Answer:USMLE step 2 Mcq 72:A 16 year old girl is brought by her mother to her physician


Correct Answer: C
It is not uncommon for patients with anorexia nervosa to be referred months after the onset; growth failure may be the first sign, and this condition must be considered in the differential diagnosis of growth failure. Anorexia nervosa, a common cause of gonadotropin deficiency in adolescence, is a functional disorder, apparently increasing in prevalence in girls but rare in boys, and is characterized by a distorted body image, obsessive fear of obesity, and food avoidance that can cause severe weight loss, primary or secondary amenorrhea in affected females, and even death. Other features include onset in middle adolescence, hyperactivity, defective thermoregulation with hypothermia and sensitivity to cold, constipation, bradycardia and hypotension, decreased basal metabolic rate, dry skin, fine downy hypertrichosis, peripheral edema, and parotid enlargement. In anorexia nervosa the levels of plasma FSH, LH, leptin, and estradiol and of urinary gonadotropins are low.


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