CMN 568 - Unit 4 Questions with Complete
Solutions
Acute onset of severe pain and vomiting suggests what? - Correct Answer + Peritoneal irritation
+ Acute gastric or intestinal obstruction
+ Pancreaticobiliary disease
(McPhee p 588)
Persistent vomiting suggests what? - Correct Answer + Pregnancy
+ Gastric outlet obstruction
+ Gastroparesis
+ Intestinal dysmotility
+ Psychogenic disorders
+ CNS or systemic disorders
(McPhee p 589)
Vomiting in the morning suggests what? - Correct Answer + Pregnancy
+ Uremia
+ ETOH intake
+ ↑ ICP
Vomiting after meals suggests what? - Correct Answer + Bulimia
+ Peptic ulcer disease
+ Other psychogenic causes
(McPhee p 589, Shimp p 373)
Vomiting of undigested food 1-2 hours after a meal suggests what? - Correct Answer + Gastroparesis
+ Small bowel obstruction
+ Gastric outlet obstruction
,NOTE: Sucussion splash often heard on auscultation
(McPhee p 589, Shimp p 373)
4 causes of nausea and vomiting - Correct Answer 1) Visceral afferent stimulation (seratonin
receptors)
2) Vestibular disorders (fibers ↑ in histamine and muscarinic receptors)
3) CNS disorders
4) Irritation of chemoreceptor trigger zone
(McPhee Table 15.1)
Ways to stimulate the chemoreceptor trigger zone and cause vomiting - Correct Answer 1) Chemo
2) Medications and drugs
3) Radiation therapy
4) Systemic disorders
CNS disorders that can cause vomiting - Correct Answer 1) Migraine
2) ↑ ICP
3) Infections (e.g. meningitis, encephalitis)
4) Psychogenic
Vestibular disorders that can cause vomiting - Correct Answer Labyrinthitis, Meniere syndrome,
motion sickness
Define RETCHING - Correct Answer Strong, spasmodic, involuntary effort to vomit without bringing
up emesis.
(McPhee and Shimp)
,Define REGURGITATION - Correct Answer Effortless return of gas or small amounts of food from
stomach (McPhee and Shimp)
Common causes of vomiting in infants - Correct Answer 1) Any acute illness (esp gastroenteritis)
2) Hypertrophic pyloric stenosis (2 - 8 weeks of life, may feel an "olive" in epigastric area after
feeding)
3) Intussisception (6 - 18 months of life, sausage-shaped mass and "currant jelly" stools)
4) Regurgitation ("spitting up") -- usually normal and usually resolves by 6 - 12 months.
(Shimp)
Medications associated with N/V - Correct Answer + Antidepressants
--SSRIs
--venlafaxine
+ Cardiac meds
--antiarrhythmics
--anti-HTN meds (diuretics, beta blockers, CCBs)
-- ↓ CHO meds (statins, gemfibrozil, niacin)
-- Digoxin
+ Chemotherapy agents
+ GI meds
--sulfasalazine (for tx of UC)
--azathioprine (tx of Crohns or UC)
+ Meds to treat infectious diseases
-- Acyclovir
-- Anti-fungals
-- ABX
-- UTI meds
, -- TB meds
+ Pain meds
-- Anti-gout meds
-- Aspirin
-- NSAIDs
-- Opioids
+ Others
-- Lithium
-- Metformin
-- BC pills
-- Quinidine
(Shimp Table 46-2)
OLD CART - Correct Answer *O*nset -- When did it start
*L*ocation -- Can you pinpoint it? Does it radiate?
*D*uration -- How long have you had it?
*C*haracter-- Is it sharp, dull, throbbing, burning, crampy, colicky?
*A*ggravating factors -- What makes it worse?
*R*elieving factors -- What makes it better?
*T*iming -- Is the pain constant or intermittent? Does it occur at a certain time of day?
Antiemetic medications - Correct Answer 1) Seratonin-receptor antagonists (McPhee/Shimp)
- Ondansetron (and other -setrons)
2) Corticosteroids (McPhee)
- Dexamethasone and methylprednisolone (used to enhance action of seratonin-receptor antagonists
used for post-operative and chemo-related n/v)
3) Dopamine receptor antagonists -- SEDATING but good for post-op gastroparesis or nausea
Solutions
Acute onset of severe pain and vomiting suggests what? - Correct Answer + Peritoneal irritation
+ Acute gastric or intestinal obstruction
+ Pancreaticobiliary disease
(McPhee p 588)
Persistent vomiting suggests what? - Correct Answer + Pregnancy
+ Gastric outlet obstruction
+ Gastroparesis
+ Intestinal dysmotility
+ Psychogenic disorders
+ CNS or systemic disorders
(McPhee p 589)
Vomiting in the morning suggests what? - Correct Answer + Pregnancy
+ Uremia
+ ETOH intake
+ ↑ ICP
Vomiting after meals suggests what? - Correct Answer + Bulimia
+ Peptic ulcer disease
+ Other psychogenic causes
(McPhee p 589, Shimp p 373)
Vomiting of undigested food 1-2 hours after a meal suggests what? - Correct Answer + Gastroparesis
+ Small bowel obstruction
+ Gastric outlet obstruction
,NOTE: Sucussion splash often heard on auscultation
(McPhee p 589, Shimp p 373)
4 causes of nausea and vomiting - Correct Answer 1) Visceral afferent stimulation (seratonin
receptors)
2) Vestibular disorders (fibers ↑ in histamine and muscarinic receptors)
3) CNS disorders
4) Irritation of chemoreceptor trigger zone
(McPhee Table 15.1)
Ways to stimulate the chemoreceptor trigger zone and cause vomiting - Correct Answer 1) Chemo
2) Medications and drugs
3) Radiation therapy
4) Systemic disorders
CNS disorders that can cause vomiting - Correct Answer 1) Migraine
2) ↑ ICP
3) Infections (e.g. meningitis, encephalitis)
4) Psychogenic
Vestibular disorders that can cause vomiting - Correct Answer Labyrinthitis, Meniere syndrome,
motion sickness
Define RETCHING - Correct Answer Strong, spasmodic, involuntary effort to vomit without bringing
up emesis.
(McPhee and Shimp)
,Define REGURGITATION - Correct Answer Effortless return of gas or small amounts of food from
stomach (McPhee and Shimp)
Common causes of vomiting in infants - Correct Answer 1) Any acute illness (esp gastroenteritis)
2) Hypertrophic pyloric stenosis (2 - 8 weeks of life, may feel an "olive" in epigastric area after
feeding)
3) Intussisception (6 - 18 months of life, sausage-shaped mass and "currant jelly" stools)
4) Regurgitation ("spitting up") -- usually normal and usually resolves by 6 - 12 months.
(Shimp)
Medications associated with N/V - Correct Answer + Antidepressants
--SSRIs
--venlafaxine
+ Cardiac meds
--antiarrhythmics
--anti-HTN meds (diuretics, beta blockers, CCBs)
-- ↓ CHO meds (statins, gemfibrozil, niacin)
-- Digoxin
+ Chemotherapy agents
+ GI meds
--sulfasalazine (for tx of UC)
--azathioprine (tx of Crohns or UC)
+ Meds to treat infectious diseases
-- Acyclovir
-- Anti-fungals
-- ABX
-- UTI meds
, -- TB meds
+ Pain meds
-- Anti-gout meds
-- Aspirin
-- NSAIDs
-- Opioids
+ Others
-- Lithium
-- Metformin
-- BC pills
-- Quinidine
(Shimp Table 46-2)
OLD CART - Correct Answer *O*nset -- When did it start
*L*ocation -- Can you pinpoint it? Does it radiate?
*D*uration -- How long have you had it?
*C*haracter-- Is it sharp, dull, throbbing, burning, crampy, colicky?
*A*ggravating factors -- What makes it worse?
*R*elieving factors -- What makes it better?
*T*iming -- Is the pain constant or intermittent? Does it occur at a certain time of day?
Antiemetic medications - Correct Answer 1) Seratonin-receptor antagonists (McPhee/Shimp)
- Ondansetron (and other -setrons)
2) Corticosteroids (McPhee)
- Dexamethasone and methylprednisolone (used to enhance action of seratonin-receptor antagonists
used for post-operative and chemo-related n/v)
3) Dopamine receptor antagonists -- SEDATING but good for post-op gastroparesis or nausea
