American Board of Internal Medicine (ABIM) Certification Practice Exam

If a patient with ulcerative colitis does not respond to oral glucocorticoids, what alternative approach should be considered?

1. Increase oral intake

2. Switch to over-the-counter medications

3. Hospitalization for intravenous glucocorticoids

4. Cognitive behavior therapy

The correct answer is: Hospitalization for intravenous glucocorticoids

In patients with ulcerative colitis who do not respond adequately to oral glucocorticoids, the next step in management typically involves escalation of therapy, which often includes the use of intravenous glucocorticoids. This approach is essential in cases of moderate to severe ulcerative colitis flare-ups, as it allows for higher doses of medication to be delivered directly into the bloodstream, ensuring better distribution and more rapid effects compared to oral formulations. Intravenous glucocorticoids can help control inflammation more effectively and may lead to quicker clinical improvement in patients unable to manage their symptoms with oral therapy alone. Other options such as increasing oral intake or switching to over-the-counter medications are not effective strategies for managing an inadequate response and can exacerbate the patient's condition. Cognitive behavior therapy is primarily focused on addressing psychological aspects and may assist in managing chronic illness but is not appropriate as a primary treatment for the acute exacerbation of ulcerative colitis. Therefore, hospitalization for intravenous glucocorticoids is the most appropriate alternative approach when oral treatment fails.