Acute Mountain Sickness

Question 0

Acute high-altitude illness has a variable time of onset and severity following exposure. All but one of the following contributes to earlier and more adverse symptoms in susceptible individuals.

a) increased metabolic activity at altitude.
b) increasing altitude
c) predisposition to the syndrome
d) rapid ascent
e) inclement meteorological conditions at altitude.

Answer 0

B) High altitude illness will occur at a particular altitude, but once it occurs it is NOT made worse by increasing altitude. It is however, made better by decreasing altitude. Therefore it does not follow a dose response curve.

Question 1

Symptoms of acute mountain sickness at 5000 m include malaise, vomiting, and intractable headache. The symptoms have been found to be closely related to:

a) inner ear hydrops, nausea, and vertigo.
b) renal oliguria, excess sodium retention and acidosis.
c) hyperventilation, excess sodium retention and acidosis.
d) psychosomatic reactions to the mountain environment.
e) cerebral edema, pulmonary gas abnormalities and pulmonary edema.

Answer 1

e) Cerebral edema, pulmonary gas abnormalities, and pulmonary edema.

Question 2

A 23 year old male in excellent health flew from sea level to a ski resort at 2,700 m for a week of skiing. He began skiing the day after arrival but as he skied he developed progressive malaise, myalgias, and headache. That evening he noted shortness of breath and later that night developed a productive cough of blood sputum. What is the most probable diagnosis?

a) pulmonary infarct with pulmonary edema
b) bacterial pneumonia
c) High altitude pulmonary edema
d) Congestive heart failure precipitated by the decreased oxygen tension at 2,700 m.

Answer 2

C) High Altitude Pulmonary Edema

Question 3

The altitude at which most people become susceptible to serious altitude related illnesses such as HACE and HAPE is:

a) 10,000 feet
b) 12,000 feet
c) 15,000 feet
d) 17,000 feet
e) 20,000 feet

Answer 3

a) 10,000 feet.

Question 4

A patient presents with the following symptoms after an initial altitude exposure of 12,000 feet while mountain climbing. The symptoms appeard on the 2nd day of the trek and included headache, fatigue, difficulty sleeping, and loss of appetite. The most likely diagnosis is:

a) AMS (Acute Mountain Sickness)
b) HAPE (High Altitude Pulmonary Edema)
c) HACE (High Altitude Cerebral Edema)
d) hypoxia
e) None of the above

Answer 4

a) Acute Mountain Sickness

Question 5

The previous patient with headache and loss of appetite while mountian climbing is now experiencing headache, vomiting, weakness and confusion. What disease process are you most concerned about?

a) AMS
b) HAPE
c) HACE
d) Cerebral bleed
e) Hypoxia

Answer 5

c) HACE (High Altitude Cerebral Edema)

Question 6

You are trekking with a group that has just reached a base camp at 14,500 feet. One of your fellow trekkers begins complaining of shortness of breath and cough. You listen to his chest and discover diffuse wheezes and crackles in the right upper lobe as well as a respiratory rate of 30. Your diagnosis is: 
A) AMS
B) HAPE
C) HACE
D) Exacerbation of underlying asthma
E) Pneumonia

Answer 6

B) HAPE (High Altitude Pulmonary Edema). Treated with Lasix, nifedipine, acetazolamide, oxygen.

Question 7

Of AMS, HAPE, HACE, which has the highest mortality rate?

Answer 7

HACE

Question 8

What drug is useful in the prevention of AMS?

Answer 8

Acetazolamide

Question 9

Which of the following conditions requires the patient to descend immediately in all cases?

a) Nausea, weakness and headache in a confused patient.
b) Moderate shortness of breath that is controlled with nifedipine and oxygen
c) A patient with ataxia and confusion but no other symptoms
d) A and C
e) All of the above

Answer 9

d) A and C. Any patient with symptoms of HACE should descend immediately to a lower altitude. However, a patient with mild to moderate HAPE who is responding to treatment can be managed at altitude with oxygen, rest, medication and observation.

Question 10

Which of the following conditions requires the patient to descend immediately in all cases?

a) Nausea, weakness and a headache in a confused patient
b) Moderate shortness of breath that is controlled with nifedipine and oxygen
c) A patient with ataxia and confusion but no other symptoms
d) A and C
e) all of the above

Answer 10

d. Any patient with symptoms consistent with HACE should descend immediately to a lower altitude. However, a patient with moderate HAPE who is responding to treatment can be managed at altitude with oxygen, rest, and observation.