623 Adult - IBS, IBD - NP Certification,
Fitzgerald 4th ed
b. Crohn's disease - answerin a 28 y/o man who presents with a 6 month hx of
involuntary wt loss, recurrent abdominal cramping, loose stools, and anterior and
posterior anal fissure, which of the following dx should be considered?
a. ulcerative colitis
b. Crohn's disease
c. C. difficile colitis
d. condyloma acuminata
1. ulcerative colitis in which the pathological changes are limited to the colon
2. Crohn's disease in which the changes can involve any part of the GI tract - answerthe
two major types of IBD are
involves an autoimmune response to the GI tract - answerinflammatory bowel disease
(IBD) is a disease of unclear etiology, but likely
abdominal pain or discomfort and altered bowel habits in the absence of detectable
structural abnormalities - answerirritable bowel disease is a functional bowel disorder
characterized by
1) IBS-D - predominantly diarrhea - small volumes of loose stools, volumes < than
200ml without nocturnal diarrhea, often aggravated by emotional stress or eating with
passage of lg amts of mucus
2) IBS-C - constipation predominant - can be episodic then intractable to laxative with
hard, narrowed stool caliber and a sense of incomplete evacuation for wks or months
interrupted with bouts of diarrhea
3) IBS-A - diarrhea/constipation alternating, eventually one becomes more dominant
4) IBS-M - mixed diarrhea and constipation - answerthere are four typical bowel
patterns with irritable bowel syndrome:
female - answerwhich gender is more often dx with IBS? male or female?
c. both patients outlined in responses A and B - answerwhich of the following pt
complaints should be evaluated further in making a differential of irritable bowel
syndrome
a. a 52 y/o female with a first degree family hx 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 y/o female with chronic, alternating constipation and diarrhea when she is
studying for high school exams and worrying about her parents' impending divorce?
c. a condition that is the result of abnormal gut motor/sensory activity - answerthe
pathophysiology of IBS can be best described as:
a. shares 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
d. unexplained wt loss - answerdiagnostic 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 wt loss
a. dx is largely based on clinical presentation and application of the ROME III Criteria -
answerwhen considering an IBS dx, the NP should be aware that:
a. dx is largely based on clinical presentation and application of the ROME III Criteria
b. a colonscopy should be done routinely when the dx is suspected
c. CBC, ESR, CRP and serum albumin should be the initial labs for an IBS workup
d. once an IBS dx has been confirmed, you can assure the pt that tx is generally
curative
d. amitriptylin (elavil) - answeraltering the gut pain threshold in IBS is a possible
therapeutic outcome with the use of:
a. loperamide
b. dicyclomine
c. bismuth subsalicylate
d. amitriptylin (elavil)
b. a sensation of incomplete bowel emptying that is distressing and sometimes painful -
answertenesmus 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. wt loss that accompanies many bowel diseases
d. appearance of frank blood in the stool
c. pts can present with bowel issues ranging from diarrhea to constipation -
answerconcerning IBS, which of the following statements is most accurate?
a. pts most often report chronic diarrhea as the most distressing part of the problems
b. wt gain is often reported
c. pts can present with bowel issues ranging from diarrhea to constipation
d. the condition is associated with a strongly increased risk of colorectal cancer
Fitzgerald 4th ed
b. Crohn's disease - answerin a 28 y/o man who presents with a 6 month hx of
involuntary wt loss, recurrent abdominal cramping, loose stools, and anterior and
posterior anal fissure, which of the following dx should be considered?
a. ulcerative colitis
b. Crohn's disease
c. C. difficile colitis
d. condyloma acuminata
1. ulcerative colitis in which the pathological changes are limited to the colon
2. Crohn's disease in which the changes can involve any part of the GI tract - answerthe
two major types of IBD are
involves an autoimmune response to the GI tract - answerinflammatory bowel disease
(IBD) is a disease of unclear etiology, but likely
abdominal pain or discomfort and altered bowel habits in the absence of detectable
structural abnormalities - answerirritable bowel disease is a functional bowel disorder
characterized by
1) IBS-D - predominantly diarrhea - small volumes of loose stools, volumes < than
200ml without nocturnal diarrhea, often aggravated by emotional stress or eating with
passage of lg amts of mucus
2) IBS-C - constipation predominant - can be episodic then intractable to laxative with
hard, narrowed stool caliber and a sense of incomplete evacuation for wks or months
interrupted with bouts of diarrhea
3) IBS-A - diarrhea/constipation alternating, eventually one becomes more dominant
4) IBS-M - mixed diarrhea and constipation - answerthere are four typical bowel
patterns with irritable bowel syndrome:
female - answerwhich gender is more often dx with IBS? male or female?
c. both patients outlined in responses A and B - answerwhich of the following pt
complaints should be evaluated further in making a differential of irritable bowel
syndrome
a. a 52 y/o female with a first degree family hx 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 y/o female with chronic, alternating constipation and diarrhea when she is
studying for high school exams and worrying about her parents' impending divorce?
c. a condition that is the result of abnormal gut motor/sensory activity - answerthe
pathophysiology of IBS can be best described as:
a. shares 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
d. unexplained wt loss - answerdiagnostic 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 wt loss
a. dx is largely based on clinical presentation and application of the ROME III Criteria -
answerwhen considering an IBS dx, the NP should be aware that:
a. dx is largely based on clinical presentation and application of the ROME III Criteria
b. a colonscopy should be done routinely when the dx is suspected
c. CBC, ESR, CRP and serum albumin should be the initial labs for an IBS workup
d. once an IBS dx has been confirmed, you can assure the pt that tx is generally
curative
d. amitriptylin (elavil) - answeraltering the gut pain threshold in IBS is a possible
therapeutic outcome with the use of:
a. loperamide
b. dicyclomine
c. bismuth subsalicylate
d. amitriptylin (elavil)
b. a sensation of incomplete bowel emptying that is distressing and sometimes painful -
answertenesmus 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. wt loss that accompanies many bowel diseases
d. appearance of frank blood in the stool
c. pts can present with bowel issues ranging from diarrhea to constipation -
answerconcerning IBS, which of the following statements is most accurate?
a. pts most often report chronic diarrhea as the most distressing part of the problems
b. wt gain is often reported
c. pts can present with bowel issues ranging from diarrhea to constipation
d. the condition is associated with a strongly increased risk of colorectal cancer
