TEST BANKS For Family Practice Guidelines, 6th Edition b
b b b b b b b b
y Jill C. Cash; Cheryl A. Glass
b b b b b b
Hypoglycemiabandbacutebischemicbstrokebcanbpresentbsimilarlybbecause:
•bA:bothboxygenbandbglucosebarebneededbforbbrainbfunction.
•bB:thebmajoritybofbstrokebpatientsbhavebabhistorybofbdiabetes.
•bC:thebmostbcommonbcausebofbabstrokebisbhypoglycemia.
•bD:theybarebbothbcausedbbyblowblevelsbofbglucosebinbthebblood.b-
bANSWER:•bA:bothboxygenbandbglucosebarebneededbforbbrainbfunction.
Reason:bAlthoughbstrokebandbhypoglycemiabarebtwobdistinctlybdifferentbconditions,bth
eirbsignsbandbsymptomsbareboftenbsimilar.bThisbisbbecausebthebbrainbrequiresbbothboxyg
enbandbglucosebtobfunctionbnormally.bAnbacutebischemicbstrokebisbcausedbbybablackbofbo
xygenbtobabpartbofbthebbrainbduebtobabblockedbcerebralbartery,bwhereasbhypoglycemiab(
lowbbloodbglucoseblevel)bdeprivesbthebentirebbrainbofbglucose.bInbeitherbcase,bthebpatie
ntbpresentsbwithbsignsbofbimpairedbbrainbfunctionb(ie,bslurredbspeech,bweakness,balter
edbmentalbstatus).bBothbconditionsbmaybleadbtobpermanentbbrainbdamageborbdeathbifb
notbtreatedbpromptly.
Whenbdealingbwithbanbemotionallybdisturbedbpatient,byoubshouldbbebMOSTbconcerned
bwith:
•bA:gatheringballbofbthebpatient'sbmedications.
•bB:safelybtransportingbtobthebhospital.
•bC:whetherbthebpatientbcouldbharmbyou.
•bD:obtainingbabcompletebmedicalbhistory.b-bANSWER:YoubselectedbC;bThisbisbcorrect!
Reason:bWhenbmanagingbanybpatientbwithbanbemotionalborbpsychiatricbcrisis,byourbpri
marybconcernbisbyourbownbsafety.bSafelybtransportingbthebpatientbtobthebhospitalbisbyo
urbultimatebgoal.bIfbpossible,byoubshouldbattemptbtobobtainbabmedicalbhistorybandbshou
ldbtakebanybofbthebpatient'sbprescribedbmedicationsbtobthebhospital.bHowever,bthisbsho
uldbnotbsupercedebyourbownbsafetyborbinterferebwithbsafelybtransportingbthebpatient.
Youbarebatbthebscenebwherebabmanbpanickedbwhilebswimmingbinbabsmallblake.bYourbiniti
albattemptbtobrescuebhimbshouldbinclude:
•bA:rowingbabsmallbraftbtobthebvictim.
•bB:reachingbforbthebvictimbwithbablongbstick.
•bC:throwingbabropebtobthebvictim.
•bD:swimmingbtobthebvictimbtobrescuebhim.b-bANSWER:YoubselectedbB;bThisbisbcorrect!
Reason:bGeneralbrulesbtobfollowbwhenbattemptingbtobrescuebabpatientbfrombthebwaterbi
ncludeb"reach,bthrow,brow,bandbthenbgo."bInbthisbcase,byoubshouldbattemptbtobreachbth
ebvictimbbybhavingbhimbgrabbholdbofbablargebstickborbsimilarbobject.bIfbthisbisbunsuccessf
ul,bthrowbthebvictimbabropeborbflotationbdeviceb(ifbavailable).bIfbthesebarebnotbavailable,b
rowbtobthebpatientbinbabsmallbraftb(ifbavailable).bGoingbintobthebwaterbtobretrievebthebvic
,timbisbablastbresort.bThebrescuerbmustbbebabstrongbswimmerbbecausebpatientsbwhobarebi
nbdangerbofbdrowningbarebinbabstatebofbblindbpanicbandbwillbmakebeverybattemptbtobkee
pbthemselvesbafloat,bevenbifbitbmeansbforcingbthebrescuerbunderwater.
Howbshouldbyoubclassifybabpatient'sbnaturebofbillnessbifbheborbshebhasbablowbbloodbgluco
seblevel,bbizarrebbehavior,bandbshallowbbreathing?
•bA:Behavioralbemergency
•bB:Alteredbmentalbstatus
•bC:Respiratorybemergency
•bD:Cardiacbcompromiseb-bANSWER:ThebcorrectbanswerbisbB;
Reason:bThebnaturebofbillnessb(NOI)bisbthebmedicalbequivalentbtobmechanismbofbinjuryb(
MOI).bAlteredbmentalbstatusbshouldbbebthebsuspectedbNOIbinbanybpatientbwithbanybfluc
tuationbinblevelbofbconsciousness,bwhichbcanbrangebfrombbizarrebbehaviorbtobcompleteb
unresponsiveness.bCausesbofbanbalteredbmentalbstatusbincludebhypo-
borbhyperglycemia,bheadbtrauma,bstroke,bbehavioralbcrises,bdrugboverdose,bandbshock,b
amongbothers.
Abyoungbfemalebisbunresponsivebafterboverdosingbonbanbunknownbtypebofbdrug.bHerbre
spirationsbarebslowbandbshallowbandbherbpulsebisbslowbandbweak.bWhichbofbthebfollowi
ngbdrugsbisbthebLEASTblikelybcausebofbherbcondition?
•bA:Seconal
•bB:Heroin
•bC:Cocaine
•bD:Valiumb-bANSWER:ThebcorrectbanswerbisbC;
Reason:bOfbthebdrugsblisted,bcocainebwouldbbebthebleastblikelybcausebofbthebpatient'sbco
ndition.bCocainebisbabcentralbnervousbsystemb(CNS)bstimulant;byoubwouldbexpectbherbt
obbebhypertensive,btachycardic,btachypneic,bandbperhapsbevenbviolent.bHeroin,bValium
,bandbSeconalbareballbCNSbdepressantsbandbcouldbexplainbherbcondition.bHeroinbisbanbill
egalbnarcoticb(opiate),bValiumbisbabbenzodiazepinebsedative-
hypnoticbdrug,bandbSeconalbisbabbarbiturate.bNarcotics,bbenzodiazepines,bandbbarbitur
atesbareballbCNSbdepressants.bWhenbtakenbinbexcess,btheybcausebabdecreasedblevelbofbc
onsciousness,brespiratorybdepression,bbradycardia,bandbhypotension.
Activatedbcharcoalbisbcontraindicatedbforbabpatientbwhobis:
•bA:consciousbandbalertbandbhasbingestedbablargebamountbofbMotrin.
•bB:emotionallybupsetbandbhasbingestedbtwobbottlesbofbaspirin.
•bC:agitatedbandbclaimsbtobhavebingestedbabbottlebofbTylenol.
•bD:awakebandbalertbandbhasbswallowedbabcommercialbdrainbcleaner.b-
bANSWER:YoubselectedbD;bThisbisbcorrect!
Reason:Activatedbcharcoalbadsorbsb(sticksbto)bmanybingestedbsubstances,bpreventingbt
hembfrombbeingbabsorbedbintobthebbodybbybthebstomachborbintestines.bInbsomebcases,b
youbmaybgivebactivatedbcharcoalbtobpatientsbwhobhavebingestedbcertainbsubstances,bifb
approvedbbybmedicalbcontrolborblocalbprotocol.bActivatedbcharcoalbisbcontraindicatedbf
orbpatientsbwhobhavebingestedbanbacidborbalkalib(ie,bdrainbcleaner)borbabpetroleumbprod
,uctb(ie,bgasoline),bwhobhavebabdecreasedblevelbofbconsciousnessbandbcannotbprotectbth
eirbownbairway,borbwhobarebunablebtobswallow.
ThebMOSTbobviousbwaybtobreducebheatblossbfrombradiationbandbconvectionbisbto:
•bA:movebawaybfrombabcoldbobject.
•bB:increasebmetabolismbbybshivering.
•bC:wearbabthickbwind-proofbjacket.
•bD:movebtobabwarmerbenvironment.b-bANSWER:youbselectedbD;bThisbisbcorrect!
Reason:Inbabcoldbenvironment,bthebbodybhasbtwobwaysbofbstayingbwarm:bgeneratingbh
eatb(thermogenesis)bandbreducingbheatbloss.bRadiationbisbthebtransferbofbheatbbybradia
ntbenergy.bThebbodybcanblosebheatbbybradiation,bsuchbasbwhenbabpersonbstandsbinbabcol
dbroom.bConvectionboccursbwhenbheatbisbtransferredbtobcirculatingbair,basbwhenbcoolbai
rbmovesbacrossbthebbody'sbsurface.bAbpersonbstandingbinbwindybcoldbweather,bwearingb
lightweightbclothing,bisblosingbheatbtobthebenvironmentbmostlybbybconvection.bThebqui
ckestbandbmostbobviousbwaybtobdecreasebheatblossbfrombradiationbandbconvectionbisbto
bmoveboutbofbthebcoldbenvironmentbandbseekbshelterbfrombwind.bShiveringbincreasesbt
hebbody'sbmetabolismbandbisbabmechanismbforbgeneratingbheat,bnotbreducingbheatbloss
.bLayersbofbclothingbtrapbairbandbprovidebexcellentbinsulation;bthus,blayeredbclothingbde
creasesbheatblossbbetterbthanbabsingle,bthickbjacket.bConductionbisbthebdirectbtransferbo
fbheatbfrombabpartbofbthebbodybtobabcolderbobjectbbybdirectbcontact,basbwhenbabwarmbh
andbtouchesbcoldbmetalborbice.bThebmostbobviousbwaybtobdecreasebheatblossbbybconduc
tionbisbtobremovebyourbhandbfrombthebcoldbobject.
Abnear-drowningbisbMOSTbaccuratelybdefinedbas:
•bA:complicationsbwithinb24bhoursbfollowingbsubmersionbinbwater.
•bB:immediatebdeathbduebtobprolongedbsubmersionbinbwater.
•bC:survivalbforbatbleastb24bhoursbfollowingbsubmersionbinbwater.
•bD:deathbgreaterbthanb24bhoursbfollowingbsubmersionbinbwater.b-
bANSWER:YoubselectedbC;bThisbisbcorrect!
Reason:Collectively,bdrowningbandbnear-
drowningbarebreferredbtobasbsubmersionbinjuries.bDrowningbisbdefinedbasbdeathbafterbs
ubmersionbinbabliquidbmedium,busuallybwater.bInbabdrowning,bdeathbisbeitherbimmediat
eborboccursbwithinb24bhoursbfollowingbsubmersion.bNear-
drowningbisbdefinedbasbsurvival,batbleastbtemporarilyb(24bhours),bafterbsubmersion.bItbs
houldbbebnoted,bhowever,bthatbcomplicationsbsuchbasbpneumoniabandbpulmonarybede
mabcanbcausebdeathbgreaterbthanb24bhoursbfollowingbsubmersion.bForbthisbreason,ballb
patientsbwithbabsubmersionbinjurybshouldbbebtransportedbtobthebhospital,bevenbifbtheyb
appearbfinebatbthebscene.
Abyoungbwomanbreportsbsignificantbweightblossboverbtheblastbmonth,bpersistentbfever,b
andbnightbsweats.bWhenbyoubassessbher,byoubnotebthebpresencebofbdarkbpurpleblesionsb
coveringbherbtrunkbandbupperbextremities.bYoubshouldbsuspect:
•bA:end-stagebcancer.
•bB:HIV/AIDS.
•bC:tuberculosis.
, •bD:rheumaticbfever.b-bANSWER:YoubselectedbB;bThisbisbcorrect!
Reason:Weightbloss,bfever,bandbnightbsweatsbcouldbindicatebtuberculosisborbHIV/AIDS;b
however,bthebdarkbpurpleblesionsbonbthebskin,bwhichbarebcalledbKaposi'sbsarcoma,bareb
malignantbskinbtumorsbandbarebabclassicbfindingbinbpatientsbinbtheblaterbstagesbofbAIDS.
Ab48-year-
oldbmalebbecamebacutelybhypoxic,bexperiencedbabseizure,bandbisbnowbpostictal.bThebM
OSTbeffectivebwaybtobpreventbanotherbseizurebisbto:
•bA:dimbtheblightsbinbthebbackbofbthebambulance.
•bB:placebhimbinbthebrecoverybposition.
•bC:administerbhigh-flowbsupplementalboxygen.
•bD:givebhimboralbglucosebifbhebcanbswallow.b-bANSWER:YoubselectedbC;bThisbisbcorrect!
Reason:Youbshouldbadministerbhigh-
flowboxygenbtoballbpatientsbwhobarebactivelybseizingbandbtobpatientsbwhobexperiencedb
abseizurebandbarebpostictal.bThisbisbespeciallybtruebifbthebseizurebwasbcausedbbybhypoxia
.bIncreasingbtheboxygenbcontentbofbthebblood,bwhichbminimizesbhypoxia,bmaybpreventb
anotherbseizure.bThebrecoverybpositionbisbappropriatebforbuninjuredbpatientsbwithbabde
creasedblevelbofbconsciousnessbandbadequatebbreathing;bitbwillbhelpbmaintainbthebairw
aybandbfacilitatebdrainagebofbsecretionsbfrombthebmouth,bbutbwillbnotbpreventbanotherb
seizure.bOralbglucosebmaybpreventbanotherbseizurebifbhypoglycemiabwasbthebcausebofbt
hebseizure.bYoubshouldbdimbtheblightsbinbthebbackbofbthebambulancebtobhelpbpreventban
ybseizure,bnotbjustbthosebthatbarebcausedbbybhypoxia.
WhichbofbthebfollowingbconditionsbwouldbbebthebLEASTblikelybtobbebpresentbinbabpatien
tbwhobwasbsubmergedbinbwater?
•bA:Spinalbinjury
•bB:Gastricbdistention
•bC:Hyperglycemia
•bD:Laryngospasmb-bANSWER:YoubselectedbC;bThisbisbcorrect!
Reason:bManybfactorsbcanbcontributebtoborbresultbfrombabsubmersionbinjuryb(eg,bdrow
ning,bnear-
drowning).bItbisbnotbuncommonbforbabpersonbtobexperiencebabspinalbinjurybafterbdivingb
headbfirstbintobshallowbwater,bespeciallybifbheborbshebisbunderbthebinfluencebofbalcohol.b
Whenbabswimmerbpanics,bheborbshebinitiallybswallowsblargebamountsbofbwater,bresultin
gbinbgastricbdistention.bGastricbdistentionbcanbcausebaspirationbifbthebpatientbregurgitat
esbwaterbduringbrescuebbreathing;bprotectbthebairway!bDuringbthebpanicbphase,bthebvic
timbexpendsbabtremendousbamountbofbenergyb(andbglucose)bfrombflailingbaroundbinbth
ebwater,bpossiblybresultingbinbhypoglycemia.bInhalingbevenbabsmallbamountbofbfreshborb
saltbwaterbcanbseverelybirritatebtheblarynx,bwhichbsendsbthebmusclesbofbtheblarynxbandb
vocalbcordsbintobspasmb(laryngospasm),bresultingbinbairwaybblockagebandbhypoxia.
Ab42-year-
oldbmalebpresentsbwithbfever,babseverebheadache,bandbabstiffbneck.bHebisbconscious,bbu
b b b b b b b b
y Jill C. Cash; Cheryl A. Glass
b b b b b b
Hypoglycemiabandbacutebischemicbstrokebcanbpresentbsimilarlybbecause:
•bA:bothboxygenbandbglucosebarebneededbforbbrainbfunction.
•bB:thebmajoritybofbstrokebpatientsbhavebabhistorybofbdiabetes.
•bC:thebmostbcommonbcausebofbabstrokebisbhypoglycemia.
•bD:theybarebbothbcausedbbyblowblevelsbofbglucosebinbthebblood.b-
bANSWER:•bA:bothboxygenbandbglucosebarebneededbforbbrainbfunction.
Reason:bAlthoughbstrokebandbhypoglycemiabarebtwobdistinctlybdifferentbconditions,bth
eirbsignsbandbsymptomsbareboftenbsimilar.bThisbisbbecausebthebbrainbrequiresbbothboxyg
enbandbglucosebtobfunctionbnormally.bAnbacutebischemicbstrokebisbcausedbbybablackbofbo
xygenbtobabpartbofbthebbrainbduebtobabblockedbcerebralbartery,bwhereasbhypoglycemiab(
lowbbloodbglucoseblevel)bdeprivesbthebentirebbrainbofbglucose.bInbeitherbcase,bthebpatie
ntbpresentsbwithbsignsbofbimpairedbbrainbfunctionb(ie,bslurredbspeech,bweakness,balter
edbmentalbstatus).bBothbconditionsbmaybleadbtobpermanentbbrainbdamageborbdeathbifb
notbtreatedbpromptly.
Whenbdealingbwithbanbemotionallybdisturbedbpatient,byoubshouldbbebMOSTbconcerned
bwith:
•bA:gatheringballbofbthebpatient'sbmedications.
•bB:safelybtransportingbtobthebhospital.
•bC:whetherbthebpatientbcouldbharmbyou.
•bD:obtainingbabcompletebmedicalbhistory.b-bANSWER:YoubselectedbC;bThisbisbcorrect!
Reason:bWhenbmanagingbanybpatientbwithbanbemotionalborbpsychiatricbcrisis,byourbpri
marybconcernbisbyourbownbsafety.bSafelybtransportingbthebpatientbtobthebhospitalbisbyo
urbultimatebgoal.bIfbpossible,byoubshouldbattemptbtobobtainbabmedicalbhistorybandbshou
ldbtakebanybofbthebpatient'sbprescribedbmedicationsbtobthebhospital.bHowever,bthisbsho
uldbnotbsupercedebyourbownbsafetyborbinterferebwithbsafelybtransportingbthebpatient.
Youbarebatbthebscenebwherebabmanbpanickedbwhilebswimmingbinbabsmallblake.bYourbiniti
albattemptbtobrescuebhimbshouldbinclude:
•bA:rowingbabsmallbraftbtobthebvictim.
•bB:reachingbforbthebvictimbwithbablongbstick.
•bC:throwingbabropebtobthebvictim.
•bD:swimmingbtobthebvictimbtobrescuebhim.b-bANSWER:YoubselectedbB;bThisbisbcorrect!
Reason:bGeneralbrulesbtobfollowbwhenbattemptingbtobrescuebabpatientbfrombthebwaterbi
ncludeb"reach,bthrow,brow,bandbthenbgo."bInbthisbcase,byoubshouldbattemptbtobreachbth
ebvictimbbybhavingbhimbgrabbholdbofbablargebstickborbsimilarbobject.bIfbthisbisbunsuccessf
ul,bthrowbthebvictimbabropeborbflotationbdeviceb(ifbavailable).bIfbthesebarebnotbavailable,b
rowbtobthebpatientbinbabsmallbraftb(ifbavailable).bGoingbintobthebwaterbtobretrievebthebvic
,timbisbablastbresort.bThebrescuerbmustbbebabstrongbswimmerbbecausebpatientsbwhobarebi
nbdangerbofbdrowningbarebinbabstatebofbblindbpanicbandbwillbmakebeverybattemptbtobkee
pbthemselvesbafloat,bevenbifbitbmeansbforcingbthebrescuerbunderwater.
Howbshouldbyoubclassifybabpatient'sbnaturebofbillnessbifbheborbshebhasbablowbbloodbgluco
seblevel,bbizarrebbehavior,bandbshallowbbreathing?
•bA:Behavioralbemergency
•bB:Alteredbmentalbstatus
•bC:Respiratorybemergency
•bD:Cardiacbcompromiseb-bANSWER:ThebcorrectbanswerbisbB;
Reason:bThebnaturebofbillnessb(NOI)bisbthebmedicalbequivalentbtobmechanismbofbinjuryb(
MOI).bAlteredbmentalbstatusbshouldbbebthebsuspectedbNOIbinbanybpatientbwithbanybfluc
tuationbinblevelbofbconsciousness,bwhichbcanbrangebfrombbizarrebbehaviorbtobcompleteb
unresponsiveness.bCausesbofbanbalteredbmentalbstatusbincludebhypo-
borbhyperglycemia,bheadbtrauma,bstroke,bbehavioralbcrises,bdrugboverdose,bandbshock,b
amongbothers.
Abyoungbfemalebisbunresponsivebafterboverdosingbonbanbunknownbtypebofbdrug.bHerbre
spirationsbarebslowbandbshallowbandbherbpulsebisbslowbandbweak.bWhichbofbthebfollowi
ngbdrugsbisbthebLEASTblikelybcausebofbherbcondition?
•bA:Seconal
•bB:Heroin
•bC:Cocaine
•bD:Valiumb-bANSWER:ThebcorrectbanswerbisbC;
Reason:bOfbthebdrugsblisted,bcocainebwouldbbebthebleastblikelybcausebofbthebpatient'sbco
ndition.bCocainebisbabcentralbnervousbsystemb(CNS)bstimulant;byoubwouldbexpectbherbt
obbebhypertensive,btachycardic,btachypneic,bandbperhapsbevenbviolent.bHeroin,bValium
,bandbSeconalbareballbCNSbdepressantsbandbcouldbexplainbherbcondition.bHeroinbisbanbill
egalbnarcoticb(opiate),bValiumbisbabbenzodiazepinebsedative-
hypnoticbdrug,bandbSeconalbisbabbarbiturate.bNarcotics,bbenzodiazepines,bandbbarbitur
atesbareballbCNSbdepressants.bWhenbtakenbinbexcess,btheybcausebabdecreasedblevelbofbc
onsciousness,brespiratorybdepression,bbradycardia,bandbhypotension.
Activatedbcharcoalbisbcontraindicatedbforbabpatientbwhobis:
•bA:consciousbandbalertbandbhasbingestedbablargebamountbofbMotrin.
•bB:emotionallybupsetbandbhasbingestedbtwobbottlesbofbaspirin.
•bC:agitatedbandbclaimsbtobhavebingestedbabbottlebofbTylenol.
•bD:awakebandbalertbandbhasbswallowedbabcommercialbdrainbcleaner.b-
bANSWER:YoubselectedbD;bThisbisbcorrect!
Reason:Activatedbcharcoalbadsorbsb(sticksbto)bmanybingestedbsubstances,bpreventingbt
hembfrombbeingbabsorbedbintobthebbodybbybthebstomachborbintestines.bInbsomebcases,b
youbmaybgivebactivatedbcharcoalbtobpatientsbwhobhavebingestedbcertainbsubstances,bifb
approvedbbybmedicalbcontrolborblocalbprotocol.bActivatedbcharcoalbisbcontraindicatedbf
orbpatientsbwhobhavebingestedbanbacidborbalkalib(ie,bdrainbcleaner)borbabpetroleumbprod
,uctb(ie,bgasoline),bwhobhavebabdecreasedblevelbofbconsciousnessbandbcannotbprotectbth
eirbownbairway,borbwhobarebunablebtobswallow.
ThebMOSTbobviousbwaybtobreducebheatblossbfrombradiationbandbconvectionbisbto:
•bA:movebawaybfrombabcoldbobject.
•bB:increasebmetabolismbbybshivering.
•bC:wearbabthickbwind-proofbjacket.
•bD:movebtobabwarmerbenvironment.b-bANSWER:youbselectedbD;bThisbisbcorrect!
Reason:Inbabcoldbenvironment,bthebbodybhasbtwobwaysbofbstayingbwarm:bgeneratingbh
eatb(thermogenesis)bandbreducingbheatbloss.bRadiationbisbthebtransferbofbheatbbybradia
ntbenergy.bThebbodybcanblosebheatbbybradiation,bsuchbasbwhenbabpersonbstandsbinbabcol
dbroom.bConvectionboccursbwhenbheatbisbtransferredbtobcirculatingbair,basbwhenbcoolbai
rbmovesbacrossbthebbody'sbsurface.bAbpersonbstandingbinbwindybcoldbweather,bwearingb
lightweightbclothing,bisblosingbheatbtobthebenvironmentbmostlybbybconvection.bThebqui
ckestbandbmostbobviousbwaybtobdecreasebheatblossbfrombradiationbandbconvectionbisbto
bmoveboutbofbthebcoldbenvironmentbandbseekbshelterbfrombwind.bShiveringbincreasesbt
hebbody'sbmetabolismbandbisbabmechanismbforbgeneratingbheat,bnotbreducingbheatbloss
.bLayersbofbclothingbtrapbairbandbprovidebexcellentbinsulation;bthus,blayeredbclothingbde
creasesbheatblossbbetterbthanbabsingle,bthickbjacket.bConductionbisbthebdirectbtransferbo
fbheatbfrombabpartbofbthebbodybtobabcolderbobjectbbybdirectbcontact,basbwhenbabwarmbh
andbtouchesbcoldbmetalborbice.bThebmostbobviousbwaybtobdecreasebheatblossbbybconduc
tionbisbtobremovebyourbhandbfrombthebcoldbobject.
Abnear-drowningbisbMOSTbaccuratelybdefinedbas:
•bA:complicationsbwithinb24bhoursbfollowingbsubmersionbinbwater.
•bB:immediatebdeathbduebtobprolongedbsubmersionbinbwater.
•bC:survivalbforbatbleastb24bhoursbfollowingbsubmersionbinbwater.
•bD:deathbgreaterbthanb24bhoursbfollowingbsubmersionbinbwater.b-
bANSWER:YoubselectedbC;bThisbisbcorrect!
Reason:Collectively,bdrowningbandbnear-
drowningbarebreferredbtobasbsubmersionbinjuries.bDrowningbisbdefinedbasbdeathbafterbs
ubmersionbinbabliquidbmedium,busuallybwater.bInbabdrowning,bdeathbisbeitherbimmediat
eborboccursbwithinb24bhoursbfollowingbsubmersion.bNear-
drowningbisbdefinedbasbsurvival,batbleastbtemporarilyb(24bhours),bafterbsubmersion.bItbs
houldbbebnoted,bhowever,bthatbcomplicationsbsuchbasbpneumoniabandbpulmonarybede
mabcanbcausebdeathbgreaterbthanb24bhoursbfollowingbsubmersion.bForbthisbreason,ballb
patientsbwithbabsubmersionbinjurybshouldbbebtransportedbtobthebhospital,bevenbifbtheyb
appearbfinebatbthebscene.
Abyoungbwomanbreportsbsignificantbweightblossboverbtheblastbmonth,bpersistentbfever,b
andbnightbsweats.bWhenbyoubassessbher,byoubnotebthebpresencebofbdarkbpurpleblesionsb
coveringbherbtrunkbandbupperbextremities.bYoubshouldbsuspect:
•bA:end-stagebcancer.
•bB:HIV/AIDS.
•bC:tuberculosis.
, •bD:rheumaticbfever.b-bANSWER:YoubselectedbB;bThisbisbcorrect!
Reason:Weightbloss,bfever,bandbnightbsweatsbcouldbindicatebtuberculosisborbHIV/AIDS;b
however,bthebdarkbpurpleblesionsbonbthebskin,bwhichbarebcalledbKaposi'sbsarcoma,bareb
malignantbskinbtumorsbandbarebabclassicbfindingbinbpatientsbinbtheblaterbstagesbofbAIDS.
Ab48-year-
oldbmalebbecamebacutelybhypoxic,bexperiencedbabseizure,bandbisbnowbpostictal.bThebM
OSTbeffectivebwaybtobpreventbanotherbseizurebisbto:
•bA:dimbtheblightsbinbthebbackbofbthebambulance.
•bB:placebhimbinbthebrecoverybposition.
•bC:administerbhigh-flowbsupplementalboxygen.
•bD:givebhimboralbglucosebifbhebcanbswallow.b-bANSWER:YoubselectedbC;bThisbisbcorrect!
Reason:Youbshouldbadministerbhigh-
flowboxygenbtoballbpatientsbwhobarebactivelybseizingbandbtobpatientsbwhobexperiencedb
abseizurebandbarebpostictal.bThisbisbespeciallybtruebifbthebseizurebwasbcausedbbybhypoxia
.bIncreasingbtheboxygenbcontentbofbthebblood,bwhichbminimizesbhypoxia,bmaybpreventb
anotherbseizure.bThebrecoverybpositionbisbappropriatebforbuninjuredbpatientsbwithbabde
creasedblevelbofbconsciousnessbandbadequatebbreathing;bitbwillbhelpbmaintainbthebairw
aybandbfacilitatebdrainagebofbsecretionsbfrombthebmouth,bbutbwillbnotbpreventbanotherb
seizure.bOralbglucosebmaybpreventbanotherbseizurebifbhypoglycemiabwasbthebcausebofbt
hebseizure.bYoubshouldbdimbtheblightsbinbthebbackbofbthebambulancebtobhelpbpreventban
ybseizure,bnotbjustbthosebthatbarebcausedbbybhypoxia.
WhichbofbthebfollowingbconditionsbwouldbbebthebLEASTblikelybtobbebpresentbinbabpatien
tbwhobwasbsubmergedbinbwater?
•bA:Spinalbinjury
•bB:Gastricbdistention
•bC:Hyperglycemia
•bD:Laryngospasmb-bANSWER:YoubselectedbC;bThisbisbcorrect!
Reason:bManybfactorsbcanbcontributebtoborbresultbfrombabsubmersionbinjuryb(eg,bdrow
ning,bnear-
drowning).bItbisbnotbuncommonbforbabpersonbtobexperiencebabspinalbinjurybafterbdivingb
headbfirstbintobshallowbwater,bespeciallybifbheborbshebisbunderbthebinfluencebofbalcohol.b
Whenbabswimmerbpanics,bheborbshebinitiallybswallowsblargebamountsbofbwater,bresultin
gbinbgastricbdistention.bGastricbdistentionbcanbcausebaspirationbifbthebpatientbregurgitat
esbwaterbduringbrescuebbreathing;bprotectbthebairway!bDuringbthebpanicbphase,bthebvic
timbexpendsbabtremendousbamountbofbenergyb(andbglucose)bfrombflailingbaroundbinbth
ebwater,bpossiblybresultingbinbhypoglycemia.bInhalingbevenbabsmallbamountbofbfreshborb
saltbwaterbcanbseverelybirritatebtheblarynx,bwhichbsendsbthebmusclesbofbtheblarynxbandb
vocalbcordsbintobspasmb(laryngospasm),bresultingbinbairwaybblockagebandbhypoxia.
Ab42-year-
oldbmalebpresentsbwithbfever,babseverebheadache,bandbabstiffbneck.bHebisbconscious,bbu
