Question 1
Which of the followin is NOT part of Truelove and Witts criterion for the diagnosis of severe colitis
(A) Pulse >90
(B) Temperature > 38
(C) CRP >30
(D) Hb <105
(E) Bloody stool frequency > 6/ 24 hours
B: Temperature >37.8C is the requirement (2007 ESCO guidelines)
Question 2
A 46 year old male recently treated with antibiotics for an MRSA related cellulitis presents with 12 episodes of bloody diarrhoea, a fever, CRP 95, albumin 21. He is hypotensive, and is rushed to endoscopy, where the following image is found (image courtesy of e-medicine)
Which of the followin is NOT part of Truelove and Witts criterion for the diagnosis of severe colitis
(A) Pulse >90
(B) Temperature > 38
(C) CRP >30
(D) Hb <105
(E) Bloody stool frequency > 6/ 24 hours
B: Temperature >37.8C is the requirement (2007 ESCO guidelines)
Question 2
A 46 year old male recently treated with antibiotics for an MRSA related cellulitis presents with 12 episodes of bloody diarrhoea, a fever, CRP 95, albumin 21. He is hypotensive, and is rushed to endoscopy, where the following image is found (image courtesy of e-medicine)
With regards to the likely aetiology, what is the LEAST correct answer
(A) This organism if a gram positive anaerobic bacillus whose toxic effect is mediated through toxin interactions with GTP receptors causing receptor inactivation and colonocyte apoptosis
(B) Fluroquinolone resistance may be associated with a hypervirulent strain
(C) Whilst all antibiotics may be associated with C. difficile colitis, aminoglycosides are particularly common
(D) Efficient sporulation and hyper-production of the binary toxins are associated with virulence
(E) The risk of C. difficile infection increases with age
C: The antibiotics most associated are clindamycin, amoxicillin and ampicillin. N Engl J Med 2015; 372:1539-1548
Question 3
Which of the following is not a recognised treatment for recurrent C. difficile colitis?
(A) Repeat dose of metronidazole or vancomycin
(B) Fidoxamicin
(C) Faecal microbiota transplant
(D) Tapered vancomycin schedule
(E) Vaccination against the toxoid
E: Whilst this is now under investigation in clinical trials, it is not currently recognised. For the first recurrence, options include repeating the dose of metronidazole or vancomycin. Fidoxamicin has been shown to be as good as Vancomycin but reduces recurrence rates, however its treatment expense lowers its use. Faecal microbiota transplant has been used effectively, the hypothesis is that it promotes re-colonisation outcompeting C. difficile spores for the intestinal mucosa. N Engl J Med 2013; 368:407-415, N Engl J Med 2015; 372:1539-1548
Question 4
Recurrent C. difficle colitis is a current indication for consideration of faecal microbiota transplantation (FMT). However, failure of this procedure does occur. Which of the following factors is the strongest predictor of failure of FMT?
(A) Severe complicated C. difficle colitis
(B) In-patient status at time of FMT
(C) Out-patient FMT
(D) Previous hospitalisation for C. difficle
(E) Previous use of Fidoxamicin
A: Data on 328 patients from two referral centers was used to determine predictors of FMT failure. Patients from a third center provided a validation cohort. Predictors of FMT failure were severe or severe-complicated disease, inpatient status at the time of FMT, and previous hospitalisation for C. difficile. Highest risk patients had 41% early failure risk (defined as nonresponse or recurrent diarrhoea with positive C. difficile tests within 1 month of FMT) Am J Gastroenterol 2016 Jul 111:1024
(A) This organism if a gram positive anaerobic bacillus whose toxic effect is mediated through toxin interactions with GTP receptors causing receptor inactivation and colonocyte apoptosis
(B) Fluroquinolone resistance may be associated with a hypervirulent strain
(C) Whilst all antibiotics may be associated with C. difficile colitis, aminoglycosides are particularly common
(D) Efficient sporulation and hyper-production of the binary toxins are associated with virulence
(E) The risk of C. difficile infection increases with age
C: The antibiotics most associated are clindamycin, amoxicillin and ampicillin. N Engl J Med 2015; 372:1539-1548
Question 3
Which of the following is not a recognised treatment for recurrent C. difficile colitis?
(A) Repeat dose of metronidazole or vancomycin
(B) Fidoxamicin
(C) Faecal microbiota transplant
(D) Tapered vancomycin schedule
(E) Vaccination against the toxoid
E: Whilst this is now under investigation in clinical trials, it is not currently recognised. For the first recurrence, options include repeating the dose of metronidazole or vancomycin. Fidoxamicin has been shown to be as good as Vancomycin but reduces recurrence rates, however its treatment expense lowers its use. Faecal microbiota transplant has been used effectively, the hypothesis is that it promotes re-colonisation outcompeting C. difficile spores for the intestinal mucosa. N Engl J Med 2013; 368:407-415, N Engl J Med 2015; 372:1539-1548
Question 4
Recurrent C. difficle colitis is a current indication for consideration of faecal microbiota transplantation (FMT). However, failure of this procedure does occur. Which of the following factors is the strongest predictor of failure of FMT?
(A) Severe complicated C. difficle colitis
(B) In-patient status at time of FMT
(C) Out-patient FMT
(D) Previous hospitalisation for C. difficle
(E) Previous use of Fidoxamicin
A: Data on 328 patients from two referral centers was used to determine predictors of FMT failure. Patients from a third center provided a validation cohort. Predictors of FMT failure were severe or severe-complicated disease, inpatient status at the time of FMT, and previous hospitalisation for C. difficile. Highest risk patients had 41% early failure risk (defined as nonresponse or recurrent diarrhoea with positive C. difficile tests within 1 month of FMT) Am J Gastroenterol 2016 Jul 111:1024
