ANOREXIA NERVOSA

Ans:A-Female: male ratio is 2:1 

Anorexia nervosa — is an eating disorder characterized by an abnormally low body weight, an intense fear of gaining weight and a distorted perception of weight.

People with anorexia place a high value on controlling their weight and shape, using extreme efforts that tend to significantly interfere with their lives.

Epidemiology

• It occurs 10 to 20 times more often in females than in males
• Most common age of onset is between 14 and 18 years

Complications

• Cachexia
• Cardiac arrhythmias
• Delayed gastric emptying, bloating, constipation, abdominal pain
• Amenorrhea
• Leukopenia
• Lanugo (fine baby-like hair over body), edema
• Abnormal taste sensation (zinc deficiency)
• Osteoporosis
• Electrolyte abnormalities, particularly hypokalemic, hypochloremic alkalosis; hypomagnesemia
• Erosion of dental enamel
• Seizures (related to large fluid shifts and electrolyte disturbances)

Ans:C.)Self Induced Vomitting.

ANOREXIA NERVOSA

• This disorder is characterized by self imposed dietary restrictions leading to malnutrition and severe weight loss.

Clinical features

• Females are far more commonly affected than males. Onset usually occurs between the age of 10-30 years, usually in mid adolescence. A deliberate and persistent restriction of food is usually the earliest presenting symptom. There is intense fear of becoming of obese, even if body becomes very thin and underweight.
• There is a body-image disturbance. 
• Patients with anorexia nervosa exhibit peculiar behavior about food. They hide food all over the house, frequently carry large quantities of candies in their pockets and purses. They try to dispose of food in their napkins or hide in their pockets, while eating meals. 
• There is significant weight loss and patient is underweight.
• Amenorrhea is seen in almost all women and loss of libido may occur in male patients. 
• Obsessive compulsive neurosis, depression and anxiety like psychiatric illness may coexist.
• Complications of malnutrition may occur, e.g., hypoglycemia, hypothermia, low BP, bradycardia, leucopenia, endocrine changes (raised GH and Cortisol, reduced gonadotrophin), and appearance of lanugo hair.

Bulimia 

• It is characterized by a cycle of dieting, binge-eating and compensatory purging behavior to prevent weight gain.
• Purging behavior includes vomiting, diuretic or laxative abuse.

Self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise are characteristic of bulimia nervosa.

• 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.

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.

Ans:A-Binge eating

• Anorexia nervosa  — is an eating disorder characterized by an abnormally low body weight, an intense fear of gaining weight and a distorted perception of weight.
• People with anorexia place a high value on controlling their weight and shape, using extreme efforts that tend to significantly interfere with their lives.
• To prevent weight gain or to continue losing weight, people with anorexia usually severely restrict the amount of food they eat.
• They may control calorie intake by vomiting after eating or by misusing laxatives, diet aids, diuretics or enemas.
• They may also try to lose weight by exercising excessively. No matter how much weight is lost, the person continues to fear weight gain.
• Physicsl signs include abnormal blood counts

D. i.e. Peculiar patterns of food handeling

• Both anorexia nervosa and bulimia are characterized by an overvalued drive for thinness and a disturbance in eating behavior.
• The main difference between diagnoses is that anorexia nervosa is a syndrome of self-starvation involving significant weight loss of 15 percent or more of ideal body weight, whereas patients with bulimia nervosa are, by definition, at normal weight or above.
• Bulimia is characterized by a cycle of dieting, binge-eating and compensatory purging behavior to prevent weight gain.
• Purging behavior includes vomiting, diuretic or laxative abuse.
• Excessive exercise aimed at weight loss or at preventing weight gain is common in both anorexia nervosa and in bulimia.

D. i.e. Menorrhagia

Ans:D-Decreased appetite.

Anorexia nervosa — is an eating disorder characterized by an abnormally low body weight, an intense fear of gaining weight and a distorted perception of weight.

Physical signs and symptoms of anorexia may include:

• Extreme weight loss or not making expected developmental weight gains
• Thin appearance
• Abnormal blood counts
• Fatigue
• Insomnia
• Dizziness or fainting
• Bluish discoloration of the fingers
• Hair that thins, breaks or falls out
• Soft, downy hair covering the body
• Absence of menstruation
• Constipation and abdominal pain
• Dry or yellowish skin
• Intolerance of cold
• Irregular heart rhythms
• Low blood pressure
• Dehydration
• Swelling of arms or legs
• Eroded teeth and calluses on the knuckles from induced vomiting

Ans.is C (Amenorrhea is rare):

• Anorexia nervosa often referred to simply as anorexia, is an eating disorder, characterized by low weight, food restriction, fear of gaining weight, and a strong desire to be thin.
• Complications may include osteoporosis, infertility, and heart damage, among others. Women will often stop having menstrual periods.
• Amenorrhea is associated with almost a hundred percent of cases of Anorexia Nervosa.

Ans: A i.e. Menorrhagia

Anorexia nervosa

• Signs and symptoms of anorexia include amenorrhoea, bradycardia, hypothermia, constipation etc.
• Laboratory markers of anorexia includes decreased FSH, LH and T, and increased Cortisol
• Bulimia (binging and purging with vomiting, laxatives, or diuretics) may be seen in 50% of patients

Ans. B i.e. Weight

• Both anorexia nervosa and bulimia are characterized by an overvalued drive for thinness and a disturbance in eating behavior.
• The main difference between diagnoses is that anorexia nervosa is a syndrome of self-starvation involving significant weight loss of 15 percent or more of ideal body weight, whereas patients with bulimia nervosa are, by definition, at normal weight or above.
• Bulimia is characterized by a cycle of dieting, binge-eating and compensatory purging behavior to prevent weight gain.
• Purging behavior includes vomiting, diuretic or laxative abuse.
• Excessive exercise aimed at weight loss or at preventing weight gain is common in both anorexia nervosa and in bulimia.

Ans. D: Menorrhagia

*  Excessive weight loss

*  Scanty or absent menstrual periods

*  Thinning hair

– Dry skin

* Cold ors wollen hands and feet
Bloated or upset stomach

* Downy hair covering the body Low blood pressure

* Fatigue

* Abnormal heart rhythms

*Osteoporosis

Psychological and Behavioral Signs in anorexia nervosa

*  Distorted perception of self (insisting they are overweight when they are thin)

*  Being preoccupied with food Refusing to eat

*  Inability to remember things

*  Refusing to acknowledge the seriousness of the illness

Obsessive-compulsive behavior

*  Depression

• Anorexia nervosa is less common in male, but can be seen.
• There is binge eating and self induced vomiting.

“Amenorrhea often precedes severe weight loss” – Essentials of psychiatry

ANOREXIA NERVOSA

• The term ‘`anorexia nervosa” is a misnomer as loss of appetite is a rare symptom. This disorder is characterized by self imposed dietary restrictions leading to malnutrition and severe weight loss.

Clinical features

• Females are far more commonly affected than males. Onset usually occurs between the age of 10-30 years, usually in mid adolescence. A deliberate and persistent restriction of food is usually the earliest presenting symptom. There is intense fear of becoming of obese, even if body becomes very thin and underweight.
• There is a body-image disturbance. The person is unable to perceive the body size accurately.
• Some patients cannot continuously control their voluntary restriction of food intake and So have eating binges. These binges usually occur secretly and often at night and are frequently followed by self-induced vomiting. Patients abuse laxatives and even diuretics to lose weight, and ritualistic exercising, extensive cycling, walking, jogging and running are common activities.
• Patients with anorexia nervosa exhibit peculiar behavior about food. They hide food all over the house, frequently carry large quantities of candies in their pockets and purses. They try to dispose of food in their napkins or hide in their pockets, while eating meals. They cut their meat into very small pieces and spend a great deal of time rearranging the pieces on their plates.
• There is significant weight loss and patient is underweight.
• Amenorrhea is seen in almost all women and loss of libido may occur in male patients. There may be poor sexual adjustment.
• Obsessive compulsive neurosis, depression and anxiety like psychiatric illness may coexist.
• Complications of malnutrition may occur, e.g., hypoglycemia, hypothermia, low BP, bradycardia, leucopenia, endocrine changes (raised GH and Cortisol, reduced gonadotrophin), and appearance of lanugo hair.         
  

Ans. B. Hallucination

PSYCHOLOGICAL SYMPTOMS:

• Distorted Body Image.

EMOTIONAL:

• Mood swings.
• Increased commitment to work.
• BEHAVIORAL -Excessive exercise, starvation.
• PHYSICAL: Extreme weight loss and stunted growth, amenorrhea, nipple discharge, dehydration, hypothermia, osteoporosis.