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Adolescent confidentiality — USMLE Step 3 MCQ

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HardPediatrics (well-child, chronic management)Adolescent confidentialityUSMLE Step 3

A hospitalized patient with acute severe ulcerative colitis has 10 bloody stools daily and CRP 82 mg/L despite 3 days of IV methylprednisolone. C difficile testing is negative, abdominal radiography shows no megacolon, and colorectal surgery is involved. What is the best next treatment?

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Correct answer: C — Begin infliximab or cyclosporine rescue therapy with surgical follow-up

The best answer is “Begin infliximab or cyclosporine rescue therapy with surgical follow-up”. Failure to improve by day 3 indicates steroid-refractory acute severe colitis. Infliximab or cyclosporine is appropriate rescue therapy while surgical assessment continues; delay increases complications and colectomy risk. Antimotility therapy can precipitate toxic megacolon, and mesalamine is inadequate for this severity.

Reference: AGA Guideline: Management of Moderate-to-Severe Ulcerative Colitis: https://gastro.org/clinical-guidance/management-of-moderate-to-severe-ulcerative-colitis/