Malignancy risk factors in IBD

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Q) WHich is not a  risk factor for malignancy in inflammatory bowel disease?

a) >50% crohn disease in colon

b) PSC

c) Old age of onset

d) use of Infliximab 

Steroid Refractory Ulcerative colitis

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Q) Not used in steroid refractory severe Ulcerative Colitis ( AIIMS 2020 Nov) 

a) Infliximab
b) Azathioprine
c) Cyclosporine
d) Surgery

Ans b- Azathioprine

Cyclosporine is  immunomodulator indicated for second-line therapy in the case of severe, steroid refractory ulcerative colitis. Treatment is usually initiated after 3 to 5 days of failed steroid response

Tacrolimus is appropriate as second-line therapy in patients with severely active ulcerative colitis unresponsive to steroids.

The use of various anti–tumor necrosis factor-α  (TNF-α) monoclonal antibodies ( infliximab)  is well supported in the case of
severe ulcerative colitis refractory to steroids. 

Bleeding in Ulcerative colitis

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Q) 30 yr old female with severe rectal bleed known case of UC , on admission not responding to steroids and medical treatment  .. next line of treatment ?
a) Subtotal colectomy with Ilerorectal anastomosis
b) Subtotal colectomy with ileostomy

c) Total Proctocolectomy TPC with ipaa
d) Tpc with end iliostomy


Histology of Crohn disease

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Q) WHich of the following is not a histological feature of Crohn disease of the bowel

a) Stricture

b) Granuloma

c) Crypt Abscess

d) Goblet cell atrophy

Ca Rectum

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Q) CA rectum 5 cm from anal verge which is T1N0 on evaluation. which of the following cannot be done for the treatment of the patient
A. Inter sphincteric resesction
C. Transanal endoscopic resection

Rectal Intussusception

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Q) Pick the true statement about rectal intussusception

a) It is a rare finding in defecography

b) When found, it is found to be a common cause of refractory constipation

c) Biofeedback therapy and fibre intake is the mainstream treatment of choice

d) Rectopexy has had good long term results

Genetics ca rectum

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Q) Good prognosis seen in – ca rectum.





Neoadjuvant Response in Rectal cancer

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Q) In Regression of tumour after Neoadjuvant CTRT for rectal cancer are all except

A) Decrease in size

B) Nodal regression

C) Mucosal venous invasion in mri

D) Depth change


Perioperative steroid management in IBD

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Q) All are true  regarding perioperative management Of IBD on steroid except

a) Minor procedure needs only routine steroidal dose supplementation
b) Major procedures  needs Hydrocort 100-150 mg tds
3.Chronic steroid use causing adrenal failure that  presents with hypotension, vomiting, fever, lethargy
4.All cases of UC need supraphysiological dose of steroid.

Pouchitis Disease severity index

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Q) Pouchitis disease activity index includes all except (AIIMS 2019)

a)  Fever
b)  Malaise
c)  Fecal urgency
d)  Bleeding PR

Pouchitis is commonly asked in AIIMS and JIPMER MCH exams. Previous year questions are here and here 

Ans b ) Malaise, Clinical data includes Frequency, urgency and rectal bleed

Summary of the PAS

I. Clinical
 1. Stool frequency (0, 2, 4, 6)
 2. Fecal urgency (0, 3)
 3. Rectal bleeding (0, 3)
Maximal clinical subscore: 12
II. Endoscopic findings
 1. Oedema (0, 1)
 2. Granularity (0, 1)
 3. Friability (0, 1, 2)
 4. Erythema (0, 2, 3)
 5. Mucosal flattening (0, 2)
 6. Ulcerations/erosions (0, 2, 3)
Maximal endoscopic subscore: 12
III. Histological Acute inflammation
 1. Polymorphonuclear infiltration (0, 1, 2, 3)
 2. Ulcerations/erosions (0, 1, 2, 3)
Chronic inflammation
 1. Mononuclear infiltration (0, 1, 2, 3)
 2. Villous atrophy (0, 1, 2, 3)
Maximal (total) histological subscore: 12
Maximal total PAS: 36