Return to Scenario ListShow Learning Points most relevant to Phase 1:

Eating disorders

Clinical Discipline(s)/Organ System(s)
Paediatrics, Psychiatry/Health Psychology, Endocrinology, Clinical Biochemistry
Progress Test Topic(s)
Mental health
You see a 17 year old female NZ European high school student with her mother at the general practice where you are based. You sit in on the consultation with the GP. She is a gymnast and in her penultimate year of high school. Her coach had met with you to discuss her concerns. She had noted progressive weight loss over the past 6 months despite her always having been a thin person. At a recent gymnastics competition, her coach saw a large container of docusate sodium (Coloxyl) tablets in her kit bag. In view of her noticeable weight loss, the coach wanted to withdraw her from further competitions until she had gained a 'better weight'. The coach also worried that she would set a bad example to the younger gymnasts. Her mother has long been aware of her daughter's weight issues and only made occasional comments expressing her concerns. Her daughter, however, was typically dismissive of these and became irritable when these were raised. The patient's mother has spoken to her friends and most reported that their teenage daughters were very focused on their appearance, changing body shapes (particularly around menarche) and were embarking on weight management strategies. This had partially reassured her until the coach raised the issue. When she and the coach discussed this issue with her daughter, she became tearful and agreed to see her doctor. She admitted that she used laxatives on a daily basis as part of a weight control regime in addition to vigorous exercise workouts at the gym and at home. She mentioned that she has made herself vomit after eating in order to lose weight. The GP calculates her body mass index (BMI) to be 15kg/m2.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Changes in physiology observed at low body weight
   - Cognitive changes associated with low weight (including perceptual distortion)
   - Currently accepted theories relating to appetite and hunger regulation
   - Current biopsychosocial theories of the aetiology of anorexia nervosa
   - Genetics of eating disorders
Clinical and Communication Skills 
   - Elicit a history from a patient with an eating disorder including social and psychological risk factors, e.g. bullying and sexual or other abuse
   - Perform an examination of a patient with an eating disorder; recognise signs of self-purging and dermatological manifestations of anorexia
   - Perform and record a mental state examination of a patient with an eating disorder
   - Calculate BMI
   - Differential diagnosis of low body mass
   - Interpret relevant investigations: electrolytes, hormonal screening, toxicology screen, imaging
   - Management of eating disorder: pharmacological and non-pharmacological
   - Role of dietitian
   - Complications associated with eating disorders
   - Management of complications: especially electrolyte disturbance
   - Recognise specific macronutrient and micronutrient deficiency states
   - Recognise the need for medical stabilisation in a general hospital setting when critical vs. management as an outpatient
Personal and Professional Skills 
   - Competence and consent
   - Best interests principle
   - Non-judgemental approach to mental illness
   - Awareness of your own personal reactions to eating disorders; show empathy
   - Social impact of mental illness
   - Communicating the diagnosis of a mental illness to a patient and their family/whānau
   - Mental Health Act application and criteria for compulsory admission
Hauora Māori 
   - Culturally safe engagement with this patient, her Whānau and communities
Population Health 
   - Epidemiology of eating disorders
   - Morbidity and mortality rates associated with eating disorders
   - Clustering of eating disorders, influence of media on body shape and attitudes towards weight
Conditions to be considered relating to this scenario
anorexia nervosa, bulimia nervosa, coeliac disease, depression, obsessive-compulsive personality disorder, borderline personality disorder, substance abuse, hyperthyroidism
Less common but 'important not to miss'
Crohn's disease, systemic lupus erythematosus (SLE), multiple sclerosis
medically unexplained physical symptoms (somatoform disorder), body dysmorphic disorder, pancreatic insufficiency (cystic fibrosis), Lyme disease