Answer and Explanation 18

18.  The correct answer C.  Antibiotics in cases of Shiga Toxin Producing E. Coli have not been shown to be of clear benefit.  Antibiotics that interfere with DNA synthesis such as fluoroquinolones, have been shown to induce bacteriophage and increase production of toxins.  Lomotil should not be used unless the symptoms are causing significant dehydration.  It may prolong the duration of the toxin.  Symptomatic treatment is recommended with good hydration and close follow up.

Question 18

18.  Your patient is a 19 year old female that presents with a 10 day history of watery brown diarrhea.  You have ordered stool studies and they have came back positive for Shiga Toxin Producing E. Coli.  The patient is afebrile and otherwise healthy and has not been vomiting.  The remainder of vital signs are normal.  Which of the following is the best management option?

A.  Admit to the hospital for IV Cipro and Flagyl and monitor for clinical improvement.

B.  Treat as an outpatient with oral Cipro and Flagyl and monitor for clinical improvement.

C.  Encourage good oral hydration and re-evaluate in 5-7 days

D.  Start the patient on Lomotil

Answer and Explanation 17

17.  D is the correct answer.  Smoking has not been identified as a cause for hepatitis.  CMV, Hepatitis A-E viruses, and mononucleosis has been known to cause hepatitis.  Statins and Seizure meds are common meds that can cause hepatitis.  Some herbal medications also have been identified as a cause.  You can also get immune mediated attack on the liver causing hepatitis.

Question 17

17.  Your patient is an a 45 year old male who was sent to your office for further work up after an employment physical reveal he may have hepatitis.  The patient during his office visit was inquiring about potential etiologies of hepatitis.  Which of the following is not an etiology of hepatitis?

A.  Viruses

B.  Medications

C.  Immune Mediated Attack on the liver

D.  Smoking

Answer and Explanation 16

16.  C is the incorrect answer.  This is not common in HIV unless there is some malnourished condition.  The causative organism is usually Enterobacteriae or Pneumococcus.  A PMN count greater than 250 in the peritoneal fluid confirms the diagnosis.  Treatment is usually a 3rd generation cephalosporin or Zosyn is recommended.

Question 16

16.  Which of the following is not true in patients with Spontaneous Bacterial Peritonitis?

A.  The causative organism is usually Enterobacteriae or Pneumococcus

B.  Treatment with third generation cephalosporin or Zosyn is usually effective

C.  Common to get in patients with HIV

D.  Criteria for diagnosis is a PMN count greater than 250

Answer and Explanation 15

15.  C is the correct answer.  Inserting an NG tube in this situation would not be the thing to do.  This patient is presenting with a history suggestive of bleeding esophageal varices.  This would be contraindicated.  This patient needs transfused and may need vasopressors.  This patient needs good IV access.  You need to involve the appropriate specialists as soon as possible because this condition has a high mortality rate.