Eating Disorders

Question 1

diagnostic criteria for anorexia?

Answer 1

BMI of 17.5 or less
self induced weight loss
body image disturbance
fear of fatness
amenorrhoea

Question 2

what physical symptoms may accompany anorexia?

Answer 2

muscle wasting
hair loss
lanugo hair
cold, blue peripheries
dry skin
hypercarotenaemia
bradycardia, hypotension
bruising

Question 3

what psychological conditions can accompany anorexia?

Answer 3

depression
OCD
substance misuse
diabetes mellitus

Question 4

what situations are defined as “high risk”?

Answer 4

BMI <13 or weight loss >1kg per week
cardio - prolonged QT, HR <40, systolic BP<80
core temp <34
unable to rise from squat position without using arms for leverage
cognitive impairment

Question 5

what investigations are done in suspected anorexia?

Answer 5

haematology
biochemistry
ECG
DXA

Question 6

8 possible medical complications of anorexia?

Answer 6

cardio
GI
renal
endocrine
MSK
dental
dermatological
metabolic

Question 7

specific blood tests done in anorexia?

Answer 7

GGT - 485
ALT - 442
protein - 56
albumin - 34

Question 8

what is refeeding syndrome?

Answer 8

occurs after sudden intake of food after starvation
caused by depletion of already inadequate stores of nutrients (e.g magnesium, potassium, phosphate etc) which are used up quickly as the body starts to repair itself once food is reintroduced

Question 9

how can refeeding syndrome be prevented?

Answer 9

frequent blood monitoring and slow pace of initial refeeding

Question 10

what bloods are seen in refeeding syndrome?

Answer 10

ALT - 208
albumin - 27
phosphate - 0.66
magnesium - 0.68
Hb - 96

Question 11

what is marzipan?

Answer 11

management of really sick patients with anorexia nervosa

guidelines aims to reduce mortality of starved patients admitted to medical wards

Question 12

psychological management for anorexia?

Answer 12

psychological therapy - CBT etc
dietician
medical monitoring
art therapy/drama therapy
family therapy 
inpatient treatment for high risk

Question 13

what is involved in the mental health act concerning eating disorders?

Answer 13

capacity
risk
reciprocity
artificial feeding

Question 14

diagnostic criteria for bulimia?

Answer 14

persistent preoccupation with eating
irresistible craving for food
binges
attempts to counter the effects of binges (vomiting, laxatives, starvation, drugs etc)
morbid dread of fatness

Question 15

what can be seen on physical assessment in bulimia?

Answer 15

calluses on knuckles (russel’s sign)
parotid hypertrophy
dental caries
Us and Es

Question 16

what can be seen on psychological assessment in bulimia?

Answer 16

depression
self harm
substance misuse
impulsive personality

Question 17

possible medical complications in bulimia?

Answer 17

oesophageal reflux
oesophageal tears/ruptures
hypokalaemia
subconjunctival haemorrhage
dehydration
seizures - metabolic abnormalities

Question 18

management of bulimia?

Answer 18

guided self help
CBT
SSRI