Acute diarrhoea — structured viva

Structured oral on acute diarrhoea: the triage frame, dehydration assessment with NIRUDAK validation data, racecadotril versus loperamide evidence, probiotics' demotion, C. difficile in the older adult, and the returned traveller with fever and blood.

Prompt

The examiner opens: 'A 45-year-old rings with two days of diarrhoea. What do you actually need to know?' The viva branches through the triage frame, dehydration assessment, symptom agents and their rules, testing indications, C. difficile, and the traveller.

Stem

Diarrhoea is common; the deaths and admissions from it are preventable — and the decisions that prevent them are made in the first five minutes. ^[2]

References7Show

[2]Levine AC, Gainey M, Qu K et al. A comparison of the NIRUDAK models and WHO algorithm for dehydration assessment in older children and adults with acute diarrhoea: a prospective, observational study. The Lancet. Global health, 2023.PMID 37776870
[4]Aziz M, Malik LU, Javed E et al. Racecadotril Versus Loperamide for Acute Diarrhea of Infectious Origin in Adults: A Systematic Review and Meta-Analysis. Health science reports, 2025.PMID 40415979
[1]Collinson S, Deans A, Padua-Zamora A et al. Probiotics for treating acute infectious diarrhoea. The Cochrane database of systematic reviews, 2020.PMID 33295643
[7]Fischer M, Vaughn BP, Peery AF et al. AGA Clinical Practice Update on Management of Clostridioides difficile Infection in Adults: Expert Review. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2026.PMID 42383946
[8]Donskey CJ Update on Clostridioides difficile Infection in Older Adults. Clinics in geriatric medicine, 2026.PMID 42547174
[3]Johns T, Lawrence E Evaluation and Treatment of Nausea and Vomiting in Adults. American family physician, 2024.PMID 38804756
[6]GBD 2023 Diarrhoeal Disease and Enteric Infectious Diseases Collaborators Global burden of enteric infectious diseases, diarrhoeal diseases, and corresponding aetiologies, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023. The Lancet. Infectious diseases, 2026.PMID 42229499

Acute diarrhoea — structured viva

Stem

Diarrhoea is common; the deaths and admissions from it are preventable — and the decisions that prevent them are made in the first five minutes. ^[2]

References7Show

[2]Levine AC, Gainey M, Qu K et al. A comparison of the NIRUDAK models and WHO algorithm for dehydration assessment in older children and adults with acute diarrhoea: a prospective, observational study. The Lancet. Global health, 2023.PMID 37776870
[4]Aziz M, Malik LU, Javed E et al. Racecadotril Versus Loperamide for Acute Diarrhea of Infectious Origin in Adults: A Systematic Review and Meta-Analysis. Health science reports, 2025.PMID 40415979
[1]Collinson S, Deans A, Padua-Zamora A et al. Probiotics for treating acute infectious diarrhoea. The Cochrane database of systematic reviews, 2020.PMID 33295643
[7]Fischer M, Vaughn BP, Peery AF et al. AGA Clinical Practice Update on Management of Clostridioides difficile Infection in Adults: Expert Review. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2026.PMID 42383946
[8]Donskey CJ Update on Clostridioides difficile Infection in Older Adults. Clinics in geriatric medicine, 2026.PMID 42547174
[3]Johns T, Lawrence E Evaluation and Treatment of Nausea and Vomiting in Adults. American family physician, 2024.PMID 38804756
[6]GBD 2023 Diarrhoeal Disease and Enteric Infectious Diseases Collaborators Global burden of enteric infectious diseases, diarrhoeal diseases, and corresponding aetiologies, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023. The Lancet. Infectious diseases, 2026.PMID 42229499