Gastroenterology: Clostridioides difficile infection: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Gastroenterology: Clostridioides difficile infection

Sample item

A 70-year-old woman who received ceftriaxone for pneumonia a week ago has 8 watery stools daily and a white cell count of 18,000 per mm3. Stool C. difficile toxin is positive and creatinine is 1.2 mg/dL. Which treatment is appropriate along with stopping the inciting antibiotic?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Oral vancomycin

C. difficile colitis follows disruption of gut flora by antibiotics. Oral vancomycin (or fidaxomicin) is the recommended therapy, because it reaches high intraluminal concentrations. Intravenous vancomycin is not excreted into the colon, and antimotility drugs risk toxic megacolon.

Option by option

  • A. Oral ciprofloxacin

    Fluoroquinolones predispose to C. difficile infection and do not treat it.

  • B. Intravenous vancomycin

    Intravenous vancomycin is not secreted into the gut lumen in useful concentrations.

  • C. Loperamide

    Loperamide slows the transit of toxin and can precipitate toxic megacolon.

  • D. Oral vancomycin (correct)

    Correct. Oral vancomycin achieves high colonic levels and is recommended.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Oral vancomycin. C.

Why is "Oral ciprofloxacin" not the answer?

Fluoroquinolones predispose to C. difficile infection and do not treat it.

Why is "Intravenous vancomycin" not the answer?

Intravenous vancomycin is not secreted into the gut lumen in useful concentrations.

Why is "Loperamide" not the answer?

Loperamide slows the transit of toxin and can precipitate toxic megacolon.

What concept does this question test?

It tests Gastroenterology: Clostridioides difficile infection in General Medicine. difficile colitis follows disruption of gut flora by antibiotics. Oral vancomycin (or fidaxomicin) is the recommended therapy, because it reaches high intraluminal concentrations. Intravenous vancomycin is not excreted into the colon, and antimotility drugs risk toxic megacolon.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastroenterology: Clostridioides difficile infection?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.