How is multiple sclerosis diagnosed. What tests are used to confirm MS. When should you seek medical attention for potential MS symptoms. What are the McDonald Criteria for diagnosing MS. How does MRI help in MS diagnosis. Why is early and accurate diagnosis of MS crucial.

Understanding the Diagnostic Process for Multiple Sclerosis

Multiple sclerosis (MS) is a complex neurological condition that requires a careful and comprehensive diagnostic approach. Due to the varied nature of MS symptoms and their similarity to other conditions, no single test can definitively diagnose the disease. Instead, healthcare providers rely on a combination of clinical assessments, imaging studies, and laboratory tests to confirm an MS diagnosis and rule out other potential causes.

The Importance of Timely and Accurate Diagnosis

Obtaining an accurate MS diagnosis as quickly as possible is crucial for several reasons:

• It helps alleviate patient anxiety by providing answers to unexplained symptoms.
• Early diagnosis allows for prompt initiation of treatment, potentially slowing disease progression.
• It enables patients to make informed decisions about their health and future.

Can early treatment impact the course of MS? Research suggests that starting disease-modifying therapies early in the course of MS can reduce the frequency and severity of relapses, slow the accumulation of disability, and potentially delay the progression to secondary progressive MS.

Key Criteria for Diagnosing Multiple Sclerosis

The diagnosis of MS is based on specific criteria that have evolved over time. Currently, healthcare providers use the McDonald Criteria, last revised in 2017, to diagnose MS. These criteria require:

1. Evidence of damage in at least two separate areas of the central nervous system (CNS).
2. Proof that the damage occurred at different points in time.
3. Exclusion of all other possible diagnoses.

How do the McDonald Criteria facilitate MS diagnosis? These guidelines incorporate the use of MRI and cerebrospinal fluid analysis to expedite the diagnostic process, allowing for earlier treatment initiation in many cases.

Comprehensive Medical History and Neurological Examination

The first step in diagnosing MS involves a thorough medical history and neurological examination. During this process, the healthcare provider:

• Collects information about past and present symptoms potentially related to MS.
• Gathers data on birthplace, family history, environmental exposures, and travel history.
• Conducts a comprehensive neurological exam to assess various nervous system functions.

Why is a detailed medical history crucial in MS diagnosis? A comprehensive medical history can reveal patterns of symptoms or risk factors that may point towards MS or suggest alternative diagnoses, guiding further diagnostic testing.

Magnetic Resonance Imaging (MRI) in MS Diagnosis

Magnetic Resonance Imaging (MRI) plays a pivotal role in diagnosing MS and monitoring disease progression. This non-invasive imaging technique provides detailed views of the brain and spinal cord, allowing healthcare providers to:

• Identify characteristic MS lesions in the white matter of the brain and spinal cord.
• Determine if lesions have developed in different areas of the CNS and at different times.
• Exclude other conditions that may mimic MS symptoms.

How does MRI contribute to meeting the McDonald Criteria? MRI can demonstrate dissemination of lesions in space (multiple areas of the CNS) and time (new lesions appearing on follow-up scans), which are key components of the diagnostic criteria for MS.

Types of MRI Scans Used in MS Diagnosis

Several types of MRI scans may be employed in the diagnosis and monitoring of MS:

• T1-weighted scans: Show “black holes” indicative of permanent tissue damage.
• T2-weighted scans: Highlight both new and old lesions.
• FLAIR (Fluid-Attenuated Inversion Recovery): Enhances the visibility of white matter lesions.
• Gadolinium-enhanced scans: Identify active, inflammatory lesions.

Why are multiple types of MRI scans necessary? Different MRI techniques provide complementary information about the nature, location, and activity of MS lesions, offering a more comprehensive picture of disease status and progression.

Cerebrospinal Fluid Analysis in MS Diagnosis

Analysis of cerebrospinal fluid (CSF) can provide valuable information in the diagnosis of MS. This clear, colorless liquid that surrounds the brain and spinal cord can reveal specific markers associated with MS:

• Oligoclonal bands: Specific antibodies indicating an immune response within the CNS.
• Elevated IgG index: Suggests increased antibody production within the CNS.
• Myelin basic protein: Indicates ongoing myelin damage.

How does CSF analysis contribute to MS diagnosis? The presence of oligoclonal bands in CSF, not found in the blood, can provide evidence of an abnormal immune response within the CNS, supporting an MS diagnosis, especially in cases where MRI findings are inconclusive.

The Lumbar Puncture Procedure

CSF analysis requires a lumbar puncture (spinal tap) procedure, which involves:

1. Inserting a thin needle between vertebrae in the lower back.
2. Withdrawing a small amount of CSF for laboratory analysis.
3. Monitoring the patient for potential side effects, such as headache.

Is lumbar puncture always necessary for MS diagnosis? While CSF analysis can provide valuable diagnostic information, it is not always required if other criteria for MS diagnosis are met through clinical presentation and MRI findings.

Blood Tests and Other Diagnostic Tools

While there is no specific blood test for MS, various blood tests are often performed to rule out other conditions that may mimic MS symptoms. These may include:

• Complete blood count (CBC)
• Thyroid function tests
• Vitamin B12 levels
• Autoimmune markers (e.g., ANA, RF)
• Infectious disease screening (e.g., Lyme disease, syphilis, HIV)

Why are these blood tests important in MS diagnosis? By excluding other potential causes of neurological symptoms, these tests help healthcare providers narrow down the diagnosis and increase confidence in an MS determination.

Additional Diagnostic Tools

In some cases, healthcare providers may employ other diagnostic tools to gather more information or rule out specific conditions:

• Evoked potential tests: Measure electrical activity in the nervous system in response to stimuli.
• Optical Coherence Tomography (OCT): Assesses the thickness of the retinal nerve fiber layer, which can be affected in MS.
• Neuropsychological testing: Evaluates cognitive function, which can be impaired in MS.

How do these additional tests complement the diagnostic process? These tools can provide further evidence of CNS involvement and help characterize the extent and nature of neurological deficits associated with MS.

Differential Diagnosis: Ruling Out Other Conditions

A crucial aspect of MS diagnosis is the exclusion of other conditions that may present with similar symptoms. Some conditions that may mimic MS include:

• Neuromyelitis optica spectrum disorders (NMOSD)
• Acute disseminated encephalomyelitis (ADEM)
• Systemic lupus erythematosus (SLE)
• Sjögren’s syndrome
• Vitamin B12 deficiency
• Lyme disease
• Certain brain tumors

Why is differential diagnosis crucial in MS? Accurate differentiation ensures that patients receive the most appropriate treatment for their condition, as therapies for MS may be ineffective or potentially harmful for other neurological disorders.

Challenges in Differential Diagnosis

Several factors can complicate the differential diagnosis process:

• Overlap of symptoms between MS and other neurological conditions
• Variability in MS presentation and disease course
• Presence of comorbid conditions
• Limitations of diagnostic tests in certain scenarios

How do healthcare providers navigate these challenges? A comprehensive approach combining clinical expertise, advanced imaging techniques, and laboratory testing is essential for accurate diagnosis in complex cases.

The Role of Clinical Subtypes in MS Diagnosis

Understanding the clinical subtypes of MS is important for both diagnosis and treatment planning. The main subtypes include:

• Relapsing-Remitting MS (RRMS): The most common form, characterized by distinct attacks followed by periods of recovery.
• Secondary Progressive MS (SPMS): Follows an initial relapsing-remitting course, with gradual worsening over time.
• Primary Progressive MS (PPMS): Characterized by steady worsening of neurologic function from the onset, without early relapses or remissions.
• Clinically Isolated Syndrome (CIS): A first episode of neurologic symptoms lasting at least 24 hours, which may or may not progress to MS.

How does identifying the clinical subtype impact patient care? Recognizing the specific subtype helps guide treatment decisions, predict disease course, and set appropriate expectations for patients and healthcare providers.

Monitoring Disease Progression

Once an MS diagnosis is established, ongoing monitoring is crucial for:

• Assessing treatment efficacy
• Detecting disease progression or subtype transition
• Identifying new or worsening symptoms
• Adjusting treatment plans as needed

What tools are used for monitoring MS progression? Regular neurological exams, MRI scans, and patient-reported outcome measures are commonly employed to track disease activity and inform treatment decisions.

Emerging Diagnostic Techniques and Future Directions

The field of MS diagnosis is continually evolving, with several promising areas of research:

• Advanced MRI techniques: Such as magnetization transfer imaging and diffusion tensor imaging, which may provide more sensitive measures of tissue damage.
• Biomarkers: Identification of specific biological markers in blood or CSF that could indicate MS activity or progression.
• Artificial intelligence: Machine learning algorithms to analyze imaging data and assist in diagnosis and prognosis.
• Optical coherence tomography (OCT): Increasingly used to detect and monitor retinal changes associated with MS.

How might these emerging techniques impact MS diagnosis in the future? These advancements hold the potential to enable earlier, more accurate diagnosis, better prediction of disease course, and more personalized treatment approaches for individuals with MS.

Challenges and Ethical Considerations

As diagnostic techniques for MS advance, several challenges and ethical considerations arise:

• Balancing early diagnosis with the risk of overdiagnosis
• Ensuring equitable access to advanced diagnostic technologies
• Managing the psychological impact of early or predictive diagnosis
• Addressing privacy concerns related to genetic and biomarker testing

How can the medical community address these challenges? Ongoing dialogue between healthcare providers, researchers, ethicists, and patient advocacy groups is essential to navigate these complex issues and ensure that diagnostic advances benefit patients while minimizing potential harms.

In conclusion, the diagnosis of multiple sclerosis requires a comprehensive approach, combining clinical assessment, imaging studies, and laboratory tests. While current diagnostic criteria and tools have significantly improved our ability to identify MS accurately and promptly, ongoing research continues to refine and enhance the diagnostic process. As our understanding of MS grows and new technologies emerge, the future holds promise for even more precise and personalized diagnostic approaches, ultimately leading to better outcomes for individuals living with this complex neurological condition.

How Is MS Diagnosed | National Multiple Sclerosis Society

• How Is Multiple Sclerosis Diagnosed?
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• Newly Diagnosed
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In this article

Overview of diagnosing MS


At this time, there are no symptoms, physical findings or laboratory tests that can, by themselves, determine if you have MS. Healthcare providers will use several strategies to determine if you meet the long-established criteria for an MS diagnosis and to rule out other possible causes of whatever symptoms you are experiencing. These strategies include a careful medical history, a neurologic exam and various tests including magnetic resonance imaging (MRI), cerebrospinal fluid analysis and blood tests to rule out other conditions.

Timely and accurate diagnosis

There are many possible causes of neurological symptoms. To diagnose MS, healthcare providers must first exclude these other causes through the tools and tests outlined below. While this process of exclusion may be quick for some, it can also take much longer and involve repeat testing, to look for changes.

Making the diagnosis of MS as quickly and accurately as possible is important for several reasons:

• You are living with frightening and uncomfortable symptoms and need to know the reason for your discomfort. Getting the diagnosis allows you to begin the adjustment process and relieves worries about other diseases.
• Since we now know that permanent neurologic damage can occur even in the earliest stages of MS, it is important to confirm the diagnosis so that you can start the appropriate treatment(s) as early in the disease process as possible.

Criteria for a diagnosis of multiple sclerosis

Currently MS is diagnosed by applying several types of tests and assessments because no single test or examination can confirm that you have MS. In order to make an MS diagnosis, the physician must:

• Find evidence of damage in at least two separate areas of the central nervous system (CNS), which includes the brain, spinal cord and optic nerves AND
• Find evidence that the damage occurred at different points in time AND
• Rule out all other possible diagnoses.


The McDonald Criteria, published in 2017 by the International Panel on the Diagnosis of Multiple Sclerosis, include specific guidelines for using MRI and cerebrospinal fluid analysis to speed the diagnostic process. The MRI can be used to look for a second area of damage in a person who has experienced only one attack (also called a “relapse” or an “exacerbation”) of MS-like symptoms — referred to as clinically-isolated syndrome (CIS). The MRI can also be used to confirm that damage has occurred at two different points in time. In some circumstances, the presence of oligoclonal bands in a person’s cerebrospinal fluid analysis can be used instead of dissemination in time to confirm the MS diagnosis.

Tests and tools for diagnosing MS

Healthcare providers have a series of tests and tools for diagnosing MS, which include learning your medical history and conducting neurologic exams, screening and imaging tests, and blood tests to rule out other potential causes of your symptoms.

Medical history and neurologic exam


Your healthcare provider:


• Takes a careful history to identify any past or present symptoms that might be caused by MS.
• Gathers information about birthplace, family history, environmental exposures, history of other illnesses and places visited that might provide further clues.
• Performs a comprehensive neurologic exam, which includes tests of cranial nerves (vision, hearing, facial sensation, strength, swallowing), nerve conduction (to test sensation in the extremities), reflexes, coordination, walking and balance.

In many instances, medical history and a neurologic exam provide enough evidence to meet the diagnostic criteria. Other tests are used to confirm the diagnosis or to identify other possible causes of the symptoms or neurological exam findings.

Magnetic resonance imaging (MRI)

Magnetic resonance imaging (MRI) is a diagnostic tool that offers the most sensitive, noninvasive way to examine the brain, spinal cord or other areas of the body. It is a valuable tool for diagnosing MS and tracking the progression of the disease.

Cerebrospinal fluid (CSF) analysis

Cerebrospinal fluid (CSF) is a clear, colorless liquid that surrounds the brain and spinal cord. In MS, damage to myelin causes certain types of proteins to be released into the spinal fluid. When these proteins are identified in the spinal fluid, but not in the blood, MS is thought to be one of the possible diagnoses. Spinal fluid is collected through a lumbar puncture (also known as a spinal tap). The CSF is then sent for testing and analysis.

Blood tests

While there is no definitive blood test for MS, blood tests can rule out other conditions that cause symptoms similar to those of MS, including lupus erythematosus, Sjogren’s syndrome, vitamin and mineral deficiencies, some infections and rare hereditary diseases.

Find an MS care provider

The National MS Society’s Partners in MS Care program connects you to local healthcare providers and medical facilities that have demonstrated exceptional care, knowledge and expertise in treating patients with MS. All partners, whether they are a neurologist or social worker, have a strong relationship with the Society and connect their patients to the information, resources and support they need to live their best lives with MS. Find a Partner in MS Care.

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Getting treatment for MS | MS Society

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You have the right to ask about getting treatment for your MS. This is true no matter what kind of MS you have – or how long you’ve had it.

Some treatments help with the symptoms of MS, while others control MS itself. With these treatments you can get fewer and less serious relapses, and disability progression may slow down.

First questions about MS treatments

Who do I ask about treating my MS?


It’s best you speak to an MS specialist, like a neurologist who has many patients with MS. An MS nurse can also talk about treatments in general. Only an MS specialist can give you advice on treating your MS and prescribe drugs for you.

To see your specialist you don’t have to wait for your next appointment to come round. You can ask to see them before then. Ask your GP or MS nurse to book one for you.

If you don’t already have an MS specialist, ask your GP to refer you to one.

> Find out who’s who in the health care system

When should I ask about treatment?


Official guidelines say everyone with MS should be offered an appointment with a specialist at least once a year to talk about their care. This is true no matter what kind of MS you have and whether you’re already on treatment or not. This is a chance to talk about how your MS might be treated.

If you haven’t seen a specialist for quite a long time you have the right to ask for an appointment. And if your yearly review doesn’t happen, you should ask your GP, MS nurse or neurologist about getting one scheduled. It’s never too late to think about treatment.

If you’ve just been told you have MS, guidelines say your neurologist should have spoken to you about treatment and given you information on it when you were diagnosed. Within six weeks of this you should get a follow-up appointment where you can talk about your treatment choices.

I have relapsing MS. What are my options?


If you have relapses with your MS, over a dozen drugs can now slow down this sort of MS and reduce relapses. They’re called disease modifying therapies (DMTs). Talk to your specialist about them if they haven’t already mentioned them.

DMTs won’t cure MS but they can slow it down and mean you get fewer relapses. They range from less hard hitting drugs with fewer side effects to stronger ones with more serious side effects.

There’s a wide range of drugs and other therapies that can help with specific MS symptoms. And steroids can help you get over a relapse sooner. Talk to your specialist, MS nurse or GP about these.

I’ve got relapsing MS and I don’t think drugs are working


There are a number of very effective DMTs for relapsing MS.

If you don’t feel the drug you’re taking is controlling your relapses well enough, talk over other possible MS relapse treatments with your neurologist or MS nurse.  This might include the stem cell therapy HSCT. In the UK HSCT is only an option if two DMTs haven’t worked for you.

My MS is progressive. Is there a treatment for me?


For most people with progressive MS DMTs don’t work. The exception is if your MS is progressive but is classed as ‘active’. This means you still get relapses, or doctors see inflammation on your MRI scans. If you have secondary progressive MS and it’s ‘active’ then two DMTs might help you – Extavia (which is one of the beta interferons) or siponimod (Mayzent).

A new DMT called ocrelizumab (Ocrevus) can work against primary progressive MS early on and if inflammation can be seen on your MRI scans. You also need to have a score on the Expanded Disability Status Scale (EDSS) between 3.0 and 6.5. A score of 6.5 means you need two walking aids – such as canes or crutches – to walk 20 metres without having a rest. This drug has been recommended for use on the NHS for this kind of MS since 2019 in England, Wales and Northern Ireland, and in Scotland since the start of 2020.

If your MS is progressive then HSCT isn’t likely to help you unless you have early primary progressive MS and inflammation is seen on your MRI scans.

But there are lots of treatments, therapies, lifestyle changes and devices that help with the symptoms or disability caused by progressive MS. Ask your GP, MS nurse or neurologist for help.

Our researchers are working to find treatments for progressive MS.

What to do when

I’m not happy with what my specialist says


Maybe you don’t agree with what your specialist says about treating your MS. Or perhaps you don’t understand the information they’ve given you.

It’s worth first talking to your neurologist about your concerns or if you’d like to consider a different course of treatment.

You can ask for a second opinion from another MS specialist. Discuss this with your neurologist, your GP or with the hospital or clinic where you were seen.

However, this could mean having to travel to a different hospital and your treatment could start later. Talk this through with your specialist to see what a delay might mean for you.

> Find out more about getting a second opinion on the NHS choices website

I’ve got a long wait to see my neurologist


It can be difficult to get an appointment with a neurologist and long waiting times are sometimes an issue.

Neurologists are meant to follow NICE recommendations and offer everyone with MS a comprehensive review of all aspects of their care at least once a year.

While you’re waiting to see your neurologist, we recommend speaking to your MS Nurse about your treatment options so you’re prepared when you see them.

If you’ve been waiting a long time for an appointment with a neurologist and are concerned about the impact on your MS, please get in touch with at [email protected]. Sharing your experiences helps us make the case locally for MS services and campaign for better access to treatments.

If you’ve been waiting a long time for an appointment with a neurologist and would like some information and support on what services are available to you, please contact our Helpline on 0808 800 8000 or at [email protected].

I’ve been denied an NHS treatment for my MS


When you have a diagnosis of relapsing MS, your neurologist should guide you through which treatments you’re eligible for and help you make a decision.

If you feel you’re not being prescribed a DMT you’re eligible for, this could be due to a number of different reasons. If you have a clinician who’s reluctant to prescribe you a treatment, that doesn’t mean you’re not eligible for any. It’s important to be aware of your treatment options before you see your specialist.

If you’re unclear about why you’re not being offered your preferred treatment option, we may be able to help. Contact your local Regional External Relations Officer who may be able to raise the issue with decision-makers locally.

I’ve been denied a NHS treatment that’s not currently approved for MS


Some treatments that could help you have either been rejected by your national level commissioner or haven’t been reviewed for treating MS on the NHS yet.

Whether you’ll have any success accessing these treatments will depend on how expensive they are for your local NHS to fund and whether national commissioners have explicitly recommended they shouldn’t be used.

For exceptional circumstances it is possible to receive NHS funding through applying for an individual funding request.

I want to explore Individual Funding Requests or Individual Patient Treatment Requests


To access treatments that haven’t been approved for MS on the NHS you may want to try to get an Individual Funding Request (IFR) or Individual Patient Treatment Request (IPTR) in Scotland. These are to request funding for people who are considered to have exceptional clinical circumstances. They have to be submitted by a healthcare professional.

These requests are submitted to your local commissioner. The treatments are not routinely available and it’s unlikely funding will be granted for a non-approved treatment where there are lots of people who’d like to access it for the same reason.

Your neurologist will be able to advise you on the likely success of submitting a request.

I want to get HSCT for my MS


HSCT is now being funded by the NHS for people with relapsing MS who have continued to have relapses despite taking two other DMTs. However, it’s not yet widely available.

NICE will review HSCT for the NHS in England and Wales once they have enough clinical trial evidence. This appraisal will decide whether it should be made more widely available.

> Find out more about HSCT

Find out about your rights in different parts of the UK

England and Wales


The National Institute of Health and Care Excellence (NICE) are responsible for approving DMTs for England and Wales. Once NICE approves a treatment, the NHS across England and Wales has three months to implement that guidance. Once that has happened patients are legally entitled to be prescribed the treatment (so long as they meet the eligibility criteria ).

Northern Ireland


The Department of Health, Social Service and Public safety has formal links with NICE. Once NICE approves a treatment it’s reviewed locally for applicability to Northern Ireland. Where appropriate it’s then endorsed for implementation in Health and Social Care (HSC). This process should be completed within 8 weeks.

Scotland


The Scottish Medicines Consortium (SMC) is responsible for approving DMTs in Scotland. When the SMC approves a DMT, the NHS boards in Scotland take it into account when they decide which medicines are available in their area. But they don’t have to follow the SMC decision.

Making an official complaint

Making a complaint in England and Wales


If a NICE approved treatment that you’re eligible to take is unavailable in your area, you can make an official complaint.

Officers from the Patient Advice and Liaisons Service (PALS) are available in all hospitals. They offer confidential advice, support and information on health-related matters to patients, their families and carer.

Making a complaint in Northern Ireland


If you have a complaint about your level of treatment you can contact the Patient and Client Council who support NHS patients with complaints in Northern Ireland.

> Find contact details for each health trust’s complaints department

Making a complaint in Scotland


If you have a complaint about your level of treatment you can contact the Patient Advice and Support Service (PASS) who provide free, confidential advice and support for NHS patients in Scotland.

Take political action


If you’re repeatedly denied a treatment you feel you’re eligible to take, you can contact your MP, SMP or Assembly Member to help you challenge the decision. Find out who your representatives are here.

Contact our MS Helpline on 0808 800 8000 for support and information about taking this step.

Talking about treatments – questions to ask my MS specialist

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The correct answer is marked with +

1. Body weight in grams of a full-term baby should be:

+A) 3300-3600;

B) 3900 – 4200;

B) 2700 – 2900.

2. The body length of the newborn should be:

A) 46-48 cm;

+B) 50 – 52 cm;

B) 53 – 55 cm.

+B) 75 cm;

B) 60 cm.

4. Average head circumference of a newborn:

A) 30 – 32 cm;

B) 32 – 34 cm;

+B) 33 – 35 cm.

B) 33 – 36;

C) 35 – 37.

B) Ballard;

+B) Apgar.

7. It has a high energy value, nutrient content, rich in various immunity factors – these are:

A) Breast milk;

B) Adapted milk formula;

+B) Colostrum.

8. The first attachment to the mother’s breast should be carried out:

A) On the second day after birth;

B) 4 hours after delivery;

+B) In the first 30 minutes after birth.

9. Free feeding is:

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B) Breastfeeding every 3 hours with a break at night;

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test 10. The neonatal period lasts:

A) one year after birth;

B) 6 months after birth;

+B) 1 month after birth.

11. Supplementary food is:

A) Dietary diversity;

+B) Supplementary food given to a child of the first year of life who does not have enough breast milk;

C) Introduction of new products into the diet in order to replenish the energy costs of the baby.

12. Complementary foods are:

A) Dietary diversity;

B) Supplementary food given to a child of the first year of life who does not have enough breast milk;

+B) Introduction of new products into the diet in order to replenish the energy costs of the baby.

13. Breast period continues after birth:

+A) 1 year;

B) 6 months;

C) How long a woman will breastfeed her baby.

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A) 300-400 ml;

B) 100 – 200 ml;

+B) 500 – 600 ml.

15. Children from 1 to 3 years of age are recommended milk:

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B) Fresh whole cow;

C) Mass industrial production.

16. The following products should be included in the daily diet, except:

A) Vegetables;

+B) Fish;

C) Butter.

17. The frequency of respiratory movements in a newborn within the normal range is:

A) 60 – 70 per minute;

+B) 40 – 50 per minute;

C) 16 – 20 per minute.

18. The frequency of respiratory movements in a child of 5 years within the normal range is:

A) 30 – 35 per minute;

+B) 20 – 25 per minute;

B) 15 – 20 per minute.

19. The average value of the pulse rate in a newborn is:

A) 90 per minute;

B) 100 per minute;

+B) 130 – 140 per minute.

test-20. The average value of the pulse rate in a child of 10 years old is:

A) 100 per minute;

+B) 90 per minute;

B) 120 per minute.

21. With hypotrophy of the first degree in the postnatal period, body weight is reduced:

+A) 20%;

B) More than 35%;

B) 5%.

22. Paratrophy is:

A) Insufficient body weight within 10%;

+B) Overweight by more than 10%;

C) Excess growth of more than 10%.

23. Of all types of allergies in childhood, the most common:

+A) Food;

B) Medicinal;

C) Inhalation.

24. The following berries most often cause food allergies:

A) Currant;

+B) Strawberry;

C) Gooseberry.

25. The most common food allergies are the following vegetables;

+A) Tomatoes;

B) Courgette;

C) Carrot.

26. Flour almost never causes allergies:

A) Semolina;

B) Oatmeal;

+B) Soya.

27. The first complementary foods to prevent vitamin D deficiency should include the product:

A) Bread;

+B) Yolk;

C) Meat.

28. Early signs of rickets include:

+A) Increased sweating;

B) Change in the shape of the skull;

C) Curvature of the bones of the lower extremities.

29. One of the signs of “blue defect” in an infant is:

A) Sweating;

+B) Blue lips, fingers, neck;

C) Shortness of breath.

test_30. The appearance of “seizures” in the corners of the mouth may be the cause of the pathological condition:

A) Pneumonia;

+B) Iron deficiency anemia;

C) Atopic dermatitis.

31. BCG is administered to prevent the disease:

+A) Tuberculosis;

B) Pneumonia;

C) Hepatitis.

32. The appearance of a papule after the introduction of the BCG vaccine occurs:

A) a week later;

+B) After 3 months;

C) After 4 weeks.

33. Purulent skin lesions in newborns manifest themselves as:

A) Ritter’s disease;

B) Furunculosis;

+B) Vesiculopustulosis.

34. To confirm phenylketonuria, the following should be examined:

A) Blood;

+B) Urine;

C) Cal.

35. A reliable sign of asphyxia in a newborn is:

+A) Absence of breathing;

B) Decreased muscle tone;

C) Areflexia.

36. Birth injury occurs due to one of the following reasons:

A) Post-term pregnancy;

+B) Mismatch between the size of the pelvis of the woman and the head of the fetus;

C) Anomalies in the structure of genes.

37. Reactive conditions in newborns include all of the following except:

+A) Melena;

B) Breast engorgement;

C) Physiological jaundice.

38. The period of closure of the large fontanel is within the normal range:

+A) 1.5 – 2 years;

B) 6 months;

C) 2.5 years.

39. A potential problem with pyoderma is:

A) Diaper rash;

B) prickly heat;

+B) Sepsis.

test*40. Atopic dermatitis at an early age is manifested by the occurrence of:

A) Enlargement of the thyroid gland;

+B) Milk scab;

C) Neurasthenia.

41. It is possible to improve sputum discharge during productive cough if:

+A) Carry out vibration massage;

B) Place mustard plasters;

C) Administer antibiotics.

42. Using the Zimnitsky test, you can determine:

A) Color, volume, density of urine;

B) Glucose in urine;

+B) The concentration function of the kidneys.

43. Rashes on the skin in the form of vesicles are characteristic of an infectious disease:

A) Measles;

B) Scarlet fever;

+B) Chicken pox.

44. Treatment of the umbilical wound refers to:

+A) Independent nursing intervention;

B) Dependent nursing intervention;

C) Interdependent nursing intervention.

45. In case of allergic diathesis, the following should be excluded from the diet in the first place:

A) Apple juice;

+B) Oranges;

C) Kefir.

46. In what disease is scraping from perinatal folds performed for diagnostic purposes:

+A) Enterobiosis;

B) Ascariasis;

C) Trichuriasis.

47. The main symptom of bronchial asthma in a child:

A) Convulsions;

+B) Attack of suffocation;

C) Edema.

48. When there is a threat of stenosis of the larynx outside the medical institution, the tactics of a nurse:

+A) Urgent hospitalization;

B) Oxygen therapy;

C) ventilator.

49. The main sign of bleeding from the stomach or duodenum:

+A) Melena;

B) Pain in the gastrointestinal tract;

C) Vomiting.

tes No. 50. Leading sign of croup:

+A) Inspiratory dyspnea;

B) Temperature increase;

C) Redness of the face.

51. With glomerulonephritis in the urine of a child:

A) Bacteriuria;

+B) Hematuria;

C) Crystalluria.

52. Pyelonephritis in the urine of a child reveals:

+A) Bacteriuria;

B) Hematuria;

C) Crystalluria.

53. Epidemic parotitis can later lead to:

+A) Infertility;

B) Cystitis;

C) Pyelonephritis.

54. Head thrown back in the supine position may indicate a disease:

A) Myocarditis;

B) Pneumonia;

+B) Meningitis.

55. Late detection of diabetes mellitus can lead to the development of coma:

A) Hypoglycemic;

+B) Ketoacidotic;

B) Uremic.

56. Form 112 is:

A) Group diary;

+B) Child development history;

B) Isolator magazine.

57. The neonatal nurse is responsible for:

A) to bathe a child;

B) Measure blood pressure;

+B) Treat the umbilical wound, weigh the child.

58.