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Severe ulcerative colitis flare — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Severe ulcerative colitis flareUSMLE Step 3

A 58-year-old man with ulcerative colitis has increasing stool frequency and blood despite oral mesalamine. He has 8 stools daily, temperature 37.9°C, pulse 104/min, hemoglobin 10.4 g/dL, CRP 64 mg/L, and abdominal radiograph shows transverse colon diameter of 5 cm. Stool testing for Clostridioides difficile is negative. Which of the following is the most appropriate next step in management?

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Correct answer: A — Hospitalize for intravenous corticosteroids and monitoring

Severe ulcerative colitis flare with systemic features warrants hospitalization, IV corticosteroids, VTE prophylaxis, and close monitoring for toxic megacolon. Antimotility drugs are avoided in severe colitis.

Reference: American College of Gastroenterology Ulcerative Colitis Guideline