Inflammatory Bowel Disease USMLE Step 1 Practice Question
A 42-year-old woman with a 10-year history of ulcerative colitis presents for surveillance colonoscopy. She reports well-controlled symptoms on mesalamine monotherapy with no abdominal pain, diarrhea, or rectal bleeding over the past 6 months. Vital signs are normal and laboratory studies show hemoglobin 13.5 g/dL, normal C-reactive protein, and normal fecal calprotectin. During colonoscopy, the mucosa appears quiescent without active inflammation. However, random biopsies reveal dysplasia in multiple non-contiguous segments of the colon without an endoscopically visible lesion or mass. Which of the following is the most appropriate next step in management?
Answer choices
- ARepeat colonoscopy with dye-based or virtual chromoendoscopy and targeted biopsies of any suspicious areas
- BInitiate combination therapy with infliximab and azathioprine to suppress dysplasia development
- CPerform immediate proctocolectomy with ileal pouch-anal anastomosisCorrect answer
- DIncrease 5-aminosalicylic acid dosing and repeat colonoscopy in 3 months
- EPerform endoscopic mucosal resection of all biopsied areas and continue medical surveillance
- FContinue current medical therapy with repeat colonoscopy in 12 months with standard four-quadrant biopsies
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