Irritable Bowel Syndrome — MCQs
True about Crohn's disease except
The differentiating feature between IBS and organic GI disease is:
A young girl presents with abdominal pain and a recent change in bowel habit, with passage of mucus in stool. There is no associated blood in stool and symptoms are increased with stress. The most likely diagnosis is:
Inhibition of myenteric plexus results in
Which extra-intestinal symptom of inflammatory bowel disease worsens with exacerbation of disease activity?
A young girl presents with abdominal pain and a recent change in bowel habit, with passage of mucus in stool. There is no associated blood in stool and symptoms are increased with stress. The most likely diagnosis is.
Which of the following Vitamin deficiency is seen in short bowel syndrome with ileal resection ?
Which of the following statements regarding Ogilvie’s syndrome are correct? 1. It presents as acute large bowel mechanical obstruction 2. Marked caecal dilatation is a common feature on X-ray abdomen 3. Caecal perforation is a well recognized complication of this condition 4. Intravenous Neostigmine is used for the treatment of this condition
What is a feature of short bowel syndrome?
What is the mechanism of action of Tegaserod?
Irritable Bowel Syndrome Indian Medical PG Practice Questions and MCQs
Question 1: True about Crohn's disease except
- A. Transmural
- B. Recurrence is more common
- C. Rectum is involved (Correct Answer)
- D. Fissures are formed
Explanation: ***Rectum is involved*** - While Crohn's disease can affect any part of the gastrointestinal tract from mouth to anus, **rectal involvement is much less common** and often spares the rectum in typical cases, especially when compared to ulcerative colitis. [1] - The disease typically exhibits **skip lesions**, meaning there are healthy segments of the bowel between affected areas, and the rectum is frequently one of these spared regions. [1] *Transmural* - Crohn's disease is characterized by **transmural inflammation**, meaning the inflammation extends through all layers of the bowel wall, from the mucosa to the serosa. [1] - This transmural involvement can lead to complications such as **fistulas, strictures, and abscesses**. *Recurrence is more common* - **Recurrence after surgery is very common** in Crohn's disease, with many patients experiencing disease relapse within a few years post-operation. - This high recurrence rate often necessitates ongoing medical management and sometimes further surgical interventions. *Fissures are formed* - Due to the **transmural inflammation** and chronic nature of Crohn's disease, patients often develop **fissures**, which are deep cracks or excoriations, particularly in the perianal area. - These fissures can be quite painful and complicated by **fistula formation** or abscesses.
Question 2: The differentiating feature between IBS and organic GI disease is:
- A. Pain abdomen
- B. Mucus in stools
- C. Diarrhea
- D. Presence of inflammation indicated by elevated stool calprotectin (Correct Answer)
Explanation: ***Presence of inflammation indicated by elevated stool calprotectin*** - Elevated **stool calprotectin** is a reliable biomarker for **gastrointestinal inflammation**, indicating an **organic GI disease** such as inflammatory bowel disease (IBD). - **Irritable bowel syndrome (IBS)** is a functional disorder and typically does not involve **inflammation**, so stool calprotectin levels would be normal. *Diarrhea* - **Diarrhea** can be a symptom of both **IBS** (specifically IBS-D) and various **organic GI diseases** (e.g., Crohn's disease, ulcerative colitis, celiac disease) [1]. - Therefore, its presence alone does not differentiate between a functional and an organic cause [1]. *Pain abdomen* - **Abdominal pain** is a cardinal symptom of **IBS**, specifically related to bowel movements [1]. - It is also a very common symptom in many **organic GI diseases**, making it a non-specific differentiating feature. *Mucus in stools* - **Mucus in stools** can occur in **IBS**, often due to increased colonic transit or irritation, but without underlying inflammation [1]. - It can also be present in **organic GI diseases**, particularly those involving inflammation or structural changes in the bowel.
Question 3: A young girl presents with abdominal pain and a recent change in bowel habit, with passage of mucus in stool. There is no associated blood in stool and symptoms are increased with stress. The most likely diagnosis is:
- A. Amebiasis
- B. Irritable bowel syndrome (Correct Answer)
- C. Crohn's disease
- D. Ulcerative Colitis
Explanation: ***Irritable bowel syndrome*** - **Irritable bowel syndrome (IBS)** typically presents with **abdominal pain**, altered bowel habits (constipation, diarrhea, or mixed), and **mucus in stool** without blood [1]. - The symptoms are often exacerbated by **stress** and there is no evidence of structural or biochemical abnormalities [1]. *Amebiasis* - **Amebiasis** is an infection caused by *Entamoeba histolytica*, usually leading to **bloody diarrhea** (dysentery), abdominal pain, and fever. - The absence of blood in the stool and the presence of stress-related symptom exacerbation make amebiasis less likely. *Crohn's disease* - **Crohn's disease** is a type of inflammatory bowel disease characterized by **transmural inflammation** that can affect any part of the gastrointestinal tract. - Symptoms often include **abdominal pain**, diarrhea (which can be bloody), weight loss, and fatigue, and it does not typically show a direct correlation with stress as the primary exacerbating factor. *Ulcerative Colitis* - **Ulcerative colitis (UC)** is an inflammatory bowel disease characterized by **continuous inflammation** of the colon, typically starting in the rectum. - Key symptoms include recurrent **bloody diarrhea**, abdominal pain, and tenesmus, which are not described in this case, particularly the absence of blood.
Question 4: Inhibition of myenteric plexus results in
- A. Hyperacidity
- B. Diarrhea
- C. Decreased gut motility (Correct Answer)
- D. Increased secretions
Explanation: ***Decreased gut motility*** - The **myenteric plexus** (Auerbach's plexus) is primarily responsible for regulating **gastrointestinal motility**, including peristalsis and muscle contraction. - Its inhibition would therefore lead to **reduced peristaltic movements** and **decreased gut motility**. *Hyperacidity* - **Gastric acid secretion** is mainly regulated by the vagus nerve (via acetylcholine), gastrin, and histamine, not directly by the myenteric plexus. - While gut motility can indirectly affect acid exposure, a primary and direct consequence of myenteric plexus inhibition is not hyperacidity. *Diarrhea* - **Diarrhea** is typically caused by increased gut motility, increased secretion, or decreased absorption. - Inhibition of the myenteric plexus would lead to **decreased motility**, making diarrhea an unlikely outcome. *Increased secretions* - **Gastrointestinal secretions** are largely controlled by the submucosal plexus (Meissner's plexus) and hormonal factors. - While the myenteric plexus has some indirect influence, its primary role is motility, and its inhibition would not directly lead to increased secretions.
Question 5: Which extra-intestinal symptom of inflammatory bowel disease worsens with exacerbation of disease activity?
- A. Primary sclerosing cholangitis
- B. Uveitis
- C. Arthritis (Correct Answer)
- D. Erythema nodosum
Explanation: ***Arthritis*** - **Peripheral arthritis** associated with inflammatory bowel disease (IBD) often **worsens with intestinal disease exacerbations** and improves with resolution of flares [1]. - This type of arthritis typically affects larger joints and is **non-deforming and asymmetric**. *Erythema nodosum* - **Erythema nodosum**, a skin manifestation, is generally **correlated with IBD activity** and usually improves as the bowel disease is treated [1]. - It presents as **tender, red nodules** on the shins and is not consistently one of the symptoms that *worsens* with exacerbation, but rather is *present* during active disease. *Primary sclerosing cholangitis* - **Primary sclerosing cholangitis (PSC)** is a chronic liver condition that is **associated with IBD**, particularly ulcerative colitis. - However, the progression of PSC is largely **independent of the intestinal disease activity** and does not necessarily worsen during IBD exacerbations. *Uveitis* - **Uveitis**, an inflammation of the eye's middle layer, is an extra-intestinal manifestation of IBD that can occur **independently of intestinal disease activity**. - It does not consistently worsen during IBD exacerbations and may require separate focused treatment.
Question 6: A young girl presents with abdominal pain and a recent change in bowel habit, with passage of mucus in stool. There is no associated blood in stool and symptoms are increased with stress. The most likely diagnosis is.
- A. Crohn's disease
- B. Amebiasis
- C. Irritable bowel syndrome (Correct Answer)
- D. Ulcerative Colitis
Explanation: ***Irritable bowel syndrome (IBS)*** - **Abdominal pain** with a change in **bowel habits**, passage of **mucus in stool**, and symptoms exacerbated by **stress** are classic features of IBS. - The absence of blood in the stool is a key differentiator from inflammatory bowel diseases. *Crohn's disease* - Often presents with **abdominal pain**, **diarrhea**, and can affect any part of the **gastrointestinal tract**, sometimes with significant inflammation. - Blood in stool, weight loss, and systemic symptoms like fever are more common, and mucus alone is not characteristic without significant inflammation. *Amebiasis* - This is an **infectious disease** caused by *Entamoeba histolytica*, typically leading to **dysentery** with bloody, mucoid stools. - Fever and severe abdominal pain are common, and it is usually acquired through contaminated food or water, which is not suggested here. *Ulcerative Colitis* - Characterized by **rectal bleeding**, **tenesmus**, and **diarrhea**, affecting the **colon** and **rectum** with continuous inflammation. - While mucus can be present, the prominent feature is usually **bloody diarrhea**, and stress is less directly implicated as a primary trigger than in IBS.
Question 7: Which of the following Vitamin deficiency is seen in short bowel syndrome with ileal resection ?
- A. Vitamin K
- B. Vitamin B1
- C. Folic acid
- D. Vitamin B12 (Correct Answer)
Explanation: ***Vitamin B12*** - **Ileal resection** is a common cause of **vitamin B12 deficiency** because the **terminal ileum** is the sole site of absorption for vitamin B12, which binds to **intrinsic factor** [1]. - Without sufficient absorptive surface in the ileum, dietary vitamin B12 cannot be absorbed, leading to **megaloblastic anemia** and neurological complications [1]. *Vitamin K* - **Vitamin K** is primarily absorbed in the **jejunum and ileum**, and its deficiency is more commonly associated with fat malabsorption or liver disease, not specifically ileal resection [2]. - While overall malabsorption in **short bowel syndrome** can affect vitamin K, B12 deficiency is a more direct and specific consequence of ileal resection [3]. *Vitamin B1* - **Thiamine (Vitamin B1)** is mainly absorbed in the **duodenum and jejunum**, regions typically less affected by isolated ileal resection in short bowel syndrome. - Deficiency typically presents as **beriberi** and is not primarily linked to ileal resection. *Folic acid* - **Folic acid** is primarily absorbed in the **jejunum**, and its absorption is generally not significantly impaired by isolated ileal resection. - While extensive short bowel syndrome can cause broader malabsorption, **vitamin B12 deficiency** is the most specific concern after ileal resection [3].
Question 8: Which of the following statements regarding Ogilvie’s syndrome are correct? 1. It presents as acute large bowel mechanical obstruction 2. Marked caecal dilatation is a common feature on X-ray abdomen 3. Caecal perforation is a well recognized complication of this condition 4. Intravenous Neostigmine is used for the treatment of this condition
- A. 1, 3 and 4
- B. 1, 2 and 3
- C. 1, 2 and 4
- D. 2, 3 and 4 (Correct Answer)
Explanation: **2, 3 and 4** - **Marked caecal dilatation** is a hallmark of Ogilvie's syndrome on X-ray, indicating the pseudo-obstruction. - **Caecal perforation** is a serious and well-recognized complication, especially if the caecal diameter exceeds 12-14 cm. - **Intravenous Neostigmine** is a parasympathomimetic drug used to stimulate colonic motility and is an effective treatment for Ogilvie's syndrome. *1, 3 and 4* - Ogilvie's syndrome is characterized by **acute large bowel pseudo-obstruction**, meaning it mimics a mechanical obstruction without an actual physical blockage. - Therefore, statement 1, which claims it presents as acute large bowel *mechanical* obstruction, is incorrect. *1, 2 and 3* - As noted, Ogilvie's syndrome is a **pseudo-obstruction**, not a mechanical one, making statement 1 incorrect. - The other statements regarding caecal dilatation and perforation are correct. *1, 2 and 4* - Again, the key differentiating factor is that Ogilvie's syndrome is a **pseudo-obstruction**, not a mechanical obstruction, rendering statement 1 inaccurate. - Statements 2 and 4 are accurate descriptions of the condition and its treatment.
Question 9: What is a feature of short bowel syndrome?
- A. Hypergastrinemia & high gastric secretion is seen
- B. Diarrhea, dehydration and malnutrition
- C. Chronic TPN dependence
- D. Malabsorption leading to diarrhea, dehydration, and malnutrition. (Correct Answer)
Explanation: ***Malabsorption leading to diarrhea, dehydration, and malnutrition.*** [1], [2] - The primary characteristic of short bowel syndrome is **reduced intestinal surface area**, leading to inadequate absorption of nutrients, water, and electrolytes [1]. - This malabsorption manifests as **chronic diarrhea**, which can cause significant **dehydration** and **malnutrition** due to nutrient deficiencies [2]. *Diarrhea, dehydration and malnutrition* - While these are prominent symptoms, they are consequences of the underlying **malabsorption**, which is the fundamental process. - This option describes symptoms but doesn't fully explain the root physiological mechanism as comprehensively as the correct answer. *Chronic TPN dependence* - **Total Parenteral Nutrition (TPN)** dependence can be a severe consequence for patients with very short or severely damaged bowel segments, but it is not a feature inherent to all cases of short bowel syndrome. - Many patients can manage with oral or enteral nutrition, especially if a significant portion of the small bowel remains functional. *Hypergastrinemia & high gastric secretion is seen* - This can occur in certain cases of short bowel syndrome, particularly if there is a loss of the **duodenum** (which normally inhibits gastrin release) or if there's extensive ileal resection. - However, it's not a universal or defining feature for all patients and is secondary to the primary problem of malabsorption.
Question 10: What is the mechanism of action of Tegaserod?
- A. 5HT3 receptor antagonist
- B. Dopamine D2 receptor antagonist
- C. 5HT4 receptor agonist (Correct Answer)
- D. NK1 receptor antagonist
Explanation: ***5HT4 receptor agonist*** - Tegaserod is a **selective serotonin 5-HT4 receptor partial agonist** that facilitates the release of neurotransmitters. - This action **stimulates the peristaltic reflex** and intestinal secretion, thereby accelerating intestinal transit and alleviating symptoms of **irritable bowel syndrome with constipation (IBS-C)**. *5HT3 receptor antagonist* - **5-HT3 receptor antagonists** (e.g., ondansetron) are primarily used as **antiemetics** to prevent nausea and vomiting. - They work by blocking serotonin's action at 5-HT3 receptors in the gastrointestinal tract and the **chemoreceptor trigger zone** in the brain. *Dopamine D2 receptor antagonist* - **Dopamine D2 receptor antagonists** (e.g., metoclopramide) are used as **prokinetics** and antiemetics due to their ability to block dopamine's inhibitory effect on gastrointestinal motility. - They increase **gastric emptying** and intestinal transit, but this is not the primary mechanism of tegaserod. *NK1 receptor antagonist* - **Neurokinin-1 (NK1) receptor antagonists** (e.g., aprepitant) are primarily used for their **antiemetic properties**, particularly in chemotherapy-induced nausea and vomiting. - They block the action of **substance P** at the NK1 receptor, which is involved in the emetic reflex.
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