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MC > Nausea and Vomiting > Flashcards

Nausea and Vomiting Flashcards

1
Q

The effortless passage of gastric
contents into the mouth in the absence of
nausea and without diaphragmatic muscular
contractions.

A

Regurgitation

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2
Q

An involuntary act with all the movements

of vomiting without the expulsion of gastric contents because the cardiac orifice remains closed

A

Retching

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3
Q

The effortless regurgitation of recently

ingested food into the mouth, followed by rechewing and reswallowing or spitting out.

A

Rumination

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4
Q

What are the red flags for vomiting

A
  • Marked pallor
  • Signs of hypovolaemia
  • Peritoneal signs
  • Headache, stiff neck, confusion
  • Distended tympanic abdomen
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5
Q

Vomiting without bile-stained vomitus =

A

pyloric

obstruction

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6
Q

Vomiting of bile =

A

obstruction below duodenal

ampulla

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7
Q

Vomiting of ingested food =

A

oesophageal obstruction.

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8
Q

Vomiting without nausea and possibly

projectile =

A

↑ intracranial pressure

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9
Q

Green vomiting = urgent surgical referral for

possible_____ and ____

A

intestinal malrotation with volvulus

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10
Q

Non bile-stained vomitus (curdled milk): consider________

A

pyloric stenosis, GORD, feeding problems, concealed infection (e.g. UTI, meningitis).

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11
Q

Important warning signs in neonates of vomiting

A
  • Excessive drooling of frothy secretions from mouth
  • Bile-stained vomitus—always abnormal
  • Delayed passage of meconium (beyond 24 hours)
  • Inguinal hernias
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12
Q
  • Usually sudden onset vomiting 3rd–6th week
  • Projectile vomitus
  • Failure to thrive
A

Congenital hypertrophic pyloric stenosis

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13
Q

Congenital hypertrophic pyloric stenosis biochemistry

A

metabolic alkalosis: sodium usually

<130 mmol/L, chloride <100 mmol/L

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14
Q

Special investigations for Congenital hypertrophic pyloric stenosis

— barium meal (_______)—concern about
aspiration
— ________

A

string sign

abdominal ultrasound

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15
Q

________ or severely delayed gastric emptying is a moderately common condition, which is a cause of nausea and vomiting.

A

Gastroparesis (gastropathy)

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16
Q

Medications to improve gastric motility

A

domperidone 10–20 mg (o) tds, 15–30 minutes before meals
or
metoclopramide 5–10 mg (o) tds, 30 minutes
before meals
or
erythromycin (has prokinetic properties)

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17
Q

Other measures to improve gastric motility
1
2

A

• Injection of botulinum toxin into the pylorus
• Gastric pacing with internally implanted
neurostimulators

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18
Q
  • severe, unexplained vomiting or nausea occurring at varying intervals in a normal healthy person
  • lasts hours to days
A

Cyclical vomiting

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19
Q

The first-line management in vomiting is to _______

A

ensure that any fluid and electrolyte imbalance is corrected and that any underlying cause is identified and treated

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20
Q 
Avoid the use of centrally acting dopamine
antagonist drugs (DADS, e.g. metoclopramide and prochlorperazine) in children because of risk of \_\_\_\_\_\_\_
A

extrapyramidal side effects (EPSE), usually acute dystonic reactions.

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21
Q

These include ondansetron, granisetron, dolasetron, palonosetron and tropisetron and are effective at _______ and ____

A

preventing chemotherapy- and radiotherapyinduced

emesis when initiated prior to treatment

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22
Q

_______ enhances the effect of 5-HT3 agents

A

Dexamethasone

23
Q

How to manage severe Drug-induced nausea and vomiting

A

ondansetron 8 mg (o) or IV prior to therapy then two doses 6 hourly
plus
dexamethasone 8 mg IV 30 minutes prior to
therapy, then two doses 6 hourly

24
Q

Most effective drugs for vestibular disturbances

A

The phenothiazine derivatives are the most effective, while the dopamine D 2 -receptor antagonists are relatively ineffective

25
Q

Mx of vomiting in pregnancy

A

pyridoxine hydrochloride 25–50 mg (o) tds

if still ineffective add
metoclopramide 10 mg (o) tds or IM (if oral
intolerance)

26
Q

Consider the possibility of _____ and _____ in adolescent females with a history of vomiting immediately after meals, especially after binge eat

A

anorexia nervosa and bulimia

27
Q

__________ can be caused typically by alcohol, pregnancy, kidney failure and raised intracranial pressure

A

Early morning nausea and vomiting

28
Q

Anti-emetic drug therapy should not be used in infants and children with _______

A

gastroenteritis

29
Q

what receptor?

Promethazine

Metoclopramide

Prochlorperazine

A

H1

D2 + 5-HT3

D2 (central)

30
Q

Domperidone

Haloperidol

Ondansetron

A

D2 (peripheral)

D2 (central)

5-HT3

31
Q

Most neck lumps are ______

A

reactive lymph nodes—to

concurrent infection

32
Q

what is the 20-40s rule

A 
— 0–20 years: congenital, inflammatory,
lymphoma, tuberculosis
— 20–40 years: inflammatory, salivary, thyroid,
lymphoma
— >40 years: lymphoma, metastases
33
Q

_________of malignant nodes in the
anterior triangle have their primary tumour in
the head and neck

A

Eighty-five per cent

34
Q

Consistency of enlarged nodes
Rules of thumb are:

  • hard:_________
  • rubbery: ________
  • soft: _______
  • tender and multiple:______
A

secondary carcinoma

lymphoma
sarcoidosis or infection

infection

35
Q

causes of Acute cervical lymphadenitis

A
  • Acute viral lymphadenitis

* Acute bacterial lymphadenitis—coccal infection

36
Q

Widespread spread of neck lumps

1
2

A
  • Sebaceous cysts

* Lipomas

37
Q

Midline spread of neck lumps
1
2
3

A

• Thyroid nodule (moves upon swallowing)
• Thyroglossal cysts (moves upwards on tongue
protrusion)
• Dermoid cyst (beneath chin)

38
Q 
Examples of tumors in the anterior triangle
1
2
3
4
A
  • Branchial cyst (in upper part):
  • Carotid body tumour:
  • Carotid aneurysm
  • Lateral thyroid tumours
39
Q

Determine what tumor?

— opposite thyroid cartilage
— smooth and pulsatile
— can be moved laterally but not vertically
— usually 40–60 years
— requires excision (with care)
A

Carotid body tumour:

40
Q

Tumors of the posterior triangle

A
  • Developmental remnants
  • Pancoast tumour (from apex lung)
  • Cervical rib
41
Q

— chronic granulomatosis infection due to
Gram-positive Actinomyces israelii
— forms a multilocular abscess (pus has ‘sulphur granules’)
— infection follows dental extraction or poor
dental hygiene, esp. severe caries
— treat with high-dose penicillin G, 4 months

A 
Cervicofacial actinomycosis (lumpy jaw
syndrom
42
Q
  • A soft, squelchy, indefinite mass
  • Base of left neck
  • History of difficulty in swallowing
A

Pharyngeal pouch

43
Q

The most likely cause of a solitary thyroid nodule is the _____

A

dominant nodule in a multinodular goitre.

44
Q

In Children,

Benign lumps usually occur in
the _______ while malignant lumps are more likely in the ______

A

anterior triangle,

posterior triangle

45
Q

The common

midline lump in children is the _____

A

thyroglossal cyst

46
Q

Most enlarged lymph nodes are either ‘normal’ or local infections (mainly viral), especially if______ diameter, and not hard or fixed

A

<2 cm

47
Q

Inflammatory nodes may be caused by infection in the

A

tonsils, the teeth or other oral or

nasopharyngeal cavities

48
Q

Suspicious nodes are
1
2
3

A

> 2.5 cm, with firmer
consistency than normal and less mobility
(investigate especially with biopsy

49
Q

MAIS lymphadenitis is caused by?

A

Caused by Mycobacterium avium-intracellulares crofulaceum

(MAIS) infection

50
Q

•Produces chronic cervical lymphadenitis and
collar stud abscesses
• A relatively common infection of cervical nodes, yet often unrecognised
• Painless swelling due to development of a cold abscess in healthy child

A

MAIS lymphadenitis

51
Q

Common sites of MAIS

A

Common sites are submandibular, tonsillar and

pre-auricular nodes

52
Q

Tx of MAIS

A

Unresponsive to antimicrobials: treatment is by surgical excision of abscess and underlying lymph nodes

53
Q

etiology of Acute bacterial lymphadenitis

A

Usually coccal infections— Staphylococcus,

Streptococcus

MC (90 decks)

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