Endocrine Credit

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1. Parents of a 6-year-old child noticed that the kid developed thirst.

It lasts
about 3 weeks. Fasting blood glucose - 5.9 mmol/l (capillary blood). Which
antibodies have to be checked to diagnose diabetes?
TSH-receptors antibodies (TSHRAb)
Glutamic acid decarboxylase antibodies (GADA);
Insulin antibodies(IAA);
Thyroid-peroxidase antibodies (TPO)

2. A 13-year-old boy complains of severe general weakness, thirst, frequent


urination, itchy skin, weight loss. Recently contracted mumps. He is positive
for glutamic acid decarboxylase antibodies (GADA). What is the stage of
pathogenesis of type 1 diabetes in this patient now and which one
will be next? Immunological changes with insulitis
Initial immune processes
Complete destruction of β-cells
Active immune processes

3. The patient 38 years old takes glucocorticoids for bronchial asthma.


Recently, he has developed thirst, appetite has increased, urination has
become more frequent. Glycemia: 8.9; 7.3; 10.4; 7.8; 8.4 mmol / L. What is
the probable diagnosis?
Steroid diabetes
Impaired glucose tolerance
Type 1 diabetes
Secondary diabetes

4. The patient 32-year-old developed mouth dryness, thirst, frequent urination.


His eating behavior is impaired: he consumes a lot of snacks, mostly at
night. Oral glucose tolerance test was performed. What test results can
confirm diabetes?
Fasting glucose - 5.0 mmol/l, after 1 hour -7.2 mmol/l, after 2 hours. - 6.0 mmol/l.
Fasting glucose - 7.0 mmol/l, after 1 hour - 13.2 mmol/l, after 2 hours - 11.0 mmol/l.
Fasting glucose - 6.0 mmol/l, after 1 hour-11.2 mmol/l, after 2 hours-15.0 mmol/l.
Fasting glucose - 5.8 mmol/l, after 1 hour-7.1 mmol/l, after 2 hours. - 7.0 mmol/l

5. The child, 11 years old, 20 days after chickenpox, developed thirst, nicturia.
Objectively: decreased weight, dry skin, dry tongue. Breathing is vesicular,
heart tones are rhythmic. The abdomen is soft, painless, the liver is slightly
enlarged, moderately painful. Which test should be performed?
Complete blood count
Clinical urine test
Fasting glucose
Ketones urine

6. The patient, 55 years old, complains of itchy skin, especially in the


perineum, frequent candidiasis, increased appetite. Objectively: obese
(body mass index 38 kg/m2, waist circumference 121 cm), hypertension
(180/100 mm Hg), fasting blood glucose 6.3 mmol/l. Which tests are
necessary to perform for diabetes determination?
Lipid profile.
Oral glucose tolerance test.
Ketonemia.
Glycated hemoglobin

7. A 61-year-old patient complains of frequent dental problems, recurrent


periodontitis, and constant mouth dryness. Has been suffering from arterial
hypertension for 12 years. Objectively: BMI-35.8 kg/m2. Rhythmic heart
tones, blood pressure 170/105 mm Hg, PS -76 / min. The abdomen is soft,
painless, liver is not enlarged. Pastosity of the extremities. Laboratory:
fasting blood glucose -
6.2 mmol/l, hypercholesterolemia, GFR 81 ml / min / 1.73 m². Which diagnoses
should be suspected?
Type 2 diabetes.
AIDS.
Impaired glucose tolerance Impaired
fasting glucose.

8. A 41-year-old patient has been suffering from bronchial asthma for 19 years.
In recent years, due to worsening of the condition and more severe asthma
attacks, he started taking prednisolone. While admitting to the hospital, he
complained of polydipsia, mouth dryness, increased appetite and polyuria.
Fasting blood glucose
- 10.9 mmol/L. Which diagnoses shoud be suspected? Secondary diabetes Type
1 diabetes.
Type 2 diabetes.
Steroid diabetes
9. A 35-year-old man complains of weight loss (5.5 kg in 6 months), mouth
dryness, thirst, polyuria.. Objectively: blood pressure - 125/80 mm Hg.
Fasting blood glucose - 13.4 mmol/l; glucosuria - 25 g/l, urine acetone -
negative. Which tests should be performed to confirm diabetes?
Fructosamine level
Glucagon level
Insulin antibodies (IAA)
Glutamic acid decarboxylase antibodies
10.A 56-year-old woman came to an endocrinologist. Anamnesis: 5 years ago
she was diagnosed with type 2 diabetes. She sticks to a diet, takes no
antidiabetic agents. Fasting blood glucose range from 4.8 to 5.8 mmol/l;
aglucosuria. Which of the following methods are used to assess diabetes
compensation?
Glycated hemoglobin
Glucosuric profile
Glycemic profile
Fructosamine level

11.Woman, 34-year-old, complains of mouth dryness, thirst, polyuria, weight


loss (8 kg in 1 year). Objectively: temperature - 36.60C, repiration rate -
17/min, PS - 81 beats/min., BP - 120/70 mm Hg. Skin and mucous
membranes are dry. Fasting blood glucose - 11.9 mmol/l; glucosuria - 20
g/l, urine acetones - 0. Which tests can help to differentiate types of
diabetes?
C-peptide
Insulin level.
Glycemic profile.
Glutamic acid decarboxylase antibodies

12.The 49-year-old patient came to the family doctor. He has been suffering
from diabetes for 3 years. He takes metformin 2000 mg a day. Fasting blood
glucose -
6.4 mmol / l; ketone bodies - 0. Which of the following methods are useful to assess
the compensation of diabetes?
Glucosuric profile
Glycemic profile
Glycated hemoglobin
Fasting glucose
13.The parents of an 8-year-old child are worried about kid’s frequent urination.
Over the past two months the child has lost 4 kg, started drinking more,
complains of fatigue and drowsiness. Objectively: pale face and red cheeks,
dry tongue, the smell of acetone from the mouth, reduced skin turgor, traces
of itching in the groin area. The thyroid gland is not palpable. Daily diuresis
is about 1.9-2.2 liters. What laboratory tests should be performed to verify
the diagnosis?
Complete blood test, clinical urine test
Protein in urine
Blood glucose
Urine Ketones
14.A 57-year-old patient complaines of frequent urination and itching in the
groin area. Objectively: BMI 34.1 kg / m2, daily urinatuin - 2.5 liters.
Laboratory: fasting blood glucose - 11.2 mmol / l, glycated hemoglobin
9.6%. Make a correct diagnosis:
Diabetes type 1, decompensation
Obesity, class 1
Type 2 diabetes, decompensation
Obesity, class 2

15.A 55-year-old woman. Objectively: height 178 cm, weight 115 kg, BMI 36.3
kg / m2, tongue is dry, thyroid gland is not palpable, lungs and heart -
unchanged.
Laboratory: CBC - unchanged, fasting blood glucose 6.1 mmol / l. What tests
should be recommended?
abdomen ultrasound
Glucose tolerance test
Glycated hemoglobin
None, the patient is healthy

16.Patient U., 31 years old, complains of thirst, dry mouth, weight loss,
increased urination. Weight 85 kg, height 168 kg, BMI - 29.4 kg / m2,
HbA1c - 8.2%, fasting blood glucose 7.9 mmol/l, urine sugar 1.5%, acetone
0. C-peptide 130 (ranges - 298, 0-2350) pmol / l, insulin - 3.58 (tanges 229.1)
μIU/ dl, glutamic acid decarboxylase antibodies - 697.0 (range up to
10) mg / ml. Prescribe therapy: Prescribe diet and biguanides
Prescribe diet, biguanides and sulfonylurea derivates
Prescribe diet and basal-bolus insulin therapy
Prescribe diet, long-acting insulin and ultra-short-acting insulin (Glargin + Aspart)

17.Patient K., 34 years old, has had type 1 diabetes for 1.5 years, complains of
thirst, dry mouth, more in the morning. He uses insulin therapy Actrapid NM
12 IU Protafan NM 16 IU in the morning, Actrapid NM 8 IU at noon,
Actrapid NM 8 IU and Protafan NM 12 IU in the evening. HbA1c - 7.9%,
glycemic profile 800- 7.4 mmol/l; 1100 - 13.3 mmol/l; 1300-14.9 mmol/l;
16.00-7.1 mmol/l; 21.00 - 7.6 mmol/l; 3.00 - 5.8 mmol/l. Your treatment
tactics?
No changes required
Increase morning Actrapid NM and morning Protafan NM
Improve diet and increase morning Actrapid NM and morning Protafan NM Increase
morning insulin Protafan NM

18.Patient K., 26 years old, complains of frequent hypoglycemic conditions,


mostly at night and in the morning, recorded 2 hypoglycemic coma. Has had
diabetes mellitus type 1 since 10 years, labile with frequent ketoacidotic
conditions. He uses insulin therapy Actrapid NM 10 IU of Protafan NM 18
IU in the morning, Actrapid NM 10 IU at noon, Actrapid NM 10 IU and
Protafan NM 16 IU in the evening. Recently, developed renal complaints.
Clinical urine analysis: urine specific gravity -1020; protein - 0.99%;
epithelium - 1-2 in field of view; Leu - 3-5 in field of view, Er - 3-5 in field
of view, hyaline cylinders -3-4 in field of view.
Blood analysis: creatinine-155.7 μMol / l; urea - 12.3 mmol/l, ALT-24.5 mmol/l;
AST-21.3 mmol/l, β-lipoproteids - 31 IU, cholesterol 3.56 mg / dl. Your treatment
tactics?
Diet
Analogue insulin (peakless and ultrashort)
Analogue insulin (peakless and ultrashort) and consult a nephrologist
Prescribe hemodialysis and analogue insulin (peakless and ultrashort)

19.Patient L., 38 years old, has had type 1 diabetes for 12 years. After
hypothermia, she contracted pneumonia. Feels relatively satisfactory, but
worried about cough, chest pain, intermittent thirst, dry mouth, increased
urination. He uses Apidra (Glulizin) 10 IU in the morning, 12 IU at lunch,
10 IU in the evening. HbA1c 7.3%. glycemic profile 800- 13.1 mmol/l;
1100 - 12.7 mmol/l; 1300-13.6 mmol/l;
1600-12.3 mmol/l; 2100 - 14.9 mmol/l; 300 - 12.4 mmol/l. Urine glucose 1.5%,
acetone (+). Choose treatment tactics.
No changes
Improve a diet
Increase each insulin injection by 2-4 IU
Switch therapy to short-acting insulin until pneumonia finishes

20.Patient F., 36 years old, has had type 1 diabetes for 8 years. He uses insulin
therapy Pharmasulin H 12 IU and Pharmasulin HNP 18 IU (at 830), lunch -
Pharmasulin H 14 IU (1330), evening - Pharmasulin H 10 IU and

Pharmasulin HNP 14 IU (at 1830). The patient’s HbA1c is 8.4%. Glycemic


profile 8.00-14.1
mmol/l; 11.00 - 8.7 mmol/l; 13.00-5.7 mmol/l; 16.00-8.3 mmol/l; 21.00 - 8.9
mmol/l; 3.00 - 4.4 mmol/l. Urine sugar 0.5%, acetone (0). Is it advisable to change
treatment tactics?
No change in therapy is required
Improve a diet
Strengthen diet and reduce the dose of evening Pharmasulin HNP
Strengthen the diet and postpone the dose of evening Pharmasulin HNP to
22.00-23.00

21.Patient L., 34 years old, complains of recurrent hypoglycemic conditions not


related to exercise or eating disorders, which occur 2 hours after dinner. The
patient He uses insulin therapy Pharmasulin H 12 IU and Pharmasulin HNP
20 IU in the morning, Pharmasulin H 8 IU at lunch, Pharmasulin H 12 IU and
Pharmasulin HNP 14 IU in the evening. HbA1c - 7.8%, glycemic profile 800-
7.4 mmol/l; 1100 - 8.3 mmol/l; 1300-6.8 mmol/l; 1600-7.3 mmol/l; 2100 - 3.6
mmol/l; 300 - 8.2 mmol/l. Your treatment tactics?
Reduce the amount of calories of dinner
Increase the dose of Actrapid NM in the evening
Reduce the dose of Actrapid NM in the evening
Increase the amount of calories of dinner and reduce the dose of insulin Actrapid NM
in the evening

22.Patient M., 29 years old, recently developed type 1 diabetes. In the hospital,
where the patient he was prescribed insulin therapy: Pharmasulin H 30/70 at a
dose of 30 IU (18 IU in the morning and 12 IU in the evening). The
constitution is
normosthenic, height 165 cm, weight - 64 kg, BMI - 22.9 kg / m2, HbA1c - 8.6%.
Glycemic profile: 800 - 8.4 mmol/l; 1100 - 13.1 mmol/l; 1300-11.8 mmol/l;
1600-16.2 mmol/l; 2100 - 6.6 mmol/l; 300 - 10.5 mmol/l. Your treatment tactics.
Improve a diet
Switch to the basal-bolus of insulin therapy
Switch to short- and medium-acting insulin in the morning, short-acting at
lunch, short-acting in the evening
Increase the evening dose of insulin Pharmasulin H 30/70

23.Which of the following statements are typical for type 1 diabetes?


Gradual start
Weight loss
The need for insulin therapy
Stable flow

24.The level of C-peptide is usually: Reduced in type 2 diabetes.


Reduced in type 1 diabetes.
Reduced in LADA diabetes. Gets
activated by insulin therapy.

25.Determination of immunoreactive insulin is performed: In people who


regularly uses insulin.
In patients with a predisposition to labile diabetes.
In people who have never received insulin. In
patients with newly diagnosed type 1 diabetes.
1. Parents of a 6-year-old child noticed that the kid developed thirst. It lasts
about 3 weeks. Fasting blood glucose - 5.9 mmol/l (capillary blood). Which
antibodies have to be checked to diagnose diabetes?
TSH-receptors antibodies (TSHRAb)
Glutamic acid decarboxylase antibodies (GADA);
Insulin antibodies(IAA);
Thyroid-peroxidase antibodies (TPO)

2. A 13-year-old boy complains of severe general weakness, thirst, frequent


urination, itchy skin, weight loss. Recently contracted mumps. He is positive
for glutamic acid decarboxylase antibodies (GADA). What is the stage of
pathogenesis of type 1 diabetes in this patient now and which one
will be next? Immunological changes with insulitis
Initial immune processes
Complete destruction of β-cells
Active immune processes

3. The patient 38 years old takes glucocorticoids for bronchial asthma.


Recently, he has developed thirst, appetite has increased, urination has
become more frequent. Glycemia: 8.9; 7.3; 10.4; 7.8; 8.4 mmol / L. What is
the probable diagnosis?
Steroid diabetes
Impaired glucose tolerance
Type 1 diabetes
Secondary diabetes

4. The patient 32-year-old developed mouth dryness, thirst, frequent urination.


His eating behavior is impaired: he consumes a lot of snacks, mostly at
night. Oral glucose tolerance test was performed. What test results can
confirm diabetes?
Fasting glucose - 5.0 mmol/l, after 1 hour -7.2 mmol/l, after 2 hours. - 6.0 mmol/l.
Fasting glucose - 7.0 mmol/l, after 1 hour - 13.2 mmol/l, after 2 hours - 11.0 mmol/l
Fasting glucose - 6.0 mmol/l, after 1 hour-11.2 mmol/l, after 2 hours-15.0 mmol/l
Fasting glucose - 5.8 mmol/l, after 1 hour-7.1 mmol/l, after 2 hours. - 7.0 mmol/l

5. The child, 11 years old, 20 days after chickenpox, developed thirst, nicturia.
Objectively: decreased weight, dry skin, dry tongue. Breathing is vesicular,
heart tones are rhythmic. The abdomen is soft, painless, the liver is slightly
enlarged, moderately painful. Which test should be performed?
Complete blood count
Clinical urine test
26.
Which of the following insulins are characterized by the start of action in
0.5-1 hours, the peak of action in 2-3 hours, the duration of action - 5-8
hours? Humulin R
Protafan NM
Actrapid NM
Humulin 30/70

27.Which of the following insulins are characterized by the start of action in


0.5-1.5 hours, the peak of action in 4-6 hours, the duration of action - 8-
16 hours?
Insuman Basal
Novorapid (Aspart)
Protafan NM
Insuman Comb 25

28.Which of the following insulins are biphasic agents? Actrapid NM


Lantus (Glargin 100)
Mixstard NM
Insuman Comb 25

29.Which of the following insulins are recombinant analogues of


ultrashortacting insulin
Humalog (Insulin Lispro)
Lantus (Glargin 100)
Toujeo (Glargin 300)
Novorapid (Aspart)

30.Which of the following insulins are recombinant analogues of long-acting


insulin Toujeo (Glargin 300)
Tresiba (Degludek)
Humalog Mix 25
Novorapid (Aspart)

31.A diabetic patient suddenly lost consciousness at 11 o'clock. It is known


that the patient did not eat breakfast after insulin injection. Intensive
care?
Glucagon 1.0 i/m.
40% glucose 20-40 ml IV push.
Wait for blood test results. Glucose
with insulin infusion.
32.The 65-year-old patient was admitted to the gynecological department
with uterine bleeding. For 5 years she was under a gynecologist
supervision for fibroids. Three years ago, the patient was diagnosed with
diabetes type 2, which was managed by diet and gliclazide. Blood
glucose - 8 mmol/l, urine glucose - 0.5%, ketone bodies
- negative. The patient requires surgery. Your tactics?
Diet.
Discontinue gliclazide, short-acting insulin monotherapy.
Add maninil.
Combination of short- and long-acting insulin.

33.A 62-year-old woman is obese, diabetes for 22 years. Constantly takes oral
hypoglycemic drugs. Diabetes is subcompensated. Developed severe pain in
the epigastrium, constipation, bloating, loose stools. Which are probable
diagnoses? Chronic pancreatitis.
Chronic gastritis.
Chronic cholecystitis.
Diabetic hepatosis.

34.Agents used for hypoglycemic coma management, except:


Insulin.
Cordiamine.
Prednisolone.
Glucagon.

35.A pregnant woman who doesn’t have diabetes in history, got labaratory
results: glycemia - 7.73 mmol/l, ketonuria. When she was sticking to the diet,
glycemia decreased to 7.0 mmol/l, ketonuria remains. What are the next steps
to manage this patient?
Totally exclude fats and allow sugars.
Increase amounts of sugars.
Add metformin.
Rescribe insulin therapy.

36.Patient with type 2 diabetes, obesity and pulmonary tuberculosis. He takes


metformin 2000 mg/day. Your tactics?
Continue metformin.
Prescribe insulin therapy.
Add sulfonylurea derivates.
Add liraglutide.
37.Agents used for lactic acidosis management, except: Intensive insulin therapy
Basis-bolus insulin therapy 40% glucose IV.
Sodium bicarbonate IV.
38.A pregnant woman with diabetes was hospitalized in the intensive care unit.
Which insulin regimen would you choose? Intensive insulin therapy Basis-
bolus insulin therapy.
Metformin
5% glucose with short-acting insulin intravenously

39.For lactic acidosis management are used following agents: Short-acting


insulin.
Trisamine.
40% glucose solution. Methylene
blue 1%

40.All of these mechanisms are involved in the pathogenesis of hypoglycemic


coma, except?
Activation of the sympatho-adrenal system.
Insufficient supply of insulin.
Release of contrainsular hormones into the blood. Dehydration.

41.Which of these tests should be performed in patients with diabetes before a


planned pregnancy?
Glucosuria in the morning portion of urine.
C-peptide.
HbA1c.
Fructosamine.

42.A woman consulted an endocrinologist due to miscarriage. From her personal


history it was found that the first pregnancy ended with the death of the fetus
in the womb at 38 weeks, two after that ended with early miscarriages.
Objectively: obese, BMI – 33,2 kg/m2. Labaratory:
glucosuria. Which of the following tests should be performed?
HbA1c.
Fructosamine Basal
thermometry. Oral
glucose tolerance

43.Typical signs of diabetic neurotrophic ulcer are:


Painful ulcer.
Painless ulcer.
Arterial blood flow to the arteries of the feet is significantly reduced. The
most common localization is on the lateral surface of the foot.

44.Patient D., 50 years old, has had type 2 diabetes for 10 years. Since diabetes
onset she constantly takes glibenclamide 5 mg 3 times a day. She has not
consulted an endocrinologist for the past three years. Over the last year, she
lost 9 kg.
Objectively: body weight 58 kg, height 166 cm, BMI - 21.02 kg/m2. Laboratory:
fasting blood glucose 13.0 mmol/L, after 2 hours - 16.0 mmol/L, glycated
hemoglobin - 13.2%. Choose treatment tactics:
Add biguanides to glibenclamide.
Prescribe basal-bolus insulin therapy after short-term intensive insulin therapy.
Add SGLT-2 inhibitors
Prescribe Actrapid in 4 injections, followed by switching to basal-bolus insulin
therapy

45.A 60-year-old woman has had type 2 diabetes for 4 years. She takes
metformin at a dose of 1000 mg twice a day. Fasting blood glucose - 8.2
mmol/L, two hours after a meal - 10.1 mmol/L., Glycated hemoglobin -
8.6%. Clinical urine test - proteinuria up to 0.099% ₒ. Objectively: height
167 cm, body weight 98 kg (BMI -
35.1 kg/m2). Cardiologist: “Coronary heart disease. Postinfarction cardiosclerosis.
HF IIA (NYHA II). Symptomatic hypertension, III stage, II grade”. Prescribe
treatment.
Do not change the therapy, but improve the diet.
Combine metformin with long-acting insulin.
Add dapagliflozin.
Switch to a combination with sulfonylurea derivatives.
Add empagliflozin.
Add liraglutide

46.A 49-year-old woman has had type 2 diabetes for 6 years. Takes metformin
at a dose of 1000 mg per day. Fasting blood glucose 9.2 mmol/L, two hours
after a meal - 11.5 mmol/L., Glycated hemoglobin - 8.2%. Clinical urine
test: proteinuria
up to 0.033% ₒ. Objectively - height 162 cm, body weight 102 kg (BMI - 39.2
kg/m2). Correct therapy.
Do not change therapy, but recommend to improve the diet.
Combine metformin with repaglinide.
Add GLP-1 agonist to metformin. Add
sulfonylureas derivate agent.
Add SGLT-2 inhibitor.
Increase the daily dose of metformin to 2000 mg

47.A 58-year-old woman has been suffering from diabetes for 4 years. She
takes glimepiride at a dose of 4 mg per day. She follows a diet. Laboratory:
fasting blood glucose 8.2 mmol/L, postprandial - 9.3 mmol/L, glycated
hemoglobin 8.5%. BMI 24 kg/m2. Intensify therapy.
Increase the daily dose of glimepiride to 6 mg and add repaglinide.
Add metformin at a dose of 500 mg per day.
Prescribe dapagliflozin + metformin, discontinue glimepiride Add
metformin at a dose of 2000 mg per day to treatment.
Diet, insulin therapy with intermediate-acting insulin.
Prescribe empagliflozin + metformin, discontinue glimepiride

48.The patient is 74 years old, has type 2 diabetes. Takes glibenclamide at a


dose of 15 mg and metformin - 2000 mg per day. After physical activity felt
weakness, dizziness, shortness of breath, pain in the heart. Blood pressure
70/30 mm Hg.
Pulse - 110 beats / min. ECG: ST segment increase, QS-phenomen. The patient was
hospitalized to the cardiology department. How to manage this patient?
Short-acting insulin therapy in 4 injections.
Discontinue metformin and glibenclamide, administer Protafan
Discontinue metformin and glibenclamide, administer
Actrapid. Prescribe emphagliflozin

49.A woman, 57 years old, with obesity 3 grade. Two months ago he was
diagnosed with diabetes. The patient's endocrinologist recommended a low-
calorie diet and exercises. The level of fasting blood glucose is 8.2 mmol/L,
glycated hemoglobin is 8.1%. Which antidiabetic drug should not be
recommended to the patient?
Metformin.
Gliclazide.
Repaglinide.
Glimepiride.
Empagliflozin.
Glibenclamide.
Dapagliflozin
Liraglutide

50.Patient B, 57 years old. He suffers from type 2 diabetes mellitus, uses


Sinjardy (a combination of empagliflozin 12.5 mg and metformin 1000 mg)
twice a day. He has been suffering from acute respiratory disease caused by
coronavirus
COVID-19 for 10 days. He was diagnosed with bilateral polysegmental pneumonia
with lesions of 60% of the lungs, and was hospitalized. Currently, SpO2 is 76%.
Specify how to manage this patient:
Short-acting insulin therapy.
Add basal insulin.
Cancel sinjardy.
After recovery, the patient can take oral hypoglycemic drugs.
Add gliclazide 60 mg to therapy. Add Lantus 22 Units to
therapy

51.A 64-year-old woman with BMI 28.6 kg/m2 complains of itching in the
inner surfaces of thighs and external genitalia. In the history - MI (EF -
55%).
Labaratory: glycemia - 8.7 mmol/L, glycated hemoglobin - 8.3%, no acetone in the
urine. Your treatment tactics (Choose all possible options).
Lifestyle modification.
Biguanides.
Sulfonylureas of the second generation (gliclazide MR).
Administration of short-acting insulin.
SGLT-2 inhibitors.
Basal-bolus insulin therapy

52.A 64-year-old woman has type 2 diabetes. She takes glimepiride at a dose of
4 mg per day. Fasting blood glucose is 7.8 mmol/L, two hours after a meal -
10.5 mmol/L. Blood pressure 150/90 mm Hg. Lipidogram: dyslipidemia,
type IIB. Ophthalmologist: "Diabetic proliferative retinopathy". How to
manage this patient?
Laser photocoagulation of the retina.
Insulin therapy immediately.
Gliclazide.
To correct the lipid profile and blood pressure.
Add SGLT-2 inhibitors. Add
GLP-1 agonists

53.A patient with type 2 diabetes, 59 years old, has been using basal-bolus
therapy (Actrapid + Protafan). Developed frequent headaches in the
morning, palpitations, nightmares, night sweating. What can be the reasons
for these symptoms?
Hypoglycemia.
An overdose of Protafan in the evening.
Menopausal neurosis. Unstable
angina.

54.Which of the following methods is mandatory in the treatment of all clinical


forms of type 2 diabetes?
Diet.
Phytopreparations.
Physical activity
Physiotherapeutic agents.
Hypoglycemic agents.
Insulin therapy with short-acting insulin

55.A 45-year-old woman came to an endocrinologist with concerns about the


possibility of developing of type 2 diabetes. Complained of mouth dryness
and thirst. No family history of diabetes. Objectively: BMI - 23.2 kg/m2.
Fasting blood glucose - 5.2 mmol/L. Choose high-risk groups for type 2
diabetes.
The first degree of affinity with patients with diabetes.
Pregnant women.
People with dyslipoproteinemia and hypertension.
People who use glucocorticosteroids on a regular basis.
Women with polycystic ovary syndrome and BMI ≥ 30 kg/m2. People
with acute pancreatitis

56.Patient 43 years old complained of weight gain, drowsiness, difficulty


concentrating, secondary amenorrhea. Objectively: height 165 cm, weight 78
kg, female phenotype, t = 35,8C, HR = 58 / min, blood pressure - 105/60
mm/Hg.
Other internal organs unchanged. Thyroid gland diffusely compacted 1 degree.
Celebrated galactorrhea 1 st. Laboratory study found an increase in TSH and
prolactin levels and decrease FT4 level. What should be the subject of differential
diagnosis?
Primary hypothyroidism. Tertiary
hypothyroidism.
Polycystic ovary. Prolactinoma.

57.A resident of the mountain district of Ivano-Frankivsk region, 22 years old,


complains of misbirths (in history - 2 abortions). Palpation of the thyroid
gland of the first degree, elastic, homogeneous; ultrasound - slightly reduced
echo and heterogeneity of the structure. There are no clinical signs of thyroid
dysfunction. Laboratory: TSH level is 7.2 mIU / l (N: 0.3–4.0), FT4 level is
1.22 ng / dL (N: 0.93–1.7), anti-TPO - 120 IU / ml ( N: <100). What is the
probable cause of this situation?
Autoimmune thyroiditis, subclinical hypothyroidism.
Iodine deficiency subclinical hypothyroidism.
Thyrotoxicosis.
Post-stress disorder.

58.Sick 54 years old, complains of rapid fatigue, swelling in the neck, feeling
cold, constipation. Sick for 3 years. Objectively: height is 172 cm, weight is
94 kg, the face is pasty, dry skin, hair thin, pulse 60 /minute, blood pressure
is 100/70 mm/ Hg. The thyroid gland is diffusely enlarged 2 degree,
moderately dense, heterogeneous, painless. Ultrasound: 34 cm3 volume,
echogenicity reduced, structure heterogeneous, blood flow increased. What
is the likely diagnosis?
Endemic diffuse goiter, hypothyroidism. Hashimoto's
thyroiditis, hypothyroidism.
Diffuse toxic goiter. Autoimmune
thyroiditis, hypothyroidism.

59.In a 32-year-old woman, who has no complaints, palpation of the thyroid


gland found Ø 1.5 cm in the left lobe, moderately dense in consistency,
indistinctly delineated, sensitive to palpation. In ultrasound examination, it
has reduced echogenicity, heterogeneous structure, with fuzzy contours.
What is the scope of the examination that is appropriate to clarify the
diagnosis?
TSH level determination.
Determination of TSH, FT4 and FT3 levels.
Fine needle aspiration biopsy.
Determination of thyroglobulin content.
Determination of calcitonin level
%-100% Determination of vitamin D content

60.Woman 59 years old, complains of dry skin, memory loss, constipation,


feeling cold. On examination: dry, cold to the touch skin, slow reflexes,
swelling of the face and extremities. These symptoms are not typical for:
Graves-Bazedov Disease.
Manifest hypothyroidism.
%100%Subclinical hypothyroidism.
Subacute thyroiditis

61.Patient M., 44, who had a sore throat 2 weeks ago, had sudden pain in the
right half of his neck with irradiation into his lower jaw and ear. Objectively:
thyroid gland of the second century. due to the right lobe, which is dense and
sharply painful on palpation; body temperature 38,6˚С; strong weakness,
hyperhidrosis. Which of the following may be likely in a patient:
Nodal Toxic Goiter.
Subacute thyroiditis (de Kerven).
Hashimoto's thyroiditis. Acute
purulent thyroiditis.

62.Patient 66 years old, for 14 years is being monitored for multiple nodular
euthyroid goiter IB degree. Heredity is not burdened. Clinically and
sonographically, the nodes do not show active growth. Cytological
examination of the dominant biopsy specimen confirmed a benign process.
Which therapeutic tactic does not have sufficient grounds in this case?
Surgical treatment.
Radioiodine therapy.
Observation, annual control.
Use of thiamazole.

63.A 47-year-old man who suffered a sore throat 3 weeks ago had pain in the
left half of his neck with irradiation in his lower jaw and ear. Objectively:
thyroid gland of the second century, at the expense of the left lobe, which is
considerably thickened and sharply painful on palpation; body temperature
38,3˚С; clinical and
laboratory signs of thyrotoxicosis, ESR = 48 mm / h. Which of the following
medication should not be used in this patient?
Thiamazole.
Ciprofloxacin.
Prednisone.
Levothyroxine.
Celecoxib
Torasemide

64.A man of 39 years, drew attention to the swelling of the right half of the
neck, which has gradually increased over the past 10 months; predisposition
to diarrhea. Palpator in the right lobe of the thyroid gland revealed a Ø 3 cm,
dense consistency, indistinctly delimited, restrictedly mobile, not painful. At
ultrasound examination it has low echogenicity, with fuzzy contours and
increased blood flow. Serum concentrations of TSH, FT4 and thyroglobulin
within normal limits, calcitonin – significantly increased. What is the likely
diagnosis?
Differentiated thyroid cancer.
Medullary thyroid cancer.
Anaplastic thyroid cancer. C-cell
carcinoma of the thyroid gland.

65.A 56-year-old woman complains of apathy, lethargy, memory loss, feeling


cold, dry skin, constipation, facial swelling. Objectively: temperature is
36.00 C, heart rate is 53 rpm, blood pressure is 110/85. On
electrocardiography (ECG) the interval R-R is increased, voltage of waves is
reduced, and inversion of T wave. Hormone concentrations: FT4 = 0.70 ng /
dl (N: 0.93-1.7), TSH = 22.5 mIU / l (N:
0.3 -4.0), anti-TPO = 335MO / ml (N: <100). Thyroid enlarged to II degree,
moderately dense and patchy, hilly, not painful. What is your diagnosis?
Autoimmune thyroiditis, euthyroid condition.
Autoimmune thyroiditis, manifest hypothyroidism.
Hashimoto's disease, manifest hypothyroidism. Endemic
goiter, manifest hypothyroidism.

66.Patient M., 47 years old, has been treated for chronic hypochromic anemia
for 3 years. In the last 4 - 5 months, she began to worry about frostbite,
drowsiness, constipation, memory loss. Objectively: leather, dry, hair loss on
the temples. BP is 100/70 mm Hg., bradycardia. Hb = 109 g / l, ferritin = 105
ng / ml (N), TSH = 14,7 mMO / l (N: 0,3–4,0). Which statement is most
likely?
Iron deficiency anemia → continue treatment.
Iron deficiency anemia → intensify treatment.
%- Hypothyroidism → replacement therapy. Hypothyroidism
→ Levothyroxine.

67.Patient K., 58, complains of unpleasant sensations in the neck, difficulty


breathing, hoarseness. Duration is unknown. There are no objective signs of
thyroid dysfunction. The thyroid gland is enlarged up to the 2nd century. It is
very dense in consistency, with a smooth surface, it is limited in mobility, it
is not painful. Laboratory: TSH = 2.18 mIU / l (N: 0.3–4.0); antibodies to
PO, thyroglobulin and calcitonin within normal limits. What diagnosis
should be considered?
Subacute thyroiditis (de Kerven).
Autoimmune thyroiditis (Hashimoto).
Thyroid cancer. Fibrous
thyroiditis (Riddle).

68.Patient M., 35, who had a sore throat 3 weeks ago, had pain in the right half
of his neck with irradiation in his lower jaw and ear. Objectively: thyroid
gland of the second century. due to the right lobe, which is fairly dense and
sharply painful on palpation; body temperature 38,0˚С; moderate signs of
thyrotoxicosis. The scope of examination in this patient should include all
items except:
Thyroid ultrasound.
TSH, FT4, FT3, thyroglobulin.
Antibodies to TPO and TG.
Calcitonin level.

69.Patient K., 69 years old, addressed the appearance of a circular formation on


the neck 3 months ago. Worked in the Chernobyl zone in 1987-1988.
Objectively: in the lower pole of the right lobe of the thyroid gland, the
nodular formation of an oval shape of 3.2 x 2.7 cm in size, dense
consistency, with uneven hilly surface, painless, motile. Ultrasound: a large
part of the right lobe is occupied by a heterogeneous structure of a fuzzy
contour, containing multiple microcalcins.
Suggest optimal tactics:
Surgical treatment.
Active surveillance.
Prolonged use of levothyroxine.
Intraoperative rapid biopsy.

70.The man is 50 years old, nodular goiter and moderate clinical signs of
thyrotoxicosis were detected. Laboratory: TSH = 0.12 mIU / l (N: 0.3–4.0),
FT4 = 1.76 ng / dL (N: 0.93–1.7), FT3 = 5.88 pg / dL (N: 2.5-4.3). On the
scintigram - "hot zone" in the projection of the node. Which of the following
is suitable for diagnosis?
Diffuse toxic goiter.
Thyrotoxicosis syndrome.
Nodular goiter, euthyroidism. Toxic
adenoma of the thyroid gland.

71.Patient V., with postoperative hypothyroidism, who was prescribed 125 μg


of L-thyroxine per day, tachycardia, sweating, sleep disorders, tremor of the
fingers.
How can a diagnosis be made?
Iatrogenic thyrotoxicosis.
Drug thyrotoxicosis.
Thyroid hormone resistance.
Toxic goiter recurrence.
72.Patient A., 33 years old, after experiencing psycho-emotional stress
complains of irritability, sweating, tremor of the hands, palpitations (≈ 110
beats / min.), Weight loss with the appetite preserved. The thyroid gland is
enlarged to the second degree at the expense of all departments, elastic, not
painful, auscultative systolic noise is heard over it. The above symptoms are
most consistent with:
Diffuse toxic goiter.
Neurasthenia.
Graves-Bazedov's disease.
Hypoparathyroidism.

73.Patient M., 36 years. Complains of irritability, palpitations, sweating, general


weakness, shortness of breath on loading. Weight lost 7 kg. Objectively:
height 168 cm, weight 58 kg. The skin is moist. The thyroid gland is
enlarged at the expense of all departments, elastic, without nodular
formations. There is a glint, a slight bilateral exophthalmos, tremor of the
fingers. Pulse 120 for/ min., BP 150/60 mm Hg. Art. Which diagnoses
should not be considered?
Toxic thyroid adenoma.
Diffuse toxic goiter.
Thyrotoxicosis syndrome.
Chronic fibrous thyroiditis

74.Patient O., 40 years. Has been suffering from diffuse toxic goiter for 6 years
and has had recurrences twice. Which of the medicines administered at
different times has anti-thyroid effects? Prednisolone Thiamazole.
Carbimazole.
Anaprilin.

75.Patient M., has been suffering from diffuse toxic goiter for 10 years. Due to a
postponed appendectomy, a thyrotoxic crisis developed due to poor
compensation of thyrotoxicosis. To remove the patient from this critical
condition use: Thiamazole.
Hydrocortisone.
Insulini.
Levothyroxine.
Iodine in large doses
Adrenalini

76.Woman 39 years old, emotionally labile, on examination - tremor of fingers,


skin moist, warm, apical impulse increased, atrial fibrillation. Temperature is
37.2 C, heart rate is 96 beats / min., blood pressure 170/70 mm Hg. Art.
Thyroid gland II degree. The patient's pathogenetic mechanisms are at the
heart of impaired cardiovascular function:
Increased receptor sensitivity to corticosteroids. Increasing
the sensitivity of receptors to catecholamines Increased
catabolism in the myocardium.
The effect of thyroid stimulating antibodies.
Effect of excess thyroid hormones on the myocardium
Decrease receptor sensitivity to corticosteroids

77.In a patient of 37 years after surgical treatment of diffuse toxic goiter


seizures of chewing muscles, hands with predominance of flexor tone are
observed. Cramps are painful, symmetrical. On examination positive
symptoms of Hvostek, Trusso. Which of the following is suitable for
diagnosis?
Postoperative hypoparathyroidism.
Latent form.
Manifest form.
Epilepsy.

78.A woman 37 years old in the postpartum period experienced nausea,


vomiting, severe psychomotor agitation with partial disorientation,
hyperthermia up to 39.5˚C, tachyarrhythmia, increased blood pressure up to
180/80 mm Hg., abdominal pain. From the anamnesis it is known that the
patient was treated for a long time with mercazolyl. Suspected thyrotoxic
crisis. What pathologies may require differential diagnosis?
Acute psychosis.
Hypercalcemic crisis
Hypertensive crisis.
Sepsis.
Neurasthenia
Postoperative hypoparathyroidism

79.Patient P., 35, received complaints of weight loss, severe weakness,


palpitations, limb tremor, sweating. Objectively: the thyroid gland enlarged
to the second century, at the expense of all departments, elastic, not painful,
blood pressure 180/60 mm Hg. Art., pulse 120 beats / min. Bilateral
ophthalmopathy of the
III-IV centuries. Laboratory: TSH = 0.02 mIU / l (N: 0.3–4.0), FT4 = 2.26 ng / dL
(N: 0.93–1.7), FT3 = 6.88 pg / dL (N: 2.5–4.3), antibodies to the TSH receptor =
18.5 IU / l (N: <1.75). In the etiopathogenesis of this disease the leading role is
played by:
Provoking factors.
Genetic predisposition.
Immune mechanisms of development.
Non-immune mechanisms of development.
Adrenal dysfunction
Pancreatic dysfunction
80. Patient N., 42 years old, complains of headache, tearing, feeling of sand in
the eyes, fissure, sometimes diplopia. He became ill suddenly after suffering
from the flu. He was treated by an optometrist, but to no effect. Objectively:
skin moist, heart rate 92 beats / min, blood pressure 140/75 mm Hg. Art.
Pronounced bilateral exophthalmos, conjunctivitis, movements of the
eyeballs are limited. The
thyroid gland is diffusely enlarged IB degree, smooth not painful. Signs of which
pathology was present in the described clinical picture?
Hypothyroidism syndrome.
Graves-Bazedov's disease.
Subacute thyroiditis.
Autoimmune thyroiditis.
Endocrine orbitopathy.

81. In the patient 34, after experiencing stress, general weakness, weight loss of
3 kg, irritability, palpitations, tremor of the fingers appeared.
Objectively: heart rate 100 beats / minute, blood pressure 140/65 mm Hg
Art., skin moist, warm, light bilateral exophthalmos. The thyroid gland
enlarged to the 2nd century, moderately compacted, homogeneous, slightly
painful. Which of the following diagnoses should be considered?
Acute purulent thyroiditis.
Endemic goiter.
Diffuse toxic goiter.
Autoimmune thyroiditis, thyrotoxic stage.
Subacute thyroiditis, thyrotoxic stage
Hypothyroidism

82. Patient S., 63, complains of increased irritability, emotional lability,


increased sweating, palpitations, tremor of the fingers. Objectively: heart
rate ≈ 110 beats / minute, atrial fibrillation, blood pressure 150/60 mm Hg
The thyroid gland (thyroid gland) is enlarged to the second century, palpated
by several well-defined nodes with a diameter of 1 to 2 cm in both parts.
Laboratory: TSH = 0.02 mIU / L (N: 0.3–4.0), FT4 = 1.86 ng / dl (N:
0.93–1.7), FT3 = 9.66 ng / dl ( N: 2,5-4,3), antibodies to the TSH receptor
= 0.65 IU / l (N: <1,75). Which of the following definitions matches the
diagnosis?
Diffuse toxic goiter.
Endemic nodular goiter.
Multi-site toxic goiter.
Functional autonomy of the thyroid gland, Art. decompensation. Subacute
thyroiditis, thyrotoxic stage.

83. The intensive care unit received a patient with suspected hypercalcemic
crisis. Blood calcium 3.3 mmol / l. What should the treatment program
include?
Sedative therapy.
Use of glucocorticoids.
Rehydration, forced diuresis.
Introduction of calcitonin and / or bisphosphonates.
Antihypertensives
The use of thyrostatics

84. The family doctor has a patient of 37 years old with complaints of fatigue,
loss of body weight. The patient loves salted food. During examination his
face and hands turn out to be hyperpigmented, BMI 18.6 kg/m2 AO 80/55
mmHg Elevated blood ACTH and potassiumlevels, reduced cortisol,
sodium, testosterone, and glucose were found in the laboratory, and
tuberculosis is not confirmed. A diagnosis of primary chronic adrenal cortex
failure has been established. What treatment should be prescribed?
Glucocorticoids
Mineralocorticoids
Diuretics
% -100%. alpha-blocker

85. The patient, 39 years old suffers from sudden increase of arterial blood
pressure up to 245/110 mmHg, followed with nausea, vomiting, tachycardia,
perspiration. After the attack, there is an abundant release of urine. On the
sonography of the kidneys, a section of lighting was found adjacent to the
upper pole of the right kidney, which belongs to the adrenal gland. What
additional studies need to be done to establish a diagnosis?
Determination of insulin and C-peptide in blood.
Determination of the level of vanillmigdal acid in urine.
Determination of catecholamine excretion. Blood
renin determination.

86. The patient, 28 years old, taken to the reception department. The disease
began gradually, 5 months ago. The condition deteriorated sharply after
SARS. Weakened heart sounds, HR 61 od/min., arterial blood pressure
85/40 mmHg. The abdomen is somewhat painful in the epigastric region.
Leukocytes - 8.1x109/l, blood glucose - 3.1 mmol/l. Diagnosis: Adison
crisis. What clinical signs are characteristic of this condition?
Nausea, vomiting. Muscle
weakness.
Abdominal pain.
Bronze skin color.
Dizziness.
Constipation.
87. A woman was taken to the hospital 48 years old. Complaints: sharp head
pain, heartbeat, feeling of fear, pain in the regions of heart and abdomen,
nausea.
During examination: pale skin, HR 130 ud/min, arterial blood pressure 220/110
mmHg Suspected of pheochromocytoma. With what diseases should differential
diagnosis be carried out?
Myocardial infarction.
Thyrotoxicosis.
Vegetal dystonia.
Migraine.

88. The patient, 52, general urine analysis: specific gravity of urine 1004;
proteinuria. K-2.4 mmol/l; level of 18-hydroxycorticosterone in serum - 97
ng (norm <30); on ECG signs of hypokalemia. Suspected Conn”s syndrom.
What blood tests do you need to do to confirm your diagnosis?
% Determination of renin in blood plasma. blood
test for cortisol.
ACTH study. blood test
for aldosterone.

89. The patient complains of weakness, excitability, hyperpigmentation of open


areas of the skin, nausea and vomiting, reduced potency. Arterial blood
pressure 85/60 mmHg, ECG: reduced voltage, S-T segment depression. In
the blood: lymphocytosis, eosinophilia, normochromic anemia, cortisol in
the blood 110 nmol/l. What statement will be correct for blood changes in
chronic excess failure?
Hypokalemia.
Hypercholesterolemia,
Hypocholesterolemia,
Hypernatremia,
Hyperkalemia.
hyponatremia.
90. A 42 years old patient has long been treated for arterial hypertension, a
cardiologist suspected Conn”s disease. What blood tests do you need to do
to confirm the diagnosis?
Blood aldosterone determination.
Blood cortisol definition. Blood
Calcium Determination.
adrenal ultrasound

91. A patient ,33, complains of weight gain, weakness, drowsiness, headache,


reduced potency. Ob: height 173 cm, weight 108 kg. Depositing fat mainly
on the shoulders, torso. The skin is dry with a crimson-cyanotic pattern. On
the shoulders, chest, thighs, crimson-blue streaks. Blood pressure 160/100
mm.Hg.
Pulse 76 oud/min. Evaluate the results of blood electrolytes: potassium 3.0
mmol/l, sodium 160 mmol/l? % Hypokalemia.
Hyperkalemia
Normocalemia Hypernatremia.

92. What are the forms of adrenogenital syndrome (congenital adrenal cortex
hyperplasia) deficient in 21-hydroxylase?
Salt-losing
Virilna
Non-classical (post-pubertal)
None of the listed
Hypertensive. Hypotonic.

93. A patient, 36, complaints of periodic compressive pain in the heart area,
marked weakness in the proximal muscles of the limbs and seizures, pain in
the back of the head, dizziness for 2 years. Height 177 cm, body weight 82
kg. Pulse 92/min. Blood pressure 195/100 mmHg. Urine test according to
Zimnitsky: polyuria, nicturia with isostenuria. What is the claim about
Conn”s syndrome?
Low renin level
Hyponatremia
Hypokalemia
Generalized edema
Arterial hypertension
Arterial hypotension.

94. A patient 39, pheochromocytoma is diagnosed. Complains of high blood


pressure, polyuria, headache, general weakness, perspiration, tremor.
Objectively: Blood pressure 175/100-210/115 mm Hg, Ps-126 ud/min.
Blood Na level 150 mmol/L. K-2,8 mmol/l. What are the features of arterial
hypertension in pheochromocytoma?
Increase in systolic and diastolic blood pressure
Slow Buying Crisis
Pulse pressure increase expressed
Repeated similar crises in history
Paradoxical hypertensive response to α-blockers. Lower
systolic and diastolic blood pressure.

95. The patient suffers from Addison”s disease. Receives prednisolone daily.
After the influenza, the patients condition deteriorated sharply: there was
pain in the heart, weakness, dizziness, nausea, liquid defecation. Pulse 113
ud/min, Blood pressure 64/36 mmHg. What is the basis for the development
of a hypotensive condition in Addison”s disease?
Sodium loss
Dehydration
Circulating Blood Volume Increase
Reduced sensitivity of vessel adrenoceptors to catecholamines
None of the listed items. Potassium Loss.

96. The patient is 38 years old with complaints of obesity, general weakness,
drowsiness, headache,4 years after suffering a viral infection. Objectively:
Height 171 cm, body weight 77 kg. Laboratory: cortisol in blood - 51 μg/dL
(4.3-22.4), ACTH - 45.38 ng/L (8.3-57.8), sodium - 159mmol/L (132-146),
potassium - 3.2 mmol/L (3.5-5.5), glucose-tolerant test: 5.8-10.7 mmol/L.
Based on the examinations, the patient was diagnosed with ItsenkoCushing
syndrome. Which of these clinical signs are characteristic of this disease:
Dysplastic obesity
Menoragia
Arterial hypertension
Potency Reduction
Crimson-Blue Lines
Arterial hypotension.

97. A woman, 33, complains of body weight loss, dizziness, dyspeptic


disorders, muscle and joint, BP - 100/70 mm Hg, Ps 92, rhythmic. There are
no swellings. ZAC: Hb 92 g/l, red blood cells 3.1 *
1012/l, white blood cells 3.7 * 109/l, platelets 162 * 109/l. Blood sugar 4.0 mmol/l,
K + 5.2 mmol/l, Na + 130 mmol/l. What screening test is appropriate and what
examinations need to be carried out to establish a diagnosis?
Urine cortisol, ACTH, aldosterone
FSH, LH, ACTH
Small dexamethasone sample
Excretion 17-KS, 17-OKS with daily urine Serum
Na and K levels ACTH stimulating sample
98. A woman 25, complains of an increase in the size of her jaw, hands, feet,
heart attacks, menstrual cycle disorder. Rtg shows stop - subperiosteal
layers.
Laboratory examination shows normal thyroid hormone content, increased growth
hormone content. Establish the correct diagnosis.
% Acromegaly Gigantism
macroprolactin aud Increased
prolactin content

99. A woman, 29, complains of dizziness, decreased ABP, loss of body weight,
dyspeptic disorders, pain in muscles and joints. In order to clarify the
diagnosis, a stimulating test was carried out. Set the correct symptoms and
diagnosis.
Primary adrenal insufficiency
Adrenogenital Syndrome
Secondary adrenal insufficiency
After administration of 250 mg corticotropin, cortisone levels decreased
After administration of 250 mg corticotropin, the aldosterone level decreased 50%
After administration of 250 mg corticotropin, the ACTH level was normal

100. A woman, 22, disturbed by disorders from menarche type


oligomenorrhea. A mother of a full-term, healthy child. Objectively: the skin
is moderately wet, acne, hirsutism, hypertrichosis. Height 180 cm, weight 76
kg, BMI 23.46 kg/m2. Stretch marks: single, pale on the front wall of the
abdomen and the internal surfaces of the thighs. A postpubertal form of
adrenogenital
syndrome is suspected. What laboratory indicator will confirm this diagnosis?
Increase in 17-hydroxyprogesterone under condition of normal cortisol content
Increase in 17-oxyprogesterone and decrease in cortisone
Increase in FSH, LG
Development of hypertrichosis in menarche

101. A woman, 38, had one pregnancy, a mother of a full-term, healthy


child. Objectively: the skin is moderately wet, acne, hirsutism,
hypertrichosis. Height 180 cm, weight 76 kg, BMI 23.46 kg/m2. Stretch
marks: single, pale on the front wall of the abdomen and the internal
surfaces of the thighs. The postpubertal form of adrenogenital syndrome has
been confirmed. What symptom confirms this diagnosis and what treatment
is advisable to offer the patient?
Assign 17-OH-progesterone derivatives
Prescribe monoestrogenic drugs Assign
dexamethasone
102. A woman, 58 years old, in the premenopause period. It was decided to
prescribe hormone replacement therapy. Which one is not among absolute
contraindication to the use of this group of drugs:
Urinary Incontinence Renal
failure Endometriosis.
nNon-partial endometrial hyperplasia

103. Patient, 28, complains of polyuria, nicturia, thirst. It is known that a


year ago she was hospitalized with a concussion after a car accident.
Питома вага сечі 1004- 1008. Select the most likely diagnosis:
Secondary diabetes mellitus
Diabetes insipidus
Hypernatremia
Hyponatremia

104. The patient, 38, complains of frequent headaches, fatigue, disability.


Increased intracranial pressure, secondary hypothyroidism. On X-ray of a
skull: expansion of a Turkish saddle, double contour of a bottom with
preselar pneumatization. On MRI: cerebrospinal fluid in the intracellular
area, the sickle-shaped pituitary gland. Establish the correct symptoms and
diagnosis:
Empty Turkish saddle syndrome
Changes in sexual function
Diabetes insipidus Pituitary
adenoma

105. The patient, 28 g, complains of an increase in the size of the jaw,


hands, feet, heart attacks, menstrual cycle disorder like oligomenorrhea. If
further examined, dyslipoproteinemia, increased prolactin-42 ng/ml and
somatotropic hormone were diagnosed. During the MRI, a cystic adnous
pituitary gland of 9 mm was detected. Choose symptoms and correct
diagnosis.
Acromegaly
Gigantism
Facial changes in the form of enlargement of protruding parts Increased
visual acuity.
Hand and leg pain (joint), reduced limb sensitivity

106. The patient, 24, complains of disproportionate obesity (upper type),


impaired menstrual cycle, hair growth in androgen-dependent areas. The
examination revealed an increase in the level of cortisol, ACTH. During the
MRI, 11 mm of adenoid pituitary gland was detected. Itsenko- Cushing
disease was diagnosed. Select a false statement for this disease.
Patients have a "moon-shaped" face.
Arterial hypertension.
Development of osteoporosis Frequent
hypoglycemic states.
No menstrual disorder in women, increased libido

107. A patient, 31, complains of expressed thirst and polyuria. During the
day he drinks more than 8 liters of liquid. The disease is associated with a
recently suffered psycho-emotional trauma. Upon further examination,
hypoisostenuria of urine, a decrease in antidiuretic hormone, were found.
What functional tests are performed to diagnose diabetes insipidus?:
With veropyron
%100With dexamethasone
Sample with hypertensive (3%) sodium chloride solution
Vasopresin Sample
Desmopresin Test Liquid Restricted
108. A patient, 30, complains of progressive obesity with the predominant
deposition of subcutaneous
fiber in the brachial girdle, mammary glands, abdomen, buttocks and thighs.
Height 180cm, weight-96 kg IMT - 29.6Kg/m2.OG-109cm, OT-89cm AO
130/80mHg Glycemia, sodium - 5.6 mmol/L. Metabolic syndrome is suspected.
What blood readings need to be checked to confirm diagnosis?
Glycemia level hint
HDL
Thyroid hormone level
LG, FSH
Total cholesterol
109. A patient, 21, complains of undersize and overweight. Low growth rate
since childhood, lag in growth was more than 3 sigmal deviations. Pituitary
nanism is diagnosed. What symptoms and size of growth are the criteria for
a given disease in a patient? Less than 100 cm less than 110 cm Less than
120 cm
Short limbs or short torso The disease is caused by insufficient
anterior pituitary gland.

110. A man, 36, complained of a sharp increase in weight (22 kg during the
year), periodic headaches and reduced potency. Objectively: height 170 cm,
body weight 114 kg. Fat deposits are mainly on the chest and abdomen. On
the shoulders, abdomen and hips there are stretch marks of a
crimsoncyanotic color. Heart tones are low, ABP 170/100 mm Hg. Art.
External and internal sexual organs are well developed. Glycemia on empty
stomach is 9.6 mmol/L. Set the correct symptoms and diagnosis.
Obesity alimentary-constitutional
Hypothyroid obesity
Itsenko-Cushing Disease
Electrolyte metabolism disorder, lower limb edema
Hypoovarian Obesity
Steroid Diabetes Mellitus
1. The parents of 12-year-old child noticed that the boy developed thirst after the
flu 2 months ago. His state gradually deteriorates and lasts about 2 weeks.
Fasting blood glucose - 5.5 mmol/liter. Glutamic acid decarboxylase
antibodies are positiv Which stage of type 1 diabetes is in this patient?
Initial immune processes
Active immune processes
Immunological changes with the development of insulitis
Manifestation of diabetes type 1 Complete
destruction of β-cells

2. Patient R., 45 years old, complains of furunculosis which cannot be managed


under treatment. The family doctor prescribed a glucose tolerance test. Results:
fasting glucose - 5.4 mmol / l, after 1 hour - 12.1 mmol / l, after 2 hours - 11.7
mmol / l. Which diagnosis is most likely?
Chronic furunculosis without impaired carbohydrate metabolism.
Chronic furunculosis. Impaired glucose toleranc
Type 2 diabetes, first detecte Chronic furunculosis
Type 1 diabetes, first detecte Chronic furunculosis Chronic
furunculosis, symptomatic diabetes mellitus.

3. A 17-year-old boy complains of severe general weakness, lethargy, thirst,


increased urination, itchy skin, weight loss. He recently has contracted mumps.
The most probable diagnosis?
Asthenic syndrome after viral infection.
Reinfection.
Puberty.
Diabetes mellitus.
Psychogenic polydipsi

4. A patient with suspected diabetes was appointed with an oral glucose tolerance
test: fasting glucose - 5.4 mmol / l, after 1 hour - 12.5 mmol / l, after 2 hours -
8.1 mmol / l. Evaluate the test results.
Normal results
Impaired glucose toleranc Diabetes.
Results are inaccurat
One more oral glucose tolerance test should be performe
5. The patient is 39 years old, constantly taking glucocorticoids for bronchial
asthm Recently, he developed thirst, appetite has increased, urination has
become more frequent. Glycemia during the day: 8.9; 7.7; 9.1; 7.8; 8.1
mmol/L. Probable diagnosis?
Renal diabete
Functional disorder of carbohydrate metabolism Type
1 diabetes.
Type 2 diabetes
Secondary diabetes mellitus.
6. A 50-year-old woman consulted a cardiologist about high blood pressure,
does not take any drugs, over the past six months has increased body weight
by 10 kg. Objective: BMI 33.8 kg / m2, heart - the boundaries are shifted to
the left, heart rate 72 beats / min, blood pressure 155/100 mm. Hg; the
abdomen is soft, painless, with traces of itching in the groin are Daily diuresis
- 2-2.5 liters.
Laboratory: CBC - Er - 4.2 1012 / l, Le - 6.4 109 / l, glycemia - 10.9 mmol / l.
What laboratory test will allow to assess the average sugar level for the last 3
months?
Hemoglobin in CBC
Fructosamine
GAD Antibodies
Glycated hemoglobin
Glucose tolerance test

7. Patient L., 55 years old, was referred for a consultation due to recurrent
furunculosis. Labaratory: fasting blood glucose tests: 5.9 - 6.8 mmol / L.
Glucosuria in the night portion of urine - 0. Which of these tests will help to
assess the carbohydrate metabolism?
Repeated determination of fasting blood glucos
Glucose tolerance test
Determine postprandial blood glucose levels.
Determine glucose in daily urin Determine
the concentration of C-peptid

8. Patient H., 39 years old, has been suffering from acromegaly for 7 years.
Recently, he starts complaining about mouth dryness, polyuria, polydipsi
Fasting glycemia - 9.1 mmol / l, glucosuria 1.0%, ketonuria (0). What type of
diabetes is in this patient?
Type 1 diabetes.
Type 2 diabetes.
Symptomatic diabetes.
Secondary diabetes of psychogenic (stress) genesis.
Impaired glucose toleranc

9. In a 28-year-old woman, during the first pregnancy, fasting blood glucose


was first detected at 5.5 mmol/l, postprandial - 10.6 mmol/l, glucosuria 1.5%,
ketonuria (+). How should this condition be assessed:
Type 1 diabetes.
Type 2 diabetes.
Gestational diabetes.
Symptomatic diabetes. Diabetes
of unspecified genesis.

10.Patient J., 27 years old, was diagnosed with diabetes. Her doctor prescribed
the determination of C-peptide and immunoreactive insulin (IRI) in the bloo
What is the purpose of these tests?
To verify diabetes type 2.
Predicting the severity of diabetes type 1.
To determine the dose of insulin Correction
of the insulin therapy schem Assessment of
the functional state of β-cells.

11.Patient , 41 years old, went to the doctor because of a wound on his arm,
which has not healed for about a month. Examination: internal organs without
features, within the age norms. Laboratory: standard GTT: fasting glucose -
5.1 mmol / l, after 1 hour - 10.9 mmol / l, after 2 hours - 9.1 mmol / l. Your
assessment of the results:
Type 1 diabetes. Impaired
glucose toleranc
Decompensated diabetes.
The test is questionabl
Normal state

12.The pregnant woman has fasting glucose 7.6 mmol/l and postprandial - 7.8
mmol/l, HbA1c - 6.1%. What is the next step to assess glucose metabolism?
Glucose tolerance test Glucose in urine
Insulin level in the blood
The concentration of acetone in the urine
Determine the concentration of antibodies to glutamatic acid decarboxylas

13.A 59-year-old woman is obes For a long time complains of itching of the
vagin Treated by a gynecologist because of candidiasis of the vulv
Glucosuria is absent. Fasting blood glucose three times: 4.4; 6.3; 5.1 mmol/L.
Which of these examinations can help to make a diagnosis?
To determine the serotype of Candid
To determine the sensitivity of candida to drugs.
Glucose tolerance test
Daily glucosuri
Protein concentration in the urin

14.Patient S., who has had type 1 diabetes for 10 years, uses base-bolus
insulintherapy. He has height - 178 cm, weight 80 kg, uses Novorapid
(Aspart) 8 IU in the morning, 10 IU at noon, 6 IU in the evening and Lantus
(Glargin) 36 IU at 22 hours. HbA1c - 8.5%. The patient often has morning
hyperglycemia 14-16 mmol/l. He complains of sleep disturbances with
frequent restless dreams. Night glycemia was not checke Your tactics:
Decrease a dose of Lantus
Increase a dose of Lantus
Increase a dose of evening Novorapid
Reduce a dose of evening Novorapid
Change the patient's diet

15.Patient N., 20 years old, has newly-developed type 1 diabetes. The


constitution is asthenic, height 172 cm, weight - 57 kg, BMI - 20.1 kg/m2,
HbA1c - 9.8%. After coping with ketoacidosis, normalization of laboratory
parameters, the patient was prescribed with the basal-bolus regimen of insulin
therapy.
Calculate the optimal daily amount of insulin for this patient.
20-26 IU of insulin per day
30-36 IU of insulin per day
40-45 IU of insulin per day
45-50 IU of insulin per day
55-60 IU of insulin per day
16. Patient , 31 years old, complains of recurrent hypoglycemic conditions not
related to physical activity or eating disorders, which periodically occur 2
hours after dinner. The patient uses insulin therapy: Actrapid NM 12 IU and
Protafan NM 20 IU in the morning, Actrapid NM 8 IU at noon, Actrapid NM
12 IU and Protafan NM 14 IU in the evening. HbA1c - 7.6%, glycemic
profile: 800- 7.4 mmol/l; 1100 - 8.3 mmol/l; 1300-6.8 mmol/l; 1600-7.3
mmol/L; 2100
- 3.6 mmol/l; 300 - 8.2 mmol/l. Your treatment tactics?
Reduce the amount of calories of dinner
Increase the amount of calories of dinner
Increase the dose of Actrapid NM in the evening
Reduce the dose of Actrapid NM in the evening
Reduce the dose of Protafan NM in the evening

17. Patient J., 32 years old, has had type 1 diabetes for 5 years, is on base-bolus
insulin therapy. He set off to a business trip and forgot insulin, which he has
not been injecting for 3 days. Objectively: the skin is dry, cold, blood pressure
115/70 mm Hg, pulse - 94 beats per minut HbA1c - 7.6%. Glycemic profile:
800-16.4 mmol/l; 1100 - 18.3 mmol/l; 1300 - 15.8 mmol/l; 1600-17.5 mmol/l;
2100 - 16.6 mmol/l; 300 - 14.5 mmol/l. Urine glucose - 2.5%, acetone +. Your
treatment tactics?
To improve diet
Resume insulin therapy at previous doses
Increase the doses of insiluns by 6-8 IU
Start intensive insulin therapy
Reduce the previous insulin doses by 6-8 IU

18.Patient V., 23 years old, recently developed type 1 diabetes. In the hospital she
was prescribed insulin therapy: Pharmasulin H 30/70 at a dose of 30 IU (18 IU
in the morning and 12 IU in the evening). The constitution is normosthenic,
height 165 cm, weight - 64 kg, BMI - 22.9 kg/m2, HbA1c - 8.6%. Glycemic
profile 800- 8.4 mmol/l; 1100 - 13.1 mmol/l; 1300-11.8 mmol/l; 1600-16.2
mmol/l; 2100 - 6.6 mmol/l; 300 - 10.5 mmol/l. Your treatment tactics.
To improve the diet
Apply the basal-bolus insulin therapy
Increase the morning dose of insulin Pharmasulin H 30/70
Increase the evening dose of insulin Pharmasulin H 30/70
Increase morning and evening doses of insulin Pharmasulin H 30/70
19.Patient P., 44 years old, has had type 1 diabetes for 12 years. 3 years ago he
was diagnosed with chronic kidney disease, microalbuminuria, and he wants
to set off to resort. HbA1cv- 7.1%, self-control of blood-glucose is
satisfactory. Is it recommended for him to go to resort rehabilitation?
Contraindicate
Not recommended due to the threat of diabetes decompensation
Possible, but without the use of mineral waters at the resort
There are no contraindications
Possible deterioration because of chronic kidney disease

20.Patients with newly diagnosed type 1 diabetes should calculate a diet at the
school for diabetics. Which ratio of macronutrients is correct?
Carbohydrates 50-60%, fats 20-30%, proteins 15-20%
Carbohydrates 40-50%, fats 15-25%, proteins 25-30%
Carbohydrates 50-60%, fats 30-40%, proteins 10-20%
Carbohydrates 60-70%, fats 10-20%, proteins 15-20%
Carbohydrates 40-50%, fats 20-30%, proteins 20-30%

21.Patient O., 46 years old, has had type 1 diabetes for 18 years. He is on the
basis
-bolus-insulin therapy. He injects Novorapid (Aspart) 3 times a day 10-12-8 IU
and Toujeo (Glargin 300) 24 IU at 22.00. HbA1c - 7.9%, glycemic profile 800-
13.4 mmol/l; 1100 - 6.7 mmol/l; 1300-10.9 mmol/l; 1600-8.1 mmol/l;
2100 - 7.9 mmol/l; 300 - 10.8 mmol/l. Choose treatment tactics.
Insulin therapy does not need any changes
Improve the diet
Reduce the dose of Toujeo
Increase the dose of Toujeo
Reduce the dose of Novorapid

22.Patient M., 30 years old, a taxi driver, complains of weight loss (14-16 kg in
the last 2 months), polyuria, polydipsi Fasting blood glucose - 17.6 mmol/l,
glucosuria - 3.0%, ketone bodies (++). Your treatment tactics?
Diet.
Diet and biguanides.
Diet Pevzner and sulfonylureas derivates. Diet
and insulin therapy.
Diet and Soliqua (Glargin + Lixisenatide)
23.In a 62-year-old patient the examination revealed glycemia - 8.9 mmol/l and
glucosuria -15 g/l. HbA1c - 8.7%, C-peptide - 0.92 (references range - 0.9-
3.0) μOd/dL, insulin 2.6 (references range - 2-25) ng/dL, He does not have
any complaints. Glutamic acid dexarboxylase andibodies - 324.3 (references
range – up to 10). Your treatment tactics:
Diet.
Diet and biguanides.
Diet and sulfonylureas derivates.
Diet and SGLT-2-inhibitors.
Diet and insulin therapy
24.Patient , 25 years old, has been suffering from hypoglycemia in the first half
of the day for 2 weeks. It is not related to physical activity or the diet
violation.
He uses insulin therapy: Pharmasulin H 14 IU and Pharmasulin HNP 26 IU (at
830), at lunch - Pharmasulin H 10 IU (at 1330), in the evening - Pharmasulin H
10 IU and Pharmasulin HNP 14 IU (1830). HbA1c - 9.1%. Glycemic profile:

800- 7.1 mmol/l; 1100 - 3.7 mmol/l; 1300-3.2 mmol/l; 1600-14.3 mmol/l; 2100
- 7.8 mmol/l; 300 - 5.4 mmol/l. Urine glucoser - 0.5%, ketones (0). Your tactics?
Increase calories consumption in the afternoon
Decrease calories consumption in the afternoon
Reduce the dose of evening Pharmasulin HNP
Reduce the dose of morning Pharmasulin HNP
Reduce the dose of morning Pharmasulin H and Pharmasulin HNP

25.Indications for the appointment of recombinant insulin analogues are, except:


Frequent unexplained nocturnal hypoglycemia
Low vision (Vis 0.4 / 0.4 uncorrected)
Diabetic autonomic neuropathy
Severe labile type 1 diabetes
Morning hyperglycemic preprandial conditions

26.Patient K., 21 years old, was newly diagnosed with glycemia 13 mmol/l, daily
glucosuria 40 g/l. The last two weeks she has been experiencing an increased
appetite, but lost 5-6 kg; thirst, frequent urination, weakness. The constitution
is hypersthenic, height 175 cm, weight 75 kg, BMI - 25.1 kg/m2. C-peptide 0.9
(range: 0.9-3.0) μOd/dl, HbAlc - 8.3%. Your tactics.
Diet.
Diet and biguanides
Diet and Soliqua (Glargin + Lixisenatide)
Diet and Victose (Liraglutide) Diet
and insulin therapy
27.The patient is in the intensive care unit with a diagnosis: "Diabetes type 1,
severe form, brittle, decompensate Diabetic (ketoacidotic) coma ". The skin is
dry, turgor is reduced, the tonus of the eyeballs is reduced, blood pressure -
90/60 mm Hg, heart rate - 130 beats/min. Glycemia - 23 mmol/l, pH - 7.1.
The content of ketone bodies (++++). What is the initial tactics?
Administration of 5% glucose solution 500 ml.
Administration of 4% sodium bicarbonate 2.5 ml/kg.
Administration of short-acting insulin 10-20 units in bolus, and then - 0.1 IU/kg/h
to eliminate ketoacidosis.
Administration of intermediate-acting insulin 10-20 units in bolus, and then -
0,05 IU/kg/h before elimination of ketoacidosis.
Administration of 0.9% sodium chloride 500 ml IV.

28.The unconsciousness patient was transported by ambulance to the intensive


car A card of a patient with diabetes was foun Breathing with ralses,
Kussmaul type, the smell of acetone from the mouth, dry skin, turgor is
reduced, periosteal reflexes are negative, the tonus of the eyeballs is reduce
The content of lactic acid in the blood is 1.2 mmol/l (normal ranges - 0.621.3
mmol/l), glycemia is 29 mmol/l. Which emergency can be suspected?
Lactic acidosis.
Hyperosmolar com
Hypoglycemic com
Diabetic ketoacidosis.
Uremic com

29.The patient has been suffering from type 1 diabetes for six years. Constantly
uses the basal-bolus regimen of insulin therapy. During the last week there is
a fever, general weakness, nausea in the morning, elevated blood glucose
levels in the morning. Urine acetones - positive (+). Specify the diet for this
patient.
Exclude fats, allow sugars
Exclude fats and sugars
Exclude fats and proteins
Exclude proteins and allow sugars
No special dietary recommendations

30.The boy, 12 years old, was admitted to the surgical department with
complaints of severe abdominal pain, nausea and vomiting. He has been sick
for 2 weeks after SARS, since when thirst, dry mouth, polyuria began to
increas Objectively: consciousness is darkened, the tonus of the eyeballs is
reduced, deep breathing with ralses, blood pressure is 100/55 mm Hg, pulse is
136 beats/min. Abdominal muscle tension. Glycemia - 21 mmol/l, acetonuria,
plasma osmolarity - 200 mosm/l. Make the correct diagnosis.
Diabetic ketoacidosis, abdominal typ
Diabetic ketoacidosis, colaptoid typ
Diabetic ketoacidosis, encephalopathic typ
Hyperosmolar com
Acute peritonitis.
31.The 78-year-old patient has type 2 diabetes and uses a combination of
metformin 1000 mg twice/day and dapagliflozin 10 mg/day. In the morning,
according to relatives, he complained of nausea, general weakness, diarrhea
and calf pain. Due to the progressive deterioration of his condition, he was
transported to the hospital, where he lost consciousness. Make a preliminary
diagnosis and the treatment.
Type 2 diabetes, decompensate Lactic acidosis. Treatment: control of hypoxia,
anti-shock measures, insulin therapy.
Type 2 diabetes, decompensate Diabetic Diabetic ketoacidosis. Treatment:
rehydration, insulin therapy, electrolyte correction.
Type 2 diabetes, decompensate Hyperosmolar com Treatment: rehydration,
insulin therapy, thrombosis prevention.
Type 2 diabetes, decompensate Lactic acidosis. Treatment: rehydration, anti-
shock measures, insulin therapy.
Type 2 diabetes, decompensate Hyperosmolar com Treatment: rehydration,
insulin therapy, electrolyte correction.

32.A 40-year-old patient with severe type 1 diabetes developed decompensation


of the disease, which was accompanied by the development of ketoacidosis.
Small
doses of short-acting insulin and isotonic sodium chloride solution were
performe An hour later, the patient developed a headache, sweating, and heart
failur Blood sugar - 2.8 mmol / l, sodium content - 140 mmol / l. What caused
this condition? Hyperhydration.
Hypokalemi
Ketoacytic intoxication.
Hyponatremi
Hypoglycemi

33.All the causes lead to the development of hypoglycemic coma, except: Insulin
overdos Heavy physical exercises.
Alcohol consumption.
Eating fatty foo Skip
meals.

34.The girl, 18-year-old, has been suffering from diabetes for 5 years. The daily
dose of insulin is 36 IU. During pneumonia, the condition shrply deteriorated:
significantly increased thirst, abdominal pain, nausea, vomiting, drowsiness.
The patient refused to eat in the evening, skipped the insulin injection, and
lost consciousness in the morning. Objectively: the skin is dry, turgor is
reduce The tongue is dry. Breathing is deep, with ralses, smell of acetone
from the mouth. Body temperature - 36.6º C, pulse - 100 beats/min, weak
filling and tension, blood pressure - 90/50 mm Hg. In urine - a positive
reaction to aceton Blood glucose - 33 mmol/ liter. What is the previous
diagnosis?
Ketosis
Hyperosmolar coma
Diabetic ketoacidosis
Hepatic coma
Cerebral coma

35.The 52-year-old patient was taken unconscious to the hospital. Objectively:


facial features are pointed, eyeballs are soft, skin and mucous membranes are
dry, subfebrile body temperature, muscle tonus is reduce Heart rate 110
beats/min, blood pressure 70/40 mm Hg. Periodically occur convulsions.
Labpratory: glucose - 20.7 mmol/l, sodium - 148 mmol/l, glucosuria, ketonemi
Make a preliminary diagnosis.
Hyperosmolar coma
Hyperacidotic coma
Hyperlactacidemic coma
Hyperketonemic coma
Uremic coma

36.A 27-year-old woman was found unconscious. Objectively: the skin is dry,
the tongue is dry, the smell of acetone, shortness of breath, deep breathing,
with ralses. Heart rate 120 beats/min, blood pressure 80/50 mm Hg. Muscle
tension of the anterior abdominal wall, palpation of the abdomen is painless.
Laboratory: leukocytes - 17.0x109/l, glucose - 21 mmol/l, creatinine 84 μmol/l,
pH - 7.2. Urone reaction with sodium nitroprusside +++. Choose the most
appropriate treatment in the prehospital stag Short-acting insulin at a dose of
10-12 IU IV
Short-acting insulin at a dose of 100 IU IV
Intermediate-acting insulin at a dose of 10-12 IU
4% sodium bicarbonate solution - 400.0 ml
Glucagon 1.0 mg i/m

37.Woman, 26-year-old, has bronchopneumonia, developed com Objectively:


the skin is dry, turgor is reduce Breathing is deep, with ralses. Smell of aceton
Heart rate - 122 beats/min, extrasystoles, blood pressure - 90/50 mm Hg.
Liver
+ 3 cm. Glycemia - 32 mmol / l, blood pH - 6.8. What medication should be
included in the treatment of this patient?
4.2% sodium bicarbonate solution
5% glucose solution
40% glucose solution
long-acting insulin
1 ml of 0.1% adrenaline solution

38.A 64-year-old woman has had type 2 diabetes for 21 years, including 6 years
of basal-bolus insulin. Adheres to the diet, calculates carbohydrate calories,
HbA1c - 6.0%. Was diagnosed with CKD IV, GFR (CKD-EPI) - 19 ml/
min/1.73 m2, microalbumin/creatinine ratio - 7.6 mg/mmol. This does not
include: Macroalbuminuria Hypertension.
Increased daily insulin dos
Reduced of daily insulin dos
Edem

39.The patient, 42 years old, has had type 2 diabetes for 10 months, follows the
diet. Objectively: fasting blood glucose - 5.5 mmol/L, postprandial - 7.6
mmol/L, HbA1c - 6.8%, glucosuria 0%. Blood pressure - 125/80 mm Hg.
There are no complications of diabetes. Make the correct diagnosis.
Type 1 diabetes mellitus, moderate severity, compensate Honeymoon phase
Type 2 diabetes mellitus, moderate severity, compensate
Type 2 diabetes, first detected, subcompensate
Diabetes mellitus type 1, mild form, compensate
Type 2 diabetes, mild form, compensate

40.A 65-year-old woman has been suffering from type 2 diabetes for 10 years.
She takes metformin at a dose of 2000 mg per day and gliclazide at a dose of
120 mg per day. She has developed numbness and freezing of the feet for the
last 6 months. Examination: BMI - 34 kg/m2, blood pressure 160/100 mm
Hg, glycated hemoglobin level 8.3%. Choose the appropriate therapy.
Increase the dose of both drugs to the maximum doses.
Add meglitinides to the therapy
Instead of gliclazide prescribe a DPP-4 inhibitor
Prescribe a GPP-1 agonist instead of metformin
Add SGLT-2 inhibitor to the therapy

41.Which of the following antidiabetic drugs increases the risk of acute


pancreatitis? Metformin.
Glimepirid
Nateglinid
Gliclazid
Dulaglutide

42.Patient A, who has type 2 diabetes and takes metformin at a dose of 2000
mg/d, developed finger gangren Laboratory: glycated hemoglobin - 7,5%
Which therapy should be applied in this case?
Replace metformin with gliclazide at the maximum therapeutic dos
Combine metformin with gliclazide at a medium therapeutic dos
Combine metformin with intermediate-acting insulin in 2 injections per day.
Switch the patient to exenatide in combination with a DPP-4 inhibitor.
Prescribe insulin therapy with short-acting insulin in 4 injections per day.

43.What is the main mechanism of action of biguanides? Stimulation of


glucagon production.
Stimulation of insulin exocytosis from β-cells of the islets of the pancreas.
Enhancement of insulin action at receptor and postreceptor levels in insulin-
dependent tissues.
Inhibition of sodium-glucose linked transporter type 2 in distal nephron tubules
Inhibition of dipeptidyl peptidase-4.

44.What is the main mechanism of action of GPP-1 agonists? Stimulation of


glucagon-like peptide 1.
Stimulation of insulin exocytosis from β-cells of the islets of the pancreas.
Enhanced insulin action at receptor and postreceptor levels in insulin-dependent
tissues.
Inhibition of sodium-glucose linked transporter type 2 in distal nephron tubules
Inhibition of dipeptidyl peptidase-4.

45.What is the main mechanism of action of sulfonylurea derivatives?


Stimulation of glucagon production.
Stimulation of insulin exocytosis from β-cells of the pancreatic islets.
Enhanced insulin action at receptor and postreceptor levels in insulin-dependent
tissues.
Inhibition of sodium-glucose linked transporter type 2 in distal nephron tubules
Inhibition of dipeptidyl peptidase-4.

46.What is the main mechanism of action of saxagliptin? Stimulation of


glucagon production.
Stimulation of insulin exocytosis from pancreatic islet beta cells.
Enhanced insulin action at receptor and postreceptor levels in insulin-dependent
tissues.
Inhibition of sodium-glucose linked transporter type 2 in distal nephron tubules
Inhibition of dipeptidyl peptidase-4.
47.A patient with type 2 diabetes had to undergo surgery (appendectomy). He
takes metformin at a dose of 2000 mg / day, gliclazide (diabetes MR) 60 mg
/ day and saxagliptin at a dose of 5 mg / day. Fasting blood glucose - 6.2
mmol/L,
postprandial - 7.6 mmol/L, the level of glycated hemoglobin - 7.3%. What should be
the tactics of hypoglycemic therapy?
Switch to 4 injections of short-acting insulin.
Do not change this therapy.
Continue metformin and prescribe intermediate-acting insulin in 2 injections.
Discontinue drugs and recommend strict diet therapy during surgery.
Prescribe GPP-1 agonist (liraglutide)

48.All statements regarding biguanides are correct, except:


Decreased gastrointestinal glucose absorption.
Inhibition of gluconeogenesis in the liver.
Increased tissue sensitivity to insulin at the periphery.
Decrease the levelf of cholesterol, triglycerides. Activation of β-
cell proliferation and inhibition of its apoptosis.

49.A woman with type 2 diabetes is worried about being overweight. She
consulted a doctor about recommendations for weight loss. Which of the tips
would you choose for her?
Do not change her eating habits, but only reduce the amount of salt consume Do
not change her eating habits, but eliminate alcohol consumption.
Do unloading days three times a week.
Do not change eating habits, but introduce 2 unloading days a week. None
of them

50.Indications for insulin therapy for type 2 diabetes are all except: Diabetic
ketoacidosis. Diabetic foot syndrom Dilated cardiomyopathy.
Pregnancy and lactation.
Surgery

51.Non-calorie sugar substitute is: Sorbitol.


Maltodextrin
Aspartam
Fructos
Xylitol.
52.Female 26 years of age, taking daily levothyroxine 50 mcg / day due to
hypothyroidism on the basis of chronic autoimmune thyroiditis. In the
control examination: no complaints, objectively - without pathological
abnormalities, IMT 58 kg; TSH 7.2 mIU / l, FT4 1.26 ng / dL, FT3 3.08 ng /
dL. Your suggestion for therapeutic tactics at the moment:
No correction is require Reduce
the dose to 25 mcg / day.
Increase the dose to 75 mcg / day.
Leave dose, add selenium preparation. Correction
after determination of lipidogram.

53.Patient V., 3 years old, was admitted to hospital for congenital


hypothyroidism. Which of the following drugs should be prescribed?
Levothyroxine *
Somatotropic
Potassium iodide
Thiamazole
Prednison

54.Patient V., 2 years old, was admitted to the hospital for delayed physical and
mental development. Objectively: height 52 cm, body weight 13 kg.
Expressed skin dryness, hair thin and brittl The skull is large, the crown is
not close The tongue protrudes from the oral cavity. Heart rate 55 beats / min
Heart tones are mute The thyroid gland is not enlarge Mental and physical
development lags behind the passport. Make a preliminary diagnosis.
Subacute thyroiditis
Congenital hypothyroidism *
Autoimmune thyroidin, hypothyroid phas
Endemic goiter Sporadic goiter.
55.From anamnesis of the patient M., 45 years old, it is known about chronic
thyroiditis. Recently, she has been worried about frostbite, drowsiness,
drowsiness, constipation, memory loss. Objectively: the skin is pale, dry,
cold and swollen, the loss of eyebrows and hair on the temples. HELL
100/70 mm Hg. bradycardi What is the most likely diagnosis?
Endemic goiter, euthyroid condition
Chronic fibrous thyroiditis
Autoimmune thyroiditis, euthyroid condition
Secondary hypothyroidism
Autoimmune thyroiditis, hypothyroidism. *

56.The patient is diagnosed with acute purulent thyroiditis at the stage of


abscission. Which of the following treatments is appropriate?
Surgical treatment *
Thiamazole
Radioiodine therapy
Prednisone
Potassium iodid

57.In the complex treatment of thyrotoxic crisis, the following drugs are
prescribed, except:
Anaprilin
The Lugol solution
Adrenaline *
Cordyamine 40%
glucose solution.

58.Patient L., 39 years ol Operated for the diffuse toxic goiter of the third
century. A month after surgery, the patient had convulsive contractions of
the muscles of the extremities. Objectively: Pulse 76 beats / min., Blood
pressure 136/80, symptoms of Chvostek, Trusso positiv What is the most
likely diagnosis?
Postoperative hypothyroidism
Recurrence of goiter
Vegetative-vascular dystonia
Postoperative hypoparathyroidism *
None of the abov

59.The boy is 11 days, sluggish, motionless, constantly drowsy, suffering from


constipation. He rarely screams, his voice rough. Objectively: the language
is large; the skin is dry, yellowish in color, col Bradycardia, hypotension.
The thyroid gland is not palpabl Karyotype 46XY. Establish a probable
diagnosis. Down disease
Congenital hypothyroidism *
Hemolytic disease of the newborn
Iron deficiency anemia
Endemic goiter.

60.A woman has 32 years of complaints of frostbite, adynamia, inhibition,


drowsiness. Objectively: the skin is pale, dry, cold and swollen, the loss of
eyebrows and hair on the temples. HELL 100/70 mm Hg. bradycardia, fluid
in the pericardium cavity. On ECG bradycardia, the low voltage of the QRS
complexes and the teeth of P and T. The thyroid gland is not enlarge Which
diagnosis is most likely?
Autoimmune thyroiditis, euthyroid state
Endemic goiter
Subacute thyroiditis
Hypothyroidism *
Cardiovascular failur
61.Patient S., 38, complains of emotional lability, tachycardia during agitation,
hyperhidrosis of the palms. Thyroid enlarged to IV century, moderately
compacted and heterogeneous, lobe surfac Ultrasound: echogenicity of the
gland is reduced, the structure is heterogeneous. TSH - 2.1 mIU / l, free T4 -
13.6 pmol /
l. What is the most likely diagnosis?
Primary hypothyroidism
Secondary hypothyroidism
Primary hyperthyroidism
Secondary hyperthyroidism
Autoimmune thyroiditis, euthyroid stat

62. Patient 29 years old complained of weight gain, frostbite, dry skin,
drowsiness, difficulty concentrating. Objectively: height 165 cm, weight 78
kg, female phenotype, t 35,8C, HR 58 / min, blood pressure 105/60 mm Hg
Other internal organs unchange Thyroid 1 st., Diffusely compacte The
galactorrhea of the 1st century Laboratory study found an increase in TSH
and prolactin levels, a decrease in T4. What is the probable cause of the
galactorrhea?
Primary hypothyroidism.
Secondary hypothyroidism.
Tertiary hypothyroidism.
Hippopituitarism.
Prolactinom
63. Patient hospitalized after influenz From anamnesis (according to relatives) it
is known about hypothyroidism, the last 6 months have not been treate On
examination, consciousness is absent, tendon reflexes are lowered, body
temperature is 35.50 C, breathing 10 per 1 min, superficial. HELL 80/50 mm
Hg. Art. Pulse 48 beats / min, fluid in the cavity of the pericardium. ECG low
voltage QRS complexes and teeth P and T. What is the most likely diagnosis?
Acute disorders of cerebral circulation Myocardial
infarction.
Acute cardiovascular failure
Hypothyroid coma Chronic
adrenal insufficiency.

64. In a patient of 26 years with postoperative hypothyroidism who received L -


thyroxine 100 μg twice a day, tachycardia, sweating, irritability, and sleep
disorders appeare Determine the tactics of further treatment.
Reduce the dose of thyroxine
Add thiamazole
Assign beta blockers
Increase the dose of thyroxine Prescribe
sedatives.

65. In the patient K., 46 years, six months after subtotal resection of the thyroid
gland appeared general weakness, apathy, drowsiness, hair loss, dry skin,
constipation. Pulse 60 beats / min., Blood pressure 130/80 mm Hg. Art. What
is the most likely diagnosis? Iodine deficiency state
Subacute thyroiditis, hypothyroid stage
Autoimmune thyroiditis
Postoperative hypothyroidism
Hyperthyroidism.

66. Patient S., 25, has no complaints. The examination revealed an increase in the
thyroid glan He resides in the Skole district. Objectively: the thyroid gland
enlarged to the 2nd century., Of uniform consistency, elastic, not painful.
Total T4 - 80 mmol / l, T3 - 2.3 mmol / l, TSH - 3.6 mmO / l.
Diffuse toxic goiter
Subacute thyroiditis
Autoimmune thyroiditis, euthyroid state
Endemic goiter, euthyroid state Endemic
goiter, hypothyroidism.

67. Patient K., age 52, complains of weight gain, weakness, discomfort in the
neck. Objectively: dry skin, moderate swelling of the face and extremities.
Pulse rate of 60 beats / min. The thyroid gland enlarged to the second
century, is heterogeneous, not painful. Antibodies against thyroid peroxidase
300 IU / ml.
Hormone levels: total T4 - 40 nmol / l, T3 - 0.68 nmol / l, TSH - 12.4 mIU / l.
What is your diagnosis? Endemic goiter
Subacute thyroiditis
Autoimmune thyroiditis, hypothyroidism
Autoimmune thyroiditis, euthyroid state
Fibrous thyroiditis.

68. Patient , 41 years old, found an increase in thyroid gland of II., Painful on
palpation, pain radiates into the lower jaw, body temperature 37-38 ° C, a
week ago suffered angin Most likely that the patient:
Diffuse toxic goiter
Toxic thyroid adenoma
Subacute thyroiditis
Autoimmune thyroiditis
Riedel's goiter
69. Patient S., 24, has no complaints. The examination revealed an increase in the
thyroid glan He resides in the Skole district. Objectively: thyroid gland
enlarged to the 2nd century., Of uniform consistency, elastic, not painful,
sensitive to palpation. Total T4 - 80 mmol / l, TSH - 1,8 mmO / l. Assign
therapy.
L-thyroxine
Thiamazole
Potassium iodide
Combination of L-thyroxine and potassium iodide None
of the following.

70. The main reason for thyroid enlargement in Hashimoto thyroiditis is:
Thyrocyte hyperplasi Formation of fibrous tissu TSH stimulation.
Lymphoid infiltration of the glan
Influence of antimicrosomal antibodies.

71. An “accumulation defect” on a thyroid scan may be a sign of: Subacute


thyroiditis.
Malignant tumor.
Riddle's thyroiditis.
Acute purulent thyroiditis.
Any underlying pathology

72. A resident of the mountain district of Ivano-Frankivsk region, 23 years old,


complains of miscarriage (in history - 2 miscarriages). Palpatory thyroid
gland I., Soft, homogeneous; on ultrasound - without pathological changes.
There are no clinical signs of thyroid dysfunction. Laboratory: TSH 6.2 mIU
/ L, BT4 1.46 ng
/ dL, anti-TPO 20 IU / ml. What is the probable cause of this situation?
Hashimoto thyroiditis.
Iodine deficiency subclinical hypothyroidism.
Thyrotoxicosis.
Manifest hypothyroidism.
Stressful condition.

73. Clinical manifestations of Riddle thyroiditis may be:


Bradycardi Tachycardi
Leukocytosis.
Weight loss. Swallowing
disorders.
74. A 45-year-old man was diagnosed with nodular goiter. On scintigraphy - "hot
zone" in the projection of the nod T3 and T4 levels are elevate Your
diagnosis? Diffuse toxic goiter
Thyroid cancer
Autoimmune thyroiditis
Toxic thyroid adenoma
Subacute thyroiditis.
75. Patient 29 years old with postoperative hypothyroidism, who receives 150
mсg of Levothyroxine 2 times a day, developed tachycardia, sweating, sleep
disturbances. Determine the tactics of further treatment:
Prescribe sedatives.
Prescribe beta-blockers.
Replace L-thyroxine with another similar drug.
Increase the dose of the hormon Reduce
the dose of the hormon

76. In a 28-year-old woman, palpation of the thyroid gland in the left lobe
revealed a nodule, an oval nodule measuring 3.2x2.5 cm, dense in
consistency, limited mobility, not painful. Heredity is burdened, from the
history of the patient it is known about cancer in the family. Which of the
following thyroid cancers are familial (inherited cancer)?
Papillary cancer.
Follicular cancer.
Medullary cancer Anaplastic
cancer .
Adenoma of the thyroid gland

77. A 40-year-old woman has a nodule in her thyroid glan Heredity is burdene
From the anamnesis of the patient it is known about cancer in the family.
Suspected medullary thyroid cancer Which diagnostic method is effective for
detecting medullary thyroid cancer?
Hypocalcemi
Increased levels of calcitonin in the blood
Hypercalcemi
Thyroglobulin level.
TSH level

78. To diagnose medullary cancer, thyroid TAB (fine-needle biopsy) was


performe What morphological features are characteristic of this disease?
Presence of multinucleated giant cells in the punctat
Presence of bacteria in the punctat
Presence of neutrophilic leukocytes in the punctate
Presence of erythrocytes in the punctat
79. A 28-year-old woman has a nodule in her thyroid glan Scintigraphy from
I131 showed that he was "cold". From the anamnesis it was found out that at
the age of 10 she underwent a course of radiotherapy for chronic tonsillitis.
Treatment tactics?
Thyroid hormones.
Glucocorticoids.
Prescribe iodine preparations.
Surgical treatment. Dynamic
observation.

80. In a 40-year-old woman, palpation of the thyroid gland in the left lobe
revealed a nodule, dense, moderately painful. Ultrasound revealed reduced
echogenicity, containing calcinat What additional tests should be performed
to confirm the diagnosis?
ECG.
Scintigraphy.
Aspiration fine-needle biopsy.
Determination of urinary iodine excretion. Thyroglobulin

81. A 29-year-old man consulted an endocrinologist due to the presence of a


nodule in the thyroid glan There are no other complaints. The node was
found accidentally during a preventive examination. Heredity is not burdene
History - without features. The general condition is satisfactory. In the left
lobe of the thyroid gland is palpated node 4 cm in diameter, hard, painless,
mobil Cervical lymph nodes are not enlarge The level of thyroxine in the
blood is 120 nmol / l. Preliminary diagnosis?
Toxic thyroid adenoma
Simple non-toxic nodular goiter.
Anaplastic thyroid cancer
Papillary thyroid cancer. Subacute
de Kerwen's thyroiditis.

82. The patient complains of lethargy, drowsiness and convulsions. From the
anamnesis it was established that a calcium preparation with vitamin D3 was
used for the treatment of osteoporosis. Which of the following drugs reduces
the entry of Ca ions into the tissues? Sodium fluoride
Amiodarone
Procainomide
Verapamil
Aimalin
83. Patient , 48 years ol Complains of weakness, intermittent pain in the heart,
palpitations, drowsiness, irritability. Ill for 3 years. She was treated without
effect by a cardiologist and a neurologist. Objectively: height 166 cm, body
weight 70 kg. Skin of normal color, moist. The thyroid gland is diffusely
enlarged to the II degree, elastic-elastic consistency, with a smooth surface,
mobil Pulse 96 per minute, blood pressure 140/70 mm Hg. Art. Heart tones
are sonorous, systolic murmur over the apex. Additional data: general
analysis of blood and urine without pathology. The level of thyroid hormones
is moderately elevate Ultrasound: evenly reduced echogenicity. Make a
preliminary diagnosis:
Diffuse toxic goiter of the II degree, manifest thyrotoxicosis.
Autoimmune thyroiditis.
Thyroid cancer.
Riedel's goiter.
Diffuse euthyroid goiter of II degre

84. A 32-year-old woman went to an endocrinologist for a nodule in her thyroi


There are no other complaints. Which diagnostic method is most effective for
determining medullary thyroid cancer? Ultrasound ultrasound of the thyroid
glan Blood calcitonin level.
Thyroglobulin level.
Radiograph of soft tissues of the glan Thyroid
scan.
85. The patient has complaints of irritability, sweating, hand tremors,
palpitations, weight loss with preserved appetit The thyroid gland is enlarged
to the second degree, elastic, not painful. These symptoms are most
consistent with:
Diffuse toxic goiter
Neurasthenia
Autoimmune thyroiditis Hypothyroidism
Hypoparathyroidism.
86. Patient , 37 years ol Complains of irritability, palpitations, sweating, general
weakness, shortness of breath. She lost 7 kg. Objective: height 168 cm, body
weight 58 kg. The skin is moist. The thyroid gland is enlarged due to all
departments. There is a gleam in the eyes, a slight bilateral exophthalmos,
tremor of the fingers. Pulse 120 for 1 min., Blood pressure 150/60 mm Hg.
Art. What is the previous diagnosis?
Toxic thyroid adenoma
Diffuse toxic goiter
Chronic fibrous thyroiditis
Autoimmune thyroiditis, euthyroid state Neurastheni
87. Patient G., 48 years ol Has been suffering from diffuse toxic goiter for 7
years. Which of the prescribed drugs has an antithyroid effect?
Prednisolone
Thiamazole
B-vitamin complex
Phytosedative complex
Anaprilin.

88. A 24-year-old woman who has recently had hypertension has serum
potassium level of 2.7 mEq / l, plasma aldosterone (AP) level is 55 ng%
(norm 1-6). The following studies revealed: AP after saline infusion - 54 ng%
(norm 1-8), after a 4-hour walk - 32 ng% (norm 4-31); serum
18hydroxycorticosterone level is 108 ng% (norm <30). What is the most
likely diagnosis?
Primary hyperaldosteronism (Conn syndrome)
Corticosteroma
Androsteroma
Pheochromocytoma
Corticosterom

89. Which statement will be incorrect about congenital adrenal cortex


hyperplasia The disease develops as a result of birth defects in the enzyme 21
hydroxylase The disease develops as a result of birth defects in the enzyme
3β dehydrogenase The disease develops as a result of birth defects in the
enzyme 11 β hydroxylase The disease develops as a result of birth defects of
the enzyme 17α hydroxylase The disease develops as a result of birth defects
in the enzyme lactate dehydrogenase
90. Which hormone is produced in the retina of the adrenal cortex? Cortisone
Adrenaline
Testosterone
Corticosterone
Norepinephrine

91. Which of the diagnostic criteria is uncharacteristic of pheochromocytoma?


Increased urinary excretion of vanillylmagic acid
Decreases in blood catecholamines
Increase in ESR
Leukocytosis, eosinophilia, erythrocytosis
Conduction disorders and left ventricular hypertrophy on the ECG

92. Which statement will be true for Itsen-Cushing's syndrome? Cortisol and
ACTH levels are elevated
Cortisol and ACTH levels are reduced
Cortisol levels are elevated, ACTH is lowered
Cortisol levels are elevated, ACTH is lowered
Cortisol levels unchanged, ACTH elevated

93. Which of the antihypertensive drugs is the drug of choice for treating
hypertension with pheochomocytoma?
Alpha blockers
Beta blockers
Clonidine
ACE inhibitors
Receptor antagonists for angiotensin II

94. Which statement would be incorrect for acute adrenal insufficiency?


Develops in pathology of the adrenal glands
May accompany severe violations of other organs and systems
It is accompanied by hypertension
It is accompanied by collapse and hypotension
95. It is accompanied by a decrease in cortisol, corticosterone, aldosterone Which

statement will be true for adipozogenital dystrophy?

Cortisol, ACTH, testosterone, progesterone levels are elevated


ACTH cortisol, testosterone, and progesterone levels decreased
Cortisol levels increased, ACTH, testosterone, progesterone reduced
ACTH cortisol levels increased, testosterone lowered, progesterone lowered
Cortisol levels unchanged, ACTH of testosterone, progesterone elevated

96. Patient K., aged 51, complained of severe headache, heartache, severe
general muscle weakness, seizures, thirst, rapid urination in large portions.
Laboratory studies: ZAK - without features, urine test - alkaline reaction,
proteinuria, isohypostenuria, biochemical analysis of urine - hyperkaliuria,
hyponatriuria, increased daily excretion of aldosteron What is your
diagnosis?
Hyperaldosteronism
Hypoparathyroidism
Diabetes mellitus
Addison's Disease
Chronic renal failure

97. Konn's disease was suspected in a patient of 46 years. What blood test should
you do to confirm your diagnosis?
Blood tests for aldosterone
Blood tests for cortisone
Blood tests for calcium content
Research on cholesterol
General blood test

98. A man, 17 years old, last 3 weeks, feeling tired, muscular weakness,
dizziness. He left the house early and lost consciousness. AO 95/60 mmHg,
Ps 115 beats / min. The skin is cool, dry, dark. Laboratory data: hematocrit
36%, glucose 62 mg / dL, Na 120 lv / l, K 6.7, creatinine 1.4 mg%. Which
endocrine disease should be suspected?
Adrenogenital syndrom
Corticosterom
Waterhouse-Friederick syndrom
Sheehan Syndrom Addison's
diseas

99. Which statement will be true for secondary chronic adrenal insufficiency?
Cortisol levels, ACTH elevated
Cortisol levels, ACTH reduced
Cortisol levels are lowered, ACTH increased
Cortisol levels are elevated, ACTH is lowered
Cortisol levels unchanged, ACTH elevated

100. Which statement will be true for changes in blood in chronic adrenal
insufficiency?
Hypernatremia, hypercholesterolemia, hyperkalemia
Hyponatremia, hypercholesterolemia, hypokalemia
Hyponatremia, hypocholesterolemia, hypokalemia
Hyponatremia, hypercholesterolemia, hyperkalemia
Hypernatremia, hypocholesterolemia, hypokalemia

101. Patient , 58, was admitted to the endocrinology department with


headaches, general weakness, increased blood pressure, which is bad for
correction, dry mouth, thirst, weight loss, dry cough. Hypertensive disease is
more than 10 years. On examination: thin, pale skin, dry, in the lungs -
vesicular breathing, heart rhythmic tones, heart rate - 88 beats per minute,
blood pressure 180/110 mm Hg Laboratory data: blood sugar - 7.8 mmol / l,
ZAK and ZAS without features.
Adrenal ultrasound - enlarged left adrenal gland, CT of the adrenal gland - volume
formation of the left adrenal glan What is your healing tactic?
Adrenalectomy unilateral
Phentolamine in / in to stabilization of blood pressure
Adrenalectomy bilateral
ß-blockers Seduxen

102. Which of the hormones is produced in the glomerular zone of the


adrenal cortex? Cortisone
Adrenaline
Testosterone
Aldosterone
Estrogens

103. The causes of hyperaldosteronism may be all of the following except:


Hormone-active tumor of the adrenal gland (aldosteroma)
Bilateral hyperplasia of the glomerular zone of the adrenal glands
Bilateral hyperplasia of the retinal mesh
Long-term use of medicines (diuretics, contraceptives)
May develop in some kidney diseases

104. The patient 37 years after the stressful situation had an attack,
accompanied by pain in the chest and head, a sense of fear of death, internal
chills. HELL - 180/100 mmHg, heart rate - 100 per min. The attack ended
with the release of a large amount of light urin What is the disease you
suspect?
Sympatho-adrenal crisis
Weight-insular crisis
Epileptic seizure
Neurasthenia Migraine
attack

105. Patient , 26, complains of severe weakness, lack of appetite, nausea,


weight loss (by 10 kg for 3 months). He was treated in the gastroenterology
department, but the disease is progressing. On examination:
hyperpigmentation occurs on the skin and gums against the background of
reduced nutrition. In the lungs - unchange Heart tones - deaf, heart rate - 80
beats per minut Pain on palpation of the abdomen is observe Emptying - 3-4
times a day. What is the most likely diagnosis?
Addison's disease
Hypothyroid coma
Hyperlactacidemic coma
Hyperosmolar coma
Acute insufficiency of adrenal cortex
106. Patient H 26 years old, complains of thirst (drinks more than 8 liters of
fluid during the day), polyuri Examination revealed hypoisostenuri Which
drug should be prescribed?
Cabergoline 0.5 mg once a week
Minirin 1 tablet 1-3 times a day
Dexamethasone 0.5 mg once a day 1 Bromocriptine 2.5 mg once daily Diacarb
0.25 once daily

107. Patient O., 25 years old, complained of menstrual irregularities


(amenorrhea) for 3 months), intermittent headach On examination, the
constitution is normosthenic, nutrition is satisfactory, the skin is clean,
moderately moist, when pressed from the
breasts, a whitish fluid is release The thyroid gland is not palpabl Pregnancy is
exclude What additional examination should be prescribed in the first place?
Determine the level of thyrotropic hormone, free T4
Determine the level of thyroid-stimulating hormone, free T4, prolactin, MRI of the
pituitary gland
Determine the level of prolactin
Determine the level of female sex hormones MRI of
the pituitary gland, ultrasound of the ovaries

108. A 28-year-old woman is being examined for primary infertility.


Diagnosed with pituitary macroadenoma (supraselar growth) without
impaired visual function. The prolactin content is 104.6 ng / ml (norm 4.79-
23.3 ng / ml).
Bromocriptine 5 mg three times a day
Cabergoline 0.5 mg once a week
Cabergoline 0.5 mg once a day
Transphenoidal removal of pituitary macroadenoma
Octreotide 0.05 mg p / w twice a day

109. Patient M. 32, examined for hypercorticism. In order to differentially


diagnose the source of hypercortisolemia, it was decided to conduct a large
dexamethasone test. Specify the correct schedule of dexamethasone for this
purpose?
0.5 mg 4 times a day for 2 days
1.0 mg 4 times a day for 2 days
2.0 mg 4 times per day for 2 days
0.5 mg 6 times a day for 2 days

110. A 22-year-old woman is being examined for obesity and periodic high
blood pressur The family doctor referred the patient to an endocrinologist,
who suggested a small dexamethasone test. Specify the correct schedule of
dexamethasone for this purpos
Dexamethasone 0.5 mg every 6 hours for 48 hours
Dexamethasone 1.0 mg every 6 hours for 48 hours
Dexamethasone for 0.5 mg every 6 hours for 72 hours
Dexamethasone 0.5 mg every 4 hours for 48 hours
Dexamethasone 1.5 mg every 6 hours for 48 hours 2.0 mg 6 times a day for 2 days

111. The patient, P 38, complains of frequent headaches, fatigue, loss of


ability to work. An increase in intracranial pressure,
secondary hypothyroidism was note On
X-ray of a skull: expansion of a Turkish saddle, double-contour of a bottom with
preselar pneumatization. On MRI: cerebrospinal fluid in the intracellular area, the
sickle-shaped pituitary glan Diagnose:
Tertiary hypothyroidism
Parkhon's syndrome
Pituitary cyst
"Empty" Turkish saddle syndrome
Picture of transcranial adenomectomy

112. The patient, A 30 years old, complains of an increase in the size of the
jaw, hands, feet, palpitations, menstrual irregularities such as oligomenorrhe
The examination diagnosed dyslipoproteinemia, elevated prolactin and
somatotropic hormon MRI revealed a cystic pituitary adenoma of 9 mm.
Choose the correct diagnosis.
Acromegaly
Gigantism
Macroprolactinoma
Craniopharyngioma Prolactotrophic
hyperplasia

113. A 28-year-old woman complained of being overweight. From the


anamnesis it is known that overweight from adolescence, but began to gain
weight after childbirth. On examination: the skin is clean, moderately moist.
Excess of adipose tissue, the distribution is uniform. Height 172 cm, weight
96.3 kg, BMI 32.53 kg / m2. Set the degree of obesity.
Normal body weight.
Overweight.
Grade I
Grade II
Grade III
114. A 21-year-old girl complains of disproportionate obesity (upper type),
menstrual irregularities, and hair growth in androgen-dependent areas. The
examination revealed an increase in cortisol, ACTH. MRI revealed an 11 mm
pituitary adenom Itsenko-Cushing's disease was diagnose Choose a false
statement for this diseas Patients have a "moon-shaped" fac Hypertension.
Dysplastic obesity.
Development of osteoporosis.
Frequent hypoglycemic conditions .

115. Patient H, 42 years old, complains of severe polydipsia and polyuri


During the day he drinks more than 8 liters of flui He associates the disease
with a recent
psycho-emotional traum The additional examination revealed hypoisostenuria of the
urine, a decrease in antidiuretic hormon What functional tests are performed to
diagnose diabetes insipidus?:
With clonidine
With verospirone
With fluid restriction
With dexamethasone
With starvation

116. The patient complains of progressive obesity with a predominant


deposition of subcutaneous fat in the shoulder girdle, mammary glands,
abdomen, buttocks and thighs. Consulted by a gynecologist, confirmed the
underdevelopment of the genitals. At additional inspection decrease in levels
of FSH, LH, estrogens is diagnose Make the correct diagnosis.
Pehkrantz-Babinski-Frelich syndrome
Alimentary-constitutional obesity
Itsenko-Cushing's disease
Shereshevsky-Turner syndrome
Lawrence-Moon-Bardet syndrome -For
117. Patient O., 28 years old, is being examined for infertility. According to
the results of instrumental and laboratory examinations, polycystic ovary
disease was diagnose Which statement is wrong for this disease?
Ovarian-menstrual cycle disorders
Anovulatory cycles
Female phenotype
Overweight Thyroid
enlargement

118. The patient, K 22 years old, complains of short stature and overweight.
Low growth rate since childhood, growth retardation was more than 3 sigma
deviations. Pituitary dwarfism was diagnose What height is the criterion for
this disease in patients?
Less than 100 cm
Less than 110 cm
Less than 120 cm
Less than 130 cm 1 Less than 140 cm

119. The patient, 36 years old, complained of a sharp increase in weight (22
kg during the year), periodic headache, decreased potency. Objective: height
170 cm, body weight 114 kg. Fat deposits mainly on the chest, abdomen. On
the shoulders, abdomen and thighs stretch crimson-cyanotic color. Heart tones
are deaf, blood pressure 170/100 mm of mercury. Art. External and internal
genitals are well develope Fasting blood glucose 7.6 mmol / L
Alimentary-constitutional obesity
Hypothyroid obesity
Hypoovarian obesity
Itsenko-Cushing's disease
Lipomatosis

120. The parents of a 13-year-old girl went to the doctor with complaints
about her child's short stature and overweight. Objectively: proportional
growth retardation, excess body weight with uniform deposition of
subcutaneous fat, delayed sexual development. The doctor suspected pituitary
dwarfism. Which criterion is considered correct to confirm the diagnosis?
Height less than 120 cm
Growth lag of 3 or more sigmoid deviations
Height less than 130 cm
Lag growth by 2 sigma deviations
Growth lag by 1 sigma deviation

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