A 32-year-old individual arrives at the emergency department complaining of bloody diarrhea that has been ongoing for two days. The patient mentions experiencing a similar episode six months ago, although it was less severe and resolved within a week. The possibility of inflammatory bowel disease (IBD) crosses your mind. Which of the following statements about IBD is accurate?
A 5-year-old girl is brought into the Emergency Department with stomach pain and throwing up. Her mom tells you that she has been losing weight lately and seems to be drinking a lot and peeing a lot. During the examination, she appears tired and you notice that she is dehydrated. She is breathing deeply and quickly. Her blood sugar levels are found to be extremely high when her blood is tested.
What is the MOST likely diagnosis?
A 10-year-old boy is brought to the Emergency Department by his parents with a history of thirst and increased frequency of urination. He is also complaining of severe abdominal pain, and his parents are concerned he may have a urinary tract infection. His condition has deteriorated over the past few hours, and he is now lethargic and slightly confused. His observations are as follows: HR 145, RR 34, SaO2 97%, temperature 37.5°C. On examination, he has dry mucous membranes, and his capillary refill time is 4 seconds. Cardiovascular and respiratory system examinations are both unremarkable. His abdomen is tender across all quadrants with voluntary guarding is evident. The paediatric nurse has performed urinalysis, which has revealed a trace of leukocytes and protein with 3+ ketones and glucose.
What is the SINGLE most likely diagnosis?
A 35-year-old woman with a long history of heavy alcohol abuse and liver cirrhosis comes in with a fever, abdominal pain, worsening ascites, and confusion. You suspect she may have spontaneous bacterial peritonitis and decide to perform an ascitic tap.
Which of the following is NOT a reason to avoid performing an ascitic tap?
A 28-year-old woman has been experiencing severe vomiting for the past 10 hours. She informs you that she consumed Chinese takeout the night before. She is unable to tolerate any liquids by mouth, so you initiate an intravenous saline infusion.
What type of acid-base imbalance would you anticipate in a patient with severe vomiting?
A 25-year-old man comes in with severe bloody diarrhea caused by a gastrointestinal infection.
Which organism is the SINGLE LEAST likely cause?
A 68 year old male presents to the emergency department with a 4 day history of colicky abdominal pain and diarrhea. The patient reports feeling worse in the past 24 hours, although the diarrhea has stopped as he last had a bowel movement more than 12 hours ago. The patient visited his primary care physician 2 days ago, who requested a stool sample. The patient’s vital signs are as follows:
Temperature: 38.8ºC
Blood pressure: 98/78 mmHg
Pulse: 106 bpm
Respiration rate: 18
Upon reviewing the pathology results, it is noted that the stool sample has tested positive for clostridium difficile. Additionally, the patient’s complete blood count, which was sent by the triage nurse, is available and shown below:
Hemoglobin: 12.4 g/l
Platelets: 388 * 109/l
White blood cells: 23.7 * 109/l
How would you classify the severity of this patient’s clostridium difficile infection?
A 72 year old female presents to the emergency department with a 3 day history of watery diarrhea. She reports having approximately 4-5 episodes of diarrhea accompanied by lower abdominal cramping pain each day. The patient mentions that she visited her primary care physician 2 days ago, who requested a stool sample. The patient’s vital signs are as follows:
Temperature: 37.6ºC
Blood pressure: 138/82 mmHg
Pulse: 90 bpm
Respiration rate: 16
Upon reviewing the pathology results, it is noted that the stool sample has tested positive for clostridium difficile. Additionally, the patient’s complete blood count, which was sent by the triage nurse, has been received and is shown below:
Hemoglobin: 13.5 g/l
Platelets: 288 * 109/l
White blood cells: 13.9 * 109/l
How would you classify the severity of this patient’s clostridium difficile infection?
You treat a 65-year-old woman for a urinary tract infection with nitrofurantoin. She returns one week later with severe, foul-smelling diarrhea and abdominal pain. Her urinary tract infection has resolved. You are concerned that she may have developed Clostridium difficile associated diarrhea (CDAD).
Which SINGLE statement is true regarding this diagnosis?
A 68-year-old woman presents with severe diarrhea one week after having a total knee replacement. The diarrhea has a foul odor and is yellow in color. A stool sample is sent to the laboratory and tests positive for Clostridium difficile toxin.
What is the MOST suitable course of action for management?