AANP Family Nurse Practitioner (FNP) Certification ExamDiagnosisHard
A 35-year-old female presents with a 3-month history of non-bloody diarrhea, abdominal pain, and unintentional weight loss of 10 pounds. She reports occasional oral aphthous ulcers and perianal skin tags. Her ESR and CRP are elevated, and a colonoscopy reveals patchy inflammation with skip lesions and cobblestoning in the terminal ileum and ascending colon. Which of the following is the most appropriate diagnosis?
- AUlcerative colitis
- BDiverticulitis
- CIrritable bowel syndrome (IBS)
- DCrohn's disease
Show answer & explanationAnswer & explanation
Correct answer: D. Crohn's disease
The patient's symptoms of chronic diarrhea, abdominal pain, weight loss, oral aphthous ulcers, elevated inflammatory markers, and critically, the colonoscopic findings of patchy inflammation, skip lesions, and cobblestoning in the terminal ileum and ascending colon are pathognomonic for Crohn's disease.
Why the other options are wrong
- A. Ulcerative colitis typically involves continuous inflammation limited to the colon and rectum, starting distally, without skip lesions, cobblestoning, or oral/perianal manifestations seen in Crohn's.
- B. Diverticulitis presents with acute localized abdominal pain, fever, and leukocytosis, usually in older adults, and would not show chronic diarrhea, weight loss, or the specific colonoscopic findings described.
- C. IBS is a functional disorder with normal inflammatory markers and no structural changes on colonoscopy, which contradicts this patient's findings.
Crohn's Disease
A chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract from mouth to anus, characterized by transmural inflammation and skip lesions.
- Symptoms: abdominal pain, diarrhea (often non-bloody), weight loss, fatigue.
- Extraintestinal manifestations: oral aphthous ulcers, perianal disease, arthralgias.
- Endoscopy: patchy inflammation, skip lesions, cobblestoning, strictures, fistulas.
Memory trick: Crohn's 'Crawls' from mouth to anus, with 'Cobblestones' and 'Skip' stops.