4.3 Gastrointestinal I) Gastroenteritis

Front 1

(Cameron)
Which of the following causes of

gastroenteritis is not treated with antibiotics?
A. Staphylococcus aureus
B. Giardia
C. Shigellosis
D. Clostridium difficile.

Back 1

A.

Front 2

(Cameron)
Which of the following is incorrect regarding the treatment of gastroenteritis?
A. Salmonella should be treated with antibiotics in infant, the elderly, and the immunosuppressed.
B. Antibiotics are contraindicated in uncomplicated salmonella infections.
C. Many isolates of Campylobacter, Shigella and Salmonella are resistant to antibiotics.
D. Traveller's diarrhoea does not require antibiotics.

Back 2

D. Traveller's Diarrhoea =

Norfloxacin OR Azithromycin

Front 3

(Cameron)
Which of the following is incorrect regarding

gastroenteritis?
A. The WHO definition = > 5 abnormally loose stools in 24 hours
B. There are 5 groups of strains of E coli.
C. Gastric acid secretion and normal bowel flora are natural defences against gastroenteritis.
D. Salmonella and Campylobacter can cause bloody diarrhoea.

Back 3

A. > 3

Front 4

(Cameron)
Which of the following is unlikely to cause bloody diarrhoea?
A. E coli
B. Entamoeba histolytica
C. Giardia
D. Shigella.

Back 4

C.

Front 5

(Cameron)
List the potential causes of bloody diarrhoea in gastroenteritis.

Back 5

1. Campylobacter
2. Shigella
3. Salmonella
4. E coli (Enterohaemorrhagic)
5. Entamoeba histolytica

Front 6

(Cameron)
Which of the following cause of gastroenteritis is least likely to cause severe abdominal pain?
A. Campylobacter jejuni
B. Giardia lamblia
C. Yersinia enterocolitica
D. Escherichia coli

Back 6

B.

Front 7

(Cameron)
Which of the following is incorrect regarding

gastro-enteritis?
A. Severe vomiting often occurs with organisms that produce preformed toxins ( Staphylococcus / Bacillus )
B. Fever and systemic symptoms (headache) are prominent with

organisms that invade the bowel wall and enter the systemic circulation

( eg. Bacillus)
C. The principal clinical manifestation of gastroenteritis is diarrhoea.
D. Pale, loose, greasy stools are produced by infection with Giardia.

Back 7

B. Not Bacillus

Typical of Yersinia enterocolitica

Front 8

(Cameron )
Which of the following is incorrect regarding Campylobacter infection?
A. It is associated with ingesting untreated water and undercooked

poultry / meats
B. It has been associated with Guillain Barre Syndrome
C. It has been associated with a reactive arthritis
D. The symptoms usually last 24 -48 hours.

Back 8

D. Campylobacter Symptoms last 2-5 days

Occassionally > 10 days.

Front 9

(Cameron)
In regards to gastroenteritis and Traveller's

Diarrhoea, which of the following is incorrect?
A. The incidence can be as high as 30-50% in certain areas of travel,

including Southeast Asia.
B. Viruses are the most common causes.
C. Many cases are not symptomatic until return from overseas.
D. Bacteria, protozoans and viruses all cause Traveller's Diarrhoea.

Back 9

B. Bacterial Causes of Traveller's Diarrhoea are:

1. ETEC -Enterotoxigenic E coli
2. EAEC
3. Salmonella
4. Shigella
5. Campylobacter.

Front 10

(Cameron)
In regards to Gastroenteritis in the

Immunocompromised patient, which is

incorrect?
A. Infections are often more severe and resistant to conventional

therapy.
B. The less common organisms include CMV, Cryptosporidium and

Microsporidium.
C. Those on long term corticosteroids, Immunosuppressive therapy, and those with AIDS are at risk.
D. They have, however, the same incidence of complications as the

immunocompetent individual.

Back 10

D. Higher incidence of complications.

Front 11

(Cameron)
In regards to Antibiotic-associated diarrhoea, which of the following is incorrect?
A. It is the most common cause of acute diarrhoea in Hospitalised

patients.
B. ANY antibiotic can cause it - but particularly cephalosporins and

clindamycin.
C. It can be tested for by Clostridium difficile serum PCR.
D. Oral metronidazole or vancomycin are the treatment .

Back 11

C. Clostridium difficile Stool sample / rectal swab PCR

Front 12

(Cameron)
Which of the following is incorrect regarding

gastroenteritis?
A. The History and Examination are unreliable as to the aetiological agent.
B. Stool samples should be kept at room temperature for testing for

organisms .
C. In most circumstances, no investigations are necessary in order to make the diagnosis.
D. Identification of an organism may guide antimicrobial therapy, or

ensure adequate Public health measures are instituted.

Back 12

B. Stool samples should be kept Cool - at 4

degrees.

Front 13

(Cameron)
In regards to the treatment of gastroenteritis, which of the following is incorrect?
A. The principles of treatment include replacing fluid and electrolytes.
B. Antimotility agents can be used, but their significant side effects

preclude regular usage.
C. In oral rehydration, fruit juices and degassed lemonades are not

recommended due to them being hypo-osmolar, and promoting further fluid losses.
D. Milk and caffeine-containing products should be avoided ( transient lactose malabsorption and cAMP-increased fluid secretion respectively).

Back 13

C. Fruit juices and degassed lemonades are hyper-osmolar and deficient in electrolytes

Front 14

(Cameron)
In regards to the antibiotic treatment of

gastroenteritis, which of the following is not an indication?
A. Giardia : metronidazole
B. Traveller's diarrhoea : azithromycin
C. Campylobacter in food handlers: metronidazole
D. Salmonella in infants and immunosuppressed.

Back 14

C. Campylobacter in food handlers:

erythromycin

Front 15

(NNT.com)
In regards to Ondansetron in gastroenteritis, which of the following is incorrect?
A. The studies thus far only really have a low-mid grade evidence quality-with wide confidence intervals.
B. the NNT for vomiting is 5.
C. The reduction in Hospital admission rates is controversial-seeming to delay rather than avoid.
D. 1 in 4 were prevented from IV hydration.

Back 15

D. The use of Ondansetron in Gastroenteritis :

IV hydration is avoided in 1 in 6.

Front 16

Tintinalli

Which of the following is incorrect regarding Clostridium Difficile infection?

A. It is common- particularly in Hospitalised patients .

B. It is primarily a nosocomial infection

C. C. difficile is an anaerobic , gram negative , spore-forming bacillus.

D. The organism secretes 2 toxins.

Back 16

C. Clostridium difficile is :

Anaerobic, gram positive, spore forming

bacillus.

Front 17

Tintinalli

Which is correct regarding Clostridium Difficile infection?

A. More than 50% C. difficile -diarrhoea begins during antibiotic

treatment.

B. Almost all antibiotics have been associated with C. difficile infection,

including metronidazole and vancomycin - known treatments.

C. The most sensitive test is Stool toxin assay.

D. First line therapy for moderate disease involves IV metronidazole.

Back 17

B. True

A = > 80% cases

C = Anaerobic stool culture is most sensitive

ELISA stool toxin assay is 80-95% sensitive for toxins A and B.

D = Oral metronidazole

Front 18

Tintinalli

Which of the following is incorrect regarding

C. difficile infection?

A. It is the most common cause of infectious diarrhoea in Hospitalised patients.

B. The development of diarrhoea in recently discharged patients should suggest C. difficile.

C. Toxin A is a cytotoxin and Toxin B an enterotoxin

D. 1-3 % patients develop Toxic megacolon or colonic perforation.

Back 18

C. Toxin A = enterotoxin

Toxin B = cytotoxin

Front 19

Tintinalli

List the causes of Clostridium difficile Pseudomembranous Colitis .

Back 19

1. Almost any antibiotic

2. Chemotherapeutic agents

3. Proton Pump Inhibitors (PPI)

4. Antiviral agents

Front 20

Tintinalli

List the spectrum of disease of Clostridium

difficile infection (Mild-Severe)

Back 20

Diarrhoea ( mild --> frequent - mucoid and

watery --> Profuse [ 20-30 daily ] )

Abdominal pain ( mild crampy- severe )

Fevers

Pseudomembranous Colitis

Toxic Megacolon

Colonic perforation

Front 21

Tintinalli

List the complications of infection with

Clostridium difficile.

Back 21

Abdominal -Surgical

1. Pseudomembranous Colitis :

• Toxic megacolon
• Colonic perforation
• Fulminant colitis

Extra-Abdominal

1. Severe electrolyte imbalance

2. Hypovolaemia - shock

3. Anasarca ( decreased serum albumin )

4. Extraintestinal complications rare

( arthritis ; cellulitis ; osteomyelitis )

Front 22

Tintinalli

In regards to the diagnosis of Clostridium

difficile infection, which of the following is

incorrect?

A. Diagnosis is strongly suggested by a diarrhoea history preceded by

current / recent antibiotic use.

B. Colonoscopy can depict the yellowish plaques of

pseudomembranous colitis in unwell patients.

C. Stool culture is 100% sensitive but not assistive in the ED diagnosis of C.diff infection .

D. ELISA Toxin assay is only 50 % sensitive but 75-100% specific.

Back 22

D. ELISA C. diff Toxin assay is :

• 60-90% sensitive
• 75-100% specific.
  

Front 23

Tintinalli

what are the indications for Emergency

Colectomy in Severe Clostridium difficile

infection ? ( 8)

Back 23

1. Age > 75

2. Immunosuppression

3. Leucocytosis -WCC > 20.0

4. Lactate > 5

5. Shock

6. Toxic megacolon

7. Colonic perforation

8. Multi organ failure

Front 24

Tintinalli

Which is correct regarding C. difficile infection ?

A. Strict Contact isolation and PPE is only required for severe infection .

B. Pseudomembranous colitis is typically isolated to the left colon.

C. ELISA is 99% sensitive for Toxin detection.

D. Toxin A is an enterotoxin.

Back 24

D.

A. Contact isolation , use of personal protective equipment (PPE) and thorough hand washing in prevention of disease in other patients is imperative for all patents suspected of having C. diff infection.

B. Right colon - lesions can be seen throughout entire Alimentary tract.

C. ELISA is 60-90% sensitive for toxin detection.