IBD Past Paper PDF

**1.**\ **Question**: Which subtype of IBS is characterized by alternating episodes of constipation and diarrhea?\ **Choices**:\ A. IBS-C\ B. IBS-D\ C. IBS-M\ D. IBS-U\ **Correct Answer**: C\ **Explanation**: IBS-M (mixed type) involves alternating episodes of constipation and diarrhea, distinguishi...

**1.**\ **Question**: Which subtype of IBS is characterized by alternating episodes of constipation and diarrhea?\ **Choices**:\ A. IBS-C\ B. IBS-D\ C. IBS-M\ D. IBS-U\ **Correct Answer**: C\ **Explanation**: IBS-M (mixed type) involves alternating episodes of constipation and diarrhea, distinguishing it from IBS-C (constipation-predominant) and IBS-D (diarrhea-predominant). **2.**\ **Question**: Which of the following is considered a nonpharmacologic therapy for IBS management?\ **Choices**:\ A. Low FODMAP diet\ B. Probiotic therapy\ C. Cognitive Behavioral Therapy (CBT)\ D. All of the above\ **Correct Answer**: D\ **Explanation**: Nonpharmacologic approaches such as dietary modification (e.g., low FODMAP diet), probiotics, and CBT are effective in managing IBS symptoms. **3.**\ **Question**: A patient with IBS-C presents with bloating and abdominal discomfort. What is the most appropriate first-line treatment?\ **Choices**:\ A. Linaclotide\ B. Polyethylene glycol (PEG)\ C. Antispasmodics\ D. Probiotics\ **Correct Answer**: B\ **Explanation**: PEG is a first-line treatment for IBS-C as it helps relieve constipation without significant systemic absorption. **4.**\ **Question**: Which of the following is a hallmark feature of ulcerative colitis but not Crohn\'s disease?\ **Choices**:\ A. Skip lesions\ B. Transmural inflammation\ C. Continuous mucosal inflammation starting in the rectum\ D. Fistula formation\ **Correct Answer**: C\ **Explanation**: Ulcerative colitis is characterized by continuous inflammation of the colonic mucosa starting in the rectum, whereas Crohn's disease often has skip lesions and transmural involvement. **5.**\ **Question**: What is the main therapeutic goal in managing inflammatory bowel disease?\ **Choices**:\ A. Preventing disease progression\ B. Inducing and maintaining remission\ C. Minimizing drug side effects\ D. Reducing surgical intervention rates\ **Correct Answer**: B\ **Explanation**: The primary goal of IBD therapy is to induce and maintain remission while preventing flare-ups. **6.**\ **Question**: A patient with Crohn\'s disease presents with a fistula. What class of medication is most appropriate to treat this complication?\ **Choices**:\ A. Aminosalicylates\ B. Corticosteroids\ C. Anti-TNF agents (e.g., infliximab)\ D. Antibiotics\ **Correct Answer**: C\ **Explanation**: Anti-TNF agents such as infliximab are effective in treating fistulas and other complications of Crohn's disease. **7.**\ **Question**: Which medication is primarily used for mild to moderate ulcerative colitis?\ **Choices**:\ A. Methotrexate\ B. Sulfasalazine\ C. Cyclosporine\ D. Infliximab\ **Correct Answer**: B\ **Explanation**: Sulfasalazine and other aminosalicylates are first-line treatments for mild to moderate ulcerative colitis. **8.**\ **Question**: What is a common side effect of sulfasalazine therapy?\ **Choices**:\ A. Renal failure\ B. Hepatotoxicity\ C. Nausea and headache\ D. Photosensitivity\ **Correct Answer**: C\ **Explanation**: Nausea and headache are common side effects of sulfasalazine, and patients may require folate supplementation. **9.**\ **Question**: Which of the following is most commonly used to induce remission in moderate to severe IBD?\ **Choices**:\ A. Budesonide\ B. Methotrexate\ C. Cyclosporine\ D. Probiotics\ **Correct Answer**: A\ **Explanation**: Budesonide, a corticosteroid, is effective for inducing remission in moderate to severe IBD. **10.**\ **Question**: Which medication is indicated for maintaining remission in Crohn\'s disease and requires regular monitoring of CBC and liver function?\ **Choices**:\ A. Methotrexate\ B. Azathioprine\ C. Infliximab\ D. Sulfasalazine\ **Correct Answer**: B\ **Explanation**: Azathioprine is used for maintaining remission in Crohn's disease and requires monitoring for bone marrow suppression and hepatotoxicity. **11.**\ **Question**: Which of the following symptoms is more specific to Crohn's disease than ulcerative colitis?\ **Choices**:\ A. Bloody diarrhea\ B. Perianal fistulas\ C. Tenesmus\ D. Continuous rectal inflammation\ **Correct Answer**: B\ **Explanation**: Perianal fistulas are a hallmark of Crohn's disease due to its transmural inflammation. **12.**\ **Question**: Which IBD medication inhibits purine synthesis and reduces immune cell proliferation?\ **Choices**:\ A. Infliximab\ B. Methotrexate\ C. Azathioprine\ D. Budesonide\ **Correct Answer**: C\ **Explanation**: Azathioprine inhibits purine synthesis, suppressing immune cell activity and inflammation. **13.**\ **Question**: A patient on infliximab therapy develops fever and malaise. What is the most likely cause?\ **Choices**:\ A. Drug toxicity\ B. Secondary infection\ C. Infusion reaction\ D. Pancreatitis\ **Correct Answer**: C\ **Explanation**: Infusion reactions, including fever and malaise, are common with infliximab and other anti-TNF agents. **14.**\ **Question**: Which medication for IBD is a selective glucocorticoid with high first-pass metabolism, minimizing systemic effects?\ **Choices**:\ A. Prednisone\ B. Methotrexate\ C. Budesonide\ D. Infliximab\ **Correct Answer**: C\ **Explanation**: Budesonide is a selective glucocorticoid with minimal systemic absorption, making it ideal for localized GI inflammation. **15.**\ **Question**: What is a key adverse effect of methotrexate in IBD patients?\ **Choices**:\ A. Nephrotoxicity\ B. Bone marrow suppression\ C. Infusion-related reactions\ D. Hyperkalemia\ **Correct Answer**: B\ **Explanation**: Methotrexate can cause bone marrow suppression and requires regular monitoring of CBC and liver function tests. **16.**\ **Question**: Which supplement should be prescribed for patients on sulfasalazine to prevent deficiency?\ **Choices**:\ A. Vitamin B12\ B. Folic acid\ C. Iron\ D. Calcium\ **Correct Answer**: B\ **Explanation**: Sulfasalazine impairs folic acid absorption, necessitating supplementation. **17.**\ **Question**: Which feature is more commonly seen in ulcerative colitis than in Crohn's disease?\ **Choices**:\ A. Granulomas\ B. Non-bloody diarrhea\ C. Continuous mucosal involvement\ D. Skip lesions\ **Correct Answer**: C\ **Explanation**: Continuous mucosal involvement is characteristic of ulcerative colitis, whereas skip lesions are typical of Crohn's disease. **18.**\ **Question**: Which biologic agent is effective in patients with both Crohn\'s disease and ulcerative colitis?\ **Choices**:\ A. Infliximab\ B. Azathioprine\ C. Methotrexate\ D. Budesonide\ **Correct Answer**: A\ **Explanation**: Infliximab is an anti-TNF biologic agent effective in moderate to severe Crohn\'s disease and ulcerative colitis. **19.**\ **Question**: A patient with Crohn\'s disease presents with macrocytic anemia. What is the most likely cause?\ **Choices**:\ A. Iron deficiency\ B. Vitamin D deficiency\ C. Vitamin B12 deficiency\ D. Folic acid toxicity\ **Correct Answer**: C\ **Explanation**: Crohn\'s disease often affects the terminal ileum, impairing vitamin B12 absorption and leading to macrocytic anemia. **20.**\ **Question**: Which of the following is NOT a goal of IBD therapy?\ **Choices**:\ A. Induce remission\ B. Maintain remission\ C. Prevent complications\ D. Eradicate the disease\ **Correct Answer**: D\ **Explanation**: IBD is a chronic condition that cannot be eradicated, so therapy focuses on remission and preventing complications. **21.**\ **Question**: Which of the following is an extraintestinal manifestation commonly associated with inflammatory bowel disease?\ **Choices**:\ A. Polycythemia\ B. Erythema nodosum\ C. Hypertension\ D. Peripheral neuropathy\ **Correct Answer**: B\ **Explanation**: Erythema nodosum is a common extraintestinal manifestation of IBD, particularly Crohn's disease. **22.**\ **Question**: A patient with ulcerative colitis has failed treatment with sulfasalazine and corticosteroids. What is the next appropriate step?\ **Choices**:\ A. Methotrexate\ B. Azathioprine\ C. Probiotics\ D. Antibiotics\ **Correct Answer**: B\ **Explanation**: Azathioprine is often used for patients with UC who fail to respond to first-line therapies. **23.**\ **Question**: A patient with Crohn\'s disease develops an ileal stricture. Which complication is the most likely result?\ **Choices**:\ A. Fistula formation\ B. Obstruction\ C. Toxic megacolon\ D. Perforation\ **Correct Answer**: B\ **Explanation**: Ileal strictures in Crohn's disease often lead to bowel obstruction due to narrowing of the intestinal lumen. **24.**\ **Question**: Which type of colonic inflammation is limited to the mucosal layer?\ **Choices**:\ A. Crohn\'s disease\ B. Ulcerative colitis\ C. Ischemic colitis\ D. Microscopic colitis\ **Correct Answer**: B\ **Explanation**: Ulcerative colitis is limited to the mucosal layer of the colon, unlike Crohn's disease, which is transmural. **25.**\ **Question**: What is a potential adverse effect of infliximab that requires screening prior to initiation?\ **Choices**:\ A. Hepatotoxicity\ B. Tuberculosis reactivation\ C. Neutropenia\ D. Hyperglycemia\ **Correct Answer**: B\ **Explanation**: Infliximab can reactivate latent tuberculosis; patients should be screened with a TB test before initiating therapy. **26.**\ **Question**: Which vitamin deficiency is commonly seen in patients with Crohn's disease involving the terminal ileum?\ **Choices**:\ A. Vitamin A\ B. Vitamin D\ C. Vitamin B12\ D. Folic acid\ **Correct Answer**: C\ **Explanation**: The terminal ileum is the site of vitamin B12 absorption, and its involvement in Crohn's disease can lead to deficiency. **27.**\ **Question**: Which of the following is a contraindication to methotrexate therapy in IBD?\ **Choices**:\ A. Bone marrow suppression\ B. Pregnancy\ C. Vitamin D deficiency\ D. Uncontrolled hypertension\ **Correct Answer**: B\ **Explanation**: Methotrexate is teratogenic and contraindicated in pregnancy. **28.**\ **Question**: Which of the following symptoms is more specific to ulcerative colitis than Crohn\'s disease?\ **Choices**:\ A. Abdominal pain\ B. Rectal bleeding\ C. Perianal fistulas\ D. Aphthous ulcers\ **Correct Answer**: B\ **Explanation**: Rectal bleeding is more common in ulcerative colitis due to continuous mucosal inflammation. **29.**\ **Question**: Which medication is most effective for long-term maintenance of remission in ulcerative colitis?\ **Choices**:\ A. Prednisone\ B. Sulfasalazine\ C. Cyclosporine\ D. Antibiotics\ **Correct Answer**: B\ **Explanation**: Sulfasalazine is a first-line agent for maintaining remission in ulcerative colitis. **30.**\ **Question**: A patient with Crohn\'s disease reports increased fatigue and pallor. Laboratory tests show macrocytic anemia. What is the most likely cause?\ **Choices**:\ A. Iron deficiency\ B. Folic acid deficiency\ C. Vitamin B12 deficiency\ D. Hemolysis\ **Correct Answer**: C\ **Explanation**: Macrocytic anemia in Crohn's disease is most often caused by vitamin B12 deficiency due to terminal ileum involvement. **31.**\ **Question**: Which corticosteroid is commonly used for localized inflammation in mild to moderate Crohn's disease?\ **Choices**:\ A. Prednisone\ B. Hydrocortisone\ C. Budesonide\ D. Methylprednisolone\ **Correct Answer**: C\ **Explanation**: Budesonide has a high first-pass metabolism, making it ideal for localized GI inflammation with minimal systemic effects. **32.**\ **Question**: Which extraintestinal manifestation of IBD often parallels disease activity?\ **Choices**:\ A. Primary sclerosing cholangitis\ B. Erythema nodosum\ C. Ankylosing spondylitis\ D. Uveitis\ **Correct Answer**: B\ **Explanation**: Erythema nodosum is an extraintestinal manifestation of IBD that correlates with disease activity. **33.**\ **Question**: Which of the following is true about the use of biologics in IBD?\ **Choices**:\ A. They are first-line therapy for all IBD patients.\ B. They target pro-inflammatory cytokines.\ C. They are contraindicated in Crohn's disease.\ D. They do not require infection screening prior to use.\ **Correct Answer**: B\ **Explanation**: Biologics, such as infliximab, target pro-inflammatory cytokines like TNF-α and are effective for moderate to severe IBD. **34.**\ **Question**: Which feature is characteristic of Crohn's disease but not ulcerative colitis?\ **Choices**:\ A. Bloody diarrhea\ B. Granulomas on biopsy\ C. Rectal involvement\ D. Mucosal inflammation\ **Correct Answer**: B\ **Explanation**: Granulomas on biopsy are specific to Crohn's disease and result from transmural inflammation. **35.**\ **Question**: Which IBD medication is most likely to cause hepatotoxicity?\ **Choices**:\ A. Methotrexate\ B. Sulfasalazine\ C. Budesonide\ D. Infliximab\ **Correct Answer**: A\ **Explanation**: Methotrexate can cause hepatotoxicity, necessitating regular liver function monitoring. **36.**\ **Question**: Which dietary modification is most commonly recommended for patients with IBS?\ **Choices**:\ A. High-fat diet\ B. Gluten-free diet\ C. Low FODMAP diet\ D. High-protein diet\ **Correct Answer**: C\ **Explanation**: The low FODMAP diet has been shown to reduce symptoms in many IBS patients by limiting fermentable carbohydrates. **37.**\ **Question**: Which symptom is a hallmark of Crohn's disease but not ulcerative colitis?\ **Choices**:\ A. Tenesmus\ B. Weight loss\ C. Perianal disease\ D. Bloody diarrhea\ **Correct Answer**: C\ **Explanation**: Perianal disease, including fistulas and abscesses, is a hallmark of Crohn's disease. **38.**\ **Question**: A patient on azathioprine for IBD develops fever and sore throat. What is the most appropriate next step?\ **Choices**:\ A. Discontinue azathioprine immediately.\ B. Continue therapy and monitor symptoms.\ C. Reduce the dose of azathioprine.\ D. Start antibiotics empirically.\ **Correct Answer**: A\ **Explanation**: Fever and sore throat in a patient on azathioprine may indicate bone marrow suppression, requiring discontinuation. **39.**\ **Question**: Which of the following is a potential complication of long-term corticosteroid use in IBD?\ **Choices**:\ A. Fistula formation\ B. Osteoporosis\ C. Hepatic steatosis\ D. Splenomegaly\ **Correct Answer**: B\ **Explanation**: Long-term corticosteroid use can lead to osteoporosis due to impaired bone metabolism. **40.**\ **Question**: Which IBD medication inhibits folate metabolism and requires supplementation with folic acid?\ **Choices**:\ A. Methotrexate\ B. Sulfasalazine\ C. Azathioprine\ D. Cyclosporine\ **Correct Answer**: B\ **Explanation**: Sulfasalazine inhibits folate absorption, necessitating supplementation with folic acid.