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Common Crohn’s disease exam questions for medical finals, OSCEs and MRCP PACES


Question 1.

How does Crohn’s disease present?

  • Diarrhoea (can be bloody and/or chronic)
  • Abdominal pain
  • Weight loss
  • Malaise, anorexia, fever
  • Poor growth or delayed puberty in kids
  • Mouth ulcers
  • Abdominal
    • Abdominal tenderness and distension
    • Palpable masses
    • Anal/perianal skin tags, fissures and fistulas (may be asymptomatic)


Question 2.

What are the extra-intestinal manifestations of Crohn’s disease?

  • Arthritis
  • Conjunctivitis/Uveitis/Episcleritis
  • Erythema nodosum
  • Pyoderma granulosum (purulent ulcers with blue-black edge)
  • Clubbing


Question 3.

What are the macro and microscopic features of Crohn’s disease?


  • Distribution
    • 20% colonic; 30% ileocaecal; 40% small bowel
  • Bowel thickened and narrowed.
  • Deep fissures and ulcers in mucosa, giving a ‘cobblestone’ appearance.
  • Fistulae, abcesses and strictures.
  • Fat wrapping around affected bits of bowel
  • ‘Skip lesions’ – areas of unaffected bowel between inflamed areas.
  • Mouth ulcers and anal/peri-anal disease (ulcers, fissures, fistulae)


  • Full-thickness (transmural) inflammation
  • Increase in chronic inflammatory cells (macrophages)
  • Granulomata – not caseating


Question 4.

What are the complications of Crohn’s disease?

  • Toxic megacolon and perforation
  • Stricturing and bowel obstruction
  • Fistulae
  • Small bowel cancer (if ileal involvement)
    • NB. No overall increased risk of bowel cancer in IBD – only certain subgroups have increased risk (NEJM 2013)
  • Iron, folate and B12 deficiencies (terminal ileum disease)
  • Osteoporosis from steroid therapy
  • Short-bowel syndrome and malabsorption