QuestionSBA
QuestionChoice
Starting vancomycin would be correct however there is no clinical indication for stopping this patient's colecalciferol.
50222
b
Suspend his colecalciferol and start vancomycin 125mg PO QDS
QuestionChoice
There is no clinical indication for stopping this patient's colecalciferol.
50223
c
Suspend his colecalciferol
QuestionChoice
This question requires you to know that PPIs increase the risk of clostridium difficile infection. In this case, the gentleman's omeprazole may be contributing to his c. difficile infection and therefore it should be stopped. The c. difficile infection should be treated, the first line treatment is vancomycin 125mg PO QDS (this patient is stable and therefore doesn't need a higher dose).
50221
a
Suspend his omeprazole and start vancomycin PO QDS
QuestionChoice
This patient has a c. difficile infection. Precipitants of said infection should be stopped (in this case the PPI) and antibiotics to treat the c. difficile should be given.
50224
d
No change in treatment required
QuestionChoice
Starting this patient on vancomycin would be the right thing to do however this is the wrong dose, and you would still also need to suspend the PPI he is taking due to it exacerbating c. difficile infections.
50225
e
Start vancomycin 100mg PO QDS
QuestionComment
The right answer should at least say the right dose and frequency. I was put off it because it said OD and I knew that the right dose was QDS
17453
User
subscriber
Gas Botox
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3622
Proton pump inhibitors increase the risk of c. difficile infection
Topic
74
Elderly Care
10092
Case Presentation:  A 79-year-old gentleman has been admitted to a general surgical ward. He has recently been treated for a pelvic collection with IV cefuroxime and metronidazole. He has finished his antibiotics and a repeat CT scan of his abdomen and pelvis shows that the collection has resolved. 


Today he is complaining of loose stools.

**PMH** Depression, hypertension, hypercholesterolaemia, osteoporosis,

**DH**

Omeprazole 20mg PO BD, sertraline 50mg PO OD, atorvastatin 20mg PO OD, alendronic acid 10mg PO OD, colecalciferol 800 units PO OD

**Investigations**
Observations:

HR 65 bpm, RR 12, blood pressure 123/67 mmHg, O2 saturations 96% on room air, temperature 37.4

Stool type - 7

C. difficile toxin - positive

Question: Select the most appropriate decision option based on this data
a