Emergency medicine: heat stroke: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Emergency medicine: heat stroke

Sample item

A 22-year-old soldier collapses during a march in 42 degrees Celsius heat. His core temperature is 41.5 degrees Celsius, he is confused, with hot dry skin, heart rate 140 per minute and blood pressure 90/50 mmHg. What is the most important immediate step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Rapid cooling, such as cold-water immersion, with intravenous fluids

Exertional heat stroke is a core temperature above 40 degrees Celsius with central nervous system dysfunction, and outcome depends on how fast the temperature is lowered. Cold or ice water immersion is the most effective method, with evaporative cooling as an alternative, and cooling continues until about 38.5 degrees Celsius. Antipyretics do not work because the hypothalamic set point is normal.

Option by option

  • A. Intravenous chlorpromazine

    Chlorpromazine can lower seizure threshold and impair sweating and is not recommended.

  • B. Oral paracetamol

    Paracetamol is ineffective because the problem is heat load rather than a raised set point.

  • C. Intravenous dantrolene

    Dantrolene has not been shown to help in heat stroke.

  • D. Rapid cooling, such as cold-water immersion, with intravenous fluids (correct)

    Correct. Rapid active cooling limits the duration of hyperthermia and organ damage.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Rapid cooling, such as cold-water immersion, with intravenous fluids. Exertional heat stroke is a core temperature above 40 degrees Celsius with central nervous system dysfunction, and outcome depends on how fast the temperature is lowered.

Why is "Intravenous chlorpromazine" not the answer?

Chlorpromazine can lower seizure threshold and impair sweating and is not recommended.

Why is "Oral paracetamol" not the answer?

Paracetamol is ineffective because the problem is heat load rather than a raised set point.

Why is "Intravenous dantrolene" not the answer?

Dantrolene has not been shown to help in heat stroke.

What concept does this question test?

It tests Emergency medicine: heat stroke in General Medicine. Cold or ice water immersion is the most effective method, with evaporative cooling as an alternative, and cooling continues until about 38.5 degrees Celsius. Antipyretics do not work because the hypothalamic set point is normal.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Emergency medicine: heat stroke?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.