Anorexia Nervosa — MCQs

10 questions

Which of the following is FALSE regarding Anorexia Nervosa:

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:

Which eating disorder is characterized by episodes of binge eating while maintaining a normal weight?

The following symptoms are common in Anorexia nervosa EXCEPT

Which of the following is not a common feature of anorexia nervosa?

Indoor management of anorexia nervosa is done on priority patients with:-

All of the following are features of anorexia nervosa except:

Best predictor of good prognosis in anorexia nervosa is:

Q10

A young lady presents with a history of repeated episodes of overeating followed by purging using laxatives. She is probably suffering from -

Anorexia Nervosa Indian Medical PG Practice Questions and MCQs

Question 1: Which of the following is FALSE regarding Anorexia Nervosa:

A. Decreased appetite (Correct Answer)
B. Body image distortion
C. Vigor exceeding physical ill being
D. Weight loss

Explanation: ***Decreased appetite*** - Patients with anorexia nervosa typically experience **increased hunger** and **preoccupation with food**, despite efforts to restrict intake, rather than a decreased appetite. - The sensation of hunger often intensifies due to severe caloric restriction, making the statement "decreased appetite" false. *Body image distortion* - This is a core diagnostic criterion of anorexia nervosa, where individuals perceive themselves as **overweight** even when they are severely underweight. - The distorted body image drives their relentless pursuit of thinness and fear of weight gain. *Vigor exceeding physical ill being* - Patients with anorexia nervosa often display surprising **energy and hyperactivity** despite severe physical debilitation and malnutrition. - This "vigor" can be a mechanism to burn calories, suppress hunger, or avoid rest, exceeding what would be expected given their poor health status. *Weight loss* - **Significant weight loss** or failure to gain weight during growth is a defining characteristic of anorexia nervosa. - This weight loss is intentionally achieved through severe dietary restriction, excessive exercise, or purging behaviors.

Question 2: 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 3: 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 4: 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 5: 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 6: 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 7: 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 8: 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 9: Best predictor of good prognosis in anorexia nervosa is:

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

Explanation: ***Shorter duration of illness*** - **Shorter duration** at the time of presentation is the most consistently cited predictor of good prognosis in anorexia nervosa across psychiatric literature. - Patients with **brief illness duration** (typically <6 months) have significantly higher rates of complete recovery and remission. - Longer duration leads to entrenchment of **maladaptive eating patterns**, more severe medical complications, and greater resistance to treatment interventions. - Early recognition and presentation inherently means shorter duration, making this the most actionable and reliable prognostic indicator. *Early treatment* - While initiating treatment early is therapeutically crucial, it is an **intervention** rather than a prognostic predictor. - Early treatment is beneficial precisely because it prevents progression to **longer illness duration**. - The effectiveness of treatment depends on multiple factors including patient motivation, comorbidities, and treatment modality. *Supportive family* - A supportive family environment facilitates recovery by providing **emotional support** and reinforcing treatment adherence. - Family-based therapy (FBT) is particularly effective in adolescents with anorexia nervosa. - However, family support alone does not predict outcome as strongly as **illness duration** or other core clinical features. *Higher BMI at diagnosis* - Higher BMI at presentation indicates less severe **malnutrition** and reduced immediate medical risk. - However, BMI alone does not correlate strongly with psychological recovery, as the underlying **eating disorder psychopathology** (body image distortion, fear of weight gain) requires addressing regardless of weight. - Some patients may maintain relatively higher BMI while still meeting diagnostic criteria and having poor outcomes.

Question 10: 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.

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