Snapshot A 24-year-old woman visits her gynecologist for an annual visit. She has no physical complaints. Her BMI is 24 kg/m2. On exam it is noted that she has enlarged parotid glands and poor dentition. Upon further questioning, she admits that she binges on pizza and pasta at least once or twice week. She admits to feeling guilty after these episodes of excessive consumption and takes laxatives after binging. Introduction Overview bulimia nervosa is an eating disorder marked by recurrent episodes of binge eating accompanied by compensatory behaviors (e.g., purging) Epidemiology prevalence 1% in the US 0.5% for males 1.5% for females demographics females > males risk factors jobs or hobbies that require rapid gain or loss of weight (e.g., wrestling and bodybuilding) or emphasize a thin body type (e.g., ballet and cheerleading) Pathophysiology result of a complex of psychosocial factors Prognosis ~50% of patients with bulimia will recover fully ~30% of patients have partial recovery while 10-20% continue to have chronic symptoms Presentation Symptoms recurrent episodes of binge-eating followed by compensatory behavior eating a large amount of food in a discrete period of time feeling loss of control during the episode common compensatory behaviors self-induced vomiting laxative use excessive exercise restrictive eating episodes occur at least once a week for 3 months Physical exam weight often normal or slightly above ideal body weight parotid gland enlargement dental cavities Russell sign dorsal hand calluses from inducing vomiting Studies Basic metabolic panel may show electrolyte abnormalities hypokalemic metabolic alkalosis with significant vomiting ECG QT-interval prolongation, especially in the setting of hypokalemia, indicates serious risk for cardiac arrhythmias Differential Anorexia nerviosa key distinguishing factor food and calorie restriction; lower-than-normal BMI Binge-eating disorder key distinguishing factor episodes of binging that are not accompanied by compensatory behaviors Treatment Stabilization always stabilize the patient's volume status and replete electrolytes prior to psychiatric therapy ringer lactate or normal saline electrolyte repletion potassium magnesium calcium Lifestyle cognitive behavioral therapy first-line treatment Medical selective serotonin reuptake inhibitors (SSRIs) (e.g., fluoxetine) particularly helpful for patients with concurrent symptoms of depression and anxiety indicated in patients who have suboptimal response to cognitive behavioral therapy Complications Electrolyte disturbances hypokalemia metabolic alkalosis
QUESTIONS 1 of 3 1 2 3 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M2.OMB.18.1) A 17-year-old girl presents to her primary care physician with a concern for a puffy cheek. She has noticed she has had a puffy cheek for the past month despite exercising more often and eating a healthy diet. The patient states she is an otherwise healthy student, does not smoke, and is not sexually active. Her temperature is 97.9°F (36.6°C), blood pressure is 114/74 mmHg, pulse is 105/min, respirations are 13/min, and oxygen saturation is 98% on room air. Physical exam is notable for a healthy young woman with a nontender abdomen. Exam reveals the finding in Figure A as well as poor dentition. Her BMI is 26 kg/m^2 and she has normal development for her age. Laboratory values are ordered as seen below.Hemoglobin: 10 g/dLHematocrit: 30%Leukocyte count: 12,900/mm^3 with normal differentialPlatelet count: 191,000/mm^3 Serum:Na+: 139 mEq/LCl-: 100 mEq/LK+: 3.0 mEq/LHCO3-: 29 mEq/LBUN: 23 mg/dLGlucose: 99 mg/dLCreatinine: 1.2 mg/dLCa2+: 10.2 mg/dLWhich of the following is the most likely diagnosis? QID: 210744 FIGURES: A Type & Select Correct Answer 1 Anorexia nervosa 0% (0/6) 2 Bulimia nervosa 50% (3/6) 3 Sialolithiasis 17% (1/6) 4 Suppurative parotitis 33% (2/6) 5 Viral parotitis 0% (0/6) M 6 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (M2.PY.16.32) A 22-year-old female college student comes to your clinic to establish care. She has no significant past medical history and her only complaint today is that she has had trouble maintaining a consistent weight. Her temperature is 98.6°F (37.0°C), blood pressure is 100/65 mmHg, pulse is 62/min, and respirations are 12/min. Her body mass index is 19.5. Her physical exam is significant for callused knuckles and dental enamel erosions. What laboratory abnormalities are likely to be found in this patient? QID: 104306 Type & Select Correct Answer 1 Decreased chloride, decreased potassium, decreased bicarbonate 0% (0/7) 2 Decreased chloride, decreased potassium, increased bicarbonate 71% (5/7) 3 Decreased chloride, increased potassium, increased bicarbonate 14% (1/7) 4 Increased chloride, decreased potassium, decreased bicarbonate 14% (1/7) 5 Increased chloride, increased potassium, increased bicarbonate 0% (0/7) M 6 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic