USMLE Step 1 Question 344

Question:

An 18-year-old girl visits her college student health office for a required physical. She complains of irritableness and concerns about decision-making now that she has left home. On exam she appears exceedingly thin, with decreased muscle mass and dry skin. She is hypotensive, with resting bradycardia. What other finding is most likely to be present?

Correct Answer: E.  Secondary amenorrhea

This patient appears to be suffering from anorexia nervosa, as evidenced by weight loss with decreased muscle mass. Decisionmaking concerns, irritability, and dry skin are three of many common complaints.

Anorexia nervosa will often cause a secondary amenorrhea (choice E); treatment of anorexia nervosa should restore ovulation.

Calluses on hands/fingers (choice A), as well as dental erosions (choice B) are often seen in patients with bulimia, as a result of induced vomiting.

Hirsutism (choice C) is not typically found in patients with anorexia nervosa; on the contrary, these patients often show signs of hair loss, presumably as a result of poor nutrition. In some patients with anorexia nervosa, a thin, soft hair called lanugo grows on the body to serve as insulation in place of insufficient subcutaneous fat. This is distinct from hirsutism, however, which is characterized by coarse hair in an androgenic pattern.

Primary amenorrhea (choice D) is defined as failure of menses to occur by age 16. If present, this condition should have been worked up well before the current patient visit.