NBME free 150 question

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10+ Year Member
Feb 6, 2009
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Question got me stumped:

A previously healthy 36-year-old man comes to the emergency department 12hours after the sudden onset of increasingly severe abdominal pain. He recently returned from a 3-week sailing trip around Central America and several Caribbean islands. His temperature is 38.3°C (100.9°F), pulse is 96/min, respirations are 18/min, and blood pressure is 130/72 mm Hg. Abdominal examination shows right lower quadrant tenderness. His leukocyte count is 12,200/mm3 (70% segmented neutrophils, 6% bands, 1% eosinophils, 20% lymphocytes, and 3% monocytes). Exploratory laparotomy and an appendectomy are done. Examination of the appendix shows multiple mucosal ulcers. Unicellular microorganisms are seen within the exudates at the base of the ulcers. Some of the microorganisms contain erythrocytes. Which of the following is the most likely source of this patient's infection?

(A) Being bitten by a sand fly
(B) Infection from a sexual partner
(C) Mosquito bite
(D) Undercooked freshwater fish
(E) Undercooked saltwater fish
(F) Water contaminated by human feces
(G) Water contaminated by infected snails

Answer is F... what is it?

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