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Acute severe ulcerative colitis — SCE Acute Medicine MCQ

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EasyAcute Gastrointestinal PresentationsAcute severe ulcerative colitisSCE Acute Medicine

A 51-year-old woman presents with acute abdominal pain, bleeding, jaundice or vomiting. Relevant history includes gastrointestinal or hepatobiliary risk factors. On assessment, abdominal examination and physiology suggest significant acute illness. Investigations show bloody diarrhoea eight times daily with fever, tachycardia and high CRP. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Admit for intravenous corticosteroids, stool cultures and VTE prophylaxis

The key discriminator is that bloody diarrhoea eight times daily with fever, tachycardia and high CRP, which makes Admit for intravenous corticosteroids, stool cultures and VTE prophylaxis the single best answer. Optimise chronic medication and discharge is less appropriate because it does not address the dominant acute risk in the vignette; Arrange urgent specialist referral would fit a different presentation or later stage of care. Give analgesia and antiemetic therapy and Arrange routine outpatient follow-up are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: BSG IBD guideline; NICE NG130