USMLE REVIEW QUESTIONS

FOR THE USMLE EXAMS

Ulcerative colitis vs Crohns disease MCQs

QUESTIONs: What is IBD?

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ANSWER: IBD is inflammatory bowel disease, inflammatory disease of the GI tract

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QUESTION: What are the two inflammtory bowel diseases?

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ANSWER: Crohn’s disease and ulcerative colitis

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QUESTION: What is the cause of IBD?

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ANSWER:  No one knows, but probably an autoimmune process with environmental factors contributing

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QUESTION: What are the extraintestinal manifestations seen in both types of IBD?

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ANSWER:

- ankylosing spondylitis

- aphthous (oral) ulcers

- iritis

- pyoderma gangrenosum

- erythema nodosum

- clubbing of fingers

- sclerosing cholangitis

- arthritis

- kidney disease (nephrotic syndrome, amyloid deposits)

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QUESTION: In contrast to ulcerative colitis, Crohn’s disease of the colon:

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a. Is not associated with increased risk of colon cancer

b. Frequently presents as daily hematochezia

c. Is usually segmental rather than continuous

d. Has a lower incidence of perianal fistulas

e. Never develops toxic megacolon

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ANSWER: The answer is c: Crohn’s is patchy, segmental, chronic, and penetrates bowel wall to form fistulas, but seldom causes rectal bleeding. UC is mucosal ulcerating process that extends continuously from rectum proximal and has frequent rectal bleeds. Both can have toxic megacolon and both increase risk of cancer in large bowel.

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QUESTION:   Match the clinical comment below to either being associated with Crohn’s disease, Ulcerative colitis, Both, or Neither.

A. Anal involvement in 50%

B. Rectal involvement frequently seen

C. Small bowel involvement common

D. Chronic diarrhea, cramps, and fever

E. Curative surgery available

F. Toxic megacolon

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ANSWER:

A – Crohn’s disease

B – Both

C – Crohn’s disease

D – Both

E – Ulcerative colitis

F – Both

- Rectal involvement can be seen with both of these inflammatory diseases of the colon but is more common in ulcerative colitis (95% vs 50%)

- The clinical prsentations of these two entities are similar: chronic diarrhea, cramping, abdominal pain, and fever.

- a toxic megacolon can be an emergent, life threatening complication of either ulcerative colitis or Crohn’s disease, although it occurs less frequently with the latter.

ULCERATIVE COLITIS

- In ulcerative colitis, the anus is spared,

- “Backwash ileitis” a nonspecific dilatation of the terminal ileum, occurs in perhaps only 10% of patients with ulcerative colitis and has no prognostic or physiologic implications.

- Bloody stools, common with ulcerative colitis, are less common in Crohn’s disease.

- Total proctocolectomy or colectomy, rectal mucosectomy, and ileal pouch-anal anastomosis eliminate ulcerative colitis, whereas there is no curative operation for Crohn’s disease.

CROHN’S DISEASE

- In Crohn’s disease, anal or perianal disease is the first manifestation in 25-30% of cases.

- Ultimately, 50-70% of patients with Crohn’s colitis develop anal disease

- The small bowel is extensively involved in approximately 50% of patients with Crohn’s disease.

- There is no curative operation for Crohn’s disease

- Indeed even after total proctocolectomy for pancolonic invovelement with Crohn’s disease, its recurrence rate may be as high as 50%

- One third of patients require additional surgery for such recurrence

ULCERATIVE COLITIS VS CROHN’S DISEASE: REVIEW 

Pathology                                           Crohn’s Disease    Ulcerative Colitis

Transmural inflammation             Yes                   Uncommon

Granulomas                                          50-75%              No

Fissures                                                Common            Rare

Submucosal thickening, fibrosis    Common            No

Submucosal inflammation            Common          Uncommon

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Characteristic                  Crohn’s Colitis                                    Ulcerative Colitis

Location                             Small bowel involvement             Colon only

                                                                                                                (rare backwash ileitis)10%

Anatomic distribution       Asymmetric distribution            Contiguous involvement
                                                      (skip lesions)                                    beginning distally

Rectal involvement         Rectal sparing common 50%      Involved 90%

Gross bleeding                Absent in 25-30%                    Universal

Perianal disease              ≤75%                                    Rare, may be severe

Fistulization                     Yes                                      No

Granulomas                    50-75%                                 No

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Endoscopic feature                       Crohn’s Colitis                     Ulcerative Colitis

Mucosal involvement                  Discontinuous                   Contiguous

Discreet ulcers (aphthous ulcers)  Common                         Rare

Surrounding mucosa                   Relatively normal             Abnormal

Longitudinal ulcer                       Common                        Rare

Cobblestoning                           In severe cases                No

Rectal involvement                    Sparing common              Involved in 90%

Mucosal friability                        Uncommon                     Common

Vascular pattern                        Normal                           Distorted

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SOURCES
ABSITE KILLER Q&A

                

            

STUDY SCHEDULE FOR FUTURE   QUESTIONS

 
SMALL BOWEL
12/21 MCQs on Crohns disease
12/22 MCQs on Meckel’s diverticulum
12/23 MCQs on Small bowel obstruction
12/24 MCQs on Small bowel tumors
12/25 MCQs on Gallstone ileus
12/26 MCQs on Intestinal anastomosis and strength layer of the bowel
12/27 MCQs on Fistulas
12/28 MCQs on SMA syndrome
 
COLON
Colon anatomy MCQs
Colon physiology MCQs

Familial adenomatous polyposis MCQs
Colonoscopy MCQs
HNPCC (Lynch’s syndrome) MCQs
Colorectal cancer MCQs

ESOPHAGUS
Esophagus anatomy MCQs
Esophagus physiology MCQs

Achalasia MCQs
Esophageal leiomyoma MCQs
Caustic esophageal injury MCQs
Barrett’s esophagus MCQs
Gastroesophageal reflux disease (GERD)
Zenker’s diverticulum
Hiatal Hernias
Esophageal cancer
Anastomotic leaks
Esophageal perforation

THYROID
Thyroid anatomy MCQs
Thyroid physiology MCQs
Hyperthyroidism MCQs
Hypothyroidism MCQs
Thyroid cancer MCQs
Thyroidectomy MCQs
 
PARATHYROID
Parathyroid anatomy MCQs
Parathyroid physiology MCQs
Hyperparathyroidism MCQs
Hypoparathyroidism MCQs
Parathyroidectomy MCQs
 
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ARCHIVE
12/17 Carcinoid tumors MCQs .  
12/18 Appendicitis MCQs .
12/19 Small bowel syndrome MCQs .
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Categorised as: Crohns Disease, Ulcerative Colitis


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