Eating Disorders Practice Questions

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

Amenorrhea. ### 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").

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

Bulimia nervosa. **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.

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

fluoxetine. **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.

Q: Appetite for non-nutritive substances is called:

Pica. **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).

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

Obesity. **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 1

Which of the following is NOT characteristic of bulimia nervosa?

Accepted Answer

Amenorrhea

Answer

Binge eating

Answer

Purgation and vomiting

Answer

Maintenance of normal body contour

Question 2

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

Accepted Answer

Self-induced vomiting after meals

Answer

Absence of menstrual cycles

Answer

Distortion of body image

Answer

Body weight < 85% of the predicted

Question 3

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

Accepted Answer

Bulimia nervosa

Answer

Anorexia nervosa

Answer

Obesity

Answer

Metabolic syndrome

Question 4

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

Accepted Answer

fluoxetine

Answer

clozapine

Answer

pimozide

Answer

lurasidone

Question 5

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?

Accepted Answer

Epinephrine

Answer

ACTH

Answer

Calcitonin

Answer

Insulin

Question 6

Appetite for non-nutritive substances is called:

Accepted Answer

Pica

Answer

Anorexia

Answer

Bulimia

Answer

Binge

Question 7

Anorexia nervosa is associated with which of the following?

Accepted Answer

Admission in severe cases

Answer

Metabolic syndrome

Answer

Overweight

Answer

Obesity

Question 8

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

Accepted Answer

Menorrhagia

Answer

Parotitis

Answer

Oligomenorrhea

Answer

Caries Teeth

Question 9

Type I Anorexia nervosa is characterized by

Accepted Answer

Avoidance of food, restrictive type of food intake, weight less than normal

Answer

Avoidance of food, binge eating and purging episodes, weight less than normal

Answer

Binge eating and no compensation, overweight

Answer

None of the above

Question 10

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

Accepted Answer

Obesity

Answer

Self-induced vomiting

Answer

Menstrual disorder

Answer

Short duration

Eating Disorders — MCQs

Eating Disorders — MCQs

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