Environmental Post Test April 1, 2010
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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
- 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)
- 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
- 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
- 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
- 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
- 7.True/False: Immediate and routine cervical spine immobilization is warranted in the majority of submersion victims
- A.
True
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 17.True/False: Alpha particles can potentially have serious long-term effects if absorbed in large amounts through open wounds
- A.
True
- B.
False
- 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
- 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
- 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
- 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
- 22."The staggers" refers to:
- A.
Inner ear decompression sickness (DCS)
- B.
Pulmonary DCS
- C.
Spinal DCS
- D.
Type I 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
- 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
- 25.Chelating agents and blocking agents may be beneficial in preventing/limiting radionucleotide uptake when ingestion or inhalation has occurred.
- A.
True
- B.
False
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