Q.1 Which of the following is the most effective initial treatment for severe hypothermia?
Immersion in hot water
Active external rewarming with blankets and warm fluids
Application of ice packs to the core
Rapid exercise to generate heat
Explanation - In severe hypothermia, gradual rewarming using external methods and warm IV fluids is recommended. Hot water or ice packs can worsen the condition.
Correct answer is: Active external rewarming with blankets and warm fluids
Q.2 What is the hallmark sign of heat stroke?
Sweating and pallor
Hot, dry skin with altered mental status
Bradycardia and hypothermia
Shivering and confusion
Explanation - Heat stroke presents with hyperthermia (>40°C), hot dry skin, and central nervous system dysfunction, distinguishing it from heat exhaustion.
Correct answer is: Hot, dry skin with altered mental status
Q.3 In snakebite management, which of the following is most important in the initial prehospital setting?
Applying a tourniquet proximal to the bite
Incision and suction of the bite
Immobilizing the limb and rapid transport to hospital
Applying ice directly to the bite site
Explanation - For venomous bites, immobilization and prompt medical care are crucial. Tourniquets, incisions, suction, or ice can worsen tissue damage.
Correct answer is: Immobilizing the limb and rapid transport to hospital
Q.4 Which type of shock is most commonly associated with severe burns?
Cardiogenic shock
Hypovolemic shock
Septic shock
Neurogenic shock
Explanation - Severe burns lead to fluid loss and hypovolemia, causing hypovolemic shock. Early fluid resuscitation is critical.
Correct answer is: Hypovolemic shock
Q.5 Which electrolyte abnormality is most commonly seen in patients with severe rhabdomyolysis after wilderness trauma?
Hyperkalemia
Hypokalemia
Hypernatremia
Hypocalcemia
Explanation - Rhabdomyolysis releases potassium from damaged muscle cells, often leading to hyperkalemia, which can cause life-threatening arrhythmias.
Correct answer is: Hyperkalemia
Q.6 What is the first-line treatment for frostbite of the fingers with clear blisters?
Rapid rewarming in warm water
Application of dry ice
Leaving it exposed to air
Massage the affected area
Explanation - Frostbite should be rewarmed in a water bath of 37-39°C. Ice, air exposure, or massage can cause further tissue injury.
Correct answer is: Rapid rewarming in warm water
Q.7 In lightning strike victims, which of the following is a priority?
Immediate CPR for pulseless patients
Administering epinephrine
Immobilizing suspected fractures first
Keeping the patient in a supine position
Explanation - Cardiac arrest is the most common cause of death in lightning strikes, so CPR is prioritized over other interventions.
Correct answer is: Immediate CPR for pulseless patients
Q.8 Which type of environmental emergency is characterized by exposure to cold and wet conditions, with intact skin but systemic hypothermia?
Frostbite
Immersion (trench) foot
Hypothermia
Chilblains
Explanation - Hypothermia affects the core temperature and can occur even with intact skin, often from prolonged cold and wet exposure.
Correct answer is: Hypothermia
Q.9 Which marine envenomation typically causes delayed systemic symptoms, including muscle cramps, vomiting, and respiratory distress?
Box jellyfish sting
Sea urchin spine injury
Cone snail sting
Stingray puncture
Explanation - Cone snail venom contains neurotoxins that can cause delayed systemic toxicity, unlike sea urchin or stingray injuries which are mostly local.
Correct answer is: Cone snail sting
Q.10 Which of the following is a key feature of heat exhaustion but not heat stroke?
Altered mental status
Core temperature >40°C
Profuse sweating
Seizures
Explanation - Heat exhaustion presents with heavy sweating, whereas heat stroke may involve hot, dry skin and CNS dysfunction.
Correct answer is: Profuse sweating
Q.11 In a drowning victim rescued from cold water, which of the following is recommended before removing wet clothing?
Immediate vigorous drying and warming
Leaving wet clothes and transporting rapidly
Immersion in warm bath
Administering oral fluids
Explanation - Wet clothing should remain on to prevent further heat loss; the priority is rapid transport and gradual rewarming.
Correct answer is: Leaving wet clothes and transporting rapidly
Q.12 Which of the following is the most life-threatening complication of a brown recluse spider bite?
Necrotic skin ulcer
Systemic hemolysis
Mild erythema
Localized pain
Explanation - Although local necrosis is common, systemic hemolysis and renal failure are the most dangerous complications.
Correct answer is: Systemic hemolysis
Q.13 Which type of venomous snake is most commonly associated with coagulopathy rather than neurotoxicity?
Elapids (cobras, kraits)
Vipers (pit vipers, rattlesnakes)
Sea snakes
Coral snakes
Explanation - Viper venom often contains hemotoxins causing coagulopathy and tissue damage; elapids mainly cause neurotoxicity.
Correct answer is: Vipers (pit vipers, rattlesnakes)
Q.14 What is the most important first aid measure for a jellyfish sting?
Rubbing the site vigorously
Immersing in hot water or vinegar
Applying alcohol or fresh water
Scrubbing with sand
Explanation - Hot water (40-45°C) or vinegar can inactivate nematocysts and reduce pain; rubbing or fresh water can worsen stings.
Correct answer is: Immersing in hot water or vinegar
Q.15 Which of the following is a major risk factor for high-altitude pulmonary edema (HAPE)?
Rapid ascent above 2500 m
History of asthma
High fluid intake
Sedentary lifestyle at low altitude
Explanation - HAPE occurs due to pulmonary vasoconstriction from hypoxia at high altitudes, especially with rapid ascent.
Correct answer is: Rapid ascent above 2500 m
Q.16 Which symptom is most specific for decompression sickness ('the bends')?
Diffuse itching
Joint and limb pain
Nausea and vomiting
Headache
Explanation - Pain in large joints, often elbows and shoulders, is a hallmark symptom of decompression sickness due to nitrogen bubble formation.
Correct answer is: Joint and limb pain
Q.17 Which of the following is an essential component of prehospital management of a patient with severe lightning injury and cardiac arrest?
Defibrillation only after transport
Immediate airway management and CPR
Immobilization without resuscitation
Administration of IV antibiotics
Explanation - Airway management and early CPR are lifesaving in lightning victims, as cardiac arrest is common.
Correct answer is: Immediate airway management and CPR
Q.18 Which type of frostbite presents with hemorrhagic blisters?
Superficial frostbite
Deep frostbite
Chilblains
Trench foot
Explanation - Deep frostbite damages underlying tissues and blood vessels, leading to hemorrhagic blisters, unlike superficial frostbite.
Correct answer is: Deep frostbite
Q.19 Which of the following is a contraindicated intervention in a patient with hypothermic cardiac arrest?
Continuous CPR
Rapid defibrillation attempts
Passive external rewarming
Transport to advanced care center
Explanation - Defibrillation may be ineffective in severe hypothermia (<30°C) until core temperature is partially restored; CPR and warming are prioritized.
Correct answer is: Rapid defibrillation attempts
Q.20 Which environmental emergency is associated with hypotension, bradycardia, and warm skin following spinal cord injury in wilderness settings?
Hypothermia
Neurogenic shock
Septic shock
Heat stroke
Explanation - Neurogenic shock results from loss of sympathetic tone after spinal injury, causing hypotension, bradycardia, and warm skin.
Correct answer is: Neurogenic shock
Q.21 Which of the following measures is recommended for preventing altitude sickness during rapid ascent?
Gradual ascent, limiting altitude gain per day
High carbohydrate diet only
Hydration avoidance
Strenuous activity immediately
Explanation - Gradual ascent allows acclimatization and reduces the risk of acute mountain sickness, HAPE, and HACE.
Correct answer is: Gradual ascent, limiting altitude gain per day
Q.22 What is the most important initial management step in a patient with crush syndrome in a wilderness setting?
Immediate vigorous movement
Aggressive IV fluid resuscitation before release of pressure
Application of tourniquet
Rapid cooling of the affected limb
Explanation - Fluid resuscitation before extrication helps prevent sudden hyperkalemia and renal failure from rhabdomyolysis.
Correct answer is: Aggressive IV fluid resuscitation before release of pressure
Q.23 Which of the following is a typical feature of cold urticaria after exposure to low temperatures?
Painless skin redness
Itchy wheals and hives
Necrotic lesions
Blistering only
Explanation - Cold urticaria is an allergic response to cold, resulting in pruritic hives; severe reactions may cause systemic symptoms.
Correct answer is: Itchy wheals and hives
Q.24 Which of the following toxins is associated with ciguatera fish poisoning?
Neurotoxin from reef fish
Bacterial endotoxin from shellfish
Tetrodotoxin from pufferfish
Mercury from large predatory fish
Explanation - Ciguatera toxin accumulates in reef fish and causes gastrointestinal and neurological symptoms, including temperature reversal.
Correct answer is: Neurotoxin from reef fish