Ulcerative Colitis Diagnosis and Severity Assessment
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Questions and Answers

What is the major difference in disease distribution between ulcerative colitis (UC) and Crohn’s disease (CD)?

  • UC and CD both exclusively affect the large intestine.
  • UC and CD both primarily affect the small intestine.
  • UC affects only the colon, while CD can affect any part of the gastrointestinal tract. (correct)
  • UC can affect any part of the gastrointestinal tract, while CD is limited to the colon.

    • Which of the following is NOT considered as a potential etiology for inflammatory bowel disease?

  • Psychological factors (correct)
  • Infectious agents
  • Dietary factors
  • Genetic factors

    • What is the genetic role of NOD2 in the pathophysiology of Crohn’s disease?

  • NOD2 regulates secretion of diverse intracellular components in cells.
  • 1 copy of NOD2 increases CD risk by 2-4x. (correct)
  • NOD2 is associated with increased risk of UC.
  • NOD2 increases IL-1B secretion in immune cells.

    • How are first-degree relatives of patients with inflammatory bowel disease (IBD) affected in terms of risk?

    <p>They have up to a 20x increased risk of developing IBD.</p> Signup and view all the answers

    Which diagnostic test is commonly used to assess the severity and extent of ulcerative colitis (UC)?

    <p>Colonoscopy</p> Signup and view all the answers

    What distinguishes intermediate colitis from the types of inflammatory bowel disease (IBD) like UC and CD?

    <p>*Intermediate colitis is not a recognized type within IBD.</p> Signup and view all the answers

    Which of the following is not a poor prognostic factor for Ulcerative Colitis?

    <p>Age over 40 at diagnosis</p> Signup and view all the answers

    What is a distinguishing feature of Crohn's Disease compared to Ulcerative Colitis?

    <p>Transmural involvement</p> Signup and view all the answers

    Which of the following clinical signs is more specific to Crohn's Disease?

    <p>Weight loss, fever, and night sweats</p> Signup and view all the answers

    Which diagnostic test is essential for confirming Crohn's Disease?

    <p>Pathological evaluation</p> Signup and view all the answers

    What distinguishes distal from extensive Ulcerative Colitis?

    <p>Involvement proximal to the splenic flexure</p> Signup and view all the answers

    Why is 'cobblestone' appearance mentioned in relation to Crohn's Disease?

    <p>To highlight the discontinuous nature of the disease</p> Signup and view all the answers

    Which of the following lifestyle factors is NOT considered a potential etiology for inflammatory bowel disease (IBD)?

    <p>Protein</p> Signup and view all the answers

    What is a common clinical feature that helps differentiate Ulcerative Colitis (UC) from Crohn's Disease (CD)?

    <p>Rectal bleeding</p> Signup and view all the answers

    Which medication is NOT listed as a potential etiology for inflammatory bowel disease (IBD)?

    <p>Hygiene</p> Signup and view all the answers

    Which of the following is a severe complication more commonly associated with Ulcerative Colitis (UC) than Crohn's Disease (CD)?

    <p>Colonic stricture</p> Signup and view all the answers

    What is a common extraintestinal manifestation seen in patients with inflammatory bowel disease?

    <p>Arthritis</p> Signup and view all the answers

    Which clinical presentation is more characteristic of Crohn's Disease compared to Ulcerative Colitis?

    <p>Local complications like anal fissures</p> Signup and view all the answers

    Which biologic agent targeting TNF-α is described as fully humanized with no murine sequences?

    <p>Adalimumab</p> Signup and view all the answers

    What is a possible adverse effect associated with the subcutaneous delivery of a biosimilar version of infliximab?

    <p>Warm, red, swollen, or painful skin, blisters, skin sores</p> Signup and view all the answers

    Which of the following is a potential side effect of a biologic agent targeting TNF-α according to information from PubMed Health?

    <p>Seizures, numbness, tingling, problems with vision, speech, or walking</p> Signup and view all the answers

    Which biologic agent is delivered subcutaneously and considered a new drug due to its delivery method?

    <p>Certolizumab pegol</p> Signup and view all the answers

    What distinguishes adalimumab from infliximab in terms of their composition?

    <p>Adalimumab is fully humanized with no murine sequences while infliximab contains murine sequences.</p> Signup and view all the answers

    Which of the following potential side effects is associated with the subcutaneous delivery of a biosimilar version of infliximab?

    <p>Warm, red, swollen, or painful skin, blisters, skin sores</p> Signup and view all the answers

    Which biologic agent is a humanized antigen-binding fragment (Fab) directed against TNF-α conjugated to polyethylene glycol?

    <p>Certolizumab pegol</p> Signup and view all the answers

    Which biologic agent targets the cellular adhesion molecule α4-integrin and carries a risk of developing progressive multifocal leukoencephalopathy (PML)?

    <p>Natalizumab</p> Signup and view all the answers

    Which possible adverse effect is specifically associated with Vedolizumab?

    <p>Fever, chills, cough, runny or stuffy nose, sore throat, and body aches</p> Signup and view all the answers

    Which biologic agent is a humanized IgG-I monoclonal antibody that binds to integrin and blocks the binding of MAdCAM-1 to a4b7 integrin?

    <p>Vedolizumab</p> Signup and view all the answers

    Which biologic agent inhibits soluble and membrane-bound TNF-α as well as signaling through both the p55 and p75 TNFα receptors in vitro?

    <p>Certolizumab pegol</p> Signup and view all the answers

    Which possible adverse effect includes itching or hives, swelling in face or hands, and trouble breathing?

    <p>Allergic reaction: Itching or hives, swelling in face or hands, swelling or tingling in the mouth or throat, chest tightness, trouble breathing</p> Signup and view all the answers

    Which enzyme is responsible for the conversion of thiopurine to 6-methyl-mercaptopurine?

    <p>Thiopurine methyltransferase (TPMT)</p> Signup and view all the answers

    What is the primary mode of action of infliximab, a biologic agent targeting TNF-α?

    <p>Binds TNF-α and inhibits its inflammatory effects</p> Signup and view all the answers

    Which biologic agent targeting TNF-α is associated with a warning on government websites regarding hepatic injuries?

    <p>Infliximab</p> Signup and view all the answers

    What adverse effect is commonly associated with Cyclosporine, a calcineurin inhibitor?

    <p>Increased risk of infections due to lowered immune system ability</p> Signup and view all the answers

    What is the FDA-approved biologic agent targeting TNF-α that was approved around 2023?

    <p>Infliximab-dyyb</p> Signup and view all the answers

    Which enzyme inhibition is a key mechanism of action for methotrexate, a drug used in inflammatory diseases?

    <p>Dihydrofolate reductase</p> Signup and view all the answers

    What is the typical timeframe for Budesonide (Uceris®) 2 mg rectal foam to show efficacy in patients with mild to moderate disease in the colon?

    <p>3-6 months</p> Signup and view all the answers

    Which enzyme activity should be assessed before starting Thiopurines like Azathioprine and 6-mercaptopurine for IBD patients?

    <p>TPMT activity</p> Signup and view all the answers

    Which adverse effect is associated with long-term use of Metronidazole in treating inflammatory bowel disease?

    <p>Neuropathy</p> Signup and view all the answers

    What is the mechanism of action of Ciprofloxacin when used in the treatment of inflammatory bowel disease?

    <p>Inhibits DNA-gyrase promoting breakage of DNA</p> Signup and view all the answers

    Which enzyme activity level guides dosing adjustments of Thiopurines to prevent myelosuppression?

    <p>TPMT activity</p> Signup and view all the answers

    Which medication is indicated for active steroid-refractory or steroid-dependent IBD and requires 3-6 months for efficacy to be seen?

    <p>Azathioprine</p> Signup and view all the answers

    What is the maximum recommended duration for Budesonide CIR in managing Crohn's disease?

    <p>4 months</p> Signup and view all the answers

    Which pharmacological agent has been shown to have similar efficacy to mesalamine in Crohn's disease treatment according to the guidelines?

    <p>Ciprofloxacin</p> Signup and view all the answers

    What is the recommendation for 5-ASAs in the maintenance of Mild-Moderate Crohn's disease?

    <p>Not recommended for maintenance</p> Signup and view all the answers

    Which of the following statements about Metronidazole and Ciprofloxacin in Crohn's disease treatment is TRUE?

    <p>Neither should be used as primary therapy</p> Signup and view all the answers

    Which of the following pharmacological agents is NOT recommended for the maintenance of Mild-Moderate Crohn's disease?

    <p>5-ASAs</p> Signup and view all the answers

    What is a key limitation of using Mesalamine alone in Crohn's disease induction therapy?

    <p>No significant difference compared to placebo</p> Signup and view all the answers

    Which medication is generally used for induction, remission, and mucosal healing in Moderate-Severe Crohn's Disease?

    <p>Budesonide</p> Signup and view all the answers

    What is the recommended alternative treatment in Step 3 for Moderate-Severe Crohn's Disease after a failed anti-TNF-α therapy?

    <p>Add monoclonal antibody</p> Signup and view all the answers

    What is the common approach to maintenance in Crohn's Disease according to guidelines?

    <p>Use what worked to achieve induction</p> Signup and view all the answers

    Which statement about immunomodulators in Crohn's Disease is accurate?

    <p>Immunomodulators help to reduce the rate of antibodies formation</p> Signup and view all the answers

    What is the recommended treatment approach for Severe-Fulminant Crohn's Disease in case of bowel obstruction?

    <p>High-dose IV methylprednisolone with bowel rest</p> Signup and view all the answers

    Which medication is considered ineffective for the maintenance of Moderate-Severe Crohn's Disease according to guidelines?

    <p>Systemic steroids</p> Signup and view all the answers

    What is the primary consideration when choosing maintenance therapy for Crohn's Disease?

    <p>Continue the medication that induced remission</p> Signup and view all the answers

    Which scoring system is used for staging liver disease, including cirrhosis, based on specific criteria such as ascites and bilirubin levels?

    <p>Child-Pugh Classification Score</p> Signup and view all the answers

    What is the purpose of the MELD score in liver disease management?

    <p>To predict the need for liver transplantation</p> Signup and view all the answers

    Which diagnostic imaging modality is typically used as the first-line investigation in evaluating liver pathologies?

    <p>Ultrasound (US)</p> Signup and view all the answers

    In liver cirrhosis, which factor is NOT part of the criteria used in the Child-Pugh Classification Score for staging?

    <p>Platelet count</p> Signup and view all the answers

    What is a recommended preventive measure in patients with cirrhosis to reduce the risk of progression and complications?

    <p>Receiving vaccinations for hepatitis A and B</p> Signup and view all the answers

    What are some common risk factors for the development of liver cirrhosis?

    <p>Alcohol abuse, chronic viral hepatitis, autoimmune hepatitis</p> Signup and view all the answers

    Which of the following is a complication associated with decompensated cirrhosis?

    <p>Variceal bleeding</p> Signup and view all the answers

    What are some stigmata of chronic liver disease that can be observed in patients with cirrhosis?

    <p>Splenomegaly and spider angiomata</p> Signup and view all the answers

    What is a common cause of primary sclerosing cholangitis, a condition less commonly associated with liver cirrhosis?

    <p>Autoimmune hepatitis</p> Signup and view all the answers

    Which of the following is a function of the liver that gets impaired in patients with cirrhosis leading to complications?

    <p>Regulation of blood sugar levels</p> Signup and view all the answers

    What is the primary mechanism of action for using beta blockers in portal hypertension?

    <p>Decreasing splanchnic blood flow</p> Signup and view all the answers

    Which condition can be a consequence of portal hypertension due to liver cirrhosis?

    <p>Esophageal varices</p> Signup and view all the answers

    In patients with ascites and spontaneous bacterial peritonitis, which antibiotic is commonly used for prophylaxis?

    <p>Ciprofloxacin</p> Signup and view all the answers

    Which medication is commonly used in the pharmacologic management of varices to reduce the risk of bleeding?

    <p>Vasopressin</p> Signup and view all the answers

    What is the primary difference between propranolol and nadolol in relation to dosing for portal hypertension?

    <p>Nadolol has a longer half-life than propranolol</p> Signup and view all the answers

    What is the primary goal when titrating Propranolol or Nadolol for varices prophylaxis?

    <p>Achieving a 25% reduction in heart rate</p> Signup and view all the answers

    What is the mechanism of action of Beta blockers like Propranolol in varices prophylaxis?

    <p>Inhibiting glucagon activity</p> Signup and view all the answers

    What is the preferred treatment for bleeding varices during an acute episode?

    <p>Endoscopic band ligation</p> Signup and view all the answers

    Which pharmacological agent is recommended for slowing or stopping bleeding in cases of variceal hemorrhage?

    <p>Vasopressin</p> Signup and view all the answers

    When should antibiotics be considered in patients with liver cirrhosis and ascites?

    <p>For patients with signs of ascites or infection</p> Signup and view all the answers

    Which system is activated due to NO and hypotension in the pathophysiology of ascites?

    <p>RAAS system</p> Signup and view all the answers

    Which enzyme is responsible for converting angiotensin I to angiotensin II in the RAAS system related to the pathophysiology of ascites?

    <p>ACE inhibitor</p> Signup and view all the answers

    What is the primary effect of angiotensin II binding to the AT1 receptor in the pathophysiology of ascites?

    <p>Increased aldosterone production</p> Signup and view all the answers

    Which of the following consequences does NOT arise from the activation of the RAAS system in response to NO and hypotension in ascites?

    <p>Decreased renin release</p> Signup and view all the answers

    What effect does splanchnic vasodilation have on arterial perfusion pressure in the pathophysiology of ascites?

    <p>Increases</p> Signup and view all the answers

    What does a SAAG (serum-ascites albumin gradient) value of ≥1.1 g/dL and Ascitic Protein <2.5 g/dL indicate?

    <p>Fluid accumulation due to portal hypertension</p> Signup and view all the answers

    Which statement is true regarding the treatment of Grade 3 Ascites?

    <p>Therapeutic paracentesis can cause circulatory collapse</p> Signup and view all the answers

    Which medication is commonly used for maintenance in patients with ascites?

    <p>Diuretics</p> Signup and view all the answers

    What is the primary cause of fluid accumulation in ascites when SAAG is <1.1 g/dL?

    <p>Cancer</p> Signup and view all the answers

    Which adverse effect is associated with furosemide but not spironolactone when used in ascites treatment?

    <p>Hypokalemia</p> Signup and view all the answers

    What is the primary role of lactulose in treating hepatic encephalopathy?

    <p>Reducing ammonia reabsorption</p> Signup and view all the answers

    Which medication is NOT recommended for long-term use in hepatic encephalopathy due to peripheral neuropathy risk?

    <p>Metronidazole</p> Signup and view all the answers

    What is the classification system used to subdivide hepatic encephalopathy based on the underlying cause?

    <p>Type A, Type B, Type C</p> Signup and view all the answers

    Which of the following is NOT a common sign or symptom of hepatic encephalopathy?

    <p>Severe abdominal pain</p> Signup and view all the answers

    What is the potential consequence of excessive ammonia intake in patients with hepatic encephalopathy?

    <p>Altered mental status</p> Signup and view all the answers

    In the West Haven Criteria grading system for hepatic encephalopathy, which grade is characterized by somnolence, severe confusion, aggressive behavior, and asterixis?

    <p>Grade III</p> Signup and view all the answers

    Which factor necessitates cautious dosing of lactulose in patients with hepatic encephalopathy?

    <p>Risk of nephrotoxicity</p> Signup and view all the answers

    What is the primary diagnostic method for hepatic encephalopathy that involves excluding other possible causes?

    <p>Diagnosis of exclusion</p> Signup and view all the answers

    What is the main purpose of adding a second agent in the treatment of hepatic encephalopathy for patients who are unresponsive to lactulose alone?

    <p>Achieving short-term relief</p> Signup and view all the answers

    Which of the following substances is NOT implicated in causing changes in astrocytes leading to brain edema in hepatic encephalopathy?

    <p>Serotonin</p> Signup and view all the answers

    What is the most common etiology of Spontaneous Bacterial Peritonitis in patients with cirrhosis?

    <p>Intestinal bacterial overgrowth</p> Signup and view all the answers

    Which of the following is NOT a medication contributor to the development of Spontaneous Bacterial Peritonitis?

    <p>Antibiotics</p> Signup and view all the answers

    What is the confirmatory laboratory finding for diagnosing Spontaneous Bacterial Peritonitis in a patient with cirrhosis and ascites?

    <p>&gt;250 white blood cells/mL in ascitic fluid</p> Signup and view all the answers

    Which antibiotic is the preferred empiric treatment for Spontaneous Bacterial Peritonitis in patients with no risk of multi-drug resistant organisms (MDROs)?

    <p>Ceftriaxone</p> Signup and view all the answers

    What is the recommended duration of antibiotic treatment for Spontaneous Bacterial Peritonitis?

    <p>10-14 days</p> Signup and view all the answers

    What is the primary prophylaxis recommended for inpatients with cirrhosis and certain complications even if they have not had spontaneous bacterial peritonitis (SBP) before?

    <p>No prophylactic treatment is recommended</p> Signup and view all the answers

    What are the conditions that warrant primary prophylaxis for SBP in patients with cirrhosis and other complications?

    <p>Ascitic fluid protein &lt;1.5 g/dl + renal dysfunction</p> Signup and view all the answers

    Who should receive secondary prophylaxis for spontaneous bacterial peritonitis (SBP) and for how long?

    <p>Patients with cirrhosis regardless of prior SBP episodes should receive it indefinitely</p> Signup and view all the answers

    Why is daily dosing of antibiotics preferred over intermittent dosing for SBP prophylaxis?

    <p>Daily dosing minimizes the selection of resistant flora</p> Signup and view all the answers

    What is the appropriate duration of secondary prophylaxis for spontaneous bacterial peritonitis (SBP)?

    <p>Indefinitely unless liver transplant is done</p> Signup and view all the answers

    In hepatorenal syndrome, what is the primary pathophysiological mechanism that leads to renal impairment?

    <p>Vasoconstriction leading to kidney hypoperfusion</p> Signup and view all the answers

    What is a major diagnostic criterion for identifying hepatorenal syndrome (HRS-AKI)?

    <p>Development of shock</p> Signup and view all the answers

    What is a recommended non-pharmacologic management strategy to prevent hepatorenal syndrome in patients with elevated serum creatinine levels?

    <p>Administer albumin daily up to 100 g/day</p> Signup and view all the answers

    What is the primary prophylactic treatment approach recommended for inpatients with cirrhosis who have not experienced spontaneous bacterial peritonitis before?

    <p>Administer albumin along with antibiotics</p> Signup and view all the answers

    Which medication intervention may be necessary for patients with hepatorenal syndrome until they undergo liver transplant?

    <p>Continuous renal replacement therapy (CRRT)</p> Signup and view all the answers

    Which parameter is essential for diagnosing hepatorenal syndrome after withdrawal of diuretics in a patient with cirrhosis and ascites?

    <p>Acute kidney injury (AKI)</p> Signup and view all the answers

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