Rosh Psychiatry Board Practice Exam

Which diagnosis is most likely for a woman with concerns about weight, parotid gland enlargement, and abrasions on her knuckles?

1. Anorexia nervosa

2. Bulimia nervosa

3. Major depressive disorder

4. Obsessive-compulsive disorder

The correct answer is: Bulimia nervosa

The diagnosis of bulimia nervosa is most fitting for a woman presenting with concerns about her weight, parotid gland enlargement, and abrasions on her knuckles. These symptoms provide crucial insight into her potential eating disorder. Weight concerns are a central feature of bulimia nervosa, where individuals often engage in episodes of binge eating followed by compensatory behaviors aimed at preventing weight gain, such as vomiting, excessive exercise, or using laxatives. The parotid gland enlargement is particularly noteworthy, as repeated vomiting can lead to swelling of the salivary glands due to the body's response to frequent purging. This physical manifestation often serves as a clinical clue suggesting the diagnosis of bulimia nervosa. Abrasions on the knuckles can be indicative of a common behavior associated with bulimia, known as "Russell's sign." This occurs when individuals induce vomiting by using their fingers to trigger gag reflex, leading to repeated trauma and abrasions on the knuckles. In contrast, anorexia nervosa primarily involves significant weight loss and an intense fear of gaining weight, but the parotid gland enlargement and associated abrasions characterizing bulimia are less common in anorexia. Major depressive disorder and obsessive-compulsive disorder may have features that overlap