EXAM #1: DIAGNOSING GI INFECTIONS

Question 1

What is a the major host defense against esophagitis?

Answer 1

Motility

Question 2

What are the typical pathogens that cause esophagitis?

Answer 2

1) Candida
2) HSV
3) CMV

Question 3

What is the major host defense against gastritis?

Answer 3

Acidity

Question 4

What is the typical pathogen that causes gastritis?

Answer 4

H. pylori

Question 5

What are the typical pathogens that causes infectious diarrhea?

Answer 5

1) C. diff
2) E. coli
3) Salmonella
4) Shigella

Question 6

What are the sx. of esophagitis?

Answer 6

1) Dysphagia
2) Retrosternal pain
3) Fever

Question 7

Why is it important to determine if a patient has Candida cruzi?

Answer 7

This is resistant to the normal first line therapy (fluconazole)

Question 8

What causes ulcerative esophagtitis?

Answer 8

1) HSV

2) CMV

Question 9

You suspect a patient has infectious esophagitis; however, diagnostic work-up is negative. What should be next on your differential diagnosis?

Answer 9

GERD

Question 10

What inclusion is associated with HSV?

Answer 10

asdf

Question 11

How is candida esophagitis treated?

Answer 11

1) Oral fluconazole
2) IV echinocandin

or

Amphoterocin B

Question 12

How is HSV esophagitis treated?

Answer 12

Acyclovir

Question 13

How is CMV treated?

Answer 13

Valganciclovir or Ganciclovir

Question 14

How is H. pylori non-invasively diagnosed?

Answer 14

1) Urea breath test*

2) Stool antigen test

Question 15

If you have to do an endoscopy for H. pylori infection, what is the first choice test?

Answer 15

Biopsy urease test

Question 16

How is H. pylori treated?

Answer 16

1) PPI + amoxicillin, then

2) PPI + clarithromycin + tinidazole

Question 17

For patients that are allergic to clarithromycin, what should you do for H. pylori?

Answer 17

Quad therapy:

1) Bismuth subsalicylate
2) TCN
3) Metronidazole
4) Omeprazole

Question 18

How long to you have to wait to re-test urea breath test and stool antigen s/p H. pylori treatment?

Answer 18

6-8 weeks

Question 19

In taking a patient history, what is the most important feature to ask about when a patient has diarrhea?

Answer 19

Duration

• Less than 2 weeks= infectious
• More than 4 weeks= non-infectious

Question 20

What is unique about the morphologic appearance of v. cholerae?

Answer 20

Curved* gram negative rod

Question 21

What is C. perfringens highly associated with?

Answer 21

Home canned foods

Question 22

What is Bacillus cereus highly associated with?

Answer 22

Rice

Question 23

What is enterotoxigenic E. coli highly assocaited with?

Answer 23

Traveling to foreign countries

Question 24

What is Salmonella highly associated with?

Answer 24

Caesar salad

Question 25

What are the epidemiological clues that differentiate between Rotavirus and Norovirus?

Answer 25

``` Rotavirus= daycare Norovirus= nursing home/ cruise ship ```

Question 26

What is Hepatitis A highly associated with?

Answer 26

Overcrowding

Question 27

What organism is highly associated with swimming pools?

Answer 27

Cryptosporidium

Question 28

How long does it take to get ill from a preformed toxin?

Answer 28

6-8 hours

Question 29

How long does it take to get ill from an enterotoxin toxin?

Answer 29

8-72 hours

Question 30

How long does it take to get ill from a cytotoxin?

Answer 30

Days

Question 31

List the non-inflammatory diarrheas.

Answer 31

- V. cholerae | - Enterotoxigenic E. coli

Question 32

List the inflammatory diarrheas.

Answer 32

- Shigella - Salmonella - Campylobacter jejuni

Question 33

What is the difference between inflammatory and non-inflammatory diarrhea?

Answer 33

Non-inflammatory= watery (voluminous) Inflammatory= - Bloody/mucus - Fever - Positive fecal leukocytes

Question 34

What is unique about E. coli O157:H7

Answer 34

- Inflammatory diarrhea (bloody) but no fever | - NO abx, may give patient HUS

Question 35

Is it recommended to test stools of an asymptomatic patient for C. diff? What about for cure s/p treatment?

Answer 35

No- neither

Question 36

What is emerging as the diagnostic of choice for C. diff?

Answer 36

PCR Toxin Gene Detection

Question 37

If a patient has a positive endoscopy for PMC, do you need to do further testing?

Answer 37

No

Question 38

How is C.diff treated?

Answer 38

1) Metronidazole | 2) Vancomycin (more severe)

Question 39

What route does Vancoymin need to be given for C. diff?

Answer 39

Oral, NOT IV *Can be given as an enema if ileus with PMC

Question 40

If a patient has chronic c. diff, what should you do?

Answer 40

- Normal regimen for first recurrence - AFTER FIRST RECURRENCE, NO METRONIDAZOLE - Vancomycin with second or later recurrence

Question 41

Should probiotics be given to patients with recurrent C. diff?

Answer 41

No

Question 42

When should you AVOID antiperistaltic agents in lower GI infections?

Answer 42

1) Fever | 2) Bloody stool