Rosh Psychiatry Board Practice Exam

What physical examination finding is expected in a patient diagnosed with anorexia nervosa?

1. Fine, downy, unpigmented hair growth

2. Hyperactive bowel sounds

3. Hyperthermia

4. Oily skin

The correct answer is: Fine, downy, unpigmented hair growth

In a patient diagnosed with anorexia nervosa, the presence of fine, downy, unpigmented hair growth, known as lanugo, is a common physical examination finding. Lanugo develops as the body attempts to maintain warmth in response to significant weight loss and decreased body fat. The growth of this fine hair is a physiological adaptation in states of starvation, as the body seeks to protect itself from the cold by increasing insulation. In contrast, other physical findings such as hyperactive bowel sounds are less typical, as anorexia nervosa tends to lead to decreased gastrointestinal motility due to reduced food intake and potential electrolyte imbalances. Hyperthermia is not characteristic of anorexia nervosa; instead, patients often present with lower body temperature due to metabolic adaptations. Oily skin is not a common finding either, as inadequate nutrition typically leads to dry skin rather than an oily appearance. Thus, the emergence of lanugo serves as an indicative clinical sign of the body's response to malnutrition and is consistent with the diagnosis of anorexia nervosa.