CMN 568 Unit 4 Exam Correctly Solved
At what point should lab work be done on stool of patient with diarrhea? - ✅✅ If it
persists or worsens for more than 7 - 14 days, stool should be sent for analysis for viral,
protozoal or bacterial pathogens.
Criteria for prompt medical evaluation of patient with diarrhea - ✅✅ 1) Signs of
inflammatory diarrhea, such as: Fever > 38.5 C (101.5 F), WBC ≥ 15k/mcL or more,
bloody diarrhea, severe abdominal pain
2) Passage of *SIX* or more unformed stools in 24 hours
3) Profuse watery diarrhea and dehydration.
4) Frail older people or nursing home pts
5) Immunocompromised patients (e.g. AIDS, post-transplantation)
6) Exposure to ABX
7) Hospital-acquired diarrhea (onset following at least 3 days of hospitalization)
8) Systemic illness
Specific things to note on physical exam of patient with complaints of diarrhea - ✅✅ 1)
Hydration
2) Mental status
3) Abdominal tenderness or peritonitis
Definition of "bowel rest" - ✅✅ Avoid the following:
1) High-fiber foods
2) Fats
3) Milk products
4) Caffeine
5) ETOH
Frequent feedings of:
1) Tea
2) Flat carbonated beverages
3) Soft, easily digestible foods (soups, crackers, bananas, applesauce, rice, toast)
Preferred composition of rehydrating liquids for pts with diarrhea - ✅✅ Fluids
containing:
Glucose
Sodium
Potassium
Chloride
Bicarbonate or citrate
,True/False: Empiric ABX treatment of patients with acute, community acquired diarrhea
is generally not indicated. - ✅✅ True
NOTE: Even patients with inflammatory diarrhea caused by invasive pathogens usually
have symptoms that will resolve within several days without ABX.
When should empiric ABX treatment be considered for patients with acute diarrhea? -
✅✅ When rapid stool microbial testing is not available, empiric tx may be considered
for patients:
1) With non-hospital acquired diarrhea
2) With moderate to severe fever, tenesmus or bloody stools
3) With no suspicion of Shiga toxin-producing E.Coli (STEC)
4) Who are immunocompromised
5) Who are significantly dehydrated
Oral drugs of choice for empiric tx of acute diarrhea - ✅✅ Duration: 1 - 3 days
+*Fluoroquinolones* -- Cipro 500 mg, ofloxacin 400 mg or levofloxacin 500 mg per day
+*Bactrim* -- 160/800 BID
+*Doxycycline* -- 100 mg BID
NOTE: Macrolides and penicillin are not recommended r/t resistance
Oral drugs of choice for empiric tx of acute traveler's diarrhea - ✅✅ + Rifaximin 200
mg TID, 3 days
+ Azythromycin 1000 mg ONCE or 500 mg daily for 3 days.
Acute onset of severe pain and vomiting suggests what? - ✅✅ Peritoneal irritation
Acute gastric or intestinal obstruction
Pancreaticobiliary disease
Persistent vomiting suggests what? - ✅✅ Pregnancy
Gastric outlet obstruction
Gastroparesis
Intestinal dysmotility
Psychogenic disorders
CNS or systemic disorders
Vomiting in the morning suggests what? - ✅✅ Pregnancy
Uremia
ETOH intake
↑ ICP
Vomiting after meals suggests what? - ✅✅ Bulimia
Peptic ulcer disease
, Other psychogenic causes
Vomiting of undigested food 1-2 hours after a meal suggests what? - ✅✅
Gastroparesis
Small bowel obstruction
Gastric outlet obstruction
4 causes of nausea and vomiting - ✅✅ 1) Visceral afferent stimulation (serotonin
receptors)
2) Vestibular disorders (fibers ↑ in histamine and muscarinic receptors)
3) CNS disorders
4) Irritation of chemoreceptor trigger zone
Ways to stimulate the chemoreceptor trigger zone and cause vomiting - ✅✅ 1)
Chemo
2) Medications and drugs
3) Radiation therapy
4) Systemic disorders
CNS disorders that can cause vomiting - ✅✅ 1) Migraine
2) ↑ ICP
3) Infections (e.g. meningitis, encephalitis)
4) Psychogenic
Vestibular disorders that can cause vomiting - ✅✅ Labyrinthitis, Meniere syndrome,
motion sickness
Define retching - ✅✅ Strong, spasmodic, involuntary effort to vomit without bringing
up emesis.
Define regurgitation - ✅✅ Effortless return of gas or small amounts of food from
stomach
Common causes of vomiting in infants - ✅✅ 1) Any acute illness (esp gastroenteritis)
2) Hypertrophic pyloric stenosis (2 - 8 weeks of life, may feel an "olive" in epigastric
area after feeding)
3) Intussusception (6 - 18 months of life, sausage-shaped mass and "currant jelly"
stools)
4) Regurgitation ("spitting up") - usually normal and usually resolves by 6 - 12 months.
Medications associated with N/V - ✅✅ + Antidepressants
-SSRIs
-venlafaxine
+ Cardiac meds
-Antiarrhythmics
At what point should lab work be done on stool of patient with diarrhea? - ✅✅ If it
persists or worsens for more than 7 - 14 days, stool should be sent for analysis for viral,
protozoal or bacterial pathogens.
Criteria for prompt medical evaluation of patient with diarrhea - ✅✅ 1) Signs of
inflammatory diarrhea, such as: Fever > 38.5 C (101.5 F), WBC ≥ 15k/mcL or more,
bloody diarrhea, severe abdominal pain
2) Passage of *SIX* or more unformed stools in 24 hours
3) Profuse watery diarrhea and dehydration.
4) Frail older people or nursing home pts
5) Immunocompromised patients (e.g. AIDS, post-transplantation)
6) Exposure to ABX
7) Hospital-acquired diarrhea (onset following at least 3 days of hospitalization)
8) Systemic illness
Specific things to note on physical exam of patient with complaints of diarrhea - ✅✅ 1)
Hydration
2) Mental status
3) Abdominal tenderness or peritonitis
Definition of "bowel rest" - ✅✅ Avoid the following:
1) High-fiber foods
2) Fats
3) Milk products
4) Caffeine
5) ETOH
Frequent feedings of:
1) Tea
2) Flat carbonated beverages
3) Soft, easily digestible foods (soups, crackers, bananas, applesauce, rice, toast)
Preferred composition of rehydrating liquids for pts with diarrhea - ✅✅ Fluids
containing:
Glucose
Sodium
Potassium
Chloride
Bicarbonate or citrate
,True/False: Empiric ABX treatment of patients with acute, community acquired diarrhea
is generally not indicated. - ✅✅ True
NOTE: Even patients with inflammatory diarrhea caused by invasive pathogens usually
have symptoms that will resolve within several days without ABX.
When should empiric ABX treatment be considered for patients with acute diarrhea? -
✅✅ When rapid stool microbial testing is not available, empiric tx may be considered
for patients:
1) With non-hospital acquired diarrhea
2) With moderate to severe fever, tenesmus or bloody stools
3) With no suspicion of Shiga toxin-producing E.Coli (STEC)
4) Who are immunocompromised
5) Who are significantly dehydrated
Oral drugs of choice for empiric tx of acute diarrhea - ✅✅ Duration: 1 - 3 days
+*Fluoroquinolones* -- Cipro 500 mg, ofloxacin 400 mg or levofloxacin 500 mg per day
+*Bactrim* -- 160/800 BID
+*Doxycycline* -- 100 mg BID
NOTE: Macrolides and penicillin are not recommended r/t resistance
Oral drugs of choice for empiric tx of acute traveler's diarrhea - ✅✅ + Rifaximin 200
mg TID, 3 days
+ Azythromycin 1000 mg ONCE or 500 mg daily for 3 days.
Acute onset of severe pain and vomiting suggests what? - ✅✅ Peritoneal irritation
Acute gastric or intestinal obstruction
Pancreaticobiliary disease
Persistent vomiting suggests what? - ✅✅ Pregnancy
Gastric outlet obstruction
Gastroparesis
Intestinal dysmotility
Psychogenic disorders
CNS or systemic disorders
Vomiting in the morning suggests what? - ✅✅ Pregnancy
Uremia
ETOH intake
↑ ICP
Vomiting after meals suggests what? - ✅✅ Bulimia
Peptic ulcer disease
, Other psychogenic causes
Vomiting of undigested food 1-2 hours after a meal suggests what? - ✅✅
Gastroparesis
Small bowel obstruction
Gastric outlet obstruction
4 causes of nausea and vomiting - ✅✅ 1) Visceral afferent stimulation (serotonin
receptors)
2) Vestibular disorders (fibers ↑ in histamine and muscarinic receptors)
3) CNS disorders
4) Irritation of chemoreceptor trigger zone
Ways to stimulate the chemoreceptor trigger zone and cause vomiting - ✅✅ 1)
Chemo
2) Medications and drugs
3) Radiation therapy
4) Systemic disorders
CNS disorders that can cause vomiting - ✅✅ 1) Migraine
2) ↑ ICP
3) Infections (e.g. meningitis, encephalitis)
4) Psychogenic
Vestibular disorders that can cause vomiting - ✅✅ Labyrinthitis, Meniere syndrome,
motion sickness
Define retching - ✅✅ Strong, spasmodic, involuntary effort to vomit without bringing
up emesis.
Define regurgitation - ✅✅ Effortless return of gas or small amounts of food from
stomach
Common causes of vomiting in infants - ✅✅ 1) Any acute illness (esp gastroenteritis)
2) Hypertrophic pyloric stenosis (2 - 8 weeks of life, may feel an "olive" in epigastric
area after feeding)
3) Intussusception (6 - 18 months of life, sausage-shaped mass and "currant jelly"
stools)
4) Regurgitation ("spitting up") - usually normal and usually resolves by 6 - 12 months.
Medications associated with N/V - ✅✅ + Antidepressants
-SSRIs
-venlafaxine
+ Cardiac meds
-Antiarrhythmics
