ROSH Gastrointestinal Practice Exam

A 24-year-old man presents with foul-smelling diarrhea after a hiking trip. What is the most likely cause of his illness?

1. Entamoeba histolytica

2. Escherichia coli

3. Giardia lamblia

4. Shigella sonnei

The correct answer is: Giardia lamblia

The presentation of foul-smelling diarrhea in a young man who recently went on a hiking trip strongly points to Giardia lamblia as the likely cause of his illness. Giardia lamblia is a protozoan parasite that is often associated with gastrointestinal distress and is commonly contracted from contaminated water sources, which can occur in outdoor settings like hiking. The characteristic symptoms of giardiasis include foul-smelling, greasy, and floating stools, which correlate with the description of diarrhea in this case. Additionally, Giardia is notorious for causing prolonged diarrhea and can also be associated with fatigue and weight loss if not treated. In contrast, although the other pathogens mentioned can cause diarrhea, they typically present with different clinical features or are associated with different exposure risks. For instance, Entamoeba histolytica is usually linked to amebic dysentery and may cause bloody diarrhea but is less likely to cause foul-smelling stools. Escherichia coli can lead to diarrhea as well, but it usually manifests with more acute and sometimes bloody symptoms, depending on the strain. Shigella sonnei typically causes dysentery with bloody diarrhea and is less common in association with hiking in untreated water sources. Overall, the symptoms and context of the hiking trip strongly suggest