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nbme23/Block 4/Question#33 (65.4 difficulty score)
A 16-year-old girl with bulimia nervosa is ...
Potassium: decreased;
Chloride: increased;
Bicarbonate: decreased


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submitted by nwinkelmann(293),
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I elltyarli just edlaierz why tish oeuqnsit doenscuf me so cuhm na(d ve'I diret to frgeui ti tou a loucpe of msiet, l).ol I tel the ooulallcqi niitoiendf of mlbuiia .e(i. igoitvnm) ctksi ni my ,dmni thta I otforg the tclaau acieldm ontiiefnid = narmol BMI g1t&;()8 + ngbie tanige dan ignrgpu ehewr( ipungrg coldu be ndceiud ontmgivi or eritdicu eus ro txeaivla sue nrda/o sexsveiec rexs.)ceei oS lyerla, hwta thsi sitoqneu was agnksi si yisplm wtha is het ytletorlcee ncaeabl fo xseecvise hrdei?raa ZEE!G I emda it os chum rdehra in ym hdea hwen rtigyn to arwnse it nlorliyga.i

aDarrhei eucass nooinann- pag ei(.. erpe)iolrcmychh ltoibecam idacssoi. oolSt eioradmnyntlp oicatnsn C-HO3 dna +,K os vxsesecie hreaidar = ceevsexsi loss fo -OCH3 nad K.+ oCrheild lsvele in teh sumer wlil eb rcansdeei deu to eht rmnlao -3OH/C-Cl uirmiuie,blq so sa eiegvatn ghraec ispeistdas deu to slso fo C,O3H- l-C ilwl eicsnrae cegocrtrni the p.go-aainn

drdoom  Bulimia comes from Greek "ravenous hunger"; the term is a literal concatenation of the words for ox (bous) + hunger (limos). So, in Greek, bou-limia is literally "ox hunger", which is a nod to how the word is used in medicine = perpetual and insatiable appetite for food (the very "opposite" of vomiting). +4  
abhishek021196  I agree with your reasoning but the classic case description of Bulima lists electrolyte disturbance of HypOkalemia, HypOchloremia, and Metabolic Alkalosis, along with other things like parotid hypertrophy and dorsal hand calluses due to the induced vomiting. I tripped up there. :/ FA 20 Pg 567 +  
llamastep1  Take home lesson: reasoning > memorizing +2  

submitted by rhsteps(2),
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eht touinseq iilspem ahtt it si a cesa fo vtaxleai ubeas ( tsuh mlbcaoeit alisolsak) btu het rewsan rstnu uto ot eb het oreyltlcete isedaubtrnc of smiylp erahdrai r(moanl aoinn agp atcibelm od)iiascs . neuqst io ywlgorn psrehad adn iuogsfcnn

osgoodschlatter10  Not really. Diarrhoea and dehydration are A/Es of Laxative use (for Sketchy fans remeber the spoiling mud bath). +1  

submitted by brookly_(0),
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I totguhh iliabum veig eirs ot amtoeibcl aolisklsa a.n.c. nsemooe loerabeat ?

drdoom  Remember, bulimia itself does not mean “purging”; it means “ox-hunger”. It is purging (e.g., intentional vomiting, laxative abuse, diuretic abuse, excessive exercise, or extreme fasting) which creates metabolic disturbance. The type of disturbance depends on your preferred route of “exit”. +1  

submitted by usmleuser007(396),
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treTa this ekil a IVaoPm (Wtyare a,drraehi idyrolhahcra = deeurcd HCl in het luenm, am;p& ama)hkoyleip

isth llwi ldae ot tibeolacm scidsioa d/t slos of abcrbi ni losto

btl_nyc  Chloride is increased though. +  
maxillarythirdmolar  This comment is gold. @btl_nyc, this is actually accute. you would expect hyperchloremia +  

submitted by maxillarythirdmolar(36),
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Btse cmmntoe i erda saw to aetrt sthi leik 'sit a Va.moIP uoY lwuod etg all rehte tt/lmcercleoaotliebye disbnarutsce.


submitted by dr.xx(150),
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sbAeu fo asxvliaet ;g&=t laluuys rddeaeces murse pu.stmisoa As ot hroiedlc dan ,ibrcab ttah p.needsd yThe ucodl eb eeanirscd ro ad.seedcre