TEST BANKS For Family Practice Guidelines, 6th Edition
g g g g g g g g
by 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,gt
heirgsignsgandgsymptomsgaregoftengsimilar.gThisgisgbecausegthegbraingrequiresgbothgo
xygengandgglucosegtogfunctiongnormally.gAngacutegischemicgstrokegisgcausedgbygaglac
kgofgoxygengtogagpartgofgthegbraingduegtogagblockedgcerebralgartery,gwhereasghypogl
ycemiag(lowgbloodgglucoseglevel)gdeprivesgthegentiregbraingofgglucose.gIngeithergcase
,gthegpatientgpresentsgwithgsignsgofgimpairedgbraingfunctiong(ie,gslurredgspeech,gwea
kness,galteredgmentalgstatus).gBothgconditionsgmaygleadgtogpermanentgbraingdamag
egorgdeathgifgnotgtreatedgpromptly.
Whengdealinggwithgangemotionallygdisturbedgpatient,gyougshouldgbegMOSTgconcern
edgwith:
•gA:gatheringgallgofgthegpatient'sgmedications.
•gB:safelygtransportinggtogtheghospital.
•gC:whethergthegpatientgcouldgharmgyou.
•gD:obtaininggagcompletegmedicalghistory.g-gANSWER:YougselectedgC;gThisgisgcorrect!
Reason:gWhengmanagingganygpatientgwithgangemotionalgorgpsychiatricgcrisis,gyourgpr
imarygconcerngisgyourgowngsafety.gSafelygtransportinggthegpatientgtogtheghospitalgisg
yourgultimateggoal.gIfgpossible,gyougshouldgattemptgtogobtaingagmedicalghistorygandg
shouldgtakeganygofgthegpatient'sgprescribedgmedicationsgtogtheghospital.gHowever,gt
hisgshouldgnotgsupercedegyourgowngsafetygorginterferegwithgsafelygtransportinggtheg
patient.
Yougaregatgthegscenegwheregagmangpanickedgwhilegswimminggingagsmallglake.gYourgin
itialgattemptgtogrescueghimgshouldginclude:
•gA:rowinggagsmallgraftgtogthegvictim.
•gB:reachinggforgthegvictimgwithgaglonggstick.
•gC:throwinggagropegtogthegvictim.
•gD:swimminggtogthegvictimgtogrescueghim.g-gANSWER:YougselectedgB;gThisgisgcorrect!
Reason:gGeneralgrulesgtogfollowgwhengattemptinggtogrescuegagpatientgfromgthegwate
rgincludeg"reach,gthrow,grow,gandgthenggo."gIngthisgcase,gyougshouldgattemptgtogreac
hgthegvictimgbyghavingghimggrabgholdgofgaglargegstickgorgsimilargobject.gIfgthisgisgunsu
ccessful,gthrowgthegvictimgagropegorgflotationgdeviceg(ifgavailable).gIfgthesegaregnotga
,vailable,growgtogthegpatientgingagsmallgraftg(ifgavailable).gGoinggintogthegwatergtogretr
ievegthegvictimgisgaglastgresort.gThegrescuergmustgbegagstronggswimmergbecausegpati
entsgwhogaregingdangergofgdrowninggaregingagstategofgblindgpanicgandgwillgmakegever
ygattemptgtogkeepgthemselvesgafloat,gevengifgitgmeansgforcinggthegrescuergunderwat
er.
Howgshouldgyougclassifygagpatient'sgnaturegofgillnessgifghegorgsheghasgaglowgbloodgglu
coseglevel,gbizarregbehavior,gandgshallowgbreathing?
•gA:Behavioralgemergency
•gB:Alteredgmentalgstatus
•gC:Respiratorygemergency
•gD:Cardiacgcompromiseg-gANSWER:ThegcorrectganswergisgB;
Reason:gThegnaturegofgillnessg(NOI)gisgthegmedicalgequivalentgtogmechanismgofginjur
yg(MOI).gAlteredgmentalgstatusgshouldgbegthegsuspectedgNOIginganygpatientgwithgany
gfluctuationginglevelgofgconsciousness,gwhichgcangrangegfromgbizarregbehaviorgtogco
mpletegunresponsiveness.gCausesgofgangalteredgmentalgstatusgincludeghypo-
gorghyperglycemia,gheadgtrauma,gstroke,gbehavioralgcrises,gdruggoverdose,gandgshoc
k,gamonggothers.
Agyounggfemalegisgunresponsivegaftergoverdosinggongangunknowngtypegofgdrug.gHerg
respirationsgaregslowgandgshallowgandghergpulsegisgslowgandgweak.gWhichgofgthegfoll
owinggdrugsgisgthegLEASTglikelygcausegofghergcondition?
•gA:Seconal
•gB:Heroin
•gC:Cocaine
•gD:Valiumg-gANSWER:ThegcorrectganswergisgC;
Reason:gOfgthegdrugsglisted,gcocainegwouldgbegthegleastglikelygcausegofgthegpatient'sg
condition.gCocainegisgagcentralgnervousgsystemg(CNS)gstimulant;gyougwouldgexpectgh
ergtogbeghypertensive,gtachycardic,gtachypneic,gandgperhapsgevengviolent.gHeroin,gV
alium,gandgSeconalgaregallgCNSgdepressantsgandgcouldgexplainghergcondition.gHeroing
isgangillegalgnarcoticg(opiate),gValiumgisgagbenzodiazepinegsedative-
hypnoticgdrug,gandgSeconalgisgagbarbiturate.gNarcotics,gbenzodiazepines,gandgbarbit
uratesgaregallgCNSgdepressants.gWhengtakengingexcess,gtheygcausegagdecreasedglevelg
ofgconsciousness,grespiratorygdepression,gbradycardia,gandghypotension.
Activatedgcharcoalgisgcontraindicatedgforgagpatientgwhogis:
•gA:consciousgandgalertgandghasgingestedgaglargegamountgofgMotrin.
•gB:emotionallygupsetgandghasgingestedgtwogbottlesgofgaspirin.
•gC:agitatedgandgclaimsgtoghavegingestedgagbottlegofgTylenol.
•gD:awakegandgalertgandghasgswallowedgagcommercialgdraingcleaner.g-
gANSWER:YougselectedgD;gThisgisgcorrect!
Reason:Activatedgcharcoalgadsorbsg(sticksgto)gmanygingestedgsubstances,gpreventing
gthemgfromgbeinggabsorbedgintogthegbodygbygthegstomachgorgintestines.gIngsomegcas
es,gyougmayggivegactivatedgcharcoalgtogpatientsgwhoghavegingestedgcertaingsubstanc
,es,gifgapprovedgbygmedicalgcontrolgorglocalgprotocol.gActivatedgcharcoalgisgcontraindi
catedgforgpatientsgwhoghavegingestedgangacidgorgalkalig(ie,gdraingcleaner)gorgagpetrol
eumgproductg(ie,ggasoline),gwhoghavegagdecreasedglevelgofgconsciousnessgandgcanno
tgprotectgtheirgowngairway,gorgwhogaregunablegtogswallow.
ThegMOSTgobviousgwaygtogreducegheatglossgfromgradiationgandgconvectiongisgto:
•gA:movegawaygfromgagcoldgobject.
•gB:increasegmetabolismgbygshivering.
•gC:weargagthickgwind-proofgjacket.
•gD:movegtogagwarmergenvironment.g-gANSWER:yougselectedgD;gThisgisgcorrect!
Reason:Ingagcoldgenvironment,gthegbodyghasgtwogwaysgofgstayinggwarm:ggeneratingg
heatg(thermogenesis)gandgreducinggheatgloss.gRadiationgisgthegtransfergofgheatgbygra
diantgenergy.gThegbodygcanglosegheatgbygradiation,gsuchgasgwhengagpersongstandsging
agcoldgroom.gConvectiongoccursgwhengheatgisgtransferredgtogcirculatinggair,gasgwheng
coolgairgmovesgacrossgthegbody'sgsurface.gAgpersongstandinggingwindygcoldgweather,g
wearingglightweightgclothing,gisglosinggheatgtogthegenvironmentgmostlygbygconvectio
n.gThegquickestgandgmostgobviousgwaygtogdecreasegheatglossgfromgradiationgandgcon
vectiongisgtogmovegoutgofgthegcoldgenvironmentgandgseekgsheltergfromgwind.gShiveri
nggincreasesgthegbody'sgmetabolismgandgisgagmechanismgforggeneratinggheat,gnotgre
ducinggheatgloss.gLayersgofgclothinggtrapgairgandgprovidegexcellentginsulation;gthus,gl
ayeredgclothinggdecreasesgheatglossgbettergthangagsingle,gthickgjacket.gConductiongisg
thegdirectgtransfergofgheatgfromgagpartgofgthegbodygtogagcoldergobjectgbygdirectgcont
act,gasgwhengagwarmghandgtouchesgcoldgmetalgorgice.gThegmostgobviousgwaygtogdecr
easegheatglossgbygconductiongisgtogremovegyourghandgfromgthegcoldgobject.
Agnear-drowninggisgMOSTgaccuratelygdefinedgas:
•gA:complicationsgwithing24ghoursgfollowinggsubmersiongingwater.
•gB:immediategdeathgduegtogprolongedgsubmersiongingwater.
•gC:survivalgforgatgleastg24ghoursgfollowinggsubmersiongingwater.
•gD:deathggreatergthang24ghoursgfollowinggsubmersiongingwater.g-
gANSWER:YougselectedgC;gThisgisgcorrect!
Reason:Collectively,gdrowninggandgnear-
drowninggaregreferredgtogasgsubmersionginjuries.gDrowninggisgdefinedgasgdeathgafter
gsubmersiongingagliquidgmedium,gusuallygwater.gIngagdrowning,gdeathgisgeithergimme
diategorgoccursgwithing24ghoursgfollowinggsubmersion.gNear-
drowninggisgdefinedgasgsurvival,gatgleastgtemporarilyg(24ghours),gaftergsubmersion.gIt
gshouldgbegnoted,ghowever,gthatgcomplicationsgsuchgasgpneumoniagandgpulmonaryg
edemagcangcausegdeathggreatergthang24ghoursgfollowinggsubmersion.gForgthisgreaso
n,gallgpatientsgwithgagsubmersionginjurygshouldgbegtransportedgtogtheghospital,geveng
ifgtheygappeargfinegatgthegscene.
Agyounggwomangreportsgsignificantgweightglossgovergtheglastgmonth,gpersistentgfeve
r,gandgnightgsweats.gWhengyougassessgher,gyougnotegthegpresencegofgdarkgpurpleglesi
onsgcoveringghergtrunkgandguppergextremities.gYougshouldgsuspect:
•gA:end-stagegcancer.
, •gB:HIV/AIDS.
•gC:tuberculosis.
•gD:rheumaticgfever.g-gANSWER:YougselectedgB;gThisgisgcorrect!
Reason:Weightgloss,gfever,gandgnightgsweatsgcouldgindicategtuberculosisgorgHIV/AIDS
;ghowever,gthegdarkgpurpleglesionsgongthegskin,gwhichgaregcalledgKaposi'sgsarcoma,ga
regmalignantgskingtumorsgandgaregagclassicgfindinggingpatientsgingtheglatergstagesgofgA
IDS.
Ag48-year-
oldgmalegbecamegacutelyghypoxic,gexperiencedgagseizure,gandgisgnowgpostictal.gTheg
MOSTgeffectivegwaygtogpreventganothergseizuregisgto:
•gA:dimgtheglightsgingthegbackgofgthegambulance.
•gB:placeghimgingthegrecoverygposition.
•gC:administerghigh-flowgsupplementalgoxygen.
•gD:giveghimgoralgglucosegifghegcangswallow.g-
gANSWER:YougselectedgC;gThisgisgcorrect!
Reason:Yougshouldgadministerghigh-
flowgoxygengtogallgpatientsgwhogaregactivelygseizinggandgtogpatientsgwhogexperience
dgagseizuregandgaregpostictal.gThisgisgespeciallygtruegifgthegseizuregwasgcausedgbyghyp
oxia.gIncreasinggthegoxygengcontentgofgthegblood,gwhichgminimizesghypoxia,gmaygpre
ventganothergseizure.gThegrecoverygpositiongisgappropriategforguninjuredgpatientsgwi
thgagdecreasedglevelgofgconsciousnessgandgadequategbreathing;gitgwillghelpgmaintaing
thegairwaygandgfacilitategdrainagegofgsecretionsgfromgthegmouth,gbutgwillgnotgpreven
tganothergseizure.gOralgglucosegmaygpreventganothergseizuregifghypoglycemiagwasgth
egcausegofgthegseizure.gYougshouldgdimgtheglightsgingthegbackgofgthegambulancegtogh
elpgpreventganygseizure,gnotgjustgthosegthatgaregcausedgbyghypoxia.
WhichgofgthegfollowinggconditionsgwouldgbegthegLEASTglikelygtogbegpresentgingagpati
entgwhogwasgsubmergedgingwater?
•gA:Spinalginjury
•gB:Gastricgdistention
•gC:Hyperglycemia
•gD:Laryngospasmg-gANSWER:YougselectedgC;gThisgisgcorrect!
Reason:gManygfactorsgcangcontributegtogorgresultgfromgagsubmersionginjuryg(eg,gdro
wning,gnear-
drowning).gItgisgnotguncommongforgagpersongtogexperiencegagspinalginjurygaftergdivin
ggheadgfirstgintogshallowgwater,gespeciallygifghegorgshegisgundergtheginfluencegofgalco
hol.gWhengagswimmergpanics,ghegorgsheginitiallygswallowsglargegamountsgofgwater,gr
esultingginggastricgdistention.gGastricgdistentiongcangcausegaspirationgifgthegpatientgr
egurgitatesgwatergduringgrescuegbreathing;gprotectgthegairway!gDuringgthegpanicgph
ase,gthegvictimgexpendsgagtremendousgamountgofgenergyg(andgglucose)gfromgflailingg
aroundgingthegwater,gpossiblygresultingginghypoglycemia.gInhalinggevengagsmallgamou
ntgofgfreshgorgsaltgwatergcangseverelygirritategtheglarynx,gwhichgsendsgthegmusclesgof
g g g g g g g g
by 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,gt
heirgsignsgandgsymptomsgaregoftengsimilar.gThisgisgbecausegthegbraingrequiresgbothgo
xygengandgglucosegtogfunctiongnormally.gAngacutegischemicgstrokegisgcausedgbygaglac
kgofgoxygengtogagpartgofgthegbraingduegtogagblockedgcerebralgartery,gwhereasghypogl
ycemiag(lowgbloodgglucoseglevel)gdeprivesgthegentiregbraingofgglucose.gIngeithergcase
,gthegpatientgpresentsgwithgsignsgofgimpairedgbraingfunctiong(ie,gslurredgspeech,gwea
kness,galteredgmentalgstatus).gBothgconditionsgmaygleadgtogpermanentgbraingdamag
egorgdeathgifgnotgtreatedgpromptly.
Whengdealinggwithgangemotionallygdisturbedgpatient,gyougshouldgbegMOSTgconcern
edgwith:
•gA:gatheringgallgofgthegpatient'sgmedications.
•gB:safelygtransportinggtogtheghospital.
•gC:whethergthegpatientgcouldgharmgyou.
•gD:obtaininggagcompletegmedicalghistory.g-gANSWER:YougselectedgC;gThisgisgcorrect!
Reason:gWhengmanagingganygpatientgwithgangemotionalgorgpsychiatricgcrisis,gyourgpr
imarygconcerngisgyourgowngsafety.gSafelygtransportinggthegpatientgtogtheghospitalgisg
yourgultimateggoal.gIfgpossible,gyougshouldgattemptgtogobtaingagmedicalghistorygandg
shouldgtakeganygofgthegpatient'sgprescribedgmedicationsgtogtheghospital.gHowever,gt
hisgshouldgnotgsupercedegyourgowngsafetygorginterferegwithgsafelygtransportinggtheg
patient.
Yougaregatgthegscenegwheregagmangpanickedgwhilegswimminggingagsmallglake.gYourgin
itialgattemptgtogrescueghimgshouldginclude:
•gA:rowinggagsmallgraftgtogthegvictim.
•gB:reachinggforgthegvictimgwithgaglonggstick.
•gC:throwinggagropegtogthegvictim.
•gD:swimminggtogthegvictimgtogrescueghim.g-gANSWER:YougselectedgB;gThisgisgcorrect!
Reason:gGeneralgrulesgtogfollowgwhengattemptinggtogrescuegagpatientgfromgthegwate
rgincludeg"reach,gthrow,grow,gandgthenggo."gIngthisgcase,gyougshouldgattemptgtogreac
hgthegvictimgbyghavingghimggrabgholdgofgaglargegstickgorgsimilargobject.gIfgthisgisgunsu
ccessful,gthrowgthegvictimgagropegorgflotationgdeviceg(ifgavailable).gIfgthesegaregnotga
,vailable,growgtogthegpatientgingagsmallgraftg(ifgavailable).gGoinggintogthegwatergtogretr
ievegthegvictimgisgaglastgresort.gThegrescuergmustgbegagstronggswimmergbecausegpati
entsgwhogaregingdangergofgdrowninggaregingagstategofgblindgpanicgandgwillgmakegever
ygattemptgtogkeepgthemselvesgafloat,gevengifgitgmeansgforcinggthegrescuergunderwat
er.
Howgshouldgyougclassifygagpatient'sgnaturegofgillnessgifghegorgsheghasgaglowgbloodgglu
coseglevel,gbizarregbehavior,gandgshallowgbreathing?
•gA:Behavioralgemergency
•gB:Alteredgmentalgstatus
•gC:Respiratorygemergency
•gD:Cardiacgcompromiseg-gANSWER:ThegcorrectganswergisgB;
Reason:gThegnaturegofgillnessg(NOI)gisgthegmedicalgequivalentgtogmechanismgofginjur
yg(MOI).gAlteredgmentalgstatusgshouldgbegthegsuspectedgNOIginganygpatientgwithgany
gfluctuationginglevelgofgconsciousness,gwhichgcangrangegfromgbizarregbehaviorgtogco
mpletegunresponsiveness.gCausesgofgangalteredgmentalgstatusgincludeghypo-
gorghyperglycemia,gheadgtrauma,gstroke,gbehavioralgcrises,gdruggoverdose,gandgshoc
k,gamonggothers.
Agyounggfemalegisgunresponsivegaftergoverdosinggongangunknowngtypegofgdrug.gHerg
respirationsgaregslowgandgshallowgandghergpulsegisgslowgandgweak.gWhichgofgthegfoll
owinggdrugsgisgthegLEASTglikelygcausegofghergcondition?
•gA:Seconal
•gB:Heroin
•gC:Cocaine
•gD:Valiumg-gANSWER:ThegcorrectganswergisgC;
Reason:gOfgthegdrugsglisted,gcocainegwouldgbegthegleastglikelygcausegofgthegpatient'sg
condition.gCocainegisgagcentralgnervousgsystemg(CNS)gstimulant;gyougwouldgexpectgh
ergtogbeghypertensive,gtachycardic,gtachypneic,gandgperhapsgevengviolent.gHeroin,gV
alium,gandgSeconalgaregallgCNSgdepressantsgandgcouldgexplainghergcondition.gHeroing
isgangillegalgnarcoticg(opiate),gValiumgisgagbenzodiazepinegsedative-
hypnoticgdrug,gandgSeconalgisgagbarbiturate.gNarcotics,gbenzodiazepines,gandgbarbit
uratesgaregallgCNSgdepressants.gWhengtakengingexcess,gtheygcausegagdecreasedglevelg
ofgconsciousness,grespiratorygdepression,gbradycardia,gandghypotension.
Activatedgcharcoalgisgcontraindicatedgforgagpatientgwhogis:
•gA:consciousgandgalertgandghasgingestedgaglargegamountgofgMotrin.
•gB:emotionallygupsetgandghasgingestedgtwogbottlesgofgaspirin.
•gC:agitatedgandgclaimsgtoghavegingestedgagbottlegofgTylenol.
•gD:awakegandgalertgandghasgswallowedgagcommercialgdraingcleaner.g-
gANSWER:YougselectedgD;gThisgisgcorrect!
Reason:Activatedgcharcoalgadsorbsg(sticksgto)gmanygingestedgsubstances,gpreventing
gthemgfromgbeinggabsorbedgintogthegbodygbygthegstomachgorgintestines.gIngsomegcas
es,gyougmayggivegactivatedgcharcoalgtogpatientsgwhoghavegingestedgcertaingsubstanc
,es,gifgapprovedgbygmedicalgcontrolgorglocalgprotocol.gActivatedgcharcoalgisgcontraindi
catedgforgpatientsgwhoghavegingestedgangacidgorgalkalig(ie,gdraingcleaner)gorgagpetrol
eumgproductg(ie,ggasoline),gwhoghavegagdecreasedglevelgofgconsciousnessgandgcanno
tgprotectgtheirgowngairway,gorgwhogaregunablegtogswallow.
ThegMOSTgobviousgwaygtogreducegheatglossgfromgradiationgandgconvectiongisgto:
•gA:movegawaygfromgagcoldgobject.
•gB:increasegmetabolismgbygshivering.
•gC:weargagthickgwind-proofgjacket.
•gD:movegtogagwarmergenvironment.g-gANSWER:yougselectedgD;gThisgisgcorrect!
Reason:Ingagcoldgenvironment,gthegbodyghasgtwogwaysgofgstayinggwarm:ggeneratingg
heatg(thermogenesis)gandgreducinggheatgloss.gRadiationgisgthegtransfergofgheatgbygra
diantgenergy.gThegbodygcanglosegheatgbygradiation,gsuchgasgwhengagpersongstandsging
agcoldgroom.gConvectiongoccursgwhengheatgisgtransferredgtogcirculatinggair,gasgwheng
coolgairgmovesgacrossgthegbody'sgsurface.gAgpersongstandinggingwindygcoldgweather,g
wearingglightweightgclothing,gisglosinggheatgtogthegenvironmentgmostlygbygconvectio
n.gThegquickestgandgmostgobviousgwaygtogdecreasegheatglossgfromgradiationgandgcon
vectiongisgtogmovegoutgofgthegcoldgenvironmentgandgseekgsheltergfromgwind.gShiveri
nggincreasesgthegbody'sgmetabolismgandgisgagmechanismgforggeneratinggheat,gnotgre
ducinggheatgloss.gLayersgofgclothinggtrapgairgandgprovidegexcellentginsulation;gthus,gl
ayeredgclothinggdecreasesgheatglossgbettergthangagsingle,gthickgjacket.gConductiongisg
thegdirectgtransfergofgheatgfromgagpartgofgthegbodygtogagcoldergobjectgbygdirectgcont
act,gasgwhengagwarmghandgtouchesgcoldgmetalgorgice.gThegmostgobviousgwaygtogdecr
easegheatglossgbygconductiongisgtogremovegyourghandgfromgthegcoldgobject.
Agnear-drowninggisgMOSTgaccuratelygdefinedgas:
•gA:complicationsgwithing24ghoursgfollowinggsubmersiongingwater.
•gB:immediategdeathgduegtogprolongedgsubmersiongingwater.
•gC:survivalgforgatgleastg24ghoursgfollowinggsubmersiongingwater.
•gD:deathggreatergthang24ghoursgfollowinggsubmersiongingwater.g-
gANSWER:YougselectedgC;gThisgisgcorrect!
Reason:Collectively,gdrowninggandgnear-
drowninggaregreferredgtogasgsubmersionginjuries.gDrowninggisgdefinedgasgdeathgafter
gsubmersiongingagliquidgmedium,gusuallygwater.gIngagdrowning,gdeathgisgeithergimme
diategorgoccursgwithing24ghoursgfollowinggsubmersion.gNear-
drowninggisgdefinedgasgsurvival,gatgleastgtemporarilyg(24ghours),gaftergsubmersion.gIt
gshouldgbegnoted,ghowever,gthatgcomplicationsgsuchgasgpneumoniagandgpulmonaryg
edemagcangcausegdeathggreatergthang24ghoursgfollowinggsubmersion.gForgthisgreaso
n,gallgpatientsgwithgagsubmersionginjurygshouldgbegtransportedgtogtheghospital,geveng
ifgtheygappeargfinegatgthegscene.
Agyounggwomangreportsgsignificantgweightglossgovergtheglastgmonth,gpersistentgfeve
r,gandgnightgsweats.gWhengyougassessgher,gyougnotegthegpresencegofgdarkgpurpleglesi
onsgcoveringghergtrunkgandguppergextremities.gYougshouldgsuspect:
•gA:end-stagegcancer.
, •gB:HIV/AIDS.
•gC:tuberculosis.
•gD:rheumaticgfever.g-gANSWER:YougselectedgB;gThisgisgcorrect!
Reason:Weightgloss,gfever,gandgnightgsweatsgcouldgindicategtuberculosisgorgHIV/AIDS
;ghowever,gthegdarkgpurpleglesionsgongthegskin,gwhichgaregcalledgKaposi'sgsarcoma,ga
regmalignantgskingtumorsgandgaregagclassicgfindinggingpatientsgingtheglatergstagesgofgA
IDS.
Ag48-year-
oldgmalegbecamegacutelyghypoxic,gexperiencedgagseizure,gandgisgnowgpostictal.gTheg
MOSTgeffectivegwaygtogpreventganothergseizuregisgto:
•gA:dimgtheglightsgingthegbackgofgthegambulance.
•gB:placeghimgingthegrecoverygposition.
•gC:administerghigh-flowgsupplementalgoxygen.
•gD:giveghimgoralgglucosegifghegcangswallow.g-
gANSWER:YougselectedgC;gThisgisgcorrect!
Reason:Yougshouldgadministerghigh-
flowgoxygengtogallgpatientsgwhogaregactivelygseizinggandgtogpatientsgwhogexperience
dgagseizuregandgaregpostictal.gThisgisgespeciallygtruegifgthegseizuregwasgcausedgbyghyp
oxia.gIncreasinggthegoxygengcontentgofgthegblood,gwhichgminimizesghypoxia,gmaygpre
ventganothergseizure.gThegrecoverygpositiongisgappropriategforguninjuredgpatientsgwi
thgagdecreasedglevelgofgconsciousnessgandgadequategbreathing;gitgwillghelpgmaintaing
thegairwaygandgfacilitategdrainagegofgsecretionsgfromgthegmouth,gbutgwillgnotgpreven
tganothergseizure.gOralgglucosegmaygpreventganothergseizuregifghypoglycemiagwasgth
egcausegofgthegseizure.gYougshouldgdimgtheglightsgingthegbackgofgthegambulancegtogh
elpgpreventganygseizure,gnotgjustgthosegthatgaregcausedgbyghypoxia.
WhichgofgthegfollowinggconditionsgwouldgbegthegLEASTglikelygtogbegpresentgingagpati
entgwhogwasgsubmergedgingwater?
•gA:Spinalginjury
•gB:Gastricgdistention
•gC:Hyperglycemia
•gD:Laryngospasmg-gANSWER:YougselectedgC;gThisgisgcorrect!
Reason:gManygfactorsgcangcontributegtogorgresultgfromgagsubmersionginjuryg(eg,gdro
wning,gnear-
drowning).gItgisgnotguncommongforgagpersongtogexperiencegagspinalginjurygaftergdivin
ggheadgfirstgintogshallowgwater,gespeciallygifghegorgshegisgundergtheginfluencegofgalco
hol.gWhengagswimmergpanics,ghegorgsheginitiallygswallowsglargegamountsgofgwater,gr
esultingginggastricgdistention.gGastricgdistentiongcangcausegaspirationgifgthegpatientgr
egurgitatesgwatergduringgrescuegbreathing;gprotectgthegairway!gDuringgthegpanicgph
ase,gthegvictimgexpendsgagtremendousgamountgofgenergyg(andgglucose)gfromgflailingg
aroundgingthegwater,gpossiblygresultingginghypoglycemia.gInhalinggevengagsmallgamou
ntgofgfreshgorgsaltgwatergcangseverelygirritategtheglarynx,gwhichgsendsgthegmusclesgof
