KSA Care of Women Exam
1. A 24-year-old graduate student comes to your office to be
tested for sexually transmitted infections. The medical
assistant tells you that the patient was upset when she saw
how much she weighed. On questioning, the patient says that
for the past year she has experienced episodes of
uncontrollable eating followed by self-induced vomiting. Her
weight is 82 kg (181 lb) and her BMI
is 32 kg/m2. Which one of the following is true regarding
treatment for this condition?
A. Cognitive behavioral therapy has the best evidence for
treatment
B. SSRI monotherapy is a first-line treatment option
C. Anemia is an indication for hospitalization
D. More than half of patients will relapse after treatment:
ANSWER: A
Eating disorders include anorexia nervosa, bulimia nervosa, and
binge eating dis- order, and the DSM-5 added avoidant/restrictive
food intake disorder, rumination disorder, and pica to this group in
2014. Mood disorders, anxiety, substance use, and personality or
somatic disorders are common in these patients. Screening can
,include regularly asking questions about mood, body image
concerns, and eating behaviors. Before establishing the diagnosis
based on history, it is important to perform a physical examination
that includes measurement of orthostatic vital signs and obtain a
metabolic panel that includes magnesium and phosphate levels.
This patient appears to have bulimia nervosa, which consists of
eating an excessive amount of food in a short period of time (often
>2000 calories in one sitting),
with a concomitant feeling of loss of control. Because patients
with bulimia base their self-worth on their body shape and weight,
they follow this binge eating with compensatory behaviors to
prevent weight gain, such as vomiting, laxative use, food
restriction, excessive exercise, or taking diuretics. Episodes occur,
on average, one or more times a week for 3 months or longer, and
the disorder is associated with a two- to sixfold increase in age-
adjusted mortality.
After the diagnosis is established and a goal weight has been
accepted, the patient is best served with treatment delivered by a
team that includes a therapist, a nutritionist, and a clinician,
preferably with each having prior experience in caring for patients
with eating disorders. Cognitive behavioral therapy (CBT) has the
,best evidence for treatment of adults with bulimia, while family-
based therapy is the
first-line treatment for adolescents with this condition. Early
behavioral response, with rapidly declining episodes of binge
eating, is associated with a greater chance of sustained
remission.Medication should not be considered as monotherapy
for eating disorders, and care must be taken to avoid medications
that affect electrolyte levels or heart rate, or predispose the patient
to a prolonged QT interval. Fluoxetine titrated up to 60 mg daily is
FDA approved for the treatment of bulimia, and may
be used as an adjunct to CBT. Other SSRIs have demonstrated
benefit as well, but all must be prescribed at dosages higher than
those used to treat depression. Citalopram and escitalopram
should be avoided because of the increased risk of prolonging the
QT interval.
Criteria for inpatient treatment of bulimia include dehydration,
hematemesis, syn- cope or seizure, EKG abnormalities,
autonomic dysfunction (bradycardia, hypoten- sion, hypothermia,
orthostatic blood pressure), electrolyte abnormalities, and un-
controllable symptoms or co-occurring conditions that cannot be
treated success- fully on an outpatient basis.
, Disordered eating may persist for as long as 20 years after the
diagnosis is made in approximately one-third of patients. Success
rates for treatment of bulimia are higher than those for anorexia
nervosa, with less than one-third of patients experiencing relapse
after treatment.
2. A 35-year-old female presents to your office for treatment
of insomnia. You ask if she has experienced any trauma in
her life and she discloses that she was sexually assaulted 6
weeks ago. She has not sought medical, legal, or
psychological counseling since the assault. During today's
visit, you should do which one of the following?
A. Assess for symptoms of posttraumatic stress disorder
B. Prescribe levonorgestrel (Plan B One-Step), 1.5 mg
C. Prescribe HIV postexposure prophylaxis
D. Perform a forensic examination to collect evidence, such
as a rape kit evaluation
E. Refer her for cognitive behavioral therapy: ANSWER: A
Sexual assault affects 43.6% of women in the United States
during their lifetimes, with increased risks seen in adolescents,
college students, LGBTQ persons, and active-duty military
personnel. The risk is also increased by physical or mental
disabilities, poverty, homelessness, incarceration, and substance
1. A 24-year-old graduate student comes to your office to be
tested for sexually transmitted infections. The medical
assistant tells you that the patient was upset when she saw
how much she weighed. On questioning, the patient says that
for the past year she has experienced episodes of
uncontrollable eating followed by self-induced vomiting. Her
weight is 82 kg (181 lb) and her BMI
is 32 kg/m2. Which one of the following is true regarding
treatment for this condition?
A. Cognitive behavioral therapy has the best evidence for
treatment
B. SSRI monotherapy is a first-line treatment option
C. Anemia is an indication for hospitalization
D. More than half of patients will relapse after treatment:
ANSWER: A
Eating disorders include anorexia nervosa, bulimia nervosa, and
binge eating dis- order, and the DSM-5 added avoidant/restrictive
food intake disorder, rumination disorder, and pica to this group in
2014. Mood disorders, anxiety, substance use, and personality or
somatic disorders are common in these patients. Screening can
,include regularly asking questions about mood, body image
concerns, and eating behaviors. Before establishing the diagnosis
based on history, it is important to perform a physical examination
that includes measurement of orthostatic vital signs and obtain a
metabolic panel that includes magnesium and phosphate levels.
This patient appears to have bulimia nervosa, which consists of
eating an excessive amount of food in a short period of time (often
>2000 calories in one sitting),
with a concomitant feeling of loss of control. Because patients
with bulimia base their self-worth on their body shape and weight,
they follow this binge eating with compensatory behaviors to
prevent weight gain, such as vomiting, laxative use, food
restriction, excessive exercise, or taking diuretics. Episodes occur,
on average, one or more times a week for 3 months or longer, and
the disorder is associated with a two- to sixfold increase in age-
adjusted mortality.
After the diagnosis is established and a goal weight has been
accepted, the patient is best served with treatment delivered by a
team that includes a therapist, a nutritionist, and a clinician,
preferably with each having prior experience in caring for patients
with eating disorders. Cognitive behavioral therapy (CBT) has the
,best evidence for treatment of adults with bulimia, while family-
based therapy is the
first-line treatment for adolescents with this condition. Early
behavioral response, with rapidly declining episodes of binge
eating, is associated with a greater chance of sustained
remission.Medication should not be considered as monotherapy
for eating disorders, and care must be taken to avoid medications
that affect electrolyte levels or heart rate, or predispose the patient
to a prolonged QT interval. Fluoxetine titrated up to 60 mg daily is
FDA approved for the treatment of bulimia, and may
be used as an adjunct to CBT. Other SSRIs have demonstrated
benefit as well, but all must be prescribed at dosages higher than
those used to treat depression. Citalopram and escitalopram
should be avoided because of the increased risk of prolonging the
QT interval.
Criteria for inpatient treatment of bulimia include dehydration,
hematemesis, syn- cope or seizure, EKG abnormalities,
autonomic dysfunction (bradycardia, hypoten- sion, hypothermia,
orthostatic blood pressure), electrolyte abnormalities, and un-
controllable symptoms or co-occurring conditions that cannot be
treated success- fully on an outpatient basis.
, Disordered eating may persist for as long as 20 years after the
diagnosis is made in approximately one-third of patients. Success
rates for treatment of bulimia are higher than those for anorexia
nervosa, with less than one-third of patients experiencing relapse
after treatment.
2. A 35-year-old female presents to your office for treatment
of insomnia. You ask if she has experienced any trauma in
her life and she discloses that she was sexually assaulted 6
weeks ago. She has not sought medical, legal, or
psychological counseling since the assault. During today's
visit, you should do which one of the following?
A. Assess for symptoms of posttraumatic stress disorder
B. Prescribe levonorgestrel (Plan B One-Step), 1.5 mg
C. Prescribe HIV postexposure prophylaxis
D. Perform a forensic examination to collect evidence, such
as a rape kit evaluation
E. Refer her for cognitive behavioral therapy: ANSWER: A
Sexual assault affects 43.6% of women in the United States
during their lifetimes, with increased risks seen in adolescents,
college students, LGBTQ persons, and active-duty military
personnel. The risk is also increased by physical or mental
disabilities, poverty, homelessness, incarceration, and substance
