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Author: Laurence Scott Bailen, M.D.

1. Question 1

Inflammatory bowel disease (IBD) is comprised of two major disorders: ulcerative colitis and Crohn’s disease.

Which of the following best describes the current theory of the pathogenesis of inflammatory bowel disease?

  1. A mutation in the NOD2/CARD15 gene leads to an altered immune response to bacteria leading to intestinal inflammation.

  2. Toxic effects of nicotine in cigarette smoke cause intestinal inflammation.

  3. Infection with mycobacterium paratuberculosis causes intestinal inflammation.

  4. Combination of genetic susceptibility, environmental exposures including infections, and a dysregulated immune response leads to intestinal inflammation.

  5. Circulating autoantibodies lead to intestinal inflammation.

2. Question 2

A 32 year-old man has Crohn’s disease involving the ileum and colon. When he was first diagnosed he had ocular discomfort and was diagnosed with uveitis. Several years later he developed back pain due to sacroileitis and a rash consistent with pyoderma gangrenosum. He has had intermittent bouts of right knee inflammation consistent with arthritis. Recently, abnormal liver function tests were noted and a diagnosis of primary sclerosing cholangitis is being entertained.

Of the all the extraintestinal manifestations of Crohn’s disease, which of the following will most likely be related to the activity of the intestinal disease?

  1. Sacroileitis

  2. Peripheral arthritis

  3. Uveitis

  4. Primary sclerosing cholangitis

  5. Pyoderma gangrenosum

3. Question 3

A 22 year-old woman comes to the emergency room with crampy left lower quadrant abdominal pain, 10-12 small volume bloody bowel movements daily with urgency to move her bowels, and a 5 lb weight loss in the past 2 weeks. She has a low grade temperature and a mildly tender abdomen on physical exam. She has a colonoscopy which shows pinpoint ulcerations and friable mucosa throughout the entire colon in a continuous distribution. Biopsies are taken from the colon. Multiple stool cultures are all negative.

Which of the following would you most likely find in this patient?

  1. Anti-saccharomyces cerevisiae antibodies (ASCA)

  2. Granulomas on histologic analysis

  3. Fstulae seen on a barium enema

  4. Peri-nuclear anti-neutrophil cytoplasmic antibodies (P-ANCA)

  5. Strictures seen on a barium small bowel x-ray