Here’s the second part of the altered bowel habit question set we have. Make sure you don’t get stuck and miss the first part on constipation presentations!
Reviewed by: awaiting review
Stem 1 of 6
A 73YO male presents with severe diarrhoea, exhausted and weak. He is feverish with cramping, diffuse abdominal pain. History is notable for LRTI, for which he was successfully treated with ciprofloxacin orally in the community two weeks ago. His obs are T38.5ºC ; HR90 ; RR17 ; pO299% air ; BP140/95 ; GCS15 ; BM 4.5mmol/L
Given the most likely differential, what pathological process best explains the patient’s colitis?
Dendritic presentation to GALT
Inhibition of the chloride antiporter.
Overexpression of gp120 coreceptor.
Secretion of enterotoxin A and B.
Upregulation of ACE-2 receptor.
Stem 2 of 6Select all the options that may apply to help confirm the diagnosis
36.9ºC tympanic temperature
Toxic megacolon on AXR
Ulcerated mucosa on endoscope
Yellow plaques on endoscope
Stem 3 of 6The physician orders an ELISA to confirm the diagnosis of CDI. What is the common antigen sought in this investigation?
Stem 4 of 6What further tests are required to distinguish non-pathological carriage from CDI?
Electron microscopy of stool
ELISA of toxin
NAAT of toxin
No further tests required
PCR of toxin
Stem 5 of 6Which of the following are appropriate management techniques of CDI?
Isolate the patient within four hours
Mild CDI treated with vancomycin PO
Non-responders to therapy require metro+vanco IV
Severe CDI treated with metronidazole PO
Test within four hours
Stem 6 of 6Which of the following would indicate a colectomy?
Deteriorating NEWS score despite monotherapy
Elevated LDH levels
Increasing albumin levels on serial screen
Yellow plaque on scope
Stem 1 of 4
A 50 year old obese, hypertensive female presents with left lower quadrant pain. Her abdomen is tender in the left flank and constipation is reported for the last day. She has had some rectal bleeding (bright red) that quickly arrested. She is feverish and routine bloods reveal leukocytosis and elevated acute phase protein.
Which of the following definitions are true?
Diverticular are outpouchings of gut wall
Diverticular rarely occur at the site of entry of perforating arteries
Diverticulitis is most commonly seen in the sigmoid colon
Diverticulosis refers to the presence of diverticula
LLQ pain and frank blood in middle age females with low grade fever is common for diverticulosis
Stem 2 of 4What is the strongest risk factor of diverticular disease?
Age over 50 years old
A sodium and glucose-rich diet
Low dietary fibre
Obese type I BMI
Use of naproxen
Stem 3 of 4Given the best-matched diagnosis, what is the most diagnostic test?
Abdominal X ray
Stem 4 of 4Which of the option(s) below are best to manage this patient?
Bowel rest (NPO)
Changing diet to low residue