You are taking the history of a 14 years old girl who has a BMI of 18. The girl reports inability to eat, induces vomiting and severe constipation. Which of the following would you most likely suspect?

1. A

   Anorexia nervosa

2. B

   Bulimia

3. C

   Multiple sclerosis

4. D

   Systemic sclerosis

Appeared in: UPUMS Nsg.Officer-2024

Explanation

• The patient's low Body Mass Index (BMI) of 18 is a critical indicator of being underweight, a hallmark criterion for Anorexia Nervosa.
• The presentation includes both food restriction ('inability to eat') and purging behaviors ('induces vomiting'), which are characteristic of the binge-eating/purging subtype of Anorexia Nervosa.
• Severe constipation is a common physiological consequence of malnutrition and slowed gastrointestinal motility seen in individuals with Anorexia Nervosa.

Why Other Options Were Wrong

• Option B: Individuals with Bulimia Nervosa typically maintain a normal or above-normal body weight. The primary feature is recurrent binge eating, which is not reported here; instead, 'inability to eat' suggests restriction.
• Option C: This is a chronic, demyelinating disease of the central nervous system. Its symptoms are neurological (e.g., weakness, vision problems, poor coordination) and do not include the specific psychological and behavioral patterns of an eating disorder.
• Option D: This is an autoimmune connective tissue disorder causing fibrosis of the skin and internal organs. While it can cause GI symptoms like constipation or dysphagia, it does not involve the core psychological features of an eating disorder like induced vomiting or an intense fear of gaining weight.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Differentiating eating disorders based on clinical presentation, specifically distinguishing Anorexia Nervosa from Bulimia Nervosa using BMI and reported behaviors as background academic context rather than a clinical decision trigger.
• Anorexia Nervosa has the highest mortality rate of any psychiatric disorder, primarily due to medical complications like cardiac arrhythmias from electrolyte imbalances (e.g., hypokalemia from vomiting) and suicide.
• Nurses play a crucial role in monitoring for refeeding syndrome during nutritional rehabilitation, a potentially fatal condition caused by rapid shifts in fluids and electrolytes when a malnourished person begins to eat again.
• A multidisciplinary approach involving medical, psychological, and nutritional experts is essential for successful treatment and recovery.

How to Approach the Question

• First, analyze the patient's key data: age (14), BMI (18), and presenting symptoms.
• Recognize that a BMI of 18 in an adolescent is a strong indicator of being underweight.
• Identify the core behaviors described: food restriction ('inability to eat') and purging ('induces vomiting').
• Compare these findings against the diagnostic criteria for the eating disorders listed in the options. The most critical differentiating factor between Anorexia and Bulimia is body weight/BMI.
• Conclude that the combination of significantly low body weight plus restrictive and purging behaviors fits the diagnosis of Anorexia Nervosa.
• Rule out the non-psychiatric medical conditions (Multiple Sclerosis, Systemic Sclerosis) as they do not match the primary psychological and behavioral presentation.

Concept Tested & Keywords

• Concept Tested: Differentiating eating disorders based on clinical presentation, specifically distinguishing Anorexia Nervosa from Bulimia Nervosa using BMI and reported behaviors.
• Stem keywords: 14 years old, BMI of 18, inability to eat, induces vomiting, severe constipation
• Lead-in keywords: most likely suspect
• Clinical cues: A BMI of 18 in a 14-year-old is a strong indicator of being underweight, which is a cornerstone for diagnosing Anorexia Nervosa.
• Clinical cues: The combination of restrictive behavior ('inability to eat') and purging behavior ('induces vomiting') points to the binge-eating/purging subtype of Anorexia Nervosa.

Question ID

QBjOakoj5huIAKWoFLPJ9V

Copy ID

Reference Book

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 43-45

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 312-314

E6 Medicine Harrison 22e Part 2 p. 1575-1577