A 14-year-old girl is brought to the physician by her parents for evaluation of fatigue for the past 6 months. Her parents are concerned because she eats only a vegetarian diet. During this period, she has had a 5-kg (11-lbs) weight loss. She states that she has no friends. When she is not in school, she spends most of her time in bed. She has no history of serious illness. She appears pale. She is at 25th percentile for height, 15th percentile for weight, and 20th percentile for BMI; her BMI is 17 kg/m2. Her temperature is 37.0°C (98.6°F), pulse is 65/min, and blood pressure is 110/70 mm Hg. Examination shows dry skin, brittle nails, and calluses on the knuckles. Which of the following is the most appropriate next step in management of this patient?

Question

Quizplus · Accepted Answer

Eductional Objective: This patient appears to have normal growth, development, and physical examination findings. However, additional information about the patient's attitudes toward eating, weight, and body image is needed before ruling out an eating disorder and reassuring the parents. Educational objective: Abrupt dietary and other behavioral changes are common in adolescents and are often due to benign reasons. However, an eating disorder (eg, anorexia nervosa) should also be considered, especially in a patient with a low or low-normal BMI.

A 14-Year-Old Girl Is Brought to the Physician by Her