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.

Question 15

15.  Your patient is a 63 year old male that has a history of alcoholic cirrhosis presents with vomiting of copious amounts of bright red blood.  His blood pressure is 70/48, HR 154, and the patient looks pale.  Which of the following would not be appropriate to order?

A.  Type and cross, and transfuse the patient with 6 units of packed red blood cells

B.  Have two large bore IV's in place

C.  Insert an NG tube

D. Notify the GI doctor on call as well as the General Surgeon and ask them to come evaluate the patient.

Answer and Explanation 14

14.  The correct answer is D.  This situation is very typical for patients with Hirschsprung's Disease.   This is a problem of a decrease of ganglion nerve cells at that section of the large intestine.  Barium Enema aids in the diagnosis but confirmation is made with a full thickness intestinal biopsy.  Miralax and fleets would give temporary relief but not fix the problem.  A KUB would be little yield. Ultimately  if the diagnosis is confirmed, this patient needs surgery to remove the disease portion of colon.

Question 14

14.  Your patient is a 4 year old male brought into your office because of constipation.  The parents relay that this has basically been a problem that has been happening to some extent since they can remember.  They have tried to increase fruits, vegetables, and fiber in his diet without any help.  The only thing that alleviates it is stimulant laxatives or manual removal.  Given this information, what is the best management option for this patient?

A.  Start the patient on Miralax daily

B.  Order fleets enemas as needed

C.  Send the patient for a KUB

D.  Send the patient for a barium enema