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  #1  
Old 09-06-2012
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Question Mexico Diarrhea!

A 47-year-old man with diabetes and hypertension travels with his family to Mexico. The next morning after eating out at a local restaurant and despite drinking bottled water, he develops severe crampy abdominal pain and watery, frequent diarrhea. Which of the following is the best approach for his care?

(A) ciprofloxacin 3 days
(B) penicillin 5 days
(C) tetracycline 3 days
(D) observation of symptoms
(E) metronidazole 10 days

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Old 09-06-2012
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E.) metronidazole for 10 days to treat Giardiasis or H. Amebiasis( but the question does not mention bloody diarrhea)

please correct me if I am wrong.
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Old 09-06-2012
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Would go with D, as i know antibiotics are indiacted in the case of diarrhea when its associated with fever or blood
The important point in diarrheal illness in fluid and electrolytes replacement.
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Old 09-07-2012
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I would go for
(A) ciprofloxacin 3 days

Travellers diarrhoea is associated with E coli..
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Old 09-07-2012
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ans D as anders said ......... treatment is ORS type fluid not just plain fluid .
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Old 09-07-2012
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Quote:
Originally Posted by cingulate.gyrus View Post
I would go for
(A) ciprofloxacin 3 days

Travellers diarrhoea is associated with E coli..
(A) ciprofloxacin 3 days
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would go for D......no fever and bloody stools so watchful waiting would be the best intervention
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Old 09-07-2012
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LOL im from Mexico and whenever isee this questions i just laugh so bad..

This is ETEC acute gastroenteritis, you just observe and hydrate

This disease is called by mexicans as "Moctezuma" revenge, against all foreign people hahaha
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Quote:
Originally Posted by XpaezX View Post
LOL im from Mexico and whenever isee this questions i just laugh so bad..

This is ETEC acute gastroenteritis, you just observe and hydrate

This disease is called by mexicans as "Moctezuma" revenge, against all foreign people hahaha

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Old 09-07-2012
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Answer (A) Ciprofloxacin is the drug of choice in a dose of 500 mg bid for 1–3 days because most cases of travelers’ diarrhea are from E. coli. This patient’s
symptoms are moderate to severe and warrant antibiotic treatment which will decrease the frequency of bowel movements and duration of illness. Erythromycin and tetracycline are effective for Vibrio which is an uncommon cause of travelers’ diarrhea. Metronidazole is used for Clostridium difficile enteritis.
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mmm I dont know chich qbank is this from but I dont agree with the answer, ETEC is the cause of travelers diarrhea and it is a toxin the one that is producing the symptoms, just like S.aureus

We cannot evaluate the severity of the patient's condition because they dont even mention BP or general status on the question stem

This is a very bad worded question and thus it leaves room for controversy..

Im not saying is your fault step_enhancer, im saying that whoever wrote this question sucks.
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Quote:
Originally Posted by XpaezX View Post
mmm I dont know chich qbank is this from but I dont agree with the answer, ETEC is the cause of travelers diarrhea and it is a toxin the one that is producing the symptoms, just like S.aureus

We cannot evaluate the severity of the patient's condition because they dont even mention BP or general status on the question stem

This is a very bad worded question and thus it leaves room for controversy..

Im not saying is your fault step_enhancer, im saying that whoever wrote this question sucks.

Crampy abdominal pain indicate a moderaltly sever symptom..

In USMLE never expect a typical case sinario ...There will only be subtle clincal features which should be picked up..
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Old 09-07-2012
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mmm ok ,the thing is that this topic is so vague that even the CDC and harrison dont have a regular consensus and there is room for variability but ok
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Quote:
Originally Posted by XpaezX View Post
mmm I dont know chich qbank is this from but I dont agree with the answer, ETEC is the cause of travelers diarrhea and it is a toxin the one that is producing the symptoms, just like S.aureus

We cannot evaluate the severity of the patient's condition because they dont even mention BP or general status on the question stem

This is a very bad worded question and thus it leaves room for controversy..

Im not saying is your fault step_enhancer, im saying that whoever wrote this question sucks.
I agree with you ,forget about this Q.They dont ask controversial stuff,I will go with D if it appears in exam .
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You have to consider the co-morbid conditions, severity of the disease and the duration before deciding on the treatment.

This patient is a diabetic>>>he is very likely to develop complications of diabetes.

The disease is moderate to severe >>>> as above

Duration is at least 8 hours>>>> That means the organism is producing toxins inside his GI tract and his diarrhea is not from preformed toxins>>>>>> He needs antibiotics ASAP.

Also, he is not having bloody diarrhea so rules out the likes of shigella /salmonella.
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  #16  
Old 09-08-2012
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i would go with answer D..Observation/Oral rehydration...!
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Gastroenterology-, Infectious-Diseases, Step-2-Questions

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