Question 1

Delayed gastric emptying and gastric distension are common in

Accepted Answer

Complaints of gastric discomfort associated with distention and are common in anorexia nervosa because of delayed gastric emptying.The complaints generally occur as the calorie prescription is increased and between-meal snacks become necessary.

Question 2

Which is a typical personality characteristic of people with anorexia nervosa?

Accepted Answer

Psychological features of a person with anorexia nervosa include perfectionism, harm avoidance, overly restrained emotional expression, and limited social spontaneity.People with bulimia nervosa tend to be more extroverted and easygoing and are more likely to engage in risk-taking behaviors.

Question 3

The treatment goal be for a patient with bulimia nervosa who is mildly overweight should be

Accepted Answer

The actions pursued by the person with bulimia nervosa are aimed at weight loss; however, the immediate goals for treatment should focus on interrupting the binge-purge cycle, restoring normal eating behaviors, and stabilizing body weight.Exercise may be used later to help with weight loss, but this is secondary to helping the patient with bulimia nervosa understand and avoid patterns of binge eating and purging.

Question 4

In conjunction with anorexia nervosa, the definition of amenorrhea is the absence of _____ menstrual cycle(s) in postmenarchal women.

Accepted Answer

The DSM-IV-TR defines amenorrhea as the absence of three consecutive menstrual cycles in postmenarchal women.This definition may not be adequate because some patients continue to menstruate at very low body weight.

Question 5

During the acute stage of anorexia nervosa, what is the focus of psychological management in treatment?

Accepted Answer

The immediate, short-term goal in treatment of anorexia nervosa is to initiate weight gain.From a psychological management point of view, this entails the positive encouragement of actions taken by the patient to initiate weight gain.Such actions include praise, reassurance, coaching, and encouragement.Long-term goals of psychological management are more focused on understanding and changing attitudes and psychological conflicts that promote disordered eating, as well as improving the patient's interpersonal and social functioning.

Question 6

Which of the following is a characteristic of bulimia nervosa?

Accepted Answer

A person with bulimia nervosa is commonly within the normal weight range, although some may be slightly under- or overweight.A person with bulimia nervosa is very concerned about body shape and size.Binge eating, which involves short periods (usually 2 hours or less) of intake of large amounts of food, and purging behaviors are commonly used by a person with bulimia nervosa.

Question 7

Urine specific gravity should be checked when patients being treated for eating disorders are weighed to

Accepted Answer

To obtain a reliable weight of a patient with an eating disorder, the patient should be weighed daily on the same scale, wearing only a gown, and before eating and after voiding.The urine is checked for urine specific gravity to determine its density.Concentrated urine reflects dehydration.A patient with an eating disorder may consume water to simulate weight gain, and a diluted urine specific gravity will reflect this.Other measures of the urine may be used to determine muscle wasting and ketosis.

Question 8

For the diet therapy in individuals with anorexia nervosa, what percentages of protein, carbohydrate, and fat are recommended, respectively?

Accepted Answer

Distribution of the calories is necessary as many people with anorexia nervosa try to avoid fat.A dietary fat range of 25% to 30% of calories is recommended to ensure overall caloric intake, which needs to increase for the person with anorexia nervosa to gain weight.Protein should provide 15% to 20% of total calories.This should be protein of high biologic value.Patients with anorexia nervosa often ask for vegetarian diets, but these should be discouraged.Carbohydrates should provide from 50% to 55% of total calories.

Question 9

During the treatment of patients with eating disorders, which of the following is an additional feature that should be monitored in the food records of patients with bulimia nervosa as opposed to anorexia nervosa?

Accepted Answer

Because of bingeing, purging, and restrictive eating, the patient with bulimia nervosa often has impaired hunger and satiety cues.By recording emotions and feelings whenever she eats, the patient with bulimia nervosa can learn to recognize these cues.Additionally, patients with bulimia nervosa are more receptive to nutrition counseling than patients with anorexia nervosa, and discussion of the recorded feelings can be used in the counseling to help promote behavioral changes.

Question 10

In which eating disorder might a person exercise excessively after an episode of binge eating?

Accepted Answer

People with bulimia nervosa of the nonpurging type engage in compensatory activities such as exercise or fasting to make up for the intake of a binge episode.People with eating disorder not otherwise specified may use inappropriate compensatory activities less frequently than people with bulimia nervosa or may do so after eating small amounts of food.

Question 11

Low T₃ syndrome is a

Accepted Answer

Low T₃ or active triiodothyronine is a characteristic of a reduced state of metabolism in patients with anorexia nervosa.Thyroid hormone production remains normal; however, peripheral deiodization of thyroxine favors the formation of reduced triiodothyronine.The reduced form of triiodothyronine is less metabolically active than the regular form.This alteration in metabolism resolves as weight gain occurs.

Question 12

In which eating disorder might a person binge often but not try to compensate for this behavior?

Accepted Answer

In binge-eating disorder, a patient will demonstrate binge-eating behaviors but no means of compensating for the excessive intake of food.These people tend to be overweight.The person with binge-eating disorder feels incapable of controlling eating, which results in feelings of depression, disgust, and guilt.In the other eating disorders, binge eating is commonly followed by purging or some other compensatory mechanism, such as fasting or excessive exercise.

Question 13

How frequently should binge episodes occur for a binge-eating disorder to be diagnosed?

Accepted Answer

The DSM-IV-TR definition of binge-eating disorder specifies that binge episodes must occur for 2 days per week for 6 months.In regard to bulimia nervosa, the definition specifies binge episodes and inappropriate compensatory behaviors at least twice a week for 3 months.

Question 14

How many calories should be provided in the diet of a patient with anorexia nervosa to initiate weight gain?

Accepted Answer

Because of the low weight of the patients with anorexia nervosa, 30 to 40 kcal/kg/day is sufficient to start weight gain.To continue to promote weight gain, increasing energy intake by 100 to 200 calories every 2 to 3 days is tolerated by the patients with anorexia nervosa.To eventually reach healthy weight gain, some patients with anorexia nervosa may need to be advanced to 70 to 100 kcal/kg/day in their diet therapy.

Question 15

How do anorexia nervosa and bulimia nervosa commonly affect the patient's metabolic rate?

Accepted Answer

For patients who experience a loss of lean body tissue, a concurrent decrease in metabolic rate occurs.For patients with bulimia nervosa, this may be unpredictable; however, during times of dietary restraint between binge episodes, the patient with bulimia nervosa may experience a semistarvation state, which will result in a decrease in RMR.

Question 16

Which of the following is often exhibited in patients with anorexia nervosa?

Accepted Answer

Loss of lean body mass and muscle wasting are common physical attributes in individuals with anorexia nervosa.Enamel wasting, esophagitis, and Russell's sign (scarring of the dorsum of the hand) are signs that a person uses vomiting as a purging behavior.Although some people with anorexia nervosa may be of the binge-eating and purging type, these signs are more commonly seen in people with bulimia nervosa.

Question 17

In which eating disorder might a person chew and spit out, but not swallow, large amounts of food?

Accepted Answer

Eating disorder not otherwise specified is the category for disorders of eating that do not meet the criteria for other specific eating disorders.Although people with anorexia nervosa or bulimia nervosa may perform binge-eating activities, these are generally associated with purging after the food is swallowed.A person with binge-eating disorder will have recurrent episodes of binge eating but will not follow them with some inappropriate compensatory behavior.

Question 18

After a binge episode, how much of the energy intake can be eliminated through purging?

Accepted Answer

The rule of thumb is that most purging activities cause only 50% of the calories taken in through a binge to be eliminated.This means that half of the calories taken in during the binge are retained in the body.

Question 19

Lanugo is soft, downy hair growth associated with

Accepted Answer

Lanugo is soft, downy hair growth associated with anorexia nervosa.They also appear cachectic, and their prepubescent body habitus causes them to appear younger.

Question 20

In which eating disorder might a person have an intense fear of becoming overweight even though she is underweight?

Accepted Answer

Although a person with anorexia nervosa may have a low BMI, this person will have a body image distortion, causing the person to feel fat even when wasted in appearance.People with bulimia nervosa tend to be within normal weight standards but are also concerned with body image.People with eating disorder not otherwise specified may vary in their weight and perception of self and body image.People with binge-eating disorder tend to be overweight.

Quiz 23: Nutrition in Eating Disorders