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Ulcerative Colitis Flare — UKMLA MCQ

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ModerateGastroenterologyUlcerative Colitis FlareUKMLAMRCGP AKTPARAMRCP Part 1PSA

A 32-year-old with known ulcerative colitis presents to their GP with 6 bloody stools in the past 24 hours. Their temperature is 37.2°C, resting pulse is 92 beats/min and CRP is 28 mg/L. What is the best initial management?

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Correct answer: B — Arrange urgent hospital admission for intravenous corticosteroids and specialist management

This is acute severe ulcerative colitis: 6 bloody stools per day plus a resting pulse above 90 beats/min meets the NICE-adopted Truelove and Witts criteria. The patient therefore requires urgent hospital admission, gastroenterology and colorectal surgical involvement, and intravenous corticosteroids. Being afebrile does not exclude acute severe disease. A CRP above 45 mg/L predicts an increased likelihood of surgery but is not required for diagnosis. High-dose oral and topical mesalazine is appropriate for mild-to-moderate exacerbations, not acute severe colitis. Azathioprine has a delayed onset and is used for maintenance rather than acute induction. Empirical antibiotics are not routine unless infection or a septic complication is suspected.

Reference: NICE guideline NG130, Ulcerative colitis: management, sections 1.2.21–1.2.27 and Table 1: Truelove and Witts' severity index; published 2019, last reviewed March 2026. https://www.nice.org.uk/guidance/ng130/chapter/recommendations