American Board of Internal Medicine (ABIM) Certification Practice Exam

How is travelers' diarrhea defined?

1. The occurrence of 4 or more formed stools

2. The occurrence of 3 or more unformed stools per day

3. The occurrence of 2 or more bloody stools with fever

4. The occurrence of 5 or more unformed stools with nausea

The correct answer is: The occurrence of 3 or more unformed stools per day

Travelers' diarrhea is defined as the occurrence of three or more unformed stools per day. This definition is rooted in clinical observations that recognize that a significant increase in the frequency of unformed bowel movements, particularly when accompanied by relevant context such as recent travel to areas with poor sanitation or different dietary habits, points to an acute infectious process commonly affecting travelers. In general, the distinction between unformed stools and formed stools is crucial in diagnosing diarrhea. The volume and consistency of stools help clinicians assess the severity and potential causes of gastrointestinal symptoms. Thus, three or more unformed stools per day is an appropriate threshold for identifying diarrhea in travelers, facilitating timely recognition and management of the condition. The other options either define diarrhea in terms that do not align with typical clinical guidelines or specify additional symptoms that do not strictly adhere to the foundational definition of travelers' diarrhea. The focus on unformed stool consistency with a minimum frequency is key to diagnosing this condition effectively.