IBD

Question 1

What is the causation triad of IBD?

Answer 1

Genetic susceptibility + altered microbiome + environmental trigger.

Question 2

How does smoking affect IBD?

Answer 2

Worsens Crohn’s disease; protective in ulcerative colitis.

Question 3

Most sensitive noninvasive marker of intestinal inflammation?

Answer 3

Faecal calprotectin (≥150 µg/g suggests active inflammation).

Question 4

First infections to exclude in suspected IBD?

Answer 4

Stool M/C/S, C. difficile, ova/cyst/parasite.

Question 5

Preferred imaging for small-bowel Crohn’s disease?

Answer 5

MR enterography (capsule only if no stricture).

Question 6

Histologic chronicity marker in UC?

Answer 6

Basal plasmacytosis.

Question 7

Key histologic feature distinguishing Crohn’s?

Answer 7

Transmural inflammation ± granulomas.

Question 8

Mnemonic CCAT in IBD histology?

Answer 8

Crypt abscess, Chronic changes, Architectural distortion, Transmural inflammation.

Question 9

UC endoscopic pattern?

Answer 9

Continuous mucosal inflammation from rectum proximally.

Question 10

Crohn’s endoscopic pattern?

Answer 10

Skip lesions with cobblestoning and transmural ulcers.

Question 11

Tool used to grade UC severity?

Answer 11

Truelove–Witts criteria.

Question 12

Definition of ASUC?

Answer 12

≥6 bloody stools/day plus systemic toxicity (fever, tachycardia, anaemia).

Question 13

Crohn’s classification system?

Answer 13

Montreal classification (Age, Behaviour, Location).

Question 14

Crohn’s behaviour codes in Montreal classification?

Answer 14

B1 inflammatory, B2 stricturing, B3 penetrating ± p perianal.

Question 15

Harvey–Bradshaw Index cut-off for moderate–severe Crohn’s?

Answer 15

> 8 points.

Question 16

Two poor prognostic factors in Crohn’s?

Answer 16

Deep ulcers and age <40 years.

Question 17

Short-term target in STRIDE-II?

Answer 17

Symptom control.

Question 18

Intermediate target in STRIDE-II?

Answer 18

CRP and faecal calprotectin improvement.

Question 19

Long-term STRIDE-II goal?

Answer 19

Endoscopic ± histologic healing (deep remission).

Question 20

STRIDENT (Australia) treat-to-target biomarker?

Answer 20

Faecal calprotectin ≤250 µg/g by 24 weeks.

Question 21

Why treat to biomarker normalisation in IBD?

Answer 21

Deep remission lowers hospitalisation and surgery risk.

Question 22

First-line therapy for mild–moderate UC?

Answer 22

5-ASA (mesalazine/sulfasalazine).

Question 23

5-ASA delivery principle?

Answer 23

Use both oral and rectal formulations to reach all colonic segments.

Question 24

Role of corticosteroids in IBD?

Answer 24

Induction only; not for maintenance.

Question 25

Budesonide MMX indication?

Answer 25

Mild–moderate left-sided or extensive UC.

Question 26

Purpose of TPMT and NUDT15 testing before thiopurine use?

Answer 26

Identify risk of myelotoxicity.

Question 27

Thiopurine metabolite targets?

Answer 27

6-TGN 235–450; 6-MMP <5700 pmol/8×10^8 RBCs.

Question 28

What is an allopurinol 'shunter' strategy?

Answer 28

Add low-dose AZA + allopurinol to redirect metabolism from 6-MMP to 6-TGN.

Question 29

High-risk lymphoma combination in IBD?

Answer 29

Young male on thiopurine plus anti-TNF therapy.

Question 30

When are biologics indicated in UC?

Answer 30

After failure or intolerance of immunomodulators.

Question 31

Australian PBS rule for continuing biologics?

Answer 31

Documented steroid-free remission for ≥6 months.

Question 32

Initial therapy for acute severe UC?

Answer 32

IV hydrocortisone 100 mg q6h (or methylpred 60 mg daily).

Question 33

Next step if no improvement by day 3–5 in ASUC?

Answer 33

Rescue infliximab 5 mg/kg or cyclosporin 2 mg/kg IV.

Question 34

Ultimate step if medical therapy fails in ASUC?

Answer 34

Urgent colectomy ± ileal pouch formation.

Question 35

Why VTE prophylaxis in ASUC?

Answer 35

Severe colitis increases thrombotic risk even without bleeding.

Question 36

Rule for stricturing Crohn’s?

Answer 36

Hot = inflammatory treat medically; Cold = fibrotic dilate or resect.

Question 37

First step in perianal Crohn’s management?

Answer 37

Examination under anaesthetic with drainage ± seton placement.

Question 38

Main biologic class for fistulising Crohn’s?

Answer 38

Anti-TNF agents (Infliximab/Adalimumab).

Question 39

When does early anti-TNF reduce surgery risk?

Answer 39

Within first 6 months of diagnosis (CREOLE study).

Question 40

Anti-TNF onset speed?

Answer 40

Fastest among biologics (1–2 weeks).

Question 41

Vedolizumab key property?

Answer 41

Gut-selective; slower onset but safest profile.

Question 42

Ustekinumab target and antibody rate?

Answer 42

IL-12/23 p40 blockade; low antibody rate (~2%).

Question 43

Tofacitinib indication?

Answer 43

Moderate–severe ulcerative colitis.

Question 44

Upadacitinib indication?

Answer 44

Moderate–severe UC and Crohn’s (JAK1 selective).

Question 45

S1P modulator example and risk?

Answer 45

Ozanimod; bradycardia or macular oedema.

Question 46

JAK inhibitor major safety concerns?

Answer 46

VTE, major adverse cardiovascular events, zoster.

Question 47

Methotrexate role in IBD?

Answer 47

Induction/maintenance in Crohn’s; ineffective in UC.

Question 48

Methotrexate dosing rule?

Answer 48

25 mg weekly (then 15 mg maintenance) + folate 5 mg weekly.

Question 49

When to stop methotrexate pre-pregnancy?

Answer 49

At least 3 months before conception.

Question 50

UC surgical indications (two)?

Answer 50

Toxic megacolon and refractory disease.

Question 51

Crohn’s surgical indications (two)?

Answer 51

Obstruction or penetrating complications.

Question 52

Postoperative Crohn’s recurrence risk factor?

Answer 52

Active smoking.

Question 53

Post-ileal resection diarrhoea cause and treatment?

Answer 53

Bile-salt malabsorption; treat with cholestyramine.

Question 54

Endoscopic surveillance timing after Crohn’s surgery?

Answer 54

6–12 months postoperatively.

Question 55

Mnemonic for major EIM systems?

Answer 55

J-SHE-B → Joints, Skin, Hepatobiliary, Eyes, Bone/Blood.

Question 56

Peripheral arthritis Type 1 vs Type 2?

Answer 56

Type 1 <5 joints and parallels bowel; Type 2 >5 joints and independent.

Question 57

Axial arthritis association?

Answer 57

Often HLA-B27 positive; independent of bowel activity.

Question 58

Concordant EIM examples?

Answer 58

Erythema nodosum, Type 1 arthritis, episcleritis.

Question 59

Discordant EIM examples?

Answer 59

Pyoderma gangrenosum, Type 2 arthritis, uveitis, PSC.

Question 60

PSC link with IBD?

Answer 60

Occurs mainly with UC (~4%).

Question 61

PSC CRC and CCA risk?

Answer 61

Colorectal cancer 5×, cholangiocarcinoma ~400× general population.

Question 62

PSC imaging sign?

Answer 62

Beaded appearance on MRCP.

Question 63

PSC colonoscopy frequency?

Answer 63

Annual colonoscopy from diagnosis.

Question 64

IBD bone loss prevalence?

Answer 64

≈30%, due to steroids and inflammation.

Question 65

VTE risk in IBD?

Answer 65

3–4× higher, especially during flares.

Question 66

When to start colonoscopic surveillance in UC?

Answer 66

8 years after symptom onset (earlier if PSC).

Question 67

Surveillance interval for high-risk UC?

Answer 67

Every 1 year.

Question 68

Preferred method for dysplasia detection?

Answer 68

Chromoendoscopy with targeted biopsies.

Question 69

Which is riskier: active IBD or medication exposure in pregnancy?

Answer 69

Active IBD is riskier; continue effective therapy.

Question 70

Safe drugs in pregnancy?

Answer 70

5-ASA, thiopurines, anti-TNF, vedolizumab, ustekinumab.

Question 71

Unsafe drugs in pregnancy?

Answer 71

Methotrexate, JAK inhibitors, S1P modulators.

Question 72

Mode of delivery for active perianal Crohn’s?

Answer 72

Caesarean section preferred.

Question 73

Registry confirming biologic safety in pregnancy?

Answer 73

PIANO registry (no ↑ malformation or prematurity).

Question 74

Live vaccine timing with biologics?

Answer 74

Give ≥4 weeks before starting or ≥3 months after stopping.

Question 75

Zoster vaccination timing recommendation?

Answer 75

At ≥50 years, before immunosuppression if possible.

Question 76

Annual vaccines for all IBD patients?

Answer 76

Influenza and COVID-19 boosters.

Question 77

Routine baseline screening before immunosuppression?

Answer 77

TB, HBV/HCV, HIV, VZV, TPMT/NUDT15, vitamin D, B12, iron.

Question 78

EEN role in Crohn’s?

Answer 78

Induces remission (especially paediatric) without bone loss.

Question 79

CDED stands for?

Answer 79

Crohn’s Disease Exclusion Diet (partial enteral nutrition).

Question 80

Probiotics proven benefit in IBD?

Answer 80

Prevent pouchitis (e.g. VSL#3).

Question 81

Low-FODMAP diet role in IBD?

Answer 81

Helpful only for IBS-overlay, not active inflammation.

Question 82

Postoperative metronidazole benefit?

Answer 82

Reduces early Crohn’s recurrence.

Question 83

DEXA scan interval on steroids or post-menopause?

Answer 83

Every 2–3 years.

Question 84

Anaemia treatment of choice in active IBD?

Answer 84

IV iron preferred over oral.

Question 85

Why avoid COX-1 NSAIDs in IBD?

Answer 85

May trigger mucosal relapse; use COX-2 if necessary.

Question 86

Why biologic therapy may fail?

Answer 86

Antidrug antibodies or underdosing (check trough >5 µg/mL).

Question 87

Why no live vaccines on thiopurines?

Answer 87

Risk of disseminated infection.

Question 88

Why steroids should be minimised?

Answer 88

Cause osteoporosis and metabolic side effects.

Question 89

VARSITY (NEJM 2019) main finding?

Answer 89

Vedolizumab superior to Adalimumab for UC remission.

Question 90

SEAVUE (Lancet 2022) main finding?

Answer 90

Ustekinumab equivalent efficacy to Adalimumab in CD, fewer AEs.

Question 91

LIR!C (Lancet 2017) main finding?

Answer 91

Early ileal resection comparable QoL to Infliximab in ileal CD.

Question 92

SPARE/STORI (Lancet 2023) lesson?

Answer 92

Stopping immunomodulator increases relapse if low anti-TNF level.

Question 93

PROFILE (NEJM 2023) message?

Answer 93

Top-down Adalimumab achieves better mucosal healing than conventional step-up.

Question 94

STRIDENT (AUS 2021) message?

Answer 94

Treating to FCP ≤250 µg/g reduces hospitalisation.

Question 95

CREOLE (Gastroenterology 2017) message?

Answer 95

Early anti-TNF (<6 months) reduces surgery and complications.

Question 96

NHMRC 2019 guideline relevance?

Answer 96

Defines CRC surveillance intervals for UC and PSC.

Question 97

PIANO (Gastro 2020) key point?

Answer 97

Biologic/thiopurine exposure not linked to adverse pregnancy outcomes.