Inflammatory Bowel Disease — MCQs

10 questions

Which of the following is a type of inflammatory bowel disease primarily affecting the small intestine? a) Coeliac disease b) Tropical sprue c) Regional ileitis d) Cystic fibrosis e) Ulcerative colitis

Extraintestinal manifestations of Inflammatory bowel disease include all of the following, Except:

Which of the following is a feature of ulcerative colitis?

A 40-year-old woman with Crohn's disease reports multiple bowel movements with frequent stools. She was previously treated with a mesalamine derivative "Pentasa" and in the latest episode of the disease flare-up, she didn't tolerate the oral steroid therapy with budesonide. What is the next appropriate step in her treatment?

All of the following are true about Crohn's disease except.

Which X-ray finding is more suggestive of ulcerative colitis than Crohn's disease?

Surgery is indicated in Ulcerative Colitis in all except?

A 52 year old male patient comes with history of rectal bleeding, alteration in bowel habits and tenesmus. The ideal investigation would be:

Most common site of colorectal carcinoma?

Q10

Which of the following stoma is formed in Hartmann's procedure?

Inflammatory Bowel Disease Indian Medical PG Practice Questions and MCQs

Question 1: Which of the following is a type of inflammatory bowel disease primarily affecting the small intestine? a) Coeliac disease b) Tropical sprue c) Regional ileitis d) Cystic fibrosis e) Ulcerative colitis

A. Ulcerative colitis
B. Cystic fibrosis
C. Tropical sprue
D. Regional ileitis (Correct Answer)
E. Coeliac disease

Explanation: ***Regional ileitis*** - **Regional ileitis** is another name for **Crohn's disease** when it primarily affects the **ileum**, which is part of the small intestine [1]. - Crohn's disease is a type of **inflammatory bowel disease (IBD)** [1] characterized by **transmural inflammation** that can affect any part of the gastrointestinal tract, but most commonly involves the small intestine. *Ulcerative colitis* - **Ulcerative colitis** is an **inflammatory bowel disease** that exclusively affects the **large intestine (colon and rectum)** [2]. - Unlike Crohn's disease, it involves continuous inflammation of the mucosa and submucosa, usually starting in the rectum and extending proximally [2]. *Cystic fibrosis* - **Cystic fibrosis** is a **genetic disorder** that affects the lungs, pancreas, liver, and intestine, leading to the production of **thick, sticky mucus**. - While it can cause malabsorption and intestinal issues due to pancreatic insufficiency, it is not primarily an inflammatory bowel disease in itself. *Tropical sprue* - **Tropical sprue** is a malabsorption syndrome thought to be caused by **environmental factors and microbial changes** in the small intestine, typically affecting individuals in tropical regions [3]. - It results in abnormal small intestinal architecture and nutrient malabsorption, but it is not classified as an inflammatory bowel disease like Crohn's or ulcerative colitis. *Coeliac disease* - **Coeliac disease** is an **immune-mediated condition** triggered by the ingestion of **gluten**, leading to damage of the small intestinal villi [3]. - While it affects the small intestine and involves an immune response, it is distinct from inflammatory bowel diseases which are characterized by chronic, relapsing inflammation of the GI tract.

Question 2: Extraintestinal manifestations of Inflammatory bowel disease include all of the following, Except:

A. Sclerosing cholangitis
B. Skin nodules
C. Osteoarthritis (Correct Answer)
D. Uveitis

Explanation: ***Osteoarthritis*** - **Osteoarthritis** is a **degenerative joint disease** caused by wear and tear on cartilage, and it is **not** an extraintestinal manifestation of IBD [3]. - While patients with IBD can develop osteoarthritis, it does not share the same **pathophysiological link** to the inflammatory process of IBD as other extraintestinal manifestations. *Uveitis* - **Uveitis** is an inflammation of the **uvea** (middle layer of the eye) and is a well-recognized ocular extraintestinal manifestation of IBD [2]. - It can cause eye pain, redness, and blurred vision, and its severity may correlate with IBD disease activity. *Sclerosing cholangitis* - **Primary sclerosing cholangitis (PSC)** is a chronic cholestatic liver disease characterized by inflammation and fibrosis of the **bile ducts**, and it is strongly associated with **ulcerative colitis** [1]. - It often progresses to **cirrhosis** and liver failure and is a significant extraintestinal manifestation. *Skin nodules* - **Erythema nodosum** and **pyoderma gangrenosum** are common cutaneous extraintestinal manifestations of IBD, often presenting as **painful red nodules** or ulcers on the skin [2]. - These skin conditions are thought to be immune-mediated and often parallel the activity of the underlying inflammatory bowel disease.

Question 3: Which of the following is a feature of ulcerative colitis?

A. Spiking fever
B. Proctitis (Correct Answer)
C. Fistula formation
D. Cobble stone mucosa

Explanation: ***Proctitis*** - **Proctitis**, or inflammation of the rectum, is a hallmark feature of ulcerative colitis as the disease always begins in the rectum and can extend proximally [1]. - Patients typically experience **tenesmus**, urgency, and bloody diarrhea due to rectal involvement. *Spiking fever* - While patients with severe ulcerative colitis can experience fever, a **spiking fever** is less common than in other inflammatory conditions or infections. - Fever is a more common and prominent symptom in **Crohn's disease**, particularly with perianal complications or abscesses. *Fistula formation* - **Fistulas** (abnormal connections between organs or to the skin) are a characteristic complication of **Crohn's disease**, not ulcerative colitis. - Ulcerative colitis affects only the **mucosa** and submucosa, making transmural inflammation and fistula formation rare [1]. *Cobble stone mucosa* - **Cobblestone mucosa**, characterized by linear ulcers interspersed with edematous, normal-appearing mucosa, is a classic endoscopic finding in **Crohn's disease**. - In contrast, ulcerative colitis presents with **diffuse, continuous inflammation** and ulceration without skip lesions or cobblestoning [1].

Question 4: A 40-year-old woman with Crohn's disease reports multiple bowel movements with frequent stools. She was previously treated with a mesalamine derivative "Pentasa" and in the latest episode of the disease flare-up, she didn't tolerate the oral steroid therapy with budesonide. What is the next appropriate step in her treatment?

A. Sulfasalazine
B. Prednisolone (oral)
C. Hydrocortisone (IV)
D. Azathioprine (Correct Answer)

Explanation: ***Azathioprine*** - This patient has **moderate-to-severe Crohn's disease** (based on frequency and previous treatment failures with mesalamine and budesonide), indicating a need for **immunosuppressive therapy**. [1] - **Azathioprine** is a thiopurine, an **immunomodulator** used for maintaining remission and reducing the need for corticosteroids in Crohn's disease. [1] Its delayed onset of action (weeks to months) makes it suitable for long-term management after initial symptom control. *Hydrocortisone (IV)* - While intravenous corticosteroids like **hydrocortisone** are effective for inducing remission in severe Crohn's disease, the question implies a flare-up that didn't tolerate *oral* steroid therapy with budesonide, suggesting a need for a **steroid-sparing agent** or a different class of medication for long-term management. - The use of IV steroids would be for initial severe flare management, but for a patient with repeated flares and steroid intolerance, a **maintenance immunomodulator** is the next step. *Prednisolone (oral)* - Similar to budesonide, **oral prednisolone** is a corticosteroid used to induce remission. [1] However, the patient's history of not tolerating oral steroid therapy (budesonide) suggests that another oral corticosteroid might also be poorly tolerated or not effective for sustained remission. - Long-term use of systemic corticosteroids like prednisolone carries significant **side effects**, making a steroid-sparing agent a more appropriate next step in chronic management. [1] *Sulfasalazine* - **Sulfasalazine** is an aminosalicylate derivative, similar to mesalamine, and is primarily effective in **mild-to-moderate ulcerative colitis** or Crohn's colitis, but **not as effective for Crohn's disease affecting the small bowel**. [1] - The patient has already failed **mesalamine** (a 5-ASA derivative), making another 5-ASA derivative like sulfasalazine an unlikely effective option for this flare-up, especially since it's typically used for milder disease.

Question 5: All of the following are true about Crohn's disease except.

A. Cobble stone appearance
B. Perianal fistula is seen
C. Skip lesions seen
D. It is superficial inflammation involving mucosa (Correct Answer)

Explanation: ***It is superficial inflammation involving mucosa*** - Crohn's disease is characterized by **transmural inflammation**, meaning it affects all layers of the bowel wall, not just the superficial mucosa [1]. - This **full-thickness inflammation** contributes to complications like **fistulas** and **strictures** [2]. *Cobble stone appearance* - The **cobblestone appearance** on endoscopic examination is a classic finding in Crohn's disease, resulting from deep longitudinal ulcers and intervening edematous mucosa. - This is a direct consequence of the **transmural inflammation**. *Perianal fistula is seen* - **Perianal fistulas** are common manifestations of Crohn's disease, occurring due to the transmural inflammation extending into the perianal tissues [2]. - These are formed when an inflamed crypt gland ruptures into the perianal tissue, creating a tract. *Skip lesions seen* - **Skip lesions** refer to discontinuous areas of inflammation, where segments of diseased bowel are separated by healthy, uninvolved segments [1]. - This **patchy pattern** is a hallmark feature distinguishing Crohn's disease from ulcerative colitis [1].

Question 6: Which X-ray finding is more suggestive of ulcerative colitis than Crohn's disease?

A. Rectal sparing
B. Tracking of contrast within the bowel wall
C. Discontinuous lesions
D. Loss of haustrations (Correct Answer)

Explanation: ***Loss of haustrations*** - **Loss of haustrations**, also known as "lead pipe" appearance, is a classic X-ray finding in **ulcerative colitis**. - This indicates chronic inflammation leading to fibrosis and shortening of the colon, which obliterates the normal haustral markings. *Rectal sparing* - **Rectal sparing** is more characteristic of **Crohn's disease**, as ulcerative colitis typically involves the rectum and extends proximally. - While rare, some cases of ulcerative colitis can spare the rectum, but it is not the typical presentation seen on imaging. *Tracking of contrast within the bowel wall* - **Tracking of contrast within the bowel wall** (e.g., fistulas, sinus tracts) is a hallmark feature of **Crohn's disease**. - This indicates **transmural inflammation**, which is characteristic of Crohn's disease but not usually seen in ulcerative colitis. *Discontinuous lesions* - **Discontinuous lesions**, also known as "skip lesions," are a classic feature of **Crohn's disease**. - **Ulcerative colitis** is characterized by **continuous inflammation** that starts in the rectum and extends proximally without skipped areas.

Question 7: Surgery is indicated in Ulcerative Colitis in all except?

A. Colonic polyp (Correct Answer)
B. Toxic megacolon
C. Colonic obstruction
D. Failure of medical management

Explanation: ***Colonic polyp*** - **Colonic polyps** in ulcerative colitis (UC) are often managed with **endoscopic polypectomy** and surveillance; surgery (colectomy) for polyps is typically reserved for those with **high-grade dysplasia** or **colorectal cancer**. - Simple polyps themselves, without high-grade dysplasia or malignancy, do not independently warrant surgical intervention in UC. *Toxic megacolon* - **Toxic megacolon** is a severe and life-threatening complication of UC characterized by rapid **colonic dilation** and systemic toxicity, which carries a high risk of perforation and mortality. - Urgent surgical intervention, often **subtotal colectomy**, is indicated to prevent perforation and manage sepsis. *Colonic obstruction* - Although uncommon in UC, **colonic obstruction** can occur due to strictures, fibrosis, or malignant transformation, causing symptoms like abdominal pain, distension, and vomiting. - When medically refractory or associated with significant symptoms or suspicion of malignancy, surgery is often required to relieve the obstruction. *Failure of medical management* - **Chronic medically refractory UC** is one of the most common indications for elective colectomy, accounting for approximately 20-30% of surgical cases. - When patients fail to respond to maximal medical therapy including corticosteroids, immunomodulators, and biologics, or experience steroid-dependent disease with unacceptable side effects, surgical intervention with **proctocolectomy** may be required for definitive management.

Question 8: A 52 year old male patient comes with history of rectal bleeding, alteration in bowel habits and tenesmus. The ideal investigation would be:

A. Contrast-enhanced CT scan
B. Fecal occult blood test
C. Colonoscopy (Correct Answer)
D. Ultrasonogram

Explanation: ***Colonoscopy*** - **Colonoscopy** is the gold standard for investigating symptoms like rectal bleeding, altered bowel habits, and tenesmus, as it allows for direct visualization of the entire colon and rectum. - It enables **biopsy of suspicious lesions** for histopathological diagnosis, which is crucial for confirming conditions like colorectal cancer or inflammatory bowel disease. *Contrast-enhanced CT scan* - A **contrast-enhanced CT scan** is primarily used for **staging known malignancies** and assessing for distant metastases, not as a primary diagnostic tool for initial symptoms. - While it can identify large masses, it might miss smaller lesions and does not allow for tissue biopsy. *Fecal occult blood test* - A **fecal occult blood test** screens for blood in the stool, which indicates gastrointestinal bleeding but does not pinpoint the source or cause. - It has **low sensitivity and specificity** for diagnosing underlying conditions like colorectal cancer or inflammatory bowel disease and is mainly a screening tool. *Ultrasonogram* - An **ultrasonogram** is generally not effective for evaluating the colon and rectum due to bowel gas interference. - It is more commonly used for investigating abdominal organs like the liver, gallbladder, and kidneys, or for pelvic pathology, but not the primary investigation for these colorectal symptoms.

Question 9: Most common site of colorectal carcinoma?

A. Ascending Colon
B. Descending Colon
C. Rectum
D. Sigmoid Colon (Correct Answer)

Explanation: ***Sigmoid Colon*** - The **sigmoid colon** is the most common site for colorectal carcinoma, accounting for approximately **25%** of all cases. - This higher incidence is potentially due to its role in stool storage, leading to longer contact time with potential carcinogens. *Rectum* - While the rectum is a common site, it accounts for about **15-20%** of colorectal cancers, making it less frequent than the sigmoid colon. - Rectal cancers often present with **hematochezia** and changes in bowel habits. *Ascending Colon* - The **ascending colon** is less frequently affected, around **10-15%** of cases. - Tumors here are often associated with **iron deficiency anemia** due to chronic blood loss. *Descending Colon* - The **descending colon** is also less commonly affected, making up approximately **5-10%** of colorectal cancers. - Tumors in this segment may present with **obstruction** due to the narrower lumen.

Question 10: Which of the following stoma is formed in Hartmann's procedure?

A. End Colostomy (Correct Answer)
B. End Ileostomy
C. Loop Ileostomy
D. Caecostomy

Explanation: ***End Colostomy*** - Hartmann's procedure involves resection of a diseased segment of the **colon**, typically the sigmoid colon, with the creation of a **proximal colostomy** and closure of the distal rectal stump. - The proximal end of the colon is brought out through the abdominal wall to form a **stoma**, which is a type of end colostomy. *End Ileostomy* - An end ileostomy involves bringing the **ileum** (small intestine) to the abdominal wall, which is not part of the standard Hartmann's procedure. - This is typically performed after a **total colectomy** or in cases of severe Crohn's disease affecting the colon. *Loop Ileostomy* - A loop ileostomy involves bringing a **loop of the ileum** to the surface of the abdomen, creating two openings that are then joined together. - This is often a **temporary diversion** and does not involve resection of the colon in the same manner as Hartmann's procedure. *Caecostomy* - A caecostomy is a stoma created from the **cecum**, the beginning of the large intestine. - This is typically performed for various reasons such as **bowel decompression** or management of fecal incontinence, and is not a component of Hartmann's procedure.

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