2 Уровень
1
*! The test on glucose tolerance was carried out: the glycemia on an empty stomach of 5,4 mmol/l, in 2 hours after loading by glucose - 10,1mmoll.
Estimate result of test:
*MODI Diabetum
*Diabetes mellitus 2 types
*Normal response for glucose load
* Fasting glycemia disturbance
* Tolerance to glucose disturbance
2
*!Woman, 55 years old, complaints: dry mouth, frequent urination, candidosis. Height 170 cm, weight 60 kg, BMI 20.8. In analyses: b/c (fasting glucose 6.3 mmol/l). Glucolated hemoglobin 5.9%. Fasting glucose loading was performed, venous blood 6.7 mmol/l, 2 hours after the load 6.8 mmol/l.
Based on above-mentioned data, set the MOST probable diagnosis:
* Type 1 diabetes mellitus
* Type 2 diabetes mellitus
* LADA diabetes
* Fasting glycemia disturbance
* Disturbed carbohydrates tolerance
3
*!Woman, 20 years old, pregnancy 26-28 weeks. Complaints against dry mouth, thirst, frequent urination, fatigue. On ambulatory observation, at week 16, fasting glycemia 5.0 mmol/l. At admission, glycemia 2 hours after meal, 20 mmol/l. Glycolated hemoglobin 8.0%. In the urine test, glucose +++, ketons++.
What consequences possible for her baby?
*no any consequences
*overweighting in future
*low weight at birth
*long period of hyperbilirubinemia of newborns
*high risk of diabetes in future
4
*!Man, 55 years old, complaints against itching, frequent urination. Height 170 cm, weight 100 kg, BMI 34.6 C. For 8 years he has under supervision by cardiologist with diagnosis IHD. Stable angina. FC 2. He takes bisoprolol 10 mg per day. Adapted BP 150/100 mmHg. In analyses: fasting glucose 7.0 mmol/l. Glucolated hemoglobin 8.1%. glucose tolerant test - 2 hours after the load 14 mmol/l.
Based on above-mentioned data, set the MOST probable diagnosis:
*Type 1 diabetes mellitus
*Type 2 diabetes mellitus
*LADA diabetes
*MODY diabetes
*Secondary diabetes
5
*!Woman, 25 years old, admitted in urgent condition with complaints against dyspnea, moist skin, rapid pulse, body tremor, insomnia. In last 3 days she cannot leave the bed. General condition is poor. Skin clean, wet. At the examination, cardiac impulse is seen visually, in auscultation, systolic-diastolic murmur on the apex is heard. HR 120 per min. At abdominal palpation: improved abdominal aorta pulsation. At the examination: thyroid US: summary volume 35 ccm. TTH – 0.001 mIU/l, cv Т4 80 pmol/l, cv Т3-20 pmol/l, antibodies to TTH receptor – 5 IU/l.
Based on above-mentioned data, set the MOST probable diagnosis?
*Subacute thyroiditis
*Graves-Basedov's disease
*Hashimoto's thyroiditis
*Adenoma of hypophysis
*Papillary carcinoma
6
*! Woman, 35 years old, admitted in urgent condition with complaints against dyspnea, moist skin, rapid pulse, body tremor, insomnia. In last 3 days she cannot leave the bed. Skin clean, wet. At the examination, cardiac impulse is seen visually, in auscultation, systolic-diastolic murmur on the apex is heard. HR 120 per min. At abdominal palpation: improved abdominal aorta pulsation. At the examination: thyroid US: summary volume 35 ccm. TTH – 0.002 mIU/l, cv Т4 80 pmol/l, cv Т3-20 pmol/l, antibodies to TTH receptor – 5 IU/l.
What changes could be find in biochemistry analysis?
* glucose 3,4 mmol/l
* glucose 4,4 mmol/l
* glucose 7,4 mmol/l
*cholesterol 8,5 mmol/l
*cholesterol 10,5 mmol/l
7
*!Man of 54 years within half a year complains of weakness, weight loss against the background of good appetite, a frequent urination, an itch of skin. He was treated concerning a furunculosis without improvement. Objective: subnutrition, skin dry, traces. Enlarged lymphatic nodules at axillar area.
What research MOST IS EXPEDIENT to appoint first of all?
* Fasting glucose on an empty stomach
*Urine analysis
* Endoscopic research of a stomach
* lymphonodus biopsy
* blood on sterility
8
*!The man of 52 years. 5 years ago the diabetes mellitus was revealed. Now does not show complaints. Objective status: body temperature is 36,7C, BP 140/85 of mm Hg., the HR 72 per min.. Indexes of a glycemia on an empty stomach do not exceed 5,9 mmol/l; in urine – no glucosuria.
What of following methods is the MOST INFORMATIVE for assessment of compensation of a diabetes mellitus?
* Definition of a glicated hemoglobin
* Definition of a glucosuria profile
* Definition of a glycemic profile
* Determination of tolerance to glucose
* Determination of level of glucose on an empty stomach
9
*!The woman has 30 years, after flu infection, the glycemia on an empty stomach - 11,3 mmol/l, a glucosuria - 25 g/l is revealed. Body height - 168 cm. Weight - 67 kg.
What research is the MOST informative for specification of the diagnosis?
* Insulin level in serum on an empty stomach
* Daily fluctuations of a glycemia
* Daily fluctuations of a glucosuria
* A glycemia in an hour after a meal
* Glucose tolerant test
10
*!The young girl of 16 years within 2 months had a polyuria, a polydipsia, lost weight by 8 kg at good appetite. There were complaints on abdominal pains and nausea. In connection with the complaints it was hospitalized in an urgent order, the glycemia of 18 mmol/l, a glucosuria of 24 g/l is revealed. Against the background of purpose of insulin and infusions of isoosmotic solutions of Sodium chloridum and glucose these complaints, including, thirst, disappeared.
What MOST possible diagnosis?
* Diabetes mellitus type I
* Diabetes mellitus type ІІ
* Renal glucosuria
* MODY diabetes
* Secondary (symptomatic) diabetes mellitus
11
*! Girl of 16 years within 2 months had a polyuria, a polydipsia, lost weight by 8 kg at good appetite. There were complaints on abdominal pains and nausea. In connection with the complaints it was hospitalized in an urgent order, the glycemia of 18 mmol/l, a glucosuria of 24 g/l is revealed.
Which treatment most necessarily at first step?
*Continue saline 0.45%
*5% glucose 1500 ml
*Short-acting insulin subcutaneous
*Alkaline drink
*Long-acting insulin
12
*!The patient of 28 years with diabetes mellitus. He received insulin in dosage of 14 units per day. Within the last year in urine appearance of protein 1,1 g/l, glucose 0,8%, some erythrocytes, cylinders.
The specified signs MOST more probable are manifestation:
* Diabetic nephropathy
* Insulin resistance
* Diabetes mellitus decompensations
* Urine tract infection
* Syndrome of chronic overdose of insulin
13
*!A woman, 52 years old, complaints against dry mouth, spasms in lower limbs, feeling of numbness in feet. Height 155 cm. Weight 90 kg. For a long time, she suffers from arterial hypertension, max. elevation 180/120 mmHg. At the examination was detected: In CBA glucose+, ketones negative. In b/ch: fasting glucose 6.5 mmol/l. Glycated hemoglobin 7.5%.
Which treatment is most necessary to this patient?
*Metformin
*Glibenclamide
*Short-acting insulin
*Long-acting insulin
*Orlistat