robin082006
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A 17-year-old girl is brought in to your clinic by her mother with complaints of weight loss. The mother says she’s “fed up with her daughter” because of her eating habits. She insists on cooking her own meals and has lost 15 lbs (6.8kg) in the past 3 months. She is a high school athlete and devotes a minimum of 3 hour daily to her training. The mother adds that in all other aspects, "she’s ideal, well behaved and gets good grades at school". When you talk to her she says, “I think I’m just fine, except for all that flab on my abdomen”. Her past history is significant for hepatitis, at the age of 11yrs. Her menstrual cycles are regular. She smokes 1/2 pack/day cigarettes. She does not take any medication, and has no allergies. Height: 5'4"(165cm); Weight: 100lbs(45.3kg). Her vital signs are, Temperature: 97.5F(36C); BP: 99/78mm of Hg, RR: 14/min; PR: 70/min. On physical examination, you find calluses at the back of her fingers. Examination of the oral cavity reveals enamel erosion. This girl is suffering from:
A. Eating disorder, not otherwise specified
B. Anorexia nervosa
C. Bulimia nervosa
D. Conduct disorder
E. Normal adolescent behavior
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| sarika
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A. Eating disorder, not otherwise specified
cant be anorexia due to lack of amenorhea...bulimic have normal wt while she is underwt...
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| young_doc
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C. Bulimia (lesions on the back of the fingers and enamel erosions due to self-induced emesis are characteristic)
Bulimia can present with underweight, normal weight, or overweight.
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| drashishmahajan
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A
cant be bulimia .. in bulimia theres stress-->binge--> guilt ---> purge...
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| Guptashutosh
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Bulimia dis
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| CocaCola
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A - eating disorder not otherwise specified
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| robin082006
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Correct answer is A
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| fox
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Robin can u xplain why its not bulimia?
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| robin082006
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underweight---> rule out bulimia
No amenorrhea, callusea of hand---> rule out anorexia
This patient has symptoms of both bulimia and anorexia---> A
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| huyniid
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I got the wrong answer in UW, but still be wrong this time. Check DSM-IV
The Eating disorder, not otherwise specified (EDNOS) category include disorders that do not meet the criteria for a specific eating disorder. Each one of the following disorders is an example:
* All of the criteria for anorexia nervosa are met except that the individual has regular menses.
* All of the criteria for anorexia nervosa are met except that, despite substantial weight loss, the individual's current weight is in the normal range.
* All of the criteria for bulimia nervosa are met except that binge eating and inappropriate compensatory mechanisms occur at a frequency of less than twice a week or for a duration of less than 3 months.
* The regular use of inappropriate compensatory behavior by an individual of normal body weight after eating small amounts of food (eg, self-induced vomiting after the consumption of two cookies).
* Repeatedly chewing and spitting out, but not swallowing, large amounts of food.
* Binge eating disorder: recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of bulimia nervosa.
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| dipsite
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hhhmmmm....
Callouses at the back of fingers and enamel erosions point to self purging.
If loss of weight is more than 15% of previous weight then diagnose it as Anorexia Nervosa.Also self purging can occur in both Anorexia and Bulimia.She doesn't take any medicattion so no diuretic or laxative abuse.
I think answer to be anorexia because anorexia is seen in high academic achievers and high socio-economic status there is only one point against anorexia that is NO amenorrhoea.".Also she cooks her own food that is typical Of Anorexia(Ref.Niraj Ahuja)"
From where have you taken this question?
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| dipsite
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Regarding Robin's explanation that underweight so rule out Bulimia thats correct but then what second line says No amenorrhoea rule out Anorexia thats correct but callouses on hand are seen in anorexia and bulimia..and on the sole basis of amenorrhoea we can't exclude Anorexia.
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| 92306
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that is the most important point if amenorrhoea is there it is Anorexia.
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| dr in trouble
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A
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| dipsite
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You guys wanna mean that "Amenorrhoea is a must for diagnosing Anorexia"..May be..I don't know. BUt where is this "Eating Disorder Not Otherwise specified" Given? Which Book?
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| kotikoti
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dipsite wrote:
You guys wanna mean that "Amenorrhoea is a must for diagnosing Anorexia"..May be..I don't know. BUt where is this "Eating Disorder Not Otherwise specified" Given? Which Book?
Yes, you need three consecutive missed periods to diagnose AN. The answer is A. Check Wickepedia
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| coolmavs
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Yes, AMENORRHEA is a must for diagnosis of anorexia. But calluses can be present in both Bulimia and Anorexia. Hey Robin, what is the source of this question?
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