NBME Form 9 Practice Test

Starting therapy for mild to moderate ulcerative colitis is typically with a 5-aminosalicylic acid agent, specifically mesalamine, because it directly reduces mucosal inflammation in the colon with a strong safety profile and can be used for maintenance to prevent relapse. Mesalamine acts locally in the colon, limiting systemic effects while effectively controlling mild-to-moderate disease activity. Prednisone is reserved for induction of remission during flares or when mesalamine alone isn’t enough, but it carries systemic side effects that make it unsuitable as a first-line long-term option. Azathioprine is an immunomodulator used mainly as a steroid-sparing agent or for maintenance in steroid-dependent or refractory disease, and it has a slower onset. Infliximab is a biologic used for moderate-to-severe disease or refractory cases after conventional therapy fails, and it’s not a first-line choice due to cost, infection risk, and need for monitoring.