Eating Disorders Practice Questions

Q: Pagophagia involves eating which of the following?

Ice. **Explanation:** **Pagophagia** is a specific form of **Pica**, an eating disorder characterized by the persistent craving and compulsive consumption of non-nutritive, non-food substances. 1. **Why Option A is Correct:** The term is derived from the Greek words *pagos* (frost/ice) and *phagia* (to eat). Pagophagia specifically refers to the compulsive consumption of **ice**, freezer frost, or iced water. Clinically, it is a highly specific sign often associated with **Iron Deficiency Anemia (IDA)**. Interestingly, studies suggest that chewing ice may increase alertness and cognitive function in patients with IDA by increasing cerebral blood flow. 2. **Why Other Options are Incorrect:** * **Option B (Sand):** The consumption of sand or soil is termed **Geophagia**. * **Option C (Clay):** This is also a form of **Geophagia**. It is common in certain cultures and during pregnancy, often linked to iron or zinc deficiency. * **Option D (Salt):** While salt cravings can occur in conditions like Addison’s disease, it is not classified under Pica as salt is a food additive/mineral. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis:** According to DSM-5, the behavior must persist for at least **one month** and be developmentally inappropriate (child >2 years old). * **Associations:** Pica is frequently associated with **Iron Deficiency Anemia**, **Zinc deficiency**, and **Pregnancy**. It is also seen in individuals with Intellectual Disabilities and Autism. * **Complications:** Lead poisoning (from paint chips/Plumbism), intestinal obstruction, and dental injuries. * **Treatment:** The primary approach is treating the underlying nutritional deficiency and using behavioral therapy.

Q: "Russel sign" is:

Development of callus over the knuckles. **Explanation:** **Russell’s Sign** refers to the development of calluses, scars, or abrasions on the knuckles or the back of the hand. It is a classic physical finding in patients with **Bulimia Nervosa** or the purging subtype of Anorexia Nervosa. * **Mechanism:** The sign is caused by repeated friction between the incisor teeth and the skin of the hand when the patient uses their fingers to manually stimulate the gag reflex to induce vomiting. Over time, this chronic mechanical trauma leads to hyperkeratosis (callus formation). **Analysis of Incorrect Options:** * **Option A (Hyperpigmented patch over the nose):** This describes a "Malar rash" or "Butterfly rash," typically associated with Systemic Lupus Erythematosus (SLE). * **Option C (Inverted tree-shaped rash over the back):** This is characteristic of **Pityriasis Rosea** (specifically the "Christmas Tree" distribution). * **Option D (Loss of the buccal pad of fat):** This is a sign of severe emaciation or malnutrition, often seen in the Marasmic type of Protein-Energy Malnutrition or end-stage Anorexia Nervosa, but it is not specific to the act of purging. **High-Yield Clinical Pearls for NEET-PG:** 1. **Bulimia Nervosa:** Patients usually maintain a **normal or near-normal BMI**, unlike Anorexia Nervosa where BMI is significantly low (<18.5 kg/m²). 2. **Dental Findings:** Look for **Perimylolysis** (erosion of dental enamel), especially on the lingual surfaces of teeth due to gastric acid exposure. 3. **Metabolic Profile:** Chronic vomiting leads to **Hypokalemic Hypochloremic Metabolic Alkalosis**. 4. **Parotid Gland:** Recurrent vomiting can cause bilateral, painless parotid gland swelling ("Chipmunk facies"). 5. **Treatment:** **Fluoxetine** (SSRI) is the only FDA-approved pharmacological treatment for Bulimia Nervosa.

Q: Anorexia nervosa can be differentiated from bulimia by which of the following?

Peculiar patterns of food handling. **Explanation:** The core clinical distinction between Anorexia Nervosa (AN) and Bulimia Nervosa (BN) lies in the behavioral rituals surrounding food and the patient's weight status. **Why Option D is Correct:** Patients with **Anorexia Nervosa** exhibit **peculiar patterns of food handling**. These are obsessive-compulsive behaviors used to avoid calorie consumption while being preoccupied with food. Examples include cutting food into tiny pieces, rearranging food on the plate to make it look eaten, hiding food, or prolonged chewing. While Bulimia involves chaotic eating (bingeing), these specific, rigid, and ritualistic handling patterns are hallmark diagnostic clues for Anorexia. **Why Other Options are Incorrect:** * **A & B (Intense fear of weight gain & Body image disturbance):** These are **common to both** AN and BN. In both disorders, the individual’s self-worth is unduly influenced by body shape and weight. * **C (Adolescent age):** Both disorders typically have their onset during adolescence or young adulthood, making age an unreliable factor for differentiation. **NEET-PG High-Yield Pearls:** 1. **Weight Status:** The most definitive differentiator is BMI. AN is characterized by **significantly low body weight** (BMI <18.5 kg/m²), whereas BN patients are usually of **normal or slightly above-normal weight**. 2. **Amenorrhea:** Previously a diagnostic criterion for AN, it is now considered a common clinical feature but not mandatory (DSM-5). 3. **Russell’s Sign:** Calluses on the knuckles from self-induced vomiting; seen in both BN and the Binge-purge subtype of AN. 4. **Treatment of Choice:** * **AN:** Family-Based Treatment (FBT) is first-line for adolescents; no specific FDA-approved drug. * **BN:** Cognitive Behavioral Therapy (CBT) is first-line; **Fluoxetine** is the drug of choice.

Q: Which of the following drugs is used for anorexia nervosa?

Cyproheptadine. ### **Explanation: Pharmacotherapy in Anorexia Nervosa** **Correct Option: A. Cyproheptadine** Cyproheptadine is a first-generation antihistamine with potent **5-HT2 receptor antagonist** properties. In the context of Anorexia Nervosa (AN), it is used primarily as an **appetite stimulant**. By blocking serotonin receptors in the hypothalamus, it helps counteract the satiety signals that contribute to restrictive eating patterns. It is particularly beneficial in the **restrictive type** of AN to promote weight gain, though it does not address the underlying body image distortion. **Analysis of Incorrect Options:** * **B. Haloperidol & D. Pimozide:** These are high-potency typical antipsychotics. While they may be used off-label in severe, refractory cases to manage delusional body image or extreme agitation, they are not first-line treatments and carry a high risk of extrapyramidal side effects (EPS). * **C. Chlorpromazine:** This is a low-potency typical antipsychotic. While it was historically used for its sedative and weight-gain side effects, it is rarely used today due to the risk of lowering the seizure threshold and causing orthostatic hypotension in malnourished patients. **High-Yield Clinical Pearls for NEET-PG:** * **First-line Treatment:** Nutritional rehabilitation and **Psychotherapy** (Family-Based Therapy/Maudsley Approach for adolescents; CBT for adults) are the mainstays. * **Fluoxetine (SSRI):** It is the drug of choice for **Bulimia Nervosa**. In Anorexia Nervosa, SSRIs are generally **ineffective** until the patient is weight-restored, as tryptophan (serotonin precursor) levels are low during starvation. * **Olanzapine:** Currently the most preferred atypical antipsychotic for AN due to its side effect of significant weight gain and its ability to reduce obsessive thoughts about food. * **Contraindication:** **Bupropion** is strictly contraindicated in all eating disorders due to an increased risk of seizures.

Q: Which of the following is an eating disorder?

Bulimia nervosa. **Explanation:** **Bulimia Nervosa (Option B)** is the correct answer as it is a major eating disorder characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors (purging) to prevent weight gain. These behaviors include self-induced vomiting, misuse of laxatives/diuretics, fasting, or excessive exercise. Unlike Anorexia Nervosa, patients with Bulimia Nervosa usually maintain a normal or near-normal body weight. **Analysis of Incorrect Options:** * **Enuresis (Option A):** This is an **Elimination Disorder** defined by the repeated voiding of urine into bed or clothes, whether involuntary or intentional, in children old enough to have acquired bladder control (typically age 5+). * **Encopresis (Option C):** This is also an **Elimination Disorder** involving the repeated passage of feces into inappropriate places (e.g., clothing or floor) in children aged 4 years or older. * **Tourette Disorder (Option D):** This is a **Neurodevelopmental (Tic) Disorder** characterized by multiple motor tics and at least one vocal tic persisting for more than one year. **High-Yield Clinical Pearls for NEET-PG:** * **Russell’s Sign:** Calluses on the knuckles due to repeated self-induced vomiting; a classic physical finding in Bulimia. * **Metabolic Profile:** Bulimia often leads to **Hypokalemic Hypochloremic Metabolic Alkalosis** due to loss of gastric acid. * **Drug of Choice:** **Fluoxetine** (an SSRI) is the only FDA-approved pharmacological treatment for Bulimia Nervosa. * **Binge Eating Disorder:** The most common eating disorder; unlike Bulimia, it involves bingeing *without* compensatory purging.

Q: Which of the following psychiatric disorders is characterized by the clinical sign presented?

Bulimia Nervosa. ***Bulimia Nervosa*** - **Russell's sign** (calluses/scarring on dorsal knuckles) is pathognomonic for bulimia nervosa, resulting from repeated **self-induced vomiting**. - Characterized by **binge eating episodes** followed by compensatory behaviors like vomiting, laxative use, or excessive exercise. *Mania* - Presents with **elevated mood**, **grandiosity**, **decreased need for sleep**, and **increased goal-directed activity**. - Does not involve **self-induced vomiting** or eating-related behaviors that would cause Russell's sign. *Depression* - Characterized by **persistent low mood**, **anhedonia**, **fatigue**, and **changes in appetite or sleep**. - May involve **weight loss** due to decreased appetite, but not associated with **self-induced vomiting** or Russell's sign. *Necrophagia* - An extremely rare paraphilia involving **consumption of dead bodies** or **corpses**. - Not associated with **self-induced vomiting** or the development of **calluses on knuckles** from purging behaviors.

Q: Which of the following is NOT true about trichobezoars?

It is caused by Trichuris.. ### Explanation **1. Why Option A is the Correct Answer (The "False" Statement):** The term **Trichobezoar** is derived from the Greek word *thrix* (hair). It is a physical mass of accumulated hair in the gastrointestinal tract, not an infection. **Trichuris trichiura** (Whipworm), on the other hand, is a soil-transmitted helminth (parasite) that causes trichuriasis. There is no causal link between the parasite *Trichuris* and the formation of a hairball. **2. Analysis of Incorrect Options (True Statements):** * **Option B:** It is indeed a psychiatric manifestation. It is most commonly associated with **Trichotillomania** (impulse-control disorder involving hair pulling) and **Trichophagia** (compulsive eating of hair). * **Option C:** By definition, a bezoar is a solid mass of indigestible material. A trichobezoar specifically refers to a **ball of hair** typically found in the stomach, as hair cannot be digested or moved effectively by peristalsis. * **Option D:** The clinical history usually involves chronic **hair pulling** (trichotillomania) followed by **hair sucking or swallowing** (trichophagia). Over time, this leads to the accumulation of the bezoar. **3. Clinical Pearls for NEET-PG:** * **Rapunzel Syndrome:** An extreme form of trichobezoar where the "tail" of the hairball extends from the stomach into the small intestine (jejunum/ileum). * **Demographics:** Most commonly seen in adolescent females with underlying psychiatric comorbidities (Anxiety, OCD, or Depression). * **Clinical Presentation:** Often presents with epigastric pain, nausea, vomiting, early satiety, and a palpable abdominal mass. * **Diagnosis:** Gold standard is **Upper GI Endoscopy**; CT scan shows a characteristic mottled gas pattern within the mass.

Q: Which of the following changes is least likely to occur in anorexia nervosa, binge-purging type?

Hyperchloremia. In **Anorexia Nervosa (Binge-Purging type)**, the primary metabolic derangements result from repetitive self-induced vomiting and laxative abuse. ### Why Hyperchloremia is the Correct Answer The hallmark of purging (vomiting) is **Hypochloremic, Hypokalemic Metabolic Alkalosis**. When a patient vomits, they lose gastric hydrochloric acid (HCl). The loss of chloride ions leads to **Hypochloremia**, not hyperchloremia. Therefore, hyperchloremia is the "least likely" finding. ### Explanation of Incorrect Options * **Hypokalemia (B):** This is a classic finding. Potassium is lost directly through gastric juices and indirectly via the kidneys. In response to volume depletion, aldosterone is secreted, which causes the kidneys to reabsorb sodium at the expense of excreting more potassium. * **Hyperamylasemia (C):** Frequent purging stimulates the salivary glands, leading to compensatory hypertrophy (sialadenosis) and an increase in **salivary isoamylase** levels in the blood. * **Hypocalcemia (A):** This can occur due to dietary restriction (poor Vitamin D and Calcium intake) or as a consequence of laxative abuse, which impairs intestinal absorption. ### NEET-PG High-Yield Clinical Pearls * **Russell’s Sign:** Calluses or scars on the knuckles caused by using fingers to induce vomiting. * **Parotid Gland Swelling:** A common physical finding due to chronic purging. * **ECG Changes:** Look for U-waves or flattened T-waves due to severe hypokalemia, which can lead to fatal arrhythmias. * **Laxative Abuse:** Often leads to **Metabolic Acidosis** (due to bicarbonate loss in stool), whereas vomiting leads to **Metabolic Alkalosis**.

Question 1

Pagophagia involves eating which of the following?

Accepted Answer

Ice

Answer

Sand

Answer

Clay

Answer

Salt

Question 2

"Russel sign" is:

Accepted Answer

Development of callus over the knuckles

Answer

Hyperpigmented patch over the nose

Answer

Inverted tree-shaped rash over the back

Answer

Loss of the buccal pad of fat

Question 3

Anorexia nervosa can be differentiated from bulimia by which of the following?

Accepted Answer

Peculiar patterns of food handling

Answer

Intense fear of weight gain

Answer

Disturbance of body image

Answer

Adolescent age

Question 4

Which of the following drugs is used for anorexia nervosa?

Accepted Answer

Cyproheptadine

Answer

Haloperidol

Answer

Chlorpromazine

Answer

Pimozide

Question 5

Which of the following is an eating disorder?

Accepted Answer

Bulimia nervosa

Answer

Enuresis

Answer

Encoparesis

Answer

Tourette disorder

Question 6

Which of the following psychiatric disorders is characterized by the clinical sign presented?

Accepted Answer

Bulimia Nervosa

Answer

Mania

Answer

Depression

Answer

Necrophagia

Question 7

Which of the following is NOT true about trichobezoars?

Accepted Answer

It is caused by Trichuris.

Answer

It is a psychiatric manifestation.

Answer

It is a ball of hair found in the stomach.

Answer

Hair pulling and hair sucking are usually seen.

Question 8

Type II Anorexia nervosa is characterized by?

Accepted Answer

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

Answer

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

Answer

Binge eating and purging episodes, weight less than normal

Answer

None of the above

Question 9

Anorexia nervosa is most common in which demographic group?

Accepted Answer

Adolescents

Answer

Middle-aged adults

Answer

Males

Answer

Elderly individuals

Question 10

Which of the following changes is least likely to occur in anorexia nervosa, binge-purging type?

Accepted Answer

Hyperchloremia

Answer

Hypocalcemia

Answer

Hypokalemia

Answer

Hyperamylasemia

Eating Disorders — MCQs

Eating Disorders — MCQs

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