1. What is bronchitis? What types of it do you know?

Speak on its causes, clinical

pattern.
2. Describe treatment options and complications of bronchitis.
4. What is atherosclerosis? Speak on its causes and pathogenesis
5. Describe the clinical pattern of atherosclerosis, its prevention and treatment. What can
it lead to?
6. What is ischemic heart disease? What types of it do you know? What are the causes of
it?
8. What is acute myocardial infarction? Describe its pathogenesis.
9. What are patients’ complains during the attack?
10. What are the treatment options for myocardial infarction?
11. What is different in clinical pattern of angina pectoris and myocardial infarction?
12. What is gastritis? What are its causes and symptoms of gastritis?
13. How to diagnose and treat gastritis?
14. What is stomach cancer? Speak on the stages of stomach cancer development.
15. What symptoms may develop during cancer progressing?
16. How is the stomach cancer treated? What is the role of nutrition for cancer patients?
17. What is hepatitis and its types? Compare different types of viral hepatitis (causes, way
of transmission, duration of incubation period etc).
18. What symptoms are typical of hepatitis? When is it considered chronic?
19. How is it possible to treat different types of hepatitis?
20. What is cirrhosis, its types and causes, symptoms and complication.
21. What is HIV infection? Speak on two main strains of HIV. What does HIV affect in
the human body? What are the ways of HIV transmission?
22. Describe the course and possible treatment options of AIDS.
23. How to reduce the risk of being infected with HIV?
24. What is allergy? What are the most common allergens? What are the ways of their
penetrating into body?
25. When does an allergic reaction occur? What is the role of IgE in the allergic reaction?
26. Describe the symptoms of allergic reaction
27. How to determine the cause of allergy?
28. What is the treatment for allergy?
29. Describe its complications. What is the first aid for anaphylactic shock?
30. What types of diabetes mellitus do you know? What are the causes, symptoms
31. Outline the treatment for both types of diabetes mellitus?
32. What are the complications of diabetes mellitus?
33. What is stroke? What are the types of the brain stroke?
34. What are the main causes of stroke? What are the risk factors for having different
types of stroke?
35. What do the symptoms and treatment of the brain stroke depend on? What are they?
Name the complications
36. What therapy does rehabilitation of the patient afler the stroke include?
37. What is nephritis? Name its types. Speak on its causes, clinical pattern.
38. What is the treatment for nephritis and name the complications of nephritis.
39. What is surgery? What does it deal with and what methods does it use?
40. What is anaesthesia? What are its main types? Speak on them.
41. What should be done with the patient before and after the operation?
42. What instruments and equipment are used during the operation?
43. What are the methods of surgical instruments sterilization?

1
44. What is a medical emergency? Give examples of medical emergency cases? Define
them.
45. What is the first aid for suspected poisoning.
46. What is the first aid for bleeding?
47. What is circulatory shock? What types of shock do you know? What is the cause of
hypovolemic shock?
48. What are the basic recommendations for managing shock? What can it result in?
49. What is the first aid for heart arrest?
50. What are the most serious injuries and their warning signs? What is the first aid for
them?
51. Define the types of fractures.
52. What is the first aid in case of fracture?
53. What is sprain and strain? What are the causes, symptoms and treatment? How to
differentiate them from fractures?
54. What soft tissue injuries do you know? Define them.
55. Describe the first aid for soft tissue injury.

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 1. What is bronchitis? What types of it do you know?  Speak on its causes, clinical pattern.
Acute bronchitis is a frequently diagnosed viral infection leading to inflammatory changes within the
bronchi. The viral pathogens of upper respiratory infections, including those of the common cold,
influenza A or B, parainfluenza, respiratory syncytial virus, or coronavirus, most often cause acute
bronchitis. Bacterial infections cause less than 10% of cases of bronchitis.
Acute bronchitis is characterized by acute cough with or without sputum production and can last up to
3 weeks. Clear, yellowish, and sometimes purulent sputum may be present. Cough is commonly
disturbing and slow to resolve. Patients may experience chest pain when coughing. Other signs and
symptoms of acute bronchitis include dyspnea, nasal congestion, headache, and fever. Fever is not a
typical symptom after the first few days. The first few days of acute bronchitis may be mistaken for
the common cold. Bronchitis occurs most often during the cold and flu season, usually coupled with
an upper respiratory infection. It also occurs when a person inhales irritating fumes of dust, chemical
solvent and smoke.
Chronic bronchitis is defined as chronic cough and sputum production for at least 3 months in a year
for 2 consecutive years. The risk factors for chronic bronchitis include cigarette smoking,
occupational exposure to harmful substances, exposure to agricultural pesticides, use of domestic
solid fuels, electronic cigarettes, marijuana smoking, and air pollution. Chronic bronchitis is linked to
a decline in lung function as well as an increased risk of chronic obstructive pulmonary disease.

2. Describe treatment options and complications of bronchitis.

Supportive care and symptomatic treatment are prescribed for acute bronchitis. The role of antibiotics
is limited. For cough relief, nonpharmacological and pharmacological therapy should be prescribed.
Nonpharmacological therapy includes warm tea, honey, and ginger. Over-the-counter medications are
the first-line treatment for acute bronchitis. Antihistamines are often used in combination with
decongestants in the treatment of acute cough. Antitussives reduce the cough reflex. Expectorants
stimulate respiratory tract secretions and increase respiratory fluid volumes and decrease mucus
viscosity. Patients with evidence of airflow obstruction should be treated with bronchodilators. They
relieve dyspnea and reduce coughing. Analgesic and antipyretic agents may be used to treat malaise,
myalgia, and fever. Lifestyle modification, including smoking cessation and the avoidance of
allergens and pollutants, plays an important role in the prevention of recurrence and complications.
Acute bronchitis is regarded as a mild, self-limiting illness. That is why healthy adults recover
completely and are typically uncomplicated cases. However, patients with underlying lung disease,
congestive heart failure, or immune compromise are at high risk for complications, such as chronic
cough or progression to chronic bronchitis or pneumonia.
Pharmacologic therapy for chronic bronchitis is directed towards relieving symptoms during stable
disease (mucoactive agents, beta-agonists, muscarinic antagonists), reducing loss of lung function
(smoking cessation), preventing exacerbations (mucoactive agents, macrolides) and treating
exacerbations (antibiotics, glucocorticoids) when they develop.

4. What is atherosclerosis? Speak on its causes and pathogenesis.

Atherosclerosis is a disease of the large and medium-sized arteries. Atherosclerosis is
defined as the gradual buildup of fatty plaques within the arterial wall. This may result in a
significant narrowing of the vessel lumen as well as impair blood flow. The plaques may
become unstable and thrombose, leading to an acute coronary syndrome.
The atherogenic process is characterized by dysfunction of the endothelial lining of the
vessel, associated with inflammation of the vascular wall. This leads to the accumulation of
lipids, foam cells, inflammatory cells, and cellular debris within the intimal and subintimal
layers of the vessel. The earliest lesions are known as “fatty streaks”. These lesions develop
into fibrous plaques. Further growth of the plaque causes remodeling of the arterial wall.
Progressive plaque accumulation results in luminar narrowing and vessel obstruction.
Erosion of the endothelial layer or rupture of the overlying fibrous cap may expose the highly
thrombogenic, lipid-rich core of the plaque to circulating blood. Collagen and tissue factors
activate platelets and trigger the coagulation cascade, leading to acute thrombosis, which
may occlude the vessel. Myocardial infarction may occur.

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5. Describe the clinical pattern of atherosclerosis, its prevention and treatment. What
can it lead to?
The symptoms of atherosclerosis depend on the artery that is affected. If atherosclerosis is
found in the coronary arteries, the symptoms include angina (chest pain), shortness of
breath, and arrhythmias (abnormal heartbeat). If atherosclerosis is detected in the carotid
arteries, the symptoms are weakness, paralysis or numbness in the face, arms or legs,
confusion, breathing problems, dizziness, and sudden and severe headache. If
atherosclerosis is observed in the peripheral arteries, the symptoms include numbness and
pain in the legs, arms, and pelvis. If atherosclerosis is established in the renal arteries, it can
lead to chronic kidney disease. As kidney disease progresses, the symptoms include fatigue,
changes in frequency of urination, loss of appetite, nausea, itchiness, or numbness.
The lipid-lowering medications are prescribed and include statins, fibrates, and inhibitors of
intestinal cholesterol absorption. Statins reduce cholesterol levels and increase clearance of
circulating LDL. Fibrates improve the lipid profile, which results in a lowering of total and LDL
cholesterol, a reduction in triglycerides, and an increase in HDL. Inhibitors of intestinal
cholesterol absorption reduce LDL cholesterol and are sometimes used in statin-intolerant
patients, but they should not be used as first-line therapy as a substitute for statins as clinical
outcome data are lacking.
Therapeutic lifestyle changes, including exercise, weight loss, and dietary modifications, are
the first step in the treatment of all patients.

6. What is ischemic heart disease? What types of it do you know? What are the
causes of it?
Ischemic heart disease is a disease characterized by ischemia (reduced blood supply) of the
heart muscle.
There two types of IHD: stable (symptoms appear at predictable level of exertion and can
be managed by the patient) and unstable (symptoms appear at unpredictable level of
exertion and are poorly managed by the patient; new symptoms may appear or angina may
worsen). Symptoms of stable IHD include angina (chest pain) and decreased exercise
tolerance. Symptoms of unstable IHD include chest pain at the rest or rapidly worsening
angina. +shortness of breath, arrhythmia, weakness, anxiety, Nausea and vomiting, Heart
palpitations, Swelling in the legs and feet and abdomen, Difficulty sleeping, Cough caused
by fluid in the lungs.
The main causes of IHD are atherosclerosis, thrombosis, embolism, hypotension, heart
failure, renal failure. Its risk increases with age, smoking, hypercholesterolemia, diabetes,
hypertension and genetic predisposition.
The main complications of IHD include cardiac insufficiency, myocardial infarction,
myocarditis, ventricular hypertrophy, acute coronary syndrome.
Treatment: depending on symptoms and risk, it can be with medication which includes
aspirin (to prevent blood clotting), beta-blockers (to reduce heart rate), statins (to reduce
level of LDL), nitroglycerin (to dilate coronary arteries). Diuretics to rid the body of excess
fluid, which reduces the amount of blood that needs to be pumped, leading to reduced blood
pressure and less work for the heart muscle.
Sometimes surgical treatment may be needed such as percutaneous coronary transluminal
angioplasty, coronary artery bypass surgery.

8. What is acute myocardial infarction? Describe its pathogenesis.

Acute myocardial infarction (MI) is one of the leading causes of death in the world. The
prevalence of the disease approaches three million people worldwide.
MI results in irreversible damage to the heart muscle due to a lack of oxygen.
Acute myocardial infarction develops due to decreased coronary blood flow. The available
oxygen supply cannot meet the oxygen demand, resulting in cardiac ischemia. Decreased
coronary blood flow is multifactorial. Atherosclerotic rupture induces an inflammatory
cascade of monocytes and macrophages, thrombus formation, and platelet aggregation.
This results in decreased oxygen delivery through the coronary artery, leading to decreased

4
oxygenation of the myocardium. Other etiologies of decreased oxygenation/myocardial
ischemia include coronary artery embolism, cocaine-induced ischemia, coronary dissection,
and coronary vasospasm. The main causes of myocardial infarction include: atherosclerosis
of coronary artery, aneurism, rupture of aorta, hyper or hypotension, bacterial infection,
anemia, stenosis. The risk factors include: previous cardiovascular disease, older age,
tobacco smoking, high blood levels of lipids and low level of high density lipoproteins,
diabetes, high blood pressure, obesity, chronic kidney disease, heart failure, living in polluted
areas.

9. What are patients’ complains during the attack?

The main symptoms of myocardial infarction are: chest pain, which is described as a
sensation of tightness, pressure; shortness of breath; diaphoresis and fatigue; weakness;
lightheadedness; fainting; fear of death, nausea and vomiting; palpitations and sometimes
loss of consciousness.
It should be noted that women often have atypical symptoms such as abdominal pain or
dizziness and may present without any chest pain. Elderly patients more often have
shortness of breath.

10. What are the treatment options for myocardial infarction?

Patients with MI require aspirin. They should have oxygen supplementation if oxygen
saturation is less than 91%. If the blood pressure is adequate, opioids may be used for pain
control in addition to sublingual nitroglycerin. Patients may routinely be given high-dose
statins, beta-blockers, and/or ACE-inhibitors. In addition to antiplatelet therapy, parenteral
anticoagulation is recommended for all patients.

11. What is different in clinical pattern of angina pectoris and myocardial infarction?

The difference between them lies in their symptoms.

Symptoms of myocardial infarction: pain due to ischemia, pain is radiating to the left arm,
shoulder, back, epigastrium. Nitroglycerin does not relieve pain. Pain lasts for more than 15
minutes

Symptoms of angina pectoris: substernal, knife-like, clearly localized pain. Short up to 15

minutes and Removed by nitroglycerin. Mainly caused by imbalance between myocardial
blood supply and oxygen demand

12. What is gastritis? What are its causes and symptoms of gastritis?
Gastritis is an acute or chronic inflammation of the stomach protective lining. Whereas, the
disease is multifaceted and the most common causes include bacterial infection (H. pylori),
smoking, excessive alcohol and caffeine intake, chronic stress, routine use of NASIDs,
steroids, iron and potassium supplements, autoimmune disorders, vitamin B 12 deficiency,
irregular and imbalanced nutrition, bile reflux and food allergies.
The clinical pattern of the disease depends on the type of gastritis, but usually patient
experiences pain in epigastrium, a full feeling in the abdomen after a meal intake, bloating,
nausea, vomiting, starving pain, tarry stool, loss of appetite, abnormal stool, belching, weight
loss, coated tongue, bad breath, skin pallor, and even hiccups. Heartburn or burning
sensation is typical for patients suffering from excess acid production due to poor digestion.

13. How to diagnose and treat gastritis?

Diagnostic procedure of gastritis requires the review of personal complaints and specialized
tests, among them endoscopy. Endoscopy helps to evaluate the inner lining condition,
detects the erosion and other lesions. Blood test is aimed at defining the general blood cell
count that determines if a patient has anemia. Stool test indicates the presence of blood in
feces, which is typical for the patients suffering from advanced gastritis.

5
The treatment of gastritis is a complex issue, based on the underlying reasons which
determine related clinical protocol. According to the type of gastritis patient can be
prescribed antacids, proton pump inhibitors, H-2 blockers, cytoprotective agents. Several
antibiotics are necessary for the treatment of bacterial gastritis. Gastritis provoked by the
vitamin B 12 deficiency demands the injections to renew the vitamin supply of the organism.
But conservative treatment is not enough. Treatment implies strict dietary regimen and
change of the lifestyle. Nutrition contributes to the recovery process greatly. Patient with
gastritis should eat well-balanced food cooked in a special dietary way, all meals should be
either boiled or baked and mashed, it is necessary to avoid hot and spicy food. Diet helps
not to overload the suffering stomach and promotes recovery. Taking the decoction of
scalded flaxseed on starving stomach helps to protect the inner walls of the digestive system
from destructive acid action. Based on the latest research data mainly all types of gastritis
require the prescription of sedatives.

14. What is stomach cancer? Speak on the stages of stomach cancer development.
Stomach cancer breaks down when cancer cells start to form in the stomach lining, usually
the disease develops slowly and the process takes many years. The explicit reasons for
cancer development have not been distinguished yet, but scientists claim the wide range of
causes may contribute to the development of the disease, among them bacteria, e.g. H.
pylori that leads to ulcer formation, long-term inflammatory process in stomach or intestines,
pernicious anemia, polyps.
Stage 0. The lining of the stomach has a number of cancerous cells that may promote the
disease; the lymph nodes are not involved in the process.
Stage 1. The tumor has spread into the inner layer of the stomach involving some lymph
nodes.
Stage 2. Cancer has penetrated the deeper layers of the stomach and the nearby lymph
nodes.
Stage 3. Cancer has spread to all the layers of the stomach involving the greater number of
the lymph nodes and the nearby organs.
Stage 4. The advanced stage, cancer has affected the distant organs and all the area
around the stomach.

15. What symptoms may develop during cancer progressing?

The symptoms that may develop can be the following: indigestion, bloating, heartburn,
nausea, loss of appetite and weight, pain in epigastrium, melena, swallowing problems,
yellowing of the skin and eyes, stool problems and fatigue.

16. How is the stomach cancer treated? What is the role of nutrition for cancer
patients?
The treatment of the disease depends on the defined stage of cancer. Stage 0 usually
requires surgery that removes the part of the stomach and the nearby lymph nodes. Stage 1
and 2 involve the combination of methods; surgery and chemotherapy. Stage 3 also requires
surgical intervention that removes the stomach completely, in case of poor health condition
surgery may be temporary replaced by chemotherapy and radiation therapy; in extremely
advanced cases both methods are applied. Stage 4 has very poor recovery statistics, and in
general stomach cancer statistics is far from being satisfactory. The main aim of the
treatment during the following stage is to relieve the condition of the cancerous patient.
Patient may be given chemotherapy, radiation therapy, targeted therapy and palliative care.
(Nutrition) The patient needs the right amount of calories, protein, vitamins, and minerals to
maintain his strength to heal. He may need to take daily supplements of vitamin D, B12,
calcium and iron.

17. What is hepatitis and its types? Compare different types of viral hepatitis (causes,
way of transmission, duration of incubation period etc).

6
Hepatitis is an inflammatory condition of the liver, which is usually caused by viral infection,
medications, toxins, alcohol and autoimmune disorders.
Viral infections of the liver are defined as hepatitis A, B, C, D and E.
Hepatitis A is always an acute condition caused by infection with hepatitis virus A through
oral- fecal way of transmission as a result of poor personal hygiene, it is not usually a
serious condition, people recover within a couple of months, some people may not
experience any symptoms. any acute infectious disease hepatitis A has a cyclic flow which
can be described by several periods: incubation period (5-70 days), preicteric period (3-7
days) can be characterized by flu-like symptoms, icteric period (7-10 days) and posticteric
period (2-3 weeks).
Hepatitis B is provoked by hepatitis B virus and mainly transmitted through blood. Usually it
is spread from infected pregnant women to their infant or as a result of child-to-child contact,
but also it can be obtained by unprotected sex and injections. The incubation period lasts
from 12 months up to 2-6 years.
Hepatitis C is provoked by hepatitis C virus. It is transmitted by blood and has long-term
incubation period (2 weeks – 6 months). Chronic form of hepatitis C may provoke the
formation of 2 conditions: cirrhosis and liver failure.
Hepatitis D is provoked by hepatitis D virus and affects people who are already affected
with hepatitis B. It is transmitted through blood and sexual intercourse. Chronic hepatitis D
may provoke cirrhosis and liver cancer. There is no vaccine against hepatitis D, but vaccine
against hepatitis B may protect a person. This disease is not typical for European countries
and often met in the Middle East, Africa and South America.
Hepatitis E is provoked by hepatitis E virus, it is an acute condition related to a poor
personal hygiene, consumption of raw or undercooked meat and shellfish. The disease is
not typical for European countries and mainly met in the Middle East, Africa and South
America. Symptoms of the disease are similar to hepatitis A together with the way of
transmission and incubation period.

18. What symptoms are typical of hepatitis? When is it considered chronic?

Hepatitis A - The general clinical pattern of the disease can be described by the following
symptoms: fatigue, joint and muscle pain, subfebrile temperature, loss of appetite, dull pain
in the upper right quadrant under the ribs, dark urine and pale stool, itchy skin jaundice.
Hepatitis B - disease can be asymptomatic and as the disease develops the clinical pattern
can be described by flu- like symptoms including fatigue, fever, generalized aches, diarrhea,
and jaundice.
Hepatitis C - has no perceptible symptoms, sometimes they can be described as the flu-like
that is why the disease is often called “tender or silent killer”.
Hepatitis D - similar to hepatitis B
Hepatitis E - Symptoms of the disease are similar to hepatitis A
If an individual with hepatitis remains symptomatic for more than a few months, the condition
is considered chronic.

19. How is it possible to treat different types of hepatitis?

A - Treatment of the disease requires bed regimen, drinking lots of fluids, antiviral therapy
with immunomodulators and symptomatic treatment. Prevention of hepatitis A predisposes
strict personal hygiene and vaccine against hepatitis A.
B - Treatment of hepatitis B depends on how long the patient has been infected. If patient
suffers from acute form of hepatitis B he may require the treatment to fight against
symptoms, chronic form of hepatitis B requires lifelong treatment with antiviral therapy. The
WHO recommends Tenofovir and Entecavir for the treatment of chronic hepatitis B, the
action of these medications suppresses the viral activity and prevents cirrhosis development.
The risk group for hepatitis B is recommended a vaccine; the vaccine is also injected to
infants as a part of the routine vaccination schedule.
C - can be treated with special antiviral drugs according to their viral genotype. The active
substances of these medications are usually ledipasvir and sofosbuvir. The up-to-date

7
medical treatment protocols can be defined as more sophisticated and profound with fewer
complications either on physiological or psychic background, but there is still no available
vaccine today.
D - There is no vaccine against hepatitis D, but vaccine against hepatitis B may protect a
person.
E - There is no vaccine against hepatitis E, so while travelling to the parts of the world with
poor sanitary conditions people should follow all the rules of personal hygiene.

20. What is cirrhosis, its types and causes, symptoms and complication.
Cirrhosis is a result of permanent liver damage that causes its scarring and loss of function.
The most common causes of the disease are hepatitis C, obesity and alcohol abuse.
Cirrhosis can develop in women who drink more than 2 alcoholic beverages per day for
several years (that also refers to beer and wine) in men the number of alcoholic drinks is 3.
Other causes that may provoke cirrhosis include infectious hepatitis B and C, autoimmune
hepatitis, damage to the bile ducts, hemochromatosis, Wilson’s disease and hepatotoxic
medications. According to the possible causes of cirrhosis it can be classified into different
types: alcoholic cirrhosis, postnecrotic cirrhosis caused by infectious hepatitis, biliary
cirrhosis, cardiac cirrhosis and nonspecific metabolic cirrhosis.
Clinical pattern of cirrhosis can be described by following symptoms: epistaxis, jaundice,
anorexia, cachexia, itchy skin, fatigue, small spider-like arteries under the skin. The
advanced symptoms include confusion, trouble thinking, edema of the legs, impotence and
gynecomastia, presence of caput medusa, the appearance of bulged and swollen superficial
epigastric veins. All the symptoms of cirrhosis appear due to the loss of liver function.
Cirrhosis is a life-threatening condition accompanied by a number of complications. High
blood pressure in the veins provokes portal hypertension. Portal hypertension may also
provoke splenomegaly and internal bleeding. Generalized edema and ascites are the causes
of liver inability to produce albumin. Cirrhosis may contribute
to the development of different infections, e.g. bacterial peritonitis, and malnutrition as a
result of poor vitamins processing. A buildup of toxins in the blood provokes hepatic
encephalopathy. Besides, a large number of people may develop cancer if suffered cirrhosis
previously.

21. What is HIV infection? Speak on two main strains of HIV. What does HIV affect in
the human body? What are the ways of HIV transmission?
HIV (human immunodeficiency virus) is a virus that attacks the body’s immune system. If
HIV is not treated, it can lead to AIDS (acquired immunodeficiency syndrome). There are two
types of HIV, HIV-1 and HIV-2. HIV-1 can be found throughout the world, but HIV-2 is almost
exclusively limited to West Africa. HIV-1 is transmitted more easily than HIV-2, and HIV-1
infection progresses more rapidly to AIDS. HIV infects cells of the human immune system,
particularly a kind of white blood cell called the CD4 T-cell. These cells help in identifying
and destroying harmful material in the body, including bacteria, viruses, parasites, and even
some cancer cells. Over time, HIV infection destroys the CD4 cells, leading to a weakened
immune system, certain kinds of infections, severe illness, and death. The infections are
often called “opportunistic infections” (OIs) because they are rare or mild in healthy people
but can take advantage of the opportunity provided by the HIV-weakened immune system
and can be life threatening. The HIV virus can also damage tissue directly, causing
neurologic disease, heart disease, and other problems.
You can only get HIV by coming into direct contact with certain body fluids from a person
with HIV who has a detectable viral load. These fluids are:

• Blood
• Semen and pre-seminal fluid
• Rectal fluids
• Vaginal fluids

8
• Breast milk
the HIV in these fluids must get into the bloodstream of an HIV-negative person through a
mucous membrane (found in the rectum, vagina, mouth, or tip of the penis), through open
cuts or sores, or by direct injection (from a needle or syringe).

22. Describe the course and possible treatment options of AIDS.

Various drugs have been developed to fight the HIV infection. They are AZT (zidovudine),
DDI (didanosine). These drugs try to disrupt key chemical reactions in HIV’s metabolic cycle,
including those controlling its reproduction. But the virus mutates rapidly, and the drugs lose
their effectiveness. However, there are new antiviral drugs that are used to treat HIV
infection. They are protease inhibitor, entry inhibitor, reverse transcriptase inhibitor, and
integrase inhibitor. These classes of drugs prevent development and spread of new viruses.
A doctor may prescribe a combination of these drug classes known as highly active
antiretroviral therapy (HAART). Treatment for AIDS consists of treatment for HIV infection
and treatment for opportunistic infections. It includes medications specific for each type of
infection.

23. How to reduce the risk of being infected with HIV?

To prevent the HIV infection, needles should be safely disposed and shouldn’t be shared,
blood for transfusion should be tested before use, people should practice safe sex, and a
pregnant woman with AIDS should take zidovudine to reduce the chances of passing HIV to
the foetus.

24. What is allergy? What are the most common allergens? What are the ways of their
penetrating into body?

Allergies, also known as allergic diseases, refer to a number of conditions caused by the
hypersensitivity of the immune system to typically harmless substances in the environment.
These diseases include hay fever, food allergies, atopic dermatitis, allergic asthma, and
anaphylaxis.
Things that cause allergic reactions are called allergens.

Common allergens include:

• tree and grass pollen

• house dust mites
• foods, such as peanuts, milk and eggs
• animal fur, particularly from pets like cats and dogs
• insect stings, such as bee and wasp stings
• certain medicines

Allergens can be inhaled, ingested, or enter through the skin.

9
25. When does an allergic reaction occur? What is the role of IgE in the allergic
reaction?
Most severe allergic reactions occur within seconds or minutes after exposure to the
allergen. Some reactions can occur after several hours, particularly if the allergen causes a
reaction after it has been eaten. In very rare cases, reactions develop after 24 hours.

If you have an allergy, your immune system overreacts to an allergen by producing

antibodies called Immunoglobulin E (IgE). These antibodies travel to cells that release
chemicals, causing an allergic reaction. This reaction usually causes symptoms in the nose,
lungs, throat, or on the skin. Each type of IgE has specific "radar" for each type of allergen.
That's why some people are only allergic to cat dander (they only have the IgE antibodies
specific to cat dander); while others have allergic reactions to multiple allergens because
they have many more types of IgE antibodies.

26. Describe the symptoms of allergic reaction.

Symptoms of an allergic reaction can include:

• a runny nose or sneezing

• pain or tenderness around your cheeks, eyes or forehead
• coughing, wheezing or shortness of breath
• itchy skin or a raised rash
• diarrhoea
• feeling or being sick
• swollen eyes, lips, mouth or throat

27. How to determine the cause of allergy?

If a person believes that they may have an allergy, their doctor will be able to help them
identify what is causing the reaction.

The person should be ready to explain:

• any symptoms they have noticed

• when and how often they occur
• what seems to cause them
• any family history of allergies
• whether or not other household members have a similar reaction
The doctor may recommend some tests or refer the person to a specialist.

Examples of allergy tests:

• Blood tests: These measure the levels of IgE antibodies to specific allergens in the
immune system.

10
 • Skin prick tests: A doctor will prick the skin with a small amount of a possible allergen. If
the skin reacts and becomes itchy, red, or swollen, the person may have an allergy.
• Patch tests: To check for contact eczema, a doctor may tape a metal disc with a small
amount of a suspected allergen to the person’s back. They will check for a skin reaction
48 hours later, and then again after 2 days.
28. What is the treatment for allergy?
The best way to manage an allergy is to avoid the allergen, but this is not always possible. In
these cases, medical treatment can help. Many treatments are available over the counter.
Before using a medication, however, a person should speak to a pharmacist or doctor.
Options include:

• Antihistamines: These block the action of histamine, which the immune system releases
during a reaction.
• Decongestants: These can help relieve a blocked nose.
• Corticosteroids: These are available in the form of a pill, cream, nasal spray, or inhaler.
They help reduce inflammation.
• Immunotherapy: This can help a person develop long-term tolerance. A person will take
gradually increasing doses of the allergen, either as a tablet or an injection.
• Leukotriene receptor antagonists (antileukotrienes): These may help with some
allergies if other treatments have not worked. The drugs block some of the chemicals
that cause swelling.

29. Describe its complications. What is the first aid for anaphylactic shock?
The most dangerous allergy complications include anaphylactic shock and airway edema.
Main clinical manifestations of anaphylactic shock: hemodynamic disorders - hypotension,
cardialgia, tachycardia, rarely bradycardia, deafness of heart sounds; involuntary urination
and defecation; respiratory distress - dyspnea, bronchospasm, choking; skin rash - urticaria,
Quincke's edema; gastrointestinal tract disorders - nausea, vomiting, diarrhea

First aid for anaphylactic shock:

1. Lay the person flat – do not allow them to stand or walk.
2. Give adrenaline injector into the outer mid-thigh.
3. Phone an ambulance
4. Phone family or emergency contact.
5. Further adrenaline may be given if there is no response after 5 minutes.

30. What types of diabetes mellitus do you know? What are the causes, symptoms
Diabetes mellitus is considered as heterogeneous syndrome of chronic hyperglycemia
resulting from inadequate amounts of insulin, resistance to insulin or a combination of both.

11
There are two forms of diabetes mellitus that characterized by high blood glucose levels and
appearance of glucose in the urine.
The better-known but less common form of diabetes is called insulin-dependent
diabetes mellitus (IDDM). Type I diabetes is an autoimmune insulin deficiency disorder
caused by the destruction of pancreatic cells. Insulin deficiency means that the pancreatic
beta cells do not secrete enough insulin. Formerly IDDM was called "juvenile-onset
diabetes" because it was most commonly diagnosed among children.
Symptoms include: polydipsia, polyphagia, polyuria, weight loss, nausea, vomiting, blurred
vision, extreme fatigue, and slow wound healing. IDDM is incurable and ultimately shortens
the lifespan of the patient, often leading to blindness and loss of limbs in later life. Treatment
involves insulin replacement therapy administered by injection or pump as well as careful
attention to diet.
The more common form of diabetes was formerly called "maturity-onset diabetes," it is now
called non-insulin-dependent diabetes mellitus (NIDDM). These patients exhibit insulin
resistance. It means that insulin is being produced, but the body does not use it effectively.
In an attempt to compensate for this lack of response, the body secretes more insulin. The
onset of NIDDM is often gradual and occurs past the ages of 30 and 40. Obesity is a marked
characteristic and the patient often experiences chronic fatigue. Neuropathic and vascular
symptoms can occur at time of diseases diagnosis due to occult disease onset. Ketosis is
rare except with stress. Type II diabetes can be asymptomatic for years. When symptoms
occur, they include those of Type I diabetes plus recurring infections, irritability, and a
tingling sensation in the hands or feet.
(ПРО ВСЯК ВИПАДОК) Gestational Diabetes is a form of diabetes mellitus that
occurs during some pregnancies. This condition usually disappears after delivery, however,
many of these women later develop Type II diabetes.

31. Outline the treatment for both types of diabetes mellitus?

The treatment goals for all types of diabetes are to most effectively control the blood sugar
levels and prevent complications.
For type 1 diabetes: treatment involves insulin replacement therapy administered by injection
or pump as well as careful attention to diet.
For type 2 diabetes: loss of excessive weight and control of diet. If the condition is severe,
oral hypoglycemic drugs may be administered to increase the effectiveness of the insulin
already being secreted. Glucophage (metformin hydrochloride) and similar medications work
within the cells to combat insulin resistance and to help insulin let blood sugar into the cells.

32. What are the complications of diabetes mellitus?

Most diabetic complications result from the damage to capillaries and other blood vessels
due to long-term exposure to excessive blood sugar. Diabetic retinopathy occurs when
diabetes damages the tiny blood vessels in the retina, causing blood to leak into the
posterior segment of the eyeball. This can cause the loss of vision. Heart disease occurs
because excess blood sugar makes the walls of the blood vessels sticky and rigid. This
encourages hypertension and atherosclerosis. Kidney disease can lead to renal failure
because damage to the blood vessels reduces blood flow through the kidneys and ulcers 
of the foot and toes.

12
33. What is stroke? What are the types of the brain stroke?
A stroke, is properly known as a cerebrovascular accident (CVA), can cause lasting brain
damage, long-term disability, or even death. This condition occurs when the blood flow to the
brain is disrupted. The interruption is most often due to the blockage of a cerebral artery by a
blood clot, which may have formed within the artery (thrombosis), or may have been carried
into the artery in the circulation from a clot elsewhere in the body (embolism). Stroke may
also result from localized hemorrhage due to rupture of a blood vessel in or near the brain.
Strokes are classified as either ischemic or hemorrhagic.
An ischemic stroke occurs when the blood flow to the brain is blocked by narrowing of the
carotid artery or by a cerebral thrombosis. This blockage damages the controls of
movement, senses, and speech. Ischemic strokes are further divided into thrombotic
stroke and embolic stroke. Thrombotic stroke is usually seen in those with high
cholesterol and atherosclerosis or diabetes.
(ПРО ВСЯК ВИПАДОК) Thrombotic stroke may be preceded by "mini-strokes," called
transient ischemic attacks, or TIAs. A transient ischemic attack is the temporary interruption
in the blood supply to the brain. Symptoms of a TIA include numbness, blurred vision,
dizziness or loss of balance. A TIA passes in less than an hour; however, this incident is
often a warning sign that the individual is at risk for a more serious and debilitating stroke.
Embolic strokes often result from atrial fibrillation and a recent myocardial infarction; these
can cause clots in the heart which may migrate to the brain or heart surgery. It occurs rapidly
and without any warning signs.
A hemorrhagic stroke occurs when a blood vessel in the brain leaks or when an aneurysm
within the brain ruptures. This type of stroke is less common than ischemic strokes and is
often fatal. Hemorrhagic stroke may be further subdivided into intracerebral hemorrhage
(ICH) and subarachnoid hemorrhage (SAH). ICH is bleeding into the brain parenchyma, and
SAH is bleeding into the subarachnoid space. The most common cause of hemorrhagic
stroke is hypertension.
34. What are the main causes of stroke? What are the risk factors for having different
types of stroke?
This condition occurs when the blood flow to the brain is disrupted. The interruption is most
often due to the blockage of a cerebral artery by a blood clot, which may have formed within
the artery (thrombosis), or may have been carried into the artery in the circulation from a clot
elsewhere in the body (embolism). Stroke may also result from localized hemorrhage due to
rupture of a blood vessel in or near the brain.
An ischemic stroke occurs when the blood flow to the brain is blocked by narrowing of the
carotid artery or by a cerebral thrombosis. A hemorrhagic stroke occurs when a blood vessel
in the brain leaks or when an aneurysm within the brain ruptures.
The major risk factors for stroke include:

• High blood pressure

• Diabetes
• Heart and blood vessel diseases: Conditions that can cause blood clots or other
blockages include coronary heart disease, atrial fibrillation, heart valve disease, and
carotid artery disease.
• High LDL cholesterol levels
• Smoking
• Brain aneurysms or arteriovenous malformations

13
 • Viral Infections or conditions that cause inflammation, such as lupus or rheumatoid
arthritis
• Age: A stroke can happen at any age, but the risk is higher for babies under the age
of 1 and for adults. In adults, the risk increases with age.
• Sex: At younger ages, men are more likely than women to have a stroke. But women
tend to live longer, so their lifetime risk of having a stroke is higher. Women who take
birth control pills or use hormone replacement therapy are at higher risk. Women are
also at higher risk during pregnancy and in the weeks after giving birth. High blood
pressure during pregnancy raises the risk of stroke later in life.
• (НЕ ОБОВ’ЯЗКОВО) Race and ethnicity: In the United States, stroke occurs more
often in African American, Alaska Native, American Indian, and Hispanic adults than in
white adults.
• Family history and genetic: Your risk of having a stroke is higher if a parent or other
family member has had a stroke, particularly at a younger age. Certain genes affect
your stroke risk, including those that determine your blood type. People with blood type
AB (which is not common) have a higher risk.

35. What do the symptoms and treatment of the brain stroke depend on? What are
they? Name the complications

Symptoms and treatment of the brain stroke depends on its type:

Ischemic stroke: Symptoms usually depend on the site, cause, and extent of brain
damage, may include headache, dizziness, visual disturbance, and difficulty in swallowing.
Sensation, movement, or function controlled by the damaged area of the brain is impaired.
Weakness or paralysis on one side of the body, called hemiplegia, is a common effect of a
serious stroke. A stroke that affects the dominant cerebral hemisphere may cause
disturbance of language (aphasia). Ischemic stroke treatment tends to focus on restoring
an adequate flow of blood to the brain. Anticoagulants may be given if there is an obvious
source of an embolism, such as atrial fibrillation or a narrowed carotid artery. In some cases,
antiplatelet agents such as aspirin or an injection of tissue plasminogen activator (TPA) are
given. Emergency procedures include administering TPA directly into an artery in the brain
or using a catheter to physically remove the clot. Surgical procedures include: a carotid
endarterectomy or angioplasty
Hemorrhagic stroke symptoms: Acute onset headache, vomiting, neck stiffness, increases
in blood pressure, and the rapidly developing neurological signs. The clinical features of
subarachnoid hemorrhage are severe headache described as a thunderclap, vomiting,
syncope, photophobia, nuchal rigidity, seizures and decreased level of consciousness.
Treatment of hemorrhagic stroke focuses on controlling the bleeding and reducing the
pressure on the brain. There are many trials on the optimal management of hemorrhagic
stroke - Antihypertensive Treatment, Intensive Blood Pressure Reduction and Surgical Trial
in Intracerebral Hemorrhage.

Complications caused by brain stroke are:

• Paralysis (inability to move some parts of the body), weakness, or both on one side of
the body.
• Trouble with thinking, awareness, attention, learning, judgment, and memory.
• Problems understanding or forming speech.
• Trouble controlling or expressing emotions.
• Numbness or strange sensations.
• Pain in the hands and feet that worsens with movement and temperature changes.

14
 • Trouble with chewing and swallowing.
• Problems with bladder and bowel control.
• Depression.

36. What therapy does rehabilitation of the patient afler the stroke include?
Rehabilitation can include working with speech, physical, and occupational therapists.

• Speech therapy can help you regain lost abilities in speaking, listening, writing.
• Physical therapy uses exercises to help you relearn movement and coordination skills
you may have lost because of the stroke. Exercises can help improve muscle strength
and coordination throughout the body. These can include muscles used for balance,
walking and even swallowing. Patients might learn to use mobility aids, such as a
walker, canes, wheelchair or ankle brace. The ankle brace can stabilize and strengthen
your ankle to help support your body's weight while you relearn to walk. Also electricity
can be used to weakened muscles, causing them to contract. The electrical stimulation
may help reeducate your muscles.
• Occupational therapy focuses on improving daily activities, such as eating, drinking,
dressing, bathing, reading, and writing.
Therapy and medicine may help with depression or other mental health conditions following
a stroke. Emotional adjustment might be tested. Patients might also have counseling or
participate in a support group. Doctor might recommend an antidepressant or a medication

that affects alertness, agitation or movement.

37. What is nephritis? Name its types. Speak on its causes, clinical pattern.

-
NSAIDs

15
 -
proton pump inhibitors

38. What is the treatment for nephritis and name the complications of nephritis.

39. What is surgery? What does it deal with and what methods does it use?

Surgery is a branch of medicine, which treats diseases, injuries, deformities and other
pathological conditions by methods which involve opening, manipulating and repairing a part
of body. It applies different manual interventions such amputation, excision, incision,
stretching, resection and other.

The diseases which can be treated by operations include appendicitis, tumours, hernias,
fractures, abscesses, cleft palates, inborn defects etc.

It is also necessary to prepare the patient for the operation. So he/she should not eat or
drink anything for twelve hours before the operation to avoid complications with anaesthesia.
A patient is often given an enema before the operation to empty the colon from wastes.

Surgery requires a large variety of specialized equipment. In addition to the special operating
table, there are high-intensity lights and the anaesthesia machine. The are vacuum

16
machines to suck out the excessive blood and other fluids from the part of the body which is
being operated on.

The main controlling factors in surgery are anaesthesia and asepsis. Anaesthesia is used to
avoid shocks and to make him insensitive to pain. It’s produced by anaesthetic
drugs.Asepsis is a complex of measures, which is used to prevent introduction of
microorganism into the wound from the external world. That’s why everything, what is going
to contact the wound, must be sterile.

40. What is anaesthesia? What are its main types? Speak on them.

Anaesthesia is the loss of feeling or sensation. It may be accomplished without the loss of
consciousness or with partial or total loss of consciousness. There are such types of
anaesthesia: general (loss of consciousness) and local, regional, spinal and epidural.
General is characterized by:

- loss of consciousness, amnesia

- is administered with inhalational or intravenous agents

- there may be present analgesia and muscle relaxation

Local:

- is similar to regional

- - has an effect on a smaller area of the body

- is used for medical examination, dental procedures

- can be taken as creams, gels, sprays, liquids, injections or eye drops -

Regional:

- loss of pain sensation

- muscle relaxation in certain body regions

- is administered with local anaesthesia to peripheral nerve bundles

Spinal:

- small volume of local anaesthesia is injected into the spinal canal

- is injected between 4th and 5th lumbar vertebrae (because spinal cord stops at the 1st
lumbar

vertebrae)

17
- loss of pain sensation and muscle strength up to the level of chest

Epidural:

- an injection is made into the epidural space

- actually, its an injection around spinal canal

- is used to relief pain during childbirth and abdominal surgeries

It can occur also

complications after
anaesthesia:

it mostly happens under

general anaesthesia. It
includes low of blood
pressure, irregular heart
beat, heart attack,
vomiting and sometimes
it can lead to coma and
death.

41. What should be

done with the patient
before and after the
operation?

42. What instruments and equipment are used during the operation?

Surgery requires a large variety of specialized equipment. In addition to the special operating
table, there are high-intensity lights and the anaesthesia machine. The are vacuum
machines to suck out the excessive blood and other fluids from the part of the body which is
being operated on. The main instrument table is covered with a large collection of scalpels,
forceps, suture needles, retractors, clamps and other instruments.

18
Surgical forceps are used for grasping and holding various objects during surgical
procedures. These tools include hand forceps, needle holders, clamping forceps, and others.

Scissors are basically used for cutting. To cut sutures, bandages, tape, cotton or cloth.
Retractors are used for retracting and lifting the skin.

Clamps can be used to hold tissues together, to stop bleeding, and to secure instruments or
other materials in place.

Scalpel is one of the most basic instruments used during surgery. It is a knife with a short
blade (about 1 to 3 cm) that makes cuts in the skin or other tissues.

Needle holders are used to hold suturing needles during surgical procedures.

Also is used equipment such as: the apparatus of blood transfusion, blanket warmers,
surgical displays, scrub sinks.

43. What are the methods of surgical instruments sterilization?

Sterilization is a process of killing live microorganisms.

There are several methods of instruments sterilization, including:

1)Heat sterilization

This is the most common type of sterilization because the heat used kills all microbes. The
extent of sterilization is affected by the duration of heating and heat temperature. As the
temperature goes up, the duration of heating goes up. The heat method of sterilization can
be further divided into two:

Dry heat sterilization:

This process removes moisture content from coatings and other materials. This method
should only be used “for materials that might be damaged by moist heat (powders, sharp
instruments).

Moist heat methods:

Here, heat is applied through boiling and includes methods like pasteurization, using steam,
and boiling. Boiling is sterilization applied for edged instruments to prevent them from
blunting

This type of sterilization is done for metal devices such as surgical scissors, custom trays,
and needles.

2) Steam sterilization.

19
It can be characterized as an effective, fast, safe, and affordable option for sterilization. An
autoclave, which is a large steel chamber circulating steam, destroys microorganisms and
bacterial spores via high temperatures and pressure.

3) Chemical sterilization.

Chemical sterilization is the process of using low temperature chemicals to kill, eliminate,
and remove all germs, viruses, and bacteria. This can be in the form of gas or liquid
chemicals.

Chemical sterilization uses the following elements and compounds:

• Silver

• Peracetic Acid

• Hydrogen Peroxide

• Bleach

• Ozone

44. What is a medical emergency? Give examples of medical emergency cases?

Define them.

A medical emergency is an injury or illness that is acute and poses an immediate risk to a
person's life or health. Not all medical emergencies are life-threatening. There are
emergencies, that require assistance from a qualified person. But sometimes people can
handle themselves, before the medical support comes, by knowing the ABC-rule of first aid
and having first aid kit.

The ABC of the first aid refers to the assessment of person’s state. A — for airways, B — for
breathing and C for circulation (if the person is not in cardiac arrest).

One of the most serious emergencies occurs when the person has stopped breathing. This
may be the result of asphyxiation, electrocution, drowning, a heart attack or another type of
accident. Artificial respiration must be started immediately, the mouth-to-mouth or mouth-to-
nose breathing is used. If the heart stops beating, then cardiac massage is used. In this
situation must be undertaken the cardiopulmonary resuscitation. It contains two aspects:

1) The first one is getting oxygen into the blood by blowing air into the lungs.

2) 2) The second one is the heart massage.

By giving of the first aid three key P must be kept in mind: to preserve life, to prevent further
harm and to promote recovery.

20
The second most critical emergency is severe bleeding, especially from a main artery. It
can be stopped by pressing on the bleeding site. If a vein bleeds, extremity must be
elevated.

A condition which accompanies many medical emergencies is circulatory shock,

commonly known simply as shock. It is a serious, life-threatening medical condition in which
the victim's bodily tissues do not receive enough oxygenated blood. The essential signs of
the shock are: Tachycardia, nausea, vomiting, loss of consciousness. The victim should be
put supine with feet raised, not allowed to eat or drink. Shock may lead to cardiac arrest or
hypoxia.

Another serious emergency situation occurs when a poisonous substance is swallowed.

This usually happens in a household where a child swallows any chemical household
product (ammonia, bleach or even shampoo), or takes an overdose of medicine.

Poisoning is a condition when a person swallows a toxic substance or takes on overdose of

medicine.

Symptoms: vomiting, drowsiness, difficulty of breathing, stomach pain, diarrhoea, skin rash.

In some cases the victim should be forced to vomit or even gastric lavage in hospital may be
needed.

Burns - is one of the most common household injuries, especially among children. It is a
severe skin damage that causes the affected skin cells to die.

First aid: soak the wound under the cool water, take ibuprofen to relieve pain, apply special
cream to protect the affected area.

45. What is the first aid for suspected poisoning.

Poisoning - is a condition or process in which the organism becomes chemically

intoxicated. Children are particularly sensitive to even small amounts of certain drugs and
chemicals.

Symptoms: vomiting, drowsiness, difficulty of breathing, stomach pain, diarrhoea, skin rash.

Causes: overdose of medicine, children can swallow some chemical household products
The first aid is different and it depends on causes of poisoning:

- If the poison was swallowed: you should remove all things from mouth, read the
container’s label and read the instruction for accidental poisoning. (the antidote for each
substance may be different); in some cases, the victim should be forced to vomit or even
gastric lavage in hospital may be needed.

- If it is a poison on the skin: you should remove clothing from the affected area, rinse the
skin for 15-20 minutes with water

21
- If it’s a poison in eye: you should rinse eyes with warm water for 20 minutes. Allow the
stream to flow from the inner corner across the eye to the outer corner. Do not apply eye
drops.

- If a poison is inhaled: you should get the person on the fresh air as soon as possible.
Loosen any tight clothing at the neck. Also you should open doors and windows, if indoors.
Avoid breathing fumes. Do not try to rescue an unconscious person, where a highly toxic or
unknown gas is involved, without a breathing apparatus.

46. What is the first aid for bleeding?

For severe bleeding you should:

Call ambulance. Don't move the injured person except if needed to avoid further injury.
Before checking for the source of the wound, put on disposable gloves and other personal
protective equipment if you have them.

Remove any clothing or debris from the wound. Look for the source of the bleeding.
There could be more than one injury. Remove any obvious debris but don't try to clean the
wound. Don't remove large or deeply embedded objects, and don't probe the wound.

Stop the bleeding. Cover the wound with sterile gauze or a clean cloth. Press on it firmly
with the palm of your hand until bleeding stops. But don't press on an eye injury or
embedded object. Don't press on a head wound if you suspect a skull fracture. Wrap the
wound with a thick bandage or clean cloth and tape.

Help the injured person lie down. If possible, place the person on a rug or blanket to
prevent loss of body heat. Elevate the feet if you notice signs of shock, such as weakness,
clammy skin or a rapid pulse

Tourniquets: A tourniquet is effective in controlling life-threatening bleeding from a limb.

When emergency help arrives, tell them how long the tourniquet has been in place.

Keep the person still. If you're waiting for emergency help to arrive, try to keep the injured
person from moving.
If you haven't called for emergency help, get the injured person to an emergency room as
soon as possible.

Wash your hands. After helping the injured person, wash your hands, even if it doesn't look
like any blood got on your hands.

47. What is circulatory shock? What types of shock do you know? What is the cause
of hypovolemic shock?

Circulatory shock, commonly known simply as shock, is a serious, life-threatening medical

condition defined as an inadequate perfusion of tissues which is insufficient to meet cellular
metabolic needs. That’s means that the victim's bodily tissues do not receive enough
oxygenated blood.

22
Hinshaw and Cox suggested the following classification which is still used today. It names
four types of shock: hypovolemic, cardiogenic. distributive and obstructive shock. Also in
many patients, shock is a combination of two or more of these four types of shock.

Hyporolemic shock this is the most common type of shock and based on insufficient
circulating volume. Its primary cause is loss of fluid from the circulation (most often
"hemorrhagic shock"). Causes may include internal bleeding, traumatic bleeding, high output
fistulae or severe burns.

Cardiogenic shock this type of shock is caused by the failure of the heart to pump
effectively. This can be due to damage to the heart muscle, most often from a large
myocardial infarction. Other causes of cardiogenic shock include arrhythmias,
cardiomyopathy, congestive heart failure (CHF). or cardiac valve problems.

Distributive shock as in hypovolemic shock there is an insufficient intravascular volume of

blood. Examples of this form of shock are:

Septic shock. It caused by an overwhelming systemic infection resulting vasodilation

leading to hypotension.

Anaphylactic shock. It caused by a severe anaphylactic reaction to an allergen, antigen,

drug or foreign protein causing the release of histamine which causes widespread
vasodilation, leading to hypotension and increased capillary permeability.

Neurogenic shock. It caused by trauma to the spinal cord resulting in the sudden loss of
autonomic and motor reflexes below the injury level.

Obstructive shock. In this situation the flow of blood is obstructed which impedes
circulation and can result in circulatory arrest. The severity of shock can be graded 1-4,
based on the physical signs. This approximates to the effective loss of blood volume.

Grade 1. Up to about 15 % loss of effective blood volume.

Grade 2. Between 15-30% loss of blood volume.

Grade 3. At 30-40 % loss of effective blood volume.

Grade 4. At 40-50 % loss of effective blood volume.

48. What are the basic recommendations for managing shock? What can it result in?

The basic recommendations for managing shock are:

Lay the person down and elevate the legs and feet slightly, keep the person still and don't
move him or her unless necessary, begin CPR if the person shows no signs of life, such as
not breathing, coughing or moving, loosen tight clothing and, if needed, cover the person
with a blanket to prevent chilling, don't let the person eat or drink anything,If that the person
is having an allergic reaction, you should use antihistamines(for example an epinephrine).If
the person is bleeding, hold pressure over the bleeding area, using a towel or sheet. And If

23
the person vomits or begins bleeding from the mouth, and no spinal injury is suspected, turn
him or her onto a side to prevent choking.

Shock may lead to hypoxia (a lack of oxygen in blood) or cardiac arrest (the heart stops),
organ damage or even death.

49. What is the first aid for heart arrest?

Heart arrest - is a sudden loss of blood flow resulting from the failure of heart to pump
effectively. Possible warning signs of a heart attack are absence of heartbeat and breathing,
shortness of breath (more common in women than men),extreme tiredness (unusual
fatigue),back pain,Flu-like symptoms,belly pain,nausea and vomiting,chest pain, mainly
angina (more common in men than women).

First aid for heart arrest consists of such actions as: ensure scene safety, ask for response,
shout for help, call the ambulance, check for breathing or gasping If the person isn’t
breathing or is only gasping, start CPR with compressions.CPR (cardiopulmonary
resuscitation) is an emergency lifesaving procedure, which is performed when the heart
stops beating. And it includes two aspects: getting oxygen into the blood by blowing air into
the lungs and heart massage is chest pressure to compress the heart and squeeze the
blood out it into the circulatory system. Actions during resuscitation are: kneel by the
casualty and put the heel of the hand on the middle of the victim’s chest. Put the other hand
on top of the first and interlock the fingers. Keep the arms straight and lean over the
casualty. Press down hard, to a depth of about 5-6cm at a steady rate of 100 to 120
compressions a minute.After every 30 chest compressions, give 2 rescue breaths until
person begin to recover or emergency help arrives.

50.What are the most serious injuries and their warning signs? What is the first aid for
them?

The most serious injuries or severe injuries are head, neck and back injuries.

If the skull is fractured or a victim suffers a concussion from a heavy blow, the brain can be
irreparably damaged.

Neck and back injuries are equally serious. A broken back can result in paralysis if the spinal
cord is damaged.

Warning signs of damage include unconsciousness, excessive sleepiness, drowsiness,

vomiting, severe headaches, paralysis, bleeding, and irregular breathing, slowing of the
pulse, loss of memory, and speech disorders.

First aid for these injuries are:

-call the ambulance;

-don’t move the person;

-check ABC - airways, breathing and circulation: mouth should be cleaned, the pelvic region
should be fixed with bandage;

24
-if needed, make CPR - cardiopulmonary resuscitation( kneel by the casualty and put the
heel of the hand on the middle of the victim’s chest. Put the other hand on top of the first and
interlock the fingers. Keep the arms straight and lean over the casualty. Press down hard, to
a depth of about 5-6cm at a steady rate of 100 to 120 compressions a minute.After every 30
chest compressions, give 2 rescue breaths until person begin to recover or emergency help
arrives.) Про всяк випадок.

-stop bleeding;

-don’t remove any objects;

-no sedatives, alcohol or pain medications should be given;

-food and fluids should be minimised.

51.Define the types of fractures.

There are a lot of different types of fractures: closed, open, compression, complete,
incomplete, linear, transverse, oblique, spiral, comminuted, impacted and displaced fracture.

1. The Closed (or simple) fracture – is a broken bone does not break through the skin and is
not visible on the surface.

2.Open (compound) fracture – is a broken bone breaks through the skin and is visible on the
surface.

3.Compression – is a fracture usually occurs in the vertebrae, for example when the front
portion of the vertebra in the spine collapses.

4.Complete – is a fracture in which bone fragments separate completely.

5.Incomplete (greenstick) – is a fracture in which bone fragments are still partially joined. In
such cases, there is a crack in the osseous tissue that does not completely transverse the
width of the bone. Usually occurs in children.

6.Linear - is a fracture that is parallel to the bone’s long axis.

7.Transverse - is a fracture is at a right ankle to the bone’s long axis.

8.Oblique -is a fracture that is diagonal to a bone’s long axis.

9.Spiral – is a fracture, where at least one part of the bone has been twisted.

10.Communicated -is a fracture in which the bone is broken into a number of pieces.

11.Impacted – is a fracture caused when bone fragments are driven into each other.

12. And Displaced -is a fracture which involves the bones of the joint.

25
52. What is the first aid in case of fracture?

The first aid in case of fracture are:

-call the ambulance;

-apply ice to relieve pain;

- the bleeding must be stopped by compressing the bleeding area with a finger or hand or
applying tourniquet for at least five minutes. Then the wound should be cleaned and
disinfected with an antiseptic and covered with sterile dressing;

-put temporary splint until medical attention is available. Anything which will keep the area
stiff, such as a wooden stick or rolled newspapers can be used for a splint. Pain
management and immobilization of the damaged area or the whole victim are also
recommended. A doctor will ultimately realign the bones and put the limb in a plaster cast
until it heals, but a splint will protect it until then;

-treat for shock;

-painkillers are also recommended.

53. What is sprain and strain? What are the causes, symptoms and treatment? How to
differentiate them from fractures?

A sprain (розтягнення зв’язки, суглоба) is quite a serious injury of a joint caused by a

forcible twisting with damage to the surrounding blood vessels, nerves and mainly ligaments.
Mostly, they occur in wrists, ankles, thumbs, knees.

The causes of sprain can be such as:

-walking or running on an uneven surface;

-sudden twisting;

-falling and landing on the wrist or knee;

-injuries from contacting sports;

A strain (розтягнення сухожилля, м’яза) is an injury to a muscle or a tendon in which the

muscle fibres tear as the result of overstretching. Mostly, they occur in knees, feet, legs,
back.

The causes of strain can be such as:

-sudden movements;

-heavy lifting ;

26
-slipping or falling.

People with both injuries are usually unable to walk or use an injured part. The symptoms of
sprain and strain are swelling, painful muscle spasms or just severe pain, stiffness,
discolouration, bruising, and tenderness.

First aid of the sprain and strain include the RICE therapy, that consists of the four
points:

1. Rest – stop any exercise or activities and try not to put any weight on the injury.

2. Ice – apply an ice pack (or a bag of frozen vegetables wrapped in a tea towel) to the injury
for up to 20 minutes every 2 to 3 hours.

3. Compression – wrap a bandage around the injury to support it.

4. Elevate – keep it raised on a pillow as much as possible.

Due to the fact that mostly symptoms of sprain and strain are close to the fractures, it’s
difficult to differentiate them. Usually, it’s important to X-Ray the area to define what kind of
injury it is.

54.What soft tissue injuries do you know? Define them.

Soft-tissue injuries are damages of muscles, ligaments and tendons. There are such kinds of
injuries:

1.Bruise – is the result of contusion, when the blood vessels are broken. It results in bleeding
into tissues under the skin. In several days bruises can change colour from purple to yellow
or brown.

2.Lacerations –are the cuts or tears in tissue in which the skin is opened. They are usually
caused by sharp objects and bleed heavily.

3.Abrasions –is a scrapping of the skin surface, opened damaged areas without epidermis.

4.And the last soft tissue injuries are the deep lacerations that can damage nerves and large
blood vessels.

55.Describe the first aid for soft tissue injury.

The first aid for Bruise: put an ice on the injured part of the body

First aid for Lacerations: the bleeding must be stopped by applying tourniquet for at least 5
minutes. The wound must be cleaned and disinfected, covered with sterile dressing. If it is
deep, stitches may be applied.

First aid for Abrasions: wash the wound with water, stop bleeding, apply antibiotics if
needed.

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Also used the RICE therapy-is a popular acronym for general soft tissue injury treatment.
RICE stands for Rest, Ice, Compression and Elevation. Employing these immediate first aid
measures can relieve pain, limit swelling and help protect the injured soft tissue.

-Rest: Rest is vital to protect the injured muscle, tendon, ligament or other tissue from
secondary injury or further strain. If injury is suspected, stop activity and protect the injured
part from further damage. Avoid putting weight on the injured part and get help moving to a
safe area.

-Ice: When icing an injury, choose a cold pack, crushed ice or a bag of frozen peas wrapped
in a thin towel to apply to the injured area. This provides short-term pain relief and also limits
swelling by reducing blood flow to the injured area. Never leave ice on an injury for more
than 20 minutes at a time. Longer exposure can damage the skin and even result in
frostbite.

-Compression: Compression also helps limit and reduce swelling and can help relieve the
pain. An easy way to compress the area of the injury is to wrap an ACE bandage around the
swollen part.

-Elevation: Elevate the injury to help control swelling. It’s most effective when the injured
area is raised above the level of the heart.

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