1 Уровень

27

*!About a year ago woman, 32 years old, appealed to the clinic with complaints of overweight, dry skin and dry mouth. After identifying the fasting plasma glucose is 7.5 mmol / L and 13.3 mmol / L, after eating doctor prescribed metformin 1000 mg in the evening and recommended diet. Condition was improved, she hadn’t any complaints. She lost 5 kg. The patient is planning a pregnancy. At this time moment fasting blood sugar is 5.2 mmol / l.

Which of the principles of treatment is the most indicated in the case of pregnancy?

*metformin

*+insulin

*diet is enough

*receiving α-glucosidase inhibitor

*receiving sulfonylurea

28

*!Man, 47 year old, come to the doctor because his wife noticed that during the last months his right eye became more convex. He is healthy and does not notice any visual violations. Works as a plasterer. About once a week he drinks 0.5 l of beer and about 100 grams of vodka, smokes 20 cigarettes per day and does not take medication. During hormonal examination the doctor revealed suppression of TTH and small increase of the free thyroxine concentration up to 27 pmol / L (normal 12-25 pmol / l).

What additional research shall be designate on the first place?

*thyroglobulin

*ocular fundus examination

*electrocardiogram

*+antibody to the TTH receptor

*free triiodothyronine

29

*!Woman, 26 years old, complained on feeling tired and painful periods. She is planning a pregnancy. The state of health is good, she does not take any medicines. The concentration of TTH in the blood is increased to 7.2 mIU / L (normal to 4.0), thyroid hormones within normal limits.

Which of the following methods of study is the most informative for the additional examination of patient?

*+antibodies to TPO

*electrocardiogram

*pelvic ultrasound

*Determination of prolactin

*biopsy of the thyroid gland

30

*!Woman, 40 years old, teacher, complains on the weight gain, hirsutism, spontaneous appearance of hemorrhages in the skin. During the last 3 years, these signs progressed. Cortisol serum increased to 700 nmol / L (normal 50-450 nmol / L). Determination of what hormone is most important in the future hold?

*TTH

*+ACTH

*Prolactin

*Estradiol

*Testosterone

31

*!A patient with diabetes mellitus type 1 was given 16 units of short insulin. Due to the lack of appetite he did not have breakfast. At 11 o'clock he became unconsciousness.

What coma is most likely to develop in such patients?

*brain coma

*hyperosmolar

*ketoatsidotic

*+hypoglycemic

*hyperlactatacidotic

32

*!A woman of 35 years during six months used tirozol. On the advice of family members she abruptly stopped the treatment. After a trip to the sea and sunburn, condition deteriorated rapidly. Body temperature - 37.9 , profuse sweating, tachycardia 150 beats in 1 minute, severe weakness, nausea, hand tremor.

Which of the following diagnoses is MOST LIKELY can be in this patient?

*infectious myocarditis

*acute viral infection

*+thyrotoxic crisis

*acute myocardial infarction

*food poisoning

33

*!Women, 57-years-old had followed thyreostatic therapy during the last 2 years. According to the patient’s words, she took the preparations irregularly, did not follow the control. Arterial hypotony, weakness, fatigue and hyperpigmentation of the skin were added during last week on the background of respiratory disease. After repeated measuring, BP is 90-85/60-55 mm of Hg.

What is the most possible result of the hormone investigation in the blood?

*increase of aldosterone level

*increase of cortisol level

*+decrease of cortisol level

*decrease of ACTH

*decrease of TTH

34

*!Patient 58 y.o. is at a regular medical exam in connection with a history of tuberculosis. In recent years, began to disturb the weakness, weight loss, increased skin pigmentation. Blood pressure is 90/50 mm Hg. A doctor revealed low levels of cortisol.

What a change in hormone levels is most likely?

*decrease of TTH

*+increase of ACTH

*decrease of insulin

*increase of glucagon

*increase of prolactin

35

*!Female 46 years due to previously diagnosed chronic adrenal insufficiency is on the replacement therapy with hydrocortisone. When referring to the dentist because of toothache, caries was identified and tooth extraction was recommended.

What correction of treatment is the most shown due to future extraction of tooth?

*the temporary cancellation hydrocortisone

*the appointment of large doses of vitamin C

*+the additional prescription of hydrocortisone

*correction of the diet with the salt added food

*A tooth extraction on a background of antibacterial therapy