Eating Disorders — MCQs

Eating Disorders Indian Medical PG Practice Questions and MCQs

Question 31: A patient of normal body weight presents with parotid abscess and dental caries. The patient becomes irritable when questioned about eating habits. What is the most probable diagnosis?

A. Adjustment disorder
B. Bulimia nervosa (Correct Answer)
C. Anorexia nervosa
D. Conversion disorder

Explanation: **Explanation:** The clinical presentation of **Bulimia Nervosa (BN)** is characterized by a cycle of binge eating followed by compensatory behaviors (purging). This patient exhibits classic physical signs of self-induced vomiting: 1. **Parotid Gland Enlargement/Abscess:** Chronic vomiting leads to sialadenosis (swelling of the salivary glands) due to autonomic stimulation and retrograde inflammation. 2. **Dental Caries/Erosion:** Frequent exposure to gastric acid causes the destruction of tooth enamel (perimolysis), primarily on the lingual surfaces. 3. **Normal Body Weight:** Unlike Anorexia Nervosa, patients with Bulimia are typically of **normal weight or slightly overweight**, which is a key diagnostic differentiator. **Analysis of Incorrect Options:** * **Anorexia Nervosa:** While purging can occur (Binge-eating/purging type), the hallmark is a **significantly low body weight** (BMI <18.5 kg/m²) and an intense fear of gaining weight. * **Adjustment Disorder:** This is a psychological response to an identifiable stressor resulting in emotional or behavioral symptoms; it does not manifest with specific physical signs like parotid abscesses or dental erosion. * **Conversion Disorder:** Involves unexplained neurological symptoms (e.g., paralysis, blindness) without a physical cause, unrelated to eating patterns or dental health. **High-Yield Clinical Pearls for NEET-PG:** * **Russell’s Sign:** Calluses or scars on the knuckles/dorsum of the hand from inducing vomiting; a classic sign of BN. * **Metabolic Profile:** Bulimia often leads to **Hypokalemic Hypochloremic Metabolic Alkalosis**. * **Drug of Choice:** **Fluoxetine** (SSRI) is the only FDA-approved medication for Bulimia Nervosa. * **Mallory-Weiss Tears:** Forceful vomiting in BN can lead to esophageal mucosal tears and hematemesis.

Question 32: What is a characteristic feature of anorexia nervosa?

A. Being overweight
B. Intense fear of becoming fat (Correct Answer)
C. Binge eating
D. Metabolic syndrome

Explanation: **Explanation:** Anorexia Nervosa (AN) is a complex eating disorder characterized by three core criteria according to DSM-5: persistent restriction of energy intake leading to significantly low body weight, an intense fear of gaining weight, and a disturbance in the way one's body weight or shape is experienced. **1. Why Option B is Correct:** The **intense fear of becoming fat** (morbid dread of obesity) is a hallmark psychological feature. Even when severely underweight, patients possess a distorted body image (dysmorphophobia) and employ extreme behaviors to prevent weight gain. This fear is not alleviated by weight loss; rather, it often intensifies as weight decreases. **2. Why Other Options are Incorrect:** * **Option A:** Patients with AN are, by definition, **underweight** (BMI <18.5 kg/m² in adults). Being overweight excludes a diagnosis of Anorexia Nervosa. * **Option C:** While the "Binge-eating/Purging type" of AN exists, binge eating is the primary characteristic of **Bulimia Nervosa** or Binge Eating Disorder. In AN, the defining feature is the refusal to maintain a healthy weight. * **Option D:** Metabolic syndrome is associated with obesity and insulin resistance. AN typically presents with the opposite: **hypometabolic states**, bradycardia, hypotension, and hypoglycemia. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of death:** Suicide or cardiac complications (arrhythmias due to QT prolongation). * **Endocrine hallmark:** Hypogonadotropic hypogonadism leading to **amenorrhea** (though no longer a mandatory DSM-5 criterion). * **Physical signs:** Lanugo hair, Russell’s sign (calluses on knuckles from self-induced vomiting), and "chipmunk facies" (parotid gland enlargement). * **Refeeding Syndrome:** A critical complication during treatment caused by a shift from fat to carbohydrate metabolism, leading to severe **hypophosphatemia**.

Question 33: Which of the following is/are not a feature of anorexia nervosa?

A. Strict dieting
B. Hallucination (Correct Answer)
C. Amenorrhoea
D. Distortion of body image

Explanation: **Explanation:** Anorexia Nervosa (AN) is a complex eating disorder characterized by a pathological pursuit of thinness and significant weight loss. The diagnosis is primarily based on behavioral and cognitive symptoms rather than psychotic features. **Why Hallucination is the correct answer:** Hallucinations are sensory perceptions in the absence of external stimuli and are characteristic of **Psychotic Disorders** (like Schizophrenia). While patients with Anorexia Nervosa have a distorted perception of their body, this is considered a **delusion-like belief or a disturbance in body image**, not a sensory hallucination. Therefore, it is not a diagnostic feature of AN. **Analysis of other options:** * **Strict Dieting:** This is the hallmark behavioral feature. Patients engage in severe caloric restriction and may also use excessive exercise or purging to maintain a body weight significantly below the minimum expected for their age and height. * **Amenorrhoea:** Historically a diagnostic criterion in DSM-IV, it refers to the absence of at least three consecutive menstrual cycles due to hypothalamic-pituitary-gonadal axis suppression caused by low body fat. While removed from the "required" list in DSM-5 to include males and prepubertal girls, it remains a classic clinical feature. * **Distortion of Body Image:** This is a core cognitive feature. Patients perceive themselves as "fat" even when they are emaciated (overvaluation of shape and weight). **High-Yield Clinical Pearls for NEET-PG:** * **DSM-5 Criteria:** 1. Restriction of energy intake leading to significantly low body weight; 2. Intense fear of gaining weight; 3. Disturbance in the way one's body weight/shape is experienced. * **Two Types:** Restricting type and Binge-eating/purging type. * **Most Common Cause of Death:** Cardiac arrhythmias (due to electrolyte imbalances like hypokalemia) or suicide. * **Physical Signs:** Lanugo hair, bradycardia, hypotension, and "Russell’s sign" (calluses on knuckles if purging).

Question 34: What is the duration criterion for anorexia nervosa?

A. 5 months
B. 3 months (Correct Answer)
C. 2 months
D. 4 months

Explanation: In Psychiatry, diagnostic criteria for eating disorders are strictly defined by the DSM-5 and ICD-11 to ensure clinical accuracy. **Explanation of the Correct Answer:** The correct answer is **3 months (Option B)**. According to the DSM-5 criteria, for a diagnosis of Anorexia Nervosa (AN), the persistent behavior that interferes with weight gain and the disturbance in self-perceived weight or shape must be present for a minimum duration of **3 months**. This timeframe helps clinicians differentiate a transient loss of appetite (due to acute illness or stress) from a chronic psychiatric pathology characterized by an intense fear of gaining weight. **Analysis of Incorrect Options:** * **Options A, C, and D (2, 4, and 5 months):** These durations do not align with the standardized diagnostic manuals. While a patient may show symptoms for 2 months, they would technically be classified under "Other Specified Feeding or Eating Disorder" (OSFED) until the 3-month threshold is met. **High-Yield Clinical Pearls for NEET-PG:** * **Key Features:** The three pillars of AN are: 1) Restriction of energy intake leading to significantly low body weight, 2) Intense fear of gaining weight, and 3) Disturbance in body image (Body Dysmorphic component). * **Subtypes:** There are two types—**Restricting type** (fasting/exercise) and **Binge-eating/purging type** (self-induced vomiting/laxatives). * **Severity:** Based on **BMI** (Mild: ≥17, Moderate: 16–16.99, Severe: 15–15.99, Extreme: <15 kg/m²). * **Common Complication:** Amenorrhea (though no longer a mandatory criterion in DSM-5) and **Lanugo hair** (fine, downy hair growth). * **Refeeding Syndrome:** The most dangerous complication during treatment, characterized by **Hypophosphatemia**.

Question 35: A 28-year-old female weighing 35 kg reports feeling excessively overweight and hesitates to eat. Upon further evaluation, she is diagnosed with anorexia nervosa. Which of the following symptoms is NOT commonly associated with anorexia nervosa?

A. Weight loss
B. Hypothermia
C. Mood changes
D. Menorrhagia (Correct Answer)

Explanation: **Explanation:** The correct answer is **D. Menorrhagia**. In Anorexia Nervosa (AN), the body enters a state of severe energy deficiency, leading to the suppression of the **Hypothalamic-Pituitary-Gonadal (HPG) axis**. This results in low levels of GnRH, LH, and FSH, leading to **amenorrhea** (absence of menstruation) rather than menorrhagia (heavy menstrual bleeding). In fact, amenorrhea was previously a core diagnostic criterion in DSM-IV. **Analysis of Incorrect Options:** * **A. Weight Loss:** This is the hallmark of AN. Patients maintain a body weight significantly below the minimally normal level for their age and height (typically BMI <18.5 kg/m²). * **B. Hypothermia:** Malnutrition leads to a decrease in the basal metabolic rate and loss of insulating subcutaneous fat. The body struggles with thermoregulation, often resulting in cold intolerance and hypothermia. * **C. Mood Changes:** Patients frequently exhibit irritability, social withdrawal, and depressive symptoms. These can be primary or secondary to the physiological effects of starvation on the brain. **Clinical Pearls for NEET-PG:** * **Lanugo hair:** Fine, downy hair growth on the body is a classic compensatory sign of AN to maintain body heat. * **Vital Signs:** Look for "The 3 Hypos": **Hypotension, Hypothermia, and Bradycardia.** * **Laboratory findings:** Common abnormalities include leukopenia, elevated growth hormone (due to resistance), and increased cortisol. * **Russell’s Sign:** Calluses on the knuckles (seen in the Binge-eating/Purging type of AN).

Question 36: What is the treatment for bulimia nervosa?

A. Pimozide
B. Clozapine
C. Reserpine
D. Escitalopram (Correct Answer)

Explanation: **Explanation:** The primary pharmacological treatment for **Bulimia Nervosa (BN)** involves the use of **Selective Serotonin Reuptake Inhibitors (SSRIs)**. Serotonin dysregulation is implicated in the binge-purge cycle; SSRIs help reduce the frequency of binge eating episodes and compensatory behaviors (purging), even in patients without comorbid depression. * **Why Escitalopram is correct:** As an SSRI, Escitalopram is effective in managing BN. While **Fluoxetine** is the only FDA-approved drug specifically for Bulimia (often used at higher doses like 60mg/day), other SSRIs like Escitalopram are considered first-line pharmacological options in clinical practice. * **Why the others are incorrect:** * **Pimozide:** A typical antipsychotic primarily used for Tourette’s syndrome and delusional parasitosis. * **Clozapine:** An atypical antipsychotic reserved for treatment-resistant schizophrenia; it is associated with significant weight gain, which is contraindicated in patients with eating disorders. * **Reserpine:** An older antihypertensive and antipsychotic that depletes monoamines; it can actually trigger severe depression. **High-Yield Clinical Pearls for NEET-PG:** 1. **First-line Treatment:** Nutritional rehabilitation and **Cognitive Behavioral Therapy (CBT-BN)** are the gold standards. 2. **Drug of Choice:** Fluoxetine (60 mg) is the most frequently tested SSRI for Bulimia. 3. **Absolute Contraindication:** **Bupropion** must be avoided in Bulimia and Anorexia because it lowers the seizure threshold, especially in patients with electrolyte imbalances due to purging. 4. **Physical Sign:** Look for **Russell’s sign** (calluses on knuckles) and parotid gland enlargement in clinical vignettes.

Question 37: Which feature differentiates binge eating disorder from bulimia nervosa?

A. Absence of recurrent episodes of binge eating (Correct Answer)
B. Absence of inappropriate compensatory behaviors
C. Presence of marked distress associated with binge eating
D. Significant increase in weight following binge eating episodes

Explanation: **Explanation:** The fundamental distinction between Binge Eating Disorder (BED) and Bulimia Nervosa (BN) lies in the **absence of inappropriate compensatory behaviors** in BED. 1. **Why Option B is the conceptual differentiator:** Both BED and BN involve recurrent episodes of binge eating (consuming large amounts of food with a sense of loss of control). However, in Bulimia Nervosa, the binge is followed by compensatory actions to prevent weight gain (e.g., self-induced vomiting, laxative abuse, excessive exercise, or fasting). In Binge Eating Disorder, these compensatory behaviors are absent. *Note: There appears to be a discrepancy in the provided key. Option B is the standard clinical differentiator. If Option A is marked correct, it is technically incorrect as both disorders **require** recurrent binge eating episodes for diagnosis.* 2. **Analysis of Incorrect Options:** * **Option A:** Incorrect because recurrent binge eating is the core requirement for *both* BED and BN. * **Option C:** Incorrect because marked distress regarding the eating behavior is a diagnostic criterion for both disorders. * **Option D:** While patients with BED are often overweight or obese, weight gain is a clinical consequence, not a diagnostic criterion used to differentiate the two. **High-Yield Clinical Pearls for NEET-PG:** * **Time Criteria:** For both BED and BN (DSM-5), episodes must occur at least **once a week for 3 months**. * **BMI:** Patients with Bulimia Nervosa usually have a **normal or slightly high BMI**, whereas patients with Anorexia Nervosa (Binge-purge type) have a **low BMI** (<18.5 kg/m²). * **Treatment of Choice:** * **BN:** Fluoxetine (high dose, 60mg) + CBT. * **BED:** Psychotherapy (CBT/IPT) is first-line; Lisdexamfetamine is the only FDA-approved medication.

Question 38: All of the following are true about bulimia nervosa, except?

A. Binge eating
B. Self-induced vomiting
C. Weight loss (Correct Answer)
D. Purgative abuse

Explanation: **Explanation:** The core clinical feature that distinguishes **Bulimia Nervosa (BN)** from Anorexia Nervosa (AN) is the patient’s weight. In Bulimia Nervosa, patients typically maintain a **normal or slightly above-normal body weight** (BMI ≥ 18.5 kg/m²). Significant weight loss is the hallmark of Anorexia Nervosa; if a patient meets the criteria for Bulimia but is significantly underweight, the diagnosis shifts to Anorexia Nervosa (Binge-eating/Purging type). **Analysis of Options:** * **A. Binge eating:** This is a mandatory 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. * **B. Self-induced vomiting:** This is the most common compensatory behavior used to prevent weight gain after a binge. * **D. Purgative abuse:** This includes the misuse of laxatives, diuretics, or enemas. Along with vomiting and excessive exercise, these are "inappropriate compensatory behaviors" central to the diagnosis. **Clinical Pearls for NEET-PG:** 1. **Russell’s Sign:** Calluses or scars on the knuckles due to repeated self-induced vomiting (high-yield physical finding). 2. **Electrolyte Imbalance:** The most common metabolic abnormality is **Hypokalemic Hypochloremic Metabolic Alkalosis**. 3. **Parotid Gland Swelling:** Chronic vomiting leads to sialadenosis (painless enlargement of salivary glands). 4. **Drug of Choice:** **Fluoxetine** (SSRI) is the only FDA-approved medication for Bulimia Nervosa, typically used at higher doses (60mg). 5. **Contraindication:** **Bupropion** is strictly contraindicated in patients with eating disorders due to an increased risk of seizures.

Question 39: Which of the following statements is false regarding bulimia nervosa?

A. Weight is normal
B. Common in females
C. Onset in early adulthood
D. Mortality is high (Correct Answer)

Explanation: ### Explanation **Bulimia Nervosa (BN)** is characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors (purging, excessive exercise, or fasting) to prevent weight gain. **Why Option D is the Correct Answer (False Statement):** While Bulimia Nervosa is associated with significant morbidity (e.g., electrolyte imbalances, dental erosion), its **mortality rate is relatively low** (approx. 2% per decade). In contrast, **Anorexia Nervosa (AN)** has the highest mortality rate of any psychiatric disorder (approx. 5-10% per decade) due to medical complications of starvation or suicide. Therefore, stating mortality is high for BN is incorrect. **Analysis of Incorrect Options (True Statements):** * **A. Weight is normal:** Unlike Anorexia Nervosa (where BMI is <18.5 kg/m²), patients with Bulimia Nervosa typically maintain a **normal or slightly above-normal weight**. This often makes the disorder harder to detect by family members. * **B. Common in females:** BN is significantly more prevalent in females, with a female-to-male ratio of approximately 10:1. * **C. Onset in early adulthood:** The peak age of onset for BN is typically late adolescence or **early adulthood** (18–24 years), slightly later than the onset of Anorexia Nervosa (mid-adolescence). --- ### High-Yield Clinical Pearls for NEET-PG: * **Russell’s Sign:** Calluses on the knuckles/back of the hand due to repeated self-induced vomiting. * **Metabolic Profile:** Hypokalemic hypochloremic metabolic alkalosis (due to vomiting). * **Parotid Gland Enlargement:** Often seen in chronic purgers ("chipmunk facies"). * **Drug of Choice:** **Fluoxetine** (SSRI) is the only FDA-approved medication for BN; it helps reduce binge-purge cycles. * **Contraindication:** **Bupropion** is strictly contraindicated in bulimic patients due to an increased risk of seizures.

Question 40: Which of the following statements about Bulimia nervosa is false?

A. More common in males. (Correct Answer)
B. Seen in the 20-40 year age group.
C. Serotonin is implicated in its pathophysiology.
D. Characterized by binge eating followed by compensatory behaviors.

Explanation: ### Explanation **Bulimia Nervosa (BN)** is an eating disorder characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors to prevent weight gain. **1. Why Option A is the Correct Answer (False Statement):** Bulimia nervosa is significantly **more common in females** than in males, with a female-to-male ratio of approximately **10:1**. The lifetime prevalence is about 1–3% in women and only 0.1% in men. Therefore, the statement that it is more common in males is incorrect. **2. Analysis of Other Options:** * **Option B (Age Group):** BN typically has a slightly later onset than Anorexia Nervosa. While it often begins in late adolescence, it is frequently seen and diagnosed in the **20–40 year age group**. * **Option C (Pathophysiology):** **Serotonin (5-HT)** and norepinephrine are heavily implicated. Low serotonin levels are linked to reduced satiety and increased impulsivity, which triggers binge episodes. This is why SSRIs (specifically Fluoxetine) are effective in treatment. * **Option D (Clinical Feature):** This is the hallmark of BN. Patients experience a "loss of control" during binge eating, followed by purging (vomiting, laxatives) or non-purging (excessive exercise, fasting) behaviors. **3. High-Yield Clinical Pearls for NEET-PG:** * **Body Weight:** Unlike Anorexia, patients with Bulimia usually maintain a **normal or slightly above-normal BMI**. * **Physical Signs:** Look for **Russell’s sign** (calluses on knuckles from self-induced vomiting) and **parotid gland swelling** (sialadenosis). * **Electrolytes:** Recurrent vomiting leads to **Hypokalemic Hypochloremic Metabolic Alkalosis**. * **Drug of Choice:** **Fluoxetine** (at a higher dose of 60mg/day) is the only FDA-approved medication for BN. * **Contraindication:** **Bupropion** is strictly contraindicated in bulimic patients due to an increased risk of seizures.

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

Practice Questions

Prevention Strategies

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free