MSN 622 WEEK 6 - MULTISYSTEM DISORDERS,
PALLIATIVE CARE, AND OFFICE EMERGENCIES
A 41-year-old male presents to urgent care with concerns that his feet have swollen for
the past two days. He has recently arrived in New Mexico from Alaska to hike with a
group of friends. He states this is the first time this has happened to him, and he is
finding it difficult to put on his boots. He has no other complaints at this time and has no
chronic medical problems. His vital signs are normal. His exam shows non-pitting
edema up through his ankles. The skin is non-tender without increased redness or
warmth. There is no pain with calf squeeze. What is the next step in the management of
the patient? - Answers :Tell the patient that compression stocking can help and to keep
his limbs elevated and avoid excessive heat exposure
An 18-year-old football player presents to the emergency department (ED) with
complaints of nausea after a training session at high heat. His coach was concerned
because he was very warm to the touch and was sweating profusely. A couple of
minutes after arrival at the ED, the patient has an episode of vomiting. His uniform and
padding are quickly removed as he is laid on a stretcher. His vital signs demonstrated a
core temperature of 38.9 C (102 F), heart rate of 118 beats/minute, blood pressure of
119/82 mmHg, and breathing at a rate of 22 breaths/minute. His point-of-care glucose
was 80 mg/dL, and his skin remains very sweaty. Which of the following is the most
appropriate treatment to initiate at this time? - Answers :IV fluids with normal saline
A 49-year-old otherwise healthy male with no past medical history apart from
hypertension well controlled with medications presents to the emergency department
with a friend after having an episode in which he lost consciousness. The patient stated
that they were outside taking their dog for a walk at a local dog park when he got dizzy,
sat on the ground, and then passed out. The friend states the patient was out for about
30 seconds. The patient is currently feeling normal. He does admit he hasn't been
drinking much water today. Which of the following will help prevent this from happening
in the future? - Answers :Staying well hydrated during periods of heat exposure
A 17-year-old female presents to the emergency department after having an episode of
syncope. She was out watching fireworks during the day and drinking alcohol. She
reports that she took ibuprofen earlier in the day for a mild headache. Her vital signs are
normal, and she has no symptoms at this time. Which of the following is a risk factor for
what happened to the patient? - Answers :Alcohol consumption
A 24-year-old man is brought to the emergency department with a traumatic head injury
following a motor vehicle collision. His body temperature is 102.2 F (39 C), which is not
associated with infection or inflammation. A lesion has most likely occurred in which of
the following? - Answers :Hypothalamus
A man becomes lost in the woods during a winter hike through snowy mountains. Two
days pass and he remains lost in the 5 degrees F temperature with -10 degrees F
, windchill. He becomes extremely tired, confused, and begins removing his clothes.
Which of the following is the most common fatal complication of his current condition? -
Answers :Cardiac arrythmia
A 48-year-old obese man is jogging outside at noon on a July afternoon. He recently
began an outdoor exercise regimen in an attempt to lose weight. He gradually became
confused, tachycardic, short of breath, and stopped sweating. Someone nearby saw
him collapse and he was unresponsive when emergency medical personnel arrived.
Rectal temperature was 105.2 degrees F. After resuscitation with CPR, what should be
done for rapid cooling? - Answers :Cold water immersion
A 14-year-old girl is brought to the emergency department by her parents. Her parents
state that she was playing outside during a softball game when she developed nausea
and started complaining of fatigue and mild headache. Further evaluation reveals that
she has a heart rate of 120 beats/min and a temperature of 103 degrees Fahrenheit.
However, she has no mental status changes or muscle fasciculations but is sweating
profusely. What is the most likely diagnosis? - Answers :Heat exhaustion
While attending your child's soccer game, a teammate of theirs develops nausea,
fatigue, and a mild headache. He is taken out of the game and sent to the medical tent
where he is found to be tachycardic with an oral temperature of 101 degrees
Fahrenheit. Their blood pressure is normal, and he does not have any other symptoms
of CNS involvement. Which of the following is the next best step in the management of
this patient? - Answers :Recommend the patient stop playing and continue to observe in
a cool, shaded area, providing oral rehydration with electrolyte-containing fluids
A 36-year-old male patient presents to the clinic because of daytime sleepiness. He
explains that he is a long-route truck driver and cannot afford to feel sleepy during the
daytime. He also complains of associated decreased concentration, poor memory, and
irritability. The patient says that over the past year, his snoring has become louder and
"scarier." On detailed inquiry, he admits having fallen asleep a couple of times while
driving. He drinks 4 or 5 beers per day. He also has a 15-pack-year history of smoking.
His past medical history is significant for dyslipidemia managed on statins. Vitals show a
blood pressure of 145/85 mmHg, a pulse of 95/min, and a respiratory rate of 22/min. His
body mass index is 37 kg/m^2. The examination is insignificant. What long-term
complication is most likely to develop in this patient if his disease goes untreated? -
Answers :Cor pulmonale
A 50-year-old man complains of a lack of energy. He nods off during the day, usually
when reading or watching television. He goes to bed at 11 pm and wakes up at 8 am.
He has no medical illnesses and takes no medication. He drinks a glass of wine daily,
usually with dinner, and denies smoking. He states that his wife complains about his
snoring. His vital signs show blood pressure of 130/85 mmHg, heart rate of 67
beats/minute, respiratory rate of 16 breaths/minute, and body mass index of 27 kg/m^2.
Which of the following is the gold standard test for diagnosing this patient's condition? -
Answers :Nocturnal polysomnography
PALLIATIVE CARE, AND OFFICE EMERGENCIES
A 41-year-old male presents to urgent care with concerns that his feet have swollen for
the past two days. He has recently arrived in New Mexico from Alaska to hike with a
group of friends. He states this is the first time this has happened to him, and he is
finding it difficult to put on his boots. He has no other complaints at this time and has no
chronic medical problems. His vital signs are normal. His exam shows non-pitting
edema up through his ankles. The skin is non-tender without increased redness or
warmth. There is no pain with calf squeeze. What is the next step in the management of
the patient? - Answers :Tell the patient that compression stocking can help and to keep
his limbs elevated and avoid excessive heat exposure
An 18-year-old football player presents to the emergency department (ED) with
complaints of nausea after a training session at high heat. His coach was concerned
because he was very warm to the touch and was sweating profusely. A couple of
minutes after arrival at the ED, the patient has an episode of vomiting. His uniform and
padding are quickly removed as he is laid on a stretcher. His vital signs demonstrated a
core temperature of 38.9 C (102 F), heart rate of 118 beats/minute, blood pressure of
119/82 mmHg, and breathing at a rate of 22 breaths/minute. His point-of-care glucose
was 80 mg/dL, and his skin remains very sweaty. Which of the following is the most
appropriate treatment to initiate at this time? - Answers :IV fluids with normal saline
A 49-year-old otherwise healthy male with no past medical history apart from
hypertension well controlled with medications presents to the emergency department
with a friend after having an episode in which he lost consciousness. The patient stated
that they were outside taking their dog for a walk at a local dog park when he got dizzy,
sat on the ground, and then passed out. The friend states the patient was out for about
30 seconds. The patient is currently feeling normal. He does admit he hasn't been
drinking much water today. Which of the following will help prevent this from happening
in the future? - Answers :Staying well hydrated during periods of heat exposure
A 17-year-old female presents to the emergency department after having an episode of
syncope. She was out watching fireworks during the day and drinking alcohol. She
reports that she took ibuprofen earlier in the day for a mild headache. Her vital signs are
normal, and she has no symptoms at this time. Which of the following is a risk factor for
what happened to the patient? - Answers :Alcohol consumption
A 24-year-old man is brought to the emergency department with a traumatic head injury
following a motor vehicle collision. His body temperature is 102.2 F (39 C), which is not
associated with infection or inflammation. A lesion has most likely occurred in which of
the following? - Answers :Hypothalamus
A man becomes lost in the woods during a winter hike through snowy mountains. Two
days pass and he remains lost in the 5 degrees F temperature with -10 degrees F
, windchill. He becomes extremely tired, confused, and begins removing his clothes.
Which of the following is the most common fatal complication of his current condition? -
Answers :Cardiac arrythmia
A 48-year-old obese man is jogging outside at noon on a July afternoon. He recently
began an outdoor exercise regimen in an attempt to lose weight. He gradually became
confused, tachycardic, short of breath, and stopped sweating. Someone nearby saw
him collapse and he was unresponsive when emergency medical personnel arrived.
Rectal temperature was 105.2 degrees F. After resuscitation with CPR, what should be
done for rapid cooling? - Answers :Cold water immersion
A 14-year-old girl is brought to the emergency department by her parents. Her parents
state that she was playing outside during a softball game when she developed nausea
and started complaining of fatigue and mild headache. Further evaluation reveals that
she has a heart rate of 120 beats/min and a temperature of 103 degrees Fahrenheit.
However, she has no mental status changes or muscle fasciculations but is sweating
profusely. What is the most likely diagnosis? - Answers :Heat exhaustion
While attending your child's soccer game, a teammate of theirs develops nausea,
fatigue, and a mild headache. He is taken out of the game and sent to the medical tent
where he is found to be tachycardic with an oral temperature of 101 degrees
Fahrenheit. Their blood pressure is normal, and he does not have any other symptoms
of CNS involvement. Which of the following is the next best step in the management of
this patient? - Answers :Recommend the patient stop playing and continue to observe in
a cool, shaded area, providing oral rehydration with electrolyte-containing fluids
A 36-year-old male patient presents to the clinic because of daytime sleepiness. He
explains that he is a long-route truck driver and cannot afford to feel sleepy during the
daytime. He also complains of associated decreased concentration, poor memory, and
irritability. The patient says that over the past year, his snoring has become louder and
"scarier." On detailed inquiry, he admits having fallen asleep a couple of times while
driving. He drinks 4 or 5 beers per day. He also has a 15-pack-year history of smoking.
His past medical history is significant for dyslipidemia managed on statins. Vitals show a
blood pressure of 145/85 mmHg, a pulse of 95/min, and a respiratory rate of 22/min. His
body mass index is 37 kg/m^2. The examination is insignificant. What long-term
complication is most likely to develop in this patient if his disease goes untreated? -
Answers :Cor pulmonale
A 50-year-old man complains of a lack of energy. He nods off during the day, usually
when reading or watching television. He goes to bed at 11 pm and wakes up at 8 am.
He has no medical illnesses and takes no medication. He drinks a glass of wine daily,
usually with dinner, and denies smoking. He states that his wife complains about his
snoring. His vital signs show blood pressure of 130/85 mmHg, heart rate of 67
beats/minute, respiratory rate of 16 breaths/minute, and body mass index of 27 kg/m^2.
Which of the following is the gold standard test for diagnosing this patient's condition? -
Answers :Nocturnal polysomnography
