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CMN 568 Unit 4 > IBS and IBD Fitz > Flashcards

IBS and IBD Fitz Flashcards

1
Q
  1. In a 28-year-old man who presents with a 6-month history of involuntary weight loss, recurrent abdominal
    cramping, loose stools, and anterior and posterior anal fissure, which of the following diagnoses should
    be considered?
    A. ulcerative colitis
    B. Crohn’s disease
    C. C. difficile colitis
    D. condyloma acuminata
A

B. Crohn’s disease

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2
Q
  1. Which of the following patient complaints should be evaluated further when making the differential diagnosis of irritable bowel syndrome (IBS)?

A. a 52-year-old female with a first-degree family history of colorectal cancer, recent constipation, and abdominal pain
B. a middle-aged adult with low albumin and leukocytosis
C. both patients outlined in responses A and B
D. a 16-year-old female with chronic, alternating constipation and diarrhea when she is studying for high school exams and worrying about her
parents’ impending divorce

A

C. both patients outlined in responses A and B

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3
Q
  1. The pathophysiology of IBS can be best described as:
    A. sharing the same pathophysiology as inflammatory bowel disease.
    B. a patchy inflammatory process in the small bowel that most adolescents will outgrow with vigorous
    exercise and a low-residue diet.
    C. a condition that is the result of abnormal gut motor/sensory activity.
    D. an overstimulation of pancreatic beta cell
    production
A

C. a condition that is the result of abnormal gut motor/sensory activity.

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4
Q 
128. Diagnostic criteria for irritable bowel syndrome include abdominal pain that is associated with all of the following except:
A. improvement with defecation.
B. a change in frequency of stool.
C. a change of stool form.
D. unexplained weight loss.
A

D. unexplained weight loss.

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5
Q
  1. When considering an IBS diagnosis, the NP should be aware that:
    A. diagnosis is largely based on clinical presentation and application of the Rome III Criteria.
    B. a colonoscopy should be done routinely when the diagnosis is suspected.
    C. complete blood count (CBC), erythrocyte sedimentation
    rate (ESR), CRP, and serum albumin
    should be the initial labs for an IBS workup.
    D. once an IBS diagnosis has been confirmed, you can assure the patient that treatment is generally
    curative.
A

A. diagnosis is largely based on clinical presentation and application of the Rome III Criteria.

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6
Q
  1. Altering the gut pain threshold in IBS is a possible therapeutic outcome with the use of:
    A. loperamide (Imodium®).
    B. dicyclomine (Bentyl®).
    C. bismuth subsalicylate (Pepto-Bismol®).
    D. amitriptyline (Elavil®).
A

D. amitriptyline (Elavil®).

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7
Q
  1. Tenesmus is defined as which of the following?
    A. rectal burning with defecation
    B. a sensation of incomplete bowel emptying that is
    distressing and sometimes painful
    C. weight loss that accompanies many bowel diseases
    D. appearance of frank blood in the stool
A

B. a sensation of incomplete bowel emptying that is

distressing and sometimes painful

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8
Q
  1. Concerning IBS, which of the following statements is
    most accurate?
    A. Patients most often report chronic diarrhea as the most distressing part of the problems.
    B. Weight gain is often reported.
    C. Patients can present with bowel issues ranging from diarrhea to constipation.
    D. The condition is associated with a strongly increased risk of colorectal cancer.
A

C. Patients can present with bowel issues ranging from diarrhea to constipation.

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9
Q 
133. An example of a medication with prokinetic activity is:
A. dicyclomine (Bentyl®).
B. metoclopramide (Reglan®).
C. loperamide (Imodium®).
D. psyllium (Metamucil®).
A

B. metoclopramide (Reglan®).

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10
Q
  1. Diagnostic testing in IBS often reveals:
    A. evidence of underlying inflammation.
    B. anemia of chronic disease.
    C. normal results on most testing.
    D. mucosal thickening on abdominal radiological
    imaging
A

C. normal results on most testing.

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11
Q
  1. Which of the following is an appropriate treatment for IBS?
    A. high-fat, low-residue diet.
    B. high-fiber, low-fat diet and stress modification.
    C. antispasmotics and loperamide for diarrhea predominance.
    D. tricyclic antidepressants for constipation predominance.
A

C. antispasmotics and loperamide for diarrhea predominance.

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12
Q
  1. The clinical indication for the use of lubiprostone (Amitiza®) is for:
    A. the treatment of constipation that is not amenable to standard therapies.
    B. intervention in intractable diarrhea.
    C. control of intestinal inflammation.
    D. the relief of intestinal spasms
A

A. the treatment of constipation that is not amenable to standard therapies.

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13
Q
  1. Irritable bowel syndrome is characterized by all of the following except:
    A. weight loss and malnutrition.
    B. abdominal pain or discomfort (hypersensitivity) at least three times per month for a 6-month period.
    C. altered bowel pattern in the absence of detected structural abnormalities.
    D. occurs two to three times more often in women than men.
A

A. weight loss and malnutrition.

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14
Q
  1. Diagnostic testing in inflammatory bowel disease (IBD) often reveals:
    A. evidence of underlying inflammation.
    B. notation of intestinal parasites.
    C. normal results on most testing.
    D. a characteristic intra-abdominal mass on
    radiological imaging
A

A. evidence of underlying inflammation.

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15
Q 
139. Laboratory evaluation during an IBD flare will reveal elevated levels of all of the following except:
A. CRP.
B. SeCr.
C. ESR.
D. WBC.
A

B. SeCr.

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16
Q
  1. IBD is associated with all of the following types of anemia except:
    A. anemia of chronic disease.
    B. iron-deficiency anemia.
    C. megaloblastic anemia.
    D. anemia associated with acute blood loss.
A

C. megaloblastic anemia.

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17
Q 
141. Which of the following best describes the hemogram results in a person with anemia of chronic disease that often accompanies IBD?
A. microcytic, hypochromic
B. macrocytic, normochromic
C. normocytic, normochromic
D. hyperproliferative
A

C. normocytic, normochromic

18
Q
  1. IBD is a term usually used to describe:
    A. ulcerative colitis and irritable bowel syndrome.
    B. C. difficile colitis and Crohn’s disease.
    C. Crohn’s disease and ulcerative colitis.
    D. inflammatory colitis and ileitis.
A

C. Crohn’s disease and ulcerative colitis.

19
Q 
143. “Skip lesions” are usually reported during colonoscopy in:
A. irritable bowel syndrome.
B. ulcerative colitis.
C. Crohn’s disease.
D. C. difficile colitis.
A

C. Crohn’s disease.

20
Q 
144. First-line therapy for Crohn’s disease or ulcerative colitis is:
A. oral aminosalicylates.
B. parenteral corticosteroids.
C. antibiotics.
D. immune modulators.
A

A. oral aminosalicylates.

21
Q
  1. Immune modulators are often used for intervention in:
    A. ulcerative colitis.
    B. irritable bowel syndrome.
    C. Crohn’s disease.
    D. ulcerative colitis and Crohn’s disease.
A

D. ulcerative colitis and Crohn’s disease

22
Q 
147. Crohn’s disease is associated with increased risk
of malignancy involving the:
A. small bowel.
B. large intestine.
C. duodenum.
D. stomach.
A

B. large intestine.

23
Q

Which of the following statements is most
consistent with IBD, with IBS, or with both
conditions?

  1. Onset of symptoms is before age 30 to 40 years
    in most cases.
A

Both

24
Q

Which of the following statements is most
consistent with IBD, with IBS, or with both
conditions?

  1. The patient population is predominately
    female.
A

IBS

25
Q

Which of the following statements is most
consistent with IBD, with IBS, or with both
conditions?

  1. The condition is often referred to as spastic colon
    by the general population.
A

IBS

26
Q

Which of the following statements is most
consistent with IBD, with IBS, or with both
conditions?
151. Extraintestinal manifestations occasionally
include nondestructive arthritis and renal
calculi.

A

IBD

27
Q

Which of the following statements is most
consistent with IBD, with IBS, or with both
conditions?

  1. This is a potentially life-threatening condition.
A

IBD

28
Q

Which of the following statements is most
consistent with IBD, with IBS, or with both
conditions?

  1. The etiology likely involves an autoimmune
    response to the GI tract.
A

IBD

29
Q

Which of the following statements is most
consistent with IBD, with IBS, or with both
conditions?

  1. Patients should be advised to avoid trigger
    foods.
A

Both

30
Q

Which of the following statements is most
consistent with IBD, with IBS, or with both
conditions?

  1. Involvement can be limited to intestinal mucosa
    only, or the full thickness of the intestinal wall
    can be involved.
A

IBD

31
Q

Which of the following statements is most
consistent with IBD, with IBS, or with both
conditions?

  1. The etiology is considered to be an alteration in
    small and large bowel motility.
A

IBS

32
Q

Which of the following statements is most
consistent with IBD, with IBS, or with both
conditions?

  1. Potential complications include fistula formation
    and perineal disease.
A

IBD

33
Q

Which of the following statements is most
consistent with IBD, with IBS, or with both
conditions?

  1. Potential complications include increased risk for
    colonic malignancy.
A

IBD

34
Q

ANTISPASMODICS (ANTICHOLINERGIC) AGENTS

A

Dicyclomine, hyoscyamine, methscopolamine

35
Q

ANTIDIARRHEAL AGENT

A

Loperamide

36
Q

OSMOTIC LAXATIVES

A

PEG 3350 (Miralax®)
Milk of magnesia
Lubiprostone (Amitiza®)

37
Q

TRICYCLIC AND RELATED ANTIDEPRESSANTS

NOT RECOMMENDED FOR PATIENTS WITH PREDOMINANT CONSTIPATION

A

Nortriptyline, desipramine, imipramine

38
Q

SEROTONIN REUPTAKE INHIBITORS

NOT RECOMMENDED FOR PATIENTS WITH PREDOMINANT DIARRHEA

A

Sertraline, fluoxetine, citalopram, paroxetine

39
Q
  1. A 74-year-old man presents with recurrent abdominal cramping and pain
    associated with diarrhea that occurs from four to five times per day. He reports that
    currently he is having an exacerbation. The stools are bloody with mucus and pus.
    The patient reports that he has lost weight and is always fatigued. The patient denies
    recent travel or outdoor camping. Which of the following conditions is most likely?
    A) Giardiasis
    B) Irritable bowel syndrome (IBS)
    C) Diverticulitis
    D) Ulcerative colitis
A

D) Ulcerative colitis The most important clue for ulcerative colitis is bloody stools that are covered with mucus and pus along with the systemic symptoms
(fatigue, low-grade fever).

40
Q

All the following signs and symptoms are associated with irritable bowel syndrome
except:
A) Diarrhea with blood mixed in the stool
B) Diarrhea and/or constipation
C) Abdominal pain relief after defecation
D) Mucus with stools
1289

A

A) Diarrhea with blood mixed in the stool

Irritable bowel syndrome (IBS) is considered a functional disorder because the colon tissue is normal. There is no inflammation or bleeding in IBS.

Patients report chronic abdominal pain, flatulence,
bloating, and changes in bowel movements.

IBS is more common in women than
men.

Rectal bleeding, blood in stool, anemia, fatigue, and weight loss are associated with inflammatory bowel disease (IBD), such as Crohn’s disease or ulcerative colitis.

41
Q
  1. A 14-year-old boy is brought in by his mother who reports that her son has been
    complaining for several months of recurrent bloating, stomach upset, and occasional
    loose stools. She reports that he has difficulty gaining weight and is short for his age.
    She has noticed that his symptoms are worse after eating large amounts of crackers,
    cookies, and breads. She denies seeing blood in the boy’s stool. Which of the
    following conditions is most likely?
    A) Amebiasis
    B) Malabsorption
    C) Crohn’s colitis
    D) Celiac disease
A

D) Celiac disease Celiac disease is also known as celiac sprue.

Patients should avoid foods containing gluten, which causes malabsorption (diarrhea, gas, bloating,
and abdominal pain). Foods to avoid are wheat, rye, and barley.

Oats do not damage the mucosa in celiac disease.

Antigliadin IgA and IgG are elevated in almost all patients (90%).

42
Q 
427. Symptoms suggestive of ulcerative colitis include all of the following except:
A) Bloody diarrhea mixed with mucus
B) Nausea and vomiting
C) Weight gain
D) Abdominal pain
A

C) Weight gain Symptoms of ulcerative colitis include bloody diarrhea mixed with mucus, nausea/vomiting, abdominal pain, and possible weight loss with longterm
diarrhea.

CMN 568 Unit 4 (18 decks)

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