NMS Q&A Family Medicine

284 NMS Q&A Family Medicine9 Regarding the patient in Question 8, which of the followingmeasures would be most reasonable and beneficial,assuming descent is not a practical solutionand relief seems necessary at this time?(A) Acetazolamide (Diamox) administration(B) Dexamethasone in a tapering course(C) Oxygen administration(D) Pressure tent(E) Diltiazem10 The most serious symptoms that may occur withhigh-altitude sickness (HAI) are pulmonary edema,that is, high-altitude pulmonary edema (HAPE), andcerebral edema, that is, high-altitude cerebral edema(HACE). At what altitude do they become significantpossibilities for travelers who are unaccommodatedto altitude?(A) 2,000 ft (610 m)(B) 6,500 ft (1,981 m)(C) 8,000 ft (2,438 m)(D) 12,500 ft (3,810 m)(E) 15,000 ft (4,572 m)11 An 18-year-old man, who lives on the east coast, fliesto Cuzco, Peru (11,152 ft, or 3,399 m) and immediatelypursues his plan to hike to 2,000 ft (610 m)above the town, joining a group of high-altitude hikers.On the morning of the 2nd day, the group hasreached 12,000 ft (3,658 m) of altitude en route to theFortress of Sacsayhuaman. He begins to complain ofcoughing and shortness of breath, eventually producinga frothy pink sputum. Each of the followingwould be appropriate except for (which) one?(A) Rapid descent of 500 ft (152 m), if possible(B) Furosemide(C) Oxygen 1 to 2 L/minute(D) Acetazolamide(E) Hyperbaric tent12 A 45-year-old female patient reveals that a friend hasoffered to take her on a transcontinental flight in hisprivate unpressurized aircraft. The patient has a historyof HAI at 13,500 ft (4,114 m) during a mountainhiking expedition. She has had numerous benignexperiences at altitudes of 10,000 ft (3,048 m) orlower. Otherwise, she is healthy. Which of the followingis appropriate advice for her regarding the prospectiveflight and her health?(A) She should not make the flight because of herhistory of HAI.(B) She should postpone the trip until she hasundergone blood gas studies.(C) She may take the trip and will require no specialpreparations or treatments compared withother people on the plane.(D) She is safe but should undergoelectrocardiogram testing before making thefinal decision.(E) She may go on the trip as long as she takesoxygen throughout the flight.13 What cabin altitudes (terrestrial altitudes equivalent inatmospheric pressure to pressures in cabins of pressurizedaircraft) would the patient in Question 11 expectto encounter in pressurized commercial jet aircraft?(A) Sea level (cabin pressure encountered at sea level)(B) 500 ft (152 m)(C) 2,000 ft (610 m)(D) Up to 5,000 ft (1,524 m)(E) Up to 10,000 ft (3,048 m)14 Many immunizations are recommended before travelsimply for the general principle of the travelerremaining current for all routine immunizations.Others are recommended for reasons more specificto the country to be visited. Which of the followingimmunizations is recommended in the period of 1 to3 months before travel to any developing country?(A) A tetanus booster with an attenuated dose ofdiphtheria (Td)(B) Influenza(C) Polio(D) Rabies(E) Japanese encephalitis15 A 36-year-old woman with a history of atopic diseasesconsisting of seasonal rhinitis (in the springand fall), but without asthma, consults you in Augustafter a week of rhinitis symptoms because she is planninga trip by commercial air travel to Nova Scotia.Once, while recovering from a cold, she had sufferedsevere ear pain. Which of the following statements istrue regarding secretory otitis media of flight (“barotitis”or “aerotitis”)?(A) It occurs most frequently during ascent in flight.(B) The proximate cause of barotitis media isStreptococcus pneumoniae.(C) It can be prevented if the patient is able to forceair into the middle ears through the Eustachiantube during descent by means of the modifiedValsalva maneuver.(D) The physical evidence of this form of secretoryotitis media is a bulging tympanic membraneseen at otoscopy.(E) The same problem may occur during scubadiving, requiring the diver to delay ascent tocontrol symptoms and to “clear the ears.”