Rosh Emergency Medicine Practice Test

What is the most common historical factor associated with multiple linear mucosal tears after vomiting?

1. Chronic GERD

2. Chronic NSAID use

3. Heavy alcohol use leading to retching

4. Portal hypertension

The correct answer is: Heavy alcohol use leading to retching

The association of multiple linear mucosal tears after vomiting is primarily observed in cases of heavy alcohol use leading to retching. This condition is known as Mallory-Weiss syndrome, which occurs when forceful vomiting causes a tear in the esophagus at the gastroesophageal junction. Chronic alcohol use increases the likelihood of episodes of severe vomiting and retching, which contributes to the mechanical stress on the gastrointestinal tract, leading to these tears. In this context, heavy drinking often leads to situations where an individual might experience significant episodes of vomiting, creating a perfect storm for the development of these linear tears. While chronic GERD, NSAID use, and portal hypertension can certainly cause various gastrointestinal issues, they do not primarily manifest as multiple linear mucosal tears from vomiting in the same manner that heavy alcohol consumption and subsequent retching does. Chronic GERD typically leads to other complications, NSAID use can cause gastric ulcers but not usually multiple linear tears, and portal hypertension is more associated with varices. Thus, heavy alcohol use stands out as the most relevant historical factor in this scenario.