American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the treatment option for ulcerative colitis patients whose symptoms do not respond to glucocorticoids?

1. Antibiotics

2. Colectomy

3. IV fluids

4. Oral steroids

The correct answer is: Colectomy

In patients with ulcerative colitis who do not respond to glucocorticoids, a colectomy, or surgical removal of the colon, is a definitive treatment option. This procedure may be considered when medical management fails, particularly in cases of severe disease, complications like perforation, or significant side effects from medications. Glucocorticoids are often used to control inflammation during flare-ups of ulcerative colitis. If symptoms persist despite appropriate glucocorticoid therapy, the severity of the condition might necessitate surgical intervention to alleviate symptoms and prevent further complications. Surgical options may range from a partial colectomy to total colectomy, sometimes accompanied by formation of an ostomy or ileal pouch-anal anastomosis. The other treatment options listed, such as antibiotics or oral steroids, do not directly address the underlying pathology of ulcerative colitis in the same definitive way that a colectomy would. Antibiotics are typically not indicated unless there is a concurrent infection, and while oral steroids may help manage inflammation, they are not effective when a patient is already refractory to glucocorticoids. IV fluids are supportive and not a curative approach for the disease itself. Hence, in this context, colectomy represents an important surgical