Clostridium difficile

Clostridium difficile

Q. 1

True about clostridium difficile is:

 A

Gram negative

 B

Obligatory aerobic

 C

Spore forming cocci

 D

None of the above is true

Q. 1

True about clostridium difficile is:

 A

Gram negative

 B

Obligatory aerobic

 C

Spore forming cocci

 D

None of the above is true

Ans. D

Explanation:

C. difficile:

1. Gram positive
 
2. Obligately anaerobic
 
3. Spore-forming bacillus (spores are found widely in nature) 
 

Q. 2

Most common manifestation of clostridium difficile infection is:

 A

Fever

 B

Leukocytosis

 C

Abdominal pain

 D

Diarrhea

Q. 2

Most common manifestation of clostridium difficile infection is:

 A

Fever

 B

Leukocytosis

 C

Abdominal pain

 D

Diarrhea

Ans. D

Explanation:

Most common manifestation of clostridium difficile infection is Diarrhea

Stool is soft, watery or mucoid in consistency, with a characteristic odor with 20 bowel movements per day.
 
Other features:
 
Fever in 28%
 
Abdominal pain in 22%,
 
Leukocytosis in 50%
 
Unexplained leukocytosis, with 15,000 white blood cells (WBCs)/L may indicate c. difficile infection.
 
Complications:
 
1. Toxic megacolon and sepsis.
 
Ref: Harrison, Edition-18, page-1092.

Q. 3

All are included in the diagnostic criteria for clostridium difficile infection, EXCEPT:

 A

3 unformed stools per 24h for 2days

 B

Toxin A or B detected in the stool

 C

Pseudo membranes in colonoscopy

 D

Fever

Q. 3

All are included in the diagnostic criteria for clostridium difficile infection, EXCEPT:

 A

3 unformed stools per 24h for 2days

 B

Toxin A or B detected in the stool

 C

Pseudo membranes in colonoscopy

 D

Fever

Ans. D

Explanation:

The diagnosis of CDI is based on:

1. Diarrhea (3 unformed stools per 24 h for 2 days) with no other recognized cause
 
PLUS
 
2. Toxin A or B detected in the stool,
 
3. Toxin-producing C. difficile detected in the stool by polymerase chain reaction (PCR) or culture.
 
3. Pseudomembranes in the colon.
 
ALSO KNOW:
Endoscopy is a rapid diagnostic tool in seriously ill suspected patients
 
A negative test does not rule out infection
 
Ref: Harrison, Edition-18,page-1093.

Q. 4

Subterminal spores are found in-

 A

Clostridium sordelli 

 B

Clostridium sporogenes

 C

Clostridium difficile 

 D

All

Q. 4

Subterminal spores are found in-

 A

Clostridium sordelli 

 B

Clostridium sporogenes

 C

Clostridium difficile 

 D

All

Ans. D

Explanation:

Ans. is ‘a’ i.e., Clostridium sordelli; ‘b’ i.e., Clostridium sporogenes; ‘c’ i.e., Clostridium difficile


Q. 5

Most common organism responsible for pseudo membranous colitis is –

 A

Clostridium difficile

 B

Clostridium botulism

 C

Clostridium histolyticum

 D

Clostridium butyricum

Q. 5

Most common organism responsible for pseudo membranous colitis is –

 A

Clostridium difficile

 B

Clostridium botulism

 C

Clostridium histolyticum

 D

Clostridium butyricum

Ans. A

Explanation:

Ans. is ‘a’ i.e., Clostridium difficile 


Q. 6

. Clostridium difficale infection occurs after ‑

 A

After prolong antibiotic therapy 

 B

Pantoprazole increases the risk

 C

Associated with use of rectal thermometer

 D

All

Q. 6

. Clostridium difficale infection occurs after ‑

 A

After prolong antibiotic therapy 

 B

Pantoprazole increases the risk

 C

Associated with use of rectal thermometer

 D

All

Ans. D

Explanation:

Ans. is ‘a’ i.e., After prolong antibiotic therapy, ‘b’ i.e., Pantoprazole increases the risk, ‘c’ i.e.,

Associated with use of rectal thermometer 


Q. 7

A patient of Acute lymphocytic leukemia with fever and neutropenia develops diarrhoea after administration of amoxicillin therapy, which of the following organism is most likely to be the causativeagent –

 A

Salmonella typhi

 B

Clostridium difficile

 C

Clostridium perfringens 

 D

Shigella flexneri

Q. 7

A patient of Acute lymphocytic leukemia with fever and neutropenia develops diarrhoea after administration of amoxicillin therapy, which of the following organism is most likely to be the causativeagent –

 A

Salmonella typhi

 B

Clostridium difficile

 C

Clostridium perfringens 

 D

Shigella flexneri

Ans. B

Explanation:

Ans. is ‘b’ i.e., Clostridium difficile 


Q. 8

True regarding pseudomembranous colitis are all except –

 A

It is caused by clostridium difficile

 B

The organism is a normal commensal of gut

 C

It is due to production of phospholipase A

 D

It is treated by vancomycin

Q. 8

True regarding pseudomembranous colitis are all except –

 A

It is caused by clostridium difficile

 B

The organism is a normal commensal of gut

 C

It is due to production of phospholipase A

 D

It is treated by vancomycin

Ans. C

Explanation:

Ans. is ‘c’ i.e., It is due to production of phospholipase A 


Q. 9

Patient presenting with abdominal pain, diarrhea taking clindamycin for 5 days. Treated with metronidazole symptoms subsided. What is the causative agent –

 A

Clostridium difficile 

 B

Clostridium perfringens 

 C

Clostridium welchi 

 D

Clostridium marneffi

Q. 9

Patient presenting with abdominal pain, diarrhea taking clindamycin for 5 days. Treated with metronidazole symptoms subsided. What is the causative agent –

 A

Clostridium difficile 

 B

Clostridium perfringens 

 C

Clostridium welchi 

 D

Clostridium marneffi

Ans. A

Explanation:

Ans. is ‘a’ i.e., Clostridium difficile 


Q. 10

In antibiotic associated colitis, organism involved is –

 A

Clostridium difficile 

 B

Pseudomonas

 C

Staphylococcus

 D

Enterococcus

Q. 10

In antibiotic associated colitis, organism involved is –

 A

Clostridium difficile 

 B

Pseudomonas

 C

Staphylococcus

 D

Enterococcus

Ans. A

Explanation:

Ans. is ‘a’ i.e., Clostridium difficile

Antibiotic – associated (or clostridium difficile associated) colitis

o It is an example of superinfection.

o It is caused by alteration of normal bowel flora, which allows multiplication of clostridium difficle which releases several toxins that damage the mucosa of the bowel and promote excretion of fluid.

o It takes the form of an acute, nonspecific colitis, i.e. pseudomembranous colitis.

o Almost any antimicrobial may initiate this condition, but the drugs most commonly reported today are injectable cephalosporins and amoxi/ampicillin — Laurence 9th/e 212 o

Clindamycin, not commonly used in routine practice today, had an even greater propensity.

o Metronidazole is the DOC for pseudomembranous colitis and vancomycin is an alternative.


Q. 11

Which of the following antibiotic is used in the treatment of Clostridium difficile associated diarrhoea?

 A

Ciprofloxacin

 B

Metronidazole

 C

Piperacillin

 D

Clindamycin

Q. 11

Which of the following antibiotic is used in the treatment of Clostridium difficile associated diarrhoea?

 A

Ciprofloxacin

 B

Metronidazole

 C

Piperacillin

 D

Clindamycin

Ans. B

Explanation:

Ans. is ‘b’ i.e. Metronidazole

o Metronidazole is the DOC for clostrdium difficle associated diarrhoea.

o Alternative drugs are vancomycin, fusidic acid, teicoplanin, and bacitracin.


Q. 12

In a surgical patient, the causes of non-surgical infection –

 A

Lower RTI

 B

Wound infection

 C

Clostridium difficile diarrhoea

 D

a and c

Q. 12

In a surgical patient, the causes of non-surgical infection –

 A

Lower RTI

 B

Wound infection

 C

Clostridium difficile diarrhoea

 D

a and c

Ans. D

Explanation:

Ans. is ‘a’ i.e. Lower RTI, ‘c’ Clostridium difficile diarrhoea; 

  • Postoperative patients are at increased risk for a variety of non-surgical postoperative nosocomial infections. These are:

Urinary tract infection- (Most common)

–  Lower respiratory tract infections-3rd most common (2nd MC cause being surgical site infection (SSI)) LRTI are the leading cause of death d/t nosocomial inf.

Antibiotic-associated diarrhoea, caused by clostridium difficile.

–  Sinusitis

– Meningitis


Q. 13

Crohn’s disease may be caused by which one of the following infectious agents:

 A

Clostridium difficle

 B

Mycobacterium paratuberculosis

 C

Cytomegalo virus (CMV)

 D

Mycoplasma

Q. 13

Crohn’s disease may be caused by which one of the following infectious agents:

 A

Clostridium difficle

 B

Mycobacterium paratuberculosis

 C

Cytomegalo virus (CMV)

 D

Mycoplasma

Ans. A

Explanation:

Answer is A (Clostridium Difficle)

A possible infectious etiology includes clostridium difficle and Mparatuberculosis amongst the options provided.

Clostridium difficle is the single best answer of choice when based on Harrisons 17th edition.

Role of infections in Inflammatory bowel disease (Infectious etiology)

Infection with multiple pathogens may initiate inflammatory bowel disease (IBD) by triggering an inflammatory response that the mucosal & immune system may fail to control

Agents According to Harrisons 16th edition (Do not mention Clostridium difficle)

  • ‘Multiple pathogens (Salmonella, Shigella sp. Campylobacter sp.) may initiale IBD by triggering an inflammatory response’ – H/16th
  • Anaerobic organisms particularly Bacterioides species may be responsible for induction of inflammation – H/16th
  • Regarding M. Paratuberculosis
  • Three specific agents, M. paratuberculosis paramyxovirus and Helicobacter species have received greatest attention’ However
  • Mparatuberculosis does not have a confirmed disease association and antimycobacterial agents are not effective in treating CD.

Agents according to Harrisons 17th edition (Include Clostridium difficle)

  • ‘Multiple pathogens (Salmonella, Shigella sp, Campylobacter sp, Clostiridium difficle) may initiate IBD by triggering an inflammatory response’ – H/17th
  • Anaerobic organisms particularly Bacterioides and Clostridia species and some aerobic species as Escherechia may be responsible for the induction of inflammation’ – H/1 7th
  • Regarding M. Paratuberculosis
  • Harrisons 17′h edition does not mention M
  • Paratuberculosis amongst the list of agents implicated in causing Crohn’s disease.

Q. 14

Secretory Diarrhea is caused by all of the following, Except:

 A

Cholera

 B

Laxatives

 C

Excess phenolphthalein intake

 D

Clostridium difficle

Q. 14

Secretory Diarrhea is caused by all of the following, Except:

 A

Cholera

 B

Laxatives

 C

Excess phenolphthalein intake

 D

Clostridium difficle

Ans. D

Explanation:

Answer is D (Clostridium Difficle)

Clostridium difficle is typically associated with Inflammatory’ diarrhea and not ‘secretory’ diarrhea. Clostridium Difficle may rarely cause a secretory type of diarrhea, but it remains the single best answer of exclusion.



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