Eating disorders

Question 1

what is the criteria for diagnosis anorexia nervosa according to ICD-10

Answer 1

BMI < 17.5 or (< 15% of expected)
self induced weight loss e.g. starvation, excessive exercising, vomiting
body image disturbance
fear of fatness
amenorrhoea

Question 2

when is anorexia nervosa most commonly seen

Answer 2

teen girls

Question 3

what is the most common cause of death in anorexia nervosa

Answer 3

cardiovascular complications

Question 4

what are some common co-morbidities with anorexia nervosa

Answer 4

depression
OCD
substance misuse
diabetes

Question 5

what are some s/s of anorexia nervosa

Answer 5

appearance - bruising, hypercarotenemia, blue cold peripheries, muscle wasting, dry skin, lanugo hair,
cognitive - reduced concentration, poor sleep, depression
bradycardia and hypotension
cold sensitivity
amenorrhoea

Question 6

what is an oral complication of anorexia nervosa

Answer 6

dental caries

Question 7

what are some cardiovascular complications of anorexia nervosa

Answer 7

hypotension
bradycardia
QT prolongation

Question 8

what are some GI complications of anorexia nervosa

Answer 8

delayed gastric emptying

bloating

Question 9

what are some derm complications of anorexia nervosa

Answer 9

dry skin
hair loss
lanugo hair

Question 10

what are some neuro complications of anorexia nervosa

Answer 10

peripheral neuropathy

cognitive impairment

Question 11

what are some endocrine complications of anorexia nervosa

Answer 11

HYPO - glycaemia, kalaemia, natraemia, thermia

altered TFT, osteoporosis, reduced fertility, delayed puberty, growth arrest

Question 12

low risk BMI

Answer 12

16-17.5

Question 13

moderate risk BMI

Answer 13

15-16

Question 14

high risk BMI

Answer 14

13-15

Question 15

very high risk BMI

Answer 15

< 13

Question 16

what are some investigations for anorexia nervosa

Answer 16

haematology
biochemistry
ECG
DEXA

Question 17

what is the management for high risk anorexia nervosa

Answer 17

immediate treatment as an inpatient

Question 18

what is the general management for anorexia nervosa

Answer 18

education/monitoring/dietician
psychological therapy e.g. CBT, family therapy
antidepressant if comorbid illness

Question 19

weight loss over what per week would be high risk

Answer 19

1kg

Question 20

HR and SBP are indicative of high risk

Answer 20

HR < 40

SBP < 80

Question 21

failure of what test indicates high risk

Answer 21

SUSS - sit up squat stand test

• patient lies on floor and sits up without using hands
• patient squats down and rises without using hands

Question 22

what is the scoring system for SUSS

Answer 22

0 = unable
1 = able only using hands to help
2 = able with noticable dificulty 
3 = able with no difficulty

Question 23

what is refeeding syndrome

Answer 23

metabolic abnormalities that occur on feeding a person following a period of starvation - occurs when an extended period of catabolism ends with abruptly switching to carbohydrate metabolism

Question 24

how can refeeding syndrome be avoided

Answer 24

frequent blood monitoring
slow pace of initial feeding
no more than 50% of requirements for 1st 2 days

Question 25

why does refeeding syndrome occur

Answer 25

depletion of already inadequate stores of nutrients which are used up quickly as body starts to repair itself

Question 26

what nutrient imbalances are seen in refeeding syndrome

Answer 26

HYPO - phosphataemia, kalaemia, magnesaemia

Question 27

what may refeeding syndrome lead to

Answer 27

organ failure | electrolyte imbalance may predispose to TdP

Question 28

according to ICD-10 what are the requirements for Bullimia Nervosa

Answer 28

- persistent preoccupation with food - irresistable craving for food - binge eats (2 times a week for at least 3 months, during binge cannot control amount of food eaten) - attempts to counter binge e.g. exercise, drugs, starvation, vomiting - morbid dread of fatness

Question 29

in Bullimia Nervosa the BMI is typically within what range

Answer 29

healthy

Question 30

when is Bullimia Nervosa most often seen

Answer 30

teen girls

Question 31

what are some signs seen in Bullimia Nervosa

Answer 31

Russels sign | parotic hypertrophy

Question 32

what is russels sign

Answer 32

callouses on knuckles caused by fingers being used to induce vomiting

Question 33

people with Bullimia Nervosa often have comorbidities such as

Answer 33

``` depression anxiety substance misuse self harm impulsive personality ```

Question 34

what are some oral complications seen in Bullimia Nervosa

Answer 34

dental caries

Question 35

what are some general complications seen in Bullimia Nervosa

Answer 35

dehydration hypokalaemia subconjunctival haemorrhage

Question 36

what are some cardiac abnormalities seen in Bullimia Nervosa

Answer 36

arrhythmia

Question 37

what are some GI complications seen in Bullimia Nervosa

Answer 37

oesophageal erosions oesophageal perforation peptic ulcer gastric perforation

Question 38

what are some neuro complications seen in bullimia nervosa

Answer 38

seizures due to electrolyte imbalance

Question 39

what is the management of Bullimia Nervosa

Answer 39

guided self help CBT SSRI - fluoxetine

Question 40

what is binge eating disorder

Answer 40

uncontrollable binges as in bullimia but no compensatory mechanism once per week for 3 months

Question 41

what is Pica disorder

Answer 41

disorder associated with appetite for substances that are not nutritious e.g. hair, ice, chalk

Question 42

what is EDNOS

Answer 42

eating disorder not otherwise specified - when patient doesnt meet criteria for BN or AN but has an eating disorder - common