STDs + C. Diff Flashcards

1
Q

When exposed to STIs, women are more likely to become ___ and less likely to be ____

A

When exposed to STIs, women are more likely to become infected and less likely to be symptomatic.

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2
Q

__ is the most common sexually transmitted disease in the United States

A

Chlamydia is the most common sexually transmitted disease in the United States

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3
Q

HSV-2 accounts for ___ of the genital herpes infections. HSV-1 accounts for ___ and is the common cause of ___; silent infection is common in this disease. The diagnosis is made by viral culture and subtyping. HSV enters the nerve and remains latent/active in the nerve cell body. It may cause ___ and ___, which may lead to urinary retention

A

HSV-2 accounts for 90% of the genital herpes infections. HSV-1 accounts for the remainder and is the common cause of cold sores; silent infection is common in this disease. The diagnosis is made by viral culture and subtyping. HSV enters the nerve and remains latent in the nerve cell body. It may cause aseptic meningitis and autonomic dysfunction, which may lead to urinary retention

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4
Q

Chancroid is caused by ____ and results in a ___,___ covered by an exudate. ____ occurs and may become suppurative.

A

Chancroid is caused by Haemophilus ducreyi and results in a painful, nonindurated ulcer covered by an exudate. Inguinal adenopathy occurs and may become suppurative.

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5
Q

____ of syphilis is single, painless, indurated, and clean. It is associated with nontender/tender inguinal lymphadenopathy.

A

. Chancre of syphilis is single, painless, indurated, and clean. It is associated with nontender inguinal lymphadenopathy.

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6
Q

Latent syphilis is ___ with no evidence of disease. Early latent syphilis occurs in __. Late latent syphilis occurs___

A

Latent syphilis is seropositive with no evidence of disease. Early latent syphilis occurs in less than 1 year. Late latent syphilis occurs beyond 1 year

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7
Q

Primary syphilis is the ___.

Secondary syphilis is manifested by __ and constitutional signs and symptoms that are often associated with a ___.

Tertiary syphilis is a ___ involving the (3)

A

Primary syphilis is the acute infection.

Secondary syphilis is manifested by mucocutaneous and constitutional signs and symptoms that are often associated with a maculopapular rash.

Tertiary syphilis is a systemic disease involving the cardiovascular, skeletal, and central nervous system

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8
Q

t/F

  1. Treponemal tests for syphilis are generally positive for life and do not indicate treatment response.
  2. RPR, Venereal Disease Research Laboratory (VDRL), and the toluidine red unheated serum test (TRUST) are nontreponemal tests and correlate with disease activity. They are still positive after treatment.
  3. Nontreponemal tests (RPR or VDRL) are used to monitor disease activity.
A

TRUE: Treponemal tests for syphilis are generally positive for life and do not indicate treatment response.

FALSE: RPR, Venereal Disease Research Laboratory (VDRL), and the toluidine red unheated serum test (TRUST) are nontreponemal tests and correlate with disease activity. They usually become negative after treatment.

tRUE: Nontreponemal tests (RPR or VDRL) are used to monitor disease activity.

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9
Q

The ___ reaction occurs when patients with syphilis are treated with penicillin, resulting in the release of toxic products when the treponemes are killed. The symptoms include: (5)

A

The Jarisch-Herxheimer reaction occurs when patients with syphilis are treated with penicillin, resulting in the release of toxic products when the treponemes are killed. The symptoms include headache, myalgia, fever, tachycardia, and increased respiratory rate

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10
Q

LGV presents as a ___ and ___. LGV is marked by tender inguinal and/or femoral lymphadenopathy, typically ___

A

LGV presents as a single painless ulcer and painful inguinal adenopathy. LGV is marked by tender inguinal and/or femoral lymphadenopathy, typically unilateral.

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11
Q

___ are used for diagnosing chlamydial infection

A

Polymerase chain reaction (PCR) assays are used for diagnosing chlamydial infection

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12
Q

A strawberry rash on the vulva or strawberry cervix is seen in ____

A

A strawberry rash on the vulva or strawberry cervix is seen in trichomoniasis.

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13
Q

More than 99% of cervical cancers and 84% of anal cancers are associated with ___ and ___. The most common serotype associated with squamous cell carcinoma of the penis is ____

A

More than 99% of cervical cancers and 84% of anal cancers are associated with HPV 16 or 18. The most common serotype associated with squamous cell carcinoma of the penis is HPV 16.

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14
Q

Biopsies of genital warts are routinely/not routinely indicated

A

Biopsies of genital warts are not routinely indicated but should be performed when the wart is atypical, pigmented, indurated, or fixed and ulcerated.

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15
Q

HPV vaccine is recommended for females age ___ years and may also be given to males of the same age range.

A

HPV vaccine is recommended for females age__ years and may also be given to males of the same age range.

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16
Q

T/F Antiviral therapy for HIV does not necessarily make the patient infectious.

A

FALSE : Antiviral therapy for HIV does not necessarily make the patient noninfectious.

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17
Q

True/false Men who are circumcised are at lower risk for HIV infection.

A

TRUE: Men who are circumcised are at lower risk for HIV infection.

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18
Q

There are two types of HIV viruses: HIV-1 and HIV-2.

There are very few cases of ___ in the developed world, and it is less easily transmitted and less virulent than ___

A

There are two types of HIV viruses: HIV-1 and HIV-2. There are very few cases of HIV-2 in the developed world, and it is less easily transmitted and less virulent than HIV-1.

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19
Q

HIV is a retrovirus that infects: (2)

A

HIV is a retrovirus that infects T cells and dendritic cells.

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20
Q

Overt AIDS is marked by a__

A

Overt AIDS is marked by a low CD4+ T-cell count.

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21
Q

TF: Plasma HIV RNA load is the most accurate predictor of disease progression.

A

true Plasma HIV RNA load is the most accurate predictor of disease progression.

22
Q

The diagnosis of HIV is made by screening for __ and __ If this is positive, confirmation is made by using __. After treatment, the ___ of plasma HIV RNA predicts long-term outcome.

A

The diagnosis of HIV is made by screening for anti-HIV-1 and antiHIV-2 antibodies. If this is positive, confirmation is made by using Western blot analysis. After treatment, the nadir of plasma HIV RNA predicts long-term outcome.

23
Q

T/F HIV testing is recommended for anyone diagnosed with a STI or at risk for STIs.

A

HIV testing is recommended for anyone diagnosed with a STI or at risk for STIs.

24
Q

The most common intrascrotal pathologic process in AIDS patients is ___.

A

The most common intrascrotal pathologic process in AIDS patients is testicular atrophy.

25
Q

T/F Voiding dysfunction is common in patients with advanced HIV infection.

A

true Voiding dysfunction is common in patients with advanced HIV infection.

26
Q

. Urinary calculi have been associated with, most notably, protease inhibitors such as ___ These stones are soluble at an ___

A

. Urinary calculi have been associated with, most notably, protease inhibitors such as indinavir. These stones are soluble at an acidic pH

27
Q

HIV-associated nephropathy is a glomerular disease that often presents as ___

A

HIV-associated nephropathy is a glomerular disease that often presents as proteinuria.

28
Q

___ is essential for all forms of Kaposi sarcoma.

A

Human herpesvirus 8 is essential for all forms of Kaposi sarcoma.

29
Q

HIV protease inhibitors are also potent antiangiogenic molecules and are useful in treating ___. However, localized lesions may be treated by irradiation, laser, cryotherapy, or intralesional injections of antineoplastic drugs. Corticosteroids should/should not be used to treat the lesions.

A

HIV protease inhibitors are also potent antiangiogenic molecules and are useful in treating Kaposi sarcoma. However, localized lesions may be treated by irradiation, laser, cryotherapy, or intralesional injections of antineoplastic drugs. Corticosteroids should not be used to treat the lesions.

30
Q

Patients with HIV are at particular increased risk for Kaposi sarcoma and non-Hodgkin lymphoma. Kaposi sarcoma presents as a ___ , reflecting the presence of __ ___ ___ and ___

A

Patients with HIV are at particular increased risk for Kaposi sarcoma and non-Hodgkin lymphoma. Kaposi sarcoma presents as a raised, firm, indurated purplish plaque, reflecting the presence of abundant blood vessels, extravasated erythrocytes, and siderophages.

31
Q

Current treatment of uncomplicated gonococcal infections of the cervix, urethra, and rectum

A

Current treatment of uncomplicated gonococcal infections of the cervix, urethra, and rectum are ceftriaxone 250 mg IM single-dose PLUS azithromycin, 1 g orally in single dose or doxycycline, 100 mg orally twice per day for 7 days.

32
Q

___ noted in granuloma inguinale are intracellular inclusions of the bacteria within the cytoplasm of macrophages and appear deep purple when stained with a (3)

A

Donovan bodies noted in granuloma inguinale are intracellular inclusions of the bacteria within the cytoplasm of macrophages and appear deep purple when stained with a Wright, Giemsa, or Leishman stain

33
Q

Characteristic findings for bacterial vaginosis on microscopic exam are __ which are vaginal epithelial cells covered with bacteria.

A

Characteristic findings for bacterial vaginosis on microscopic exam are clue cells, which are vaginal epithelial cells covered with bacteria.

34
Q

PDE5 inhibitors depend on___ for clearance, and all protease inhibitors and NNRTIs are inhibitors of CYP3A to some extent. This can lead to a significant increase in the serum dose of PDE5 inhibitors, and therefore they should be started at the lowest possible dose in patients on these antiretroviral medications.

A

PDE5 inhibitors depend on CYP3A for clearance, and all protease inhibitors and NNRTIs are inhibitors of CYP3A to some extent. This can lead to a significant increase in the serum dose of PDE5 inhibitors, and therefore they should be started at the lowest possible dose in patients on these antiretroviral medications.

35
Q

The major health risk to untreated Chlamydia infection in men is: a. epididymitis. b. Reiter syndrome. c. orchitis. d. chronic prostatitis/chronic pelvic pain syndrome. e. transmission to a female partner resulting in pelvic inflammatory disease

A

e. Transmission to a female partner resulting in pelvic inflammatory disease. Up to 75% of women with chlamydial infection can be asymptomatic. Ascending chlamydial infection can result in scarring of the fallopian tubes, pelvic inflammatory disease, risk for ectopic pregnancy, pelvic pain, and infertility. The risk of untreated chlamydial infection producing pelvic inflammatory disease is estimated to be between 9.5% and 27% of cases.

36
Q

In addition to treatment for chlamydia, what other medication is recommended as a first-line treatment for gonorrhea?

a. Ciprofloxacin
b. Levofloxacin
c. Ceftriaxone
d. Cefixime
e. Penicillin VK

A

c. Ceftriaxone. As of 2007, quinolones are no longer recommended in the United States for treatment of gonorrhea and associated conditions such as pelvic inflammatory disease. As of August 2012, because of high resistance, cefixime is no longer recommended as first-line therapy to treat gonorrhea. Current treatment of uncomplicated gonococcal infections of the cervix, urethra, and rectum is ceftriaxone, 250 mg IM, single-dose PLUS azithromycin, 1 g orally in single dose.

37
Q

___ is the treatment of choice for all of the stages of syphilis. Treatment varies by dose and duration of therapy.

A

Benzathine penicillin is the treatment of choice for all of the stages of syphilis. Treatment varies by dose and duration of therapy. Not considered appropriate treatments are combinations of benzathine and procaine penicillin (Bicillin C-R), or oral penicillin.

38
Q

Polymorphisms of which gene are associated with development of HIV-associated nephropathy (HIVAN) in African American patients? a. Tyrosine kinase b. Antichymotrypsin-1 c. Apolipoprotein-1 d. Tumor necrosis alpha e. Interleukin-10

A

c. Apolipoprotein-1. African Americans carrying two variants of the APOL-1 gene are at very high risk for HIVAN. These genes encode a secreted lipid binding protein called apolipoprotein-1 (apoL1). The variants G1 and G2 are common in African chromosomes but absent in European chromosomes; these variants lyse trypanosomes, including Trypanosoma brucei rhodesiense, which causes African sleeping sickness. Thus, these loci are thought to be selected out in this population. The presence of these two genes together increases the risk 29-fold, resulting in a 50% risk of developing HIVAN in untreated individuals as compared with a 12% baseline risk. Focal segmental glomerulosclerosis

39
Q

What type of genitourinary (GU) cancer is not increased in frequency in patients with HIV? a. Prostate cancer b. Kidney cancer c. Penile cancer d. Testis cancer e. Kaposi sarcoma

A
  1. What type of genitourinary (GU) cancer is not increased in frequency in patients with HIV? a. Prostate cancer b. Kidney cancer c. Penile cancer d. Testis cancer e. Kaposi sarcoma
40
Q

Clinical Vignette: A 28-year-old man presents with a genital lesion that is painless and indurated with a clean base. He denies any systemic symptoms.
Question: What type of lymphadenopathy would you expect in this patient?

A. Tender, regional, painful, suppurative nodes
B. Nontender, rubbery, nonsuppurative bilateral lymphadenopathy
C. Painful, matted, large nodes with fistulous tracts
D. Tender, bilateral inguinal adenopathy

A

Correct Answer: B
Explanation:

A: Seen in Chancroid. Incorrect.
B: Seen in Primary Syphilis. Correct.
C: Seen in Lymphogranuloma. Incorrect.
D: Seen in Genital Herpes. Incorrect.

Memory Tool: Think “SNN” for Syphilis: Singular, Nontender, None (systemic symptoms).
Reference Citation: Based on material from TABLE 58.2.
Rationale for Question: Understanding the presentation of primary syphilis, including its characteristic lymphadenopathy, is crucial for diagnosis and treatment.

41
Q

Clinical Vignette: A 35-year-old woman reports painful genital vesicles. She also complains of flu-like symptoms.
Question: What is the nature of the lymphadenopathy in this patient?

A. Nontender, rubbery, nonsuppurative bilateral lymphadenopathy
B. Painful, matted, large nodes with fistulous tracts
C. Tender, regional, painful, suppurative nodes
D. Tender, bilateral inguinal adenopathy

A

Correct Answer: D
Explanation:

A: Seen in Primary Syphilis. Incorrect.
B: Seen in Lymphogranuloma. Incorrect.
C: Seen in Chancroid. Incorrect.
D: Seen in Genital Herpes. Correct.
Memory Tool: Think “Herpes Hurts” for painful vesicles and tender nodes.
Reference Citation: Based on material from TABLE 58.2.
Rationale for Question: Recognizing the features of genital herpes is essential as it presents differently than other genital ulcer diseases.

42
Q

Clinical Vignette: A 40-year-old man has a painful genital ulcer with undermined, purulent edges. He has no systemic symptoms.
Question: What type of lymphadenopathy would you expect?

A. Nontender, rubbery, nonsuppurative bilateral lymphadenopathy
B. Painful, matted, large nodes with fistulous tracts
C. Tender, regional, painful, suppurative nodes
D. Tender, bilateral inguinal adenopathy

A

Correct Answer: C
Explanation:

A: Seen in Primary Syphilis. Incorrect.
B: Seen in Lymphogranuloma. Incorrect.
C: Seen in Chancroid. Correct.
D: Seen in Genital Herpes. Incorrect.
Memory Tool: Think “Chancroid Causes Chunky nodes” for suppurative lymphadenopathy.
Reference Citation: Based on material from TABLE 58.2.
Rationale for Question: Chancroid presents with its own specific set of symptoms, and identifying them can be key for treatment.

43
Q

A 30-year-old woman presents with vulvar pruritus and external dysuria. She reports that the discharge is white and thick. Which of the following is the most likely diagnosis based on these symptoms?

A. Normal Vaginal Discharge
B. Candidiasis
C. Trichomoniasis
D. Bacterial Vaginosis

A

Correct Answer: B. Candidiasis

In-depth Explanation:

A. Normal Vaginal Discharge: Although normal vaginal discharge is white and thick, it is not associated with symptoms such as vulvar pruritus or dysuria. (Paragraph 1, Table 58.8)
B. Candidiasis: The symptoms and the nature of the vaginal discharge are characteristic of candidiasis. White, thick, curd-like discharge along with vulvar pruritus and external or superficial dysuria are classic signs. (Paragraph 1, Table 58.8)
C. Trichomoniasis: Typically presents with frothy or purulent discharge and is associated with vulvar erythema and edema, not described in the vignette. (Paragraph 1, Table 58.8)
D. Bacterial Vaginosis: The discharge in bacterial vaginosis is thin and white but lacks the symptoms described in the vignette. (Paragraph 1, Table 58.8)
Memory Tool:
Remember “Candid Candice” has “Curdy Discharge and is Itchy” to remember symptoms of Candidiasis.

Rationale:
Differentiating between various causes of vaginitis is a frequent issue in urology and gynecology. Knowing the specific clinical and microscopic features of each can lead to accurate and prompt treatment.

44
Q

Question 2:
Which of the following diagnoses would most likely have a pH of greater than or equal to 4.5 and present with white blood cells?

A. Normal Vaginal Discharge
B. Candidiasis
C. Trichomoniasis
D. Bacterial Vaginosis

A

Correct Answer: C. Trichomoniasis

In-depth Explanation:

A. Normal Vaginal Discharge: Has a pH of less than or equal to 4.5 and white blood cells are absent. (Paragraph 1, Table 58.8)
B. Candidiasis: Also has a pH of less than or equal to 4.5 and white blood cells are absent. (Paragraph 1, Table 58.8)
C. Trichomoniasis: Is the only condition among the choices that has a pH of greater than or equal to 4.5 and has white blood cells present. (Paragraph 1, Table 58.8)
D. Bacterial Vaginosis: Although it has a pH of greater than or equal to 4.5, white blood cells are absent. (Paragraph 1, Table 58.8)
Memory Tool:
Remember “Tri-4.5-White” for Trichomoniasis: pH greater than 4.5 and White Blood Cells.

Rationale:
Understanding the pH and white blood cell count can be valuable diagnostic clues for urologists and gynecologists.

45
Q

Question 3:
A 28-year-old female presents with frothy vaginal discharge. Upon microscopic examination, you observe mobile organisms. What is the most likely diagnosis?

A. Normal Vaginal Discharge
B. Candidiasis
C. Trichomoniasis
D. Bacterial Vaginosis

A

Correct Answer: C. Trichomoniasis

In-depth Explanation:

A. Normal Vaginal Discharge: Microscopy usually reveals lactobacilli and no mobile organisms are seen. (Paragraph 1, Table 58.8)
B. Candidiasis: Microscopy shows mycelia, not mobile organisms. (Paragraph 1, Table 58.8)
C. Trichomoniasis: This is the only condition where microscopy reveals mobile trichomonads, aligning with the frothy nature of the discharge. (Paragraph 1, Table 58.8)
D. Bacterial Vaginosis: Microscopy typically reveals clue cells, not mobile organisms. (Paragraph 1, Table 58.8)
Memory Tool:
Think “Mobile Monads” to remember that Trichomoniasis features mobile trichomonads under microscopy.

Rationale:
Microscopic findings are often confirmatory in diagnosing vaginal conditions. Being familiar with the typical findings can streamline diagnosis and treatment.

46
Q

Question 4:
A 35-year-old woman presents with an increased vaginal discharge that has a fishy odor. Which of the following conditions is she most likely suffering from?

A. Normal Vaginal Discharge
B. Candidiasis
C. Trichomoniasis
D. Bacterial Vaginosis

Correct Answer: D. Bacterial Vaginosis

A

Correct Answer: D. Bacterial Vaginosis

In-depth Explanation:

A. Normal Vaginal Discharge: Typically has no odor and is not described as increased in volume. (Paragraph 1, Table 58.8)
B. Candidiasis: Does not typically have a fishy odor. (Paragraph 1, Table 58.8)
C. Trichomoniasis: While it may have an amine odor, it is not specifically described as having a fishy odor. (Paragraph 1, Table 58.8)
D. Bacterial Vaginosis: This condition is specifically described as having a fishy odor along with increased discharge. (Paragraph 1, Table 58.8)
Memory Tool:
Recall “Fishy BV” to remember that Bacterial Vaginosis typically has a fishy odor.

Rationale:
Odor characteristics can provide a straightforward diagnostic clue, making it easier for clinicians to reach a diagnosis without invasive tests.

47
Q

Clinical Vignette:
A 56-year-old man presents with diarrhea and abdominal pain. Lab tests reveal his albumin levels are 2.9g/dL, and his WBC count is 16,000 cells/mm^3. What would be the appropriate treatment?

Choices:
A. Metronidazole 500 mg PO TID × 10 days
B. Vancomycin 125 mg PO QID × 10 days
C. Vancomycin 500 mg PO QID and metronidazole 500 mg q8h
D. Fecal microbiota transplant

A

Correct Answer:
B. Vancomycin 125 mg PO QID × 10 days

Explanation:
A is incorrect. The patient has a low albumin (<3g/dL) and high WBC (>15,000 cells/mm^3), which qualifies as severe, not mild-to-moderate.
B is correct. Given the albumin and WBC levels, the patient falls under the “severe” category, requiring vancomycin.
C is for severe and complicated cases, not applicable here.
D is generally reserved for recurrent cases.
Memory Tool:
Think “Van for the Severe Man” to remember Vancomycin for severe cases.

Reference Citation:
Modified from Surawicz CM, et al. Am J Gastroenterol 108:478–498; quiz 499, 2013. (Table 139.4)

Rationale:
Understanding the treatment for different severities of C. difficile is essential for appropriate patient management.

48
Q

Clinical Vignette:
A 49-year-old woman was successfully treated for C. difficile but now presents with symptoms of another episode within 7 weeks of completing her therapy. What is the recommended treatment?

Choices:
A. Metronidazole pulse regimen
B. Repeat vancomycin or metronidazole pulse regimen
C. Fecal microbiota transplant after one recurrence
D. Vancomycin PR (500 mg in 500 mL of saline as enema QID)

A

Correct Answer:
B. Repeat vancomycin or metronidazole pulse regimen

Explanation:
A is incomplete; either vancomycin or metronidazole could be repeated.
B is correct as per guidelines for recurrence within 8 weeks.
C is incorrect; fecal transplant is considered after three recurrences.
D is used in severe and complicated cases, not recurrent.
Memory Tool:
“Back in 8? Repeat the Plate” - to remember to repeat the initial treatment if recurrence is within 8 weeks.

Reference Citation:
Modified from Surawicz CM, et al. Am J Gastroenterol 108:478–498; quiz 499, 2013. (Table 139.4)

Rationale:
Recurrence is a frequent problem in C. difficile, and knowing the guidelines for treatment is crucial.

49
Q

Clinical Vignette:
A 60-year-old female with a history of alcoholism is unable to take metronidazole due to potential liver toxicity. Her symptoms are consistent with a mild to moderate C. difficile infection. What should be the first-line treatment?

Choices:
A. Vancomycin 125 mg PO QID × 10 days
B. Vancomycin 500 mg PO QID × 10 days
C. Metronidazole 500 mg PO TID × 10 days
D. Surgical consultation

A

Correct Answer:
A. Vancomycin 125 mg PO QID × 10 days

Explanation:
A is correct. In cases where metronidazole can’t be taken, vancomycin 125 mg is the alternative.
B is for severe and complicated cases.
C should not be used due to the patient’s history of alcoholism and potential liver toxicity.
D is indicated only for severe and complicated cases requiring surgical consultation.
Memory Tool:
Vancomycin is the “Van you CAN when you CAN’T with Metronidazole.”

Reference Citation:
Modified from Surawicz CM, et al. Am J Gastroenterol 108:478–498; quiz 499, 2013. (Table 139.4)

Rationale:
Knowing alternative treatments is important for patient safety and effective disease management.

50
Q

Clinical Vignette:
A 43-year-old man with mild to moderate C. difficile shows no improvement after 6 days on metronidazole. What’s the next course of action?

Choices:
A. Continue metronidazole for another 4 days
B. Switch to vancomycin for 10 days
C. Add vancomycin to the ongoing metronidazole treatment
D. Consider fecal microbiota transplant

A

Correct Answer:
B. Switch to vancomycin for 10 days

Explanation:
A is incorrect; guidelines suggest switching if no improvement is seen after 5–7 days.
B is correct; if there’s no improvement, a switch to vancomycin is recommended.
C is not a recommended combination in this case.
D is reserved for recurrent cases after three recurrences.
Memory Tool:
“If Metron doesn’t Settle, Vanco will Net-tle” — meaning switch to Vancomycin if Metronidazole doesn’t show improvement.

Reference Citation:
Modified from Surawicz CM, et al. Am J Gastroenterol 108:478–498; quiz 499, 2013. (Table 139.4)

Rationale:
Treatment modification based on patient response is vital for managing C. difficile effectively.

51
Q

Clinical Vignette:
A 75-year-old man is admitted to the ICU with hypotension, a fever of 39°C, and a WBC count of 36,000 cells/mm^3. What treatment should be initiated for his C. difficile infection?

Choices:
A. Vancomycin 125 mg PO QID × 10 days
B. Vancomycin 500 mg PO QID and metronidazole 500 mg q8h and vancomycin PR (500 mg in 500 mL of saline as enema QID)
C. Metronidazole 500 mg PO TID × 10 days
D. Surgical consultation only

A

Correct Answer:
B. Vancomycin 500 mg PO QID and metronidazole 500 mg q8h and vancomycin PR (500 mg in 500 mL of saline as enema QID)

Explanation:
A is for severe but not complicated cases.
B is correct as the patient has severe and complicated C. difficile, requiring a multi-drug regimen.
C is generally for mild to moderate cases and is insufficient here.
D is not enough; medical therapy should accompany surgical consultation.
Memory Tool:
“For Complications, Pull out All the Stops” — signifying the multi-drug approach for severe and complicated cases.

Reference Citation:
Modified from Surawicz CM, et al. Am J Gastroenterol 108:478–498; quiz 499, 2013. (Table 139.4)

Rationale:
The treatment of severe and complicated cases of C. difficile often involves a combination of medications, and it’s crucial to recognize this.

52
Q

Clinical Vignette:
A 50-year-old woman presents with her fourth recurrence of C. difficile within a year. What is the next recommended step?

Choices:
A. Continue with the previous treatment
B. Surgical consultation
C. Fecal microbiota transplant
D. Start a new antibiotic not previously used

A

orrect Answer:
C. Fecal microbiota transplant

Explanation:
A is not advised given the frequent recurrences.
B may not be warranted yet.
C is correct. Fecal microbiota transplant is considered after three recurrences.
D is not a standard guideline recommendation for this situation.
Memory Tool:
“Three Strikes, You’re Out” — After three recurrences, consider a fecal microbiota transplant.

Reference Citation:
Modified from Surawicz CM, et al. Am J Gastroenterol 108:478–498; quiz 499, 2013. (Table 139.4)

Rationale:
Recurrent C. difficile can be challenging to manage, and it’s crucial to know when fecal microbiota transplant becomes an option.