anorexia and bulimia

Question 1

What are some common features of Anorexia Nervosa and Bulimia?

Answer 1

Dysfunctional eating patterns
Underlying psychosocial issues
Low self-esteem
Depression
Family dynamics
Body image disturbance
Weight changes/fluctuations

Question 2

What are the three DSM-5 criteria for anorexia?

Answer 2

Restriction of energy intake
Intense fear of weight gain even though underweight
Distortion in body weight/shape experience

Question 3

Large amount of food intake in a short amount of time (less than 2 hours) with loss of control

Answer 3

Definition of binge eating

Question 4

What is DSM-5 criteria for bulimia?

Answer 4

Cycles of binge eating
Recurrent inappropriate compensatory behaviors to prevent weight gain
Frequency of episodes: one time per week

Question 5

Eating disorders primarily affect males or females?

Answer 5

Females

***More than 90 percent female; 95 percent Caucasian

Question 6

In regards to eating disorders, athletes, diabetics, and obese adolescents are at an increased or decreased risk?

Answer 6

Increased risk

Question 7

Peak onset for anorexia is between ______ and _____ years

Answer 7

15-19

Question 8

Peak onset for bulimia is between ______ and _______ years.

Answer 8

18 and 23 years

**Bulimia may arise out of anorexia

Question 9

BMI below _______ indicates anorexia?

Answer 9

below 17.5%

Question 10

What are some symptoms or conditions you can see in an individual with an eating disorder?

Answer 10

Dizziness, blackout, weakness
Pallor, easy bruising
Cold intolerance
Hair loss, dry skin
Vomiting, diarrhea, bloating, abdominal pain
Muscle cramps, joint pains, chest pains
Menstrual irregularities

Question 11

If a patient presents with the following symptoms (clues) which eating disorder am I? Anorexia or bulimia
Rapid/severe weight loss
Dieting, taboo foods, calorie counting
Excessive exercise
Focus on body image
Symptoms such as weakness or fatigue

Answer 11

anorexia

Question 12

What three cardiac conditions can be seen in a patient with anorexia?

Answer 12

bradycardia
arrhythmias (EKG abnormalities)
mitral valve prolapse
*** can also see hypotension and syncope

Question 13

What GI complications are seen in patients with eating disorders?

Answer 13

Hypomotility/constipation
Abdominal pain
Elevated liver enzymes

Question 14

What are some Musculoskeletal Complications seen with anorexia?

Answer 14

Muscle wasting
Loss of sub-Q fat tissue
Low weight
Low body mass index and low bone density
Pathologic/stress fractures

Question 15

What are some Neurological Complications seen with anorexia?

Answer 15

Seizures
Cognitive and memory dysfunction
Depression
Anxiety
Abnormal EEG

Question 16

What are some Hematologic Complications seen with anorexia?

Answer 16

Easy bruising
Leukopenia
Anemia
Thrombocytopenia

Question 17

What are some routine lab tests to do if you suspect an eating disorder?

Answer 17

CBC with differential
Sed rate
Electrolytes ( especially if frequent vomiting)
Urine, serum protein, and albumin

Question 18

Hemoglobin and BUN can be falsely __________ due to dehydration

Answer 18

elevated

Question 19

What happens to potassium if patient is vomiting frequently?

Answer 19

hypokalemia

Question 20

Cholesterol will increase or decrease if patient is severely underweight?

Answer 20

Increase

Question 21

What is one of the most dangerous complications of anorexia?

Answer 21

Refeeding Syndrome

Question 22

With refeeding syndrome sudden high caloric intake leads to possibility of ____________.

Answer 22

heart failure

Question 23

How do you prevent refeeding syndrome from occurring?

Answer 23

Prevented by refeeding patient slowly
Start with 500 calories above what patient’s taking
Add 200–300 calories every three to four days

Question 24

What are some indications that the patient needs to be hospitalized?

Answer 24

Blood pressure below 85/50
Severe malnutrition
Dehydration
Electrolyte imbalances
EKG abnormalities
Sinus bradycardia
Suicidality

Question 25

Help patient regain and maintain adequate weight equivalent to BMI of at least ________.

Answer 25

16 or above

Question 26

What are some manifestations seen in patients with bulimia?

Answer 26

Weight cycles (gain/loss)
Trips to bathroom after meals
Vomiting, laxatives, enemas, and excessive exercise

Question 27

What are some physical signs seen in patients with bulimia?

Answer 27

Russell's sign
Parotid swelling
Loss of dental enamel
Gastroesophageal reflux disease (GERD)
Constipation

Question 28

What is Russell’s sign?

Answer 28

calluses or scars on backs of hands from inducing vomiting

Question 29

Mean duration of behavior of bulimia before diagnosis is __________.

Answer 29

6 years

Question 30

What EKG abnormalities are seen with bulimia?

Answer 30

QTc prolongation

Question 31

What are some comorbidities seen frequently in bulimia patients?

Answer 31

Majority of bulimics meet criteria for at least one personality disorder
Obsessive compulsive disorder (OCD)
Borderline personality disorder
Depression
History of high substance abuse rate
History of sexual conflicts, impulsive behaviors, promiscuity, and self-mutilation

Question 32

What are some comorbidities seen frequently in bulimia patients?

Answer 32

Majority of bulimics meet criteria for at least one personality disorder
Obsessive compulsive disorder (OCD)
Borderline personality disorder
Depression
History of high substance abuse rate
History of sexual conflicts, impulsive behaviors, promiscuity, and self-mutilation

Question 33

What lab results would likely be seen in a bulimic patient?

Answer 33

Electrolytes: purging of any kind can cause fluid and electrolyte imbalance
Low calcium (hypocalcemia)
Low sodium (hyponatremia)
Low chloride (hypochloremia)
Loss of stomach acid from vomiting can produce a metabolic acidosis

Question 34

Serum electrolyte screening panel combined with exam of teeth, hands, and salivary glands can detect up to ____ of normal weight bulimics

Answer 34

85%

Question 35

What is first line medication treatment with bulimia?

Answer 35

SSRI