Inflammatory bowel disease

Question 1

Mainstay of therapy of mild to moderate UC

Effective in inducing remission in UC (limited in CD)

Answer 1

Sulfasalazine and other 5 ASA agents

Question 2

Composed of 2 ASA radicals linked by an azithromycin bond, which is split in colon by bacterial reduction

Answer 2

Ols alanine

Question 3

Unencapsulated version of mesalamine used in Europe for maintenance of remission

Answer 3

Salofalk

Question 4

Once a day formulation of mesalamine

Answer 4

Lialda

Question 5

When are glucocorticoids indicated

Answer 5

Mod to severe UC and CD remission

They have no role in maintenance therapy and must be tapered once remission has been induced

Question 6

What are the role of antibiotics in IBD?

Answer 6

Abx have no role in treatment of active to quiescent UC, except in pouchitis in UC patient

+ role in CD

Question 7

Top of the pyramid treatment for moderate to severe ulcerative colitis

Answer 7

Cyclosporine

Question 8

Rx mild to moderate ulcerative colitis

Answer 8

5) infiliximab/ adalimumab/ go limutan
4) 6-MP/ azathioprine
3) GC oral
2) GC rectal
1) 5-ASA oral/rectal

Question 9

Rx mod to severe ulcerative colitis

Answer 9

5) cyclosporine
4) adalimumab/ golimumab
3) 6-MP/ azathioprine
2) GC oral
1) GC rectal

Question 10

Rx fistulizing crohns disease

Answer 10

4) Total parenteral nutrition
3) natalizumab/ vedilimimab
2) anti TNF
1) abscess drainage and antibiotics

Question 11

Rx MILD TO MODERATE CROHNS DISEASE

Answer 11

5) infliximab/adalimumab
4) 6 MP, azathioprine, MXT
3) prednisone
2) sulfasalazine
1) budesonide (ideal and right colon)

Question 12

Rx MOD TO SEVERE CROHNS DISEASE

Answer 12

4) TPN
3) Glucocorticoid IV
2) Natalizumab/ vedolizumab
1) 6-MP/ azathioprine/MXT+infliximab/adalimumab/certolizumab

Question 13

CROHNS vs UC

Antibiotic use confers 2.9x risk of developing childhood IBD

Answer 13

UC

Question 14

CROHNS vs UC

Smoking may prevent disease
Appendectomy is protective

Answer 14

UC

Question 15

CROHNS vs UC

OCP use is a risk factor for disease

Answer 15

CROHNS

Question 16

CROHNS vs UC

38-58% concordance in monozygotic twins

Answer 16

CROHNS a

Question 17

Focal crypt abscesses

Answer 17

CROHNS

Question 18

Bifid crypts
Distorted architecture of colon
(+) basal plasma cells and multiple basal lymphoid aggregates

Answer 18

UC

Question 19

Earliest change of UC seen on single contrast barium enema

Answer 19

Fine mucosal granularity

Question 20

Collar button ulcers

Answer 20

UC

Question 21

Post common part of inflammation I CROHNS

Answer 21

Terminal ileum

Question 22

Serologic markers in IBD

P ANCa
P ASCA

Answer 22

ANCa UC

ASCA CD

Question 23

Complications of these two drugs mimic IBD

Answer 23

Ipilimumab CTLA4

Mycophenolate mofetil

Question 24

Responsive to antibiotics

Answer 24

CROHNS

In UC if with puchitis

Question 25

``` Radiographic features Small bowl abnormal Abnormal terminal ileum Segmental colitis Asymmetric colitis Structure ```

Answer 25

CROHNS disease

Question 26

Extraintestinal manifestations of I D

Answer 26

``` Derma Rheuma Ocular Hepatobiliary Urologic Metabolic bone disorders Thromboembolic ```

Question 27

Neutrophilic dermatitis and metastatic CD

Answer 27

Sweet sun

Question 28

Arthritis as an extraintestinal manifestation of CROHNS disease

Answer 28

Asymmetric poly articular and migratory | Most often affects the large joints of supper and lower extremities

Question 29

Mainstay of treatment mild to moderate UC

Answer 29

Sulfasalazine and other ASA agents

Question 30

Common side effects of ASA

Answer 30

Headache nausea hair loss and abdominal pain

Question 31

Management of glucocorticoid dep I d

Answer 31

Azathioprine and mercaptopurine

Question 32

AE of AZathioprine and 6-MP

Answer 32

Pancreatitis 3-4% | Bone marrow suppression

Question 33

Effective in maintaining remission in active CD

Answer 33

Methotrexate

Question 34

Macrolid antibiotic with immunomodulatory properties similar to CSA

Answer 34

Tacrolimus

Question 35

Solution to development of anti TNF antibodies (results to decreased response to treatment and inc risk of transfusion reactions)

Answer 35

Decreasing dosing intervals | Increasing dosage to 10 mg/kg

Question 36

Risk for this CA when using azathioprine or 6MP

Answer 36

Nonhodgkins lymphoma

Question 37

Gold STD diagnostic test for PSC

Answer 37

ERCP

Question 38

Extraintestinal manifestation of IBD occurs more often in UC than in CD

Answer 38

Primary sclerosing cholangitis

Question 39

Use of UDcA in patients with IBD may cause

Answer 39

Colorectal dysplasia | Cancer

Question 40

Risk of psc patients in developing cholangiocarcinoma

Answer 40

10-15%

Question 41

MF genitourinary complications of IBD

Answer 41

Calculi Ureteral obstruction Ileal bladder fistulas

Question 42

TPN plays a role, as dietary antigens may stimulate the mucosal immune response and this may respond to bowel read

Answer 42

Active CD (but NOT UC)