American Board of Internal Medicine (ABIM) Certification Practice Exam

What is indicated for patients who initially respond to glucocorticoids in ulcerative colitis treatment?

1. Immediate surgery

2. Monitoring only

3. Tapering of glucocorticoids

4. Increased glucocorticoid dosage

The correct answer is: Tapering of glucocorticoids

In the management of ulcerative colitis, when a patient initially responds to glucocorticoid therapy, it is crucial to taper the dosage of glucocorticoids rather than continuing at full or increased doses. This approach is necessary to reduce the risk of potential side effects associated with prolonged high-dose glucocorticoid use, which may include infections, osteoporosis, adrenal suppression, and gastric ulcers. Tapering glucocorticoids allows for the gradual reduction of medication while monitoring for disease flare-ups. This is important because some patients can remain in remission or experience sufficient symptom control with lower doses. Therefore, the guidance on tapering glucocorticoids strikes a balance between managing the condition effectively and minimizing adverse effects. In contrast, options that suggest immediate surgery or monitoring only would not adequately address ongoing treatment needs or the potential challenges of flare-ups, whereas increasing the glucocorticoid dosage fails to consider the goal of minimizing medication risks and maintaining patient safety. Thus, tapering of glucocorticoids is the best practice for patients showing an initial positive response to treatment in this context.