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Clinical clerk: Junsay, Nicole Xyza T.

Big Group 3

Date and Time: January 3, 2022; 9:40 AM

1. How to diagnose pneumonia based on the CPG?

According to the CPG, Community Acquired Pneumonia (CAP) is a lower respiratory tract infection acquired in the community
within 24 hours to less than 2 weeks. It usually presents with acute cough, tachypnea (respiratory rate >20 breaths per
minute), tachycardia (cardiac rate >100/minute), and fever (temperature >37.8ºC) with at least one abnormal chest finding of
diminished breath sounds, rhonchi, crackles, or wheeze. These findings may be used to presumptively diagnose patients with
pneumonia.
Also from the same guidelines, clinical prediction rules combining history and physical examination findings may be utilized to
presumptively identify patients with pneumonia. A chest x-ray is essential in the diagnosis of CAP, and a new parenchymal
infiltrate in the chest radiograph remains the reference diagnostic standard for pneumonia.

2. What is the empiric treatment for pneumonia based on the CPD and based on its classification?
According to the CAP CPG 2016, the empiric therapy for low-risk CAP patients without comorbidities includes amoxicillin 1 g
TID or extended macrolides such as Azithromycin 500 mg OD or Clarithromycin 500 mg BID. For those with stable co-morbids
who are also under the low-risk stratification, they can be given B-lactam/B-lactamase inhibitor combination or 2nd gen oral
cephalosporin +/- extended macrolides. The combination may include Co-amoxiclav 1 gm BID or Sultamicillin 750 mg BID or
Cefuroxime axetil 500 mg BID +/- Azithromycin 500 mg OD or Clarithromycin 500 mg BID.
In addition, empiric treatments for MODERATE risk CAP patients are IV non-antipseudomonal B-lactam + extended
macrolides or respiratory fluoroquinolones (PO). Combination may be Ampicillin-Sulbactam 1.5 gm 16h IV or Cefuroxime 1.5 g
q8h IV or Ceftriaxone 2 g OD plus Azithromycin 500 mg OD PO or Clarithromycin 500 mg BID PO or Levofloxacin 500 mg OD
PO or Moxifloxacine 400 mg OD PO. If aspiration pneumonia is suspected and, a regimen containing ampicillin sulbactam
and/or moxifloxacin is used, there is no need to add another antibiotic for additional anaerobic coverage. If another
combination is used we may add clindamycin to the regimen to cover microaerophilic streptococci. Thank you doctor.
For high risk CAP patients, the empiric therapy are the ff: No risk for P. aeruginosa IV non-antipseudomonal β-lactamd + IV
extended macrolidesa or IV respiratory fluoroquinolonese Ceftriaxone 2 gm OD OR Ertapenem 1 gm OD + Azithromycin
dihydrate 500 mg OD IV OR Levofloxacin 500 mg OD IV OR Moxifloxacin 400 mg OD IV Risk for P. aeruginosa IV
antipneumococcal antipseudomonal β-lactamf (BLIC, cephalosporin or carbapenem) + IV extended macrolidesa +
aminoglycosideg Piperacillin-tazobactam 4.5 gm q6h OR Cefepime 2 gm q8-12h OR Meropenem 1 gm q8h + Azithromycin
dihydrate 500 mg OD IV + Gentamicin 3 mg/kg OD OR Amikacin 15 mg/kg OD OR IV antipneumococcal antipseudomonal β-
lactamf (BLIC, cephalosporin or carbapenem) + IV ciprofloxacin / high dose levofloxacin Piperacillin-tazobactam 4.5 gm q6h
OR Cefepime 2 gms q8-12h OR Meropenem 1 gm q8h + Levofloxacin 750 mg OD IV OR Ciprofloxacin 400 mg q8-12h IV
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Clinical clerk: Junsay, Nicole Xyza T.
Big Group 3

To add empiric treatment for suspected MRSA pneumonia. We give Vancomycin 15 mg/kg q8-12 h OR Linezolid 600 mg q12h
IV OR Clindamycin 600 mg q8h IV.

LOW RISK MODERATE RISK HIGH RISK

3. Why request procalcitonin, what is its significance?

Procalcitonin was requested to determine the presence of severe inflammation particularly in response to bacterial pathogens.
It has been used as biomarker for early detection of systemic bacterial infections or sepsis. It also helps in the decision
whether antibacterial therapy is needed or as a guide for the duration of antibiotic therapy use.
In addition to this, procalcitonin should not be used on their own but must be correlated with other findings from the history,
physical examination, imaging and laboratory tests for us to provide appropriate management of seriously ill patients with
CAP.
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Clinical clerk: Junsay, Nicole Xyza T.
Big Group 3

4. What is the significance of FOBT?

Since the patient that was presented earlier manifested with epigastric pain/ abdominal pain, along with low hemoglobin levels,
we can request FOBT to rule in/out possible causes of the abdominal pain that might manifest with GI bleeding.

5. Define hypoxic ischemic encephalopathy, its pathology, manifestations, treatment.

Definition of HIE Perinatal asphyxia, more appropriately known as hypoxic-ischemic encephalopathy (HIE), is characterized by
clinical and laboratory evidence of acute or subacute brain injury due to asphyxia. It is a serious birth complication affecting full
term infants: 40–60% of affected infants die by 2 years of age or have severe disabilities.
For the pathology of HIE, principal histologic findings in HIE are extensive multifocal or diffuse laminar cortical necrosis, most
often in the hippocampus since hippocampal neurons are vulnerable to even just short episodes of hypoxia-ischemia. This
perhaps explaining why selective persistent memory deficits may occur after a brief cardiac arrest. Scattered small areas of
infarction or neuronal loss may be present in the basal ganglia, hypothalamus, or brainstem. And in some cases, extensive
bilateral thalamic scarring may affect pathways that mediate arousal, and this pathology may be responsible for the persistent
vegetative state. Watershed infarcts, a specific form of hypoxic-ischemic encephalopathy, may occur at the distal territories
between the major cerebral arteries and can cause cognitive deficits, including visual agnosia, and weakness that is greater in
proximal than in distal muscle groups.
Hypoxic ischemic encephalopathy is a brain dysfunction from lack of delivery of oxygen to the brain because of extreme
hypotension (hypoxia-ischemia) or hypoxia due to respiratory failure. Causes include cardiac arrest, shock, paralysis or
respiration, or in the case presented, strangulation. Its manifestations or disability outcome vary depending on the severity and
length of insult. Mild pure hypoxia may cause impaired judgment, inattentiveness, motor incoordination, and at times,
euphoria. Hypoxia-ischemia often causes loss of consciousness within seconds and if circulation is restored within 3-5 min, full
recovery occurs; but if it lasts beyond 3-5 min, permanent cerebral damage often results. Treatment goal is to restore normal
cardiorespiratory function which includes, securing clear airway, adequate oxygenation and ventilation, and restoring cerebral
perfusion by CP resuscitation, fluids, pressors, and cardiac pacing.

Date and Time: January 3, 2022; 3:00 PM

1. Indications for ERCP.

For the common indications of ERCP. It includes: Jaundice, Postbiliary surgery complaints, Cholangitis, Gallstone pancreatitis,
Pancreatic/biliary/ampullary tumor, unexplained pancreatitis, pancreatitis with unrelenting pain, Fistulas, biopsy radiologic
abnormality, pancreaticobiliary drainage, sample bile, and sphincter of Oddi manometry.

2. How can tramadol affect GI motility?

Tramadol, a centrally acting synthetic opioid analgesic SNRI with a structure similar with codeine and morphine, is a drug
commonly used to manage pain.

As to its effect on the GI system, it causes delay in digestion of food in the small intestine and there are lesser propulsive
contractions. This is due to the decrease in the motility of the GI tract alongside an increase in the smooth muscle tones of the
gastric antrum and the duodenum.

Propulsive peristaltic waves in the colon are also decreased, while tone may be increased to the point of spasm resulting in
constipation.

Tramadol’s other effects in the GI system include lesser secretions in the stomach, biliary system, and pancreas. It can also
cause spams of the sphincter of Oddi and even temporary increase in serum amylase levels.
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Clinical clerk: Junsay, Nicole Xyza T.
Big Group 3

3. What type of LDL cholesterol do diabetics have?

LDLs in patient with DM2 are subclass B LDLs which are small dense triglycerides rich LDL, oxidized LDL, glycated LDL.
These LDLs are more atherogenic. Small dense LDLs even if quantitative value is normal warrants statin therapy giving
atorvastatin 10 mg OD among DM2 patients. CARDS trial

4. What study states that regardless of level of cholesterol we should start statins?

The study that states that regardless of level of Cholesterol we should start statins in px with Type 2 DM, is the CARDS Trial.
The study was a multicenter, randomized, placebo-controlled trial of atorvastatin, 10 mg/d, in the primary prevention of with
type 2 DM. The rationale for starting statins was because of a previous study the "HPS trial" which shows that cardiovascular
risk and not necessarily elevated LDL that predicts the benefit of statin therapy for patients with diabetes and. So in this study,
it demonstrated that treatment of type 2 DM patients with a fixed dose of atorvastatin (10 mg/d) significantly reduced risk for
cardiovascular events

5. What maneuvers can we do preoperatively to prevent post op complications pulmonary wise?

One preoperative maneuver done to prevent pulmonary complications includes the use of Incentive Spirometry. It is known to
prevent and decrease the incidence of atelectasis, hospital length of stay, duration of mechanical ventilation, and improved
postoperative oxygenation. It is also indicated as a pre-operative screening of patients at risk of postoperative complications to
obtain a baseline of their inspiratory flow and volume. An incentive spirometer can keep the lungs active during bed rest.

However, evidence is still lacking for a specific frequency for the use of incentive spirometry. In some clinical trials,
suggestions have been made which includes 1. Ten breaths every one hour on awake hours 2. Ten breaths, five times a day
3. Fifteen breaths every 4 hours . To add doc, post operatively, incentive spirometry can be used at home, still 10 breaths
every 2 hours for the first seven days.

Also to add with regards to the maneuvers or strategies in reducing post-op pulmonary complications like atelectasis and
infection. Cigarette cessation (preferably 8 wks PTOR) would also be effective. For patient with COPD or asthma, we can also
give systemic glucocorticoids and delay elective surgery until COPD/asthma is controlled.

To add, another simple maneuver that we can teach patients preoperatively would be performing respiratory exercises such
as deep breathing exercises. Along with the use of incentive spirometry, this is also known to decrease the incidence and
severity of pulmonary complications, such as pneumonia, atelectasis, and hypoxemia.

6. What is the role of parenteral nutrition preoperatively in the prognosis of a patient who is in cholangitis or
planned for abdominal surgery

The role of parenteral nutrition preoperatively is to improve surgical outcome especially recovery and prognosis of the patient.
Nutrition is a key component for surgical recovery. This helps in wound healing from the stress of surgery and also prevents
leakage from sites where there is anastomosis thus, improves prognosis of the patient. This should be only indicated in
malnourished surgical patients and therefore nutrition screening and assessment by validated tools should be implemented in
all patients who undergo elective surgery.

7. TB liver abscess, its incidence and work – up.

Hepatic TB is an uncommon form of extrapulmonary TB, reported in 10-15% of patients having extrapulmonary tuberculosis,
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Clinical clerk: Junsay, Nicole Xyza T.
Big Group 3

but TLA is extremely rare with a prevalence of 0.34%. These appear to occur more frequently in immunocompromised patients
or in association with foci of infection in the lung and/or gastrointestinal tract.

Gastrointestinal TB is uncommon, making up 3.5% of extrapulmonary cases in the United States. TB is one of the most
common diseases among HIV-infected persons worldwide and a major cause of death. In some African countries, the rate of
HIV infection among TB patients reaches 70–80% in certain urban settings. A person with a positive TST who acquires HIV
infection has a 3–13% annual risk of developing active TB.

In addition, a retrospective study in England done in 1985-2004 which included 84 patients with abdominal tuberculosis, liver
involvement accounted for only 4. According to the CPG of tuberculosis in Filipinos, the recommended diagnostic test for
bacterial confirmation of extrapulmonary tuberculosis cases are direct microscopy, TB culture, and Xpert MTB/Rif using
aspirate of the abscess.

The recommended baseline laboratory examinations before starting treatment includes baseline ALT, Creatinine, and HIV
testing, and screening for DM using FBS and RBS. The effective treatment for new EPTB cases is 2 months of HRZE and 4
months of HR. The role of surgery in hepatic TB is reserved when malignancy is considered. Percutaneous aspiration and
drainage may be needed in patients with multiple large hepatic abscess and biliary decompression is done when there is
obstructive jaundice.

Also to add, the diagnosis of TB liver abscess classically relies on demonstration of AFB on Zeil –Neelson stain of tissue
samples or on the presence of caseating necrotizing granulomas on histology. Mycobacterial culture, although has a high
specificity, has a low positive yield of 10%. More recently, enzyme-linked immunosorbent assay (ELISA), polymerase chain
reaction (PCR) and T-SPOT.TB test have emerged as useful tools to clinch the diagnosis. Also, one should raise the index of
suspicion for hepatic TB if the patient is with an unusual presentation of liver mass lesion or in atypical abscesses (non-
pyogenic and non-amoebic) and has one of the following: Asian or Afro-Caribbean descent, young age (20– 40 years) and
unexplained weight loss or fever.

8. What is the significance of knowing the location and size of the hepatic abscess/nodules?

The significance of knowing the location, number, and size of hepatic abscess/nodules is that it can aid in identifying pyogenic
and amebic liver abscess as well as aid in choosing the appropriate management. Pyogenic liver abscesses are often has
multiple nodules on either lobes of the liver. Amebic liver abscess are commonly single and localized to the right hepatic lobe,
close to the diaphragm.
Knowing the size of the abscess is important in the management as large abscesses (>5cm) may require drainage while
smaller abscesses may be managed with antibiotics.

Date and Time: January 4, 2022; 3:00 PM

1. What are the four different types of Acute Respiratory Failure (ARF) and their causes?
The 4 types of respiratory failure are:
Type 1 or acute hypoxemic failure characterized by an arterial oxygen tension of PaO2 of <60 mmHg with a low or normal
PaCO2. It is usually from alveolar flooding with intrapulmonary shunting. This can be cause by pulmonary edema from
cardiogenic or non-cardiogenic causes, pneumonia, pulmonary alveolar haemorrhage, ARDS.
Type 2 or hypercarbic respiratory failure with PaCO2 > 45-50 mmHg. This results from the alveolar hypoventilation which
leads to the inability to eliminate CO2 effectively. Can be probably from diminished breathing effort of the CNS like in
brainstem injury, drug overdose, etc.; Can be probably from reduced strength of neuromuscular function such as in
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Clinical clerk: Junsay, Nicole Xyza T.
Big Group 3

myasthenia gravis, Guillain-Barre, ALS, phrenic nerve injury; can be from increased overall load of the respiratory system like
in COPD, asthma, suffocation.
Type 3 RF occurs as a result of lung atelectasis. It also called as perioperative respiratory failure as this is commonly found in
the perioperative period (usually from pain)
Type 4 RF results from hypoperfusion of respiratory muscles in patients in shock. Patient in shock often experience respiratory
distress due to pulmonary edema, lactic acidosis, and anemia.

2. What is the role of ferrous sulfate in px with Chronic Kidney disease? Is it still warranted if the patient is
already on erythropoietin?
According to Harrison's, adequate bone marrow iron stores should be available before treatment with erythropoeitin is initiated.
Iron supplementation is usually essential to ensure an optimal response to erythropoeitin in patients with CKD because the
demand for iron by the marrow frequently exceeds the amount of iron that is immediately available for erythropoiesis
(measured by percent transferrin saturation), as well as the amount in iron stores (measured by serum ferritin). For the CKD
patient not yet on dialysis or the patient treated with peritoneal dialysis, oral iron supplementation should be attempted.
Ferrous sulfate is the most common formulation in use in clinical practice. Although often assumed to be ineffective because
of diminished gut iron absorption, data from several large randomized controlled trials suggest that treatment with ferrous
sulfate increases circulating iron stores and hemoglobin in patients with CKD not requiring dialysis.

3. How do you give iron supplementation? Dose, route, etc? When are we warranted to give parentetal iron
supplementation?
Ferrous sulfate, 65 mg/tablet, 1 tablet, 1–3 times per day
With regards to iron parenteral therapy, according to Katzung it should be reserved for patients with documented iron
deficiency who are unable to tolerate or absorb oral iron and for patients with extensive chronic anemia who cannot be
maintained with oral iron alone. This includes patients with advanced CKD requiring hemodialysis and treatment with
erythropoietin, various postgastrectomy conditions and previous small bowel resection, inflammatory bowel disease involving
the proximal small bowel, and malabsorption syndromes.

4. What is/are the criteria for COPD in exacerbation? What is Anthonisen's criteria?
Anthonisen criteria are used to classify the acute exacerbation of COPD (AECOPD). There are three parameters in the criteria
including increased dyspnea, increased sputum volume, and increased sputum purulence. Type 1 AECOPD is the most
severe (all 3 symptoms are present), type 2 if any 2 symptoms are present, and type 3 if one symptom is present plus at least
one of the ff: URTI in the past 5 days, increased wheezing, increased cough, fever without an obvious source, a 20% increase
in RR, and heart rate above baseline.

Date and Time: January 5, 2022; am

1. How to diagnose diabetes mellitus; and what is our target pre-prandial CBGs.
Criteria for diagnosing Diabetes Mellitus
 Symptoms of diabetes plus random blood glucose concentration ≥11.1 mmol/L (200 mg/dL) or
 Fasting plasma glucose ≥7.0 mmol/L (126 mg/dL) or
 Hemoglobin A1c ≥ 6.5%c or
 2-h plasma glucose ≥11.1 mmol/L (200 mg/dL) during an oral glucose tolerance test
The treatment goals for adults with diabetes for preprandial cbgs it should be 4.4–7.2 mmol/L (80–130 mg/dL)
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Clinical clerk: Junsay, Nicole Xyza T.
Big Group 3

2. What are the clinical features of a typical gout flare? and a gout flare is usually characterized by what on
synovial fluid analysis?
A typical gout flare includes the ff features: severe pain, redness, warmth, swelling, and disability, onset more often at night,
lower-extremity involvement most often at the base of the great toe (first metatarsophalangeal joint, known as podagra) or the
knee. Present also are the signs of inflammation extending beyond the confines of the joint that is primarily involved. On
synovial fluid analysis, there is the presence of monosodium urate (MSU) crystals in synovial fluid obtained from joints or
bursas visualized by direct examination of a sample of fluid using compensated polarized light microscopy. Urate crystals may
also be identified frequently by this technique in material aspirated during the intercritical period from previously affected joints
and tophaceous deposits. The synovial fluid is inflammatory, with white blood cell counts in joint fluid that usually range
between 10,000 to 100,000 with neutrophil predominance. Bursal fluid white blood cell counts are usually elevated but to a
much lesser degree than joint fluid, similar to findings in patients with septic bursitis.

Date and Time: January 17, 2022; 3:00 PM

1. What other pathology can give you an elevated CEA?

CEA, an oncofetal glycoprotein can be elevated in adenocarcinomas of the colon, pancreas, lung, breast and ovary. Some
nonneoplastic conditions that can also have increased CEA are pancreatitis, hepatitis, IBD and those who are smoking.

2. What are the classifications of seizures, their definition based on Harrisons?

Seizures can be classified based on clinical features and associated EEG findings; focal and generalized.
Focal seizures originate within networks limited to one brain region. It is usually associated with structural abnormalities of the
brain.
Generalized seizures arise within and rapidly engage networks of disturbed across both cerebral hemispheres. It is usually a
result from cellular, biochemical, or structural abnormalities

Date and Time: January 17, 2022; 3:00 PM

1. How to compute for Mean arterial pressure (MAP)?

Formula of MAP is =(SP + 2DP)/3
To solve for MAP, we double the diastolic blood pressure and add the sum to the systolic blood pressure then we divide it by
3.

2. What are the MAP targets for ischemic stroke vs. hemorrhagic stroke?
For infarct: 110-130 mmHg
For bleed: 140-160 mmHg

3. Mode of action of Nimodipine and its role in stroke patients?

The primary function of nimodipine is to block voltage-gated L-type calcium channels in their inactive conformation, avoiding
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Clinical clerk: Junsay, Nicole Xyza T.
Big Group 3

the influx of calcium ions, to prevent vasoconstriction. It has a preference doc to act on cerebral blood vessels since it is
lipophilic and can cross the blood-brain barrier.

4. Role of Lactulose in stroke patients?

According to a study by Chen et al in 2012, lactulose can produce considerable amounts of hydrogen which is protective for
ischemic stroke as a unique antioxidant. This reduces the oxidative stress and ameliorates the stroke damage.
Lactulose promotes peristalsis by producing an osmotic effect in the colon with resultant distention. It is usually given to avoid
constipation.

Date and Time: January 26, 2022

1. What other Xray findings in the Xray can further strengthen the existence of atelectasis in that area?
For atelectasis, other xray findings include displacement of interlobular fissures; surrounding structures deviated to the side of
the collapsed lung, ipsilateral diaphragmatic elevation.

2. Relationship of TB and low vitamin D level

Vitamin D is a potent immunomodulator of innate immune responses by acting as a cofactor for induction of antimycobacterial
activity. The likely mechanism through which vitamin D may prevent or limit infection by Mycobacterium Tuberculosis is
through the binding of the bioactive form of vitamin D (1,25-dihydroxycholecalciferol) to the vitamin D receptor (VDR), a
polymorphic nuclear receptor that regulates the expression of genes important for immune function and involved in cytokine
production. The VDR is present in immune cells and bronchial and pulmonary epithelial cells and is up-regulated following the
ligation of specific toll-like receptors (TLRs) during an antimicrobial response. Through this mechanism, calcitriol induces
several endogenous antimicrobial peptides specifically cathelicidin LL-37 and β defensin and suppresses matrix
metalloproteinase enzymes that degrade the pulmonary extracellular matrix. Serum levels <20 ng/mL may therefore impair the
macrophage-initiated innate immune response to M. tuberculosis. Thus, vitamin D deficiencies is associated with the risk of
tuberculosis (TB) infection and have a greater susceptibility to developing TB and worse disease progression if infected with
TB.

3. Comparing dexamethasone, hydrocortisone, Methylprednisolone in acute spine injury.

Trials of steroid therapy for acute spinal injury are mainly focused on the role of methylprednisolone. In a Cochrane
collaboration entitled Steroids for acute spinal injury: review, high dose methylprednisolone therapy is the only pharmacologic
therapy known to how efficacy when administered 8 hours of injury. High dose methylprednisolone was defined as an
intravenous dose of 15mg-kg or 1g MPSS given as a single or repeated dose within a maximum of three days and
discontinued afterwards.

Date and Time: January 31, 2022

1. Nimodipine MOA in the context of ischemic stroke

The primary function of nimodipine is to block voltage-gated L-type calcium channels in their inactive conformation, avoiding
the influx of calcium ions, to prevent vasoconstriction. It has a preference to act on cerebral blood vessels since it is lipophilic
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Clinical clerk: Junsay, Nicole Xyza T.
Big Group 3

and can cross the blood-brain barrier.

2. Lactulose MOA in the context of ischemic stroke

According to a study by Chen et al in 2012, lactulose can produce considerable amounts of hydrogen which is protective for
ischemic stroke as a unique antioxidant. This reduces the oxidative stress and ameliorates the stroke damage.
Lactulose also promotes peristalsis by producing an osmotic effect in the colon with resultant distention. It is usually given to
treat or avoid constipation. Straining or doing the valsalva maneuver increases the intracranial pressure.

3. Length for antibiotics in pyogenic liver abscess, drug of choice, how to follow-up.
PYOGENIC LIVER ABSCESS
The choice of the antibiotics should cover the most common microorganisms cultured from liver abscesses. The underlying
disease may be a clue to the possible microorganism for empirical treatment. Targeted antibiotic therapy can be commenced
earlier based on culture of the organism of the pus aspirated. Antibiotics used should be wide spectrum. The antibiotic therapy
should consist of a combination of an aminoglycoside with either metronidazole or clindamycin, or a beta lactam antibiotic with
anaerobic coverage. In case of Staphylococcal or Streptococcal infection a penicillinase resistant penicillin or first generation
cephalosporin can be used for treatment. The antibiotic treatment in liver abscess secondary to biliary disease should consist
of ampicillin or ureidopenicillin combined with an aminoglycoside. Antibiotic therapy alone should be reserved only for the
patients in good clinical condition and those who have a solitary or micro abscesses smaller than 2 cm in diameter. The length
of the antibiotic therapy should be individualized on the basis of the number of abscesses and the clinical response. Patients
with multiple abscesses should receive antibiotics for 4–6 weeks.
Drainage of pyogenic liver abscesses is the mainstay of the treatment. Drainage can be accomplished either surgically or
US/CT guided percutaneously.
AMEBIC LIVER ABSCESS
Metronidazole is the drug of choice. The size of the abscess is an important factor in determining the response to medical
treatment. Percutaneous needle aspiration and/or catheter drainage are the other modalities of treatment. The treatment
modalities are selected depending on the presence of complications. Metronidazole is effective against both the intestinal and
hepatic phase. Metronidazole 750 mg three times a day for 7–10 days is recommended. Abscess smaller than 5 cm in
diameter respond better to metronidazole treatment.

Date and Time: February 14, 2022

1. How do we differentiate ulcerative colitis from Crohn disease? What are the therapeutic armamentariums for
IBD in general?
For ulcerative colitis, it involves the colon and the rectum and is generally limited to the mucosa and submucosa doctor. While
Crohn's may affect any portion of the intestinal tract.
For the differentiation of crohn vs ulcerative colitis. In terms of location in the colon doc, the UC involves all or part of the colon
and is continuous, while the Crohn affects any part of the GIT and is often described as segmental and skipped areas doc.
Ulcerative colitis and Crohn’s disease are both dynamic diseases characterized by remissions and exacerbations. For UC doc,
It involves only the colon and rectum and is generally limited to the mucosa and submucosa. Crohn’s disease, however, may
affect any portion of the intestinal tract, from mouth to anus. For the treatment doc, medical therapy for IBD focuses on
decreasing inflammation and alleviating symptoms. Salicylates, Corticosteroids, and Immunomodulating agents such as
Cyclosporine or Azathrioprine may be used.
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Big Group 3

2. The role of targeted or biologic therapy in IBD

Biologic therapy for IBD is now commonly given as an initial therapy for patients with moderate to severe CD and UC. It is also
reported that patients who respond to biologic therapies enjoy improvement in clinical symptoms, better QOL, less disability,
fatigue and depression, and fewer chances for them to go into surgical procedures and hospitalizations for IBD. (Source:
Harrison's)
It is Anti-TNF therapy doc, with Infliximab is the first biologic therapy approved for moderate to severely active CD and UC.
For the name of biologic therapy of IBD, 2 proven therapies to be effective for Crohn’s disease:
1.) infliximab and CDP571 which acts as monoclonal antibodies to tumor necrosis factor
2.) natalizumab which acts as monoclonal antibodies to the leukocyte adhesion molecule alpha4 integrin.

Date and Time: February 14, 2022

1. Modified well's criteria.

Well's Score for this patient, it is 4.5: Clinical signs of DVT (3) plus the tachycardia (1.5)