USMLE · Question #601
A 17-year-old female is brought to the emergency department by her parents due to right foot pain. She denies recent trauma and has no history of major illnesses. She is physically active and walks fo
The correct answer is E. metatarsal fracture. This patient's low BMI and a year long history of poor eating habits are consistent with anorexia nervosa. Anorexic patients have an unreasonable fear of gaining weight and "feel fat" even when overweight and engage in prolonged physical activity in order to lose weight. This pat
Question
A 17-year-old female is brought to the emergency department by her parents due to right foot pain. She denies recent trauma and has no history of major illnesses. She is physically active and walks for at least one hour daily. She says that she is doing well in high school and gets along well with her parents except that they keep telling her to eat more especially since her boyfriend broke up with her a year ago. Vitals reveal a weight 47.6 kg (105 lbs) and BMI of16 kg/m . The most likely diagnosis is
Options
- Aconversion disorder
- Bdepressive disorder
- Cgonococcal arthritis
- Dinjured medial ankle tendon
- Emetatarsal fracture
How the community answered
(23 responses)- A9% (2)
- B9% (2)
- D4% (1)
- E78% (18)
Explanation
This patient's low BMI and a year long history of poor eating habits are consistent with anorexia nervosa. Anorexic patients have an unreasonable fear of gaining weight and "feel fat" even when overweight and engage in prolonged physical activity in order to lose weight. This patient most likely started eating poorly after her breakup with her boyfriend. Metatarsal stress fractures are a complication of rigorous physical activity in patients with anorexia due to chronic malnourishment which results in low bone density. Other findings include amenorrhea, electrolyte disturbances, lanugo, anemia and coexisting depression. Psychotherapy and nutritional rehabilitation are first line treatments.
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