Eating Disorders — MCQs

Eating Disorders Indian Medical PG Practice Questions and MCQs

Question 41: Pagophagia involves eating which of the following?

A. Ice (Correct Answer)
B. Sand
C. Clay
D. Salt

Explanation: **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.

Question 42: "Russel sign" is:

A. Hyperpigmented patch over the nose
B. Development of callus over the knuckles (Correct Answer)
C. Inverted tree-shaped rash over the back
D. Loss of the buccal pad of fat

Explanation: **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.

Question 43: Anorexia nervosa can be differentiated from bulimia by which of the following?

A. Intense fear of weight gain
B. Disturbance of body image
C. Adolescent age
D. Peculiar patterns of food handling (Correct Answer)

Explanation: **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.

Question 44: Which of the following drugs is used for anorexia nervosa?

A. Cyproheptadine (Correct Answer)
B. Haloperidol
C. Chlorpromazine
D. Pimozide

Explanation: ### **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.

Question 45: Which of the following is an eating disorder?

A. Enuresis
B. Bulimia nervosa (Correct Answer)
C. Encoparesis
D. Tourette disorder

Explanation: **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.

Question 46: Which of the following psychiatric disorders is characterized by the clinical sign presented?

A. Mania
B. Depression
C. Necrophagia
D. Bulimia Nervosa (Correct Answer)

Explanation: ***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.

Question 47: Which of the following is NOT true about trichobezoars?

A. It is caused by Trichuris. (Correct Answer)
B. It is a psychiatric manifestation.
C. It is a ball of hair found in the stomach.
D. Hair pulling and hair sucking are usually seen.

Explanation: ### 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.

Question 48: Type II Anorexia nervosa is characterized by?

A. Avoidance of food, restrictive type of food intake, weight less than normal
B. Avoidance of food, binge eating and purging episodes, weight less than normal (Correct Answer)
C. Binge eating and purging episodes, weight less than normal
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 refusal to maintain a minimally normal body weight (BMI < 18.5 kg/m²). According to DSM-5 criteria, it is classified into two distinct types: 1. **Restricting Type (Type I):** Weight loss is achieved primarily through dieting, fasting, and/or excessive exercise. There is no regular engagement in binge-eating or purging behavior. 2. **Binge-Eating/Purging Type (Type II):** During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (e.g., self-induced vomiting, misuse of laxatives, diuretics, or enemas). **Analysis of Options:** * **Option B is correct** because it encompasses the defining features of Type II AN: restrictive food avoidance (the "Anorexia" component) coupled with active bingeing/purging, all while maintaining a **weight less than normal**. * **Option A** describes **Type I (Restricting Type)** Anorexia Nervosa. * **Option C** is incomplete as it omits the primary restrictive behavior (avoidance of food) which is the hallmark of Anorexia, and could be confused with Bulimia Nervosa if the weight criteria were not specified. **High-Yield Clinical Pearls for NEET-PG:** * **Weight is the Key:** The primary differentiator between AN (Binge-Purge Type) and Bulimia Nervosa is **BMI**. In AN, the patient is underweight; in Bulimia, the patient is usually normal weight or overweight. * **Physical Signs:** Look for **Lanugo hair** (fine body hair), **Russell’s sign** (calluses on knuckles from induced vomiting), and **parotid gland swelling**. * **Electrolytes:** Purging often leads to **Hypokalemic Hypochloremic Metabolic Alkalosis**. * **Treatment:** The first priority is nutritional restoration. **Fluoxetine** is the only FDA-approved drug for Bulimia, but it is *not* effective for AN until the patient is weight-restored.

Question 49: Anorexia nervosa is most common in which demographic group?

A. Adolescents (Correct Answer)
B. Middle-aged adults
C. Males
D. Elderly individuals

Explanation: **Explanation:** **Anorexia Nervosa (AN)** is a psychiatric disorder characterized by an intense fear of gaining weight, a distorted body image, and persistent restriction of energy intake leading to significantly low body weight. **Why Adolescents is the Correct Answer:** Epidemiological data consistently show that the peak age of onset for Anorexia Nervosa is during **early to mid-adolescence (14–18 years)**. This period is high-risk due to the physiological changes of puberty, increased social pressure regarding body image, and the developmental transition toward independence. It is significantly more common in females (female-to-male ratio is approximately 10:1). **Why Other Options are Incorrect:** * **Middle-aged adults:** While eating disorders can persist into or rarely begin in adulthood, the incidence rate drops significantly after the early 20s. * **Males:** AN is disproportionately more common in females. While the incidence in males is rising, they represent only about 10% of clinical cases. * **Elderly individuals:** New-onset AN is extremely rare in the elderly. Weight loss in this group is more commonly attributed to depression, cognitive decline, or systemic medical illness. **High-Yield Clinical Pearls for NEET-PG:** * **ICD-11/DSM-5 Criteria:** Low BMI (<18.5 kg/m²), intense fear of weight gain, and body image distortion. (Note: Amenorrhea is no longer a mandatory criterion in DSM-5). * **Subtypes:** 1. Restricting type; 2. Binge-eating/purging type. * **Physical Signs:** Lanugo hair, bradycardia, hypotension, and "Russell’s sign" (calluses on knuckles if purging is present). * **Most Common Cause of Death:** Cardiac complications (arrhythmias due to electrolyte imbalance) or suicide. * **Treatment:** Nutritional rehabilitation is the priority. **Family-Based Therapy (FBT)** is the first-line psychotherapy for adolescents. No specific drug is curative, but SSRIs (Fluoxetine) may help prevent relapse *after* weight restoration.

Question 50: Which of the following changes is least likely to occur in anorexia nervosa, binge-purging type?

A. Hypocalcemia
B. Hypokalemia
C. Hyperamylasemia
D. Hyperchloremia (Correct Answer)

Explanation: 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**.

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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