What is the best approach for a patient requiring elective surgery for Crohn disease with

obstructive symptoms?
A. Resection of the bowel to microscopically clear margins with primary anastomosis
B. Diverting ileostomy and future anastomosis
C. Resection of grossly normal bowel and primary anastomosis
D. Dilatation and transverse closure

Ans: A

A 25-year-old man presents with low-grade fever, weight loss, fatigue, crampy abdominal pain,
episodic diarrhea, and recurrent urinary tract infections. Physical examination reveals pallor,
and tender, erythematous lesions on the extensor surfaces of his legs. Right lower quadrant
tenderness is elicited on palpation of the abdomen. A capsule endoscopy reveals thickening of
the terminal ileum, edema, marked luminal narrowing, and a cobblestone appearance of the
mucosa. The patient undergoes successful surgery with an unremarkable post-operative course.
When should the patient undergo repeat ileocolonoscopy to monitor his disease course?

A. 1 year
B. 2 years
C. 3 years
D. 5 years

Ans: A

Which feature most reliably differentiates Crohn disease from ulcerative colitis?
A. Age at presentation
B. Presence of extraintestinal symptoms
C. Blood in stools
D. Presence of granulomas

Ans: D

A 31-year-old female presents with progressive abdominal discomfort for the past few weeks.
Most days she has diarrhea, but on occasion, she has constipation. She also reports bloating
and flatulence. Stress and eating seem to increase symptoms, while defecation improves her
condition. She has not traveled out of the United States. Temperature is 36.7 C (98 F), blood
pressure is 118/74 mm Hg, the pulse is 74/min, and respirations are 14/min. A physical exam is
essentially normal. Labs show white blood cell count 7000 cells/microliter, hemoglobin 10
grams/dL, hematocrit 30%, platelets 200,000, AST 91 U/L, ALT 112 U/L, and erythrocyte
sedimentation rate of 49 mm/hr. Stool shows no blood but is positive for lactoferrin. Which of
the following is the next best step in the management of this patient?

A. Fiber supplements
B. Colonoscopy
C. Biofeedback and antidepressants
D. Broad-spectrum antibiotics

Ans:B

Which of the following is the most common cause of ulcerative colitis-related mortality
A. Colonic adenocarcinoma
B. Toxic megacolon
C. Perforated colon
D. Colonic infarction

Ans: B

Which of the following is the most common extraintestinal manifestation associated with
ulcerative colitis?
A. Pulmonary manifestations
B. Hepatopancreatobiliary manifestations
C. Ocular manifestations
D. Musculoskeletal manifestations

Ans: D

Which of the following is a defining characteristic of severe ulcerative colitis?

A. More than four bowel movements per day
B. Bleeding from the rectum
C. A systemic illness with hypoalbuminemia (< 30 g/L)
D. Fistulae

Ans: C

Which of the following studies is used to help distinguish ulcerative colitis from infectious colitis
in a patient with acute onset of bloody diarrhea?
A. Radiography
B. Stool assays
C. Double-contrast barium enema
D. Mucosal biopsy

Ans: D

Which of the following is the preferred therapy in mild ulcerative colitis confined to the
rectum?
A. Topical mesalazine given by suppository
B. Oral prednisone
C. Intravenous azathioprine
D. Hydrocortisone given by enema

Ans: A

Inflammatory bowel disease (IBD) includes both Crohn disease and ulcerative colitis. IBD is a
relapsing and remitting condition characterized by chronic inflammation at various sites in the
GI tract resulting in diarrhea and abdominal pain. Which of the following is indicative of Crohn
disease but NOT ulcerative colitis?

A Gross rectal bleeding is always present

B. Inflammation is confined to mucosa except in severe cases
C. Inflammation is uniform and diffuse
D. Rectum is often spared

Ans: D

Which of the following disorders is clearly associated with IBD but appears regardless of
whether or not the patient is experiencing an IBD flare-up?
A. Aphthous stomatitis
B. Episcleritis
C. Erythema nodosum
D. Uveitis

Ans: D

MJP, a 25 year old female, diagnosed with Crohn’s Disease came in for complaints of pallor,
easy fatigability, and carpopedal spasm. Upon physical examination, (+) Chvostek’s sign and
Trousseau’s sign. Which of the following organs is most likely involved?
A. duodenum
B jejunum
C. ileum
D. cecum

Ans: A

True about inflammatory bowel disease except?

A. ulcerative colitis is a continuous process
B. Ulcerative colitis is associated with intestinal fistula, strictures, and perianal disease
C. elevated levels of alkaline phosphatase in a patient with UC suggest the presence of primary
schlerosing colangitis
D. the presence of strictures in patient with active UC suggest colonic adenocarcinoma

Ans: B
True of Crohn disease but not true of ulcerative colitis:
A. gross blood and mucus in stool
B. systemic symptoms
C. recurrence after surgery
D. ANCA (+)

Ans: D

A patient undergoing therapy for Crohn's Disease, had a reactivation of his Latent TB, what
Drug may have been responsible?
A. Rituximab
B. Sulfasalazine
C. 5-ASA
D. Infliximab

Ans: D

This condition presents with crypt abscesses and friable mucosal pseudopolyps. There is also
leadpipe appearance on imaging. What disease is this?
A. Crohn's disease
B. Ulcerative colitis
C. Irritable bowel syndrome
D. Peutz-Jeghers syndrome

Ans: B

Among elderly patients, which of the following is the most common cause of lower GI bleeding?
A. Diverticulosis
B. Colorectal cancer
C. Anal fissure
D. Ulcerative colitis

Ans: B