Inflammatory Bowel Disease (IBD): Pathophysiology, Diagnosis, and Management

Question 1

The most common extraintestinal manifestation of ulcerative colitis is:

Accepted Answer

Erythema nodosum

Answer

Primary sclerosing cholangitis

Answer

Ankylosing spondylitis

Answer

Pyoderma gangrenosum

Question 2

Which of the following is NOT a first-line medication for active Crohn's disease?

Accepted Answer

Infliximab

Answer

Mesalamine

Answer

Budesonide

Answer

5-aminosalicylate (5-ASA)

Question 3

The primary mechanism of action of anti-TNF agents in the treatment of IBD is:

Accepted Answer

Inhibition of cytokine production

Answer

Enhancement of regulatory T cell function

Answer

Blockade of leukocyte adhesion

Answer

Stimulation of mucosal healing

Question 4

Which clinical manifestation is commonly seen in ulcerative colitis but not in Crohn's disease?

Accepted Answer

Rectal bleeding

Answer

Abdominal pain

Answer

Weight loss

Question 5

Which clinical manifestation is characteristic of Crohn's Disease?

Accepted Answer

Transmural inflammation involving all layers of the intestinal wall

Answer

Mucosal inflammation limited to the rectum

Answer

Superficial ulcerations confined to the colonic mucosa

Answer

Absence of granulomas in affected intestinal tissue

Question 6

Which of the following is NOT a characteristic symptom of Crohn's disease?

Accepted Answer

Skin rashes

Answer

Abdominal pain

Answer

Diarrhea

Answer

Weight loss

Question 7

A complication commonly associated with Crohn's disease but not ulcerative colitis is:

Accepted Answer

Perianal fistulas

Answer

Toxic megacolon

Answer

Stricture formation

Answer

Pseudopolyps

Question 8

Which surgical intervention is most frequently performed for severe ulcerative colitis?

Accepted Answer

Colectomy

Answer

Ileostomy

Answer

Stricturoplasty

Answer

Bowel resection

Question 9

Which type of Inflammatory Bowel Disease (IBD) is the most common?

Accepted Answer

Ulcerative Colitis

Answer

Crohn's Disease

Answer

Microscopic Colitis

Answer

Diverticulitis

Question 10

In Crohn's Disease, which inflammatory cell type is primarily involved in its pathogenesis?

Accepted Answer

Lymphocytes

Answer

Neutrophils

Answer

Macrophages

Answer

Eosinophils

Question 11

What is the most common clinical manifestation associated with Ulcerative Colitis?

Accepted Answer

Rectal bleeding

Answer

Fever

Answer

Abdominal pain

Answer

Weight loss

Question 12

In IBD, which endoscopic procedure is typically utilized to visualize and biopsy the gastrointestinal tract?

Accepted Answer

Colonoscopy

Answer

Esophagogastroduodenoscopy (EGD)

Answer

Upper endoscopy

Answer

Sigmoidoscopy

Question 13

For mild to moderate Ulcerative Colitis, which medication is commonly used as a first-line therapy?

Accepted Answer

5-aminosalicylic acid (5-ASA)

Answer

Prednisone

Answer

Methotrexate

Answer

Azathioprine

Question 14

Anti-tumor necrosis factor (TNF) medications primarily exert their therapeutic effects in IBD through which mechanism?

Accepted Answer

Inhibition of cytokine production

Answer

Stimulation of immune cell activity

Answer

Reduction of intestinal inflammation

Answer

Promotion of mucosal healing

Question 15

Which of the following is NOT a recognized risk factor for the development of Inflammatory Bowel Disease (IBD)?

Accepted Answer

Advanced age

Answer

Family history

Answer

Smoking

Answer

Use of nonsteroidal anti-inflammatory drugs (NSAIDs)

Question 16

Which of the following is a characteristic histological finding in Crohn's disease?

Accepted Answer

Non-caseating granulomas

Answer

Crypt abscesses

Answer

Lymphoid follicles

Answer

Superficial ulcerations

Question 17

What is the primary pharmacological agent used in the induction of remission in ulcerative colitis?

Accepted Answer

5-Aminosalicylic acid (5-ASA)

Answer

Budesonide

Answer

Azathioprine

Answer

Infliximab

Question 18

Which of the following endoscopic findings is suggestive of a severe flare-up in ulcerative colitis?

Accepted Answer

Loss of vascular pattern

Answer

Superficial ulcerations

Answer

Friability

Answer

Punctate hemorrhage

Question 19

What is the primary goal of dietary management in Inflammatory Bowel Disease (IBD)?

Accepted Answer

Nutritional optimization

Answer

Avoidance of trigger foods

Answer

Reduction of inflammation

Answer

Weight loss

Question 20

What is the most common presenting symptom of Crohn's disease?

Accepted Answer

Abdominal pain

Answer

Diarrhea

Answer

Weight loss

Answer

Tenesmus

Question 21

Which of the following is NOT a characteristic feature of ulcerative colitis?

Accepted Answer

Presence of granulomas

Answer

Continuous mucosal inflammation confined to the colon

Answer

Formation of skip lesions

Answer

Rectal bleeding

Question 22

The predominant cytokine driving the inflammatory response in Crohn's disease is:

Accepted Answer

Tumor necrosis factor-alpha (TNF-alpha)

Answer

Interleukin-6 (IL-6)

Answer

Interleukin-10 (IL-10)

Answer

Interferon-gamma (IFN-gamma)

Question 23

In the management of active IBD, which class of medications is primarily indicated for inducing remission?

Accepted Answer

Corticosteroids

Answer

5-aminosalicylates

Answer

Immunomodulators

Answer

Biologics

Question 24

Which of the following is strongly linked to the development of IBD as a potentially modifiable risk factor?

Accepted Answer

Smoking

Answer

Obesity

Answer

Appendectomy

Answer

High fiber intake

Question 25

Infliximab, a biologic medication used in IBD treatment, primarily exerts its therapeutic effect by:

Accepted Answer

Inhibiting TNF-alpha

Answer

Stimulating IL-10 production

Answer

Modulating gut microbiota composition

Answer

Inducing apoptosis in immune cells

Question 26

Which of the following clinical manifestations is commonly associated with Crohn's disease but not ulcerative colitis?

Accepted Answer

Perianal fistulas

Answer

Diarrhea

Answer

Abdominal pain

Answer

Rectal bleeding

Question 27

The diagnostic gold standard for confirming the diagnosis of IBD is:

Accepted Answer

Endoscopy with biopsy

Answer

Colonoscopy with barium enema

Answer

Capsule endoscopy

Answer

Magnetic resonance imaging (MRI)

Question 28

Which of the following dietary modifications may be beneficial in improving symptoms of IBD?

Accepted Answer

Low-fat, high-fiber diet

Answer

Gluten-free diet

Answer

Ketogenic diet

Answer

Intermittent fasting

Question 29

The primary goal of IBD management is to achieve:

Accepted Answer

Symptom control and prevention of complications

Answer

Complete cure

Answer

Eradication of all disease-causing bacteria

Answer

Complete reversal of intestinal damage

Question 30

What is the primary target of the monoclonal antibody infliximab used in the treatment of IBD?

Accepted Answer

Tumor necrosis factor-alpha (TNF-α)

Answer

Interleukin-6

Answer

Interferon-gamma

Answer

C-reactive protein

Question 31

What is the most strongly associated genetic risk factor for developing ulcerative colitis?

Accepted Answer

NOD2

Answer

HLA-B27

Answer

IL-23R

Answer

CARD9

Question 32

The preferred first-line pharmacological treatment for mild to moderate ulcerative colitis is:

Accepted Answer

Mesalamine

Answer

Sulfasalazine

Answer

Budesonide

Answer

Infliximab

Question 33

The main objective of Fecal Microbiota Transplant (FMT) in IBD management is to:

Accepted Answer

Restore gut microbial balance

Answer

Suppress immune activity

Answer

Replace damaged intestinal cells

Answer

Induce rapid disease remission

Question 34

A distinctive pathological feature of Crohn's disease is:

Accepted Answer

Transmural inflammation involving all intestinal wall layers

Answer

Inflammation limited to the mucosal layer

Answer

Discrete areas of inflammation separated by healthy segments

Answer

Ulceration and abscess formation restricted to the colon

Question 35

The central inflammatory cytokine in the IBD disease process is:

Accepted Answer

Tumor necrosis factor-alpha (TNF-alpha)

Answer

Interleukin-2

Answer

Interleukin-6

Answer

Interleukin-10

Question 36

For a patient with IBD presenting with abdominal pain, diarrhea, and weight loss, the most appropriate diagnostic test is:

Accepted Answer

Colonoscopy with biopsy

Answer

Upper endoscopy with biopsy

Answer

Capsule endoscopy

Answer

Magnetic resonance enterography (MRE)

Question 37

The first-line pharmacological therapy for mild to moderate ulcerative colitis is:

Accepted Answer

5-aminosalicylic acid (5-ASA) agents

Answer

Corticosteroids

Answer

Immunomodulators

Answer

Biologic agents

Question 38

The main objective of surgical intervention in IBD management is:

Accepted Answer

Resecting damaged bowel segments

Answer

Achieving disease remission

Answer

Preventing further disease progression

Answer

Restoring normal bowel function

Question 39

Which of the following cytokines is a key mediator of inflammation in Crohn's disease?

Accepted Answer

Tumor necrosis factor-alpha (TNF-α)

Answer

Interleukin-10 (IL-10)

Answer

Interferon-gamma (IFN-γ)

Answer

Interleukin-6 (IL-6)

Question 40

A patient with ulcerative colitis presents with bloody diarrhea and abdominal cramps. Digital rectal examination reveals diffuse mucosal inflammation. What is the most likely endoscopic finding?

Accepted Answer

Continuous mucosal inflammation extending proximally from the rectum

Answer

Discrete ulcers with intervening areas of normal mucosa

Answer

Skip lesions with areas of normal mucosa between inflamed segments

Question 41

Which of the following medications is a first-line therapy for inducing and maintaining remission in Crohn's disease?

Accepted Answer

5-aminosalicylic acid (5-ASA)

Answer

Infliximab

Answer

Azathioprine

Answer

Budesonide

Question 42

A patient with Crohn's disease has developed a perianal fistula. Which of the following is the preferred initial treatment?

Accepted Answer

Antibiotics and drainage

Answer

Anti-TNF therapy

Answer

Immunomodulators

Answer

Surgery

Question 43

Which of the following laboratory tests is most useful in differentiating Crohn's disease from ulcerative colitis?

Accepted Answer

Fecal calprotectin

Answer

Erythrocyte sedimentation rate (ESR)

Answer

C-reactive protein (CRP)

Answer

Antinuclear antibody (ANA)

Question 44

A patient with ulcerative colitis has experienced a severe flare-up despite optimal medical therapy. Which of the following surgical interventions is most likely to be performed?

Accepted Answer

Total colectomy with ileal pouch-anal anastomosis (IPAA)

Answer

Subtotal colectomy with ileostomy

Answer

Laparoscopic-assisted colectomy

Question 45

Which of the following is a characteristic clinical manifestation of microscopic colitis?

Accepted Answer

Watery diarrhea without blood or mucus

Answer

Rectal bleeding

Answer

Tenesmus

Answer

Crampy abdominal pain

Question 46

A patient with a known history of IBD presents with a new onset of joint pain and swelling. Which of the following is the most likely diagnosis?

Accepted Answer

IBD-associated arthritis

Answer

Gout

Answer

Osteoarthritis

Answer

Rheumatoid arthritis