Answer B.
Pregnancy has an increased risk of flare in 1st trimester and postpartum period with decreased rate of flare in 2nd and 3rd trimesters and overall no increased risk of flare, however, flares may be more severe. The most important factor for a healthy delivery is a healthy mother and therefore it is important to continue maintenance therapy with sulfasalazine or mesalamine. Some of the increase flare rate in 1st trmester and postpartum period is secondary to ill advised stopping of medication especially when breast feeding
Answer B.
There is no association between CARD 15 mutations and UC. CARD 15 mutations are found in up to 35% of patients with Crohns disease. They are more common in familial than sporadic disease and are not found or rare in Japan. CARD 15 mutations are associated with ileal and fibrostenosing disease. The presence of CARD 15 mutations in mny unaffected persons indicates that additional genes or environental factors are also necessary for phenotypic expression of Crohns disease.
Answer D.
Pouchitis patients are more likely to have pANCA which tends to have higher titers. pANCA is not related to
UC disease activity and persists after colectomy. It is not specific for UC occurring in 5-15% of Crohns disease patients and 43% of Crohns patients with UC features.
Answer B.
Cancers in ulcerative colitis are distributed equally throughout the colon. They tend to be multiple, anaplastic and occur at a younger age.
Answer C. 
In scleroderma severe enough to cause the blind loop syndrome, the intestinal musculature has been replaced by fibrous tissue and can not respond to pro-kinetic agents. The stasis may produce bacterial overgrowth and therefore, antibiotics may be helpful. In severe, intractable cases, TPN may be required.
Answer A.
Only 20% have pancolitis or extensive colitis (beyond 60cm). 25% have disease limited to rectum. The absence of rectal involvement is rare and suggests a diagnosis of Crohns colitis. UC is more common in non smokers and exsmokers and in a subset of patients disease onset or flares can repeatedly triggered by cessation of smoking and remission can be induced by resumption of smoking or nicotine therapy. NSAIDs can lead to flare.
Answer. B
Folate malabsorption does not occur in the blind loop syndrome. In fact, due to bacterial production of folate, serum folate levels may be high. Alkaline phosphatase can be high if vitamin D malabsorption is severe and long-standing resulting in osteomalacia.
Answer B.
Biopsy is still the “gold standard” for the diagnosis of celiac disease. Negative serologies do not unequivocally rule out celiac disease. In a patient in whom you have a high degree of suspicion, a biopsy should be done in spite of a negative serology.
Answer A.
The findings in celiac sprue can be subtle (increased intraepithelial lymphocytes) or severe (a “Flat” mucosa). Neither is specific for celiac disease. The other listed entities have specific findings
Answer C.
A stool pH less than 7.0 and sometimes as low as 5.0 is due to malabsorberd substrates such as sugars and sugar alcohols and the bacterial conversion to short chain fatty acids.
Answer A.
An abnormal stage 2 Schilling test
can be due to bacterial overgrowth, pancreatic insufficiency, or to severe ileal disease. Pernicious anemia is due to lack of Intrinsic Factor production by the stomach. Provision of Intrinsic Factor (IF) with a step 2 Schilling test would correct for the lack of IF in pernicious anemia and thus would be normal.
Answer C.
Gatorade is a solution high in sugar and low in electrolytes. It is ideal for replacement of s
weat not diarrheal fluid.
Answer D.
Oxalates are absorbed in the colon and do not require an intact ileum or any ileal function. Vitamin B12 can only be absorbed in the terminal ileum.
Answer: C.
Although, some studies have suggested that chemotherapy has marginal benefit (tumor stabilization or mild shrinkage) in patients with metastatic disease, survival does not appear to be significantly impacted in patients with NET’s. Leukocyte interferon has been used with varying success in this group of patients. It is not considered first line treatment due to it’s limited benefit as a single agent and drug toxicity (A). OLT has been utilized with marginal success in patients with metastatic disease and is not considered standard therapy in this patient population (B). Selected patients, for example those with limited metastatic disease, those with symptoms refractory to medical therapy may benefit from aggressive debulking procedures (D).
Answer:D.
Solitary rectal ulcer syndrome (SRUS) is a chronic benign condition that is most prevalent in women under the age of 40. Patients often report a history of difficult defecation and digital rectal manipulation is not uncommon. The ulcers may be single or multiple and are usually located on the anterior rectal wall, within 10 cm of the anal verge. Fibrosis of the lamina propria with thickening of the muscularis mucosal fibers is the characteristic pathologic finding, although distortion of crypt architecture and thickening of the muscularis propria may sometimes be present. Rectopexy to prevent intussusception and prolapse is the most common surgical procedure performed for this condition
Answer: C.
Although early studies suggested that gastrinomas occur primarily in the pancreas (A), earlier diagnosis and intervention indicates that the duodenum is a common site for tumor occurrence. This has significantly changed the surgical approach in these patients. Gastrinomas, as opposed to carcinoid tumors rarely occur in the stomach (B). Although metastatic disease to the bone has been reporte
d in patients with ZE syndrome, local lymph node and liver are the most common sites for metastatic disease (D).
Answer: D.
A sub epithelial collagen band of at least 10 microns is needed to make the diagnosis of collagenous colitis. Smaller bands may be seen in the setting of inflammation but
do not meet the criterion for collagenous colitis. Rectal biopsies may be negative in the setting of positive proximal biopsies due to the sometimes patchy distribution of the collagen band.
The correct answer is D.
The patient has acute prostatitis, which is characterized by fever, chills, and dysuria, with a swollen, extremely tender prostate on rectal exam. The urine Gram's stain and culture will generally be positive. The treatment regimen for this bacterial infection is typically a 21-day course of ampicillin, a fluoroquinolone, or sulfamethoxazole/trimethoprim (SMX-TMP). G-6-PD deficiency is an X-linked recessive disorder affecting 10% to 15% of American black males. The medications most commonly associated with the induction of hemolytic anemia in deficient patients are sulfonamides, nitrofurantoin, dapsone, primaquine, and quinine. The sulfamethoxazole in the SMX-TMP combination is a sulfonamide, and can produce hemolytic anemia in patients with G-6-PD deficiency.
Ampicillin (choice A) is a broad-spectrum penicillin antibiotic commonly used in the treatment of infections in the genitourinary, respiratory, or GI tracts, as well as in the skin and soft tissues.
Cefaclor (choice B) is a second-generation cephalosporin indicated for a variety of bacterial infections, including those of the respiratory and GI tracts.
Ciprofloxacin (choice C) is a fluoroquinolone commonly used in the treatment of serious infections caused by gram-negative organisms.
Tetracycline (choice E) is most commonly used in the treatment of acne vulgaris and gonococcal infections.
The correct answer is A.
Acute pyelonephritis is an infectious disease involving the kidney parenchyma and the renal pelvis. Gram-negative bacteria, such as Escherichia coli, Proteus, Klebsiella, and Enterobacter, are the most common causative organisms in acute pyelonephritis.
Laboratory evaluation will often reveal leukocytosis with a left shift, and urinalysis typically shows pyuria, varying degrees of hematuria , and white cell casts. Since bacteremia is present, the patient should be hospitalized and empirically started on IV ampicillin and gentamicin . This regimen may be need to be changed, however, once the sensitivity results are available.
Erythromycin (choice B) and tetracycline (choice E) are both bacteriostatic antibiotics and would not be recommended in a patient with a severe infection, such as acute pyelonephritis with bacteremia.
Vancomycin (choice C) is primarily used in the treatment of severe gram-positive infections.
Phenazopyridine (choice D) is a urinary analgesic, and nitrofurantoin (choice D) is a urinary tract anti-infective. Although nitrofurantoin is indicated for the treatment of "mild" cases of pyelonephritis, as well as cystitis, this patient's condition is severe and should be treated withappropriate antibiotics.
