Nausea, Vomiting, Diarrhea, and Constipation PDF

**Nausea, Vomiting, Diarrhea, and Constipation (N/V/D/C) Part 2 PANCE-Style Questions** **1.**\ **Question**: Which of the following medications is most likely to cause constipation as a side effect?\ **Choices**:\ A. Metformin\ B. Oxycodone\ C. Amoxicillin\ D. Amlodipine\ **Correct Answer**: B\ **...

**Nausea, Vomiting, Diarrhea, and Constipation (N/V/D/C) Part 2 PANCE-Style Questions** **1.**\ **Question**: Which of the following medications is most likely to cause constipation as a side effect?\ **Choices**:\ A. Metformin\ B. Oxycodone\ C. Amoxicillin\ D. Amlodipine\ **Correct Answer**: B\ **Explanation**: Oxycodone, an opioid, commonly causes constipation by reducing gastrointestinal motility. **2.**\ **Question**: A 55-year-old female with chronic constipation is prescribed polyethylene glycol (PEG). What is its primary mechanism of action?\ **Choices**:\ A. Stimulates colonic motility\ B. Inhibits water absorption in the colon\ C. Draws water into the bowel via osmotic activity\ D. Stimulates bile release\ **Correct Answer**: C\ **Explanation**: Polyethylene glycol is an osmotic laxative that draws water into the bowel, softening stool and promoting bowel movements. **3.**\ **Question**: Which medication is the most appropriate first-line treatment for opioid-induced constipation?\ **Choices**:\ A. Senna\ B. Docusate sodium\ C. Bisacodyl\ D. Methylnaltrexone\ **Correct Answer**: A\ **Explanation**: Senna, a stimulant laxative, is effective in managing opioid-induced constipation by increasing colonic motility. **4.**\ **Question**: Which of the following is a bulk-forming laxative?\ **Choices**:\ A. Magnesium hydroxide\ B. Psyllium\ C. Polyethylene glycol\ D. Bisacodyl\ **Correct Answer**: B\ **Explanation**: Psyllium is a bulk-forming laxative that absorbs water and increases stool bulk, facilitating bowel movements. **5.**\ **Question**: A patient presents with diarrhea after antibiotic use. Which pathogen is most likely responsible?\ **Choices**:\ A. Shigella\ B. Clostridium difficile\ C. Escherichia coli\ D. Salmonella\ **Correct Answer**: B\ **Explanation**: Clostridium difficile is a common cause of diarrhea following antibiotic use due to disruption of normal gut flora. **6.**\ **Question**: Which medication is contraindicated in patients with infectious diarrhea due to the risk of prolonged infection?\ **Choices**:\ A. Loperamide\ B. Bismuth subsalicylate\ C. Ciprofloxacin\ D. Metronidazole\ **Correct Answer**: A\ **Explanation**: Loperamide is contraindicated in infectious diarrhea because it reduces bowel motility, potentially prolonging the infection. **7.**\ **Question**: Which laxative is most appropriate for patients requiring rapid bowel evacuation for a colonoscopy?\ **Choices**:\ A. Psyllium\ B. Magnesium hydroxide\ C. Polyethylene glycol-electrolyte solution (PEG-ELS)\ D. Bisacodyl\ **Correct Answer**: C\ **Explanation**: Polyethylene glycol-electrolyte solution (PEG-ELS) is commonly used for bowel preparation before a colonoscopy due to its efficacy and safety. **8.**\ **Question**: A patient with mild constipation is prescribed docusate sodium. What is its primary mechanism of action?\ **Choices**:\ A. Stimulates intestinal motility\ B. Draws water into the stool\ C. Softens stool by increasing water and fat penetration\ D. Inhibits colonic water absorption\ **Correct Answer**: C\ **Explanation**: Docusate sodium is a stool softener that facilitates water and fat penetration into the stool, making it easier to pass. **9.**\ **Question**: Which of the following antibiotics is associated with a high risk of causing C. difficile infection?\ **Choices**:\ A. Amoxicillin\ B. Clindamycin\ C. Ciprofloxacin\ D. Azithromycin\ **Correct Answer**: B\ **Explanation**: Clindamycin is highly associated with C. difficile infection due to its broad-spectrum activity and disruption of gut flora. **10.**\ **Question**: A patient is started on bismuth subsalicylate for diarrhea. What is a common side effect of this medication?\ **Choices**:\ A. Black stools\ B. Constipation\ C. Hypokalemia\ D. Sedation\ **Correct Answer**: A\ **Explanation**: Bismuth subsalicylate can cause black discoloration of stools and the tongue, which is harmless and temporary. **11.**\ **Question**: What is the recommended first-line treatment for functional constipation in children?\ **Choices**:\ A. Bisacodyl\ B. Polyethylene glycol (PEG)\ C. Docusate sodium\ D. Senna\ **Correct Answer**: B\ **Explanation**: Polyethylene glycol is safe and effective for managing functional constipation in children. **12.**\ **Question**: A 70-year-old patient with heart failure presents with constipation. Which laxative is contraindicated due to the risk of electrolyte imbalance?\ **Choices**:\ A. Psyllium\ B. Magnesium hydroxide\ C. Docusate sodium\ D. Polyethylene glycol\ **Correct Answer**: B\ **Explanation**: Magnesium hydroxide, an osmotic laxative, can cause electrolyte disturbances, making it unsafe for patients with heart failure or renal impairment. **13.**\ **Question**: Which medication is most appropriate for treating mild Traveler's diarrhea?\ **Choices**:\ A. Ciprofloxacin\ B. Rifaximin\ C. Loperamide\ D. Metronidazole\ **Correct Answer**: B\ **Explanation**: Rifaximin is effective for mild Traveler's diarrhea caused by non-invasive strains of Escherichia coli. **14.**\ **Question**: Which of the following is a common complication of chronic laxative use?\ **Choices**:\ A. Dependence\ B. Hyperkalemia\ C. Weight loss\ D. Diarrhea\ **Correct Answer**: A\ **Explanation**: Chronic laxative use can lead to dependence, where bowel movements become reliant on laxatives. **15.**\ **Question**: Which of the following medications is most effective for preventing diarrhea in patients undergoing antibiotic therapy?\ **Choices**:\ A. Probiotics\ B. Loperamide\ C. Bismuth subsalicylate\ D. Rifaximin\ **Correct Answer**: A\ **Explanation**: Probiotics help restore normal gut flora, reducing the risk of antibiotic-associated diarrhea. **16.**\ **Question**: What is a common adverse effect of magnesium hydroxide therapy?\ **Choices**:\ A. Constipation\ B. Diarrhea\ C. Hypomagnesemia\ D. Dry mouth\ **Correct Answer**: B\ **Explanation**: Magnesium hydroxide, an osmotic laxative, commonly causes diarrhea as it draws water into the bowel. **17.**\ **Question**: Which of the following is most appropriate for treating diarrhea caused by irritable bowel syndrome (IBS-D)?\ **Choices**:\ A. Loperamide\ B. Polyethylene glycol\ C. Docusate sodium\ D. Magnesium hydroxide\ **Correct Answer**: A\ **Explanation**: Loperamide reduces bowel motility, making it effective for managing diarrhea in IBS-D. **18.**\ **Question**: A patient is prescribed senna for constipation. What is its primary mechanism of action?\ **Choices**:\ A. Stimulates intestinal motility\ B. Draws water into the bowel\ C. Softens stool by increasing water absorption\ D. Forms a protective barrier in the colon\ **Correct Answer**: A\ **Explanation**: Senna is a stimulant laxative that works by stimulating colonic motility to promote bowel movements. **19.**\ **Question**: Which of the following is an appropriate indication for loperamide therapy?\ **Choices**:\ A. Bloody diarrhea\ B. Traveler's diarrhea without fever\ C. C. difficile-associated diarrhea\ D. Infectious diarrhea with systemic symptoms\ **Correct Answer**: B\ **Explanation**: Loperamide can be used for Traveler's diarrhea without fever or systemic symptoms, as it reduces bowel motility and diarrhea. **20.**\ **Question**: What is the primary indication for using sodium phosphate as a bowel preparation?\ **Choices**:\ A. Chronic constipation\ B. Colonoscopy\ C. C. difficile infection\ D. Small bowel obstruction\ **Correct Answer**: B\ **Explanation**: Sodium phosphate is commonly used for bowel preparation before a colonoscopy due to its effectiveness in clearing the bowel. **21.**\ **Question**: A 45-year-old patient with chronic idiopathic constipation is prescribed linaclotide. What is the primary mechanism of action of this medication?\ **Choices**:\ A. Enhances serotonin activity\ B. Stimulates chloride and bicarbonate secretion into the intestine\ C. Increases water reabsorption in the colon\ D. Inhibits acetylcholine in the GI tract\ **Correct Answer**: B\ **Explanation**: Linaclotide stimulates chloride and bicarbonate secretion via activation of guanylate cyclase-C, increasing intestinal fluid and promoting bowel movements. **22.**\ **Question**: Which of the following is most appropriate for severe constipation in a patient unresponsive to other therapies?\ **Choices**:\ A. Polyethylene glycol\ B. Methylnaltrexone\ C. Docusate sodium\ D. Bisacodyl\ **Correct Answer**: B\ **Explanation**: Methylnaltrexone, a peripherally acting opioid antagonist, is used for refractory opioid-induced constipation. **23.**\ **Question**: What is the most common adverse effect of polyethylene glycol (PEG) therapy?\ **Choices**:\ A. Electrolyte imbalances\ B. Abdominal cramping\ C. Diarrhea\ D. Rectal bleeding\ **Correct Answer**: C\ **Explanation**: Diarrhea is a common side effect of polyethylene glycol, as it increases water retention in the bowel. **24.**\ **Question**: A patient presents with persistent diarrhea. Which finding would most likely indicate an infectious etiology?\ **Choices**:\ A. Fever and bloody stools\ B. Watery diarrhea without fever\ C. Diarrhea improving with fasting\ D. Diarrhea only at night\ **Correct Answer**: A\ **Explanation**: Fever and bloody stools suggest an invasive or infectious diarrhea caused by pathogens like Shigella or Campylobacter. **25.**\ **Question**: Which of the following is the best initial treatment for diarrhea caused by lactose intolerance?\ **Choices**:\ A. Loperamide\ B. Lactase enzyme supplementation\ C. Polyethylene glycol\ D. Probiotics\ **Correct Answer**: B\ **Explanation**: Lactase enzyme supplementation aids in the digestion of lactose, addressing the root cause of diarrhea in lactose-intolerant patients. **26.**\ **Question**: Which of the following is a first-line treatment for mild to moderate ulcerative colitis-associated diarrhea?\ **Choices**:\ A. Loperamide\ B. Sulfasalazine\ C. Ciprofloxacin\ D. Probiotics\ **Correct Answer**: B\ **Explanation**: Sulfasalazine reduces inflammation in ulcerative colitis, improving symptoms, including diarrhea. **27.**\ **Question**: What is the primary adverse effect of sodium phosphate when used for bowel preparation?\ **Choices**:\ A. Hyperkalemia\ B. Hypocalcemia\ C. Dehydration\ D. Hyperphosphatemia\ **Correct Answer**: C\ **Explanation**: Sodium phosphate can cause significant fluid loss and dehydration, especially in elderly or frail patients. **28.**\ **Question**: Which of the following is recommended for chronic idiopathic constipation in adults?\ **Choices**:\ A. Linaclotide\ B. Polyethylene glycol\ C. Magnesium hydroxide\ D. Bisacodyl\ **Correct Answer**: A\ **Explanation**: Linaclotide is effective for chronic idiopathic constipation by increasing intestinal secretion and motility. **29.**\ **Question**: Which probiotic strain is most commonly used for antibiotic-associated diarrhea prevention?\ **Choices**:\ A. Lactobacillus\ B. Escherichia coli\ C. Staphylococcus\ D. Pseudomonas\ **Correct Answer**: A\ **Explanation**: Lactobacillus is widely used to restore normal gut flora and prevent antibiotic-associated diarrhea. **30.**\ **Question**: Which medication is most appropriate for diarrhea caused by irritable bowel syndrome (IBS-D)?\ **Choices**:\ A. Rifaximin\ B. Metronidazole\ C. Loperamide\ D. Polyethylene glycol\ **Correct Answer**: A\ **Explanation**: Rifaximin is an effective therapy for IBS-D as it reduces gut bacterial overgrowth, which contributes to symptoms. **31.**\ **Question**: What is the primary mechanism of action of magnesium hydroxide in treating constipation?\ **Choices**:\ A. Softens stool by increasing water penetration\ B. Stimulates intestinal motility\ C. Increases water secretion into the bowel via osmotic activity\ D. Forms a protective barrier in the colon\ **Correct Answer**: C\ **Explanation**: Magnesium hydroxide acts as an osmotic laxative, drawing water into the bowel and softening stool. **32.**\ **Question**: Which medication is used as a rescue therapy for severe refractory C. difficile infection?\ **Choices**:\ A. Vancomycin enema\ B. Oral fidaxomicin\ C. Intravenous metronidazole\ D. Fecal microbiota transplantation\ **Correct Answer**: D\ **Explanation**: Fecal microbiota transplantation is an effective treatment for severe or recurrent C. difficile infection when standard therapies fail. **33.**\ **Question**: A 65-year-old patient with diarrhea and abdominal pain is diagnosed with microscopic colitis. Which medication is most appropriate?\ **Choices**:\ A. Loperamide\ B. Budesonide\ C. Metronidazole\ D. Mesalamine\ **Correct Answer**: B\ **Explanation**: Budesonide is the treatment of choice for microscopic colitis due to its localized anti-inflammatory effects. **34.**\ **Question**: What is the most common side effect of docusate sodium?\ **Choices**:\ A. Abdominal cramping\ B. Electrolyte disturbances\ C. Diarrhea\ D. Hypercalcemia\ **Correct Answer**: C\ **Explanation**: Docusate sodium can cause mild diarrhea by softening stool and increasing water penetration. **35.**\ **Question**: A patient with ulcerative colitis is experiencing diarrhea. What medication should be avoided?\ **Choices**:\ A. Sulfasalazine\ B. Loperamide\ C. Probiotics\ D. Mesalamine\ **Correct Answer**: B\ **Explanation**: Loperamide should be avoided in active inflammatory conditions like ulcerative colitis due to the risk of toxic megacolon. **36.**\ **Question**: Which of the following medications is most appropriate for Traveler's diarrhea caused by noninvasive Escherichia coli?\ **Choices**:\ A. Loperamide\ B. Rifaximin\ C. Ciprofloxacin\ D. Amoxicillin\ **Correct Answer**: B\ **Explanation**: Rifaximin is highly effective and well-tolerated for treating Traveler's diarrhea caused by noninvasive Escherichia coli. **37.**\ **Question**: Which condition is most associated with nocturnal diarrhea?\ **Choices**:\ A. Irritable bowel syndrome (IBS)\ B. Inflammatory bowel disease (IBD)\ C. Celiac disease\ D. Lactose intolerance\ **Correct Answer**: B\ **Explanation**: Nocturnal diarrhea is a hallmark feature of inflammatory bowel disease, distinguishing it from functional disorders like IBS. **38.**\ **Question**: A patient with functional constipation is prescribed bisacodyl. What is its mechanism of action?\ **Choices**:\ A. Draws water into the bowel\ B. Stimulates colonic smooth muscle\ C. Inhibits sodium absorption in the colon\ D. Softens stool via fat emulsification\ **Correct Answer**: B\ **Explanation**: Bisacodyl stimulates colonic smooth muscle to promote bowel movements, making it a stimulant laxative. **39.**\ **Question**: A patient on chronic opioid therapy is prescribed methylnaltrexone for constipation. What is a unique feature of this medication?\ **Choices**:\ A. It crosses the blood-brain barrier.\ B. It does not affect central opioid analgesia.\ C. It is a stimulant laxative.\ D. It reduces bile secretion.\ **Correct Answer**: B\ **Explanation**: Methylnaltrexone acts peripherally, relieving constipation without affecting the central analgesic effects of opioids. **40.**\ **Question**: Which of the following is a potential side effect of chronic loperamide use?\ **Choices**:\ A. Paralytic ileus\ B. Hyperkalemia\ C. Weight gain\ D. Toxic megacolon\ **Correct Answer**: A\ **Explanation**: Chronic loperamide use can lead to paralytic ileus due to its potent effect on reducing bowel motility.