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Severe Clostridioides difficile colitis — SCE Acute Medicine MCQ

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EasySepsis and Infectious EmergenciesSevere Clostridioides difficile colitisSCE Acute Medicine

A 73-year-old man presents with fever, systemic upset and acute deterioration. Relevant history includes a plausible infectious exposure or immunocompromising context. On assessment, NEWS2 is elevated and there are features of organ dysfunction. Investigations show profuse diarrhoea, WCC 24, AKI and colonic dilatation. What is the most appropriate next step in management?

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Correct answer: A — Treat as severe C difficile infection and escalate if toxic megacolon suspected

The key discriminator is that profuse diarrhoea, WCC 24, AKI and colonic dilatation, which makes Treat as severe C difficile infection and escalate if toxic megacolon suspected the single best answer. Start broad-spectrum intravenous antibiotics is less appropriate because it does not address the dominant acute risk in the vignette; Arrange urgent specialist referral would fit a different presentation or later stage of care. Start anticoagulation after assessing bleeding risk and Optimise chronic medication and discharge are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: NICE NG199