USMLE Forums banner
1 - 13 of 13 Posts

·
Registered
Joined
·
590 Posts
Discussion Starter · #1 ·
A 22-year-old female presents with a chief complaint of frequent headaches. On physical examination, perimolysis of her upper and lower teeth is noted (see figure). The patient's BMI is 16. While she admits to excessive exercise, she insists that there is nothing wrong with her, that she has never felt better since she was a teenager, and that her slenderness is inherited from her mother. From what might this woman be suffering?
  • Acute stress disorder
  • Anorexia nervosa, purging type
  • Anorexia nervosa, restricting type
  • Bulimia nervosa, non-purging type
  • Bulimia nervosa, purging type
  • Kleine-Levin syndrome
verzak_07-3_fig6.jpg
click image to enlarge
 

·
Registered
Joined
·
4,342 Posts
I liked it when you used the word "perimolysis" because not all of us knows what that means, which is exactly the situation in USMLE exam, they bring up terms that puzzle us.

Perimylosis means acid erosion, this girl must have been vomiting and therefore the answer is BN - purging type.
 

·
Registered
Joined
·
487 Posts
Anorexia nervosa, purging type

My answer is Anorexia nervosa, purging type

Anorexia Nervosa - purging type:

An intense drive for thinness - excessive exercise

An intense fear of gaining weight or becoming fat - BMI = 16

purging behavior (self-induced vomiting) - perimolysis of teeth

In women- a cessation of the menstrual cycle for at least three months

In men- a decreased sexual drive
 

·
Registered
Joined
·
590 Posts
Discussion Starter · #7 ·
Correct!

The answer is B. Anorexia nervosa, purging type - for exactly the reasons that aktorque and mle2resident stated. That her body weight is significantly below normal, that she denies being underweight, and that she feels good about her weight loss point to anorexia nervosa rather than bulimia. Purging (Sarah-cali) and hypergymnasia (patelMD and mle2resident) may be characteristic of either anorexia nervosa or bulimia nervosa. Anorexia nervosa shows family grouping, though whether this is genetic or psychosocial or both I doubt is known. This was new information to me when I read this chapter in Fadem, which is why I wrote the question. Now we all know! The headaches were mostly unrelated, mle2resident, except that I knew a young lady who was anorexic and whose only health complaint was headaches (not that she didn't have other health issues; rather, that she didn't think they were problems). Anorexia is a life-threatening psychological disorder, with mortality rates up to 18%.
 

·
Registered
Joined
·
1,176 Posts
The answer is B. Anorexia nervosa, purging type - for exactly the reasons that aktorque and mle2resident stated. That her body weight is significantly below normal, that she denies being underweight, and that she feels good about her weight loss point to anorexia nervosa rather than bulimia. Purging (Sarah-cali) and hypergymnasia (patelMD and mle2resident) may be characteristic of either anorexia nervosa or bulimia nervosa. Anorexia nervosa shows family grouping, though whether this is genetic or psychosocial or both I doubt is known. This was new information to me when I read this chapter in Fadem, which is why I wrote the question. Now we all know! The headaches were mostly unrelated, mle2resident, except that I knew a young lady who was anorexic and whose only health complaint was headaches (not that she didn't have other health issues; rather, that she didn't think they were problems). Anorexia is a life-threatening psychological disorder, with mortality rates up to 18%.
EDIT:

You should have included the symptom of Amenhorrea ;)
 

·
Registered
Joined
·
1,684 Posts
B- Anorexia Nervosa - Purging Type

You should have included the symptom of gynecomastia ;)
Not sure where that fits in ? gynecomastia - enlargement of breast in males ? :confused:

I think the answer is B as well. Anorexia Nervosa Purging Type.
In Kaplan Lecture Notes, they stated that if a person has a lower than normal BMI (16 in this case) it points to ANOREXIA ... However, low BMI or weight are not necessarily related to Bulimia because those patients still tend to eat normal meals! (they just tend to purge it out after they eat it) Whereas, in cases of Anorexia, patients pretty much starve themselves and do whatever else they can (excessive exercise)

Also, I know that BMI is not the differentiating factor because a lot of the athletes have a BMI around that range !

If i didnt read sarah-cali's post about perimolysis of teeth i was thinking in terms of Acute Stress Disorder. Since acute stress disorder or stress (along with anxiety) in general can initiate Bruxism or grinding of teeth, it can lead to tinnitus and frequent headaches along with facial pains.
 

·
Registered
Joined
·
1,176 Posts
Not sure where that fits in ? gynecomastia - enlargement of breast in males ? :confused:

I think the answer is B as well. Anorexia Nervosa Purging Type.
In Kaplan Lecture Notes, they stated that if a person has a lower than normal BMI (16 in this case) it points to ANOREXIA ... However, low BMI or weight are not necessarily related to Bulimia because those patients still tend to eat normal meals! (they just tend to purge it out after they eat it) Whereas, in cases of Anorexia, patients pretty much starve themselves and do whatever else they can (excessive exercise)

Also, I know that BMI is not the differentiating factor because a lot of the athletes have a BMI around that range !

If i didnt read sarah-cali's post about perimolysis of teeth i was thinking in terms of Acute Stress Disorder. Since acute stress disorder or stress (along with anxiety) in general can initiate Bruxism or grinding of teeth, it can lead to tinnitus and frequent headaches along with facial pains.
Sorry I meant amenorrhea lol..

I was studying turner's syndrome when I looked at this question so thats why I wrote gynecomastia lol :rolleyes:
 

·
Registered
Joined
·
590 Posts
Discussion Starter · #11 ·
EDIT:

You should have included the symptom of Amenhorrea ;)
Amenorrhea is definitely an important diagnostic symptom of anorexia - but one that might not be reported to the physician, or even one that might be lied about. I thought that, in this case, the patient would not have offered it as a related symptom, since she is there for her headaches and doesn't want to be treated for her anorexia...
 

·
Registered
Joined
·
1,176 Posts
Amenorrhea is definitely an important diagnostic symptom of anorexia - but one that might not be reported to the physician, or even one that might be lied about. I thought that, in this case, the patient would not have offered it as a related symptom, since she is there for her headaches and doesn't want to be treated for her anorexia...
Haha, its the physicians job to take a complete and thorough history! :))
 
1 - 13 of 13 Posts
Top