3 Уровень
14
*!Man 16 years in 2 weeks after postponed by a AVRI notes weight reduction, emergence of thirst, the frequent urination. Skin and language are dry. The liver acts from under a costal arch on 3 cm. Glycemia on an empty stomach 12,7 and 16,6 mmol/l. A density of urine - 1030.
What tactics of treatment is MOST expedient?
*Metformin
*Glibenclamide
*Orlistat
*Long-acting insulin
*Insulin therapy
15
*!The young man of 23 years came to unconscious clinic. Objective: skin dry, a flush on cheeks, in the exhaled air a pungent smell of an acetone, Kussmaul's respiration, a BP of-130/90 mm Hg., pulse - 102 beats/min. At inspection: a glycemia - 28,4 mmol/l, a glucosuria - 6%, reaction of urine to an acetone – extensive positive.
What of the listed comas MOST possibly developed at the patient?
* Renal
* Uraemic
* Hyperosmolar
* Ketoacidosis
* Hyperlacticacidosis
16
*!The woman of 60 years admitted in unconsciousness condition. In anamnesis – diabetes mellitus. The last 2 days vomiting, a multiple fluid stool, spasms was noted. Objective: skin dry, the turgor is lowered. The weak eyeballs. Pupils are expanded. RR - 22 in min, a BP - 60/40 mm Hg. The HR - 110 beats/min. A glycemia - 50 mmol/l.
What of the listed comas MOST possibly developed at the patient?
* Renal
* Uraemic
* Hyperosmolar
* Ketoacidosis
* Hyperlacticacidosis
17
*! Man 67 years suffering from a diabetes mellitus and accepting guanyl guanidines is brought to clinic in unconsciousness. There were vomiting, a fluid chair, a sleepiness three days ago. Objective: integuments are dry, pale. Kussmaul's respiration. A BP - 50/30 mm Hg. Beats/min CHSS-112. Blood sugar - 12 mmol/l, the level of lactic acid in blood - 5,5 mmol/l.
What appointment from the listed medicines MOST is expedient?
* Insulin of short action and 5% glucose solution
* Insulin of the long action and 5% glucose solution
* Insulin of short action and 0,9% Sodium chloridum solution
* Insulin of short action and 0,45% Sodium chloridum solution
* Insulin of the moderate-long action and 5% glucose solution
18
*! Man, 52 years, complains of increase in body weight, weakness, locks, memory impairment. The specified symptoms gradually increased within the last 1,5 years. Objective: the xeroderma, a moderate face edema and extremities, border of heart are expanded, tones are muffled, pulse 66 in 1 min. a BP of 110/70 mm Hg. The thyroid gland is not palpated. The IFA method revealed antibodies to a thyreoglobulin (+) and to a thyreoperoxidase (+++); the TTH level - 15,2 mI/l. Ultrasonography: gland is reduced in sizes, the structure is diffuse changes.
What diagnosis is MOST probable.
* Autoimmune thyroiditis, hypothyrosis
* Autoimmune thyroiditis, euthyrosis
* Endemic goiter
* Subacute thyroiditis
* Diffuse toxic goiter
19
*! The woman of 38 years notes thirst, increase in body weight. Objective: height is 162 cm, weight is 94 kg. A glycemia on an empty stomach – 5,9 mmol/l, the common cholesterin of-5,4 mmol/l, triglycerides – 2,5 mmol/l.
Which treatment is most necessary?
*Orlistat 120 mg 3 times a day
*Metformin 1000 mg 3 times a day
*Glibenclamide 5 mg 1 time a day
*Liraglutid 120 mg 1 time a day
*Sitagliptin 100 mg 1 time a day
20
*! Man, 37 years, complains of apathy, decrease in memory, headaches, chill, lack of appetite, constipation. The listed complaints appeared gradually within 2 years. Weight increased by 8 kg. Objective: skin pale, cold, person hypomimic. Speaks sluggishly, language is increased, prints of teeth are visible. Arterial blood pressure of 104/68 mm Hg. Pulse 54/min.
Your MOST probable preliminary diagnosis?
* Hypothyrosis
* Endemic goiter
* Itsenko-Cushing's syndrome
* Alimentary and constitutional obesity
* Itsenko-Cushing's Disease
21.
*! The man of 42 years within 5 years suffers from a chronic adrenal failure. Receives 25,0-37,5 mg of Cortisonum a day. Two days ago catch cold and acute viral infection, but did not increase a dose of Cortisonum. Condition is severe. Body temperature - 41,8 °C. The terrible weakness, adynamia, BP of 60/30 mm Hg.
What of the listed diagnoses is MOST probable?
* sepsis
* infectious toxic shock
* acute adrenal crisis
*adrenal hemorrhage
* hyperthermia crisis
22
! At the woman of 45 years are observed permanent increase in a BP to 200/110 mm Hg., muscle weakness, spasms, the frequent urinationspeeded-up emiction. These symptoms disturb within a year. On the computer tomogram increase in the lefthand adrenal gland is revealed.
What appointment from the listed medicines MOST is expedient?
* bisoprolol
* lisinopril
* furosemidum
* indapamid
* veroshpiron
23
*! Man 45 years, complaints: weakness, dizziness, loss of appetite, weight reduction for the last year, skin darkening. Objective: a subnutrition, the muscle weekness, the considerable pigmentation of skin. A spotty pigmentation of mucous a mouth, language, gums was noted. BP – 85/60 mm Hg.
What of the listed diagnoses is MOST probable?
* Hemochromatosis
* Poisoning with salts of heavy metals
* Cirrhosis
* Porphyria
* +Addison disease
24
*! The patient has 24 years with violation of a menstrual cycle and a galactorrhea. Prolactine level – 10,000 ng/ml. MRT – focal changes in pituitary gland are revealed.
What optimum treatment method in this case?
*Adenomectomy
*The long-term treatment with diphereline
*Radiation therapy
*The long-term treatment with bromcreptinum
*The long-term treatment with somutaline
25
*! The patient of 43 years is diagnosed hypophysis adenoma with manifestations of an acromegalia
What changes could be founded in hormone profile?
*increasing of somatotropin
*increasing of ACTH
*increasing of TTH
*decreasing of somatostatin
*decreasing of realizing factor
26
*! The boy 6 years considerably lags behind classmates in body height. Body height of the father of 170 cm, mothers – 160 cm. At inspection: body height and a bone age correspond to the 3rd years. The TTH level – is normal. Clonidine stimulation test - the somatotropin level in all temporary points is not higher than 5 ng/ml.
What of the listed diagnoses is MOST probable?
* Genetic short stature
* Intrauterine growth retardation
* The isolated deficiency of growth hormone
* Cerebral and hypophysial nanizm
* Congenital hypothyrosis