Colorectal Dz #4

Question 1

C. diff testing for making the dx: (2)

Answer 1

*only diarrhea samples should be tested!!
1- Enzyme immunoassay (EIA): may be insensitive; multiple samples improves
2- PCR for C. diff: more sensitive, but more expensive

Question 2

Drugs less likely to cause C.difficile: (5)

Answer 2

• IV aminoglycosides
• Sulfonamides
• Macrolides
• Vancomycin
• Tetracycline

Question 3

Drugs that cause C.diff: (4)

Answer 3

• 3rd generation cephalosporin- Ceftriaxone (rocephin)
• fluoroquinalones
• ampicillin
• clindamycin

Question 4

Progressive SXS to watch out for with colitis: (4)

Answer 4

• Dehydration: may lead to AKI
• Electrolyte derangements: MC hypokalemia
• Abdominal pain: can give narcotics
• Sepsis i.e. HoTN, increasing abdominal pain, rigidity, etc.

Question 5

When is C. diff classified as severe? (3)

Answer 5

C. diff is generally considered severe if the following criteria are met:
1- Leukocytosis > 15k
2-Serum creatinine > 1.5x pts baseline
3-Shock, HoTN

Question 6

When might ischemic colitis occur? (3)

Answer 6

• Trauma
• Surgery
• Syncope (secondary to HoTN)

Question 7

Places most vulnerable to ischemic colitis: (2)

Answer 7

splenic flexure and rectosigmoid junction

Question 8

Common etiologies of LGIB include: (5)

Answer 8

1- diverticular bleeding
2- angiodysplasia/AVM
3- benign anorectal dz
4- IBD
5- neoplasias

Question 9

Diverticulitis mild SXS outpt pharm tx: (3)

Answer 9

1- cipro and flagyl
2- augmentin
3- avelox

Question 10

Diverticulitis mod-severe SXS inpt pharm tx: (4)

Answer 10

1- meropenum
2- imipenem
3- augmentin
4- zosyn

Question 11

If pt must take an NSAID with PUD, these precautions should be made: (3)

Answer 11

1- NSAID to lowest dose
2- concomitant PPI or misoprostolol (cytotec)
3- administer with meals

Question 12

cytotoxic agents w/ high emetic risk: (3)

Answer 12

high: (90%)
cisplatin
carmustine
cyclophosphamide (>1500)

Question 13

cytotoxic agents w/ moderate emetic risk: (2)

Answer 13

moderate: (30-90%)
carboplatin
cyclophosphamide (<1500)

Question 14

cytotoxic agents w/ low emetic risk: (2)

Answer 14

low: (10-30%)
etoposide
5-FU

Question 15

emetic preventative measures should be used in these 2 situations:

Answer 15

chemo-induced emesis

Question 16

indications for surgery with toxic megacolon: (5)

Answer 16

1- free perforation
2- massive hemorrhage (6-8 units)
3- progression of colonic dilation
4- increasing toxicity (HoTN)
5- persistent dilation on maximal medication tx after 24-72 hrs

Question 17

this drug is only available to women <55 y.o. with either IBS or chronic idiopathic constipation tx:

Answer 17

Tegaserod (Zelnorm)

Question 18

Common SE of bowel stimulants: (3)

Answer 18

• PRO loss
• salt overload
• hypokalemia

Question 19

this drug is indicated for post-op ileus constipation tx:

Answer 19

alvimopan (entereg)

Question 20

this drug is indicated for BOTH cancer and non cancer opioid use and can be injected SQ:

Answer 20

methylnaltrexone (relistor)

Question 21

this drug is indicated for ONLY non-cancer opioid use and can be taken PO:

Answer 21

naloxegol (movantik)

Question 22

this is a key finding in making the dx of fecal impaction:

Answer 22

copious amounts of stool in the rectum

Question 23

what are the locations where fecal impactions can occur: (3)

Answer 23

1- rectal vault (DRE dx)
2- proximal rectum (DRE nondx)
3- sigmoid colon (DRE nondx)

Question 24

TX for fecal impaction:

Answer 24

• multiple enemas (soapsuds, mineral oil)

- manual disimpaction

Question 25

Risk factors for c.diff development: (7)

Answer 25

1- MC secondary to ampicillin, Ceftriaxone, fluoroquinolones, or clindamycin use
2- ppi use
3- enteral feeding
4- receiving multiple abx or prolonged abx (>10d)
5- elderly, debilitated, or immunocompromised
6- GI dz
7- surgery