•••• 1.

Crohn’s disease may be caused by which one of the following infectious agents?

• a.Clostridium difficle

• b.Mycobacterium paratuberculosis

• c.Cytomegalo virus (CMV)

• d.Mycoplasma

• A possible infectious etiology for IBD includes clostridium difficile, maparatuberculosis,

paramyxovirus and helicobacter species, salmonella shigella, campylobacter species.

M.para tuberculosis does not have a confirmed disease association and antimycobacterial

agents are not effective in treating Crohn’s disease.

•••• 2.

Epitheloid like giant cells are seen in all the following except

• a.Leprosy

• b.Ulcerative Colitis

• c.Crohns disease

• d.Brucellosis

• Ans. is ‘c’ i.e., Ulcerative colitis

•••• 3.

Megaloblastic anemia is seen in ?

• a.ileal resection

• b.Crohn's disease

• c.Intestinal lymphatic ectasia

• d. Both a and b

• Ans. is ‘a’ i.e., heal resection ‘b’ i.e., Crohn’s disease

Crohn’s disease is a type of ilitis.

Chronic pancreatitis is a malabsorption state.

“About 40% of patients with chronic pancreatitis have vitamin B12 malabsorption”

•••• 4.

During an operation for presumed appendicitis, the patient appendix is found to

be markedly thickened and feels rubbery to firm. The serosa is edematous and

inflamed and the mesentery is thickened with fat growing about the bowel

circumference. Most likely diagnosis

• a.Ileal Crohn’s disesase

• b.Meckel’s diverticulitis

• c.Ulcerative colitis

• d.Ileocecal tuberculosis

• Crohn’s disease can present acutely, and when it involves the terminal ileum may

clinically resemble appendicitis. The bowel in this patient has the characteristic gross

findings and inflammatory changes of Crohn’s disease including the “creeping fat”

within the mesentery. Meckel’s diverticulitis can mimic appendicitis but it presents as an

inflammatory phlegmon located approximately 50 cm (2 feet) from the ileocecal varve

and does not have the bowel changes seen in this patient. Ulcerative colitis is usually

confined to the large bowel and, although it may occasionally be associated with

inflammatory changes of the ileal mucosa (backwash ieitis), it is generally not associated

with full- thickness changes described above. Ileal carcinoid would present as a mass in

the ileum and would not be associated the inflammatory changes seen in this patient.

•••• 5.

Yellowish exudates at multiple sites seen in colonoscopy indicates -

• a.Crohn's disease

• b.Hirshspruing disease

• c.Tuberculosis

• d.Lymphoma

• In Crohn’s disease focal inflammation and ulceration are frequently seen. o In ulcerative

colitis usually hyperemia is seen

•••• 6.

Comb sign in CT abdomen is seen in:

• a.Crohns disease

• b.Ulcerative colitis

• c.Tuberculosis

• d.Intestinal lymphoma

• CT finding in Crohns disease:

Mural thickening with stratification is seen with active inflammation

Vascular engorgement of the mesentery (comb sign)

Hypodense lymph nodes

CT findings in intestinal tuberculosis:

Mural thickening with contiguous ileo-cecal involvement

Hypodense lymph nodes with peripheral enhancement

•••• 7.

A young girl presents with abdominal pain and a recent change in bowel habit,

with passage of mucus in stool. There is no associated blood in stool and

symptoms are increased with stress. The most likely diagnosis is:

• a.Irritable bowel syndrome

• b.Ulcerative Colitis

• c.Crohn's disease

• d.Amebiasis

• IBS is a disorder for which no pathognomonic abnormalities are identified. Females are

more commonly affected. People of all age groups are affected, but most have the onset

of symptoms before 45 years. Patients usually presents with recurrent lower abdominal

pain, abdominal bloating and altered bowel habits. Stool is accompanied by large amount

of mucus, Bleeding is not a feature. Symptoms occur at times of stress or emotion.

•••• 8.

Skip lesions of colon with epitheloid granuloma are usually seen with -

• a.Crohn's disease

• b.Ulcerative colitis

• c.Intestinal TB

• d.Sarcoidosis

• Crohn’s disease

•••• 9.

Toxic megacolon is most commonly associated with -

• a.Ulcerative colitis

• b.Crohn's disease

• c.Whipple's disease

• d.Reiter's disease

• Ulcerative colitis

•••• 10.

Thump print sign in the abdominal radiograph indicates which of the following

conditions?

• a.Ischemic colitis

• b.Crohn’s disease

• c.Pseudomembranous colitis

• d.All the above

• The thump print sign is seen in Inflamatory bowel disease (Ulcerative colitis, Crohns),

infectious colitis (amoebic, pseudomembranous), ischaemic bowel disease and

diverticulitis. The sign is a result of haustral mucosal thickening in most of the cases.

•••• 11.

The endoscopic finding which suggests crohns in a patient with chronic diarrhea

among the following is:

• a.Transverse ulcer

• b.Nodularity

• c.Hypertrophic lesions

• d.Anorectal lesions

• Endoscopic difference between tuberculosis and crohns:

The ileo-cecal region is the most common site affected in either condition

Findings favouring TB:

1. Transversely placed ulcers

2. Nodularity

3. Hypertrophic lesions

4. Involvement of fewer than four segments

5. Patulous ileocecal valve,

6. Pseudopolyps

Findings favouring crohns:

1. Aphthoid or longitudinal, deep, fissuring ulcers

2. Cobblestone appearance are said to be more typical of CD

3. Ano-rectal lesions

4. Skip lesions in the colon

•••• 12.

A patient complains to his physician of chronic constipation. On the instruction

of his physician, the patient increases his dietary fiber, but his constipation

persists. The physician refers the patient to a gastroenterologist. Colonoscopy

reveals over fifty 2-3 mm openings into the bowel mucosa. No bleeding is seen,

and the intervening mucosa appears normal. Which of the following is the most

likely diagnosis?

• a.Amebiasis

• b.Crohn disease

• c.Diverticulosis

• d.Pseudomembranous colitis

• The appearance described is typical for diverticulosis. The openings seen are into

diverticula, which are small, acquired outpouchings of the mucosa through the muscle of

the bowel. Milder cases of diverticulosis are usually asymptomatic; patients with

extensive diverticula may experience mild cramps, bloating, or constipation.

In amebiasis, the patient would have much more severe symptoms and bleeding would

probably be present.

In Crohn disease, pseudomembranous colitis, and ulcerative colitis, the mucosa would

appear obviously diseased.

•••• 13.

Thymoma may be associated with all the conditions, EXCEPT:

• a.Polymyositis

• b.Sjogrens syndrome

• c.Ulcerative colitis

• d.Crohns disease

• Patients with myasthenia gravis-10–15% have thymoma.

Thymoma may be associated with polymyositis, systemic lupus erythematosus,

thyroiditis, Sjögren’s syndrome, ulcerative colitis, pernicious anemia, Addison’s disease,

scleroderma, and panhypopituitarism.

•••• 14.

Fistula is most common in -

• a.Crohn's disease

• b.Ulcerative colitis

• c.Infective entero colitis

• d.Coeliac sprue

• Crohn’s disease

•••• 15.

Which of the following would be the best morphological feature to distinguish

ulcerative colitis from Crohn’s disease -

• a.Diffuse distributions of pseudopolyps

• b.Mucosal edema

• c.Crypt abscesses

• d.Lymphoid aggregates in the mucosa

• Pseudopolyps (inflammatory polyps) can be seen in both crohn’s disease and ulcerative

colitis

In ulcerative colitis the distribution of these pseudopolyps can be diffuse but in crohn’s

disease the distribution can not be diffuse because a classic feature of crohn’s disease is

the sharp demarcation of diseased bowel segments from the adjacent uninvolved bowel.

When multiple bowel segments are involved the intervening bowel is essentially normal

(skip lesions).

o Mucosal edema –

The hallmark of both ulcerative colitis and crohn’s disease is mucosal inflammation and

chronic mucosal damage. So mucosal edema is a feature of both of these diseases.

The important point is that while in Ulcerative colitis these processes are limited to

mucosa or submucosal, in crohn’s disease these processes extend beyond the mucosa and

submucosa and involves the entire wall. o Crypt abscesses –

Crypt abscesses are produced due to infiltration of the neutrophil into crypt lumen.

These crypt abscesses are not specific for ulcerative colitis and may be observed in

crohn’s disease or any active inflammatory colitis.

Lymphoid aggregates in mucosa –

The characteristic mucosal feature of idiopathic inflammatory bowel disease on histology

includes —

(i) Distortion of crypt architecture

(ii) Destruction and loss of crypt

(iii) Marked increase in lymphocytes and plasma cells in lamina propria.

(iv) These features are specific to inflammatory bowel disease and helps to differentiate

idiopathic inflammatory bowel disease from acute infectious colitis and other chronic

colitis.

•••• 16.

A 26 year old man has had Crohn’s disease of the ileum for 10 months and has

been treated with several drugs. He now suffers from muscle weakness,

centripetal obesity, and a round, plethoric face. These side effects are most likely

associated with the long-term use of:

• a.Azathioprine

• b.Cyclosporine

• c.Olsalazine

• d.Prednisone

• Prednisone is frequently used to treat inflammatory bowel disease, as well as rheumatic

disorders.The long-term use of glucocorticoids (such as prednisone, prednisolone, and

triamcinolone), is associated with various side effects, including muscle weakness,

weight gain, redistribution of fat, moon facies, osteoporosis, cataract formation,

glaucoma, adrenal insufficiency, and exacerbation of peptic ulcers.

•••• 17.

Anti-Saccharomyces cerevisiae antibodies are seen in?

• a.Crohn's disease

• b.Scleroderma

• c.SLE

• d. Both A and C

• Screening test is presence of anti-Saccharomyces cerevisae antibody (ASCA). Antibody

formation is common against cell wall of yeast, Saccharomyces cerevisae in patients of

CD

•••• 18.

Least predilection for distal ileum -

• a.Carcinoid syndrome

• b.Meckel's diverticulum

• c.Crohn disease

• d.Zollinger - Ellison syndrome

• Zollinger-Ellison syndrome (gastrinoma) does not usually occur in distal ileum.

o Carcinoid syndrome, Meckel’s diverticulum and crohn disease can affect distal ileum

•••• 19.

True regarding crohn’s disease are A/E ?

• a.Scleroderma

• b.Transmural involvement

• c.Cobble stone appearance

• d.Skin involvement

• The skin involvement in Crohn’s disease causes erythema nodosum, scleroderma does

not occur in Crohn’s disease.

Other extra intestinal manifestations of Crohn’s disease:

I. Migratory polyarthritis 2. Sacroiliaitis 5. Hepatic pericholangitis 7. Clubbing

3. Ankylosing spondylitis 4. Uveitis 6. Primary sclerosing cholangitis

•••• 20.

A 28 year old female with a several-year history of intermittent diarrhea and

abdominal pain is seen for inflammatory bowel disease. Endoscopic evaluation of

her terminal ileum, colon, and rectum is undertaken. Which of the following

endoscopic observations is more indicative of Crohn’s disease than of ulcerative

colitis?

• a.Discontinuous mucosal involvement

• b.Mucosal atrophy

• c.Mucosal ulceration

• d.Pseudopolyps

• Crohn’s disease is frequently associated with “skip lesions,” discontinuous areas of active

disease in the colon and small intestine with intervening segments that appear normal.

This is in marked contrast to ulcerative colitis, which most commonly shows continuous

mucosal involvement.

Both ulcerative colitis and Crohn’s disease can show mucosal atrophy. Chronic mucosal

inflammation produces glandular atrophy, and a loss of mucosal folding.

Mucosal ulceration is seen in both Crohn’s disease and ulcerative colitis. The ulcers of

Crohn’s disease are generally described as linear fissures, following the longitudinal axis

of the intestine. Ulcerative colitis typically produces broad, extensive areas of ulceration.

Pseudopolyps are most commonly associated with ulcerative colitis, and represent the

islands of spared mucosa between the broad ulcerations.