[MCQ] Inflammatory bowel disease- Part 2

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Inflammatory bowel disease- Part 2

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Question 1

Which of the following cells induce transmural granulomatous inflammation that resembles CD ?

A	TH1 cells
B	TH2 cells
C	TH17 cells
D	All of the above

Question 1 Explanation:

TH1 cells induce transmural granulomatous inflammation that resembles CD

Question 2

Which of the following cells induce superficial mucosal inflammation resembling UC ?

A	TH1 cells
B	TH2 cells
C	TH17 cells
D	All of the above

Question 2 Explanation:

TH2 cells, & related natural killer T cells that secrete IL-13 induce superficial mucosal inflammation resembling UC. TH17 cells may be responsible for neutrophilic recruitment

Question 3

The TH1 cytokine pathway is initiated by ?

A	IL-4
B	IL-6
C	IL-12
D	IL-23

Question 3 Explanation:

The TH1 cytokine pathway is initiated by

Question 4

Which of the following is also called “lymphotoxin” ?

A	TNF-α
B	TNF-β
C	IFN-α
D	IFN-γ

Question 4 Explanation:

Tumor-necrosis factor-beta (TNF-) is also known as lymphotoxin

Question 5

Levels of which of the following is elevated in IBD ?

A	Tumor necrosis factor α (TNF-α)
B	Interleukin-1β
C	Interferon-γ
D	All of the above

Question 5 Explanation:

Levels of tumor necrosis factor  (TNF-), interleukin-1, interferon-, and cytokines of the interleukin-23–Th17 pathway are elevated in IBD.

Question 6

In unstimulated cells, NF-B is found in ?

A	Nucleus
B	Cytoplasm
C	Cell membrane
D	All of the above

Question 6 Explanation:

NF-B (nuclear factor kappa-light-chain-enhancer of activated B cells) is located in the cytosol complexed with the inhibitory protein IB

Question 7

Which of the following can activate NF- B ?

A	Cytokines
B	Activators of protein kinase C
C	Viruses
D	All of the above

Question 7 Explanation:

NF-B is a rapidly acting primary transcription factor found in all cell types. It is activated activated through TLR-4 by cytokines, activators of protein kinase C, bacteria / viruses, stress, UV

Question 8

Which of the following is not a probiotic ?

A	Lactobacillus sp.
B	Taenia suis
C	Campylobacter sp
D	Saccharomyces boulardii

Question 8 Explanation:

Salmonella sp., Shigella sp., Campylobacter sp., Clostridium difficile are pathogens that may initiate IBD by triggering an inflammatory response. While Faecalibacterium prausnitzii, Lactobacillus, Bifidobacterium, Taenia suis, and Saccharomyces boulardii are probiotics that may inhibit inflammation.

Question 9

What proportion of UC patients have involvement of whole colon ?

A	10 %
B	20 %
C	30 %
D	40 %

Question 9 Explanation:

~40-50% of UC patients have disease limited to rectum & rectosigmoid, 30-40% have disease extending beyond sigmoid but not involving whole colon. 20% have a total colitis

Question 10

Backwash ileitis occurs when which part of colon is involved in UC ?

A	Ascending colon
B	Transverse colon
C	Descending colon
D	Whole colon

Question 10 Explanation:

UC is a mucosal disease that almost always involves rectum and extends proximally to involve colon in continuity without areas of uninvolved mucosa. When “whole colon” is involved, inflammation extends 1-2 cm into terminal ileum in 10–20% of patients. This is called backwash ileitis.

Question 11

Psychosocial factors can contribute to worsening of symptoms in which of the following illnesses ?

A	IBD
B	Chronic back pain
C	Amyotrophic lateral sclerosis
D	All of the above

Question 12

Which of the following statements about pathology of Ulcerative colitis (UC) is false ?

A	Mucosal disease involving rectum and colon
B	Proximal spread occurs in continuity
C	Sandpaper like appearance of mucosa reflects severe inflammation
D	Inflammatory polyps (pseudopolyps) are due to epithelial regeneration

Question 12 Explanation:

In UC, with “mild inflammation” mucosa is erythematous & has a fine granular surface that looks like sandpaper

Question 13

Which of the following statements about pathology of Ulcerative colitis (UC) is false ?

A	Limited to mucosa & superficial submucosa
B	Crypt architecture of colon is preserved
C	Basal lymphoplasmacytosis suggests chronicity
D	Cryptitis and crypt atrophy

Question 13 Explanation:

UC process is limited to mucosa and superficial submucosa, with deeper layers unaffected except in fulminant disease. Histologic features that suggest chronicity are that crypt architecture of colon is distorted and presence of basal plasma cells and multiple basal lymphoid aggregates

Question 14

Which of the following statements about pathology of Crohn’s disease (CD) is false ?

A	Can affect any part of gastrointestinal tract
B	Terminal ileum involved in 90% of patients
C	Rectum is always involved in CD
D	Segmental with skip areas

Question 14 Explanation:

Unlike UC, which almost always involves the rectum, the rectum is often spared in CD

Question 15

Which of the following statements about pathology of Crohn’s disease (CD) is false ?

A	Perirectal fistulas, abscesses & anal stenosis common
B	Never involves liver & pancreas
C	Transmural process
D	“Cobblestone” appearance on endoscopy

Question 15 Explanation:

In CD, granulomas are seen in lymph nodes, mesentery, peritoneum, liver & pancreas.

Question 16

“Cobblestone mucosa” in CD is mainly seen in ?

A	Sigmoid colon
B	Transverse colon
C	Ileum
D	Rectum

Question 16 Explanation:

Unlike UC, CD is a transmural process. CD is segmental with skip areas in the midst of diseased intestine. In CD, stellate ulcerations fuse longitudinally & transversely to demarcate islands of mucosa that are histologically normal. This “cobblestone” appearance is characteristic of CD, endoscopically and by barium radiography. Oral mucosal lesions in CD include aphthous stomatitis & “cobblestone” lesions of the buccal mucosa

Question 17

Which of the following statements about pathology of Crohn’s disease (CD) is false ?

A	Earliest lesions are aphthoid ulcerations & focal crypt abscesses
B	Caseating granulomas in all bowel wall layers common
C	Granulomas can be seen in liver & pancreas
D	Granulomas can be seen in lymph nodes, mesentery, peritoneum

Question 17 Explanation:

In CD, earliest lesions are aphthoid ulcerations & focal crypt abscesses with loose aggrega-tions of macrophages, forming “noncaseating” granulomas in all layers of bowel wall

Question 18

In CD, “Creeping fat” is the term given to ?

A	Excessive enlargement of omentum
B	Necrosis of omentum
C	Projections of thickened mesentery encasing bowel
D	Fatty adhesions

Question 18 Explanation:

Projections of thickened mesentery encase the bowel is termed as “creeping fat”.

Question 19

Which of the following is not a major symptom of UC ?

A	Rectal bleeding
B	Constipation
C	Crampy abdominal pain
D	Tenesmus

Question 19 Explanation:

The major symptoms of UC are diarrhea, rectal bleeding, tenesmus, passage of mucus, and crampy abdominal pain. Other symptoms in moderate to severe disease include anorexia, nausea, vomiting, fever, and weight loss

Question 20

Which of the following statements about clinical features of Ulcerative colitis (UC) is false ?

A	Tenesmus is a major symptom
B	Severity of symptoms do not correlate with extent of disease
C	Constipation seen in patients with distal disease
D	Diarrhea is often nocturnal and/or postprandial

Question 20 Explanation:

Severity of symptoms correlates with the extent of disease

Question 21

Which is not a manifestion severe UC ?

A	Bowel movements 4-6/day
B	Mean body temperature >37.5ºC
C	Mean pulse rate > 90 / minute
D	ESR > 30 mm in first hou

Question 21 Explanation:

In severe UC, bowel movements are >6 per day

Question 22

In severe ulcerative colitis, number of bowel movements per day is ?

A	2 - 3
B	3 - 4
C	4 - 5
D	> 6

Question 23

Which of the following about investigative features of Ulcerative colitis (UC) is false ?

A	CRP levels may rise in active disease
B	Orosomucoid levels may rise in active disease
C	Leukocytosis is a specific indicator of disease activity
D	Proctitis or proctosigmoiditis rarely cause rise in CRP

Question 23 Explanation:

In UC, leukocytosis occurs but is not a specific indicator of disease activity. Proctitis or proctosigmoiditis rarely causes a rise in CRP

Question 24

Which of the following is a highly sensitive & specific marker for detecting intestinal inflammation ?

A	Fecal lactoferrin
B	Fecal transferrin
C	Fecal hemolysin
D	Fecal reactin

Question 24 Explanation:

Fecal lactoferrin is a highly sensitive and specific marker of fecal leukocytes and for detecting intestinal inflammation, tested by latex agglutination & enzyme-linked immunosorbent assays.

Question 25

Which of the following about fecal calprotectin is false ?

A	Levels correlate well with histologic inflammation
B	Predict relapses
C	Detects pouchitis
D	None of the above

Question 26

Which of the following is false about “fecal calprotectin” ?

A	Neutrophilic cytosolic protein
B	Resistant to colonic bacterial degradation
C	Formerly called L1 protein
D	None of the above

Question 27

Which of the following is false about “fecal calprotectin” ?

A	Calcium binding
B	Has antimicrobial properties
C	Predict relapses in IBD
D	None of the above

Question 27 Explanation:

Fecal Calprotectin is a neutrophilic cytosolic protein, first isolated from granulocytes by Fagerhol and named L1 protein. It was renamed calprotectin upon identification of its calcium binding, antimicrobial properties and resistance to colonic bacterial degradation. Calprotectin, although present in blood, enters bowel lumen as part of an inflammatory process. It is positive in stools of IBD and colorectal cancer patients. Fecal calprotectin & lactoferrin is useful in predicting impending clinical relapse in CD & UC patients

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See all quizzes of Peptic Ulcer Disease at here:

1.Which of the following cells induce transmural granulomatous
inflammation that resembles CD ?
A. TH1 cells
B. TH2 cells
C. TH17 cells
D. All of the above

2. Which of the following cells induce superficial mucosal
inflammation resembling UC ?
A. TH1 cells
B. TH2 cells
C. TH17 cells
D. All of the above

3. The TH1 cytokine pathway is initiated by ?
A. IL-4
B. IL-6
C. IL-12
D. IL-23

4. Which of the following is also called “lymphotoxin” ?
A. TNF-
B. TNF-
C. IFN-
D. IFN-

5.Levels of which of the following is elevated in IBD ?
A. Tumor necrosis factor  (TNF-)
B. Interleukin-1
C. Interferon-
D. All of the above

6. In unstimulated cells, NF–B is found in ?
A. Nucleus
B. Cytoplasm
C. Cell membrane
D. All of the above

7. In unstimulated cells, NF– B remains bound to ?
A. G–B
B. H–B
C. I- B
D. J– B

8. Which of the following can activate NF– B ?
A. Cytokines
B. Activators of protein kinase C
C. Viruses
D. All of the above

9. Which of the following is not a probiotic ?
A. Lactobacillus sp.
B. Taenia suis
C. Campylobacter sp.
D. Saccharomyces boulardii

10.What proportion of UC patients have involvement of whole colon ?
A. 10 %
B. 20 %
C. 30 %
D. 40 %

11. Backwash ileitis occurs when which part of colon is involved
in UC ?
A. Ascending colon
B. Transverse colon
C. Descending colon
D. Whole colon

12.Psychosocial factors can contribute to worsening of symptoms
in which of the following illnesses ?
A. IBD
B. Chronic back pain
C. Amyotrophic lateral sclerosis
D. All of the above
13. Which of the following statements about pathology of
Ulcerative colitis (UC) is false ?
A. Mucosal disease involving rectum and colon
B. Proximal spread occurs in continuity
C. Sandpaper like appearance of mucosa reflects severe inflammation
D. Inflammatory polyps (pseudopolyps) are due to epithelial regeneration

14.Which of the following statements about pathology of
Ulcerative colitis (UC) is false ?
A. Limited to mucosa & superficial submucosa
B. Crypt architecture of colon is preserved
C. Basal lymphoplasmacytosis suggests chronicity
D. Cryptitis and crypt atrophy

15.Which of the following statements about pathology of Crohn’s
disease (CD) is false ?
A. Can affect any part of gastrointestinal tract
B. Terminal ileum involved in 90% of patients
C. Rectum is always involved in CD
D. Segmental with skip areas

16.Which of the following statements about pathology of Crohn’s
disease (CD) is false ?
A. Perirectal fistulas, abscesses & anal stenosis common
B. Never involves liver & pancreas
C. Transmural process
D. “Cobblestone” appearance on endoscopy

17. “Cobblestone mucosa” in CD is mainly seen in ?
A. Sigmoid colon
B. Transverse colon
C. Ileum
D. Rectum

18. Which of the following statements about pathology of Crohn’s
disease (CD) is false ?
A. Earliest lesions are aphthoid ulcerations & focal crypt abscesses
B. Caseating granulomas in all bowel wall layers common
C. Granulomas can be seen in liver & pancreas
D. Granulomas can be seen in lymph nodes, mesentery, peritoneum

19. In CD, “Creeping fat” is the term given to ?
A. Excessive enlargement of omentum
B. Necrosis of omentum
C. Projections of thickened mesentery encasing bowel
D. Fatty adhesions

20. Which of the following is not a major symptom of UC ?
A. Rectal bleeding
B. Constipation
C. Crampy abdominal pain
D. Tenesmus

21. Which of the following statements about clinical features of
Ulcerative colitis (UC) is false ?
A. Tenesmus is a major symptom
B. Severity of symptoms do not correlate with extent of disease

C. Constipation seen in patients with distal disease
D. Diarrhea is often nocturnal and/or postprandial
Severity of symptoms correlates with the extent of disease.
22. Which is not a manifestion severe UC ?
A. Bowel movements 4-6/day
B. Mean body temperature >37.5ºC
C. Mean pulse rate > 90 / minute
D. ESR > 30 mm in first hour
In severe UC, bowel movements are >6 per day.
23. In severe ulcerative colitis, number of bowel movements per
day is ?
A. 2 – 3
B. 3 – 4
C. 4 – 5
D. > 6
24. Which of the following about investigative features of
Ulcerative colitis (UC) is false ?
A. CRP levels may rise in active disease
B. Orosomucoid levels may rise in active disease
C. Leukocytosis is a specific indicator of disease activity
D. Proctitis or proctosigmoiditis rarely cause rise in CRP

25. Which of the following is a highly sensitive & specific marker
for detecting intestinal inflammation ?
A. Fecal lactoferrin
B. Fecal transferrin
C. Fecal hemolysin
D. Fecal reactin

26. Which of the following about fecal calprotectin is false ?
A. Levels correlate well with histologic inflammation
B. Predict relapses
C. Detects pouchitis
D. None of the above

27. Which of the following is false about “fecal calprotectin” ?
A. Neutrophilic cytosolic protein
B. Resistant to colonic bacterial degradation
C. Formerly called L1 protein
D. None of the above

28. Which of the following is false about “fecal calprotectin” ?
A. Calcium binding
B. Has antimicrobial properties
C. Predict relapses in IBD
D. None of the above

Inflammatory bowel disease

[MCQ] Inflammatory bowel disease- Part 2

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Inflammatory bowel disease- Part 2

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