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crohn's disease

Practice targeted AMC-style multiple-choice questions on crohn's disease.

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A 28-year-old male presents to the emergency department with severe abdominal pain, fever, and bloody diarrhea for the past 2 days. He has a known history of Crohn's disease, diagnosed 5 years ago, and has been managed with azathioprine. He admits to inconsistent adherence to his medication regimen over the past year due to feeling well. On examination, he is febrile (38.9°C), tachycardic (110 bpm), and hypotensive (90/60 mmHg). His abdomen is distended and tender to palpation, particularly in the lower quadrants, with guarding. Laboratory investigations reveal a white blood cell count of 18,000/mm³ with a left shift, hemoglobin of 10 g/dL, platelets of 450,000/mm³, albumin of 28 g/L, and C-reactive protein (CRP) of 150 mg/L. An abdominal X-ray shows dilated loops of bowel. Which of the following is the MOST appropriate next step in the management of this patient?

A. Perform a colonoscopy to assess the extent of the inflammation and obtain biopsies
B. Administer intravenous corticosteroids and anti-diarrheal medications
C. Increase the dose of azathioprine and monitor the patient's symptoms
D. Intravenous fluids, broad-spectrum antibiotics, and urgent surgical consultation
E. Start infliximab infusion immediately after blood cultures are taken
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Ileitis terminalis bei langjaehrigem Morbus Crohn 63W - CT und MRT - 001
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A 32-year-old male with Crohn's disease presents with worsening abdominal pain and diarrhea despite being on maintenance infliximab. The provided imaging was obtained. What is the MOST appropriate next step in management?

A. Increase the dose of infliximab
B. Start a course of oral corticosteroids
C. Perform a colonoscopy with biopsy
D. Surgical resection of the affected bowel segment
E. Initiate treatment with metronidazole and ciprofloxacin
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Ileitis terminalis bei langjaehrigem Morbus Crohn 63W - CT und MRT - 001
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A 45-year-old male with Crohn's presents with persistent right lower quadrant pain. Stool studies are negative. Review the imaging. What is the MOST likely complication?

A. Toxic megacolon
B. Fistula formation
C. Appendicitis
D. Small bowel obstruction
E. Perforation
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A 25-year-old man with Crohn's disease presents with increased abdominal pain and frequent diarrhea. He is on azathioprine. Stool studies are negative for infection. Which of the following is the most appropriate next step?

A. Order a colonoscopy with biopsies
B. Start a course of corticosteroids
C. Initiate infliximab therapy
D. Increase the dose of azathioprine
E. Prescribe a trial of antibiotics
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Ileitis terminalis bei langjaehrigem Morbus Crohn 63W - CT und MRT - 001
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A 63-year-old woman with a 20-year history of Crohn's disease presents with a one-month history of worsening abdominal pain, bloating, and occasional vomiting, associated with a 3kg weight loss. She is currently managed with mesalazine and azathioprine. Her vital signs are stable, and physical examination reveals mild right lower quadrant tenderness. Imaging is performed. Considering the clinical presentation and the provided images, which of the following represents the most appropriate next step in this patient's management?

A. Provide symptomatic relief and arrange follow-up in the outpatient clinic.
B. Surgical consultation for assessment of operative management.
C. Repeat cross-sectional imaging in three months to monitor disease progression.
D. Perform a colonoscopy to assess disease activity and extent.
E. Initiate a course of oral corticosteroids and optimise immunosuppression.
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Ileitis terminalis bei langjaehrigem Morbus Crohn 63W - CT und MRT - 001
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A 32-year-old male with a history of Crohn's disease presents with worsening abdominal pain, diarrhea, and a low-grade fever. He reports that his symptoms have been progressively worsening over the past few months despite being on maintenance therapy with azathioprine. A CT scan of the abdomen and pelvis is performed, as shown. Based on the imaging findings, which of the following is the MOST appropriate next step in management?

A. Increase the dose of azathioprine
B. Perform a colonoscopy with biopsy
C. Initiate anti-TNF therapy
D. Prescribe a course of oral corticosteroids
E. Start a trial of antibiotics for possible infectious colitis
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Ileitis terminalis bei langjaehrigem Morbus Crohn 63W - CT und MRT - 001
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A 28-year-old male with Crohn's presents with increased abdominal pain, non-bloody diarrhea, and fatigue for 3 weeks. He denies fever. Exam shows mild RLQ tenderness. Labs show elevated CRP. Imaging is shown. What is the MOST appropriate next step?

A. Prescribe antibiotics for possible infectious colitis
B. Schedule a colonoscopy with biopsy
C. Start a course of oral corticosteroids
D. Initiate anti-TNF therapy
E. Increase mesalamine dose
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Ileitis terminalis bei langjaehrigem Morbus Crohn 63W - CT und MRT - 001
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A 63-year-old woman with a 20-year history of Crohn's disease presents with worsening abdominal pain, bloating, and occasional post-prandial vomiting. She is currently managed with mesalazine and budesonide. Physical examination reveals mild right lower quadrant tenderness. Laboratory tests show a slightly elevated CRP. Given her presentation and the provided imaging, what is the most appropriate next step in her management?

A. Perform an urgent colonoscopy with biopsies
B. Increase the dose of budesonide
C. Continue current medical therapy and monitor symptoms
D. Switch mesalazine to an oral corticosteroid like prednisone
E. Refer for surgical assessment for potential stricture or complication
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Ileitis terminalis bei langjaehrigem Morbus Crohn 63W - CT und MRT - 001
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A 63-year-old woman with a 20-year history of Crohn's disease presents with a one-month history of worsening colicky abdominal pain, bloating, and occasional non-bilious vomiting, associated with a 3kg weight loss. She reports reduced stool frequency. She is currently managed with mesalazine and azathioprine. Her vital signs are stable (BP 120/75, HR 82, Temp 36.8), and physical examination reveals mild right lower quadrant tenderness without guarding or rebound. Bowel sounds are hyperactive. Imaging is performed. Considering the clinical presentation, her current therapy, and the findings suggested by the provided images, which of the following represents the most appropriate next step in this patient's management?

A. Performing a colonoscopy with attempted balloon dilation
B. Recommending a high-fibre diet and increased fluid intake
C. Initiating therapy with an anti-TNF agent such as infliximab
D. Increasing the dose of azathioprine and adding oral corticosteroids
E. Referral for surgical consultation regarding potential resection
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Ileitis terminalis bei langjaehrigem Morbus Crohn 63W - CT und MRT - 001
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A 28-year-old male with Crohn's presents with increased abdominal pain, non-bloody diarrhea, and fatigue for 3 weeks. He denies fever. Exam shows mild RLQ tenderness. Labs show elevated CRP. Imaging is shown. What is the MOST appropriate next step?

A. Prescribe a 5-ASA enema
B. Start a course of oral corticosteroids
C. Increase the dose of his current mesalamine
D. Order a stool culture to rule out infection
E. Initiate anti-TNF therapy
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Ileitis terminalis bei langjaehrigem Morbus Crohn 63W - CT und MRT - 001
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A 32-year-old male presents to the emergency department with a 3-day history of worsening abdominal pain, primarily localized to the right lower quadrant. He reports associated nausea and decreased appetite but denies vomiting or diarrhea. His past medical history is significant for Crohn's disease, diagnosed 8 years ago, managed with intermittent courses of oral corticosteroids and azathioprine. He admits to poor adherence to his azathioprine regimen over the past year. On examination, he is afebrile with a heart rate of 92 bpm, blood pressure of 120/80 mmHg, and oxygen saturation of 98% on room air. Abdominal examination reveals tenderness to palpation in the right lower quadrant with guarding. Bowel sounds are normoactive. Laboratory investigations reveal a white blood cell count of 11,500/µL with neutrophilia, a C-reactive protein (CRP) of 45 mg/L, and normal liver function tests. A CT scan of the abdomen and pelvis with IV contrast is performed, the relevant images of which are shown. Given the patient's presentation and imaging findings, which of the following is the MOST appropriate next step in management?

A. Prescribe a 6-week course of oral prednisone and monitor symptoms closely.
B. Order a colonoscopy with biopsy to assess for dysplasia.
C. Initiate intravenous corticosteroids and antibiotics, and consult general surgery for possible bowel resection.
D. Start infliximab infusion and schedule a follow-up appointment with gastroenterology in 4 weeks.
E. Discharge the patient with pain medication and instructions to follow up with their gastroenterologist in 1 week.
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Ileitis terminalis bei langjaehrigem Morbus Crohn 63W - CT und MRT - 001
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A 32-year-old male with a history of Crohn's disease presents with worsening abdominal pain, diarrhea, and a low-grade fever. He reports that his symptoms have been progressively worsening over the past few weeks despite being compliant with his prescribed mesalamine. A CT scan of the abdomen and pelvis is performed, as shown. What is the MOST appropriate next step in management?

A. Schedule a colonoscopy with biopsy
B. Start a course of oral prednisone
C. Initiate infliximab therapy
D. Increase the dose of mesalamine
E. Prescribe a course of oral ciprofloxacin and metronidazole
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Ileitis terminalis bei langjaehrigem Morbus Crohn 63W - CT und MRT - 001
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A 28-year-old with Crohn's presents with new fever and abdominal pain. The patient's CRP is elevated. Review the imaging. What is the MOST appropriate next step?

A. Surgical consultation
B. Initiate a course of corticosteroids
C. Increase current infliximab dose
D. Repeat imaging in 6 weeks
E. Start oral metronidazole and ciprofloxacin
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Ileitis terminalis bei langjaehrigem Morbus Crohn 63W - CT und MRT - 001
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A 32-year-old male with Crohn's disease presents with worsening abdominal pain and diarrhea despite being on maintenance infliximab. He denies fever or blood in his stool. An abdominal CT and MRI are performed. Based on the imaging, what is the MOST appropriate next step in management?

A. Initiate treatment with ustekinumab
B. Perform a colonoscopy with biopsy
C. Prescribe a course of oral metronidazole
D. Start a course of oral budesonide
E. Increase the dose of infliximab
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Ileitis terminalis bei langjaehrigem Morbus Crohn 63W - CT und MRT - 001
Image by Hellerhoff CC BY-SA 4.0 · Source

A 63-year-old woman with a 20-year history of Crohn's disease presents with a one-month history of worsening abdominal pain, bloating, and occasional vomiting, associated with a 3kg weight loss. She is currently managed with mesalazine and azathioprine. Her vital signs are stable, and physical examination reveals mild right lower quadrant tenderness. Considering the clinical presentation and the provided images, which of the following represents the most appropriate adjustment to her medical therapy?

A. Increase the dose of azathioprine.
B. Initiate treatment with an anti-TNF agent.
C. Discontinue azathioprine and switch to methotrexate.
D. Add a course of oral prednisolone.
E. Switch mesalazine to sulfasalazine.
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A 28-year-old male with Crohn's disease presents with increased abdominal pain, fever, and bloody stools. He is on azathioprine. What is the most appropriate next step?

A. Prescribe a high-fibre diet.
B. Start a course of oral metronidazole.
C. Increase the dose of azathioprine.
D. Order a CT scan of the abdomen and pelvis.
E. Reassure the patient and schedule a follow-up appointment.
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Ileitis terminalis bei langjaehrigem Morbus Crohn 63W - CT und MRT - 001
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A 32-year-old male with a 10-year history of Crohn's disease presents with worsening abdominal pain and diarrhea despite being on maintenance infliximab. He denies fever or blood in his stool. Physical exam reveals mild tenderness in the right lower quadrant. The provided imaging was obtained. What is the MOST appropriate next step in management?

A. Start a course of oral budesonide
B. Initiate treatment with vedolizumab
C. Perform a colonoscopy with biopsy
D. Prescribe a course of oral metronidazole and ciprofloxacin
E. Increase the dose of infliximab
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Ileitis terminalis bei langjaehrigem Morbus Crohn 63W - CT und MRT - 001
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A 32-year-old male with a 10-year history of Crohn's disease presents with worsening abdominal pain and increased frequency of bowel movements. He reports no fever or weight loss. Physical examination reveals mild tenderness in the right lower quadrant. His inflammatory markers are elevated. Review the provided imaging. What is the MOST appropriate next step in management?

A. Initiate anti-TNF therapy
B. Perform a colonoscopy with biopsy
C. Recommend a low-FODMAP diet
D. Start a trial of antibiotics for possible infection
E. Prescribe a course of oral corticosteroids
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Ileitis terminalis bei langjaehrigem Morbus Crohn 63W - CT und MRT - 001
Image by Hellerhoff CC BY-SA 4.0 · Source

A 63-year-old woman with a 20-year history of Crohn's disease presents with a one-month history of worsening abdominal pain, bloating, and occasional vomiting, associated with a 3kg weight loss. She is currently managed with mesalazine and azathioprine. Her vital signs are stable, and physical examination reveals mild right lower quadrant tenderness. Imaging is performed. Considering the clinical presentation and the findings demonstrated in the provided images, which of the following management approaches is most likely indicated?

A. Addition of an anti-TNF alpha agent
B. Initiation of a systemic corticosteroid course
C. Switching azathioprine to methotrexate
D. Increasing the dose of mesalazine
E. Surgical consultation for potential intervention
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Ileitis terminalis bei langjaehrigem Morbus Crohn 63W - CT und MRT - 001
Image by Hellerhoff CC BY-SA 4.0 · Source

A 32-year-old male with Crohn's disease presents with increased abdominal pain and diarrhea. Review the imaging. What is the MOST appropriate next step?

A. Order a stool culture
B. Prescribe a course of antibiotics
C. Perform a colonoscopy with biopsy
D. Initiate corticosteroid therapy
E. Increase the dose of current TNF-alpha inhibitor
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Ileitis terminalis bei langjaehrigem Morbus Crohn 63W - CT und MRT - 001
Image by Hellerhoff CC BY-SA 4.0 · Source

A 28-year-old male with a history of Crohn's disease presents with increased abdominal pain and non-bloody diarrhea. He is currently on azathioprine. The provided imaging was obtained. What is the MOST appropriate next step?

A. Prescribe a bowel preparation for colonoscopy
B. Increase azathioprine dose
C. Initiate vedolizumab
D. Perform flexible sigmoidoscopy
E. Start a course of oral corticosteroids
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