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 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 disease (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 bt 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. |
| Approved | Approved::No |
| Keyword | |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |