IBD Practice Questions

Question 1

A 63-year-old man comes to the physician with a 4-week history of fatigue, crampy abdominal pain, watery diarrhea, and pain in his mouth and gums. He returned from a 2-week trip to the Dominican Republic 2 months ago. He has smoked one pack of cigarettes daily for 45 years. Examination shows three 1.5-cm, painful ulcers in the mouth. Abdominal examination shows mild tenderness to palpation in the right lower quadrant without guarding or rebound. His hemoglobin concentration is 11.2 g/dL, mean corpuscular volume is 75 fL, and leukocyte count is 11,900/mm³. Colonoscopy shows a cobblestone mucosa. A photomicrograph of a biopsy specimen is shown. Which of the following is the most likely diagnosis?

Accepted Answer

Crohn disease

Answer

Behcet disease

Answer

Tropical sprue

Answer

Ulcerative colitis

Answer

Whipple disease

Question 2

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?

Accepted Answer

Increasing dose of prednisone

Answer

Adding infliximab

Answer

No modification of therapy at this time

Answer

Discontinuing mesalazine

Answer

Decreasing dose of azathioprine

Question 3

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?

Accepted Answer

Rectal involvement

Answer

Cobblestone mucosa

Answer

Skip lesions

Answer

Fistulas and strictures

Answer

Noncaseating granuloma

Question 4

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?

Accepted Answer

Colonoscopy: Continuous ulcerated lesions involving the mucosa and submucosa, granular mucosa, crypt abscess, and pseudopolyps, Barium study: Lead pipe colon appearance

Answer

Colonoscopy: Multiple vascular malformations that resemble telangiectasias on the colon wall, Barium study: Normal

Answer

Colonoscopy: Patches of mucosal erosions with pseudomembrane formation, Barium study: Cobblestone appearance with strictures

Answer

Colonoscopy: Discontinuous transmural ‘skip lesions’ with aphthoid linear ulcers and transverse fissures, non-caseating granulomas, and strictures, Barium study: Cobblestone appearance with strictures

Answer

Colonoscopy: Normal, Barium study: Lead pipe colon appearance

Question 5

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?

Accepted Answer

Mesalamine

Answer

Azathioprine

Answer

Systemic corticosteroids

Answer

Total proctocolectomy

Answer

Sulfasalazine

Question 6

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?

Accepted Answer

Nucleic acid amplification test

Answer

Stool culture for bacterial isolation and toxin presence

Answer

Enzyme immunoassay glutamate dehydrogenase

Answer

Gram stain of stool sample

Answer

Endoscopy

Question 7

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?

Accepted Answer

Start annual colonoscopy starting in 8 years

Answer

Obtain genetic studies now

Answer

Obtain barium follow-through radiography in 1 year

Answer

Obtain glutamate dehydrogenase antigen immunoassay now

Answer

Start annual magnetic resonance cholangiopancreatography screening in 10 years

Question 8

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:

Accepted Answer

Fistulas

Answer

Paneth cell metaplasia

Answer

Toxic megacolon

Answer

Plummer-Vinson syndrome

Answer

Widening of the intestinal lumen

Question 9

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?

Accepted Answer

"Can you tell me more about the symptoms you have been experiencing?"

Answer

"Does the diarrhea typically precede the constipation, or vice-versa?"

Answer

"Is the diarrhea foul-smelling?"

Answer

"Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life"

Answer

"Are the symptoms worse in the morning or at night?"

Question 10

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?

Accepted Answer

Urinary 5-hydroxyindoleacetic acid level

Answer

Pulmonary function tests

Answer

Plasma free metanephrine levels

Answer

Echocardiography

Answer

Stool culture and ova and parasite analysis

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