Wilderness and Rescue Medicine Test 4

1. Wilderness and Rescue MedicineTest 4 10 multiple choice and 10 multiple response questions.

2. Multiple choice 1 The hasty team has just located the subject of a 36 hour search in wet and cold conditions. He is curled up under a spruce tree and is awake but confused and shivering. He feels cold to the touch. You find no evidence of trauma. The most likely case for his altered mental status is: • mild hypothermia. • traumatic brain injury • severe hypothermia. • volume shock.

3. Multiple choice 2 What is the most appropriate field treatment for the patient in the previous question? You are on a steep hillside 3 miles from the trailhead in fog and rain. • Get him up and immediately start hiking out. • Delay treatment until you arrive at the hospital. • Strip off his wet clothes and wrap him in a tarp with the hasty team. • Wrap him in a sleeping bag and feed him sugar and electrolyte drink.

4. Multiple choice 3 Why is it important to distinguish between mild and severe hypothermia in the field? • Mild hypothermia is not important and severe hypothermia is important. • Severe hypothermia is a stable metabolic state in which the patient can safely remain for many hours. Call for immediate helicopter evacuation since this is a systemic infection. • The ideal treatment for mild hypothermia is immediate field rewarming. • The ideal treatment for severe hypothermia is immediate exercise.

5. Multiple choice 4 Your SAR team is called to a body recovery but the “body” is still pliable and has a core temperature of 28 degrees C (82 F). You detect shallow respiration and a slow pulse. The most appropriate course of action would be to: • package the patient in a hypothermia wrap and evacuate gently but urgently to medical care. • immerse the patient in a nearby hot spring and force vigorous exercise. • perform CPR and external warming for 30 minutes before transporting. • pack the patient in snow to maintain the metabolic icebox until the hospital is reached.

6. Multiple choice 5 A competitor in an adventure race complains of feeling weak and dizzy. She has made every water stop along the way and reports that she has stopped to urinate several times in the last five miles of running. VS: P 100, R 20, Skin: warm and moist. T 37.5C. The most appropriate treatment is: • immediate cooling with a water sprayer. • fluid restriction, food, and rest. • aggressive hydration. • immediate immersion in cold water.

7. Multiple choice 6 During this same race, you are called to the scene of a runner down. You find a young man staggering, confused and combative. He is hot to the touch. VS: P 140, R irregular and rapid. Skin: hot, red, moist. The most appropriate immediate treatment is: • salt tablets. • food, fluids, and rest • IV hydration. • Immediate and aggressive cooling

8. Multiple choice 7 Why is it important to distinguish between heat exhaustion and heat stroke? • Heat stroke is injury to the brain caused by a blood clot and requires emergency evacuation. Numbness and tingling. • Heat exhaustion is primarily a body core temperature problem while heat stroke is primarily a fatigue and fluid volume problem. • Heat exhaustion always precedes heat stroke and immediate radical cooling can help prevent it. • Heat exhaustion is primarily a fatigue and fluid problem while heat stroke is primarily a core temperature problem.

9. Multiple choice 8 Four hours into a backcountry ski-touring race, a competitor removes his boot to reveal several frozen toes with frostbite extending into the forefoot. The area is completely numb, frosted and firm. The competitor is otherwise healthy. The most appropriate plan is to: • rewarm the foot in 39ºC water and allow him to continue the race. • have him immediately ski back to the trail head for evacuation to the hospital. • rewarm the foot in 39ºC water and keep him at the hut until the frostbite has healed. • pack the foot in snow while awaiting evacuation.

10. Multiple choice 9 Why is it important to distinguish between superficial and full thickness frostbite in the field? • Superficial frostbite should be rewarmed immediately in the field. • The ideal treatment for full thickness frostbite is controlled rewarming in a hospital. • Superficial frostbite is not important and full thickness frostbite is important. • Both a and b, but not c.

11. Multiple choice 10 Which is the most appropriate treatment for respiratory failure due to high altitude pulmonary edema? • Oxygen, PPV and emergency descent. • Oxygen, albuterol and observation. • Epinephrine, diphenhydramine and prednisone. • Oxygen, antibiotics, and observation.

12. Multiple response 11 You are evaluating a student in your Wilderness Trip Leader program who has been complaining of abdominal pain for the past 12 hours. What would motivate you to perform an urgent evacuation? • She reveals that she is 14 weeks pregnant and at risk for miscarriage. • The pain is crampy and relieved by passing gas. • The pain constant and is exacerbated by palpation and movement. • Her vital signs include a pulse of 120, a temperature of 39 C, and a respiratory rate of 24.

13. Multiple response 12 A female crew member complains of a urinary tract infection. Which signs and symptoms would lead you to believe that it is more serious than an uncomplicated UTI? • Tenderness over the kidneys. • Pain on urination. • Cloudy urine. • Fever and lethargy.

14. Multiple response 13 A crew member aboard your boat in a remote anchorage complains of chest pain for the past hour. What elements of history would make you more likely to insist on an emergency evacuation? • He is a 2 pack per day smoker for the past 25 years. • He has a history of hypertension and high blood cholesterol. • She raised the anchor and 75 feet of chain by hand yesterday. • She’s just celebrated her 21st birthday by learning to windsurf.

15. Multiple response 14 One of your clients on a winter trip presents with a white fingertip. The tissue is numb and cold but soft to the touch. Appropriate field treatment includes: • hydration and calories to warm the patient up. • emergency evacuation to a medical facility. • keeping the finger frozen until tomorrow when the patient can be evacuated. • immediate rewarming of the finger inside a warm glove or pocket.

16. Multiple response 15 You have resuscitated your paddling partner with PPV after recovering him from an entrapment underwater. He is now awake and coughing, but breathing adequately. Your anticipated problems include: • infection from water inhalation. • respiratory distress from pulmonary edema. • volume shock from fluid loss into the lungs. • hyponatremia from water intoxication.

17. Multiple response 16 Your client on a canyon hike in Arizona has just been bitten by a snake. You see two fang marks on her lower leg. The most appropriate plan includes: • applying a Sawyer Extractor and waiting to see of symptoms develop. • applying a tourniquet to restrict blood flow to the leg. • turning around and hiking back to the trailhead for evacuation to the hospital. • sending a runner to notify the hospital about the incoming snakebite victim.

18. Multiple response 17 Stable angina is the pain of myocardial ischemia that... • resolves with rest and reduced oxygen demand. • occurs when oxygen demand temporarily exceeds oxygen supply. • is always followed by myocardial infarction. • always needs urgent evacuation.

19. Multiple response 18 One of your more adventurous clients becomes V on AVPU and develops muscle spasms and respiratory distress after eating a salad made from wild plants. The most appropriate plan includes: • inducing vomiting and forcing fluids and activated charcoal. • bringing the salad left-overs to the hospital. • providing airway protection and PPV as needed during emergency evacuation. • recommending the recipe to other annoying clients.

20. Multiple response 19 helicopter evacuation at sea or in mountainous terrain is a high-risk operation. Which situations might justify it? • Volume shock from a posterior nosebleed. • A rib fracture. • A traumatic brain injury with persistent vomiting. • A 10 cm scalp laceration.

21. Multiple response 20 A crew member complains of a sore throat for the past few days. Which symptoms indicate that this is a serious problem? • He is unable to eat or drink anything. • You see white patches on the tonsils. • The pain is worse at night than during the day. • He has a fever of 41C and altered mental status.