Nausea/Vomiting

Question 1

What key history would you obtain for a patient that has nausea and/or vomiting?

Answer 1

Acuity of onset
\+/- abdominal pain
Relation to meals
Sick contacts
Possible food poisoning
Pregnancy?
Neurologic symptoms (headache, stiff neck, vertigo, focal numbness or weakness)
Associated symptoms (GI, chest pain)
Exacerbating and alleviating factors
Medications

Question 2

What key exams would you perform for a patient that has nausea and/or vomiting?

Answer 2

Vital signs
ENT
Consider funduscopic exam (increased intracranial pressure)
Complete abdominal exam
Consider heart, lung and rectal exams

Question 3

20 yo F presents with nausea, vomiting (especially in the morning), fatigue and polyuria. Her last menstrual period was six weeks ago, and her breast are full and tender. She is sexually active with her boyfriend, and they use condoms for contraception. Differentials?

Answer 3

Pregnancy
Gastritis
Hypercalcemia
Diabetes mellitus
UTI
Depression

Question 4

20 yo F presents with nausea, vomiting (especially in the morning), fatigue and polyuria. Her last menstrual period was six weeks ago, and her breast are full and tender. She is sexually active with her boyfriend, and they use condoms for contraception. Differentials: pregnancy, gastritis, hypercalcemia, DM, UTI, depression. Workup?

Answer 4

Urine hCG
Pelvic exam
U/S - pelvis
CBC, electrolytes, calcium, glucose
UA, urine culture
Baseline Pap smear, cervical cultures, rubella antibody, HIV antibody, hepatitis B surface antigen, and VDRL/RPR