An 82-year-old woman receives oral amoxicillin-clavulanate for a skin abscess on her leg. She develops new onset of frequent watery stool that persists for several days after the antibiotic is stopped. You obtain a stool for Clostridium difficile antigen, toxin, and polymerase chain reaction (PCR). The antigen and PCR are both positive. She has never had C. difficile infection before. What one statement is the best answer regarding her management?

Correct Answer: D

Rationale: The correct answer is D: Either vancomycin or fidaxomicin are recommended for the first episode of C. difficile infection. 1. Choice A is incorrect because metronidazole is no longer recommended as first-line treatment due to increasing resistance. 2. Choice B is incorrect because there is no evidence suggesting older adults require a longer duration of treatment with vancomycin for their first episode. 3. Choice C is incorrect because while fecal transplantation can be used in refractory cases, it is not typically the first-line treatment. 4. The rationale for D being correct is that both vancomycin and fidaxomicin are recommended as first-line treatments for the initial episode of C. difficile infection based on current guidelines. This allows for flexibility in selecting the appropriate antibiotic based on individual patient factors.

Correct Answer: C

Rationale: The correct answer is C: Approximately 25% better quit rates than younger individuals. Older adults tend to have higher quit rates compared to younger individuals due to factors like increased motivation, life experience, and health concerns. Older adults often have more resources and support systems in place to help them quit smoking successfully. Choice A is incorrect because older adults do not necessarily have the same quit rates as younger individuals. Choice B is also incorrect as the difference in quit rates is not as high as 50%. Choice D is incorrect as older adults do not generally have much lower quit rates than younger individuals.

Correct Answer: C

Rationale: The correct answer is C: There is moderate quality evidence to suggest control of cardiovascular and metabolic risk factors, such as blood pressure, weight, and blood sugar, may reduce the risk of dementia. This statement is true because studies have shown that managing cardiovascular and metabolic risk factors can help reduce the risk of developing dementia. High blood pressure, obesity, and diabetes have been linked to an increased risk of cognitive decline and dementia. By controlling these risk factors through lifestyle changes or medication, individuals can potentially lower their risk of developing dementia. Choice A is incorrect because while vitamin B12 and fish oil may have some benefits for cognitive health, the evidence supporting their use in preventing dementia is not strong. Choice B is incorrect because while genetics and family history play a role in dementia risk, there are behavioral interventions, such as maintaining a healthy lifestyle and managing risk factors, that can help reduce the risk of dementia. Choice D is incorrect because there is not enough strong evidence to support the claim that cannabinoids can reduce rates

Correct Answer: E

Rationale: I believe you made a typo in listing the correct answer as "E" while there is no "E" option in the choices provided. Could you please confirm the correct answer choice so I can provide you with a detailed explanation and summary of why the correct answer is correct and why the other choices are incorrect?

Correct Answer: C

Rationale: Correct Answer: C - Suggesting completion of an advance directive at the visit with his goals of care in mind. Rationale: 1. Age and health concerns: At 81 years old with weight loss, fatigue, and a history of falls, addressing end-of-life planning becomes crucial. 2. Advance Directive: Helps the patient make decisions about the care they want if they become unable to communicate their wishes. 3. Goals of care: Understanding his wishes ensures healthcare decisions align with his values, enhancing patient autonomy and quality of care. Summary: - A: Blood pressure is important but not the priority compared to end-of-life planning. - B: Cognitive testing is valuable, but addressing care preferences takes precedence. - D: Colonoscopy report is not urgent compared to ensuring the patient's wishes are known for future care.