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Tricks of the Trade – Ulcerative Colitis Therapy

  1. Which of the following is the preferred first-line therapy for induction and maintenance of remission in a patient with mild, distal ulcerative colitis (UC)?

    • A) Rectal corticosteroids
    • B) Rectal 5-ASA
    • C) Oral corticosteroids
    • D) Infliximab
  2. What is the hallmark symptom of UC?

    • A) Abdominal pain
    • B) Fever
    • C) Bloody diarrhea
    • D) Toxic megacolon
  3. Which of the following is recommended for induction of remission as well as maintenance of remission for a patient with mild-to-moderate UC?

    • A) Oral corticosteroids
    • B) Azathioprine
    • C) Probiotics
    • D) Oral 5-ASA
  4. A patient presents with more than 6 bloody stools per day, abdominal tenderness, and tachycardia. How would you classify the patient's UC?

    • A) Mild
    • B) Moderate
    • C) Severe
    • D) Fulminant
  5. Which of the following should be monitored biweekly when initiating therapy or increasing the dose of AZA or 6-MP?

    • A) Complete blood count
    • B) Electrocardiogram
    • C) Liver function tests
    • D) Renal function
  6. Which of the following is a prodrug that is activated by colonic bacteria when given orally?

    • A) Budesonide
    • B) Balsalazide
    • C) Mesalamine
    • D) Prednisolone
  7. Where is a patient with proctosigmoiditis experiencing inflammation?

    • A) Entire colon
    • B) Sigmoid colon and rectum
    • C) Rectum only
    • D) Descending colon only
  8. Which of the following is NOT a reason to suggest oral 5-ASA rather than rectal 5-ASA in a patient with mild UC?

    • A) A patient is noncompliant with rectal 5-ASA therapy due to discomfort on instillation
    • B) The inflammation extends throughout the entire colon
    • C) A patient is unwilling to self-administer rectal 5-ASA
    • D) Oral 5-ASA has a faster onset of action
  9. Adverse effects that may occur with oral 5-ASA therapy include which of the following?

    • A) Mild gastrointestinal complaints
    • B) Interstitial nephritis
    • C) Pancreatitis
    • D) All of the above
  10. Which of the following can be used for maintenance of remission in patients with corticosteroid-dependent UC?

    • A) Azathioprine
    • B) Cyclosporine
    • C) Nicotine
    • D) Rectal corticosteroids
  11. In which of the following situations should IV cyclosporine be used in a patient with UC?

    • A) Maintenance of remission in patients experiencing side effects with oral 5-ASA
    • B) Mild to moderate active disease refractory to oral corticosteroids
    • C) Hospitalized patients with severe disease refractory to IV corticosteroids
    • D) Ambulatory patients having multiple exacerbations requiring PO corticosteroids
  12. Which of the following adverse effects is the most common severe complication resulting from cyclosporine therapy?

    • A) Nephrotoxicity
    • B) Myocardial infarction
    • C) Lymphoma
    • D) Infusion related allergic reactions
  13. Which of the following statements about infliximab therapy is INCORRECT?

    • A) Infliximab is effective for both induction and maintenance of remission for ambulatory patients with UC that are intolerant to conventional therapies
    • B) Infliximab is more effective than cyclosporine for IV corticosteroid-refractory UC
    • C) Infliximab is given as a 2 hour IV infusion every 8 weeks for maintenance of remission
    • D) Diphenhydramine and acetaminophen can be used to treat the minor infusion related adverse effects associated with infliximab
  14. Which of the following should be given to all patients with UC who require frequent courses of high dose corticosteroids?

    • A) Probiotics
    • B) Parenteral nutrition
    • C) Nicotine gum
    • D) Calcium and vitamin D
  15. Surgery is recommended immediately in which of the following patients?

    • A) A patient diagnosed with colon cancer
    • B) A hospitalized patient being treated with IV corticosteroids
    • C) A patient who developed pancreatitis from oral 5-ASA therapy
    • D) A patient not responding to high doses of oral 5-ASA and rectal 5-ASA
  16. A patient who has previously been treated with oral and rectal 5-ASA is now experiencing a moderate exacerbation of his UC. Which of the following is the most appropriate treatment?

    • A) Initiate 6-MP therapy as an outpatient
    • B) Begin weekly infusions with infliximab
    • C) Admit the patient to the hospital for IV corticosteroids
    • D) Begin oral corticosteroids and taper once the patient responds to therapy
  17. Which of the following is true of UC?

    • A) It may involve the stomach, small intestine, and colon
    • B) It is associated with fistulas and transmural ulceration
    • C) It is rarely associated with diarrhea or abdominal pain
    • D) It is associated with mucosal ulceration and inflammation in a continuous spread
  18. Which of the following is a life threatening condition associated with severe colonic dilatation?

    • A) C. difficile infection
    • B) Toxic megacolon
    • C) Bowel perforation
    • D) Colectomy
  19. Mesalamine is available in the United States in all of the following dosage forms EXCEPT:

    • A) Rectal foam
    • B) Delayed release tablet
    • C) Rectal suppository
    • D) Rectal liquid enema
  20. Which of the following is an advantage of rectal 5-ASA over oral 5-ASA?

    • A) Direct delivery to the site of action
    • B) Minimal systemic adverse effects
    • C) Better efficacy for mild to moderately active distal disease
    • D) All of the above are advantages