease/ malabsorption, DM, carcinoma, TB.

Question 5

Which psychiatric disorder has the highest mortality rate?

Answer 5

Anorexia Nervosa. Most deaths due to complications of dieting, purging and bingeing.

Question 6

What percentage of anorexia deaths are due to suicide?

Answer 6

20-40%

Question 7

What effects does starvation have on the CVS?

Answer 7

Bradycardia, hypotension, sudden death

Question 8

What effects does starvation have on the renal system?

Answer 8

Oedema, electrolyte abnormalities, renal calculi and renal failure.

Question 9

What effects does starvation have on the GI system?

Answer 9

Parotid swelling, delayed gastric emptying, nutritional hepatitis, constipation.

Question 10

What effects does starvation have on the skeletal system?

Answer 10

Osteoporosis, pathological features, short stature

Question 11

What effects does starvation have on the endocrine system?

Answer 11

Amenorrhoea, infertility and hypothyroidism

Question 12

What effects does starvation have on haem?

Answer 12

Anaemia, leukopenia, thrombocytopenia.

Question 13

What effects does starvation have on the neuro system?

Answer 13

Generalised seizures and can cause confusion states.

Question 14

What effects does starvation have on the metabolic system?

Answer 14

Impaired temperature regulation, hypoglycaemia.

Question 15

What effects does starvation have on derm?

Answer 15

Lanugo (fine soft hair), brittle hair and nails.

Question 16

What effects does bingeing/purging have on the CVS?

Answer 16

Arrhythmias, cardiac failure & sudden death.

Question 17

What effects does bingeing/purging have on the renal system?

Answer 17

Severe oedema, electrolyte abnormalities, renal calculi and renal failure.

Question 18

What effects does bingeing/purging have on the GI system?

Answer 18

Parotid swelling, dental erosion, oesophageal erosion/perforation and constipation.

Question 19

What effects does bingeing/purging have on the skeletal system?

Answer 19

Osteoporosis, pathological fractures.

Question 20

What effects does bingeing/purging have on the endocrine system?

Answer 20

Oligomenorrhoea and Amenorrhoea

Question 21

What effects does bingeing/purging have on haem?

Answer 21

Leukopenia, lymphocytosis (inc in number of white blood cells)

Question 22

What effects does bingeing/purging have on neuro?

Answer 22

Generalised seizures and confused states.

Question 23

What effects does bingeing/purging have on metabolism?

Answer 23

Impaired temperature regulation and hypoglycaemia.

Question 24

What effects does bingeing/purging have on derm?

Answer 24

Calluses on dorsum of the hand (russel’s sign) (from repeated contact with incisor and hand)

Question 25

What is involved in the physical assessment of someone with an eating disorder?

Answer 25

Clinical history and physical exam, BMI, ECG and blood investigations,

Question 26

What is considered as rapid weight loss?

Answer 26

> 1kg/week

Question 27

How do you work out BMI?

Answer 27

BMI = wt(kg)/ ht (m)2

Question 28

What BMI falls into moderate risk?

Answer 28

<15

Question 29

What BMI falls into severe risk?

Answer 29

<13

Question 30

What percentage of patients with AN have cardiac abnormalities?

Answer 30

86%

Question 31

Which cardiac abnormalities are commonly seen?

Answer 31

T wave change (hypokalaemia) and bradycardia (<40bpm) and QTc prolongation(>450ms).

Question 32

Which blood changes does starvation cause?

Answer 32

Hypoglycaemia

Question 33

What blood changes does vomiting cause?

Answer 33

Hypokalaemia

Question 34

What blood changes does water-loading cause?

Answer 34

Hyponatraemia

Question 35

What blood changes does laxative misuse cause?

Answer 35

Hyperkalaemia and hyponatraemia

Question 36

What blood changes does diuretics misuse cause?

Answer 36

Hypokalaemia and hyponatraemia

Question 37

What blood changes does thyroxine misuse cause?

Answer 37

Increased T3, T4, and decreased TSH.

Question 38

What blood changes does bone marrow hypoplasia have?

Answer 38

Normocytic anaemia, and leacopenia

Question 39

What blood changes does refeeding syndrome have?

Answer 39

Hypophosphataemia Hypomagnesaemia Hypocalcaemia Hypokalaemia

Question 40

What blood changes are seen in proximal myopathy?

Answer 40

Increased CK, and increased LFTS.

Question 41

What factors make someone at ‘moderate risk’?

Answer 41

BMI, <15 weight loss >0.5kg/week
BP <90/60 mmHg Postural drop >10 mmHg HR <50 bpm, proximal myopathy of grade 2 (found out by doing the stand up or sit up test), concern if WCC, neutrophils, haemoglobin or platelets, potassium, sodium, phosphate are outside the normal levels.

Question 42

What factors make someone at ‘high risk’?

Answer 42

BMI <13 kg/m2 weight loss >1kg/week
BP <80/50 mmHg Postural drop>20 mmHg
HR<40bpm, peripheral cyanosis
Grade 0-1- sit up test (proximal myopathy)
<34.5°C body temp
WCC <2.0 x 109/l Neutrophil count <1.0 x 109/l Haemoglobin<9.0 g/dl
Platelets<110 x 109/l
Potassium<2.5 mmol/l Sodium<130 mmol/l Phosphate<0.5 mmol/l

Pulse rate QTc interval Arrhythmias
<40 bpm >450 msec Yes

Question 43

Concerning levels of stuff in the blood of an anorexic, what is it?

Answer 43

Most things low

G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia