Environmental Exposures 467431.A 25-year-old female scuba diver presents to the ED with multiple areas
of periarticular joint pain and red, itchy skin. Her initial vitals include an
oral temperature of 98°F, BP of 110/65 mm Hg, HR of 88 beats per minute,
RR of 14 breaths per minute, and oxygen saturation of 97% on room air.
Upon physical examination, the patient has pain upon palpation of bilateral
knees and ankles with full range of motion in these joints. Areas of erythema
that do not follow a specific dermatomal pattern cover most of the lower
extremities, torso, and back with areas of excoriation where patient reports
scratching. There are no other lesions. Which of the following is the most likely
diagnosis?
a. Sexually transmitted disease (STD)
b. Decompression sickness
c. Descent barotrauma
d. Ascent barotrauma
e. Nitrogen narcosis
432.A 19-year-old rookie Navy Seal presents to the ED with a history of
syncope upon ascent from a dive. The length and depth of the dive was within
decompression regulation. He currently complains of feeling light-headed with
a moderate frontal headache. Vital signs include HR of 86 beats per minute, BP
of 130/65 mm Hg, and RR of 16 breaths per minute with oxygen saturation of
93% on room air. Upon physical examination, he appears somewhat confused
and is oriented only to person and place. He has no focal neurologic deficits.
What underlying event is the cause for this patient’s symptoms?
a. Pulmonary embolism
b. Cardiac ischemia
c. Transient ischemic attack
d. Dysbaric air embolism
e. Nitrogen narcosis