Eating Disorders — MCQs

Eating Disorders Indian Medical PG Practice Questions and MCQs

Question 61: False regarding anorexia nervosa:

A. Weight loss is a feature
B. Excessive exercising can be a feature
C. Psychiatric symptoms such as depression may be associated
D. Decreased appetite is a feature (Correct Answer)

Explanation: ***Decreased appetite is a feature*** - Anorexia nervosa is characterized by a **distorted body image** and an intense fear of gaining weight, leading to **intentional restriction** of food intake, not necessarily a lack of appetite. - Patients often experience hunger but **actively suppress** it due to their psychological drive to lose weight. *Weight loss is a feature* - **Significant weight loss** or failure to gain weight during a growth period is a core diagnostic criterion for anorexia nervosa. - This weight loss is **self-imposed** and often extreme, leading to a body weight that is significantly below normal for age and height. *Excessive exercising can be a feature* - Many individuals with anorexia nervosa engage in **excessive physical activity** as a means to burn calories and further reduce weight. - This compulsion to exercise often becomes **rigid and ritualistic**, contributing to energy deficit and weight loss. *Psychiatric symptoms such as depression may be associated* - **Comorbid psychiatric conditions** like **depression**, anxiety disorders, and obsessive-compulsive traits are very common in individuals with anorexia nervosa. - These symptoms can either **precede or be exacerbated** by the physiological and psychological impact of starvation and the disorder itself.

Question 62: A young girl hospitalised with anorexia nervosa is on treatment. Even after taking adequate food according to the recommended diet plan for last 1 week, there is no gain in weight. What is the next step in management:

A. Increase the caloric intake from 1500 kcal to 2000 kcal per day
B. Increase fluid intake
C. Increase the dose of anxiolytics
D. Observe patient for 2 hours after meal (Correct Answer)

Explanation: ***Observe patient for 2 hours after meal*** - Patients with **anorexia nervosa** often engage in compensatory behaviors like **purging** or extensive exercise, which would counteract the effects of increased caloric intake and lead to a lack of weight gain despite consuming an "adequate" diet. - Observing the patient post-meal helps identify these behaviors and ensures that the ingested calories are actually being retained and utilized for weight restoration. *Increase the caloric intake from 1500 kcal to 2000 kcal per day* - Increasing caloric intake is a valid long-term strategy but is not the immediate next step when there's **no weight gain despite adequate intake**; the primary concern is identifying *why* the initial intake isn't leading to weight gain. - Doing so without addressing potential compensatory behaviors might only increase patient distress or lead to more intense purging/exercise. *Increase fluid intake* - While adequate **hydration** is important, it does not directly address the issue of **lack of weight gain** in anorexia nervosa, which is fundamentally a caloric deficit problem. - Increased fluid intake would not provide the necessary calories for weight restoration. *Increase the dose of anxiolytics* - Anxiolytics may help manage **anxiety** related to eating, but they do not directly promote **weight gain** or prevent compensatory behaviors. - This step does not address the core issue of why the recommended diet is not leading to weight gain.

Question 63: Pagophagia involves eating

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

Explanation: ***Ice*** - **Pagophagia** is a specific form of **pica**, characterized by a compulsive desire to consume **ice**, ice chips, or iced drinks. - It is often associated with **iron-deficiency anemia**, though the exact mechanism for this craving is unclear. *Sand* - The compulsive consumption of **sand** is known as **geophagy**, which is another form of pica. - This behavior is distinct from pagophagia and is not specifically linked to ice consumption. *Salt* - An excessive craving for **salt**, while sometimes indicative of an underlying condition (e.g., adrenal insufficiency), is not referred to as pagophagia. - **Pagophagia** specifically refers to the consumption of ice. *Clay* - The ingestion of **clay** is a specific type of **geophagy**, similar to eating sand. - It is a different form of pica and does not describe the selective craving for and consumption of ice.

Question 64: Diagnostic criteria for Bulimia nervosa are all EXCEPT

A. Lack of control over eating behaviour
B. Self induced vomiting
C. Presence of other psychiatric disorders (Correct Answer)
D. Binge eating

Explanation: ***Presence of other psychiatric disorders*** - While psychiatric comorbidities like depression, anxiety, and substance abuse are **extremely common** in individuals with bulimia nervosa, they are **not a diagnostic criterion** for the disorder. - The DSM-5 diagnosis of bulimia nervosa focuses specifically on **eating behaviors** (binge eating), **compensatory mechanisms** (purging/non-purging), and the impact on self-evaluation, not on the presence of co-occurring mental health conditions. - This is the correct answer as it is **NOT** a diagnostic criterion. *Lack of control over eating behaviour* - This is a **core diagnostic criterion** of bulimia nervosa. - Individuals must experience a sense of **lack of control** over eating during binge episodes (feeling unable to stop eating or control what or how much they are eating). - This feeling of loss of control during binges is essential for diagnosis. *Self induced vomiting* - This is a **diagnostic criterion** as one of the inappropriate compensatory behaviors used to prevent weight gain after binge eating. - Other compensatory behaviors include misuse of laxatives, diuretics, enemas, fasting, or excessive exercise. - At least one type of compensatory behavior must occur regularly (average of once weekly for 3 months). *Binge eating* - This is a **fundamental diagnostic criterion** involving eating an amount of food that is definitely larger than what most people would eat in a similar period under similar circumstances. - Must occur in a discrete time period (e.g., within any 2-hour period) with a sense of lack of control. - Binge episodes must occur, on average, at least once a week for 3 months for diagnosis.

Question 65: The most appropriate management approach for anorexia nervosa includes:

A. Immediate high-calorie diet with rapid weight gain
B. Strict bed rest with minimal physical activity
C. Antipsychotic medications as first-line treatment
D. Multidisciplinary approach with psychological therapy and nutritional rehabilitation (Correct Answer)

Explanation: ***Multidisciplinary approach with psychological therapy and nutritional rehabilitation*** - This is the **gold standard** and most appropriate management approach for **anorexia nervosa** according to all major guidelines (APA, NICE, IPS). - The multidisciplinary team includes: **psychiatrists, psychologists, dietitians, physicians**, and social workers working collaboratively. - **Psychological therapy** (particularly **CBT-E** for adults and **Family-Based Therapy/FBT** for adolescents) addresses distorted body image, eating behaviors, and underlying psychological factors. - **Nutritional rehabilitation** involves gradual, monitored weight restoration to prevent **refeeding syndrome** while addressing nutritional deficiencies. - **Medical monitoring** for complications (cardiovascular, electrolyte imbalances, bone health) is integrated throughout treatment. - This comprehensive approach addresses both the acute medical needs and long-term recovery, with evidence showing best outcomes. *Strict bed rest with minimal physical activity* - While temporary bed rest may be used in cases of **severe medical instability** (very low heart rate, severe electrolyte disturbances), it is not the overall management "approach." - Prolonged bed rest can worsen outcomes by causing **muscle wasting**, **bone density loss**, and psychological dependence. - Modern guidelines emphasize **gradual mobilization** with medical supervision rather than strict bed rest. - Bed rest is a specific medical intervention, not a comprehensive management strategy. *Immediate high-calorie diet with rapid weight gain* - Rapid refeeding is dangerous and can cause **refeeding syndrome**, characterized by severe shifts in **phosphate, potassium, and magnesium** levels. - Complications include **cardiac arrhythmias**, **respiratory failure**, and **seizures**. - Proper nutritional rehabilitation starts with **lower calories** (30-40 kcal/kg/day initially) and increases gradually under close monitoring. *Antipsychotic medications as first-line treatment* - **Antipsychotics are NOT first-line treatment** for anorexia nervosa. - Limited evidence for efficacy; **olanzapine** may be used as adjunct for severe anxiety or obsessive thoughts about food. - Medications alone are insufficient; psychological and nutritional interventions are essential. - May be considered for comorbid conditions but not as primary treatment.

Question 66: The following symptoms are common in Anorexia nervosa EXCEPT

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

Explanation: ***Menorrhagia*** - Anorexia nervosa typically leads to **amenorrhea** (absence of menstruation) or **oligomenorrhea** (infrequent menstruation) due to hormonal imbalances, not **menorrhagia** (abnormally heavy or prolonged menstrual bleeding). - The severe nutritional deficiencies and low body fat percentage disrupt the hypothalamic-pituitary-gonadal axis, leading to **estrogen deficiency**, which prevents regular ovulation and uterine lining development. *Weight loss* - **Significant weight loss** is a defining characteristic of anorexia nervosa, resulting from self-imposed starvation and excessive exercise. - This symptom is central to the diagnostic criteria for the disorder. *Mood changes* - Individuals with anorexia nervosa frequently experience various **mood changes**, including **depression**, **anxiety**, **irritability**, and **social withdrawal**. - These emotional disturbances can be both a cause and a consequence of the eating disorder, often driven by constant food preoccupation and body image concerns. *Dehydration* - **Dehydration** is a common physical complication of anorexia nervosa, often resulting from inadequate fluid intake, persistent vomiting (if purging is involved), and potential misuse of laxatives or diuretics. - This can lead to **electrolyte imbalances** and other serious health problems.

Question 67: Bulimia nervosa is treated with

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

Explanation: ***Escitalopram*** - **SSRIs** like escitalopram are considered first-line pharmacological treatment for **bulimia nervosa**, especially when combined with **psychotherapy**. - They help reduce the frequency of **binge-eating** and **purging** episodes by modulating serotonin levels. *Clozapine* - This is an **atypical antipsychotic** primarily used for **treatment-resistant schizophrenia**. - It has significant side effects, including **agranulocytosis**, and is not indicated for eating disorders. *Reserpine* - An **antihypertensive** and **antipsychotic** drug that depletes catecholamines and serotonin from central neurons. - Due to its severe side effects, including **depression** and **parkinsonism**, it is rarely used today and not for eating disorders. *Pimozide* - A **first-generation antipsychotic** specifically approved for treating **Tourette's syndrome** but sometimes used off-label for severe tics. - It is not indicated for the treatment of bulimia nervosa and may carry significant **cardiac side effects**.

Question 68: All of the following are features of anorexia nervosa except:

A. Restriction of energy intake relative to requirement
B. Intense fear of gaining weight
C. Symptoms emerge in later adolescence
D. Individual has engaged in recurrent episodes of binging or purging behavior (Correct Answer)

Explanation: ***Individual has engaged in recurrent episodes of binging or purging behavior*** - This statement is **NOT universally true** for all individuals with anorexia nervosa - Anorexia nervosa has **two subtypes**: - **Restricting type**: No recurrent binge-eating or purging behavior - **Binge-eating/purging type**: Regular engagement in binge-eating and/or purging - Since the restricting type does **not** involve binging or purging, this cannot be considered a general feature of anorexia nervosa - This makes it the correct answer for an "EXCEPT" question *Restriction of energy intake relative to requirement* - This is a **core diagnostic criterion** (DSM-5 Criterion A) for anorexia nervosa - Individuals deliberately limit food intake leading to **significantly low body weight** relative to age, sex, developmental trajectory, and physical health *Intense fear of gaining weight* - This is a **core diagnostic criterion** (DSM-5 Criterion B) for anorexia nervosa - The fear persists even when the individual is **significantly underweight** - May also manifest as **persistent behavior** that interferes with weight gain *Symptoms emerge in later adolescence* - Anorexia nervosa typically has its onset during **adolescence or young adulthood** - Peak onset is between **15-19 years of age**, which falls within the adolescent period - While onset can occur in early adolescence, later adolescence (ages 15-19) is indeed the most common period for symptom emergence

Question 69: With respect to anorexia nervosa the following is true except -

A. Phobic avoidance of normal weight
B. Self induced vomiting
C. Menorrhagia (Correct Answer)
D. Distorted body image

Explanation: ***Menorrhagia*** - Anorexia nervosa typically causes **amenorrhea** (absence of menstruation) or oligomenorrhea, not menorrhagia (excessive menstrual bleeding), due to hormonal dysregulation from severe weight loss. - The starvation state leads to a significant decrease in **gonadotropin-releasing hormone (GnRH)**, disrupting the menstrual cycle. *Phobic avoidance of normal weight* - Individuals with anorexia nervosa exhibit an intense **fear of gaining weight** or becoming fat, even when significantly underweight. - This fear often translates into a **phobic avoidance** of any behaviors or situations perceived to lead to weight gain. *Self induced vomiting* - While not exclusive to anorexia nervosa, **self-induced vomiting** is a common compensatory behavior observed in the purging type of anorexia nervosa. - This behavior is used to prevent weight gain after consuming food and can lead to various medical complications. *Distorted body image* - Patients with anorexia nervosa often have a **distorted body image**, perceiving themselves as overweight even when they are severely emaciated. - This **body image disturbance** is a core diagnostic criterion and significantly influences their eating behaviors and restrictive practices.

Question 70: Anorexia Nervosa is characterized by all EXCEPT:

A. Distortion of body image
B. Decreases 25% weight
C. Self induced vomiting
D. Amenorrhea for 3 months (Correct Answer)

Explanation: ***Amenorrhea for 3 months*** - While **amenorrhea** has historically been a common feature of anorexia nervosa due to hormonal imbalances from malnutrition, the **DSM-5 criteria no longer require it for diagnosis**. - Its presence can still suggest severe malnutrition, but its absence does not rule out anorexia nervosa. *Distortion of body image* - This is a core diagnostic criterion for anorexia nervosa, where individuals perceive themselves as **overweight** despite being underweight. - This **body image distortion** drives much of the restrictive eating and weight control behaviors. *Decreases 25% weight* - Anorexia nervosa is characterized by a **restriction of energy intake** leading to a significantly low body weight. - While there isn't a specific percentage that defines this, a significant weight loss (e.g., body weight **less than 85% of normal** for age and height) is a key feature. *Self induced vomiting* - **Self-induced vomiting** is a common compensatory behavior in the **binge-eating/purging subtype** of anorexia nervosa. - It is one of several behaviors (like laxative misuse, excessive exercise) used to prevent weight gain after food intake.

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

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