IBD

IBD US Medical PG Question 1: A 33-year-old woman with Crohn’s disease colitis presents to her physician after 2 days of photophobia and blurred vision. She has had no similar episodes in the past. She has no abdominal pain or diarrhea and takes mesalazine, azathioprine, and prednisone as maintenance therapy. Her vital signs are within normal range. Examination of the eyes shows conjunctival injection. The physical examination is otherwise normal. Slit-lamp examination by an ophthalmologist shows evidence of inflammation in the anterior chamber. Which of the following is the most appropriate modification to this patient’s medication at this time?

• A. Adding infliximab
• B. Increasing dose of prednisone (Correct Answer)
• C. No modification of therapy at this time
• D. Discontinuing mesalazine
• E. Decreasing dose of azathioprine

IBD Explanation: ***Increasing dose of prednisone*** - This patient is presenting with **anterior uveitis**, a common **extraintestinal manifestation of Crohn’s disease**, characterized by photophobia, blurred vision, and inflammation of the anterior chamber. - **Corticosteroids** (like prednisone) are the **first-line treatment for acute uveitis**, and increasing the dose will help control the inflammation effectively. *Adding infliximab* - While **biologics like infliximab** can be effective for refractory uveitis or systemic disease control, they are **not the immediate first-line treatment for an acute uveitis flare**, especially when corticosteroids are already part of the regimen. - Adding a new biologic would also involve a longer onset of action and additional risks, making it less suitable for urgent symptom control compared to adjusting prednisone. *No modification of therapy at this time* - The patient clearly has **acute anterior uveitis**, which is a potentially serious ocular condition requiring prompt treatment to prevent complications such as synechiae, glaucoma, and vision loss. - Doing nothing would lead to worsening inflammation and potential irreversible damage. *Discontinuing mesalazine* - **Mesalazine** (an aminosalicylate) is primarily used for maintaining remission in inflammatory bowel disease and is **not implicated in causing uveitis**, nor is discontinuing it a treatment for uveitis. - It would also risk a flare of her Crohn's disease. *Decreasing dose of azathioprine* - **Azathioprine** is an **immunosuppressant** used to maintain remission in Crohn’s disease and is not a direct treatment for acute uveitis. - Decreasing the dose would weaken her overall immunosuppression, potentially leading to a flare of her Crohn's disease or making her more susceptible to other issues, without directly addressing the acute ocular inflammation.

IBD US Medical PG Question 2: An 18-year-old man presents with bloody diarrhea and weight loss. He undergoes endoscopic biopsy which shows pseudopolyps. Biopsies taken during the endoscopy show inflammation only involving the mucosa and submucosa. He is diagnosed with an inflammatory bowel disease. Which of the following characteristics was most likely present?

• A. Cobblestone mucosa
• B. Skip lesions
• C. Fistulas and strictures
• D. Noncaseating granuloma
• E. Rectal involvement (Correct Answer)

IBD Explanation: **_Rectal involvement_** - The description of **bloody diarrhea** and **pseudopolyps** on endoscopy, along with inflammation limited to the **mucosa and submucosa**, is highly characteristic of **ulcerative colitis (UC)**. UC invariably involves the rectum and extends proximally in a continuous fashion. - The presence of **pseudopolyps** is common in UC due to cycles of mucosal ulceration and regeneration. *Cobblestone mucosa* - **Cobblestone mucosa** is a classic endoscopic finding in **Crohn's disease**, resulting from deep ulcerations interspersed with islands of edematous, non-ulcerated mucosa. - This feature points to a transmural pattern of inflammation, which is inconsistent with the superficial inflammation confined to the **mucosa and submucosa** described. *Skip lesions* - **Skip lesions** refer to discontinuous areas of inflammation separated by healthy tissue, a hallmark feature of **Crohn's disease**. - **Ulcerative colitis** (implied by the superficial inflammation) is characterized by continuous inflammation extending proximally from the rectum without skipped areas. *Fistulas and strictures* - **Fistulas** (abnormal connections between organs or to the skin) and **strictures** (narrowing of the intestinal lumen) are complications typically associated with **Crohn's disease**, due to its **transmural inflammation**. - These are rare in **ulcerative colitis**, which primarily affects the superficial layers of the colon. *Noncaseating granuloma* - The presence of **noncaseating granulomas** on biopsy is a key histological feature distinguishing **Crohn's disease** from ulcerative colitis. - The inflammation described as restricted to the **mucosa and submucosa** makes granulomas less likely, as they often imply a transmural process.

IBD US Medical PG Question 3: A 33-year-old man has a history of intermittent bloody diarrhea, tenesmus, fever, fatigue, and lower abdominal cramps for the past 2 weeks. On physical examination, he is lethargic and appears lean and pale. He has aphthous stomatitis, red congested conjunctiva, and tender swollen joints. At the doctor’s office, his pulse is 114/min, blood pressure is 102/76 mm Hg, respirations are 20/min, and his temperature is 39.4°C (102.9°F). There is vague lower abdominal tenderness and frank blood on rectal examination. Laboratory studies show: Hemoglobin 7.6 g/dL Hematocrit 33% Total leucocyte count 22,000/mm3 Stool assay for C.difficile is negative Abdominal X-ray shows no significant abnormality He is symptomatically managed and referred to a gastroenterologist, who suggests a colonoscopy and contrast (barium) study for the diagnosis. Which of the following is the most likely combination of findings in his colonoscopy and barium study?

• A. Colonoscopy: Multiple vascular malformations that resemble telangiectasias on the colon wall, Barium study: Normal
• B. Colonoscopy: Patches of mucosal erosions with pseudomembrane formation, Barium study: Cobblestone appearance with strictures
• C. Colonoscopy: Discontinuous transmural ‘skip lesions’ with aphthoid linear ulcers and transverse fissures, non-caseating granulomas, and strictures, Barium study: Cobblestone appearance with strictures
• D. Colonoscopy: Normal, Barium study: Lead pipe colon appearance
• E. Colonoscopy: Continuous ulcerated lesions involving the mucosa and submucosa, granular mucosa, crypt abscess, and pseudopolyps, Barium study: Lead pipe colon appearance (Correct Answer)

IBD Explanation: ***Colonoscopy: Continuous ulcerated lesions involving the mucosa and submucosa granular mucosa, crypt abscess, and pseudopolyps, Barium study: Lead pipe colon appearance*** - The patient's symptoms (bloody diarrhea, tenesmus, fever, fatigue, weight loss, aphthous stomatitis, red congested conjunctiva, tender swollen joints, anemia, high WBC count) are highly suggestive of **Ulcerative Colitis (UC)**. - **UC** on colonoscopy is characterized by **continuous mucosal and submucosal inflammation**, granular mucosa, crypt abscesses, and **pseudopolyps**. The barium study finding of a **"lead pipe" colon** is classic for long-standing UC due to loss of haustrations. *Colonoscopy: Multiple vascular malformations that resemble telangiectasias on the colon wall, Barium study: Normal* - **Angiodysplasia** presents with vascular malformations, but it typically causes painless lower GI bleeding, not the inflammatory symptoms described. - The patient's severe systemic symptoms (fever, weight loss, anemia, high WBC) are inconsistent with angiodysplasia. *Colonoscopy: Patches of mucosal erosions with pseudomembrane formation, Barium study: Cobblestone appearance with strictures* - **Pseudomembrane formation** is characteristic of **_Clostridioides difficile_ infection**, which has been ruled out by the stool assay. - While "cobblestone appearance" and strictures can be seen in inflammatory bowel disease, the pseudomembranes point away from UC or Crohn's. *Colonoscopy: Discontinuous transmural ‘skip lesions’ with aphthoid linear ulcers and transverse fissures, non-caseating granulomas, and strictures, Barium study: Cobblestone appearance with strictures* - This description is characteristic of **Crohn's disease**, which involves **discontinuous**, **transmural inflammation** with **skip lesions**, aphthoid ulcers, and non-caseating granulomas. - While some symptoms overlap with UC, the involvement of mucocutaneous lesions and generalized systemic symptoms fits better with the continuous inflammation of UC than the patchy disease of Crohn's. *Colonoscopy: Normal, Barium study: Lead pipe colon appearance* - A **normal colonoscopy** would be inconsistent with the patient's severe symptoms of bloody diarrhea, anemia, and elevated inflammatory markers. - A "lead pipe" colon indicates chronic inflammatory changes, which would undoubtedly be visible on colonoscopy.

IBD US Medical PG Question 4: A 31-year-old man presents to an urgent care clinic with symptoms of lower abdominal pain, bloating, bloody diarrhea, and fullness, all of which have become more frequent over the last 3 months. His vital signs are as follows: blood pressure is 121/81 mm Hg, heart rate is 87/min, and respiratory rate is 15/min. Rectal examination reveals a small amount of bright red blood. Lower endoscopy is performed, showing extensive mucosal erythema, induration, and pseudopolyps extending from the rectum to the splenic flexure. Given the following options, what is the most appropriate initial treatment for this patient's underlying disease?

• A. Azathioprine
• B. Mesalamine (Correct Answer)
• C. Systemic corticosteroids
• D. Total proctocolectomy
• E. Sulfasalazine

IBD Explanation: ***Mesalamine*** - The patient's symptoms (bloody diarrhea, abdominal pain, erythema, pseudopolyps, and inflammation extending from the rectum to the splenic flexure) are highly suggestive of **ulcerative colitis (UC) affecting the left colon (distal colitis)**. - **Mesalamine** (a 5-aminosalicylic acid or 5-ASA derivative) is the first-line treatment for mild to moderate UC, especially for proctitis and left-sided colitis. Its anti-inflammatory action is exerted topically on the colonic mucosa. *Azathioprine* - Azathioprine is an **immunomodulator** used for maintaining remission in UC or in cases where patients are steroid-dependent or refractory to 5-ASAs. - It is not typically used as a first-line agent for acute, mild to moderate disease. *Systemic corticosteroids* - **Systemic corticosteroids** are used for moderate to severe UC or for severe flares, not for initial mild to moderate disease, due to their significant side effect profile. - While effective in inducing remission, their long-term use is limited, and they are not considered a maintenance therapy. *Total proctocolectomy* - **Total proctocolectomy** is a surgical option reserved for severe, refractory UC that does not respond to medical therapy, or in cases of dysplasia/cancer. - It is an invasive procedure and not an appropriate initial treatment for a patient presenting with symptoms of mild to moderate disease. *Sulfasalazine* - **Sulfasalazine** is an older 5-ASA compound that is also effective for mild to moderate UC. - However, it has a **higher incidence of side effects** (e.g., GI upset, headaches, hypersensitivity) compared to mesalamine, making mesalamine generally preferred for better tolerability.

IBD US Medical PG Question 5: On the 4th day of hospital admission due to pneumonia, a 69-year-old woman develops non-bloody diarrhea and abdominal pain. She is currently treated with ceftriaxone. Despite the resolution of fever after the first 2 days of admission, her temperature is now 38.5°C (101.3°F). On physical examination, she has mild generalized abdominal tenderness without abdominal guarding or rebound tenderness. Laboratory studies show re-elevation of leukocyte counts. Ceftriaxone is discontinued. Given the most likely diagnosis in this patient, which of the following is the most sensitive test?

• A. Nucleic acid amplification test (Correct Answer)
• B. Stool culture for bacterial isolation and toxin presence
• C. Enzyme immunoassay glutamate dehydrogenase
• D. Gram stain of stool sample
• E. Endoscopy

IBD Explanation: ***Nucleic acid amplification test*** - **NAAT** (PCR) for *C. difficile* toxin genes is the most **sensitive** and specific test for routine clinical diagnosis of *C. difficile* infection. - It detects the **DNA** of toxin-producing *C. difficile* (tcdB gene) and is highly reliable even with low bacterial loads. - NAAT has become the **gold standard** in most clinical settings due to its rapid turnaround time (hours) and excellent sensitivity (~90-95%) and specificity (~95%). *Enzyme immunoassay glutamate dehydrogenase* - **EIA GDH** detects an antigen common to all *C. difficile* strains (both toxin-producing and non-toxin-producing). - While it has **high sensitivity** (~85-95%), it has **low specificity** and requires confirmation with a toxin test or NAAT, as it cannot distinguish between toxigenic and non-toxigenic strains. - Often used as part of a **two-step algorithm** for screening. *Gram stain of stool sample* - A **Gram stain** of stool is generally not helpful for diagnosing *C. difficile* infection. - It would show a mix of **gut flora** and would not specifically identify *C. difficile* or its toxins. *Stool culture for bacterial isolation and toxin presence* - **Stool culture** for *C. difficile* is technically the most sensitive method (~95-100%) but does not differentiate toxin-producing from non-toxin-producing strains without subsequent **toxin testing**. - It is also **time-consuming** (2-3 days) and labor-intensive, making it impractical for routine clinical diagnosis. - Primarily used for **research** or **epidemiological typing**. *Endoscopy* - **Endoscopy** with visualization of **pseudomembranes** is highly specific for severe *C. difficile* infection. - However, it is an **invasive procedure**, not sensitive for mild-to-moderate disease, and is usually reserved for cases where diagnosis is unclear or severe complications (toxic megacolon, fulminant colitis) are suspected.

IBD US Medical PG Question 6: A 31-year-old woman comes to the emergency department because of a 4-day history of fever and diarrhea. She has abdominal cramps and frequent bowel movements of small quantities of stool with blood and mucus. She has had multiple similar episodes over the past 8 months. Her temperature is 38.1°C (100.6°F), pulse is 75/min, and blood pressure is 130/80 mm Hg. Bowel sounds are normal. The abdomen is soft. There is tenderness to palpation in the left lower quadrant with guarding and no rebound. She receives appropriate treatment and recovers. Two weeks later, colonoscopy shows polypoid growths flanked by linear ulcers. A colonic biopsy specimen shows mucosal edema with distorted crypts and inflammatory cells in the lamina propria. Which of the following is the most appropriate recommendation for this patient?

• A. Obtain genetic studies now
• B. Obtain barium follow-through radiography in 1 year
• C. Obtain glutamate dehydrogenase antigen immunoassay now
• D. Start annual magnetic resonance cholangiopancreatography screening in 10 years
• E. Start annual colonoscopy starting in 8 years (Correct Answer)

IBD Explanation: ***Start annual colonoscopy starting in 8 years*** - The patient's presentation with bloody diarrhea, abdominal cramps, and repetitive episodes is consistent with <b>inflammatory bowel disease (IBD)</b>, specifically likely <b>ulcerative colitis</b> given the left lower quadrant tenderness and colonic biopsy findings (distorted crypts, inflammatory cells in lamina propria). - Patients with IBD, particularly ulcerative colitis affecting a significant portion of the colon and diagnosed at a younger age, are at increased risk for <b>colorectal cancer</b>. Annual colonoscopy screening is recommended 8–10 years after diagnosis for early detection and prevention. *Obtain genetic studies now* - While genetic factors play a role in IBD susceptibility, <b>genetic studies are not routinely indicated for diagnosis or management</b> of inflammatory bowel disease, nor do they guide current screening recommendations for colorectal cancer in IBD patients. - Genetic studies would not provide immediate clinical benefit for this patient's acute symptoms or long-term management plan regarding cancer surveillance. *Obtain barium follow-through radiography in 1 year* - <b>Barium follow-through radiography</b> is primarily used to evaluate the small intestine, often in suspected Crohn's disease. This patient's symptoms and colonoscopy findings point towards colonic involvement, making this less appropriate. - Furthermore, this imaging modality uses <b>ionizing radiation</b> and is less sensitive for detecting mucosal changes indicative of dysplasia or early cancer compared to colonoscopy. *Obtain glutamate dehydrogenase antigen immunoassay now* - <b>Glutamate dehydrogenase antigen immunoassay</b> is a test for <b><i>Clostridioides difficile</i> infection</b>. While C. difficile can cause severe diarrhea and colitis, the patient's history of recurrent episodes over 8 months and the specific colonoscopy findings (polypoid growths, linear ulcers, distorted crypts) are more characteristic of IBD. - Although C. difficile infection can exacerbate IBD, it does not explain the chronic, recurrent nature of her illness or the long-term cancer surveillance needs. *Start annual magnetic resonance cholangiopancreatography screening in 10 years* - <b>MRCP screening</b> is used to monitor for <b>primary sclerosing cholangitis (PSC)</b>, a condition associated with IBD, particularly ulcerative colitis. However, PSC screening is performed <b>when clinically indicated</b> (e.g., elevated alkaline phosphatase, cholestatic symptoms), not as routine scheduled surveillance. - This patient has no clinical features suggesting PSC at present, and there is no guideline recommending routine MRCP screening at a predetermined time interval for all IBD patients.

IBD US Medical PG Question 7: A 22-year-old Caucasian female presents with severe right lower quadrant pain, malaise, and diarrhea. The physician performs an endoscopy and finds disease involvement in the terminal ileum, noting that the disease process is patchy with normal intervening mucosa. The entire wall of the region is thickened and inflamed, which may directly lead to formation of:

• A. Paneth cell metaplasia
• B. Toxic megacolon
• C. Plummer-Vinson syndrome
• D. Widening of the intestinal lumen
• E. Fistulas (Correct Answer)

IBD Explanation: ***Fistulas*** - **Transmural inflammation**, characteristic of **Crohn's disease**, means the entire wall of the intestine is affected, leading to deep ulcerations and sinus tracts that can bore through tissues. - This deep, penetrating inflammation often results in the formation of **fistulas** (abnormal connections between organs or to the skin) or **abscesses**. *Paneth cell metaplasia* - This is a histological change where **Paneth cells**, normally found in the small intestine, appear in regions they shouldn't, such as the colon. - While it can occur in **inflammatory bowel disease**, it is a microscopic change and not a direct consequence of the described gross pathology (transmural inflammation leading to a larger structural complication like a fistula). *Toxic megacolon* - This is a severe complication characterized by **colonic dilation** and systemic toxicity, usually seen in **ulcerative colitis**, not typically Crohn's disease limited to the terminal ileum. - It arises from acute, severe inflammation that extends to the muscularis propria, causing paralysis of the colon, which is distinct from the **transmural inflammation** in Crohn's leading to fistulas. *Plummer-Vinson syndrome* - This syndrome is characterized by a triad of **iron-deficiency anemia**, **dysphagia** (due to esophageal webs), and **glossitis**, which is unrelated to inflammatory bowel disease. - It is a condition of the upper gastrointestinal tract and has no direct link to the pathology described in the terminal ileum. *Widening of the intestinal lumen* - The **transmural inflammation** described in Crohn's disease typically leads to **thickening of the bowel wall** and, more commonly, **strictures** (narrowing) of the lumen rather than widening. - The inflammatory process usually causes fibrosis and scarring, which reduces the luminal diameter, particularly in chronic disease.

IBD US Medical PG Question 8: A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?

• A. "Does the diarrhea typically precede the constipation, or vice-versa?"
• B. "Is the diarrhea foul-smelling?"
• C. "Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life"
• D. "Are the symptoms worse in the morning or at night?"
• E. "Can you tell me more about the symptoms you have been experiencing?" (Correct Answer)

IBD Explanation: ***Can you tell me more about the symptoms you have been experiencing?*** - This **open-ended question** encourages the patient to provide a **comprehensive narrative** of their symptoms, including details about onset, frequency, duration, alleviating/aggravating factors, and associated symptoms, which is crucial for diagnosis. - In a patient presenting with vague, intermittent symptoms like alternating constipation and diarrhea, allowing them to elaborate freely can reveal important clues that might not be captured by more targeted questions. *Does the diarrhea typically precede the constipation, or vice-versa?* - While knowing the sequence of symptoms can be helpful in understanding the **pattern of bowel dysfunction**, it is a very specific question that might overlook other important aspects of the patient's experience. - It prematurely narrows the focus without first obtaining a broad understanding of the patient's overall symptomatic picture. *Is the diarrhea foul-smelling?* - Foul-smelling diarrhea can indicate **malabsorption** or **bacterial overgrowth**, which are important to consider in some gastrointestinal conditions. - However, this is a **specific symptom inquiry** that should follow a more general exploration of the patient's symptoms, as it may not be relevant if other crucial details are missed. *Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life* - Quantifying pain intensity is useful for assessing the **severity of discomfort** and monitoring changes over time. - However, for a patient with intermittent rather than acute, severe pain, understanding the **character, location, and triggers** of the pain is often more diagnostically valuable than just a numerical rating initially. *Are the symptoms worse in the morning or at night?* - Diurnal variation can be relevant in certain conditions, such as inflammatory bowel diseases where nocturnal symptoms might be more concerning, or functional disorders whose symptoms might be stress-related. - This is another **specific question** that should come after gathering a more complete initial picture of the patient's symptoms to ensure no key information is overlooked.

IBD US Medical PG Question 9: A 48-year-old man presents to his primary care physician with diarrhea and weight loss. He states he has had diarrhea for the past several months that has been worsening steadily. The patient recently went on a camping trip and drank unfiltered stream water. Otherwise, the patient endorses a warm and flushed feeling in his face that occurs sporadically. His temperature is 97.2°F (36.2°C), blood pressure is 137/68 mmHg, pulse is 110/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for a murmur heard best over the left lower sternal border and bilateral wheezing on pulmonary exam. Which of the following is the best initial step in management?

• A. Pulmonary function tests
• B. Plasma free metanephrine levels
• C. Urinary 5-hydroxyindoleacetic acid level (Correct Answer)
• D. Echocardiography
• E. Stool culture and ova and parasite analysis

IBD Explanation: ***Urinary 5-hydroxyindoleacetic acid level*** - The combination of **diarrhea**, **weight loss**, episodic **flushing**, **wheezing**, and a **cardiac murmur** (suggesting right-sided valve involvement) is highly suggestive of **carcinoid syndrome**. The **urinary 5-HIAA** level is the most reliable initial biochemical test to diagnose this condition. - Carcinoid tumors secrete **serotonin**, which is metabolized to 5-HIAA and excreted in the urine. Elevated levels confirm the diagnosis. *Pulmonary function tests* - While the patient has **wheezing**, which could be due to **bronchospasm** as part of carcinoid syndrome, pulmonary function tests are not the best initial diagnostic step. - They would characterize the lung involvement but not identify the underlying cause of the systemic symptoms. *Plasma free metanephrine levels* - This test is used to diagnose **pheochromocytoma**, a condition that can also cause episodic flushing and palpitations. - However, pheochromocytoma does not typically cause chronic diarrhea, weight loss, or the characteristic right-sided cardiac involvement seen in this patient. *Echocardiography* - An **echocardiogram** would be useful to evaluate the cardiac murmur and assess for **right-sided valvular heart disease**, which is a common manifestation of **carcinoid heart disease**. - However, it is a follow-up imaging study to characterize complications, not the initial diagnostic test to confirm the biochemical syndrome. *Stool culture and ova and parasite analysis* - Given the history of drinking unfiltered stream water, **gastrointestinal infections** are a possibility for the diarrhea. - However, the combination of **flushing**, **wheezing**, and a **cardiac murmur** points away from an infectious etiology as the primary cause of all symptoms.

IBD US Medical PG Question 10: A 32-year-old man presents to his physician with a complaint of pain with urination that has developed and persisted over the past 8 days. Upon awakening today, he also noted a clear discharge from his urethra. The patient states he is otherwise healthy. Social history is notable for the patient working at a local farm with livestock. Review of systems is notable for left knee and ankle pain for the past week and worsening of his seasonal allergies with red and itchy eyes. His temperature is 97.7°F (36.5°C), blood pressure is 122/83 mmHg, pulse is 89/min, respirations are 14/min, and oxygen saturation is 98% on room air. Which of the following is likely to be positive in this patient?

• A. p-ANCA
• B. HLA-B27 (Correct Answer)
• C. Anti-dsDNA
• D. Anti-CCP
• E. HLA-DR4

IBD Explanation: ***HLA-B27*** - The patient presents with a classic triad of symptoms: **urethritis** (painful urination, clear discharge), **arthritis** (left knee and ankle pain), and **conjunctivitis** (red and itchy eyes), which is highly suggestive of **reactive arthritis**. - **Reactive arthritis** is strongly associated with the presence of the **HLA-B27** allele, found in 30-50% to up to 80% of patients depending on the population. *p-ANCA* - **p-ANCA (perinuclear anti-neutrophil cytoplasmic antibodies)** are typically associated with certain **vasculitides** like microscopic polyangiitis or eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome). - Symptoms of **vasculitis** such as constitutional symptoms, organ damage, or purpuric rash are not described in this patient's presentation. *Anti-dsDNA* - **Anti-double-stranded DNA (anti-dsDNA) antibodies** are a highly specific marker for **systemic lupus erythematosus (SLE)**. - The patient's symptoms (urethritis, arthritis, conjunctivitis) are not typical for a primary presentation of SLE, which often involves skin rashes, serositis, and renal or hematological manifestations. *Anti-CCP* - **Anti-cyclic citrullinated peptide (anti-CCP) antibodies** are a specific and sensitive marker for **rheumatoid arthritis (RA)**. - While the patient has arthritis, the accompanying conjunctivitis and urethritis are not characteristic features of RA, and RA typically presents with symmetrical polyarthritis. *HLA-DR4* - **HLA-DR4** is a genetic marker strongly associated with **rheumatoid arthritis (RA)**, particularly in certain ethnic groups. - As with anti-CCP antibodies, the overall clinical picture, including urethritis and conjunctivitis, makes RA an unlikely primary diagnosis.

IBD Flashcard 1 of 10

Question: Crohn disease most commonly involves the _____

Answer: terminal ileum

IBD Flashcard 2 of 10

Question: Treatment for acute exacerbation of Crohn disease often involves _____

Answer: corticosteroids

IBD Flashcard 3 of 10

Question: _____ (IBD) is characterized by continuous colonic lesions that always involve the rectum

Answer: Ulcerative colitis

IBD Flashcard 4 of 10

Question: In Crohns disease, loss of the innate barrier function of the intestinal mucosa allows intestinal microbes to induce an exaggerated response by the _____, resulting in chronic GI inflammation

Answer: adaptive immune system

IBD Flashcard 5 of 10

Question: Azathioprine/6-MP can be used to treat _____ disease (crohn's, ulcerative colitis)

Answer: inflammatory bowel

IBD Flashcard 6 of 10

Question: Crohn disease is typically characterized by _____ lower quadrant pain (left or right)

Answer: right

IBD Flashcard 7 of 10

Question: Complications of both ulcerative colitis and Crohn disease include malabsorption and _____ cancer

Answer: colorectal

IBD Flashcard 8 of 10

Question: Which immunodeficiency presents with bone fractures from minor trauma? _____

Answer: Job (hyper-IgE) syndrome

Extra Information:   Watch Phagocytic Cell Disorders [https://dashboard.sketchy.com/study/medical/courses/medical-pathophysiology/units/medical-pathophysiology-immunology/videos/medical-pathophysiology-immunology-immunodeficiency-phagocytic-cell-disorders?utm_source=anki&utm_medium=partnership&utm_campaign=february_update&utm_content=medical] https://onlinemeded.org/spa/pediatrics/immunodeficiency/acquire?ref=anki 

IBD Flashcard 9 of 10

Question: Which form of inflammatory bowel disease typically spares the rectum? _____

Answer: Crohn disease

Extra Information:   https://onlinemeded.org/spa/gastroenterology/ibd/acquire?ref=anki Atlas: 

IBD Flashcard 10 of 10

Question: What HLA subtype is associated with multiple sclerosis? _____

Answer: DR2

Extra Information:  https://onlinemeded.org/spa/immunology?ref=anki