Paediatrics CAMHS Flashcards

Question

How does **anorexia nervosa present**?

Answer 1

Person feels they are **overweight despite evidence of norma**l / **low body weight** Obsessively **restricting calorie intake** **Exercising excessively** **Diet pills** / laxatives

Answer 2

Excessive **weight loss** **Amenorrhoea** **Lanugo hair** (fine soft hair across most of the body) **Hypokalaemia** **Hypotension** **Hypothermia** **Changes in mood**, anxiety and depression **Solitude** **Cardiac complications** - arrhythmia, cardiac atrophy and sudden cardiac death

Answer 3

**Unlike with anorexia,** people with bulimia have normal body weight **Fluctuating** body **weight** **Binge eating** followed by **“purging”** by **inducing vomiting** or taking laxatives

Answer 4

**Alkalosis**, due to vomiting HCl from the stomach **Hypokalaemia** **Erosion** of **teeth** **Swollen salivary glands** Mouth **ulcers** **GORD** Calluses on the knuckles where they have been scraped along the teeth (**RUSSELL’S SIGN**)

Answer 5

A **planned binge involving** “**binge** foods” **Eating very quickly** **Unrelated** to **whether they are hungry** or not Becoming **uncomfortably full** Eating in a **“dazed state”**

Answer 6

**Patient** and **career** education **Self help resources** **Counselling** **CBT** **Addressing other areas of life,** e.g. relationships and past experiences **SSRIs**

Answer 7

Occurs in people who **have been** in a **severe nutritional deficit**, patients are at **higher risk if BMI below 20** and have had **little to eat for past 5 days** As **starved cells start to process glucose**, **protein** and **fats** they use up **magnesium**, **potassium** and **phosphorus**, leading to: **Hypomagnesaemia, hypokalaemia, hypophosphataemia** Risk of cardiac **arrhythmias**, **heart failure** and **fluid overload**

Answer 8

**Slowly reintroduce food** with restricted calories **Magnesium, potassium, phosphate** and **glucose** monitoring along with other routine bloods **Fluid balancing monitoring** **ECG monitoring** in **severe** cases **Supplementation** with **electrolytes and vitamins**, **particularly B vitamins** and **thiamine**

Answer 9

**SCOFF** **Sick** (do you **make yourself sick**) **Control** (do you **worry you have lost control** over how much you eat) **One stone** (weight **loss in last 3 months**) **Fat** (you think you’re **fat when others say you are thin**?) **Food** (dominates your life?) Answering yes to **two or more** suggests **bulimia nervosa**

Answer 10

**Stress** / **anxiety** / **depression** **Malignancy** (e.g. stomach, pancreatic, lymphoma, bowel cancers) **Chronic infection** (TB, HIV, infective endocarditis) **GI causes** (Coeliac disease, peptic ulcer disease, other cause of malabsorption) **Metabolic** causes (Addison’s, hyperthyroidism, diabetes) **Medications** - NSAIDS, anti hypertensives, digoxin)

Answer 11

How much **weight lost** and **over what period**? **Changes to diet**? **Appetite**? **Clothes** become **more loose**? **General health**? **Anxious** / **stressed** / **depressed**? **Metabolic disorder** (thirsty, pass a lot of urine, hot / sweaty, irritable / tremors) **Other causes** (Night sweats? Change in bowel habit? Abdo pain? Chronic cough? Medications? Recreational drugs?)

Answer 12

**Weight**, **height** and **BMI** **Check teeth** for **acid damage** **Consider abdo examination** +/- PR as indicated from history **Check reflexes** and **examine thyroid gland**

Answer 13

**FBC**, **U&Es**, **ESR**, **CRP,** **TFTs**, **LFTs**, random blood sugar **CXR** **Urinalysis** **Faecal occult blood** If indicated: **HIV** serology **Endoscopy** (upper and or lower bowel) **USS** or **CT abdo** **Specific tumour markers** e.g. CEA or ca-125

Answer 14

**Overestimation** of **actual weight** and **body size** (pt denys any weight loss) **Phobia** of **normal body size** and **weight** **Restricting calorie intake**, over exercise, use of laxatives, vomiting, diuretics **Very low body weight** (\<48kg = amenorrhoea) **Obsession** and **pre-occupation** with food and cooking

Answer 15

**Low metabolic rate** **Cold peripheries** **Bradycardia** **Alopecia** **Osteopenia** **Vitamin deficiencies** & electrolyte disturbances **Amenorrhoea** **Lanugo hair** (fine downy hair which may appear on the body) **Skin changes** Ankle **oedema** **Urine** ( low LH and low FSH)

Answer 16

**Parental counselling** (to get across seriousness) **Weight gain** (by setting targets - 500g per week) **Drug therapy** is not effective (e.g. SSRI)

Answer 17

Usually **normal weight**

Answer 18

Change from **metabolising fats** to **metabolising carbs** causes **hypophosphataemia**, **hypogylcaemia**, **hypokalaemia** Due to **massive cellular** uptake of **electrolytes**

Answer 19

Muscle **weakness** and **diaphragmatic** insufficiency

Answer 20

**Confusion**, **coma**, **convulsions** and **death**

Answer 21

**Thiamine** and **vitamin B complex** supplements when feeding resumes in anorexia **Biochemistry monitored** and **abnormalities** in **potassium**, magnesium and phosphate should be corrected

Answer 22

**Maladaptive** **personality traits** causing significant **psychosocial distress** and interfere with everyday functioning. **Patterns of thought**, **behaviour** and **emotions** which differ from what is normally expected by society **Result** of **genetic** and **environmental factors**

Answer 23

**Strong intense emotions** **Emotional instability** **Anger** **Low self esteem** **Impulsive** behaviour **Substance abuse** **Poor sense** of **identity** **Difficulty maintaining relationships** **Risky** behaviour **Violence** and aggression **Self harm** **Suicide attempts**

Answer 24

**Anxious** **Suspicious** **Emotional** / impulsive

Answer 25

Severe anxiety about rejection or disapproval and avoidance of social situations or relationships

Answer 26

**Heavy reliance** on others to make **decisions and take responsibility for their lives**, taking a **very passive approach**

Answer 27

Unrealistic expectations of how things should be done by themselves and others, **catastrophising** about what will happen if **these expectations are not met**

Answer 28

**Difficulty in trusting** or **revealing personal information** to others

Answer 29

**Lack of interest** or **desire to form relationships** with others / feeling that this is of no benefit

Answer 30

**Unusual belief**, **thoughts and behaviours** as well a **social anxiety** which makes **forming relationships difficult**

Answer 31

**Fluctuating strong emotions** and **difficulties with identity** and maintaining healthy relationship

Answer 32

Need to be at the **centre of attention** and having to perform for others to maintain that attention

Answer 33

**Feelings** that **they are special** and **need others to recognised this** or else they get upset. They put themselves first

Answer 34

**CBT** **Psychotherapy** **No medical treatments** specifically

Answer 35

**Tics** which are **persistent for over a year**

Answer 36

**Involuntary movement** or **sound** which the child performs **rapidly** throughout the **day** (more prominent when the person is under pressure or excited) - **overwhelming urge to perform**, increases more they suppress it, need to get relief by performing (premonitory sensation)

Answer 37

**After 5** years of age (associated with OCD and ADHD)

Answer 38

**Clearing of throat** **Blinking** **Head jerking** **Sniffing** **Grunting** **Eye rolling**

Answer 39

Performing **physical movements** e.g. twirling on the spot / touching objects **Copropaxia**- performing obscene movements **Coprolalia** - saying obscene words **Echolalia** - repeating others words

Answer 40

Usually **improve over time** (mild cases with no signs of underlying disease may only require reassurance and monitoring) **Measures to reduce stress**, **anxiety** and **triggers** can be helpful

Answer 41

**Habit reversal** training **Exposure** with **response prevention** **Medications** (antipsychotics)

Answer 42

**Home** = e.g who is at home, do you have your own room **Education** / **Employment** = e.g. school / college, subjects you like? Who are your friends? Does anyone bully you? **Activities** = spare time? relax? spend time with friends? **Drugs** = e.g. some people around your age try smoking, alcohol or drugs? who supplies you? **Sex** = are you seeing anyone? have you ever had sex? contaception? **Self harm** = how is your mood? sad / depressed? hurting yourself? **Safety and abuse** = do you ever feel unsafe?