TEST BANKS For Family Practice Guidelines, 6th Edition b
g g g g g g g g
y Jill C. Cash; Cheryl A. Glass
g g g g g g
Hypoglycemiagandgacutegischemicgstrokegcangpresentgsimilarlygbecause:
•gA:bothgoxygengandgglucosegaregneededgforgbraingfunction.
•gB:thegmajoritygofgstrokegpatientsghavegaghistorygofgdiabetes.
•gC:thegmostgcommongcausegofgagstrokegisghypoglycemia.
•gD:theygaregbothgcausedgbyglowglevelsgofgglucosegingthegblood.g-
gANSWER:•gA:bothgoxygengandgglucosegaregneededgforgbraingfunction.
Reason:gAlthoughgstrokegandghypoglycemiagaregtwogdistinctlygdifferentgconditions,gthe
irgsignsgandgsymptomsgaregoftengsimilar.gThisgisgbecausegthegbraingrequiresgbothgoxyge
ngandgglucosegtogfunctiongnormally.gAngacutegischemicgstrokegisgcausedgbygaglackgofgoxy
gengtogagpartgofgthegbraingduegtogagblockedgcerebralgartery,gwhereasghypoglycemiag(lo
wgbloodgglucoseglevel)gdeprivesgthegentiregbraingofgglucose.gIngeithergcase,gthegpatientg
presentsgwithgsignsgofgimpairedgbraingfunctiong(ie,gslurredgspeech,gweakness,galteredg
mentalgstatus).gBothgconditionsgmaygleadgtogpermanentgbraingdamagegorgdeathgifgnotgt
reatedgpromptly.
Whengdealinggwithgangemotionallygdisturbedgpatient,gyougshouldgbegMOSTgconcernedg
with:
•gA:gatheringgallgofgthegpatient'sgmedications.
•gB:safelygtransportinggtogtheghospital.
•gC:whethergthegpatientgcouldgharmgyou.
•gD:obtaininggagcompletegmedicalghistory.g-gANSWER:YougselectedgC;gThisgisgcorrect!
Reason:gWhengmanagingganygpatientgwithgangemotionalgorgpsychiatricgcrisis,gyourgprim
arygconcerngisgyourgowngsafety.gSafelygtransportinggthegpatientgtogtheghospitalgisgyourg
ultimateggoal.gIfgpossible,gyougshouldgattemptgtogobtaingagmedicalghistorygandgshouldgt
akeganygofgthegpatient'sgprescribedgmedicationsgtogtheghospital.gHowever,gthisgshouldg
notgsupercedegyourgowngsafetygorginterferegwithgsafelygtransportinggthegpatient.
Yougaregatgthegscenegwheregagmangpanickedgwhilegswimminggingagsmallglake.gYourginitia
lgattemptgtogrescueghimgshouldginclude:
•gA:rowinggagsmallgraftgtogthegvictim.
•gB:reachinggforgthegvictimgwithgaglonggstick.
•gC:throwinggagropegtogthegvictim.
•gD:swimminggtogthegvictimgtogrescueghim.g-gANSWER:YougselectedgB;gThisgisgcorrect!
Reason:gGeneralgrulesgtogfollowgwhengattemptinggtogrescuegagpatientgfromgthegwatergi
ncludeg"reach,gthrow,grow,gandgthenggo."gIngthisgcase,gyougshouldgattemptgtogreachgthe
gvictimgbyghavingghimggrabgholdgofgaglargegstickgorgsimilargobject.gIfgthisgisgunsuccessful,g
throwgthegvictimgagropegorgflotationgdeviceg(ifgavailable).gIfgthesegaregnotgavailable,grow
gtogthegpatientgingagsmallgraftg(ifgavailable).gGoinggintogthegwatergtogretrievegthegvictimgi
,sgaglastgresort.gThegrescuergmustgbegagstronggswimmergbecausegpatientsgwhogaregingda
ngergofgdrowninggaregingagstategofgblindgpanicgandgwillgmakegeverygattemptgtogkeepgthe
mselvesgafloat,gevengifgitgmeansgforcinggthegrescuergunderwater.
Howgshouldgyougclassifygagpatient'sgnaturegofgillnessgifghegorgsheghasgaglowgbloodgglucos
eglevel,gbizarregbehavior,gandgshallowgbreathing?
•gA:Behavioralgemergency
•gB:Alteredgmentalgstatus
•gC:Respiratorygemergency
•gD:Cardiacgcompromiseg-gANSWER:ThegcorrectganswergisgB;
Reason:gThegnaturegofgillnessg(NOI)gisgthegmedicalgequivalentgtogmechanismgofginjuryg(
MOI).gAlteredgmentalgstatusgshouldgbegthegsuspectedgNOIginganygpatientgwithganygfluct
uationginglevelgofgconsciousness,gwhichgcangrangegfromgbizarregbehaviorgtogcompletegu
nresponsiveness.gCausesgofgangalteredgmentalgstatusgincludeghypo-
gorghyperglycemia,gheadgtrauma,gstroke,gbehavioralgcrises,gdruggoverdose,gandgshock,g
amonggothers.
Agyounggfemalegisgunresponsivegaftergoverdosinggongangunknowngtypegofgdrug.gHergres
pirationsgaregslowgandgshallowgandghergpulsegisgslowgandgweak.gWhichgofgthegfollowingg
drugsgisgthegLEASTglikelygcausegofghergcondition?
•gA:Seconal
•gB:Heroin
•gC:Cocaine
•gD:Valiumg-gANSWER:ThegcorrectganswergisgC;
Reason:gOfgthegdrugsglisted,gcocainegwouldgbegthegleastglikelygcausegofgthegpatient'sgco
ndition.gCocainegisgagcentralgnervousgsystemg(CNS)gstimulant;gyougwouldgexpectghergtog
beghypertensive,gtachycardic,gtachypneic,gandgperhapsgevengviolent.gHeroin,gValium,ga
ndgSeconalgaregallgCNSgdepressantsgandgcouldgexplainghergcondition.gHeroingisgangillega
lgnarcoticg(opiate),gValiumgisgagbenzodiazepinegsedative-
hypnoticgdrug,gandgSeconalgisgagbarbiturate.gNarcotics,gbenzodiazepines,gandgbarbitur
atesgaregallgCNSgdepressants.gWhengtakengingexcess,gtheygcausegagdecreasedglevelgofgco
nsciousness,grespiratorygdepression,gbradycardia,gandghypotension.
Activatedgcharcoalgisgcontraindicatedgforgagpatientgwhogis:
•gA:consciousgandgalertgandghasgingestedgaglargegamountgofgMotrin.
•gB:emotionallygupsetgandghasgingestedgtwogbottlesgofgaspirin.
•gC:agitatedgandgclaimsgtoghavegingestedgagbottlegofgTylenol.
•gD:awakegandgalertgandghasgswallowedgagcommercialgdraingcleaner.g-
gANSWER:YougselectedgD;gThisgisgcorrect!
Reason:Activatedgcharcoalgadsorbsg(sticksgto)gmanygingestedgsubstances,gpreventinggt
hemgfromgbeinggabsorbedgintogthegbodygbygthegstomachgorgintestines.gIngsomegcases,gy
ougmayggivegactivatedgcharcoalgtogpatientsgwhoghavegingestedgcertaingsubstances,gifga
pprovedgbygmedicalgcontrolgorglocalgprotocol.gActivatedgcharcoalgisgcontraindicatedgfor
gpatientsgwhoghavegingestedgangacidgorgalkalig(ie,gdraingcleaner)gorgagpetroleumgproduc
,tg(ie,ggasoline),gwhoghavegagdecreasedglevelgofgconsciousnessgandgcannotgprotectgtheirg
owngairway,gorgwhogaregunablegtogswallow.
ThegMOSTgobviousgwaygtogreducegheatglossgfromgradiationgandgconvectiongisgto:
•gA:movegawaygfromgagcoldgobject.
•gB:increasegmetabolismgbygshivering.
•gC:weargagthickgwind-proofgjacket.
•gD:movegtogagwarmergenvironment.g-gANSWER:yougselectedgD;gThisgisgcorrect!
Reason:Ingagcoldgenvironment,gthegbodyghasgtwogwaysgofgstayinggwarm:ggeneratingghe
atg(thermogenesis)gandgreducinggheatgloss.gRadiationgisgthegtransfergofgheatgbygradiantg
energy.gThegbodygcanglosegheatgbygradiation,gsuchgasgwhengagpersongstandsgingagcoldgro
om.gConvectiongoccursgwhengheatgisgtransferredgtogcirculatinggair,gasgwhengcoolgairgmo
vesgacrossgthegbody'sgsurface.gAgpersongstandinggingwindygcoldgweather,gwearingglight
weightgclothing,gisglosinggheatgtogthegenvironmentgmostlygbygconvection.gThegquickestg
andgmostgobviousgwaygtogdecreasegheatglossgfromgradiationgandgconvectiongisgtogmove
goutgofgthegcoldgenvironmentgandgseekgsheltergfromgwind.gShiveringgincreasesgthegbod
y'sgmetabolismgandgisgagmechanismgforggeneratinggheat,gnotgreducinggheatgloss.gLayers
gofgclothinggtrapgairgandgprovidegexcellentginsulation;gthus,glayeredgclothinggdecreasesg
heatglossgbettergthangagsingle,gthickgjacket.gConductiongisgthegdirectgtransfergofgheatgfro
mgagpartgofgthegbodygtogagcoldergobjectgbygdirectgcontact,gasgwhengagwarmghandgtouch
esgcoldgmetalgorgice.gThegmostgobviousgwaygtogdecreasegheatglossgbygconductiongisgtogr
emovegyourghandgfromgthegcoldgobject.
Agnear-drowninggisgMOSTgaccuratelygdefinedgas:
•gA:complicationsgwithing24ghoursgfollowinggsubmersiongingwater.
•gB:immediategdeathgduegtogprolongedgsubmersiongingwater.
•gC:survivalgforgatgleastg24ghoursgfollowinggsubmersiongingwater.
•gD:deathggreatergthang24ghoursgfollowinggsubmersiongingwater.g-
gANSWER:YougselectedgC;gThisgisgcorrect!
Reason:Collectively,gdrowninggandgnear-
drowninggaregreferredgtogasgsubmersionginjuries.gDrowninggisgdefinedgasgdeathgaftergs
ubmersiongingagliquidgmedium,gusuallygwater.gIngagdrowning,gdeathgisgeithergimmediat
egorgoccursgwithing24ghoursgfollowinggsubmersion.gNear-
drowninggisgdefinedgasgsurvival,gatgleastgtemporarilyg(24ghours),gaftergsubmersion.gItgsh
ouldgbegnoted,ghowever,gthatgcomplicationsgsuchgasgpneumoniagandgpulmonarygedem
agcangcausegdeathggreatergthang24ghoursgfollowinggsubmersion.gForgthisgreason,gallgpat
ientsgwithgagsubmersionginjurygshouldgbegtransportedgtogtheghospital,gevengifgtheygapp
eargfinegatgthegscene.
Agyounggwomangreportsgsignificantgweightglossgovergtheglastgmonth,gpersistentgfever,ga
ndgnightgsweats.gWhengyougassessgher,gyougnotegthegpresencegofgdarkgpurpleglesionsgc
overingghergtrunkgandguppergextremities.gYougshouldgsuspect:
•gA:end-stagegcancer.
•gB:HIV/AIDS.
•gC:tuberculosis.
, •gD:rheumaticgfever.g-gANSWER:YougselectedgB;gThisgisgcorrect!
Reason:Weightgloss,gfever,gandgnightgsweatsgcouldgindicategtuberculosisgorgHIV/AIDS;g
however,gthegdarkgpurpleglesionsgongthegskin,gwhichgaregcalledgKaposi'sgsarcoma,gareg
malignantgskingtumorsgandgaregagclassicgfindinggingpatientsgingtheglatergstagesgofgAIDS.
Ag48-year-
oldgmalegbecamegacutelyghypoxic,gexperiencedgagseizure,gandgisgnowgpostictal.gThegM
OSTgeffectivegwaygtogpreventganothergseizuregisgto:
•gA:dimgtheglightsgingthegbackgofgthegambulance.
•gB:placeghimgingthegrecoverygposition.
•gC:administerghigh-flowgsupplementalgoxygen.
•gD:giveghimgoralgglucosegifghegcangswallow.g-gANSWER:YougselectedgC;gThisgisgcorrect!
Reason:Yougshouldgadministerghigh-
flowgoxygengtogallgpatientsgwhogaregactivelygseizinggandgtogpatientsgwhogexperiencedga
gseizuregandgaregpostictal.gThisgisgespeciallygtruegifgthegseizuregwasgcausedgbyghypoxia.gI
ncreasinggthegoxygengcontentgofgthegblood,gwhichgminimizesghypoxia,gmaygpreventgan
othergseizure.gThegrecoverygpositiongisgappropriategforguninjuredgpatientsgwithgagdecre
asedglevelgofgconsciousnessgandgadequategbreathing;gitgwillghelpgmaintaingthegairwayga
ndgfacilitategdrainagegofgsecretionsgfromgthegmouth,gbutgwillgnotgpreventganothergseiz
ure.gOralgglucosegmaygpreventganothergseizuregifghypoglycemiagwasgthegcausegofgthegs
eizure.gYougshouldgdimgtheglightsgingthegbackgofgthegambulancegtoghelpgpreventganygsei
zure,gnotgjustgthosegthatgaregcausedgbyghypoxia.
WhichgofgthegfollowinggconditionsgwouldgbegthegLEASTglikelygtogbegpresentgingagpatientg
whogwasgsubmergedgingwater?
•gA:Spinalginjury
•gB:Gastricgdistention
•gC:Hyperglycemia
•gD:Laryngospasmg-gANSWER:YougselectedgC;gThisgisgcorrect!
Reason:gManygfactorsgcangcontributegtogorgresultgfromgagsubmersionginjuryg(eg,gdrowni
ng,gnear-
drowning).gItgisgnotguncommongforgagpersongtogexperiencegagspinalginjurygaftergdivinggh
eadgfirstgintogshallowgwater,gespeciallygifghegorgshegisgundergtheginfluencegofgalcohol.gW
hengagswimmergpanics,ghegorgsheginitiallygswallowsglargegamountsgofgwater,gresultinggi
nggastricgdistention.gGastricgdistentiongcangcausegaspirationgifgthegpatientgregurgitatesg
watergduringgrescuegbreathing;gprotectgthegairway!gDuringgthegpanicgphase,gthegvictimg
expendsgagtremendousgamountgofgenergyg(andgglucose)gfromgflailinggaroundgingthegwa
ter,gpossiblygresultingginghypoglycemia.gInhalinggevengagsmallgamountgofgfreshgorgsaltgw
atergcangseverelygirritategtheglarynx,gwhichgsendsgthegmusclesgofgtheglarynxgandgvocalgc
ordsgintogspasmg(laryngospasm),gresultinggingairwaygblockagegandghypoxia.
Ag42-year-
oldgmalegpresentsgwithgfever,gagseveregheadache,gandgagstiffgneck.gHegisgconscious,gbutg
g g g g g g g g
y Jill C. Cash; Cheryl A. Glass
g g g g g g
Hypoglycemiagandgacutegischemicgstrokegcangpresentgsimilarlygbecause:
•gA:bothgoxygengandgglucosegaregneededgforgbraingfunction.
•gB:thegmajoritygofgstrokegpatientsghavegaghistorygofgdiabetes.
•gC:thegmostgcommongcausegofgagstrokegisghypoglycemia.
•gD:theygaregbothgcausedgbyglowglevelsgofgglucosegingthegblood.g-
gANSWER:•gA:bothgoxygengandgglucosegaregneededgforgbraingfunction.
Reason:gAlthoughgstrokegandghypoglycemiagaregtwogdistinctlygdifferentgconditions,gthe
irgsignsgandgsymptomsgaregoftengsimilar.gThisgisgbecausegthegbraingrequiresgbothgoxyge
ngandgglucosegtogfunctiongnormally.gAngacutegischemicgstrokegisgcausedgbygaglackgofgoxy
gengtogagpartgofgthegbraingduegtogagblockedgcerebralgartery,gwhereasghypoglycemiag(lo
wgbloodgglucoseglevel)gdeprivesgthegentiregbraingofgglucose.gIngeithergcase,gthegpatientg
presentsgwithgsignsgofgimpairedgbraingfunctiong(ie,gslurredgspeech,gweakness,galteredg
mentalgstatus).gBothgconditionsgmaygleadgtogpermanentgbraingdamagegorgdeathgifgnotgt
reatedgpromptly.
Whengdealinggwithgangemotionallygdisturbedgpatient,gyougshouldgbegMOSTgconcernedg
with:
•gA:gatheringgallgofgthegpatient'sgmedications.
•gB:safelygtransportinggtogtheghospital.
•gC:whethergthegpatientgcouldgharmgyou.
•gD:obtaininggagcompletegmedicalghistory.g-gANSWER:YougselectedgC;gThisgisgcorrect!
Reason:gWhengmanagingganygpatientgwithgangemotionalgorgpsychiatricgcrisis,gyourgprim
arygconcerngisgyourgowngsafety.gSafelygtransportinggthegpatientgtogtheghospitalgisgyourg
ultimateggoal.gIfgpossible,gyougshouldgattemptgtogobtaingagmedicalghistorygandgshouldgt
akeganygofgthegpatient'sgprescribedgmedicationsgtogtheghospital.gHowever,gthisgshouldg
notgsupercedegyourgowngsafetygorginterferegwithgsafelygtransportinggthegpatient.
Yougaregatgthegscenegwheregagmangpanickedgwhilegswimminggingagsmallglake.gYourginitia
lgattemptgtogrescueghimgshouldginclude:
•gA:rowinggagsmallgraftgtogthegvictim.
•gB:reachinggforgthegvictimgwithgaglonggstick.
•gC:throwinggagropegtogthegvictim.
•gD:swimminggtogthegvictimgtogrescueghim.g-gANSWER:YougselectedgB;gThisgisgcorrect!
Reason:gGeneralgrulesgtogfollowgwhengattemptinggtogrescuegagpatientgfromgthegwatergi
ncludeg"reach,gthrow,grow,gandgthenggo."gIngthisgcase,gyougshouldgattemptgtogreachgthe
gvictimgbyghavingghimggrabgholdgofgaglargegstickgorgsimilargobject.gIfgthisgisgunsuccessful,g
throwgthegvictimgagropegorgflotationgdeviceg(ifgavailable).gIfgthesegaregnotgavailable,grow
gtogthegpatientgingagsmallgraftg(ifgavailable).gGoinggintogthegwatergtogretrievegthegvictimgi
,sgaglastgresort.gThegrescuergmustgbegagstronggswimmergbecausegpatientsgwhogaregingda
ngergofgdrowninggaregingagstategofgblindgpanicgandgwillgmakegeverygattemptgtogkeepgthe
mselvesgafloat,gevengifgitgmeansgforcinggthegrescuergunderwater.
Howgshouldgyougclassifygagpatient'sgnaturegofgillnessgifghegorgsheghasgaglowgbloodgglucos
eglevel,gbizarregbehavior,gandgshallowgbreathing?
•gA:Behavioralgemergency
•gB:Alteredgmentalgstatus
•gC:Respiratorygemergency
•gD:Cardiacgcompromiseg-gANSWER:ThegcorrectganswergisgB;
Reason:gThegnaturegofgillnessg(NOI)gisgthegmedicalgequivalentgtogmechanismgofginjuryg(
MOI).gAlteredgmentalgstatusgshouldgbegthegsuspectedgNOIginganygpatientgwithganygfluct
uationginglevelgofgconsciousness,gwhichgcangrangegfromgbizarregbehaviorgtogcompletegu
nresponsiveness.gCausesgofgangalteredgmentalgstatusgincludeghypo-
gorghyperglycemia,gheadgtrauma,gstroke,gbehavioralgcrises,gdruggoverdose,gandgshock,g
amonggothers.
Agyounggfemalegisgunresponsivegaftergoverdosinggongangunknowngtypegofgdrug.gHergres
pirationsgaregslowgandgshallowgandghergpulsegisgslowgandgweak.gWhichgofgthegfollowingg
drugsgisgthegLEASTglikelygcausegofghergcondition?
•gA:Seconal
•gB:Heroin
•gC:Cocaine
•gD:Valiumg-gANSWER:ThegcorrectganswergisgC;
Reason:gOfgthegdrugsglisted,gcocainegwouldgbegthegleastglikelygcausegofgthegpatient'sgco
ndition.gCocainegisgagcentralgnervousgsystemg(CNS)gstimulant;gyougwouldgexpectghergtog
beghypertensive,gtachycardic,gtachypneic,gandgperhapsgevengviolent.gHeroin,gValium,ga
ndgSeconalgaregallgCNSgdepressantsgandgcouldgexplainghergcondition.gHeroingisgangillega
lgnarcoticg(opiate),gValiumgisgagbenzodiazepinegsedative-
hypnoticgdrug,gandgSeconalgisgagbarbiturate.gNarcotics,gbenzodiazepines,gandgbarbitur
atesgaregallgCNSgdepressants.gWhengtakengingexcess,gtheygcausegagdecreasedglevelgofgco
nsciousness,grespiratorygdepression,gbradycardia,gandghypotension.
Activatedgcharcoalgisgcontraindicatedgforgagpatientgwhogis:
•gA:consciousgandgalertgandghasgingestedgaglargegamountgofgMotrin.
•gB:emotionallygupsetgandghasgingestedgtwogbottlesgofgaspirin.
•gC:agitatedgandgclaimsgtoghavegingestedgagbottlegofgTylenol.
•gD:awakegandgalertgandghasgswallowedgagcommercialgdraingcleaner.g-
gANSWER:YougselectedgD;gThisgisgcorrect!
Reason:Activatedgcharcoalgadsorbsg(sticksgto)gmanygingestedgsubstances,gpreventinggt
hemgfromgbeinggabsorbedgintogthegbodygbygthegstomachgorgintestines.gIngsomegcases,gy
ougmayggivegactivatedgcharcoalgtogpatientsgwhoghavegingestedgcertaingsubstances,gifga
pprovedgbygmedicalgcontrolgorglocalgprotocol.gActivatedgcharcoalgisgcontraindicatedgfor
gpatientsgwhoghavegingestedgangacidgorgalkalig(ie,gdraingcleaner)gorgagpetroleumgproduc
,tg(ie,ggasoline),gwhoghavegagdecreasedglevelgofgconsciousnessgandgcannotgprotectgtheirg
owngairway,gorgwhogaregunablegtogswallow.
ThegMOSTgobviousgwaygtogreducegheatglossgfromgradiationgandgconvectiongisgto:
•gA:movegawaygfromgagcoldgobject.
•gB:increasegmetabolismgbygshivering.
•gC:weargagthickgwind-proofgjacket.
•gD:movegtogagwarmergenvironment.g-gANSWER:yougselectedgD;gThisgisgcorrect!
Reason:Ingagcoldgenvironment,gthegbodyghasgtwogwaysgofgstayinggwarm:ggeneratingghe
atg(thermogenesis)gandgreducinggheatgloss.gRadiationgisgthegtransfergofgheatgbygradiantg
energy.gThegbodygcanglosegheatgbygradiation,gsuchgasgwhengagpersongstandsgingagcoldgro
om.gConvectiongoccursgwhengheatgisgtransferredgtogcirculatinggair,gasgwhengcoolgairgmo
vesgacrossgthegbody'sgsurface.gAgpersongstandinggingwindygcoldgweather,gwearingglight
weightgclothing,gisglosinggheatgtogthegenvironmentgmostlygbygconvection.gThegquickestg
andgmostgobviousgwaygtogdecreasegheatglossgfromgradiationgandgconvectiongisgtogmove
goutgofgthegcoldgenvironmentgandgseekgsheltergfromgwind.gShiveringgincreasesgthegbod
y'sgmetabolismgandgisgagmechanismgforggeneratinggheat,gnotgreducinggheatgloss.gLayers
gofgclothinggtrapgairgandgprovidegexcellentginsulation;gthus,glayeredgclothinggdecreasesg
heatglossgbettergthangagsingle,gthickgjacket.gConductiongisgthegdirectgtransfergofgheatgfro
mgagpartgofgthegbodygtogagcoldergobjectgbygdirectgcontact,gasgwhengagwarmghandgtouch
esgcoldgmetalgorgice.gThegmostgobviousgwaygtogdecreasegheatglossgbygconductiongisgtogr
emovegyourghandgfromgthegcoldgobject.
Agnear-drowninggisgMOSTgaccuratelygdefinedgas:
•gA:complicationsgwithing24ghoursgfollowinggsubmersiongingwater.
•gB:immediategdeathgduegtogprolongedgsubmersiongingwater.
•gC:survivalgforgatgleastg24ghoursgfollowinggsubmersiongingwater.
•gD:deathggreatergthang24ghoursgfollowinggsubmersiongingwater.g-
gANSWER:YougselectedgC;gThisgisgcorrect!
Reason:Collectively,gdrowninggandgnear-
drowninggaregreferredgtogasgsubmersionginjuries.gDrowninggisgdefinedgasgdeathgaftergs
ubmersiongingagliquidgmedium,gusuallygwater.gIngagdrowning,gdeathgisgeithergimmediat
egorgoccursgwithing24ghoursgfollowinggsubmersion.gNear-
drowninggisgdefinedgasgsurvival,gatgleastgtemporarilyg(24ghours),gaftergsubmersion.gItgsh
ouldgbegnoted,ghowever,gthatgcomplicationsgsuchgasgpneumoniagandgpulmonarygedem
agcangcausegdeathggreatergthang24ghoursgfollowinggsubmersion.gForgthisgreason,gallgpat
ientsgwithgagsubmersionginjurygshouldgbegtransportedgtogtheghospital,gevengifgtheygapp
eargfinegatgthegscene.
Agyounggwomangreportsgsignificantgweightglossgovergtheglastgmonth,gpersistentgfever,ga
ndgnightgsweats.gWhengyougassessgher,gyougnotegthegpresencegofgdarkgpurpleglesionsgc
overingghergtrunkgandguppergextremities.gYougshouldgsuspect:
•gA:end-stagegcancer.
•gB:HIV/AIDS.
•gC:tuberculosis.
, •gD:rheumaticgfever.g-gANSWER:YougselectedgB;gThisgisgcorrect!
Reason:Weightgloss,gfever,gandgnightgsweatsgcouldgindicategtuberculosisgorgHIV/AIDS;g
however,gthegdarkgpurpleglesionsgongthegskin,gwhichgaregcalledgKaposi'sgsarcoma,gareg
malignantgskingtumorsgandgaregagclassicgfindinggingpatientsgingtheglatergstagesgofgAIDS.
Ag48-year-
oldgmalegbecamegacutelyghypoxic,gexperiencedgagseizure,gandgisgnowgpostictal.gThegM
OSTgeffectivegwaygtogpreventganothergseizuregisgto:
•gA:dimgtheglightsgingthegbackgofgthegambulance.
•gB:placeghimgingthegrecoverygposition.
•gC:administerghigh-flowgsupplementalgoxygen.
•gD:giveghimgoralgglucosegifghegcangswallow.g-gANSWER:YougselectedgC;gThisgisgcorrect!
Reason:Yougshouldgadministerghigh-
flowgoxygengtogallgpatientsgwhogaregactivelygseizinggandgtogpatientsgwhogexperiencedga
gseizuregandgaregpostictal.gThisgisgespeciallygtruegifgthegseizuregwasgcausedgbyghypoxia.gI
ncreasinggthegoxygengcontentgofgthegblood,gwhichgminimizesghypoxia,gmaygpreventgan
othergseizure.gThegrecoverygpositiongisgappropriategforguninjuredgpatientsgwithgagdecre
asedglevelgofgconsciousnessgandgadequategbreathing;gitgwillghelpgmaintaingthegairwayga
ndgfacilitategdrainagegofgsecretionsgfromgthegmouth,gbutgwillgnotgpreventganothergseiz
ure.gOralgglucosegmaygpreventganothergseizuregifghypoglycemiagwasgthegcausegofgthegs
eizure.gYougshouldgdimgtheglightsgingthegbackgofgthegambulancegtoghelpgpreventganygsei
zure,gnotgjustgthosegthatgaregcausedgbyghypoxia.
WhichgofgthegfollowinggconditionsgwouldgbegthegLEASTglikelygtogbegpresentgingagpatientg
whogwasgsubmergedgingwater?
•gA:Spinalginjury
•gB:Gastricgdistention
•gC:Hyperglycemia
•gD:Laryngospasmg-gANSWER:YougselectedgC;gThisgisgcorrect!
Reason:gManygfactorsgcangcontributegtogorgresultgfromgagsubmersionginjuryg(eg,gdrowni
ng,gnear-
drowning).gItgisgnotguncommongforgagpersongtogexperiencegagspinalginjurygaftergdivinggh
eadgfirstgintogshallowgwater,gespeciallygifghegorgshegisgundergtheginfluencegofgalcohol.gW
hengagswimmergpanics,ghegorgsheginitiallygswallowsglargegamountsgofgwater,gresultinggi
nggastricgdistention.gGastricgdistentiongcangcausegaspirationgifgthegpatientgregurgitatesg
watergduringgrescuegbreathing;gprotectgthegairway!gDuringgthegpanicgphase,gthegvictimg
expendsgagtremendousgamountgofgenergyg(andgglucose)gfromgflailinggaroundgingthegwa
ter,gpossiblygresultingginghypoglycemia.gInhalinggevengagsmallgamountgofgfreshgorgsaltgw
atergcangseverelygirritategtheglarynx,gwhichgsendsgthegmusclesgofgtheglarynxgandgvocalgc
ordsgintogspasmg(laryngospasm),gresultinggingairwaygblockagegandghypoxia.
Ag42-year-
oldgmalegpresentsgwithgfever,gagseveregheadache,gandgagstiffgneck.gHegisgconscious,gbutg
