Eating disorders

Question 1

ICD-10 features of anorexia nervosa?

Answer 1

1. Low body weight <17.5 or 15% lower than expected weight loss
2. Self induced weight loss
3. Body image distortion- overvalued ideas
4. Endocrine disorders- amenorrhoea, arrested puberty, raised GH, cortisol, cholesterole, low T3,

Question 2

What are the complications of refeeding syndrome and how do they manifest

Answer 2

Cardiac decompensation in first two weeks

Oedema, excessive bloating, and CCF

Question 3

How do you manage refeeding syndrome?

Answer 3

Measure U and E’s before treatment and correct abnormalities

monitor U and E’s 3 days for first week and then every week until refeeding syndrome

slow calorie intake of 200-300 until 1-2 pounds weight gain each week

Question 4

What are the invesitigations for anorexia nervosa?

Answer 4

1. FBC, ESR, U and Es (creatinine and urea raised), TFT’s, LFT’s raised, glucose, cholesterol, GH, cortisol
2. ECG and ECHO if indicated

Question 5

What is management of anorexia nervosa?

Answer 5

CBT- eating disorder- 40 sessions
MANTRA
Or congitive support

Nutritional education

Family therapy if adolescent

Question 6

What are the physical and psychological signs of anorexia nervosa?

Answer 6

Physical- Russel’s sign, Hypercartionaemia, submandibular and parotid glad swelling, breast atrophy

Psychological- obsessions about food, overvalued ideas, depression, low self esteem, difficulty concentrating, social withdrawal

Question 7

What is the diagnosis of Bullimia?

Answer 7

1. Preoccupied with eating
2. Irresistible craving for food
3. Binge eating
4. Counteract fatty food- purging, vomiting, laxatives,appetite supressants
5. Body image distortion- overvalued ideas of dread of fattnes, low weight threshold

Question 8

What questionarre is used in GP to screen for eating diosrders?

Answer 8

SCOFF questionarre

Question 9

What is management of bullimia?

How long do you give pharmacological management for?

Answer 9

1. SSRIs- fluoxetine for a year

2. CBT- ed or Interpersonal therapy

Question 10

What are some long term concequences of bullimia nervosa?

Answer 10

• Cardiac arrythmias sudden death
• Oesophageal varicies, gastric ulceration, peritonitis
• Dental erosion
• low sodium, pottassium, chloride
• constipation
• leukopenia

Question 11

What are the features of conversion disorder?
Conversion disorders are repressed emotions result or disturbance in motor and sensory function

Clue sensory and motor?

Answer 11

Motor:
Paralysis- Hoover’s test
Seizures- AED
Aphonia- partial or complete loss of speech

Sensory:
Sensory loss in glove distribution of mid line splitting
Amnesia- recent, patchy, selective loss
Fugue- amnesia with travel away from home

Question 12

What is hypochondrial disorder?

Answer 12

Overvalued idea whereby patients believe themselves to have serious medical condition despite negative medical investigations

Question 13

What is somatization disorder?

Answer 13

Episodes of persistent, repeated atypical non-specific symptoms affecting multiple organ systems in someone aged below 40

Question 14

How do you manage the medically unexplained symptoms?

Answer 14

1. Explain the diagnosis framing diagnosis positively and emotional component- avoid IX and TX to prevent patients sick role
2. Psychological support- CBT, IPT, family therapy and or psychosocial supportive therapy if helping to cope with stressor etc
3. Pharmacological- antidepressants, pain clinic if somatoform pain disorder (antidepressants, Transcutaneous electrical stimualation, local or regional nerve block)

Question 15

What are the cardiac complications of anorexia nervosa and what do you see on ECG?

Answer 15

ECG- prolonged QT, hypotension (systolic <70), bradycardia and reduced LV mass and heart size

ECG- prolonged QT, ST elevation, bradycardia, T wave flattening, right axis deviation

ECHO- reduced heart size and LV mass