Inflammatory Bowel Disease HPIM 20th ed

Question 1

In a patient with Crohn’s disease with jejunoileitis, what nutritional deficiencies are expected arising from intestinal malabsorption?

Answer 1

Anemia

Hypoalbuminemia

Hypocalcemia

Hypomagnesemia

Coagulopathy

Hyperoxaluria with nephrolithiasis

Question 2

Definition of toxic megacolon (complication in UC)

Answer 2

transverse or right colon with a diameter of >6 cm, with loss of haustration in patients with severe attacks of UC

Question 3

Most dangerous local complication of Ulcerative Colitis

Answer 3

PERFORATION

Question 4

__________ is a highly sensitive and specific marker for detecting intestinal inflammation. It is a glycoprotein in activated neutrophils.

Answer 4

Fecal lactoferrin

Question 5

_________ is present in neutrophils, monocytes and correlates well with histologic inflammation, predict relapses and detect pouchitis.

Answer 5

FECAL CALPROTECTIN

Question 6

What are endoscopic features of Crohn’s disease?

Answer 6

Rectal sparing, aphthous ulcerations, fistulas, and skip lesions

Question 7

True or False. CT enterography allows direct visualization of the entire small-bowel mucosa.

Answer 7

False. Wireless Capsule Endoscopy.

Question 8

_________ from longitudinal and transverse ulcerations most frequently involves the small bowel.

Answer 8

Cobblestoning

Question 9

The earliest macroscopic findings of colonic CD are ____________.

Answer 9

Aphtous ulcers

Question 10

Standard therapy for intraabdominal and pelvic abscess which occur in CD.

Answer 10

CT-guided percutaneous drainage of the abscess

Question 11

_______________ increases the risk of intraabdominal and pelvic abscesses in CD patients who have never had an operation.

Answer 11

Systemic Glucocorticoid therapy

Question 12

Serologic test: Inc titer of ASCAs (anti-Saccharomyces cerevisiae antibodies) associated with which IBD?

Answer 12

Crohn’s Disease

Question 13

Inc in P-ANCA is associated with ________

Answer 13

Ulcerative Colitis

Question 14

This infectious disease causes watery diarrhea, abdominal pain and fever followed by rectal tenesmus and by the passage of blood and mucus per rectum.

Answer 14

Shigellosis

Question 15

Infectious disease that mimics IBD which occurs mainly in the terminal ileum and causes mucosal ulceration, neutrophil invasion and thickening of the ileal wall.

Answer 15

Yersinia enterocolitica

Question 16

Epidemiology of IBD

Answer 16

Question 17

Different Clinical Features between Ulcerative Colitis vs Crohn’s Disease

Answer 17

Question 18

Herpes simplex infection of the GI tract is limited to which areas?

Answer 18

Oropharynx

Anorectum

Perianal areas

Question 19

Histologic components in Collagenous Colitis

Answer 19

Increased subepithelial collagen deposition

Colitis with increased intraepithelial lymphocytes

Main symptom: chronic watery diarrhea

Question 20

Risk factors of Collagenous colitis

Answer 20

Smoking

Use of NSAIDs

PPIs

Beta Blockers

History of autoimmune disease

Question 21

Histologic feature of Lymphocytic Colitis

Answer 21

NO subepithelial collagen deposition

Intraepithelial lymphocytes INCREASED

Question 22

Two drugs that may have complication which mimic IBD

Answer 22

IPILIMUMAB

MMF (Mycophenolate Mofetil)

Question 23

Describe the lesion of Erythema nodosum which occurs in CD and UC

Answer 23

Lesions are hot, red, tender nodules measuring 1-5 cm in diameter and are found on the anterior surface of the lower legs, ankles, thighs and arms.

Question 24

Lesion of Pyoderma gangrenosum

Answer 24

PG usually begins as a pustule and then spreads concentrically to rapidly undermine healthy skin. Lesions then ulcerate with violaceous edges surrounded by a margin of erythema. Centrally, they contain necrotic tissue with blood and exudate. Lesions may be single or multiple and grow as large as 30 cm.

Question 25

True or False. Patients with peripheral arthritis associated with IBD worsens with exacerbations of bowel activity.

Answer 25

True, as opposed to Ankylosing spondylitis which is not related to bowel activity.

Question 26

___________ is a disorder characterized by both intrahepatic and extrahepatic bile duct inflammation and fibrosis, frequently leading to biliary cirrhosis and hepatic failure.

Answer 26

Primary sclerosing cholangitis

Question 27

Traditional gold standard diagnostic test for Primary Sclerosing Cholangitis

Answer 27

ERCP

Question 28

What are the most frequent genitourinary complications in IBD are ______, ________, and __________.

Answer 28

Calculi, Ureteral obstruction, and ileal bladder fistulas.

Question 29

Pathophysiology of formation of nephrolithiasis in patients with CD following small bowel resection

Answer 29

Normally, dietary calcium combines with luminal oxalate to form insoluble calcium oxalate, which is elimated in the stool. In patients, with ileal dysfunction, however, nonabsorbed fatty acids bind calcium and leave oxalate unbound. The unbound oxalate is then delivered to the colon, where it is readily absorbed, especially in the presence of inflammation.

Question 30

Factors responsible for the hypercoagulable state in IBD.

Answer 30

Abnormalities of the platelet-endothelial interaction

Hyperhomocysteinemia

Alterations in the coagulation cascade

Impaired fibrinolysis

Involvment of tissue-bearing microvesicles

disruption of the normal coagulation system by autoantibodies