skip to main content

Retained common bile duct stone — USMLE Step 3 MCQ

Instant feedback + full explanation. One question, done properly.

HardSurgery (post-operative, follow-up)Retained common bile duct stoneUSMLE Step 3

A 21-year-old collapses near the finish of a summer road race. He is combative, rectal temperature is 41.2°C, glucose is normal, and sodium is 139 mEq/L. An ambulance is present and cold-water immersion equipment is immediately available. Which action should occur next?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Begin cold-water immersion while emergency transport is coordinated

The best answer is “Begin cold-water immersion while emergency transport is coordinated”. Exertional heat stroke is hyperthermia plus central neurologic dysfunction. Outcome depends on rapid reduction of core temperature, and cold-water immersion is the most effective method; cooling should precede nonessential transport or testing. Antipyretics do not correct environmentally driven hyperthermia. The alternatives are less suitable because they mistime the intervention, omit a necessary component, or apply treatment for a different physiologic problem; the stem's decisive findings determine the sequence.

Reference: CDC Yellow Book, Heat Stroke Management: https://www.cdc.gov/yellow-book/hcp/environmental-hazards-risks/heat-and-cold-illness-in-travelers.html