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EWAHEC CME Session – Medical Complications and Identifying an Eating Disorder Client Quiz and EvaluationBulimia Nervosa is characterized by:Primarily food restrictionPrimarily vomitingPrimarily binging followed by a negative compensatory behaviorPrimarily bingingAvoidant Restrictive Food Intake Disorder (ARFID) is characterized by:Food restriction due to a fear of gaining weightEating a large quantity food, larger than what most people would eat, in a short amount of time Lactose intoleranceA refusal to eat food due to an adverse or fear- based experience like a fear of vomiting, choking or abdominal pain.Possible clinical presentations of an eating disorder include:Loss of mensesWeight lossConstipationFainting or lightheadedness/dizzinessChest painAll of the aboveThe following are examples of purging behaviors after eating, please select as many that apply:Food restriction or fastingExcessive exerciseVomitingLaxative abuseDiet pills14 year old obese male reports eating a package of cookies, 2-3 snack-size chip bags, several glasses of juice and leftovers from the fridge after school. He reports this happening at least 5 days a week, he will have these eating episodes despite eating earlier in the day or when he is not hungry. He will often eat large amounts of food when he is alone, bored or he is up late at night. He denies vomiting, using laxatives or over exercising after meals. He feels like he has little control over his eating and feels ashamed when he has these episodes of uncontrolled eating. Which of the following is the most likely diagnosis?Anorexia Nervosa, restricting typeAvoidant restrictive food intake disorderBinge eating disorderBulimia Nervosa, extremeA 16 year old athletic female presents for a sports physical. She enjoys basketball, cross country and track. She has been running 3 to 7 miles every day based upon her cross country team schedule. She made it to state last fall and is hoping to qualify this season. She has been eating more “healthy” and adding in extra runs to increase her time. She feels she is too big and if she weighs less, her running time may improve. In the review of systems, she reports increasing fatigue. The teen reports she feels fine, but lately, she is not running as fast as she would like. Her last menstrual cycle was 3 months ago. You note that she is 5’4”, her weight a year ago was 118lbs, now she weighs 100lbs. Her heartrate is 48 bpm, respiratory rate of 16, blood pressure 90/58. On her physical exam, you note that she has a slow heart rate, cold fingers with slightly purple nailbeds and no swelling. What is the most appropriate next step in the patient’s evaluation?DEXA scan, ANA, CRP or Sed rateEKG, comprehensive metabolic profile, CBC, magnesium phosphorusPregnancy test and referral to OB/GYN for secondary amenorrheaANA, CRP or Sed Rate and a referral to rheumatology for fatigueFor the 16 year old female described in the previous question, of the following treatment modalities, which are recommended? Select as many that apply.DieticianExercise restrictionPrescribed meal planReferral to a sports training program TherapistFor an adolescent female patient who has developed secondary amenorrhea, which of the following is the BEST recommendation to preserve bone density?Prescribe a bisphosphonateRecommend Calcium and vitamin D supplementationIncrease weight bearing activitiesWeight restorationA slender 14 year old female presents with complaints of anxiety and depression. She has struggled with making friends and was bullied last year. Her anxiety is so high at times that she sometimes can’t leave her home to get to school on time. Her mother notes that her daughter has not been eating well for the past month and may have lost a little weight. You ask the teen why she has not been eating as much over the past month. Which of the following responses may indicate an eating disorder?I feel too sad to eat and I would rather sleep all day.I get nauseous in the morning, so I skip breakfast. I don’t want to gain weight because I already feel fat.We don’t have the food I like at home.A 16 year old male presents for a well child check. You note that he was previously overweight at 5’9” and 200lbs last year. He is on the baseball team and decided he wanted to be healthier after learning his weight at his last well child check. He is now 5’10” and weighs 158 lbs. All of his vitals are normal today. He reports he feels fine and thinks he is at a good weight and has maintained this weight for the past 3 months. His mother reports that while she is proud of him for cutting out junk food and soda, she is concerned because he has become very rigid about what he will allow himself to eat and he seems to be working out all the time. You explore his eating habits further and recommend that he speak with a dietician as you are concerned he is developing an eating disorder. When should he return for a weight check and medical follow-up?1 week1 month1 yearNone of the above, he should be immediately hospitalizedAt EWAHEC, we are constantly trying to improve the quality of the sessions that we offer. Please help us with this process by completing the session evaluation questions below.What are one or two important “takeaways” that you have gotten from this training?After this training, please rate your ability to recognize various clinical presentations of an eating disorder at a medical visit [learning objective 1].Increased SignificantlyIncreasedStayed the SameDecreasedDecreased SignificantlyAfter this training, please rate your ability to identify medical complications related to an eating disorder and manage them in your office[learning objective 2].Increased SignificantlyIncreasedStayed the SameDecreasedDecreased SignificantlyA “commercial interest” is defined as any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on, patients. Among the exemptions to this definition are government organizations, non-healthcare related companies and non-profit organizations that do not advocate for commercial interests.Did you perceive any bias toward a “commercial interest” in any presentation?NoYesIf yes, please explain.What problems or challenges do you feel that you’re not able to address appropriately or to your satisfaction?What potential barriers do you anticipate encountering as you incorporate what you learned at this activity? ................
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