Inflammatory Bowel Disease USMLE Step 1 Practice Question
A 27-year-old woman with a 5-year history of ulcerative colitis presents to the emergency department with a 3-day history of crampy abdominal pain, bloody diarrhea 8-10 times daily, and fever to 38.9°C (102°F). She reports increased urgency and tenesmus. On examination, she appears ill, with diffuse abdominal tenderness and rebound tenderness. Vital signs show heart rate 110 bpm, blood pressure 95/58 mmHg, and respiratory rate 22/min. Laboratory studies reveal hemoglobin 9.2 g/dL, WBC 14,500/μL, albumin 2.8 g/dL, and CRP 8.2 mg/dL. Abdominal radiograph demonstrates a dilated colon with a maximum diameter of 6.5 cm. Stool studies are negative for Clostridioides difficile and infectious pathogens. Which of the following is the most appropriate next step in management?
Answer choices
- AInitiate infliximab therapy and transition to oral 5-aminosalicylates
- BPerform urgent colonoscopy with biopsy to confirm disease severity
- CAdminister broad-spectrum antibiotics and begin mesalamine therapy
- DBegin high-dose intravenous corticosteroids and consult surgeryCorrect answer
- EStart oral corticosteroids with antispasmodic agents for symptomatic relief
- FInitiate total parenteral nutrition and observe for clinical improvement over 72 hours
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