Episode one of three on inflammatory bowel disease, covering ulcerative colitis from classification through full medical management. Walks the UC-versus-Crohn distinction, the Mayo score driving severity-tiered therapy, the acute severe UC inpatient script with its day-three salvage rule, mesalamine for mild-to-moderate disease, and mechanism-based positioning of biologics and small molecules. Board-focused framework for choosing therapy by matching drug mechanism to patient phenotype. Topics covered UC vs Crohn distinction Montreal extent classification Mayo score and severity Acute severe UC management Mesalamine formulations and delivery Biologics and small molecules JAK and S1P modulators Mechanism-to-patient drug selection Key decisions Smoking is protective in UC but harmful in Crohn's; a quiescent UC patient who quits can flare within months. Day three is the salvage trigger in acute severe UC: Oxford rule is more than eight stools daily, or three to eight stools with CRP above forty-five. Salvage is a single shot: no response to infliximab or cyclosporine within five to seven days means colectomy, not sequential salvage. Antimotility agents are contraindicated in acute severe UC because they precipitate toxic megacolon; anticoagulate despite rectal bleeding. Combined oral plus topical mesalamine beats either alone for distal and left-sided disease; oral induction dose is 4.8 g/day. Sulfasalazine wins in the UC patient with peripheral inflammatory arthritis; give mandatory folic acid, and mesalamine paradoxical worsening means stop the drug. For the full chapter with MCQs, tables, and primary-guideline references, visit www.boardpearls.com. Questions or feedback: [email protected]. (00:00) - One immune problem, two faces (01:16) - Sorting UC from Crohn's (02:35) - Diagnosis and Montreal extent (03:56) - Mayo score and mucosal healing (04:52) - The acute severe UC script (08:45) - Mesalamine for mild-to-moderate disease (12:26) - Biologics and small molecules by mechanism (17:28) - Matching mechanism to patient

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“What did the council decide on item 42?” — answered with the speaker and the moment.

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