WBR0889
| Author | [[PageAuthor::Ayokunle Olubaniyi, M.B,B.S [1]]] |
|---|---|
| Exam Type | ExamType::USMLE Step 3 |
| Main Category | MainCategory::Community Medical Health Center |
| Sub Category | SubCategory::Infectious Disease |
| Prompt | [[Prompt::A 65-year old man comes to the outpatient gastroenterology clinic for a routine check-up. He was admitted and treated 2 months ago for community acquired pneumonia. He has no complaint today and his vitals are within normal limit. His laboratory investigations are also normal except for a positive Clostridium difficile toxin assay.
What is the best next step to take in the management of this patient?]] |
| Answer A | AnswerA::Observe and counsel |
| Answer A Explanation | AnswerAExp::No treatment is indicated for patients who have a positive C. diff toxin assay without symptoms. |
| Answer B | AnswerB::Administer oral metronidazole as prophylaxis for the next 7 days |
| Answer B Explanation | AnswerBExp::Oral metronidazole is indicated as an initial treatment of a mild form of C. diff infection. It is usually administered for 10-14 days. |
| Answer C | AnswerC::Administer oral vancomycin as prophylaxis for the next 2 weeks |
| Answer C Explanation | [[AnswerCExp::This is reserved for severe cases, and also for those who experienced a relapse after a course of metronidazole treatment. The use of vancomycin is limited due its expensive cost, and also the risk of developing vancomycin-resistant enterococci (VRE).]] |
| Answer D | AnswerD::Schedule colonoscopy immediately |
| Answer D Explanation | [[AnswerDExp::This is reserved for cases with a high suspicion of C. diff infection despite negative laboratory assay, failure of response to drug treatment or in cases where prompt diagnosis is required. This reveals the presence of a pseudomembrane in the colon.]] |
| Answer E | AnswerE::Order an abdominal CT |
| Answer E Explanation | AnswerEExp::This demonstrates a pronounced thickening of the colonic wall in patients with pseudomembranous colitis. |
| Right Answer | RightAnswer::A |
| Explanation | [[Explanation::Clostridium difficile is an organism normally seen in the intestine. However, it may overgrow when you take antibiotics which kill a lot of gut flora which impede their growth in the intestine. The bacteria release a powerful toxin that causes the lining of the colon to become inflamed and bleed. The symptoms experienced during an acute infection are offensive-smelling watery diarrhea, fever, and abdominal pain. Toxic megacolon may result in severe cases which involves surgery.
A positive Clostridium difficile toxin assay may signify an acute infection or a recent infection. However, treatment is not indicated for an asymptomatic patient with a positive assay. Educational Objective: No treatment is indicated for patients who have a positive C. diff toxin assay without symptoms. |
| Approved | Approved::No |
| Keyword | WBRKeyword::Pseudomembranous colitis |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |