Lower GI Bleeding and Bowel Disorders Practice Questions

25 multiple-choice questions on Lower GI bleeding and bowel disorders for paramedic and EMT students, from Chapter 21 (Abdominal and Gastrointestinal Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. The most common cause of significant lower GI bleeding in older adults is:

   1. A. Diverticulosis
   2. B. Appendicitis
   3. C. Peptic ulcer
   4. D. Esophageal varices
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   Answer: A. Diverticulosis

   Diverticula form at weak spots where arteries enter the colon wall. They can bleed painlessly and heavily. Ulcers and varices are upper sources.

2. Bright red blood coating the stool, with rectal itching and pain on defecation, most suggests:

   1. A. Diverticulitis
   2. B. Colon cancer
   3. C. Mesenteric ischemia
   4. D. Hemorrhoids
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   Answer: D. Hemorrhoids

   Hemorrhoids cause small amounts of bright red blood on the toilet paper or stool surface. They are usually not dangerous but can bleed more in anticoagulated patients.

3. Diverticulitis differs from diverticulosis in that diverticulitis is:

   1. A. Painless bleeding from diverticula
   2. B. Presence of pouches without symptoms
   3. C. Inflamed, infected diverticula
   4. D. Bleeding from swollen rectal veins
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   Answer: C. Inflamed, infected diverticula

   Diverticulosis means pouches exist; diverticulitis means they are inflamed or infected. Diverticulitis usually causes LLQ pain and fever.

4. A 68-year-old has left lower quadrant pain, fever, and tenderness for 2 days. The most likely cause is:

   1. A. Acute appendicitis
   2. B. Diverticulitis
   3. C. Cholecystitis
   4. D. Pancreatitis
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   Answer: B. Diverticulitis

   Diverticulitis is called 'left-sided appendicitis' because most diverticula are in the sigmoid colon. The appendix is in the RLQ.

5. Crohn disease differs from ulcerative colitis because Crohn disease:

   1. A. Only involves the rectum and colon
   2. B. Can involve any part of the gut
   3. C. Never causes bloody diarrhea
   4. D. Affects only the inner lining
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   Answer: B. Can involve any part of the gut

   Crohn disease can occur anywhere from mouth to anus and involves the full thickness of the wall, causing fistulas and strictures. UC involves only the colon and rectum lining.

6. Ulcerative colitis typically presents with:

   1. A. Black, tarry stools
   2. B. Projectile vomiting
   3. C. Bloody diarrhea, cramping
   4. D. Pain radiating to the back
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   Answer: C. Bloody diarrhea, cramping

   UC inflames the colon lining starting at the rectum, causing bloody, mucus-filled diarrhea and urgency. Melena suggests an upper GI source.

7. A patient with ulcerative colitis has a distended, tender abdomen, fever, and tachycardia. You should suspect:

   1. A. Simple flare of diarrhea
   2. B. Irritable bowel syndrome
   3. C. Hemorrhoid bleeding
   4. D. Toxic megacolon
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   Answer: D. Toxic megacolon

   Toxic megacolon is massive dilation of an inflamed colon with systemic toxicity and a risk of perforation. It needs emergency care.

8. Irritable bowel syndrome is best described as:

   1. A. Functional, with no inflammation
   2. B. An infection of the small bowel
   3. C. An autoimmune ulcer of the colon
   4. D. A precancerous polyp condition
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   Answer: A. Functional, with no inflammation

   IBS causes cramping and altered bowel habits without structural damage. Weight loss, bleeding, or fever point to a different cause.

9. A patient on vacation develops watery diarrhea, cramping, and nausea after eating at a buffet. The most likely cause is:

   1. A. Gastroenteritis
   2. B. Appendicitis
   3. C. Diverticulitis
   4. D. Bowel obstruction
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   Answer: A. Gastroenteritis

   Acute infectious gastroenteritis from contaminated food or water causes diarrhea, vomiting, and cramps. Most cases resolve but can cause dehydration.

10. The greatest danger from severe gastroenteritis in infants and older adults is:

    1. A. Bowel perforation and peritonitis
    2. B. Bleeding from the colon
    3. C. Liver failure
    4. D. Dehydration and electrolyte loss
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    Answer: D. Dehydration and electrolyte loss

    Fluid losses from diarrhea and vomiting can quickly cause hypovolemia and dangerous electrolyte changes in the very young and old.

11. A 74-year-old with vascular disease has sudden crampy left-sided abdominal pain followed within a day by bloody diarrhea. A likely cause is:

    1. A. Irritable bowel syndrome
    2. B. Ischemic colitis
    3. C. Internal hemorrhoids
    4. D. An anal fissure
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    Answer: B. Ischemic colitis

    Ischemic colitis, from reduced colonic blood flow, typically affects older adults with vascular disease and causes sudden cramping pain and an urge to pass stool, followed by bloody diarrhea. Hemorrhoids and fissures cause bright red bleeding without this pain pattern, and IBS does not cause bleeding.

12. A patient recently finished antibiotics and now has frequent foul-smelling watery diarrhea. You should suspect:

    1. A. Ulcerative colitis flare
    2. B. Appendicitis
    3. C. C. difficile infection
    4. D. Hemorrhoids
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    Answer: C. C. difficile infection

    Antibiotics disrupt normal gut flora, allowing C. difficile to overgrow and release toxins. It can become severe and life-threatening.

13. Which finding with lower GI bleeding most suggests a need for urgent transport?

    1. A. A small streak of blood on tissue
    2. B. Dizziness and a pulse of 120
    3. C. A history of hemorrhoids
    4. D. Mild cramping relieved by passing gas
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    Answer: B. Dizziness and a pulse of 120

    Signs of hypovolemia matter more than the volume reported. Tachycardia and dizziness mean significant blood loss.

14. Colorectal cancer may present in the field as:

    1. A. Sudden tearing back pain
    2. B. Pain radiating to the left shoulder
    3. C. Rash and joint pain
    4. D. Weight loss, anemia, stool changes
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    Answer: D. Weight loss, anemia, stool changes

    Gradual blood loss causes fatigue and pallor. A change in bowel habits or narrow stools may come before obstruction.

15. An anal fissure is:

    1. A. A tear in the anal lining
    2. B. Swollen veins in the rectum
    3. C. An infected pouch in the colon
    4. D. A twist of the sigmoid colon
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    Answer: A. A tear in the anal lining

    Fissures cause sharp pain and bright red blood with bowel movements. Hemorrhoids are swollen veins.

16. A tender, swollen, red area near the anus with fever is most likely a:

    1. A. Internal hemorrhoid
    2. B. Anal fissure
    3. C. Perianal abscess
    4. D. Sigmoid volvulus
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    Answer: C. Perianal abscess

    A collection of pus near the anus causes painful swelling and fever. It requires drainage and can lead to systemic infection.

17. Which patient with diarrhea is most likely to need IV fluids in the field?

    1. A. A healthy 30-year-old drinking fluids
    2. B. A 20-year-old after one loose stool
    3. C. A teen with mild cramps
    4. D. A confused 84-year-old with low BP
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    Answer: D. A confused 84-year-old with low BP

    Altered mental status and hypotension in an older patient indicate significant dehydration needing IV fluids per protocol.

18. Constipation can become an emergency when it causes:

    1. A. Mild bloating after meals
    2. B. Two days without a bowel movement
    3. C. Fecal impaction with obstruction
    4. D. Hard stools relieved by fiber
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    Answer: C. Fecal impaction with obstruction

    Impacted stool can block the colon and lead to distension, vomiting, and perforation risk, especially in older and immobile patients.

19. Which medication class commonly causes constipation?

    1. A. Opioid pain medications
    2. B. Antibiotics
    3. C. Laxatives
    4. D. Antacids with magnesium
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    Answer: A. Opioid pain medications

    Opioids slow gut motility. Many antibiotics and magnesium-based antacids cause diarrhea instead.

20. A man with known hemorrhoids has painless rectal bleeding, HR 128, and pale skin. How should you interpret this?

    1. A. Hemorrhoids explain it; no further care
    2. B. Consider a serious source; treat for shock
    3. C. Have him follow up with his own doctor
    4. D. Advise a stool softener and drinking more fluids
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    Answer: B. Consider a serious source; treat for shock

    Hemorrhoids rarely cause hemodynamically significant bleeding. Tachycardia and pallor point to a larger lower or brisk upper GI bleed, so treat for shock and transport. Anchoring on a known diagnosis is a common error.

21. Hematochezia most often indicates bleeding from the:

    1. A. Esophageal veins
    2. B. Stomach
    3. C. Colon or rectum
    4. D. Upper duodenum
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    Answer: C. Colon or rectum

    Bright red or maroon blood per rectum usually comes from a lower source. A very brisk upper bleed can also cause it.

22. Why are patients with inflammatory bowel disease often at increased risk of infection?

    1. A. Many take immunosuppressants
    2. B. Diarrhea washes away gut immunity
    3. C. Their bowel makes too much mucus
    4. D. IBD is itself an infection
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    Answer: A. Many take immunosuppressants

    Steroids and biologic drugs used for IBD suppress immunity and may hide fever and pain. IBD is an immune disorder, not an infection, and neither diarrhea nor mucus production is the reason for the added risk.

23. Mesenteric ischemia may cause which stool finding as the bowel dies?

    1. A. Clay-colored stools
    2. B. Bloody or maroon stools
    3. C. Green, watery stools
    4. D. Mucus-free normal stool
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    Answer: B. Bloody or maroon stools

    Ischemic bowel lining sloughs and bleeds. Combined with severe pain out of proportion to the exam, this is an emergency.

24. Which home remedy history in a dehydrated older patient with diarrhea is most concerning?

    1. A. Drinking oral rehydration fluids
    2. B. Eating bananas and rice
    3. C. Resting in bed
    4. D. Taking extra diuretic pills
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    Answer: D. Taking extra diuretic pills

    Diuretics add fluid and potassium loss to the diarrhea, increasing the risk of hypovolemia and arrhythmias.

25. Bloody diarrhea with fever after eating undercooked ground beef should raise concern for:

    1. A. Irritable bowel syndrome
    2. B. E. coli O157:H7
    3. C. Lactose intolerance
    4. D. Hemorrhoids
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    Answer: B. E. coli O157:H7

    This E. coli strain causes bloody diarrhea and can lead to hemolytic uremic syndrome and kidney failure, especially in children.