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Worksheets8-20 Board Review
Total questions: 15
Worksheet time: 8mins
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
A 48-year-old woman presents 1 week after Roux-en-Y gastric bypass with severe abdominal pain, tachycardia, and fever. She appears toxic. What is the most concerning complication to rule out?
Dumping syndrome
Anastomotic leak
Cholelithiasis
Small bowel obstruction
A 42-year-old man presents 6 months after bariatric surgery with nausea, vomiting, and postprandial diaphoresis and lightheadedness. What is the most likely diagnosis?
Late dumping syndrome
Acute cholecystitis
Afferent loop syndrome
Marginal ulcer
A patient presents with sudden epigastric pain and vomiting 1 year after gastric bypass. CT shows a dilated excluded stomach. What is the most likely cause?
Cholelithiasis
Internal hernia
Anastomotic leak
Esophageal stricture
Which of the following is true regarding nutritional deficiencies after bariatric surgery?
Iron deficiency is rare unless the patient is vegetarian
Vitamin B12 deficiency may present with peripheral neuropathy
Calcium supplementation is not required after sleeve gastrectomy
Thiamine deficiency typically occurs >1 year after surgery
A 36-year-old woman presents 18 months after gastric bypass with iron-deficiency anemia. What is the primary mechanism behind this complication?
Rapid transit time in the colon
Excess acid secretion in the remnant stomach
Bypassing the duodenum and proximal jejunum
Increased vitamin C absorption interfering with iron
