Eating disorders

Question 1

ICD-10 diagnostic criteria for anorexia?

Answer 1

BMI; <17.5
Self-induced weight loss; strict dieting, vomiting, excessive exercise, medication 
Body image disturbance
Fear of fatness
Amenorrhoea

Question 2

Physical assessment findings in anorexia nervosa?

Answer 2

Muscle wasting, hair loss 
Lanugo hair
Cold, blue peripheries
Dry skin 
Hypercarotenemia
Bradycardia
Hypotension 
Bruising

Question 3

Psychological assessment in anorexia nervosa `

Answer 3

Depression
OCD
Substance misuse
Diabetes mellitus

Question 4

Risk assessment for a high risk individual with anorexia nervosa?

Answer 4

BMI <13.0 
Wt loss >1kg/week 
Prolonged QT, HR <40, Syst. BP <80
Core temp <34
Unable to rise from squat without using arms for leverage
Cognitive impairement

Question 5

What investigations should be performed when to aid with the diagnosis and risk assessment of anorexia nervosa?

Answer 5

Haematology
Biocehm
ECG
DXA

Question 6

What is refeeding syndrome?

Answer 6

Caused by depletion of already inadequate stores of nutrients e.g. magnesium, potassium and phosphate which are quickly used up as the body start to repair itself

Question 7

How can you prevent refeeding syndrome?

Answer 7

Frequent blood monitoring

Slow pace of initial refeeding

Question 8

What is MARSIPAN?

Answer 8

Management of really sick patients with anorexia nervosa

Question 9

What psychological management is offered for anorexia nervosa?

Answer 9

Psychological therapies; CBT
Dietitian
Medical monitoring
Art therapy/ drama therapy
Family therapy
Inpatient treatment for high risk

Question 10

What are the implications for the MHA in anorexia?

Answer 10

Assess capacity
Assess risk
Assess reciprocity
Need for artificial feeding

Question 11

ICD-10 diagnostic criteria for bulimia nervosa

Answer 11

Persistent preoccupation with eating
Irresistible craving for food
Binges
Attempts to counter the effects of binges; starvation, vomiting, laxatives, drug misuse
Morbid dread of fatness

Question 12

What can be seen on physical assessment of bulimia nervosa?

Answer 12

Russell’s sign; calluses on knuckles
Parotid hypertrophy
Dental caries
U+Es

Question 13

What can be seen on psychological assessment of bulimia nervosa?

Answer 13

Depression
Self-harm
Substance misuse
Impulse personality

Question 14

Medical complications of bulimia nervorsa

Answer 14

Oesophageal reflux
Oesophageal tears/ rupture
Hypokalaemia
Subconjunctival haemorrhage
Dehydration 
Seizures; metabolic abnormalities

Question 15

Management of bulimia nervosa?

Answer 15

Guided self help
CBT
SSRI