American Board of Internal Medicine (ABIM) Certification Practice Exam

What syndrome is characterized by episodic vomiting after prolonged cannabis use?

1. Cyclic vomiting syndrome

2. Cannabinoid hyperemesis syndrome

3. Gastroparesis

4. Pyloric stenosis

The correct answer is: Cannabinoid hyperemesis syndrome

Cannabinoid hyperemesis syndrome is characterized by recurrent episodes of severe nausea and vomiting in individuals who have been using cannabis regularly for a prolonged period. The unique aspect of this syndrome is that patients often experience a relief of symptoms after taking hot showers or baths, which is a distinct behavior sometimes seen in those affected. The underlying mechanism is thought to involve the interaction of cannabinoids with the body's endocannabinoid system, leading to dysregulation that results in symptoms reminiscent of cyclical vomiting. Unlike conditions such as cyclic vomiting syndrome, which can occur independently of cannabis use, cannabinoid hyperemesis syndrome specifically correlates with heavy cannabis consumption. While conditions like gastroparesis and pyloric stenosis can lead to vomiting, they are not directly associated with cannabis use and typically have different underlying pathophysiological mechanisms.