A 28-year-old women has a history of chronic diarrhea and abdominal pain for five years,and now has rectovaginal fistul

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• 1患者男性，22岁，发现克罗恩病3个月，目前泼尼松减量中，5-ASA每日2g口服，近日突发腹痛及腹泻加重，下述不宜考虑的是

  A.克罗恩病复发

  B.激素减量太快

  C.5-ASA量不足

  D.如无禁忌，可同时加用TNF-α单抗

  E.克罗恩病导致结肠癌

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• 2患者男性，40岁，拟诊溃疡性结肠炎入院，腹泻每日10次以上，有明显黏液血便，T大于37.7℃，P大于90次/分，Hb小于等于75g/L，ESR大于30mm/h，血清白蛋白小于30g/L，短期内体重明显减轻，使用激素冲击2周无效，腹部平片见结肠扩张明显，进一步治疗考虑

  A.加大激素用量再使用1周

  B.肌注MTX每周15mg

  C.口服AZA 2mg/(kg·d)

  D.加大抗生素用量

  E.手术治疗

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• 3患者女性，19岁，溃疡性结肠炎入院治疗，腹泻每日4次以下，无全身症状，血沉正常，但粪便常规检査发现白细胞，下述哪项治疗不宜使用

  A.5-ASA

  B.SASP

  C.泼尼松

  D.抗生素

  E.益生菌

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• 4患者男性，20岁，黏液脓血便1个月伴低热，常规使用抗生素无效，粪便检查未发现寄生虫。钡剂灌肠发现直肠至横结肠黏膜炎症性改变伴浅溃疡形成，首先考虑

  A.溃疡性结肠炎

  B.克罗恩病

  C.肠结核

  D.结肠癌

  E.肠易激综合征

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• 5下述哪种药物属于炎症性肠病的生物治疗药物

  A.SASP

  B.5-ASA

  C.AZA

  D.6-MP

  E.TNF-α单抗

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• 6以下哪几项符合溃疡性结肠炎的内镜下表现

  A.黏膜粗糙呈细颗粒状，黏膜血管模糊，质脆易出血

  B.黏膜弥漫性充血、水肿伴多发性浅表溃疡，有脓血性分泌物黏附

  C.可见假性息肉(炎性息肉)形成，结肠袋往往变钝或消失

  D.可有糜烂、溃疡、隐窝脓肿、腺体排列异常、杯状细胞减少及上皮变化

  E.纵行或匍行溃疡伴周围黏膜正常或鹅卵石样改变

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• 7以下哪些是克罗恩病不同于溃疡性结肠炎的特征

  A.病变分布呈节段性

  B.直肠受累少见

  C.小肠受累

  D.纵行或匍行溃疡伴周围黏膜正常或鹅卵石样改变

  E.节段性全壁炎，有裂隙状溃疡，非干酪性肉芽肿

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• 8炎症性肠病的并发症包括

  A.中毒性结肠扩张

  B.结肠气囊肿

  C.直肠结肠癌变

  D.肠穿孔

  E.肠梗阻

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• 9案例：A 30-year-old man has a history of ulcerative colitis for five years.He has now had acute flare over one week，and developed high fever，bloody diarrhea with bowel movements more than 10 per day，as well as abdominal distention，cecum with a diameter of 13cm，and transverse colon diameter of 8cm on X-ray.Which of the following is the most likely diagnosis

  A.Ulcerative colitis with mild attack

  B.Ulcerative colitis with moderate attack

  C.Ulcerative colitis with colonic perforation

  D.Severe (or fulminant) ulcerative colitis with toxic megalon

  E.Ulcerative colitis with colonic obstruction

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• 10案例：A 30-year-old man has a history of ulcerative colitis for five years.He has now had acute flare over one week，and developed high fever，bloody diarrhea with bowel movements more than 10 per day，as well as abdominal distention，cecum with a diameter of 13cm，and transverse colon diameter of 8cm on X-ray.Which of the following is the best next step

  A.Oral proton pump inhibitor

  B.Oral azathioprine or 6-Mercaptopurine

  C.Antibiotics and prompt surgical consultation

  D.Diuretic therapy

  E.Oral 5-aminosalicylate

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