In Class Quiz week 8 Flashcards
22 yo male. 10 episodes diarrhea in 36 hours. Felt feverish but hasn’t taken temp. No dizzy, blood. Normal vitals and PE notable for diffuse, mild abdominal tenderness to palpation.
A. Celiac B. C. Difficile colitis C. Food poisoning D. Viral gastroenteritis E. Lactose intolerance
D. Viral gastroenteritis
C difficile colitis = recent antibiotic use
Food poisoning self resolves 12 hours
What is the most appropriate step in mgmt from that patient at this point?
Hydration and over the counter antidiarrheals
What % of acute diarrhea are d/t infection?
90%
42 yo woman w/ abdominal pain, bloating, constipation several days/ week. Sx started 5 yrs ago and getting worse w/in last 6 months with intermittent diarrhea. Dull pain in lower abdomen. P alleviated by passing gas or having bowel movements. Denies fever and blood in stool. Gained 5 lbs w/in the last year. What is highest on ddx list?
A. Chronic constipation B. Crohn’s disease C. Irritable bowel syndrome D. Diverticulitis E. Celiac disease
C. Irritable bowel syndrome
Constipation + diarrhea makes IBS go to the top of the list
3 things that make IBS likely: Recurrent abdominal P, change in frequency of bowel movements, change in consistency, relieved with dedication.
Diverticulitis: fever + LLQ pain
Weight gain means they aren’t that sick. Crohn’s and celiac tend to lose weight.
Likely not chronic constipation because they are having P and diarrhea. She has chronic constipation and then mixed diarrhea, so it sounds like IBS.
The same 42 yo woman underwent a colonoscopy 2 years ago and it was normal. She’s taking a multivitamin daily. Her PE is normal, neg stool hemoccult. Which test would be most helpful to eval for a 2˚ cause of constipation?
A. Check TSH level
B. Order abdominal CT
C. Refer for colonoscopy
D. Check IgA and anti-TTG antibodies
A. Check TSH level
Because you want to see if she has hypothyroidism causing IBS.
CT scan is not helpful for the colon, but maybe good for diverticulitis.
She doesn’t need another colonoscopy because she just had one a few years ago and its unlikely that anything has grown since then.
IgA and anti-TTG antibodies are testing for celiac disease (gold standard is the duodenal biopsy)
Which of the following is most appropriate Tx for diverticulitis?
A. Exercise B. Antibiotics C. Increase fiber D. B12 supplements E. Avoid gluten
B. Antibiotics
- osis means someone’s colon has pockets. NO pain.
- itis means pockets are inflamed and infected. PAIN. And LLQ P + fever and they need antibiotics.
If recommending fiber for constipation predominant irritable bowel syndrome, what should you tell your pt to expect?
Increase stool frequency and stool volume with less need for straining
Which of the following OTC constipation Tx work by increasing stool bulk and colon peristalsis?
A. Psyllium and Metamucil
B. Polyethylene glycol and magnesium salts
C. Senna and bisacodyl
D. Glycerine
Psyllium and Metamucil
When you recommend fiber: start low and go slow.
Polyethylene glycol and magnesium salts: works by bringing more water into gut.
Senna and bisacodyl: work to increase motility.
Glycerine: sipository, so it goes in the rectum and makes them feel full and helps to defacate.
Which is not recommended as Tx for IBS?
A. Peppermint oil B. Antidepressants med C. Exercise D. Probiotics E. Antibiotics
E. Antibiotics
28 yo otherwise healthy person. RLQ pain made worse with eating. Painless anal fissure. Weight loss.
Crohn’s
Next step for Crohn’s patient?
Get colonoscopy
Features outside the GI tract that are associate with IBD include all except:
A. Alopecia (hairless)
B. Migrating arthritis
C. Spondyloarthropathy
D. Erythema …
A. Alopecia
