Inflammatory Bowel Disease USMLE Step 1 Practice Question
A 38-year-old man with a 10-year history of Crohn disease presents to the emergency department with acute-onset periumbilical abdominal pain, nausea, and bilious vomiting for 6 hours. He reports his last bowel movement was 2 days ago. Vital signs: BP 138/82 mmHg, HR 102/min, RR 20/min, temperature 37.2°C. On physical examination, the abdomen is distended and hyperactive high-pitched bowel sounds are appreciated; there is no rebound tenderness or guarding. Abdominal radiograph shows multiple air-fluid levels and dilated small bowel loops with a transition point in the proximal ileum. Laboratory studies reveal albumin 3.2 g/dL, hemoglobin 11.2 g/dL, and WBC 7,800/μL. Which of the following is the most likely diagnosis?
Answer choices
- AAcute exacerbation of Crohn disease with severe inflammation
- BSmall bowel obstruction from adhesions secondary to prior abdominal surgery
- CSmall bowel obstruction from fibrotic stricture formationCorrect answer
- DToxic megacolon complicated by intestinal perforation
- ECrohn disease with acute enterocutaneous fistula formation
- FSmall bowel volvulus with ischemic compromise
See the full explanation
Get the correct-answer rationale, why each distractor is wrong, the underlying mechanism, and high-yield associations — plus adaptive practice that targets your weak areas — with a free MedBoardPRO account.