6: Eating disorders

Question 1

What are the two most common eating disorders?

Answer 1

Anorexia nervosa

Bulimia nervosa

Question 2

What are the five ICD-10 criteria for anorexia nervosa?

Answer 2

BMI < 17.5

Self-induced weight loss

Body image disturbance

Fear of fatness

Amenorrhoea

Question 3

A BMI below what is diagnostic of anorexia?

Answer 3

17.5

Question 4

How do anorexic patients behave re: food portions?

Answer 4

Obsession with portion sizes

Portion sizes themselves are tiny

Question 5

How do anorexic patients encourage their own weight loss?

Answer 5

Overexercise

Self-induced vomiting

Laxatives

Question 6

Anorexic patients obsess over their ___ ___.

Answer 6

body weight

Question 7

What are some of the physical features of anorexia nervosa?

Answer 7

Significant weight loss and muscle atrophy

Dry skin

Lanugo hair

Swollen salivary glands

Question 8

Why do patients with anorexia develop dry, cracked skin?

Answer 8

Dehydration

Question 9

What is lanugo hair?

Which disease does it present in?

Answer 9

Fine, soft, unpigmented hair which sheds - usually seen in newborns

Anorexia nervosa

Question 10

Patients with anorexia often present with jaundice - true or false?

Answer 10

Yellow skin pigmentation

but NOT jaundice

Question 11

Which pigment is responsible for yellow skin decolouration seen in anorexia nervosa?

Answer 11

Beta-carotene

Hypercarotenaemia

Question 12

Why do some anorexic patients present with hypercarotenaemia?

Answer 12

Excess of beta carotene

Diet consisting of excess veg

Question 13

Which bilateral structures hypertrophy in anorexia nervosa?

Answer 13

Parotid and submandibular glands

Question 14

The physical features of anorexia nervosa are

widespread ___

___ skin

___ hair

hypertrophy of the ___ glands.

Answer 14

widespread atrophy

dry skin

lanugo hair

hypertrophy of the salivary glands

Question 15

Eating disorders often co-exist or precipitate other psychiatric conditions. Can you name some?

Answer 15

Mood disorders - depression, bipolar

Anxiety - e.g OCD

Psychosis

Question 16

Which chronic disease may anorexic patients mismanage on purpose to lose weight?

Answer 16

Diabetes mellitus

Patients may omit insulin injections to lose weight (hyperglycaemia)

Question 17

A BMI < ___ or rapid weight loss are red flags for poorly managed anorexia nervosa.

Answer 17

BMI < 13

Rapid weight loss

Question 18

Which arrhythmia may anorexic patients develop?

Answer 18

Prolonged QT interval

Question 19

As muscles atrophy in anorexia nervosa, they become weaker.

How is muscle weakness assessed?

Answer 19

Sit up squat stand test

Some patients won’t be able to do it

Question 20

What investigations should you ask for in anorexic patients and why?

Answer 20

FBC - anaemia

U&Es - electrolyte abnormalities

ECG - arrhythmias

LFTs - hepatocellular autophagy in starvation

DEXA scan - osteopenia/porosis

Question 21

Which test is used to assess muscle weakness in anorexia nervosa?

Answer 21

Sit up squat stand test (SUSS)

Question 22

Patients with extreme anorexia nervosa may present with ___ impairment.

Answer 22

cognitive impairment

Question 23

What is an extreme form of electrolyte imbalance which may be seen when managing an anorexic patient?

Answer 23

Refeeding syndrome

Question 24

How is refeeding syndrome avoided?

Answer 24

Feed patient slowly

Monitor their U&Es closely

Question 25

Can a patient with an eating disorder be **detained** against their will?

Answer 25

**Yes, under the MHA** (anorexia and bulimia are classed as mental disorders) ## Footnote **If that patient is posing significant risk to themselves**

Question 26

Which **guidelines** explain how to manage **anorexia nervosa**?

Answer 26

**MARSIPAN guidelines**

Question 27

Which **AHP** has a crucial role in the management of patients with anorexia?

Answer 27

**Dietician**

Question 28

What are the **five ICD-10** **criteria** for diagnosing **bulimia nervosa**?

Answer 28

**Persistent preoccupation with food** **Irresistible food cravings** **Binges** **Compensatory behaviour (starving, overexercise, purging)** **Fear of fatness**

Question 29

What is **Russell's sign**?

Answer 29

**Callused knuckles** caused by self-induced vomiting

Question 30

Which structures **hypertrophy** in both anorexia and bulimia?

Answer 30

**Parotid and submandibular glands**

Question 31

Which **electrolyte disturbance** is caused by **repeated vomiting?**

Answer 31

**Hypokalaemia**

Question 32

The management of **bulimia nervosa** is largely the same as that of anorexia (psychological therapy, AHP input). Which **class** of drug can be given to patients to help reduce **food cravings**?

Answer 32

**SSRIs**