8-20 Board Review

A 27-year-old woman presents to the ED with her fifth episode this year of intense vomiting lasting 24–48 hours. She is symptom-free between episodes. Labs are unremarkable. She has a history of childhood migraines. What is the most likely diagnosis?

• Bulimia nervosa

• Gastroparesis

• Cyclical vomiting syndrome (CVS)

• Cannabinoid hyperemesis syndrome

Which of the following features best helps distinguish cannabinoid hyperemesis syndrome from cyclic vomiting syndrome?

• A) Abdominal pain during vomiting

• B) Cyclical vomiting patterns

• C) Use of hot showers for relief

• D) Nausea and vomiting on awakening

A 34-year-old man with a diagnosis of cyclic vomiting syndrome presents with ongoing vomiting despite antiemetics. He is dehydrated and anxious. Which IV medication is best supported for abortive treatment?

• IV ondansetron only

• IV haloperidol

• IV lorazepam

• IV diphenhydramine

Which of the following best describes the inter-episodic phase of cyclic vomiting syndrome?

• Persistent nausea and food intolerance

• Low-grade abdominal pain with intermittent vomiting

• Complete symptom resolution with return to baseline health

• Anorexia with early satiety and bloating

Which of the following is an evidence-based preventive treatment for patients with frequent episodes of cyclical vomiting?

• Loperamide

• Triptans

• Amitriptyline

• Promethazine

A 74-year-old man with atrial fibrillation presents with sudden severe abdominal pain out of proportion to exam. He is tachycardic but afebrile. Which diagnosis must be ruled out first?

• Acute diverticulitis

• Acute mesenteric ischemia

• Small bowel obstruction

• Pancreatitis

Which of the following findings is most supportive of acute mesenteric ischemia?

• Elevated serum lactate

• Leukocytosis

• Abnormal bowel sounds

• Bright red blood per rectum

A 66-year-old woman with a history of vascular disease presents with diffuse abdominal pain. CT angiography reveals occlusion of the superior mesenteric artery (SMA). What is the definitive management?

• IV fluids and bowel rest

• Broad-spectrum antibiotics and NG decompression

• Emergent vascular surgery consultation for revascularization

• Thrombolytics

Which of the following patients is most likely to develop non-occlusive mesenteric ischemia?

• A) A 35-year-old on chronic NSAIDs

• B) A 68-year-old on hemodialysis with recent hypotension

• C) A 50-year-old with recent appendectomy

• D) A 72-year-old with chronic constipation

What is the best imaging modality to evaluate suspected acute mesenteric ischemia?

• Abdominal X-ray

• Non-contrast CT abdomen

• CT angiography

• Colonoscopy