A 23-year-old woman has recurrent episodes of binge eating (consuming large amounts of food rapidly with loss of control) followed by self-induced vomiting, occurring at least once per week for 3 months. She is of normal weight. Dental examination shows enamel erosion. What is the PATHOGNOMONIC physical sign found on examination of her hands?
- A Koilonychia
- B Leuconychia
- C Russell's sign (calluses on dorsum of hand from self-induced vomiting) ✓
- D Palmar erythema
Correct answer: C. Russell's sign (calluses on dorsum of hand from self-induced vomiting)
Explanation
Russell's sign refers to calluses or abrasions on the dorsal surface of the hand (specifically over the metacarpophalangeal joints) from repeated contact with the teeth during self-induced vomiting in Bulimia Nervosa. It is a pathognomonic physical finding. Other physical findings in BN include: dental enamel erosion (acid from vomitus), parotid gland hypertrophy (sialadenosis), hypokalemia, hypochloremic metabolic alkalosis, and elevated serum amylase (salivary isoform). Koilonychia is spoon-shaped nails seen in iron-deficiency anemia.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.