Infections of the GUT Flashcards
1
Q
What determines ACUTE diarrhea?
A
< 14 DAYS (infectious)
2
Q
What determines PERSISTENT diarrhea?
A
14-28 DAYS (infetious)
3
Q
What determines CHRONIC diarrhea?
A
≥28 DAYS (usualy NON-INFECTIOUS)
4
Q
Diarrhea that PERSISTS with ASYMPTOMATIC INTERVALS is usually caused by?
A
C.diff Inection or IBS-D
5
Q
An INFECTIOUS DIARRHEA that is NON-IVASIVE, WATERY, NON-BLOODY, LARGE-VOLUME, with MID-ABDOMINAL PAIN, with MALABSORPTION is localized to what portion of the GI tract?
A
SMALL BOWEL
6
Q
An INFECTIOUS DIARRHEA that is IVASIVE, CAN BE BLOODY, SMALL-VOLUME, with LOWER-ABDOMINAL PAIN, is localized to what portion of the GI tract?
A
COLON
7
Q
An INFECTION initially causing NAUSEA and VOMITING, then a WATERY (non-ivasive) or BLOODY (invasive) DIARRHEA?
A
FOOD POISONING
8
Q
Which are the FOUR most COMMON INVASIVE (bloody diarrhea) pathogens?
A
Campylobacter, Shigella, Salmonella, E.coli
9
Q
Nausea and Vomiting 1-6 HOURS after eating PROTEIN-RICH foods?
A
Staph aureus
10
Q
Nausea and Vomiting 3-12 HOURS after eating STARCHY foods (rice)?
A
Bacilus cereus
11
Q
When developing Nausea and Vomiting 24-48 HOURS after eating, this is likely caused by?
A
VIRUSES (norovirus)
12
Q
Infection with this VIRUS causes NAUSEA and VOMITING for 1-3 DAYS and sheds up to 4 WEEKS (must ISOLATE)?
A
NOROVIRUS (cruise ship virus)
13
Q
C.perfringens (meat, poulty, gravy), EnteroToxigenic E.Coli (ETEC) (travelers diarrhea, water), Giardia (stream water, DAYCARE), Cryptosporidium (milk, cheese, produce), Cyclospora (raspberries, basil), Viruses cause what TYPE of diarrhea?
A
WATERY
14
Q
BLOODY DIARRHEA 2-5 DAYS after eating MEAT, POULTRY, PRODUCE?
A
Campylobacter, Salmonella, Shigella
15
Q
WATERY DIARRHEA that BECOMES BLOODY 1-7 DAYS after eating GROUND BEEF, FRUITS, VEGETABLES, UNPASTEURIZED JUICES, causes HUS (microangiopathic)?
A
E.coli (shiga-toxin) 0157:H7
16
Q
BLOODY DIARRHEA after eating UNDERCOOKED PORK or UNPASTEURIZED MILK?
A
YERSINIA, plesiomonas, aeromonas (LOOKS LIKE CROHN’s - ileocolitis)
17
Q
BLOODY DIARRHEA after eating RAW FISH?
A
Vibrio Parahemolyticus
18
Q
BLOODY DIARRHEA with BULLOUS SKIN RASH after handling FISH?
A
Vibrio Vulnificus
19
Q
What infectious BLOODY (invasive) DIARRHEA is associated with DEATH in the immunocompromised or those with chronic liver disease?
A
Vibrio
20
Q
How is VIRAL GASTROENTERITIS treated (small bowel, watery diarreha)?
A
SUPPORTIVE
21
Q
Does the use of ALCOHOL GELS prevent VIRUS or C.diff transmission?
A
NO
22
Q
WATERY DIARRHEA after exposure to FAMILY GATHERINGS, NURSING HOMES, CRUISE SHIPS 24-48 HOURS post exposure with ABRUPT nausea and vomiting, fever and myalgias and lasts < 72 HOURS, contagious for 3 WEEKS?
A
NOROVIRUS (can be ETEC)
23
Q
WATERY DIARRHEA, very SEVERE in children, 2 VACCINES exist?
A
ROTAVIRUS
24
Q
How is Vibrio Cholera (toxin-producing) watery diarrhea treated?
A
ORAL REHYDRATION SOLUTION
25
This **watery diarrhea** is caused by a **TOXIN-PRODUCING** bacteria which can be **HEAT labile** or **HEAT tolerant**?
**ETEC** (Entero Toxigenic E.Coli) - food/water fecal-oral route - **TRAVELER**'s diarrhea
26
How is **TRAVELER's DIARRHEA** (**ETEC**) treated if it's **MILD**, **SEVERE** or **DYSENTERY** (bloody)?
**MILD**: Rifaximin
**SEVERE**: Cipro or azithromycin
**DYSENTERY**: azithromycin
27
What is the best **TEST** for **DIARRHEA** caused by **PARASITES** (large volume, watery?
Stool **GIADIA antigen** or **ACID-FAST** test
28
A patient with **LOW IgG** (**HYPOgammaglobulinemia**), with **RECURRENT** large volume **WATERY** diarrhea, **SINUS INFECTIONS**?
**Giardia**
29
**CRYPTOSPORIDIA** (watery diarrhea) is treated **HOW**?
**NITAZOXANIDE** (3 DAYS)
30
**SOLID-ORGAN** transplant recepients are at **RISK** for an infection with this **ORGANISM** that causes watery diarrhea?
**STRONGYLOIDES** (also those on steroids, HIV, HTLV-1)
31
**POSITIVE SEROLOGY** (best for screening) where as serology and stool antigen best for **DIAGNOSIS**, increased **EOSINOPHILS**, **ELISA**, **STOOL ANTIGEN** in patients on STEROIDS, HIV, HTLV-1 and solid organ transplant recepients?
**STRONGYLOIDES**
32
What are the most **COMMON** bacteria in the **COLON** that cause **INFECTIOUS** diarreha?
**Campylobacter**, **Salmonella**, **Shigella**, **E.coli**
33
Patient ate **UNDERCOOKED** (**RAW**) **CHICKEN**, developed **NAUSEA** and **VOMITING**, **WATERY** diarrhea that turned **BLOODY** with **ILEOCOLITIS** (mimics Crohn's) and patient develops **GUILLAIN-BARRE** post infection resolution?
**Campylobacter**
34
How are infections (dysentery - bloody diarrhea) with **CAMPYLOBACTER** treated?
**AZITRHOMYCIN**, or erythromycin, trtracycline (cipro has resistence)
35
**DYSENTERY** (bloody diarrhea) with **FEVER** and **JOINT PAINS** after **TOUCHING LIZARDS**, **SNAKES**, **FROGS**, **TURTLES** and other **REPTILES** or EATING **EGGS**, **PEANUT BUTTER**, **SPINACH**, **SALAMI**, **MANGOS**, **CANTALOUPES** is usually caused by?
**TYPHOID** FEVER (**SALMONELLA**)
36
Which **SALMONELLA** cases should be **TREATED**?
**ALL** (**AZITHROMYCIN** or Cipro)
37
**WATERY** to **BLOODY** diarrhea, SHIGELLA - how do you **TREAT** (highly contagious)?
**AZITHROMYCIN** or Cipro
38
Initially **WATERY** diarrhea, then **BLOODY**, **SEVERE CRAMPS**, **SEVERE ABDOMINAL PAIN**, low grade fever, acts like ischemic colitis. If you **TREAT** with **ANTIBIOTICS**, you'll **PRECIPITATE HUS**?
**SHIGA TOXIN**-producing **E.Coli** (**STEC**)
39
If suspecting **Shiga Toxin-producing E.COli**, what **MUST** you do?
**CULTURE + EIA** (ELISA)
and
**DO NOT TREAT** with **ANTIBIOTICS** (HUS)
40
Infection with this causes **WATERY** to **BLOODY** diarrhea (**SEVERE ABDOMINAL PAIN**) can cause HEMOLYTIC ANEMIA, RENAL FAILURE, **THROMBOCYTOPENIC PURPURA** and if treated with antibiotics, **HUS**?
**Shiga Toxin-producing E.Coli** (STEC)
41
**ANTIBIOTICS** and **ANTIMOTILITY** agents (loperamide, immodium) are **CONTRAINDICATED** for this **DYSENTERY**-causing bacteria?
**Shiga Toxin-producing E.Coli** (STEC) - can precipitate HUS
42
This diarrhea-causing organism presents like **CROHN's**, has **GRANULOMATOUS APPENDICITIS**, causes **ILEITIS**, **MESENTERIC ADENITIS**, can be mistaken for **SARCOIDOSIS** or a **FOREIGN BODY** and is grown on **COLD ENRICHMENT MEDIUM** - get it by eating **PORK PRODUCTS**?
**YERSINIA** (no treatment needed)
43
Which diarrhea-causing organisms can cause **REACTIVE ARTHRITIS** (Reiter's - can't see, can't pee, can't climb a tree)?
**YERSINIA** (no treatment needed)
Shigella, Salmonella, Campylobacter (Guillain-Barre)
44
When **HANDLING** or **EATING RAW SHELLFIS**H, a patient develops **NAUSEA**, **VOMITING** and **DIARRHEA** and its **SELF-LIMITED**? What if they developed a **BULLOUS-RASH**?
**No rash**: Vibrio **Parahemolyticus**
**RASH**: Vibrio **Vulnificus**
45
In which patients do you **TREAT** Vibrio Vulnificus?
**Immunocompromised** (diabetes as well, achlorhydria) **Chronic Liver Disease**, **Severe** Presentation (**bullous** rash)
46
Diarrheal illness after eatign **ICE CREAM**, **DELI MEATS**, **UNPASTEURIZED CHEESE**, **HOT DOGS**, **CANTALOUPES** (resists cold, salts, acid)?
**LISTERIA**
47
**WATERY** diarrhea with **HEADACHE** (**MENINGITIS**) after eating **ICE CREAM**, **DELI MEATS**, **UNPASTEURIZED CHEESE**, **HOT DOGS**, **CANTALOUPES**?
**LISTERIA**
48
If a patient is found to have diarrhea because of **Entamoeba Histolytica** (cysts are infectious), what do you do?
**ALWAYS TREAT**
49
What is the **BEST** way to diagnose **Entamoeba Histolytica**?
**Stool Antigen** or **SEROLOGY**
50
If a patient gets a colonoscopy, where would you **SPECIFICALLY** biopsy for **Entamoeba Histolytica**?
**ASCENDING** colon, **ILEUM**
51
An **IMMIGRANT** or from the **TROPICS** patient presents with **CHRONIC DIARRHEA**, **COLITIS** or **DYSENTERY** and you find this on colonoscopy?
**TRICHURIS** (whipworm)
52
If **WATERY DIARRHEA** is **MODERATE-SEVERE AND** there is a **TRAVEL HISTORY**, how do you **TREAT**? If **NON-TRAVEL**?
**TRAVEL**: **ANTIBIOTICS**
**NON-TRAVEL**: **TEST FIRST**, then **ANTIBIOTICS** **ONLY** if **FEVER ≥72 HR**
53
If **BLOODY DIARRHEA** is **NO FEVER**, what's the **NEXT** step?
**TEST FIRST** then **ANTIBIOTICS**
54
If **BLOODY DIARRHEA**, **SEVERE** with **FEVER**, what's the **NEXT** step?
**TRAVEL**: EMPIRIC **ANTIBIOTICS** (azithromycin)
**NO-TRAVEL**: **TEST FIRST**, then **ANTIBIOTICS**
55
Which **VIRUS** causes **DISTAL PROCTITIS**?
**HSV**
56
Which **VIRUS** causes diarrheal colitis in the immunocompromised (transplant, IBD, chemotherapy?
**CMV**
57
In the **TROPICS**, within **10-30 MINUTES** after eating **TUNA** or **MAHI MAHI** pt presents with **FACIAL RASH** and **ERYTHEMA**, **TACHYCARDIA** and **WHEEZING**, a brief **DIARRHEA**, **SEVERE ABDOMINAL PARALYSIS** with **BLURRED VISION**, **RESPIRATORY DISTRESS**, **SWOLLEN TONGUE**?
**SCROMBOID** - treat with **ANTIHISTAMINES**
58
**SEVERE HISTAMINE REACTION** after eating **TUNA** or **MAHI MAHI**?
**SCROMBOID** - treat with antihistamines
59
Patient ate **BARRACUDA**, **RED SNAPPER**, **EEL**, **SEA BASS**, **MACKEREL** and developed **N/V/D** with **MUSCLE PAINS**, **ABDOMINAL PAIN**, **DIZZINESS**, **VERTIGO**, **RASH** and **PARALYSIS** (can be deadly)?
**CIGUATERA** toxin poisoning - treat with **ANTIHISTAMINES**
60
If suspecting **C.diff** Infection (**CDI**), what's the **SCREENING** test **RECOMMENDED**? If **POSITIVE**?
**GDH** (glutamate dehydrogenase antigen)
If **POSITIVE**: **PCR** or **NAAT** to confirm toxigenic strain (NAAT can detect non-toxigenic strains too - 3-7% carriers)
**ELISA** - confirmation
61
**ALL IBD** patients who present with a **FLARE** or **POUCHITIS**, **ALWAYS** test for?
**C.diff** Infection
62
An **IBD** patient with **C.diff** Infection should be treated with **WHAT** and for **HOW LONG**?
**VANCOMYCIN 125 mg 4x/day PO x 14** DAYS
63
Should **IBD** therapy be **HELD** while treating **C.diff** Infection?
**NO!!**
64
If patient with **IBD** has **C.diff** Infection that is **RECURRENT**, what should be **CONSIDERED**?
**FMT** (Fecal Microbiota Transplant)
If **NO IBD**, **FMT** after **SECOND RECURRENCE** (i.e. THIRD episode)
65
For **MILD**, **MODERATE** or **SEVERE C.diff** Infection (abd pain, WBC ≥15K, Cr >1.5, LOW Alb, fever, high calprotectin) what is the **RECOMMENDED** treatment?
**VANCOMYCIN 125 mg PO 4x/day for 10 DAYS**
or
**FIDAXOMYCIN 200 mg PO BID for 10 DAYS**
66
**FULMINANT C.diff** Infection (**HYPO**tension, **SHOCK**, **ILEUS**, **MEGACOLON**) is treated how?
**VANCOMYCIN 500 mg PO 4x/day + METRONIDAZOLE 500 mg IV TID**
Use **VANCOMYCIN 500 mg ENEMAS 4x/day** if **ILEUS** present
67
**When a C.diff Infection RECURS** for the **FIRST** time, what is recommended for **TREATMENT**?
A **DIFFRRENT** regimen that what was initially used
**or**
**PULSED DOSING** (Vancomycin 125 mg PO 4x/day for 10 DAYS, then 125 mg PO DAILY every 3 DAYS for an additional 10 DOSES)
68
**When a C.diff Infection RECURS** for the **SECOND** time, what is recommended for **TREATMENT**?
**PULSED DOSING**: (Vancomycin 125 mg PO 4x/day for 10 DAYS, then 125 mg PO DAILY every 3 DAYS for an additional 10 DOSES)
**or**
Vancomycin 125 mg PO 4x/day for 10 DAYS then **RIFAXIMIN 400** mg PO TID for 20 DAYS
**or**
**FIDAXOMICIN** 200 mg PO BID x 10 DAYS
**or**
**Fecal Microbiota Transplant** (FMT) by colonoscopy or capsules or enemas, then **REPEAT FMT in 8 WEEKS** again
69
For patients with **RECUREENT C.diff** Infections who are **NOT** candidates for **FMT** or who **RELAPSED** after **FMT**, what is **RECOMMENDED** for **PROPHYLAXIS** especially when they have to take antibiotic regimens for other infections?
**LONG-TERM** suppressive **VANCOMYCIN** prophylaxis
70
A drug which is an **ANTIBODY** against the **C.diff TOXIN**, can be used in patients who are at **HIGH-RISK** for **RECURRENCE**?
**BEZLOTOXUMAB**
71
Most common cause of **DEATH** from **GI** infections in the **US**?
**C.diff** Infection (CDI)
72
**Nursing Home** outbreak with nausea, vomiting, diarrhea?
**NOROVIRUS** (hand washing alone will NOT control it)
spreads by fecal-oral, aerosolized
73
Best **ANTIBIOTIC** to use in a **PREGNANT** patient with infectious diarrhea?
**AZITHROMYCIN**
74
Traveler's diarrhea in **AFRICA** is most likely caused by?
**Campylobacter**
75
Watery diarrhea and bloating **4-7 DAYS** post eating an affected meal?
**Cyclospora** (raspberries, fruit plate)
76
When a patient has bloody diarrhea and fever **DOMESTICALLY**, what is **RECOMMENDED**?
**STOOL STUDIES**, then ANTIBIOTICS
77
When are **STOOL STUDIES** recommended **DOMESTICALLY** for **WATERY DIARRHEA**?
When **FEVER is >101F** and **diarrhea >72 HOURS**
78
What is **RECOMMENDED** for **TRAVELERS** diarrhea whether **WATERY** or **BLOODY**?
EMPIRIC **ANTIBIOTIC** treatment, **NO STOOL STUDIES**
79
What is **RECOMMENDED** for a **DOMESTIC** patient with **WATERY DIARRHEA** and **LOW-GRADE** fever for 2 days?
**LOPERAMIDE** and **REHYDRATION**
80
Best feature on **BIOPSY** to differentiate **IBD** from acute colitis?
**BRANCHING** at the base of the crypts
81
When should a **VANCOMYCIN ENEMA** be used to treat **C.diff** Infection?
**ILEUS**
82
When should a patient undergo **COLONOSCOPY** post **DIVERTICULITIS** episode?
**6-8 WEEKS** (to look for malignancy)
83
**NSAIDs**, **CORTICOSTEROIDS**, **OPIATES** affect **DIVERTICULITIS** how?
**INCREASE** the risk of **PERFORATION**
84
How is **UNCOMPLICATED LEFT** sided **DIVERTICULITIS** treated?
SUPPORTIVE (**NO ANTIBIOTIC**S)
85
If **HAMARTOMATOUS** polyps are discovered on colonoscopy what is **RECOMMENDED** for **OVERALL** surveillance?
**EGD**, **VIDEO CAPSULE**, **MRCP (pancreas & bile ducts) NOW** and **COLONOSCOPY** every **2-3 YEARS**
86
How **MANY** polyps on a colonoscopy are required to make a **PEUTZ-JEGHER's** diagnosis?
**2 POLYPS**
or
If **FAMILY HISTORY** (in **1st degree** relative), **ANY POLYPS**
87
**WHEN** do you survey the **SMALL BOWEL** (video capsule or MRE), **EGD**, **COLONOSCOPY** of a child with family history of **PEUTZ-JEGHER's** and thereafter?
Between **8-10** years old **IF NO POLYPS**, then **at age 18**, **EGD/COLONOSCOPY** every **2-3 YEARS** otherwise every 2-3 years
88
For a patient with **PEUTZ-JEGHER's**, when do you start **ANNUAL MRCP** or **EUS** for surveillance of pancreatic and biliary cancers?
At **age 35**
89
When is **EUS/FLEX SIG** recommended post **TRANS-ANAL** or **ESD** resection of a **RECTAL CANCER**?
**3-6 MONTHS** (for the **first 2-3 YEARS**)
90
When is **COLONOSCOPY** surveillance after **SURGICAL REMOVAL** of a **COLON CANCER**?
**1 YEAR**, **3 YEARS**, **5 YEARS** (ongoing)
91
**STUDY** of **CHOICE** when **SUSPECTING APPENDICITIS** (elevated **CRP** and **WBCs**) especially in **YOUNG** individual?
RLQ **ULTRASOUND**
92
**Collagenous COLITIS** (associated with CELIAC and THYROID disease) can be caused by these meds and when presenting with abdominal pain, diarrhea, **STOP** the **MEDS** (if persists, BUDESONIDE)?
**NSAIDs**, **ACE-I**
93
If **≥ 20** (**< 10 mm**) **HYPERPLASTIC POLYPS** are found on colonoscopy in the **LEFT** colon, when do you seuvey again?
**10 YEARS** (3-5 years if these are >10 mm)
94
**FIRST** test to do for **DISORDERED DEFECATION**?
**DRE** (Digital Rectal Exam) - then do anorectal manometry and baloon expulsion test, then pelvic floor EMG and MRI defecography
95
In patients with **DISORDERED DEFECATION** who have a **NORMAL** anorectal manometry and baloon expulsion test and do **NOT** respond to **BIOFEEDBACK**, what do you **TEST** next?
**COLONIC TRANSIT STUDY**
96
**TREATMENT** of **CHOICE** for **DISORDERED DEFECATION**?
**BIOFEEDBACK** (anorectal) NOT pelvic floor therapy
97
In a patient with **INTUSSUSCEPTION** with pain, distention, what is the **RECOMMENDED** therapy?
**LAPAROSCOPY** - **75%** of cases are **NEOPLASM** (reduction is avoided due to perforation and recurrence)
98
Which **INFECTIOUS** organism causes **intussusception**?
**YERSINIA**
99
Patient is being treated with an **IMMUNE-CHECK** inhibitor and develops **COLITIS** (with or without enteritis) with **DIARRHEA** **>4 STOOLS/DAY** , (with or without hepatitis) whats the nex step?
Rule out C.diff or CMV, check CRP, calprotectin, CT scan (if fever, blood, abdominal pain),**COLONOSCOPY** with **BIOPSIES** to ASSESS severity of colitis (if mild: mesalamine/budesonide; if severe: IV STEREOIDS + infliximab/vedolizumab)
100
Patient with **ACUTE** abdominal **PAIN** and LGIB, hematochezia with **MAROON or BRBPR** and clots, no melena, whats the next step?
**COLONOSCOPY** (after resusscitation and rapid prep)
101
In a patient with **GIB**, when **SOURCE** is not found on **ENDOSCOPY**, what is the **PREFERRED NEXT TEST**?
**CT ANGIOGRAPHY** (not bleeding scan)
102
Pt develops **ILEITIS**, with **mesenteric adenopathy** on CT, has **fever**, **sore throat**, **PROLONGED DIARRHEA** that subsides as well as **ERYTHEMA NODOSUM**, then develops **arthralgias** and abdominal **pain**?
**YERSINIA** (**TMP-SMX**) - MIMICS IBD
**REACTIVE ARTHRITIS** after **DIARRHEA**
103
**DIARRHEA**, **ILEITIS**, **PHARYNGITIS** and **REACTIVE ARTHITIS**?
**YERSINIA** (TMP-SMX) - mesenteric adenopathy on CT
104
What constitutes **FAMILY HISTORY** of **COLON CANCER** or **ADVANCED ADENOMA**?
**1st** degree relative **< 60 yo**
or **2 1st degree relatives** of **ANY AGE**
if **≥60** yo - **AVERAGE SCREENING** starting at **40 yo**
105
When should **COLORECTAL CANCER SCREENING** start for a patient with a **FAMILY HISTORY of COLON CANCER** or **ADVANCED ADENOMA** (high-grade dysplasia)?
**10 YEARS** before the age of diagnosis of the family member or at **age 40**, whichever **EARLIER**
106
What should be done for patients undergoing **ELECTIVE/PLANNED** (**LOW-RISK SCREENING**) **ENDOSCOPIC** procedures while on **WARFARIN**?
**CONTINUE WARFARIN**
107
Is **BRIDGING ANTICOAGULATION RECOMMENDED**?
**NO**
108
**BEZLOTUXAMAB** is a consideration for patients with **RECURRENT C.diff infections** (**NOT AS A TREATMENT** BUT AS PREVENTION) **EXCEPT** in patients with?
**CHF**
109
What is the recommened **technique** for removal of **< 5 mm colon polyp**?
**COLD SNARE POLYPECTOMY**
110
**BEST** treatment for hematochezia due to **RADIATION PROCTOPATHY** (around 3 months after therapy)?
**ENDOSCOPY** with **PULSED APC** to **DISCRETE AREAS**
**DO NOT BIOPSY** - non-healing ulcers, fistula
111
What should be **FIRST LINE THERAPY** for a patient with **MEGACOLON** or **OGILVIE's** or **ACUTE COLONIC PSEUDOOBSTRUCTION** that is not **TOXIC** (life threatening)?
**NEOSTYGMINE** 2 mg IVP
SURGERY if >10-12 cm and prolonged course
