Post test approach diarrhea
1.A 20 year-old student developed severe abdominal cramp,
vomiting and watery diarrhea after eating fried rice with shrimp 4
hours. The physical examination showed no fever, mild dehydration,
hyperactive bowel sound, no tenderness of abdomen. The stool
examination showed no WBC nor parasite. The most likely causative
agent is
•
•
•
•
A. B. cereus food poisoning.
B. V cholera
C. Shigela dysenteriae
D. V parahemolyticus
2.A poorly controlled diabetic patient has developed watery diarrhea for 2
months. She has diabetic retinopathy, nephropathy, peripheral neuropathy
and dry gangrene of right great toe. The examination showed : BP 140/70
mmHg(supine),120/60 mmHg(standing).Mild pitting edema both legs. Dosalis
pedis pulse absent both . No distended abdomen, no tenderness of abdomen.
Per rectal examination :empty rectum, no stool .No wbc nor rbc in stool.
What is the most likely diagnosis?
A. fecal incontinence
B. Ischemic enterocolitis
C. Diabetic autonomic neuropathy.
D. Pseudo diarrhea (overflow)
3. A patient with acute pyelonephritis developed
mucous-bloody diarrhea after 4 days of ceftriaxole 1
gm iv daily. Stool examination showed numerous WBC
and RBC. What is the most appropriate management?
A.
B.
C.
D.
Add vancomycin intravenously.
Stop ceftriaxole and change to ciprofloxacin.
Sigmoidoscopy and stool for cytotoxic assay.
Increase dosing of ceftriaxole to 2 gm iv daily
to cover gram negative septicemia.
4.A newly diagnosed HIV patient presented with fever, severe
abdominal cramp and tender at right Lower quadrant of
abdomen for 1month. His CD4 is only 40 cells. Stool showed
WBC 10-20 cells/HF. The least likely diagnosis is.
A.
B.
C.
D.
TB terminal ileum
CMV enterocolitis
Clamydial procto-colitis
MAC.
5.A previously healthy man with acute mucous bloody diarrhea for 1 week.
He was mild dehydration. Normal BP and PR. He was oliguric and azotemia
(BUN =56 mg/dl, Cr 2.5 mg/dl).He also had mild anemia. The blood smear as
showed. What is the most likely cause?
A.
B.
C.
D.
Shigella
Aeromonas
Capilliasis
V. vulnificus
6. A 24 year-old farmer form Sakolnakorn, with history of chronic
diarrhea for 3 months. He had history of eating raw fish and fresh
vegetable. On examination, he was anemic, generalized pitting
edema and muscle weakness and hyperactive bowel sound . Stool
examination showed no rbc , no wbc. The most likely diagnosis is
A.
B.
C.
D.
Strongyloidiasis.
Giardiasis
Opisthorchiasis
Amebiasis
7. The stool examination in case 6 showed
as picture. What is your diagnosis?
A. Opisthrochiasis and
enterobiasis
B. Opisthrochiasis and
capilliasis
C. Trichomanas and
enterobiasis
D. Trichuriasis and hook
worm
8.A 48 year-old diabetic man with chronic diarrhea for 3 months.
His was likely to developed abdominal pain and diarrhea after
meal . He lost 8 kg. The plain abdomen showed as picture .What
is the most likely mechanism of diarrhea?
A. Maldigestion
B. Autonomic neuropathy
cause gi dysmotility.
C. Bacterial overgrowth
D. Villous atrophy
9.A diarrheal stool showed as picture.
Treatment of choice is?
A.
B.
C.
D.
Metronidazole
Albendazole
TMP/SMX
Azithromycin
10.A patient with previously ill with acute diarrhea. She
consequence developed ankle joint arthritis ,dysuria
and painful red eyes. What causative agent is less likely
responsible for?
A.
B.
C.
D.
Salmonella
Campylobacter
Shigella
Tropheryma whippelii