Objectives:

• Evaluate acute and chronic diarrhea
• Treat diarrhea
• Recognize different causes of diarrhea

1		A 22-year-old previously healthy male reports a 3-day history of explosive and watery diarrhea. He is having up to 6 bowel movements per day. He recalls eating at a new Mexican restaurant 5 days ago. His head sinks a little low as he recalls drinking a "fish bowl" sized margarita. . .or at least he thinks he remembers drinking it! He denies fever, blood in his stool, or recent travel. Multiple people ate the same food but he is the only one who is sick. His vital signs are normal (including supine and standing blood pressures), and the remainder of the physical exam is remarkable only for mild, diffuse abdominal tenderness. What is the most likely diagnosis?
			A)	Celiac sprue.
			B)	Gastroenteritis.
			C)	Lactose intolerance.
			D)	Small bowel bacterial overgrowth.
			E)	Clostridium difficile colitis.
2		What is the MOST appropriate diagnostic or therapeutic step to perform at this point?
			A)	Order a CBC.
			B)	Order electrolytes.
			C)	C) Order stool examination for ova and parasites.
			D)	Recommend hydration and antidiarrheals as needed.
			E)	Order an abdominal film.
3		You treat the patient with oral rehydration and prochlorperazine for some nausea and he does well. He returns to see you a few weeks later after a trip to Mexico. He liked that fish-bowl sized margarita so much he decided to go for an original (remember that we live in a college town. . .this could easily be true!!). He has diarrhea that began a couple of days after his arrival in Cancun and has now been present for 5 days. He has had frequent, watery diarrhea with nausea but no vomiting. He has noticed no blood in the stool. He was very careful to avoid salads and water but did have some ice in a pop (generic midwestern term for soft drink). The most likely organism in this patient is:
			A)	Salmonella.
			B)	Shigella.
			C)	Enterotoxigenic E. coli.
			D)	Enterohemorrhagic E. coli.
			E)	Campylobacter.
4		In the treatment of which of the following organisms are antibiotics CONTRAINDICATED?
			A)	Campylobacter.
			B)	Shigella.
			C)	Clostridium difficile.
			D)	E. coli subtype O157:H7 (enterohemorrhagic E. coli).
5		Which of the following is (are) appropriate for the treatment of a patient with traveler's diarrhea without vomiting?
			A)	Oral rehydration.
			B)	Antidiarrheals.
			C)	Avoidance of dairy products during the acute stage.
			D)	Any non lactose containing food eaten from day one (e.g., no need for a bland diet with slow advancement).
			E)	All of the above.
6		The patient's symptoms seem to get better for a while, then worsen. He returns 3 weeks later complaining of persistent symptoms. Which of the following steps is NOT appropriate now?
			A)	Treat empirically with antibiotics.
			B)	Send stool for ova and parasites.
			C)	Check cultures and sensitivities.
			D)	Obtain fecal fat measurements.
			E)	Check serum electrolyte measurements.