American Board of Internal Medicine (ABIM) Certification Practice Exam

Which condition is associated with diarrhea accompanied by abdominal pain, fever, and weight loss?

1. Inflammatory bowel disease

2. Noninvasive infections

3. Hormone-producing tumors

4. Bile acid malabsorption

The correct answer is: Inflammatory bowel disease

The association of diarrhea with abdominal pain, fever, and weight loss is most characteristic of inflammatory bowel disease (IBD), which encompasses conditions such as Crohn's disease and ulcerative colitis. Both forms of IBD can lead to significant gastrointestinal symptoms due to inflammation of the bowel. The inflammation can result in not only diarrhea but also intermittent abdominal pain due to cramping and spasms, fever from systemic inflammation or infection, and weight loss from malabsorption of nutrients and decreased appetite during active disease phases. In contrast, noninvasive infections typically cause diarrhea but are less likely to present with both fever and significant weight loss over time, as the acute nature of these infections more commonly resolves without long-term implications. Hormone-producing tumors might lead to metabolic changes causing various gastrointestinal symptoms, but they are not characteristically associated with the combination of diarrhea, abdominal pain, and weight loss. Bile acid malabsorption can certainly result in diarrhea but lacks the systemic inflammatory symptoms like fever and tends to present differently when considering the clinical context. Thus, IBD fits the clinical picture most accurately due to the chronicity and inflammatory nature of the condition, which accounts for the array of symptoms experienced by affected individuals.