Of the following, which one is the most effective treatment for bulimia nervosa?
Correct Answer A:
A number of placebo-controlled, double-blind trials have demonstrated the effectiveness of a variety of antidepressants in the treatment of bulimia nervosa. Fluoxetine has FDA approval for this indication. The other agents are not used for treating bulimia.
A 19-year-old college student comes to your office with her mother. The mother reports that her daughter has frequently been observed engaging in binge eating followed by induced vomiting. She has also admitted to using laxatives to prevent weight gain.
Which one of the following laboratory abnormalities is most likely to be found in this patient?
The patient described is likely suffering from bulimia. These patients use vomiting, laxatives, or diuretics to prevent weight gain after binge eating. This often causes a loss of potassium, leading to weakness, cardiac arrhythmias, and respiratory difficulty. The levels of other electrolytes are not as dramatically affected.
A male patient comes to you for follow-up. His depression is well controlled with his medications, however, now he tells you that he sees aliens just when he is about to sleep.
What is the problem?
Correct Answer E:
The hypnagogic experience occurs as one is falling asleep, while the hypnopompic experience occurs as one is waking up.
Experienced qualities vary and include fear, awareness of a "presence," chest or back pressure, an inability to breathe, a falling sensation or a feeling of tripping, and sometimes joy.
Which one of the following types of hallucination is normal?
Correct Answer A: Hypnagogic phenomena are particularly vivid auditory or visual illusions or hallucinations that may occur when just falling asleep. They are difficult to distinguish and are somewhat similar to vivid dreams, which are normal in REM sleep. Hypnagogic phenomena occur in about 1⁄3 of patients with narcolepsy, are common among healthy young children, and occasionally occur in healthy adults.
Note:
Hypnagogic hallucinations and hypnopompic hallucinations are considered normal phenomena. Hypnagogic hallucinations can occur as one is falling asleep and hypnopompic hallucinations occur when one is waking up.
A 23-year-old male student presents with a six-month history of extreme daytime fatigue and repeatedly falling asleep in classes, on the bus, and other inappropriate places. On review of systems, he admits to sometimes “fainting” when he is upset. He describes these fainting spells as a sudden feeling of weakness, causing him to fall down, but with preserved consciousness throughout.
On further questioning which of the following symptoms are also likely to be present in this patient?
Correct Answer B:
Hallucination-like dreams occurring at sleep onset (hypnagogic hallucinations) or on waking (hypnopompic hallucinations) are often associated with narcolepsy. The most common presentation of narcolepsy is of excessive daytime fatigue and irresistible attacks of refreshing sleep. Cataplexy is also common, and is defined as the sudden loss of muscle tone, usually precipitated by intense emotions.
A. This is a separate sleep disorder.
C. Cogwheel rigidity occurs in parkinsonism.
D. Loud snoring is characteristic of obstructive sleep apnea, which also presents with excessive sleepiness, but is not associated with cataplexy.
E. Palpitations might be associated with syncope, which by definition involves loss of consciousness.
Click to expand