ROSH Gastrointestinal Practice Exam

What is the most likely cause of gastrointestinal symptoms in a patient who recently returned from a Caribbean cruise?

1. Giardia

2. Hepatitis A

3. Norovirus

4. Rotavirus

The correct answer is: Norovirus

The presence of gastrointestinal symptoms in a patient who has recently returned from a Caribbean cruise points strongly towards a viral etiology, particularly Norovirus. Norovirus is a highly contagious virus frequently associated with outbreaks on cruise ships due to the close quarters and communal dining settings. Symptoms typically include vomiting, diarrhea, and abdominal cramps, developing rapidly within 12 to 48 hours after exposure. Norovirus is notorious for its ability to spread quickly in settings where people are in close contact, making cruises ideal environments for outbreaks. Certain factors, such as traveling with a large group of people, sharing meals, and limited sanitation options, further increase transmission risk. While Giardia, Hepatitis A, and Rotavirus can also cause gastrointestinal symptoms, they are less likely given the context of cruise travel. Giardia generally spreads through contaminated water and would be more associated with untreated water sources rather than cruise ship environments. Hepatitis A primarily causes liver inflammation and is primarily spread through fecal-oral transmission, often linked to contaminated food or water but not typically presenting immediately after exposure like Norovirus. Rotavirus primarily affects infants and young children, causing severe diarrhea, and is less common in adults. Thus, considering the scenario and typical presentation, Norovirus emerges as the most probable cause of the