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Central line infection prevention — USMLE Step 2 CK MCQ

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HardEthics, patient safety, quality improvementCentral line infection preventionUSMLE Step 2 CK

A 37-year-old hospitalized with acute severe ulcerative colitis receives intravenous methylprednisolone and pharmacologic VTE prophylaxis. Stool testing for C difficile is negative. On day 3 she still has 9 bloody stools daily, tachycardia and rising CRP without perforation or toxic megacolon. What is the next treatment step?

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Correct answer: C — Begin rescue therapy with infliximab or cyclosporine

Persistent acute severe ulcerative colitis after 3 days of appropriately dosed intravenous corticosteroids warrants rescue therapy with infliximab or cyclosporine while colorectal surgery remains involved. Continuing ineffective steroids through day 7 delays rescue and increases complications. Immediate colectomy is required for perforation, uncontrolled hemorrhage, toxic megacolon or failed rescue, none of which is present. Oral tofacitinib and intravenous vedolizumab are not the guideline-standard day-3 rescue choices in this setting.

Reference: ACG 2025 guideline for ulcerative colitis in adults: https://gi.org/journals-publications/ebgi/alkazzi_aug2025/