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Bulimia nervosa — USMLE Step 2 CK MCQ

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ModeratePsychiatryBulimia nervosaUSMLE Step 2 CK

A 34-year-old White woman comes to the emergency department because of changes in mood, behavior, or thinking. History and focused examination are notable for recurrent binge eating with self-induced vomiting and dental enamel erosion. Temperature is 98.6°F (37.0°C), blood pressure is 126/78 mmHg, pulse is 84/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. There is no evidence of intoxication, delirium, or a primary neurologic disorder unless described in the vignette. Which of the following is the most appropriate next step in management?

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Correct answer: A — Cognitive behavioral therapy and fluoxetine

The vignette describes Bulimia nervosa, supported by recurrent binge eating with self-induced vomiting and dental enamel erosion. Cognitive behavioral therapy and fluoxetine is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: APA Eating Disorders Guideline