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

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• 1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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• 2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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• 3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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• 4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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• 5A 28-year-old women has a history of chronic diarrhea and abdominal pain for five years,and now has rectovaginal fistul

  A.Which of the following is the most likely diagnosisA.Crohn disease

  B.Ulcerative colitis

  C.Systemic lupus erythematosus

  D.Irritable bowel syndrome

  E.Infectious colitis

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• 6案例：患者男性，19岁，黏液脓血便伴腹痛2个月，入院时腹泻每日6次以上，有明显黏液血便，T大于37.7℃，P大于90次/分，ESR大于30mm/h。目前哪项检查不宜使用

  A.粪常规

  B.p-ANCA和ASCA检测

  C.钡剂灌肠

  D.肠镜

  E.腹部平片

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• 7案例：患者男性，19岁，黏液脓血便伴腹痛2个月，入院时腹泻每日6次以上，有明显黏液血便，T大于37.7℃，P大于90次/分，ESR大于30mm/h。入院后该患者肠镜发现全结肠黏膜充血、水肿，溃疡形成，粪常规见大量白细胞，未见虫卵，首先考虑

  A.溃疡性结肠炎

  B.克罗恩病

  C.肠结核

  D.肠易激综合征

  E.肠癌

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• 8案例：患者男性，19岁，黏液脓血便伴腹痛2个月，入院时腹泻每日6次以上，有明显黏液血便，T大于37.7℃，P大于90次/分，ESR大于30mm/h。该患者排除小肠病变、结核及肝炎后，使用何种治疗较为合理

  A.5-ASA和AZA治疗

  B.5-ASA和激素冲击治疗

  C.MTX和使用TNF-α单抗

  D.益生菌和抗生素联合治疗

  E.甲硝唑联合他克莫司治疗

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• 9案例：患者男性，19岁，黏液脓血便伴腹痛2个月，入院时腹泻每日6次以上，有明显黏液血便，T大于37.7℃，P大于90次/分，ESR大于30mm/h。该患者经治疗后发现腹痛加剧，腹部立位平片表现为巨大肠腔扭曲，考虑

  A.治疗无效加大激素剂量

  B.治疗有效，可按缓解期治疗

  C.中毒性巨结肠

  D.加用肠内营养

  E.加大抗生素剂量

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