GIq2 - cs.step

[ArchivalUser]

D B D A ? B D E D

[ArchivalUser]

now please answersssssssssssssssssssssss.......... cs step!!!!

i love yr qnsssssssssssss..

[ArchivalUser]

Sorry for late explanations....

1
The correct answer is D. The patient™s history and
physical findings with a painless, anteriorly located
anal fissure are consistent with Crohn™s disease. The
best next step in her evaluation is colonoscopy with
inspection of the terminal ileum. Serologic tests have
recently been advocated in the diagnosis of idiopathic
inflammatory bowel disease. Crohn™s disease is associated
with antibodies against Saccharomyces (ASCA),
while ulcerative colitis patients are more often positive
for anti-neutrophil cytoplasmic antibodies (ANCA).
However, the sensitivity of these tests is only about
60%. Moreover, roughly 20% overlap (e.g., ANCA
positive in Crohn™s), raising further questions about
the overall usefulness of these tests. Answer B is incorrect
because tissue transglutaminase antibodies are typically
seen with gluten-sensitive enteropathy. Answer
E is also incorrect. Fissures are one of the anal manifestations
of Crohn™s disease and should be approached
by treating the underlying disease rather than using
surgical techniques, botulinum injection, etc.

2
The correct answer is E. The findings described
above suggest pyoderma gangrenosum, an idiopathic
ulcerating skin disease that is often associated with
inflammatory bowel disease. The activities of skin and
intestinal disease are linked in about half of the
cases. Since skin cancer can be confused with pyoderma
gangrenosum, biopsy is important to rule out
malignancy. Treatment is either topical or systemic
immunosuppression. Complete excision and debridement
are not indicated and will only increase the ulcer
size. Since this is not an infectious process, antibiotics
and wound culture are not necessary or helpful

3
The correct answer is B. Crohn™s and ulcerative colitis
are both relapsing/remitting diseases. Up to 30% of
initial exacerbations of Crohn™s will remit without any
intervention. While there is a genetic component to
IBD (up to a 100-fold increase in risk among firstdegree
relatives with IBD), no single, autosomaldominant
gene has been identified. Answer C is incorrect
because half or more of patients with Crohn™s will
ultimately require some sort of surgery. Answer D is
incorrect. Unfortunately, chronic glucocorticoid
administration does not lower the rate of relapse.
There are many complications of IBD (see next question),
and gastrointestinal abscesses and fistulae occur
with a relatively high frequency (20“40%) in Crohn™s
disease.

HELPFUL TIP: Although considered a disease
of the young, there is a second peak
of inflammatory bowel disease (IBD) in the
seventies

4
The correct answer is A. There are many extraintestinal
manifestations of IBD, but alopecia is not known
to be one of them. Arthritis is fairly common and is
usually migratory in nature, involving the large joints.
Sclerosing cholangitis can occur and may be fatal. The
converse association also occurs: most patients with
sclerosing cholangitis have IBD. Autoimmune hepatitis
and cholelithiasis can also occur. Eye disease may
include uveitis and episcleritis. Importantly, the main
treatment for extraintestinal manifestations is to treat
the IBD.

5
The correct answer is D. Thalidomide has been used
as chronic therapy for IBD, but it is not indicated in
the acute setting. First things first: the patient should
be stabilized, and this includes IV access and fluid
resuscitation. An exacerbation (or relapse) of IBD can
be treated with glucocorticoids in the acute setting,
and antibiotics are often helpful. It appears that
metronidazole has beneficial effects that are not solely
due to its antimicrobial properties. In this patient,
who may have an abscess or obstruction, further evaluation
(e.g., labs, abdominal CT, etc.) and surgical
consultation are necessary

6
The correct answer is E. All of the above are indicated
for the treatment of inflammatory bowel disease.
Additional drugs for treatment include cyclosporine,
6-MP (6-mercaptopurine), oral steroids (budesonide),
and azathioprine, among others. Of special note are
the 5-ASA drugs (e.g., Pentasa, Asacol). These are
actually more active than sulfasalazine. Antidiarrheal
drugs such as loperamide are useful to control symptoms.
However, be sure to avoid these drugs in patients
who may have impending toxic megacolon

7
The correct answer is D. Sulfasalazine contains both
sulfa and salicylate moieties.

8
The correct answer is E. All of the rest are common
(or particularly severe in the case of sepsis) complications
of infliximab (an antitumor necrosis factor antibody).
In fact, ongoing infection is an absolute contraindication
to the use of infliximab. In general, anemia
should improve with the treatment of inflammatory
bowel disease (inflammatory bowel disease leads to
anemia of chronic disease).

9
IBD increases the risk of
colon cancer, so more frequent and earlier
colonoscopies are recommended. Recommendations
vary, but most recommend colonoscopy
every 1“2 years in patients with
ulcerative colitis. Screening for Crohn™s is less
well established.

HELPFUL TIP: Medical and surgical treatments
for UC and Crohn™s are similar. Patients
with long-standing UC with frequent relapses
are candidates for colectomy.

[ArchivalUser]

thanks