Eating Disorders — MCQs
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Which of the following is NOT true about anorexia nervosa?
Which of the following features is not seen in Anorexia Nervosa?
Which eating disorder is characterized by normal weight?
What is true about Anorexia nervosa?
What is the primary goal in the management of anorexia nervosa?
Excessive eating followed by purging using laxatives in 20-year-old females is characteristic of which condition?
What is a characteristic feature of anorexia nervosa?
For diagnosing bulimia nervosa, binge eating should be present for a duration of:
Trichobezoar is pathological ingestion of:
Which of the following is NOT characteristic of Anorexia nervosa?
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.
Practice by Chapter
Anorexia Nervosa
Practice Questions
Bulimia Nervosa
Practice Questions
Binge Eating Disorder
Practice Questions
Avoidant/Restrictive Food Intake Disorder
Practice Questions
Pica and Rumination Disorder
Practice Questions
Medical Complications of Eating Disorders
Practice Questions
Inpatient Management
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Outpatient Treatment Approaches
Practice Questions
Family-Based Treatment
Practice Questions
Cognitive-Behavioral Therapy for Eating Disorders
Practice Questions
Pharmacotherapy
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Prevention Strategies
Practice Questions
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