American Board of Internal Medicine (ABIM) Certification Practice Exam

What is often the first-line treatment for moderate to severe ulcerative colitis?

1. Oral glucocorticoids such as prednisone

2. Monoclonal antibodies

3. Immunosuppressants

4. Antibiotics

The correct answer is: Oral glucocorticoids such as prednisone

First-line treatment for moderate to severe ulcerative colitis typically involves the use of oral glucocorticoids, such as prednisone. This approach is grounded in the understanding that glucocorticoids are effective anti-inflammatory agents that can help quickly reduce inflammation in the colonic mucosa, leading to symptomatic relief and improvement in the disease's underlying pathology. In patients with moderate to severe ulcerative colitis, corticosteroids are particularly useful during exacerbations due to their ability to achieve rapid control of inflammation. They are often preferred because of their relatively quick onset of action compared to other therapies. While monoclonal antibodies, immunosuppressants, and antibiotics can also play roles in the management of ulcerative colitis, they are generally considered for more specific cases or in patients who do not respond adequately to first-line therapies. Monoclonal antibodies, such as infliximab or adalimumab, are typically used for people with more severe disease or those who have not responded to initial treatments. Immunosuppressants might be used in chronic or maintenance therapy rather than as first-line treatment for acute exacerbations. Antibiotics are generally not a first-line treatment for ulcerative colitis, as the condition is primarily an inflammatory process