American Board of Internal Medicine (ABIM) Certification Practice Exam

What typical symptom sequence is observed in typhoid fever?

1. Initial constipation followed by diarrhea

2. Persistent vomiting followed by nausea

3. Sudden onset of diarrhea and dehydration

4. Acute abdominal pain with fever spikes

The correct answer is: Initial constipation followed by diarrhea

In typhoid fever, the typical symptom sequence often starts with constipation, which can be attributed to the underlying intestinal inflammation and the effects of the Salmonella typhi pathogen, followed by a transition to diarrhea as the infection progresses. This pattern reflects the progression of the disease as it affects the gastrointestinal tract. In the early stages, constipation is more common because of the altered gut motility caused by the infection. As the disease advances, the body's inflammatory response can lead to diarrhea. This symptom pattern is characteristic of typhoid fever, distinguishing it from other gastrointestinal infections where diarrhea is often one of the initial complaints. The other options, while representing symptoms that can be associated with different conditions or complications, do not reflect the typical progression seen in typhoid fever.