| A |
CocaCola, aspire, cool doctor, foucesed doc, lq2006, guangyu, doc4mle, khiladi, ansalshah, smalley, vijay1900 |
11 |
69% |
| B |
toofar |
1 |
6% |
| C |
Justice, doc649 |
2 |
13% |
| D |
nyimalay |
1 |
6% |
| E |
inkspot |
1 |
6% |
| Author | 9 Posts |
Justice
Forum Fanatic
Topics: 100
Posts: 1,900
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Please vote with your answer
A 63-year-old woman is hospitalized because of refractory cellulitis. An intravenous cephalosporin is started, and she appears to be improving. On the fifth hospital day, however, she develops profuse diarrhea and a low-grade fever. Her abdomen is soft, with minimal diffuse tenderness to deep palpation and normal bowel sounds.
Which of the following is the most appropriate next step in managing this patient?
A. Obtain routine bacterial stool cultures
B. Start an antimotility agent
C. Institute contact isolation
D. Obtain CT scans of the abdomen
E. Add an aminoglycoside to her current regimen
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| cool doctor
Forum Junior
Topics: 1
Posts: 219
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I'm thinking about C.difficile. but none of the choices refer to it
so Ill choose A
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| toofar
Forum Newbie
Topics: 3
Posts: 19
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no way it cants b A cusase c.difficile normally isolated from stool .. but i think its b . because it cant be A,C,D,E
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| peter90036
Forum Elite
Topics: 28
Posts: 315
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it is highly not recommandable to give anti-diarrheics to a possible infectious diarrhea.
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| inkspot
Forum Guru
Topics: 26
Posts: 554
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ok since there is no option of C. Difficile. it probably is infectious.
most diarroheal infections are gram negative so i choose option E as an emperical tx. cultures are usually not taken.
waiting for correct answer
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| guangyu
Forum Elite
Topics: 29
Posts: 308
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i think it is A
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| Justice
Forum Fanatic
Topics: 100
Posts: 1,900
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The correct answer is C
This patient is at high risk forCiostridium difficile infection on the basis of her hospitalization and treatment with antibiotics. In high-risk patients with suspectedC. difficile infection, empiric contact isolation should be instituted until the pathogen can be ruled out, asC. difficile is easily spread by contact and may cause outbreaks of nosocomial diarrhea.
Routine bacterial cultures are rarely helpful, since they primarily determine foodborne pathogens such as Salmonella, Shigellaand Campylobacter, which are all uncommon in hospitalized patients. Antimotility agents are contraindicated in patients withC. difficile diarrhea. Because the patient has a soft abdomen and normal bowel sounds, radiologic imaging is not indicated. Treatment of C. difficile diarrhea requires discontinuing the causative antibiotic and starting metronidazole or vancomycin. Adding an aminoglycoside without stopping the cephalosporin provides no benefit.
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| Justice
Forum Fanatic
Topics: 100
Posts: 1,900
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 I see that most ppl voted for A.
Guys, please recall that C. Difficile is diagnosed by looking at toxin in the stool, not buy culturing it...
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| inkspot
Forum Guru
Topics: 26
Posts: 554
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lol you know what justice every one knew that it is c. difficile and i bet most of us know its the toxin that you look for . but C: Institute contact isolation should be done was not known.
so now we know that c. difficile patients should be isolated ! aaahhh
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