USMLE PRACTICE QUESTION OF THE WEEK

Question for September 19, 2025

A 48-year-old man with a history of ulcerative colitis presents to the emergency department with fever, abdominal pain, and bloody diarrhea. He also reports increasing abdominal distension over the past day. On examination, he is tachycardic and hypotensive. The abdomen is markedly distended and tender with decreased bowel sounds. Abdominal X-ray reveals a massively dilated colon with loss of haustral markings.

Which of the following is the most appropriate next step in management?

A. Administer oral corticosteroids and observe

B. Begin broad-spectrum antibiotics and supportive care

C. Immediate colonoscopic decompression

D. Intravenous corticosteroids and surgical consultation

E. Repeat abdominal X-ray in 6 hours

Get Detailed Explanation

Correct Answer:

D. Intravenous corticosteroids and surgical consultation

Correct Answer Explanation

The patient's toxic megacolon secondary to ulcerative colitis (severe distension, fever, hypotension) requires IV corticosteroids and urgent surgical consultation secondary to the risk of perforation.

Why These Are Incorrect:

A. Oral therapy is insufficient for toxic megacolon; urgent IV management is needed.
B. Antibiotics are adjunctive but corticosteroids are primary for UC-induced toxic megacolon.
C. Colonoscopy is not recommended due to the risk of perforation in delicate colonic walls.
E. Delaying intervention risks perforation and sepsis.