Paeds MH

Question 1

What resilience factors should you enquire about?

Answer 1

1. time spent together as family incl. meals eaten
2. regular exercise
3. sleep
4. absence of bullying

Question 2

What are the diagnostic criteria of anorexia nervosa?

Answer 2

1. Self-induced W/L <17.5 BMI
2. Distorted perception of own body, which increases with w/L
3. Determined attempt to lose weight or avoid gain
   
   1. calorie restricting
   2. vomiting
   3. laxatives
   4. exercising
   5. combination
4. reversal or halt of puberty
5. control → ↑self worth / efficacy
6. dreams of food /cooking
7. benefits of disease - e.g. uniting parents

+ perfectionism

Question 3

What are the examination findings of anorexia?

Answer 3

Inspection:

• Lanugo hair
• Emaciation

Low metabolic rate:

• ↓CRT peripherally
• slow to relax tendon reflexes
• bradycardia
• amenorrhea

Question 4

What conditions can cause rapid weight loss in adolescents?

Answer 4

• GI:
  
  • Coeliac disease
  • IBD
  • Oesphageal problems eg achalasia
• Metabolic:
  
  • Type 1 DM
  • Hyperthyroidism ↑↑
  • Addisons
• Psych:
  
  • Anorexia nervosa
  • Severe depression/OCD/autism
• Malignancy
• Juvenile arthritis

Question 5

what is the most common deficiency in “refeeding syndrome”?

why does this deficiency occur

Answer 5

hypophoshatemia

due to sudden reintroduction of glucose into blood, insulin drives glucose into cells which then require phosphate to use glucose / make ATP, so pull all the phosphate from the blood into the cells

Question 6

What vitimins should be given to prevent refeeding syndrome?

Answer 6

thiamine, Vitamin B complex and multivitamins

Question 7

What is the mortality of anorexia nervosa due to?

Answer 7

1. suicide
2. chronic emaciation
3. cardiac arrhythmias