Deck 62: Irritable Bowel Syndrome

Question 1

All of the following are part of the Rome III criteria for the diagnosis of IBS except:

A) Improvement of pain with defecation
B) Onset associated with a change in frequency of stool
C) Onset before age 45
D) Increased or decreased stool frequency
E) Abdominal bloating and distention

Answer 1

C

Question 2

Psychiatric illness, stress, anxiety, and depression are not associated with IBS.

Answer 2

False

Question 3

The following are all mechanisms/causative factors of IBS except:

A) Visceral hyposensitivity
B) Altered bowel motility (exaggerated or diminished)
C) Under or over expression of neurotransmitters
D) Bacterial overgrowth
E) Stress, anxiety, and dietary factors play a role in IBS

Answer 3

A

Question 4

A 32-year-old female comes to the clinic because of altered bowel motility. She is having daily diarrhea and bloating, although she says she has experienced bowel irregularity for years. She was recently treated aggressively for a sinus infection with antibiotics. A stool culture was negative for clostridium difficile or other pathogens. Which treatment would you consider before a referral to gastroenterology?

A) Loperamide 4 mg two to three times daily
B) Antispasmodic Bentyl 20 mg four times daily prn.
C) Amitriptyline 25 mg at bedtime.
D) Rifaximin 200-400 mg three times daily for 7 days, followed by a probiotic.

Question 5

Which symptom is an alarm symptom in patients and requires a referral to gastroenterology for further work-up?

A) Bloating
B) Diarrhea or constipation
C) Spasm/pain
D) Intermittent rectal bleeding
E) Onset over 50 years old

Question 6

A 62-year-old female comes into the clinic with chronic diarrhea. An exhaustive work-up was negative except for an abnormal pancreatic elastase, found to be very low. The most beneficial treatment would be:

A) Antidiarrheal medication
B) Antibiotics
C) Antispasmodics
D) Pancreatic enzymes
E) Increase her fiber intake

Question 7

Which of the following is not true?

A) It is not normal to develop IBS after age 50.
B) Rectal bleeding is not normal with IBS.
C) Severe diarrhea and/or constipation warrants a GI referral.
D) Nocturnal symptoms are not normal with IBS.
E) Unrelenting symptoms despite treatment indicate a severe case of IBS.

Question 8

Which is not a good option for treating diarrhea-predominant IBS?

A) FODMAP diet
B) Concentrated fiber supplements
C) Amitiza 8 micrograms twice a day
D) Empiric antibiotics
E) Loperamide 4 mg two to four times daily

Question 9

Which of the following treatments should be avoided in constipation-predominant IBS?

A) High-fiber diet with plenty of water
B) Miralax 18 g in 8 ounces of water daily to twice daily
C) Senna and cascara
D) Linzess 290 micrograms daily
E) Increased oral fluids

Question 10

A low FODMAP diet consists of a diet low in short chain sugars, which are poorly absorbed by the small intestine. Which food is acceptable on this diet?

A) Onions, garlic, broccoli, cabbage, brussels sprouts, asparagus, and cauliflower
B) Dairy
C) Carbonated beverage/coffee/alcohol
D) Red meat
E) Sugars
F) Beans