Gastroenterology: Truelove and Witts severity: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Gastroenterology: Truelove and Witts severity

Sample item

Which finding defines severe ulcerative colitis by Truelove and Witts criteria?

ASix or more bloody stools per day with tachycardia or fever or anaemia or raised ESRBNormal haemoglobin and ESR with 5 stoolsCFewer than four stools per dayDOccasional blood without systemic features

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Six or more bloody stools per day with tachycardia or fever or anaemia or raised ESR

Severe colitis means 6 or more bloody stools daily plus at least one marker of systemic toxicity: pulse above 90, temperature above 37.8 C, haemoglobin below 10.5 g/dL or ESR above 30. Severe attacks need admission and intravenous steroids. Failure at day 3 leads to rescue therapy with infliximab or ciclosporin.

Option by option

A. Six or more bloody stools per day with tachycardia or fever or anaemia or raised ESR (correct)
Correct. This is the severe category definition.
B. Normal haemoglobin and ESR with 5 stools
Normal markers with fewer stools do not meet severe criteria.
C. Fewer than four stools per day
Fewer than four stools is mild.
D. Occasional blood without systemic features
Occasional blood without toxicity is mild.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Six or more bloody stools per day with tachycardia or fever or anaemia or raised ESR. Severe colitis means 6 or more bloody stools daily plus at least one marker of systemic toxicity: pulse above 90, temperature above 37.

Why is "Normal haemoglobin and ESR with 5 stools" not the answer?

Normal markers with fewer stools do not meet severe criteria.

Why is "Fewer than four stools per day" not the answer?

Fewer than four stools is mild.

Why is "Occasional blood without systemic features" not the answer?

Occasional blood without toxicity is mild.

What concept does this question test?

It tests Gastroenterology: Truelove and Witts severity in General Medicine. 8 C, haemoglobin below 10.5 g/dL or ESR above 30. Severe attacks need admission and intravenous steroids. Failure at day 3 leads to rescue therapy with infliximab or ciclosporin.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastroenterology: Truelove and Witts severity?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.