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CMN 568 - Unit 4 Questions with Complete Solutions

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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 + Pre...

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  • September 3, 2024
  • 34
  • 2024/2025
  • Exam (elaborations)
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  • CMN 568
  • CMN 568
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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

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