Flashcards in Adolescent Deck (60)
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.
Age of consent to sexual activity in Canada?
16 years old
Side effects of anabolic steroids?
decreased endogenous testosterone production (due to exogenous testosterone) resulting in gynecomastia, testicular atrophy, decreased libido
What ADHD medications have low abuse potential?
Intuniv (long-acting guanfacine)
What is guarana?
"natural" caffeine product in energy drinks
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
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
Clinical signs of bulimia nervosa
1. Russell’s sign (calluses on dorsum of hand)
2. Dental enamel erosion
3. Parotid gland enlargement
5. Fluctuating weight (healthy/overweight)
What lab test is diagnostic for bulimia?
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
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
Hallmark electrolyte abnormality of refeeding syndrome
What metabolic abnormality do you see with vomiting?
hypokalemia, metabolic alkalosis
What metabolic abnormality do you see with laxative abuse?
hypokalemia, metabolic acidosis (non-anion gap)
– Compression of 3rd portion of duodenum by abdominal aorta & overlying superior mesenteric artery
– Due to lack of retroperitoneal fat - cushions duodenum
Factors contributing to osteoporosis in eating disorders
–Poor nutrition (protein, Vit. D, calcium)
–Amenorrhea (low estrogen)
Hematologic abnormalities associated with ED?
indications for hospitalization in ED?
•Weight ≤75%-80% expected
–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
Management of ED
family based therapy
Female athlete triad in ED
2. Decreased BMD
3. Disordered eating
When can you give contraception after an abortion?
What is gonorrhea?
An intracellular diplococcus
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)
Sequelae of gonorrhea in males?
Epididymo-orchitis, reactive arthritis, infertility (rare), DGI
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
which is more common, chlamydia or gonorrhea?
how do you make the diagnosis of chlamydia?
(culture for medico-legal issues)
Azithromycin 1 gm single dose
Doxycycline 100 mg bid x 7d
what is primary HSV?
first clinically evident episode in a patient seronegative for antibody to HSV-1 or HSV-2