08-23-2014, 04:42 PM
21.
An 18-year-old college student is admitted to the hospital for observation after sustaining a closed head injury in a fall from a second-story porch. According to paramedics, the patient was unconscious for several minutes after the fall. On arrival at the emergency department 9 hours ago, he was oriented to person but not to place or time. At that time, vital signs and physical examination, including funduscopic and neurologic examinations, were otherwise noncontributory. A CT scan of the head was normal. The patient's confusion improved during the next 8 hours. Now, he is alert and oriented. He says he remembers tripping on the stairs and falling after drinking beer and smoking marijuana with a group of older students. The patient was seen in the student health center 3 weeks ago because of difficulty sleeping. At that time, depression was diagnosed and fluoxetine therapy was initiated, in addition to recommending sessions at the campus counseling center. Which of the following is the most significant risk factor leading to this patient's injury?
A) History of depression
B) Patient's age
C) Use of alcohol (confirmed by nbme)
D) Use of fluoxetine
E) Use of marijuana
Ans) C (confirmed by nbme)
There is a significant difference in the pattern and severity of injury sustained during falls if the patient has consumed alcohol or not. Alcohol related falls are more often associated with severe craniofacial injury. The severity of both limb and head injury is greater and correlates directly with blood alcohol concentration.
An 18-year-old college student is admitted to the hospital for observation after sustaining a closed head injury in a fall from a second-story porch. According to paramedics, the patient was unconscious for several minutes after the fall. On arrival at the emergency department 9 hours ago, he was oriented to person but not to place or time. At that time, vital signs and physical examination, including funduscopic and neurologic examinations, were otherwise noncontributory. A CT scan of the head was normal. The patient's confusion improved during the next 8 hours. Now, he is alert and oriented. He says he remembers tripping on the stairs and falling after drinking beer and smoking marijuana with a group of older students. The patient was seen in the student health center 3 weeks ago because of difficulty sleeping. At that time, depression was diagnosed and fluoxetine therapy was initiated, in addition to recommending sessions at the campus counseling center. Which of the following is the most significant risk factor leading to this patient's injury?
A) History of depression
B) Patient's age
C) Use of alcohol (confirmed by nbme)
D) Use of fluoxetine
E) Use of marijuana
Ans) C (confirmed by nbme)
There is a significant difference in the pattern and severity of injury sustained during falls if the patient has consumed alcohol or not. Alcohol related falls are more often associated with severe craniofacial injury. The severity of both limb and head injury is greater and correlates directly with blood alcohol concentration.