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Heat acclimation — MRCP Part 1 MCQ

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HardExercise PhysiologyHeat acclimationMRCP Part 1

A collapsed runner is confused and combative after a hot-weather race. Rectal temperature is 41.3°C; glucose is normal and there is no major trauma. An ambulance is available immediately and a cold-water immersion tub is beside the finish area. What should happen next?

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Correct answer: B — Begin cold-water immersion before ambulance transport

The best answer is “Begin cold-water immersion before ambulance transport”. This is exertional heat stroke: central neurological dysfunction with severe hyperthermia. The priority is rapid whole-body cooling—preferably cold-water immersion—at the scene, following the “cool first, transport second” principle, because outcome depends on minimising time above the critical temperature. Rectal measurement is the reliable field standard; tympanic readings may mislead. Antipyretics do not correct exercise-generated heat, and chilled fluid alone is much less effective than active external cooling.

Reference: RCSEd 2024 pre-hospital exertional heat illness consensus: https://fphc.rcsed.ac.uk/media/3665/fphc-exertional-heat-illness-consensus-statement-2024-v14-_final.pdf