A skin lesion on the back of a young woman's hand

doi:10.1136/bmj.b980

Published 8 April 2009, doi:10.1136/bmj.b980
Cite this as: BMJ 2009;338:b980

Endgames

Picture Quiz

A skin lesion on the back of a young woman’s hand

Jane Morris, consultant psychiatrist

¹ Royal Edinburgh Hospital, Edinburgh EH10 5HF

ejanemorris@talk21.com

The first 150 words of the full text of this article appear below.

This skin lesion, seen on the back of a young woman’shand, was named, unusually, after an eminent living professorof psychiatry (figure).

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1 Whose sign is this? In which disorder(s) might it be seen,and what causes it?

2 On further investigation of the patient,which abnormalityis most likely to be present on biochemistryscreen and on electrocardiography?

3 What is the managementof the disorder?

1 Russell’s sign, after Gerald Russell. It is seen inbulimia nervosa, which Russell described in 1979, and in thebulimic subtype of anorexia nervosa. Abrasions on the dorsumof the hand result from using the fingers to induce vomiting.

2 Hypokalaemia is virtually pathognomonic of vomiting in patientswith eating disorders, and it may be reflected on electrocardiographyas flattening of the T wave.

3 The treatments endorsed bythe National Institute for Healthand Clinical Excellence (NICE)in 2004 . . . [Full text of this article]