1. Type 2 Diabetes mellitus, high pressure disease, stage 3

2. Chronic glomerulonephritis

3. Type 2 Diabetes mellitus, hard form in the stage of decompensation. Diabetic nephropathy

4. Type 2 Diabetes mellitus, hard form in the stage of compensation. Chronic pyelonephritis, high pressure disease

5. Non of this variant

Case N 15. A patient W., which is ill for 15 years by type 2 Diabetes Mellitus, during last year determine weakness, hypertonia, swelling of lower limbs and face. In the general analis of urine: albumen – 0,99 g/L, glucose - 11 mmol/L, leukocyte 3 – 5, creatinine, urea are normal. The fasting level of glucose – 11,5 mmol/L. Established the most suitable diagnosis:

1. Type 2 Diabetes Mellitus, adequate control, diabetic nephropathy, persistent proteinuria

2. Type 2 Diabetes Mellitus, inadequate control, diabetic nephropathy, persistent proteinuria

3. Type 2 Diabetes Mellitus, adequate control, diabetic nephropathy, renal impairment

4. Type 2 Diabetes Mellitus, inadequate control, diabetic nephropathy, microalbuminuria

5. Non of this variant

Case N 16. A patient W., 66 year old man who has had diabetes mellitus for 6 years is seen for a routine evaluation. He strictly adheres to his diet and exercise regimen and takes glipizide 5 mg twice daily. His blood pressure (BP) varies on multiple readings but remains in the range of 145–150/85–90 mm Hg. Laboratory findings are a hemoglobin A1c value of 6,4%, a urine albumin–creatinine ratio of 120 to 190 mg/g on multiple measurements, and a serum creatinine level of 141,47 mmol/L. Which of the following is a recommended blood pressure goal in this patient?

A.  No higher than 140/85 mmHg

Начало формы

Конец формы

B.  No higher than 140/80 mmHg

Начало формы

Конец формы

C.  No higher than 130/85 mmHg

Начало формы

Конец формы

D.  Less than 130/80 mmHg

Case N 17. A 43 year old man comes to the physician for evaluation and management of cardiac risk factors 8 weeks after sustaining a myocardial infarction. He takes aspirin and metoprolol daily, and he does not smoke cigarettes. His father and brother both had myocardial infarctions before the age of 50 years, their serum cholesterol levels are unknown. There is no family history of diabetes mellitus. He weighs 86 kg and is 180 cm tall. His blood pressure is 130/70 mm Hg, pulse is 68/min. Two years ago, his serum cholesterol level was 6,5 mmol/L. Fasting serum glucose level- 4,84 mmol/L. Which of the following is the most appropriate next step to evaluate his cardiac risk factors?

1. Random measurements of serum cholesterol level

2. Measurement of fasting serum cholesterol level only

3. Fasting serum lipid studies only

4. Oral glucose tolerance test (gtt) and fasting serum lipid studies

5. GTT and measurement of fasting serum cholesterol level

Case N 18. At a patient with the heart attack of myocardium the level of the glucose is 8,2 mmol/L. 2 years passed from the beginning of the disease. What is the most expedient inspections to appoint the patient for estimation of the state of carbohydrate exchange?

1. Determination level of the HbAlc

2. Test of the tolerance to glucose

3. Determine the fasting level of the glucose during 3 days

4. Determination of day's glucoseurine

5. Determination level of the glucose in the blood for a day

Case N 19. Which of the statement given below is correct relatively to oral glucose tolerance test (GTT)?

1. Helpful to choose the most appropriate treatment

2. Used to differentiate type of diabetes

3. Indicate stage of diabetes

4. Useful in the seeking of early diabetic complications

5. Correlates with determination of potential abnormalities of glucose tolerance

Case N 20. Interpret oral glucose tolerance test (GTT) in obese patient. Fasting glucose level is 7,6 mmol/L; 2 hours after glucose ingestion 14,9 mmol/L in plasma.

1. Type 2 diabetes mellitus

2. Impairment of carbohydrate tolerance

3. Normal

4. Necessary to repeat test

5. Additional laboratory investigations are indicate

Case N 21. A 56 year old man with type 2 diabetes mellitus of 23 years duration was seen in the clinic. He was noted to have hypertension (blood pressure 160/100 mmHg) and microalbuminuria and his serum creatinine was 120 mmol/L (Normal 50–110 mmol/L). He was prescribed a small daily dose of the angiotensin-converting enzyme inhibitor ramipril. Three days later, he was seen in the Emergency Room having become acutely short of breath. His blood pressure was 110/70 with a tachycardia of 110/min and he had bilateral basal crackles on auscultation of his chest. The chest X-ray indicated that he had developed pulmonary edema. The serum creatinine had risen markedly to 410 mmol/L. Which investigation would you perform next?