Gastrointestinal: Crohn disease: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Gastrointestinal: Crohn disease

Sample item

A 24-year-old man has chronic diarrhoea, a right iliac fossa mass and a perianal fistula. An ileal resection shows skip lesions and mesenteric fat wrapping the bowel. Which morphological feature best explains his strictures and fistulae?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Transmural inflammation with lymphoid aggregates and deep fissuring ulcers

Crohn disease is characterised by transmural inflammation with skip lesions, lymphoid aggregates, deep fissuring ulcers, creeping fat and sometimes non-caseating granulomas. Transmural fibrosis causes strictures, while fissures tunnel through the wall into adjacent bowel, skin or bladder to form fistulae. Ulcerative colitis is mucosal and continuous from the rectum.

Option by option

  • A. A subepithelial collagen band with intraepithelial lymphocytes

    A thick subepithelial collagen band is collagenous colitis, a cause of watery diarrhoea with normal endoscopy.

  • B. Ischaemic submucosal fibrosis from occlusion of the superior mesenteric artery

    Ischaemic fibrosis follows mesenteric vascular compromise and would not give skip lesions with fat wrapping.

  • C. Transmural inflammation with lymphoid aggregates and deep fissuring ulcers (correct)

    Correct. Transmural disease with fissuring ulcers produces strictures and fistulae.

  • D. Inflammation confined to mucosa with crypt abscesses and pseudopolyps

    Mucosa-limited inflammation with crypt abscesses and pseudopolyps describes ulcerative colitis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Pathology questions

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is C, Transmural inflammation with lymphoid aggregates and deep fissuring ulcers. Crohn disease is characterised by transmural inflammation with skip lesions, lymphoid aggregates, deep fissuring ulcers, creeping fat and sometimes non-caseating granulomas.

Why is "A subepithelial collagen band with intraepithelial lymphocytes" not the answer?

A thick subepithelial collagen band is collagenous colitis, a cause of watery diarrhoea with normal endoscopy.

Why is "Ischaemic submucosal fibrosis from occlusion of the superior mesenter…" not the answer?

Ischaemic fibrosis follows mesenteric vascular compromise and would not give skip lesions with fat wrapping.

Why is "Inflammation confined to mucosa with crypt abscesses and pseudopolyps" not the answer?

Mucosa-limited inflammation with crypt abscesses and pseudopolyps describes ulcerative colitis.

What concept does this question test?

It tests Gastrointestinal: Crohn disease in Pathology. Transmural fibrosis causes strictures, while fissures tunnel through the wall into adjacent bowel, skin or bladder to form fistulae. Ulcerative colitis is mucosal and continuous from the rectum.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastrointestinal: Crohn disease?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.