Previous year question on anorexia based on neet pg, usmle, plab and fmge or mci screening exams

A 40 year old man presents with anorexia, nausea, vomiting,
abdominal pain and bone pains.
Assertion: Characteristic X-ray feature of this condition is subperiosteal resorption of the phalanges.
Reason: There is increased release of calcium from bone secondary to stimulation of osteoclastic resorption.
A: Both Assertion and Reason are true, and Reason is the correct explanation for Assertion
B:
Both Assertion and Reason are true, and Reason is not the
correct explanation for Assertion
C: Assertion is true, but Reason is false
D: Assertion is false, but Reason is true
Correct Ans:A
Explanation
This patient is showing features of hyperparathyroidism. Increased level of parathyroid hormone acts on the bone to
release calcium into the extracellular fluid by stimulating osteoclastic resorption. Subperiosteal resorption of
phalanges is a diagnostic f eature of hyperparathyroidism.
Ref: Essentials Orthopedics By J Maheswari, 3rd Edition, Page 266.
Sample Previous Year Question on Anorexia based on previous Year Questions
of NEET PG, USMLE,PLAB,FMGE (MCI Screening). Please visit
www.medicoapps.org for more such Quizzes
Which of the following condition is best treated with bright light therapy?
A: Schizophrenia
B: Anorexia nervosa
C: Seasonal affective disorder
D: Obsessive compulsive disorder
Correct Ans:C
Explanation
Bright light treatment is effective in the treatment of seasonal affective disorder. It also responds to SSRIs.
Seasonal affective disorder is a depressive disorder in which patients experience depressive episodes, which begin in
fall or winter and remit in spring. It is more common in higher latitudes and among younger people, particularly in
females. It is characterized clinically by hypersomnia, anergia, and a craving for sweets.

Ref: Current Diagnosis & Treatment: Psychiatry, 2e chapter 18; Kaplan & Sadock's Comprehensive Textbook of
Psychiatry, 9th edition, page 3671 - 6.
All of the following may be seen in anorexia nervosa, EXCEPT:
A: Self-induced vomiting after meals
B:
Absence of menstrual
cycles
C: Distortion of body image
D: Body weight < 85% of the predicted
Correct Ans:A
Explanation
Self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise are
characteristic of bulimia nervosa.
DSM-IV-TR Diagnostic Criteria:
 Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g.,
weight loss leading to maintenance of body weight less than 85% of that expected; or failure to
make expected weight gain during a period of growth, leading to body weight less than 85% of
that expected).
 Intense fear of gaining weight or becoming fat, even though underweight.
 Disturbance in the way in which one's body weight or shape is experienced, undue influence of
body weight or shape on self -evaluation, or denial of the seriousness of the current low body
weight.
 In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual
cycles.
Ref: Gwirtsman H.E., Mitchell J.E., Ebert M.H. (2008). Chapter
26. Eating Disorders. InEbert M.H., Loosen P.T., Nurcombe B,
Leckman J.F. (Eds), CURRENT Diagnosis & Treatment:
Psychiatry, 2e.

A young lady presented with repeated episodes of overeating followed by purging by the use of laxatives. She is
probably suffering from which of the following disorder?
A: Schizophrenia
B: Bulimia nervosa
C: Anorexia nervosa
D: Binge eating disorder
Correct Ans:B
Explanation
Bulimia nervosa is an eating disorder in which the patient consumes large amount of food (Binges) following which
they try to vomit it out (Purging). They also may use laxatives to purge it out. This disorder is commonly found in
females.
Ref: Harrison’s Principles of Internal M edicine, 18th Edition, C hapter 79
A medical student of normal body weight comes with parotid abscess and dental caries. She gets irritated on
enquiring about her eating habits. What is the most probable diagnosis?
A: Adjustment disorder
B: Bulimia
C: Anorexia Nervosa
D: Conversion reaction
Correct Ans:B
Explanation
Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder.
Bulimia nervosa is characterized by recurrent and frequent episodes of eating unusually large amounts of food and
feeling a lack of control over these episodes. This binge-eating is followed by behavior that compensates for the
overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a
combination of these behaviors.
Anorexia nervosa is characterized by emaciation, a relentless pursuit of thinness and unwillingness to maintain a
normal or healthy weight, intense fear of gaining weight, distorted body image, a self -esteem that is heavily
influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight, lack of
menstruation among girls and women, extremely restricted eating.
With binge-eating disorder a person loses control over his or her eating. Unlike bulimia nervosa, periods of binge-

eating are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorder often
are over-weight or obese.
Adjustment disorder occurs when an individual is unable to adjust to or cope with a particular stressor, like a major
life event.
Conversion disorder is where patients suffer from apparently neurological symptoms, such
as numbness, blindness, paralysis, or fits, but without a neurological cause.
A young lady presents with repeated episodes of excessive eating followed by purging by use of laxatives. What is she
suffering from?
A: Bulimia nervosa
B:
Binge
eating
C: Schizophrenia
D: Anorexia nervosa
Correct Ans:A
Explanation
This patient is suffering from purging type of bulimia nervosa. In this, patients engages in binge eating followed by
engaging in self induced vomiting, misuse of laxatives, diuretics, enemas, or other medications, fasting or excessive
exercise as compensatory behaviour to prevent weight gain.
For diagnosing this condition, the binge eating and inappropriate compensatory behaviors should both occur at least
twice a week for 3 months.
In non purging type of Bulimia nervosa, patients uses fasting or excessive excercise as compensatory behaviors.
Co morbidities of Bulimia Nervosa are:
 Mood disorder (24-88%)
 Anxiety (2-3%)
 OCD (3-80%)
 Substance abuse (9-55%)
 Personality disorders
Ref: CURRENT Diagnosis & Treatment: Psychiatry, 2nd Edition, Chapter 26

A 20 year old female presents with complaints of excessive eating followed by purging using laxatives. What is she
MOST likely suffering from?
A: Bulimia nervosa
B: Anorexia nervosa
C: Binge eating disorder
D: Schizophrenia
Correct Ans:A
Explanation
This patient is showing features of Bulimia nervosa. This condition usually begins in the late adolescence or early
adulthood. These patients have increased hunger and they overeat and in order to prevent weight gain they either
induce vomiting or use laxatives as compensatory methods. These patients place an unusual emphasis on weight and
shape as a basis for their self -esteem. Many of them have mild symptoms of depression.
Binge eating disorder is characterized by frequent episodes of eating unusually large amounts of food accompanied by
feeling loss of control. They do not frequently engage in appropriate behavior to compensate for binge eating. People
with binge eating disorder have higher rates of anxiety, depression, and health care use.
Ref: Walsh B.T., Attia E. (2012). Chapter 79. Eating Disorders.
A28 year old female weighs 35 kg. She is hesitated to take food telling that she is already fatty. On further evaluation,
diagnosis of anorexia nervosa is made. The following symptoms are common in anorexia nervosa, EXCEPT:
A: Weight loss
B: Hypothermia
C: Mood changes
D: Menorrhagia
Correct Ans:D
Explanation
Amenorrhea is seen in anorexia nervosa. It may precede the onset of appreciable diminished weight, because it may
be related to the loss of body fat stores rather than decrease of body mass. Menarche may be delayed in prepubertal
females.
Physical findings in anorexia nervosa:
 Emaciation
 Hypotension
 Bradycardia
 Hypothermia

 Skin dryness and flakiness
 Lanugo
 Peripheral edema
 Petechiae on extremities
 Sallow complexion
 Salivary gland hypertrophy
 Dental enamel erosion
 Osteoporosis
 Russell's sign
 Scars and calluses on the back of the hand
 Amenorrhea
 Mood changes
Ref: Gwirtsman H.E., Mitchell J.E., Ebert M.H. (2008). Chapter
26. Eating Disorders. In M.H. Ebert, P.T. Loosen, B.
Nurcombe, J.F. Leckman (Eds), CURRENT Diagnosis &
Treatment: Psychiatry, 2e.
A 30-year-old woman presents with symptoms of jaundice, right upper quadrant
pain, anorexia and clay stools. She also has elevated ALT. Few other adults in
her family are also infected. What should be done to protect the remaining
family members?
A: No treatment is necessary
B: One dose of IM HAV immunoglobulin
C: Alpha Interferon
D: Vaccinations should be administered at 0, 6, and 12 months
Correct Ans:B
Explanation
HAV immunoglobulin should be given to household contacts in one IM dose. This
must be done within 14 days of exposure to the index patient as prophylaxis
against hepatitis A.
Series of three vaccinations at time 0, 1, and 6 months, is the immunization
schedule for hepatitis B, not hepatitis A.
Alpha-Interferon is used to treat symptomatic patients with HBV and HCV, not
prophylaxis of family members of patients with HAV.

Ref: Ray C.G., Ryan K.J. (2010). Chapter 13. Hepatitis Viruses. In C.G. Ray,
K.J. Ryan (Eds), Sherris Medical Microbiology, 5e.
A pregnant lady from north east India presents for prenatal care. Her past
medical history is significant for a severe illness 3 years ago characterized by
fatigue, nausea, anorexia, vomiting, jaundice, joint pains, and generalized skin
lesions that slowly disappeared. She has felt well recently. Which of the following
laboratory tests should be ordered to investigate the patient's past illness?
A: Hepatitis B surface antigen (HBsAg)
B: IgG cytomegalovirus (CMV) antibody levels
C: IgM antibody to HBsAg
D: IgM antibody to hepatitis B core antigen
Correct Ans:A
Explanation
The clinical signs suggest that this woman had hepatitis B three years ago and
the fact that she is now feeling better also suggests that she recovered from this
infection. Since she is pregnant, it is necessary to find out if she still has the
organism in her liver (chronic hepatitis B infection) by performing a test for
HBsAg. This test will be negative if she has completely recovered from the
disease, but it would be positive if she is a chronic carrier.
The clinical signs of the disease she had 3 years ago do not match those of CMV
(2nd Choice), and CMV does not produce chronic infections.
Measurement of IgM antibody to hepatitis B core antigen (4th Choice) would be
of no value at this time. This antibody is positive in acute cases of hepatitis B, but
would no longer be positive in this case. Measurement of IgM anti-hepatitis B
core antigen is one of the most important tests in the hepatitis profile because the
appearance of the antibody correlates with the disappearance of HBsAg.

Examination of IgM antibody to HBsAg (3rd Choice) would be of no value at this
time. This IgM antibody would be formed early during the recovery from acute
hepatitis B, and would class switch to IgG later on in the disease.
A 32 year old man presents with a 3-month history of weight loss, night sweats, a
productive cough with blood-tinged sputum, anorexia, general malaise, and a low
grade fever. A PPD skin test shows > 10 mm of induration. If the area of
induration were biopsied, which of the following type of reactive cells would be
found?
A: B lymphocyte
B:
Eosinophi
l
C: Mast
D: T lymphocyte
Correct Ans:D
Explanation
The CD4+ population of T lymphocytes, specifically TH1 cells, are responsible
for the delayed hypersensitivity reaction seen with a skin test in a previously
sensitized patient. The clinical pattern in the test question is classic for
reactivation or adult-type tuberculosis. B lymphocytes are involved in humoral
immune reactions. Antibody production is not a feature of tuberculin
hypersensitivity.
Eosinophils are important in type I hypersensitivity reactions and in immune
mediated responses to parasitic infections (ADCC). They are not associated with
tuberculin hypersensitivity.
Mast cells are tissue cells which are involved in type I hypersensitivity reactions.
They have surface receptors for the Fc fragment of the IgE molecule.

A 1 week old female infant with symptoms of vomiting and anorexia has a
temperature of 102° F. A bulging fontanel is noted on physical examination. The
most likely agent is?
A: Haemophilus influenzae type b
B:
Listeria
monocytogenes
C: Neisseria meningitidis
D: Streptococcus agalactiae
Correct Ans:D
Explanation
Vomiting, anorexia, high fever (above 100.4° F), and a bulging fontanel equals
neonatal meningitis until proven otherwise. Streptococcus agalactiae (group B
strep) and Escherichia coli (not an answer choice) are the most common causes
in neonates up to 1 month of age. The next most reasonable response would have
been Listeria monocytogenes, another, though less common, cause of neonatal
meningitis.
Most cases of meningitis caused by Haemophilus influenzae occur in children
between 6 months and 6 years of age, 90% of which result from the capsular type
b strain. It has become much less prevalent since the H. influenzae type b
conjugate vaccine has been routinely administered to infants.
Neisseria meningitidis is the most common cause of epidemic meningitis. The two
organisms most often associated with sporadic cases are Haemophilus influenzae
and Streptococcus pneumoniae (the most common cause in adults over 30).
Ref: Ray C.G., Ryan K.J. (2010). Chapter 25. Streptococci and Enterococci. In
C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e.

Which of the following is not an extra ocular manifestation of vitamin A deficiency:
A: Anorexia
B: Growth retardation
C: Follicular hyperkeratosis
D: None of the above
Correct Ans:D
Explanation
Extra ocular manifestations of vitamin A deficiency include anorexia, growth retardation and follicular hyperkeratosis.
Ref: Park 22nd edition, page 570
Excess intake of retinol causes:
A: Nausea
B: Hepatomegaly
C: Anorexia
D: All of the above
Correct Ans:D
Explanation
An excess intake of retinol causes nausea, vomiting, anorexia and sleep disorders followed by skin desquamation and
then an enlarged liver and papillar edema.
Ref: Park 22nd edition, page 571
A 35-year-old woman is evaluated for jaundice in an emergency department. For several days, the patient has had
mild flu-like symptoms of anorexia, nausea and vomiting, fatigue, low-grade fever, and malaise. This morning, she
noted that her urine was brown in color, and she has also developed moderate, steady, pain of the right upper
quadrant of her abdomen. She has not had any similar episodes in the past. On physical examination, the patient is
noted to be jaundiced and to have an enlarged, tender liver. Blood chemistry studies are notable for alanine
aminotransferase (ALT) of 15,000 mIU/L, aspartate aminotransferase (AST) of 11,000 mIU/L, and alkaline
phosphatase of 100 U/L. Which of the following is the most likely diagnosis?
A: Acute hepatitis
B: Chronic hepatitis

C: Gallstone disease
D:
Hepatic
cirrhosis
Correct Ans:A
Explanation
This person's markedly elevated AST and ALT with modest elevation of alkaline phosphatase strongly suggests that
she has acute hepatitis. The clinical presentation with flu-like symptoms that progress to jaundice is also typical.
Chronic hepatitis and cirrhosis would present more insidiously and would not have the extremely high elevations of
AST and ALT.
Gallstone disease can cause acute abdominal pain, and occasionally jaundice (if a small stone occludes the common
bile duct), but would not usually cause the very high elevations of AST and ALT seen in this patient.
A patient presents to the clinic with severe pain in the right lower quadrant, anorexia and vomiting. Which of the
following is not a sign of appendicitis?
A: Rovsing's sign
B:
Murphy's
sign
C: Obturator sign
D: Psoas sign
Correct Ans:B
Explanation
Rovsing’s sign, Obturator sign and Psoas sign are seen in appendicitis. Positive Murphy’s sign is seen in acute
cholecystitis. It is an ultrasonographic sign in which there is an area of maximum tenderness directly under the probe.
Rovsing’s sign refers to pain in the right lower quadrant when palpatory pressure is exerted in the left lower
quadrant.
Obturator sign refers to presence of hypogastric pain on stretching the obturator internus due to its irritation in the
pelvis. This test is performed by passive internal rotation of the flexed right thigh with the patient supine.
Psoas sign is positive in retrocecal appendicitis. In this, irritation of the of the psoas muscle gives rise to pain when
the patient’s right thigh is extended from the flexed position.
Ref: Abdominal Ultrasound By Mike Stocksle, page 77 ; Schwartz's Principles of Surgery, 9e, chapter 30

Which of the following is NOT a finding within 24 hrs of starvation in a 19-year-old patient with Anorexia Nervosa?
A: Increase in free fatty acids
B:
Increase in ketone
bodies
C: Decrease in glycogen
D: Decrease in serum proteins
Correct Ans:D
Explanation
Proteins are the last reservoir during starvation. It will not be utilized within 12-24 hours of starvation.
Ref: Marks' Basic Medical Biochemistry: A Clinical Approach By Michael A. Lieberman, Allan Marks, 2008, Page 35
Which of the following conditions are associated with osteoporosis?
A: Cushing’s syndrome
B:
Anorexia
nervosa
C: Acromegaly
D: All the above
Correct Ans:D
Explanation
Cushing's syndrome, anorexia nervosa and acromegaly are
all associated with osteoporosis. Other endocrine disorders
associated with osteoprosis are hyperparathyroidism,
thyrotoxicosis, type 1 diabetes and adrenal insufficiency.

Which of the following is not a common feature of Anorexia Nervosa?
A:
Binge
eating
B: Amennorhea
C: Self perception of being fat
D: Underweight
Correct Ans:A
Explanation
Though all the features mentioned above are associated with anorexia nervosa, binge eating is seen in only one-
quarter to one- half of the patients. Binge eating is not a essential criteria to diagnose anorexia nervosa. Binge eating
is a definite feature of bulimia nervosa.
So the single best answer of choice is ‘Binge eating’.
Ref: Harrisons Principles of Internal Medicine, 16th Edition, Page 430-32.
An 18 year old college girl, Minu, has been on a diet for the last 6 months as she is over concerned about putting on
weight. She gives a history of frequent vomiting and over-exercising. She was emasciated with a BMI of 13.3.
However she was not really bothered about her weight loss. She was taken to a young physician by her parents and
he diagnosed her with anorexia nervosa. She was admitted to the ward for refeeding with diet which is rich in protein
and calories. What will be the dangerous adverse effect of this type of re-feeding?
A: Metabolic acidosis
B: Osmotic disequilibrium
C: Hypomagnesemia and renal tubular toxicity
D: Hypophosphatemia and cardiorespiratory failure
Correct Ans:D
Explanation
Aggresive replenision of nutritional support will lead to re-feeding syndrome. It is a serious and fatal condition which
leads to hypophophatemia and cardiorespiratory failure.
Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 606.

A patient suffering from anorexia nervosa is diagnosed to have euthyroid sick syndrome. Which of the following lab
values correctly correlate with this thyroid condition?
A: Normal T3, Normal T4, Normal rT3, High TSH
B:
Normal T3, Normal T4, Low rT3, Normal
TSH
C: Low T3, Low T4, Normal rT3, High TSH
D: Low T3, Low T4, increased rT3, Normal TSH
Correct Ans:D
Explanation
Euthyroid sick syndrome is a clinical condition in which patients suffering from nonthyroid diseases show biochemical
evidence of altered thyroid function, but appear euthyroid when examined clinically. On examination they have
normal or low T3, Low T4, increased rT3, Normal TSH and normal scintigraphic imaging.
This alteration in hormone level is due to increase in type III deiodinase activity and can also be due to impaired
conversion of T4 to T3. This condition can be precipitated by stress, anorexia nervosa, fasting, trauma etc.
Ref: Molina P.E. (2010). Chapter 4. Thyroid Gland. In P.E. Molina (Ed), Endocrine Physiology, 3e.

Previous year question on anorexia based on neet pg, usmle, plab and fmge or mci screening exams

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Previous year question on anorexia based on neet pg, usmle, plab and fmge or mci screening exams