Friday, September 22, 2023
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Professor of Medical Microbiology
Sir Edward Brotherton Chair of Bacteriology
University of Leeds
Leeds Teaching Hospitals NHS Trust
Leeds, United Kingdom
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Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™
This educational activity is intended for an international audience of non-US gastroenterologists, infectious disease specialists, and primary care physicians.
The goal of this activity is for learners to be better able to optimize first-line management of patients with C difficile.
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Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.
Professor of Medical Microbiology
Sir Edward Brotherton Chair of Bacteriology
University of Leeds
Leeds Teaching Hospitals NHS Trust
Leeds, United Kingdom
This activity has been peer reviewed and the reviewer has no relevant financial relationships.
Medscape, LLC designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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CME Released: 11/23/2022
Valid for credit through: 11/23/2023, 11:59 PM EST
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Jane, a 72-year-old patient, is transferred to the emergency department (ED) by her nursing home care staff. She presents
with severe, watery diarrhea and appears lethargic and disoriented. Jane communicates that she feels nauseous but is unable
to provide more information on her condition.
Jane's caregiver reports that Jane was recently taken on holiday to a nearby coastal village by her daughter. When Jane returned
to the nursing home, she resumed her typical weekly routine of sitting with cats at the local animal rescue to provide socialization.
Two weeks after returning home, Jane began to experience diarrhea that rapidly became more severe. The care staff waited 2
days to see if the symptoms would resolve before bringing her for further evaluation.
You admit Jane to hospital and begin supportive care while working on a diagnosis. Her history and physical examination findings
can be found below (Tables 1 and 2).
Table 1. Patient History
| History | Findings |
|---|---|
| Medical | Gastrointestinal reflux disease Unstable mobility -- fall risk |
| Current medications | Omeprazole Midodrine |
| Allergies | None |
| Psychosocial | Mild cognitive impairment |
| Immunizations | Up to date |
Table 2. Physical Examination
| Physical Examination | Findings |
|---|---|
| Vital signs | • Height 1.68 m • Weight 49.4 kg • BMI 18.1 • BP 100/70 mm Hg • Heart rate 105 bpm • Temp 39°C |
| General | Appears lethargic and disoriented |
| Chest and lungs | Normal |
| Heart | Normal |
| Abdomen | Some pain on palpation |
BMI, body mass index; BP, blood pressure; temp, temperature.
