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January CME Exam 2 Questions
384
CME ACTIVITY
GASTROENTEROLOGY Vol. 138, No. 1
Question 3: Which of the following explains the majority of overuse of colonoscopy-based surveillance after an initial colonoscopy that identifies patients as having a low risk for colorectal cancer?
a. Initial incomplete colonoscopy. b. Switch to a different gastroenterologist/colonoscopist who was unaware of the initial findings. c. Poor bowel preparation d. Interval adenomatous polyp findings. e. None of the above.
Exam 2: Phenotypic Variation of Colonic Motor Functions in Chronic Constipation Test ID No.: gast00114
Contact hours: 1.0
Expiration Date: December 31, 2010
Question 1: A 44-year-old woman presented with lifelong constipation. Despite using laxatives and dietary fiber supplements, she had no desire to defecate, complained of a sense of anorectal blockage, strained excessively even to evacuate rectal enemas, and was unsatisfied after evacuation. There were no alarm symptoms or signs. There is no family history of colon polyps or cancer. Routine blood tests and a colonoscopy were normal within the past 3 years. The most appropriate next step to evaluate the patient’s symptoms is to:
a. b. c. d. e.
Repeat a colonoscopy. Increase dietary fiber content. Assess colonic transit and anorectal functions. Refer her to a surgeon for subtotal colectomy. Refer her for psychological counseling.
Question 2: Which of the following statements regarding normal colonic motor activity in humans is most accurate?
a. Motor activity is comprised of tone, which can be measured by a barostat, and phasic pressure activity, which is measured by manometric sensors. b. There is no diurnal variation in phasic pressure activity. c. Eating does not affect colonic motor activity. d. Colonic high amplitude propagated contractions (HAPCs) occur an average of 5 times daily and do not propel colonic contents.
CME ACTIVITY
Question 3: Which of the following statements regarding the relationship between colonic motor activity recorded by intraluminal manometry and a barostat, and transit and anorectal dysfunctions in chronic constipation is most accurate?
a. Fasting and postprandial colonic tone and phasic pressure activity are invariably normal in normal transit and abnormal in slow transit constipation with or without defecatory disorders. b. Fasting and postprandial colonic tone are normal in patients with normal fasting and postprandial phasic activity. c. On average, colonic compliance is normal in normal transit constipation but increased in slow transit constipation and defecatory disorders. d. Neostigmine reduces colonic compliance to a lesser extent in slow transit than normal transit constipation.
January 2010
CME ACTIVITY
385
Question 4: a. A principal component analysis of fasting and postprandial motor parameters revealed 4 factors that could be used to cluster patients into specific endophenotypes and are also very useful for guiding management in chronic constipation. b. Factor 1 is most strongly correlated with fasting sigmoid phasic motility and was inversely correlated with the postprandial change in phasic motility. c. Factor 2 is most strongly associated with increased fasting tone (ie, reduced fasting volume), a stiffer (ie, less compliant) colon, and a more prominent tonic response to a meal. d. Factors 3 and 4 are most strongly correlated with postprandial HAPCs and the tonic contractile response to a meal.
CME ACTIVITY
Characteristics of endophenotypes in chronic constipation include all of the following except:
CME ACTIVITY
GASTROENTEROLOGY Vol. 138, No. 1
Question 3: Which of the following explains the majority of overuse of colonoscopy-based surveillance after an initial colonoscopy that identifies patients as having a low risk for colorectal cancer?
a. Initial incomplete colonoscopy. b. Switch to a different gastroenterologist/colonoscopist who was unaware of the initial findings. c. Poor bowel preparation d. Interval adenomatous polyp findings. e. None of the above.
Exam 2: Phenotypic Variation of Colonic Motor Functions in Chronic Constipation Test ID No.: gast00114
Contact hours: 1.0
Expiration Date: December 31, 2010
Question 1: A 44-year-old woman presented with lifelong constipation. Despite using laxatives and dietary fiber supplements, she had no desire to defecate, complained of a sense of anorectal blockage, strained excessively even to evacuate rectal enemas, and was unsatisfied after evacuation. There were no alarm symptoms or signs. There is no family history of colon polyps or cancer. Routine blood tests and a colonoscopy were normal within the past 3 years. The most appropriate next step to evaluate the patient’s symptoms is to:
a. b. c. d. e.
Repeat a colonoscopy. Increase dietary fiber content. Assess colonic transit and anorectal functions. Refer her to a surgeon for subtotal colectomy. Refer her for psychological counseling.
Question 2: Which of the following statements regarding normal colonic motor activity in humans is most accurate?
a. Motor activity is comprised of tone, which can be measured by a barostat, and phasic pressure activity, which is measured by manometric sensors. b. There is no diurnal variation in phasic pressure activity. c. Eating does not affect colonic motor activity. d. Colonic high amplitude propagated contractions (HAPCs) occur an average of 5 times daily and do not propel colonic contents.
CME ACTIVITY
Question 3: Which of the following statements regarding the relationship between colonic motor activity recorded by intraluminal manometry and a barostat, and transit and anorectal dysfunctions in chronic constipation is most accurate?
a. Fasting and postprandial colonic tone and phasic pressure activity are invariably normal in normal transit and abnormal in slow transit constipation with or without defecatory disorders. b. Fasting and postprandial colonic tone are normal in patients with normal fasting and postprandial phasic activity. c. On average, colonic compliance is normal in normal transit constipation but increased in slow transit constipation and defecatory disorders. d. Neostigmine reduces colonic compliance to a lesser extent in slow transit than normal transit constipation.
January 2010
CME ACTIVITY
385
Question 4: a. A principal component analysis of fasting and postprandial motor parameters revealed 4 factors that could be used to cluster patients into specific endophenotypes and are also very useful for guiding management in chronic constipation. b. Factor 1 is most strongly correlated with fasting sigmoid phasic motility and was inversely correlated with the postprandial change in phasic motility. c. Factor 2 is most strongly associated with increased fasting tone (ie, reduced fasting volume), a stiffer (ie, less compliant) colon, and a more prominent tonic response to a meal. d. Factors 3 and 4 are most strongly correlated with postprandial HAPCs and the tonic contractile response to a meal.
CME ACTIVITY
Characteristics of endophenotypes in chronic constipation include all of the following except: