A medical student comes with normal weight, parotid abscess and dental caries. She gets irritated by inquiry of her eating habit. Most probable diagnosis is?
ANSWER: (B) BulimiaREF: Kaplan and sadock's 10th edition page 736 Anorexia NervosaBulimia NervosaBinge Eating DisorderClinical characteristics OnsetMid-adolescenceLate adolescence/early adulthoodLate adolescence/early adulthoodFemale :male10:110:12:1Lifetime prevalence1% of women1-3% of women4% of men and womenWeightMarkedly decreasedUsually normalUsually obeseMenstruationAbsentUsually normalUsually normalBinge earing25-50%Required for diagnosisRequired for diagnosisMortality5% per decadeLowLowPhysical and laboratory Endings Skin/extremitiesLanugoCallus/abrasion on dorsum of hand Anorexia NervosaBulimia NervosaBinge Eating Disorder Acrocyanosis Edema CardiovascularBradycardia Hypotension GastrointestinalSalivary gland enlargementSalivary gland enlargement Slow gastric emptyingDental erosion Constipation Elevated liver enzymes HematopoieticNormochromic, normocytic anemia Leukopenia Fluid/ElectrolyteIncreased BUN, creatinineHypokalemia HypokalemiaHypochloremia Hypophosphatemia,Alkalosis Hypomagnesemia EndocrineHypoglycemia Low estrogen or testosterone Low LH andESH Low-normalthyroxine Normal TSH Increased cortisol BoneOsteopenia DSM-IV DIAGNOSTIC CRITERIA FOR BULIMIA NERVOSA:Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:eating, in a discrete period of time (e.g,, within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstancesa sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self- induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.Self-evaluation is unduly influenced by body shape and weight.The disturbance does not occur exclusively during episodes of anorexia nervosa.
Adjustment disorder
Bulimia
Anorexia
Conversion reaction
Sleep Disorders