Eating disorders

Question 1

anorexia nervosa clinical features

Answer 1

BMI<18.5
intense fear of weight gain
distorted views of body weight and shape

Question 2

treatment of anorexia nervosa

Answer 2

cognitive behavioral therapy (individual, family or group and with motivational interviewing, family therapy, psychodynamic psychotherapy)
nutritional rehab
olanzapine if no response to above

Question 3

bulimia nervosa clinical features

Answer 3

recurrent episodes of binge eating
binge eating followed by inappropriate compensatory behavior to prevent weight gain
excessive worry about body shape and weight

Question 4

treatment of bulimia nervosa

Answer 4

cognitive behavioral therapy
nutritional rehab
SSRI medication often in combo with above

Question 5

can we use antidepressant bupropion for anorexia nervosa

Answer 5

no because of increased risk for seizures.

Question 6

when to hospitalize for anorexia nervosa

Answer 6

bradycardia <40 or dysrhythmia
hypotension <80/60 or orthostasis
hypothermia <35
electrolyte disturbance and marked dehydration
organ compromise (renal, hepatic, cardiac
<70% of expected weight BMI <15

Question 7

what is seen with low body weight and anorexia nervosa?

Answer 7

see lanugo hair - fine small hairs

Question 8

what are the cardiac complications of anorexia nervosa?

Answer 8

see cardiomyopathy, cardiac atrophy, arrhythmia, respiratory failure and seizures from lack of nutrients or from electrolyte abnormalities and fluid imbalances.

Question 9

difference in treatment between anorexia nervosa and bulimia nervosa?

Answer 9

anorexia - treat with olanzapine

bulimia treat with SSRI

Question 10

Recurrent binge eating is seen with self induced vomiting and calorie restriction is seen with

Answer 10

bulimia nervosa

Pt is in normal weight range or above normal weight

Question 11

difference between bulimia nervosa and anorexia nervosa

Answer 11

bulimia pts have normal weight or above normal weight.

bulimia - treat with SSRI

anorexia - treat with olanzapine (can’t rationalize behavior and are crazy b/c fundamentally think they are fat - need anti-psychotic)

Question 12

things that contribute to bulimia nervosa

Answer 12

lowself esteem, interpersonal stressors (conflicts or tension in social relationships)
feelings of dysphoria and poor self esteem related to body image.

Question 13

treatment of bulimia nervosa

Answer 13

nutritional rehab- develop a structured consistent meal plan
cognitive behavioral therapy
SSRI - fluoxetine has the best evidence - they can rationalize behavior

combination of therapy is the best than one component alone.

Question 14

Can we give bupropion in pts who have bulimia?

Answer 14

no it’s contraindicated due to risk of seizures

Question 15

binge eating disorder

Answer 15

repetitive episodes of binge eating but has no inappropriate compensatory behaviors seen with bulimia nervosa

Question 16

difference between binge eating and bulimia nervosa

Answer 16

bulimia nervosa - inappropriate compensatory behavior

binge eating - just eat a lot

Question 17

labs associated with bulimia nervosa?

Answer 17

see hypokalemia, hypochloremia, metabolic alkalosis
erosion of dental enamel and see parotid hypertrophy

some can also misuse laxatives, enemas, diuretics, diet pills, fasting, and excessive exercise to control weight.

Question 18

see loss of control with eating and consume large amounts of food in short amounts of time

Answer 18

bulimia

Question 19

binge-eating/purging subtype of anorexia nervosa VS bulmia nervosa?

Answer 19

difference is weight

they have the same behaviors but anorexia nervosa will have BMI<18.5

bulmics will have BMI that is normal .

Question 20

body dysmophic disorder is

Answer 20

intense preoccupation with perceived defect in physical appearance.

Question 21

bulimia will have

Answer 21

bilateral parotid gland hypertrophy and mild electrolyte abnormalities (hypokalemia and elevation of serum bicarbonate and decreased serum chloride levels)

look for oropharyngeal ulcers, erosion of dental enamel and scars and calluses on back of hand.

Question 22

how to start feeding an anorexic pt who is hospitalized?

Answer 22

supervised oral intake of 800 daily

need to be supervised because they will try to restrict without supervision

risk for refeeding syndrome and hypophosphotemia.