🔴 بررسی سوالات زبان عمومی - صبح پنجشنبه 🔴

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🪴 گروه آموزشی گام آخر پرستاری

121- Many victims of car crash in Iran
severe injuries, ........ affecting their health years after the accidents.
a) decline
b) sustain
e) enquire
d) devise

122- Healthy diet can never eliminate the risk of stroke but can........... it by reducing its intensity.
a) augment
b) attenuate
c) accelerate
d) sophisticate

123- Further studies are clearly needed if we are to ........... the hidden effects of ethanol on the gastric cells.
a) elucidate
b) stimulate
e) exaggerate
d) invigorate

124- Conventional wisdom on cancer management is to use... chemotherapy to destroy the tumor as rapidly as possible, despite its complications.
a) aggressive
b) outdated
c) detrimental
d) detached

125- As infants and young children are more ........... microbial harms, they need more care and protection.
a) affiliated to
b) deprived of
c) vulnerable to
d) terrified of

126- Some allergens........... our breathing and can lead to respiratory insufficiency.
a) hinder
b) induce
c) reinforce
d) enhance

127- Anxiety that has no discernible cause is a sign of an emotional difficulty, which can indicate mental ............
a) supremacy
b) tranquility
c) disturbance
d) serenity

128- Practitioners need to make a good........... with their clients to make a better diagnosis.
a) struggle
b) conflict
c) rapport
d) revenge

129- Regarding the elderly care, ....... nursing is the best source for clinical information and management advice.
a) geriatric
b) pediatric
c) surgical
d) obstetric

💡 کلید احتمالی سوالات این آزمون ، با بولد شدن گزینه مشخص شده است.

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130- The use of pain relievers is confirmed to........ the symptoms of migraine headache.
a) substantiate
b) alleviate
c) exacerbate
d) intimidate

131- My roommates all believe that I have to........... my bad spending habits.
a) curb
b) cast
c) propagate
d) disseminate

132- According to national reports, thank to e-health system, the government's annual ........ on health has lessened, helping to save money for better care.
a) profit
b) earning
c) revenue
d) expenditure

133- About 60% of people who survive a stroke are afflicted with visual........... to some degree and need visual rehabilitation therapy.
a) perception
b) inspiration
c) impairment
d) enhancement

134- During surgery, the patient was given spinal anesthesia and positioned on an operating room table, with her right hip........... on a small pillow.
a) elevated
b) stained
c) twisted
d) sprained


135- The report on the etiology of the virus was quite...... Anybody could understand it easily..
a) intelligible
b) complicated
c) intolerable
d) convoluted

136- The malaria vaccine campaigns, .......... for the first time in 2019, are increasing equity in access to malaria prevention for the most vulnerable people.
a) launched
b) terminated
c) relinquished
d) eradicated

137- All the children were ........... hepatitis after taking the new vaccine.
a) inspected by
b) inflated by
c) disseminated by
d) inoculated against

138- The insurance companies have limited their health services coverage, bearing significant ........... for the health system budget.
a) accomplishments
b) implications
c) privileges
d) revenues

139- In severe accidents, the broken rib might the patient's lung; therefore, surgery is usually recommended since the lung tissue would not be able to repair itself.
a) alleviate
b) regenerate
c) consolidate
d) puncture

140- The patient's father was shocked to realize that his son should... a major surgery.
a) undergo
b) understand
c) underpin
d) underscore

💡 کلید احتمالی سوالات این آزمون ، با بولد شدن گزینه مشخص شده است.

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Passage 1

Stress and depression share many symptoms and etiologies, along with anxiety. When stress becomes chronic, it can result in a wide variety of symptoms that overlap with anxiety and depression, from sleep and appetite disturbances to triggering or exacerbating high blood pressure, pain, or autoimmune disorders. While the signs can feel similar and sometimes overlap, there are specific differences between being stressed and being depressed. Stress typically starts as feeling overwhelmed or worried, triggered by a specific trigger or stressor, whether it is a real, immediate threat or a perceived threat. Stress is a psychophysiological state generated by the perception of demands (deadlines, bills, training load) being greater than the resources available (mental energy, bank account balance, fitness level, etc.) to accomplish a given task. Stress manifests differently for everyone. Sometimes it is more physical (e.g., elevated heart rate, muscle tension) and sometimes it is more cognitive (eg, racing thoughts, difficulty seeing the big picture).
Depression, however, includes feelings of hopelessness, persistent sadness, irritability, loss of motivation, joy, or interest in previously pleasurable activities, sleep troubles, slowed thinking or speaking, or unexplained physical pains. The severity of these symptoms can range from mild to severe.



141- Which of the following is NOT among the symptoms of chronic stress?
a) auto-immune disorders and muscle tension
b) hopelessness and loss of motivation
c) elevated blood pressure and pain
d) appetite and sleep problems

142- Stress typically starts with a ............
a) physical symptom
b) feeling of depression
c) particular stimulant
d) sudden physical pain

143- The writer has mentioned "deadlines, bills, training load" to remark that stress
a) can be generated when needs are greater than the available resources
b) is always accompanied by some feelings of hopelessness and sadness c) rarely has cognitive effects such as difficulty seeing the big picture
d) can have manifestations different from one person to another

144- Which sentence is NOT true about stress and depression?
a) They sometimes have overlapping signs.
b) Sleep and appetite disturbances may appear in both.
c) They generally manifest similarly across individuals.
d) Both conditions may come with pain and auto-immune disorders.

145. According to the passage, symptoms of depression.............
a) may not influence interest in activities pleasurable before
b) form a wide range, varying from mild to a severe
c) are commonly observed in the majority of cases
d) do not affect thinking and verbal abilities

💡 کلید احتمالی سوالات این آزمون ، با بولد شدن گزینه مشخص شده است.


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Passage 2

Quality of life has become a recognized health care goal. In 1990, the National Cancer Institute recommended that it should be an outcome variable in all the clinical trials it sponsors and was identified by the Oncology Nursing Society as its highest research priority in 1991. Quality of life is perceived according to individual conception and is best evaluated by the patient rather than by others. It is the condition of one's being, reflected in the ability to perform everyday activities, as assessed according to physical, psychological, spiritual, and social dimensions.
Among oncology patients, the quality of life is reflected in satisfaction with levels of functioning and control of the symptoms of both disease and treatment. Oncology nurses understand the value of the quality as well as the quantity of life; the former transcends physical health, clinical symptoms, and functional ability. Betty Ferrell has devised a model that incorporates the four dimensions of the quality of life: physical, psychological, social, and spiritual. In spite of her model, in practice, much attention has been given to the body in terms of symptom management, functional ability, and the use of technology in treatment. But spiritual and social well-being are equally important and deserving of attention. Consideration of the psychological aspect of the quality of life brings us to the subject of humor and how it can enhance well- being


146- Cancer patients' well-being can be.......
a) delayed by the identification of spritual symptoms
b) deteriorated by individual reflection on functional ability
c) enhanced by considering physcial as well as spiritual aspects
d) promoted by the restriction of humor and use of technlogy

147- The underlined term "former" refers to .....
a) quality of life
b) quantity of life
c) oncology nurses
d) physical health

148- As stated in the passage, a patient's quality of life.....
a) can be defined based on bodily, mental, spiritual, and social aspects
b) can be assessed by physicians' dissatisfaction with oncology nurses c) is conceived best by others rather than the individual patient
d) determines the conditions of disease and treatment

149- Ferrel's Model............
a) emphasizes the use of technology to treat diseases
b) focuses on one's physical as well as mental dimensions
c) has attracted attention as it prioritizes quality rather than quantity of life
d) indicates that physical symptoms are more important than psychological health

150- According to the passage .......
a) in cancer both the disease and its treatment symptoms need to be control
b) oncology patients are all satisfied with the level of functioning when they are under treatment
c) cancer patients can be satisfied with their quality of life merely when they can function well
d) cancer patients enjoy a good quality of life if oncology nurses understand them

💡 کلید احتمالی سوالات این آزمون ، با بولد شدن گزینه مشخص شده است.

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Passage 3

Growing evidence suggests an interrelationship between dementia on one side and Non- Communicable Disease (NCDs) and behavioral risk factors, such as physical inactivity, unhealthy diets, tobacco use and the harmful use of alcohol, on the other. NCDs that are associated with the risk of cognitive impairment and dementia include depression, hypertension, diabetes, hearing impairments, mid-life hypercholesterolemia and obesity. Additionally, air pollution and traumatic brain injuries are increasingly being recognized as risk factors. At the same time, access to formal education, employment and other opportunities for cognitive stimulation as well as social connections are considered protective. The Global Dementia Action Plan recognizes the inherent links between dementia and other NCDs by linking its risk reduction target directly to the Global action plan for prevention and control of NCDs. Globally, from 2000 to 2016, the probability of dying from cardiovascular diseases, cancer, diabetes and chronic lung diseases has declined from 22% to 18%. Additionally, there has been a roughly 2% decrease in both tobacco smoking and heavy episodic drinking among people 15 years of age or older, and a 1% reduction in the prevalence of high blood pressure. However, these changes fall short of global NCD targets. Physical inactivity in adults remains unchanged and the prevalence of diabetes and obesity in adults has increased.


151- According to the passage, which of the following is true?
a) NCDs are limited to behavioral risk factors
b) Formal education contributes to NCDs development
c) Air pollution can contribute to dementia development
d) Depression is a behavioral risk factor of NCDs

152- Which of the following could increase the risk of cognitive deficits?
a) High cholesterol
b) Smoking tobacco
c) Poor food choices
d) Passive life style

153- The Global dementia action plan
a) initiates a plan to recognize the relationship between dementia and NCDs
b) establishes the goals for linking risk factors to the prevention of NCDs
c) sets its risk reduction target on prevention and control of NCDs
d) considers dementia a condition different from other NCDS

154- As mentioned in the passage, ........... in the early 21st century.
a) dying from chronic lung diseases elevated
b) mortality due to diabetes decreased in adults
c) exercise and physical activity among adults increased
d) drinking alcohol decreased among those at fifteen or more

155- It can be inferred from the passage that the Global action plan......
a) succeeded in educating people to prevent NCDs
b) caused an increase in death resulting from diabetes
c) failed to accomplish its task according to standards set
d) missed the link between dementia and NCDs prevention

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Passage 4

Food addiction, in case you're not familiar with it, is a term used to describe an eating behavior that involves over-consuming specific foods in an addictive manner. People with food addiction tend to experience symptoms such as a loss of control over how much they eat, intense cravings, continuing to eat certain foods despite experiencing negative consequences and having feelings of withdrawal such as agitation, irritability. and depression when cutting down on those foods.
Food addiction is often linked to ultra-processed foods, which are foods made with little to no whole ingredients, along with a lot of sugar, salt, and fat, to "make them highly palatable," Keri Gans, author of The Small Change Diet and a registered dietitian, tells Yahoo Life. "When consumed, they lead to a release of dopamine in our brain, and leave us wanting more and more of this feel-good hormone," she says. Experts say this is done on purpose since "there is evidence that the food industry designs ultra-processed foods to be highly rewarding, to maximize craveability and to make us want more and more and more," Gearhardt says. "This is good for profits, but not good for our health. Also, these ultra-processed foods are cheap, accessible, convenient, and heavily marketed, which makes it harder to resist them."


156- Cutting down on certain foods one is addicted to may cause all of the following EXCEPT:
a) bad temper
b) nervousness
c) severe hunger
d) downheartedness

157- According to the passage, people with food addiction undesirable outcomes.......... even if they know and see its
a) continue consumption of certain foods
b) gain control over negative consequences
c) effortlessly resist eating too much
d) tend to minimize the use of certain foods

158- Based on the information in the passage, ........... contribute to intense cravings for certain foods because they may make foods highly appetizing.
a) abundant additives
b) negative consequences
c) feelings of withdrawal
d) agitation and irritability

159- The author describes dopamine as a ........... hormone.
a) tranquilizing
b) irritating
c) monitoring
d) regulatory

160- In paragraph 2, the underlined "this" refers to ..........
a) release of the dopamine hormone
b) lessened desirability of some foods c) food to which whole ingredients are added
d) production of foods which are highly processed


💡 کلید احتمالی سوالات این آزمون ، با بولد شدن گزینه مشخص شده است.

چطور H. pylori رو درمان بکنیم؟

دو تا سوال می‌پرسیم:

۱. آیا حساسیت به پنی‌سیلین داره؟
۲. آیا ماکرولید مصرف کرده قبلا؟

جاهایی که مقاومت به ماکرولید بالای ۱۵ درصد هست، بهتره شبیه به مصرف قبلی ماکرولید در نظر بگیریم.

بر اساس این دو تا سوال میریم جلو. رژیمی که در حالت میشه داد Bismuth Quadraple هست. اما تعداد قرص‌هاش واقعا زیاده:

۱. مترونیدازول ۵۰۰ هر ۸ ساعت
۲. تتراسایکلین ۵۰۰ هر ۶ ساعت
۳. بیسموت سابسیترات ۱۲۰ میلی‌گرم، ۲ قرص هر ۶ ساعت
۴. پنتوپرازول ۴۰ میلی‌گرم، هر ۱۲ ساعت

اما عملی نیست دیگه. خیلی هست تعداد قرص‌ها. در ادامه رژیم‌های منطقی‌تر رو میگم.

خلاصه‌ای از درمان و فالو آپ H. pylori:

درمان سه دارویی یا چهار دارویی برای ۱۴ روز و سپس ادامه‌ی سرکوب اسید برای ۲ تا ۴ هفته‌ی دیگر. پس از گذشت ۴ هفته از اتمام آنتی‌بیوتیک‌ها فرد باید مجددا برای H. pylori بررسی بشه.

تستی که درخواست می‌کنیم یا H. pylori Stool Ag هست یا UBT. اولی در دسترس‌تر هست. حواسمون باشه که حداقل باید ۷ روز از داروهای antisecretory اسید گذشته باشه تا تست معتبر باشه.

اگر فرد GU داشته، ۸ تا ۱۲ هفته‌ی بعد باید مجدد اندوسکوپی بشه تا فرایند بهبودی رویت بشه. این برای DU لازم نیست. تنها در صورتی اندوسکوپی نیازه که علامت‌ها با درمان DU باقی بمونه.

اگر یک GU ظرف ۱۲ هفته و یک DU ظرف ۸ هفته خوب نشه، Refractory هست. چه کارش کنیم؟
۱. مطمئن بشیم دارو رو درست مصرف کرده.
۲. مطمئن بشیم H. pylori از بین رفته.
۳. راجع به مصرف سیگار و NSAIDs بپرسیم.
۴. رد کردن Zollinger Ellison و سندرم‌های مشابه

بیش از ۹۰ درصد آلسرهای مقاوم، با دو برابر کردن دوز PPI بعد ۸ هفته خوب میشن.


حواسمون به اتیولوژی‌های نادر هم باشه:
Ischemia
Crohn's disease
Amyloidosis
Sarcoidosis
Lymphoma
Eosinophilic GE
Smoking crack cocaine
Infection (CMV, TB, syphilis)

🌸 با تشکر از دکتر امیرمحمد قربانی

#cardiology 🫀

تشخیص و تریاژ بیمار های قلبی یکی از مشکلات بزرگیه که ما باهاش روبرو هستیم
کدام مریض را بستری و کدام را میشه مرخص کرد ؟

حتی بهترین مراکز هم تشخیصشون حداکثر ۹۰ ٪ ئه و ۱۰ درصد بیماران میس میشن

برای دسته بندی و تریاژ بیماران به پر خطر و کم خطر و  روش های زیادی ایجاد شده ولی یکی از کاربردی ترین روش ها HEART score است.

HEART score :
از ۵ جز تشکیل شده که طبق حروف خود کلمه HEART است..
۱- اولین حرف H : شرح حال یا History

اگر خیلی تیپیک درد قلبی بود » ۲ امتیاز
( تعریف درد تیپیک چیه ؟ 🤔 توی پست بعدی میگم خدمتتون)
اگر مشکوک بود » ۱ امتیاز
اگر خیلی کم مشکوک بودید »  ۰ امتیاز

۲- حرف E : نوار قلب یا EKG
اگر تغییرات St dep داشت » ۲ امتیاز
اگر هر تغییری داشت ولی نرمال نبود » ۱ امتیاز
اگر نوار قلب کاملا نرمال بود » ۰ امتیاز

۳ - حرف A : سن یا Age
سن بیشتر از ۶۵ سال » ۲ امتیاز
سن بین ۶۵ تا ۴۵ سال » ۱ امتیاز
سن زیر ۴۵ سال » ۰ امتیاز

۴- حرف R : ریسک فاکتور
حالا ریسک فاکتورها چی‌ هستند ؟ (۱- سیگار ، ۲- سابقه خانوادگی ، ۳- دیابت ، ۴- فشار خون ، ۵- هایپرکلسترمی ،۶- چاقی )

اگر ۳ مورد را داشت » ۲ امتیاز
۱-۲ مورد » ۱ امتیاز
هیچ ریسک فاکتور » ۰ امتیاز

۵- تروپونین:
تروپونین اینجا منظورش high sensetive است که متاسفانه توی ایران نداریم
ولی تروپونین مثبت ما » ۲ امتیاز میشه
منفی » هیچ امتیاز

طبق تصویر
اگر بین ۱ تا ۳ امتیاز بگیره » با ریسک خیلی کم میشه  و احتمال حادثه قلبی (MACE) major adverse cardiac events
حدود ۱٪ طی ۶ هفته آینده است و مریض را  میتوان با توصیه به انجام یک تست قلبی ( تست ورزش یا سی تی آنژیو و ... ) مرخص کرد

امتیاز ۴تا ۶ » حدود ۱۲ تا ۱۶ درصد احتمال حادثه قلبی داره و بستری موقت کافیه

امیتاز ۷ به بالا » حدود ۵۰٪ احتمال حادثه قلبی براشون وجود داره 😳 و بیمار باید بستری قرار بگیره و درمان شروع شود