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A. MLA Map Paediatrics > Crohns Disease (IBD) > Flashcards

Crohns Disease (IBD) Flashcards

1
Q

Crohns disease is one of the 2 types of inflammatory bowel disease. Where can this affect in the bowel?

1 - rectum only
2 - mouth to anus
3 - large bowel only
4 - small bowel only

A

2 - mouth to anus
- essentially anywhere

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2
Q

What is the prevalence (number of people with disease at a specific time) of crohns disease in the western world?

1 - 0.1 / 100,000
2 - 1 / 100,000
3 - 10 / 100,000
4 - 100 / 100,000

A

4 - 100 / 100,000

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3
Q

What is the incidence (number of new cases of a disease at a specific time) of crohns disease in the western world?

1 - 0.1 / 100,000
2 - 1 / 100,000
3 - 10-20 / 100,000
4 - 100 / 100,000

A

3 - 10-20 / 100,000

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4
Q

What age group does crohns typically affect?

1 - 10-20 y/o
2 - 20-40 y/o
3 - 40-60 y/o
4 - >65 y/o

A

3 - 10-20 / 100,000

  • can affect younger adults and children
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5
Q

What is a lifestyle factor that has been shown to significantly increases the risk of crohns disease?

1 - weight gain
2 - smoking
3 - alcohol
4 - chronic steroid use

A

2 - smoking

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6
Q

Although the exact cause of crohns is unknown, which of the following is NOT a common risk factor?

1 - genetics / immunity family history
2 - smoking
3 - constipation
4 - NSAIDs
5 - mucosal barriers deficiencies

A

3 - constipation

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7
Q

What is a first degree relative?

1 - share 100% genetics
2 - share at >50% genetics
3 - share no genetics
4 - share >25% genetics

A

2 - share at >50% genetics

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8
Q

There is a genetic risk of developing crohns disease. What is the risk of developing crohns if you have a first degree relative with it?

1 - 0.13-0.18%
2 - 1.3-1.8%
3 - 13-18%
4 - 26 - 36%

A

3 - 13-18%

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9
Q

There is a genetic risk of developing crohns disease. What is the risk of developing crohns if you are a monozygotic (one egg is released and fertilised) twin?

1 - 0.5%
2 - 5%
3 - 50%
4 - 100%

A

3 - 50%

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10
Q

There are multiple genes that have been associated with Crohns disease. Of the following which one has received the most interest?

1 - NOD2 (nucleotide binding domain) gene
2 - BRCA gene
3 - APC gene
4 - MLH1 gene

A

1 - NOD2 (nucleotide binding domain) gene

  • BUT over 200 other variants have been identified
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11
Q

What religious group are at a higher risk of developing Crohns disease?

1 - Catholics
2 - Ashkenazi jews
3 - Christians
4 - Muslims

A

2 - Ashkenazi Jewish

  • insular group, meaning they mate within the group so the genetic aspect of crohns is enhanced
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12
Q

To remember important points for Crohn’s disease we can use the mnemonic crows NESTS. What does the N stand for?

1 - no lymphocyte involvement
2 - needle fine aspirations of GIT
3 - no blood or mucus
4 - new onset of blood in stool

A

3 - no blood or mucus
- can occur, but much more common in UC

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13
Q

To remember important points for Crohn’s disease we can use the mnemonic crows NESTS. What does the E stand for?

1 - entire GIT
2 - ends at ileum
3 - enormous blood loss
4 - endocytosis

A

1 - entire GIT

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14
Q

To remember important points for Crohn’s disease we can use the mnemonic crows NESTS. What does the S stand for?

1 - sore anus
2 - sacral nerve affected
3 - skip lesions
4 - spondylosis

A

3 - skip lesions

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15
Q

To remember important points for Crohn’s disease we can use the mnemonic crows NESTS. What does the T stand for?

1 - transmural effects and terminal ileum most affected
2 - time dependent
3 - tumour forming
4 - trichomonas

A

1 - transmural effects and terminal ileum most affected

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16
Q

To remember important points for Crohn’s disease we can use the mnemonic crows NESTS. What does the 2nd S stand for?

1 - sacral oedema
2 - smoking increases risk of crohns
3 - sickle cell risk
4 - symbiotic increases risk

A

2 - smoking increases risk of crohns
- think don’t set fire to crows nest

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17
Q

Organise the suspected pathophysiology of crohns?

1 - deep fissured ulcers form
2 - dome shaped mucosa and submucosa forms creating cobblestone appearance
3 - immune response is triggered causing inflammation of the bowel wall
4 - epithelial cells remain largely intact
5 - bowel wall becomes thickened , especially in submucosa

A

3 - immune response is triggered causing inflammation of the bowel wall

5 - bowel wall becomes thickened , especially in submucosa

4 - epithelial cells remain largely intact

1 - deep fissured ulcers form

2 - dome shaped mucosa and submucosa forms creating cobblestone appearance

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18
Q

Which of the following is NOT a common symptom of crohns disease (CD)?

1 - chronic/episodic diarrhoea
2 - abdominal pain
3 - weight loss
4 - fatigue/malaise
5 - fever
6 - anorexia

A

1 - chronic/episodic diarrhoea

  • this is what happens in UC
  • in CD diarrhoea may occur, BUT it is not chronic or episodic
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19
Q

What are granulomas?

1 - collections of fluid lines by various cells
2 - collection of pus lines by epithelial cells
3 - collection of pus lines by granulation tissue
4 - aggregates of immune cells around foreign body

A

4 - aggregates of immune cells around foreign body

  • mainly macrophages surround foreign body and try to eliminate
  • hallmarks of crohns disease
20
Q

When comparing crohns and ulcerative colitis, which has granulomas?

A
  • crohns
  • bacteria get into lamina propria and granuloma is formed to trap the responsible agent
21
Q

What is the primary aim of treatment in crohns disease?

1 - cure CD
2 - reduce small intestines below 180-200cm to reduce recurrence rate
3 - prevent excessive surgery and limit chance of small bowel syndrome
4 - place a colostomy

A

3 - prevent excessive surgery and limit chance of small bowel syndrome

  • currently no known cure
  • small bowel syndrome = <180-200cm
22
Q

Does crohns disease affect the GI tract continuously or is it patchy?

A
  • patchy with healthy and disease tissue side by side
  • described as skip lesions and have a cobblestone appearance
23
Q

Does crohns disease cause transmural or mucosal/submucosal tissue injury?

A
  • transmural (affects all layers of GIT)
  • affects mucosa, submucosa, muscularis propria and serous layers
24
Q

Is there any fibrosis in the GIT walls of of patients with crohns disease and ulcerative colitis?

A
  • CD = marked fibrosis
  • UC = minimal
25
Q

Is rectal bleeding a common symptom in crohns disease?

A
  • can occur, but not commonly
26
Q

Which of the following is NOT a typical sign of crohns disease (CD)?

1 - abdominal masses/tender
2 - bowel ulceration
3 - perianal abscess/fistula / skin tags and strictures
4 - fever/tachycardia

A

4 - fever/tachycardia
- common in UC but not CD

27
Q

In patients with crohns disease (CD) absorption can be affected. Which of the following is NOT true in CD?

1 - protein-calorie malnutrition
2 - iron and folate deficiency
3 - anaemia
4 - increased bile reabsorbed causing darker urine
5 - B12 deficiency

A

4 - increased bile reabsorbed causing darker urine

  • we get less bile reabsorbed causing colonic irritation and diarrhoea
  • extreme cases this can lead to gall stones
28
Q

Crohns disease lead to localised pain and peritonitis. Which of the following is this most likely to cause this?

1 - GI ruptures faecal contents
2 - abscess formation
3 - obstruction
4 - inflamed bowel impinges and forms adhesions

A

4 - inflamed bowel impinges and forms adhesions

29
Q

In addition to the generic GI manifestations of crohns disease (CD), there are other extra intestinal symptoms. Which of the following is NOT a typical extra intestinal symptom of CD?

1 - clubbing
2 - arthropathy (joint problems, arthritis)
3 - skin problems
4 - mouth ulcers
5 - scleritis/episcleritis (eye problems)
6 - ankylosing spondylitis

A

6 - ankylosing spondylitis
- common in UC

  • scleritis = inflammation of sclere
  • episcleritis = inflammation of tissue between conjunctive and sclera
30
Q

When performing an abdominal examination on a patient with suspected crohns disease, why might there be a mass in the RIF?

1 - appendicitis is common in crohns
2 - greater omentum wraps around inflamed terminal ileum
3 - abscess forms here in crohns
4 - previous surgery

A

2 - greater omentum wraps around inflamed terminal ileum

31
Q

Is surgery curative in crohns disease?

A
  • no
  • there is no known cure
32
Q

How can crohns, if it is affecting the lower bowels be diagnosed effectively?

1 - X-ray
2 - MRI
3 - CT
4 - Ultrasound

A

3 - CT

  • allows biopsies to be taken as well
33
Q

If medication or conservative management fails, what % of patients with crohns require surgery?

1 - 0.8%
2 - 8%
3 - 40%
4 - 80%

A

4 - 80%

  • up to 80% will require it at some time
34
Q

How can crohns, if it is affecting the upper bowels be diagnosed effectively?

1 - X-ray
2 - MRI
3 - barium enema CT
4 - Ultrasound

A

3 - barium enema CT

  • called the follow through
  • can also use barium infused using a nasogastric tube
35
Q

In a patient with crohns what imaging modality should be used in the lower GI?

1 - colonoscopy
2 - sigmoidoscopy
3 - endoscopy
4 - ERCP

A

1 - colonoscopy

  • biopsy can also be taken
36
Q

Are faecal calprotectin typically higher in ulcerative colitis or crohns?

A
  • ulcerative colitis
37
Q

We can do a myriad of tests to help diagnose and identify the severity of crohns disease. Which of the following is NOT normally helpful?

1 - ESR
2 - CRP
3 - FBC
4 - LFTs
5 - stool culture and microscopy
6 - urinalysis

A

6 - urinalysis

  • stool culture and microscopy rules out infective cause
38
Q

Which lifestyle factor is important to ensure patients with crohns do?

1 - stops drinking alcohol
2 - stop smoking
3 - lose weight
4 - gluten free diet

A

2 - stop smoking
- smoking increases the risk of crohns

39
Q

When treating a patient with an acute attack of crohns that is mild to moderate, which of the following should they be prescribed with first?

1 - prednisolone
2 - prednisolone, methylprednisolone or biologics
3 - prednisolone, methylprednisolone or hydrocortisone
4 - mesalazine, biologics, or hydrocortisone

A

1 - prednisolone
- given orally

  • 40mg/day for 1 week then taper down 5mg every week
  • methylprednisolone or hydrocortisone could also be prescribed, but prednisolone is 1st choice
  • depends on the severity and if they can have steroids
  • hydrocortisone normally given via IV for more serious cases
40
Q

When treating a patient with a mild to moderate acute attack of crohns, we generally prescribe prednisolone, but methylprednisolone or hydrocortisone can also be prescribed. However, in a patient who is unable to have the typical steroids listed here they can be prescribed what other steroid?

1 - fludrocortisone
2 - fluticasone
3 - budesonide
4 - atropine

A

3 - budesonide

  • newish steroid
  • not as effective in some patients, but less side effects
41
Q

In an acute flare up of crohns disease, the 1st line medication is hydrocortisone given IV, or prednisolone give orally. The patient must also remain nil by mouth so they can be investigated. If there are no abdominal abscesses they should be given antibiotics. Which would the next medication be for this patient if the antibiotics and steroids do not help?

1 - methotrexate
2 - infliximab
3 - azathioprine and 6-mercatopurine
4 - all of the above

A

2 - infliximab

  • BUT could give all of them, BUT depends on the patients response to treatment
42
Q

Following their 1st operation, what % of patients with CD will likely need a further operation within 5 years?

1 - 0.7%
2 - 7%
3 - 17%
4 - 70%

A

4 - 70%

  • surgery may be the only option for draining an abscesses or treating fibrostenotic strictures that are causing an obstruction
43
Q

Which of the following medications should NOT be routinely used to ensure remission in Crohns disease?

1 - methotrexate
2 - hydrocortisone
3 - mercaptopurine
3 - azathioprine

A

2 - hydrocortisone
- glucocorticoids should not be used to maintain remission

44
Q

Thiopurines are the first line of treatment in Crohns disease, but are the second line for ulcerative colitis. How long do these drugs take to act?

1 - 6 hours
2 - 6 days
3 - 6 weeks
4 - 6 months

A

3 - 6 weeks

  • this is why patients are often given glucocorticoids to help alleviate symptoms 1st
45
Q

Thiopurines are the first line of treatment in Crohns disease, but are the second line for ulcerative colitis. They tend to take 6 weeks to act, so another class of drug can be prescribed alongside to help, what drug is this?

A
  • corticosteroids
46
Q

Thiopurines are the first line of treatment in Crohns disease, but are the second line for ulcerative colitis. What is the mechanism of action of this drug?

A
  • anti-inflammatory
  • Thiopurines metabolised into thioguanine nucleotides
  • thioguanine nucleotides are inserted into DNA backbone
  • stop DNA unwinding, which is required for inflammatory processes
47
Q

Thiopurine methyl transferase (TPMT) is the enzyme that metabolises Thiopurines. Why is it important to do genetic testing on patients with crohns before prescribing them with Thiopurines?

A
  • 1 in 300 patients have no TPMT
  • they are much more likely to suffer severe side effects such as bone marrow suppression

A. MLA Map Paediatrics (75 decks)

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