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OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose answer is ulcerative colitis. While this may seem a odd practice, it is useful to see multiple examples of how ulcerative colitis will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
KEY CHARACTERISTICS OF THIS CONDITION (ON EXAMS)
When it comes to standardized exams, each topic has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for ulcerative colitis.
- Diarrhea can be bloody
- Abdominal pain
- Ulcers in intestine
QUESTION EXAMPLES
Question # 1
A 15 year old boy is brought to the clinic because of lower abdominal pain as well as intermittent pain in her knees and hips. He has been experiencing these symptoms for the past 2 months. He explains that his abdominal pain is improved after he has a bowel movement. When asked about his bowel movements the patient explain that he has been having about 10 bloody bowel movements a day. A physical exam shows a swollen and tender right knee. The patients labs are listed below:
- Hemoglobin: 14.6 g/dL
- Leukocyte count: 15,000/mm³
- Platelet count: 800,000/mm³
When the knee joint fluid is aspirated, there is straw-colored turbid fluid with a leukocyte count of 2200/mm³ (45% segmented neutrophils). What diagnosis could explain this presentation?
Explanation # 1
Question # 2
30-year-old male comes to the emergency room because of a four month history of both diarrhea and of Domino pain. He explains that he has bowel movements three or four times a day and has now begun to notice the presence of blood in his stool. Patient denies having any fever but explains that he has very low energy. He was diagnosed with anterior uveitis four years ago but his past medical history is otherwise unremarkable. He does not take any medications and does not have any allergies. His vital signs are within normal limits. The physical exam shows an abdomen that is tender and his Bal sounds are hyper active. D. Anal region is unremarkable. Lab results demonstrate the anemia and also an elevated ESR. Colonoscopy and biopsy of the bowel show noncaseating granuloma’s. What is the diagnosis in this patient?
Explanation # 2
Bloody diarrhea + biopsy with granulomas = ulcerative colitis
TESTABLE FACTS ABOUT THIS TOPIC (BEYOND ITS IDENTIFICATION)
Many questions on standardized exams go beyond simply recognizing the underlying topic. Often there are specific testable facts regarding some aspect of the topic’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:
- Treatment:
- Sulfasalazine: this is a combination medication composed of sulfapyridine (antibacterial) and 5-aminosalicylic acid (anti-inflammatory agent). It is activated by colonic bacteria.