IBS Flashcards
According to the Rome IV criteria, how often must abdominal pain occur to consider a diagnosis of IBS?
A) Daily for 6 months
B) At least 1 day per week for the last 3 months
C) At least 3 days per month for the last 6 months
D) At least 7 days per month for the last year
Correct Answer: B) At least 1 day per week for the last 3 months
Rationale: The Rome IV criteria specify that IBS requires recurrent abdominal pain occurring, on average, at least 1 day per week during the last 3 months.
Which of the following must be associated with recurrent abdominal pain to meet the diagnostic criteria for IBS?
A) Nausea and vomiting
B) Fever and weight loss
C) Defecation and changes in stool frequency or form
D) Hematochezia and steatorrhea
Correct Answer: C) Defecation and changes in stool frequency or form
Rationale: IBS is diagnosed when recurrent abdominal pain is associated with at least two of the following: relation to defecation, change in stool frequency, and change in stool form (appearance).
Which of the following is a required clinical feature for the diagnosis of IBS according to current criteria?
A) Sleep disturbances due to abdominal pain
B) Abdominal pain
C) Malnutrition due to caloric intake reduction
D) Hematochezia
Correct Answer: B) Abdominal pain
Rationale: The current diagnostic criteria for IBS, including the Rome IV criteria, identify abdominal pain as a prerequisite clinical feature. Other features, such as sleep disturbances or malnutrition, are not consistent with IBS.
Which of the following characteristics of abdominal pain is most consistent with IBS?
A) Pain is present only during sleep.
B) Pain is relieved by defecation or passage of flatus.
C) Pain is localized and constant in the upper right quadrant.
D) Pain is accompanied by significant weight loss.
Correct Answer: B) Pain is relieved by defecation or passage of flatus.
Rationale: IBS-related abdominal pain is typically episodic, crampy, and often relieved by the passage of stools or flatus. Pain localized to a specific area, constant, or associated with weight loss is atypical for IBS.
Pain is often exacerbated by eating or emotional
stress and improved by passage of flatus or stools. In addition, female patients with IBS commonly report worsening symptoms during the premenstrual and menstrual phases.
What is the most consistent clinical feature of IBS?
a) Abdominal pain
b) Alteration in bowel habits
c) Weight loss
d) Nighttime diarrhea
b) Alteration in bowel habits
Rationale: The most consistent clinical feature of IBS is alteration in bowel habits, as mentioned in the passage. Bowel pattern changes, including constipation and diarrhea, are central to the diagnosis of IBS.
Which of the following best describes the most common pattern of bowel symptoms in IBS?
a) Diarrhea with severe dehydration
b) Constipation alternating with diarrhea
c) Diarrhea as the predominant symptom
d) Persistent constipation with no diarrhea
b) Constipation alternating with diarrhea
Rationale: The most common pattern of bowel symptoms in IBS is constipation alternating with diarrhea, with one of the symptoms predominating at any given time.
The most common pattern is constipation alternating with diarrhea, usually with one of these symptoms predominating. At first, constipation may be episodic, but eventually, it becomes continuous and increasingly intractable to treatment with laxatives.
What is a typical characteristic of constipation in IBS?
a) Occasional diarrhea during constipation
b) Stools are usually soft and easy to pass
c) Stools are usually hard with narrowed caliber
d) It resolves completely with laxatives
c) Stools are usually hard with narrowed caliber
Rationale: In IBS, constipation often results in hard stools with a narrowed caliber, possibly due to excessive dehydration caused by prolonged colonic retention and spasm.
Most patients also experience a sense of incomplete evacuation, thus leading to repeated attempts at defecation in a short time span.
In patients with IBS-D, how is diarrhea typically described?
a) Large volumes of watery stools
b) Small volumes of loose stools
c) Continuous watery diarrhea
d) Nocturnal diarrhea
b) Small volumes of loose stools
Rationale: Diarrhea in IBS-D usually consists of small volumes of loose stools. Nocturnal diarrhea does not occur in IBS.
Diarrhea resulting from IBS usually consists of small volumes of loose stools. Most patients have stool volumes of <200 mL. Nocturnal diarrhea does not occur in IBS. Diarrhea may be aggravated by emotional stress or eating
What is a potential effect of excessive fructose and artificial sweeteners like sorbitol or mannitol in IBS patients?
a) Weight gain
b) Diarrhea, bloating, cramping, or flatulence
c) Increased energy levels
d) Reduced abdominal discomfort
b) Diarrhea, bloating, cramping, or flatulence
Rationale: Excessive fructose and artificial sweeteners such as sorbitol or mannitol may cause diarrhea, bloating, cramping, or flatulence in IBS patients.
Which diet has been shown to be helpful for IBS patients?
a) A diet high in saturated fats
b) A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs)
c) A diet consisting solely of fruits and vegetables
d) A high-protein, low-carbohydrate diet
b) A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs)
Rationale: A low FODMAP diet (low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) has been shown to be helpful in managing IBS symptoms.
In diarrhea-prone IBS patients, how does dietary fiber typically affect colonic transit?
a) It has no effect on colonic transit
b) It speeds up colonic transit
c) It delays colonic transit
d) It normalizes colonic transit without changing speed
c) It delays colonic transit
Rationale: In diarrhea-prone patients, colonic transit is faster than average, but fiber can also delay transit depending on the individual’s response.
Which of the following is a documented benefit of fiber supplementation with psyllium in IBS patients?
a) Increased perception of rectal distention
b) Decreased perception of rectal distention
c) Increased abdominal pain
d) Increased bloating and gas
b) Decreased perception of rectal distention
Rationale: Fiber supplementation with psyllium has been shown to decrease the perception of rectal distention, indicating a positive effect on visceral afferent function.
How should fiber supplementation be introduced in IBS patients to minimize adverse effects?
a) Start with the maximum dose and decrease gradually
b) Start at a nominal dose and slowly titrate up over several weeks
c) Introduce fiber suddenly for immediate results
d) Use fiber only if symptoms are severe
b) Start at a nominal dose and slowly titrate up over several weeks
Rationale: Fiber should be started at a nominal dose and slowly titrated up over several weeks to a targeted dose of 20–30 g per day. This gradual approach helps minimize adverse effects such as bloating and gas.
What is the initial therapy of choice for IBS-D?
a) Bile acid binders
b) Peripherally acting opiate-based agents
c) Antibiotics
d) Probiotic supplements
b) Peripherally acting opiate-based agents
Rationale: Peripherally acting opiate-based agents are the initial therapy of choice for IBS-D, as they help reduce diarrhea through various physiological mechanisms.
What physiological effects do peripherally acting opiate-based agents have on the colon?
a) Increase in colonic motility
b) Delay in fecal transit and increase in anal pressures
c) Decrease in anal pressure
d) Increased rectal perception
b) Delay in fecal transit and increase in anal pressures
Rationale: These agents increase segmenting colonic contractions, delay fecal transit, increase anal pressures, and reduce rectal perception, making them effective for controlling diarrhea in IBS-D
