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Файл:Emergency medical care at the prehospital stage. Assessment of the severity of the condition of patients. Study aid
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121
The scale turned out to be useful not only in providing emergency care at the
prehospital stage, but also in assessing the condition of patients and injured at the
hospital stage.
3.11. CLOCK DRAWING TEST TO ASSESS
THE MENTAL STATE OF THE PATIENT
The simplicity and high informativity of this test, including in mild dementia,
makes it one of the most commonly used tools for diagnosing clinical syndrome. The
test is performed as follows. The patient is provided with a clean sheet of unlined paper and a pencil. Instructions are given: please draw a round clock with numbers on
the dial so that the hands of the clock show without fifteen two. The patient must
draw a circle on his own, put all 12 numbers in the right places and draw arrows
pointing to the right positions. Normally, this task is never difficult. If errors occur,
they are quantified on a 10-point scale. The performance of the tasks of this test is
disrupted both in frontal dementias and in Alzheimer's dementia and dementias with
a predominant damage to subcortical structures.
For differential diagnosis of these conditions, in case of incorrect independent
drawing, the patient is asked to draw the arrows on the dial already drawn (by the
doctor) with numbers. With frontal dementias and dementias with predominant damage to subcortical structures of light and moderate severity, only independent drawing
suffers, while the ability to position arrows on an already drawn dial is preserved.
With dementia of the Alzheimer's type, both independent drawing and the ability to
position the arrows on an already finished dial are impaired. Test results may range
from 0 to 18 points; with 18 points corresponding to the highest cognitive abilities.
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KNOWLEDGE MONITORING MATERIALS
TEST TASKS
Diseases of the respiratory system.
Acute respiratory failure (DMA)
1. The main manifestations of ODN include:
a) hypoxia;
b) hypoxemia;
c) hypercapnia;
d) hypotension.
Specify error (1).
2. The clinical presentation of stage I ODN is most characterized by the
following features:
a) the patient in consciousness;
b) the skin is pale, moist, with elements of acrocyanosis;
c) tachypnea up to 25–30 per minute;
d) hypotension is noted;
e) PaO2 decreases to 70 mmHg.
Specify error (1).
3. In stage II ODN, the following is determined:
a) cyanosis of the skin, sometimes in combination with hyperemia, profuse
sweat;
b) bradycardia;
c) arterial hypertension;
d) PaO2 is reduced to 60 mmHg;
e) PaCO2 increases to 50 mmHg.
Specify error (1).
4. Stage III ODN is characterized by the following features:
a) the patient in consciousness;
b) rapid transition of tachypnea to bradypnea;
c) arterial hypotension;
d) decrease in PaO2 to 50 mmHg and below;
e) increase in PaCO2 to 80–90 mmHg and below.
Specify error (1).
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5. Absolute indications for mechanical ventilation are:
a) hypoxemic ODN (PaO2 less than 50 mmHg);
b) hypercapnic ODN (PaCO2 more than 60 mmHg);
c) critical reduction of reserve respiration;
d) chest injury;
e) NPV more than 40 per minute, provided that it is not associated with other
causes (hyperthermia, severe, not eliminated hypovolemia, etc.).
Specify error (1).
6. Relative (differentiated) indications for mechanical ventilation are:
a) coma (Glasgow waking score less than 8 points);
b) chest injuries;
c) grade I asthmatic status (ventilation disorders);
d) hypoventilation syndrome of central genesis;
e) the presence of pathological conditions requiring muscle relaxation for their
treatment.
Specify error (1).
7. Central-origin ODN is pathogenetically related:
a) with the effect on the respiratory center of intracranial hypertension;
b) with impaired innervation of respiratory muscles;
c) with the effect on the respiratory center of the lesion;
d) with impaired breathing mechanics in case of chest injuries;
e) with exposure of the respiratory center to toxic substances.
Specify error (1).
8. The main causes of airway obstruction syndrome are:
a) laryngospasm;
b) bronchiolospasm;
c) asthmatic states of various etiologies;
d) convulsive syndrome;
e) foreign body of the upper respiratory tract.
Specify error (1).
9. The leading role in the pathogenesis of bronchial obstruction syndrome
is played by such mechanisms as:
a) spasm of smooth bronchial muscle;
b) dis- and hypercrinia;
c) inflammatory edema of the bronchial mucosa;
124
d) swelling of interstitial lung tissue;
e) expiratory collapse of small bronchi.
Specify error (1).
10. The principles for the elimination of ODN caused by asthmatic status
include:
a) carrying out oxygenotherapy;
b) elimination of hypovolemia;
c) prescription of antihistamines;
d) relief of inflammatory edema of the bronchial mucosa;
e) relief of bronchial obstruction.
Specify error (1).
11. The following types of drowning in water are distinguished:
a) true;
b) asphyxic;
c) expiratory;
d) syncopal (death in water).
Specify error (1).
12. The main clinical options for pulmonary embolism (PE) are:
a) asphyxic;
b) coronary ischemic;
c) collaptoid;
d) abdominal;
e) comatose.
Specify error (1).
13. The most persistent clinical signs of PE include:
a) shortness of breath and tachypnea;
b) increased pressure in the pulmonary artery system;
c) rapid formation of the pulmonary heart;
d) arterial systemic hypertension;
e) anginose-like pain syndrome.
Specify error (1).
14. The following clinical signs indicate a high probability of PE:
a) tachycardia (HR 95 or more per minute);
b) male sex;
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c) events deep vein thrombosis of the lower extremities;
d) previously established oncological pathology;
e) surgery, injury (fracture) or disease (ONMC), which entailed the forced immobilization of the patient over the past month.
Specify error (1).
15. Anatomical guidelines for conicotomy are not:
a) thyroid cartilage;
b) ring-shaped cartilage;
c) ring-shaped thyroid membrane;
d) external carotid artery.
Specify error (1).
16. If the victim has signs of a foreign body of the upper respiratory tract
with rapidly increasing ODN events, it is possible to:
a) apply the Heimlik technique;
b) try to remove the foreign body with a finger or clamp;
c) perform emergency conicotomy;
d) puncture the cricothyroid ligament and leave 2–3 needles of large (at least
2–2.5 mm) diameter in it.
Please enter the correct answer (1).
Diseases of the cardiovascular system
17. Sudden cardiac death is:
a) death in the presence of witnesses, which occurred instantly or within
6 hours of the onset of a heart attack;
b) death that occurred instantly or within 6 hours of the onset of a heart attack;
c) death occurring suddenly, without any prior symptomatology, or within
1 hour of the occurrence of acute symptomatology, but the onset of death is unexpected.
Please enter the correct answer (1).
18. The diagnosis of acute coronary syndrome is highly likely if the pa-
tient has:
a) first onset anginal pain within 2 months;
b) anginal pain lasting 3–5 minutes during normal physical activity;
126
c) anginal pain during excessive exercise for 3–5 minutes;
d) anginal pain of wave-like nature lasting more than 30 minutes;
e) anginal pain at rest for 2–3 minutes.
Specify error (1).
19. Acute coronary syndrome includes:
a) newly occurring angina within 1 month;
b) angina pectoris with uncooked pain syndrome for 15 minutes;
c) angina pectoris with stopped pain syndrome for 15 minutes;
d) resting angina developing more than 5 times a day.
Specify error (1).
20. Atypical forms of myocardial infarction include:
a) asthmatic;
b) arrhythmic;
c) cerebral;
d) abdominal;
e) renal;
f) low-symptom (pain-free).
Please enter the correct answer (1).
21. Heart rhythm and conduction disorders requiring emergency elimina-
tion include:
a) a complete atrioventricular block accompanied by attacks of Morgane —
Adams — Stokes;
b) rare ventricular extrasystole;
c) sinus tachycardia.
Please enter the correct answer (1).
22. Acute vascular failure is a condition due to:
a) impaired venous return due to increased vascular bed capacity;
b) impaired venous return due to a decrease in the capacity of the vascular bed;
c) short-term loss of consciousness due to a decrease in the capacity of the vascular bed;
d) impaired venous return due to increased overall peripheral vascular resistance.
Specify error (1).
127
23. Conditions requiring emergency BP reduction in hypertensive crisis
include:
a) dissecting aortic aneurysm;
b) acute coronary syndrome;
c) cardiogenic pulmonary edema;
d) brain stroke.
Specify error (1).
24. Complications of hypertensive crisis include:
a) acute hypertensive encephalopathy;
b) brain stroke;
c) acute coronary syndrome;
d) pulmonary embolism;
e) aortic dissection.
Specify error (1).
Shock states
25. Clinical criteria for microcirculation disorder include:
a) diuresis less than 30 ml/hour;
b) temperature gradient between skin and rectum is more than 2 °C;
c) development of metabolic acidosis;
d) presence of metabolic alkalosis;
e) symptom of a “white spot” lasting more than 2 seconds, marbling of the skin.
Specify error (1).
26. Pathogenetic variants of shock include:
a) hypovolemic;
b) obstructive;
c) system;
d) vasogenic;
e) cardiogenic.
Specify error (1).
27. Vasogenic types of shock include:
a) traumatic;
b) septic;
128
c) anaphylactic;
d) bacterial-septic.
Specify error (1).
28. For hypovolemic shock, the most characteristic are the following
changes in hemodynamics:
a) decreased cardiac output;
b) increase of jamming pressure in pulmonary capillaries;
c) reduction of central venous pressure;
d) increased total peripheral vascular resistance.
Specify error (1).
29. For cardiogenic shock, the most characteristic are the following chang-
es in hemodynamics:
a) decreased cardiac output;
b) increase of jamming pressure in pulmonary capillaries;
c) reduction of central venous pressure;
e) increased total peripheral vascular resistance.
Specify error (1).
30. Anaphylactic shock is characterized by the following changes in hemo-
dynamics:
a) a decrease in cardiac output is possible;
b) reduction of jamming pressure in pulmonary capillaries;
c) increasing the central venous pressure;
d) reduced total peripheral vascular resistance.
Specify error (1).
31. Septic shock is characterized by the following changes in hemody-
namics:
a) increased cardiac output;
b) reduction of jamming pressure in pulmonary capillaries;
c) reduction of central venous pressure;
d) increase of total peripheral resistance.
Please enter the correct answer (1).
129
Acute disorders of consciousness
32. Fainting is understood as:
a) short-term loss of consciousness with impaired postural tone;
b) prolonged loss of consciousness in combination and impaired postural tone;
c) short-term loss of consciousness with transient neurological symptoms;
d) short-term loss of consciousness with a drop in vascular tone and a relative
decrease in BCC;
e) loss of consciousness of different duration due to activation of sympathetic
influences.
Please enter the correct answer (1).
33. Collapse is usually understood as:
a) acute vascular insufficiency characterized by a fall in vascular tone in combination with a relative decrease in BCC;
b) acute vascular insufficiency with an increase in vascular tone and a fall
in BCC;
c) chronic vascular failure with a decrease in vascular tone and a decrease in
BCC due to blood loss;
d) acute vascular failure with decreased vascular tone and increased BCC.
Please enter the correct answer (1).
34. When measuring BP in patients with syncope, the following is de-
tected:
a) its sharp increase;
b) its sharp decline;
c) gradual reduction over several hours;
d) BP does not change.
Please enter the correct answer (1).
35. The duration of syncope (syncope) is usually:
a) from 6 to 60 seconds;
b) more than 30 minutes;
c) several tens of minutes;
d) not less than 1 hour.
Please enter the correct answer (1).
130
36. The state of the sopor in TBI corresponds to the following number of
points on the ShH:
a) 13–14;
b) 10–12;
c) 8–9;
d) 6–7;
e) 4–5.
Please enter the correct answer (1).
37. The state of deep coma in TBI corresponds to the number of points
on ShH:
a) 13–14;
b) 10–12;
c) 8–9;
d) 6–7;
e) 4–5.
Please enter the correct answer (1).
38. Moderate stun status in a TBI patient corresponds to the following
number of ShH scores:
a) 13–14;
b) 10–12;
c) 8–9;
d) 6–7;
e) 4–5.
Please enter the correct answer (1).
39. In the sopor state, the patient has the following symptoms:
a) almost complete lack of consciousness;
b) absence of targeted protective movements;
c) opening the eyes to pain and sound stimuli;
d) occasionally monosyllabic answers to a repeatedly repeated question;
e) loss of control over pelvic functions.
Specify the wrong answer (1).
40. The following symptoms correspond to the state of deep coma:
a) lack of consciousness;
b) absence of protective movements;
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