Rosh Internal Medicine Boost Practice Exam

What therapy is recommended for a patient with an acute flare of Crohn disease?

1. Azathioprine

2. Budesonide

3. Mesalamine

4. Prednisone

The correct answer is: Prednisone

For a patient experiencing an acute flare of Crohn disease, corticosteroids are the primary therapy recommended to quickly control inflammation and manage symptoms. Prednisone is a commonly used systemic corticosteroid that helps reduce inflammation in the gastrointestinal tract during flare-ups. This treatment provides rapid relief and is effective in managing acute symptoms associated with Crohn disease, such as abdominal pain, diarrhea, and fatigue. While other medications like azathioprine, budesonide, and mesalamine can be part of long-term management or remission maintenance in Crohn disease, they are not primarily indicated for acute flares. Azathioprine is an immunosuppressant that takes weeks to months to exert its effects and is used for maintenance therapy. Budesonide is a local corticosteroid with fewer systemic effects, suited more for mild cases or maintenance therapy rather than severe acute exacerbations. Mesalamine is mainly used for ulcerative colitis and has limited efficacy in Crohn disease during active inflammation. Therefore, using prednisone for an acute flare provides rapid and effective control of symptoms, making it the recommended therapy in this scenario.