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A 20-year-old college student comes to the clinic because her parents told her that they are going to make her come home if she does not "get help." She says that she is not sure what her parents are so concerned about. She exercises "regularly", gets good grades in school, has a couple of fraternity guys that she goes out with, and drinks 2-3 beers on the weekends at parties. She believes that she has a "typical college lifestyle." Her menstrual periods occur at regular 29-day intervals and have been normal. Her blood pressure is 120/80 mm Hg, pulse is 65/min, and respirations are 15/min. She is 157 cm (5 ft 2 in) tall and weighs 54.1 kg (119 lb). Physical examination shows many dental caries, periodontal disease, pharyngeal abrasions, nail changes, and multiple, linear lacerations on her forearms in various stages of healing.
Laboratory studies show:
Sodium 139 mEq/L
Potassium 2.8 mEq/L
Chloride 94 mEq/L
Bicarbonate32 mEq/L
The most appropriate question to help establish a diagnosis is:
A. "Do you ever feel guilty about drinking alcohol?"
B. "Do you typically restrict your diet to under 800 calories a day?"
C. "Have you ever taken laxatives as a way to lose weight?"
D. "Have you ever consumed large quantities of food and then regurgitated it to prevent weight gain?"
E. "Please describe your exercise routine"
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Posts: 3,675,934
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Posts: 3,675,934
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Posts: 3,675,934
Threads: 734,342
Joined: Sep 2021
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Posts: 3,675,934
Threads: 734,342
Joined: Sep 2021
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bulimia, but maybe better let her talk? E?
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ans is D.
This patient most likely has bulimia nervosa, which is an eating disorder characterized by recurrent episodes of binge eating followed by a compensatory behavior to prevent weight gain (vomiting, exercise, laxative abuse). Other features include stealing food, alcohol and drug abuse, self-mutilation, and depression. The individuals are usually at or slightly over the normal weight for their body, sexual activity is normal or increased, and they continue to menstruate. Clinical findings that are caused by recurrent vomiting include dental caries, periodontal disease, pharyngeal lacerations, and nail changes. Metabolic alkalosis and hypokalemia are often present and are due to repeated vomiting. Complications include aspiration and rupture of the esophagus or stomach.
"Do you ever feel guilty about drinking alcohol?" (choice A) is a question that would be asked if you suspected alcohol abuse. While alcohol abuse has been associated with bulimia nervosa, it does not seem that this patient is an alcoholic.
"Do you typically restrict your diet to under 800 calories a day?" (choice B) would be an indication of anorexia nervosa, which is characterized by the refusal to maintain a normal, healthy body weight and the disturbance of body image. These individuals have an intense fear of gaining weight and therefore restrict food intake to dangerously low levels. Women become amenorrheic, have decreased sexual desire, ritualized exercise routines, and changes in their skin and hair. Complications include ventricular tachyarrhythmias.
"Have you ever taken laxatives as a way to lose weight?" (choice C) and "Please describe your exercise routine" (choice E) are questions that should be asked to both anorexics and bulimics. Laxative abuse and exercise rituals are common in both diseases but laxative abuse is probably more common in bulimia, while ritualized exercise is more common in anorexia. This patient has the clinical findings associated with vomiting and therefore the question about binge eating and purging would more likely establish a diagnosis.
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