Eating Disorders Practice Questions

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**.

Q: A 15-year-old girl has been losing weight and exercising vigorously. She feels overweight and wants to lose more weight. On examination, she is thin with muscle wasting. Which of the following physical signs is also suggestive of the diagnosis?

Salivary gland enlargement. **Explanation:** The clinical presentation of a 15-year-old girl with weight loss, vigorous exercise, and a distorted body image (feeling overweight despite being thin) is highly suggestive of **Anorexia Nervosa**. [1] **Why Salivary Gland Enlargement is Correct:** In patients with eating disorders, particularly those who engage in self-induced vomiting (purging subtype), **bilateral painless enlargement of the parotid glands (Sialadenosis)** is a classic physical sign. This occurs due to hypertrophy of the acinar cells, likely triggered by repeated stimulation of the autonomic nervous system during vomiting or nutritional deficiencies. **Analysis of Incorrect Options:** * **B. Coarse body hair:** Patients with anorexia nervosa typically develop **Lanugo hair**—fine, downy, soft hair on the back and arms—as a physiological response to conserve body heat in the absence of insulating fat. Coarse hair is more characteristic of hypothyroidism or PCOS. * **C. Diarrhea:** Anorexia is associated with slowed gastrointestinal motility and decreased intake, leading to **constipation**, not diarrhea. [2] * **D. Tachycardia:** Malnutrition and starvation lead to a hypometabolic state and increased vagal tone, resulting in **bradycardia** and hypotension. [2] Tachycardia would be an unusual finding unless the patient is severely dehydrated or in heart failure. **NEET-PG High-Yield Pearls:** * **Russell’s Sign:** Calluses or scars on the knuckles from self-induced vomiting. * **Electrolyte Abnormalities:** Hypokalemic hypochloremic metabolic alkalosis (due to vomiting). * **Endocrine Profile:** Low FSH, LH, and Estrogen (leading to amenorrhea); "Sick Euthyroid" syndrome (low T3); and elevated Cortisol levels. * **Most common cause of death:** Cardiac arrhythmias (due to electrolyte imbalance) or suicide.

Q: Binge eating disorder is characterized by?

Obesity. **Explanation:** **Binge Eating Disorder (BED)** is characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort) accompanied by a feeling of a loss of control. Unlike Bulimia Nervosa, BED is **not** associated with regular compensatory behaviors (purging). 1. **Why Obesity is Correct:** Because there are no compensatory mechanisms (like vomiting or excessive exercise) to offset the high caloric intake during binge episodes, most individuals with BED are **overweight or obese**. It is the most common eating disorder associated with metabolic syndrome and obesity-related comorbidities. 2. **Why Other Options are Incorrect:** * **Normal weight:** While possible in early stages, it is more characteristic of **Bulimia Nervosa** (where purging maintains weight) or Binge-Eating/Purging type of Anorexia. * **Weight loss:** This is the hallmark of **Anorexia Nervosa**. In BED, the positive energy balance leads to weight gain. * **Self-induced vomiting:** This is a compensatory "purging" behavior. Its presence would shift the diagnosis to **Bulimia Nervosa**. **High-Yield Clinical Pearls for NEET-PG:** * **DSM-5 Criteria:** Binge episodes must occur, on average, at least **once a week for 3 months**. * **Key Distinction:** BED = Binging + No Purging + Obesity; Bulimia = Binging + Purging + Normal Weight. * **Drug of Choice:** **Lisdexamfetamine** is the only FDA-approved medication for BED. SSRIs (like Fluoxetine) are also used to manage associated impulsivity and depression. * **Psychotherapy:** Cognitive Behavioral Therapy (CBT) is the first-line psychological treatment.

Q: Bulimia nervosa is associated with which of the following?

Impulsive behaviour. **Explanation:** **Bulimia Nervosa (BN)** is characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors (purging, fasting, or excessive exercise). **Why Option A is Correct:** Patients with Bulimia Nervosa frequently exhibit **impulsive behavior** and poor impulse control. This is a high-yield association often tested in NEET-PG. BN is frequently comorbid with **Cluster B personality disorders** (especially Borderline Personality Disorder), substance abuse, self-harm, and shoplifting. Unlike Anorexia Nervosa (associated with high inhibitory control and perfectionism), Bulimia represents a "dyscontrol" pathology. **Why Other Options are Incorrect:** * **B. Obesity:** While patients with Binge Eating Disorder (BED) are often obese, patients with Bulimia Nervosa are typically of **normal weight or slightly overweight**. * **C. Metabolic Syndrome:** This is a complication of obesity and sedentary lifestyle, more commonly associated with BED or side effects of second-generation antipsychotics, rather than the purging cycles of BN. * **D. Amenorrhea:** This is a classic hallmark of **Anorexia Nervosa** (due to hypothalamic-pituitary-ovarian axis suppression from low body weight). In Bulimia, menstrual cycles are usually preserved, though they may be irregular. **High-Yield Clinical Pearls for NEET-PG:** * **Russell’s Sign:** Calluses on the knuckles from self-induced vomiting. * **Electrolyte Imbalance:** Hypokalemic hypochloremic metabolic alkalosis is the most common finding due to vomiting. * **Drug of Choice:** **Fluoxetine** (SSRI) is the only FDA-approved medication for BN (at a higher dose of 60mg). * **Contraindication:** **Bupropion** is strictly contraindicated in Bulimia due to an increased risk of seizures.

Q: Need for thinness despite being lean is a feature of which condition?

Anorexia nervosa. **Explanation:** The core psychopathology of **Anorexia Nervosa (AN)** is a morbid fear of obesity and a distorted body image. Patients maintain a relentless pursuit of thinness and a refusal to maintain a minimally normal body weight, even when they are significantly underweight or emaciated. This "need for thinness despite being lean" is the hallmark of the disorder, often accompanied by a "body image disturbance" where the patient perceives themselves as fat despite objective evidence to the contrary. **Analysis of Options:** * **Bulimia Nervosa:** While these patients are also over-concerned with weight and shape, they typically maintain a **normal or slightly above-normal weight**. The condition is characterized by binge eating followed by compensatory behaviors (purging). * **Metabolic Syndrome:** This is a cluster of physical conditions (hypertension, high blood sugar, excess body fat around the waist) that increase the risk of heart disease and stroke; it has no primary psychiatric component related to the "need for thinness." * **Binge Eating Disorder:** Patients experience episodes of losing control over eating but, unlike Bulimia, they do not engage in compensatory behaviors. These patients are often **overweight or obese** and do not typically exhibit the drive for thinness seen in AN. **High-Yield Clinical Pearls for NEET-PG:** * **DSM-5 Criteria for AN:** 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. * **Subtypes:** Restricting type and Binge-eating/purging type. * **Physical Signs:** Lanugo hair, bradycardia, hypotension, and amenorrhea (though amenorrhea is no longer a mandatory criterion in DSM-5). * **Russell’s Sign:** Calluses on the knuckles (seen in the purging subtype of AN and Bulimia).

Q: All of the following are features of Anorexia Nervosa except?

Amenorrhea is rare. **Explanation:** **Anorexia Nervosa (AN)** is a psychiatric disorder characterized by an intense fear of gaining weight, a distorted body image, and self-imposed starvation leading to significantly low body weight. **Why "Amenorrhea is rare" is the correct answer:** In the ICD-10 criteria for Anorexia Nervosa, **amenorrhea** (absence of at least three consecutive menstrual cycles) was a hallmark diagnostic feature in post-pubertal females. It occurs due to hypothalamic-pituitary-gonadal axis dysfunction triggered by low body fat and emotional stress. While DSM-5 removed amenorrhea as a mandatory diagnostic criterion to include males and those on contraceptives, it remains a **very common** clinical finding, not a rare one. **Analysis of other options:** * **A. Predominantly seen in females:** This is correct. The female-to-male ratio is approximately 10:1. * **B. Body Mass Index (BMI) is higher than normal:** This is **incorrect** (making the question technically have two false statements, but "Amenorrhea is rare" is the classic "except" choice in standard medical exams). In AN, BMI is characteristically **low** (typically <17.5 kg/m²). * **D. Malabsorption Syndrome:** While not the *cause* of AN, it is often a differential diagnosis. However, the question likely implies that the weight loss is due to voluntary restriction, not primary malabsorption. **NEET-PG High-Yield Pearls:** 1. **Two Types:** Restricting type and Binge-eating/purging type. 2. **Lanugo hair:** Fine, downy hair found on the body is a classic physical sign. 3. **Refeeding Syndrome:** The most dangerous complication during treatment, characterized by **Hypophosphatemia**. 4. **Russell’s Sign:** Calluses on knuckles from self-induced vomiting (more common in Bulimia). 5. **Treatment:** Family-based therapy (Maudsley approach) is the first-line for adolescents; SSRIs (Fluoxetine) are only effective *after* weight restoration.

Q: A mother presented her daughter with complaints that she has started behaving weirdly about her food habits for the last few months. She eats a lot of burgers in one go, and then she vomits it out. Her BMI is 27. What is the most probable diagnosis?

Bulimia nervosa. ***Bulimia nervosa***- Involves recurrent episodes of **binge eating** followed by inappropriate **compensatory behaviors** (like self-induced **vomiting**, excessive exercise, or laxative use).- Unlike **anorexia nervosa**, patients with bulimia nervosa typically maintain a body weight that is normal or overweight (BMI $\geq$ 18.5), which aligns with the given BMI of 27.*Anorexia nervosa*- The primary criterion requires the patient to have a weight that is significantly low for their age and height (e.g., BMI $\leq$ 17.5 in adults).- This diagnosis is excluded because the patient's BMI is 27, placing her in the **overweight** category.*Binge eating disorder*- Characterized by recurrent episodes of **binge eating** without inappropriate use of **compensatory behaviors** (purging).- This patient engages in **vomiting** after eating, which is a compensatory behavior that rules out a diagnosis of simple binge eating disorder.*OCD*- Involves the presence of **obsessions** (recurrent, intrusive thoughts) and/or **compulsions** (repetitive behaviors) that cause significant distress.- While eating disorders can feature obsessive elements, the core presentation of binging followed by compensatory purging is specific to **bulimia nervosa**, not Obsessive-Compulsive Disorder.

Q: Indoor management of anorexia nervosa is done on priority patients with:-

Weight for height less than 75% of normal. ***Weight for height less than 75% of normal*** - A **weight for height less than 75% of normal** (or **BMI <15 kg/m²**) indicates severe **malnutrition** and a high risk of medical complications, necessitating urgent inpatient care. - This level of **underweight** is a critical indicator for hospital admission in **anorexia nervosa** to prevent severe organ dysfunction, refeeding syndrome, and even death. *Depression* - While **depression** is a common comorbidity with **anorexia nervosa** and often requires treatment, it does not, by itself, warrant immediate inpatient management unless there are acute **suicidal risks**. - **Depression** is usually managed in an outpatient setting initially, with hospitalization being reserved for severe cases where safety is compromised. *Amenorrhea* - **Amenorrhea** (absence of menstruation) is a common symptom of **anorexia nervosa** due to hormonal imbalances caused by low body weight. - Though an indicator of significant caloric restriction, **amenorrhea** alone is not typically an immediate criterion for inpatient admission unless accompanied by other severe physical complications. *Binging episodes* - While **binging episodes** can occur in **anorexia nervosa** (specifically the binge-purging subtype) and can lead to electrolyte imbalances or medical complications, they are not the primary, stand-alone trigger for immediate inpatient admission. - The severity of **binging** and associated **purging behaviors** must be evaluated in the context of overall medical stability and weight to determine the appropriate level of care.

Q: Which of the following disorders is more common in females?

Eating disorders. ***Eating disorders*** - **Eating disorders**, particularly **anorexia nervosa** and **bulimia nervosa**, are significantly more prevalent in females than in males, with female-to-male ratios ranging from **3:1 to 10:1**. - Sociocultural factors (body image expectations, media influence), biological factors (hormonal influences), and psychological vulnerabilities contribute to this **gender disparity**. - This is the **only option** in this list that is more common in females. *ADHD* - **Attention-deficit/hyperactivity disorder (ADHD)** is diagnosed more frequently in **males** than in females, with a male-to-female ratio of approximately **2:1 to 3:1** in childhood. - Although females with ADHD may present with more inattentive symptoms (which can be underdiagnosed), the overall prevalence remains higher in males. *Conduct disorder* - **Conduct disorder** is substantially more common in **males**, with a male-to-female ratio typically ranging from **2:1 to 4:1**. - Males tend to exhibit more overtly aggressive behaviors (physical aggression, property destruction), while females might present with more covert forms (relational aggression, rule-breaking). *Autism* - **Autism spectrum disorder (ASD)** is diagnosed more frequently in **males**, with a male-to-female ratio of approximately **4:1**. - This difference may be partly due to diagnostic biases and presentation differences, as females often present with less recognized or "camouflaged" symptoms and better social mimicry.

Question 1

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

Question 2

Which of the following indications for hospitalization is the most appropriate for patients with eating disorders?

Accepted Answer

Body weight is less than 75% of expected

Answer

Body weight is less than 90% of expected

Answer

Electrolyte disturbances occur

Answer

Body weight is less than 60% of expected

Question 3

A 15-year-old girl has been losing weight and exercising vigorously. She feels overweight and wants to lose more weight. On examination, she is thin with muscle wasting. Which of the following physical signs is also suggestive of the diagnosis?

Accepted Answer

Salivary gland enlargement

Answer

Coarse body hair

Answer

Diarrhea

Answer

Tachycardia

Question 4

Binge eating disorder is characterized by?

Accepted Answer

Obesity

Answer

Normal weight

Answer

Weight loss

Answer

Self-induced vomiting

Question 5

Bulimia nervosa is associated with which of the following?

Accepted Answer

Impulsive behaviour

Answer

Obesity

Answer

Metabolic syndrome

Answer

Amenorrhea

Question 6

Need for thinness despite being lean is a feature of which condition?

Accepted Answer

Anorexia nervosa

Answer

Bulimia nervosa

Answer

Metabolic syndrome

Answer

Binge eating disorder

Question 7

All of the following are features of Anorexia Nervosa except?

Accepted Answer

Amenorrhea is rare

Answer

Predominantly seen in females

Answer

Body Mass Index is higher than normal population

Answer

Malabsorption Syndrome is the most common cause

Question 8

A mother presented her daughter with complaints that she has started behaving weirdly about her food habits for the last few months. She eats a lot of burgers in one go, and then she vomits it out. Her BMI is 27. What is the most probable diagnosis?

Accepted Answer

Bulimia nervosa

Answer

Anorexia nervosa

Answer

OCD

Answer

Binge eating disorder

Question 9

Indoor management of anorexia nervosa is done on priority patients with:-

Accepted Answer

Weight for height less than 75% of normal

Answer

Depression

Answer

Amenorrhea

Answer

Binging episodes

Question 10

Which of the following disorders is more common in females?

Accepted Answer

Eating disorders

Answer

ADHD

Answer

Conduct disorder

Answer

Autism

Eating Disorders — MCQs

Eating Disorders — MCQs

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