Environmental

Question 1

What is acute mountain sickness(AMS)?

Answer 1

It is a syndrome of high altitude illness that is characterized by a vague set of symptoms similar to carbon monoxide poisoning or influenza caused by acute exposure to low partial pressures of oxygen at high altitude.

Question 2

What are some risk factors in the development of AMS?

Answer 2

Read of ascent/altitude acclimatization.
History of altitude sickness
Duration of stay at a given altitude
Vigorous exertion and altitude before acclimatization
Sedativehypnotic use or alcohol intake

Question 3

What are some signs and symptoms of AMS?

Answer 3

Most important feature is a headache with other associated symptoms, such as fatigue, insomnia, and nausea.

Question 4

What are some indications for immediate descent?

Answer 4

Evidence of developing HAPE or HACE, such as severe pulmonary edema, or neurological symptoms, such as confusion or ataxia.

Question 5

What is the mechanism of action of Acetazolamide?

Answer 5

It is a carbonic anhydrase inhibitor that induces, a bicarbonate diuresis, causing a metabolic acidosis and increasing ventilation and oxygenation

Question 6

What are some contraindications of Acetasol made?

Answer 6

Sulfa allergy in pregnant women.

Question 7

What is the most common fetal form of high altitude illness?

Answer 7

High altitude, pulmonary edema, HAPE

Question 8

What are some important for features of HAPE?

Answer 8

Typically more common at a higher altitudes greater than 12,000 fee
Presentation can be sudden
Increased risk for children and younger ad

Question 9

What are some signs and symptoms of HAPE?

Answer 9

Dry cough
Fatigue with minimal exercise
Dyspnea at rest
Cyanosis
Tachycardia and tachypnea

Question 10

What are some important tests to consider of available when evaluating HAPE?

Answer 10

Chest radiograph: typically bilateral patch infiltrates
Electro cardiogram: make sure, tachycardia, right heart strain, and abnormal P-wave morphology

Question 11

What is the differential diagnosis of HAPE?

Answer 11

Pneumonia
Pulmonary embolism
Bronchitis

Question 12

Name some treatment options for HAPE?

Answer 12

Rest
Oxygen
Descent (Mandatory if above not possible)
Hyperbaric chambers (simulate descent, if Unable to move patient)

Question 13

Name some preventative measures to help avoid HAPE?

Answer 13

Nifedipine
Slow ascent

Question 14

Name some treatment options for modern AMS?

Answer 14

Acetazolamide
Oxygen
Dexamethasone for severe cases

Question 15

What is high-altitude cerebral edema HACE?

Answer 15

The most severe form of high altitude illness, which typically is associated with AMS or HAPE.

Question 16

What are some signs and symptoms of HACE?

Answer 16

Severe headache
Altered mental status
Ataxia (most sensitive sign)
Seizures
Papilledema
Retinal hemorrhage

Question 17

Name some treatment options for HACE?

Answer 17

Oxygen
Descent
Hyperbaric chamber (simulates descent if unable to move the patient)

Question 18

What chronic medical conditions place people are higher risk for AMS

Answer 18

Sickle cell disease
Severe, chronic obstructive pulmonary disease
Symptomatic, pulmonary hypertension
Decompensated heart failure
Patient to experience angina with minimal effort

Question 19

What are the effects of Rattlesnake venom?

Answer 19

Venom effects: local inflamm., DIC, angioedema.

Question 20

What labs should you order in a Rattlesnake bite?

Answer 20

CBC, CMP, INR/PTT, fibrinogen, D-dimer, FDPs → may show VICC (venom-induced consumptive coagulopathy (basically DIC labs)
CK for rhabdomyolysis

Question 21

What is the risk of anaphylaxis for CroFab?

Answer 21

5-6% risk of anaphylaxis.

Question 22

Do you treat snake bites with abx?

Answer 22

NO prophylactic antibiotics needed. <3% risk of infection.

Question 23

Coral snakes.
“red on yellow, kill a fellow, red on black’s a friendly jack” Venom effects:

Answer 23

Venom effects: neurotoxicity. Presentation: delayed! Minimal skin/soft tissue symptoms. Descending muscle paralysis (much like botulism). Mechanism = blocks Ach.

Question 24

Treatment of Coral snake bites…

Answer 24

Treatment: 2 things - Airway and breathing issues. NIF, FVC. But we’ll get into that late on.

Question 25

Symptoms of Black Widow Bite

Answer 25

Symptoms will be: muscle cramps, tachycardia, nausea and vomiting, diaphoresis, and HYPERtension (due to the type of venom). Red flag if the patient is “hypotensive”. Patients oftentimes are in distress.

Question 26

Black Widow Spider Bite Managment

Answer 26

Management: tetanus prophylaxis, NSAIDS, benzodiazepines (they might offer this answer choice on the test), opioids, and IV fluids. Symptoms will improve throughout their ER stay, and they might require a prescription for benzodiazepines for a few days. Within a day or two symptoms should be fully resolved

Question 27

When do you give antivenom to black widow spider bites?

Answer 27

Antivenom ONLY if severe cases, and it is very controversial. Reason why? Can lead to serum sickness and anaphylaxis. Very controversial depending on the toxicologist you talk to. In the cases the boards might make this an answer choice (which I doubt they would) – it would be in the following: a patient having severe systemic symptoms AND PEDIATRIC patient OR severe systemic symptoms AND PREGNANT women OR severe systemic symptoms AND elderly. In regards to pediatric patients, it can present with abdominal pain and should be on your differential if there is no other explanation.