Eating Disorders — MCQs
A young lady presents with a history of repeated episodes of overeating followed by purging using laxatives. She is probably suffering from -
Which eating disorder is characterized by episodes of binge eating while maintaining a normal weight?
Which of the following conditions is characterised by episodes of excessive and uncontrolled eating?
All are true about Bulimia Nervosa, except which of the following?
True about anorexia nervosa is all except ?
In a child having diarrhoea with perianal moist crust, which condition is most likely diagnosed?
Which is true about an infant with failure to thrive and the following findings?
Severe hypothermia in a neonate is defined by a temperature below which of the following?
What is the recommended daily dosage of zinc supplementation for infants aged 8 months?
Compared with cow's milk, mother's milk has more?
Eating Disorders Indian Medical PG Practice Questions and MCQs
Question 1: A young lady presents with a history of repeated episodes of overeating followed by purging using laxatives. She is probably suffering from -
- A. Binge eating disorder
- B. Schizophrenia
- C. Anorexia nervosa
- D. Bulimia nervosa (Correct Answer)
Explanation: ***Bulimia nervosa*** - This condition is characterized by recurrent episodes of **binge eating** followed by inappropriate compensatory behaviors like **purging (e.g., laxative use)**, self-induced vomiting, excessive exercise, or fasting. - The patient's presentation of repeated overeating followed by purging with laxatives directly aligns with the diagnostic criteria for **bulimia nervosa**. *Binge eating disorder* - While it involves recurrent episodes of **binge eating**, it **does not include** the regular use of inappropriate compensatory behaviors such as purging. - Individuals with binge eating disorder typically experience significant distress about their binging but do not attempt to undo the caloric intake. *Schizophrenia* - This is a severe mental disorder characterized by **distortions in thinking, perception, emotions, language, sense of self, and behavior**, such as hallucinations and delusions. - It is a **psychotic disorder** and does not involve specific eating patterns or purging behaviors. *Anorexia nervosa* - This eating disorder is characterized by a persistent restriction of energy intake leading to a **significantly low body weight**, an intense **fear of gaining weight**, and a distorted body image. - Although some individuals with anorexia nervosa may engage in binge-purging type behavior, the primary defining feature is **significantly low body weight**, which is not mentioned in the patient's presentation.
Question 2: Which eating disorder is characterized by episodes of binge eating while maintaining a normal weight?
- A. Anorexia nervosa
- B. Bulimia nervosa (Correct Answer)
- C. Binge eating disorder
- D. Night eating syndrome
Explanation: ***Bulimia nervosa*** - This disorder is characterized by recurrent episodes of **binge eating** followed by compensatory behaviors such as self-induced vomiting, misuse of laxatives, or excessive exercise, while the individual generally maintains a **normal body weight**. - The key differentiator from anorexia nervosa is the **normal weight** and the cyclical pattern of binging and compensatory behaviors. - According to **DSM-5 criteria**, bulimia nervosa requires both binge eating episodes and inappropriate compensatory behaviors occurring at least once weekly for 3 months. *Anorexia nervosa* - This eating disorder is primarily characterized by an intense fear of gaining weight, leading to **severe restriction of food intake** and significantly **low body weight**. - Individuals with anorexia nervosa do not maintain a normal weight; rather, their weight is often **below minimally normal** (BMI < 18.5 kg/m² in adults). *Binge eating disorder* - This disorder involves recurrent episodes of **binge eating**, defined as consuming an unusually large amount of food in a short period with a sense of loss of control, but it does **not involve recurrent compensatory behaviors** like purging. - Individuals with binge eating disorder are often **overweight or obese**, contrasting with the normal weight seen in bulimia nervosa. *Night eating syndrome* - This disorder is characterized by recurrent episodes of **nighttime eating** (consuming food after evening meal or upon awakening from sleep) with full awareness. - Unlike bulimia nervosa, it does **not involve binge eating** in the classic sense, and there are **no compensatory behaviors** like purging or excessive exercise. - Individuals may maintain normal weight but the eating pattern is distinctly different from the binge-purge cycle.
Question 3: Which of the following conditions is characterised by episodes of excessive and uncontrolled eating?
- A. Bulimia nervosa (Correct Answer)
- B. Body dysmorphobia
- C. Anorexia nervosa
- D. All of the options
Explanation: **Bulimia nervosa** - This condition is characterized by recurrent episodes of **binge eating**, which involve consuming an unusually large amount of food in a short period and feeling a lack of control over eating during the episode. - These episodes are followed by inappropriate compensatory behaviors to prevent weight gain, such as **self-induced vomiting**, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise. *Body dysmorphobia* - This is a mental disorder characterized by a persistent and intrusive preoccupation with an imagined or slight defect in one's **physical appearance**. - It does not involve episodes of excessive and uncontrolled eating, but rather focuses on perceived flaws that are often unnoticeable to others. *Anorexia nervosa* - This eating disorder is characterized by an intense fear of gaining weight and a **distorted body image**, leading to severe restriction of food intake. - While there may be episodes of binge eating in a subtype of anorexia nervosa (binge-eating/purging type), the primary characteristic is a persistent restriction of energy intake leading to a significantly low body weight. *All of the options* - This is incorrect as only bulimia nervosa is primarily characterized by episodes of excessive and uncontrolled eating. - The other conditions listed do not fit this description.
Question 4: All are true about Bulimia Nervosa, except which of the following?
- A. Purgative abuse
- B. Weight loss (Correct Answer)
- C. Binge eating
- D. Self-induced vomiting
Explanation: ***Weight loss*** - While individuals with bulimia nervosa may attempt to lose weight, significant **weight loss** is not a defining characteristic; they are typically of **normal weight** or overweight. - Unlike **anorexia nervosa**, which is characterized by being underweight, bulimia nervosa focuses on recurrent episodes of binge eating followed by compensatory behaviors. *Binge eating* - **Binge eating** is a core diagnostic criterion for bulimia nervosa, involving consuming a large amount of food in a short period with a sense of **loss of control**. - These episodes are often accompanied by feelings of guilt, shame, and distress. *Self-induced vomiting* - **Self-induced vomiting** is a common **purging behavior** in bulimia nervosa, used as a compensatory mechanism to prevent weight gain after binge eating. - Other compensatory behaviors include misuse of laxatives, diuretics, enemas, or excessive exercise. *Purgative abuse* - **Purgative abuse**, such as the misuse of **laxatives or diuretics**, is a type of compensatory behavior seen in bulimia nervosa to counteract the effects of binge eating. - This behavior is often driven by a desperate attempt to control weight and body shape.
Question 5: True about anorexia nervosa is all except ?
- A. Amenorrhea starts before severe loss of weight
- B. More common in females than males
- C. Self-induced vomiting
- D. Binge eating is common (Correct Answer)
Explanation: ***Binge eating is common*** - **Binge eating** is NOT common in all cases of anorexia nervosa - It occurs only in the **binge-eating/purging subtype**, which represents approximately **50% of cases** - The **restricting subtype** (the other ~50%) does NOT involve binge eating episodes - Characterizing binge eating as "common" in anorexia nervosa overall is **inaccurate** and misleading *Amenorrhea starts before severe loss of weight* - This statement is **TRUE** - amenorrhea can and often does occur **before or concurrently** with significant weight loss in anorexia nervosa - **Hypothalamic-pituitary-gonadal axis dysfunction** occurs early in the disease process - Studies demonstrate that **hormonal changes** leading to amenorrhea can precede marked weight loss - DSM-5 removed amenorrhea as a required diagnostic criterion partly due to variable timing *More common in females than males* - **TRUE** - Anorexia nervosa has significantly higher prevalence in **females** compared to males - Female-to-male ratio is approximately **10:1** - This gender disparity is consistent across various populations *Self-induced vomiting* - **TRUE** - Self-induced vomiting is a common compensatory behavior in the **binge-eating/purging subtype** of anorexia nervosa - Used to prevent weight gain and maintain control over body weight - Represents a purging behavior alongside laxative/diuretic abuse and excessive exercise
Question 6: In a child having diarrhoea with perianal moist crust, which condition is most likely diagnosed?
- A. Acrodermatitis enteropathica (Correct Answer)
- B. Pellagra
- C. Riboflavin deficiency
- D. Kwashiorkor
Explanation: ***Acrodermatitis enteropathica*** - This condition is a **zinc deficiency** syndrome, which can be either inherited or acquired. - It presents with a classic triad of **diarrhoea**, **dermatitis** (often periorificial and acral with moist, crusted lesions), and **alopecia**. - The **perianal moist crust** is a characteristic finding of the periorificial dermatitis seen in this condition. *Pellagra* - Pellagra is caused by **niacin (Vitamin B3) deficiency** and is characterized by the "4 D's": **dermatitis** (often sun-exposed areas), **diarrhoea**, **dementia**, and eventually death. - The dermatitis of pellagra is typically **symmetrical, hyperpigmented, and photosensitive**, not moist perianal crusts, differentiating it from the presented case. *Riboflavin deficiency* - **Riboflavin deficiency** typically manifests as **cheilosis**, angular stomatitis, glossitis, and seborrheic dermatitis, but not specifically perianal moist crusts with diarrhoea. - While it can affect mucous membranes, the specific perianal presentation with diarrhoea points away from this diagnosis. *Kwashiorkor* - **Kwashiorkor** is a form of protein-energy malnutrition that can present with **diarrhoea** and skin changes (flaky paint dermatosis, hypopigmentation). - However, the skin changes are typically **desquamating** and affect dependent areas, not the characteristic **moist, crusted periorificial lesions** seen in zinc deficiency. - Kwashiorkor also typically presents with **edema**, which is not mentioned in this case.
Question 7: 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 8: Severe hypothermia in a neonate is defined by a temperature below which of the following?
- A. < 35 °C
- B. < 34 °C
- C. < 33 °C
- D. < 32 °C (Correct Answer)
Explanation: ***< 32 °C*** - Severe hypothermia in neonates is defined by a body temperature falling below **32 °C** according to WHO classification. - This level of hypothermia is associated with significant physiological compromise including bradycardia, hypoglycemia, metabolic acidosis, and coagulopathy. - Requires immediate and aggressive warming interventions with continuous monitoring of vital signs and blood glucose. *< 35 °C* - A temperature below 35 °C falls into the **moderate hypothermia** range (32-35.9°C) in neonates, not mild. - While serious and requiring active warming, it is not classified as severe hypothermia. - May present with lethargy, poor feeding, and peripheral vasoconstriction. *< 34 °C* - A temperature below 34 °C is also within the **moderate hypothermia** category. - More concerning than temperatures closer to 35°C but does not meet the threshold for severe hypothermia. - Requires active warming and close monitoring but typically less aggressive than severe hypothermia management. *< 33 °C* - A temperature below 33 °C remains in the **moderate hypothermia** range, approaching the severe threshold. - While clinically significant, the WHO classification defines severe hypothermia specifically as <32°C. - The distinction is important for determining the urgency and intensity of warming protocols.
Question 9: What is the recommended daily dosage of zinc supplementation for infants aged 8 months?
- A. 10 mg/day for 10 days
- B. 20 mg/day for 10 days
- C. 10 mg/day for 14 days
- D. 20 mg/day for 14 days (Correct Answer)
Explanation: ### Explanation The correct answer is **D: 20 mg/day for 14 days.** **Underlying Medical Concept:** Zinc is a critical micronutrient for intestinal mucosal integrity and immune function. During an episode of acute diarrhea, zinc levels drop significantly. Supplementation reduces the duration and severity of the current episode and prevents recurrences for the next 2–3 months. According to the **WHO and IAP (Indian Academy of Pediatrics) guidelines**, the dosage is age-dependent: * **Infants < 6 months:** 10 mg elemental zinc daily for 14 days. * **Children ≥ 6 months:** 20 mg elemental zinc daily for 14 days. Since the infant in the question is **8 months old**, the recommended dose is 20 mg for a full 14-day course. **Analysis of Incorrect Options:** * **Option A & B (10 days):** While clinical improvement often occurs within a few days, a 10-day course is insufficient to fully replenish body stores to provide the prophylactic benefit against future diarrheal episodes. * **Option C (10 mg for 14 days):** This is the correct duration but the incorrect dose for an 8-month-old. This dose is reserved for infants younger than 6 months. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Zinc acts as an antisecretory agent by inhibiting cAMP-induced chloride secretion. * **Impact:** It reduces stool frequency by 20% and stool volume by 30%. * **Administration:** Zinc should be given between meals for better absorption; however, if it causes gastric irritation/vomiting, it can be given with food. * **ORS + Zinc:** This combination is the cornerstone of "Plan A" diarrhea management to prevent dehydration and malnutrition.
Question 10: Compared with cow's milk, mother's milk has more?
- A. Lactose (Correct Answer)
- B. Vitamin D
- C. Proteins
- D. Fat
Explanation: **Explanation:** The composition of human milk is uniquely tailored to the developmental needs of a human infant, whereas cow’s milk is designed for the rapid muscle and skeletal growth of a calf. **1. Why Lactose is the Correct Answer:** Human milk contains a significantly higher concentration of **lactose (6.8–7 g/dL)** compared to cow’s milk (approx. 4.5–5 g/dL). Lactose is the primary carbohydrate source; it provides essential energy for the rapidly developing brain and promotes the growth of *Lactobacillus bifidus* in the gut, which maintains an acidic environment to inhibit pathogens. **2. Why Other Options are Incorrect:** * **Proteins:** Cow’s milk has nearly **three times more protein** (3.3 g/dL) than human milk (1.1 g/dL). High protein in cow's milk (especially casein) creates a high renal solute load, making it unsuitable for young infants. * **Vitamin D:** Both human and cow’s milk are **inherently low in Vitamin D**. However, cow’s milk typically contains slightly more than unfortified breast milk. Regardless, all breastfed infants require Vitamin D supplementation (400 IU/day). * **Fat:** The total fat content is roughly **similar** in both (approx. 3.5–4 g/dL). However, the *quality* differs; human milk is richer in essential fatty acids and contains **lipase**, which aids in fat digestion. **High-Yield Clinical Pearls for NEET-PG:** * **Iron:** Both are low in iron, but **bioavailability** is much higher in breast milk (50% absorption) compared to cow’s milk (10%). * **Whey:Casein Ratio:** In human milk, it is **60:40** (easy to digest); in cow’s milk, it is **20:80** (forms hard curds). * **Minerals:** Cow’s milk has higher Calcium and Phosphorus, but the high phosphorus can lead to hypocalcemic tetany in neonates. * **Immunological factors:** IgA, Lactoferrin, and Lysozymes are present **only** in human milk.
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