Eating Disorders

Question 1

Mother of 15 yo bulimic pt calls stating that she found large bag of empty ipecac bottles hidden in daughter’s closet. What concerning condition may. this patient have developed 2/2 to chronic ipecac usage?

a. Hemolytic anemia
b. Short QT interval
c. Mitral stenosis
d. Reduced EF
e. Elevated WBC

Answer 1

d. Reduced EF

Pts who chronically abuse ipecac may develop cardiomyopathy, cardiomegaly, reduced EF, prolonged. QT, arrythmias, leukopenia, mitral insufficiency, tricuspid insufficiency, and elevated liver enzymes.

Ipecac syrup acts locally by irritating the gastric mucosa –> vomiting.

Question 2

First line tx for bulimia?

Answer 2

SSRI –> fluoxetine (only FDA approved tx)

Question 3

Patients with anorexia nervosa who are hospitalized for a tx program may complain of constipation. This sx is usually relieved when they begin to eat normally.

Which one of the following can you give them?

a. Lactulose
b. Senna
c. Magnesium hydroxide
d. Bisacodyl
e. Docusate

Answer 3

e. Docusate

Do NOT give laxative. Can give stool softener.

Question 4

What is the most effective treatment for bulimia nervosa overall?

Answer 4

CBT

Can do CBT + SSRI (fluoxetine)

Question 5

Among general population, which of the following disorders is most commonly comorbid in anorexia nervosa?

a. Somatic disorders
b. Personality disorders
c. MDD
d. Bipolar disorders
e. OCD

Answer 5

c. MDD

A nationally representative survey found 56% of anorexic pts had comorbid psychiatric diagnoses. Unipolar major depression was the most prevalent comorbid disorder (39%), followed by alcohol use disorders, specific phobias, and social anxiety disorder (each in approximately 25% of anorexic patients).

Question 6

Acid base status of anorexic pt abuses laxatives and diuretics

Answer 6

Hypokalemic alkalosis

Diarrhea usually produces a hyperchloremic metabolic acidosis from bicarb losses in stool, but diarrhea associated with chronic laxative abuse is rich in potassium and chloride. This typically results in hypokalemia and a saline (chloride)-responsive metabolic alkalosis.

It results from hypokalemia, increased renal-bicarbonate reabsorption, and volume contraction due to a profound loss of sodium and water in the stool. Diuretics also cause metabolic alkalosis, likely derived from multiple contributing mechanisms. Secondary hyperaldosteronism often develops due to volume depletion, renal chloride loss, or a contraction alkalosis.

Question 7

What is the goal of interpersonal psychotherapy in treating individuals with bulimia nervosa?

Answer 7

Address relationship-related stressors contributing to eating disturbance

Interpersonal psychotherapy normalizes the disturbed eating behavior, decreasing the number of binge-purge episodes by addressing interpersonal sources of stress believed to preciiptate or promote the behavior.

Question 8

Lucy is a 26 yo woman who is referred by her PCP. She admits to frequent binge eating followed by purging through self-induced vomiting several times a day for the past several months. In terms of her disorder, what does “Russell’s sign” indicate?

a. Halitosis and tooth decay due to stomach acids
b. Scars and abrasions on hands from using them to induce vomiting
c. Enlarged parotid glands and elevated amylase
d. Hypokalemia due to vomiting

Answer 8

b. Scars and abrasions on hands from using them to induce vomiting

Question 9

What differentiates anorexia from bulimia?

Answer 9

Low BMI and calorie restricting