Diarrhea Flashcards

1
Q

Acute Diarrhea:
Duration: ___ weeks

Persistent Diarrhea:
Duration: ____ weeks

Chronic Diarrhea:
Duration: >4 weeks.

A

<2

2-4

> 4

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2
Q

The frequent passage of small volumes of stool, is often associated with rectal urgency, tenesmus, or a feeling of incomplete evacuation and accompanies IBS or proctitis

A

Pseudodiarrhea

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3
Q

The involuntary discharge of rectal contents and is most often caused by neuromuscular disorders or structural anorectal problems.

A

Fecal incontinence

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4
Q

More than 90% of cases of acute diarrhea are caused by _____

A

infectious agents;

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5
Q

Diarrhea occasionally is an early symptom of infection such as ____

A

SARS-CoV-2 and Legionella.

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6
Q

_____are probably the most common noninfectious causes of acute diarrhea,

A

Side effects from medications

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7
Q

The cornerstone of diagnosis in those suspected of severe acute infectious diarrhea is _____

A

microbiologic analysis of the stool

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8
Q

Brainerd diarrhea is an increasingly recognized entity characterized by an abrupt-onset diarrhea that persists for _____but may last 1–3 years, and is thought to be of infectious origin.

A

at least 4 weeks,

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9
Q

Indications for evaluation of acute diarrhea include:

A

profuse diarrhea with dehydration, grossly bloody stools, fever ≥38.5°C (≥101°F), duration >48 h without improvement, recent antibiotic use, new community outbreaks, associated severe abdominal pain in patients aged >50 years, and elderly (≥70 years) or immunocompromised patients.

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10
Q

______ may reduce symptoms of vomiting and diarrhea but should not be used to treat immunocompromised patients or those with renal impairment because of the risk ofencephalopathy.

A

Bismuth subsalicylate

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11
Q

Bismuth subsalicylate may reduce the frequency of ____

A

traveler’s diarrhea

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12
Q

Diarrhea lasting >4 weeks warrants evaluation to exclude serious underlying pathology.

A

Chronic diarrhea

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13
Q

______ are the most common secretory causes of chronic diarrhea.

A

Side effects from regular ingestion of drugs and toxins

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14
Q

Due to dihydroxy bile acids escaping absorption in the terminal ileum (e.g., Crohn’s ileitis, resection <100 cm).

A

Cholerheic diarrhea

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15
Q

Causes: Reduced feedback regulation (FGF-19 deficiency), genetic receptor protein variations, or accelerated colonic transit.

A

Idiopathic secretory diarrhea or BAD

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16
Q

____, one of the most common neuroendocrine tumors, most typically presents with refractory peptic ulcers, but diarrhea occurs in up to one-third of cases and may be the only clinical manifestation in 10%

A

Gastrinoma

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17
Q

The watery diarrhea hypokalemia achlorhydria syndrome, also called pancreatic cholera, is due to a ____

A

non-β cell pancreatic adenoma, referred to as a VIPoma,

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18
Q

Diarrhea caused by calcitonin, secretory peptides, or prostaglandins.
Associated with metastatic disease and poor prognosis.

A

Medullary thryroid carcinoma

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19
Q

Which drug is associated with spruelike enteropathy leading to secretory diarrhea?
A) Metoprolol
B) Olmesartan
C) Lisinopril
D) Amlodipine

A

B

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20
Q

What is the hallmark clinical feature of secretory diarrhea?
A) Presence of a fecal osmotic gap
B) Watery, large-volume fecal outputs that persist with fasting
C) Bloody stools with abdominal pain
D) Small, frequent stools with tenesmus

A

B

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21
Q

Which condition accounts for up to 40% of unexplained chronic diarrhea and is related to bile acid malabsorption?
A) Addison’s disease
B) Idiopathic bile acid diarrhea (BAD)
C) Villous adenomas
D) Systemic mastocytosis

A

B

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22
Q

Which hormonal tumor is associated with massive secretory diarrhea, hypokalemia, and flushing?
A) Medullary thyroid carcinoma
B) VIPoma
C) Carcinoid tumor
D) Gastrinoma

A

B

The watery diarrhea hypokalemia achlorhydria syndrome, also called pancreatic cholera, is due to a non-β cell pancreatic adenoma, referred to as a VIPoma.”

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23
Q

Which congenital defect is caused by a mutation in the NHE3 gene and results in acidosis?
A) Congenital chloridorrhea
B) Congenital sodium diarrhea
C) Villous adenoma
D) Addison’s disease

A

B

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24
Q

What is a potential cause of secretory diarrhea in chronic ethanol consumption?
A) Enhanced bile acid absorption
B) Enterocyte injury and impaired sodium and water absorption
C) Increased gastric motility
D) Reduced gastric acid secretion

A

B

Chronic ethanol consumption may cause a secretory-type diarrhea due to enterocyte injury with impaired sodium and water absorption as well as rapid transit.”

25
Q

Which tumor is associated with secretory diarrhea and pellagra-like skin lesions due to niacin depletion?
A) Carcinoid tumor
B) Medullary thyroid carcinoma
C) Villous adenoma
D) VIPoma

A

A

26
Q

Which genetic variation leads to accelerated colonic transit in bile acid diarrhea?
A) Mutation in TGR5 receptor
B) Mutation in DRA gene
C) Mutation in NHE3 gene
D) Mutation in FGF-19 receptor

A

A

27
Q

____occurs when ingested, poorly absorbable, osmotically active solutes draw enough fluid into the lumen to exceed the reabsorptive capacity of the colon.

A

Osmotic diarrhea

28
Q

What is the hallmark feature of osmotic diarrhea?
A) Presence of a fecal osmotic gap <50 mosmol/L
B) Persistence despite fasting
C) Ceases with fasting or discontinuation of the causative agent
D) Accompanied by high fever and blood in stool

A

C

29
Q

Which of the following is used to calculate the stool osmotic gap in osmotic diarrhea?
A) Serum sodium and potassium concentration
B) Serum osmolarity and fecal sodium/potassium concentration
C) Fecal carbohydrate concentration
D) Serum calcium and magnesium concentration

A

B

Stool osmotic gap (>50 mosmol/L): serum osmolarity (typically 290 mosmol/kg) − (2 × [fecal sodium + potassium concentration]).”

30
Q

Which condition is the most common cause of carbohydrate malabsorption leading to osmotic diarrhea in adults?
A) Congenital brush-border enzyme deficiency
B) Lactase deficiency
C) Sorbitol malabsorption
D) Fructose intolerance

A

B

31
Q

Which of the following substances commonly found in medications and candies can cause osmotic diarrhea?
A) Glucose and sucrose
B) Sorbitol and lactulose
C) Maltose and dextrin
D) Starch and cellulose

A

B

32
Q

FODMAP intolerance is associated with which of the following symptoms?
A) Fever and bloody stools
B) Chronic diarrhea, bloating, and abdominal pain
C) Malnutrition and weight loss
D) Persistent constipation with rectal bleeding

A

B

33
Q

What is the feature of steatorrheal diarrhea?
A) Watery, painless diarrhea
B) Greasy, foul-smelling, difficult-to-flush stools
C) Bloody stools with abdominal pain
D) Small, frequent stools with tenesmus

A

B

34
Q

Which stool fat level is typically associated with pancreatic exocrine insufficiency?
A) ≤7 g/day
B) 15–25 g/day
C) >32 g/day
D) 14 g/day

A

C

“Daily fecal fat averages 15–25 g with small-intestinal diseases and is often >32 g with pancreatic exocrine insufficiency.”

35
Q

Which condition is characterized by villous atrophy and crypt hyperplasia in the proximal small bowel?
A) Tropical sprue
B) Whipple’s disease
C) Celiac disease
D) Abetalipoproteinemia

A

C

36
Q

Which condition is likely in a patient with steatorrhea, arthralgias, fever, lymphadenopathy, and extreme fatigue?
A) Celiac disease
B) Whipple’s disease
C) Abetalipoproteinemia
D) Intestinal lymphangiectasia

A

B

37
Q

What is the unifying feature of stool analysis in inflammatory diarrhea?
A) High fecal fat content
B) Presence of leukocytes or leukocyte-derived proteins
C) Stool osmotic gap >50 mosmol/L
D) Absence of red blood cells

A

B

38
Q

Which condition must be excluded in a middle-aged or older patient with chronic inflammatory-type diarrhea, especially with blood?
A) Celiac disease
B) Colorectal tumor
C) Irritable bowel syndrome
D) Diverticulitis

A

B

39
Q

Which medication is commonly associated with microscopic colitis?
A) Lisinopril
B) NSAIDs
C) Metformin
D) Atorvastatin

A

B

40
Q

Which condition is a common cause of intestinal stasis with secondary bacterial overgrowth leading to diarrhea?
A) Irritable bowel syndrome
B) Primary visceral neuromyopathies
C) Hyperthyroidism
D) Carcinoid syndrome

A

B

41
Q

Which of the following is a common co-presenting feature in patients with factitial diarrhea?
A) Hypertension and hyperkalemia
B) Hypotension and hypokalemia
C) Weight gain and peripheral edema
D) Abdominal distension and hypoalbuminemia

A

B

42
Q

A 35-year-old female presents with acute diarrhea. She is otherwise healthy and reports no fever or bloody stools. Her daily activities are unaffected. What is the next step in management?
A) Stool microbiology studies
B) Empirical treatment with a quinolone
C) Observation
D) Antidiarrheal agents

A

C

43
Q

A 60-year-old male presents with incapacitating acute diarrhea, fever of 39°C, and bloody stools. He is immunocompromised due to chemotherapy. What is the next step?
A) Antidiarrheal agents
B) Stool microbiology studies
C) Observation
D) Empirical treatment with metronidazole

A

B

44
Q

A 45-year-old patient with acute diarrhea has moderate symptoms that have altered his daily activities but no fever, bloody stools, or other alarming features. Fluid replacement has been initiated, but the symptoms persist. What is the next step?
A) Stool microbiology studies
B) Empirical treatment with metronidazole
C) Antidiarrheal agents
D) Hospital admission

A

C

45
Q

A 28-year-old male presents with acute diarrhea, fever of 38.7°C, and increased fecal WBCs. Stool microbiology studies do not identify a pathogen. What is the next step in management?
A) Observation
B) Select specific treatment based on pathogen
C) Empirical treatment and further evaluation
D) Antidiarrheal agents

A

C

46
Q

A 55-year-old female presents with severe diarrhea that started 48 hours ago. She has been unable to leave home due to incapacitation but has no fever or blood in the stool. Stool studies are pending. What supportive care measure should be prioritized?
A) Antidiarrheal agents
B) Fluid and electrolyte replacement
C) Immediate antibiotics
D) Observation

A

B

47
Q

In idiopathic constipation, a subset of patients exhibits delayed emptying of the _____ with prolongation of transit (often in the proximal colon) and a reduced frequency of propulsive HAPCs.

A

ascending and transverse colon

48
Q

[Constipation] The presence of weight loss, rectal bleeding, or anemia with constipation mandates either ______

A

flexible sigmoidoscopy plus barium enema or colonoscopy

48
Q

[Constipation] _____ alone is most cost-effective in this setting because it provides an opportunity to biopsy mucosal lesions, perform polypectomy, or dilate strictures.

A

Colonoscopy

49
Q

_____has advantages over colonoscopy in the patient with isolated constipation because it is less costly and identifies colonic dilation and all significant mucosal lesions or strictures that are likely to present with constipation

A

Barium enema

50
Q

Melanosis coli, or pigmentation of the colon mucosa, indicates the use of _____

A

anthraquinone laxatives such as cascara or senna;

51
Q

Measurement of serum ______ will identify rare patients with metabolic disorders.

A

calcium, potassium, and thyroid-stimulating hormone levels

52
Q

Since evacuation disorders also retard colonic transit through the left colon or the entire colon, _____should precede transit measurements if there is clinical suspicion of an evacuation disorder. If an evacuation disorder is identified on testing, colonic transit may be unnecessary.

A

anorectal and pelvic floor testing

53
Q

The collection of gas in the rectum between the level of the ischial spines and the lower border of the sacroiliac joints may suggest the presence of a _____as the cause of constipation.

A

rectal evacuation disorder

54
Q

Motion ____with paradoxical contraction or l ited perineal descent (<1.5 cm) during simulated evacuation indicates pelvic floor dysfunction.

A

anteriorly

55
Q

This test also identifies rare syndromes, such as adult Hirschsprung’s disease, by the absence of the rectoanal inhibitory reflex.

A

Anorectal manometry

56
Q

The most common cause of outlet obstruction is failure of the puborectalis muscle to relax; this is not identified by barium defecography but can be demonstrated by _____, which provides more information about the structure and function of the pelvic floor, distal colorectum, and anal sphincters.

A

magnetic resonance defecography

57
Q
A