Intended for healthcare professionals

Endgames Picture Quiz

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

BMJ 2009; 338 doi: (Published 08 April 2009) Cite this as: BMJ 2009;338:b980
  1. Jane Morris, consultant psychiatrist
  1. 1Royal Edinburgh Hospital, Edinburgh EH10 5HF
  1. ejanemorris{at}

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


    • 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 abnormality is most likely to be present on biochemistry screen and on electrocardiography?

    • 3 What is the management of the disorder?


    Short answers

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

    • 2 Hypokalaemia is virtually pathognomonic of vomiting …

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