WBR0148

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 2 CK
Main Category
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 this 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::Patchy 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.]]
Answer C	AnswerC::Absence of on 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. 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
Keyword
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