PEDIATRICS OBJECTIVE

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The most probable reason of the subarachnoid haemorrhage in case of child that had 2000 grams at birth:

- hypoxia

- functional morphological immaturity

- birth trauma

- pneumonia

+ prematurity

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Point the most probable sources of the intracranial hemorrhage in case of overmature child with birth trauma:

+ System of Galen’s ven

- vessels of the subarachnoid space

- vessels of the hermentative matrix

- vessels of the subdural space

- intraventrical hemorrhage

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Point the most probable localization of intracranial hemorrhage in case of mature pregnancy and complicated birth:

+ Subdural hemorrhage

- small hemorrhages into the grey matter

- subarachnoid hemorrhage

- peri- and intraventricular hemorrhage

- vessels of the hermentative matrix

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Point the most probable localization of intracranial hemorrhage in case of difficult perinatal hypoxia in a mature child:

+ subarachnoid

- at the hermentative matrix

- intraventricular

- subdural

- small hemorrhages into the grey matter

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If there are difficulties of delivery of the child’s shoulders during birth the biggest compications appear at:

+ spinal cord structures ( C4- C6)

- intracranial brain structures

- spinal cord structures ( T1- T12)

- peripheral nervous system

- diaphragm innervation

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Apnoe, that appears during neonatal period, testifies on:

+ all the answers are right

- hypoglicemia

- CNS violations

- sepsis

- prematurity

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Lumbal punction was used for newborn with suspicion of intracranial birth trauma. Bloody liquor was received during this research

What kind of hemorrhage was this:

+ subarachnoid

- caephalohaematoma

- subtentorial

- supratentorial

- epidural

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Hypotonia and consciousness depression were observed in case of newborn with 31 weeks of gestation.

Hematocrit was 35%. The total liquor analysis: erythrocytes and proteins rate was increased, glucose contant was redused. What is the preliminary diagnosis?

+ intracranial hemorrhage

- sepsis

- anemia

- meningitis

-antenatal infection

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At the anamnesis of the 1-month child was weakness of the mother’s birth activity, complicated shoulders delivery. Objective: left hand hangs down along the trunc inertly.

Its upper part is turned inside a little, forearm is pronated and banded at the elbow joint, manus is turned back and entoectad. Left Moro’s reflex is negative, Babkin’s and Robinson’s reflexes are redused considerably, muscle hypotonia of the upper left extremity was detected.

What is the most probably pathology, that could cause this clinics?

+paralysis of Dushen- Erb

- paralysis of Dejerin- Clumpke

- upper paraparesis

- left hemiparesis

- double hemiplegia

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Child was born with the body weight of 4300 grams with complicated sholders delivery after prolonged birth. Objective: cyanosis, thorax falling back and ballooning of the nose wings. What pathology you should suspect firstly?

+ paralysis of the diaphragmal nerve

- paralysis of Dushen-Erb

- twoside paralysis of the laryngeal nerve

- paralysis of Dejerin- Clumpke

- oneside paralysis of the laryngeal nerve

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Point the most probable localization of intracranial hemorrhage in case of difficult perinatal hypoxia in a premature child:

+ intraventricular

- epidural

- subdural

- Galen’s vein

- subarachnoidal

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Dominated clinical symptoms of craniospinal hemorrhage as a resucf of birth trauma are:

+ all answers are right

- brain monotone scream

- paresis, paralysis

- SDR of the II type

- brain edema

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Depression syndrome (flabbiness, adynamia, muscle hypotonia) is dominated in the clinics of:

+ intraventricular hemorrhage

- subarachnoid hemorrhage

- epidural hemorrhage

- subdural hemorrhage

- subtentorial hemorrhage

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Syndrome of hyperexcitability (anxiety, brain scream, increase of motional activity and muscle tone) prevales at clinics of :

+ subarachnoid hemorrhage

-intraventricular hemorrhage

- subtentorial hemorrhage

- subdural hemorrhage

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The period of “imaginary welfare” ( 2-3 days) is typical for:

+ supratentorial hemorrhage

- subtentorial hemorrhage

- intraventricular hemorrhage

- subarachnoid hemorrhage

- epidural hemorrhage

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What kind of therapy is important at the treatment of the CNS birth trauma:

+ haemostatic therapy

- dehydrational therapy

- anticonvulsive therapy

- oxygen therapy

- metabolic therapy

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Clinical picture of the spinal shock is characteristic for violations of:

- intracranial brain stuctures

- pectoral part of spinal cord

+ neck segments of the spinal cord

- lumbosacral part

- diaphragm

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Flabby paresis of the lower extremities is characteristic for clinical picture of the spinal cord damage at the level of:

-С3-С4

-Т1-Т12

-С1-С4

+lumbosacral part

-С5-С6

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For the Dejerin- Klumpke paralysis everything is characteristic, except:

+ absence of the moves at the shoulder joint

- absence of the grasping reflex

- manus edema

- absence of the moves at the elbow joint

- affected manus is in the position of “ the seal claw”

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Gorner’s symptom is characteristic for:

+ Dejerin- Klumpke paralysis

- total type of obstetric paralysis

- Dushen-Erb paralysis

- diaphragm paresis

- spinal birth trauma

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Point the dayly dose of proserin in case of muscle hypotonia of newborns:

+0,009 mg/kg

-0,09 ml/kg

-0,018 mg/kg

-0,09 mg/kg

-0,002 mg/kg

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Point the dose of galantaminum in case of muscle hypotonia of newborns:

-0,018 mg/kg intramuscularly

-0,9 ml/kg subcutaneously

+0,18 mg/kg subcutaneously

-0,09 mg/kg intramuscularly

-0,02 mg/kg subcutaneously

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Point the dose of dibasol in case of muscle hypotonia of newborns:

+0,001 g/кg

-0,001 мg/кg

-0,05 g/кg

-0,005 g/кg

-0,5 мg/кg

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At the syndrome of CNS depression in newborns intestenon is prescribed in doses:

+0,2 мl/кg intravenously dropped

-0,5 мl/кg intravenously dropped

-2 мl/кg intravenously dropped

-0,2 мl/кg intramuscularly

-0,1 мl/кg intravenously

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Point the dose of actovegin for newborns:

-1 мl/кg intravenously or intramuscularly 1 time a day

+1 мl intravenously or intramuscularly 1 time a day

-2 мl intravenously or intramuscularly 1 time a day

-5 мl/кg intravenously or intramuscularly 1 time a day

-10 мl/кg intravenously or intramuscularly 1 time a day

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Contraindication for the intestenon prescription for the newborns are all, except:

- intracranial hemorrhage

- prematurity

+ acute desease period

- convulsions

-subarachnoid hemorrhage

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Choose the method of the tactile stimulation, that can not harm the child:

- percussion on the back

- pressing on the thorax

- blowing the child with cold oxygen or air

+ percssion on the foot or heel

- percussion on the buttocks

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Tactile stimulation is used:

- by 1 method 1 time

+ by 2 methods not more than 2 times

- it doesn’t matter

- after the oxygenation

- after the medicines injection

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The newborn has the independent breathing, heart rate is 100 times per minute, total cyanosis. What does this child requires?

- injection of the sodium bicarbonate

- injection of the glucosae 5-% solution

+ supply of the oxygen injection through the mask at the distance of 1 cm from the face

- beginning of the pulmonary ventilation with mask and oxygen bag

- intubation and sanation of the tracheobronchial system

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Trachea intubation is needed in case of:

- presence of the meconium in the amniotic liquid, the child is not active

- at the suspicion on diaphragm hernia

- at the unefficiency of the ventilation through the mask-bag

- urgent medicines injection

+ all answers are right

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Child has apnoe, it does not react to the tactile stimulation, or the heart rate is less than 100 beats per minute. You need:

+ to start the artificial pulmonary ventilation with mask and oxygen bag

- to make tactile stimulation one more time

- to start undirect heart massage

- to enter adrenaline

- to make an auxiliary oxygenation

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Child has apnoe, heart rate is less than 100 beats per minute after 15-30 seconds of the auxiliary pulmonary ventilation. You need:

+ to continue pulmonary ventilation with mask and bag

- to start undirect heart massage

- to inject medicines

- to make a tactile stimulation

- to make trachea intubation

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At firstly reanimation of the newborn the undirect heart massage should be started, if:

- heart rate at birth is less than 80 beats per minute

- heart rate at birth is less than 60 beats per minute

- in 15-30 seconds after artificial pulmonary ventilation by the 100% oxygen heart rate is less than 80 beats per minute and it does not increase

+ in 15-30 seconds after artificial pulmonary ventilation by the 100% oxygen heart rate is less than 60 beats per minute

- heart rate at birth is less than 100 beats per minute

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During reanimation of newborns medicines injections should be done, if :

- in 15-30 seconds after heart undirect massage heart rate is less than 80 beats per minute

- in 15-30 seconds after artificial pulmonary ventilation by the 100% oxygen under the possitive pressure heart rate is less than 80 beats per minute

+ in 15-30 seconds after artificial pulmonary ventilation by the 100% oxygenunder possitive pressure and heart undirect massage heart rate is less than 60 beats per minute

-breathing on the type of “ gasps”

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For the urgent medical help adrenalin is injected :

- intravenously or intramuscularly 0,1-0,3 ml/kg

- intravenously or intramuscularly 0,01 – 0,03 ml/kg

- endotrachealy or intravenously 0,01- 0,03 mg/kg

- endotrachealy or intravenously 0,1- 0,3 mg/kg

+ endotrachealy or intravenously 0,1- 0,3 ml/kg

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During reanimation of newborns first of all you need to estimate:

- color of skin and mucoes layers

- presence of central cyanosis

- haert rate

+ presence and character of breath

- respiratory rate

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The main criteria of the efficiency of the oxygen therapy for intracranial birth trauma are:

+91-95% oxygen saturation of blood

- partial tension of oxygen is 40-60 mm rt st

- oxygen concentration in the inspirated air is 60%

- 81-85% oxygen saturation of blood

- 61-65% oxygen saturation of blood

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The complications of the noncontroled prolonged therapy are:

+ bronchopulmonar dyspasia

- haemorrhage syndrome

- hypertensial syndrome

- convulsion syndrome

- syndrome of metabolic violations

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Indication for the artificial pulmonary ventilation at the birth trauma of CNS are all the following, except:

+ the increasing heart unsufficiency

- decrease of the oxygen partial tension level

- increase of the carbon dioxide partial tension level

- prolonged apnoe and apnoe, that repeat frequently

- decrease of the oxygen saturation of blood

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In case of birth CNS trauma the usage of the mixture of 80% oxygen for artificial pulmonary ventilation is possible during:

+2-3 hours

-6-10 hours

-24 hours

- it can be used continuously

- it can be used at firstly reanimation

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In case of birth CNS trauma the usage of the mixture of 60% oxygen for artificial pulmonary ventilation is possible during:

-2-3 hours

+6-10 hours

-24 hours

- it can be used continuously

- it can be used at firstly reanimation

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In case of birth CNS trauma the usage of the mixture of 30% oxygen for artificial pulmonary ventilation is possible during:

-2-3 hours

-6-10 hours

-24 hours

+ it can be used continuously

- it can be used at firstly reanimation

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In case of birth CNS trauma the usage of the mixture of 100% oxygen for artificial pulmonary ventilation is possible during:

-2-3 hours

-6-10 hours

-24 hours

- it can be used continuously

+it can be used at firsty reanimation

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In case of birth CNS trauma the temperature of the air-oxygen mixture during oxygenation should be:

+31-34 Celsius degree

-24-26 Celsius degree

-36-38 Celsius degree

-36-38 Fahrenheit degree

-21-25 Fahrenheit degree

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For brain edema and dehydratation the following treatment can be used:

+5-10 мl/кg of dry concenrtated plasma intravenously

-1 g/кg of manit intravenously

-15-20 мl/кg of dry concenrtated plasma intravenously

-10-15 мl/кg of natrium tiopentat intravenously

-50 мg/кg of pyracetam intravenously

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At haemorrhagic syndrome in newborns the best therapy to be prescribed:

+ vikasol 2-5 mg 1% solution intravenously or intramuscularly

- diacarb 80-100 ml/kg/day per os

- glycerol 1 g/kg/day

- furasemid 1 ml/kg/day

- manit 5 mg/kg/day

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What from the following can not be the reason for belch and emesis in newborns?

+ hypogalactia of mother

- chalasia of the esophagus

- pylorospasmus

- increase of the intracranial pressure

- syndrome of vegetovisceral violations at hypoxical damage of the CNS

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Anticonvulsional dose of phenobarbital for newborn is:

+15-20 mg/kg/day

-1-2 mg/kg/day

-100 mg/kg/day

-3-4 mg/kg/day

-5-10 mg/kg/day

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Sedative dose of phenobarbital for newborn is:

-15-20 mg/kg/day

-1-2 mg/kg/day

-100 mg/kg/day

-3-4 mg/kg/day

+5-10 mg/kg/day

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Supporting dose of phenobarbital for newborn is:

-15-20 mg/kg/day

-1-2 mg/kg/day

-100 mg/kg/day

-3-4 mg/kg/day

-5-10 mg/kg/day

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For newborns Vitaminum E is prescribed in dose:

+15-20 mg/kg/day

-5 mg/kg/day

-7 mg/kg/day

-5-10 mg/kg/day

-1-5 mg/kg/day

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Prescribe lazix for newborn with body weight of 3 kg:

+0,3 мl 1% solution

-10 mg/kg

-0,1 мl 1% solution

-1 мl 1% solution

-5 mg/kg

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For brain dehydratation at birth trauma best therapy to be prescribed:

+ concentrated plasma 10 ml/kg intravenously

- native plasma 10 ml/kg intravenously

-5% solution of glucose 20 ml/kg intravenously

- pyracetam 100 mg/kg intramuscularly

- dyacarb 100 mg/kg per os

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For newborn 1 injection of Calcium gluconatis is prescribed in dose:

+2 мl 10% solution intravenously

-0,5 мl/кg solution intramuscularly

-0,2 мl/кg 10% solution intravenously

-5 мl 10% solution intravenously

-10 мl 10 % solution intravenously

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Point the one-time dose of natrium oxybutiratis for therapy for convulsions in newborn:

+100-150 mg/kg

-10-15 mg/kg

-80 mg/kg

-200 mg/kg

-50 mg/kg

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For the firstly newborn reanimation is used:

+adrenaline 0,01% solution 0.1 ml/kg

-cocarboxylase 8 mg/kg

- prednisilon 1 mg/kg

- furosemid 1 mg/kg

- plasma 10 mg/kg

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Point the prednisolon form of release

+3% solution 1ml

-30% solution 1ml

-5% solution 1ml

-1% solution 1ml

-10 % solution 2 ml

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How many mg of prednisolon is contained in 1 ml of 3% solution:

+30 mg

-0,3 мg

-3 мg

-10 мg

-5 мg

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Point the dose of prednisolon for newborns:

+1-2 mg/kg

-5 mg/kg

-10 mg/kg

-30 mg/kg

-15 mg/kg

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What volume of 3% solution of prednisolon is injected to newborn with body weight of 3 kg:

+0,1 ml

-1 мl

-0,5 мl

-0,3 мl

-2 мl

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What is the prescribed dose of hydrocortison for newborns:

+5 mg/kg

-7 mg/kg

-1 mg/kg

-20 ml/kg

-15 ml/kg

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Point the dexametason form of release:

+0,4% solution 1 мl

-4% solution 2 мl

-1% solution 1 мl

-3% solution 1 мl

-10 % solution 2 мl

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What is the prescribed dose of dexametason for newborns:

+0,5 mg/kg

-1 mg/kg

-5 mg/kg

-0,5 ml/kg

-7 mg/kg

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Point what is the correct method of cytochrom C injection to newborn:

+4 ml in the 20 мl of 5% glucose solution intravenously

-1 мl in the 3 ml of the 5% glucose solution intramuscularly

-10 мl intravenously

-3 мl in the 10 мl of the 20 % glucose solution intravenously

-5 мl in the 10 мl of the 5 % glucose solution intramuscularly

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Dexametason one-time dose for child with body weight of 3 kg is:

+1,5 mg

-0,8 мg

-0,5 мg

-1 мg

-15 мг

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Point the one-time dose of pyracetam for newborn:

+50-100 mg/kg

-2 mg/kg

-150-200 mg/kg

-5 mg/kg

-20 mg/kg

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Point the pyracetam form of release:

+20% solution 5 мl

-5% solution 20 мl

-10% solution 1 мl

-2% solution 5 мl

-15 % solution 2 мl

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For newborn with body weight of 3 kg it is possible to inject one-time intravenously:

+20% solution of pyracetam in volume of 1,5 мl

-20% solution of pyracetam in volume of 10 мl

-20% solution of pyracetam in volume of 3 мl

-20% solution of pyracetam in volume of 0,3 мl

-20 % solution of pyracetam in volume of 5 мl

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After birth the child is pale, the breathing is unrythmical, it doesn’t get better on the background of oxygenotherapy. Pulse is weak, fast, the arterial pressure is difficult to measure, there is no edema.

What is the most probable reason of these symptoms?

+ acute hypoxia

- antenatal pneumonia

- intracranial hemorrhage

- stagnant heart unsufficiency

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More often diabetes mellitus occurs at:

+children of the school age

-3-5 years old children

-first year of life children

-teenagers

-newborns

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Diabetes mellitus is a result of:

+autoimmune destruction of beta- cells

-mono-viremia

-hyperplasia of pancreas

-hypothyroidism

-hyperthyroidism

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Early signs of insulin insufficiency are:

+hyperglycemia after food

-hyperglycemia fasting

-ketoacidosis

-lactateacidosis

-hypoglycemia

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