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Crohns Disease MCQs

QUESTION: Crohn’s disease:

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a. Is caused by mumps virus

b. Is more common in Asians than in Jews

c. Tends to occur in families

d. Is less frequent in temperate climates than in tropical ones

e. Is improved by smoking

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ANSWER: The answer is c: It does occur more in families, is more frequent in temperate climates, and more common among Jews than Asians. The cause is unknown though. Smoking does not improve Crohn’s, but there is a higher incidence of smoking in patients with Crohn’s.

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QUESTION: Recurrence after operation for Crohn’s disease:

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a. Occurs after operations for ileal Crohn’s but not colonic Crohn’s

b. Is usually found just proximal to an enteric anastomosis

c. Rarely requires reoperation

d. Occurs in 1% of patients at risk per year during the first 10 years after the operation

e. Is prevented by maintenance therapy with corticosteroids

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ANSWER: The answer is b. Recurrence often occurs just proximal to an enteric anastomosis or stoma. Occurs at about 6% per year over the first 10 years. Reoperation is needed in 30-50%. Both ileal and colonic have recurrence and steroids have not shown to reduce recurrence.

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QUESTION:  Excision rather than bypass is preferred for surgical treatment of small intestinal Crohn’s because:

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a. Excision is safer

b. Bypass does not relieve symptoms

c. Excision cures the patient of Crohn’s disease but bypass does not

d. Fewer early complications appear with excision

e. The risk of small itnestine cancer is reduced.

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ANSWER: The answer is e. Bypass is safe and relieves symptoms promptly. Excision will not cure the disease, but it will decrease the risk of developing cancers (and recurrences) in these segments. Therefore excision is preferred — that is until the length of small bowel becomes compromised.

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QUESTION: A 35 year old man with Crohn’s disease has had two prior bowel resections, including an ileocolectomy, for complications related to Crohn’s disease. He has approximately 100cm of small bowel remaining and is currently readmitted for a high-grade bowel obstruction that has not responded to conservative measures. At laparotomy, three strictures are noted over a length of 50cm. The management should be:

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a. Three separate segmental bowel resections with primary anastomoses

b. Resection of the 50cm segment of involved small bowel with reanastomosis

c. Insertion of a long intestinal tube extending past the most distal stricture

d. Three stricturoplasties

e. A bypass of the strictured segment by a side-to-side jejunocolic anastomosis

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ANSWER:  The answer is d. You should only resect the bowel that is involved in the complicated process. Repeated wide resections result in no greater remissions or cure and can lead to short bowel syndrome. You would want to try and leave his remaining small bowel as much as possible. The best option would be to perform stricturoplasties to widen the lumen and not remove any bowel.

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QUESTION:  A patient with duodenal Crohn’s disease and duodenal obstruction should be treated with:

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a. Gastrojejunostomy

b. Pancreaticoduodenectomy

c. Cyclosporine

d. Duodenostomy

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ANSWER: The answer is a: The patient needs a bypass and pancreaticoduodenectomy is too aggressive. Duodenostomy would not solve the problem and cyclosporine is used in severe UC, not CD.

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SOURCES
ABSITE KILLER Q&A

          

           

STUDY SCHEDULE FOR FUTURE   QUESTIONS

SMALL BOWEL
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
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Colonoscopy MCQs
HNPCC (Lynch’s syndrome) MCQs
Colorectal cancer MCQs
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ESOPHAGUS
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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
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THYROID
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Thyroid physiology MCQs
Hyperthyroidism MCQs
Hypothyroidism MCQs
Thyroid cancer MCQs
Thyroidectomy MCQs
PARATHYROID
Parathyroid anatomy MCQs
Parathyroid physiology MCQs
Hyperparathyroidism MCQs
Hypoparathyroidism MCQs
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ARCHIVE MCQs
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SMALL INTESTINES
Carcinoid tumors MCQs .
Small bowel syndrome MCQs .
Ulcerative colitis vs Crohns disease MCQs .
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APPENDIX
Appendicitis MCQs .
ONCOLOGY
Carcinoid tumors MCQs .  
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