Mehlman. IBD 04-21 (4)

Question 1

IBD refers to both ulcerative colitis (UC) and Crohn.

Answer 1

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Question 2

Both can present with bloody, mucoid stools

Answer 2

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Question 3

Both are associated with HLA-B27 –> PAIR –> Psoriasis, Ankylosing spondylitis, IBD, Reactive arthritis.

Answer 3

.

Question 4

For example, if a patient has psoriasis + bloody stools, you say, “The bloody stools are probably …….

Answer 4

IBD

Question 5

Or likewise, if patient with known IBD has lower back pain that’s worse in the morning, you say, “that’s
probably …..

Answer 5

ankylosing spondylitis.

Question 6

Both UC and Crohn can be associated with other ….

Answer 6

autoimmune diseases UNRELATED to HLA-B27, like vitiligo

Question 7

Both can cause anterior uveitis (non-specific finding seen in many autoimmune diseases).

Answer 7

.

Question 8

Both have ­ risk of colon cancer if the colon is involved. but which one has higher risk?

Answer 8

But if you’re forced to choose, UC has > risk than
Crohn because the colon is always involved in UC but not always in Crohn

Question 9

both are treated with what?

Answer 9

Both are treated with 5-ASA NSAID compounds (mesalamine / sulfasalazine) or steroids.

Question 10

If they ask first
Tx, go with …….?

Answer 10

If they ask first
Tx, go with mesalamine or sulfasalazine, whichever they list (they won’t list both) over steroids.

Question 11

USMLE wants you to know ….. are used in IBD in patients who fail initial Tx with 5-ASAs and steroids.

Answer 11

anti-TNF-a agents (i.e., infliximab, adalimumab, etanercept)

Question 11

Q on 2CK IM form 8 has “prednisone therapy” as answer for Crohn, but a 5-ASA isn’t listed.

Answer 11

.

Question 12

f they ask you for which cytokine can be anti-inflammatory for IBD, the answer is …..

Answer 12

IL-10.

Question 13

Sounds weird, but
just know IL-10 and TGF-b are mostly anti-inflammatory mediators. Don’t worry about Th1 vs Th2 nonsense.

Answer 13

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Question 14

UC - rectum-ascending.

Answer 14

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Question 15

UC - what extent?

Answer 15

Not transmural – i.e., only affects mucosa and submucosa.

Question 16

UC can be fistula?

Answer 16

fistulae are not seen. If they say fistulae to the skin overlying the anus or to any organ,
this means transmural involvement (Crohn).

Question 17

UC what shows colonoscopy?

Answer 17

Colonoscopy will show pseudopolyps and crypt abscesses. You don’t need to
know what these look like. You just need to know they = UC.

Question 18

UC what shows barium enema?

Answer 18

Barium enema shows “lead-pipe appearance” due to loss of haustra. This detail is very important for UC.

vaizdas tiesiog kaip vamzdis

Question 19

UC with what autoimmune assoc?

Answer 19

Can cause primary sclerosing cholangitis, as discussed earlier. This can be associated with pANCA antibodies

Question 20

What skin lesion can present in patients with UC?

Answer 20

Pyoderma gangrenosum is a necrotic skin lesion seen rarely in patients with UC.
There is an NBME Q that describes this as an “ulcer with necrotic debris.”

Question 21

UC. what colon pathology can cause?

Answer 21

Can cause toxic megacolon, which presents as SIRS and sometimes low BP in a patient with UC. They might say abdominal x-ray shows a 12-cm cecum (NR 3-8).

Question 22

UC. If patient has toxic megacolon + stable –> Tx?

Answer 22

If the patient has normal BP, NBME for 2CK wants steroids first for toxic
megacolon.

Question 23

UC. If patient has toxic megacolon + UNstable –> Tx?

Answer 23

If the patient is unstable, go straight to laparotomy.

Question 24

UC. Colectomy is sometimes performed in patients with severe UC, but very rarely in Crohn

Answer 24

.

Question 25

Crohn. extension?

Answer 25

"Mouth to anus” – i.e., can occur anywhere in GI tract. USMLE loves giving mouth ulcers in Crohn. But terminal ileum is highest yield location

Question 26

Crohn. HY location?

Answer 26

But terminal ileum is highest yield location.

Question 27

Crohn. whats about fistula?

Answer 27

Transmural – i.e., can cause anal fistulae + to other organs.

Question 28

Crohn. what shows colonoscopy?

Answer 28

Colonoscopy shows skip lesions, where there is alternating diseased vs normal bowel segments, with cobblestone ulcers.

Question 29

Crohn. “Creeping fat” is buzzy term that can be seen on NBME, which refers to intestinal fat migration that wraps around the bowel

Answer 29

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Question 30

Crohn. what barium enema shows?

Answer 30

Barium enema shows “string sign,” where inflamed segments are narrowed in comparison to normal bowel.

Question 31

Crohn. biopsy?

Answer 31

Biopsy shows non-caseating granulomas. Very HY for USMLE you know that Crohn + sarcoidosis both have non-caseating granulomas.

Question 32

Crohn. Sometimes associated with erythema nodosum. Not specific for Crohn in any regard, but tends to have ­association, whereas UC is pyoderma gangrenosum. !!!!!! SKIRTUMAS!!!!!!!

Answer 32

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Question 33

Crohn = erythema nodosum

Answer 33

.

Question 34

UC = pyoderma gangrenosum.

Answer 34

.

Question 35

Crohn. keistas pirma kart girdetas dalykas.

Answer 35

Can cause anti-saccharomyces cerevisiae (yeast) antibodies. This is on a 2CK NBME, where they say (-) for these Abs, but (+) for pANCA, where answer is UC.

Question 36

Crohn. Intestinal malabsorbtion?

Answer 36

Intestinal malabsorption can occur, resulting in B12 deficiency most commonly due to terminal ileum being classic inflammatory location

Question 37

Crohn. What kidney?

Answer 37

Impaired fat absorption can result in ­ calcium oxalate urolithiasis, as discussed in the HY Renal PDF.