|
|
|
Quiz week 1 Quiz week 2 Quiz week 3 Quiz week 4 Quiz week 5 Quiz_week_6 Quiz_week 7 Quiz week 8 Quiz_week 9 Quiz_week 10 Quiz week 11 Quiz_week12 Quiz_week 13 Quiz_week 14 Quiz 15 Quiz_16 Quiz 17 Q1. A 48-year-old man comes to you with diarrhea. He was with you about four weeks ago with a sore throat. You gave him Amoxicillin at that time. He subsequently came to you with diarrhea and you found out that he had Clostridium difficile positive stool. You treated him with Oral Metronidazole for ten days and he had improved until yesterday. C. difficile testing is still positive . What is the best mode of treating the patient?
The answer is Choice 2. I could not believe it when there was only one correct entry to this quiz. This will almost definitely be on the boards. The sequence of treatment of C.diff is Oral Metronidazole » if failure » Oral Metronidazole again » if failure second time » ORAL Vancomycin » If failure » Quickly call ID! The toxin of C. diff is excreted after treatment is successful but the if the treatment is successful, the diarrhea should stop (Pseudomembranes may persist longer than toxin). Therefore in this case, there IS a need to treat as diarrhea persists and the choice is Oral metronidazole. If this fails or a repeat episode occurs soon, use Vancomycin PO. May be combined with Rifamixin. If there is an Ileus, this PO stuff will not work easily so IV Metronidazole is given and Vanco is given in a large volume of distilled water - using an NG tube. Fecal enemas with Vanco can also be done as can a fecal transplant of the patient. Q2. A 27-year-old man comes to you with urethral discharge that is yellow in color. He has multiple sexual partners and frequently practices oral sex. He also occasionally introduces foreign bodies into his urethra. His usage of condoms has been erratic. You stain the discharge and see that he has intracellular diplococci in leukocytes. You counsel him and give him a shot of Ceftriaxone (250 mg IM). He returns to you after a week. He still has a discharge from the urethra. Which of the following antibiotics is most likely to help him?
You better be ready for this one too. It will be on the boards. The correct answer is choice 4. The commonest cause for urethritis after treatment for Gonococcal urethritis is Chlamydia trachomatis. Treatment is with Doxycycline. If a single drug is to be used for both GC & Chlamydia, th boards like the answer Ofloxacin for 10 days (although Azithro 2gm single dose/Cipro too do the job). Please write back doctors. It is good to hear your views on what I do. My Email is quizmaster@superscore.com |