Medical Complications of Eating Disorders — MCQs
The following symptoms are common in Anorexia nervosa EXCEPT
Which of the following conditions is characterised by episodes of excessive and uncontrolled eating?
Which of the following causes metabolic acidosis?
Anorexia Nervosa is characterized by all EXCEPT:
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 -
Which of the following is FALSE regarding Anorexia Nervosa:
Indoor management of anorexia nervosa is done on priority patients with:-
Pagophagia involves eating
All are used in attention deficit hyperactivity disorder (ADHD) except:
Medical Complications of Eating Disorders Indian Medical PG Practice Questions and MCQs
Question 1: 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 2: 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 3: Which of the following causes metabolic acidosis?
- A. Thiazide diuretic therapy
- B. Recurrent vomiting
- C. Mineralocorticoid deficiency (Correct Answer)
- D. Bartter's syndrome
Explanation: ***Mineralocorticoid deficiency*** - **Mineralocorticoid deficiency**, such as in **Addison's disease**, leads to impaired aldosterone production. - This results in reduced **potassium excretion** and **sodium reabsorption**, causing **hyperkalemia** and metabolic acidosis due to decreased hydrogen ion secretion [1]. *Bartter's syndrome* - **Bartter's syndrome** is a genetic disorder affecting the **thick ascending limb of the loop of Henle**, leading to excessive losses of sodium, chloride, and potassium. - This condition typically results in **metabolic alkalosis** due to increased hydrogen ion secretion and volume contraction rather than acidosis. *Thiazide diuretic therapy* - **Thiazide diuretics** inhibit the **sodium-chloride cotransporter** in the **distal convoluted tubule**, promoting sodium and chloride excretion. - This can lead to **hypokalemia** and **metabolic alkalosis** due to volume contraction and increased hydrogen ion secretion, not acidosis. *Recurrent vomiting* - **Recurrent vomiting** causes the loss of **gastric acid (HCl)**, leading to a decrease in hydrogen ions in the body [1]. - This condition characteristically results in **metabolic alkalosis** due to the loss of acid and compensatory renal mechanisms, not acidosis [1].
Question 4: 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 5: 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 6: 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 7: 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 8: 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 9: 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 10: All are used in attention deficit hyperactivity disorder (ADHD) except:
- A. Dextro-amphetamine
- B. Methylphenidate
- C. Phenobarbitone (Correct Answer)
- D. Atomoxetine
Explanation: ***Phenobarbitone*** - **Phenobarbitone** (phenobarbital) is a **barbiturate** primarily used as an **anticonvulsant** and for sedation. - It works as a **CNS depressant** and would worsen, not improve, symptoms of ADHD, which include inattention, hyperactivity, and impulsivity. - **Not indicated** for ADHD management and may cause sedation, cognitive impairment, and paradoxical hyperactivity in children. *Dextro-amphetamine* - **Dextro-amphetamine** is a **stimulant medication** commonly used in ADHD. - It works by increasing levels of **dopamine** and **norepinephrine** in the brain, improving focus and reducing hyperactivity. - Approved for ADHD treatment in both children and adults. *Methylphenidate* - **Methylphenidate** is a **stimulant** widely prescribed for ADHD and considered a first-line treatment. - It acts as a **norepinephrine-dopamine reuptake inhibitor**, thereby increasing the availability of these neurotransmitters. - Available in immediate-release and extended-release formulations. *Atomoxetine* - **Atomoxetine** is a **non-stimulant** selective norepinephrine reuptake inhibitor (SNRI) used for ADHD. - It is particularly useful in patients who cannot tolerate stimulants or have comorbid anxiety disorders. - Preferred when there is concern about substance abuse or tic disorders.
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