Avoidant/Restrictive Food Intake Disorder — MCQs

10 questions

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

Diagnostic criteria for Bulimia nervosa are all EXCEPT

Which of the following disorders is classified under somatic symptom and related disorders in the DSM-5?

True about anorexia nervosa is all except ?

A nondiabetic, nonhypertensive patient has occasional extra heartbeats. The doctor informed them it is benign, but the patient continues to seek investigations from doctor to doctor. This is a type of:

The principal polypeptides that increase food intake are the following, EXCEPT:

Main difference between anorexia nervosa and bulimia nervosa lies in:

Q10

A four year old boy Tinu has normal developmental milestones except delayed speech. He is interested to watch spinning objects like fan and the washing machine. His parents struggle to get him interested in other children at home. People often comment that he is disinterested and self centred. What will be your thought regarding his diagnosis?

Avoidant/Restrictive Food Intake Disorder Indian Medical PG Practice Questions and MCQs

Question 1: 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 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: 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 4: 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 5: Which of the following disorders is classified under somatic symptom and related disorders in the DSM-5?

A. Post-Traumatic Stress Disorder (PTSD)
B. Phobic disorders (e.g., social anxiety disorder)
C. Conversion disorder (functional neurological symptom disorder) (Correct Answer)
D. Obsessive-Compulsive Disorder (OCD)

Explanation: ***Conversion disorder (functional neurological symptom disorder)*** - **Conversion disorder** is characterized by neurological symptoms (e.g., paralysis, blindness) that are **incompatible with recognized neurological or medical conditions**, yet are not intentionally produced. - It falls under **somatic symptom and related disorders** because the primary features are physical symptoms causing distress or functional impairment, rather than being malingered or feigned. *Phobic disorders (e.g., social anxiety disorder)* - **Phobic disorders** are classified under **anxiety disorders** in the DSM-5, not somatic symptom and related disorders. - They are primarily characterized by **intense, irrational fears** of specific objects or situations, leading to avoidance rather than prominent physical symptoms without a medical cause. *Post-Traumatic Stress Disorder (PTSD)* - **PTSD** is classified under **trauma- and stressor-related disorders** in the DSM-5, distinguished by symptoms developing after exposure to a traumatic event. - Its core features include **intrusive memories, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity**, rather than unexplained physical symptoms. *Obsessive-Compulsive Disorder (OCD)* - **OCD** is classified under **obsessive-compulsive and related disorders** in the DSM-5. - It is primarily characterized by the presence of **obsessions (recurrent, intrusive thoughts)** and/or **compulsions (repetitive behaviors or mental acts)**, which are distinct from somatic symptoms.

Question 6: 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 7: A nondiabetic, nonhypertensive patient has occasional extra heartbeats. The doctor informed them it is benign, but the patient continues to seek investigations from doctor to doctor. This is a type of:

A. Depression
B. Conversion disorder
C. Somatoform pain
D. Illness Anxiety Disorder (Correct Answer)

Explanation: ***Illness Anxiety Disorder*** - This condition is characterized by **preoccupation with having or acquiring a serious illness**, despite minimal or no somatic symptoms, or an excessive preoccupation if symptoms are present. - The patient's repeated seeking of investigations despite medical assurance of a benign condition aligns with the diagnostic criteria of **illness anxiety disorder**, where reassurance has little effect. *Depression* - While **depressive symptoms** (e.g., low mood, anhedonia) can coexist with health anxieties, the primary driver here is the fear of serious illness rather than pervasive sadness or loss of interest. - Patients with depression typically report a **generalized dysphoria** or lack of energy, which is not the central issue described. *Conversion disorder* - Involves **neurological symptoms** (e.g., paralysis, blindness, seizures) that are incompatible with recognized neurological conditions and are not intentionally produced. - The patient's concern is about a benign cardiac finding, not the sudden onset of **functional neurological deficits**. *Somatoform pain* - This term is older and has largely been replaced by **Somatic Symptom Disorder with predominant pain**, where psychological factors play a significant role in the onset, severity, exacerbation, or maintenance of pain. - The patient's main concern is about the **implication of a benign symptom** rather than experiencing overwhelming pain itself.

Question 8: The principal polypeptides that increase food intake are the following, EXCEPT:

A. Neuropeptide-Y
B. Orexin-A
C. Endocannabinoid
D. Leptin (Correct Answer)

Explanation: ***Leptin*** - **Leptin** is a hormone primarily produced by adipocytes (fat cells) that acts to **decrease food intake** and increase energy expenditure, signaling satiety to the brain. - High levels of leptin typically indicate sufficient stored fat, leading to a reduction in appetite and an increase in metabolism to maintain **energy homeostasis**. *Neuropeptide-Y* - **Neuropeptide-Y (NPY)** is a potent **orexigenic peptide** produced in the hypothalamus that directly stimulates food intake, especially carbohydrate consumption. - It plays a crucial role in the central regulation of appetite and **energy balance**, increasing hunger in response to energy deficits. *Orexin-A* - **Orexin-A** (also known as hypocretin-1) is a neuropeptide produced in the hypothalamus that strongly promotes **wakefulness** and **food-seeking behavior**. - It enhances appetite and food intake, particularly palatable foods, and is involved in the overall regulation of the **sleep-wake cycle** and reward system. *Endocannabinoid* - The **endocannabinoid system**, particularly through receptors like CB1, plays a significant role in stimulating appetite and **rewarding aspects of eating**. - Activation of this system by endocannabinoids such as **anandamide** and **2-arachidonoylglycerol (2-AG)** increases hunger and motivates food consumption.

Question 9: 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 10: A four year old boy Tinu has normal developmental milestones except delayed speech. He is interested to watch spinning objects like fan and the washing machine. His parents struggle to get him interested in other children at home. People often comment that he is disinterested and self centred. What will be your thought regarding his diagnosis?

A. Specific learning disability
B. Intellectual disability
C. Sibling Rivalry
D. Autism Spectrum Disorder (Correct Answer)

Explanation: ***Autism Spectrum Disorder*** - The child's delayed speech, **restricted interests** (spinning objects), lack of social engagement, and difficulty interacting with other children are classic symptoms of **Autism Spectrum Disorder (ASD)**. - Normal developmental milestones in other areas, such as motor skills, differentiate ASD from global developmental delays. - The **triad of impairments** includes social communication deficits, restricted interests, and repetitive behaviors, all evident in this case. *Specific learning disability* - This diagnosis typically presents with difficulties in specific academic areas like reading, writing, or math in a child with otherwise average intelligence. - It is generally diagnosed after school entry (age 6-7 years) when academic demands increase. - It doesn't explain the **social communication deficits** and **restricted, repetitive behaviors** seen in this case. *Intellectual disability* - This condition involves significant limitations in both intellectual functioning and adaptive behavior, with onset during the developmental period. - While delayed speech can be a feature, the child's otherwise **normal developmental milestones** in motor and other domains argue against a global intellectual deficit. - The **restricted interests** and social deficits are more characteristic of ASD than intellectual disability alone. *Sibling Rivalry* - This refers to competition or animosity between siblings, often manifesting as behavioral problems or attention-seeking from parents. - It is a normal developmental phenomenon, not a psychiatric disorder. - It does not account for the core symptoms described, such as **delayed speech**, **restricted interests** (fascination with spinning objects), or a pervasive disinterest in social interaction.

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