American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the first-line treatment for patients with mild to moderate ulcerative colitis?

1. 5-aminosalicylate agents

2. Glucocorticoids

3. Thiopurines

4. Anti-TNF agents

The correct answer is: 5-aminosalicylate agents

The first-line treatment for patients with mild to moderate ulcerative colitis is 5-aminosalicylate agents. These medications, such as mesalamine, are specifically designed to reduce inflammation in the colon and are effective in managing the symptoms and achieving remission in ulcerative colitis. They work topically on the colonic mucosa, leading to localized anti-inflammatory effects, which is particularly beneficial in this condition. Using 5-aminosalicylate agents for initial management is supported by clinical guidelines, as they have a favorable safety profile and are generally well tolerated by patients. This category of medication is considered safe for long-term use and has demonstrated efficacy in maintaining remission after initial treatment, addressing both the acute and chronic aspects of the disease. Other treatment options listed have their roles in managing ulcerative colitis, but they are typically reserved for patients who do not respond adequately to 5-aminosalicylate agents or who have more severe disease. Glucocorticoids, for instance, are effective for acute flares but are not recommended for long-term management due to potential side effects. Thiopurines and anti-TNF agents are used in more severe or refractory cases, highlighting the importance of starting treatment with