Inflammatory bowel disease: Clinical

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Inflammatory bowel disease: Clinical

USMLE® Step 2 questions

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USMLE® Step 2 style questions USMLE

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A 29-year-old man comes to the office with complaints of frequent loose stools and abdominal pain. He started having these symptoms a month ago, and they did not respond to over-the-counter antidiarrheals. He became concerned when he noticed an increase in urgency and a small amount of blood admixed with mucoid stools yesterday. Past medical history is noncontributory. He has not recently travelled outside the country. Vitals are within normal limits. Physical examination shows mild abdominal tenderness in the left lower quadrant. Colonoscopy shows erythematous rectal mucosa that is friable to touch, along with scattered ulcerations extending up to the distal part of sigmoid colon. The remainder of the colon and ileum are normal. Which of the following is the most appropriate pharmacotherapy for the patient at this stage?  


Inflammatory bowel diseases are mainly broken down into two autoimmune conditions - ulcerative colitis and Crohn's disease - both of which cause chronic inflammation in the gastrointestinal tract.

Ulcerative colitis mostly appears in individuals aged from 20 to 30 years old.

The chronic inflammation only involves the mucosal layer of the colon or the rectum and inflammation usually starts in the rectum and goes retrograde through the colon.

Ulcerative colitis can involve only the rectum, in which case it’s called ulcerative proctitis, can involve the rectum and the sigmoid colon - called ulcerative proctosigmoiditis, or can involve the rectum, sigmoid colon and the colon up to the splenic flexure - called distal ulcerative colitis. In some cases, it can also pass the splenic flexure, but spare the cecum - called extensive colitis and finally it can involve the entire colon including the cecum - called pancolitis.

The onset of the disease is gradual and symptoms are progressive over a few weeks. There may be systemic symptoms, such as fatigue, fever, unintentional weight loss, as well as dyspnea and palpitations due to iron deficiency anemia caused by blood loss.

Gastrointestinal symptoms include bloody diarrhea, colicky abdominal pain, and tenesmus.


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