Approach to diarrhea (pediatrics) Quiz: Ace Your Exams

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A 3-year-old girl presents to the primary care office accompanied by her parent because of two weeks of frequent, greasy, foul-smelling diarrhea. Her parent reports she has not been as active as usual and occasionally reports abdominal pain. She has had frequent flatulence but no vomiting. The family vacationed in Vermont, United States last month where the child was swimming in a freshwater lake daily. Nobody else around her has been sick. Past medical history is unremarkable, and she does not take any medications. Temperature is 37.0°C (98.6°F), pulse is 138/min, respiratory rate is 22/min, and blood pressure is 94/52 mmHg. On examination, the child appears tired but is alert and oriented. Mucus membranes are dry. Cardiopulmonary examination is within normal limits except for mild tachycardia. The abdomen is soft and non-tender with hyperactive bowel sounds. Microscopic examination of the stool reveals the organism pictured below. Which of the following organisms is the most likely cause of diarrhea in this patient?  

A microscopy image shows many Giardia lamblia trophozoites, small, pear-shaped organisms with whip-like flagella, scattered across a white background.

Image by Eva Nohýnková, Department of Tropical Medicine, 1st Faculty of Medicine, Charles University in Prague and Hospital Bulovka, Czech Republic. Image in paper by Marie Lipoldova, Laboratory of Molecular and Cellular Immunology, Institute of Molecular Genetics, Academy of Sciences of the Czech Republic, Prague, Czech Republic. Licensed under the Creative Commons Attribution 4.0 International license. Reproduced from WikiCommons 

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