Topic 10. Pathophysiology of extreme conditions. Shock.

1. A patient in comatose state has smell of acetone from his mouth. Content of glucose in his blood plasma is of 18 mmol/L. What kind of coma is the most possible one in this case?

A. Hyperosmolar

B. Ketoacidemic

C. Hypoglycemic

D. Toxic

E. Lactatacidemic

2. A patient with crushed muscular tissue was admitted to the traumatological department. Which biochemical index of urine is increased in this case?

A. Glucose

B. Mineral salts

C. Uric acid

D. General lipids

E. Creatinin

3. A patient is drowsy, his conscious is depressed, and his reactions to irritants are suspended. He has a pale dry and edematous skin, muscular fibrillations, mydriasis, and Cheyne-Stocks’ respiration with ammonium scent from his mouth. Pericardial friction sound was found at auscultation of the patient’s heart. What kind of coma has developed in this patient?

A. Ketoacidotic

B. Renal

C. Hyprosmolar

D. Hepatic

E. Apoplectic

4. A 35-year-old man has massive trauma of lower extremities without considerable external bleeding. The victim is in exited condition. What component of pathogenesis of traumatic shock is leading and needs immediate correction?

A. Pain

B. Internal bleeding

C. Intoxication

D. Disorder of organ functions

E. Internal loss of plasma

5. A patient with burn of 30% of body surface has decrease in BP to 75/20 mm Hg, frequent, filiform pulse (110/min). What is the main factor of decrease in BP in burn shock?

A. Intoxication by decay products

B. Plasmarrhea

C. Activation of sympathetic nervous system

D. Hypoproteinemia

E. Activation of parasympathetic nervous system

6. Spasm of resistant vessels develops in zones with alpha-adrenoreceptors in erectile phase of shock. What hemodynamic changes will be observed in this case?

A. Systemic decrease of peripheral blood flow

B. Centralization of blood flow

C. Bradycardia

D. Decrease of venous return

E. Decrease of blood flow speed

7. A victim of the earthquake felt well just after he was extracted from under ruins, but soon abrupt worsening of his condition developed. He lost consciousness, his BP was of 70/35 mmHg, and his pulse was of 90 per min; edema of previously ischemic tissues increased quickly. Which is the main cause of patient’s condition worsening?

A. Increase in tonus of sympathetic nervous system

B. Thrombosis of subcutaneous venous vessels

C. Dehydration

D. Systemic activation of proteolytic processes and PLO

E. Disorders of renal functions

8. A patient was admitted to the hospital in severe state. He does not answer the questions and does not react to pain stimuli. Patient’s BP is 50/10 mmHg, his pulse is 50 per min. What are the reasons for disorders of system hemodynamics at torpid phase of shock?

A. Total decrease in peripheral vascular resistance

B. Elevation of venous return of blood

C. Increase of CBV

D. Rise of tonicity of sympathetic nervous system

E. Decrease in permeability of exchange vessels

9. Intravenous infusion of blood and blood substitutes does not lead to the stabilization of BP in a patient with torpid phase of shock. After cessation of infusion patient’s blood pressure decreases again. What does inefficacy of medical treatment in torpid phase of shock connected to?

A. Spasm of resistant vessels

B. Hemodilution

C. Increase in velocity of blood flow

D. Tachycardia

E. Systemic increase in vessel permeability

10. Levels of plasma proteins are sharply increasing, and the number of alveolar macrophages and lymphocytes is decreasing in bronchoalveorlar contents of a patient with shock. What is the mechanism of these phenomena appearance?

A. Increase in permeability of lung capillaries

B. Spasm of resistant vessels of the lungs

C. Increase in inhibitor systems of the lungs

D. Increase in pulmonary blood flow

E. Hyperventilation

11. A patient with torn away finger was admitted to the traumatological department. He is fussy, verbose, and pale. His pulse is 120 beats per minute, BP 140/90 mmHg. What are the peculiarities of disorders of microcirculation and systemic hemodynamics in erectile phase of shock?

A. Systemic spasm of volume vessels

B. Increase in systemic peripheral resistance

C. Decrease in venous return and volume of blood circulation

D. Increase in peripheral resistance in the brain, heart and lungs vessels

E. Hypoxia in zones with beta-adrenoreceptors

12. Hemodialysis was utilized for treatment for acute renal failure developed in a patient as a result of traumatic shock. While carrying out the hemodialysis patient’s condition became worse, aggregation of erythrocytes, leukocytes, and platelets occurred in microvessels, and blood viscosity increased. What kind of disorders of microcirculation developed in the patient?

A. Sludge syndrome

B. Disorders of vascular permeability

C. Extravascular disorders

D. Capillary-trophic insufficiency

E. Lymphatic system insufficiency

13. Tourniquet was applied to upper third of hip of wounded driver just at place of car accident. The patient was admitted to a surgical department in satisfactory condition 3 hours later. Marked edema of hip tissues, frequent pulse, cold perspiration, and expressed hypotension develop in the patient after removal of tourniquet. Which pathological process develops in the patient?

A. Toxic shock

B. Anaphylactic shock

C. Collapse

D. Cardiogenic shock

E. Hemorrhagic shock

14. Daily diuresis amounts to 250 ml in a patient with anaphylactic shock. The patient has moist rales in his lungs; his consciousness is intact. In patient’s blood acidosis reveals with base deficiency of 14.5 mmol/L; plasma contents of potassium is 8.8 mmol/L and urea is 48 mmol/L. How is this disorder of kidney called?

A. Uremic coma

B. Acute diffuse glomerulonephritis

C. Acute renal failure

D. Chronic renal failure

E. Chronic glomerulonephritis

15. Sharp weakness, paleness of skin, lost of consciousness appeared in a patient the next day after resection of his stomach. The patient’s BP is 70/40 mmHg; pulse is 160 beats per minute. In the patient’s blood test Hb is 70 g/L, erythrocytes are 2.3x10¹²/L. What pathology appeared in a patient?

A. Orthostatic collapse

B. Pain shock

C. Traumatic shock

D. Hemorrhagic collapse

E. Cardiogenic collapse

16. Sharp decrease of systolic BP down to 60 mmHg, tachycardia of 140 beats per minute, dyspnea, and loss of consciousness developed in a patient on the second day after myocardial infarction. What pathways have the most important significance in pathogenesis of this shock?

A. Increase in excitability of the myocardium by products of necrotic decay

B. Decrease in blood volume

C. Development of paroxysmal tachycardia

D. Decrease in stroke volume

E. Development of anaphylactic reaction to myocardial proteins

17. A driver was admitted to an emergency department after a car accident. He does not react to questions; he is indifferent to everything, pale; he has shallow and infrequent respiration and BP of 75/50 mmHg. Name the principal link in pathogenesis of this pathology.

A. Excitement of CNS

B. Inhibition of CNS

C. Loss of blood

D. Toxemia

E. Redistribution of blood

18. To compensate considerable loss of blood resulting from knife wounding of liver, a 30-yer-old patient with blood of IV (AB) Rh (-) group was transfused with blood of IV(AB) Rh (+) group. Requirement in repeated blood transfusion appears in several days. What kind of blood is it possible to use for transfusion?

A. IV(AB) Rh (-)

B. I(O) Rh (+)

C. II(A) Rh (-)

D. IV(AB) Rh (+)

E. III(B) Rh (-)

19. A patient was admitted to a hospital with acute high bowel obstruction. He had prolonged vomiting and blood pressure decreased down to 60/40 mmHg. Which mechanism of shock development is principal one in this case?

A. Exhaustion of arteriolar alpha-adrenoreactivity

B. Hypovolemia

C. Acidotic dilation of metarteriols

D. Loss of chlorides

E. Increase in tonus of vagus nerve

20. Novocain solution was injected to a patient for anesthetization at extraction of a carious tooth. Drop of BP, loss of consciousness, dyspnea, and convulsions develop in the patient in a few minutes. What is the reason for anaphylactic shock development?

A. Desensitization of the organism

B. Toxic action of Novocain

C. Sensitization to Novocain

D. Autoallergic state

E. Para-allergy

21. Severe burn shock has developed in a patient with 40% of body surface burnt. What is the cause of shock development?

A. Dehydration of the organism

B. Mineral metabolism disturbances

C. Autoimmunization of the organism

D. Protein metabolism disturbances

E. Pain

22. A teeth was extracted in a teenager with Novocain utilization. Paleness of skin, dyspnea, and hypotension developed in the teenager 10 minutes later. What kind of allergic reactions developed in the teenager?

A. Immune complex

B. Stimulating

C. Anaphylactic

D. Cytotoxic

E. Cell-mediated

23. After a car accident a patient has BP of 70/40 mmHg; he is unconscious; his daily diuresis is about 300 ml. What is the mechanism of urinopoiesis disturbances in this case?

A. Augmentation of glomerular filtration

B. Reduction of tubular reabsorption

C. Decrease in glomerular filtration

D. Augmentation of tubular reabsorption

E. Reduction of tubular secretion

24. A 45-year-old victim with severe craniocerebral trauma was admitted to the hospital by emergency team. Shockogenic trauma was diagnosed: loss of consciousness, paleness of skin, decrease in body temperature down to 35⁰С, decrease in muscular tonus, absence of reflexes, frequent and weak pulse, and decrease in BP down to 50/30 mmHg appeared in the patient. Which clinic stage of traumatic shock is the patient in?

A. Terminal

B. Erectile

C. Excitation

D. Inhibition

E. Torpid

25. A doctor established shock condition in a patient who fell from high altitude. What is the most important in traumatic shock development?

A. Disturbances of the neurohumoral regulation

B. Toxemia

C. Disorders of regulation of the hemodynamics

D. Hypovolemia

E. Disturbances of renal functions

26. A patient developed anaphylactic shock in a dental room after injection of Lidocain solution. Which immunoglobulins underlie anaphylactic shock development?

A. Ig E

B. Ig М

C. Ig А

D. Ig G

E. Ig D

27. Traumatic shock developed in a patient as a result of severe trauma. Neuroendocrine, hemodynamic, and metabolic disorders took place during the shock development. Clinically, after erectile stage of shock, another stage developed, which is referred to as:

A. Torpid

B. Septic

C. Chronic

D. Neurocirculatory

E. Ischemic

28. Anaphylactic shock developed in a patient after injection of local anesthetic drug. Which mechanism of blood circulation disorders is the leading one in this condition?

A. Decrease in tonus of vessels

B. Hypovolemia

C. Pain

D. Activation of sympathetic-adrenal system

E. Reduction of contractile function of the heart

29. Hypovolemic shock and signs of severe hypoxia developed in a victim of aircraft crash due to severe hemorrhage. In this situation the most severe disorders for the organism develop in:

A. Heart

B. Kidneys

C. Lungs

D. Liver

E. Spleen

ANSWERS:

1.-B, 2.-E, 3.-B, 4.-A, 5.-B, 6.-E, 7.-D, 8.-A, 9.-E, 10.-A, 11.-B, 12.-А, 13.-А, 14.-С, 15.-D, 16.-D, 17.-В, 18.-А, 19.-В, 20.-С, 21.-Е, 22.-С, 23.-С, 24.-А, 25.-А, 26.-А, 27.-А, 28.-А, 29.-А.

Дата добавления: 2015-07-25