From the Guidelines
I strongly recommend structuring an oral exam on nausea, vomiting, and weight loss around a comprehensive approach that prioritizes patient-centered care, evidence-based practice, and clinical expertise, as outlined in the American Psychiatric Association's practice guideline for the treatment of patients with eating disorders 1. When designing the oral exam, consider the following key components:
- Etiology: Ask the examinee to discuss potential causes of nausea, vomiting, and weight loss, including gastrointestinal, systemic, and psychiatric conditions, as well as medication side effects and underlying medical conditions 1.
- Pathophysiology: Assess the examinee's understanding of the physiological mechanisms underlying these symptoms, including the role of neuroreceptors and the impact of chemotherapy and other treatments on the emetic response 1.
- Clinical assessment: Evaluate the examinee's ability to conduct a thorough patient history, including onset, duration, and associated symptoms, as well as physical examination techniques, such as abdominal examination and vital sign assessment 1.
- Management: Include questions about symptomatic treatment, such as antiemetics (e.g., ondansetron, metoclopramide, prochlorperazine), and treatment of underlying causes, including dietary modifications, medication adjustments, and referrals to specialists as needed 1. Some potential case presentation scenarios to consider include:
- A patient with a history of eating disorders presenting with severe weight loss and gastrointestinal symptoms
- A cancer patient experiencing chemotherapy-induced nausea and vomiting
- A patient with a systemic condition, such as pregnancy or metabolic disorder, presenting with nausea, vomiting, and weight loss. The oral exam should prioritize a patient-centered approach, focusing on the individual's unique needs, concerns, and experiences, while also emphasizing evidence-based practice and clinical expertise 1.
From the FDA Drug Label
2.1 Anorexia Associated with Weight Loss in Adult Patients with AIDS 2.2 Nausea and Vomiting Associated with Cancer Chemotherapy in Adult Patients Who Failed Conventional Antiemetics
To structure an oral exam on nausea, vomiting, and weight loss, consider the following key points:
- Indications: Understand the conditions for which dronabinol is prescribed, including anorexia associated with weight loss in adult patients with AIDS and nausea and vomiting associated with cancer chemotherapy 2.
- Dosage and administration: Be familiar with the recommended dosage and administration guidelines for dronabinol in these conditions.
- Contraindications and warnings: Recognize the potential contraindications and warnings, such as neuropsychiatric adverse reactions, hemodynamic instability, and seizures.
- Adverse reactions: Be aware of the possible adverse reactions, including paradoxical nausea, vomiting, or abdominal pain.
- Drug interactions: Understand the potential drug interactions, including additive CNS effects and additive cardiac effects.
From the Research
Structuring an Oral Exam on Nausea, Vomiting, and Weight Loss
To structure an oral exam on nausea, vomiting, and weight loss, consider the following key points:
- Definition and classification of nausea and vomiting: Understanding the difference between acute and chronic symptoms, as well as the various causes, is crucial 3, 4, 5, 6.
- Clinical approach: A practical 5-step approach to evaluating nausea and vomiting includes defining the patient's symptoms, determining the duration and severity, considering medication or toxin adverse effects, formulating a differential diagnosis, and directing treatment based on the underlying cause 3.
- Differential diagnosis: Common causes of nausea and vomiting include gastrointestinal diseases, metabolic and endocrine conditions, neurologic disorders, psychiatric causes, and medication or toxin adverse effects 4, 5, 6, 7.
- Evaluation and management: The evaluation should focus on detecting emergencies or complications, identifying the underlying cause, and providing specific therapies 4, 5, 6. Management options include nonpharmacologic interventions, such as fluid and electrolyte replacement, and pharmacologic therapies, such as antiemetic drugs 6.
Key Considerations for the Oral Exam
- Acute vs. chronic symptoms: Understanding the difference between acute and chronic nausea and vomiting is essential for guiding the evaluation and management 3, 4, 5, 6.
- Alarm signs and symptoms: Identifying alarm signs, such as dehydration, acidosis, or acute abdomen, is critical for determining the need for further evaluation and management 4, 5, 6.
- Laboratory testing and imaging: Basic laboratory tests and imaging studies, such as abdominal radiography or computed tomography, may be necessary to evaluate the underlying cause of nausea and vomiting 4, 5, 6.
- Treatment options: Treatment should be based on the underlying cause and may include nonpharmacologic interventions, pharmacologic therapies, or a combination of both 3, 6, 7.
Common Causes and Considerations
- Gastrointestinal causes: Gastroparesis, cyclic vomiting syndrome, and other gastrointestinal disorders can cause chronic nausea and vomiting 7.
- Non-gastrointestinal causes: Medications, vestibular disorders, neurologic conditions, and psychiatric causes can also contribute to chronic nausea and vomiting 4, 5, 6, 7.
- Weight loss: Unintentional weight loss can be a significant concern in patients with chronic nausea and vomiting, and its evaluation and management should be addressed in the oral exam 7.