Random IBD
UC vs Crohn's
Extraintestinal Manifestations
IBD Treatment
Mystery Box
100
What is the likely diagnosis in a patient with Crohn's disease, abdominal pain, nausea, billious vomiting, and leukocytosis?
Small Bowel Obstruction
100
Associated with granulomas, fissures/fistulas, transmural inflammation, skip lesions, and Anti-Saccharomyces cervisiae antibodies
Crohn's Disease
100
What is erythema nodosum?
100
Initial treatment of choice in mild to moderate ulcerative colitis
What is 5-Aminosalicylates (5-ASAs)
In mild to moderate ulcerative colitis, combined 5-ASA therapy (oral and topical) is superior for induction of remission compared with oral or topical therapies alone. Once remission is achieved, 5-ASAs are effective in maintaining it
100
Restrictive Lung Disease Examples (3)
1. Pulmonary Fibrosis
2. NM disease
3. Skeletal abnormalities
200
What is this?
UC leadpipe sign on imaging secondary to loss of haustra
200
Name 2 associations with UC and what antibody is found in 75% of cases?
Mucosal inflammation, continuous disease, smoking alleviates symptoms, associated with P-ANCA (75% of cases)
200
The major liver manifestation associated with IBD (roughly 5% of patients)
What is Primary Sclerosing Cholangitis
200
What are the ACG recommendations for inpatient treatment in patients with suspected Crohn's disease flare? What is the dose?
Parenteral methylprednisolone is effective for acute treatment of severe disease, with doses from 40 to 60 mg/day.
200
ECG Findings in WPW
1) short PR interval
2) Delta wave
3) Normal or prolonged QRS
300
What can you order to help determine IBD vs IBS?
- Fecal calprotectin is a helpful test that should be considered to help differentiate the presence of IBD from irritable bowel syndrome (strong recommendation, moderate level of evidence).
- Fecal calprotectin is a calcium binding protein that is derived from neutrophils and plays a role in the regulation of inflammation.
300
What percent of patients with Crohn's disease have ileolcolonic disease?
50%
Crohn disease has a different pattern of distribution from ulcerative colitis: 50% of patients have ileocolonic disease, 30% have isolated small bowel disease, and 20% have colonic disease. A minority of patients have isolated upper gastrointestinal tract or perianal disease in the absence of inflammation in the small bowel or colon
300
What is pyoderma gangrenosum?
300
What antibiotic therapy has moderate level of evidence in patients with Crohn's disease complicated by a simple perianal fistula?
As part of multimodality therapy, there is at least a moderate level of evidence that the antibiotics metronidazole and ciprofloxacin may be effective in simple perianal fistula. The combination of infliximab and antibiotics is more effective than infliximab alone for perianal fistula.
300
Definition and classification of pulmonary hypertension
Resting mean pulmonary arterial pressure of 25mmHg or greater
Group 1: Pulmonary arterial hypertension
Group 2: Left sided heart disease
Group 3: Respiratory disorders (COPD, ILD)
Group 4: CTEPH
Group 5: Everything else
400
Which IBD is more likely to promote calcium oxalate stone formation? Provide your reasoning!
Crohn's disease
Calcium no longer able to bind to oxalate in the lumen of the gut leading to increased oxalate precipitation in the kidneys
400
Severe inflammation and scarring of bile ducts and associated with jaundice, nausea, pruritus, and weight loss. What is the diagnosis and which IBD is it more commonly associated with?
PSC- Primary Sclerosing cholangitis
More common in UC and in men
400
Percent of patients with IBD that experience extraintestinal manifestations
Up to 30% of patients with IBD experience an extraintestinal manifestation at some time during the course of their disease; peripheral arthritis is the most common
400
A patient with moderate to severe Crohn's disease who has been treated with Azathioprine and failed requiring multiple courses of prednisone for Crohn's flares; should now be treated with...
What is infliximab and azathioprine
Combination therapy with infliximab and azathioprine is more efficacious than monotherapy with either agent alone in achieving glucocorticoid-free remission and mucosal healing.
400
List 4 Causes of Anterior mediastinal masses
1. Thymus (most common)
2. Teratoma/germ cell
3. Lymphoma
4. Thyroid
500
What is the Crohn's Disease Activity Index (CDAI) cuttoff for active disease and severe disease?
CDAI >150: Active disease
CDAI >45): Severe disease
See MD calc for further information: signs, symptoms, and history answers is strictly based on the last 7 days
500
What disease is this associated with?
UC
500
Name the two common ocular manifestations of IBD and how to differentiate between the two.
Ocular extraintestinal manifestations of IBD include episcleritis and uveitis. Episcleritis is more common and consists of injection of the sclera and conjunctiva. It does not affect visual acuity and occurs in association with active bowel disease. Uveitis presents with headache, blurred vision, and photophobia. Uveitis is an ocular emergency requiring prompt referral to an ophthalmologist.
500
When using natalizumab for treatment for moderate to severe Crohn's disease what should be monitored?
What is Serum antibody for JC virus?
Natalizumab should be used for maintenance of natalizumab-induced remission of Crohn disease only if serum antibody to JC virus is negative because of risk for progressive multifocal leukoencephalopathy, a CNS demyelinating infection caused by reactivation of the JC virus. Testing for anti-JC virus antibody should be repeated every 6 months and treatment stopped if the result is positive
500
What 3 specific gene mutations should be tested in advanced stage adenocarcinoma or mixed cancers?
EGFR ALK and ROS1