skip to main content

Acute severe ulcerative colitis — SCE Acute Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardAcute GI PresentationsAcute severe ulcerative colitisSCE Acute Medicine

A 29-year-old woman with ulcerative colitis presents with ten bloody stools per day, fever 38.4 C and HR 118. Hb is 92 g/L, CRP 88 mg/L and abdominal radiograph shows transverse colon diameter 5.2 cm. Stool cultures and C difficile toxin are sent. What is the most appropriate next step in management?

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

Reveal the answer and explanation

Correct answer: D — Start intravenous corticosteroids with joint gastroenterology and surgical review

This is acute severe ulcerative colitis by stool frequency and systemic toxicity, requiring admission, IV steroids and early gastroenterology-surgical involvement. Loperamide can precipitate toxic megacolon and should be avoided. Microbiology tests are essential but treatment should not wait in a severe flare. The day-three response to steroids often determines escalation to rescue therapy or colectomy.

Reference: BSG inflammatory bowel disease guideline, NICE NG130, BNF