Kaplan USMLE Step 2 prep: 5 cases where diarrhea is major symptom

Over the years, the AMA has run dozens of example questions from Kaplan Medical. If you’re preparing for the United States Medical Licensing Examination® (USMLE®) Step 2 exam, you might want to know which questions are most often missed by test-prep takers. We’ve compiled five cases from Kaplan Medical in which the major symptom is diarrhea. Each question comes with an expert explanation of the answer. You can check out all posts in this series.  

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Think you can answer these questions involving diarrhea as a major symptom? Find out now.   

6 months of diarrhea, malaise, cramps 

A 22-year-old man presents with a six-month history of non-bloody diarrhea, malaise, recurrent abdominal cramps, and temperatures to 38.5 °C (101.3 °F). At this time, he is afebrile. Examination reveals a palpable, ill-defined mass in the right lower quadrant of the abdomen. Palpation causes local tenderness without guarding. Oral ulcers are also noted. An upper gastrointestinal series with small bowel follow-through reveals a sharply demarcated stenotic segment in the terminal ileum. The patient undergoes laparotomy, and the involved segment of ileum is resected. What is the most likely diagnosis? 

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Diagnose the cause of diarrhea, fatigue, dyspnea 

A 54-year-old lawyer presents to the emergency department with diarrhea for the previous two months. He has associated fatigue, shortness of breath and weight loss. He has lost about 10 pounds over the last few months, during which time the symptoms have worsened. He has no related medical history and does not smoke or drink. He takes no medications. On examination his blood pressure is 115/75 mm Hg and his pulse is 108 beats per minute. His skin is pale. Neurologic examination reveals loss of vibration sense, spasticity and a positive Babinski sign. Which is the most likely diagnosis?

Which pathogen is to blame for diarrhea? 

A 50-year-old man returns to his home in Minnesota after a diving trip to Belize. The day after his return, he comes to the physician because of diarrhea, abdominal cramps and nausea. His temperature is 37 °C (98.6 °F). His stools do not contain mucus or blood. Microscopic examination of a stool sample reveals no leukocytes. What is the most likely pathogen? 

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Intermittent abdominal cramps, diarrhea 

A 42-year-old woman comes to the physician because of a four-month history of intermittent abdominal cramps and diarrhea. She has had episodes of skin flushing that lasted between two and 15 minutes, most pronounced in the head and neck area. She denies nausea, vomiting, constipation or blood in her stools. Her medical history is unremarkable, and she takes no medications. A grade 3/6 murmur is heard along the mid left sternal border. The lungs are clear to auscultation. Abdominal examination shows no abnormalities. Laboratory studies show urinary excretion of 5-hydroxyindoleacetic acid of 75 mg/day (normal: 0.5–9 mg/day). CT scan of the liver demonstrates a 2-centimeter lesion. Which is the most likely diagnosis? 

Next step for patient with diarrhea, cramping 

A 70-year-old woman presents to her primary care physician with diarrhea. She describes watery stools associated with abdominal cramping for the last week. There has been no fever, nausea or vomiting. She was hospitalized one month ago for community-acquired pneumonia, which was treated with ceftriaxone and azithromycin. She also has a history of watery diarrhea with abdominal cramps when she consumes milk products. Physical examination reveals lower-abdominal tenderness. The initial laboratory evaluation of stool is significant for the presence of fecal leukocytes. What is the next step in diagnosing this patient? 

For more prep questions on USMLE Steps 1, 2 and 3, view other posts in this series.

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