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CME QUESTIONS

Continuing Medical Education Questions: January 2021

Friedenberg, Frank K. MD

The American Journal of Gastroenterology: January 2021 - Volume 116 - Issue 1 - p 15
doi: 10.14309/ajg.0000000000001120
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Abstract

LEARNING OBJECTIVE

Identify the epidemiology, risk factors, clinical presentation and treatment of eating disorders.

QUESTION 1

A 53-year-old male presents for the evaluation of constipation. The patient has experienced intermittent constipation for approximately 10 years. A recent colonoscopy was normal. The patient reports that he has noticed that during periods of dieting and reduced caloric intake, constipation is a predictable side effect. On exam, he appears overweight and has a BMI of 28.6. The remainder of his exam is unremarkable. You further question him about his caloric intake, and he reveals that currently he is on an 800 kcal/d diet supplemented by mega vitamins.

Which of the following is true concerning this patient?

  • A. An eating disorder is unlikely as the patient is overweight
  • B. An eating disorder is unlikely given the patient's age and gender
  • C. The patient's dieting may result in a hypometabolic state
  • D. Whole gut transit study and anorectal manometry are indicated

QUESTION 2

You are asked to see a 25-year-old female with self-reported gluten-sensitivity. Celiac testing was negative, and biopsies of the duodenum were unrevealing. The patient is meticulous in avoiding gluten containing products. In further discussion, she elaborates on several other food sensitivities. She has eliminated all dairy products and foods she thinks are “gas producing” such as most fresh fruits and vegetables. Dinner consists of lean meat with some rice. She snacks on rice cakes and drinks broth and tea for lunch. She avoids going to restaurants with friends due to concern of developing symptoms away from home. Physical exam is normal except for a BMI of 17.3. Which of the following disorders do you suspect this patient may have?

  • A. Anorexia Nervosa
  • B. Seronegative Celiac Disease
  • C. Bulimia Nervosa
  • D. Avoidant/Restrictive Food Intake Disorder (ARFID)

QUESTION 3

A 37-year-old female presents to her primary care physician for a routine visit. She is married and concerned that she has not been able to get pregnant after 12 months of attempting to conceive. She has always been thin with a BMI ranging between 16.1 and 17.3 for the past 3 years. The PCP has always suspected an eating disorder but when approached, the patient thinks she is actually a bit too fat and is concerned about gaining weight because “diabetes runs in the family.” What additional information from history and physical would support the diagnosis of an eating disorder?

  • A. Unexplained persistent sinus tachycardia
  • B. Sacral edema
  • C. Aortic regurgitant murmur
  • D. Prolonged QTc

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