Inflammatory Bowel Disease USMLE Step 1 Practice Question
A 26-year-old man with Crohn disease of the terminal ileum presents to clinic with worsening right lower quadrant pain and early satiety over the past 4 weeks despite 8 weeks of infliximab monotherapy at standard induction and maintenance doses. He denies fever, weight loss, or changes in bowel habits. Vital signs are stable with normal temperature. Laboratory studies show hemoglobin 13.2 g/dL, WBC 7,200/μL, CRP 2.1 mg/dL (normal <3.0), and albumin 3.8 g/dL. CT enterography demonstrates a 4-cm segment of terminal ileal stricturing with proximal small bowel dilation to 3.5 cm but no fistulas, abscesses, or mesenteric fat stranding. Which of the following is the most appropriate next step in management?
Answer choices
- AIncrease the infliximab dose and add azathioprine for combination immunosuppression
- BInitiate systemic corticosteroids and escalate to vedolizumab
- CPerform colonoscopy with attempted endoscopic balloon dilation of the strictureCorrect answer
- DRefer for surgical resection of the terminal ileum
- EStart a liquid diet trial with mesalamine and repeat imaging in 6 weeks
- FInitiate ustekinumab as a biologic-class switch agent
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