Current recommendations suggest using which one of the following to check the pulse of an unresponsive apneic infant under 1 year of age?
Correct Answer A:
It is recommended to check the brachial pulse in unresponsive, apneic infants under 1 year of age, although the femoral pulse may be used as an alternative. The radial artery is peripheral and difficult to palpate even in a normal infant. The short, chubby neck of infants makes rapid location of the carotid artery difficult; palpitation may also lead to inadvertent compression of the airway and stimulation of a vagal response. Checking the apical pulse is not recommended because precordial activity represents an impulse rather than a pulse. In addition, the infant’s or child’s precordium may be quiet, and a precordial pulse may not be palpated despite the presence of satisfactory cardiac function and a strong central pulse.
Which one of the following is the most correct recommendation regarding seat belt use for a woman at 38 weeks gestation?
Correct Answer C:
Pregnant women can and should always wear a seat belt when driving or riding in a car. The seat belt should be positioned under the pregnant woman’s abdomen over both the anterior superior iliac spines and the pubic symphysis. The shoulder harness should be positioned between the breasts.
Your hospital administrator asks you to develop a community screening program for melanoma.
Which one of the following is true concerning screening for this disease?
There have been no randomized, controlled trials or other definitive data to indicate that screening of melanoma reduces mortality. There are, however, factors which indicate that screening would be beneficial, including the increasing prevalence of the disease and the fact that screening is time-effective and safe. If screening is performed, populations at greatest risk should be considered. Men, especially those over age 50, have the highest incidence of melanoma.
A 72-year-old female has stable but moderately severe COPD requiring 2 L of continuous oxygen. She plans to attend the college graduation of her first grandchild, and wants to fly to avoid a 12-hour car ride. Her PaO2 on room air is 55 mm Hg.
According to the Federal Air Regulations, she must:
According to Federal Air Regulations, passengers who require oxygen for stable medical conditions cannot bring their own supplies and equipment and must arrange through the airline, 24-48 hours in advance, for oxygen to be made available on board, at layovers, and at final destinations. Anyone with a pre-flight sea level PaO2 below 68-70 mm Hg is advised NOT to fly unless supplemental oxygen can be arranged. This is because commercial aircraft maintain a relative cabin altitude between 5000 and 8000 feet during routine flight. This altitude corresponds to a decreased barometric pressure, which causes a corresponding drop in the normal baseline PaO2. In normal healthy individuals, this corresponds to a drop from a PaO2 of 98 mm Hg to a PaO2 of 60-70 mm Hg. On the oxyhemoglobin dissociation curve, a PaO2 of 60 mm Hg is the point at which there is a steep gradient of the pressure/saturation relationship. This patient has a baseline PaO2 of only 55 mm Hg, so she certainly could not sustain a flight without oxygen.
While it may be prudent to have a given patient complete some respiratory testing prior to flying, no specific preflight testing is required.
You are asked by the local Chamber of Commerce to give a talk to business leaders about West Nile virus.
Which one of the following is true regarding infection with this virus?
Correct Answer D:
West Nile virus (WNV) is transmitted to humans by the bite of mosquitoes infected after biting virus-carrying birds. Originally discovered in West Africa, it was first seen in the North America in New York City in 1999. It is currently widespread throughout the continental U.S. Although the virus is a human neuropathogen, most infected persons have no symptoms. One out of 150 human infections results in severe neurologic disease with encephalitis, meningitis, flaccid paralysis, or coma. The elderly are at greatest risk for severe disease.
Most symptomatic patients have a self-limited febrile illness with chills, headache, myalgias, and fatigue. Stiff neck, arthralgias, cough, and rash are uncommon symptoms. Hemorrhage is not associated with WNV infection and infected bird droppings are not a mode of WNV transmission.
Treatment is supportive, even in severe disease. The efficacy of antiviral medicines is anecdotal and is not supported by the results of controlled clinical trials.
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