WBR0148

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Internal medicine
Sub Category	SubCategory::Gastrointestinal
Prompt	[[Prompt::A 23 year old male patient presents to his primary care physician for two-month-history of abdominal pain. The pain is intermittent in nature and is not associated with a particular type of food. The patient reports several episodes of bloody diarrhea and generalized fatigue. The patient underwent several blood and stool tests and was referred to a GI specialist for endoscopic evaluation. The endoscopy reveals deep ulcerations in a patchy distribution in the small intestine and colon. Which of the following findings is consistent with the diagnosis?]]
Answer A	AnswerA::Absence of involvement of the rectum
Answer A Explanation	[[AnswerAExp::Ulcerative colitis is an inflammatory bowel disease that usually starts in the rectum area an extends into the column in a continuous pattern. The patient’s patchy inflammation of the small intestine and colon is more consistent with Crohn’s disease. The involvement of the rectum is not typical for Crohn’s disease.]]
Answer B	AnswerB::Continuous inflammation
Answer B Explanation	[[AnswerBExp::Transmural inflammation is characteristic for Crohn’s disease whereas ulcerative colitis is characterized by a shallow inflammation of the gastrointestinal wall in a continuous fashion starting from the rectum.]]
Answer C	AnswerC::Absence of non caseating granuloma
Answer C Explanation	AnswerCExp::The presence of non caseating granuloma is pathognomonic for Crohn’s disease.
Answer D	AnswerD::Absence of anal fistula
Answer D Explanation	[[AnswerDExp::Anal fistulas are commonly found in Crohn’s disease.]]
Answer E	AnswerE::Absence of extra-gastrointestinal symptoms
Answer E Explanation	[[AnswerEExp::Extra-intestinal symptoms are present in inflammatory bowel disease. They include low grade fever, fatigue, skin changes and joint involvement.]]
Right Answer	RightAnswer::A
Explanation	[[Explanation::Inflammatory bowel diseases (IBD) are characterized by a chronic inflammation. There are two types of IBD which are ulcerative colitis and Crohn's disease. Crohn's disease is characterized by patchy inflammation of the gastrointestinal tract and it does not involve the rectum. Educational objective: Crohn's disease is rarely associated with the involvement of the rectum in contrast to ulcerative colitis. Educational Objective: References: ]]
Approved	Approved::No
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