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FCM Review Psych from class, With Complete Verifies solution, Updated Fall 2024/2025.
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FCM Review Psych from class, WithComplete Verifies solution, Updated
Fall 2024/2025.
1. A 17-year-old girl presents to your family practice office with her mother, who complains that the
patient has been having unusual eating habits over the past 4 months. She has seen her daughter
eat large amounts of food during a single meal and reports finding empty snack boxes in the
patient’s room. After large meals the mother notices her daughter taking laxatives and spending
excessive time in the bathroom. She has even heard the patient retching.
When patient is asked about symptoms, she admits to feeling a “loss of control” and regret after
eating large amounts and states
“I wish I looked like the girls in the magazines”.
She has a BMI of 24 kg/m2.
What is the most likely disorder?
Bulimia Nervosa
•This patient meets the diagnostic criteria for bulimia nervosa. Her mother has noticed the
symptoms occurring for ~4 months and observed the patient eating large amounts of
food. Samantha also admits to a “loss of control” and seems displeased with her body image. She is
performing compensatory behavior with laxatives and inducing vomiting, which Is a part of the
DSM criteria.
- Patient does not meet criteria for Anorexia Nervosa and does not fit criteria for Binge Eating
Disorder because she is performing compensatory behavior.
A 16-year-old is being evaluated by her pediatrician for several recent episodes of fainting. Her
parents say that she “is pushing it”. She has always been a straight A student, but now seems to be
exercising too much by running cross country and is losing “too much weight”. On exam, her BP is
100/60, HR 52, RR18, T97F. She has a flat demeanor, appears pale with sunken eyes. She
is extremely thin with BMI of 16 kg/m2, she has dry skin with lanugo. When asked what she thinks
about her weight, she replies “I’m fat”.
what is the likely diagnosis?
Anorexia Nervosa Restricting Type
Anorexia Nervosa
▸ Subtypes
,▸ Restricting Type
▸ Binge/Purge Type – during past 3 months, individual has engaged in
binge eating and/or purging behavior
▸ Severity is still determined by BMI in DSM-5
▸ Mild is BMI >= 17
▸ Moderate 16 – 17
▸ Severe 15 – 16
▸ Extreme <= 15
▸ Amenorrhea is no longer a criteria for AN
Common Symptoms with AN
▸ Depressed mood
▸ Irritability
▸ Preoccupation with food
▸ Obsessional ruminations/rituals
▸ Reduced alertness/concentration
▸ Deceptive behaviors
▸ Social withdrawal
▸ Loss of sexual interest
Anorexia
▸ Hypothermia
▸ Hypotension
▸ Bradycardia
▸ Dry Skin
▸ Lanugo on arms/legs
▸ Acrocyanosis of digits
▸ Edema of extremities
▸ Cardiac Murmur
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The laboratory findings on the previous patient (question 2) were significant for:
ECG: bradycardia, T wave flattening and QTc prolongation
Chem: Low K+, low albumin
CBC: anemia
3. What is the appropriate disposition for this patient?
Admission for medical and nutritional stabilization
Criteria for Acute Hospitalization/Stabilization
▸Cardiovascular instability
▸Resting heart rate < 45 bpm
▸Significant hypotension
▸Symptomatic orthostasis
▸Temp < 97 F
▸Risk of refeeding syndrome
▸Electrolyte abnormalities
▸Psychiatric symptoms
, ▸Acute food refusal
Acute suicidality
ANOREXIA NERVOSA (AN)
A. Restriction of energy intake leading to a significantly low body weight
B. Intense fear of gaining weight or becoming fat, or behavior that interferes with weight gain
C. Disturbance in the way one’s body weight or shape is experienced; self evaluation unduly
influenced by weight or shape; or lack of recognition of seriousness of low weight
Which of the following correctly describes Russell's Sign?
- Enamel Erosion
- Dental caries
- Enlarged parotid glands
- Calluses over the knuckles
- Lanugo
Calluses over the knuckles
Russell's sign is the most characteristic sign of purging, and the most typical sign in purging type AN.
This sign shows knuckle calluses that develop on the dorsal aspect of the dominant hand due to
friction against the teeth.
A 29-year-old is on a telehealth appointment with his provider for concerns about his eating habits
which have worsened since the pandemic lockdown. Several times per week he will eat 2-3 times
his normal amount, sometimes despite not feeling hunger. This inevitably makes him feel bloated
and uncomfortable, but he feels like he “can’t control it”. He feels guilty for not having more self
control.
He doesn’t feel overweight currently but is concerned that if this continues he will be in the near
future.
He denies the use of diuretics, laxatives or vomiting after meals.
Binge eating disorder
▸Recurrent episodes of binge eating
▸Associated with ≥ 3 or more of the following:
▸Eating much more rapidly than normal
▸Eating until feeling uncomfortably full
▸Eating large amounts of food when not feeling physically hungry
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