Constipation MCQ Quiz | Gastrointestinal System

Welcome, MBBS students! This quiz is designed to test your understanding of Constipation, a common and significant topic within the Gastrointestinal System. Covering everything from pathophysiology and Rome IV criteria to clinical diagnosis and modern management strategies, these 25 multiple-choice questions will challenge your knowledge. This interactive assessment will help you consolidate your learning on etiological factors, alarm features, and the appropriate use of various laxatives and novel therapies. After submitting your answers, you will receive your score and see a detailed breakdown of correct and incorrect responses. For your revision, you can also download a PDF document containing all the questions along with their correct answers. Good luck!

1. According to the Rome IV criteria for functional constipation in adults, which of the following is required for diagnosis?

Symptoms must be present for at least 6 months before diagnosis, with active symptoms for the last 3 months. The presence of loose stools (without laxatives) must occur in more than 25% of defecations. Daily use of laxatives is a mandatory criterion. Insufficient criteria for Irritable Bowel Syndrome (IBS) must be met.

2. A 70-year-old male presents with a 2-month history of constipation, unintentional weight loss of 5 kg, and rectal bleeding. What is the most appropriate next step in management?

Prescribe a high-fiber diet and psyllium husk. Perform a colonoscopy. Start an osmotic laxative like lactulose. Order a thyroid function test.

3. Which class of laxatives works by increasing fecal mass and stimulating peristalsis?

Osmotic laxatives (e.g., polyethylene glycol) Stimulant laxatives (e.g., senna) Bulk-forming laxatives (e.g., psyllium) Stool softeners (e.g., docusate)

4. A patient with chronic constipation who strains excessively and reports a sensation of anorectal blockage is most likely suffering from which subtype of primary constipation?

Slow-transit constipation Normal-transit constipation Dyssynergic defecation (pelvic floor dysfunction) IBS with constipation (IBS-C)

5. Which of the following medications is a common cause of drug-induced constipation by reducing gut motility via mu-opioid receptor agonism?

Metformin Amlodipine Codeine Lisinopril

6. A patient with refractory constipation undergoes a colonic transit study (Sitzmarks test), which shows markers clustered in the rectosigmoid region. This finding is most suggestive of:

Slow-transit constipation Normal-transit constipation Defecatory disorder (outlet obstruction) Megacolon

7. Prucalopride is an effective treatment for chronic constipation. What is its primary mechanism of action?

Guanylate cyclase-C agonist Selective 5-HT4 receptor agonist Chloride channel activator Peripherally acting mu-opioid receptor antagonist

8. Which of the following is a potential metabolic complication of chronic laxative abuse, particularly with stimulant laxatives?

Hyperkalemia Metabolic acidosis Hypokalemia and metabolic alkalosis Hypermagnesemia

9. An elderly, bedridden patient presents with nausea, abdominal distension, and passage of liquid “overflow” diarrhea. On digital rectal examination, a hard mass of stool is felt. What is the most likely diagnosis?

Infectious colitis Fecal impaction Colorectal carcinoma Diverticulitis

10. Linaclotide and plecanatide are used for chronic idiopathic constipation and IBS-C. They work by activating which enzyme on the luminal surface of intestinal enterocytes?

Adenylate cyclase Guanylate cyclase-C Na+/K+-ATPase Sucrase-isomaltase

11. A 45-year-old woman with scleroderma presents with severe constipation. This is most likely due to:

Smooth muscle atrophy and fibrosis of the colonic wall Autonomic neuropathy Loss of enteric neurons Associated hypothyroidism

12. Which of the following endocrine disorders is a well-established secondary cause of constipation?

Hyperthyroidism Hypothyroidism Cushing’s syndrome Addison’s disease

13. In the management of opioid-induced constipation (OIC), which medication class is specifically designed to target the underlying pathophysiology without reversing central analgesia?

Osmotic laxatives 5-HT4 agonists Peripherally Acting Mu-Opioid Receptor Antagonists (PAMORAs) Bulk-forming agents

14. What is the primary role of anorectal manometry in the evaluation of a patient with chronic constipation?

To measure whole-gut transit time. To diagnose or rule out defecatory disorders like dyssynergic defecation. To identify structural abnormalities like rectocele. To detect melanosis coli.

15. A 30-year-old pregnant woman in her third trimester complains of worsening constipation. This is primarily attributed to increased levels of which hormone?

Estrogen Progesterone Human Chorionic Gonadotropin (hCG) Prolactin

16. The most common type of chronic primary constipation is:

Slow-transit constipation Normal-transit constipation Defecatory disorders Combined slow-transit and defecatory disorder

17. Which neurological condition is strongly associated with constipation, often preceding motor symptoms by several years?

Multiple sclerosis Alzheimer’s disease Parkinson’s disease Myasthenia gravis

18. The mechanism of action of Lubiprostone involves the activation of:

Type-2 chloride channels (ClC-2) on the apical membrane of enterocytes Sodium-potassium pump on the basolateral membrane Aquaporin channels, increasing water secretion Enteric nervous system motor neurons directly

19. What is the recommended daily dietary fiber intake for adults to help prevent and manage constipation?

5-10 grams 10-15 grams 25-35 grams More than 50 grams

20. Which of these is NOT considered an “alarm feature” warranting further investigation in a patient with constipation?

New onset of symptoms in a patient over 50 years old Family history of colorectal cancer Iron deficiency anemia Sensation of incomplete evacuation

21. A patient with end-stage renal disease develops constipation. Which laxative should be used with caution due to the risk of accumulation and toxicity?

Psyllium Lactulose Magnesium hydroxide (Milk of Magnesia) Bisacodyl

22. Hirschsprung’s disease, a cause of congenital constipation, is characterized by the absence of which cells in the distal colon?

Goblet cells Enteroendocrine cells Ganglion cells in the myenteric and submucosal plexuses Paneth cells

23. Biofeedback therapy is most effective for which type of chronic constipation?

Slow-transit constipation Drug-induced constipation Normal-transit constipation Dyssynergic defecation

24. What is the mechanism of action of docusate salts?

They directly stimulate colonic nerve endings. They are anionic surfactants that lower the surface tension of stool. They are non-absorbable sugars that draw water into the colon. They absorb water and increase fecal bulk.

25. First-line management for most cases of functional constipation, after ruling out secondary causes and alarm features, typically involves:

Prescription of prucalopride or lubiprostone. Referral for anorectal manometry and biofeedback. Lifestyle and dietary modifications (fiber, fluids, exercise) and possibly a bulk-forming laxative. Starting a stimulant laxative like bisacodyl for daily use.

Quiz Results

G S Sachin

I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.

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