Endocrine Credit
Endocrine Credit
Endocrine Credit
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)
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
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
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
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
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
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
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.
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.
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
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
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.
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.
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.
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.
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.
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.
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
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
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.
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.
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.
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
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
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
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
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
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.
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.
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
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
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
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.
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
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. *
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
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.
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.
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
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
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
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
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
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
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
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
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
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