Frostbites.Solar and heatstroke.

Warmisolateddressing - this is©

+ Gauze bandage, soaked with alcohol©

cotton - gauze bandage with furacilini©

cotton - gauze bandage with vaseline oil©

a sterile cotton-gauze bandage with polyethylene or rubber cover©

a sterile cotton-gauze bandage

***

Forcedwarmingallowsfrostbite, reaching©

Freezing of tissues©

4 degree ©

3 degree©

+1 and 2 degrees©

4 and 5 degrees

***

First aid before the reactive period includes©

rapid warming, rubbing with snow©

the forced warming of frostbitten extremeties, plunging her into a bath with the water temperature in 40Ђ©

the forced warming, including warming lamp or hair dryer©

treatment with alcohol©

+ treating the alcohol, application of warmisolatedbandage

***

How many degrees of the frostbite do you know©

+4 degree©

5 degree©

2 degree©

.3 degree©

1 degree

***

What kind of periods of frostbite©

+prereactive and reactive©

primary and reactive©

subacute and acute©

prereactive and subacute©

subacute

***

.How many stages of frostbite do you know©

Stages

In the reactive period necroectomy should perform©

on 1st day©

on the third day©

+ at the 5-6th day©

on 14-15th day©

for 8-10th day

***

Amputation and disarticulation after frostbite can be listed at all, except©

primary©

secondary©

lated©

+thedeferred©

primary-secondary

***

The primary amputation for deep and extensive frostbite conducted©

immediately on admission to prereactive period©

in the early hours of prereactive period©

the first day of prereactive period©

+ for 4-5 day of reactive period ©

after 3-4 weeks in a reactive period

***

What kind of stage of frostbite characterized by absence of pain©

3 stage©

4 stage©

+ 1 stage©

2 stage©

1-2 stages

***

How do correctly implement active, but not the forced warming in water bath©

+ Warming starts with water temperature 18 ° C, raising it to 35 ° C for 10-15 min©

Warming water temperatures begin with a 0 ° C, raising it to 55 ° C for 5 min©

Warming starts with water temperature 40 ° C without temperature lift©

From reduction of the general temperature of the body till 25°С©

Reinforcement function defense mechanisms of the organism

***

The intensity of pain after warming at frostbite depends on©

the total rate of cooling©

+ the depth and spread of the pathological process©

the total reduction in body temperature to 25 ° C©

strengthening the functions of protective mechanisms of the organism©

Warming begin with temperature of water in 40°С without ascent of the temperature

***

Poisoning

Etiopatogenetic classification includes poisoning, except©

random©

intentional©

+ pathochemical©

production©

household

***

Syndrome of lesions of the respiratory syndrome includes©

convulsions©

+ hypoxic hypoxia©

OSSN©

pain©

exotoxic shock

***

Methods to enhance the natural detoxification of the body all, except©

gastric lavage©

forced diuresis©

therapeutic hyperventilation©

purgation©

+ the exchange of blood replacement

***

At poisoning with carbon monoxide when there is severe condition ©

headache, nausea©

dyspnoes,hortness of breath©

loss of consciousness, facial flushing©

vertigo, vomiting©

+ convulsions, paresis, paralysis

***

What complications can be from the point of cardio-vascular system in the administration of alkaline©

+ non-specific tachycardia, drop in blood pressure©

bradycardia, hypoxia©

atrial fibrillation©

tachycardia, sustained increase in blood pressure©

no complications

***

The main syndrome in the administration of alkaline is©

alcohol intoxication©

shortness of breath, dry cough©

+ burn of the digestive tract©

perforation of the colon©

acute respiratory failure

***

The patient A., 25 years old admitted to the hospital by ambulance, objectively: the moderate severity state, consciousness confused, delirious, pupils contracted, nausea, and vomiting. Relatives say that 4 hours ago he ate mushrooms, among which poisoned ones were. What can you do to help©

+ Atropine injection©

Conduct a hemodialysis©

Heparine injection©

The proteolytic enzymes injection©

perforation of colon

***

Bites and stings.

What is a form of allergic reaction at stings©

generalized urticaria, itch, weakness, fear feeling ©

dyspnoe, pain in abdomen, nausea, dizziness, vomiting©

asphyxia, dysphagia, inconsequence of thoughts, hoarse voice, feeling of doom©

shock, cyanosis, falling of AP, collapse, defecation, loss of consciousness©

+ All answers are right.

***

The body of these insects has length mare than 1 cm. At their stings during first 15 minutes expressed spastic pains in muscles, perspiration, and vomiting appear. For occupation of pains morphine can be used. Has considered, that atropine has favorable action in this situations©

+ sting of spider©

bite of snake©

bite of scorpion©

sting of tick©

sting of bee.

***

To the department of first medical aid a 7-th years patient with complains on the pain in the right extremity and dizziness was hospitalized. In inspection there is a pale skin. There are 2 pricking wounds with expressed edema, blushing and hemorrhage under skin in the area of thigh. The body temperature is 38 degree by Celcia, AP is 80/60 mm Hg. Your preliminary diagnosis is©

+Poisoning with snake’poison

Hydrophobia©

Poisoning with carbon monoxide©

Poisoning with sinile acid©

PTI.

***

The first aid at bite by venomous snake is©

+Horizontal position, rest, sucking out of poison by mouth during 10 minutes, process place of bite by spirits, applying of antiseptic bandage©

Horizontal position, rest, applying of tourniquet on damaged extremity©

The position is – sitting, sucking out of poison by mouth during 10 minutes, process a place of bite by spirits, applying of antiseptic bandage©

Washing a place of bite by water, applying of tourniquet on damaged extremity©

All answers are right

***

What symptoms don’t characterizes a place of sting by karakurt©

A pain in the place of bite disappears soon©

No edema in the place of bite; Опухоли в месте укуса нет©

Sharp exciting, fear of death, dyspnoe©

Strong pains in all body, in the area of abdomen, chest, small of the back©

+Sharp intense of abdominal muscles

***

A patient of 42 years old was admitted to the urgent medical aid with a bite (sting). A bite (sting) was 20 days ago. A patient has inconsequent speech, spasm and pricking at the place of bite (sting), salivation, muscular weakness. What pathology has this clinic©

Fever©

General intoxication©

Cerebral paralysis©

+ Hydrophobia

Botulism

***

Antibacterial therapy©

+Vaccination ©

Conservative treatment by analgetics©

Usage of hepacidic preparations©

Citostatics

***

In bites (stings) the following signs can appear, except

Rash and urticaria; сыпь или крапивница©

Dizziness, weakness; головокружение; слабость©

Increasing of respiration rate and pulse rate too©

Discoloration of fecalium©

+ Nausea and vomiting

***

Determine the first aid at bite by dog with suspicion on hydrophobia©

Abundant washing of wound by water©

applying of sterile bandage on the wound©

Urgent address to the doctor©

+ Vaccination©

Washing of stomach

***

The patient was admitted to the doctor with a cutting wound. The wound is not deep, a bottom is in the middle layer of subcutaneous tissue. In asking the patient said, that damage was made in fight with razor about 2 hours before. In inspection: the wound is localized on the anterior abdominal wall, there is no pus and pollution by anaerobic microflora of wound and surrounding tissue visually. What is your tactic©

+Processing and applying of sutures©

Processing and cutting of wound borders©

Applying of pressing bandage©

Applying of aseptic moist-dying bandage©

Drainage of wound

***

Which form of asphyxia is asphyxia and drown©

Instantaneous©

Electrical ©

Anaerobic©

+ Mechanical

Slow

***

Determine the extent of electrical injury: loss of consciousness, disturbance or cardiac or respiratory system (or both together) ©

1 degree©

2 degree©

+ 3degree
4 degree©

degree is not defined as data are insufficient

***

hat should be injected at respiratory depression©

strophanthin©

+ lobeline©

adrenaline©

neostigmine methylsulfate (proserine) ©

ascorbic acid

***

In the reactive period necroectomy should perform©

on 1st day©

on the third day©

+ at the 5-6th day©

on 14-15th day©

for 8-10th day

***

The main syndrome in the administration of alkaline is©

alcohol intoxication©

shortness of breath, dry cough©

+ burn of the digestive tract©

perforation of the colon©

acute respiratory failure

***

Methods to enhance the natural detoxification of the body all, except©

gastric lavage©

forced diuresis©

therapeutic hyperventilation©

purgation©

+ the exchange of blood replacement

Call at home. Boy 10 years old. Complaints: fever, cramps, headache, stuffiness in nose, frequent painful cough, anxiety, drowsiness. He ill acutely, when the body temperature increased till 38.1⁰ C, headache, in the morning appeared often painful cough, spasms of hands; the body temperature reached 39.0⁰ C, drowsiness. The boy had been in contact with flu patient 3 days before the disease. Objective: expressed depression of consciousness, the child is sleeping, not responding to inspection. The generalized convulsions are observed. Body temperature – 40,0⁰ C. The skin is pale, the single petechial rash in the neck. The marked hyperemia of the soft palate with an injection of blood vessels and petechial hemorrhages to mucosa are observed. The breathing is arhythmic, dry rales are auscultated. The tachycardia, softened tones are hear on auscultation. Put a preliminary diagnosis:©

+cerebral coma II degree©

influenza, severe form©

febrile cramps©

viral meningitis©

staphylococcal sepsis

***

Call to the girl of 2 years. At the girl against the catarrhal phenomena (the hyperemia of the soft palate and conjunctives, cold) raised body temperature to 40,2⁰С and suddenly attack of general spasms of the clonic-tonic character, proceeding developed about 3 minutes. At survey the consciousness is depressed to sopor degree, skin pale, with marble shade, acrocyanosis. Tones of heart are muffled, HR 162 per minute. RR 80 per minute. The abdomen is soft. The liver and spleen were not enlarged. Put a preliminary diagnosis: ©

meningococcal nasopharyngitis ©

encephalitis ©

neurotoxicosis II degree ©

+febrile seizures ©

child tetany, laryngospasm

***

Calling a girl seven years old, desperately ill three days ago, with a body temperature of 39.2⁰C in a background of moderate catarrhal symptoms. On the 2nd day - in a rash of small, closely spaced bubbles in the hyperemic background around the nose, around the lips and on the right ear, accompanied by a distinct local pain. On the third day at the height of the temperature 40.3⁰ C - attack of tonic-clonic seizures. Seizures spontaneously stopped, but did not come into consciousness, stopped answering questions, touching, the reaction to painful stimuli only. Hypertonicity in the legs, increased deep tendon reflexes, positive Kernig's symptoms, Brudzinskii, anisocoria right, stiff neck for 2 muscles transverse finger. Put a preliminary diagnosis: ©

encephalomyelitis, infectious-allergic©

+encephalitis herpes, cerebral coma©

flu, a heavy, neurotoxicosis II degree©

meningoencephalitis, parainfectious©

child tetany, carpo-pedal spasm

***

Calling a child 12 months, morning body temperature suddenly rose to 39.7⁰ C, there is concern, worsened appetite. By lunchtime, the child became very sluggish, marked pallor, acrocyanosis and persistent marbling of the skin, seizures. The child is given paracetamol, but the temperature is maintained within the 38⁰C. The family has the flu. Heart rate 300 per minute. The ECG character set sinus tachycardia. Put a preliminary diagnosis: ©

meningococcal disease, meningococcal nasopharyngitis©

an attack of paroxysmal tachycardia, supraventricular form©

+neurotoxicosis II degree, tachycardia syndrome, neurogenic©

influenza, severe degrees of severity, hyperthermia syndrome©

influenza of moderate severity, hyperthermia syndrome

***

Calling a child 10 months. Ill two days ago, raising the temperature to low-grade, small serous nasal discharge, catarrhal conjunctivitis. Then the body temperature rose to 39.5⁰ C, became lethargic, refused food, there was vomiting, not related to meals, once clonic-tonic convulsions. On examination: general condition difficult. Listless, crying. The body temperature of 39.2⁰C. Lying on your back with outstretched arms at your sides and bent at the knee and hip joints of your feet. There is tilting the head back, a bulging fontanelle large, sometimes jerking of the limbs. Skin pale. In the throat flushing the posterior pharyngeal wall. Muffled heart sounds, heart rate = 138 per minute. Pees a little. Put a preliminary diagnosis: ©

+ meningitis©

encephalitis©

neurotoxicosis©

febrile seizures©

child tetany

***

Calling a child of 9 years. After a tick bite, which happened 10 days ago, acute fever, and appeared to 39⁰C malaise, headache, vomiting, dizziness, sleep disturbances, muscle pain and tension of the back of the neck muscles. After 5 days the temperature returned to normal, but rose again in a week. This was accompanied by intense headache, repeated vomiting, unsteady gait. On examination, determined not sharply marked meningeal symptoms, light hemiparesis. Put a preliminary diagnosis: ©

severe meningococcal meningoencephalitis, severe©

acute encephalitis, febrile form of severe©

+acute tick-borne meningoencephalitis, two-wave during©

encephalitis, poliomieliticheskaya form during acute©

epidemic encephalitis, subacute

***

Calling a child of 5 years. On examination, the doctor found an ambulance symptoms of intoxication in the form of fever, tachycardia, blood pressure and shortness of breath. In the area of the buttocks, thighs and lower legs revealed the presence of hemorrhagic rash - a crude, which has the form of stars of different shapes and sizes, dense to the touch, protruding above the skin. Roughly pronounced meningeal symptoms. Put a preliminary diagnosis: ©

meningococcal meningitis, nasopharyngitis©

meningococcal meningitis, meningoencephalitis©

meningococcal infection, viral meningitis©

+meningococcal meningitis, meningococcemia©

meningococcal infection, fungal meningitis

***

Call an ambulance for a child 8 years old. The child developed generalized weakness, painful headache and muscle pain, fever sharply to 39C. The patient was difficult to keep her head - she "falls" on the chest, it's hard to raise their hands up, take in hand. It is known that 10 days ago, a patient bitten by a tick. Put a preliminary diagnosis: ©

tick-borne meningoencephalitis, febrile form©

+encephalitis, a form of poliomieliticheskaya©

epidemic encephalitis Economo, the primary©

parainfectoius encephalitis, secondary©

encephalitis after vaccination against tick-borne encephalitis

***

Calling a child 11 years old. Complaints of recurrent headaches. In the afternoon, after physical overstrain, he felt "a blow to the head", was vomiting and transient loss of consciousness. At survey: psychomotor agitation. Rough meningeal syndrome - a hypersensitivity to light and sound, neck muscles regidnost 4 cm. Positive Kernig's symptoms, the symptoms of upper and lower Brudzinsky. Put a preliminary diagnosis and the development of the disease is caused by©

hemorrhage in the right frontal lobe due to cardiac disease©

hypertensive crisis due to the defeat of the cortico-tract nuclei©

hypertensive crisis caused by physical overexertion©

subdural hemorrhage due to trauma©

+subarachnoid hemorrhage due to aneurysm

***

Calling a child of 5 years. Complaints from the words of my mother, shortness of breath, fainting, seizures. On examination: The child in the state soporous. Respiration irregular. Percussion clear lung sounds, auscultation, vesicular breathing, no wheezing. Tachycardia. Diffuse muscular hypotonia, absent tendon reflexes, dilated pupils as on both sides, there is no reaction to light, the eyeballs are fixed. What drug and for what purpose it is necessary to introduce a child in this case©

heparin, because the effect of hypo-coagulation has©

metamizole sodium because it has an analgesic effect©

+furosemide because of the dehydration effect has©

polyglukin, because the effect has volemic©

aminocaproic acid, because it has a hemostatic effect

***

Tactic of emergency doctor at laryngostenosis of III - IV degree : ©

intramuscular or intravenous introduction of antioxidants©

+intubation of trachea or conicotomy ©

introduction of stomach probe©

intramuscular or intravenous introduction of hormonal drugs©

lying transportation

***

A patient is 14 years old with the attack of dispnoea. The brigade of emergency aid is caused. In anamnesis: attacks of dispnoea are during 7 years. Acute attacks of disease arise in a cold season. Deterioration of the condition is during 12 hours on a background of AVRI. For past 12 hours salbutamol repeatedly used, in the beginning with an insignificant effect, after - without an effect. At examination: the condition heavy. Sits, leaning hands in knees. Dry rales an be heart in the distance, expiration difficulties. Skin pale with a cyanotic shade. Number of breathing - 30 in 1 min. Cough is dry, "uneffective". Pulse is 100 in 1 minute, rhythmic. In lungs are dry sibilant rales above all pulmonary fields, in lower parts breathing is diminished. Put a preliminary diagnosis©

laryngospasm©

obstructive bronchitis©

acute pneumonia©

+bronchial asthma©

destruction of lungs

***

A child is 2 months. Became ill sharply from the increase of temperature till 38⁰C, cough, and rhinitis. During the following 3 days the condition deteriorations, a cough had become paroxysmal, an appetite`s loss, a patient became anxiety. Perioral cyanosis, acrocyanosis, "oral" crepitation, retraction of compliant places of thorax is observed, breathing to 72 in a minute. Vesiculotympanitic resonance, mass of small moist rales on both side. Put a preliminary diagnosis©

pneumonia©

+bronchiolitis©

obstructive bronchitis©

acute bronchitis©

tracheobronchitis

***

To the child of 10 months emergency ambulance is caused. According to a mother, a child during weeping turned blue, the stop of breathing, twitch of extremities, narrowing of pupils, was marked. During an attack a child threw back a head back; a death-damp was marked. In 20 seconds, breathing was restored. Put a preliminary diagnosis©

bronchospasm©

+laryngospasm©

episyndrom©

febrile spasm©

laryngostenosis

***

Call of brigade of first-aid. Child of 1 year 4 months is, 3th day of illness. Became ill sharply: anxiety, rhinitis, temperature of 37,4⁰С appeared. To the evening there was hoarseness of voice, rough "barking" cough, breathing difficulty. During the 3th days of child treated at home. The attacks of difficulty in breathing in every next night became all heavier and longer, appetite bad. At examination a girl pale, flabby, is capricious. At breathing participation an auxiliary musculature of thorax is marked, dyspnoea to 50 in min. Hoarseness of voice, sometimes complete aphonia, cyanosys. Hoarseness of voice, sometimes complete aphonia, cyanosys of nasolabial triangle. Pulse rhythmic, tachycardia to 160 in min. Put a preliminary diagnosis©

acute laryngotracheobronchitis©

+laryngostenosis©

diphtheria of larynx, true croup©

obstructive bronchitis©

acute pharyngitis

***

Call to the child of 3 years old. On a background of ARVI in boy appeared: obtrusive cough, dispnoea and whistling breathing. Doctor-pediatrician 3 days back appointed to the child inhalation salbutamol and ambroxol in tablet. In the moment of examination: boy anxiety, temperature of body 36,8⁰ C, skin pale, a cough present, breathes noisily, dispnoea with the difficulty expiration, breathing rate-48 in a minute, in lungs rough breathing, on all surface examined mass of dry whistling rales. Define emergency doctor’s tactic to this child©

to appoint to consultation of pulmonologist©

to appoint to consultation of allergist©

to increase the dose of inhalation salbutamol©

+to hospitalize inpatient department©

to add antibacterial preparation in treatment

***

Call to the child of 1year 2 months. From words of mother a child ill during 3 days. In the moment of examination: boy anxiety, temperature of body 37,0⁰C, skin is pale, paroxysmal cough, noisy breathing heard in the distance, dispnoea with the difficulty expiration, breathing rate-45 in a minute, in lungs rough breathing, on a front surface examined the moist rales of different caliber in a small amount. Put a diagnose©

laryngostenosis©

foreign body©

acute bronchitis©

+obstructive bronchitis©

acute respiratory viral infection

***

Call to the child of 8 years old. Became ill sharply, 4 days back when a cough and increase of temperature till 39,0⁰С appeared. In the moment of examination: boy flabby, temperature of body is 37,7⁰С, skin pale, moist cough, dispnoea with participation an auxiliary musculature, and breathing rate-30 in a minute. There is the rough breathing in lungs, in an interscapular area locally examined to single moist small bubble and crepitus rales on height of inspiration. Put a diagnose©

intrahospital pneumonia, local, acute current, respiratory failure І©

extrahospital pneumonia, segmentary, prolonged current, respiratory failure ІІІ©

extrahospital pneumonia, local, acute current, respiratory failure ІІІ©

+extrahospital pneumonia, local, acute current, respiratory failure ІІ©

intrahospital pneumonia, total, acute current, respiratory failure ІІ

***

In child of 4 months the signs of anxiety appeared on a background external wellbeing, difficulty breath with retraction on inspiration jugular and subclavian fosses, dry obtrusive "barking" cough, easy perioral cyanosis. Temperature of body 36,8⁰С, sweating is marked. At examination found out the signs of easy rickets. A muscle tone decreases. Meningeal symptoms are not present. Inner organs are without pathology. Your preliminary diagnosis is©

ARVI©

laryngotracheostenosis©

+spasmophilia, laryngospasm©

acute bronchitis©

obstructive bronchitis

***

Call to the child of 4 months. Complaint from mother`s words on a sudden anxiety, difficulty breath with retraction on inspiration jugular and subclavian fosses, dry obtrusive "barking" cough, easy perioral cyanosis. Temperature of body 36,8⁰С, sweating is marked. At examination found out the signs of easy rickets. A muscle tone decreases. Meningeal symptoms are not present. Inner organs are without pathology. The emergency doctor at this disease will appoint©

+calcium gluconate i/m©

luminalum peros©

seduxeni i/m©

prednisolonum i/m©

thiaminum i/m

***

Call to the child of 3 years old. Became ill two week ago, sharply, when rhinitis, cough appeared with the insignificant secretion of light sputum, increase of temperature till 38°C, in 3 days a temperature went down till 37,2°C. However a dry cough increased, "whistle" and dispnoea appeared. In anamnesis: frequent ARVI, during a year twice carried an acute bronchitis with the prolonged dry cough till vomiting. Аllergoanamnesis: in child a rash and edema of eyelids on citrus was marked. Heredity: the mother of child reported that in summer during a few years in her stuffiness of nose, a sneeze, lacrimation, itch of nose and eyes appears. Objectively: temperature of body 36,7°C, skin is pale, dry, nasolabial triangle with cyanotic shade, breathes with open mouth, stuffiness of nose, under eyes blue circles. Fauces of usual colour is. Thorax of ordinary form is. An auxiliary musculature participates in the act of breathing. At percussion lung sound with a small box shade is. At auscultation: rough breathing with prolonged expiration, with dry whistling and buzzing rales audible identically above all surface of thorax. BR 30 in min. Heart tones are sounding, rhythmic, HR 110 in min. Abdomen is soft, painless. Stool and dieresis are in a norm. What must be appointed to the patient at this disease©

+salbutamol, because gives a rapid bronchodilatator effect©

euphyllini, because possesses a broncholytic activity©

seduxeni, because possesses a sedative action©

salmeterol, because possesses the prolonged action©

ampicillin. because possesses an antibacterial action

***

+berotec©

calcium gluconate©

broncholytin©

solutan©

aminazinum

***

Call to the child 8 months. Child with signs of atopic dermatitis on a skin and mucous membranes, patient with a respiratory disease is. On 4-th day of disease a barking rough cough, common anxiety, appeared, dispnoea with retraction of compliant places of thorax on inspiration, noisy breathing, hoarse voice. What do appearing symptoms testify about©

+croup syndrome©

congenital stridor©

attack of whooping-cough©

foreign body©

acute pneumonia

***

Call an ambulance to a child 5 years old. In the words of my mother, after eating the cake, by 6:00 there was nausea, there was frequent vomiting. OBJECTIVE: The state of moderate severity. The child was pale, there is nausea. On palpation of the abdomen is marked tenderness in the epigastric region. The liver and spleen did not appear from under the costal arch. Emergency physician performed gastric lavage. Specify the length of the probe, for which he was introduced©

from the ear lobe to the tip of the nose©

from nose to ear lobe + base xiphoid process©

from the back of the nose to the base of the ear lobe + xiphisternum©

from nose to tip of nose to base + xiphisternum©

+from the earlobe to the tip of the nose to the ground + xiphisternum

***

Call an ambulance to a child 7 years old. After the use of poor-quality food in the dining room after 6 hours there was nausea, there was frequent vomiting, headache, weakness. Indicate the total amount of fluid needed to flush the stomach: ©

600-800 ml ©

800-1000ml ©

1000-3000m©

3000-5000ml ©

+5000-7000ml

***

Indicate which of the drugs has sorbing action and why? ©

no-spa, as lowers the tone of smooth muscles of internal organs, and intestinal peristalsis, dilates blood vessels. It has no effect on the autonomic nervous system, does not penetrate the CNS. ©

because Rehydron used to correct electrolyte and fluid losses from diarrhea or vomiting. ©

+because the smectite efficiently absorbs and removes the body of viruses, bacteria, toxins, intestinal gas and bile salts. ©

because suprastin has anticholinergic activity and moderate inflammatory properties. ©

as imodium reduces motility and increases the time of the contents of the intestines. Increases the tone of the anal sphincter, contributing to a better retention of stool and reduce fecal urgency.

***

A child 2 years, 6 hours after ingestion of yogurt increased body temperature up to 380S, there was nausea, 3-fold vomiting, and headache. Indicate emergency indications for gastric lavage Prehospital: ©

in the first 2 hours after receipt of the poison in the gastrointestinal tract, and only in cases of poisoning with cauterizing is not poisonous ©

+in the first 12 hours after receipt of the poison in the gastrointestinal tract, and only preserved awareness ©

regardless of the time that has elapsed since receipt of the poison in the gastrointestinal tract, and if the patient had no vomiting ©

if there was a spontaneous vomiting, flushing it need not be repeated and only if the patient had no vomiting©

after receipt of the poison in the gastrointestinal tract and all patients with suspected acute poisoning

***

Caused by the ambulance, the child was 3 months (birth weight was 3400.0 g). Complaints from the words of my mother, to raise the body 39.8 t 0, expressed by pale skin, cold extremities, lethargy. Your tactic of pre-hospital? ©

Seduxenum 2.0 ml / m and 1.0%, 0.5 ml of atropine, prednisolone 80mg, emergency hospitalization ©

the child warm (hot-water bottles to the feet, hands), w / o no-spa 0.2 ml, 1% dibazol 0.2 ml, 2% papaverine, 0.2 ml, 0.2 ml of nicotinic acid, paracetamol syrup ½ tsp . ©

the introduction of lytic mixture / m 50% solution was injected dipyrone at a dose of 0.4 ml of 2% papaverine solution was 0.4 ml, 1% solution of 0.4 ml dimedrol. ©

the child warm (hot-water bottles to the feet, hands), w / o no-spa 0.1 ml, 1% dibazol 0.1 mL, papaverine 2% 0.1 ml, 0.1 ml of nicotinic acid, 0.5% relanium 0 4 ml / m ©

+the child warm (hot-water bottles to the feet, hands), w / o no-spa 0.1 ml, 1% dibazol 0.1 mL, papaverine 2% 0.1 ml, 0.1 ml of nicotinic acid.

***

Calling hide with a child 3 years old. From history: 20 minutes ago accidentally swallowed a small amount of reserpine tablets. Objective: The child's grave. Periodically there are convulsions. Skin face hyperemic sclera, nasal breathing is difficult. Peripheral cyanosis, marbling of the skin. Shortness of breath to 50V min. PS - 150 per minute. BP 50/20 mm. mercury. column. Abdomen soft and painless. The liver is 1.0 cm from under the costal arch. Your tactic of pre-hospital: ©

oxygen, relanium 0.1 ml / m, gastric lavage, activated charcoal 0.5 g, emergency hospitalization in the intensive care unit©

relanium 0.4 ml / m, gastric lavage, activated charcoal, 2.0 g, emergency hospitalization©

oxygen therapy, Seduxenum 1.0 ml / m and 1.0%, 0.2 ml of atropine, gastric lavage, activated charcoal 1.5 g, prednisolone 60mg, emergency hospitalization. ©

oxygen therapy, Seduxenum 0.8 ml / m and 1.0%, 0.1 ml of atropine, gastric lavage, activated charcoal 1.0 g, prednisolone 10mg, emergency hospitalization©

+relanium 0.2 ml / m, gastric lavage, activated charcoal, 2.0 g, emergency hospitalization in the intensive care unit

***

Calling the child is 2 years old, who at night have stomach pain, 3-fold vomiting, profuse with the remnants of undigested food. In the evening, according to the mother, the child ate with great appetite, a lot of dumplings. My mother, said that in the last vomit was bile. Place a provisional diagnosis? ©

Acute phlegmonous appendicitis©

Acute intestinal intussusceptions©

obstructive ileus©

dynamic ileus©

+functional dyspepsia

***

gastric lavage, giving laxatives, cleansing enema formulation, activated charcoal method©

receiving activated charcoal, gastric lavage, giving laxatives, cleansing enema formulation©

gastric lavage, giving laxatives, cleansing enema formulation, activated charcoal method©

gastric lavage, cleansing enema formulation, giving laxatives©

+gastric lavage, activated charcoal, cleansing enema formulation, hospitalization

***

Call an ambulance for a child 9 months, became ill in the morning when the body has risen 39.7 t 0, became restless. The child is given paracetamol at 4 h 39.7 t 0.Rebenok body is crying. Breathing hard, scattered wet and dry rales. RR 48 per minute. Auscultation of heart sounds are muffled. Heart rate = 138 per minute. Abdomen soft and slightly swollen. The liver and spleen were not enlarged. Urinating in the morning last. The chair was once in the last two days designed. Indicate which of the drugs used in this case and why? ©

heparin, because that increases renal blood flow, increases the resistance of cerebral vessels, has a hypolipidemic effect, enhances the activity of parathyroid hormone. ©

diazepam, since, has a depressing effect on the CNS, which is realized mainly in the thalamus, hypothalamus and limbic system. It possesses anxiolytic, sedative, hypnotic, and anticonvulsant action of miorelaksiruyuschim. ©

+dopamine, as has a positive inotropic effect (strengthens cardiac contractility), increases coronary and renal blood flow, increases mesenteric blood vessels and increases urine output. ©

adrenaline, because, increases blood pressure and increases heart rate, despite the fact that the vessels are narrowed. Release of digestive pauses, as blood pours from the stomach and intestines to the muscles and replenished©

zhelatinol as drug increases the BCC, dilute (lower viscosity) of blood, improve microcirculation, has a diuretic effect, due to the fact that it is rapidly excreted by the kidneys from the body

***

The baby 3 months., With right-sided pneumonia, within 2 days progressively deteriorated. Temperature 39-40 degree, accompanied by chills. Consciousness confused, occasionally marked convulsive twitching of facial muscles and limbs. Pale skin with marble pattern, earthy shade, acrocyanosis. Dyspnea was increased to 70 min. with nasal flaring, the participation of auxiliary muscles. Tachycardia 200 per minute, pulse voltage and weak filling. Blood pressure 60/80 mmHg, CVP 2 mm. waters. Art. Oliguria. There paresis of the gastrointestinal tract, repeated vomiting. pH 7.22, pCO2 -33mm Hg BE - -18mmol / l. Put a preliminary diagnosis. ©

hemorrhagic shock©

+anaphylactic shock©

cardiogenic shock©

infectious toxic shock©

syndrome Waterhouse-Friderichsen

***

The baby 3 months., With right-sided pneumonia, within 2 days progressively deteriorated. Temperature 39-40, accompanied by chills. Consciousness confused, occasionally marked convulsive twitching of facial muscles and limbs. Pale skin with marble pattern, earthy shade, acrocyanosis. Dyspnea was increased to 70 min. with nasal flaring, the participation of auxiliary muscles. Tachycardia 200 per minute, pulse voltage and weak filling. Blood pressure 60/80 mmHg, CVP 2 mm. waters. Art. Oliguria. There paresis of the gastrointestinal tract, repeated vomiting. CBS: pH 7.22, pCO2 -33mm Hg BE - -18mmol / l. The first step is to enter: ©

prednisolone©

Sodium Bicarbonate©

atropine©

dopamine©

+adrenaline

***

A child 12 years after intravenous radiopaque substances after 2 min. sharply deteriorated. Consciousness was absent, pupils dilated, without their reaction to light. The skin faded dramatically. Pulse thready. Tones of heart deaf sharply. BP is not detected, breathing is shallow, arrhythmic, alternates with apnea. Place a preliminary diagnosis. ©

hemorrhagic shock©

+septic shock©

cardiogenic shock©

infectious toxic shock©

hypovolemic shock

***

The child 12 years after intravenous radiopaque substances after 2 min. sharply deteriorated. Consciousness was absent, pupils dilated, without their reaction to light. The skin faded dramatically. Pulse thready. Tones of heart deaf sharply. BP is not detected, breathing is shallow, arrhythmic, alternates with apnea. Intensive therapy should first be aimed at: ©

improvement of microcirculation©

improve gas exchange©

+recovery volume of blood circulation©

the elimination of acidosis©

stabilize blood pressure

***

At the dentist's surgical office boy 12 years old at the time of dental health after the posterior superior alveolar nerve block were dizziness, nausea, chest tightness, cramping, blood pressure 80/40 mm Hg. Art., the pulse 120 beats per minute. Put a preliminary diagnosis. ©

syncope ©

orthostatic collapse©

hysterics©

+anaphylactic shock©

cardiogenic shock

***

Call the emergency physician to the school. Boy 14 years after the end of the match in basketball he felt discomfort in the heart, heartbeat, severe weakness, dizziness. At the time of inspection: pale skin, wet, cyanosis of nasolabial triangle. Marbling of the skin, a symptom of "white spots" 7 seconds. Auscultation of the lungs vesicular breathing, even the boundaries of the heart within the normal range, the tones are punctuated, no noise. BH 34 in 1 minute. Pulse weak filling and voltage of more than 200 beats per 1 minute. Blood pressure was 65/20 mm Hg. Art. Abdomen soft, painless. Machine emergency arrived 20 minutes after the call. Upon arrival service SMP: BH 36 in 1 minute, heart rate more than 200 in 1 minute, blood pressure 60/20 mm Hg .. ECG - QRS complex is narrow, P is not visible, ST contours below.Put a preliminary diagnosis. ©

+cardiogenic shock©

angidremichesky shock©

orthostatic collapse©

neurogenic shock©

obstructive shock

***

Girl 13 years after the adoption of the vertical position suddenly lost consciousness and fell. On examination pallor face, the skin of the forehead perspiration, breathing weakened, the pulse at the carotid and radial artery is rare, weak muscles of the trunk and limbs relaxed. What is the reason sudden loss of consciousness? ©

organic disturbance of CNS©

+the sudden brain anemia©

congenital disorders of brain©

sudden bleeding in the brain©

beginning atrophy of the cerebral cortex

***

Emergent call. It was a crash accident – 12 years old girl was saved from the obstruction. Her legs were pressed by the slab. After removement of slab – girl became unconscious. Breathing is free, tachypnea till 42 per min. Heart tones are rhythmical, pulse is sharply increased till 140 per min. BP=70/40 mm per mer., PS=100 per min. Skin of both extremities is bluish color, cold at palpation. Fractures are absent. Pain sensation is sharply decreased. Liver and spleen are not enlarged. Consciousness of child is spontaneously restored. Point out the consequence of emergent aid at extra-hospital stage? ©

rubber tourniquet applying, aseptic bandage, external cooling of extremity, indirect cardiac massage providing, AVL, cardiac glycosides ©

free the pressed extremity, local anesthesia, infusion, applying rubber tourniquet©

local anesthesia, free the pressed, infusion©

+applying rubber tourniquet, infusion, applying the aseptic bandage, external cooling of extremity

***

A girl of 11 years, was in the somatic department clinics, before calling the doctor felt dizziness, ringing in the ears, darkening of the eyes, nausea, syncope. The skin faded dramatically. Pupils are narrowed, their reaction to light is missing. Limbs are cold to the touch, covered with sweat. Breathing superficial. Pulse rare, weak filling and stress. Blood pressure 80/30 mm Hg Peripheral veins empty. A few minutes later, the girl regained consciousness. She raised her eyelids began to move his lips, to respond to their surroundings. Returned to normal color of the skin. Recovered cardiovascular activity and adequate breathing. Put a preliminary diagnosis. ©

hysteria©

epilepsy©

+syncope©

collapse©

acute heart failure

***

The child of 7 years, with acute hematogenous osteomyelitis, suddenly deteriorated dramatically. Consciousness soporous. Lying motionless. Pale skin with a marble figure, covered with cold sweat. The facial features sharpened. Nasolabial triangle - cyanotic. Sunken eyeballs, pupils dilated, their reaction to light sluggish. Breath superficial. Pulse frequent, weak filling and tension. BP and CVP decreased, heart sounds are muffled. Put a preliminary diagnosis. ©

syncope©

+collapse©

epilepsy©

hysteria©

acute heart failure

***

obstruction ©

mixed ©

spastic©

dynamic

***

"dagger" pains in epigastric region

***

Child of 6 years complaints on vomiting, pain in abdomen, hemorrhagic discharge from rectum. From mother's words pain in the abdomen arised suddenly. Inspection: child retarded, painful face, knees adducted to the chest, tenderness of abdominal muscles, in the upper right abdomen palpated seal oblong. The chair, according to the mother, with blood and mucus in the form of raspberry jelly. Put a preliminary diagnosis:gastric-intestinal bleeding©

Rey syndrome©

ulcer of duodenum

***

Calling an ambulance. A child 14 years old, suffering from a stomach ulcer, complained of weakness, vomiting "coffee grounds", a cold clammy sweat, dizziness. Objectively: skin and visible mucous membranes pale. In the lungs vesicular breathing. Muffled heart sounds, tachycardia to 120 beats per 1 minute, systolic murmur at the apex, BP 90/60 mm Hg A chair in black. Put a preliminary diagnosis©

Rey syndrome

***

Calling the ambulance to a child 10 years with abdominal pain. There was a single vomit.On examination: The child lies on the right side of the body temperature of 37.30 C, tongue coated with white bloom, dry, painful on palpation and passive muscle tension in the right iliac region, the appearance of pain in the right iliac region with a sharp jerk-pressure in the left iliac region and when coughing. Put a preliminary diagnosis©

renal colic©

acute intestinal obstruction

***

Call an ambulance to a child 5 years old with complaints of cramping pain in the right half of the abdomen accompanied by vomiting of food ingested. Long suffering from constipation. Lucid intervals between the attacks gradually diminish, the pain becomes severe and permanent. Enhanced motility, the stomach is asymmetrical, due to swelling of his right-hand half. Put a preliminary diagnosis©

duodenal ulcer

***

To a child 2 years due ambulance. During the day the child is cranky, sleep surface, not sleeping, lying on his right side, vomiting, and diarrhea. On palpation of the abdomen child is restless, crying, straining the abdominal muscles. Pulse 132 per minute. The body temperature of 38.10 C. Put a preliminary diagnosis©

acute intestinal obstruction

***

Call an ambulance to a child six years old, complains of a one-time vomiting, pain in the epigastric region, and then around the abdomen. Temperature 37.50 C. There was a single chair. Pain tends to shift to the right iliac region. Put a preliminary diagnosis©

acute cholecystitis

***

Calling the ambulance. In patient 13 years for two hours before calling an ambulance suddenly appeared severe cramping abdominal pain occurring after meals. There was repeated vomiting, poor single chair. Disease was preceded by a week-long course of fasting, self-conducted patient. His condition was grave, anxious, rushing to the bedside. Acrocyanosis, pained expression on his face, breathing, learning the, pulse 112 beats per minute, blood pressure - 100/60 mm. mercury. of Art. The abdomen is moderately distended, asymmetrical. In mesogaster palpable tight elastic rounded education.At the height of cramping pain auscultated enhanced, resonant peristalsis. Determined by "splashing". Put a preliminary diagnosis©

peptic ulcer©

chronic erosive gastritis

***

Call an ambulance to a child 13 years old. Complaints of pain in the right upper quadrant, nausea, repeated vomiting, bitter taste in the mouth, delayed stool. The appearance of pain relates to the uncertainty in the diet. On examination, tongue coated, stomach distended, tenderness to palpation in the right upper quadrant and effleurage on the right costal arch. Put a preliminary diagnosis: ©

renal colic©

ileus

***

Calling the ambulance to a child 10 years from onset of abdominal pain. There was a single vomit. On examination: The child lies on the right side of the body temperature of 37.30 C, tongue coated with white bloom, dry, painful on palpation and passive muscle tension in the right iliac region, the appearance of pain in the right iliac region with a sharp jerk-pressure in the left iliac region and when coughing. What is the tactic of emergency medicine at the pre-hospital emergency hospitalization, along with and why? ©

+ice pack because it narrows the blood vessels and reduces pain

***

In girl of 13 years old during 3 days abdominal pains, increase of temperature, vomiting was marked. At examination a child is pale, flabby, complains on abdominal pains. Temperature of body is 37,9⁰С. From the side of organs of pectoral cavity it is not changed. Pulse is 92 in 1 minute. An abdomen is not distentioned; at palpation in a right iliac area sickly immobile formation of 6 х 6 sm is determined. Symptom of Schetkin-Blumberg is positive. Tactics of emergency doctor in this case? ©

recommend to address to the surgery on place of residence

***

Emergency call to child 5 years. Emergency doctor diagnosed food poisoning. In child stool as "marsh slime" that for characteristic of: ©

dysenteries©

esherichiosis©

botulism

***

Emergency call to child 7 years with signs of acute abdomen. Emergency doctor at palpation of the abdomen has detected the protective muscle tension that for characteristic of: ©

acute intestine obstruction

***

Emergency call to child 10 years with signs of acute abdomen. Emergency doctor at palpation of the abdomen has detected at the same time as with the other symptoms of acute abdomen positive Sitkovskiy symptom, which observed at: ©

renal colic©

acute intestinal obstruction

***

Emergency call. In patient 13 years old for two hours before calling an ambulance suddenly appeared strong cramping abdominal pain occurring after meals. There was repeated vomiting, poor single stool. Disease was preceded by a one-week course of starvation, the autonomous patient. The patient's condition is serious, worried, tossing in bed. Acrocyanosis, pained expression on face, tachypnoea, pulse 112 beats per minute and blood pressure - 100/60 mm. Hg. The abdomen is moderately distended, asymmetrical. In mesogaster palpated hard elastic rounded formation. At the height of cramping pain auscultated enhanced, resonant peristalsis. "Splashing sound» determined. Appearance of «splashing sound» symptom at acute intestinal obstruction is explained: ©

presence of the free gas in abdominal cavity

***

Emergency call to child 12 years. Emergency doctor suspects in child mechanical intestine obstruction. The most frequent reason of mechanical obstruction of small intestine is: ©

foreign body©

gallstones©

tumors©

helminths

***

Emergency call to child 2 months. Emergency doctor suspects in child volvulus of intestine. Volvulus of small intestine belongs to one of the following type of the intestine obstruction: ©

obturation©

+strangulated©

mixed©

spastic©

dynamic

***

Sick 14 years with dyspneas attack. Emergency call. From anamnesis - dyspneas attack from 7 years. The exacerbations appear at cool time of the year. The deterioration of the condition is for 12 hours on background of ARI. During last 12 hours repeatedly used salbutamol, with small effect in the beginning, then - without effect. At survey: condition heavy. She sits, leaning hands on knees. On distance heard dry rales, the expiration lengthened. The skin is pale with cyanotic shape. The respiration rate is 30 in 1 minutes. Cough dry, "inefficient". The pulse is 100 in 1 minute, rhythmic. In lungs a dry whistling rales on all pulmonary fields, in lower parts breathing is weakened. Emergency doctor is made EKG: negative wave T in II, III, avF; the deep wave S in breast abductions. Put the preliminary diagnosis©

laryngospasm©

lung destruction

***

Emergency call to child 10 months, in heavy condition. From the words of mother install that child ill 2 days ago. The disease began with increasing of the temperature of the body up to subfebrile, insignificant serous nasal catarrh, catarrhal conjunctivitis. Then, the condition of child deteriorates, the temperature of the body increased up to 39,5 degrees, child became flaccid, refused from meal, appeared the vomiting, not connected with receiving the food and water, one-time clonic-tonic spasms. Objective: at survey general condition child heavy. Flaccid, cried. The temperature of the body 39,2 degrees. The child lays on back with extended along trunk hand and bent in knee and hip joints legs. It is noted throw one`s head back, bulging of anterior fontanel, periodical appear the convulsive twitches of the limbs. The skin is pale, dry. Visible mucous is clean, rose. In fauces moderate hyperemia of back wall of pharynx is. HR is 138 in minute. Put the preliminary diagnosis©

+meningitis©

encephalitis©

spasmophilia

***

Emergency call. The child 14 years, suffering from peptic ulcer of the stomach, complains of weakness, coffee-grounds vomiting, cold sticky sweat, and dizziness. Objective: skin and visible mucous are pale. In lungs vesicular breathing is. The tones of heart muted, tachycardia up to 120 in 1 minute, systolic murmur on apex, BP 90/60 mm. Hg. The stool is black color. Put the preliminary diagnosis: ©

Reyo syndrome

***

Emergency call. The сhild 8 years is in heavy condition. The skin is gray, arterial pressure 90/60 mm Hg, pulse 120 in minute, rhythmic. At sick during day was noted 6 once vomiting and frequent fluid stool. The tonic- clonic spasms developed in 20 minutes. After entering by ambulance GOOA from calculation 100 mg/kg spasms relief, but were then repeated again. What else medicinal preparations are used for spasms relief©

nootropil©

pyracetam©

+diasepam©

lasix©

actovegin

***

Emergency call. A girl 11 years, before calling the physician has felt the dizziness, ringing in ears, darkening in eyes, nausea. Then she lost the consciousness. The skin is sharply pale. The pupil of eyes constricts, reaction them on light is absent. The limbs cold at palpation and cover sweat. The breathing is superficial, even. The pulse is rare, weak filling and tension. BP is 80/30 mm Hg. Peripheral veins are empty. Through several minutes consciousness in girl was restored. Has raised the ayelids, became to move by lips, respond on environment. The normal coloration of skin returned. It was restored hearty-vascular activity and adequate breathing. Put the preliminary diagnosis©

epilepsy©

+syncope©

collapse©

tumor of the brain

***

Emergency call to child 7 years. From anamnesis: acute hematogenous osteomyelitis. The condition suddenly sharply deteriorates. The consciousness is sopor. He lies still. The skin is pale with marmorota, cover by cold sweat. The lines of face become more pointed. Cyanosis of nasolabial triangle is. The eyeballs are hollow, pupil of an eyes dilated, reaction them on light flaccid. The breathing is increased the frequency of, superficial. The pulse is frequent, weak filling and tension. BP is reduced, tones of heart muted. Put the preliminary diagnosis©

syncope©

+collapse©

tumor of the brain

***

Emergency call. The child 1 year 4 months, 3-rd day of disease. Acutely ill: appeared the malaise, nasal catarrh, the temperature 37,4⁰С. Soundless voice observed to evening, "barking" cough, difficulty of the breathing. During 3-rd days child give treatment at home. The attacks of dyspnea became heaviest and lengthiest in each following night, appetite bad. At survey a girl is pale, faded, and capricious. It Is noted significant retraction of compliant places of the thorax at breathing, dyspnea up to 50 in minutes. Soundless voice, periodically full aphonia, cyanosis of nasolabial triangle is. The pulse rhythmic, tachycardia up to 160 in minutes is. Put the preliminary diagnosis©

bronchospasm©

bronchiolitis

***

Emergency call to child 2 years. During day child capricious, the dream superficial, does not sleep, lies on right side, vomiting, diarrhea. At palpation of abdomen the child anxieties, cries, tenses the muscles of abdomen. The pulse is 132 at minute. The temperature of the body is 38,1⁰С. Put the preliminary diagnosis©

acute intestinal obstruction

***

Emergency call to girl of 12 years in heavy condition, in 1-st day of the disease. She ill acutely: repeated vomiting, pain in abdomen, then frequent, fluid stool, with greenery streaks. At survey: the temperature 39⁰С, skin dry, cyanosis of the lips, pulse 120 in minute, weak filling. The abdomen is soft, painful in epigastria and around umbilicus. Put the preliminary diagnosis©

dysentery©

esherichiosis©

botulism

***

Emergency call. Several members to families have recovered influenza. A child of 2 years ill; in the night increased the temperature up to 40⁰C, was repeated vomiting. At survey in the morning: the child is pale, on the face and neck single petechial elements, in fauces slightly hyperemia; neck stiffness. Has a fever. Put the preliminary diagnosis©

meningitis

***

Emergency call. A child of 4 month ill acutely, the temperature of the body increased up to 38⁰С. Repeated vomiting after meal and drinks is, stool during day 8 once, fluid, brown-green color, as "marshy slime". At survey condition heavy, is anxiety, evident thirst. The skin is pale, periorbital cyanosis. The lips are bright, dry. Anterior fontanel is hollow. The tones of heart muted. Moderate abdominal distension is, borborygmus on motion of small intestine. Put the preliminary diagnosi©

shigellosis ©

esherichiosis©

viral diarrhea

***

Emergency call. From words of the mother, in her 8-years son on 7 days of disease complaints on dizziness, indistinct speech, reeling gait, does not keep the head, 3 weeks ago father was ill the herpes zoster. There is neck stiffness at survey, on trunk - drying out a little vesicle