American Board of Internal Medicine (ABIM) Certification Practice Exam

What is a significant alarm feature requiring evaluation in patients with acute diarrhea?

1. Loose stools

2. Severe abdominal pain

3. Mild nausea

4. Dehydration

The correct answer is: Severe abdominal pain

Severe abdominal pain is a significant alarm feature in patients with acute diarrhea that necessitates further evaluation. This type of pain may indicate a more serious underlying condition that could require intervention beyond the management of diarrhea itself. While loose stools are a characteristic symptom of diarrhea, they are not alarm features on their own and are typically expected in such cases. Mild nausea, similarly, is common and usually not alarming unless it is persistent or associated with other concerning symptoms. Dehydration is indeed a critical concern with diarrhea, but it often represents a consequence rather than a direct alarm feature that requires immediate evaluation. Severe abdominal pain could suggest conditions such as appendicitis, pancreatitis, or bowel obstruction, all of which necessitate prompt diagnostic investigation and management. Therefore, its presence warrants a thorough clinical assessment to rule out potentially life-threatening issues.