American Board of Internal Medicine (ABIM) Certification Practice Exam

What approach should be taken initially when managing irritable bowel syndrome (IBS)?

1. Immediate medication prescription

2. Clear establishment of the diagnosis

3. Referral to a specialist

4. Endoscopic examination

The correct answer is: Clear establishment of the diagnosis

The initial approach to managing irritable bowel syndrome (IBS) primarily involves a clear establishment of the diagnosis. This step is essential because IBS is a functional gastrointestinal disorder characterized by symptoms such as abdominal pain, bloating, and changes in bowel habits without any identifiable structural abnormality. Before initiating treatment, it is crucial to confirm that the symptoms are consistent with IBS and not due to other underlying conditions, such as inflammatory bowel disease or celiac disease, which may require different management strategies. A thorough clinical history, along with a focused physical examination, can aid in ruling out other causes of gastrointestinal symptoms. Once a confident diagnosis of IBS is established, management can then proceed with lifestyle modifications, dietary adjustments, and possibly medications tailored to the specific symptomatology of the patient. Therefore, establishing the diagnosis is the foundational step in effectively managing the disorder and ensuring the patient receives appropriate care.