Gi Board Review

Front 1

Which CD4 T-helper cells are attributed to Crohn's disease?

Back 1

Th1 and Th17

Front 2

Which CD4 T-helper cells are attributed to Ulcerative Colitis?

Back 2

Th2

Front 3

Which disease is exacerbated by the cessation of smoking?

Back 3

Ulcerative Colitis

Front 4

2 chronic infections that can be confused with crohn's disease?

Back 4

TB and Yersinia enterocolitis

Front 5

Term to describe distal ileal involvement with severe extensive ulcerative colitis and may be confused with ileocolonic Crohn disease?

Back 5

Backwash Ileitis

Front 6

What may abdominal pain in Ulcerative Colitis represent?

Back 6

Abdominal pain in UC is unusual and may represent toxic megacolon or perforation.

Front 7

What does a stricture in a patient with Ulcerative colitis represent?

Back 7

The Wrong Diagnosis or Cancer!

Front 8

Percentage of patients who experience some form a extraintestinal manifestation of their IBD?

Back 8

15%

Front 9

2 most common skin disorders associated with IBD?

Back 9

(1) Erythema nodosum (painful subcutaneous nodules commonly on extensor surfaces of the leg); (2) Pyoderma gangrenosum (ulcers on skin that mimic cellulitis)

Front 10

IBD associated with primary sclerosing cholangitis

Back 10

Ulcerative Colitis --- these patients may represent a distinct phenotype of disease with a particular high rate of colorectal cancer

Front 11

In patients with disease flares associated with IBD, what should be considered as a cause of the flare?

Back 11

For disease flares, stool studies (routine enteric pathogens, ova and parasites, and C. difficile) should be performed, because superimposed infections are not uncommon. C. difficile is now well recognized as a cause of significant morbidity and mortality in patients with IBD and is being reported more often in ambulatory patients without recent antibiotics use.

Front 12

Next step in patients who disease becomes refractory to corticosteroid therapy?

Back 12

Colonoscopy with biopsies to evaluate for CMV colitis (found in up to 30% of patients undergoing colectomy).

Front 13

IBD characterized by the acute onset of bowel urgency, frequent watery bowel movements and often bleeding; patients often remember when symptoms first started

Back 13

Ulcerative colitis

Front 14

IBD that causes mucosal infalmmation to the colon

Back 14

Ulcerative colitis

Front 15

IBD that causes transmural bowel wall inflammation that may affect the entire gastroenterologic tract from the mouth to he anus?

Back 15

Crohn's Disease

Front 16

IBD characterized by indolent onset and variable clinical manifestation that depend on the location of disease and the presence of complications; most patients recall gradually feeling worse over time.

Back 16

Crohn's Disease

Front 17

Disease that presents with painless watery diarrhea without bleeding and is diagnosed with biopsy showing histologic inflammation in endoscopically normal-appearing colonic mucosa.

Back 17

Microscopic Colitis

Front 18

Patients with ulcerative colitis (except those with only proctitis) and Crohns colitis (With >1/3 of the colon involved) are at increased risk of colorectal cancer after approximately how many years of disease?

Back 18

8 years --- these patients should undergo surveillance colonoscopy with biopsies every 1-2 years. If flat dysplasia is present, the benefits/risks of prophylactic colectomy should be discussed with the patient.

Front 19

A diagnosis of microscopic colitis should prompt what next steps?

Back 19

1) Carefully review of medications (e.g. ASA, NSAIDs, PPIs, Ranitidine, Sertraline); (2) Consider testing for celiac disease

Front 20

Next step if an IBD patient experiences increasing abdominal pain and distention, rebound tenderness, and hypoactive bowel sounds

Back 20

CT scan to evaluate for toxic megacolon or perforation

Front 21

Immunocompromised patients with IBD should avoid what vaccinations?

Back 21

LIVE VACCINATIONS (Varicella, Yellow fever, intranasal influenza, MMR, oral typhoid).

Front 22

Study that showed better clinical outcomes when patients with recently diagnosed moderate-to-severe Crohn disease were treated aggressively with anti-TNF therapy with or without an immunomodulatero such as azathioprine or 6-mercaptopurine.

Back 22

SONIC study -- Anti-TNF tx alone was superior to azathioprine monotherapy, and the combination of these two agents results in the highest rates of remission and mucosal healing. In short, the most effective treatment for patients with recently diagnosed moderately-to-severely active Crohn disease is anti-TNF therapy with or without an immunomodulator such as azathioprine or 6-mercaptopurine. An alternative to the immediate use of anti-TNF therapy is the simultaneous initiation of an immunomodulator and corticosteroids with a goal to taper off of corticosteroids within 3 months. If symptoms are not completely controlled after stopping the corticosteroids, then an anti-TNF agent could be added at that time.

Front 23

Treatment of Crohn disease with fistulas

Back 23

Examination under anesthesia for potential surgery (for drainage of abscess and seton placement) and infliximab.