Eating Disorders — MCQs
Which of the following is FALSE regarding Anorexia Nervosa:
The most appropriate management approach for anorexia nervosa includes:
All of the following are true about bulimia except
Indoor management of anorexia nervosa is done on priority patients with:-
Which of the following is not true about bulimia nervosa?
Which is true about an infant with failure to thrive and the following findings?
A 16-year-old girl is in your office for a preparticipation sports examination. She plans to play soccer in the fall, and needs her form filled out. Which of the following history or physical examination findings is usually considered a contraindication to playing contact sports?
A child with Down syndrome is typically mentally retarded. Which of the following cytogenetic abnormalities is NOT a cause of Down syndrome?
Which of the following conditions is NOT associated with joint hyperextensibility?
All of the following are associated with Down syndrome except?
Eating Disorders Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following is FALSE regarding Anorexia Nervosa:
- A. Decreased appetite (Correct Answer)
- B. Body image distortion
- C. Vigor exceeding physical ill being
- D. Weight loss
Explanation: ***Decreased appetite*** - Patients with anorexia nervosa typically experience **increased hunger** and **preoccupation with food**, despite efforts to restrict intake, rather than a decreased appetite. - The sensation of hunger often intensifies due to severe caloric restriction, making the statement "decreased appetite" false. *Body image distortion* - This is a core diagnostic criterion of anorexia nervosa, where individuals perceive themselves as **overweight** even when they are severely underweight. - The distorted body image drives their relentless pursuit of thinness and fear of weight gain. *Vigor exceeding physical ill being* - Patients with anorexia nervosa often display surprising **energy and hyperactivity** despite severe physical debilitation and malnutrition. - This "vigor" can be a mechanism to burn calories, suppress hunger, or avoid rest, exceeding what would be expected given their poor health status. *Weight loss* - **Significant weight loss** or failure to gain weight during growth is a defining characteristic of anorexia nervosa. - This weight loss is intentionally achieved through severe dietary restriction, excessive exercise, or purging behaviors.
Question 2: The most appropriate management approach for anorexia nervosa includes:
- A. Immediate high-calorie diet with rapid weight gain
- B. Strict bed rest with minimal physical activity
- C. Antipsychotic medications as first-line treatment
- D. Multidisciplinary approach with psychological therapy and nutritional rehabilitation (Correct Answer)
Explanation: ***Multidisciplinary approach with psychological therapy and nutritional rehabilitation*** - This is the **gold standard** and most appropriate management approach for **anorexia nervosa** according to all major guidelines (APA, NICE, IPS). - The multidisciplinary team includes: **psychiatrists, psychologists, dietitians, physicians**, and social workers working collaboratively. - **Psychological therapy** (particularly **CBT-E** for adults and **Family-Based Therapy/FBT** for adolescents) addresses distorted body image, eating behaviors, and underlying psychological factors. - **Nutritional rehabilitation** involves gradual, monitored weight restoration to prevent **refeeding syndrome** while addressing nutritional deficiencies. - **Medical monitoring** for complications (cardiovascular, electrolyte imbalances, bone health) is integrated throughout treatment. - This comprehensive approach addresses both the acute medical needs and long-term recovery, with evidence showing best outcomes. *Strict bed rest with minimal physical activity* - While temporary bed rest may be used in cases of **severe medical instability** (very low heart rate, severe electrolyte disturbances), it is not the overall management "approach." - Prolonged bed rest can worsen outcomes by causing **muscle wasting**, **bone density loss**, and psychological dependence. - Modern guidelines emphasize **gradual mobilization** with medical supervision rather than strict bed rest. - Bed rest is a specific medical intervention, not a comprehensive management strategy. *Immediate high-calorie diet with rapid weight gain* - Rapid refeeding is dangerous and can cause **refeeding syndrome**, characterized by severe shifts in **phosphate, potassium, and magnesium** levels. - Complications include **cardiac arrhythmias**, **respiratory failure**, and **seizures**. - Proper nutritional rehabilitation starts with **lower calories** (30-40 kcal/kg/day initially) and increases gradually under close monitoring. *Antipsychotic medications as first-line treatment* - **Antipsychotics are NOT first-line treatment** for anorexia nervosa. - Limited evidence for efficacy; **olanzapine** may be used as adjunct for severe anxiety or obsessive thoughts about food. - Medications alone are insufficient; psychological and nutritional interventions are essential. - May be considered for comorbid conditions but not as primary treatment.
Question 3: All of the following are true about bulimia except
- A. Recurrent compensatory behaviors
- B. Body image disturbance
- C. Binge eating
- D. Significant weight loss similar to anorexia nervosa (Correct Answer)
Explanation: ***Significant weight loss similar to anorexia nervosa*** - While individuals with bulimia nervosa may experience some weight fluctuations, they do not exhibit the **significant underweight status** characteristic of anorexia nervosa. - The diagnosis of bulimia nervosa requires that the individual's weight remain within the **normal range or be overweight**, distinguishing it from anorexia nervosa. - This is the key differentiating feature between the two eating disorders. *Recurrent compensatory behaviors* - **Inappropriate compensatory behaviors** to prevent weight gain are a defining diagnostic criterion of bulimia nervosa. - These include self-induced vomiting, misuse of laxatives, diuretics, enemas, fasting, or excessive exercise. - Such behaviors occur at least once weekly for 3 months per DSM-5 criteria. *Body image disturbance* - A core diagnostic criterion for bulimia nervosa is a significant **disturbance in the perception of one's body shape or weight**, heavily influencing self-evaluation. - This distorted body image often fuels the binge-purge cycle. - Patients' self-worth is excessively influenced by body shape and weight. *Binge eating* - **Recurrent episodes of binge eating** are a hallmark symptom of bulimia nervosa, involving consumption of a large amount of food in a discrete period with a sense of loss of control. - These episodes are followed by compensatory behaviors. - Must occur at least once weekly for 3 months to meet diagnostic criteria.
Question 4: Indoor management of anorexia nervosa is done on priority patients with:-
- A. Depression
- B. Amenorrhea
- C. Binging episodes
- D. Weight for height less than 75% of normal (Correct Answer)
Explanation: ***Weight for height less than 75% of normal*** - A **weight for height less than 75% of normal** (or **BMI <15 kg/m²**) indicates severe **malnutrition** and a high risk of medical complications, necessitating urgent inpatient care. - This level of **underweight** is a critical indicator for hospital admission in **anorexia nervosa** to prevent severe organ dysfunction, refeeding syndrome, and even death. *Depression* - While **depression** is a common comorbidity with **anorexia nervosa** and often requires treatment, it does not, by itself, warrant immediate inpatient management unless there are acute **suicidal risks**. - **Depression** is usually managed in an outpatient setting initially, with hospitalization being reserved for severe cases where safety is compromised. *Amenorrhea* - **Amenorrhea** (absence of menstruation) is a common symptom of **anorexia nervosa** due to hormonal imbalances caused by low body weight. - Though an indicator of significant caloric restriction, **amenorrhea** alone is not typically an immediate criterion for inpatient admission unless accompanied by other severe physical complications. *Binging episodes* - While **binging episodes** can occur in **anorexia nervosa** (specifically the binge-purging subtype) and can lead to electrolyte imbalances or medical complications, they are not the primary, stand-alone trigger for immediate inpatient admission. - The severity of **binging** and associated **purging behaviors** must be evaluated in the context of overall medical stability and weight to determine the appropriate level of care.
Question 5: Which of the following is not true about bulimia nervosa?
- A. Recurrent episodes of binge eating
- B. Invariable weight loss with endocrine disorder (Correct Answer)
- C. Occurrence of both binge eating and inappropriate compensatory behaviors
- D. Recurrent self-induced vomiting
Explanation: ***Invariable weight loss with endocrine disorder*** - **Bulimia nervosa** is characterized by episodes of binge eating followed by compensatory behaviors, which often lead to **weight fluctuations** or the maintenance of a **normal weight**, not invariable weight loss. - While endocrine abnormalities can sometimes occur due to the disordered eating, they are not a defining or **invariable characteristic** of the diagnosis itself. *Recurrent episodes of binge eating* - This is a core diagnostic criterion for bulimia nervosa, involving eating a large amount of food in a short period with a **sense of lack of control**. - These episodes are typically accompanied by feelings of **distress** and guilt. *Recurrent self - induced vomiting* - **Self-induced vomiting** is a common **inappropriate compensatory behavior** used to prevent weight gain after binge eating. - Other compensatory behaviors include misuse of laxatives, diuretics, enemas, fasting, or **excessive exercise**. *Occurrence of both binge eating and inappropriate compensatory behaviors* - The co-occurrence of **recurrent binge eating** and **recurrent inappropriate compensatory behaviors** is a defining feature of bulimia nervosa. - This distinguishes it from other eating disorders like **anorexia nervosa** (which involves significant underweight) or **binge eating disorder** (which lacks compensatory behaviors).
Question 6: Which is true about an infant with failure to thrive and the following findings?
- A. Hypokalemia
- B. Metabolic alkalosis
- C. Increased urinary sodium (Correct Answer)
- D. Increased cortisol
Explanation: ***Increased urinary sodium*** - This image displays an infant with **ambiguous genitalia**, specifically severe clitoromegaly. This is a classic presentation of **congenital adrenal hyperplasia (CAH)** due to **21-hydroxylase deficiency**. - In salt-wasting CAH, deficient **aldosterone** production leads to **renal sodium loss**, resulting in increased urinary sodium, **hyponatremia**, and **hypotension**, contributing to failure to thrive. *Hypokalemia* - **Hypokalemia** is not typically seen in salt-wasting CAH; rather, **hyperkalemia** is more common due to the lack of aldosterone's mineralocorticoid effect, which normally promotes potassium excretion. - The absence of aldosterone causes sodium to be excreted and potassium to be retained. *Metabolic alkalosis* - **Metabolic alkalosis** is not characteristic of salt-wasting CAH; instead, these infants often develop **metabolic acidosis** due to the loss of sodium bicarbonate and impaired acid excretion. - The primary electrolyte disturbance points towards acidosis, not alkalosis. *Increased cortisol* - In 21-hydroxylase deficiency, the enzyme responsible for converting precursors to **cortisol** and aldosterone is deficient, leading to **decreased cortisol** production. - The adrenal glands instead shunt precursors towards androgen synthesis, causing **adrenal hyperplasia** and the virilization seen in the image.
Question 7: A 16-year-old girl is in your office for a preparticipation sports examination. She plans to play soccer in the fall, and needs her form filled out. Which of the following history or physical examination findings is usually considered a contraindication to playing contact sports?
- A. Congenital heart disease, repaired
- B. Obesity
- C. Absence of a single ovary
- D. Absence of a single eye (Correct Answer)
Explanation: **Explanation:** The primary goal of a preparticipation physical evaluation (PPE) is to identify conditions that predispose an athlete to injury or sudden death. In the context of contact or collision sports (like soccer), the **absence of a single paired organ** is a critical consideration. **Why Option D is Correct:** The **absence of a single eye** (or a functional loss of vision in one eye) is considered a contraindication to contact sports because the risk of injury to the remaining eye is high. If the "good" eye is injured, the patient faces permanent, total blindness. While some guidelines allow participation if the athlete wears high-quality protective eyewear (polycarbonate lenses), traditional teaching for exams like NEET-PG classifies a single eye as a contraindication for high-impact contact sports. **Analysis of Incorrect Options:** * **A. Congenital heart disease (repaired):** Most children with successfully repaired CHD (e.g., ASD or VSD) without residual pulmonary hypertension or arrhythmias can participate in sports. * **B. Obesity:** Obesity is not a contraindication; in fact, sports participation is actively encouraged as part of weight management, provided there are no underlying cardiovascular risks. * **C. Absence of a single ovary:** Unlike the eyes or kidneys, the loss of a single ovary does not pose a significant risk to life or essential function, as the remaining ovary is well-protected within the pelvic cavity and maintains hormonal/reproductive function. **High-Yield Clinical Pearls for NEET-PG:** * **Single Kidney:** Previously a contraindication, but current AAP guidelines allow participation in contact sports if the athlete is informed of the risks and uses protective padding. * **Atlantoaxial Instability:** A classic contraindication for contact sports in patients with **Down Syndrome**. * **Hypertrophic Cardiomyopathy (HCM):** The most common cause of sudden cardiac death in young athletes; it is an absolute contraindication to competitive sports. * **Acute Splenomegaly (e.g., Infectious Mononucleosis):** Contraindication due to the risk of splenic rupture; athletes must wait at least 3–4 weeks before returning to play.
Question 8: A child with Down syndrome is typically mentally retarded. Which of the following cytogenetic abnormalities is NOT a cause of Down syndrome?
- A. Deleted chromosome 21 (Correct Answer)
- B. Trisomy 21
- C. Robertsonian translocation
- D. Mosaicism
Explanation: **Explanation:** Down syndrome (Trisomy 21) is caused by an **excess of genetic material** from chromosome 21. Therefore, a **deleted chromosome 21 (Option A)** would result in monosomy or partial monosomy, which does not cause Down syndrome; in fact, complete autosomal monosomies are generally incompatible with life. **Analysis of Options:** * **Trisomy 21 (Nondisjunction):** The most common cause (approx. 95%). It usually occurs due to meiotic error, most frequently during maternal Meiosis I. Risk increases significantly with advanced maternal age. * **Robertsonian Translocation:** Occurs in about 3–4% of cases. The extra long arm of chromosome 21 is attached to another acrocentric chromosome (usually 14 or 22). This is the only form that can be inherited from a carrier parent, necessitating parental karyotyping. * **Mosaicism:** Occurs in 1–2% of cases. It results from mitotic nondisjunction after fertilization, leading to two cell lines (one normal, one trisomic). These patients often have a milder phenotype. **NEET-PG High-Yield Pearls:** * **Most common cause:** Meiotic nondisjunction (95%). * **Recurrence risk:** ~1% for Trisomy 21; however, if a parent is a **14;21 translocation carrier**, the risk is ~10-15% (maternal) or ~2-3% (paternal). If a parent has a **21;21 translocation**, the recurrence risk is **100%**. * **Screening:** First-trimester screening includes Dual Marker (PAPP-A and β-hCG) and Ultrasound (Nuchal Translucency). * **Quadruple Test:** Low AFP, Low Estriol, **High hCG, High Inhibin A** (Mnemonic: **HI**gh for **H**CG and **I**nhibin).
Question 9: Which of the following conditions is NOT associated with joint hyperextensibility?
- A. Stickler Syndrome
- B. Hyperlysinemia
- C. Fragile X syndrome
- D. Hurler's syndrome (Correct Answer)
Explanation: **Explanation:** The correct answer is **Hurler’s Syndrome (Mucopolysaccharidosis Type I)**. Unlike many connective tissue disorders that present with joint laxity, Hurler’s syndrome is characterized by **joint contractures and stiffness**. This occurs due to the progressive accumulation of glycosaminoglycans (GAGs) in the periarticular soft tissues, tendons, and ligaments, leading to restricted mobility and the classic "claw hand" deformity. **Analysis of Options:** * **Stickler Syndrome:** A connective tissue disorder caused by collagen mutations (Type II and XI). It presents with a triad of high myopia (leading to retinal detachment), hearing loss, and **joint hypermobility** (which often progresses to early-onset osteoarthritis). * **Hyperlysinemia:** An autosomal recessive metabolic disorder. Elevated lysine levels interfere with the cross-linking of collagen fibers, resulting in muscle hypotonia and **joint laxity**. * **Fragile X Syndrome:** The most common cause of inherited intellectual disability. Clinical features include a long face, large ears, macroorchidism, and significant **joint hyperextensibility** due to underlying connective tissue dysplasia. **High-Yield Clinical Pearls for NEET-PG:** * **The "Rule of Thumb":** Most Mucopolysaccharidoses (MPS) present with stiff joints, **EXCEPT for Morquio Syndrome (MPS IV)**, which is uniquely associated with significant joint laxity and ligamentous hypermobility. * **Differential for Joint Hypermobility:** Always consider Ehlers-Danlos Syndrome, Marfan Syndrome, Osteogenesis Imperfecta, and Homocystinuria. * **Hurler vs. Hunter:** Hurler (MPS I) has corneal clouding; Hunter (MPS II) does not ("The Hunter needs clear eyes to see the target"). Both typically feature joint stiffness.
Question 10: All of the following are associated with Down syndrome except?
- A. Sensory hearing loss (Correct Answer)
- B. VSD
- C. Hypothyroidism
- D. Duodenal atresia
Explanation: **Explanation:** The correct answer is **A (Sensory hearing loss)**. In Down syndrome (Trisomy 21), hearing impairment is extremely common (up to 75% of cases), but it is primarily **Conductive hearing loss**. This is due to craniofacial abnormalities leading to narrow external auditory canals and a high incidence of chronic otitis media with effusion (serous otitis media). While sensorineural hearing loss can occur, conductive loss is the hallmark association. **Analysis of other options:** * **B. VSD (Ventricular Septal Defect):** Congenital heart disease (CHD) occurs in 40-50% of Down syndrome patients. While **Endocardial Cushion Defect (AVSD)** is the most characteristic, VSD is the second most common cardiac anomaly in these children. * **C. Hypothyroidism:** Endocrine disorders are frequent in Down syndrome. Both congenital and acquired (autoimmune) hypothyroidism occur at a much higher rate than in the general population, necessitating regular thyroid function screening. * **D. Duodenal Atresia:** Down syndrome is the most common chromosomal association with duodenal atresia (the "double bubble" sign). Approximately 30% of infants with duodenal atresia have Trisomy 21. **High-Yield Clinical Pearls for NEET-PG:** * **Most common CHD:** Atrioventricular Septal Defect (AVSD). * **Most common GI anomaly:** Duodenal atresia (though Hirschsprung disease is also associated). * **Hematological association:** Increased risk of **AMKL** (Acute Megakaryoblastic Leukemia) before age 3 and **ALL** (Acute Lymphoblastic Leukemia) after age 3. * **Neurological:** Early-onset Alzheimer’s disease (due to APP gene on Chromosome 21) and Atlanto-axial instability. * **Screening:** Annual thyroid function tests and hearing evaluations are mandatory.
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