ABSTRACT
Multiple Choice (choose the one best answer) 1. A 26-year-old woman presents with a 4-month history of
diarrhea that began 1 week after returning from a camping trip. She initially had crampy abdominal pain with bloating and six nonbloody bowel movements per day. After several weeks the stools became more bulky and malodorous and appeared somewhat greasy. Three weeks ago, her primary care physician performed a stool analysis for fecal leukocytes, bacterial culture, and ova and parasites. These tests were all negative. She has lost 5 lb and is without fever or nausea or vomiting. Which of the following is least appropriate in the management of this patient? a. Repeat stool analysis for ova and parasites b. Upper endoscopy with small-bowel biopsy and aspirate c. An empiric trial of metronidazole, 250 mg three times
a day for 7 days d. Fecal analysis for Giardia antigen e. Loperamide, 2 mg after each bowel movement
2. A 1-year-old boy is brought to his pediatrician having had watery diarrhea for 10 days. He has no fever or evidence for blood in his stools. Which of the following viruses is most likely to explain his diarrhea? a. Rotavirus b. Enteric adenovirus c. Astrovirus d. Norwalk virus e. Hepatitis A virus
3. A 47-year-old man has had crampy lower abdominal pain, low-grade fever, and bloody stools that contain pus and mucus for 3 days. He has had no recent travel, antibiotics, or exposure to sick people or animals. He cannot recall any potential contaminated food exposures, although he did eat a hamburger at a fast-food restaurant last week. Which of following organisms is least likely to cause this presentation? a. Shigella b. Escherichia coli O157:H7 c. Salmonella d. Vibrio cholerae e. Campylobacter
4. A 6-year-old girl is brought for evaluation of diarrhea. Her symptoms began 2 days after a family picnic. She initially had watery diarrhea with abdominal pain and nausea and vomiting. Three days later, the volume of diarrhea decreased and the stools became bloody with mucus. Besides Escherichia coli O157:H7, which other organism causes a typical progression from watery diarrhea to dysentery? a. Salmonella b. Shigella c. Enterotoxigenic E. coli d. Vibrio cholerae e. Cryptosporidium
5. Which of the following is true regarding extraintestinal manifestations of infectious diarrhea?
