AANP Family Nurse Practitioner (FNP) Certification ExamDiagnosisHard
A 35-year-old female presents with a 3-month history of non-bloody diarrhea, crampy abdominal pain, and unintentional weight loss of 8 pounds. She also reports occasional oral aphthous ulcers and perianal skin tags. Endoscopy reveals patchy inflammation with skip lesions and deep ulcerations in the terminal ileum. What is the most likely diagnosis?
- AUlcerative Colitis (UC)
- BCrohn's Disease
- CIrritable Bowel Syndrome (IBS)
- DDiverticulitis
Show answer & explanationAnswer & explanation
Correct answer: B. Crohn's Disease
The patient's chronic non-bloody diarrhea, abdominal pain, weight loss, extra-intestinal manifestations (oral ulcers, perianal tags), and endoscopic findings of patchy inflammation with skip lesions and deep ulcerations in the terminal ileum are pathognomonic for Crohn's Disease.
Why the other options are wrong
- A. UC typically presents with bloody diarrhea, continuous inflammation limited to the colon and rectum, and superficial ulcerations. It does not usually involve skip lesions, deep ulcers, or perianal disease.
- C. IBS is a functional disorder without inflammation, weight loss, or structural changes like ulcers or skip lesions found on endoscopy.
- D. Diverticulitis presents with localized abdominal pain (usually LLQ), fever, and changes in bowel habits, but typically in older patients, and does not involve diffuse inflammation, skip lesions, or perianal disease.
Crohn's Disease
A chronic inflammatory bowel disease (IBD) characterized by transmural inflammation, skip lesions, and granulomas, that can affect any part of the gastrointestinal tract from mouth to anus.
- Commonly presents with abdominal pain, non-bloody diarrhea, and weight loss.
- Extra-intestinal manifestations (e.g., oral ulcers, perianal disease) are common.
- Endoscopic findings: patchy inflammation, skip lesions, deep ulcerations, cobblestoning.
Memory trick: CROHN'S: 'C'obblestone, 'R'egional (skip), 'O'ral ulcers, 'H'ole (transmural), 'N'o blood (often), 'S'kin tags.