Review Question - QID 220650

This patient with excessive concerns about weight, parotid gland enlargement, and dorsal hand calluses (Russel sign) most likely has bulimia nervosa.

Bulimia nervosa is an eating disorder that is characterized by excessive concerns about weight. Patients address this concern by engaging in binging and purging behaviors. Patients are typically within the normal BMI range despite the concern about weight. Many patients with bulimia nervosa present with parotid gland hypertrophy, which is secondary to self-induced vomiting. Patients with bulimia nervosa also present with calluses on the back of the knuckles due to self-induced vomiting (Russel sign), enamel erosion, xerosis, hypokalemia, hypochloremia, and metabolic alkalosis.

Harrington et al. review the evaluation, diagnosis, and treatment of eating disorders. They discuss how inpatient treatment may be required in order to stabilize the patient if the patient experiences severe complications. They recommend short-term psychotherapy and the use of psychotropic medications in patients with bulimia nervosa.

Figure/Illustration A is a clinical photograph demonstrating enlargement of the right parotid gland (red circle). This finding of painless parotid enlargement is classically seen in patients with bulimia nervosa.

Figure/Illustration B is a clinical photograph demonstrating calluses of the dorsal hand secondary to self-induced vomiting (red circles). This is also called the Russel sign and is seen in patients with bulimia nervosa.

Incorrect Answers:
Answer 1: Anorexia nervosa is characterized by restrictive food intake leading to decreased body weight (measured by the body mass index), fear of gaining weight despite being underweight, and a distorted perception of body image and weight. Patients may present with bradycardia, electrolyte abnormalities, and fine, soft body hair known as lanugo. There is a purging subtype of anorexia nervosa; however, this patient has a normal BMI.

Answer 2: Binge eating disorder is characterized by eating large amounts of food over a short period of time and a lack of control over the rate or quantity of food intake. Patients also have feelings of disgust, depression, or guilt after eating.

Answer 3: Patients with body dysmorphic disorder are preoccupied with
a physical defect that is either nonexistent or slight. Patients will engage in repetitive behaviors or mental acts at some point during the illness course to deal with this perceived deformity including mirror checking, skin picking, or excessive grooming.

Answer 5: Chondromyxoid tumor in the salivary gland describes pleomorphic adenoma, the most common benign salivary gland tumor. This patients calluses of the dorsal hand (Russel sign) suggest bulimia nervosa and parotid enlargement from vomiting.

Bullet Summary:
Bulimia nervosa presents with binging and purging with a normal or elevated BMI and can present with enamel erosion, parotitis, and dorsal hand calluses.