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Flashcards in Adolescent Deck (60)
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1

DSM-5 criteria for bulimia nervosa?

• Recurrent episodes of binge eating characterized by BOTH of the following:
o Eating in a discrete amount of time (within a 2 hour period) large amounts of food.
o Sense of lack of control over eating during an episode.

• Recurrent inappropriate compensatory behavior in order to prevent weight gain (purging).

• The binge eating and compensatory behaviors both occur, on average, at least once a week for three months.

• Self-evaluation is unduly influenced by body shape and weight.

• The disturbance does not occur exclusively during episodes of anorexia nervosa.

2

Age of consent to sexual activity in Canada?

16 years old

3

Side effects of anabolic steroids?

decreased endogenous testosterone production (due to exogenous testosterone) resulting in gynecomastia, testicular atrophy, decreased libido

4

What ADHD medications have low abuse potential?

Strattera
Intuniv (long-acting guanfacine)
Vyvance
Concerta

5

What is guarana?

"natural" caffeine product in energy drinks

6

DSM-V criteria for anorexia nervosa

1. Restriction of energy intake relative to requirements, leading to significantly low body weight in context of age, sex, development

2. Intense fear of gaining weight or persistent behaviour that interferes with weight gain

3. Disturbance in way in which one’s body weight/shape is experienced, or undue influence of body weight/shape on self-evaluation, or denial of seriousness of current low weight

7

DSM-V Bulimia Nervosa

1. Recurrent episodes of binge eating

2. Recurrent inappropriate compensatory behaviours in order to prevent weight gain

3. Binge eating and inappropriate compensatory behaviours both occur, on average, once a week for 3 months

4. Self-evaluation unduly influenced by body weight and shape

5. Disturbance not exclusively during episode of AN

8

Clinical signs of bulimia nervosa

1. Russell’s sign (calluses on dorsum of hand)

2. Dental enamel erosion

3. Parotid gland enlargement

4. Edema

5. Fluctuating weight (healthy/overweight)

9

What lab test is diagnostic for bulimia?

elevated amylase

10

DSM-V criteria for binge eating disorder

1. Recurrent episodes of binge eating

2. Binge-eating episodes associated with at least 3 of:
- Eating more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts of food when not feeling physically hungry
- Eating alone out of embarrassment at volume eating
- Feeling disgusted with oneself, guilty, or depressed after eating

3. Marked distress regarding binge eating present

4. Binge eating occurs on average at least 1x/wk x 3 months

5. No compensatory behaviours, no BN or AN

11

Risk factors for refeeding syndrome

– Low weight (less than 70% of IBW)
– Rapid weight loss
– Low levels of phosphate, potassium or magnesium prior to refeeding
– Limited nutritional intake for 5-10 days preceding refeeding

12

Hallmark electrolyte abnormality of refeeding syndrome

hypophosphatemia

13

What metabolic abnormality do you see with vomiting?

hypokalemia, metabolic alkalosis

14

What metabolic abnormality do you see with laxative abuse?

hypokalemia, metabolic acidosis (non-anion gap)

15

SMA syndrome

– Compression of 3rd portion of duodenum by abdominal aorta & overlying superior mesenteric artery
– Due to lack of retroperitoneal fat - cushions duodenum

16

Factors contributing to osteoporosis in eating disorders

–Poor nutrition (protein, Vit. D, calcium)
–Amenorrhea (low estrogen)
–High cortisol
–Low IGF-1

17

Hematologic abnormalities associated with ED?

anemia
leukopenia
thrombocytopenia

18

indications for hospitalization in ED?

•Weight ≤75%-80% expected
•Dehydration
•Electrolyte disturbance
•Cardiac dysrhythmia
•Physiologic instability
–HR<50, BP<80/50, T<36, extreme orthostatic changes (HR change >35 bpm, BP change > 20 mmHg)
•Acute food refusal
•Uncontrollable binging and purging
•Suicidal ideation

19

Management of ED

family based therapy

20

Female athlete triad in ED

1. Amenorrhea
2. Decreased BMD
3. Disordered eating

21

When can you give contraception after an abortion?

immediately!

22

What is gonorrhea?

An intracellular diplococcus

23

Sequelae of gonorrhea in females?

–PID, infertility, ectopic pregnancy, chronic pelvic pain, perihepatitis (Fitzhugh Curtis Syndrome), reactive arthritis (more common with chlamydia), disseminated GC infection (DGI)

24

Sequelae of gonorrhea in males?

Epididymo-orchitis, reactive arthritis, infertility (rare), DGI

25

gonorrhea treatment

Cefixime (Suprax) 800 mg po single dose OR Ceftriaxone 250mg IM single dose
+
Azithromycin 1gm PO single dose OR
Doxycycline 100mg PO bid x 7 days

26

which is more common, chlamydia or gonorrhea?

chlamydia

27

how do you make the diagnosis of chlamydia?

NAAT
(culture for medico-legal issues)

28

chlamydia treatment

Azithromycin 1 gm single dose
or
Doxycycline 100 mg bid x 7d

29

what is primary HSV?

first clinically evident episode in a patient seronegative for antibody to HSV-1 or HSV-2

30

what is non-primary first episode HSV?

First clinically evident episode in a person who, by testing, is demonstrated to have pre-existing heterologous antibody (ie. first outbreak HSV2 in patient with Ab for HSV1)