Eating Disorders — MCQs

Q: Which of the following is NOT true about anorexia nervosa?

Self-induced vomiting. **Explanation:** The core psychopathology of **Anorexia Nervosa (AN)** is a distorted body image and an intense fear of gaining weight, leading to restricted energy intake and significantly low body weight. **Why "Self-induced vomiting" is the correct answer:** While self-induced vomiting *can* occur in the "Binge-eating/Purging type" of Anorexia, it is **not a mandatory diagnostic feature** or a universal finding. In contrast, self-induced vomiting is a hallmark and often defining compensatory behavior of **Bulimia Nervosa**. In Anorexia, the primary mechanism of weight loss is typically severe caloric restriction and excessive exercise. **Analysis of other options:** * **Leukopenia (A):** This is a common hematological complication of starvation in AN due to bone marrow hypoplasia (gelatinous transformation of marrow). * **Amenorrhea (B):** Though no longer a strict DSM-5 diagnostic criterion, it remains a classic clinical feature caused by hypogonadotropic hypogonadism (low FSH/LH due to hypothalamic dysfunction). * **More common in adult females (D):** AN has a significant female-to-male preponderance (roughly 10:1), typically peaking in adolescence and young adulthood. **NEET-PG High-Yield Pearls:** 1. **Most common cause of death:** Suicide (psychiatric) or Cardiac Arrhythmias (medical, often due to hypokalemia). 2. **Refeeding Syndrome:** Characterized by **Hypophosphatemia** (hallmark), hypokalemia, and hypomagnesemia when food is reintroduced too rapidly. 3. **Physical signs:** Lanugo hair, bradycardia, hypotension, and "Russell’s sign" (calluses on knuckles if purging is present). 4. **Treatment:** Nutritional rehabilitation is the priority. Family-Based Therapy (FBT) is the gold standard for adolescents.

Q: Which of the following features is not seen in Anorexia Nervosa?

Decreased serum protein. **Explanation:** In **Anorexia Nervosa (AN)**, despite severe emaciation and malnutrition, the body employs remarkable compensatory mechanisms to maintain essential biochemical functions. **Why "Decreased serum protein" is the correct answer:** Counterintuitively, serum protein and albumin levels are typically **normal** in patients with Anorexia Nervosa. This is a classic "trap" in medical exams. The body prioritizes the synthesis of visceral proteins (like albumin) by breaking down somatic protein (muscle mass). Low serum protein is more characteristic of **Kwashiorkor** (protein-energy malnutrition) rather than the calorie-restricted starvation seen in AN. If an AN patient presents with low albumin, it usually indicates a very late stage of the disease or an alternative diagnosis. **Analysis of Incorrect Options:** * **A. Decreased total brain volume:** Chronic starvation leads to "pseudo-atrophy" of the brain, characterized by enlarged ventricles and reduced gray/white matter volume (reversible with refeeding). * **B. Lowered metabolic rate:** To conserve energy, the body enters a hypometabolic state. This manifests clinically as bradycardia, hypotension, and hypothermia. * **C. Impaired regulation in growth hormone (GH) levels:** In AN, there is a state of **GH resistance**. GH levels are actually **increased**, but Insulin-like Growth Factor-1 (IGF-1) is decreased, leading to impaired growth and regulatory feedback loops. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of death:** Cardiac arrhythmias (due to electrolyte imbalances like hypokalemia) or Suicide. * **Endocrine hallmark:** Hypogonadotropic hypogonadism (leading to amenorrhea). * **Hematology:** Leukopenia is the most common blood abnormality. * **Refeeding Syndrome:** Watch for **Hypophosphatemia** when starting nutrition; it is the most critical electrolyte shift to monitor.

Q: Which eating disorder is characterized by normal weight?

Bulimia nervosa. **Explanation:** The hallmark of **Bulimia Nervosa (BN)** is the maintenance of a **normal or near-normal body weight** (BMI ≥ 18.5 kg/m²). Patients engage in a cycle of binge eating followed by inappropriate compensatory behaviors (purging via vomiting, laxatives, or excessive exercise). Unlike other eating disorders, the caloric intake during binges is offset by these compensatory mechanisms, preventing significant weight loss or gain, which often makes the disorder "invisible" to family members. **Analysis of Incorrect Options:** * **Anorexia Nervosa (AN):** The defining clinical feature is **significantly low body weight** (BMI < 18.5 kg/m² in adults) due to restricted energy intake and an intense fear of gaining weight. Even the "Binge-eating/Purging type" of AN is distinguished from Bulimia by the presence of underweight status. * **Binge Eating Disorder (BED):** While patients binge, they do **not** engage in regular compensatory behaviors. Consequently, BED is most commonly associated with being **overweight or obese**. **Clinical Pearls for NEET-PG:** * **Russell’s Sign:** Calluses on the knuckles from self-induced vomiting (common in BN). * **Metabolic Profile:** Bulimia often presents with **Hypokalemia**, Hypochloremia, and **Metabolic Alkalosis** (due to loss of gastric HCl). * **Parotid Gland Swelling:** Sialadenosis is a frequent physical finding in purging-type Bulimia. * **Drug of Choice:** **Fluoxetine** (SSRI) is the only FDA-approved medication for Bulimia Nervosa, typically used at higher doses (60mg).

Q: What is true about Anorexia nervosa?

Anorexia nervosa is more commonly associated with constipation than diarrhea.. **Explanation:** **Anorexia Nervosa (AN)** is a psychiatric disorder characterized by a distorted body image, intense fear of gaining weight, and severe self-imposed dietary restriction. **Why Option D is Correct:** Constipation is the most common gastrointestinal complication of Anorexia Nervosa. It occurs due to **decreased caloric intake**, starvation-induced **slowing of colonic transit time**, and atrophy of the intestinal mucosa. While laxative abuse (in the binge-purge subtype) can cause diarrhea, the physiological hallmark of starvation is a significant reduction in bowel motility. **Analysis of Incorrect Options:** * **Option A:** Bulimia nervosa is statistically **more common** in the general population than Anorexia nervosa. * **Option B:** In AN, patients often exhibit **"Euthyroid Sick Syndrome."** This is characterized by **low T3** (triiodothyronine) levels and a low-normal T4, as the body attempts to conserve energy by reducing the peripheral conversion of T4 to the more active T3. * **Option C:** While hypochloremic hypokalemic alkalosis is seen in the **Binge-Eating/Purging type** of AN (due to vomiting), it is not a universal feature of the disorder. It is more classically the hallmark of Bulimia Nervosa. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of death:** Complications of starvation (cardiac arrhythmias) or suicide. * **ECG findings:** Bradycardia, QTc prolongation, and U-waves (if hypokalemic). * **Endocrine changes:** Increased Growth Hormone, increased Cortisol, decreased FSH/LH (leading to amenorrhea). * **Physical sign:** **Lanugo hair** (fine, downy hair) and **Russell’s sign** (calluses on knuckles from self-induced vomiting). * **Treatment:** Nutritional rehabilitation is the priority. **Fluoxetine** is FDA-approved for Bulimia, but has limited efficacy in underweight Anorexic patients.

Q: Excessive eating followed by purging using laxatives in 20-year-old females is characteristic of which condition?

Bulimia nervosa. **Explanation:** The correct answer is **Bulimia Nervosa (Option A)**. This condition is characterized by a repetitive cycle of **binge eating** (consuming large amounts of food with a sense of loss of control) followed by **compensatory behaviors** to prevent weight gain. These behaviors, known as purging, include self-induced vomiting, misuse of laxatives, diuretics, or excessive exercise. Unlike anorexia, patients with bulimia usually maintain a body weight within or above the normal range (BMI ≥ 18.5 kg/m²). **Analysis of Incorrect Options:** * **Anorexia Nervosa (Option B):** While purging can occur in the "Binge-eating/Purging type" of Anorexia, the hallmark is **significantly low body weight** (BMI < 18.5 kg/m²) and an intense fear of gaining weight. * **Binge Eating Disorder (Option C):** This involves episodes of excessive eating but is distinguished by the **absence of compensatory behaviors** (no purging, fasting, or excessive exercise). * **Schizophrenia (Option D):** This is a primary psychotic disorder. While disorganized eating habits may occur, it does not involve the specific psychopathology of body image distortion or the binge-purge cycle seen in eating disorders. **High-Yield Clinical Pearls for NEET-PG:** * **Russell’s Sign:** Calluses on the knuckles from self-induced vomiting (common in Bulimia). * **Metabolic Profile:** Purging often leads to **Hypokalemic Hypochloremic Metabolic Alkalosis**. * **Parotid Gland Enlargement:** Often seen in chronic purgers ("chipmunk facies"). * **Drug of Choice:** **Fluoxetine** (SSRI) is the only FDA-approved medication for Bulimia Nervosa, typically used at higher doses (60mg).

Q: What is a characteristic feature of anorexia nervosa?

Restricting food intake. **Explanation:** **Anorexia Nervosa (AN)** is a psychiatric disorder characterized by an intense fear of gaining weight and a distorted body image, leading to a pathological drive for thinness. **1. Why the correct answer is right:** The hallmark of Anorexia Nervosa is the **restriction of energy intake** relative to requirements, leading to a significantly low body weight. According to DSM-5 criteria, patients maintain a body weight that is less than minimally normal for their age, sex, and physical health. This is achieved through extreme dieting, fasting, and/or excessive exercise (Restricting type) or through binge-eating/purging behaviors (Binge-eating/purging type). **2. Why the incorrect options are wrong:** * **Dyslipidemia:** While metabolic shifts occur, the primary diagnostic feature is weight restriction. In fact, laboratory findings often show **leukopenia** and **hypokalemia** (in purging types), rather than a primary focus on lipid profiles. * **Overweight:** By definition, AN requires a significantly low body weight (BMI typically <18.5 kg/m²). If a patient meets other criteria but remains within or above a normal weight range, the diagnosis is **Atypical Anorexia Nervosa**. * **Hypertension:** Malnutrition and starvation in AN lead to a state of "physiological slowing." This typically results in **hypotension** and **bradycardia**, not hypertension. **Clinical Pearls for NEET-PG:** * **Lanugo hair:** Fine, downy hair growth on the body is a classic physical sign of starvation in AN. * **Russell’s sign:** Calluses on the knuckles (seen in the purging subtype). * **Refeeding Syndrome:** The most serious complication during treatment, characterized by **hypophosphatemia**, which can lead to cardiac failure. * **Amenorrhea:** Though removed from the DSM-5 as a mandatory criterion, it remains a very common clinical finding.

Q: For diagnosing bulimia nervosa, binge eating should be present for a duration of:

Once a week. **Explanation:** The diagnosis of **Bulimia Nervosa** is based on the **DSM-5 criteria**, which standardized the frequency and duration of symptoms to distinguish clinical eating disorders from occasional disordered eating. **Why Option B is Correct:** According to DSM-5, for a diagnosis of Bulimia Nervosa, both binge eating (eating an objectively large amount of food with a sense of loss of control) and inappropriate compensatory behaviors (e.g., self-induced vomiting, laxative misuse, excessive exercise) must occur, on average, **at least once a week for 3 months**. This threshold ensures the behavior is persistent and clinically significant. **Why Other Options are Incorrect:** * **Options A, C, and D:** These frequencies (once in 3 months, 2 months, or 1 month) do not meet the minimum diagnostic threshold. While these behaviors are concerning, they would likely be classified under "Other Specified Feeding or Eating Disorder" (OSFED) if they occur less than once a week. It is important to note that under the older DSM-IV criteria, the requirement was twice a week, but this was lowered to **once a week** in DSM-5 to increase diagnostic sensitivity. **High-Yield Clinical Pearls for NEET-PG:** * **Weight Status:** Unlike Anorexia Nervosa (where patients are underweight), patients with Bulimia Nervosa are typically of **normal weight or overweight**. * **Physical Signs:** Look for **Russell’s sign** (calluses on knuckles from inducing vomiting), parotid gland enlargement ("chipmunk facies"), and dental enamel erosion (perimolysis). * **Electrolyte Imbalance:** The most common metabolic abnormality is **Hypokalemic Hypochloremic Metabolic Alkalosis**. * **Drug of Choice:** **Fluoxetine** (SSRI) is the only FDA-approved medication for Bulimia Nervosa. **Bupropion is contraindicated** due to an increased risk of seizures in these patients.

Q: Trichobezoar is pathological ingestion of:

Hair. **Explanation:** A **bezoar** is a solid mass of indigestible material that accumulates in the digestive tract, most commonly in the stomach. **1. Why "Hair" is correct:** The term **Trichobezoar** is derived from the Greek word *thrix* (hair). It refers to a hairball formed in the stomach due to the chronic ingestion of hair. This is almost exclusively associated with two psychiatric conditions: * **Trichotillomania:** An impulse-control disorder characterized by the compulsive urge to pull out one's own hair. * **Trichophagia:** The compulsive eating of hair. Over time, the hair escapes digestion and peristalsis, becoming trapped in the gastric mucosal folds and forming a large, matted mass. **2. Why other options are incorrect:** * **Vegetable matter (Phytobezoar):** This is the most common type of bezoar, composed of indigestible cellulose, fiber, and lignin (often from persimmons or celery). * **Coins/Stones:** These are classified as **Foreign Bodies**. While their ingestion is common in children or patients with **Pica**, they do not typically form "bezoars" (which imply a mass formed by the accumulation of smaller particles). A bezoar specifically made of stones is rare and termed a *Lithobezoar*. **3. High-Yield Clinical Pearls for NEET-PG:** * **Rapunzel Syndrome:** An extreme form of trichobezoar where the "tail" of the hair mass extends from the stomach into the small intestine, potentially causing obstruction. * **Clinical Presentation:** Often presents with epigastric pain, nausea, vomiting, halitosis (foul breath), and a palpable abdominal mass. * **Diagnosis:** Gold standard is **Upper GI Endoscopy**. * **Treatment:** Large trichobezoars usually require surgical removal (laparotomy) as they are resistant to enzymatic dissolution.

Q: Which of the following is NOT characteristic of Anorexia nervosa?

Patient's perception of weight loss. **Explanation:** The correct answer is **D. Patient’s perception of weight loss.** In Anorexia Nervosa (AN), the hallmark psychological feature is a **distorted body image**. Patients do not perceive their weight loss accurately; instead, they perceive themselves as "fat" or overweight despite being emaciated. This lack of insight and denial of the seriousness of low body weight is a core diagnostic criterion. **Analysis of Options:** * **Option A (Significant weight loss):** This is a primary feature. ICD-10 and DSM-5 emphasize a body weight significantly below the minimum expected for age and height (often defined as BMI 15% of expected weight). * **Option B (Amenorrhea):** While no longer a mandatory criterion in DSM-5 (to include males and post-menopausal females), it remains a classic clinical characteristic of AN due to hypothalamic-pituitary-gonadal axis suppression caused by low body fat. * **Option C (Preoccupation with body shape):** Patients exhibit an intense fear of gaining weight and a morbid preoccupation with their silhouette, often engaging in "body checking" behaviors. **High-Yield Clinical Pearls for NEET-PG:** * **Subtypes:** Restricting type vs. Binge-eating/purging type. * **Physical Signs:** Lanugo hair (fine neonatal-like hair), bradycardia, hypotension, and peripheral edema. * **Russell’s Sign:** Calluses on knuckles (seen in the purging subtype due to self-induced vomiting). * **Refeeding Syndrome:** The most serious complication during treatment, characterized by **Hypophosphatemia**, hypokalemia, and hypomagnesemia. * **Treatment:** Family-based therapy (Maudsley approach) is the first-line for adolescents; SSRIs (Fluoxetine) are only effective *after* weight restoration to prevent relapse.

Eating Disorders Indian Medical PG Practice Questions and MCQs

Question 1: Which of the following is NOT true about anorexia nervosa?

A. Leukopenia
B. Amenorrhea
C. Self-induced vomiting (Correct Answer)
D. More common in adult females

Explanation: **Explanation:** The core psychopathology of **Anorexia Nervosa (AN)** is a distorted body image and an intense fear of gaining weight, leading to restricted energy intake and significantly low body weight. **Why "Self-induced vomiting" is the correct answer:** While self-induced vomiting *can* occur in the "Binge-eating/Purging type" of Anorexia, it is **not a mandatory diagnostic feature** or a universal finding. In contrast, self-induced vomiting is a hallmark and often defining compensatory behavior of **Bulimia Nervosa**. In Anorexia, the primary mechanism of weight loss is typically severe caloric restriction and excessive exercise. **Analysis of other options:** * **Leukopenia (A):** This is a common hematological complication of starvation in AN due to bone marrow hypoplasia (gelatinous transformation of marrow). * **Amenorrhea (B):** Though no longer a strict DSM-5 diagnostic criterion, it remains a classic clinical feature caused by hypogonadotropic hypogonadism (low FSH/LH due to hypothalamic dysfunction). * **More common in adult females (D):** AN has a significant female-to-male preponderance (roughly 10:1), typically peaking in adolescence and young adulthood. **NEET-PG High-Yield Pearls:** 1. **Most common cause of death:** Suicide (psychiatric) or Cardiac Arrhythmias (medical, often due to hypokalemia). 2. **Refeeding Syndrome:** Characterized by **Hypophosphatemia** (hallmark), hypokalemia, and hypomagnesemia when food is reintroduced too rapidly. 3. **Physical signs:** Lanugo hair, bradycardia, hypotension, and "Russell’s sign" (calluses on knuckles if purging is present). 4. **Treatment:** Nutritional rehabilitation is the priority. Family-Based Therapy (FBT) is the gold standard for adolescents.

Question 2: Which of the following features is not seen in Anorexia Nervosa?

A. Decreased total brain volume
B. Lowered metabolic rate
C. Impaired regulation in growth hormone levels
D. Decreased serum protein (Correct Answer)

Explanation: **Explanation:** In **Anorexia Nervosa (AN)**, despite severe emaciation and malnutrition, the body employs remarkable compensatory mechanisms to maintain essential biochemical functions. **Why "Decreased serum protein" is the correct answer:** Counterintuitively, serum protein and albumin levels are typically **normal** in patients with Anorexia Nervosa. This is a classic "trap" in medical exams. The body prioritizes the synthesis of visceral proteins (like albumin) by breaking down somatic protein (muscle mass). Low serum protein is more characteristic of **Kwashiorkor** (protein-energy malnutrition) rather than the calorie-restricted starvation seen in AN. If an AN patient presents with low albumin, it usually indicates a very late stage of the disease or an alternative diagnosis. **Analysis of Incorrect Options:** * **A. Decreased total brain volume:** Chronic starvation leads to "pseudo-atrophy" of the brain, characterized by enlarged ventricles and reduced gray/white matter volume (reversible with refeeding). * **B. Lowered metabolic rate:** To conserve energy, the body enters a hypometabolic state. This manifests clinically as bradycardia, hypotension, and hypothermia. * **C. Impaired regulation in growth hormone (GH) levels:** In AN, there is a state of **GH resistance**. GH levels are actually **increased**, but Insulin-like Growth Factor-1 (IGF-1) is decreased, leading to impaired growth and regulatory feedback loops. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of death:** Cardiac arrhythmias (due to electrolyte imbalances like hypokalemia) or Suicide. * **Endocrine hallmark:** Hypogonadotropic hypogonadism (leading to amenorrhea). * **Hematology:** Leukopenia is the most common blood abnormality. * **Refeeding Syndrome:** Watch for **Hypophosphatemia** when starting nutrition; it is the most critical electrolyte shift to monitor.

Question 3: Which eating disorder is characterized by normal weight?

A. Anorexia nervosa
B. Bulimia nervosa (Correct Answer)
C. Binge eating disorder
D. None of the above

Explanation: **Explanation:** The hallmark of **Bulimia Nervosa (BN)** is the maintenance of a **normal or near-normal body weight** (BMI ≥ 18.5 kg/m²). Patients engage in a cycle of binge eating followed by inappropriate compensatory behaviors (purging via vomiting, laxatives, or excessive exercise). Unlike other eating disorders, the caloric intake during binges is offset by these compensatory mechanisms, preventing significant weight loss or gain, which often makes the disorder "invisible" to family members. **Analysis of Incorrect Options:** * **Anorexia Nervosa (AN):** The defining clinical feature is **significantly low body weight** (BMI < 18.5 kg/m² in adults) due to restricted energy intake and an intense fear of gaining weight. Even the "Binge-eating/Purging type" of AN is distinguished from Bulimia by the presence of underweight status. * **Binge Eating Disorder (BED):** While patients binge, they do **not** engage in regular compensatory behaviors. Consequently, BED is most commonly associated with being **overweight or obese**. **Clinical Pearls for NEET-PG:** * **Russell’s Sign:** Calluses on the knuckles from self-induced vomiting (common in BN). * **Metabolic Profile:** Bulimia often presents with **Hypokalemia**, Hypochloremia, and **Metabolic Alkalosis** (due to loss of gastric HCl). * **Parotid Gland Swelling:** Sialadenosis is a frequent physical finding in purging-type Bulimia. * **Drug of Choice:** **Fluoxetine** (SSRI) is the only FDA-approved medication for Bulimia Nervosa, typically used at higher doses (60mg).

Question 4: What is true about Anorexia nervosa?

A. Anorexia nervosa is more common than bulimia nervosa.
B. Anorexia nervosa can present with a low T4 in the presence of a normal T3.
C. Anorexia nervosa may be associated with hypochloremic hypokalemic alkalosis.
D. Anorexia nervosa is more commonly associated with constipation than diarrhea. (Correct Answer)

Explanation: **Explanation:** **Anorexia Nervosa (AN)** is a psychiatric disorder characterized by a distorted body image, intense fear of gaining weight, and severe self-imposed dietary restriction. **Why Option D is Correct:** Constipation is the most common gastrointestinal complication of Anorexia Nervosa. It occurs due to **decreased caloric intake**, starvation-induced **slowing of colonic transit time**, and atrophy of the intestinal mucosa. While laxative abuse (in the binge-purge subtype) can cause diarrhea, the physiological hallmark of starvation is a significant reduction in bowel motility. **Analysis of Incorrect Options:** * **Option A:** Bulimia nervosa is statistically **more common** in the general population than Anorexia nervosa. * **Option B:** In AN, patients often exhibit **"Euthyroid Sick Syndrome."** This is characterized by **low T3** (triiodothyronine) levels and a low-normal T4, as the body attempts to conserve energy by reducing the peripheral conversion of T4 to the more active T3. * **Option C:** While hypochloremic hypokalemic alkalosis is seen in the **Binge-Eating/Purging type** of AN (due to vomiting), it is not a universal feature of the disorder. It is more classically the hallmark of Bulimia Nervosa. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of death:** Complications of starvation (cardiac arrhythmias) or suicide. * **ECG findings:** Bradycardia, QTc prolongation, and U-waves (if hypokalemic). * **Endocrine changes:** Increased Growth Hormone, increased Cortisol, decreased FSH/LH (leading to amenorrhea). * **Physical sign:** **Lanugo hair** (fine, downy hair) and **Russell’s sign** (calluses on knuckles from self-induced vomiting). * **Treatment:** Nutritional rehabilitation is the priority. **Fluoxetine** is FDA-approved for Bulimia, but has limited efficacy in underweight Anorexic patients.

Question 5: What is the primary goal in the management of anorexia nervosa?

A. To induce refeeding syndrome
B. To avoid refeeding syndrome (Correct Answer)
C. To treat obesity
D. To manage metabolic syndrome

Explanation: In the management of **Anorexia Nervosa (AN)**, the most critical initial medical priority is safe nutritional rehabilitation. While the long-term goal is weight restoration, the immediate clinical focus is to **avoid Refeeding Syndrome**. ### **Why the correct answer is right:** Refeeding syndrome is a potentially fatal condition that occurs when a severely malnourished patient receives rapid nutritional replenishment. The shift from a catabolic to an anabolic state triggers a massive release of **insulin**, which causes an intracellular shift of electrolytes. This leads to profound **hypophosphatemia** (the hallmark), hypokalemia, and hypomagnesemia. These imbalances can result in cardiac arrhythmias, seizures, heart failure, and death. Therefore, the management principle is to "start low and go slow." ### **Why the other options are wrong:** * **Option A:** Inducing refeeding syndrome is dangerous and life-threatening; it is a complication to be prevented, not a goal. * **Option C:** Anorexia nervosa is characterized by an intense fear of gaining weight and being underweight; treating obesity is irrelevant to this pathology. * **Option D:** Metabolic syndrome is a cluster of conditions (hypertension, high blood sugar, excess body fat) associated with overnutrition and insulin resistance, the opposite of the clinical picture in AN. ### **High-Yield Clinical Pearls for NEET-PG:** * **Hallmark of Refeeding Syndrome:** Hypophosphatemia. * **Most common cause of death in AN:** Cardiac complications (arrhythmias due to electrolyte imbalance or prolonged QTc) or suicide. * **First-line treatment:** Nutritional rehabilitation (Medical) + CBT (Psychological). * **Pharmacotherapy:** SSRIs (e.g., Fluoxetine) are **not** effective when the patient is severely underweight; they are only useful for relapse prevention once weight is restored. * **Indication for Hospitalization:** Heart rate <40 bpm, BP <80/50 mmHg, or weight <75% of expected.

Question 6: Excessive eating followed by purging using laxatives in 20-year-old females is characteristic of which condition?

A. Bulimia nervosa (Correct Answer)
B. Anorexia nervosa
C. Binge eating disorder
D. Schizophrenia

Explanation: **Explanation:** The correct answer is **Bulimia Nervosa (Option A)**. This condition is characterized by a repetitive cycle of **binge eating** (consuming large amounts of food with a sense of loss of control) followed by **compensatory behaviors** to prevent weight gain. These behaviors, known as purging, include self-induced vomiting, misuse of laxatives, diuretics, or excessive exercise. Unlike anorexia, patients with bulimia usually maintain a body weight within or above the normal range (BMI ≥ 18.5 kg/m²). **Analysis of Incorrect Options:** * **Anorexia Nervosa (Option B):** While purging can occur in the "Binge-eating/Purging type" of Anorexia, the hallmark is **significantly low body weight** (BMI < 18.5 kg/m²) and an intense fear of gaining weight. * **Binge Eating Disorder (Option C):** This involves episodes of excessive eating but is distinguished by the **absence of compensatory behaviors** (no purging, fasting, or excessive exercise). * **Schizophrenia (Option D):** This is a primary psychotic disorder. While disorganized eating habits may occur, it does not involve the specific psychopathology of body image distortion or the binge-purge cycle seen in eating disorders. **High-Yield Clinical Pearls for NEET-PG:** * **Russell’s Sign:** Calluses on the knuckles from self-induced vomiting (common in Bulimia). * **Metabolic Profile:** Purging often leads to **Hypokalemic Hypochloremic Metabolic Alkalosis**. * **Parotid Gland Enlargement:** Often seen in chronic purgers ("chipmunk facies"). * **Drug of Choice:** **Fluoxetine** (SSRI) is the only FDA-approved medication for Bulimia Nervosa, typically used at higher doses (60mg).

Question 7: What is a characteristic feature of anorexia nervosa?

A. Restricting food intake (Correct Answer)
B. Dyslipidemia
C. Overweight
D. Hypertension

Explanation: **Explanation:** **Anorexia Nervosa (AN)** is a psychiatric disorder characterized by an intense fear of gaining weight and a distorted body image, leading to a pathological drive for thinness. **1. Why the correct answer is right:** The hallmark of Anorexia Nervosa is the **restriction of energy intake** relative to requirements, leading to a significantly low body weight. According to DSM-5 criteria, patients maintain a body weight that is less than minimally normal for their age, sex, and physical health. This is achieved through extreme dieting, fasting, and/or excessive exercise (Restricting type) or through binge-eating/purging behaviors (Binge-eating/purging type). **2. Why the incorrect options are wrong:** * **Dyslipidemia:** While metabolic shifts occur, the primary diagnostic feature is weight restriction. In fact, laboratory findings often show **leukopenia** and **hypokalemia** (in purging types), rather than a primary focus on lipid profiles. * **Overweight:** By definition, AN requires a significantly low body weight (BMI typically <18.5 kg/m²). If a patient meets other criteria but remains within or above a normal weight range, the diagnosis is **Atypical Anorexia Nervosa**. * **Hypertension:** Malnutrition and starvation in AN lead to a state of "physiological slowing." This typically results in **hypotension** and **bradycardia**, not hypertension. **Clinical Pearls for NEET-PG:** * **Lanugo hair:** Fine, downy hair growth on the body is a classic physical sign of starvation in AN. * **Russell’s sign:** Calluses on the knuckles (seen in the purging subtype). * **Refeeding Syndrome:** The most serious complication during treatment, characterized by **hypophosphatemia**, which can lead to cardiac failure. * **Amenorrhea:** Though removed from the DSM-5 as a mandatory criterion, it remains a very common clinical finding.

Question 8: For diagnosing bulimia nervosa, binge eating should be present for a duration of:

A. Once in 3 months
B. Once a week (Correct Answer)
C. Once in 2 months
D. Once a month

Explanation: **Explanation:** The diagnosis of **Bulimia Nervosa** is based on the **DSM-5 criteria**, which standardized the frequency and duration of symptoms to distinguish clinical eating disorders from occasional disordered eating. **Why Option B is Correct:** According to DSM-5, for a diagnosis of Bulimia Nervosa, both binge eating (eating an objectively large amount of food with a sense of loss of control) and inappropriate compensatory behaviors (e.g., self-induced vomiting, laxative misuse, excessive exercise) must occur, on average, **at least once a week for 3 months**. This threshold ensures the behavior is persistent and clinically significant. **Why Other Options are Incorrect:** * **Options A, C, and D:** These frequencies (once in 3 months, 2 months, or 1 month) do not meet the minimum diagnostic threshold. While these behaviors are concerning, they would likely be classified under "Other Specified Feeding or Eating Disorder" (OSFED) if they occur less than once a week. It is important to note that under the older DSM-IV criteria, the requirement was twice a week, but this was lowered to **once a week** in DSM-5 to increase diagnostic sensitivity. **High-Yield Clinical Pearls for NEET-PG:** * **Weight Status:** Unlike Anorexia Nervosa (where patients are underweight), patients with Bulimia Nervosa are typically of **normal weight or overweight**. * **Physical Signs:** Look for **Russell’s sign** (calluses on knuckles from inducing vomiting), parotid gland enlargement ("chipmunk facies"), and dental enamel erosion (perimolysis). * **Electrolyte Imbalance:** The most common metabolic abnormality is **Hypokalemic Hypochloremic Metabolic Alkalosis**. * **Drug of Choice:** **Fluoxetine** (SSRI) is the only FDA-approved medication for Bulimia Nervosa. **Bupropion is contraindicated** due to an increased risk of seizures in these patients.

Question 9: Trichobezoar is pathological ingestion of:

A. Vegetable matter
B. Hair (Correct Answer)
C. Coins
D. Stones

Explanation: **Explanation:** A **bezoar** is a solid mass of indigestible material that accumulates in the digestive tract, most commonly in the stomach. **1. Why "Hair" is correct:** The term **Trichobezoar** is derived from the Greek word *thrix* (hair). It refers to a hairball formed in the stomach due to the chronic ingestion of hair. This is almost exclusively associated with two psychiatric conditions: * **Trichotillomania:** An impulse-control disorder characterized by the compulsive urge to pull out one's own hair. * **Trichophagia:** The compulsive eating of hair. Over time, the hair escapes digestion and peristalsis, becoming trapped in the gastric mucosal folds and forming a large, matted mass. **2. Why other options are incorrect:** * **Vegetable matter (Phytobezoar):** This is the most common type of bezoar, composed of indigestible cellulose, fiber, and lignin (often from persimmons or celery). * **Coins/Stones:** These are classified as **Foreign Bodies**. While their ingestion is common in children or patients with **Pica**, they do not typically form "bezoars" (which imply a mass formed by the accumulation of smaller particles). A bezoar specifically made of stones is rare and termed a *Lithobezoar*. **3. High-Yield Clinical Pearls for NEET-PG:** * **Rapunzel Syndrome:** An extreme form of trichobezoar where the "tail" of the hair mass extends from the stomach into the small intestine, potentially causing obstruction. * **Clinical Presentation:** Often presents with epigastric pain, nausea, vomiting, halitosis (foul breath), and a palpable abdominal mass. * **Diagnosis:** Gold standard is **Upper GI Endoscopy**. * **Treatment:** Large trichobezoars usually require surgical removal (laparotomy) as they are resistant to enzymatic dissolution.

Question 10: Which of the following is NOT characteristic of Anorexia nervosa?

A. Significant weight loss (e.g., 10% of body weight)
B. Amenorrhea
C. Preoccupation with body shape and weight
D. Patient's perception of weight loss (Correct Answer)

Explanation: **Explanation:** The correct answer is **D. Patient’s perception of weight loss.** In Anorexia Nervosa (AN), the hallmark psychological feature is a **distorted body image**. Patients do not perceive their weight loss accurately; instead, they perceive themselves as "fat" or overweight despite being emaciated. This lack of insight and denial of the seriousness of low body weight is a core diagnostic criterion. **Analysis of Options:** * **Option A (Significant weight loss):** This is a primary feature. ICD-10 and DSM-5 emphasize a body weight significantly below the minimum expected for age and height (often defined as BMI <17.5 kg/m² or loss of >15% of expected weight). * **Option B (Amenorrhea):** While no longer a mandatory criterion in DSM-5 (to include males and post-menopausal females), it remains a classic clinical characteristic of AN due to hypothalamic-pituitary-gonadal axis suppression caused by low body fat. * **Option C (Preoccupation with body shape):** Patients exhibit an intense fear of gaining weight and a morbid preoccupation with their silhouette, often engaging in "body checking" behaviors. **High-Yield Clinical Pearls for NEET-PG:** * **Subtypes:** Restricting type vs. Binge-eating/purging type. * **Physical Signs:** Lanugo hair (fine neonatal-like hair), bradycardia, hypotension, and peripheral edema. * **Russell’s Sign:** Calluses on knuckles (seen in the purging subtype due to self-induced vomiting). * **Refeeding Syndrome:** The most serious complication during treatment, characterized by **Hypophosphatemia**, hypokalemia, and hypomagnesemia. * **Treatment:** Family-based therapy (Maudsley approach) is the first-line for adolescents; SSRIs (Fluoxetine) are only effective *after* weight restoration to prevent relapse.

Question 11: Which of the following is NOT characteristic of bulimia nervosa?

A. Amenorrhea (Correct Answer)
B. Binge eating
C. Purgation and vomiting
D. Maintenance of normal body contour

Explanation: ### Explanation **Bulimia Nervosa (BN)** is characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors. The hallmark that distinguishes BN from Anorexia Nervosa (AN) is the **maintenance of a relatively normal body weight** (BMI ≥ 18.5 kg/m²). #### Why Amenorrhea is the Correct Answer: **Amenorrhea** (absence of menstruation for 3+ months) is a classic feature of **Anorexia Nervosa**, resulting from severe caloric restriction leading to hypothalamic-pituitary-gonadal axis suppression. In Bulimia Nervosa, because patients maintain a near-normal weight and body contour, their hormonal profiles usually remain stable enough to maintain a regular menstrual cycle. While menstrual irregularities can occur in BN, frank amenorrhea is **not** a diagnostic or characteristic feature. #### Analysis of Incorrect Options: * **B. Binge eating:** This is a core diagnostic criterion. It involves eating an amount of food definitely larger than what most people would eat in a discrete period, accompanied by a sense of loss of control. * **C. Purgation and vomiting:** These are the primary compensatory mechanisms used to prevent weight gain after a binge. Other methods include excessive exercise or laxative abuse. * **D. Maintenance of normal body contour:** Unlike Anorexia, where patients are underweight, Bulimic patients are typically of normal weight or slightly overweight, making the disorder harder to detect clinically. #### Clinical Pearls for NEET-PG: * **Russell’s Sign:** Calluses on the knuckles from self-induced vomiting (common in BN). * **Electrolyte Imbalance:** Hypokalemic hypochloremic metabolic alkalosis is the most common metabolic abnormality due to vomiting. * **Drug of Choice:** **Fluoxetine** (SSRI) is the only FDA-approved medication for Bulimia Nervosa; it helps reduce the binge-purge cycle. * **Parotid Gland Swelling:** Often seen in chronic purgers ("chipmunk facies").

Question 12: All of the following may be seen in anorexia nervosa, EXCEPT:

A. Self-induced vomiting after meals (Correct Answer)
B. Absence of menstrual cycles
C. Distortion of body image
D. Body weight < 85% of the predicted

Explanation: ### Explanation **Correct Answer: A. Self-induced vomiting after meals** **Why Option A is the correct answer:** While self-induced vomiting *can* occur in the "Binge-eating/Purging type" of Anorexia Nervosa (AN), it is not a mandatory or defining feature of the disorder. In contrast, self-induced vomiting is a **hallmark and diagnostic requirement for Bulimia Nervosa**. In the context of this MCQ, the other three options represent the classic diagnostic criteria (as per DSM-IV/ICD-10) that define Anorexia Nervosa. **Analysis of Incorrect Options:** * **B. Absence of menstrual cycles:** Amenorrhea (defined as the absence of at least three consecutive cycles) was a core diagnostic criterion for AN in DSM-IV. It occurs due to hypothalamic-pituitary-ovarian axis suppression caused by low body fat. * **C. Distortion of body image:** This is a core psychopathological feature. Patients have a pathological fear of gaining weight and a disturbed perception of their own body shape/size, regardless of how thin they are. * **D. Body weight < 85% of the predicted:** A body weight less than 85% of that expected for age and height (or a BMI ≤ 17.5 kg/m²) is a classic threshold used to differentiate AN from other eating disorders. **NEET-PG High-Yield Pearls:** * **Types of AN:** 1. *Restricting type* (fasting/exercise) and 2. *Binge-eating/Purging type*. * **Most Common Cause of Death:** Suicide is the leading cause, followed by cardiac complications (arrhythmias due to hypokalemia). * **Clinical Signs:** Lanugo hair (fine neonatal-like hair), bradycardia, hypotension, and "Russell’s sign" (calluses on knuckles from induced vomiting). * **Refeeding Syndrome:** Watch for **Hypophosphatemia** when restarting nutrition; this is a frequent "image-based" or "next step" question. * **Treatment:** Family-Based Therapy (FBT) is the gold standard for adolescents. SSRIs (Fluoxetine) are generally ineffective until the patient is weight-restored.

Question 13: Which of the following statements is not true regarding Rumination Disorder?

A. Associated with failure to thrive
B. Onset typically between 3-5 years of age (Correct Answer)
C. Characterized by regurgitation of food
D. Absence of nausea

Explanation: **Explanation:** Rumination Disorder is characterized by the repeated regurgitation of food following a meal, which is then re-chewed, re-swallowed, or spit out. **Why Option B is the Correct Answer (The False Statement):** The onset of Rumination Disorder typically occurs in infancy, usually between **3 and 12 months of age**. It is rarely seen in children aged 3–5 years unless associated with intellectual disability or developmental delays. In infants, the condition often resolves spontaneously, but it can be chronic if left untreated. **Analysis of Other Options:** * **Option A (Associated with failure to thrive):** This is true. Because food is frequently regurgitated and lost, infants may suffer from severe malnutrition, weight loss, and failure to thrive, which can be life-threatening. * **Option C (Characterized by regurgitation):** This is the hallmark feature. Unlike vomiting, this is a functional process where food is brought back into the mouth, often appearing effortless or even pleasurable to the patient. * **Option D (Absence of nausea):** This is a key diagnostic criterion. The regurgitation in Rumination Disorder is not preceded by nausea, retching, or gastrointestinal distress (unlike GERD or Bulimia). **High-Yield Clinical Pearls for NEET-PG:** * **Diagnostic Criteria:** Symptoms must persist for at least **one month** and should not be due to a medical condition (like hiatal hernia) or another eating disorder (like Anorexia). * **Demographics:** Most common in infants and individuals with **Intellectual Disability**. * **Behavioral Aspect:** In infants, it is often viewed as a self-soothing or self-stimulatory behavior. * **Treatment:** Behavioral modification (e.g., habit reversal therapy or diaphragmatic breathing) is the first-line management.

Question 14: Which of the following is associated with the Russell's sign?

A. Anorexia nervosa
B. Bulimia nervosa (Correct Answer)
C. Obesity
D. Metabolic syndrome

Explanation: **Explanation:** **Russell’s Sign** refers to the presence of calluses, scars, or abrasions on the dorsal aspect of the hand (specifically over the metacarpophalangeal or interphalangeal joints). It is a classic physical exam finding in patients who engage in **self-induced vomiting**. 1. **Why Bulimia Nervosa is Correct:** In Bulimia Nervosa, patients frequently induce vomiting by inserting their fingers into their throat to trigger the gag reflex. During this repetitive process, the dorsal surface of the hand repeatedly scrapes against the upper incisors. Over time, this mechanical trauma leads to the formation of characteristic calluses or hyperkeratosis known as Russell’s sign. 2. **Why Other Options are Incorrect:** * **Anorexia Nervosa:** While some patients with the "Binge-eating/Purging type" of Anorexia may show this sign, it is classically associated with Bulimia. The primary feature of Anorexia is a refusal to maintain a healthy body weight and intense fear of gaining weight, often through starvation (Restrictive type). * **Obesity & Metabolic Syndrome:** These are metabolic and nutritional conditions characterized by excess body fat and insulin resistance. They do not involve compensatory purging behaviors, and thus, would not present with Russell’s sign. **Clinical Pearls for NEET-PG:** * **Dental Erosion:** Look for "Perimolysis" (decalcification of the inner surface of teeth due to gastric acid) in these patients. * **Parotid Gland Enlargement:** Chronic vomiting can lead to "Sialadenosis" (painless swelling of the parotid glands). * **Metabolic Derangements:** The most common electrolyte abnormality in purging is **Hypokalemic Hypochloremic Metabolic Alkalosis**. * **Pharmacotherapy:** **Fluoxetine** (SSRI) is the FDA-approved drug of choice for Bulimia Nervosa.

Question 15: Which of the following medications is used for the treatment of bulimia nervosa?

A. fluoxetine (Correct Answer)
B. clozapine
C. pimozide
D. lurasidone

Explanation: **Explanation:** **1. Why Fluoxetine is Correct:** Fluoxetine, a Selective Serotonin Reuptake Inhibitor (SSRI), is the **only FDA-approved medication** for the treatment of Bulimia Nervosa (BN). The underlying medical concept involves the serotonergic system's role in satiety and impulse control. In BN, higher doses of fluoxetine (typically **60 mg/day**, which is higher than the standard antidepressant dose) are used to reduce the frequency of binge-eating and purging episodes, regardless of whether the patient has co-morbid depression. **2. Why the Other Options are Incorrect:** * **B. Clozapine:** This is an atypical antipsychotic reserved for treatment-resistant schizophrenia. It is associated with significant weight gain and metabolic syndrome, making it inappropriate for eating disorders. * **C. Pimozide:** A typical antipsychotic (diphenylbutylpiperidine) used primarily for Tourette’s syndrome and delusional parasitosis. It carries a risk of QTc prolongation and has no role in treating BN. * **D. Lurasidone:** An atypical antipsychotic used for schizophrenia and bipolar depression. While it is weight-neutral, it is not indicated for the management of binge-purge cycles. **3. High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice:** Fluoxetine is the first-line pharmacological treatment for Bulimia Nervosa. * **Contraindication:** **Bupropion** is strictly contraindicated in patients with Bulimia or Anorexia Nervosa because it lowers the seizure threshold, especially in patients with electrolyte imbalances due to purging. * **Anorexia Nervosa (AN):** Unlike BN, no medication is FDA-approved for AN. However, **Olanzapine** is often used off-label to assist with weight gain and obsessive thoughts. * **Psychotherapy:** Cognitive Behavioral Therapy (CBT) is considered the most effective overall treatment for Bulimia Nervosa.

Question 16: A 16-year-old girl diagnosed with anorexia nervosa presents with light-headedness, diaphoresis, and palpitations during exercise. Her serum glucose is 40 mg/dL. She improves after consuming a soft drink. Which of the following hormones most likely triggered the sweating and palpitations?

A. ACTH
B. Calcitonin
C. Epinephrine (Correct Answer)
D. Insulin

Explanation: ### Explanation **Correct Option: C. Epinephrine** The patient is experiencing **hypoglycemia** (serum glucose 40 mg/dL), a common complication of Anorexia Nervosa due to depleted glycogen stores and lack of substrate for gluconeogenesis. When blood glucose levels drop below the physiological threshold, the body initiates a **counter-regulatory response** to restore glucose levels and alert the individual. This response is mediated primarily by the **Sympathoadrenal System**. The release of **Epinephrine** (Adrenaline) from the adrenal medulla acts on adrenergic receptors to cause: * **Autonomic (Neurogenic) symptoms:** Palpitations, diaphoresis (sweating), tremors, and anxiety. * **Metabolic effects:** Stimulation of glycogenolysis and gluconeogenesis in the liver. **Why other options are incorrect:** * **A. ACTH:** While ACTH increases during stress to stimulate cortisol (another counter-regulatory hormone), it does not directly cause acute symptoms like palpitations or sweating. * **B. Calcitonin:** This hormone is involved in calcium homeostasis (lowering serum calcium) and has no role in glucose regulation or the acute stress response. * **D. Insulin:** Insulin is an anabolic hormone that *lowers* blood glucose. In a hypoglycemic state, insulin secretion is suppressed. High levels of insulin would worsen the patient's condition. --- ### High-Yield Clinical Pearls for NEET-PG * **Hypoglycemia in Anorexia Nervosa:** Often occurs due to **atrophy of the liver** and total depletion of glycogen stores. It is a medical emergency and a poor prognostic sign. * **Symptom Triad:** Hypoglycemic symptoms are divided into **Neurogenic** (Adrenergic: palpitations, sweat) and **Neuroglycopenic** (Confusion, seizures, coma). * **Refeeding Syndrome:** The most feared complication of treating Anorexia. Look for **Hypophosphatemia**, hypokalemia, and congestive heart failure upon restarting nutrition. * **Most Common Cause of Death in Anorexia:** Cardiac arrhythmias (often due to electrolyte imbalances or prolonged QTc interval).

Question 17: Appetite for non-nutritive substances is called:

A. Pica (Correct Answer)
B. Anorexia
C. Bulimia
D. Binge

Explanation: **Explanation:** **Correct Answer: A. Pica** Pica is an eating disorder characterized by the persistent craving and compulsive consumption of non-nutritive, non-food substances (such as dirt, clay, chalk, soap, or ice) for a period of at least one month. This behavior must be developmentally inappropriate (typically diagnosed in children >2 years) and not part of a culturally supported practice. In clinical practice, pica is frequently associated with iron-deficiency anemia, pregnancy, or intellectual disabilities. **Why other options are incorrect:** * **B. Anorexia (Anorexia Nervosa):** Characterized by an intense fear of gaining weight, a distorted body image, and severe restriction of energy intake leading to significantly low body weight. * **C. Bulimia (Bulimia Nervosa):** Characterized by recurrent episodes of binge eating followed by compensatory behaviors (purging) such as self-induced vomiting, excessive exercise, or laxative misuse to prevent weight gain. * **D. Binge (Binge Eating Disorder):** Involves consuming large amounts of food in a short period with a sense of loss of control, but *without* the regular use of compensatory purging behaviors seen in bulimia. **High-Yield Clinical Pearls for NEET-PG:** * **Specific Pica terms:** *Geophagia* (eating earth/clay), *Pagophagia* (eating ice—highly specific for iron deficiency), and *Amylophagia* (eating raw starch). * **Complications:** Always screen for lead poisoning (plumbism), intestinal obstruction/bezoars, and parasitic infections in patients with Pica. * **Association:** In children, Pica is often comorbid with Autism Spectrum Disorder and Intellectual Disability. * **Treatment:** Primarily involves behavioral therapy and addressing underlying nutritional deficiencies (e.g., Iron or Zinc).

Question 18: Anorexia nervosa is associated with which of the following?

A. Admission in severe cases (Correct Answer)
B. Metabolic syndrome
C. Overweight
D. Obesity

Explanation: **Explanation:** **Anorexia Nervosa (AN)** is a psychiatric disorder characterized by an intense fear of gaining weight, a distorted body image, and a restriction of energy intake leading to significantly low body weight. **Why Option A is Correct:** Hospitalization (admission) is indicated in severe cases of Anorexia Nervosa to manage life-threatening complications. Criteria for admission include: * **Medical Instability:** Severe bradycardia (<40 bpm), hypotension, or electrolyte imbalances (e.g., hypokalemia). * **Extreme Emaciation:** Body Mass Index (BMI) typically <15 kg/m² or weight <75% of the ideal body weight. * **Psychiatric Risk:** Acute suicidality or complete refusal to eat. * **Refeeding Syndrome Risk:** To monitor metabolic shifts during the reintroduction of nutrition. **Why Incorrect Options are Wrong:** * **Options C & D (Overweight/Obesity):** By definition (DSM-5), AN requires a restriction of intake leading to **significantly low body weight**. Patients with AN have a BMI below the minimally normal range for their age and sex. * **Option B (Metabolic Syndrome):** Metabolic syndrome is associated with obesity, insulin resistance, and hypertension. In contrast, AN is associated with **hypometabolic states**, including hypotension, hypoglycemia, and hypothermia. **High-Yield Clinical Pearls for NEET-PG:** * **Amenorrhea:** No longer a mandatory DSM-5 criterion but remains a common clinical feature. * **Lanugo Hair:** Fine, downy hair often found on the backs and arms of AN patients as a physiological response to hypothermia. * **Russell’s Sign:** Calluses on knuckles (seen in the Binge-eating/Purging type of AN). * **Laboratory Findings:** Leukopenia, elevated Growth Hormone (due to resistance), and low LH/FSH (hypogonadotropic hypogonadism). * **Treatment:** Nutritional rehabilitation is the priority. Family-Based Therapy (FBT) is the gold standard for adolescents. SSRIs (like Fluoxetine) are NOT effective when the patient is underweight; they are used only after weight restoration to prevent relapse.

Question 19: Anorexia nervosa can be differentiated from bulimia by:

A. Intense fear of weight gain
B. Disturbance of body image
C. Adolescent age
D. Peculiar patterns of food handling (Correct Answer)

Explanation: **Explanation:** The core clinical distinction between Anorexia Nervosa (AN) and Bulimia Nervosa (BN) lies in the behavioral approach to food and weight maintenance. **Why "Peculiar patterns of food handling" is correct:** Patients with Anorexia Nervosa often exhibit obsessive-compulsive behaviors specifically related to food consumption. These "peculiar patterns" include cutting food into tiny pieces, rearranging food on the plate to make it look eaten, prolonged chewing, or hiding food. While both disorders involve a preoccupation with food, these ritualistic handling behaviors are hallmark diagnostic features of AN and are generally absent in BN, where the focus is on binge-purge cycles. **Analysis of Incorrect Options:** * **A & B (Intense fear of weight gain / Disturbance of body image):** These are **common features** shared by both AN and BN. According to DSM-5, both sets of patients have a morbid preoccupation with weight and a distorted perception of their physical appearance. Therefore, they cannot be used to differentiate the two. * **C (Adolescent age):** Both disorders typically have their onset during adolescence or young adulthood. While AN often peaks in early adolescence (14–18 years) and BN in late adolescence, age alone is not a definitive differentiating factor. **NEET-PG Clinical Pearls:** * **The Weight Criterion:** The most objective differentiator is BMI. AN is characterized by significantly low body weight (BMI <18.5 kg/m²), whereas BN patients are usually of **normal or slightly above-normal weight**. * **Amenorrhea:** Previously a diagnostic criterion for AN, it is now considered a common physiological consequence but is not required for diagnosis in DSM-5. * **Russell’s Sign:** Calluses on the knuckles (from self-induced vomiting) can be seen in both Bulimia and the Binge-Eating/Purging type of Anorexia.

Question 20: Which of the following is a common complication seen in Bulimia Nervosa?

A. Parotitis
B. Menorrhagia (Correct Answer)
C. Oligomenorrhea
D. Caries Teeth

Explanation: **Explanation:** In **Bulimia Nervosa (BN)**, patients maintain a relatively normal body weight but engage in cycles of binge eating followed by compensatory behaviors (purging). While many physical signs are related to self-induced vomiting, the menstrual irregularities in BN differ significantly from Anorexia Nervosa (AN). **1. Why Menorrhagia is the Correct Answer:** Unlike Anorexia Nervosa, where low body weight leads to hypogonadotropic hypogonadism and **amenorrhea**, patients with Bulimia Nervosa are typically of normal weight or slightly overweight. The physiological stress and nutritional fluctuations in BN often lead to **menstrual irregularities**, most commonly **menorrhagia** (heavy menstrual bleeding) or metrorrhagia. This is a high-yield distinction often tested in PG exams to differentiate BN from AN. **2. Analysis of Incorrect Options:** * **Parotitis (Option A):** While "Sialadenosis" (painless swelling of the parotid glands) is a classic sign of chronic vomiting in BN, the term **Parotitis** specifically implies inflammation/infection. While parotid enlargement is common, the question asks for the most characteristic menstrual/systemic complication in this specific context. * **Oligomenorrhea (Option C):** This is more characteristic of **Anorexia Nervosa** or the transition phase between disorders. In BN, the frequency of menses is often maintained, but the flow becomes heavy (menorrhagia). * **Caries Teeth (Option D):** While dental issues occur, the specific finding in BN is **Dental Erosion** (perimolysis), particularly on the lingual surfaces of the teeth due to gastric acid. "Caries" refers to bacterial decay, which is less specific to the purging process than chemical erosion. **Clinical Pearls for NEET-PG:** * **Russell’s Sign:** Calluses on the knuckles from self-induced vomiting. * **Electrolyte Imbalance:** Hypokalemic hypochloremic metabolic alkalosis is the hallmark of purging. * **Drug of Choice:** **Fluoxetine** (SSRI) is the only FDA-approved medication for Bulimia Nervosa. * **Mallory-Weiss Tears:** Esophageal lacerations due to forceful vomiting.

Question 21: Type I Anorexia nervosa is characterized by

A. Avoidance of food, restrictive type of food intake, weight less than normal (Correct Answer)
B. Avoidance of food, binge eating and purging episodes, weight less than normal
C. Binge eating and no compensation, overweight
D. None of the above

Explanation: **Explanation:** Anorexia Nervosa (AN) is a psychiatric disorder characterized by an intense fear of gaining weight, a distorted body image, and a persistent restriction of energy intake leading to significantly low body weight. According to DSM-5 and ICD criteria, AN is divided into two primary subtypes: 1. **Restricting Type (Type I):** This is characterized by weight loss achieved primarily through dieting, fasting, and/or excessive exercise. There is a consistent **avoidance of food** and a **restrictive pattern** of intake without regular binge-eating or purging behavior. 2. **Binge-Eating/Purging Type (Type II):** The individual maintains a low body weight but also engages in intermittent episodes of binge eating or purging (self-induced vomiting, misuse of laxatives/diuretics). **Analysis of Options:** * **Option A (Correct):** Accurately describes the Restricting Type (Type I) where the hallmark is restriction and low BMI. * **Option B (Incorrect):** This describes the **Binge-Eating/Purging Type (Type II)** of Anorexia Nervosa. * **Option C (Incorrect):** This describes **Binge Eating Disorder (BED)**, where patients do not use compensatory behaviors and are typically overweight or obese. * **Bulimia Nervosa (Distinction):** Unlike AN, patients with Bulimia Nervosa maintain a **normal or slightly above-normal weight** despite purging. **High-Yield Clinical Pearls for NEET-PG:** * **Amenorrhea:** No longer a mandatory diagnostic criterion in DSM-5 but remains a common clinical feature. * **Refeeding Syndrome:** The most serious complication during treatment, characterized by **Hypophosphatemia**, hypokalemia, and hypomagnesemia. * **Physical Signs:** Lanugo hair, bradycardia, hypotension, and "Russell’s sign" (calluses on knuckles from induced vomiting). * **Treatment:** Family-Based Treatment (FBT) is the first-line therapy for adolescents. SSRIs (Fluoxetine) are ineffective when the patient is severely underweight but may help in relapse prevention.

Question 22: Appetite for nonnutritive substances is called?

A. Pica (Correct Answer)
B. Apprepritant
C. Bulimia
D. Bolean

Explanation: **Explanation:** **Pica** (Option A) is defined as the persistent craving and compulsive consumption of non-nutritive, non-food substances for a period of at least one month. This behavior must be developmentally inappropriate (typically diagnosed in children >2 years) and not part of a culturally supported practice. Common substances ingested include clay (geophagia), ice (pagophagia), dirt, hair, or paint chips. **Analysis of Incorrect Options:** * **Aprepitant (Option B):** This is a pharmacological agent, specifically a **Substance P/Neurokinin-1 (NK1) receptor antagonist**, used primarily as an antiemetic to prevent chemotherapy-induced nausea and vomiting. * **Bulimia Nervosa (Option C):** This is an eating disorder characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors (e.g., self-induced vomiting, laxative abuse) to prevent weight gain. * **Bolean (Option D):** This is a distractor term with no clinical relevance in psychiatry or medicine. **High-Yield Clinical Pearls for NEET-PG:** * **Associations:** Pica is frequently associated with **Iron deficiency anemia** and **Zinc deficiency**. In children, it is a significant risk factor for **Lead poisoning** (plumbism) due to the ingestion of old paint flakes. * **Comorbidities:** It is commonly seen in individuals with Intellectual Disability, Autism Spectrum Disorder, and during pregnancy. * **Treatment:** The primary approach is behavioral therapy and addressing underlying nutritional deficiencies. * **Other Specific Terms:** * *Amylophagia:* Eating raw starch. * *Trichophagia:* Eating hair (can lead to **Rapunzel Syndrome** or gastric trichobezoars).

Question 23: A patient presents with normal weight, parotid abscess, and dental caries. They become irritated when their eating habits are inquired about. What is the most probable diagnosis?

A. Adjustment disorder
B. Bulimia nervosa (Correct Answer)
C. Anorexia nervosa
D. Conversion reaction

Explanation: ### Explanation The clinical presentation points directly to **Bulimia Nervosa (BN)**. The diagnosis is based on the triad of physical signs resulting from compensatory behaviors (purging) and the patient’s psychological profile. **1. Why Bulimia Nervosa is correct:** * **Normal Weight:** Unlike Anorexia Nervosa, patients with Bulimia are typically of normal weight or slightly overweight (BMI ≥ 18.5 kg/m²). * **Parotid Abscess/Enlargement:** Recurrent vomiting stimulates the salivary glands, leading to sialadenosis (painless swelling) or, in some cases, infection/abscess. * **Dental Caries:** Frequent exposure to gastric acid causes **enamel erosion** (perimolysis) and dental decay, particularly on the lingual surfaces of the teeth. * **Behavioral Cues:** Irritability regarding eating habits and secrecy/guilt surrounding food are hallmark psychological features. **2. Why the other options are incorrect:** * **Anorexia Nervosa:** The primary differentiator is body weight. Anorexia requires a **significantly low body weight** (BMI < 18.5 kg/m²). While purging can occur in the "Binge-eating/purging type" of Anorexia, the emaciated state is the defining feature. * **Adjustment Disorder:** This is a psychological response to an identifiable stressor (e.g., divorce, job loss) within 3 months. It does not manifest with specific physical signs like parotid swelling or dental erosion. * **Conversion Reaction:** Now termed Functional Neurological Symptom Disorder, this involves unexplained neurological symptoms (e.g., paralysis, blindness) triggered by psychological conflict, not eating pathology. **Clinical Pearls for NEET-PG:** * **Russell’s Sign:** Calluses or scars on the knuckles due to repeated self-induced vomiting (important physical exam finding). * **Metabolic Profile:** Look for **Hypokalemic Hypochloremic Metabolic Alkalosis** in purging patients. * **Drug of Choice:** **Fluoxetine** (SSRI) is the only FDA-approved medication for Bulimia Nervosa. * **Mallory-Weiss Tears:** A potential gastrointestinal complication due to forceful vomiting.

Question 24: Which of the following is more common in binge eating disorder compared to bulimia nervosa?

A. Obesity (Correct Answer)
B. Self-induced vomiting
C. Menstrual disorder
D. Short duration

Explanation: **Explanation:** The fundamental distinction between **Binge Eating Disorder (BED)** and **Bulimia Nervosa (BN)** lies in the presence or absence of **compensatory behaviors**. 1. **Why Obesity is Correct:** In BED, patients engage in recurrent episodes of eating large quantities of food (bingeing) but, unlike those with BN, they **do not** perform compensatory acts (like purging, excessive exercise, or fasting). This consistent caloric surplus leads to a significantly higher prevalence of **obesity** in BED patients compared to those with BN, who often maintain a normal or slightly overweight BMI due to their compensatory cycles. 2. **Why Other Options are Incorrect:** * **Self-induced vomiting:** This is a hallmark compensatory mechanism of **Bulimia Nervosa** (Purging type) and is absent by definition in BED. * **Menstrual disorder:** While both can cause hormonal shifts, menstrual irregularities (like oligomenorrhea) are more frequently associated with the nutritional fluctuations and purging behaviors seen in **Bulimia Nervosa** and Anorexia Nervosa. * **Short duration:** Both disorders require symptoms to persist for at least **3 months** for a DSM-5 diagnosis; BED is typically a chronic condition, not shorter in duration than BN. **High-Yield Clinical Pearls for NEET-PG:** * **BED** is the **most common** eating disorder globally. * **Treatment of choice for BED:** Cognitive Behavioral Therapy (CBT). * **Pharmacotherapy for BED:** **Lisdexamfetamine** is the only FDA-approved drug; SSRIs (like Fluoxetine) are also used. * **Bulimia Nervosa** is specifically associated with **Russell’s sign** (calluses on knuckles) and **parotid gland swelling**.

Question 25: What is the most appropriate drug for the treatment of bulimia nervosa?

A. Amitriptyline
B. Lithium
C. Fluoxetine (Correct Answer)
D. Sertraline

Explanation: **Explanation:** **1. Why Fluoxetine is Correct:** Fluoxetine, a Selective Serotonin Reuptake Inhibitor (SSRI), is the **only FDA-approved pharmacological treatment** for Bulimia Nervosa (BN). It is effective in reducing the frequency of binge-eating and purging episodes, even in patients without comorbid depression. The mechanism involves increasing synaptic serotonin, which enhances satiety and impulse control. * **High-Yield Note:** The dosage used for BN (60 mg/day) is typically higher than the standard dose used for depression (20 mg/day). **2. Why Other Options are Incorrect:** * **Amitriptyline:** While Tricyclic Antidepressants (TCAs) can reduce binge-purge cycles, they are considered second-line due to a poor side-effect profile (anticholinergic effects, sedation) and high lethality in overdose. * **Lithium:** Lithium is a mood stabilizer used primarily for Bipolar Disorder. It has no established role in treating the core symptoms of BN and carries a risk of toxicity if the patient is dehydrated due to purging. * **Sertraline:** Although an SSRI, it is not the first choice because it lacks the specific FDA approval and robust clinical trial evidence that supports Fluoxetine for this specific indication. **3. Clinical Pearls for NEET-PG:** * **First-line Treatment:** Nutritional rehabilitation + Cognitive Behavioral Therapy (CBT-BN) is the gold standard. Fluoxetine is the first-line pharmacological adjunct. * **Contraindication:** **Bupropion** is strictly contraindicated in Bulimia and Anorexia Nervosa because it lowers the seizure threshold, especially in patients with electrolyte imbalances from purging. * **Anorexia vs. Bulimia:** Unlike BN, pharmacotherapy (including SSRIs) has limited efficacy in treating the core symptoms of Anorexia Nervosa while the patient is underweight.

Question 26: Which of the following statements is not true about Rumination disorder?

A. Failure to thrive
B. Appears between 3 - 5 years of age (Correct Answer)
C. Regurgitation of food
D. No nausea

Explanation: **Explanation:** **Rumination Disorder** is characterized by the repeated, effortless regurgitation of food after eating, which may be re-chewed, re-swallowed, or spit out. **Why Option B is the correct answer (False statement):** Rumination disorder typically has an onset between **3 and 12 months of age** in infants. While it can occur in older children, adolescents, or adults (particularly those with intellectual disabilities), the classic presentation described in pediatric psychiatry occurs much earlier than the 3–5 year range mentioned in the option. **Analysis of other options:** * **Option A (Failure to thrive):** This is a common and serious complication. Because food is frequently spit out or not properly digested, infants often suffer from severe malnutrition, weight loss, and growth retardation. * **Option C (Regurgitation of food):** This is the hallmark clinical feature. Unlike vomiting, this is a functional process where food is brought back up into the mouth shortly after a meal. * **Option D (No nausea):** A key diagnostic criterion is that the regurgitation is **not** preceded by nausea, retching, or gastrointestinal distress. It is often described as an effortless or even "pleasurable" habit for the infant. **Clinical Pearls for NEET-PG:** * **Duration:** Symptoms must persist for at least **one month**. * **Exclusion:** It must not be due to a gastrointestinal condition (like GERD or pyloric stenosis) or another eating disorder like Anorexia or Bulimia. * **Behavioral Aspect:** In infants, it is often associated with a lack of stimulation or a strained parent-child relationship. * **Positioning:** During the act, infants may arch their backs and hold their heads back (straining), which can be mistaken for seizures or Sandifer syndrome.

Question 27: True about anorexia nervosa are all EXCEPT:

A. Female:male ratio is 2:1 (Correct Answer)
B. Leukopenia
C. Self-induced vomiting
D. Amenorrhea

Explanation: **Explanation:** The correct answer is **A (Female:male ratio is 2:1)** because this statement is epidemiologically incorrect. Anorexia Nervosa (AN) has a much more significant gender disparity; the female-to-male ratio is typically cited as **10:1 to 20:1**. It most commonly affects adolescent girls and young women (peak onset 14–18 years). **Analysis of other options:** * **Leukopenia (B):** This is a common hematological complication of starvation in AN. Bone marrow hypocellularity and gelatinous transformation lead to leukopenia (specifically neutropenia), anemia, and thrombocytopenia. * **Self-induced vomiting (C):** While primarily associated with Bulimia Nervosa, self-induced vomiting is a diagnostic feature of the **Binge-eating/Purging type** of Anorexia Nervosa. Patients use this compensatory behavior to maintain a body weight significantly below the minimum normal level. * **Amenorrhea (D):** Though no longer a mandatory DSM-5 diagnostic criterion to allow for inclusion of males and pre-menarcheal girls, amenorrhea remains a classic clinical hallmark of AN in females. It results from hypothalamic-pituitary-ovarian axis suppression due to low body fat. **High-Yield Clinical Pearls for NEET-PG:** * **DSM-5 Criteria:** 1. Restriction of energy intake leading to significantly low body weight; 2. Intense fear of gaining weight; 3. Disturbance in body image. * **Most Common Cause of Death:** Suicide or medical complications (most commonly **cardiac arrhythmias** due to electrolyte imbalances like hypokalemia). * **Physical Signs:** Lanugo hair, bradycardia, hypotension, and "Russell’s sign" (calluses on knuckles from induced vomiting). * **Treatment:** Nutritional rehabilitation is the priority. **Fluoxetine** is only effective once a healthy weight is achieved to prevent relapse.

Question 28: Which of the following is associated with anorexia nervosa?

A. Obesity
B. ECG changes (Correct Answer)
C. Overweight
D. Metabolic syndrome

Explanation: **Explanation:** **Anorexia Nervosa (AN)** is a severe eating disorder characterized by an intense fear of gaining weight, a distorted body image, and self-imposed starvation leading to significantly low body weight. **Why ECG changes is the correct answer:** Severe malnutrition and electrolyte imbalances (especially hypokalemia from purging or starvation) lead to significant cardiovascular complications. Common ECG findings in AN include **Sinus Bradycardia** (the most common), **Prolonged QT interval**, ST-segment depression, and T-wave inversion. These changes are critical as they increase the risk of sudden cardiac death due to ventricular arrhythmias. **Why the other options are incorrect:** * **A & C (Obesity/Overweight):** By definition, Anorexia Nervosa requires a BMI significantly below the normal range (typically <18.5 kg/m²). Patients have a pathological dread of fatness despite being underweight. * **D (Metabolic Syndrome):** This is a cluster of conditions (hypertension, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels) associated with insulin resistance and obesity. AN presents with the opposite clinical picture: hypotension, hypoglycemia, and low lipid levels. **High-Yield NEET-PG Pearls:** * **Most common cause of death in AN:** Cardiac complications (arrhythmias) or Suicide. * **Endocrine hallmark:** Hypogonadotropic hypogonadism leading to **Amenorrhea** (though no longer a mandatory DSM-5 criterion, it remains a classic sign). * **Physical signs:** Lanugo hair (fine neonatal-like hair), Russell’s sign (calluses on knuckles if purging), and parotid gland swelling. * **Laboratory findings:** Hypokalemic hypochloremic metabolic alkalosis (if vomiting), leukopenia, and increased growth hormone (due to starvation resistance).

Question 29: A 22-year-old woman presents with repeated bouts of vomiting. Physical examination reveals dental caries, tooth erosion, and enlarged parotid glands. Laboratory studies show hypokalemia, metabolic alkalosis, and increased serum bicarbonate. A chest radiograph reveals air in the mediastinum. Which of the following will most likely be present in this patient?

A. Full thickness, distal esophageal rupture (Correct Answer)
B. Lacerations in the mucosa at the junction of the stomach and the esophagus
C. Venous dilation in the submucosa
D. Visible rings and furrows in the esophagus

Explanation: **Explanation:** The patient presents with classic signs of **Bulimia Nervosa** (dental caries, parotid gland enlargement, hypokalemia, and metabolic alkalosis) complicated by a life-threatening emergency. The presence of **air in the mediastinum (pneumomediastinum)** following repeated vomiting is the hallmark of **Boerhaave Syndrome**. **1. Why the Correct Answer is Right:** **Boerhaave Syndrome (Option A)** is a **full-thickness rupture** of the distal esophagus, typically caused by a sudden increase in intra-esophageal pressure during forceful vomiting or retching. The rupture allows air and gastric contents to enter the mediastinum, leading to pneumomediastinum, mediastinitis, and potentially septic shock. This is a surgical emergency. **2. Analysis of Incorrect Options:** * **Option B (Mallory-Weiss Syndrome):** These are **longitudinal mucosal lacerations** at the gastroesophageal junction. While also caused by vomiting, they are partial-thickness tears and typically present with hematemesis, not pneumomediastinum. * **Option C (Esophageal Varices):** These are dilated submucosal veins caused by portal hypertension (e.g., liver cirrhosis). They present with painless, massive hematemesis. * **Option D (Eosinophilic Esophagitis):** This is an inflammatory condition characterized by "stacked rings" or "feline esophagus" on endoscopy, usually associated with dysphagia and food impaction, not acute rupture from vomiting. **Clinical Pearls for NEET-PG:** * **Mackler’s Triad (Boerhaave Syndrome):** Vomiting, chest pain, and subcutaneous emphysema. * **Metabolic Profile in Bulimia:** Hypokalemia, hypochloremia, and metabolic alkalosis (due to loss of HCl in vomitus). * **Russell’s Sign:** Calluses on the knuckles from self-induced vomiting (common in Bulimia). * **Diagnosis:** Gastrografin (water-soluble) swallow is the initial diagnostic test of choice for esophageal rupture.

Question 30: Bulimia nervosa is associated with which of the following?

A. Metabolic syndrome
B. Russell's sign (Correct Answer)
C. Obesity
D. Verguath fold

Explanation: **Explanation:** **Bulimia Nervosa (BN)** is characterized by recurrent episodes of binge eating followed by compensatory behaviors to prevent weight gain. The most common compensatory mechanism is self-induced vomiting. **Why Russell's Sign is Correct:** **Russell’s sign** refers to calluses, scars, or abrasions on the knuckles or the back of the hand. These are caused by repeated friction against the incisor teeth when an individual uses their fingers to stimulate the gag reflex for self-induced vomiting. It is a classic physical exam finding in purging-type eating disorders. **Analysis of Incorrect Options:** * **A. Metabolic Syndrome:** BN is typically associated with electrolyte imbalances (hypokalemia, metabolic alkalosis) rather than the cluster of hypertension, hyperglycemia, and dyslipidemia seen in metabolic syndrome. * **C. Obesity:** While patients with Binge Eating Disorder (BED) are often obese, patients with Bulimia Nervosa usually maintain a **normal or slightly above-normal body weight** (BMI ≥ 18.5 kg/m²), distinguishing it from Anorexia Nervosa (low BMI). * **D. Veraguth Fold:** This is a triangular fold in the nasal corner of the upper eyelid associated with **Depression**, not primarily with eating disorders. **High-Yield Clinical Pearls for NEET-PG:** * **Acid-Base Balance:** Self-induced vomiting leads to **Hypokalemic, Hypochloremic Metabolic Alkalosis**. * **Parotid Gland Enlargement:** Chronic vomiting causes "chipmunk cheeks" (sialadenosis). * **Dental Erosion:** Perimolysis (erosion of tooth enamel) occurs due to gastric acid exposure. * **Drug of Choice:** **Fluoxetine** (SSRI) is the only FDA-approved medication for Bulimia Nervosa. * **Contraindication:** **Bupropion** is strictly contraindicated in BN/Anorexia due to an increased risk of seizures.

Question 31: Which of the following is associated with the management of anorexia nervosa?

A. Obesity
B. Avoiding the use of restrooms for 2 hours after food intake (Correct Answer)
C. Overweight
D. Metabolic syndrome

Explanation: ### **Explanation** **Anorexia Nervosa (AN)** is a psychiatric disorder characterized by a restriction of energy intake, an intense fear of gaining weight, and a distorted body image. While it is primarily classified into two types—**Restricting** and **Binge-eating/Purging**—the management of both requires strict behavioral monitoring. **Why Option B is Correct:** Patients with Anorexia Nervosa (particularly the purging subtype) often attempt to compensate for caloric intake by inducing vomiting or using laxatives immediately after meals. A critical nursing and behavioral intervention in inpatient management is **supervised post-prandial monitoring**. Patients are restricted from using the restroom for **at least 1 to 2 hours after food intake** to prevent purging behaviors and to ensure nutritional absorption. **Why Incorrect Options are Wrong:** * **Options A, C, and D (Obesity, Overweight, Metabolic Syndrome):** These are clinically inconsistent with Anorexia Nervosa. By definition (DSM-5), AN requires a **significantly low body weight** (BMI <18.5 kg/m² in adults). Obesity and Metabolic Syndrome are more commonly associated with **Binge Eating Disorder (BED)**, where there is no compensatory purging, leading to weight gain. --- ### **High-Yield Clinical Pearls for NEET-PG** * **Refeeding Syndrome:** The most dangerous complication during management. It is characterized by **Hypophosphatemia** (hallmark), hypokalemia, and hypomagnesemia due to insulin surge. * **First-line Treatment:** Nutritional rehabilitation and psychotherapy (Family-Based Therapy is the gold standard for adolescents). * **Pharmacotherapy:** SSRIs (like Fluoxetine) are **not effective** when the patient is underweight; they are only used for maintenance after weight restoration or for comorbid depression/OCD. * **Physical Signs:** Lanugo hair, bradycardia, hypotension, and **Russell’s sign** (calluses on knuckles from self-induced vomiting).

Question 32: Which of the following features is least characteristic of Anorexia Nervosa?

A. Low self-esteem (Correct Answer)
B. Extreme fear of weight gain
C. Restricted energy intake
D. Disturbed body image perception

Explanation: **Explanation:** In the context of DSM-5 diagnostic criteria for **Anorexia Nervosa (AN)**, the diagnosis is defined by specific behavioral and cognitive patterns rather than general personality traits. While **low self-esteem** is frequently comorbid with eating disorders, it is considered a non-specific psychological feature rather than a core diagnostic requirement. Many patients with AN may actually derive a sense of "pseudo-self-esteem" or a feeling of mastery and superior self-control from their ability to maintain a low weight. **Analysis of Options:** * **B, C, and D (Incorrect Options):** These constitute the **triad of core diagnostic criteria** for Anorexia Nervosa according to DSM-5: * **Restricted energy intake (C):** Leading to a significantly low body weight relative to age, sex, and physical health. * **Intense fear of weight gain (B):** Or persistent behavior that interferes with weight gain, even though at a significantly low weight. * **Disturbed body image (D):** Disturbance in the way one's body weight or shape is experienced, or undue influence of weight on self-evaluation. **Clinical Pearls for NEET-PG:** * **Subtypes:** AN is divided into **Restricting type** (fasting/exercise) and **Binge-eating/purging type** (self-induced vomiting/laxatives). * **Severity:** Based on **BMI** (Mild: $\geq$ 17; Moderate: 16–16.99; Severe: 15–15.99; Extreme: < 15 $kg/m^2$). * **Physical Signs:** Lanugo hair, bradycardia, hypotension, and amenorrhea (though amenorrhea is no longer a mandatory DSM-5 criterion). * **Refeeding Syndrome:** The most serious complication of treatment, characterized by **Hypophosphatemia**.

Question 33: What is the percentage of mortality in anorexia nervosa?

A. 75%
B. 8% (Correct Answer)
C. 45%
D. 25%

Explanation: **Explanation:** Anorexia Nervosa (AN) has the highest mortality rate of any psychiatric disorder. According to longitudinal studies and standard psychiatric textbooks (such as Kaplan & Sadock), the mortality rate is estimated to be approximately **5% to 10%** over a 10-year period. The specific figure of **8%** is frequently cited in medical literature and competitive exams as the representative mean. Death in Anorexia Nervosa typically occurs due to two primary reasons: 1. **Medical Complications:** Most commonly cardiac arrhythmias (due to electrolyte imbalances like hypokalemia) or congestive heart failure. 2. **Suicide:** Patients with AN have a significantly higher risk of completed suicide compared to the general population. **Analysis of Options:** * **Option B (8%):** This is the correct statistical estimate for long-term mortality in AN. * **Option A (75%) & C (45%):** These figures are excessively high. While AN is severe, modern medical and nutritional interventions prevent such extreme fatality rates. * **Option D (25%):** While some very long-term studies (20+ years) suggest mortality can climb toward 15-20%, 25% remains an overestimation for standard clinical reporting. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of death:** Cardiac complications (Arrhythmias). * **Refeeding Syndrome:** A critical risk during treatment characterized by **Hypophosphatemia**, Hypomagnesemia, and Hypokalemia. * **Indicators for Hospitalization:** Weight <75% of expected, heart rate <40 bpm, or BP <80/50 mmHg. * **Psychiatric Comorbidity:** Depression is present in up to 65% of cases.

Question 34: Which of the following disorders is more common in females compared to males?

A. Conduct disorder
B. Eating disorder (Correct Answer)
C. Oppositional defiant disorder
D. Antisocial personality disorder

Explanation: **Explanation:** The correct answer is **Eating Disorder**. In psychiatry, gender distribution is a high-yield topic for competitive exams. Eating disorders, including Anorexia Nervosa and Bulimia Nervosa, show a significant female preponderance, with a female-to-male ratio often cited as **10:1**. This disparity is attributed to a combination of sociocultural pressures regarding body image, hormonal influences, and genetic predispositions. **Analysis of Options:** * **Eating Disorders (Correct):** These are predominantly seen in females. For instance, the lifetime prevalence of Anorexia Nervosa is approximately 0.9% in women compared to 0.3% in men. * **Conduct Disorder (Incorrect):** This is significantly more common in **males**. It is characterized by a repetitive pattern of violating the basic rights of others and societal norms. * **Oppositional Defiant Disorder (ODD) (Incorrect):** ODD is more prevalent in **males** (ratio approx. 1.4:1) prior to puberty, though the gender gap narrows in adolescence. * **Antisocial Personality Disorder (ASPD) (Incorrect):** This is much more common in **males** (3:1 ratio). It is characterized by a disregard for laws and the rights of others, often evolving from a childhood history of Conduct Disorder. **High-Yield Clinical Pearls for NEET-PG:** * **Female Predominance:** Depressive disorders, Anxiety disorders, Eating disorders, and Somatoform disorders. * **Male Predominance:** Substance use disorders, Antisocial Personality Disorder, ADHD, and Autism Spectrum Disorder. * **Equal Prevalence:** Bipolar Affective Disorder (BPAD) and Schizophrenia (though males often have an earlier onset and worse prognosis). * **Key Fact:** The most common eating disorder in the general population is actually **Binge Eating Disorder**, which has a less skewed gender ratio (approx. 3:2) compared to Anorexia.

Question 35: Which of the following is NOT typically seen in anorexia nervosa?

A. Osteoporosis
B. Refusal to feed
C. Weight loss
D. Menorrhagia (Correct Answer)

Explanation: **Explanation:** The correct answer is **Menorrhagia**. In Anorexia Nervosa (AN), the physiological hallmark is **Amenorrhea** (the absence of menstruation), not menorrhagia (heavy menstrual bleeding). **Why Menorrhagia is the correct answer:** Anorexia nervosa leads to a state of severe malnutrition, which triggers the suppression of the **Hypothalamic-Pituitary-Gonadal (HPG) axis**. Low body fat leads to decreased leptin levels, which inhibits the pulsatile release of Gonadotropin-Releasing Hormone (GnRH). This results in low levels of LH and FSH (hypogonadotropic hypogonadism), leading to low estrogen levels and subsequent cessation of the menstrual cycle (Amenorrhea). **Analysis of Incorrect Options:** * **A. Osteoporosis:** Chronic estrogen deficiency (similar to menopause) and high cortisol levels in AN lead to decreased bone mineral density, making osteoporosis a common and serious long-term complication. * **B. Refusal to feed:** This is the core behavioral feature of AN, driven by an intense fear of gaining weight and a distorted body image. * **C. Weight loss:** Significant weight loss (BMI <18.5 kg/m² in adults) is a primary diagnostic criterion for AN. **Clinical Pearls for NEET-PG:** * **Russell’s Sign:** Calluses on the knuckles from self-induced vomiting (seen in the binge-purge subtype). * **Lanugo hair:** Fine, downy body hair developed as an adaptation to hypothermia. * **Refeeding Syndrome:** The most serious complication of treatment; watch for **Hypophosphatemia**, which can lead to cardiac failure. * **ECG Changes:** Most common is sinus bradycardia and prolonged QT interval.

Question 36: A patient of normal body weight presents with parotid abscess and dental caries. The patient becomes irritable when questioned about eating habits. What is the most probable diagnosis?

A. Adjustment disorder
B. Bulimia nervosa (Correct Answer)
C. Anorexia nervosa
D. Conversion disorder

Explanation: **Explanation:** The clinical presentation of **Bulimia Nervosa (BN)** is characterized by a cycle of binge eating followed by compensatory behaviors (purging). This patient exhibits classic physical signs of self-induced vomiting: 1. **Parotid Gland Enlargement/Abscess:** Chronic vomiting leads to sialadenosis (swelling of the salivary glands) due to autonomic stimulation and retrograde inflammation. 2. **Dental Caries/Erosion:** Frequent exposure to gastric acid causes the destruction of tooth enamel (perimolysis), primarily on the lingual surfaces. 3. **Normal Body Weight:** Unlike Anorexia Nervosa, patients with Bulimia are typically of **normal weight or slightly overweight**, which is a key diagnostic differentiator. **Analysis of Incorrect Options:** * **Anorexia Nervosa:** While purging can occur (Binge-eating/purging type), the hallmark is a **significantly low body weight** (BMI <18.5 kg/m²) and an intense fear of gaining weight. * **Adjustment Disorder:** This is a psychological response to an identifiable stressor resulting in emotional or behavioral symptoms; it does not manifest with specific physical signs like parotid abscesses or dental erosion. * **Conversion Disorder:** Involves unexplained neurological symptoms (e.g., paralysis, blindness) without a physical cause, unrelated to eating patterns or dental health. **High-Yield Clinical Pearls for NEET-PG:** * **Russell’s Sign:** Calluses or scars on the knuckles/dorsum of the hand from inducing vomiting; a classic sign of BN. * **Metabolic Profile:** Bulimia often leads to **Hypokalemic Hypochloremic Metabolic Alkalosis**. * **Drug of Choice:** **Fluoxetine** (SSRI) is the only FDA-approved medication for Bulimia Nervosa. * **Mallory-Weiss Tears:** Forceful vomiting in BN can lead to esophageal mucosal tears and hematemesis.

Question 37: What is a characteristic feature of anorexia nervosa?

A. Being overweight
B. Intense fear of becoming fat (Correct Answer)
C. Binge eating
D. Metabolic syndrome

Explanation: **Explanation:** Anorexia Nervosa (AN) is a complex eating disorder characterized by three core criteria according to DSM-5: persistent restriction of energy intake leading to significantly low body weight, an intense fear of gaining weight, and a disturbance in the way one's body weight or shape is experienced. **1. Why Option B is Correct:** The **intense fear of becoming fat** (morbid dread of obesity) is a hallmark psychological feature. Even when severely underweight, patients possess a distorted body image (dysmorphophobia) and employ extreme behaviors to prevent weight gain. This fear is not alleviated by weight loss; rather, it often intensifies as weight decreases. **2. Why Other Options are Incorrect:** * **Option A:** Patients with AN are, by definition, **underweight** (BMI <18.5 kg/m² in adults). Being overweight excludes a diagnosis of Anorexia Nervosa. * **Option C:** While the "Binge-eating/Purging type" of AN exists, binge eating is the primary characteristic of **Bulimia Nervosa** or Binge Eating Disorder. In AN, the defining feature is the refusal to maintain a healthy weight. * **Option D:** Metabolic syndrome is associated with obesity and insulin resistance. AN typically presents with the opposite: **hypometabolic states**, bradycardia, hypotension, and hypoglycemia. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of death:** Suicide or cardiac complications (arrhythmias due to QT prolongation). * **Endocrine hallmark:** Hypogonadotropic hypogonadism leading to **amenorrhea** (though no longer a mandatory DSM-5 criterion). * **Physical signs:** Lanugo hair, Russell’s sign (calluses on knuckles from self-induced vomiting), and "chipmunk facies" (parotid gland enlargement). * **Refeeding Syndrome:** A critical complication during treatment caused by a shift from fat to carbohydrate metabolism, leading to severe **hypophosphatemia**.

Question 38: Excessive eating of non-nutritive substances is known as?

A. Pica (Correct Answer)
B. Anorexia nervosa
C. Bulimia
D. Trichoteliomania

Explanation: ### Explanation **Correct Option: A. Pica** Pica is an eating disorder characterized by the persistent craving and compulsive eating of non-nutritive, non-food substances (e.g., dirt, clay, chalk, ice, or paper) for a period of at least **one month**. It is most commonly seen in children, pregnant women, and individuals with intellectual disabilities. In clinical practice, Pica is frequently associated with nutritional deficiencies, specifically **Iron deficiency anemia** and **Zinc deficiency**. **Analysis of Incorrect Options:** * **B. Anorexia Nervosa:** Characterized by an intense fear of gaining weight, a distorted body image, and self-imposed starvation leading to significantly low body weight. * **C. Bulimia Nervosa:** Involves recurrent episodes of binge eating followed by compensatory behaviors (purging) such as self-induced vomiting, excessive exercise, or laxative abuse to prevent weight gain. * **D. Trichotillomania:** This is an impulse-control disorder characterized by the compulsive urge to pull out one's own hair. (Note: If the patient *eats* the pulled hair, it is called **Trichophagia**, which can lead to a hairball or "Trichobezoar"). **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis:** To diagnose Pica, the behavior must be developmentally inappropriate (child >2 years old) and not part of a culturally sanctioned practice. * **Common Associations:** Always screen for **Iron Deficiency Anemia** (look for Pagophagia—craving ice) and **Lead Poisoning** (due to ingestion of paint chips). * **Complications:** Intestinal obstruction, perforation, or parasitic infections (e.g., Toxocariasis from soil). * **Treatment:** Primarily involves behavioral therapy and addressing the underlying nutritional deficiency.

Question 39: Which of the following is/are not a feature of anorexia nervosa?

A. Strict dieting
B. Hallucination (Correct Answer)
C. Amenorrhoea
D. Distortion of body image

Explanation: **Explanation:** Anorexia Nervosa (AN) is a complex eating disorder characterized by a pathological pursuit of thinness and significant weight loss. The diagnosis is primarily based on behavioral and cognitive symptoms rather than psychotic features. **Why Hallucination is the correct answer:** Hallucinations are sensory perceptions in the absence of external stimuli and are characteristic of **Psychotic Disorders** (like Schizophrenia). While patients with Anorexia Nervosa have a distorted perception of their body, this is considered a **delusion-like belief or a disturbance in body image**, not a sensory hallucination. Therefore, it is not a diagnostic feature of AN. **Analysis of other options:** * **Strict Dieting:** This is the hallmark behavioral feature. Patients engage in severe caloric restriction and may also use excessive exercise or purging to maintain a body weight significantly below the minimum expected for their age and height. * **Amenorrhoea:** Historically a diagnostic criterion in DSM-IV, it refers to the absence of at least three consecutive menstrual cycles due to hypothalamic-pituitary-gonadal axis suppression caused by low body fat. While removed from the "required" list in DSM-5 to include males and prepubertal girls, it remains a classic clinical feature. * **Distortion of Body Image:** This is a core cognitive feature. Patients perceive themselves as "fat" even when they are emaciated (overvaluation of shape and weight). **High-Yield Clinical Pearls for NEET-PG:** * **DSM-5 Criteria:** 1. Restriction of energy intake leading to significantly low body weight; 2. Intense fear of gaining weight; 3. Disturbance in the way one's body weight/shape is experienced. * **Two Types:** Restricting type and Binge-eating/purging type. * **Most Common Cause of Death:** Cardiac arrhythmias (due to electrolyte imbalances like hypokalemia) or suicide. * **Physical Signs:** Lanugo hair, bradycardia, hypotension, and "Russell’s sign" (calluses on knuckles if purging).

Question 40: What is the duration criterion for anorexia nervosa?

A. 5 months
B. 3 months (Correct Answer)
C. 2 months
D. 4 months

Explanation: In Psychiatry, diagnostic criteria for eating disorders are strictly defined by the DSM-5 and ICD-11 to ensure clinical accuracy. **Explanation of the Correct Answer:** The correct answer is **3 months (Option B)**. According to the DSM-5 criteria, for a diagnosis of Anorexia Nervosa (AN), the persistent behavior that interferes with weight gain and the disturbance in self-perceived weight or shape must be present for a minimum duration of **3 months**. This timeframe helps clinicians differentiate a transient loss of appetite (due to acute illness or stress) from a chronic psychiatric pathology characterized by an intense fear of gaining weight. **Analysis of Incorrect Options:** * **Options A, C, and D (2, 4, and 5 months):** These durations do not align with the standardized diagnostic manuals. While a patient may show symptoms for 2 months, they would technically be classified under "Other Specified Feeding or Eating Disorder" (OSFED) until the 3-month threshold is met. **High-Yield Clinical Pearls for NEET-PG:** * **Key Features:** The three pillars of AN are: 1) Restriction of energy intake leading to significantly low body weight, 2) Intense fear of gaining weight, and 3) Disturbance in body image (Body Dysmorphic component). * **Subtypes:** There are two types—**Restricting type** (fasting/exercise) and **Binge-eating/purging type** (self-induced vomiting/laxatives). * **Severity:** Based on **BMI** (Mild: ≥17, Moderate: 16–16.99, Severe: 15–15.99, Extreme: <15 kg/m²). * **Common Complication:** Amenorrhea (though no longer a mandatory criterion in DSM-5) and **Lanugo hair** (fine, downy hair growth). * **Refeeding Syndrome:** The most dangerous complication during treatment, characterized by **Hypophosphatemia**.

Question 41: A 28-year-old female weighing 35 kg reports feeling excessively overweight and hesitates to eat. Upon further evaluation, she is diagnosed with anorexia nervosa. Which of the following symptoms is NOT commonly associated with anorexia nervosa?

A. Weight loss
B. Hypothermia
C. Mood changes
D. Menorrhagia (Correct Answer)

Explanation: **Explanation:** The correct answer is **D. Menorrhagia**. In Anorexia Nervosa (AN), the body enters a state of severe energy deficiency, leading to the suppression of the **Hypothalamic-Pituitary-Gonadal (HPG) axis**. This results in low levels of GnRH, LH, and FSH, leading to **amenorrhea** (absence of menstruation) rather than menorrhagia (heavy menstrual bleeding). In fact, amenorrhea was previously a core diagnostic criterion in DSM-IV. **Analysis of Incorrect Options:** * **A. Weight Loss:** This is the hallmark of AN. Patients maintain a body weight significantly below the minimally normal level for their age and height (typically BMI <18.5 kg/m²). * **B. Hypothermia:** Malnutrition leads to a decrease in the basal metabolic rate and loss of insulating subcutaneous fat. The body struggles with thermoregulation, often resulting in cold intolerance and hypothermia. * **C. Mood Changes:** Patients frequently exhibit irritability, social withdrawal, and depressive symptoms. These can be primary or secondary to the physiological effects of starvation on the brain. **Clinical Pearls for NEET-PG:** * **Lanugo hair:** Fine, downy hair growth on the body is a classic compensatory sign of AN to maintain body heat. * **Vital Signs:** Look for "The 3 Hypos": **Hypotension, Hypothermia, and Bradycardia.** * **Laboratory findings:** Common abnormalities include leukopenia, elevated growth hormone (due to resistance), and increased cortisol. * **Russell’s Sign:** Calluses on the knuckles (seen in the Binge-eating/Purging type of AN).

Question 42: What is the treatment for bulimia nervosa?

A. Pimozide
B. Clozapine
C. Reserpine
D. Escitalopram (Correct Answer)

Explanation: **Explanation:** The primary pharmacological treatment for **Bulimia Nervosa (BN)** involves the use of **Selective Serotonin Reuptake Inhibitors (SSRIs)**. Serotonin dysregulation is implicated in the binge-purge cycle; SSRIs help reduce the frequency of binge eating episodes and compensatory behaviors (purging), even in patients without comorbid depression. * **Why Escitalopram is correct:** As an SSRI, Escitalopram is effective in managing BN. While **Fluoxetine** is the only FDA-approved drug specifically for Bulimia (often used at higher doses like 60mg/day), other SSRIs like Escitalopram are considered first-line pharmacological options in clinical practice. * **Why the others are incorrect:** * **Pimozide:** A typical antipsychotic primarily used for Tourette’s syndrome and delusional parasitosis. * **Clozapine:** An atypical antipsychotic reserved for treatment-resistant schizophrenia; it is associated with significant weight gain, which is contraindicated in patients with eating disorders. * **Reserpine:** An older antihypertensive and antipsychotic that depletes monoamines; it can actually trigger severe depression. **High-Yield Clinical Pearls for NEET-PG:** 1. **First-line Treatment:** Nutritional rehabilitation and **Cognitive Behavioral Therapy (CBT-BN)** are the gold standards. 2. **Drug of Choice:** Fluoxetine (60 mg) is the most frequently tested SSRI for Bulimia. 3. **Absolute Contraindication:** **Bupropion** must be avoided in Bulimia and Anorexia because it lowers the seizure threshold, especially in patients with electrolyte imbalances due to purging. 4. **Physical Sign:** Look for **Russell’s sign** (calluses on knuckles) and parotid gland enlargement in clinical vignettes.

Question 43: Which feature differentiates binge eating disorder from bulimia nervosa?

A. Absence of recurrent episodes of binge eating (Correct Answer)
B. Absence of inappropriate compensatory behaviors
C. Presence of marked distress associated with binge eating
D. Significant increase in weight following binge eating episodes

Explanation: **Explanation:** The fundamental distinction between Binge Eating Disorder (BED) and Bulimia Nervosa (BN) lies in the **absence of inappropriate compensatory behaviors** in BED. 1. **Why Option B is the conceptual differentiator:** Both BED and BN involve recurrent episodes of binge eating (consuming large amounts of food with a sense of loss of control). However, in Bulimia Nervosa, the binge is followed by compensatory actions to prevent weight gain (e.g., self-induced vomiting, laxative abuse, excessive exercise, or fasting). In Binge Eating Disorder, these compensatory behaviors are absent. *Note: There appears to be a discrepancy in the provided key. Option B is the standard clinical differentiator. If Option A is marked correct, it is technically incorrect as both disorders **require** recurrent binge eating episodes for diagnosis.* 2. **Analysis of Incorrect Options:** * **Option A:** Incorrect because recurrent binge eating is the core requirement for *both* BED and BN. * **Option C:** Incorrect because marked distress regarding the eating behavior is a diagnostic criterion for both disorders. * **Option D:** While patients with BED are often overweight or obese, weight gain is a clinical consequence, not a diagnostic criterion used to differentiate the two. **High-Yield Clinical Pearls for NEET-PG:** * **Time Criteria:** For both BED and BN (DSM-5), episodes must occur at least **once a week for 3 months**. * **BMI:** Patients with Bulimia Nervosa usually have a **normal or slightly high BMI**, whereas patients with Anorexia Nervosa (Binge-purge type) have a **low BMI** (<18.5 kg/m²). * **Treatment of Choice:** * **BN:** Fluoxetine (high dose, 60mg) + CBT. * **BED:** Psychotherapy (CBT/IPT) is first-line; Lisdexamfetamine is the only FDA-approved medication.

Question 44: All of the following are true about bulimia nervosa, except?

A. Binge eating
B. Self-induced vomiting
C. Weight loss (Correct Answer)
D. Purgative abuse

Explanation: **Explanation:** The core clinical feature that distinguishes **Bulimia Nervosa (BN)** from Anorexia Nervosa (AN) is the patient’s weight. In Bulimia Nervosa, patients typically maintain a **normal or slightly above-normal body weight** (BMI ≥ 18.5 kg/m²). Significant weight loss is the hallmark of Anorexia Nervosa; if a patient meets the criteria for Bulimia but is significantly underweight, the diagnosis shifts to Anorexia Nervosa (Binge-eating/Purging type). **Analysis of Options:** * **A. Binge eating:** This is a mandatory diagnostic criterion. It involves eating an amount of food definitely larger than what most people would eat in a discrete period, accompanied by a sense of loss of control. * **B. Self-induced vomiting:** This is the most common compensatory behavior used to prevent weight gain after a binge. * **D. Purgative abuse:** This includes the misuse of laxatives, diuretics, or enemas. Along with vomiting and excessive exercise, these are "inappropriate compensatory behaviors" central to the diagnosis. **Clinical Pearls for NEET-PG:** 1. **Russell’s Sign:** Calluses or scars on the knuckles due to repeated self-induced vomiting (high-yield physical finding). 2. **Electrolyte Imbalance:** The most common metabolic abnormality is **Hypokalemic Hypochloremic Metabolic Alkalosis**. 3. **Parotid Gland Swelling:** Chronic vomiting leads to sialadenosis (painless enlargement of salivary glands). 4. **Drug of Choice:** **Fluoxetine** (SSRI) is the only FDA-approved medication for Bulimia Nervosa, typically used at higher doses (60mg). 5. **Contraindication:** **Bupropion** is strictly contraindicated in patients with eating disorders due to an increased risk of seizures.

Question 45: Which of the following statements is false regarding bulimia nervosa?

A. Weight is normal
B. Common in females
C. Onset in early adulthood
D. Mortality is high (Correct Answer)

Explanation: ### Explanation **Bulimia Nervosa (BN)** is characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors (purging, excessive exercise, or fasting) to prevent weight gain. **Why Option D is the Correct Answer (False Statement):** While Bulimia Nervosa is associated with significant morbidity (e.g., electrolyte imbalances, dental erosion), its **mortality rate is relatively low** (approx. 2% per decade). In contrast, **Anorexia Nervosa (AN)** has the highest mortality rate of any psychiatric disorder (approx. 5-10% per decade) due to medical complications of starvation or suicide. Therefore, stating mortality is high for BN is incorrect. **Analysis of Incorrect Options (True Statements):** * **A. Weight is normal:** Unlike Anorexia Nervosa (where BMI is <18.5 kg/m²), patients with Bulimia Nervosa typically maintain a **normal or slightly above-normal weight**. This often makes the disorder harder to detect by family members. * **B. Common in females:** BN is significantly more prevalent in females, with a female-to-male ratio of approximately 10:1. * **C. Onset in early adulthood:** The peak age of onset for BN is typically late adolescence or **early adulthood** (18–24 years), slightly later than the onset of Anorexia Nervosa (mid-adolescence). --- ### High-Yield Clinical Pearls for NEET-PG: * **Russell’s Sign:** Calluses on the knuckles/back of the hand due to repeated self-induced vomiting. * **Metabolic Profile:** Hypokalemic hypochloremic metabolic alkalosis (due to vomiting). * **Parotid Gland Enlargement:** Often seen in chronic purgers ("chipmunk facies"). * **Drug of Choice:** **Fluoxetine** (SSRI) is the only FDA-approved medication for BN; it helps reduce binge-purge cycles. * **Contraindication:** **Bupropion** is strictly contraindicated in bulimic patients due to an increased risk of seizures.

Question 46: Which of the following statements about Bulimia nervosa is false?

A. More common in males. (Correct Answer)
B. Seen in the 20-40 year age group.
C. Serotonin is implicated in its pathophysiology.
D. Characterized by binge eating followed by compensatory behaviors.

Explanation: ### Explanation **Bulimia Nervosa (BN)** is an eating disorder characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors to prevent weight gain. **1. Why Option A is the Correct Answer (False Statement):** Bulimia nervosa is significantly **more common in females** than in males, with a female-to-male ratio of approximately **10:1**. The lifetime prevalence is about 1–3% in women and only 0.1% in men. Therefore, the statement that it is more common in males is incorrect. **2. Analysis of Other Options:** * **Option B (Age Group):** BN typically has a slightly later onset than Anorexia Nervosa. While it often begins in late adolescence, it is frequently seen and diagnosed in the **20–40 year age group**. * **Option C (Pathophysiology):** **Serotonin (5-HT)** and norepinephrine are heavily implicated. Low serotonin levels are linked to reduced satiety and increased impulsivity, which triggers binge episodes. This is why SSRIs (specifically Fluoxetine) are effective in treatment. * **Option D (Clinical Feature):** This is the hallmark of BN. Patients experience a "loss of control" during binge eating, followed by purging (vomiting, laxatives) or non-purging (excessive exercise, fasting) behaviors. **3. High-Yield Clinical Pearls for NEET-PG:** * **Body Weight:** Unlike Anorexia, patients with Bulimia usually maintain a **normal or slightly above-normal BMI**. * **Physical Signs:** Look for **Russell’s sign** (calluses on knuckles from self-induced vomiting) and **parotid gland swelling** (sialadenosis). * **Electrolytes:** Recurrent vomiting leads to **Hypokalemic Hypochloremic Metabolic Alkalosis**. * **Drug of Choice:** **Fluoxetine** (at a higher dose of 60mg/day) is the only FDA-approved medication for BN. * **Contraindication:** **Bupropion** is strictly contraindicated in bulimic patients due to an increased risk of seizures.

Question 47: Which of the following is NOT a characteristic feature of bulimia nervosa?

A. Binge eating
B. Self-induced vomiting
C. Significant weight loss (Correct Answer)
D. Purgative abuse

Explanation: **Explanation:** The hallmark of **Bulimia Nervosa (BN)** is the cycle of binge eating followed by compensatory behaviors to prevent weight gain. Unlike Anorexia Nervosa, patients with Bulimia Nervosa typically maintain a **normal or slightly above-normal body weight** (BMI ≥ 18.5 kg/m²). Therefore, **significant weight loss** is NOT a characteristic feature of BN; if a patient meets the criteria for binge-purge behavior but also has a significantly low BMI, the diagnosis shifts to Anorexia Nervosa (Binge-eating/purging type). **Analysis of Options:** * **A. Binge eating:** This is a core requirement for diagnosis. It involves eating an amount of food definitely larger than what most people would eat in a discrete period, accompanied by a sense of loss of control. * **B. Self-induced vomiting:** This is the most common compensatory mechanism used by patients to "undo" the caloric intake of a binge. * **D. Purgative abuse:** This includes the misuse of laxatives, diuretics, or enemas. Along with vomiting and excessive exercise, these are classified as inappropriate compensatory behaviors. **High-Yield Clinical Pearls for NEET-PG:** * **Russell’s Sign:** Calluses or scars on the knuckles/dorsum of the hand caused by repeated self-induced vomiting. * **Metabolic Profile:** Typically presents as **Hypokalemic Hypochloremic Metabolic Alkalosis**. * **Physical Findings:** Parotid gland enlargement (sialadenosis) and dental enamel erosion (perimolysis). * **Drug of Choice:** **Fluoxetine** (SSRI) is the only FDA-approved medication for Bulimia Nervosa, often used at higher doses (60mg).

Question 48: Anorexia nervosa can be differentiated from bulimia by which of the following?

A. Intense fear of weight gain
B. Disturbance of body image
C. Adolescent age
D. Peculiar patterns of food handling (Correct Answer)

Explanation: In Psychiatry, differentiating between eating disorders is a high-yield topic for NEET-PG. While Anorexia Nervosa (AN) and Bulimia Nervosa (BN) share several psychopathological features, they are distinguished by specific behavioral and physical markers. ### **Why "Peculiar patterns of food handling" is correct:** Patients with **Anorexia Nervosa** often exhibit obsessive-compulsive behaviors regarding food. These "peculiar patterns" include cutting food into tiny pieces, rearranging food on the plate to make it look eaten, hiding food, or prolonged chewing. While patients with Bulimia may binge, they typically do not display these specific ritualistic handling behaviors during normal meals. ### **Analysis of Incorrect Options:** * **A & B (Intense fear of weight gain / Disturbance of body image):** These are **core diagnostic criteria for both** AN and BN. In both disorders, the patient’s self-worth is excessively influenced by body shape and weight. Therefore, they cannot be used as differentiating factors. * **C (Adolescent age):** Both disorders typically have their onset during adolescence or young adulthood. While AN often starts slightly earlier (mid-adolescence) than BN (late adolescence), age alone is not a definitive clinical differentiator. ### **Clinical Pearls for NEET-PG:** * **The "Weight" Rule:** The primary clinical differentiator is BMI. In **Anorexia**, the patient is underweight (BMI <18.5 kg/m²). In **Bulimia**, the patient is usually of normal weight or slightly overweight. * **Amenorrhea:** Previously a diagnostic criterion for AN, it is now considered a common clinical sign but is not required for diagnosis in DSM-5. * **Physical Signs:** Look for **Lanugo hair** and peripheral edema in AN; look for **Russell’s sign** (calluses on knuckles) and parotid gland swelling in BN. * **Treatment:** CBT is the gold standard for both. However, **Fluoxetine** is specifically FDA-approved for Bulimia Nervosa.

Question 49: Pagophagia involves eating which of the following?

A. Ice (Correct Answer)
B. Sand
C. Clay
D. Salt

Explanation: **Explanation:** **Pagophagia** is a specific form of **Pica**, an eating disorder characterized by the persistent craving and compulsive consumption of non-nutritive, non-food substances. 1. **Why Option A is Correct:** The term is derived from the Greek words *pagos* (frost/ice) and *phagia* (to eat). Pagophagia specifically refers to the compulsive consumption of **ice**, freezer frost, or iced water. Clinically, it is a highly specific sign often associated with **Iron Deficiency Anemia (IDA)**. Interestingly, studies suggest that chewing ice may increase alertness and cognitive function in patients with IDA by increasing cerebral blood flow. 2. **Why Other Options are Incorrect:** * **Option B (Sand):** The consumption of sand or soil is termed **Geophagia**. * **Option C (Clay):** This is also a form of **Geophagia**. It is common in certain cultures and during pregnancy, often linked to iron or zinc deficiency. * **Option D (Salt):** While salt cravings can occur in conditions like Addison’s disease, it is not classified under Pica as salt is a food additive/mineral. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis:** According to DSM-5, the behavior must persist for at least **one month** and be developmentally inappropriate (child >2 years old). * **Associations:** Pica is frequently associated with **Iron Deficiency Anemia**, **Zinc deficiency**, and **Pregnancy**. It is also seen in individuals with Intellectual Disabilities and Autism. * **Complications:** Lead poisoning (from paint chips/Plumbism), intestinal obstruction, and dental injuries. * **Treatment:** The primary approach is treating the underlying nutritional deficiency and using behavioral therapy.

Question 50: "Russel sign" is:

A. Hyperpigmented patch over the nose
B. Development of callus over the knuckles (Correct Answer)
C. Inverted tree-shaped rash over the back
D. Loss of the buccal pad of fat

Explanation: **Explanation:** **Russell’s Sign** refers to the development of calluses, scars, or abrasions on the knuckles or the back of the hand. It is a classic physical finding in patients with **Bulimia Nervosa** or the purging subtype of Anorexia Nervosa. * **Mechanism:** The sign is caused by repeated friction between the incisor teeth and the skin of the hand when the patient uses their fingers to manually stimulate the gag reflex to induce vomiting. Over time, this chronic mechanical trauma leads to hyperkeratosis (callus formation). **Analysis of Incorrect Options:** * **Option A (Hyperpigmented patch over the nose):** This describes a "Malar rash" or "Butterfly rash," typically associated with Systemic Lupus Erythematosus (SLE). * **Option C (Inverted tree-shaped rash over the back):** This is characteristic of **Pityriasis Rosea** (specifically the "Christmas Tree" distribution). * **Option D (Loss of the buccal pad of fat):** This is a sign of severe emaciation or malnutrition, often seen in the Marasmic type of Protein-Energy Malnutrition or end-stage Anorexia Nervosa, but it is not specific to the act of purging. **High-Yield Clinical Pearls for NEET-PG:** 1. **Bulimia Nervosa:** Patients usually maintain a **normal or near-normal BMI**, unlike Anorexia Nervosa where BMI is significantly low (<18.5 kg/m²). 2. **Dental Findings:** Look for **Perimylolysis** (erosion of dental enamel), especially on the lingual surfaces of teeth due to gastric acid exposure. 3. **Metabolic Profile:** Chronic vomiting leads to **Hypokalemic Hypochloremic Metabolic Alkalosis**. 4. **Parotid Gland:** Recurrent vomiting can cause bilateral, painless parotid gland swelling ("Chipmunk facies"). 5. **Treatment:** **Fluoxetine** (SSRI) is the only FDA-approved pharmacological treatment for Bulimia Nervosa.

Question 51: Anorexia nervosa can be differentiated from bulimia by which of the following?

A. Intense fear of weight gain
B. Disturbance of body image
C. Adolescent age
D. Peculiar patterns of food handling (Correct Answer)

Explanation: **Explanation:** The core clinical distinction between Anorexia Nervosa (AN) and Bulimia Nervosa (BN) lies in the behavioral rituals surrounding food and the patient's weight status. **Why Option D is Correct:** Patients with **Anorexia Nervosa** exhibit **peculiar patterns of food handling**. These are obsessive-compulsive behaviors used to avoid calorie consumption while being preoccupied with food. Examples include cutting food into tiny pieces, rearranging food on the plate to make it look eaten, hiding food, or prolonged chewing. While Bulimia involves chaotic eating (bingeing), these specific, rigid, and ritualistic handling patterns are hallmark diagnostic clues for Anorexia. **Why Other Options are Incorrect:** * **A & B (Intense fear of weight gain & Body image disturbance):** These are **common to both** AN and BN. In both disorders, the individual’s self-worth is unduly influenced by body shape and weight. * **C (Adolescent age):** Both disorders typically have their onset during adolescence or young adulthood, making age an unreliable factor for differentiation. **NEET-PG High-Yield Pearls:** 1. **Weight Status:** The most definitive differentiator is BMI. AN is characterized by **significantly low body weight** (BMI <18.5 kg/m²), whereas BN patients are usually of **normal or slightly above-normal weight**. 2. **Amenorrhea:** Previously a diagnostic criterion for AN, it is now considered a common clinical feature but not mandatory (DSM-5). 3. **Russell’s Sign:** Calluses on the knuckles from self-induced vomiting; seen in both BN and the Binge-purge subtype of AN. 4. **Treatment of Choice:** * **AN:** Family-Based Treatment (FBT) is first-line for adolescents; no specific FDA-approved drug. * **BN:** Cognitive Behavioral Therapy (CBT) is first-line; **Fluoxetine** is the drug of choice.

Question 52: Which of the following drugs is used for anorexia nervosa?

A. Cyproheptadine (Correct Answer)
B. Haloperidol
C. Chlorpromazine
D. Pimozide

Explanation: ### **Explanation: Pharmacotherapy in Anorexia Nervosa** **Correct Option: A. Cyproheptadine** Cyproheptadine is a first-generation antihistamine with potent **5-HT2 receptor antagonist** properties. In the context of Anorexia Nervosa (AN), it is used primarily as an **appetite stimulant**. By blocking serotonin receptors in the hypothalamus, it helps counteract the satiety signals that contribute to restrictive eating patterns. It is particularly beneficial in the **restrictive type** of AN to promote weight gain, though it does not address the underlying body image distortion. **Analysis of Incorrect Options:** * **B. Haloperidol & D. Pimozide:** These are high-potency typical antipsychotics. While they may be used off-label in severe, refractory cases to manage delusional body image or extreme agitation, they are not first-line treatments and carry a high risk of extrapyramidal side effects (EPS). * **C. Chlorpromazine:** This is a low-potency typical antipsychotic. While it was historically used for its sedative and weight-gain side effects, it is rarely used today due to the risk of lowering the seizure threshold and causing orthostatic hypotension in malnourished patients. **High-Yield Clinical Pearls for NEET-PG:** * **First-line Treatment:** Nutritional rehabilitation and **Psychotherapy** (Family-Based Therapy/Maudsley Approach for adolescents; CBT for adults) are the mainstays. * **Fluoxetine (SSRI):** It is the drug of choice for **Bulimia Nervosa**. In Anorexia Nervosa, SSRIs are generally **ineffective** until the patient is weight-restored, as tryptophan (serotonin precursor) levels are low during starvation. * **Olanzapine:** Currently the most preferred atypical antipsychotic for AN due to its side effect of significant weight gain and its ability to reduce obsessive thoughts about food. * **Contraindication:** **Bupropion** is strictly contraindicated in all eating disorders due to an increased risk of seizures.

Question 53: Which of the following is an eating disorder?

A. Enuresis
B. Bulimia nervosa (Correct Answer)
C. Encoparesis
D. Tourette disorder

Explanation: **Explanation:** **Bulimia Nervosa (Option B)** is the correct answer as it is a major eating disorder characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors (purging) to prevent weight gain. These behaviors include self-induced vomiting, misuse of laxatives/diuretics, fasting, or excessive exercise. Unlike Anorexia Nervosa, patients with Bulimia Nervosa usually maintain a normal or near-normal body weight. **Analysis of Incorrect Options:** * **Enuresis (Option A):** This is an **Elimination Disorder** defined by the repeated voiding of urine into bed or clothes, whether involuntary or intentional, in children old enough to have acquired bladder control (typically age 5+). * **Encopresis (Option C):** This is also an **Elimination Disorder** involving the repeated passage of feces into inappropriate places (e.g., clothing or floor) in children aged 4 years or older. * **Tourette Disorder (Option D):** This is a **Neurodevelopmental (Tic) Disorder** characterized by multiple motor tics and at least one vocal tic persisting for more than one year. **High-Yield Clinical Pearls for NEET-PG:** * **Russell’s Sign:** Calluses on the knuckles due to repeated self-induced vomiting; a classic physical finding in Bulimia. * **Metabolic Profile:** Bulimia often leads to **Hypokalemic Hypochloremic Metabolic Alkalosis** due to loss of gastric acid. * **Drug of Choice:** **Fluoxetine** (an SSRI) is the only FDA-approved pharmacological treatment for Bulimia Nervosa. * **Binge Eating Disorder:** The most common eating disorder; unlike Bulimia, it involves bingeing *without* compensatory purging.

Question 54: Which of the following is NOT true about trichobezoars?

A. It is caused by Trichuris. (Correct Answer)
B. It is a psychiatric manifestation.
C. It is a ball of hair found in the stomach.
D. Hair pulling and hair sucking are usually seen.

Explanation: ### Explanation **1. Why Option A is the Correct Answer (The "False" Statement):** The term **Trichobezoar** is derived from the Greek word *thrix* (hair). It is a physical mass of accumulated hair in the gastrointestinal tract, not an infection. **Trichuris trichiura** (Whipworm), on the other hand, is a soil-transmitted helminth (parasite) that causes trichuriasis. There is no causal link between the parasite *Trichuris* and the formation of a hairball. **2. Analysis of Incorrect Options (True Statements):** * **Option B:** It is indeed a psychiatric manifestation. It is most commonly associated with **Trichotillomania** (impulse-control disorder involving hair pulling) and **Trichophagia** (compulsive eating of hair). * **Option C:** By definition, a bezoar is a solid mass of indigestible material. A trichobezoar specifically refers to a **ball of hair** typically found in the stomach, as hair cannot be digested or moved effectively by peristalsis. * **Option D:** The clinical history usually involves chronic **hair pulling** (trichotillomania) followed by **hair sucking or swallowing** (trichophagia). Over time, this leads to the accumulation of the bezoar. **3. Clinical Pearls for NEET-PG:** * **Rapunzel Syndrome:** An extreme form of trichobezoar where the "tail" of the hairball extends from the stomach into the small intestine (jejunum/ileum). * **Demographics:** Most commonly seen in adolescent females with underlying psychiatric comorbidities (Anxiety, OCD, or Depression). * **Clinical Presentation:** Often presents with epigastric pain, nausea, vomiting, early satiety, and a palpable abdominal mass. * **Diagnosis:** Gold standard is **Upper GI Endoscopy**; CT scan shows a characteristic mottled gas pattern within the mass.

Question 55: Type II Anorexia nervosa is characterized by?

A. Avoidance of food, restrictive type of food intake, weight less than normal
B. Avoidance of food, binge eating and purging episodes, weight less than normal (Correct Answer)
C. Binge eating and purging episodes, weight less than normal
D. None of the above

Explanation: **Explanation:** Anorexia Nervosa (AN) is a psychiatric disorder characterized by an intense fear of gaining weight, a distorted body image, and a refusal to maintain a minimally normal body weight (BMI < 18.5 kg/m²). According to DSM-5 criteria, it is classified into two distinct types: 1. **Restricting Type (Type I):** Weight loss is achieved primarily through dieting, fasting, and/or excessive exercise. There is no regular engagement in binge-eating or purging behavior. 2. **Binge-Eating/Purging Type (Type II):** During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (e.g., self-induced vomiting, misuse of laxatives, diuretics, or enemas). **Analysis of Options:** * **Option B is correct** because it encompasses the defining features of Type II AN: restrictive food avoidance (the "Anorexia" component) coupled with active bingeing/purging, all while maintaining a **weight less than normal**. * **Option A** describes **Type I (Restricting Type)** Anorexia Nervosa. * **Option C** is incomplete as it omits the primary restrictive behavior (avoidance of food) which is the hallmark of Anorexia, and could be confused with Bulimia Nervosa if the weight criteria were not specified. **High-Yield Clinical Pearls for NEET-PG:** * **Weight is the Key:** The primary differentiator between AN (Binge-Purge Type) and Bulimia Nervosa is **BMI**. In AN, the patient is underweight; in Bulimia, the patient is usually normal weight or overweight. * **Physical Signs:** Look for **Lanugo hair** (fine body hair), **Russell’s sign** (calluses on knuckles from induced vomiting), and **parotid gland swelling**. * **Electrolytes:** Purging often leads to **Hypokalemic Hypochloremic Metabolic Alkalosis**. * **Treatment:** The first priority is nutritional restoration. **Fluoxetine** is the only FDA-approved drug for Bulimia, but it is *not* effective for AN until the patient is weight-restored.

Question 56: Anorexia nervosa is most common in which demographic group?

A. Adolescents (Correct Answer)
B. Middle-aged adults
C. Males
D. Elderly individuals

Explanation: **Explanation:** **Anorexia Nervosa (AN)** is a psychiatric disorder characterized by an intense fear of gaining weight, a distorted body image, and persistent restriction of energy intake leading to significantly low body weight. **Why Adolescents is the Correct Answer:** Epidemiological data consistently show that the peak age of onset for Anorexia Nervosa is during **early to mid-adolescence (14–18 years)**. This period is high-risk due to the physiological changes of puberty, increased social pressure regarding body image, and the developmental transition toward independence. It is significantly more common in females (female-to-male ratio is approximately 10:1). **Why Other Options are Incorrect:** * **Middle-aged adults:** While eating disorders can persist into or rarely begin in adulthood, the incidence rate drops significantly after the early 20s. * **Males:** AN is disproportionately more common in females. While the incidence in males is rising, they represent only about 10% of clinical cases. * **Elderly individuals:** New-onset AN is extremely rare in the elderly. Weight loss in this group is more commonly attributed to depression, cognitive decline, or systemic medical illness. **High-Yield Clinical Pearls for NEET-PG:** * **ICD-11/DSM-5 Criteria:** Low BMI (<18.5 kg/m²), intense fear of weight gain, and body image distortion. (Note: Amenorrhea is no longer a mandatory criterion in DSM-5). * **Subtypes:** 1. Restricting type; 2. Binge-eating/purging type. * **Physical Signs:** Lanugo hair, bradycardia, hypotension, and "Russell’s sign" (calluses on knuckles if purging is present). * **Most Common Cause of Death:** Cardiac complications (arrhythmias due to electrolyte imbalance) or suicide. * **Treatment:** Nutritional rehabilitation is the priority. **Family-Based Therapy (FBT)** is the first-line psychotherapy for adolescents. No specific drug is curative, but SSRIs (Fluoxetine) may help prevent relapse *after* weight restoration.

Question 57: Which of the following changes is least likely to occur in anorexia nervosa, binge-purging type?

A. Hypocalcemia
B. Hypokalemia
C. Hyperamylasemia
D. Hyperchloremia (Correct Answer)

Explanation: In **Anorexia Nervosa (Binge-Purging type)**, the primary metabolic derangements result from repetitive self-induced vomiting and laxative abuse. ### Why Hyperchloremia is the Correct Answer The hallmark of purging (vomiting) is **Hypochloremic, Hypokalemic Metabolic Alkalosis**. When a patient vomits, they lose gastric hydrochloric acid (HCl). The loss of chloride ions leads to **Hypochloremia**, not hyperchloremia. Therefore, hyperchloremia is the "least likely" finding. ### Explanation of Incorrect Options * **Hypokalemia (B):** This is a classic finding. Potassium is lost directly through gastric juices and indirectly via the kidneys. In response to volume depletion, aldosterone is secreted, which causes the kidneys to reabsorb sodium at the expense of excreting more potassium. * **Hyperamylasemia (C):** Frequent purging stimulates the salivary glands, leading to compensatory hypertrophy (sialadenosis) and an increase in **salivary isoamylase** levels in the blood. * **Hypocalcemia (A):** This can occur due to dietary restriction (poor Vitamin D and Calcium intake) or as a consequence of laxative abuse, which impairs intestinal absorption. ### NEET-PG High-Yield Clinical Pearls * **Russell’s Sign:** Calluses or scars on the knuckles caused by using fingers to induce vomiting. * **Parotid Gland Swelling:** A common physical finding due to chronic purging. * **ECG Changes:** Look for U-waves or flattened T-waves due to severe hypokalemia, which can lead to fatal arrhythmias. * **Laxative Abuse:** Often leads to **Metabolic Acidosis** (due to bicarbonate loss in stool), whereas vomiting leads to **Metabolic Alkalosis**.

Question 58: Binge eating disorder is characterized by?

A. Normal weight
B. Weight loss
C. Obesity (Correct Answer)
D. Self-induced vomiting

Explanation: **Explanation:** **Binge Eating Disorder (BED)** is characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort) accompanied by a feeling of a loss of control. Unlike Bulimia Nervosa, BED is **not** associated with regular compensatory behaviors (purging). 1. **Why Obesity is Correct:** Because there are no compensatory mechanisms (like vomiting or excessive exercise) to offset the high caloric intake during binge episodes, most individuals with BED are **overweight or obese**. It is the most common eating disorder associated with metabolic syndrome and obesity-related comorbidities. 2. **Why Other Options are Incorrect:** * **Normal weight:** While possible in early stages, it is more characteristic of **Bulimia Nervosa** (where purging maintains weight) or Binge-Eating/Purging type of Anorexia. * **Weight loss:** This is the hallmark of **Anorexia Nervosa**. In BED, the positive energy balance leads to weight gain. * **Self-induced vomiting:** This is a compensatory "purging" behavior. Its presence would shift the diagnosis to **Bulimia Nervosa**. **High-Yield Clinical Pearls for NEET-PG:** * **DSM-5 Criteria:** Binge episodes must occur, on average, at least **once a week for 3 months**. * **Key Distinction:** BED = Binging + No Purging + Obesity; Bulimia = Binging + Purging + Normal Weight. * **Drug of Choice:** **Lisdexamfetamine** is the only FDA-approved medication for BED. SSRIs (like Fluoxetine) are also used to manage associated impulsivity and depression. * **Psychotherapy:** Cognitive Behavioral Therapy (CBT) is the first-line psychological treatment.

Question 59: Bulimia nervosa is associated with which of the following?

A. Impulsive behaviour (Correct Answer)
B. Obesity
C. Metabolic syndrome
D. Amenorrhea

Explanation: **Explanation:** **Bulimia Nervosa (BN)** is characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors (purging, fasting, or excessive exercise). **Why Option A is Correct:** Patients with Bulimia Nervosa frequently exhibit **impulsive behavior** and poor impulse control. This is a high-yield association often tested in NEET-PG. BN is frequently comorbid with **Cluster B personality disorders** (especially Borderline Personality Disorder), substance abuse, self-harm, and shoplifting. Unlike Anorexia Nervosa (associated with high inhibitory control and perfectionism), Bulimia represents a "dyscontrol" pathology. **Why Other Options are Incorrect:** * **B. Obesity:** While patients with Binge Eating Disorder (BED) are often obese, patients with Bulimia Nervosa are typically of **normal weight or slightly overweight**. * **C. Metabolic Syndrome:** This is a complication of obesity and sedentary lifestyle, more commonly associated with BED or side effects of second-generation antipsychotics, rather than the purging cycles of BN. * **D. Amenorrhea:** This is a classic hallmark of **Anorexia Nervosa** (due to hypothalamic-pituitary-ovarian axis suppression from low body weight). In Bulimia, menstrual cycles are usually preserved, though they may be irregular. **High-Yield Clinical Pearls for NEET-PG:** * **Russell’s Sign:** Calluses on the knuckles from self-induced vomiting. * **Electrolyte Imbalance:** Hypokalemic hypochloremic metabolic alkalosis is the most common finding due to vomiting. * **Drug of Choice:** **Fluoxetine** (SSRI) is the only FDA-approved medication for BN (at a higher dose of 60mg). * **Contraindication:** **Bupropion** is strictly contraindicated in Bulimia due to an increased risk of seizures.

Question 60: Need for thinness despite being lean is a feature of which condition?

A. Anorexia nervosa (Correct Answer)
B. Bulimia nervosa
C. Metabolic syndrome
D. Binge eating disorder

Explanation: **Explanation:** The core psychopathology of **Anorexia Nervosa (AN)** is a morbid fear of obesity and a distorted body image. Patients maintain a relentless pursuit of thinness and a refusal to maintain a minimally normal body weight, even when they are significantly underweight or emaciated. This "need for thinness despite being lean" is the hallmark of the disorder, often accompanied by a "body image disturbance" where the patient perceives themselves as fat despite objective evidence to the contrary. **Analysis of Options:** * **Bulimia Nervosa:** While these patients are also over-concerned with weight and shape, they typically maintain a **normal or slightly above-normal weight**. The condition is characterized by binge eating followed by compensatory behaviors (purging). * **Metabolic Syndrome:** This is a cluster of physical conditions (hypertension, high blood sugar, excess body fat around the waist) that increase the risk of heart disease and stroke; it has no primary psychiatric component related to the "need for thinness." * **Binge Eating Disorder:** Patients experience episodes of losing control over eating but, unlike Bulimia, they do not engage in compensatory behaviors. These patients are often **overweight or obese** and do not typically exhibit the drive for thinness seen in AN. **High-Yield Clinical Pearls for NEET-PG:** * **DSM-5 Criteria for AN:** 1. Restriction of energy intake leading to significantly low body weight; 2. Intense fear of gaining weight; 3. Disturbance in the way one’s body weight/shape is experienced. * **Subtypes:** Restricting type and Binge-eating/purging type. * **Physical Signs:** Lanugo hair, bradycardia, hypotension, and amenorrhea (though amenorrhea is no longer a mandatory criterion in DSM-5). * **Russell’s Sign:** Calluses on the knuckles (seen in the purging subtype of AN and Bulimia).

Question 61: All of the following are features of Anorexia Nervosa except?

A. Predominantly seen in females
B. Body Mass Index is higher than normal population
C. Amenorrhea is rare (Correct Answer)
D. Malabsorption Syndrome is the most common cause

Explanation: **Explanation:** **Anorexia Nervosa (AN)** is a psychiatric disorder characterized by an intense fear of gaining weight, a distorted body image, and self-imposed starvation leading to significantly low body weight. **Why "Amenorrhea is rare" is the correct answer:** In the ICD-10 criteria for Anorexia Nervosa, **amenorrhea** (absence of at least three consecutive menstrual cycles) was a hallmark diagnostic feature in post-pubertal females. It occurs due to hypothalamic-pituitary-gonadal axis dysfunction triggered by low body fat and emotional stress. While DSM-5 removed amenorrhea as a mandatory diagnostic criterion to include males and those on contraceptives, it remains a **very common** clinical finding, not a rare one. **Analysis of other options:** * **A. Predominantly seen in females:** This is correct. The female-to-male ratio is approximately 10:1. * **B. Body Mass Index (BMI) is higher than normal:** This is **incorrect** (making the question technically have two false statements, but "Amenorrhea is rare" is the classic "except" choice in standard medical exams). In AN, BMI is characteristically **low** (typically <17.5 kg/m²). * **D. Malabsorption Syndrome:** While not the *cause* of AN, it is often a differential diagnosis. However, the question likely implies that the weight loss is due to voluntary restriction, not primary malabsorption. **NEET-PG High-Yield Pearls:** 1. **Two Types:** Restricting type and Binge-eating/purging type. 2. **Lanugo hair:** Fine, downy hair found on the body is a classic physical sign. 3. **Refeeding Syndrome:** The most dangerous complication during treatment, characterized by **Hypophosphatemia**. 4. **Russell’s Sign:** Calluses on knuckles from self-induced vomiting (more common in Bulimia). 5. **Treatment:** Family-based therapy (Maudsley approach) is the first-line for adolescents; SSRIs (Fluoxetine) are only effective *after* weight restoration.

Question 62: A mother presented her daughter with complaints that she has started behaving weirdly about her food habits for the last few months. She eats a lot of burgers in one go, and then she vomits it out. Her BMI is 27. What is the most probable diagnosis?

A. Bulimia nervosa (Correct Answer)
B. Anorexia nervosa
C. OCD
D. Binge eating disorder

Explanation: ***Bulimia nervosa***- Involves recurrent episodes of **binge eating** followed by inappropriate **compensatory behaviors** (like self-induced **vomiting**, excessive exercise, or laxative use).- Unlike **anorexia nervosa**, patients with bulimia nervosa typically maintain a body weight that is normal or overweight (BMI $\geq$ 18.5), which aligns with the given BMI of 27.*Anorexia nervosa*- The primary criterion requires the patient to have a weight that is significantly low for their age and height (e.g., BMI $\leq$ 17.5 in adults).- This diagnosis is excluded because the patient's BMI is 27, placing her in the **overweight** category.*Binge eating disorder*- Characterized by recurrent episodes of **binge eating** without inappropriate use of **compensatory behaviors** (purging).- This patient engages in **vomiting** after eating, which is a compensatory behavior that rules out a diagnosis of simple binge eating disorder.*OCD*- Involves the presence of **obsessions** (recurrent, intrusive thoughts) and/or **compulsions** (repetitive behaviors) that cause significant distress.- While eating disorders can feature obsessive elements, the core presentation of binging followed by compensatory purging is specific to **bulimia nervosa**, not Obsessive-Compulsive Disorder.

Question 63: 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 64: Which of the following disorders is more common in females?

A. ADHD
B. Eating disorders (Correct Answer)
C. Conduct disorder
D. Autism

Explanation: ***Eating disorders*** - **Eating disorders**, particularly **anorexia nervosa** and **bulimia nervosa**, are significantly more prevalent in females than in males, with female-to-male ratios ranging from **3:1 to 10:1**. - Sociocultural factors (body image expectations, media influence), biological factors (hormonal influences), and psychological vulnerabilities contribute to this **gender disparity**. - This is the **only option** in this list that is more common in females. *ADHD* - **Attention-deficit/hyperactivity disorder (ADHD)** is diagnosed more frequently in **males** than in females, with a male-to-female ratio of approximately **2:1 to 3:1** in childhood. - Although females with ADHD may present with more inattentive symptoms (which can be underdiagnosed), the overall prevalence remains higher in males. *Conduct disorder* - **Conduct disorder** is substantially more common in **males**, with a male-to-female ratio typically ranging from **2:1 to 4:1**. - Males tend to exhibit more overtly aggressive behaviors (physical aggression, property destruction), while females might present with more covert forms (relational aggression, rule-breaking). *Autism* - **Autism spectrum disorder (ASD)** is diagnosed more frequently in **males**, with a male-to-female ratio of approximately **4:1**. - This difference may be partly due to diagnostic biases and presentation differences, as females often present with less recognized or "camouflaged" symptoms and better social mimicry.

Question 65: Which of the following eating disorders is most common?

A. Bulimia Nervosa
B. Binge eating disorder (Correct Answer)
C. Anorexia nervosa
D. All have same prevalence

Explanation: ***Binge eating disorder*** **Binge eating disorder (BED)** is the **most common eating disorder**, with a lifetime prevalence of approximately 2-3% in the general population. It is characterized by: - Recurrent episodes of eating large quantities of food - A sense of lack of control during binge episodes - Significant distress following binge episodes - **Absence of regular compensatory behaviors** (unlike bulimia nervosa) *Bulimia Nervosa* **Bulimia nervosa** is less common than binge eating disorder, with a lifetime prevalence of approximately 1-1.5%. It is characterized by recurrent binge eating episodes followed by inappropriate compensatory behaviors (self-induced vomiting, laxative misuse, excessive exercise, or fasting). While bulimia is a significant public health concern, its prevalence is definitively lower than that of BED. *Anorexia nervosa* **Anorexia nervosa** is the least common of the major eating disorders, with a lifetime prevalence of approximately 0.3-1%. It is characterized by intense fear of weight gain, distorted body image, and severe food restriction leading to significantly low body weight. Despite its lower prevalence, anorexia nervosa has the **highest mortality rate** among all psychiatric disorders. *All have same prevalence* The prevalence rates of eating disorders vary significantly. Epidemiological studies consistently show that **binge eating disorder** has substantially higher prevalence than both bulimia nervosa and anorexia nervosa.

Question 66: Avoidance of food is seen in

A. Binge eating disorder
B. Pica
C. Bulimia nervosa
D. Anorexia nervosa (Correct Answer)

Explanation: ***Anorexia nervosa*** - Individuals with anorexia nervosa restrict their food intake significantly, often to the point of **starvation**, driven by an intense fear of gaining weight. - This eating disorder is characterized by a **distorted body image** where the person sees themselves as overweight even when severely underweight. - **Food avoidance and restriction** are the core features of this disorder. *Binge eating disorder* - This disorder is characterized by recurrent episodes of **eating unusually large amounts of food** in a short period, accompanied by a feeling of loss of control. - Unlike anorexia, there are no regular compensatory behaviors, and the primary issue is **overconsumption**, not avoidance. *Bulimia nervosa* - Bulimia nervosa involves recurrent episodes of **binge eating followed by compensatory behaviors** like self-induced vomiting, excessive exercise, or laxative misuse. - While there is concern about weight, the pattern is one of binging and purging, rather than consistent food avoidance. *Pica* - Pica involves **persistent eating of non-nutritive substances** (e.g., soil, chalk, paper) for at least one month. - This is not characterized by food avoidance, but rather inappropriate consumption of non-food items.

Question 67: Which of the following is not seen in anorexia nervosa?

A. Avoidance of food
B. Decreased appetite (Correct Answer)
C. Purging episodes
D. Significantly reduced weight

Explanation: ***Decreased appetite*** - Patients with **anorexia nervosa** often experience a **normal or even increased appetite** but intentionally restrict food intake due to an intense fear of gaining weight. - The hallmark of the disorder is self-imposed starvation, not a physiological lack of hunger. *Avoidance of food* - **Avoidance of food** is a central feature of anorexia nervosa, driven by a pervasive **fear of weight gain** and a distorted body image. - Patients actively employ various strategies to **restrict their caloric intake**, including rigid dieting, skipping meals, and meticulously counting calories. *Purging episodes* - **Purging behaviors**, such as self-induced vomiting, misuse of laxatives, diuretics, or enemas, can be observed in the **binge-eating/purging type** of anorexia nervosa. - These behaviors are compensatory actions aimed at preventing weight gain after perceived overeating or even after consuming small amounts of food. *Significantly reduced weight* - A core diagnostic criterion for anorexia nervosa is a significantly **low body weight** for age, sex, developmental trajectory, and physical health, often defined as a body mass index (BMI) below 17.5 kg/m². - This weight loss is a direct consequence of the severe **food restriction** and compensatory behaviors.

Question 68: False regarding anorexia nervosa:

A. Weight loss is a feature
B. Excessive exercising can be a feature
C. Psychiatric symptoms such as depression may be associated
D. Decreased appetite is a feature (Correct Answer)

Explanation: ***Decreased appetite is a feature*** - Anorexia nervosa is characterized by a **distorted body image** and an intense fear of gaining weight, leading to **intentional restriction** of food intake, not necessarily a lack of appetite. - Patients often experience hunger but **actively suppress** it due to their psychological drive to lose weight. *Weight loss is a feature* - **Significant weight loss** or failure to gain weight during a growth period is a core diagnostic criterion for anorexia nervosa. - This weight loss is **self-imposed** and often extreme, leading to a body weight that is significantly below normal for age and height. *Excessive exercising can be a feature* - Many individuals with anorexia nervosa engage in **excessive physical activity** as a means to burn calories and further reduce weight. - This compulsion to exercise often becomes **rigid and ritualistic**, contributing to energy deficit and weight loss. *Psychiatric symptoms such as depression may be associated* - **Comorbid psychiatric conditions** like **depression**, anxiety disorders, and obsessive-compulsive traits are very common in individuals with anorexia nervosa. - These symptoms can either **precede or be exacerbated** by the physiological and psychological impact of starvation and the disorder itself.

Question 69: Which of the following is not a common feature of Anorexia Nervosa-

A. Amenorrhea
B. Underweight
C. Binge eating (Correct Answer)
D. Self perception of being 'fat'

Explanation: ***Binge eating*** - While some subtypes of anorexia nervosa can involve **binge-purging behavior**, binge eating as a primary, common feature is more characteristic of **bulimia nervosa** or **binge eating disorder**, not anorexia nervosa itself. - Anorexia nervosa is fundamentally characterized by severe **caloric restriction** and fear of gaining weight, often leading to significant **underweight**. *Amenorrhea* - **Amenorrhea** (absence of menstruation) is a very common physiological consequence of the severe **undernutrition** and low body fat characteristic of anorexia nervosa, though it is no longer a diagnostic criterion in DSM-5. - The hormonal changes associated with starvation disrupt the **hypothalamic-pituitary-gonadal axis**, leading to cessation of menstrual cycles. *Underweight* - Being significantly **underweight** (BMI consistently below 18.5 kg/m²) is a defining diagnostic criterion for anorexia nervosa. - This low body weight is a result of the individual's persistent efforts to **restrict caloric intake** or engage in compensatory behaviors. *Self perception of being 'fat'* - A **distorted body image** and an intense fear of gaining weight, leading to a self-perception of being "fat" even when emaciated, is a core psychological feature of anorexia nervosa. - This **body dysmorphia** drives the restrictive eating behaviors and resistance to maintaining a healthy weight.

Question 70: A young girl hospitalised with anorexia nervosa is on treatment. Even after taking adequate food according to the recommended diet plan for last 1 week, there is no gain in weight. What is the next step in management:

A. Increase the caloric intake from 1500 kcal to 2000 kcal per day
B. Increase fluid intake
C. Increase the dose of anxiolytics
D. Observe patient for 2 hours after meal (Correct Answer)

Explanation: ***Observe patient for 2 hours after meal*** - Patients with **anorexia nervosa** often engage in compensatory behaviors like **purging** or extensive exercise, which would counteract the effects of increased caloric intake and lead to a lack of weight gain despite consuming an "adequate" diet. - Observing the patient post-meal helps identify these behaviors and ensures that the ingested calories are actually being retained and utilized for weight restoration. *Increase the caloric intake from 1500 kcal to 2000 kcal per day* - Increasing caloric intake is a valid long-term strategy but is not the immediate next step when there's **no weight gain despite adequate intake**; the primary concern is identifying *why* the initial intake isn't leading to weight gain. - Doing so without addressing potential compensatory behaviors might only increase patient distress or lead to more intense purging/exercise. *Increase fluid intake* - While adequate **hydration** is important, it does not directly address the issue of **lack of weight gain** in anorexia nervosa, which is fundamentally a caloric deficit problem. - Increased fluid intake would not provide the necessary calories for weight restoration. *Increase the dose of anxiolytics* - Anxiolytics may help manage **anxiety** related to eating, but they do not directly promote **weight gain** or prevent compensatory behaviors. - This step does not address the core issue of why the recommended diet is not leading to weight gain.

Question 71: Pagophagia involves eating

A. Sand
B. Ice (Correct Answer)
C. Salt
D. Clay

Explanation: ***Ice*** - **Pagophagia** is a specific form of **pica**, characterized by a compulsive desire to consume **ice**, ice chips, or iced drinks. - It is often associated with **iron-deficiency anemia**, though the exact mechanism for this craving is unclear. *Sand* - The compulsive consumption of **sand** is known as **geophagy**, which is another form of pica. - This behavior is distinct from pagophagia and is not specifically linked to ice consumption. *Salt* - An excessive craving for **salt**, while sometimes indicative of an underlying condition (e.g., adrenal insufficiency), is not referred to as pagophagia. - **Pagophagia** specifically refers to the consumption of ice. *Clay* - The ingestion of **clay** is a specific type of **geophagy**, similar to eating sand. - It is a different form of pica and does not describe the selective craving for and consumption of ice.

Question 72: Diagnostic criteria for Bulimia nervosa are all EXCEPT

A. Lack of control over eating behaviour
B. Self induced vomiting
C. Presence of other psychiatric disorders (Correct Answer)
D. Binge eating

Explanation: ***Presence of other psychiatric disorders*** - While psychiatric comorbidities like depression, anxiety, and substance abuse are **extremely common** in individuals with bulimia nervosa, they are **not a diagnostic criterion** for the disorder. - The DSM-5 diagnosis of bulimia nervosa focuses specifically on **eating behaviors** (binge eating), **compensatory mechanisms** (purging/non-purging), and the impact on self-evaluation, not on the presence of co-occurring mental health conditions. - This is the correct answer as it is **NOT** a diagnostic criterion. *Lack of control over eating behaviour* - This is a **core diagnostic criterion** of bulimia nervosa. - Individuals must experience a sense of **lack of control** over eating during binge episodes (feeling unable to stop eating or control what or how much they are eating). - This feeling of loss of control during binges is essential for diagnosis. *Self induced vomiting* - This is a **diagnostic criterion** as one of the inappropriate compensatory behaviors used to prevent weight gain after binge eating. - Other compensatory behaviors include misuse of laxatives, diuretics, enemas, fasting, or excessive exercise. - At least one type of compensatory behavior must occur regularly (average of once weekly for 3 months). *Binge eating* - This is a **fundamental diagnostic criterion** involving eating an amount of food that is definitely larger than what most people would eat in a similar period under similar circumstances. - Must occur in a discrete time period (e.g., within any 2-hour period) with a sense of lack of control. - Binge episodes must occur, on average, at least once a week for 3 months for diagnosis.

Question 73: 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 74: The following symptoms are common in Anorexia nervosa EXCEPT

A. Weight loss
B. Mood changes
C. Dehydration
D. Menorrhagia (Correct Answer)

Explanation: ***Menorrhagia*** - Anorexia nervosa typically leads to **amenorrhea** (absence of menstruation) or **oligomenorrhea** (infrequent menstruation) due to hormonal imbalances, not **menorrhagia** (abnormally heavy or prolonged menstrual bleeding). - The severe nutritional deficiencies and low body fat percentage disrupt the hypothalamic-pituitary-gonadal axis, leading to **estrogen deficiency**, which prevents regular ovulation and uterine lining development. *Weight loss* - **Significant weight loss** is a defining characteristic of anorexia nervosa, resulting from self-imposed starvation and excessive exercise. - This symptom is central to the diagnostic criteria for the disorder. *Mood changes* - Individuals with anorexia nervosa frequently experience various **mood changes**, including **depression**, **anxiety**, **irritability**, and **social withdrawal**. - These emotional disturbances can be both a cause and a consequence of the eating disorder, often driven by constant food preoccupation and body image concerns. *Dehydration* - **Dehydration** is a common physical complication of anorexia nervosa, often resulting from inadequate fluid intake, persistent vomiting (if purging is involved), and potential misuse of laxatives or diuretics. - This can lead to **electrolyte imbalances** and other serious health problems.

Question 75: Bulimia nervosa is treated with

A. Clozapine
B. Reserpine
C. Pimozide
D. Escitalopram (Correct Answer)

Explanation: ***Escitalopram*** - **SSRIs** like escitalopram are considered first-line pharmacological treatment for **bulimia nervosa**, especially when combined with **psychotherapy**. - They help reduce the frequency of **binge-eating** and **purging** episodes by modulating serotonin levels. *Clozapine* - This is an **atypical antipsychotic** primarily used for **treatment-resistant schizophrenia**. - It has significant side effects, including **agranulocytosis**, and is not indicated for eating disorders. *Reserpine* - An **antihypertensive** and **antipsychotic** drug that depletes catecholamines and serotonin from central neurons. - Due to its severe side effects, including **depression** and **parkinsonism**, it is rarely used today and not for eating disorders. *Pimozide* - A **first-generation antipsychotic** specifically approved for treating **Tourette's syndrome** but sometimes used off-label for severe tics. - It is not indicated for the treatment of bulimia nervosa and may carry significant **cardiac side effects**.

Question 76: All of the following are features of anorexia nervosa except:

A. Restriction of energy intake relative to requirement
B. Intense fear of gaining weight
C. Symptoms emerge in later adolescence
D. Individual has engaged in recurrent episodes of binging or purging behavior (Correct Answer)

Explanation: ***Individual has engaged in recurrent episodes of binging or purging behavior*** - This statement is **NOT universally true** for all individuals with anorexia nervosa - Anorexia nervosa has **two subtypes**: - **Restricting type**: No recurrent binge-eating or purging behavior - **Binge-eating/purging type**: Regular engagement in binge-eating and/or purging - Since the restricting type does **not** involve binging or purging, this cannot be considered a general feature of anorexia nervosa - This makes it the correct answer for an "EXCEPT" question *Restriction of energy intake relative to requirement* - This is a **core diagnostic criterion** (DSM-5 Criterion A) for anorexia nervosa - Individuals deliberately limit food intake leading to **significantly low body weight** relative to age, sex, developmental trajectory, and physical health *Intense fear of gaining weight* - This is a **core diagnostic criterion** (DSM-5 Criterion B) for anorexia nervosa - The fear persists even when the individual is **significantly underweight** - May also manifest as **persistent behavior** that interferes with weight gain *Symptoms emerge in later adolescence* - Anorexia nervosa typically has its onset during **adolescence or young adulthood** - Peak onset is between **15-19 years of age**, which falls within the adolescent period - While onset can occur in early adolescence, later adolescence (ages 15-19) is indeed the most common period for symptom emergence

Question 77: With respect to anorexia nervosa the following is true except -

A. Phobic avoidance of normal weight
B. Self induced vomiting
C. Menorrhagia (Correct Answer)
D. Distorted body image

Explanation: ***Menorrhagia*** - Anorexia nervosa typically causes **amenorrhea** (absence of menstruation) or oligomenorrhea, not menorrhagia (excessive menstrual bleeding), due to hormonal dysregulation from severe weight loss. - The starvation state leads to a significant decrease in **gonadotropin-releasing hormone (GnRH)**, disrupting the menstrual cycle. *Phobic avoidance of normal weight* - Individuals with anorexia nervosa exhibit an intense **fear of gaining weight** or becoming fat, even when significantly underweight. - This fear often translates into a **phobic avoidance** of any behaviors or situations perceived to lead to weight gain. *Self induced vomiting* - While not exclusive to anorexia nervosa, **self-induced vomiting** is a common compensatory behavior observed in the purging type of anorexia nervosa. - This behavior is used to prevent weight gain after consuming food and can lead to various medical complications. *Distorted body image* - Patients with anorexia nervosa often have a **distorted body image**, perceiving themselves as overweight even when they are severely emaciated. - This **body image disturbance** is a core diagnostic criterion and significantly influences their eating behaviors and restrictive practices.

Question 78: Anorexia Nervosa is characterized by all EXCEPT:

A. Distortion of body image
B. Decreases 25% weight
C. Self induced vomiting
D. Amenorrhea for 3 months (Correct Answer)

Explanation: ***Amenorrhea for 3 months*** - While **amenorrhea** has historically been a common feature of anorexia nervosa due to hormonal imbalances from malnutrition, the **DSM-5 criteria no longer require it for diagnosis**. - Its presence can still suggest severe malnutrition, but its absence does not rule out anorexia nervosa. *Distortion of body image* - This is a core diagnostic criterion for anorexia nervosa, where individuals perceive themselves as **overweight** despite being underweight. - This **body image distortion** drives much of the restrictive eating and weight control behaviors. *Decreases 25% weight* - Anorexia nervosa is characterized by a **restriction of energy intake** leading to a significantly low body weight. - While there isn't a specific percentage that defines this, a significant weight loss (e.g., body weight **less than 85% of normal** for age and height) is a key feature. *Self induced vomiting* - **Self-induced vomiting** is a common compensatory behavior in the **binge-eating/purging subtype** of anorexia nervosa. - It is one of several behaviors (like laxative misuse, excessive exercise) used to prevent weight gain after food intake.

Question 79: 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 80: 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 81: Which of the following is not a common feature of anorexia nervosa?

A. Self-perception of being fat
B. Binge eating
C. Amenorrhea (Correct Answer)
D. Underweight

Explanation: ***Amenorrhea*** - While amenorrhea (absence of menstruation) **was previously a diagnostic criterion**, it was **removed from DSM-5 criteria** for anorexia nervosa in 2013. - It can occur as a physiological consequence of severe malnutrition and low body fat, but it is **not required for diagnosis** and does not occur in all cases. - Many individuals with anorexia nervosa continue to menstruate, and males cannot exhibit this feature, making it **not a common or universal feature**. *Self-perception of being fat* - A **core diagnostic criterion** for anorexia nervosa is distorted body image, where individuals perceive themselves as overweight despite being significantly underweight. - This intense fear of gaining weight or becoming fat is a **defining characteristic** of the disorder. *Underweight* - The most **defining feature** of anorexia nervosa is significantly low body weight relative to age, sex, developmental trajectory, and physical health. - Persistent restriction of energy intake leading to **abnormally low body weight** is essential for diagnosis (DSM-5). *Binge eating* - Binge eating **does occur in anorexia nervosa**, specifically in the **binge-eating/purging subtype**. - While the restricting subtype does not involve binge eating, it is a recognized feature in one of the two subtypes of anorexia nervosa. - This makes it a **common feature** in a significant proportion of cases.

Question 82: Which of the following is least characteristic of anorexia nervosa? a) Lowered vital signs when the weight is low b) Decreased physical activity c) History of obesity d) Denial of illness

A. a and b
B. b and d
C. c and d
D. b and c (Correct Answer)

Explanation: ***bc (Correct Answer)*** **b) Decreased physical activity** is generally *not* characteristic of anorexia nervosa. Rather, many individuals with anorexia engage in **excessive exercise** despite their emaciated state as part of their compulsive behaviors to lose weight. **c) History of obesity** is also *not typical* of anorexia nervosa. The typical onset involves deliberate and progressive weight loss from a normal or slightly above-average weight, not from obesity. *Incorrect Options:* **a) Lowered vital signs** - This IS characteristic of anorexia nervosa. Bradycardia, hypotension, and hypothermia are common and serious consequences of significant weight loss and malnutrition. **d) Denial of illness** - This IS a hallmark feature of anorexia nervosa. Patients often lack insight into the severity of their condition, reflecting the ego-syntonic nature of their disordered eating behaviors and distorted body image, and they typically resist treatment. **Clinical Note:** The question asks for features that are LEAST characteristic. Both decreased physical activity and history of obesity are atypical, making "bc" the correct combination.

Question 83: 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 84: 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 85: 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 86: 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 87: Best predictor of good prognosis in anorexia nervosa is:

A. Early treatment
B. Higher BMI at diagnosis
C. Shorter duration (Correct Answer)
D. Supportive family

Explanation: ***Shorter duration*** - **Shorter duration of illness** before treatment is consistently identified as one of the strongest predictors of good prognosis in anorexia nervosa. - Duration encompasses the total time the illness has existed, capturing the chronicity and entrenchment of maladaptive eating behaviors, psychological patterns, and physiological complications. - Patients with **brief illness duration** before intervention have higher rates of **full recovery** (up to 50-70% in some studies) compared to those with chronic illness (20-30% recovery rates). - Shorter duration indicates less time for the development of severe medical complications (osteoporosis, cardiac abnormalities) and entrenched psychological patterns that are harder to reverse. *Early treatment* - While **early treatment initiation** is extremely important and strongly correlated with better outcomes, it is typically a function of recognizing and intervening in an illness of short duration. - The benefit of early treatment is largely because it prevents the illness from becoming chronic; thus, duration remains the more fundamental prognostic indicator. - Both concepts overlap significantly, but duration captures the complete timeframe of illness pathology. *Higher BMI at diagnosis* - A **higher BMI at diagnosis** suggests less severe weight loss and may indicate less severe restriction, but it is not as strong a predictor as duration. - Patients can have relatively higher BMI but still have chronic illness with poor prognosis if the duration has been extended. *Supportive family* - A **supportive family** is crucial for treatment adherence, recovery, and relapse prevention, and is indeed a positive prognostic factor. - However, family support alone cannot overcome the physiological and psychological damage of prolonged illness duration. - In pediatric/adolescent populations, family-based therapy (FBT) outcomes are best when the **illness duration is short** at treatment onset.

Question 88: A 25-year-old woman presents with a fear of gaining weight and significantly restricts her food intake despite being underweight. What is the most likely diagnosis?

A. Anorexia nervosa (Correct Answer)
B. Bulimia nervosa
C. Binge eating disorder
D. Body dysmorphic disorder

Explanation: ***Anorexia nervosa*** - This diagnosis is characterized by a significant **restriction of energy intake** leading to a significantly low body weight, an intense **fear of gaining weight**, and a disturbance in the way one's body weight or shape is experienced. - The patient's presentation with fear of gaining weight and significant food restriction despite being underweight perfectly aligns with the diagnostic criteria for **anorexia nervosa**. *Bulimia nervosa* - This disorder involves recurrent episodes of **binge eating**, followed by compensatory behaviors such as **purging** (e.g., self-induced vomiting, misuse of laxatives) or excessive exercise. - While there is a fear of gaining weight, the primary feature missing from the patient's description is the **binge-purge cycle**. *Binge eating disorder* - This condition is defined by recurrent episodes of **binge eating** without the regular use of inappropriate compensatory behaviors characteristic of bulimia nervosa. - The patient's description does not include episodes of binge eating; instead, it highlights **chronic restriction** of food intake. *Body dysmorphic disorder* - This disorder involves a preoccupation with **one or more perceived flaws** in physical appearance that are not observable or appear slight to others. - While there can be concern about body shape, the primary focus is on a specific perceived defect, and it does not typically involve the severe **food restriction** and **underweight status** seen in the patient.

Question 89: A 25-year-old female presents with recurrent episodes of binge eating followed by self-induced vomiting. What is the most appropriate treatment?

A. Cognitive-behavioral therapy (Correct Answer)
B. Interpersonal therapy
C. Family-based therapy
D. Dialectical behavior therapy

Explanation: ***Cognitive-behavioral therapy*** - **CBT** is the most established and effective psychotherapy for **bulimia nervosa**, targeting the dysfunctional thoughts and behaviors associated with binge eating and purging. - It helps patients identify triggers, develop coping mechanisms, and normalize eating patterns. *Interpersonal therapy* - **IPT** focuses on improving interpersonal relationships and social functioning, which can indirectly help with eating disorders but is **less directly effective** than CBT for bulimia nervosa. - While it may be helpful for some patients, it is not considered the **first-line treatment** for this condition. *Family-based therapy* - **FBT** (Maudsley Method) is primarily used for **anorexia nervosa** in adolescents, involving parents in the re-feeding process. - While family dynamics can play a role in eating disorders, FBT is **not the primary intervention** for an adult with bulimia nervosa. *Dialectical behavior therapy* - **DBT** is highly effective for conditions involving **emotion dysregulation** and **impulsivity**, such as borderline personality disorder. - While some aspects of DBT, like emotion regulation skills, might be helpful, it is **not the primary evidence-based treatment** for bulimia nervosa.

Question 90: A 19-year-old woman with bulimia nervosa is likely to exhibit which of the following behaviors?

A. Frequent binge eating followed by purging (Correct Answer)
B. Significant weight loss and refusal to eat
C. Excessive fasting and exercise without binging
D. Normal eating patterns with occasional overeating

Explanation: ***Frequent binge eating followed by purging*** - **Bulimia nervosa** is characterized by recurrent episodes of **binge eating**, which is consuming an amount of food much larger than most people would eat in a similar period under similar circumstances, accompanied by a sense of lack of control. - These binge episodes are followed by **compensatory behaviors** such as self-induced vomiting (purging), misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise. *Significant weight loss and refusal to eat* - This description is more indicative of **anorexia nervosa**, characterized by restriction of energy intake leading to a significantly low body weight. - Individuals with bulimia nervosa typically maintain a normal weight or are overweight, and their compensatory behaviors are aimed at preventing weight gain after binge eating. *Excessive fasting and exercise without binging* - While excessive exercise and fasting can be compensatory behaviors in bulimia nervosa, the absence of **binge eating** suggests a different eating disorder or a subthreshold presentation. - This pattern may be seen in some forms of **anorexia nervosa** (restricting type) but lacks the hallmark binge-purge cycle of bulimia. *Normal eating patterns with occasional overeating* - **Occasional overeating** is common and does not meet the diagnostic criteria for an eating disorder. - **Bulimia nervosa** involves a recurrent and distressing pattern of binge eating and inappropriate compensatory behaviors that significantly impacts quality of life.

Question 91: Main difference between anorexia nervosa and bulimia nervosa lies in:

A. Symptomatology
B. Weight (Correct Answer)
C. Gender
D. Age

Explanation: ***Weight*** - The primary differentiator is that individuals with **anorexia nervosa** are **underweight** (BMI < 18.5 kg/m²), while those with bulimia nervosa maintain a **normal or overweight BMI**. - A persistent restriction of energy intake leading to a significantly low body weight is a diagnostic criterion for anorexia nervosa, which is not true for bulimia nervosa. *Symptomatology* - While there is overlap in symptoms like **fear of gaining weight** and body image disturbance, the **presence of significantly low body weight** in anorexia nervosa and its absence in bulimia nervosa is the key differentiating factor, making "weight" a more precise answer. - Both disorders involve **compensatory behaviors** like purging, excessive exercise, or fasting, but the underlying weight status distinguishes them. *Gender* - Both anorexia nervosa and bulimia nervosa primarily affect **females**, though rates in males are increasing for both disorders. - As such, gender is not a defining characteristic that differentiates these specific eating disorders from each other. *Age* - Both disorders typically emerge during **adolescence or young adulthood**, with slightly different peak ages of onset. - Age of onset is generally a **shared characteristic** rather than a distinguishing feature between anorexia nervosa and bulimia nervosa.

Question 92: A 16-year-old girl has intense cravings for food and consumes large amounts of it, followed by purging behaviors. What is the most likely diagnosis?

A. Anorexia nervosa
B. Bulimia nervosa (Correct Answer)
C. Major depressive disorder
D. Binge eating disorder

Explanation: ***Bulimia nervosa*** - **Bulimia nervosa** is characterized by recurrent episodes of **binge eating** (consuming large amounts of food with a sense of lack of control), followed by inappropriate **compensatory behaviors** such as self-induced vomiting, laxative abuse, or excessive exercise. - The patient's presentation of "intense cravings for food," consuming "large amounts," and "purging behaviors" directly aligns with DSM-5 diagnostic criteria for bulimia nervosa. - Peak onset is typically in **adolescence and early adulthood**, and it is more common in females. *Anorexia nervosa* - **Anorexia nervosa** is primarily characterized by **restriction of energy intake** leading to significantly low body weight, intense fear of gaining weight, and disturbance in body image. - While the binge-eating/purging subtype of anorexia exists, the defining feature is **persistent restriction** and significantly **low body weight**, which is not mentioned in this clinical scenario. *Major depressive disorder* - **Depression** is a mood disorder with persistent sadness, anhedonia, and neurovegetative symptoms. - While depression commonly co-occurs with eating disorders and may cause appetite changes, the specific cyclical pattern of **binge eating followed by compensatory purging** is not a characteristic feature of depression itself. *Binge eating disorder* - **Binge eating disorder** involves recurrent episodes of consuming large amounts of food with a sense of lack of control, accompanied by marked distress. - The key distinguishing feature is the **absence of regular compensatory behaviors** (purging, excessive exercise, fasting) that are present in bulimia nervosa.

Question 93: Which of the following is not typically seen in anorexia nervosa?

A. Osteoporosis
B. Weight loss
C. Menorrhagia (Correct Answer)
D. Food refusal

Explanation: ***Menorrhagia*** - **Anorexia nervosa** is typically associated with **amenorrhea** (absence of menstruation) or **oligomenorrhea** (infrequent menstruation) due to hormonal imbalances caused by malnutrition and low body fat. - **Menorrhagia** (heavy or prolonged menstrual bleeding) is not a common feature and would suggest a different underlying cause. *Osteoporosis* - **Osteoporosis** is a common and serious complication of **anorexia nervosa** due to prolonged low estrogen levels, poor nutrition, and hormonal dysregulation affecting bone density. - Reduced **bone mineral density** is prevalent, especially in chronic cases. *Food refusal* - **Food refusal** is a hallmark symptom of **anorexia nervosa**, driven by an intense fear of gaining weight and a distorted body image. - Patients restrict food intake, often leading to severe caloric deficit. *Weight loss* - Significant **weight loss** is a diagnostic criterion for **anorexia nervosa**, as individuals maintain a body weight that is minimally normal or even below normal for their height and age. - This weight loss is intentionally achieved through restrictive eating behaviors.

Question 94: 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 95: What does Pica refer to?

A. Ice sucking
B. Thumb sucking
C. An appetite for non-nutritive substances (Correct Answer)
D. None of the options

Explanation: ***An appetite for non-nutritive substances*** - Pica is an eating disorder characterized by a persistent and compulsive craving for and consumption of **non-nutritive, non-food substances** for at least one month. - Common ingested substances include **dirt, clay, ice, hair, paint chips, and laundry starch**, often associated with **nutritional deficiencies** like iron deficiency anemia or **developmental disabilities**. *Ice sucking* - While **pagophagia (ice craving)** is a specific form of Pica, it represents only one manifestation and not the overarching definition of the disorder. - Isolated ice sucking can sometimes be a sign of **iron deficiency anemia**. *Thumb sucking* - **Thumb sucking** is a common habit, especially in infants and young children, typically associated with self-soothing and comfort. - It is not considered an eating disorder and does not involve the consumption of non-nutritive substances. *None of the options* - This option is incorrect because "An appetite for non-nutritive substances" accurately defines Pica.

Question 96: 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 97: What is the diagnosis in a young lady who presents with repeated episodes of excessive eating followed by purging behaviors, specifically using laxatives?

A. Bulimia nervosa (Correct Answer)
B. Binge eating disorder
C. Schizophrenia
D. Anorexia nervosa

Explanation: ***Bulimia nervosa*** - This condition is characterized by recurrent episodes of **binge eating**, which is consuming an abnormally large quantity of food in a short period, followed by inappropriate **compensatory behaviors** to prevent weight gain. - The use of **laxatives for purging** is a classic compensatory behavior seen in bulimia nervosa. *Binge eating* - While binge eating is a component, **binge eating disorder** specifically lacks the recurrent compensatory behaviors (like purging) that are present in bulimia nervosa. - Individuals with binge eating disorder do not regularly engage in **purging behaviors** or excessive exercise to counteract their binges. *Schizophrenia* - This is a severe mental disorder characterized by **distortions in thought, perception, emotions, language, sense of self, and behavior**. - Its core symptoms, such as **hallucinations, delusions, and disorganized speech**, are entirely unrelated to eating patterns and purging behaviors. *Anorexia nervosa* - Anorexia nervosa is primarily defined by a **restriction of energy intake** leading to significantly low body weight, accompanied by an intense fear of gaining weight and a distorted body image. - While some individuals with anorexia nervosa may engage in binge-purging subtype behaviors, the defining characteristic is **significantly low body weight**, which is not mentioned as a primary feature in the given scenario.

Question 98: Disorder where amenorrhea was once needed for diagnosis is?

A. metabolic syndrome
B. bulimia nervosa
C. Binge eating disorder
D. Anorexia nervosa (Correct Answer)

Explanation: ***Anorexia nervosa*** - Historically, **amenorrhea** (absence of menstruation) was a diagnostic criterion for **anorexia nervosa**, reflecting the severe physiological impact of malnutrition and low body weight on the **endocrine system**. - While still common in patients with anorexia, it is **no longer a mandatory diagnostic criterion** in the DSM-5. *Metabolic syndrome* - Metabolic syndrome is a cluster of conditions that includes **increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels**. - It is **not directly associated with amenorrhea** and does not have amenorrhea as a diagnostic criterion. *Bulimia nervosa* - Bulimia nervosa is characterized by **recurrent episodes of binge eating** followed by compensatory behaviors such as self-induced vomiting, excessive exercise, or misuse of laxatives. - While it can be associated with menstrual irregularities due to nutritional imbalances, **amenorrhea is not a diagnostic criterion** for bulimia nervosa. *Binge eating disorder* - Binge eating disorder involves **recurrent episodes of eating large quantities of food**, often rapidly and to the point of discomfort, without the regular use of inappropriate compensatory behaviors. - This disorder is **not directly linked to amenorrhea as a diagnostic feature**, although nutritional status can affect menstrual cycles.

Question 99: Excessive eating of non-nutritive substances is called:

A. Pica (Correct Answer)
B. Anorexia Nervosa
C. Bulimia Nervosa
D. Rumination Disorder

Explanation: ***Pica*** - Pica is an eating disorder characterized by the persistent eating of **non-nutritive, non-food substances** over a period of at least one month. - Common substances ingested include **dirt, clay, ice, paint chips, paper, and laundry starch**, indicating an unusual craving for non-food items. - More common in **children, pregnant women, and individuals with developmental disabilities**. *Anorexia Nervosa* - Anorexia nervosa is an eating disorder characterized by **restriction of energy intake** relative to requirements, leading to a significantly low body weight. - It involves an intense **fear of gaining weight** or becoming fat, and a disturbance in the way one's body weight or shape is experienced. - Does not involve eating non-nutritive substances. *Bulimia Nervosa* - Bulimia nervosa is characterized by **recurrent episodes of binge eating** followed by compensatory behaviors such as self-induced vomiting, misuse of laxatives, fasting, or excessive exercise. - Unlike Pica, it involves eating **excessive amounts of regular food**, not non-nutritive substances. *Rumination Disorder* - Rumination disorder involves **repeated regurgitation of food** that may be re-chewed, re-swallowed, or spit out, occurring after feeding or eating. - It involves **normal food substances**, not the persistent eating of non-nutritive items as seen in Pica.

Question 100: Repeated involuntary regurgitation of food is associated with which of the following disorders?

A. Binge eating disorder
B. Rumination disorder (Correct Answer)
C. Bulimia nervosa
D. Anorexia nervosa

Explanation: ***Rumination disorder*** - This disorder is specifically characterized by the **repeated regurgitation of food** either back into the mouth for rechewing and reswallowing or spitting out. - The regurgitation is **involuntary** and not due to a medical condition or another eating disorder. *Binge eating disorder* - Characterized by recurrent episodes of **eating a large amount of food** in a short period, accompanied by a feeling of loss of control. - Does not typically involve the **regurgitation of food** after consumption. *Bulimia nervosa* - Involves recurrent episodes of **binge eating followed by compensatory behaviors** such as self-induced vomiting, excessive exercise, or laxative misuse. - While vomiting occurs, it is a **compensatory behavior** after a binge, not an involuntary regurgitation as seen in rumination disorder. *Anorexia nervosa* - Primarily defined by a **restricted energy intake** leading to significantly low body weight, intense fear of gaining weight, and a disturbed perception of body shape or weight. - Does not involve the **repeated involuntary regurgitation of food** as a primary feature.

Practice by Chapter

Anorexia Nervosa

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Bulimia Nervosa

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Binge Eating Disorder

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Avoidant/Restrictive Food Intake Disorder

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Pica and Rumination Disorder

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Medical Complications of Eating Disorders

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Inpatient Management

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Outpatient Treatment Approaches

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Family-Based Treatment

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Cognitive-Behavioral Therapy for Eating Disorders

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Pharmacotherapy

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Prevention Strategies

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