dr-khmer1, try this one guys - drkhmer

[ArchivalUser]

_ A 26-year-old man has a 4-week history of increasingly severe bloody diarrhea, urgency, tenesmus, and abdominal pain without fever, chills, or excessive sweating. The patient has an 8-pack-year smoking history.

On physical examination, he appears well. The abdomen is mildly tender without guarding or rebound. Rectal examination is normal. Hemoglobin is 12 g/dL (120 g/L), the leukocyte count is 11,300/μL (11.3 × 109/L), and the erythrocyte sedimentation rate is 38 mm/h. Colonoscopy shows areas of inflammation throughout the colon associated with friability, granularity, and deep ulcerations. The inflamed areas are separated by relatively normal-appearing mucosa, including normal rectal mucosa. The ileum appears normal. Biopsy samples from the inflamed areas of the colon show moderately active chronic colitis without granulomas. Biopsy samples from the ileum are normal.
a. Crohn disease
b. Ulcerative colitis
c. Microscopic colitis
d. Yersinia enterocolitis
e. Ischemic colitis

[ArchivalUser]

A...

[ArchivalUser]

will go for A,

and good nt, will review answer tomorrow

[ArchivalUser]

Crohns

[ArchivalUser]

hi drkhmer how r u?

[ArchivalUser]

a...

[ArchivalUser]

_ Stefan78, Congratulation for the step2 scores and i knew it that you will get really high scores as your knowledge in this forum.

Are you gonna match for this year or next year?

[ArchivalUser]

_ You guys are right, just want to wake you up. but spandipati gone to sleep.

The Correct ans is A:

This patient has colitis with biopsy samples consistent with idiopathic inflammatory bowel disease. Because his colonoscopic examination shows areas of deep ulceration separated by areas of normal mucosa (skip lesions) and rectal sparing, his findings are more consistent with Crohn's disease than with ulcerative colitis. The absence of ileal inflammation and granulomas on biopsy does not rule out a diagnosis of Crohn's disease. In addition, the patient is a smoker, which increases the risk for Crohn's disease.

Patients with ulcerative colitis have continuous inflammation, typically including the rectum, and usually do not have deep ulcers or skip lesions. Ulcerative colitis is also more common in former smokers or nonsmokers. Microscopic colitis would not be associated with the significant changes found on this patient's colonoscopic examination. Finally, the patient's history and biopsy findings are not consistent with infectious colitis or ischemic colitis.

[ArchivalUser]

interesting

[ArchivalUser]

i thought granuloma on biopsy c trans luminal involvement-confirmatory interesting!