A 27-year-old female presents with alternating loose and hard stools associated with abdominal discomfort and bloating.
Which one of the following is it most important to do before making a positive diagnosis of irritable bowel syndrome?
Correct Answer C:
Irritable bowel syndrome: diagnosis: NICE published clinical guidelines on the diagnosis and management of irritable bowel syndrome (IBS) in 2008.
The diagnosis of IBS should be considered if the patient has had the following for at least 6 months:
A positive diagnosis of IBS should be made if the patient has abdominal pain relieved by defecation or associated with altered bowel frequency stool form, in addition to 2 of the following 4 symptoms:
Features such as lethargy, nausea, backache and bladder symptoms may also support the diagnosis.
Red flag features should be inquired about:
Suggested primary care investigations are:
Which one of the following adverse effects is least associated with sulfasalazine?
Aminosalicylate drugs: 5-aminosalicyclic acid (5-ASA) is released in the colon and is not absorbed. It acts locally as an antiinflammatory.
The mechanism of action is not fully understood but 5-ASA may inhibit prostaglandin synthesis.
Sulphasalazine:
Mesalazine:
Olsalazine:
*Pancreatitis is 7 times more common in patients taking mesalazine than sulfasalazine.
Which one of the following is not a contraindication to performing a percutaneous liver biopsy?
Correct Answer B:
Liver biopsy: Contraindications to percutaneous liver biopsy:
Which one of the following factors is most responsible for the increased rate of colorectal cancer in patients with ulcerative colitis?
Correct Answer B: Chronic inflammation is an important factor in the development of a number of cancers. An example is hepatocellular carcinoma secondary to viral hepatitis.
Ulcerative colitis: colorectal cancer:
Overview:
Factors increasing risk of cancer:
Which one of the following is least associated with Crohn's disease?
Correct Answer D: Crypt abscesses are sometimes seen in Crohn's disease but they are more commonly associated with ulcerative colitis.
Crohn's disease: investigation: Crohn's disease is a form of inflammatory bowel disease. It commonly affects the terminal ileum and colon but may be seen anywhere from the mouth to anus.
Blood:
Endoscopy:
Histology:
Small bowel enema:
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