Review Question - QID 210925

The patient is presenting with a normal body mass index (BMI) and evidence of dorsal hand calluses, which is suspicious for bulimia nervosa. Bulimia nervosa is associated with increased incidence of dental cavities.

Bulimia nervosa is defined as frequent binge eating and purging, such as with self-induced vomiting. Patients will often have a normal weight or BMI. Other findings on physical exam include parotid gland enlargement and Russell sign (dorsal hand calluses from inducing vomiting). Bulimia nervosa is associated with an increased incidence of dental cavities caused by vomiting. Patients may also present with a hypochloremic metabolic alkalosis.

Incorrect Answers:
Answer 2: Galactorrhea is associated with hypothyroidism. Signs and symptoms of hypothyroidism include fatigue, constipation, cold intolerance, weight gain, depression, menstrual irregularities, and bradycardia.

Answer 3: Lanugo is very fine body hair, which is associated with anorexia nervosa. Anorexia nervosa is characterized by an intense fear of weight gain and denial of emaciated state. Patients may present with weight < 85% of ideal body weight, bradycardia, hypotension, anemia, and possibly amenorrhea.

Answer 4: Metatarsal stress fractures are associated with anorexia nervosa due to the increased risk of developing osteoporosis.

Answer 5: Motor tics are a characteristic of Tourette syndrome. While Tourette syndrome has an increased co-morbidity with obsessive-compulsive disorder, there is no literature to suggest a definitive increased incidence of Tourette syndrome in patients with bulimia nervosa.

Bullet Summary:
Bulimia nervosa is associated with an increased incidence of dental cavities.