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ANSWERS ON QUESTIONS

Main part

At the reception by a general practitioner, the patient is M., 48 years old. Diabetes mellitus 2

type detected by chance during the medical examination a week ago. Medication

does not receive therapy. From the anamnesis: myocardial infarction, stroke did not tolerate. Turned to

the general practitioner to prescribe treatment.

Objectively: height - 170 cm, weight - 106 kg. Body mass index (BMI) - 37.5 kg / m 2

.

Waist size - 120 cm. Skin of moderate humidity, deposition of subcutaneous tissue

mainly in the abdomen. Vesicular breathing. Pulse - 76 beats per minute.

Heart sounds are rhythmic, muffled, blood pressure - 160/90 mm RT. Art. The liver is not enlarged. Fathers

not.

He presented the results of self-monitoring using a glucometer: fasting glucose - 7.8

mmol / l, glucose 2 hours after a meal - 10 mmol / l. HbA1c - 7.5%. Biochemical

blood test: total protein –75 g / l, albumin - 46 g / l, total bilirubin - 13.1 mmol / l,

creatinine - 80 μmol / l, ALT - 65, AST - 53. Glomerular filtration rate (GFR) -

91 ml / min.

Questions:

1. Formulate the main clinical diagnosis of diabetes according to

modern requirements.

2. Justify your choice of individual target glycosylated level

hemoglobin in this patient. Determine your glycemic targets

this patient.

3. Determine the volume of additional examination of the patient according to the standard

medical care for type 2 diabetes.

4. Determine the patient’s treatment tactics.

5. Determine glycemic control indicators to be used.

to evaluate the effectiveness of hypoglycemic therapy in dynamic

observation.

 

Situational task 104 [K000406]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient M., 30 years old, turned to the local general practitioner with complaints of

weight loss of 10 kg over the past 3 months, heart palpitations

both at rest and during physical exertion, a feeling of trembling in the body, irritability,

sleep disturbances, weakness. On examination: height - 168 cm, weight - 53 kg, BMI - 19 kg / m 2 . Skin

the covers are warm, "velvety." Minor tremor of the body and fingers. Exophthalmos from both

parties, Gref’s symptom is positive. Heart sounds are loud, rhythmic, tachycardia -

120 beats per minute, blood pressure - 145/70 mm RT. Art. The thyroid gland is homogeneous upon examination,

lobes significantly larger than the distal phalanx of the first finger of the patient, changed

neck configuration.

General blood test: red blood cells - 3.9 × 10 12 / l, hemoglobin - 135 g / l, white blood cells -

6.4 × 10 9 / l, platelets - 311 × 10 9 / l, ESR - 16 mm / hour.

Biochemical blood test: total protein - 65 g / l, albumin - 45 g / l, total

bilirubin - 14.1 μmol / L, creatinine - 0.09 mmol / L, glucose - 5.1 mmol / L.

ECG: sinus rhythm, heart rate - 126 beats per minute, normal position of EOS.

Ultrasound of the thyroid gland: gland volume - 48 ml, normal echogenicity, structure

homogeneous, increased blood flow.

Hormonal examination: thyroid-stimulating hormone - 0.005 mIU / L (normal 0.2-4.2

mIU / l), free thyroxine - 60 pMol / l (norm 9-22 pMol / l).

Questions:

1. Put and formulate the most probable diagnosis.

2. Determine the amount of additional examination necessary to clarify

the diagnosis.

3. Justify your diagnosis.

4. Define treatment tactics.

5. Define parameters for monitoring the effectiveness and safety of therapy in

treatment process.

 

Situational task 105 [K000427]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

Patient I., 23 years old, at a reception in the clinic complains of weakness, decrease

working capacity, nervousness, irritability, sweating, weight loss, increase

appetite, poor heat tolerance, tremors, palpitations, a feeling of "sand in the eyes",

lacrimation.

From the anamnesis it is known that the onset of the disease is associated with overwork. Of

illnesses noted frequent colds.

On examination: the condition is relatively satisfactory. Integuments on

wet touch, swelling of the eyelids. The subcutaneous fat layer is moderately developed

(height - 170 cm., weight - 54 kg). Marked tremor of outstretched fingers, muscular

weakness. Symptoms of Gref and Mobius are positive. Thyroid gland enlarged to

II degree, elastic, homogeneous. The vesicular breathing, no wheezing. BH - 16 per minute.

With auscultation of the heart, systolic murmur, loud tones are heard. Heart rate - 120

beats per minute. HELL - 160/70 mm RT. Art. The abdomen is soft, painless. Chair

regular, sometimes 2-3 times a day.

Questions:

1. Assume the most likely diagnosis.

2. Justify your diagnosis.

3. Create and justify a patient examination plan necessary for

confirmation of the diagnosis.

4. Prescribe treatment according to the standards of care.

5. Is a patient with DTZ prescribed glucocorticoids? Justify your answer.

 

Situational task 106 [K000428]