Constipation, Diarrhea, and IBS Flashcards
- Which one of the following conditions is associated with constipation?
A. Hypotension
B. Diabetes mellitus
C. Hypertension
D. Chronic obstructive pulmonary disease
E. Hyperuricemia
B
- Which one of the following characteristics should prompt a patient to seek medical attention for constipation?
A. Sudden change in bowel habits after age 50
B. Presence of 4 or more bowel movements per week
C. Presence of flatulence
D. Change in dietary habits
E. Age of 7 to 12 years
A
- All of the following medications are associated with causing constipation except:
A. Ibuprofen
B. Clonidine
C. Ondansetron
D. Ferrous sulfate
E. Clindamycin
E
- Alarm factors associated with constipation include all of the following except:
A. New onset or worsening of constipation
B. Family history of colon cancer
C. Weight gain
D. Anemia
E. Blood in the stool
C
- Which one of the following oral laxatives is best to relieve constipation during pregnancy?
A. Mineral oil
B. Senna
C. Bisacodyl
D. Docusate sodium
E. Castor oil
D
- Which one of the following types of diarrhea resolves during a period of fasting?
A. Inflammatory
B. Secretory
C. Osmotic
D. Altered motility
E. None of the above
C
- The diarrhea associated with lactase deficiency may be reduced or avoided by implementing which one of the following measures?
A. Using lactose tablets with precipitating foods
B. Regular ingestion of yogurt
C. Substituting acidophilus milk for regular milk
D. Avoiding any precipitating foods
E. All of the above are correct
E
- Which one of the following treatments is preferred as fluid replacement in a 6-year-old child who is experiencing diarrhea without vomiting for the past 12 hours?
A. Gatorade
B. Mountain Dew
C. Pedialyte
D. Mineral water
E. Milk
C
- All of the conditions listed below may present with chronic diarrhea except:
A. Crohn’s disease
B. Malabsorption syndromes
C. Irritable bowel syndrome
D. Hyperthyroidism
E. All of the above conditions may present with associated chronic diarrhea
E
- In some cases of chronic diarrhea, an effective treatment may include use of which of the following?
A. Soluble fiber
B. Insoluble fiber
C. Wheat bran
D. Cheerios
E. b and c only are correct
E
- Which one of the following statements regarding irritable bowel syndrome (IBS) is false?
A. There is a significant impact on health-related quality of life
B. Work productivity is rarely affected in IBS sufferers
C. Costs to society associated with IBS are high
D. Abdominal pain and bloating affect quality of life in IBS
E. IBS affects twice as many women as men
B
- Which one of the following statements about IBS is true?
A. Bloating is identified as one of the most bothersome symptoms in patients with IBS
B. Dysregulation of the autonomic nervous system is more common in patients with mild rather than more severe left-sided cramping
C. Primary care physicians treat very few IBS patients
D. The principal outcome sought in IBS treatment is normalizing the intestine
E. Rome II and Rome III diagnostic criteria for IBS are identical
A
- Abnormal concentration and/or response to which of the following substances is thought to be an important part of the development of IBS?
A. Serotonin
B. Acetylcholine
C. Substance P
D. Secretin
E. Somatostatin
A
- Rifaximin use in IBS is best characterized by which of the following statements?
A. It is not appreciably absorbed by the gastrointestinal tract
B. It is useful for treating traveler’s diarrhea
C. It is associated with few adverse effects
D. It treats bacterial proliferation in the gut, which may be responsible for GI symptoms
E. It does not lead to bacterial resistance
D
- Which one of the following therapies is unlikely to have an effect on gut motility?
A. Cognitive behavioral therapy
B. Peppermint oil
C. Loperamide
D. Amitriptyline
E. All of the above can affect gut motility
E
- Select the predominant clinical findings or symptoms that are associated with functional constipation:
A. Fever
B. Straining during bowel movements and hard stools more for than 25% of defecations
C. Chronic opioid prescription use
D. Family history of colon cancer and unintentional weight loss of more than 10% in 3 months
B
- Which one of the following is consistent with a diagnosis of opioid-induced constipation?
A. Persistent abdominal pain and bloating associated with episodes of mixed bouts of
constipation and diarrhea
B. Intermittent passage of hard stools alternating with frequent loose stools
C. Patient perception of bowel-related stress associated with straining during defecation after increasing or initiating opioid therapy
D. Development of hemorrhoids upon change in dosage and route of administration of an opioid product
C
- A 26-year-old man presents to the clinic reporting that he is constipated. A review of his medical profile reveals that he was recently diagnosed with multiple sclerosis. Which of the following would be an appropriate primary initial pharmacologic intervention for relief of his constipation?
A. Polyethylene glycol with electrolytes
B. Linaclotide
C. Naloxegol
D. Docusate with senna
D
- A 56-year-old woman reports that she is constipated and at times has noticed bright red blood at bowel movements. She denied a history of hemorrhoids. What interventions would you recommend?
A. Take a bulk-forming laxative with adequate fluids
B. Report for medical evaluation to determine cause of bright red blood in stool
C. Take a stool softener for 7 days; if no relief, use a stimulant laxative plus stool softener
D. Exercise and include more green leafy vegetables in her diet
B
- Which one of the following is characteristic of functional diarrhea?
A. Loose or watery stools with predominant abdominal pain in more than 25% of stools
B. Loose or watery stools with predominant bloating in less than 25% of stools
C. Loose or watery stools meeting criteria for diarrhea-predominant IBS
D. Loose or watery stools without predominant abdominal pain or bothersome bloating, occurring in more than 25% of stools
D
- The evaluation of a patient with acute diarrhea should start with:
A. Description of stool form and duration of symptoms
B. Laboratory tests
C. Description of detailed family history
D. Immediate hospitalization
A
- The maximum FDA-approved prescription daily dose of loperamide is:
A. 24 mg
B. 8 mg
C. 16 mg
D. 4 mg
C
- Overuse/misuse of which one of the following agents may result in severe adverse effects including death?
A. PEG (Miralax)
B. Naloxegol (Movantik)
C. Tegaserod (Zelnorm)
D. Loperamide (Imodium, Imodium-AD)
D
- Which one of the following statements about irritable bowel syndrome (IBS) is true?
A. Abdominal pain is one of the most bothersome symptoms
B. Dysregulation of the autonomic nervous system is more common in patients with mild rather than more severe left-sided cramping
C. Primary care physicians treat very few IBS patients
D. Symptoms are present for less than 1 month
A
- Which of the following medications is indicated for treatment of IBS-C symptoms?
A. Loperamide
B. Lubiprostone
C. Linaclotide
D. Lactulose
A
A 35-year-old woman with a past
medical history of depression, hypertension, and alcohol dependency who is status-post cholecystectomy presents complaining that for years she has experienced episodic diarrhea characterized by recurring frequent loose stools, abdominal pain, and bloating. The condition is disrupting her normal daily activities and has caused her to miss work. After medical evaluation, she was diagnosed with IBS-D. Her medications include sertraline 50 mg orally once daily and hydrochlorothiazide 12.5 mg orally once daily.
- Which one of the following IBS-D medications should be avoided in this patient?
A. Loperamide
B. Rifaximin
C. Eluxadoline
D. Alosetron
C
A 35-year-old woman with a past
medical history of depression, hypertension, and alcohol dependency who is status-post cholecystectomy presents complaining that for years she has experienced episodic diarrhea characterized by recurring frequent loose stools, abdominal pain, and bloating. The condition is disrupting her normal daily activities and has caused her to miss work. After medical evaluation, she was diagnosed with IBS-D. Her medications include sertraline 50 mg orally once daily and hydrochlorothiazide 12.5 mg orally once daily.
- Which one of the following situations explains the reason for your answer to the previous question?
A. Rifaximin can reduce the antihypertensive effect of hydrochlorothiazide
B. Eluxadoline should be avoided in patients without a gallbladder
C. Loperamide can cause rebound diarrhea
D. Alosetron is contraindicated in patients who use excessive amounts of alcohol
B
A 35-year-old woman with a past
medical history of depression, hypertension, and alcohol dependency who is status-post cholecystectomy presents complaining that for years she has experienced episodic diarrhea characterized by recurring frequent loose stools, abdominal pain, and bloating. The condition is disrupting her normal daily activities and has caused her to miss work. After medical evaluation, she was diagnosed with IBS-D. Her medications include sertraline 50 mg orally once daily and hydrochlorothiazide 12.5 mg orally once daily.
- Which of the following prescription medications does the AGA recommend for treating symptoms associated with IBS?
A. Loperamide
B. Amitriptyline
C. Kaopectate
D. Bismuth subsalicylate
B
A 40-year-old male former professional athlete asks your advice about the use of naloxegol. He states that he was just diagnosed with opioid-induced constipation (OIC) and wants to know the best way to address the condition. He has a past medical history of osteoarthritis and hypertension. Current medications include hydrocodone/acetaminophen 7.5 mg/325 mg orally every 4 to 6 hours as needed for pain, amlodipine 10 mg orally once daily, and hydrochlorothiazide 50 mg orally once daily.
- According to the 2019 AGA guideline, which one of the following products comprises the first-line plan of action for treatment of OIC?
A. Laxatives
B. PAMORAs (peripherally acting µ-opioid receptor antagonists)
C. Intestinal secretagogues
D. Selective 5-HT agonists
A
A 40-year-old male former professional athlete asks your advice about the use of naloxegol. He states that he was just diagnosed with opioid-induced constipation (OIC) and wants to know the best way to address the condition. He has a past medical history of osteoarthritis and hypertension. Current medications include hydrocodone/acetaminophen 7.5 mg/325 mg orally every 4 to 6 hours as needed for pain, amlodipine 10 mg orally once daily, and hydrochlorothiazide 50 mg orally once daily.
- Select the appropriate information that should be provided to patients about naloxegol.
A. Naloxegol will worsen the OIC condition
B. At the beginning of OIC therapy, naloxegol must be used in addition to psyllium
C. For treatment of OIC, lubiprostone is recommended over use of naloxegol
D. If laxative refractory OIC is present, the most information is known about the
effectiveness of naldemedine
D
