TEST BANKS For Family Practice Guidelines, 6th Edition b
k k k k k k k k
y Jill C. Cash; Cheryl A. Glass
k k k k k k
Hypoglycemia kandkacutekischemickstrokekcankpresentksimilarlykbecause:
•kA:bothkoxygenkandkglucosekarekneededkforkbrainkfunction.
•kB:thekmajoritykofkstrokekpatientskhavekakhistorykofkdiabetes.
•kC:thekmostkcommonkcausekofkakstrokekiskhypoglycemia.
•kD:theykarekbothkcausedkbyklowklevelskofkglucosekinkthekblood.k-
kANSWER:•kA:bothkoxygenkandkglucosekarekneededkfor kbrainkfunction.
Reason:kAlthoughkstrokekandkhypoglycemia karektwokdistinctlykdifferentkconditions,kthe
irksignskandksymptomskarekoftenksimilar.kThiskiskbecausekthekbrainkrequireskbothkoxyge
nkandkglucosektokfunctionknormally.kAnkacutekischemickstrokekiskcausedkbykaklackkofkoxy
genktokakpartkofkthekbrainkduektokakblockedkcerebralkartery,kwhereaskhypoglycemia k(lo
wkbloodkglucoseklevel)kdepriveskthekentirekbrainkofkglucose.kInkeither kcase,kthekpatientk
presentskwithksignskofkimpairedkbrainkfunctionk(ie,kslurredkspeech,kweakness,kalteredk
mentalkstatus).kBothkconditionskmaykleadktokpermanentkbrainkdamagekorkdeathkifknotk t
reatedkpromptly.
Whenkdealing kwithkankemotionallykdisturbedkpatient,kyouk shouldkbekMOSTkconcernedk
with:
•kA:gathering kallkofkthekpatient'skmedications.
•kB:safelyktransporting ktokthekhospital.
•kC:whether kthekpatientkcouldkharmkyou.
•kD:obtaining kakcompletekmedicalkhistory.k-kANSWER:YoukselectedkC;kThiskiskcorrect!
Reason:kWhenkmanaging kanykpatientkwithkankemotionalkorkpsychiatrickcrisis,kyourkprim
arykconcernkiskyourkownksafety.kSafelyktransporting kthekpatientktok thek hospitalkiskyourku
ltimatekgoal.kIfkpossible,kyoukshouldkattemptktokobtainkakmedicalkhistorykandkshouldk ta
kekanykofkthekpatient'skprescribedkmedicationsktokthekhospital.kHowever,kthiskshould kn
otksupercedekyourkownksafetykorkinterferekwithksafelyktransporting kthekpatient.
Youkarekatkthekscenekwherekakmankpanickedkwhilekswimming kinkaksmallklake.kYourkinitia
lkattemptktokrescuekhimkshouldkinclude:
•kA:rowing kaksmallkraftktokthekvictim.
•kB:reaching kfor kthekvictimkwithkaklong kstick.
•kC:throwing kakropektokthekvictim.
•kD:swimming ktokthekvictimktokrescuekhim.k-kANSWER:YoukselectedkB;kThiskiskcorrect!
Reason:kGeneralkrulesktokfollowkwhenkattempting ktokrescuekakpatientkfromkthek water ki
ncludek"reach,kthrow,krow,kandkthenkgo."kInkthiskcase,kyouk shouldkattemptktokreachkthe
kvictim kbykhaving khim kgrabkholdkofka klargekstickkor ksimilar kobject.kIfkthiskiskunsuccessful, k
throwkthekvictimkakropekorkflotationkdevicek(ifkavailable).kIfkthesekareknotkavailable,krow
ktokthekpatientkinka ksmall kraftk(ifkavailable).kGoing kintokthekwater ktokretrievekthekvictim ki
,skaklastkresort.kThekrescuer kmustkbekakstrong kswimmer kbecausekpatientskwhokarekinkdan
gerkofkdrowning karekinkakstatekofkblindkpanickandkwillkmakekeverykattemptktokkeepkthem
selveskafloat,kevenkifkitkmeanskforcing kthekrescuer kunderwater.
Howkshouldkyoukclassifykakpatient'sknaturekofkillnesskifkhekorkshekhaskaklowkbloodkglucos
eklevel,kbizarrekbehavior,kandkshallowkbreathing?
•kA:Behavioral kemergency
•kB:Alteredkmentalkstatus
•kC:Respiratorykemergency
•kD:Cardiackcompromisek-kANSWER:Thekcorrectkanswer kiskB;
Reason:kTheknaturekofkillnessk(NOI)kiskthekmedicalkequivalentktokmechanismkofkinjuryk(
MOI).kAlteredkmentalkstatuskshouldkbektheksuspectedk NOIkinkanykpatientkwithkanykfluct
uationkinklevelkofkconsciousness,kwhichkcankrangekfromkbizarrekbehavior ktokcompleteku
nresponsiveness.kCauseskofkankalteredkmentalkstatuskincludekhypo-
kor khyperglycemia, kheadktrauma,kstroke,kbehavioral kcrises,kdrug koverdose,kandkshock,k
among kothers.
Akyoung kfemalekiskunresponsivekafter koverdosing konkankunknownktypekofkdrug.kHerkres
pirationskarekslowkandkshallowkandkher kpulsekiskslowkandkweak.kWhichk ofkthekfollowing k
drugskiskthekLEASTklikelykcausekofkherkcondition?
•kA:Seconal
•kB:Heroin
•kC:Cocaine
•kD:Valiumk-kANSWER:Thekcorrectkanswer kiskC;
Reason:kOfkthekdrugsklisted,kcocainekwouldkbekthekleastklikelykcausekofkthekpatient'skco
ndition.kCocainekiskakcentralknervousksystemk(CNS)kstimulant;kyoukwouldkexpectk her ktok
bekhypertensive,ktachycardic,ktachypneic,kandkperhapskevenkviolent.kHeroin,kValium,ka
ndkSeconalkarekallkCNSkdepressantskandkcouldkexplainkherkcondition.kHeroinkiskankillegal
knarcotic k(opiate),kValium kiska kbenzodiazepine ksedative-
hypnotickdrug,kandkSeconalkiskakbarbiturate.kNarcotics,kbenzodiazepines,kandk barbitura
teskarekallkCNSkdepressants.kWhenktakenkinkexcess,ktheykcausekakdecreasedklevelkofkcon
sciousness,krespiratorykdepression,kbradycardia,kandkhypotension.
Activatedkcharcoalkiskcontraindicatedkforkakpatientkwhokis:
•kA:consciouskandkalertkandkhaskingestedkaklargekamountkofkMotrin.
•kB:emotionallykupsetkandkhaskingestedktwokbottlesk ofkaspirin.
•kC:agitatedkandkclaimsktokhavekingestedkakbottlekofkTylenol.
•kD:awakekandkalertkandkhaskswallowedkakcommercialkdrainkcleaner.k-
kANSWER:YoukselectedkD;kThiskiskcorrect!
Reason:Activatedkcharcoalkadsorbsk(stickskto)kmanykingestedksubstances,k preventing kt
hemkfromkbeing kabsorbedkintokthekbodykbykthekstomachkorkintestines.kInk somekcases,ky
oukmaykgivekactivatedkcharcoal ktokpatientskwhokhavekingestedkcertainksubstances,kifkap
provedkbykmedicalkcontrolkorklocalkprotocol.kActivatedkcharcoal kiskcontraindicatedkfork
patientskwhokhavekingestedkankacidkorkalkalik(ie,kdrainkcleaner)korkakpetroleumkproductk
,(ie,kgasoline),kwhokhavekakdecreasedklevelkofkconsciousnesskandkcannotkprotectk their ko
wnkairway,korkwhokarekunablektokswallow.
ThekMOSTkobviouskwayktokreducekheatklosskfromkradiationkandkconvectionkiskto:
•kA:movekawaykfromkakcoldkobject.
•kB:increasekmetabolismkbykshivering.
•kC:wear kakthickkwind-proofkjacket.
•kD:movektokakwarmer kenvironment.k-kANSWER:youkselectedkD;kThiskiskcorrect!
Reason:Inkakcoldkenvironment,kthekbodykhask twok waysk ofkstaying kwarm:kgenerating khe
atk(thermogenesis)kandkreducing kheatkloss.kRadiationkiskthektransfer kofkheatkbykradiantk
energy.kThekbodykcanklosekheatkbykradiation,ksuchkaskwhenkakpersonkstandskinkakcoldkro
om.kConvectionkoccurskwhenkheatkisktransferredktokcirculating kair,kaskwhenkcoolkair kmo
veskacrosskthekbody'sksurface.kAkpersonkstanding kinkwindykcoldkweather,kwearing klight
weightkclothing,kisklosing kheatktokthekenvironmentkmostlykby kconvection.kThek quickestk
andkmostkobviouskwayktokdecreasekheatklosskfromkradiationkandkconvectionkisktokmovek
outkofkthekcoldkenvironmentkandkseekkshelter kfromkwind.kShivering kincreaseskthekbody'
skmetabolismkandkiskakmechanismkforkgenerating kheat,knotkreducing kheatkloss.kLayersko
fkclothing ktrapkairkandkprovidekexcellentkinsulation;kthus,klayeredkclothing kdecreaseskhe
atklosskbetter kthankaksingle,kthickkjacket.kConductionkiskthekdirectktransfer kofkheatkfromk
akpartkofkthekbodyktokakcolder kobjectkbykdirectkcontact,kaskwhenkakwarmkhandk toucheskc
oldkmetalkorkice.kThekmostkobviouskwayktokdecreasekheatklosskbykconductionkisk tokremo
vekyourkhandkfromkthekcoldkobject.
Aknear-drowning kiskMOSTkaccuratelykdefinedkas:
•kA:complicationskwithink24khourskfollowing ksubmersionkinkwater.
•kB:immediatekdeathkduektokprolongedksubmersionkinkwater.
•kC:survivalkforkatkleastk24khourskfollowing ksubmersionkinkwater.
•kD:deathkgreater kthank24khourskfollowing ksubmersionkinkwater.k-
kANSWER:YoukselectedkC;kThiskiskcorrect!
Reason:Collectively,kdrowning kandknear-
drowning karekreferredktokasksubmersionkinjuries.kDrowning kiskdefinedkaskdeathkafter ksu
bmersionkinkakliquidkmedium,kusuallykwater.kInkakdrowning,kdeathkiskeither kimmediatek
orkoccurskwithink24khourskfollowing ksubmersion.kNear-
drowning kiskdefinedkasksurvival,katkleastktemporarilyk(24khours),kafter ksubmersion.kItksh
ouldkbeknoted,khowever,kthatkcomplicationsk suchkask pneumoniakandkpulmonarykedem
akcankcausekdeathkgreater kthank24khourskfollowing ksubmersion.kForkthiskreason,kallkpati
entskwithkaksubmersionkinjurykshouldkbektransportedktok thek hospital,kevenkifktheykappe
arkfinekatkthekscene.
Akyoung kwomankreportsksignificantkweightklosskoverktheklastkmonth,kpersistentkfever,ka
ndknightksweats.kWhenkyoukassessk her,kyouk notekthek presencekofkdarkkpurpleklesionskc
overing kherktrunkkandkupperkextremities.kYoukshouldksuspect:
•kA:end-stagekcancer.
•kB:HIV/AIDS.
•kC:tuberculosis.
, •kD:rheumatickfever.k-kANSWER:YoukselectedkB;kThiskiskcorrect!
Reason:Weightkloss,kfever,kandknightksweatskcouldkindicatektuberculosisk orkHIV/AIDS;k
however,kthekdarkkpurpleklesionskonkthekskin,k whichkarekcalledkKaposi'sksarcoma,karekm
alignantkskinktumorskandkarekakclassickfinding kinkpatientskinktheklater kstageskofkAIDS.
Ak48-year-
oldkmalekbecamekacutelykhypoxic,kexperiencedkakseizure,kandkisknowkpostictal.kThekMO
STkeffectivekwayktokpreventkanother kseizurekiskto:
•kA:dimktheklightskinkthekbackkofkthekambulance.
•kB:placekhimkinkthekrecoverykposition.
•kC:administer khigh-flowksupplementalkoxygen.
•kD:givekhimkoralkglucosekifkhekcankswallow.k-kANSWER:YoukselectedkC;kThiskiskcorrect!
Reason:Youkshouldkadminister khigh-
flowkoxygenktokallkpatientskwhokarekactivelykseizing kandktokpatientskwhokexperiencedkak
seizurekandkarekpostictal.kThiskiskespeciallyktruekifkthekseizurekwaskcausedkbykhypoxia.kIn
creasing kthekoxygenkcontentkofkthekblood,kwhichkminimizeskhypoxia,kmaykpreventkanot
herkseizure.kThekrecoverykpositionkiskappropriatekforkuninjuredkpatientskwithkakdecreas
edklevelkofkconsciousnesskandkadequatekbreathing;kitkwillkhelpkmaintainkthekairwaykand
kfacilitate kdrainagekofksecretionskfrom kthekmouth,kbutkwill knotkpreventkanother kseizure.
kOral kglucosekmaykpreventkanother kseizurekifkhypoglycemia kwaskthekcausekofkthekseizur
e.kYoukshouldkdimktheklightskinkthekbackkofkthekambulancektokhelpk preventkanykseizure,k
notkjustkthosekthatkarekcausedkbykhypoxia.
Whichkofkthekfollowing kconditionskwouldk bekthekLEASTklikelyktokbek presentkinkakpatientk
whokwasksubmergedkinkwater?
•kA:Spinalkinjury
•kB:Gastrickdistention
•kC:Hyperglycemia
•kD:Laryngospasmk-kANSWER:YoukselectedkC;kThiskiskcorrect!
Reason:kManykfactorskcankcontributektokorkresultkfromkaksubmersionkinjuryk(eg,kdrowni
ng,knear-
drowning).kItkisknotkuncommonkfor kakpersonktokexperiencekakspinalkinjurykafter kdiving kh
eadkfirstkintokshallowkwater,kespeciallykifkhekorkshekiskunder kthekinfluencekofkalcohol.kW
henkakswimmerkpanics,khekorkshekinitiallykswallowsklargekamountskofkwater,kresulting kin
kgastric kdistention.kGastric kdistentionkcankcausekaspirationkifkthekpatientkregurgitateskw
ater kduring krescuekbreathing;kprotectkthekairway!kDuring kthekpanickphase,kthekvictimke
xpendskaktremendouskamountkofkenergyk(andkglucose)kfromkflailing karoundkinkthekwate
r,kpossiblykresulting kinkhypoglycemia.kInhaling kevenkaksmallkamountkofkfreshkorksaltkwat
erkcankseverelykirritatektheklarynx,kwhichksendskthekmuscleskofktheklarynxkandkvocalkcor
dskintokspasmk(laryngospasm),kresulting kinkairwaykblockagekandkhypoxia.
Ak42-year-
oldkmalekpresentskwithkfever,kakseverekheadache,kandkakstiffkneck.kHekiskconscious,kbutk
k k k k k k k k
y Jill C. Cash; Cheryl A. Glass
k k k k k k
Hypoglycemia kandkacutekischemickstrokekcankpresentksimilarlykbecause:
•kA:bothkoxygenkandkglucosekarekneededkforkbrainkfunction.
•kB:thekmajoritykofkstrokekpatientskhavekakhistorykofkdiabetes.
•kC:thekmostkcommonkcausekofkakstrokekiskhypoglycemia.
•kD:theykarekbothkcausedkbyklowklevelskofkglucosekinkthekblood.k-
kANSWER:•kA:bothkoxygenkandkglucosekarekneededkfor kbrainkfunction.
Reason:kAlthoughkstrokekandkhypoglycemia karektwokdistinctlykdifferentkconditions,kthe
irksignskandksymptomskarekoftenksimilar.kThiskiskbecausekthekbrainkrequireskbothkoxyge
nkandkglucosektokfunctionknormally.kAnkacutekischemickstrokekiskcausedkbykaklackkofkoxy
genktokakpartkofkthekbrainkduektokakblockedkcerebralkartery,kwhereaskhypoglycemia k(lo
wkbloodkglucoseklevel)kdepriveskthekentirekbrainkofkglucose.kInkeither kcase,kthekpatientk
presentskwithksignskofkimpairedkbrainkfunctionk(ie,kslurredkspeech,kweakness,kalteredk
mentalkstatus).kBothkconditionskmaykleadktokpermanentkbrainkdamagekorkdeathkifknotk t
reatedkpromptly.
Whenkdealing kwithkankemotionallykdisturbedkpatient,kyouk shouldkbekMOSTkconcernedk
with:
•kA:gathering kallkofkthekpatient'skmedications.
•kB:safelyktransporting ktokthekhospital.
•kC:whether kthekpatientkcouldkharmkyou.
•kD:obtaining kakcompletekmedicalkhistory.k-kANSWER:YoukselectedkC;kThiskiskcorrect!
Reason:kWhenkmanaging kanykpatientkwithkankemotionalkorkpsychiatrickcrisis,kyourkprim
arykconcernkiskyourkownksafety.kSafelyktransporting kthekpatientktok thek hospitalkiskyourku
ltimatekgoal.kIfkpossible,kyoukshouldkattemptktokobtainkakmedicalkhistorykandkshouldk ta
kekanykofkthekpatient'skprescribedkmedicationsktokthekhospital.kHowever,kthiskshould kn
otksupercedekyourkownksafetykorkinterferekwithksafelyktransporting kthekpatient.
Youkarekatkthekscenekwherekakmankpanickedkwhilekswimming kinkaksmallklake.kYourkinitia
lkattemptktokrescuekhimkshouldkinclude:
•kA:rowing kaksmallkraftktokthekvictim.
•kB:reaching kfor kthekvictimkwithkaklong kstick.
•kC:throwing kakropektokthekvictim.
•kD:swimming ktokthekvictimktokrescuekhim.k-kANSWER:YoukselectedkB;kThiskiskcorrect!
Reason:kGeneralkrulesktokfollowkwhenkattempting ktokrescuekakpatientkfromkthek water ki
ncludek"reach,kthrow,krow,kandkthenkgo."kInkthiskcase,kyouk shouldkattemptktokreachkthe
kvictim kbykhaving khim kgrabkholdkofka klargekstickkor ksimilar kobject.kIfkthiskiskunsuccessful, k
throwkthekvictimkakropekorkflotationkdevicek(ifkavailable).kIfkthesekareknotkavailable,krow
ktokthekpatientkinka ksmall kraftk(ifkavailable).kGoing kintokthekwater ktokretrievekthekvictim ki
,skaklastkresort.kThekrescuer kmustkbekakstrong kswimmer kbecausekpatientskwhokarekinkdan
gerkofkdrowning karekinkakstatekofkblindkpanickandkwillkmakekeverykattemptktokkeepkthem
selveskafloat,kevenkifkitkmeanskforcing kthekrescuer kunderwater.
Howkshouldkyoukclassifykakpatient'sknaturekofkillnesskifkhekorkshekhaskaklowkbloodkglucos
eklevel,kbizarrekbehavior,kandkshallowkbreathing?
•kA:Behavioral kemergency
•kB:Alteredkmentalkstatus
•kC:Respiratorykemergency
•kD:Cardiackcompromisek-kANSWER:Thekcorrectkanswer kiskB;
Reason:kTheknaturekofkillnessk(NOI)kiskthekmedicalkequivalentktokmechanismkofkinjuryk(
MOI).kAlteredkmentalkstatuskshouldkbektheksuspectedk NOIkinkanykpatientkwithkanykfluct
uationkinklevelkofkconsciousness,kwhichkcankrangekfromkbizarrekbehavior ktokcompleteku
nresponsiveness.kCauseskofkankalteredkmentalkstatuskincludekhypo-
kor khyperglycemia, kheadktrauma,kstroke,kbehavioral kcrises,kdrug koverdose,kandkshock,k
among kothers.
Akyoung kfemalekiskunresponsivekafter koverdosing konkankunknownktypekofkdrug.kHerkres
pirationskarekslowkandkshallowkandkher kpulsekiskslowkandkweak.kWhichk ofkthekfollowing k
drugskiskthekLEASTklikelykcausekofkherkcondition?
•kA:Seconal
•kB:Heroin
•kC:Cocaine
•kD:Valiumk-kANSWER:Thekcorrectkanswer kiskC;
Reason:kOfkthekdrugsklisted,kcocainekwouldkbekthekleastklikelykcausekofkthekpatient'skco
ndition.kCocainekiskakcentralknervousksystemk(CNS)kstimulant;kyoukwouldkexpectk her ktok
bekhypertensive,ktachycardic,ktachypneic,kandkperhapskevenkviolent.kHeroin,kValium,ka
ndkSeconalkarekallkCNSkdepressantskandkcouldkexplainkherkcondition.kHeroinkiskankillegal
knarcotic k(opiate),kValium kiska kbenzodiazepine ksedative-
hypnotickdrug,kandkSeconalkiskakbarbiturate.kNarcotics,kbenzodiazepines,kandk barbitura
teskarekallkCNSkdepressants.kWhenktakenkinkexcess,ktheykcausekakdecreasedklevelkofkcon
sciousness,krespiratorykdepression,kbradycardia,kandkhypotension.
Activatedkcharcoalkiskcontraindicatedkforkakpatientkwhokis:
•kA:consciouskandkalertkandkhaskingestedkaklargekamountkofkMotrin.
•kB:emotionallykupsetkandkhaskingestedktwokbottlesk ofkaspirin.
•kC:agitatedkandkclaimsktokhavekingestedkakbottlekofkTylenol.
•kD:awakekandkalertkandkhaskswallowedkakcommercialkdrainkcleaner.k-
kANSWER:YoukselectedkD;kThiskiskcorrect!
Reason:Activatedkcharcoalkadsorbsk(stickskto)kmanykingestedksubstances,k preventing kt
hemkfromkbeing kabsorbedkintokthekbodykbykthekstomachkorkintestines.kInk somekcases,ky
oukmaykgivekactivatedkcharcoal ktokpatientskwhokhavekingestedkcertainksubstances,kifkap
provedkbykmedicalkcontrolkorklocalkprotocol.kActivatedkcharcoal kiskcontraindicatedkfork
patientskwhokhavekingestedkankacidkorkalkalik(ie,kdrainkcleaner)korkakpetroleumkproductk
,(ie,kgasoline),kwhokhavekakdecreasedklevelkofkconsciousnesskandkcannotkprotectk their ko
wnkairway,korkwhokarekunablektokswallow.
ThekMOSTkobviouskwayktokreducekheatklosskfromkradiationkandkconvectionkiskto:
•kA:movekawaykfromkakcoldkobject.
•kB:increasekmetabolismkbykshivering.
•kC:wear kakthickkwind-proofkjacket.
•kD:movektokakwarmer kenvironment.k-kANSWER:youkselectedkD;kThiskiskcorrect!
Reason:Inkakcoldkenvironment,kthekbodykhask twok waysk ofkstaying kwarm:kgenerating khe
atk(thermogenesis)kandkreducing kheatkloss.kRadiationkiskthektransfer kofkheatkbykradiantk
energy.kThekbodykcanklosekheatkbykradiation,ksuchkaskwhenkakpersonkstandskinkakcoldkro
om.kConvectionkoccurskwhenkheatkisktransferredktokcirculating kair,kaskwhenkcoolkair kmo
veskacrosskthekbody'sksurface.kAkpersonkstanding kinkwindykcoldkweather,kwearing klight
weightkclothing,kisklosing kheatktokthekenvironmentkmostlykby kconvection.kThek quickestk
andkmostkobviouskwayktokdecreasekheatklosskfromkradiationkandkconvectionkisktokmovek
outkofkthekcoldkenvironmentkandkseekkshelter kfromkwind.kShivering kincreaseskthekbody'
skmetabolismkandkiskakmechanismkforkgenerating kheat,knotkreducing kheatkloss.kLayersko
fkclothing ktrapkairkandkprovidekexcellentkinsulation;kthus,klayeredkclothing kdecreaseskhe
atklosskbetter kthankaksingle,kthickkjacket.kConductionkiskthekdirectktransfer kofkheatkfromk
akpartkofkthekbodyktokakcolder kobjectkbykdirectkcontact,kaskwhenkakwarmkhandk toucheskc
oldkmetalkorkice.kThekmostkobviouskwayktokdecreasekheatklosskbykconductionkisk tokremo
vekyourkhandkfromkthekcoldkobject.
Aknear-drowning kiskMOSTkaccuratelykdefinedkas:
•kA:complicationskwithink24khourskfollowing ksubmersionkinkwater.
•kB:immediatekdeathkduektokprolongedksubmersionkinkwater.
•kC:survivalkforkatkleastk24khourskfollowing ksubmersionkinkwater.
•kD:deathkgreater kthank24khourskfollowing ksubmersionkinkwater.k-
kANSWER:YoukselectedkC;kThiskiskcorrect!
Reason:Collectively,kdrowning kandknear-
drowning karekreferredktokasksubmersionkinjuries.kDrowning kiskdefinedkaskdeathkafter ksu
bmersionkinkakliquidkmedium,kusuallykwater.kInkakdrowning,kdeathkiskeither kimmediatek
orkoccurskwithink24khourskfollowing ksubmersion.kNear-
drowning kiskdefinedkasksurvival,katkleastktemporarilyk(24khours),kafter ksubmersion.kItksh
ouldkbeknoted,khowever,kthatkcomplicationsk suchkask pneumoniakandkpulmonarykedem
akcankcausekdeathkgreater kthank24khourskfollowing ksubmersion.kForkthiskreason,kallkpati
entskwithkaksubmersionkinjurykshouldkbektransportedktok thek hospital,kevenkifktheykappe
arkfinekatkthekscene.
Akyoung kwomankreportsksignificantkweightklosskoverktheklastkmonth,kpersistentkfever,ka
ndknightksweats.kWhenkyoukassessk her,kyouk notekthek presencekofkdarkkpurpleklesionskc
overing kherktrunkkandkupperkextremities.kYoukshouldksuspect:
•kA:end-stagekcancer.
•kB:HIV/AIDS.
•kC:tuberculosis.
, •kD:rheumatickfever.k-kANSWER:YoukselectedkB;kThiskiskcorrect!
Reason:Weightkloss,kfever,kandknightksweatskcouldkindicatektuberculosisk orkHIV/AIDS;k
however,kthekdarkkpurpleklesionskonkthekskin,k whichkarekcalledkKaposi'sksarcoma,karekm
alignantkskinktumorskandkarekakclassickfinding kinkpatientskinktheklater kstageskofkAIDS.
Ak48-year-
oldkmalekbecamekacutelykhypoxic,kexperiencedkakseizure,kandkisknowkpostictal.kThekMO
STkeffectivekwayktokpreventkanother kseizurekiskto:
•kA:dimktheklightskinkthekbackkofkthekambulance.
•kB:placekhimkinkthekrecoverykposition.
•kC:administer khigh-flowksupplementalkoxygen.
•kD:givekhimkoralkglucosekifkhekcankswallow.k-kANSWER:YoukselectedkC;kThiskiskcorrect!
Reason:Youkshouldkadminister khigh-
flowkoxygenktokallkpatientskwhokarekactivelykseizing kandktokpatientskwhokexperiencedkak
seizurekandkarekpostictal.kThiskiskespeciallyktruekifkthekseizurekwaskcausedkbykhypoxia.kIn
creasing kthekoxygenkcontentkofkthekblood,kwhichkminimizeskhypoxia,kmaykpreventkanot
herkseizure.kThekrecoverykpositionkiskappropriatekforkuninjuredkpatientskwithkakdecreas
edklevelkofkconsciousnesskandkadequatekbreathing;kitkwillkhelpkmaintainkthekairwaykand
kfacilitate kdrainagekofksecretionskfrom kthekmouth,kbutkwill knotkpreventkanother kseizure.
kOral kglucosekmaykpreventkanother kseizurekifkhypoglycemia kwaskthekcausekofkthekseizur
e.kYoukshouldkdimktheklightskinkthekbackkofkthekambulancektokhelpk preventkanykseizure,k
notkjustkthosekthatkarekcausedkbykhypoxia.
Whichkofkthekfollowing kconditionskwouldk bekthekLEASTklikelyktokbek presentkinkakpatientk
whokwasksubmergedkinkwater?
•kA:Spinalkinjury
•kB:Gastrickdistention
•kC:Hyperglycemia
•kD:Laryngospasmk-kANSWER:YoukselectedkC;kThiskiskcorrect!
Reason:kManykfactorskcankcontributektokorkresultkfromkaksubmersionkinjuryk(eg,kdrowni
ng,knear-
drowning).kItkisknotkuncommonkfor kakpersonktokexperiencekakspinalkinjurykafter kdiving kh
eadkfirstkintokshallowkwater,kespeciallykifkhekorkshekiskunder kthekinfluencekofkalcohol.kW
henkakswimmerkpanics,khekorkshekinitiallykswallowsklargekamountskofkwater,kresulting kin
kgastric kdistention.kGastric kdistentionkcankcausekaspirationkifkthekpatientkregurgitateskw
ater kduring krescuekbreathing;kprotectkthekairway!kDuring kthekpanickphase,kthekvictimke
xpendskaktremendouskamountkofkenergyk(andkglucose)kfromkflailing karoundkinkthekwate
r,kpossiblykresulting kinkhypoglycemia.kInhaling kevenkaksmallkamountkofkfreshkorksaltkwat
erkcankseverelykirritatektheklarynx,kwhichksendskthekmuscleskofktheklarynxkandkvocalkcor
dskintokspasmk(laryngospasm),kresulting kinkairwaykblockagekandkhypoxia.
Ak42-year-
oldkmalekpresentskwithkfever,kakseverekheadache,kandkakstiffkneck.kHekiskconscious,kbutk
