Gastroenterology: acute severe ulcerative colitis: 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: acute severe ulcerative colitis

Sample item

A 26-year-old man with ulcerative colitis has 10 bloody stools daily for 4 days, pulse 112 per minute, temperature 38.2 C, haemoglobin 9 g/dL and CRP 90 mg/L. Abdominal radiograph shows no colonic dilatation. Stool tests for C. difficile and enteric pathogens are sent. What is the most appropriate initial drug treatment?

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

The answer and the reasoning

A. Intravenous corticosteroids

Six or more bloody stools daily with systemic toxicity (Truelove and Witts criteria) defines acute severe colitis, which needs admission and intravenous corticosteroids. If there is no clear response by day 3, rescue therapy with infliximab or ciclosporin is considered, and surgery if that fails. Infection must be excluded first.

Option by option

  • A. Intravenous corticosteroids (correct)

    Correct. Intravenous steroids are the standard initial therapy for acute severe colitis.

  • B. Higher-dose oral mesalazine alone

    Oral aminosalicylate is adequate only for mild to moderate disease and is too weak for a toxic patient.

  • C. Azathioprine induction

    Azathioprine takes weeks to work, so it is a maintenance drug and not suitable for induction in a severe attack.

  • D. Oral budesonide MMX

    Budesonide MMX acts mainly in the colon and is used for mild to moderate disease, not for a toxic severe attack.

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 A, Intravenous corticosteroids. Six or more bloody stools daily with systemic toxicity (Truelove and Witts criteria) defines acute severe colitis, which needs admission and intravenous corticosteroids.

Why is "Higher-dose oral mesalazine alone" not the answer?

Oral aminosalicylate is adequate only for mild to moderate disease and is too weak for a toxic patient.

Why is "Azathioprine induction" not the answer?

Azathioprine takes weeks to work, so it is a maintenance drug and not suitable for induction in a severe attack.

Why is "Oral budesonide MMX" not the answer?

Budesonide MMX acts mainly in the colon and is used for mild to moderate disease, not for a toxic severe attack.

What concept does this question test?

It tests Gastroenterology: acute severe ulcerative colitis in General Medicine. If there is no clear response by day 3, rescue therapy with infliximab or ciclosporin is considered, and surgery if that fails. Infection must be excluded first.

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: acute severe ulcerative colitis?

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.