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ED Flashcards

1
Q

What are the main characteristic features of bulimia?

A
  • persistent preoccupation with eating and irresistible cravings for food
  • episodes of overeating in which large amounts of food are consumed in short periods
  • efforts made to counteract by: self-induced vomiting, purgative abuse, periods of starving, use of drugs
  • morbid dread of fatness
  • patients set weight threshold below healthy weight
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2
Q

What is Atypical anorexia nervosa?

A

Atypical anorexia nervosa is the term used for those individuals in whom one or more of the key features of anorexia nervosa, such as amenorrhoea or significant weight loss, is absent but who otherwise present a fairly typical clinical picture

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3
Q

The most likely electrolyte abnormality of refeeding a grossly anorexic patient in a medical ward is?

A

Hypophosphatemia

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4
Q

This is usually normal even in severely malnourished patients in anorexia nervosa

A

Serum albumin levels

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5
Q

Characterisitcs of families of people with anorexia

A
  • Rigidity
  • conflict avoidance
  • overprotection
  • enmeshment
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6
Q

Risk factors for Eating Disroders

A 
female sex
adolescence and early adulthood
western cultural adaptation
family hx of ED, depression
adverse parenting
early menarche (bulimia)
past hx of obesity (bulimia)
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7
Q

physical signs and symptoms of ED

A

constipation, dizziness, amenrrhooea, poor sleep, dry skin, lanugo hairs, parotid swellling, bradycardia, dependent oedema

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8
Q

What is Russell’s sign?

A

calluses on kncukles due to repeated vomit induction

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9
Q

what is perimylolysis?

A

erosion of inner surface of teetch

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10
Q

Endocrine abnormalites in ED

A 
Low LH, FSH, oestradiol
Low T3, but normal T4 and TSH
Severe hypoglycaemia
increase in cortisol
increase in growth hormone
low leptin
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11
Q

cardiovascular abnormalites in ED

A

QTc prolongation
myopathy in ipecac (emetic substance) use
hypotension, arrhythmia, VT
sudden death

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12
Q

gastrointestinal abnormalites in ED

A

delayed gastric emptying

decreased colonic motility

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13
Q

haematological abnormalites in ED

A

normocytic norochromic anaemia
mild leucopenia
thrombocytopaenia

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14
Q

metabolic abnormalites in ED

A

raised cholesterol
raised serum carotene
hypophosphataemia (exaggerated in refeeding)
dehydration
hyponatraemia, hypokalemia, metabolic acidosis

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15
Q

other abnormalites in ED

A 
osteopenia
osteoperosis
enlarged cerebral ventricles
depression
pancreatitis
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16
Q

effects of ED on pregancy

A 
decreased fertility
higher rates of hypermesis gravidarum, anaemia
compromised intrauterine foetal growth
premature delivery more likely
high rates of c-section
low birth weight
low APGAR score
microcephaly
neonate hypoglycaemia
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17
Q

Management of Bulimia

A

self-help programme for 4 weeks
CBT/IPT/family therapy in young people
antidepressants - SSRIs (fluoxetine) first line at high dose BUT NOT ALONE

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18
Q

managment of anorexia

A

Individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
Specialist supportive clinical management (SSCM)

Consider IPT, family therapy (especially in addolescents), psychodymanic psychotherpay

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19
Q

Anorexia nervosa M:F ratio

A

1:9

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20
Q

Bulimia nervosa M:F ratio

A

1:9

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21
Q

Longterm prognosis of anorexia

A

Half recovered completely
A third recovered partially
20% had a chronic eating disorder
5% dies

22
Q

Poor prognostic factors for anorexia

A 
Patients with a long duration of hospital care
Psychiatric co-morbidity
Being adopted
Growing up in a one-parent household
Having a young mother
Lower minimum weight
Poor family relationships
Failed treatment
Late age of onset
Social problems
23
Q

High risk features in anorexia that suggest admission to hospital

A 
BMI < 13
Pulse < 40bpm
SUSS test < 2*
Sodium < 130 mmol/L
Potassium < 3 mmol/L
Serum glucose < 3 mmol/L
QTc > 450 ms
24
Q

What is the SUSS test?

A

*The SUSS test (sit up squat stand test)

In the SUSS Test, the patient is asked to sit up from lying supine on a flat surface without using
the hands, if possible. They are then asked to squat and to rise without using the hands, if possible.

0 completely unable to rise
1 able to rise only with use of hands
2 able to rise with noticeable difficulty
3 able to rise without difficulty

25
Q

Diagnostic criteria for anorexia according to DSM V

A
  • Restriction of energy intake relative to requirements, leading to a significantly low body weight (generally speaking a BMI < 18.5)
  • Intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain, even though at a significantly low weight (the intense fear is not usually alleviated by weight loss)
  • Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
26
Q

Two divisions of anorexia

A

a) Restricting type (weight loss attained through diet, fasting and exercise alone – in previous 3 months)
b) Binge eating / purging type (in previous 3 months has purged or engaged in binge eating)

27
Q

Criteria for rating severity of anorexia

A 
Mild = BMI > 17
Moderate = BMI 16 – 16.99
Severe = BMI 15 – 15.99
Extreme = BMI < 15
28
Q

The 12-month prevalence of anorexia in females?

A

The 12-month prevalence in females is approx. 0.4%.

29
Q

What score on SCOFF questionnaire indicates likely bulimia or anorexia?

A

2 or more
84.6% sensitivity and 98.6% specificity
NPV 99.3%

30
Q

SCOFF quetionnaire

A

Do you ever make yourself Sick because you feel uncomfortably full?
Do you ever worry that you have lost Control over how much you eat?
Have you recently lost more than One stone in a three month period?
Do you believe yourself to be Fat when others say you are too thin?
Would you say Food dominates you life?

31
Q

Risk factors for bulimia

A 
Childhood sexual abuse
Male homosexuality
Having an occupation that focuses on weight
Low self-esteem
Female gender
32
Q

estimated prevalence of bulimia

A

2-3%

33
Q

Managent of Binge eating

A
  1. self-help

2. CBT (group)

34
Q

When to consider a bone mineral density?

A

after 2 years of underweight in adults, or earlier if they have bone pain or recurrent fractures

fter 1 year of underweight in children and young people, or earlier if they have bone pain or recurrent fractures

35
Q

How does vomiting affect electrolytes?

A

sodium - may be increased, decreased or normal
potassium - decreased
chloride - decreased
pH - increased

36
Q

How does laxative use affect electrolytes?

A

sodium - may be increased or normal
potassium - decreased
chloride - increased or decreased
pH - increased or decreased

37
Q

How do diuertics affect electrolytes?

A

sodium - may be decreased or normal
potassium - decreased
chloride - decreased
pH - increased

38
Q

Whath happens to phosphate levels in ED?

A

raised in bulimia

reduced in anorexia

39
Q

When is Metabolic alkalosis seen in bullimia?

A

if induced vomiting is main method

40
Q

When is Metabolic acidosis seen in bullimia?

A

if purging is main method

41
Q

What is the most common comorbid illness in those with anorexia nervosa?

A

Depression

42
Q

What is a positive prognostic factor for anorexia?

A

young age

43
Q

Use of ipecac in patients with eating disorders is associated with?

A

Cardiomyopathy

44
Q

The hormone cholecystokinin offers a theoretical treatment for which condition?

A

Bulimia

45
Q

% people with binge eating disorder that are male

A

25%

46
Q

Bloods in refeeding syndrome

A

Hyponatraemia, Hypokalemia

47
Q

Anorexia nervosa in adulthood is most commonly associated with which mental disorder

A

Anxiety disorders

48
Q

Common cardiac problem in anorexia?

A

Congestive heart failure

49
Q

Who is credited with developing an enhanced form of CBT used for eating disorders?

A

Fairburn

50
Q

How long should psychological therapy in BDD continue to avoid relapse?

A

12 months

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