Wednesday, December 19, 2007


An 18 year old girl comes into your primary care clinic for an annual physical for her to play water polo. At first glance, she appears to be normal and healthy. However, on exam, you find a pulse of 50, BP 95/55, and QT elongation on EKG. She stopped menstruating over a year ago, but she says that it's probably due to her sports; she is unconcerned. When you ask her about school, she says her grades are all A's, but she doesn't seem to have much self confidence. As she talks, you notice chapped lips. On exam, you find this on her arms.

Challenge: This constellation of symptoms and signs worries you that she may have or be at risk for what disorder?

Related Questions:
1. What is seen on the image?

Image shown under fair use.

1 comment:

Craig said...


The image shows lanugo, very fine hairs that grow on the body to insulate the skin due to lack of fat. Though normally seen in newborns, in this case, it is a sign of anorexia nervosa. Patients with anorexia nervosa may be bradycardic, hypotensive, with QT elongation. Girls may show amenorrhea. They may be perfectionist, but lack self-esteem. The malnutrition may also cause chapped lips.

Sources: Wikipedia,