DMT 2020 - SECTION C

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Study Quiz points

Refer to Diver Medic Manual pages 36-82

There are 25 MCQs in this section.
Please select only ONE correct answer per question.
 NAME: *

Mussa bin Md Noh

1. Barotrauma 1 of 1 points

* 1/1

can occur in any gas-containing

spaces within the body

is a result of Ohm's Law

requires treatment in a hyperbaric

chamber whenever possible

is not common in scuba diving

causes one to fart foul smelling gases

ANSWER: 1. Barotrauma 0 of 0 points

Refer to page 37

Ohm's law not applicable in this course

ALL Barotrauma-type injuries do not require treatment in a

chamber

Barotrauma is VERY COMMON in scuba diving, in

particular Middle-Ear and Sinus Barotrauma
 2. Middle ear barotrauma 1 of 1 points

* 1/1

mostly occurs in middle-aged, obese

divers with facial warts

mostly occurs during descent

often results in bleeding from the affected

ear

is treated with antibiotics ear drops

can be prevented by diving head-down

during descent

ANSWER 2. Middle ear 0 of 0

barotrauma points

See page 39-42

Bleeding from the affected ear can happen BUT is not

common

Antibiotics ear drops are NOT necessary, and only

indicated if infection is present.

Prevention of middle ear barotrauma -

1) equalise on the surface before going down

2) always descent feet first
3) stop to equalise every few metres during descent
4) if one ear feel block, STOP descent. Go upwards one
metre (1msw) and try to equalise with the head tilted up
on the side of the "blocked" ear.
5) do not wait till you feel pain in the ear before stopping
your descent - that's usually too late making it potentially
even harder to equalise
:
 6) NEVER do forceful equalisation (see inner ear
barotrauma). It's better to cancel that dive and try again
later or the next day

Tips on equalisation:
1) The standard way most people equalise is by doing the
'Valsalva Manoeuvre' ie. pinching the nose and GENTLY
blowing with the mouth closed. One will hear a "pop"
sound in each ear when the eustachian tube opens.
2) If the 'valsalva manoeuvre' fails - try repeating the
procedure and then wriggling the jaw side-to-side
3) If #2 also fails, try repeating #2 and then swallow at the
same time.
4) Of course one can try to 'yawn' which is very effective in
opening the eustachian tube but it's not easy to get a yawn
on demand

3. Sinuses 1 of 1 points

* 1/1

are air spaces within the bones of the

skull and face

are mostly connected to the lungs

are lined by mucous membrane but has

little or not blood supply

if present in large numbers are

representative of increased intelligence

are seldom affected by barotrauma

ANSWER 3. Sinuses 0 of 0 points

Refer to page 49
:
 The sinuses are bony 'caves' within the face, lined with
mucous membrane and has a rich blood supply. They open
(drains) into the nose.

Sinus barotrauma (especially frontal sinus) is relatively

common.

4. Sinus barotrauma 1 of 1 points

* 1/1

results in pain in the affected sinus

is a result of Jude Law

should be treated in a hyperbaric chamber

if available

cannot occur during air travels

is treated with a tourniquet around the

neck

ANSWER 4. Sinus barotrauma 0 of 0 points

see pages 49

Any of the barotrauma may happen during standard

commercial air travel, including pulmonary barotrauma.

If you have answered 'tourniquet around the neck' as

correct - please pack your bags and go home.

5. The inner ear 1 of 1 points

:
 * 1/1

is an air-filled organ

is responsible for hearing and balance

is connected to the middle ear via the

tympanic membrane (ear-drum)

can be seen using an otoscope in some

stupid people

is connect to the nose via the eustachian

tube

ANSWER 5. The inner ear 0 of 0 points

See page 36 and 43

6. Which of the following is NOT a sign1 of 1

/ symptom of inner ear injury points
:
 * 1/1

hearing loss

imbalance

vertigo

nystagmus

cyanosis

ANSWER 6. Which of the following is

0 of 0
NOT a sign / symptom of inner ear
points
injury

Refer to the signs/symptoms of inner ear barotrauma on

page 43
A person with inner ear injury (including barotrauma) will
have imbalance (with or without vertigo)

7. Inner ear barotrauma 1 of 1 points

:
 * 1/1

is often a result of middle ear

barotrauma

there is a history of drug use before the

dive

happens when nitrogen bubbles enter the

cochlea

happens when the spouse nags too much

before a dive

results in marital discord

ANSWER 7. Inner ear barotrauma 0 of 0 points

See page 43

8. Pulmonary Barotrauma 1 of 1 points

:
 * 1/1

is also known as "Pakatan Over-Inflation

Syndrome" (POIS)

can result in pneumothorax

usually happens during descent

must always be treated in a hyperbaric

chamber

is another name for the "Chokes"

ANSWER 8. Pulmonary 0 of 0
Barotrauma points

Refer to pages 54-61

Pulmonary Barotrauma is also known as "Pulmonary over-

inflation syndrome" in the American textbooks.

It occurs only during ascent (hence 'over-inflation')

None of the barotraumas requires treatment in a

hyperbaric chamber.
Cerebral arterial gas embolism (CAGE) - a complication of
pulmonary barotrauma, requires treatment in a chamber
BUT not the pulmonary injury itself.

"Choke" is Pulmonary DCS (see page 68). The bubbles are

nitrogen bubbles released during decompression, but NOT
from pulmonary barotrauma.
:
 9. Gas-bubbles released during an
1 of 1
episode of pulmonary barotrauma may
points
cause

* 1/1

Joint pain

Subcutaneous emphysema

Impotence

Autism

Dysbaric osteonecrosis ("bone rot")

ANSWER 9. Gas-bubbles released

0 of 0
during an episode of pulmonary
points
barotrauma may cause

Refer to pages 54-61

10. Cerebral Arterial Gas Embolism 1 of 1

(CAGE) points
:
 * 1/1

occurs when gas bubbles from the

lungs enter the arterial circulation

can cause pulmonary barotrauma

is the commonest cause of seizures

is a syndrome caused by shark cage diving

should be manage by positioning the diver

upside down

ANSWER 10. Cerebral Arterial Gas 0 of 0

Embolism (CAGE) points

Refer to page 60

Pulmonary barotrauma results in (causes) CAGE

CAGE can result in seizures - BUT is not the commonest

cause of it.

11. First responder management of 1 of 1

CAGE includes: points
:
 * 1/1

placing a straw through the nasal cavity

and sucking out the bubbles

CPR if necessary and 100% oxygen

always

IV heparin to dissolve the bubbles

Keeping the head below the level of the

heart, and raising both legs

Placing a tourniquet around the neck at

C4-C5 level to prevent more bubbles from
going to the brain

ANSWER 11. First responder 0 of 0

management of CAGE includes: points

Refer to page 60

12. While waiting for patient-transfer

to hospital, the medic caring for an 1 of 1
diver with DCS should do the following points
EXCEPT
:
 * 1/1

monitor and record vital signs at regular

intervals

ask for new symptoms developing (if any)

repeat secondary survey (including a

"neuro") at regular intervals

maintain communication with the diving

doctor (if available)

perform in-water recompression if

suitable equipment are available

ANSWER 12. While waiting for patient-

transfer to hospital, the medic caring 0 of 0
for an diver with DCS should do the points
following EXCEPT

This question helps put in perspective what a diver medic

needs to do while "managing" a diver.
The sequence of DRCAB or DRABC is familiar.
What next?

The list should include:

1. Communicate with the medic/diving dr
2. Secondary survey (including the neuro exam) - feedback
to medic/dr
3. Repeat the vital signs - feedback to medic/dr
4. Act on the instructions given by the medic/dr
5. REPEAT

So, while managing a diver-patient the DMT keeps

repeating the vital signs, secondary survey plus any other
procedures the medic / dr may ask you to do, feedback to
the medic/dr.
:
 13. Decompression Sickness (DCS) 1 of 1
is a result of points

* 1/1

Newton's Law

Boyle's Law

Charles' Law

Murphy's Law

Henry's Law

ANSWER 13. Decompression 0 of 0

Sickness (DCS) is a result of points

See pages 9, 62-82

14. The following are occupations that

1 of 1
may be at risk of Decompression
points
Sickness EXCEPT
:
 1/1

Tunnel workers

Snorkellers

Astronauts

Scientific research divers

Chamber inside attendants

ANSWER 14. The following are

0 of 0
occupations that may be at risk of
points
Decompression Sickness EXCEPT

DCS was first described (discovered) in caisson (tunnel)

workers, not diver.

Any diver is at risk of DCS (scuba, commercial, scientific

research, divers who clean aquariums etc)

Any person who is exposed to increased pressure for a

period of time is at risk (tunnel workers, chamber
attendants)

Any person who may be exposed to a reduction in

pressure (decompression) is at risk (astronauts, some
fighter pilots)

15. Decompression Sickness affects 1 of 1

the following EXCEPT points
:
 * 1/1

Skin

Spinal cord

Joints

Brain

Middle Ear

ANSWER 15. Decompression Sickness 0 of 0

affects the following EXCEPT points

Refer to pages 62-82

16. Joint pain due to DCS 1 of 1 points

:
 * 1/1

is usually painful on movement

causes swelling in and around the affected

joint

may resolve without treatment in a

hyperbaric chamber

commonly affect the small joints of the

hands and feet

is categorised as DCS Type II

ANSWER 16. Joint pain due to 0 of 0

DCS points

Refer to pages 66

The joint pain due to DCS should be differentiated from

the joint-pain from sprain, or injury.

Joint pain due to DCS usually have none of the signs of

injury (local tenderness, swelling, limitation of movement,
redness or erythema over the joint)

Joint pain DCS can be fleeting - i.e. moves to different

joint momentarily

Joint pain DCS affects mostly Shoulder, Elbow, Knee and

rarely the Temporo-mandibular (jaw) joint.

17. The following are risk factors of 1 of 1

Decompression Sickness EXCEPT points
:
 * 1/1

Flying before diving

Physical fitness

Carbon dioxide retention

Repetitive dives

Decompression dives

ANSWER 17. The following are risk

0 of 0
factors of Decompression Sickness
points
EXCEPT

See pages 70-71

No-decompression diving carries a lower risk that any

diving that requires the diver to do deco-stops

All dives beyond 6msw carries a risk of DCS.

18. Gas-containing spaces in the body 1 of 1

include the following EXCEPT: points
:
 * 1/1

Face mask

The sinuses

The middle ear

Lungs

Gastrointestinal Tract

ANSWER 18. Gas-containing spaces in

0 of 0
the body include the following
points
EXCEPT:

See page 37

19. Pulmonary barotrauma may result 1 of 1

in the following EXCEPT points
:
 * 1/1

Tension pneumothorax

Mediastinal emphysema

Coughing out pink frothy sputum

Nose bleed

Fatal gas embolism

ANSWER 19. Pulmonary barotrauma 0 of 0

may result in the following EXCEPT points

See page 54
Note the typo mistake on page 54. Should be pink frothy
sputum and not "bright frothy sputum"

20. Arterial gas embolism 1 of 1 points

:
 * 1/1

Usually affects the brain

Results in a hoarse voice

Causes nose bleed after diving

Can cause pneumothorax

If the patient improves with 100% oxygen,

then recompression in a chamber is not
necessary

ANSWER 20. Arterial gas 0 of 0

embolism points

See page 60

Sometimes a diver with CAGE (or AGE) may seem improve

completely on breathing just 100%, BUT this is usually just
temporary, because deterioration will usually follow after
the initial improvement.

21. Rapid ascent from depth can 1 of 1

cause which of the following? points
:
 * 1/1

DCS, Pulmonary barotrauma, arterial

gas embolism

Nitrogen narcosis, HPNS, Oxygen toxicity

Increased in-gassing of inert gas

Rapid ascent psychoneurosis

None of the above

ANSWER 21. Rapid ascent from depth 0 of 0

can cause which of the following? points

This is a common-sense question that divers should know.

Gas toxicities (e.g. N2 narcosis, HPNS, toxicity) all occur

at depth and not during ascent

In-gassing occurs during descent, and off-gassing (or out-

gassing) occurs during ascent

There is no such thing as "rapid ascent psychoneurosis"

22. Bubble growth is decreased 1 of 1

by points
:
 * 1/1

A. Oxygen and increased barometric

pressure

B. Recompression in a chamber

C. Ascending to altitude

D. A and B above

E. A and C above

ANSWER 22. Bubble growth is 0 of 0

decreased by points

Refer to pages 75-82

23. Management of Middle Ear 1 of 1

Barotrauma include: points
:
 * 1/1

No diving for about 2-4 weeks

Antibiotics for one week

Intravenous fluids

Frequent valsalva (clearing/equalisation of

the ears)

All of the above

ANSWER 23. Management of Middle 0 of 0

Ear Barotrauma include: points

Refer to pages 39-42

Most barotrauma takes time to recover. A period of 2-4

weeks depending on severity.

24. The following are correct: 1 of 1 points

:
 * 1/1

Middle ear barotrauma is the commonest

form of barotrauma

Blood from the nose on returning to the

surface is commonly due to sinus
barotrauma

The inner ear has no air spaces but "inner

ear barotrauma" can occur

All of the above

None of the above

ANSWER 24. The following are 0 of 0

correct: points

Refer to page 39 - MEBT is the commonest form of

barotrauma

Refer to page 50 - most of the sinuses drain into the nose.

Refer to pages 36, 43-44 for inner ear and inner ear
barotrauma

25. "Mental disturbances, altered

behaviour, headaches, visual
1 of 1
disturbances, difficulties with
points
speech"....describe what type of
condition?
:
 * 1/1

Spinal cord DCS

Cerebral DCS

Sinus barotrauma

Oxygen toxicity

Nitrogen Narcosis

ANSWER 25. "Mental disturbances,

altered behaviour, headaches, visual
0 of 0
disturbances, difficulties with
points
speech"....describe what type of
condition?

There is no need to memorise all signs and symptoms of

most disease in this course.

This question is a common sense question and answering

by process of elimination.

The above Symptoms and signs are not from the Spinal
cord, Sinus, or typical of nitrogen narcosis or oxygen
toxicity. The only answer left is Cerebral DCS - those are all
'brain' symptoms and signs

You have completed the MCQs for 0 of 0

Section C points

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