Gastroenterology · UKMLA & AKT
Bulimia nervosa
A free high-yield preview for the UKMLA Applied Knowledge Test, covering how to recognise this condition. The full SA Note notes add investigations, management and complications, with practice questions on this topic.
Key high-yield points
- Normal or fluctuating body weight - key distinguishing feature from anorexia nervosa
- Russell's sign - calluses/scarring on dorsal knuckles from teeth scraping during self-induced vomiting; pathognomonic
- Parotid/submandibular gland enlargement - bilateral, painless; 'chipmunk' jaw appearance
- Dental enamel erosion - palatal surfaces of upper incisors; dentist may be first to raise concern
- GORD, bloating, mouth ulcers, sore throat - from repeated acid exposure
- Psychological features - over-evaluation of self-worth based on weight/shape; guilt and shame; comorbid depression, anxiety, self-harm
Classic vignette: young woman of normal weight with acid reflux/dental erosion, bilateral jaw swelling, and knuckle calluses. Venous blood gas shows metabolic alkalosis with hypokalaemia - this is bulimia nervosa until proven otherwise.
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