Eating Disorders — MCQs

Eating Disorders Indian Medical PG Practice Questions and MCQs

Question 11: Which of the following is NOT characteristic of bulimia nervosa?

A. Amenorrhea (Correct Answer)
B. Binge eating
C. Purgation and vomiting
D. Maintenance of normal body contour

Explanation: ### 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").

Question 12: All of the following may be seen in anorexia nervosa, EXCEPT:

A. Self-induced vomiting after meals (Correct Answer)
B. Absence of menstrual cycles
C. Distortion of body image
D. Body weight < 85% of the predicted

Explanation: ### Explanation **Correct Answer: A. Self-induced vomiting after meals** **Why Option A is the correct answer:** While self-induced vomiting *can* occur in the "Binge-eating/Purging type" of Anorexia Nervosa (AN), it is not a mandatory or defining feature of the disorder. In contrast, self-induced vomiting is a **hallmark and diagnostic requirement for Bulimia Nervosa**. In the context of this MCQ, the other three options represent the classic diagnostic criteria (as per DSM-IV/ICD-10) that define Anorexia Nervosa. **Analysis of Incorrect Options:** * **B. Absence of menstrual cycles:** Amenorrhea (defined as the absence of at least three consecutive cycles) was a core diagnostic criterion for AN in DSM-IV. It occurs due to hypothalamic-pituitary-ovarian axis suppression caused by low body fat. * **C. Distortion of body image:** This is a core psychopathological feature. Patients have a pathological fear of gaining weight and a disturbed perception of their own body shape/size, regardless of how thin they are. * **D. Body weight < 85% of the predicted:** A body weight less than 85% of that expected for age and height (or a BMI ≤ 17.5 kg/m²) is a classic threshold used to differentiate AN from other eating disorders. **NEET-PG High-Yield Pearls:** * **Types of AN:** 1. *Restricting type* (fasting/exercise) and 2. *Binge-eating/Purging type*. * **Most Common Cause of Death:** Suicide is the leading cause, followed by cardiac complications (arrhythmias due to hypokalemia). * **Clinical Signs:** Lanugo hair (fine neonatal-like hair), bradycardia, hypotension, and "Russell’s sign" (calluses on knuckles from induced vomiting). * **Refeeding Syndrome:** Watch for **Hypophosphatemia** when restarting nutrition; this is a frequent "image-based" or "next step" question. * **Treatment:** Family-Based Therapy (FBT) is the gold standard for adolescents. SSRIs (Fluoxetine) are generally ineffective until the patient is weight-restored.

Question 13: Which of the following is associated with the Russell's sign?

A. Anorexia nervosa
B. Bulimia nervosa (Correct Answer)
C. Obesity
D. Metabolic syndrome

Explanation: **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.

Question 14: Which of the following medications is used for the treatment of bulimia nervosa?

A. fluoxetine (Correct Answer)
B. clozapine
C. pimozide
D. lurasidone

Explanation: **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.

Question 15: 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?

A. ACTH
B. Calcitonin
C. Epinephrine (Correct Answer)
D. Insulin

Explanation: ### Explanation **Correct Option: C. Epinephrine** The patient is experiencing **hypoglycemia** (serum glucose 40 mg/dL), a common complication of Anorexia Nervosa due to depleted glycogen stores and lack of substrate for gluconeogenesis. When blood glucose levels drop below the physiological threshold, the body initiates a **counter-regulatory response** to restore glucose levels and alert the individual. This response is mediated primarily by the **Sympathoadrenal System**. The release of **Epinephrine** (Adrenaline) from the adrenal medulla acts on adrenergic receptors to cause: * **Autonomic (Neurogenic) symptoms:** Palpitations, diaphoresis (sweating), tremors, and anxiety. * **Metabolic effects:** Stimulation of glycogenolysis and gluconeogenesis in the liver. **Why other options are incorrect:** * **A. ACTH:** While ACTH increases during stress to stimulate cortisol (another counter-regulatory hormone), it does not directly cause acute symptoms like palpitations or sweating. * **B. Calcitonin:** This hormone is involved in calcium homeostasis (lowering serum calcium) and has no role in glucose regulation or the acute stress response. * **D. Insulin:** Insulin is an anabolic hormone that *lowers* blood glucose. In a hypoglycemic state, insulin secretion is suppressed. High levels of insulin would worsen the patient's condition. --- ### High-Yield Clinical Pearls for NEET-PG * **Hypoglycemia in Anorexia Nervosa:** Often occurs due to **atrophy of the liver** and total depletion of glycogen stores. It is a medical emergency and a poor prognostic sign. * **Symptom Triad:** Hypoglycemic symptoms are divided into **Neurogenic** (Adrenergic: palpitations, sweat) and **Neuroglycopenic** (Confusion, seizures, coma). * **Refeeding Syndrome:** The most feared complication of treating Anorexia. Look for **Hypophosphatemia**, hypokalemia, and congestive heart failure upon restarting nutrition. * **Most Common Cause of Death in Anorexia:** Cardiac arrhythmias (often due to electrolyte imbalances or prolonged QTc interval).

Question 16: Appetite for non-nutritive substances is called:

A. Pica (Correct Answer)
B. Anorexia
C. Bulimia
D. Binge

Explanation: **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).

Question 17: Anorexia nervosa is associated with which of the following?

A. Admission in severe cases (Correct Answer)
B. Metabolic syndrome
C. Overweight
D. Obesity

Explanation: **Explanation:** **Anorexia Nervosa (AN)** is a psychiatric disorder characterized by an intense fear of gaining weight, a distorted body image, and a restriction of energy intake leading to significantly low body weight. **Why Option A is Correct:** Hospitalization (admission) is indicated in severe cases of Anorexia Nervosa to manage life-threatening complications. Criteria for admission include: * **Medical Instability:** Severe bradycardia (<40 bpm), hypotension, or electrolyte imbalances (e.g., hypokalemia). * **Extreme Emaciation:** Body Mass Index (BMI) typically <15 kg/m² or weight <75% of the ideal body weight. * **Psychiatric Risk:** Acute suicidality or complete refusal to eat. * **Refeeding Syndrome Risk:** To monitor metabolic shifts during the reintroduction of nutrition. **Why Incorrect Options are Wrong:** * **Options C & D (Overweight/Obesity):** By definition (DSM-5), AN requires a restriction of intake leading to **significantly low body weight**. Patients with AN have a BMI below the minimally normal range for their age and sex. * **Option B (Metabolic Syndrome):** Metabolic syndrome is associated with obesity, insulin resistance, and hypertension. In contrast, AN is associated with **hypometabolic states**, including hypotension, hypoglycemia, and hypothermia. **High-Yield Clinical Pearls for NEET-PG:** * **Amenorrhea:** No longer a mandatory DSM-5 criterion but remains a common clinical feature. * **Lanugo Hair:** Fine, downy hair often found on the backs and arms of AN patients as a physiological response to hypothermia. * **Russell’s Sign:** Calluses on knuckles (seen in the Binge-eating/Purging type of AN). * **Laboratory Findings:** Leukopenia, elevated Growth Hormone (due to resistance), and low LH/FSH (hypogonadotropic hypogonadism). * **Treatment:** Nutritional rehabilitation is the priority. Family-Based Therapy (FBT) is the gold standard for adolescents. SSRIs (like Fluoxetine) are NOT effective when the patient is underweight; they are used only after weight restoration to prevent relapse.

Question 18: Which of the following is a common complication seen in Bulimia Nervosa?

A. Parotitis
B. Menorrhagia (Correct Answer)
C. Oligomenorrhea
D. Caries Teeth

Explanation: **Explanation:** In **Bulimia Nervosa (BN)**, patients maintain a relatively normal body weight but engage in cycles of binge eating followed by compensatory behaviors (purging). While many physical signs are related to self-induced vomiting, the menstrual irregularities in BN differ significantly from Anorexia Nervosa (AN). **1. Why Menorrhagia is the Correct Answer:** Unlike Anorexia Nervosa, where low body weight leads to hypogonadotropic hypogonadism and **amenorrhea**, patients with Bulimia Nervosa are typically of normal weight or slightly overweight. The physiological stress and nutritional fluctuations in BN often lead to **menstrual irregularities**, most commonly **menorrhagia** (heavy menstrual bleeding) or metrorrhagia. This is a high-yield distinction often tested in PG exams to differentiate BN from AN. **2. Analysis of Incorrect Options:** * **Parotitis (Option A):** While "Sialadenosis" (painless swelling of the parotid glands) is a classic sign of chronic vomiting in BN, the term **Parotitis** specifically implies inflammation/infection. While parotid enlargement is common, the question asks for the most characteristic menstrual/systemic complication in this specific context. * **Oligomenorrhea (Option C):** This is more characteristic of **Anorexia Nervosa** or the transition phase between disorders. In BN, the frequency of menses is often maintained, but the flow becomes heavy (menorrhagia). * **Caries Teeth (Option D):** While dental issues occur, the specific finding in BN is **Dental Erosion** (perimolysis), particularly on the lingual surfaces of the teeth due to gastric acid. "Caries" refers to bacterial decay, which is less specific to the purging process than chemical erosion. **Clinical Pearls for NEET-PG:** * **Russell’s Sign:** Calluses on the knuckles from self-induced vomiting. * **Electrolyte Imbalance:** Hypokalemic hypochloremic metabolic alkalosis is the hallmark of purging. * **Drug of Choice:** **Fluoxetine** (SSRI) is the only FDA-approved medication for Bulimia Nervosa. * **Mallory-Weiss Tears:** Esophageal lacerations due to forceful vomiting.

Question 19: Type I Anorexia nervosa is characterized by

A. Avoidance of food, restrictive type of food intake, weight less than normal (Correct Answer)
B. Avoidance of food, binge eating and purging episodes, weight less than normal
C. Binge eating and no compensation, overweight
D. None of the above

Explanation: **Explanation:** Anorexia Nervosa (AN) is a psychiatric disorder characterized by an intense fear of gaining weight, a distorted body image, and a persistent restriction of energy intake leading to significantly low body weight. According to DSM-5 and ICD criteria, AN is divided into two primary subtypes: 1. **Restricting Type (Type I):** This is characterized by weight loss achieved primarily through dieting, fasting, and/or excessive exercise. There is a consistent **avoidance of food** and a **restrictive pattern** of intake without regular binge-eating or purging behavior. 2. **Binge-Eating/Purging Type (Type II):** The individual maintains a low body weight but also engages in intermittent episodes of binge eating or purging (self-induced vomiting, misuse of laxatives/diuretics). **Analysis of Options:** * **Option A (Correct):** Accurately describes the Restricting Type (Type I) where the hallmark is restriction and low BMI. * **Option B (Incorrect):** This describes the **Binge-Eating/Purging Type (Type II)** of Anorexia Nervosa. * **Option C (Incorrect):** This describes **Binge Eating Disorder (BED)**, where patients do not use compensatory behaviors and are typically overweight or obese. * **Bulimia Nervosa (Distinction):** Unlike AN, patients with Bulimia Nervosa maintain a **normal or slightly above-normal weight** despite purging. **High-Yield Clinical Pearls for NEET-PG:** * **Amenorrhea:** No longer a mandatory diagnostic criterion in DSM-5 but remains a common clinical feature. * **Refeeding Syndrome:** The most serious complication during treatment, characterized by **Hypophosphatemia**, hypokalemia, and hypomagnesemia. * **Physical Signs:** Lanugo hair, bradycardia, hypotension, and "Russell’s sign" (calluses on knuckles from induced vomiting). * **Treatment:** Family-Based Treatment (FBT) is the first-line therapy for adolescents. SSRIs (Fluoxetine) are ineffective when the patient is severely underweight but may help in relapse prevention.

Question 20: Which of the following is more common in binge eating disorder compared to bulimia nervosa?

A. Obesity (Correct Answer)
B. Self-induced vomiting
C. Menstrual disorder
D. Short duration

Explanation: **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**.

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

Practice Questions

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

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