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C. Year 3: Gastroenterology Random NOT on MLA Map > GI Infection > Flashcards

GI Infection Flashcards

1
Q

Gastroenteritis is an infection of the GIT. What % of gastroenteritis cases do not isolate the pathogen?

1 - 5%
2 - 15%
3 - 25%
4 - 50%

A

4 - 50%

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2
Q

All of the following are causes of gastroenteritis, an infection of the GIT. Which of the following is the most common cause?

1 - Viruses (Norovirus)
2 - Campylobacter
3 - Salmonella
4 - Shigella
5 - C.difficile

A

1 - Viruses (Norovirus)
– accounts for 50%

  • Viruses (Norovirus) – 50%
  • Campylobacter – 20%
  • Salmonella – 15%
  • Shigella – 5%
  • C.difficile – 5%
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3
Q

Which of the following are common precipitating factors in patients with suspected gastroenteritis?

1 - history of travel
2 - unusual food/takeaway
3 - other household members affected
4 - all of the above

A

4 - all of the above

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4
Q

Which of the following is NOT a common symptoms patients with gastroenteritis present with?

1 - Diarrhoea
2 - Crampy abdominal pain
3 - Vomiting
4 - Fever, headache, myalgia
5 - AKI

A

5 - AKI

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5
Q

The most common pathogens causing gastroenteritis are:

  • Viruses (Norovirus)
  • Campylobacter
  • Salmonella
  • Shigella
  • C.difficile

Which 3 of these typically cause blood diarrhoea?

A
  • Viruses (Norovirus), specifcally enterovirus
  • Campylobacter
  • Shigella
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6
Q

The most common pathogens causing gastroenteritis are:

  • Viruses (Norovirus)
  • Campylobacter
  • Salmonella
  • Shigella
  • C.difficile

Which of these is most likely to cause abdominal cramps?

A
  • Campylobacter
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7
Q

The most common pathogens causing gastroenteritis are:

  • Viruses (Norovirus)
  • Campylobacter
  • Salmonella
  • Shigella
  • C.difficile
  • Bacillus cereus

Which of these typically causes vomiting?

A
  • Bacillus cereus
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8
Q

The most common pathogens causing gastroenteritis are:

  • Viruses (Norovirus)
  • Campylobacter
  • Salmonella
  • Shigella
  • C.difficile
  • Bacillus cereus

Which of these typically causes systemic symptoms such as fever, headache and myalgia?

A
  • Shigella
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9
Q

Gastroenteritis is an infection of the GIT. These typically do not need treatment and resolve in what time period?

1 - 12-24h
2 - 24-48h
3 - 24-96h
4 - >120h

A

3 - 24-96h

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10
Q

Gastroenteritis typically resolves within 24-96h and investigations are not required. However, if investigations are required which of the following is NOT typically performed?

1 - stool MC+S (microscopy, culture+sensitivity)
2 - flexible sigmoidoscopy
3 - abdominal MRI
4 - abdominal X-ray

A

3 - abdominal MRI

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11
Q

Gastroenteritis typically resolves within 24-96h and investigations are not required. However, if diarrhoea continues for >2 weeks, what investigation can often be performed?

1 - colonoscopy
2 - flexible sigmoidoscopy
3 - abdominal MRI
4 - abdominal drain

A

2 - flexible sigmoidoscopy

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12
Q

Gastroenteritis typically resolves within 24-96h and investigations are not required. However, an abdominal chest X-ray can often be performed to rule out what?

1 - blocked common bile duct
2 - gallstones
3 - dilation of the colon (toxic megacolon)
4 - all of the above

A

3 - dilation of the colon (toxic megacolon)
- >10cm in size

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13
Q

Which of the following is NOT used in the management of acute gastroenteritis?

1 - anti-diarrhoeal
2 - oral intake
3 - IV fluids
4 - anti-emetics (metoclopramide)
5 - empirical antibiotics

A

1 - anti-diarrhoeal

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14
Q

In the management of acute gastroenteritis, should anti-diarrhoeals be used?

A
  • no
  • we want to get rid of the pathogen in the diarrhoea
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15
Q

Is metabolic alkalosis or acidosis more common in acute gastroenteritis?

A
  • metabolic alkalosis
  • due to loss of electrolytes, specifically HCO3-
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16
Q

What acute disorder can occur due to gastroenteritis?

1 - acute liver failure
2 - acute cardiogenic shock
3 - acute kidney injury
4 - all of the above

A

3 - acute kidney injury
- loss of fluid causes dehydration and a drop in BP
- low BP causes reduces eGFR and AKI

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17
Q

If a campylobacter, a bacteria causes of gastroenteritis is present then a Quinolones antibiotic, ciprofloxacin can be considered in all of the following except:

1 - patient is immunocompromised
2 - patient is pregnant
3 - patients symptoms are deteriorating
4 - patients symptoms are prolonged >1 week
5 - patient requests immediate treatment with antibiotics

A

5 - patient requests immediate treatment

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18
Q

If salmonella, a bacteria is the causes of gastroenteritis, antibiotics should only be used in which 1 of the following?

1 - extra intestinal infection is present
2 - patient is immunocompromised
3 - patient is pregnant
4 - patients symptoms are deteriorating

A

1 - extra intestinal infection is present
- if this is not present, antibiotics can just prolong the infection

19
Q

If shigella, a bacteria is the causes of gastroenteritis, antibiotics should only be used in which 1 of the following?

1 - extra intestinal infection is present
2 - patient is immunocompromised
3 - patient is pregnant
4 - patients symptoms are deteriorating
5 - patient is infected with virulent species

A

5 - patient is infected with virulent species
- Shigella shigae or Shigella dysenteriae

20
Q

If Yersinia enterocolitica, a bacteria is the causes of gastroenteritis, then antibody testing is required. Which GIT condition has this been shown to mimic by affecting the terminal ileum?

1 - coeliac disease
2 - ulcerative colitis
3 - crohns disease
4 - irritable bowel syndrome

A

3 - crohns disease

21
Q

If E. coli -157, a bacteria is the causes of gastroenteritis, this can lead to which of the following?

1 - hemorrhagic colitis
2 - thrombocytopenia
3 - microangiopathic hemolytic anemia
4 - haemolytic - uraemic syndrome (HUS)
5 - all of the above

A

5 - all of the above
- haemolytic - uraemic syndrome (HUS) is a syndrome characterised by AKI with thrombocytopenia and microangiopathic hemolytic anemia

22
Q

If Clostridium difficile, a bacteria is the causes of gastroenteritis, this can be very dangerous and can cause diarrhoea, systemic upset and colitis. What is the mortality of this condition?

1 - 0.3%
2 - 3%
3 - 13%
4 - 30%

A

4 - 30%
- can cause persistent diarrhoea following antibiotic treatment, especially in the elderly.

23
Q

Clostridium difficile, a bacteria can causes of gastroenteritis and is dangerous with a mortality of 30%. This can be detected using C.diff toxin A+B, but which of the following is the 1st line treatment for this typically?

1 - metronidazole
2 - vancomycin
3 - fidaxomicin
4 - co-amoxicillin

A

2 - vancomycin

  • all 3 of these could be used though
24
Q

Norovirus is the most common non-bacterial cause of vomiting and diarrhoea. How is this typically transmitted?

1 - swimming pool water
2 - uncooked food
3 - inset bite
4 - contaminated drinking water

A

2 - uncooked food

25
Q

Mycobacterium tuberculosis or TB is bacterial species. Typically TB can infect the GIT at the ileocaecal valve. What symptoms can this cause?

1 - weight loss
2 - abdominal pain
3 - fevers
4 - palpable mass
5 - lymphocytosis
6 - all of the above

A

6 - all of the above

26
Q

Mycobacterium tuberculosis or TB is bacterial species. Typically TB can infect the GIT at the ileocaecal valve. Although it is able to cause all of the following, which GIT condition is TB most often confused with in the GIT?

1 - appendicitis
2 - bowel obstruction
3 - crohns disease
4 - perforation
5 - peritonitis

A

3 - crohns disease

  • treated with the same approach as pulmonary TB
27
Q

Mycobacterium tuberculosis or TB is bacterial species. Typically TB can infect the GIT at the ileocaecal valve. Imaging can be used, such as CT or MRI of the bowel to diagnose the patient. What is the most common finding on imaging?

1 - bowel obstruction
2 - perforation
3 - toxic megacolon
4 - bowel wall thickening

A

4 - bowel wall thickening
- confirmed via biopsy using sigmoidoscopy or colonoscopy

28
Q

Amoebiasis, or amoebic dysentery, is an infection of the intestines caused by a parasitic amoeba Entamoeba histolytica. What is the most common cause of this infection?

1 - swimming pool water
2 - uncooked food
3 - inset bite
4 - faecally contaminated food or water

A

4 - faecally contaminated food or water

29
Q

Amoebiasis, or amoebic dysentery, is an infection of the intestines caused by a parasitic amoeba Entamoeba histolytica, which is transmitted by faecally contaminated food or water. What % of patients are asymptomatic despite being infected?

1 - 0.9%
2 - 9%
3 - 49%
4 - >90%

A

4 - >90%

30
Q

Amoebiasis, or amoebic dysentery, is an infection of the intestines caused by a parasitic amoeba Entamoeba histolytica, which is transmitted by faecally contaminated food or water. Which GIT condition can this present in a similar way as when dysenteric symptoms are present?

1 - coeliac disease
2 - ulcerative colitis
3 - crohns disease
4 - irritable bowel syndrome

A

2 - ulcerative colitis
- rare, but can cause toxic megacolon

  • dysentery = blood and mucus present in diarrhoea
31
Q

Amoebiasis, or amoebic dysentery, is an infection of the intestines caused by a parasitic amoeba Entamoeba histolytica, which is transmitted by faecally contaminated food or water. Which GIT condition can this present in a similar way as when non-dysenteric symptoms are present?

1 - coeliac disease
2 - ulcerative colitis
3 - crohns disease
4 - irritable bowel syndrome

A

3 - crohns disease
- fistulas and strictures are present

  • fistula = abnormal connection between bowel and other organ
  • stricture = narrowing of the bowel due to fibrotic tissue
32
Q

Amoebiasis, or amoebic dysentery, is an infection of the intestines caused by a parasitic amoeba Entamoeba histolytica, which is transmitted by faecally contaminated food or water. What clinical feature will help determine that Amoebiasis is the cause of the gastroenteritis?

1 - dysentery diarrhoea
2 - diarrhoea with liver abscess
3 - diarrhoea with toxic megacolon
4 - constipation and liver abscess

A

2 - diarrhoea with liver abscess

33
Q

Amoebiasis, or amoebic dysentery, is an infection of the intestines caused by a parasitic amoeba Entamoeba histolytica, which is transmitted by faecally contaminated food or water. How can Amoebiasis typically be diagnosed?

1 - biopsy
2 - serology from stool
3 - urinalysis
4 - non-responsive to antibiotics

A

2 - serology from stool
- specifically E.histolytica-specific antigen by ELISA

34
Q

Amoebiasis, or amoebic dysentery, is an infection of the intestines caused by a parasitic amoeba Entamoeba histolytica, which is transmitted by faecally contaminated food or water. Once confirmed how is amoebiasis treated?

1 - wait and see approach
2 - anti-diarrhoeals
3 - anti-virals
4 - antibiotic (metronidazole)

A

4 - antibiotic (metronidazole)

  • a Nitroimidazole
  • release nitrosa free radicals, damaging DNA
  • without function DNA the cell cannot replicate and will die
35
Q

Which of the following are parasites identified in the aetiology of parasitic causes of gastroenteritis?

1 - Giardia - small bowel malabsorption
2 - E.histolytica – amoebic dysentery and liver abscesses
3 - Hookworm – iron deficiency anaemia
4 - Hydatid disease – hydatic cysts
5 - Liver Flukes – biliary obstruction
6 - Shistosomiasis – non-cirrhotic portal hypertension
7 - all of the above

A

7 - all of the above

36
Q

Human immunodeficiency virus (HIV) can cause gastroenteritis. Typically is a pathogen identified though?

A
  • no
37
Q

Human immunodeficiency virus (HIV) can cause gastroenteritis. Although no pathogen is commonly reported, which 2 of the following findings are commonly observed upon biopsy?

1 - crypt malabsorption
2 - villous atrophy
3 - granulomas
4 - cobblestone inflammation

A

1 - crypt malabsorption
2 - villous atrophy

38
Q

In 2009, 76 children in East Surrey became unwell and 10 seriously ill following a visit to a farm, resulting in a thrombotic cause of renal failure. What GI infection were they found to have?

  1. Clostridium Difficile
  2. Ecoli 0157
  3. Shigella
  4. Yersinia enterocolitica
  5. Campylobacter
A
  1. Ecoli 0157
  • can cause haemolytic - uraemic syndrome (HUS) is a syndrome characterised by AKI with thrombocytopenia and microangiopathic hemolytic anemia
39
Q

A 42 year old male presented to hospital with a 6 week history of diarrhoea, fever and weight loss. Imaging showed thickening of the terminal ileum. A subsequent colonoscopy showed inflammation of the ileocaecal valve, biopsies of which showed chronic inflammation without granulomas. What infection can mimic terminal ileal Crohn’s Disease?

  1. Clostridium Difficile
  2. Ecoli 0157
  3. Shigella
  4. Yersinia enterocolitica
  5. Campylobacter
A
  1. Yersinia enterocolitica
  • presents in a similar way as crohns disease
40
Q

A 25 year old presented 2 days after a barbecue with bloody diarrhoea and severe abdominal cramps. What is the most likely GI infection?

  1. Clostridium Difficile
  2. Ecoli 0157
  3. Shigella
  4. Yersinia enterocolitica
  5. Campylobacter
A
  1. Campylobacter
  • most likely to cause abdominal cramps with bloody diarrhoea
41
Q

A 75 year old lady is readmitted to hospital with watery diarrhoea a week after being in hospital for an hip operation, complicated by an infection for which she received clindamycin. What is the most likely cause for her GI infection?

  1. Clostridium Difficile
  2. Ecoli 0157
  3. Shigella
  4. Yersinia enterocolitica
  5. Campylobacter
A
  1. Clostridium Difficile
  • clindamycin often reduces pathogens and health flora, so opportunistic pathogens can flourish
42
Q

A 35 year old lady with UC is admitted with a flare which fails to respond to intravenous steroids. Rectal biopsies should be taken to exclude which pathogen?

  1. Clostridium Difficile
  2. HSV
  3. CMV
  4. Amoebiasis
  5. HIV
A
  1. CMV
  • can cause proctocolitis with bloody or watery diarrhoea
  • inclusion bodies are found when stained for on rectal biopsies
43
Q

A 50 year old man present with right upper quadrant pain, jaundice and fevers. A CT scan shows a large collection in the right lobe of his liver. What is the most likely cause for this collection?

  1. Hydatid disease
  2. E.coli
  3. Shistosomiasis
  4. Amoebiasis
  5. HIV
A
  1. Amoebiasis
  • only pathogen that causes diarrhoea and liver abscess

C. Year 3: Gastroenterology Random NOT on MLA Map (12 decks)

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