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example@example.com
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1. A 55-year-old woman presents with a 3-year history of intermittent abdominal cramps, excessive bloating, intermittent diarrhea and no weight loss. Her physical examination is normal as is a CBC. Which of the following is correct?
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a. She should be tested with a lactulose breath test and treated for SIBO if a rise in breath H2 occurs at 60 minutes.
b. If a breath test shows increased methane concentrations, she should be treated with rifaximin.
c. She likely has an increase of gas in the GI tract and may respond to a low FODMAP diet.
d. She should have a fecal calprotectin test and if elevated, undergo colonoscopy.
2. A 44-year-old woman with diarrhea predominant IBS is started on amitriptyline 25 mg daily but she complains of fatigue, disorientation and palpitations after 5 days. The most appropriate course of action is:
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a. Stop the drug; prescribe desipramine 12.5 mg daily
b. Continue the drug as she will gradually adapt to side effects
c. Stop the drug; start lubiprostone 24 mcg daily
d. Stop the drug; refer her for cognitive behavioral therapy
3. A 36-year-old woman presents with intermittent diarrhea, bloating, flatulence and abdominal discomfort of more than 10 years’ duration. Her physical examination is normal, as is a CBC and sedimentation rate. She does not smoke, consume milk products or drink carbonated beverages. You want to place her on a low FODMAP diet based on several randomized controlled trials demonstrating the effectiveness of this diet. What is the recommendation for initial FODMAP restriction to assess response?
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a. 1-2 weeks
b. 2-4 weeks
c. 4-6 weeks
d. 2-3 months
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