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Post test approach diarrhea. 1.A 20 year-old student developed severe abdominal cramp, vomiting and watery diarrhea after eating fried rice with shrimp.

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Presentation on theme: "Post test approach diarrhea. 1.A 20 year-old student developed severe abdominal cramp, vomiting and watery diarrhea after eating fried rice with shrimp."— Presentation transcript:

1 Post test approach diarrhea

2 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

3 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)

4 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.Add vancomycin intravenously. B.Stop ceftriaxole and change to ciprofloxacin. C.Sigmoidoscopy and stool for cytotoxic assay. D.Increase dosing of ceftriaxole to 2 gm iv daily to cover gram negative septicemia.

5 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 cells/HF. The least likely diagnosis is. A.TB terminal ileum B.CMV enterocolitis C.Clamydial procto-colitis D.MAC.

6 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.Shigella B.Aeromonas C.Capilliasis D.V. vulnificus

7 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.Strongyloidiasis. B.Giardiasis C.Opisthorchiasis D.Amebiasis

8 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

9 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

10 9.A diarrheal stool showed as picture. Treatment of choice is? A.Metronidazole B.Albendazole C.TMP/SMX D.Azithromycin

11 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.Salmonella B.Campylobacter C.Shigella D.Tropheryma whippelii


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