PUID: 42 || PLAB 2 Mock 8 :: EatingDisorder1: Bulimia Mother Makes Appointment

Practice a case with the AI patient 🤖

Summary:

This scenario involves a teenage girl presenting with symptoms suggestive of an eating disorder—specifically bulimia nervosa. The patient has poor insight into her condition and is engaging in self-induced vomiting. The key objectives are to recognize the diagnosis, assess for complications, ensure safety, and communicate effectively to manage the psychological and physical health risks.

Key Points:

Mental Health / Eating Disorders

• Diagnosis specificity: Clearly state and explain bulimia nervosa; avoid vague terms like "eating disorder."

• Insight issues: Most patients with bulimia lack insight; they may deny illness or dismiss concerns.

• Cough Questionnaire (SCOFF):

  • Sick due to feeling uncomfortably full

  • Control over eating lost

  • One stone weight loss in 3 months

  • Fat feelings dominate

  • Food dominates life

Gastrointestinal / Medical Emergencies

• Self-induced vomiting can lead to:

  • Electrolyte imbalance (especially hypokalemia)

  • Arrhythmias

  • Dental erosions

  • Mallory-Weiss tears or bleeding

• Ask about blood in vomitus or stools—both are red flags.

• Throat soreness due to repetitive vomiting

Adolescent Medicine / Menstrual History

• Assess menstrual regularity—amenorrhea may signal severe nutritional imbalance.

• Ask about body image perception and dietary habits (binging, restriction, excessive exercise).

Important Considerations:

• Patients may delay admission—insist on face-to-face review if red flags are present.

• Involve family only with patient’s consent, unless safety is compromised.

• Admission criteria:

  • BMI <18

  • Electrolyte abnormalities

  • Medical instability

Diagnostic Approach:

1. History Taking:

   • Vomiting patterns: frequency, context (e.g., post-meal)

   • Red flags: blood in vomit/stool, dizziness, palpitations

   • Psychosocial aspects: stress, bullying, family issues

2. Physical Examination:

   • Look for signs of malnutrition, dehydration, dental erosion

3. Investigations:

   • Blood tests (electrolytes)

   • ECG (arrhythmias)

   • Urinalysis (dehydration)

Management:

• Immediate: Arrange urgent face-to-face consultation

• Medical Stabilization:

  • Check and correct electrolyte imbalances

  • Hospitalize if needed

• Psychiatric Referral:

  • CAMHS (Child & Adolescent Mental Health Services)

  • Eating disorder clinic

• Family Therapy: Improve home support dynamics

• Provide Education:

  • Leaflets on bulimia and support networks

• Follow-Up:

  • Monitor weight, mental health, treatment adherence

Communication Skills:

• Build rapport while maintaining clinical authority

• Use non-blaming, supportive language: "This isn’t your fault"

• Explain condition and consequences clearly and compassionately

• Avoid vague reassurance or overpromising

• Emphasize confidentiality unless safety is a concern

Ethical Considerations:

• Confidentiality: Respect unless immediate risk

• Consent: Needed for parental involvement

• Patient autonomy: Balanced with safety in minors

Additional Resources:

• NICE Guidelines on Eating Disorders

• GMC Good Medical Practice on Adolescents & Mental Health

• Royal College of Psychiatrists: Managing Bulimia Nervosa

• PLAB 2 Examiner Tips