Chapter _14_Eating_Disorders_

Question 1

What are the three main DSM-5 eating disorders?

Answer 1

Anorexia nervosa, bulimia nervosa, and binge-eating disorder

Question 2

What are the DSM-5 criteria for anorexia nervosa?

Answer 2

Restriction of energy intake → significantly low weight, intense fear of weight gain, disturbed body image

Question 3

Name the subtypes of anorexia nervosa.

Answer 3

Restricting type and binge-eating/purging type

Question 4

What are common physical findings in anorexia nervosa?

Answer 4

Amenorrhea, lanugo, bradycardia, hypotension, osteoporosis, alopecia, peripheral edema, seizures

Question 5

What lab abnormalities are associated with anorexia nervosa?

Answer 5

Hypokalemia, hypochloremic alkalosis, elevated cortisol, leukopenia, anemia, transaminitis, QTc prolongation

Question 6

What is refeeding syndrome?

Answer 6

Fluid and electrolyte shifts during refeeding leading to ↓phosphate, ↓Mg, ↓Ca; can cause arrhythmia, delirium, seizures

Question 7

How is anorexia nervosa treated?

Answer 7

Nutritional rehab, CBT, family therapy (Maudsley method), olanzapine for weight gain, SSRIs for comorbid depression/anxiety

Question 8

DSM-5 criteria for bulimia nervosa?

Answer 8

Recurrent binge eating + inappropriate compensatory behavior ≥1x/week for ≥3 months, excessive influence of body shape on self-image, not during anorexia

Question 9

Common physical findings in bulimia?

Answer 9

Parotid enlargement, dental erosion, Russell’s sign, esophagitis, aspiration

Question 10

Common lab abnormalities in bulimia?

Answer 10

Hypokalemic hypochloremic alkalosis, elevated amylase, hypernatremia, increased BUN

Question 11

What is the only FDA-approved medication for bulimia nervosa?

Answer 11

Fluoxetine (60–80 mg/day)

Question 12

What medications should be avoided in bulimia and why?

Answer 12

Avoid bupropion due to risk of seizures

Question 13

DSM-5 criteria for binge-eating disorder?

Answer 13

Binge episodes ≥1x/week for ≥3 months with ≥3: rapid eating, overeating, eating when not hungry, eating alone, guilt; no compensatory behaviors

Question 14

Medical complications of binge-eating disorder?

Answer 14

Obesity-related: metabolic syndrome, T2DM, cardiovascular disease

Question 15

Pharmacologic treatments for binge-eating disorder?

Answer 15

SSRIs, lisdexamfetamine (Vyvanse), topiramate, orlistat

Question 16

What is the most common comorbidity with eating disorders?

Answer 16

Mood disorders, anxiety, OCD, personality disorders, substance use

Question 17

How do anorexia and bulimia differ in weight status?

Answer 17

Anorexia: underweight; Bulimia: normal or overweight

Question 18

What personality traits are commonly associated with anorexia?

Answer 18

Obsessive-compulsive traits, perfectionism, need for control

Question 19

What is a red flag for potential eating disorder on physical exam?

Answer 19

Lanugo, bradycardia, hypotension, parotid enlargement, Russell’s sign

Question 20

What is the mortality risk in anorexia nervosa?

Answer 20

5% per decade; most common causes: starvation, suicide, cardiac arrest

Question 21

Which of the following is a DSM-5 criterion for anorexia nervosa?
A. Intense fear of gaining weight
B. Overeating without purging
C. Excessive exercise only
D. BMI > 30

Answer 21

A

Question 22

A 17-year-old female presents with amenorrhea, lanugo, and a BMI of 16. What is the most likely diagnosis?
A. Bulimia nervosa
B. Binge-eating disorder
C. Anorexia nervosa
D. Atypical depression

Answer 22

C

Question 23

Which lab abnormality is most commonly seen in patients with purging-type anorexia nervosa?
A. Hyponatremia
B. Hyperkalemia
C. Hypokalemic hypochloremic metabolic alkalosis
D. Hyperchloremic acidosis

Answer 23

C

Question 24

What medication is FDA-approved for treatment of bulimia nervosa?
A. Fluoxetine
B. Sertraline
C. Bupropion
D. Venlafaxine

Answer 24

A

Question 25

Which finding is most consistent with bulimia nervosa? A. Lanugo B. Russell’s sign C. Severe underweight D. Bradycardia

Answer 25

B

Question 26

Which eating disorder is most associated with obesity? A. Anorexia nervosa B. Binge-eating disorder C. Bulimia nervosa D. Pica

Answer 26

B

Question 27

What is the most dangerous early complication of refeeding in anorexia? A. Hypoglycemia B. Hypertension C. Refeeding syndrome (hypophosphatemia) D. Aspiration

Answer 27

C

Question 28

Which of the following is NOT a DSM-5 criterion for bulimia nervosa? A. Recurrent binge eating B. Use of inappropriate compensatory behaviors C. Binge eating ≥1x/week for 1 month D. Self-image influenced by body shape

Answer 28

C

Question 29

A patient with binge-eating disorder is most likely to present with which of the following? A. Underweight BMI B. Compensatory purging C. Feelings of guilt after bingeing D. Amenorrhea

Answer 29

C

Question 30

Which medication is associated with increased seizure risk in bulimia nervosa? A. Fluoxetine B. Sertraline C. Bupropion D. Topiramate

Answer 30

C

Question 31

Which personality trait is commonly associated with anorexia nervosa? A. Impulsivity B. Perfectionism C. Aggression D. Sociability

Answer 31

B

Question 32

Which of the following is the most accurate marker of nutritional status in anorexia nervosa? A. BMI B. Serum albumin C. Calcium D. Creatinine

Answer 32

A

Question 33

What is Russell’s sign? A. Calluses on knuckles from induced vomiting B. Hyperpigmentation in anorexia C. Hair loss in malnutrition D. Bradycardia in bulimia

Answer 33

A

Question 34

A 23-year-old female with parotid gland enlargement and dental erosions likely has: A. Anorexia nervosa B. Binge-eating disorder C. Bulimia nervosa D. ARFID

Answer 34

C

Question 35

First-line psychotherapy for eating disorders is: A. DBT B. CBT C. EMDR D. Exposure therapy

Answer 35

B

Question 36

Which disorder is associated with binge eating without compensation? A. Bulimia nervosa B. Anorexia nervosa C. Binge-eating disorder D. Pica

Answer 36

C

Question 37

Which drug is approved for moderate to severe binge-eating disorder? A. Olanzapine B. Lisdexamfetamine C. Aripiprazole D. Escitalopram

Answer 37

B

Question 38

Which of the following is NOT typical of anorexia nervosa? A. Amenorrhea B. Bradycardia C. Elevated cholesterol D. Hyperphagia

Answer 38

D

Question 39

In anorexia, osteoporosis is primarily due to: A. Vitamin D deficiency B. Hypocalcemia C. Hypoestrogenism D. Inactivity

Answer 39

C

Question 40

Which of the following signs is common to both bulimia and anorexia purging type? A. Lanugo B. Dental enamel erosion C. Extreme thinness D. Constipation

Answer 40

B

Question 41

A patient binge-eats and uses laxatives but has a normal BMI. Diagnosis? A. Anorexia nervosa, binge-purge type B. Bulimia nervosa C. Binge-eating disorder D. ARFID

Answer 41

B

Question 42

Electrolyte imbalance that can predispose to arrhythmias in purging patients is: A. Hypernatremia B. Hyperkalemia C. Hypokalemia D. Hypercalcemia

Answer 42

C

Question 43

What is the mortality rate of anorexia nervosa per decade? A. 1% B. 2% C. 5% D. 10%

Answer 43

C

Question 44

Which therapy is most effective in adolescents with anorexia? A. Group therapy B. DBT C. Maudsley family-based therapy D. Hypnotherapy

Answer 44

C

Question 45

What is a typical finding in binge-eating disorder? A. Underweight B. Nighttime awakenings for eating C. Recurrent compensatory behaviors D. Eating rapidly until uncomfortably full

Answer 45

D