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Primary care II > Eating disorder/weight loss > Flashcards

Eating disorder/weight loss Flashcards

1
Q

1 cause of death in anorexia:

anorexia

premature death increase by ____ fold increase

A

10 fold increase

suicide #1 cause

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2
Q

Percentage men with eating disorder

A

10%

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3
Q

higher rates of ED occur in….

A

1st degree relative with ED
Identical twins
bulimia- more likely to have family hx of substance abuse

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4
Q

Dx anorexia

A

1) restriction of energy intake
2) fear of fat or verbalization or behaviors that interfere with maintenance of healthy weight
3) body image disturbance, body/self evaluation OR denial

no purging in last 3 months

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5
Q

restricting subtype of anorexia dx

A

has not purged within last 3 months

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6
Q

anorexia body weight percentage

A

85% of what is expected

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7
Q

BN body weight

A

maintain weight

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8
Q

dx bulimia

A

recurrent episodes of binge (eating large amount AND loss of control)

prevent weight gain via vomiting, laxatives

binge eating once a week***x 3 months

self esteem assoc. with weight

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9
Q

new proposed diagnostic criteria for binge eating disorder

A

eat rapidly, uncomfortably fool, large amounts when not hungry, eat alone, disgust

ONCE A WEEK x 3 months
do not occur exclusively during episodes of anorexia or bulimia***

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10
Q

Binge eating associations

A

depression
impulse control difficulty
family hx

weight fluctuations, HTN, fatigue

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11
Q

Clinical presentation anorexia

A

memory, hair, low bp hr, palpitations, heart failure, anemia, atrophy, swollen joints, osteoporosis, kidney stones failure, electrolyte imbalances (LOW), amenorrhea, infertility, skin

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12
Q

Clinical presentation bulimia

A

facial- swelling of cheeks* parotid swelling
dental cavities
throat and esophagus (tears, rupture)
fatigue
GI- ulcers delayed emptying constipation
Skin- irritated knuckles**, russells sign

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13
Q

PE ED #1 priority

A

detect emergency- cardiac, hypotension

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14
Q

urine and orthostatic should be done at ___

A

every visit, specific gravity for water loading

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15
Q

amylase often _____

A

elevated

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16
Q

do patients with ED report physical symptoms?

A

generally no- denial

report doesnt match evidence

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17
Q

considerations when taking weight

A

use same scale

johnnie only

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18
Q

BMI less than ___ is underweight

A

18.5

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19
Q

BMI guidelines

A

Mild 17+
Mod 16-17
Severe 15-16
Extreme 15

18.5-25 normal

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20
Q

heart rate anorexia

A

bradycardia

can be tachycardia if dehydrated

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21
Q

temporal wasting often seen in _____

A

anorexia

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22
Q

medical complications anorexia

A 
growth 
cardiac- arrest, atrophy, increased PR, first degree heart block 
endocrine- osteoporosis fractures 
renal/electrolyte
pulmonary- wasting, respiratory failure 
low white cells, thrombocytopenia
23
Q

Bulimia complications most common and associated dx

A

GI***

  • esophageal dismotility
  • loss gag reflex
  • reflux
  • parotid submandibular swelling
  • bloody vomit
  • mallory weis (es. tears)
  • esophageal ruptures (boerhaaves)
  • barrets esophagus
24
Q

GI continued BN

A

pancreatitis

25
Q

BN other physical presentation

lab finding

A

skin- russels sign, xerosis, acne
enamel

hypo everything

metabolic alkalosis

26
Q

BN ipecac causes

A

myopathy

27
Q

Dx labs for ED

A 
CBC D K anemia bun cr 
ca phos mg glucose
LFT 
amylase, alk phos, TSH
urine- ketone level, kidney, specific gravity
echo for cardiomyopathy
?bone density, head CT
28
Q

differential for ED

A 
AIDS 
tumor 
Hyperthyroid, diabetes
IBD, PUD, malabsorption 
Cancer 
Adrenal insufficiency 
Other mental health d/o
29
Q

key in treating ED patients

A

patience

30
Q

hospital criteria

A 
<75% ideal weight 
electrolyte 
arrhythmia 
HR,40 
hypothermia <36c
low BP SBP <80
uncontrollable pinge burge
31
Q

Unintentional weight loss definition

A

weight loss 5% or more in past 30 days
or
greater than 10% in last 6 months

32
Q

consequences Unintentional weight loss

A

depression
immunocompetence decreased
muscle wasting
complications

33
Q

correlation between weight loss and mortality in older adult?

A

HIGH CORRELATION, 5% loss in one month may die within 1 year

34
Q

changes from Unintentional weight loss

A 
taste/smell
dentition
dec. saliva 
slower GI (not as hungry)
inactivity
35
Q

anorexia def.

A

generalized loss apettite

36
Q

cachexia def.

A

muscle wasting

37
Q

sarcopenia def.

A

deg. loss of skeletal muscle mass

38
Q

satiety def.

A

how quickly getting full

39
Q

Def frail adult criteria

A

NEED 3:

  • > 10 lb in year
  • exhaustion
  • slow movement
  • low activity level (<270 kcal/week)
  • weakness
40
Q

nursing home weight loss criteria for medicare/medicaid

A

MDS

MMQ

41
Q

Evaluation Unintentional weight loss

A

-hx from caregiver
-distinguish cause
anorexia
difficulty swallowing
socioeconomic
weight loss despite intake

42
Q

Treatable causes Unintentional weight loss acronym

A 
Meals on wheels 
m-meds
e-emotion
a-anorexia
l-late life paranoia 
s-swallowing
o-oral
n-no money
w- wandering, dementia
h- thyroid parathyoid 
e- enteric 
e-eating problems (cant feed self) 
L-low salt, low cholesterol diet
43
Q

PE Unintentional weight loss, findings

A
  • cheilosis
  • glossitis
  • dental
  • tenderness
  • hepatosplenomegaly
  • cognitive/neuro
  • temporal muscle wasting
  • spider nevi, gynecomastia associated with liver
  • parotid enlargement- ETOH
  • testicular atrophy
  • ascites
  • bulging flank
  • right sided HF
  • murphys sign- cholecystitis
  • jaundice
44
Q

BMI underweight

A

less than 18.5

normal 18.5-25

45
Q

meds Unintentional weight loss

A

lisinopril
lasix
wellbutrin
digoxin

46
Q

Labs Unintentional weight loss

A 
comp panel CBC 
TSH
Prealbumin 
glucose 
renal fx 
u/a
orthostatic
EKG
Colonoscopy?
47
Q

Albumin vs. prealbumin

A

total- albumin and globulin in blood
albumin- plasma binding protein, reflects overall nutritional status
prealbumin- plasma by liver, shows nutrition in last week** better reflection of intake

48
Q

better reflection of intake (lab value)

A

pre-albumin

49
Q

overall nutrition status (lab value)

A

albumin

50
Q

Protein calorie malnutrition ranges Unintentional weight loss

A 
albumin <3.4 
10% Unintentional weight loss 6 months 
5% in one month 
BMI <18.5
poor nutrition, loss appetite, wasting
51
Q

Appetite stimulants for Unintentional weight loss

A 
consider risk vs benefit 
Megestrol/marinol 
Megace- increase thromboembolic fluid imbalance, mortality, constipation, delirium 
remeron
Peractin- anticholinergic
52
Q

PEG and dementia?

A

unfavorable

53
Q

encourage what documents for Unintentional weight loss

A

MOLST (pt preferences treatments), advanced directive

54
Q

palliative performance scale

A

help outline where patient is at

Primary care II (13 decks)

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