Gastrointestinal Flashcards
Don has recently been out for a succulent Chinese meal with his wife, Robyn, to celebrate the purchase of their new Martinborough AirBnB retreat. Around 2-4 days later, Don began to feel general malaise, even experiencing a bout of explosive diarrhoea while enjoying a spa with his wife and grandchildren (Hailey and Stan) just last night. This was associated with severe cramping abdominal pain.On direct questioning in the GP practice, Don admits to sneaking out for some KFC white bread sandwiches following this dinner, as his wife insisted on only ordering some yummy fruit (NOT one of Don’s favourites).Don’s past medical history involves reflux, mainly irritated by his penchant for spice, for which he takes Omeprazole and Gaviscon, to soothe the burning, and keep protective acids where they should be (stomach).Which of the following is NOT correct?
Select one:
Stool Culture will confirm the diagnosis of Don’s Campylobacter jejuni
Campylobacter is not usually transmitted through swine
Fatalities due to volume depletion in campylobacteriosis are rare
Campylobacter jejuni should be treated with Erythromycin 400 mg QID for 5/7, starting immediately
Campylobacter jejuni can be transmitted from unpasturised milk, or may even be from Don’s pet Gerbil, Kailash
Campylobacter jejuni should be treated with Erythromycin 400 mg QID for 5/7, starting immediately
(Campylobacter is usually self limiting and does not need antibiotic treatment.For a minority with prolonged or severe illness treatment with Erythromycin 400 mg, four times daily, for 5 days.Ciprofloxacin is an alternative.)
Which of the following causes a non-inflammatory gastroenteritis?
Select one:
EHEC (Enterohemorrhagic Escherichia Coli)
ETEC (Enterotoxigenic Escherichia Coli)
ETEC (Enteroshigatoxic Escherichia Coli)
EIEC (Enterointestinal Escherichia Coli)
ETEC (Enterotoxigenic Escherichia Coli)
Mr M, a 67 year old man presents to ED and is diagnosed with peritonitis, on a background of liver failure. He is admitted to the ward and treated initially treated with ciprofloxacin and his symptoms improve. On day 5 of the treatment Mr M develops diarrhea, fever and abdominal pain. What is the most appropriate management option?
Select one:
Continue ciprofloxacin and start metronidazole
Stop ciprofloxacin
Stop ciprofloxacin and start metronidazole
Fecal transplant
Continue ciprofloxacin
Stop ciprofloxacin and start metronidazole
Daisy is visiting family in the countryside when she decides to try unpasteurised milk. Several days following this, she becomes acutely unwell with diarrhoea and crampy abdominal pain. Which of the following is NOT a true for Campylobacteriosis?
Select one:
Rarely causes bacteraemia
Guillian-Barre Syndrome and reactive arthritis
Prodrome of fever, headache, myalgia and malaise for 12 - 24 hours
Standard treatment involves a stat dose of metronidazole
Standard treatment involves a stat dose of metronidazole
26-year old woman presents with sudden onset diarrhoea, with vomiting, abdominal cramps and fever. She was very surprised as she stated she “leads a very healthy life”. On further questioning you discover that she lives alone, hasn’t been into contact with anyone sick within the last 2 weeks and is a big gym buff, with regular raw egg intake in her morning smoothies. Given her presentation, infection with what pathogen would be the most likely cause of her symptoms?
Select one:
Shigella disentrae
Salmonella enterica (Non Typhoidal Salmonella - NTS)
Enterohemorrhagic E. coli
Giardia lamblia
Salmonella enterica (Non Typhoidal Salmonella - NTS)
A 30 year old Japanese man presents to ED with nausea and vomiting, along with watery diarrhoea. Four hours ago he ate days old left over rice. Assuming an infectious cause, what is the most likely pathogen?
Select one:
Rotavirus
B. cereus
S. aureus
E. coli
B. cereus
Penelope Stirling, a 32 year old woman from Timaru presented to her GP after experiencing “crampy” pain and diarrhoea for the past 4 days. Prior to this she experiences two days of a headache, fever and muscle aches. It is noted that her two children are experiencing symptoms, that started around the same time as Penelope. However her husband Jeremy is not sick, and was in Ashburton for a very important business trip one week ago when the rest of the family enjoyed a meal of chicken parmesan. A stool sample was collected from Penelope and her kids. Gram stain of the samples revealed gram negative bacilli with a helical or “seagull” appearance (see image below).With of the following complications is LEAST likely to arise following this presentation?
Haemolytic-Uraemic Syndrome
67-year-old female came in to hospital 2 days ago with shortness of breath and chest x-ray at the time revealed consolidation in the right lower lobe. She was diagnosed with community acquired pneumonia and started on cefuroxime. Today she complains of watery stools, lower abdominal pain and nausea. There are no signs of peritonism. Vitals show HR 72, RR 14, BP 134/82 and temperature 38.2. What testing would be most helpful for diagnosis?
Select one:
Toxin enzyme immunoassays
Abdominal x-ray
Stool culture
Blood culture
Lower gastrointestinal endoscopy and biopsy
Toxin enzyme immunoassays
A 25 year old female presents to you, her GP, with 2/52 history of non-bloody, watery diarrhoea, occasional abdominal pain and nuasea, and bloating, accompanied by an 6kg weight loss. After the first 4 days of illness, she felt better, but 2 days later got sick again.She’s currently on methotrexate for rheumatoid arthritis, which she was diagnosed with 2 years ago and is currently well-controlled. She got back from Thailand about 3 weeks ago, where she was in remote areas helping educate children, but claims she was perfectly healthy while there.OET 37.3HR 64BP 112/76RR 13Diffuse, mild abdominal tenderness without any peritoneal signs.From this information, what is the most likely causative organismandsubsequent treatment you would provide?
Select one:
Salmonella enterica,supportive care or Ciprofloxicin if septic.
Giardia lamblia,Metronidazole 2g PO once daily for three days.
ETEC, supportive care.
Staphylococcus aureus, supportive care.
Giardia lamblia,Metronidazole 2g PO once daily for three days.
A 25-year-old junior associate at a law firm, MR, presented to his GP with a 3-day history of vomiting and diarrhoea. He mentioned 2 of his flatmates just got diarrhoea today and suspected it was the flat meal that was cooked 4 days ago with chicken.What is the most likely diagnosis given the history?
Select one:
Enterohemorrahgic E. coli (EHEC)
Norovirus
Non-typhoidal salmonella
Campylobacter jejuni
Norovirus (most common, 3 day period suggests it was spread by person to person not via the chicken)
Mrs G, a 60 year old Primary School Teacher and enthusiastic vegan, is diagnosed with anaemia after a blood test. She has previously told you she has also been experiencing some stomach upset with crampy abdominal pain, bloating, and nausea. She also has foul smelling stools and increased flatulence.The symptoms all started a week or so after she returned from a hike. Where she acknowledged that she drank some ‘clean and pristine’ New Zealand river water.A stool sample is done and the pathogen you suspected is identified as the cause of her symptoms.What is the most appropriate anti-microbial treatment for Mrs G?
Select one:
Vancomycin 125mg PO qid
Ornidazole 1.5g PO od for 2 days
No treatment is necessary this will pass by itself in time.
Ciprofloxacin 500mg po BD 10 dyas
Ornidazole 1.5g PO od for 2 days (she had giardia)
A cruise ship of 250 returns from the Pacific Islands. During the trip, 100 passengers fell ill over 2-3 days with similar histories of nausea, vomiting, abdominal cramps and diarrhoea. What is the most likely diagnosis and the mode of transmission of the causative pathogen?
Select one:
Rotavirus - faecal-oral spread from poor hand hygiene
Rotavirus - zoonotic spread from contaminated produce
Norovirus - faecal-oral spread from poor hand hygiene
Norovirus - zoonotic spread from contaminated produce
Norovirus - faecal-oral spread from poor hand hygiene
