Inflammatory bowel diseases MCQs With Answer

In this focused review for B.Pharm students, Inflammatory bowel diseases MCQs With Answer provide a concise, exam-oriented resource to master pathophysiology, clinical features, diagnostics, and pharmacotherapy of ulcerative colitis and Crohn’s disease. These IBD MCQs cover mechanisms of action, drug selection, therapeutic drug monitoring, adverse effects, biosimilars, biologics (anti-TNF, anti-integrin, anti-IL12/23), JAK inhibitors, and perioperative and pregnancy considerations. Topics span epidemiology, immunology, diagnostic biomarkers, and complications such as colorectal cancer and fistulizing disease. Each question reinforces drug mechanisms, lab monitoring (TPMT, LFTs, CBC), and evidence-based treatment decisions relevant to pharmacy practice. Answers include clear key points for quick revision. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which two conditions are classically grouped under inflammatory bowel disease (IBD)?

• Ulcerative colitis and Crohn’s disease
• Irritable bowel syndrome and celiac disease
• Peptic ulcer disease and diverticulitis
• Gastritis and gastroenteritis

Correct Answer: Ulcerative colitis and Crohn’s disease

Q2. Which histologic feature most reliably helps distinguish Crohn’s disease from ulcerative colitis?

• Non-caseating granulomas
• Continuous mucosal inflammation starting at the rectum
• Crypt abscesses only
• Predominantly left-sided colonic involvement

Correct Answer: Non-caseating granulomas

Q3. Which of the following is a hallmark endoscopic pattern of ulcerative colitis?

• Continuous mucosal inflammation beginning at the rectum
• Patchy transmural inflammation with fistulae
• Multiple aphthous ulcers in the small intestine
• Normal colonoscopy with functional symptoms

Correct Answer: Continuous mucosal inflammation beginning at the rectum

Q4. Which biomarker is most useful for assessing intestinal inflammation noninvasively in IBD?

• Fecal calprotectin
• Serum amylase
• Serum ceruloplasmin
• Urinary 5-HIAA

Correct Answer: Fecal calprotectin

Q5. Which of the following is the primary mechanism of action of mesalazine (5-ASA)?

• Topical anti-inflammatory effects via inhibition of prostaglandin and leukotriene synthesis
• Systemic immunosuppression by DNA synthesis inhibition
• TNF-alpha neutralization
• JAK-STAT pathway inhibition

Correct Answer: Topical anti-inflammatory effects via inhibition of prostaglandin and leukotriene synthesis

Q6. Sulfasalazine contains sulfapyridine and 5-ASA; which adverse effect is most specifically associated with the sulfapyridine moiety?

• Oligospermia and sulfa hypersensitivity
• Renal tubular acidosis
• Pulmonary fibrosis
• QT prolongation

Correct Answer: Oligospermia and sulfa hypersensitivity

Q7. Which corticosteroid is commonly used as first-line for induction of remission in moderate-to-severe IBD?

• Prednisone
• Hydrocortisone sodium succinate inhalation
• Dexamethasone oral single low dose
• Fludrocortisone

Correct Answer: Prednisone

Q8. Which steroid has high first-pass hepatic metabolism and is useful for ileocecal Crohn’s disease with fewer systemic effects?

• Budesonide
• Methylprednisolone acetate
• Hydrocortisone
• Prednisolone

Correct Answer: Budesonide

Q9. Azathioprine and 6-mercaptopurine exert effects primarily by which mechanism?

• Inhibition of purine synthesis leading to decreased lymphocyte proliferation
• Blocking TNF-alpha signaling
• Inhibiting JAK kinases
• Neutralizing integrin receptors

Correct Answer: Inhibition of purine synthesis leading to decreased lymphocyte proliferation

Q10. Prior to starting azathioprine, which test is recommended to assess risk of myelotoxicity?

• Thiopurine methyltransferase (TPMT) activity/genotype
• HLA-B*5701 typing
• Serum ferritin
• Serum complement C3

Correct Answer: Thiopurine methyltransferase (TPMT) activity/genotype

Q11. Which serious adverse effect is classically associated with thiopurines (azathioprine/6-MP)?

• Bone marrow suppression (leukopenia)
• Hyperglycemia and insulin resistance
• Severe hypertension
• Nephrolithiasis

Correct Answer: Bone marrow suppression (leukopenia)

Q12. Which biologic is a chimeric monoclonal antibody targeting TNF-alpha used in IBD?

• Infliximab
• Vedolizumab
• Ustekinumab
• Tofacitinib

Correct Answer: Infliximab

Q13. Which biologic is gut-selective by blocking the α4β7 integrin and has lower systemic immunosuppression?

• Vedolizumab
• Adalimumab
• Infliximab
• Certolizumab pegol

Correct Answer: Vedolizumab

Q14. Ustekinumab exerts its therapeutic effect in IBD by blocking which targets?

• Interleukins 12 and 23 (IL-12/23)
• TNF-alpha and IL-6
• Integrin α4β7
• JAK1 and JAK3

Correct Answer: Interleukins 12 and 23 (IL-12/23)

Q15. Which oral small molecule JAK inhibitor is approved for moderate-to-severe ulcerative colitis?

• Tofacitinib
• Ruxolitinib
• Baricitinib
• Tolebrutinib

Correct Answer: Tofacitinib

Q16. Before starting anti-TNF therapy, which screening is essential?

• Screening for latent tuberculosis (TB)
• 24-hour urine collection for catecholamines
• Electrocardiogram (ECG) for QT interval
• Colonoscopy with chromoendoscopy

Correct Answer: Screening for latent tuberculosis (TB)

Q17. Which adverse effect is a known risk of tofacitinib therapy in IBD and needs monitoring?

• Increased risk of venous thromboembolism (VTE) and lipid abnormalities
• Severe hypokalemia
• Photosensitivity rash exclusively
• Osteomalacia

Correct Answer: Increased risk of venous thromboembolism (VTE) and lipid abnormalities

Q18. Which monitoring labs are routinely recommended for patients on thiopurines?

• Complete blood count (CBC) and liver function tests (LFTs)
• Urinalysis and serum magnesium
• Fasting blood glucose and hemoglobin A1c
• Thyroid function tests

Correct Answer: Complete blood count (CBC) and liver function tests (LFTs)

Q19. Which is the most appropriate management approach for acute severe ulcerative colitis hospitalized patient?

• Intravenous corticosteroids
• Immediate initiation of methotrexate alone
• Oral 5-ASA monotherapy only
• Watchful waiting without therapy

Correct Answer: Intravenous corticosteroids

Q20. Which complication is Crohn’s disease more likely to cause compared with ulcerative colitis?

• Fistula and strictures due to transmural inflammation
• Continuous mucosal hemorrhage only
• Higher risk of pouchitis after colectomy
• Primarily hepatic steatosis

Correct Answer: Fistula and strictures due to transmural inflammation

Q21. Which imaging modality is preferred for small bowel Crohn’s disease assessment?

• MR enterography
• Abdominal X-ray upright
• Chest radiograph
• Transvaginal ultrasound

Correct Answer: MR enterography

Q22. Which statement about smoking and IBD is correct?

• Smoking increases risk and severity of Crohn’s disease but may reduce risk of ulcerative colitis
• Smoking decreases risk of Crohn’s disease uniformly
• Smoking has no impact on either disease
• Smoking cures ulcerative colitis permanently

Correct Answer: Smoking increases risk and severity of Crohn’s disease but may reduce risk of ulcerative colitis

Q23. Therapeutic drug monitoring (TDM) for biologics commonly measures which parameter?

• Drug trough levels and anti-drug antibodies
• Peak plasma concentration only
• Urine excretion of drug metabolites
• Bone marrow drug levels

Correct Answer: Drug trough levels and anti-drug antibodies

Q24. Which vaccination is contraindicated for patients on high-dose immunosuppression?

• Live attenuated vaccines (e.g., live zoster)
• Inactivated influenza vaccine
• Pneumococcal conjugate vaccine
• Tetanus toxoid (inactivated)

Correct Answer: Live attenuated vaccines (e.g., live zoster)

Q25. What is the main rationale for TPMT testing before thiopurine therapy?

• To identify patients at risk for excessive active metabolite accumulation and myelotoxicity
• To detect hepatitis B infection
• To measure renal clearance capacity
• To check vitamin B12 levels

Correct Answer: To identify patients at risk for excessive active metabolite accumulation and myelotoxicity

Q26. Which antibiotic is often used for Crohn’s disease with perianal disease or abscesses?

• Metronidazole
• Amoxicillin-clavulanate
• Ceftriaxone
• Nitrofurantoin

Correct Answer: Metronidazole

Q27. Which of the following is a recognized extraintestinal manifestation of IBD?

• Primary sclerosing cholangitis (PSC)
• Type I diabetes mellitus
• Multiple sclerosis
• Chronic obstructive pulmonary disease

Correct Answer: Primary sclerosing cholangitis (PSC)

Q28. Which therapy is considered steroid-sparing maintenance therapy in IBD?

• Azathioprine or methotrexate
• Short course prednisone for every flare
• Continuous high-dose opioids
• Daily proton pump inhibitor only

Correct Answer: Azathioprine or methotrexate

Q29. What is the principal therapeutic use of topical mesalazine (enema or suppository) in IBD?

• Distal ulcerative colitis (proctitis or left-sided disease)
• Perianal Crohn’s fistula closure
• Small bowel Crohn’s disease exclusively
• Prevention of colorectal cancer in H. pylori infection

Correct Answer: Distal ulcerative colitis (proctitis or left-sided disease)

Q30. Which drug interaction is important when using azathioprine concomitantly?

• Allopurinol increases active thiopurine metabolites and requires dose reduction of azathioprine
• Azathioprine increases warfarin effect dramatically
• Coadministration with SSRIs causes serotonin syndrome
• Azathioprine reduces efficacy of oral contraceptives

Correct Answer: Allopurinol increases active thiopurine metabolites and requires dose reduction of azathioprine

Q31. Which factor increases colorectal cancer risk in ulcerative colitis patients?

• Long duration and extensive colonic involvement
• Exclusive proctitis of short duration
• Use of mesalazine maintenance therapy
• Young age at diagnosis with only ileal disease

Correct Answer: Long duration and extensive colonic involvement

Q32. Which adverse effect is commonly associated with anti-TNF agents?

• Increased risk of serious infections
• Severe hypocalcemia
• Widespread pigmentary skin loss
• Recurrent kidney stones

Correct Answer: Increased risk of serious infections

Q33. Which statement best describes biosimilars in IBD management?

• Biosimilars are highly similar to reference biologics with no clinically meaningful differences in safety or efficacy
• Biosimilars are generic small-molecule copies identical to biologics
• Biosimilars are always less effective than originators
• Biosimilars are live vaccines used for IBD

Correct Answer: Biosimilars are highly similar to reference biologics with no clinically meaningful differences in safety or efficacy

Q34. Which lab abnormality may indicate hepatotoxicity from methotrexate therapy?

• Elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST)
• Decreased serum creatinine only
• Isolated low albumin with normal transaminases
• Elevated hemoglobin

Correct Answer: Elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST)

Q35. Which contraceptive advice is relevant for patients starting methotrexate?

• Avoid pregnancy and use reliable contraception due to teratogenicity
• No special contraceptive advice is required
• Only barrier methods are contraindicated
• Methotrexate enhances fertility so contraception is unnecessary

Correct Answer: Avoid pregnancy and use reliable contraception due to teratogenicity

Q36. Pouchitis most commonly occurs after which surgical procedure?

• Proctocolectomy with ileal pouch-anal anastomosis (IPAA)
• Appendectomy
• Gastric bypass
• Cholecystectomy

Correct Answer: Proctocolectomy with ileal pouch-anal anastomosis (IPAA)

Q37. Which medication is contraindicated in pregnant women with IBD?

• Thalidomide (due to teratogenicity)
• Mesalazine (in recommended doses)
• Infliximab (may be continued with monitoring)
• Azathioprine (often continued if benefits outweigh risks)

Correct Answer: Thalidomide (due to teratogenicity)

Q38. Which endoscopic surveillance frequency is recommended for long-standing extensive ulcerative colitis starting 8–10 years after diagnosis?

• Surveillance colonoscopy every 1–3 years depending on risk factors
• No surveillance required at any time
• Surveillance only every 10–15 years
• Daily fecal occult blood testing instead of colonoscopy

Correct Answer: Surveillance colonoscopy every 1–3 years depending on risk factors

Q39. Which immunization is specifically recommended for IBD patients receiving immunosuppressive therapy?

• Inactivated influenza and pneumococcal vaccines
• Live oral polio vaccine
• Live intranasal influenza vaccine
• BCG vaccine

Correct Answer: Inactivated influenza and pneumococcal vaccines

Q40. What is the mechanism of action of certolizumab pegol?

• Anti-TNF-alpha monoclonal antibody fragment (PEGylated)
• Alpha-4 integrin antagonist
• IL-6 receptor antagonist
• Small-molecule JAK inhibitor

Correct Answer: Anti-TNF-alpha monoclonal antibody fragment (PEGylated)

Q41. Which clinical feature favors a diagnosis of ulcerative colitis over Crohn’s disease?

• Bloody diarrhea with continuous colonic involvement
• Perianal fistulas and transmural disease
• Skip lesions with small bowel strictures
• Isolated mouth ulcers only

Correct Answer: Bloody diarrhea with continuous colonic involvement

Q42. Which medication class is most appropriate for maintenance of remission in mild-to-moderate ulcerative colitis?

• 5-aminosalicylic acid (5-ASA) agents
• Short-course systemic corticosteroids indefinitely
• High-dose systemic antibiotics chronically
• Iron supplements as sole therapy

Correct Answer: 5-aminosalicylic acid (5-ASA) agents

Q43. Loss of response to a biologic may be due to which common mechanism?

• Development of anti-drug antibodies
• Improved drug bioavailability over time
• Spontaneous remission of disease
• Excessive dietary fiber

Correct Answer: Development of anti-drug antibodies

Q44. Which laboratory finding is typical in active IBD inflammation?

• Elevated C-reactive protein (CRP)
• Low erythrocyte sedimentation rate (ESR) always
• Decreased white blood cell count in all cases
• Hypernatremia specific to IBD

Correct Answer: Elevated C-reactive protein (CRP)

Q45. Which medication is known for causing pulmonary fibrosis as a rare adverse effect in IBD treatment?

• Methotrexate
• Mesalazine
• Vedolizumab
• Adalimumab

Correct Answer: Methotrexate

Q46. In IBD pharmacotherapy, what is primary goal of induction therapy?

• Rapid control of active inflammation and symptoms
• Providing lifelong prophylactic antibiotics
• Eradicating gut microbiota completely
• Only nutritional supplementation without drugs

Correct Answer: Rapid control of active inflammation and symptoms

Q47. Which clinical scenario is an indication for urgent colectomy in ulcerative colitis?

• Toxic megacolon with perforation
• Intermittent mild rectal bleeding only
• Asymptomatic mild disease on mesalazine
• Stable disease with normal CRP

Correct Answer: Toxic megacolon with perforation

Q48. Which medication requires monitoring of lipid profile due to potential elevations during therapy?

• Tofacitinib
• Mesalazine
• Metronidazole
• Vedolizumab

Correct Answer: Tofacitinib

Q49. Which counseling point is important when dispensing sulfasalazine to male patients?

• It may cause reversible oligospermia; fertility usually returns after discontinuation
• It permanently sterilizes males
• It increases testosterone levels dramatically
• No reproductive side effects exist

Correct Answer: It may cause reversible oligospermia; fertility usually returns after discontinuation

Q50. Which therapeutic approach is preferred for perianal fistulizing Crohn’s disease refractory to antibiotics?

• Anti-TNF therapy such as infliximab
• Oral 5-ASA monotherapy
• High-dose vitamin C and herbal supplements
• Immediate ileostomy without medical therapy

Correct Answer: Anti-TNF therapy such as infliximab

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