Inflammatory Bowel Disease USMLE Step 1 Practice Question
A 42-year-old woman with a 15-year history of ulcerative colitis presents for surveillance colonoscopy. She reports well-controlled symptoms on mesalamine monotherapy, with no diarrhea or hematochezia for the past 8 months. Vital signs are stable and hemoglobin is 12.8 g/dL. Colonoscopy reveals a 2-cm sessile lesion in the descending colon with areas of surrounding erythema and granularity. Biopsy of the lesion demonstrates high-grade dysplasia. The remainder of the colon appears minimally inflamed. Which of the following is the most appropriate next step in management?
Answer choices
- ARepeat colonoscopy with attempted endoscopic resection of the dysplastic lesion
- BIncrease mesalamine to high-dose therapy and perform surveillance colonoscopy in 3 months
- CTotal proctocolectomy with ileal pouch-anal anastomosisCorrect answer
- DSegmental colonic resection of the descending colon
- EInitiate combination therapy with infliximab and azathioprine, then reassess in 8 weeks
- FDefer intervention and perform annual surveillance colonoscopy given the patient's stable clinical course
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