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Inflammatory bowel disease flare — MCCQE Part 1 MCQ

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ModerateDiarrheaInflammatory bowel disease flareMCCQE Part 1

27-year-old woman presents with bloody diarrhoea and abdominal pain. She has weight loss, elevated CRP and faecal calprotectin; stool cultures are pending. Which of the following is the most appropriate next step?

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Correct answer: A — Exclude infection, assess severity and arrange gastroenterology-directed therapy

Exclude infection, assess severity and arrange gastroenterology-directed therapy is best because bloody diarrhoea with inflammatory markers suggests IBD flare but infection must be excluded. Discharge with reassurance and routine follow-up only is suboptimal because it underestimates acute or progressive risk; Treat symptomatically and defer definitive assessment is suboptimal because symptom control alone does not address the likely underlying diagnosis; Arrange non-urgent outpatient imaging in several months is suboptimal because delayed imaging is unsafe when the presentation has red flags; Start long-term corticosteroids without confirming the diagnosis is suboptimal because empiric steroids can obscure infection, malignancy or other diagnoses. In IBD, rule out C. difficile and other infection before escalating immunosuppression.

Reference: Canadian Association of Gastroenterology IBD guideline