Self evaluation exercise for study of Diarrhea
Dr A.J. Chandrasekhar
1. Normal daily stool weight for western diet is less than
A. 100 Grams
B. 200 Grams
C. 300 Grams
D. 400 Grams
2. Normal for bowel frequency
A. Three times a day to three times a week
B. Once a day
C. Twice a day
D. Every other day
3. All of the statements regarding Diarrhea is true except
A. In excess of the patient's usual habit
B. Increase in frequency, volume
C. More than 300 g/d stool on western diet
D. Involuntary release of rectal contents
Involuntary release of rectal contents is defined as fecal incontinence and not as diarrhea.
4. Pseudodiarrhea can be encountered in all of the following except
A. Proctitis
B. Irritable bowel syndrome
C. Hyperthyroidism
D. Fecal impaction
Pseudodiarrhea is the term used when there is increased frequency with no increase in stool weight per day.
5. Select the best option for Acute Diarrhea
A. Lasts less than two weeks
B. Self limited
C. Requires no diagnostic workup
D. All are true
6. Acute diarrhea needs workup when there is
A. Fever
B. Pus in stools
C. Causes significant fluid loss and dehydration
D. If any of the above is present
Most acute diarrhea's do not need workup as they are self limited. Workup should be initiated whenever diarrhea is associated with fever, pus in stools, dehydration and leukocytosis.
7. What is the likely consideration, when the stool is large in volume, sticky and malodorous.
A. Upper GI bleeding
B. Malabsorption
C. Secretary diarrhea
D. Amoebiasis
Upper GI bleed is also sticky and malodorous but is black.
8. What is the likely consideration, when there is diarrhea alternating with constipation
A. Irritable bowel syndrome
B. Cancer Colon
C. Neither
D. Both
9. What is the likely consideration, when the diarrhea improves with fasting
A. Osmotic diarrhea
B. Secretary diarrhea
C. factitious diarrhea
D. Intestinal dysmotility
10. Steatorrhea can be seen in
A. Pancreatic insufficiency
B. Small bowel disease
C. Deficient bile salts
D. All of the above
11. Osmotic diarrhea can be encountered in all of the following except
A. Celiac Sprue
B. Lactase deficiency
C. Short bowel syndrome
D. Villous adenoma
Villous adenoma gives rise to secretary diarrhea.
12. If there is no steatorrhea and the stool is watery consider
A. Chewing gum
B. Laxative use
C. Radiation
D. Zollinger-edison syndrome
13. In malabsorption you can see
A. Iron deficiency
B. Vitamin K deficiency
C. Vitamin D deficiency
D. All of the above
14. In regard to D-xylose test
A. >25% of ingested dose (25 gm) in the 5 hr urine collection is normal
B. Normal D-xylose test indicates small bowel disease
C. Abnormal D-xylose test indicates pancreatic disease
D. All of the statements are true
Normal D-xylose test indicates pancreatic disease, and abnormal D-xylose test indicates small bowel disease.
15. 42 y/o female from India with chronic diarrhea with large fowl smelling stools, linked to ingestion of wheat.
She likely has
A. Amoebiasis
B. Celiac disease
C. Tropical sprue
D. Cystic fibrosis
In Celiac disease, Gluten in diet (Wheat, oats, barley, rye) can induce small bowel mucosal changes and lead to diarrhea.
16. 32 y/o male returns home from Office party with diarrhea. What is the most likely cause for his diarrhea?
A. E. Coli
B. C. Difficile
C. Food toxin
D. Alcohol
Rapid onset following ingestion of food suggests pre-formed toxins, alcohol can also cause acute diarrhea.
17. 55 year old w/m with COPD consults his physician for acute exacerbation. Three days later develops diarrhea . Select the best option
A. Discontinue the Antibiotics he received for acute exacerbation
B. Check stools for pus cells
C. Needs stool sent for culture and O/P
D. Proctoscopy to r/o membranous colitis
Acute diarrhea does not require workup unless accompanied by fever, dehydration. It is very common to get acute diarrhea from antibiotics. They resolve with discontinuation of antibiotics.
18. Male homosexuals are at high risk for developing
A. Osmotic diarrhea
B. Acute diarrhea
C. Secretary diarrhea
D. Diarrhea secondary to intestinal dysmotility
19. Steatorrhea can be encountered in
A. Patient with Cystic fibrosis
B. Chronic pancreatitis
C. Cancer pancreas with obstructive jaundice
D. All of the above
20. 42 year old Diabetic has postural hypotension and diarrhea Most likely his diarrhea is due to
A. Uremia
B. Autonomic dysfunction
C. Intestinal dysmotility
D. Oral ant-diabetic agents
When Diabetics have signs of autonomic dysfunction (postural hypotension), consider that possibility for diarrhea. Of course hypotension could be due to dehydration from diarrhea.