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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor={{Rim}}, {{AJL}} {{Alison}}
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathology
|MainCategory=Pathology
Line 21: Line 21:
|SubCategory=Gastrointestinal
|SubCategory=Gastrointestinal
|Prompt=A 27-year-old male presents to the physician's office for persistent watery diarrhea of several days duration, abdominal pain, and unintentional weight loss. Upon physical examination you observe skin pallor and abdominal tenderness.  Following appropriate work-up, the patient undergoes GI endoscopy that demonstrates transmural granulomatous inflammation, with cobblestone mucosa and skip lesions in the small intestine.  Which of the following additional findings is most likely present in this patient?
|Prompt=A 27-year-old male presents to the physician's office for persistent watery diarrhea of several days duration, abdominal pain, and unintentional weight loss. Upon physical examination you observe skin pallor and abdominal tenderness.  Following appropriate work-up, the patient undergoes GI endoscopy that demonstrates transmural granulomatous inflammation, with cobblestone mucosa and skip lesions in the small intestine.  Which of the following additional findings is most likely present in this patient?
|Explanation=Inflammatory bowel disease (IBD) is divided into Crohn's disease and ulcerative colitis.  Differences between the two is based on clinical symptoms, gross morphology of the GI tract, microscopic appearance, and associated complications extraintestinal manifestations, and treatment.
|Explanation=Inflammatory bowel disease (IBD) is divided into [[Crohn's disease]] and [[ulcerative colitis]]].  Differention between the conditions is based upon clinical symptoms, gross morphology of the GI tract, microscopic appearance, associated complications, extraintestinal manifestations, and treatment.


Crohn's disease is characterized by the presence of transmural granulomatous inflammation with cobblestone mucosa and skip lesions that may be present in virtually any part of the GI tract.  In contrast, ulcerative colitis is often described as continuous inflammation that involves the rectum and almost never involves the tract except the colon (except in the case of backwash ileitis).  Crohn's disease is associated with strictures, fistulas, perianal disease, and extraintestinal symptoms, such as migratoy polyarthritis, skin lesions such as erythema nodosum and pyoderma gangrenosum, and kidney stones. Patients typically present with watery diarrhea, but bloody diarrhea is also observed.
[[Crohn's disease]] is characterized by the presence of transmural granulomatous inflammation, with cobblestone mucosa and skip lesions manifesting in any part of the GI tract.  [[Ulcerative colitis]] is often characterized by continuous inflammation, involving the the rectum and infrequently involving the GI tract with the exception of the colon (except in the case of backwash ileitis).  [[Crohn's disease]] is associated with strictures, fistulas, perianal disease, and extraintestinal symptoms, such as migratoy polyarthritis, skin lesions, such as erythema nodosum and pyoderma gangrenosum, and kidney stones. Patients typically present with watery diarrhea, but bloody diarrhea may also manifest.


Ulcerative colitis is characterized by mucosal and submucosal inflammation only with friable mucosal pseudopolyps and loss of haustra.  It is associated with crypt abscesses and ulcers. Patients typically present with bloody diarrhea.
[[Ulcerative colitis]] is characterized by mucosal and submucosal inflammation, only with friable mucosal pseudopolyps and loss of haustra, crypt abscesses, and ulcers. Patients typically present with bloody diarrhea.


Educational Objective: Crohn's disease is characterized by transmural inflammation with cobblestone appearance and skip lesions in any part of the GI tract.  It is associated with formation of fistulas.
|EducationalObjectives= [[Crohn's disease]] is characterized by transmural inflammation, with a cobblestone appearance, and skip lesions in the GI tract.  It is associated with the formation of fistulas.
|AnswerA=Loss of haustra  
|AnswerA=Loss of haustra  
|AnswerAExp=Loss of haustra is seen in patients with ulcerative colitis.
|AnswerAExp=Loss of haustra is frequently observed in patients with [[ulcerative colitis]].
|AnswerB=Sclerosing cholangitis
|AnswerB=Sclerosing cholangitis
|AnswerBExp=Sclerosing cholangitis is a complication associated with ulcerative colitis. Nonetheless, it may be present in Crohn's disease.
|AnswerBExp=Sclerosing cholangitis is a complication more frequently associated with [[ulcerative colitis]].
|AnswerC=Pseudopolyps
|AnswerC=Pseudopolyps
|AnswerCExp=Pseudopolyps are a common finding in ulcerative colitis.
|AnswerCExp=Pseudopolyps are a common finding in ulcerative colitis.
|AnswerD=Proctitis
|AnswerD=Proctitis
|AnswerDExp=Proctitis may be present in Crohn's disease, but is mostly observed in patients with ulcerative colitis.
|AnswerDExp=Proctitis may be present in [[Crohn's disease]], but is more frequently observed in patients with [[ulcerative colitis]].
|AnswerE=Fistulas
|AnswerE=Fistulas
|AnswerEExp=Fistulas are associated with Crohn's disease.
|AnswerEExp=Fistulas are associated with [[Crohn's disease]].
|RightAnswer=E
|RightAnswer=E
|WBRKeyword=crohn's, crohn, Crohn's, Crohn, inflammatory, bowel, disease, inflammatory bowel disease, ulcerative, colitis, ulcerative colitis, fistula, fistulas, transmural, inflammation, diarrhea, watery, bloody, abdominal, pain, abdominal pain, weight loss, weight loss, malabsorption, stricture, strictures, perianal disease, crypt, abscess, abscesses, sclerosing, cholangitis
|WBRKeyword=Crohn's disease, inflammatory bowel disease, ulcerative colitis, fistulas, transmural, inflammation, diarrhea, abdominal pain, weight loss, malabsorption, stricture, perianal disease, excretory system, GI tract,
|Approved=No
|Approved=Yes
}}
}}

Revision as of 15:29, 1 August 2014
Author [[PageAuthor::Rim Halaby, M.D. [1], Alison Leibowitz [2] (Reviewed by Alison Leibowitz)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pathology
Sub Category SubCategory::Gastrointestinal
Prompt [[Prompt::A 27-year-old male presents to the physician's office for persistent watery diarrhea of several days duration, abdominal pain, and unintentional weight loss. Upon physical examination you observe skin pallor and abdominal tenderness. Following appropriate work-up, the patient undergoes GI endoscopy that demonstrates transmural granulomatous inflammation, with cobblestone mucosa and skip lesions in the small intestine. Which of the following additional findings is most likely present in this patient?]]
Answer A AnswerA::Loss of haustra
Answer A Explanation [[AnswerAExp::Loss of haustra is frequently observed in patients with ulcerative colitis.]]
Answer B AnswerB::Sclerosing cholangitis
Answer B Explanation [[AnswerBExp::Sclerosing cholangitis is a complication more frequently associated with ulcerative colitis.]]
Answer C AnswerC::Pseudopolyps
Answer C Explanation AnswerCExp::Pseudopolyps are a common finding in ulcerative colitis.
Answer D AnswerD::Proctitis
Answer D Explanation [[AnswerDExp::Proctitis may be present in Crohn's disease, but is more frequently observed in patients with ulcerative colitis.]]
Answer E AnswerE::Fistulas
Answer E Explanation [[AnswerEExp::Fistulas are associated with Crohn's disease.]]
Right Answer RightAnswer::E
Explanation [[Explanation::Inflammatory bowel disease (IBD) is divided into Crohn's disease and ulcerative colitis]. Differention between the conditions is based upon clinical symptoms, gross morphology of the GI tract, microscopic appearance, associated complications, extraintestinal manifestations, and treatment.

Crohn's disease is characterized by the presence of transmural granulomatous inflammation, with cobblestone mucosa and skip lesions manifesting in any part of the GI tract. Ulcerative colitis is often characterized by continuous inflammation, involving the the rectum and infrequently involving the GI tract with the exception of the colon (except in the case of backwash ileitis). Crohn's disease is associated with strictures, fistulas, perianal disease, and extraintestinal symptoms, such as migratoy polyarthritis, skin lesions, such as erythema nodosum and pyoderma gangrenosum, and kidney stones. Patients typically present with watery diarrhea, but bloody diarrhea may also manifest.

Ulcerative colitis is characterized by mucosal and submucosal inflammation, only with friable mucosal pseudopolyps and loss of haustra, crypt abscesses, and ulcers. Patients typically present with bloody diarrhea.
Educational Objective: Crohn's disease is characterized by transmural inflammation, with a cobblestone appearance, and skip lesions in the GI tract. It is associated with the formation of fistulas.
References: ]]

Approved Approved::Yes
Keyword WBRKeyword::Crohn's disease, WBRKeyword::inflammatory bowel disease, WBRKeyword::ulcerative colitis, WBRKeyword::fistulas, WBRKeyword::transmural, WBRKeyword::inflammation, WBRKeyword::diarrhea, WBRKeyword::abdominal pain, WBRKeyword::weight loss, WBRKeyword::malabsorption, WBRKeyword::stricture, WBRKeyword::perianal disease, WBRKeyword::excretory system, WBRKeyword::GI tract
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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