vomiting

A 68-year-old male presents with abdominal distension, obstipation, and vomiting. He has a history of prior abdominal surgery. An upright abdominal X-ray is performed. What is the MOST appropriate next step in management?

A previously healthy 3-year-old boy presents with colicky abdominal pain and non-bilious vomiting. Physical exam reveals a palpable abdominal mass in the RUQ. An ultrasound is performed, revealing the finding shown. What is the MOST likely lead point?

A 3-year-old boy presents with intermittent abdominal pain, vomiting, and bloody stools. An ultrasound is performed, the image is shown. What is the MOST appropriate next step in the management of this patient?

A 3-week-old male presents with non-bilious projectile vomiting after each feed. He is otherwise well-appearing. An abdominal X-ray is unremarkable. An upper GI contrast study is performed, and relevant images are shown. What is the MOST likely acid-base disturbance in this patient?

A 6-week-old male presents with projectile vomiting after feeds. He is otherwise well-appearing, with normal vital signs and no abdominal distension. An ultrasound was performed, and an image is shown. What is the MOST appropriate next step in management?

A 6-week-old presents with projectile vomiting after feeds. An ultrasound is performed (shown). What is the MOST appropriate next step in management?

A 68-year-old man with a history of poorly controlled type 2 diabetes, hypertension, and chronic kidney disease (stage 3) presents to the emergency department with severe abdominal pain and vomiting. On examination, he has a distended abdomen with diffuse tenderness and guarding. His vital signs show a blood pressure of 90/60 mmHg, heart rate of 110 bpm, and a temperature of 38.5°C. Laboratory tests reveal leukocytosis, elevated serum lactate, and worsening renal function. A CT scan of the abdomen shows pneumoperitoneum and free fluid, suggesting perforated viscus. What is the most appropriate next step in the management of this patient?

A 3-week-old male infant is brought to the emergency department by his parents due to persistent, non-bilious vomiting after each feeding for the past week. The vomiting has become increasingly forceful. The infant appears mildly dehydrated, with slightly decreased skin turgor. His weight is below the 5th percentile for his age. An abdominal X-ray is unremarkable. Given the clinical presentation, the physician orders further imaging, the results of which are shown. What is the MOST appropriate next step in the management of this patient?

A 72-year-old male presents with a painful, irreducible right groin mass. He reports vomiting and abdominal distension. His vitals are: HR 110, BP 100/60, RR 22, SpO2 96% RA. The provided image was obtained. What is the next step?

A 38-year-old male presents to the emergency department complaining of sudden onset, severe left flank pain that radiates to his groin. He reports associated nausea and vomiting. He denies any fever, dysuria, or hematuria. His vital signs are: Temperature 37.0°C, Heart Rate 88 bpm, Blood Pressure 130/80 mmHg, Respiratory Rate 16 breaths/min, and SpO2 98% on room air. A urine dipstick is positive for blood. An ultrasound is performed, and the image is shown. Given the clinical presentation and the ultrasound findings, what is the MOST appropriate next step in management?

A 32-year-old man presents to the emergency department with severe abdominal pain that started suddenly 6 hours ago. The pain is located in the right lower quadrant and is associated with nausea and vomiting. On examination, he has rebound tenderness and guarding in the right lower quadrant. His temperature is 37.8°C, heart rate is 110 beats per minute, and blood pressure is 120/80 mmHg. A CT scan of the abdomen shows an inflamed appendix with surrounding fat stranding. What is the most appropriate next step in management?

A 3-week-old male presents with projectile vomiting. Upper GI series (image shown). What electrolyte abnormality is MOST likely?

A 68-year-old male presents to the ED with abdominal distension, obstipation, and vomiting. He reports a history of multiple abdominal surgeries. An upright abdominal X-ray is performed. Based on the image, what is the MOST appropriate next step in management?

A 6-month-old baby has abdominal swelling and vomiting. An abdominal X-ray shows a 'double bubble' sign. What is the most likely diagnosis?

A neonate, born at 38 weeks gestation, presents with bilious vomiting starting 12 hours after birth. Antenatal ultrasound revealed polyhydramnios. On examination, the baby is active and has a distended upper abdomen but a scaphoid lower abdomen. An abdominal X-ray shows a 'double bubble' sign. Which of the following is the most appropriate next step in the management of this neonate, considering potential associated complications?

A 6-week-old male presents with persistent non-bilious vomiting after feeding. He appears hungry and has lost weight since birth. Examination reveals visible peristaltic waves across the abdomen. An abdominal ultrasound is performed, as shown. What is the most likely acid-base disturbance seen in this patient?

A 40-year-old man presents to the emergency department with sudden onset of severe headache, nausea, and vomiting. He describes the headache as the worst he has ever experienced. He has a history of hypertension but is otherwise healthy. On examination, he is alert but in distress, with a blood pressure of 180/110 mmHg, heart rate of 90 bpm, and respiratory rate of 18 breaths per minute. Neurological examination reveals neck stiffness but no focal neurological deficits. A CT scan of the head shows no acute intracranial hemorrhage. What is the most appropriate next step in the management of this patient?

A 72-year-old male presents with vomiting and abdominal pain. An abdominal X-ray is performed. What is the MOST likely underlying cause?

A 45-year-old man presents to the emergency department with sudden onset of severe headache, nausea, and vomiting. He describes the headache as the worst he has ever experienced. He has a history of hypertension but is otherwise healthy. On examination, he is alert but in distress due to the headache. His blood pressure is 180/110 mmHg, heart rate is 90 bpm, and he has no focal neurological deficits. A CT scan of the head shows no acute intracranial hemorrhage. What is the next best step in management?

A neonate is born at term following an uneventful pregnancy. Immediately after birth, the baby develops bilious vomiting. Abdominal examination reveals epigastric distension, but the rest of the abdomen is scaphoid. An abdominal X-ray is performed. Which of the following findings on the abdominal X-ray would be most consistent with the likely diagnosis?

A 68-year-old male presents to the ED with colicky abdominal pain, nausea, and vomiting. He reports no bowel movements for 3 days. His abdomen is distended and tender. An X-ray is performed. Given the findings, what is the MOST likely underlying cause of this patient's condition?

A 3-year-old boy presents with sudden onset, intermittent, severe abdominal pain, vomiting, and lethargy. On examination, he is pale and has a palpable mass in the right upper quadrant. An ultrasound is performed (image provided). Based on the clinical presentation and the image, what is the most appropriate next step in management?

A 63-year-old male presents with postprandial vomiting and persistent retrosternal discomfort. He reports feeling full quickly after eating only small amounts. An abdominal CT scan is performed, the axial view is shown. What is the MOST likely underlying mechanism contributing to this patient's symptoms?

A 28-year-old female presents to the ED with acute onset right lower quadrant pain. She reports nausea and vomiting. Her last menstrual period was 6 weeks ago, and she denies any vaginal bleeding. She is hemodynamically stable. A CT scan of the abdomen and pelvis is performed, with a relevant image shown. What is the MOST appropriate next step in the management of this patient?

A 28-year-old female presents to the ED with acute onset right lower quadrant pain. She reports nausea and vomiting. Her last menstrual period was 6 weeks ago, and she denies any vaginal bleeding. She is hemodynamically stable. A CT scan of the abdomen and pelvis is performed, with a relevant image shown. What is the MOST appropriate next step in the management of this patient?

A 30-year-old man presents to the emergency department with severe right lower quadrant abdominal pain, nausea, and vomiting. The pain started around the umbilicus and then localized to the right lower quadrant. On examination, he has tenderness and guarding in the right lower quadrant. His temperature is 38.3°C, heart rate is 100 bpm, and blood pressure is 120/80 mmHg. What is the most likely diagnosis?

A 6-week-old male infant presents to the emergency department with a 2-week history of progressively worsening non-bilious vomiting, which has become projectile over the past few days. His parents report he is feeding eagerly but vomits most feeds shortly after completion. He has had fewer wet nappies than usual and appears more lethargic. On examination, he is irritable but consolable. His weight is below the 3rd percentile, having dropped from the 10th percentile at birth. Vital signs are: Temperature 36.8°C, Heart Rate 155 bpm, Respiratory Rate 40 bpm, Blood Pressure 85/50 mmHg, Oxygen Saturation 98% on room air. Capillary refill time is 3 seconds. Abdominal examination reveals a soft, non-distended abdomen with active bowel sounds; no palpable masses are appreciated. Initial blood gas shows pH 7.52, pCO2 40 mmHg, Bicarbonate 32 mmol/L, Na+ 132 mmol/L, K+ 3.0 mmol/L, Cl- 88 mmol/L. A point-of-care ultrasound was performed, and the image provided was obtained. Considering the clinical presentation and the findings demonstrated in the image, what is the most appropriate immediate next step in the management of this infant?

A 6-week-old male infant presents to the emergency department with a 5-day history of progressively worsening non-bilious vomiting, which has become projectile over the past 48 hours. He is exclusively formula-fed and his parents report decreased wet nappies and increased irritability. On examination, he is alert but appears slightly lethargic. His weight is below his birth weight. Capillary refill time is 3 seconds. Vitals are: HR 150 bpm, RR 40 bpm, T 37.2°C, BP 85/50 mmHg. Abdominal examination is soft, non-distended, and no masses are definitely palpable. Initial blood gas shows pH 7.52, pCO2 40 mmHg, HCO3 32 mmol/L, Na+ 130 mmol/L, K+ 3.0 mmol/L, Cl- 85 mmol/L. Urea and creatinine are mildly elevated. An imaging study was performed, shown above. Considering the clinical presentation and the findings on the imaging study, which of the following is the most critical immediate management step?

A 3-year-old boy presents with sudden onset, intermittent, severe abdominal pain, vomiting, and lethargy. Examination reveals a palpable mass. Vitals stable. Ultrasound performed. Based on the clinical presentation and the provided image, what is the most appropriate next step in management?

A 62-year-old woman presents to the emergency department with sudden onset of severe headache, nausea, and vomiting. She describes the headache as the worst she has ever experienced. Her medical history includes hypertension and hyperlipidemia, for which she is on regular medication. On examination, she is alert but in distress, with a blood pressure of 180/100 mmHg, heart rate of 90 bpm, and respiratory rate of 18 breaths per minute. Neurological examination reveals neck stiffness but no focal neurological deficits. A CT scan of the head shows no acute intracranial hemorrhage. Which of the following is the most appropriate next step in management?

A 5-week-old male presents with non-bilious projectile vomiting after each feed for the past week. He is alert but appears dehydrated. An ultrasound is performed, as shown. What electrolyte abnormality is MOST likely present?

A 6-week-old infant presents with a 1-week history of increasing frequency of non-bilious, projectile vomiting occurring shortly after feeds. He has lost some weight since his last check-up. Examination is otherwise unremarkable. An ultrasound is performed, shown in the image. Based on the clinical presentation and the provided image, which of the following electrolyte abnormalities is the most likely consequence if this condition remains untreated?

A 3-week-old male presents with projectile vomiting after each feed. He appears hungry and eagerly feeds, but vomits shortly after. An abdominal X-ray is ordered, the result of which is shown. What is the most appropriate next step in management?

A 5-week-old male presents with projectile vomiting after feeds. He is irritable and appears dehydrated. An upper GI contrast study is performed, with relevant images attached. What is the MOST likely underlying cause?

A 62-year-old male presents with acute onset of LLQ pain, fever, and vomiting. His WBC count is elevated. A CT scan of the abdomen and pelvis is performed. Based on the image, what is the most appropriate next step in management?

A 45-year-old woman presents to the emergency department with acute onset of severe right upper quadrant abdominal pain radiating to the back, accompanied by nausea and vomiting. She has a history of gallstones but no previous surgeries. On examination, she is febrile with a temperature of 38.5°C, her heart rate is 110 bpm, and she has tenderness in the right upper quadrant with a positive Murphy's sign. Laboratory tests reveal elevated white blood cell count, elevated liver enzymes, and elevated serum amylase. An abdominal ultrasound shows gallstones and a thickened gallbladder wall. Which of the following is the most appropriate next step in management?

A 75-year-old female presents to the emergency department with a 24-hour history of worsening colicky abdominal pain, nausea, and multiple episodes of bilious vomiting. She reports no passage of flatus or stool for the past 18 hours. Her past medical history includes an open appendectomy 30 years ago and a hysterectomy 10 years ago. On examination, she is afebrile, heart rate 92 bpm, blood pressure 130/80 mmHg, respiratory rate 18/min, oxygen saturation 98% on room air. Her abdomen is distended and diffusely tender to palpation, with high-pitched tinkling bowel sounds on auscultation. A plain abdominal X-ray series, including the image provided, was obtained. Considering the patient's clinical presentation and the findings demonstrated in the provided image, which of the following represents the most appropriate immediate next step in her management?

A 3-week-old male infant is brought to the emergency department by his parents. They report that he has been experiencing projectile vomiting after every feed for the past week. The vomiting is non-bilious. He appears dehydrated, with sunken fontanelles and decreased skin turgor. His weight has decreased since his last check-up. An abdominal X-ray is ordered, the results of which are shown. What is the most appropriate next step in the management of this patient?

A 6-week-old male infant presents with a 1-week history of progressively worsening non-bilious vomiting, often projectile, occurring shortly after feeds. His parents report he is constantly hungry and irritable but has had poor weight gain. On examination, he is alert but appears thin. Vital signs are stable. Abdominal examination is soft, non-tender, with no palpable mass. An abdominal ultrasound is performed, the image of which is shown. Considering the clinical presentation and the findings depicted, what is the most appropriate definitive management strategy after initial fluid and electrolyte correction?

A 72-year-old male with a history of diverticulitis presents with severe abdominal pain, vomiting, and inability to pass flatus for 24 hours. An upright abdominal X-ray is performed. Based on the image, what is the MOST likely underlying cause?

A 28-year-old woman presents to the emergency department with sudden onset of severe right lower abdominal pain. She reports nausea and vomiting but denies fever or urinary symptoms. Her last menstrual period was two weeks ago, and she is sexually active. On examination, she has tenderness in the right lower quadrant with guarding. A pelvic ultrasound reveals a 5 cm right ovarian cyst with free fluid in the pelvis. What is the most likely diagnosis?

A 65-year-old man presents to the emergency department with sudden onset of severe headache, nausea, and vomiting. He has a history of hypertension and is currently on antihypertensive medication. On examination, he is alert but in distress due to the headache. His blood pressure is 180/110 mmHg, heart rate is 90 bpm, and he has no focal neurological deficits. A CT scan of the head shows a subarachnoid hemorrhage. Which of the following is the most appropriate initial management step in this patient?

A 3-year-old boy presents with intermittent severe abdominal pain, vomiting, and lethargy. On examination, he is afebrile with a soft but slightly distended abdomen. An ultrasound is performed (image provided). Based on the clinical presentation and the image findings, what is the most appropriate next step in the management of this patient?

A 3-year-old boy presents to the emergency department with a 12-hour history of intermittent, severe abdominal pain, drawing his legs up to his chest. He has vomited several times. His vital signs are stable: HR 110, BP 95/60, RR 24, Temp 37.2°C. On examination, he is irritable but comfortable between episodes of pain. His abdomen is soft but mildly distended. A focused abdominal ultrasound is performed, yielding the image provided. Based on the clinical presentation and the findings shown, what is the most appropriate next step in the management of this patient?

A 3-year-old boy presents with a 12-hour history of intermittent, severe abdominal pain, drawing his legs up to his chest. He has vomited several times. His vital signs are stable: HR 110, BP 95/60, RR 24, Temp 37.2°C. On examination, he is irritable but comfortable between episodes of pain. His abdomen is soft but mildly distended. A focused abdominal ultrasound is performed, yielding the image provided. Based on the clinical presentation and the findings shown, what is the most appropriate initial therapeutic intervention?

A 32-year-old woman presents to the emergency department with severe right lower quadrant abdominal pain, nausea, and vomiting. She reports her last menstrual period was 6 weeks ago. On examination, she has tenderness and guarding in the right lower quadrant. A urine pregnancy test is positive. What is the most appropriate next step in management?

A 72-year-old male presents with abdominal distension, vomiting, and inability to pass flatus for 48 hours. He has a history of prior bowel resection. Examination reveals a tympanitic abdomen and tenderness to palpation. His vitals are stable. An abdominal X-ray is performed, as shown. What is the MOST appropriate next step in the management of this patient?

A 3-year-old boy presents with sudden onset, intermittent, severe abdominal pain, vomiting, and lethargy. Examination reveals a pale child with a soft abdomen. Vitals are stable. An abdominal ultrasound is performed (image provided). What is the most appropriate next step in management?

A 42-year-old male presents to the emergency department with a 3-day history of colicky abdominal pain, nausea, and vomiting. He reports that he has not had a bowel movement in 2 days and has noticed some blood in his vomit. He has a known history of multiple cutaneous hemangiomas since childhood. On examination, his abdomen is distended and tympanic, with tenderness to palpation in all quadrants. Bowel sounds are high-pitched and infrequent. Vitals are stable. A CT scan of the abdomen and pelvis is performed, and a representative image is shown. What is the MOST likely underlying cause of the patient's acute presentation, considering his history and the imaging findings?

A 72-year-old man with a history of a reducible inguinal hernia presents to the emergency department with severe groin pain and a firm, tender mass in the right inguinal region. He reports that he has been unable to reduce the hernia despite his usual maneuvers. He also reports nausea and vomiting for the past 6 hours. On examination, his vital signs are stable, but he appears uncomfortable. The mass in his groin is erythematous and exquisitely tender to palpation. Which of the following is the most appropriate next step in management?