AANP Family Nurse Practitioner (FNP) Certification ExamDiagnosisMedium
A 35-year-old female presents with a 3-month history of non-bloody diarrhea, crampy abdominal pain, and significant weight loss. She also reports intermittent fever and joint pain. Physical examination reveals diffuse abdominal tenderness and perianal skin tags. Which diagnostic finding would most strongly support a diagnosis of Crohn's Disease?
- APositive stool culture for Salmonella
- BColonoscopy showing continuous inflammation limited to the colon
- CElevated anti-Saccharomyces cerevisiae antibodies (ASCA)
- DNormal C-reactive protein (CRP)
Show answer & explanationAnswer & explanation
Correct answer: C. Elevated anti-Saccharomyces cerevisiae antibodies (ASCA)
Elevated ASCA is a serologic marker commonly found in Crohn's Disease and helps differentiate it from ulcerative colitis and other causes of chronic diarrhea. The clinical presentation is highly suggestive of Crohn's.
Why the other options are wrong
- A. A positive stool culture indicates an infectious cause, which is inconsistent with a 3-month chronic history and systemic symptoms of Crohn's.
- B. Continuous inflammation limited to the colon is characteristic of Ulcerative Colitis, not Crohn's Disease, which typically involves skip lesions and can affect any part of the GI tract.
- D. Normal CRP would argue against active inflammation, which is expected in Crohn's Disease given the patient's symptoms; an elevated CRP would be more supportive.
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 often skip lesions.
- Common symptoms include abdominal pain, diarrhea, weight loss, and fatigue.
- Can lead to complications like strictures, fistulas, and abscesses.
- Diagnosis involves endoscopy with biopsy, imaging, and serologic markers.
Memory trick: Crohn's ASCA: A Specific Clue for Crohn's Abscesses.