Question of the Week # 332

332) A 22 year old ballet dancer is evaluated in your office during a routine annual physical examination. She does not have any complaints except for excessive fear of gaining weight. She reports that her mother thinks she has lost a lot of weight in the past two years however, she personally believes she is excessively fat and seeks help to lose more weight. Her menstrual cycles are irregular occurring, once every three to four months. On examination, she is very thin and has a dry, scaly skin. Her Body Mass Index is 15.0. She is afebrile, heart rate is 54/min and blood pressure 86/54 mm Hg. Complete blood count shows mild anemia. Urine pregnancy test is negative. Which of the following findings are consistent with her diagnosis?

A) Metabolic Acidosis

B) Parotid swelling

C) Hyperkalemia

D) Low serum cortisol

E) Increased Pulmonary vital capacity

15 Responses

  1. Patient has anorexia and don`t have enough calories to burn, so she has to restore fat burning whic will lead to metabolic acidosis. Answer A

  2. b

  3. D

  4. B) Parotid swelling

  5. Why parotid swelling? Please elaborate.

  6. b

  7. B…parotid swelling

  8. Question

  9. d, she have anoexia nervosa ,

  10. B parotid gland swelling

  11. she may advised to go for thyroid profile which may be one of the cause of metabolic changes.

  12. B….

    Cortisol is elevate in anorexia nervosa and declines during recovery. metabolic acidosis and hyperkalemia is not seing in anorexia. Fluid and electrolyte imbalances include hypokalemia, hyponatremia, hypochloremia, metabolic alkalosis, elevated blood urea nitrogen (BUN), decreased glomerular filtration rate (GFR), and ketonuria.
    Gastrointestinal effects include constipation, bloating, early satiety, parotid gland hypertrophy, delayed gastric emptying, Mallory-Weiss tears, esophageal or gastric perforation, fatty liver infiltration, gallstones, and pancreatitis

  13. B
    Hypokalaemia is the most common electrolyte abnormality
    Metabolic alkalosis occurs in patients who vomit or abuse diuretics and acidosis in those misusing laxatives.
    Urea and creatinine are generally low
    elevation of aminotransferases
    Amenorrhoea is due to hypogonadotrophic hypogonadism.
    Reduced concentrations of free T4 and free T3
    Cortisol is elevated but the response to adrenocorticotrophic hormone is normal.

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