Environmental Post Test April 1, 2010
Based on Rosen's chapters 141-144
- 1.
A 42 year-old man arrived several hours earlier at Copper Mountain Ski Resort in Colorado. He is nauseous, has a headache, and experiences dyspnea on exertion. His vital signs are normal and his oxygen saturation is 98% on room air. Which of the following is not true?
- A.
Immediate descent is not mandated at this time
- B.
Sleep disturbance is a common manifestation of this syndrome
- C.
A medication which induces metabolic acidosis can be given to speed the process of acclimatization and lead to quicker resolution of symptoms
- D.
Infants and very young children almost never suffer from this syndrome due to their higher baseline respiratory rates
Correct Answer
D. Infants and very young children almost never suffer from this syndrome due to their higher baseline respiratory rates -
- 2.
The most common fatal manifestation of severe high-altitude illness is:
- A.
Arterial gas embolism
- B.
High-altitude pulmonary edema (HAPE)
- C.
Cryotoxic edema
- D.
High-altitude cerebral edema (HACE)
Correct Answer
B. High-altitude pulmonary edema (HAPE) -
- 3.
In remote settings, where oxygen and medical expertise are unavailable, the next best step in treating high-altitude pulmonary edema (HAPE) is:
- A.
Descend at least 1500-3000 feet
- B.
Dexamethasone 8mg IM
- C.
Furosemide 80mg PO
- D.
Nifedipine 20 mg PO
Correct Answer
A. Descend at least 1500-3000 feet -
- 4.
"High altitude" is between
- A.
6,000 - 8,000 feet
- B.
8,000 - 10,000 feet
- C.
10,000 - 18,000 feet
- D.
18,000 - 25,000 feet
Correct Answer
C. 10,000 - 18,000 feet -
- 5.
The most sensitive sign for early recognition of high-altitude cerebral edema (HACE) is:
- A.
Papilledema
- B.
Slurred speech
- C.
Cerebellar ataxia
- D.
Seizure
Correct Answer
C. Cerebellar ataxia -
- 6.
Although never proven, the mechanism of death from "dry" drowning has commonly been attributed to:
- A.
Severe laryngospasm
- B.
Syncope following cardiac dysrhythmia from sudden contact with cold water
- C.
Severe hypothermia
- D.
Prolonged QT leading to torsades de pointes
Correct Answer
A. Severe laryngospasm -
- 7.
True/False: Immediate and routine cervical spine immobilization is warranted in the majority of submersion victims
- A.
True
- B.
False
Correct Answer
B. False -
- 8.
Which of the following has been demonstrated to improve outcome in the setting of submersion injury?
- A.
Antibiotics
- B.
Corticosteroids
- C.
Corticosteroids and hyperventilation
- D.
Barbiturate-induced coma
- E.
None of the above
Correct Answer
E. None of the above -
- 9.
Of the following choices, the degree of pulmonary injury from submersion injury is most greatly affected by:
- A.
Quantity of water aspirated
- B.
Composition of water aspirated (freshwater vs saltwater)
- C.
Temperature of water aspirated
- D.
Time to administration of antibiotics and corticosteroids
Correct Answer
A. Quantity of water aspirated -
- 10.
Microwave ovens, garage door openers, radio and television broadcasting are examples of:
- A.
Ionizing radiation
- B.
Non-ionizing radiation
- C.
Beta-radiation
- D.
Disseminating radiation
Correct Answer
B. Non-ionizing radiation -
- 11.
The absolute lymphocyte count obtained at 48 hours after a radiation exposure is a good predictor of hematopoietic involvement. Levels in this range should prompt hospitalization and further treatment:
- A.
1200-1500/microliter
- B.
800-1200/microliter
- C.
500-800/microliter
Correct Answer
C. 500-800/microliter -
- 12.
Proper decontamination of a radiation-exposed patient may include all of the following except:
- A.
Decontamination in the field
- B.
Trimming of nails
- C.
Disposal of all clothing, waste water, washcloths, and towels in sealed containers labeled "radioactive waste"
- D.
Limiting repetition of the cleansing process with soap/water/shampoo to no more than twice on an individual patient
Correct Answer
D. Limiting repetition of the cleansing process with soap/water/shampoo to no more than twice on an individual patient -
- 13.
Open wounds should:
- A.
Be closed primarily in patients who have received whole-body radiation >1 Gy
- B.
Be gently irrigated once with 500 ml sterile water
- C.
Never be surgically debrided, due to friability of tissues
- D.
Be left to heal by secondary intention
Correct Answer
A. Be closed primarily in patients who have received whole-body radiation >1 Gy -
- 14.
1 Gy (gray) is:
- A.
= 100 joules of radiation absorbed per kilogram
- B.
= 0.1 joules of radiation absorbed per kilogram
- C.
1 joule of radiation absorbed per kilogram
- D.
10 joules of radiation absorbed per kilogram
Correct Answer
C. 1 joule of radiation absorbed per kilogram -
- 15.
The earliest indicator of radiation dose received is:
- A.
Increase in platelet count
- B.
Decrease in monocytes
- C.
Decrease in absolute lymphocyte count
- D.
Increase in eosinophils
Correct Answer
C. Decrease in absolute lymphocyte count -
- 16.
Following a radiation accident, 2 workers develop immediate gastrointestinal and CNS symptoms with headache, confusion, vomiting, and severe abdominal cramping. These symptoms are reflective of tissues/organs which are most radiosensitive due to their:
- A.
Relatively higher water content
- B.
Higher lipid content
- C.
Greater rates of cellular division
- D.
Large surface areas
Correct Answer
C. Greater rates of cellular division -
- 17.
True/False: Alpha particles can potentially have serious long-term effects if absorbed in large amounts through open wounds
- A.
True
- B.
False
Correct Answer
A. True -
- 18.
The term "incorporation" refers to:
- A.
Ingestion of radioactive material
- B.
Ingestion and inhalation of radioactive material
- C.
Absorption through an open wound of radioactive material
- D.
Ingestion, inhalation, and absorption through an open wound of radioactive material
Correct Answer
D. Ingestion, inhalation, and absorption through an open wound of radioactive material -
- 19.
Signs of hematopoietic involvement from a radiation exposure usually develop
- A.
Within 12 hours of the exposure
- B.
Between 2 days and 4 weeks
- C.
Between 2-3 months
- D.
Between 6-8 months
Correct Answer
B. Between 2 days and 4 weeks -
- 20.
The radiation exposure range for patients in the "survival possible group" is estimated to be:
- A.
< 2Gy
- B.
2 Gy to 10 Gy
- C.
10 Gy to 15 Gy
- D.
15 Gy to 20 Gy
Correct Answer
B. 2 Gy to 10 Gy -
- 21.
Which of the following pulmonary barotrauma disorders requires recompression therapy?
- A.
Pneumothorax
- B.
Pneumomediastinum
- C.
Alveolar hemorrhage
- D.
Subcutaneous emphysema
- E.
Acute gas embolism
Correct Answer
E. Acute gas embolism -
- 22.
"The staggers" refers to:
- A.
Inner ear decompression sickness (DCS)
- B.
Pulmonary DCS
- C.
Spinal DCS
- D.
Type I DCS
Correct Answer
A. Inner ear decompression sickness (DCS) -
- 23.
The US Navy guidelines recommend that, after recompression therapy for Type I DCS, the patient not return to diving for:
- A.
1 days
- B.
7 days
- C.
2 months
- D.
6 months
Correct Answer
B. 7 days -
- 24.
A 33 year-old diver ascends to the surface. Within minutes of reaching the top, the diver is witnessed by a fellow diver to have seizure-like activity. The most probable explanation for this is:
- A.
Decompression sickness type II
- B.
Hypoxia from alveolar hemorrhage
- C.
Nitrogen narcosis
- D.
Acute gas embolism
Correct Answer
D. Acute gas embolism -
- 25.
Chelating agents and blocking agents may be beneficial in preventing/limiting radionucleotide uptake when ingestion or inhalation has occurred.
- A.
True
- B.
False
Correct Answer
A. True -
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