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Volume 18, Number 1—January 2012

CME ACTIVITY - Synopsis

Intestinal Toxemia Botulism in 3 Adults, Ontario, Canada, 2006–2008

Earning CME Credit

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Article Title: Intestinal Toxemia Botulism in 3 Adults, Ontario, Canada, 2006–2008

CME Questions

1. You are seeing a 52-year-old woman with abdominal pain as well as neurologic complaints, and you consider whether she might have adult intestinal toxemia botulism. Which of the following statements regarding adult intestinal toxemia botulism is most accurate?

A. It produces an ascending rigid paralysis

B. It occurs after direct ingestion of neurotoxin but not spores

C. There have been fewer than 20 cases reported over the last 30 years

D. The primary infecting organism is Clostridium butyricum

2. In working through the differential diagnosis for this patient, what should you consider as an important risk factor for adult intestinal toxemia botulism?

A. Regular use of proton pump inhibitors

B. Recent infection with Salmonella species

C. The presence of Crohn disease

D. Chronic laxative use

3. Which of the following statements regarding the clinical presentation of patients with adult intestinal toxemia botulism in the current case series is most accurate?

A. All patients presented with ocular symptoms and signs

B. All patients presented with fasciculations

C. The most common source of botulism was undercooked meat

D. The most common source of botulism was fresh vegetables

4. Which of the following statements regarding the workup and prognosis of cases of adult intestinal toxemia botulism in the current case series is most accurate?

A. All patients had positive stool testing for more than 30 days

B. Nerve conduction studies were not helpful in the workup of any case

C. No patient required mechanical ventilation

D. All patients died as a result of complications of adult intestinal toxemia botulism

Activity Evaluation

1. The activity supported the learning objectives.

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2. The material was organized clearly for learning to occur.

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3. The content learned from this activity will impact my practice.

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4. The activity was presented objectively and free of commercial bias.

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