High-Altitude-Related Illnesses

Question · easy

A 45-year-old accountant is planning a trekking trip to the Everest region of Nepal and asks which personal characteristics increase his risk of developing high-altitude illness. Which of the following is NOT an established risk factor for high-altitude illness?

Low physical fitness level Heavy exertion during ascent A prior episode of high-altitude illness Rapid ascent gaining more than 3500 m in less than 2 days

Question · easy

A 28-year-old hiker develops headache, malaise, nausea, and poor sleep about 8 hours after ascending with her group to a new sleeping altitude of 2900 m. She has no ataxia or altered mentation, and the group plans no further gain in altitude for the next two days. Which is the most appropriate initial management?

Dexamethasone 4 mg every 6 hours Rest at the current altitude with aspirin or an NSAID for headache Immediate descent to below 2000 m Placement in a portable hyperbaric bag

Question · medium

Two days after flying directly to a research station at 4200 m, a 35-year-old scientist develops worsening headache and vomiting, and colleagues note he has become confused and is stumbling. On examination he is irritable with an ataxic gait. Which of the following is the most appropriate management?

Brain imaging to exclude a focal lesion before any intervention Nifedipine 30 mg and strict bed rest at the current altitude Immediate descent, supplemental oxygen, and dexamethasone Acetazolamide 250 mg every 12 hours and observation at the current altitude

Question · medium

A 32-year-old man develops dyspnea at rest, a dry cough progressing to blood-tinged sputum, tachycardia, and crackles on the third day after rapid ascent to 3600 m. Chest radiography shows patchy opacities without Kerley B lines. Which of the following is the most appropriate treatment?

Supplemental oxygen, rest, descent, and adjunctive nifedipine Empiric antibiotics for community-acquired pneumonia Furosemide and sublingual nitroglycerin to reduce pulmonary congestion Acetazolamide and continued rest at the current altitude

Question · hard

A 68-year-old man with severe COPD uses long-term home oxygen at 2 L/min; his resting sea-level pulse oximetry is 94% and he has been clinically stable for months. He asks how to manage his oxygen during a scheduled commercial flight. Which of the following is the most appropriate recommendation?

No additional oxygen is needed because his sea-level saturation exceeds 92% Double his oxygen flow rate to 4 L/min during the flight He should avoid commercial air travel entirely because of his oxygen dependence Hypoxia-altitude simulation testing must be performed before any flight