PREP Questions Week of July 24

1.A 16-year-old football player had been practicing with his teammates in full pads and uniform in the mid-day sun for 2 hours when he suddenly collapsed. When you arrive on the sidelines minutes later, he is confused and lethargic. His respiratory rate is 32 breaths/min, heart rate is 120 beats/min, and temperature is 106°F (41.1°C). You note that his skin is hot and dry.
Of the following, the MOST accurate statement about this boy's condition is that

  1. dehydration is the sole cause of damage from this condition
  2. end-organ damage due to endotoxin and cytokine release is common
  3. evaporative cooling using a fan and fine water spray is preferred over methods using ice
  4. oral rehydration is preferred over intravenous fluids
  5. the cooling process should be gradual

2.A 15-year-old clarinet player fainted during marching band practice on a very hot day. Others on the scene reported that she had facial flushing and was sweating. Although she quickly regained consciousness, she was confused and complained of nausea.
Of the following, the MOST likely explanation for these findings is

  1. heat exhaustion
  2. hyperventilation
  3. orthostatic hypotension
  4. seizure disorder
  5. supraventricular tachycardia

3.You are discussing weight loss practices (”weight-cutting”) among wrestlers with a group of high school coaches.
Of the following, the statement that you are MOST likely to include in your discussion is that

  1. an individual’s minimum wrestling weight should be based on ideal body weight
  2. use of diuretics is the most common method of weight loss
  3. weight loss practices have no demonstrable impact on physiologic performance
  4. weight loss should not exceed 3 lb (1.4 kg) or 1.5% of body weight per week
  5. weight loss techniques are practiced by fewer than 10% of high school wrestlers

4.A 6-year-old child presents to your office 30 minutes after being bitten by a snake. The snake was about 3 ft long, brownish, and had diamond-like shapes on its back. The child was bitten in the woods near his home in rural southeastern United States. The child complains of severe pain at the site of the bite and numbness around his lips. On physical examination, you note two puncture wounds 11 mm apart on the volar aspect of his forearm midway between the wrist and elbow. There is erythema and edema radiating 4 cm in each direction.
Of the following, the MOST important immediate step in management is

  1. application of ice to the bite wound
  2. close observation in the office for further progression
  3. incision and suction at the site of the bite
  4. placement of a loose-fitting constricting band just proximal to the elbow
  5. placement of a tourniquet just distal to the elbow

5.A 4-year-old child presents 1 day after receiving a spider bite to the arm. The child's mother killed the spider, but did not bring the remains for identification. She is unable to give any details about the spider except that it was approximately 1 cm in diameter and was brown. The child complains of moderate pain at the site of the bite. She has not vomited and denies headache or muscle pain. Physical examination reveals a 3-cm area of moderate erythema, swelling, and induration surrounding a 1.5-cm blister on the volar aspect of her arm. The child has no other physical abnormalities.
Of the following, the MOST appropriate next step in management is to

  1. discharge the patient with close follow-up
  2. excise the tissue immediately surrounding the bite
  3. prescribe prophylactic antibiotics
  4. prescribe prophylactic steroids
  5. treat immediately with antivenin