Eating Disorders Covered on the Physician Assistant Exam
Eating disorders are very prevalent in society. Familiarize yourself with the basics for the Physician Assistant Exam (PANCE). You don’t want to miss them or some of the clinical signs that can go along with them. This knowledge is valuable both for your clinical practice and for the PANCE. Please note that although these disorders are predominant in women, men can also be affected.
Anorexia for the PANCE
Anorexia nervosa (AN) often occurs in younger women. The affected person often has a distorted image of self; she feels that she’s “too fat” when she’s actually below a healthy weight range for her age and height. Here are the key points for recognizing and treating anorexia:
People with anorexia often severely restrict the amount of food they eat and are severely malnourished. This is the type of anorexia nervosa most people are familiar with.
Although purging behaviors are often associated with bulimia, they can occur with anorexia as well. Behavior may include excessive exercise and the use of laxatives as part of the purging.
The affected person may be adrenally insufficient as well as amenorrheic. She often needs intensive treatment, usually in a hospital, to attend to her medical needs. Consultation with a nutritionist/dietitian is vital.
The treatment for anorexia involves intense psychotherapy to change the patient’s self-image, particularly (mis)perceptions about her body.
Bulimia for the PANCE
Like anorexia, bulimia nervosa (BN) often occurs in younger women. Again, the affected person has a distorted sense of self and an abnormal self-image. Here are a few key points about bulimia:
Most commonly, the affected person engages in binging and purging behavior. The key to PANCE questions concerning bulimia is to pay attention to physical exam clues. The fingers go into the mouth to induce vomiting, so look at the knuckles and fingers for scratches, calluses, and/or discoloration. You may see parotid gland hypertrophy and loss of enamel in the teeth because of recurrent gastric exposure due to vomiting.
Pay attention to blood work. Because of the excessive vomiting, a metabolic alkalosis may be present. Often, the affected person is profoundly hypokalemic (vomiting blows out your potassium) and has low to undetectable magnesium levels.
In addition to a nutrition consultation, the affected person needs intense psychotherapy.