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Old 10-09-2012
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Arrow Billy Step 1 Questions # 19

The “fun ship” leaves port from Miami on a cruise to the Caribbean. On the third day out of port, 10 adult passengers
experience sudden onset of nausea and abdominal cramps, followed by periods of watery diarrhea. Some of the affected
passengers also experience vomiting, and most have headaches, myalgias, or abdominal pain. On physical examination,
five patients have a temperature of 38°C, but there are no other abnormal findings. Stool smears show no RBCs,
leukocytes, ova, or cysts. The affected passengers recover without therapy over the next 3 days. Which of the following is
the most likely causative agent?


□ (A) Giardia lamblia
□ (B) Norwalk-like virus
□ (C) Rotavirus
□ (D) Shigella dysenteriae
□ (E) Yersinia pseudotuberculosis
□ (F) Vibrio parahaemolyticus
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Old 10-09-2012
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b) norwalk like virus----most common in cruise ships??

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Old 10-09-2012
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Its B , Norwalk like virus
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  #4  
Old 10-09-2012
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Default my answer :)

(B) Norwalk-like virus - cruise ship is a buzzword
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Old 10-09-2012
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Is it norwalk virus
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Old 10-09-2012
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Correct Answer B is correct

Norwalk-like viruses are members of the Caliciviridae family of viruses (also known as the enteric caliciviruses) and
are transmitted by hands contaminated through the fecal-oral route, directly from person to person, through contaminated
food or water, or by contact with contaminated surfaces (known as fomites). They are the leading cause of outbreaks of
gastroenteritis. Infections occur year-round, with a clear peak in the winter. More than 80% of adults in developed and
developing countries have antibodies to Norwalk-like viruses. Giardiasis usually produces self-limited, watery diarrhea and
is acquired from untreated water supplies. Rotavirus is more common in children. Shigellosis typically leads to a more
severe, sometimes bloody, diarrhea. Yersinia pseudotuberculosis and Y. enterocolitica can produce a syndrome of
mesenteric adenitis and terminal ileitis with abdominal pain that may mimic acute appendicitis. Vibrio parahaemolyticus
causes an acute gastroenteritis with explosive watery diarrhea, vomiting, nausea, abdominal cramps, and headaches.
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