This self-assessment examination gives you the opportunity to assess your understanding and retention of the information presented in this presentation. Select an answer for each question. To earn 1.25 hours of Category 1 CME credit, you must answer at least 12 questions correctly. If you need to review information regarding each question, the section of the presentation is referenced for easy review. Upon successful completion of this examination, you will need to complete an evaluation and then your certificate will appear for printing.
1. 
Features of IBS include the following: (Section 1)
A. Increased motor reactivity of gut, increased visceral hypersensitivity, increased sensitivity to peripheral sensitization, and CNS/ENS dysregulation.
B. Decreased motor reactivity of gut, decreased visceral hypersensitivity, and increased sensitivity to peripheral sensitization.
C. Dysregulation of CNS/ENS controls and decreased motor reactivity of gut.
D. Dysregulation of CNS/ENS controls, decreased motor reactivity of gut, and decreased sensitivity to peripheral sensitization.

2.
Which is true about IBS that is constipation predominant? (Section 1)
A. Post-prandial rectal tone is increased.
B. There is increased rectal hypersensitivity.
C. There is an increase in the gastrocolic response.
D. There is decreased rectal sensitivity.

3.
Neurotransmitters that contribute to the mediation of normal motility and visceral sensation have been the focus of recent work in the field. (Section 1)
A. Neurotransmitters that contribute to the mediation of normal motility and visceral sensation have been one focus of recent work in the field.
B. Serotonin appears to play an important role in visceral sensation and the functions of the enteric nervous system.
C. There is good evidence that the 5-HT3 receptor antagonists and the 5-HT4 receptor partial agonists are effective for treatment of specific subsets of IBS.
D. The 5-HT1A and 5-HT1D receptors are potential treatment targets for IBS.

4.
Which set of factors best predict post-infectious GI symptoms? (Section 4)
A. Physical distress, female gender, older age, increased duration of constipation, and peripheral pain.
B. Psychological distress, female gender, younger age, increased duration of diarrhea, and increased duration of abdominal pain.
C. Physical distress, male gender, older age, increased duration of constipation, and peripheral pain.
D. Psychological distress, male gender, younger age, increased duration of diarrhea, and decreased duration of abdominal pain.

5.
The Rome II criteria for IBS specifically include all of the following components except for: (Section 1)
A. Pain relief with defecation.
B. Diarrhea and constipation.
C. Onset associated with change in frequency of stool.
D. Onset associated with change in form of stool.

6.
Psychological distress may enable the clinical expression of IBS symptoms through which mechanism(s)? (Section 1)
A. Initiating mucosal inflammation.
B. Triggering intestinal dysmotility and secretion.
C. Increasing visceral hypersensitivity.
D. Amplifying incoming visceral signals.

7.
A series of experiments by Sigami et al confirmed the neuro-endocrine connection in IBS by showing all of the following except for: (Section 3)
A. CRH agonists can decrease abdominal pain in response to electrical stimulation in those with IBS.
B. CRH agonists can cause significant drop in gastric motility in those with IBS
C. CRH release can slow gastric motility.
D. CRH agonists can decrease visceral stimulation induced anxiety in response to electrical stimulation in those with IBS.

8.
Data presented by Coates et al in 2004 studied serotonin reuptake inhibitor (SERT) activity in IBS and ulcerative colitis (UC). The data showed SERT mRNA and IR intensity is decreased by which factor in both IBS and UC? (Section 3)
A. 3
B. 5
C. 10
D. 20

9.
Which of the following is not a potential physiologic target for treatment of IBS?
A. Appetite
B. Secretion
C. Sensation
D. Pain perception

10. 
5-HT3 antagonists have which of the following effects? (Section 5)
A. Antidiarrheal, antinociceptive, antiemetic
B. Prokinetic, antinociceptive
C. Early satiety, antral motility, gastric accommodation
D. Gastric accommodation, antidiarrheal

11.
Data presented by O'Mahoney in 2005 on probiotics for IBS treatment showed which of the following? (Section 5)
A. L. salivarius increased IL-10: IL-12 the most post-treatment.
B. infantis increased IL-10:IL-12 the most post-treatment.
C. Placebo increased IL-10:IL-12 the most post-treatment.
D. The ratio of IL-10:IL-12 is not a useful clinical parameter.

12.
Pain perception is best modified in which manner? (Section 6)
A. Reduce the amplitude of the peripheral afferent signal through pharmacologic agents.
B. Increase central pain perception threshold through psychological treatments and/or antidepressants.
C. Combine afferent signal reduction simultaneously with an increase in pain perception threshold.
D. Combine afferent signal reduction followed by an increase in pain perception threshold.

13.
Which of the following diagnostic work-ups would have the highest pretest probability of being positive in a Caucasian individual who meets Rome II diagnostic criteria? (Section 5)
A. Colitis
B. Celiac disease
C. Thyroid dysfunction
D. Lactose malabsorption

14.
Which is true regarding placebo response rates in drug trials for IBS? (Section 5)
A. Placebo response rates are quite low.
B. Most drug trials have not had confounding results related to placebo response rates.
C. Placebo response rates can vary from 33-88% in various trials.
D. Placebo response rates are consistent in various trials.

15.
The best treatment for patients with IBS would include consideration of the following treatment approaches (from most important to least important)? (Section 6)
A. Stress reduction/symptomatic medical treatment/exercise; Establishment of therapeutic physician patient relationship; Combined antidepressant and psychiatric treatment; Cognitive behavioral therapy.
B. Establishment of therapeutic physician patient relationship; Stress reduction/symptomatic medical treatment/exercise; Low dose TCA, SNRI or SSRI; Combined antidepressant and psychiatric treatment/CBT/psychotherapy.
C. Combined antidepressant and psychiatric treatment; Stress reduction/symptomatic medical treatment/exercise; Low dose TCA, SNRI or SSRI; Combined antidepressant and psychiatric treatment/CBT/psychotherapy; Establishment of therapeutic physician patient relationship.
D. Low dose TCA, SNRI or SSRI; Combined antidepressant and psychiatric treatment/CBT/psychotherapy; Establishment of therapeutic physician patient relationship; Stress reduction/symptomatic medical treatment/exercise.

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