Gastroenterology: toxic megacolon: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Gastroenterology: toxic megacolon

Sample item

A patient with severe ulcerative colitis has fever, tachycardia, abdominal distension and a transverse colon diameter of 7 cm on plain radiograph. What is the management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Intravenous fluids, steroids, broad-spectrum antibiotics, and early surgical review

Toxic megacolon is defined by colonic dilation above 6 cm with systemic toxicity. Management is bowel rest, fluids, intravenous corticosteroids, antibiotics and early colectomy if there is no improvement within 24 to 48 hours. Antimotility drugs, barium and full-prep colonoscopy risk perforation.

Option by option

  • A. Barium enema

    Barium enema risks perforation.

  • B. Colonoscopy with full preparation

    Colonoscopy with prep risks perforation.

  • C. Loperamide

    Loperamide can precipitate or worsen megacolon.

  • D. Intravenous fluids, steroids, broad-spectrum antibiotics, and early surgical review (correct)

    Correct. Medical resuscitation with early surgical review is correct.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Intravenous fluids, steroids, broad-spectrum antibiotics, and early surgical review. Toxic megacolon is defined by colonic dilation above 6 cm with systemic toxicity.

Why is "Barium enema" not the answer?

Barium enema risks perforation.

Why is "Colonoscopy with full preparation" not the answer?

Colonoscopy with prep risks perforation.

Why is "Loperamide" not the answer?

Loperamide can precipitate or worsen megacolon.

What concept does this question test?

It tests Gastroenterology: toxic megacolon in General Medicine. Management is bowel rest, fluids, intravenous corticosteroids, antibiotics and early colectomy if there is no improvement within 24 to 48 hours. Antimotility drugs, barium and full-prep colonoscopy risk perforation.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastroenterology: toxic megacolon?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.