Eating Disorders Practice Questions

Q: Which of the following is NOT true about anorexia nervosa?

Self-induced vomiting. **Explanation:** The core psychopathology of **Anorexia Nervosa (AN)** is a distorted body image and an intense fear of gaining weight, leading to restricted energy intake and significantly low body weight. **Why "Self-induced vomiting" is the correct answer:** While self-induced vomiting *can* occur in the "Binge-eating/Purging type" of Anorexia, it is **not a mandatory diagnostic feature** or a universal finding. In contrast, self-induced vomiting is a hallmark and often defining compensatory behavior of **Bulimia Nervosa**. In Anorexia, the primary mechanism of weight loss is typically severe caloric restriction and excessive exercise. **Analysis of other options:** * **Leukopenia (A):** This is a common hematological complication of starvation in AN due to bone marrow hypoplasia (gelatinous transformation of marrow). * **Amenorrhea (B):** Though no longer a strict DSM-5 diagnostic criterion, it remains a classic clinical feature caused by hypogonadotropic hypogonadism (low FSH/LH due to hypothalamic dysfunction). * **More common in adult females (D):** AN has a significant female-to-male preponderance (roughly 10:1), typically peaking in adolescence and young adulthood. **NEET-PG High-Yield Pearls:** 1. **Most common cause of death:** Suicide (psychiatric) or Cardiac Arrhythmias (medical, often due to hypokalemia). 2. **Refeeding Syndrome:** Characterized by **Hypophosphatemia** (hallmark), hypokalemia, and hypomagnesemia when food is reintroduced too rapidly. 3. **Physical signs:** Lanugo hair, bradycardia, hypotension, and "Russell’s sign" (calluses on knuckles if purging is present). 4. **Treatment:** Nutritional rehabilitation is the priority. Family-Based Therapy (FBT) is the gold standard for adolescents.

Q: Which of the following features is not seen in Anorexia Nervosa?

Decreased serum protein. **Explanation:** In **Anorexia Nervosa (AN)**, despite severe emaciation and malnutrition, the body employs remarkable compensatory mechanisms to maintain essential biochemical functions. **Why "Decreased serum protein" is the correct answer:** Counterintuitively, serum protein and albumin levels are typically **normal** in patients with Anorexia Nervosa. This is a classic "trap" in medical exams. The body prioritizes the synthesis of visceral proteins (like albumin) by breaking down somatic protein (muscle mass). Low serum protein is more characteristic of **Kwashiorkor** (protein-energy malnutrition) rather than the calorie-restricted starvation seen in AN. If an AN patient presents with low albumin, it usually indicates a very late stage of the disease or an alternative diagnosis. **Analysis of Incorrect Options:** * **A. Decreased total brain volume:** Chronic starvation leads to "pseudo-atrophy" of the brain, characterized by enlarged ventricles and reduced gray/white matter volume (reversible with refeeding). * **B. Lowered metabolic rate:** To conserve energy, the body enters a hypometabolic state. This manifests clinically as bradycardia, hypotension, and hypothermia. * **C. Impaired regulation in growth hormone (GH) levels:** In AN, there is a state of **GH resistance**. GH levels are actually **increased**, but Insulin-like Growth Factor-1 (IGF-1) is decreased, leading to impaired growth and regulatory feedback loops. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of death:** Cardiac arrhythmias (due to electrolyte imbalances like hypokalemia) or Suicide. * **Endocrine hallmark:** Hypogonadotropic hypogonadism (leading to amenorrhea). * **Hematology:** Leukopenia is the most common blood abnormality. * **Refeeding Syndrome:** Watch for **Hypophosphatemia** when starting nutrition; it is the most critical electrolyte shift to monitor.

Q: Which eating disorder is characterized by normal weight?

Bulimia nervosa. **Explanation:** The hallmark of **Bulimia Nervosa (BN)** is the maintenance of a **normal or near-normal body weight** (BMI ≥ 18.5 kg/m²). Patients engage in a cycle of binge eating followed by inappropriate compensatory behaviors (purging via vomiting, laxatives, or excessive exercise). Unlike other eating disorders, the caloric intake during binges is offset by these compensatory mechanisms, preventing significant weight loss or gain, which often makes the disorder "invisible" to family members. **Analysis of Incorrect Options:** * **Anorexia Nervosa (AN):** The defining clinical feature is **significantly low body weight** (BMI < 18.5 kg/m² in adults) due to restricted energy intake and an intense fear of gaining weight. Even the "Binge-eating/Purging type" of AN is distinguished from Bulimia by the presence of underweight status. * **Binge Eating Disorder (BED):** While patients binge, they do **not** engage in regular compensatory behaviors. Consequently, BED is most commonly associated with being **overweight or obese**. **Clinical Pearls for NEET-PG:** * **Russell’s Sign:** Calluses on the knuckles from self-induced vomiting (common in BN). * **Metabolic Profile:** Bulimia often presents with **Hypokalemia**, Hypochloremia, and **Metabolic Alkalosis** (due to loss of gastric HCl). * **Parotid Gland Swelling:** Sialadenosis is a frequent physical finding in purging-type Bulimia. * **Drug of Choice:** **Fluoxetine** (SSRI) is the only FDA-approved medication for Bulimia Nervosa, typically used at higher doses (60mg).

Q: Excessive eating followed by purging using laxatives in 20-year-old females is characteristic of which condition?

Bulimia nervosa. **Explanation:** The correct answer is **Bulimia Nervosa (Option A)**. This condition is characterized by a repetitive cycle of **binge eating** (consuming large amounts of food with a sense of loss of control) followed by **compensatory behaviors** to prevent weight gain. These behaviors, known as purging, include self-induced vomiting, misuse of laxatives, diuretics, or excessive exercise. Unlike anorexia, patients with bulimia usually maintain a body weight within or above the normal range (BMI ≥ 18.5 kg/m²). **Analysis of Incorrect Options:** * **Anorexia Nervosa (Option B):** While purging can occur in the "Binge-eating/Purging type" of Anorexia, the hallmark is **significantly low body weight** (BMI < 18.5 kg/m²) and an intense fear of gaining weight. * **Binge Eating Disorder (Option C):** This involves episodes of excessive eating but is distinguished by the **absence of compensatory behaviors** (no purging, fasting, or excessive exercise). * **Schizophrenia (Option D):** This is a primary psychotic disorder. While disorganized eating habits may occur, it does not involve the specific psychopathology of body image distortion or the binge-purge cycle seen in eating disorders. **High-Yield Clinical Pearls for NEET-PG:** * **Russell’s Sign:** Calluses on the knuckles from self-induced vomiting (common in Bulimia). * **Metabolic Profile:** Purging often leads to **Hypokalemic Hypochloremic Metabolic Alkalosis**. * **Parotid Gland Enlargement:** Often seen in chronic purgers ("chipmunk facies"). * **Drug of Choice:** **Fluoxetine** (SSRI) is the only FDA-approved medication for Bulimia Nervosa, typically used at higher doses (60mg).

Q: For diagnosing bulimia nervosa, binge eating should be present for a duration of:

Once a week. **Explanation:** The diagnosis of **Bulimia Nervosa** is based on the **DSM-5 criteria**, which standardized the frequency and duration of symptoms to distinguish clinical eating disorders from occasional disordered eating. **Why Option B is Correct:** According to DSM-5, for a diagnosis of Bulimia Nervosa, both binge eating (eating an objectively large amount of food with a sense of loss of control) and inappropriate compensatory behaviors (e.g., self-induced vomiting, laxative misuse, excessive exercise) must occur, on average, **at least once a week for 3 months**. This threshold ensures the behavior is persistent and clinically significant. **Why Other Options are Incorrect:** * **Options A, C, and D:** These frequencies (once in 3 months, 2 months, or 1 month) do not meet the minimum diagnostic threshold. While these behaviors are concerning, they would likely be classified under "Other Specified Feeding or Eating Disorder" (OSFED) if they occur less than once a week. It is important to note that under the older DSM-IV criteria, the requirement was twice a week, but this was lowered to **once a week** in DSM-5 to increase diagnostic sensitivity. **High-Yield Clinical Pearls for NEET-PG:** * **Weight Status:** Unlike Anorexia Nervosa (where patients are underweight), patients with Bulimia Nervosa are typically of **normal weight or overweight**. * **Physical Signs:** Look for **Russell’s sign** (calluses on knuckles from inducing vomiting), parotid gland enlargement ("chipmunk facies"), and dental enamel erosion (perimolysis). * **Electrolyte Imbalance:** The most common metabolic abnormality is **Hypokalemic Hypochloremic Metabolic Alkalosis**. * **Drug of Choice:** **Fluoxetine** (SSRI) is the only FDA-approved medication for Bulimia Nervosa. **Bupropion is contraindicated** due to an increased risk of seizures in these patients.

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

Bulimia nervosa. **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.

Q: Anorexia nervosa is an eating disorder characterized by all of the following EXCEPT:

Menorrhagia. **Explanation:** Anorexia Nervosa (AN) is a psychiatric disorder characterized by restricted energy intake, an intense fear of gaining weight, and a distorted body image. The physiological consequences of AN are primarily due to starvation and compensatory behaviors (like purging). **Why Option A is the Correct Answer:** **Menorrhagia** (heavy menstrual bleeding) is **not** seen in Anorexia Nervosa. Instead, the hallmark endocrine feature is **Amenorrhea** (absence of menstruation). This occurs due to functional hypothalamic-pituitary-gonadal axis suppression. Low body fat leads to decreased leptin levels, which inhibits the pulsatile release of GnRH, resulting in low levels of FSH and LH. **Analysis of Incorrect Options:** * **B. Salivary gland enlargement:** Often seen in the "Binge-eating/Purging" subtype of AN. Frequent self-induced vomiting causes compensatory hypertrophy of the parotid glands (Sialadenosis) due to autonomic stimulation. * **C. Acrocyanosis:** This refers to a painless, bluish discoloration of the extremities. In AN, it results from peripheral vasoconstriction as the body attempts to conserve core heat in a state of severe malnutrition and hypometabolism. * **D. Bradycardia:** Sinus bradycardia is a common cardiovascular finding in AN. It is a physiological adaptation to starvation aimed at reducing the basal metabolic rate and myocardial oxygen demand. **High-Yield Clinical Pearls for NEET-PG:** * **Lanugo hair:** Fine, downy hair growth on the back and arms (a sign of starvation). * **Russell’s Sign:** Calluses on the knuckles from self-induced vomiting. * **Electrolyte Imbalance:** Hypokalemic hypochloremic metabolic alkalosis is common in purging types. * **Refeeding Syndrome:** The most serious complication of treatment; characterized by severe **Hypophosphatemia**.

Question 1

Which of the following is NOT true about anorexia nervosa?

Accepted Answer

Self-induced vomiting

Answer

Leukopenia

Answer

Amenorrhea

Answer

More common in adult females

Question 2

Which of the following features is not seen in Anorexia Nervosa?

Accepted Answer

Decreased serum protein

Answer

Decreased total brain volume

Answer

Lowered metabolic rate

Answer

Impaired regulation in growth hormone levels

Question 3

Which eating disorder is characterized by normal weight?

Accepted Answer

Bulimia nervosa

Answer

Anorexia nervosa

Answer

Binge eating disorder

Answer

None of the above

Question 4

What is true about Anorexia nervosa?

Accepted Answer

Anorexia nervosa is more commonly associated with constipation than diarrhea.

Answer

Anorexia nervosa is more common than bulimia nervosa.

Answer

Anorexia nervosa can present with a low T4 in the presence of a normal T3.

Answer

Anorexia nervosa may be associated with hypochloremic hypokalemic alkalosis.

Question 5

What is the primary goal in the management of anorexia nervosa?

Accepted Answer

To avoid refeeding syndrome

Answer

To induce refeeding syndrome

Answer

To treat obesity

Answer

To manage metabolic syndrome

Question 6

Excessive eating followed by purging using laxatives in 20-year-old females is characteristic of which condition?

Accepted Answer

Bulimia nervosa

Answer

Anorexia nervosa

Answer

Binge eating disorder

Answer

Schizophrenia

Question 7

For diagnosing bulimia nervosa, binge eating should be present for a duration of:

Accepted Answer

Once a week

Answer

Once in 3 months

Answer

Once in 2 months

Answer

Once a month

Question 8

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

Accepted Answer

Self-induced vomiting after meals

Answer

Absence of menstrual cycles

Answer

Distortion of body image

Answer

Body weight < 85% of the predicted

Question 9

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

Accepted Answer

Bulimia nervosa

Answer

Anorexia nervosa

Answer

Obesity

Answer

Metabolic syndrome

Question 10

Anorexia nervosa is an eating disorder characterized by all of the following EXCEPT:

Accepted Answer

Menorrhagia

Answer

Salivary gland enlargement

Answer

Acrocyanosis

Answer

Bradycardia

Eating Disorders — MCQs

Eating Disorders — MCQs

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