Inflammatory Bowel Disease USMLE Step 1 Practice Question
A 28-year-old woman with a 5-year history of ulcerative colitis presents to the emergency department with severe crampy abdominal pain, bloody diarrhea (15–20 stools daily), and fever. Vital signs: temperature 38.9°C, heart rate 118/min, blood pressure 102/68 mmHg, respiratory rate 22/min. Physical examination reveals diffuse abdominal tenderness with rebound and guarding. Laboratory studies show hemoglobin 9.2 g/dL, albumin 2.8 g/dL, C-reactive protein 12.4 mg/dL, and normal stool culture and C. difficile PCR. Abdominal X-ray shows colonic dilation to 7 cm without perforation. She is not currently on any medications and denies recent antibiotic use. Which of the following is the most appropriate next step in management?
Answer choices
- AInitiate high-dose intravenous corticosteroids, withhold oral intake, and correct fluid/electrolyte abnormalitiesCorrect answer
- BPerform emergency total proctocolectomy without medical optimization
- CBegin infliximab monoclonal antibody therapy immediately
- DAdminister broad-spectrum antibiotics and start oral mesalamine
- EPerform urgent colonoscopy with biopsy to assess disease severity
- FInitiate oral vancomycin and restrict all oral intake
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