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ANSWERS ON QUESTIONS
Main part
Patient M., 44 years old, at an appointment with a GP, complains of a quick
fatigue, memory loss, drowsiness, chilliness, constipation, weight gain, decrease
hearing, hoarseness of voice.
From the anamnesis it is known that these complaints arose 6 years ago without a visible
causes and developed gradually. During this time, the weight increased from 76 to 118 kg. IN
history - repeated sore throats.
On examination: satisfactory condition, height - 165 cm, skin
clean, dry, especially on the elbows, cold to the touch. The face is puffy, pale.
Brushes are pasty. On the lower extremities dense edema. Fat distribution
fiber uniform. The isthmus and both lobes of the thyroid gland are palpated, more
right; the gland is dense, painless. The vesicular breathing, no wheezing. BH - 16 in
a minute. Borders of relative dullness of the heart: left - 1.5 cm outwards from the middle
clavicular line; right - 1.5 cm outwards from the right edge of the sternum. Heart sounds
sharply weakened. Pulse - 53 per minute, rhythmic. HELL - 90/70 mm RT. Art. The tongue is wet, with
traces of teeth. The abdomen is enlarged due to fatty tissue and bloating. Palpation of it
painless. The liver is not enlarged. The chair is regular.
In a laboratory study, TSH was detected: 14 mIU / L (normal 0.4-4
mIU / l), St. T4 - 5.6 pmol / ml (10 pmol / l-25 pmol / l, anti-TPO - 364 IU / ml (up to 30
IU / ml).
General blood test: red blood cells - 3.5 × 10 12 / l, white blood cells - 5.8 × 10 9 / l, hemoglobin -
96 g / l
Blood cholesterol - 8.8 mmol / L.
General urine analysis without pathology.
Electrocardiography - reduction of the voltage of the teeth, bradycardia, flattening of the tooth
T.
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. 3 months after the prescribed pathogenetic therapy, the TSH level is 7.2
mIU / L Your further tactics.
Situational task 107 [K000429]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
A 52-year-old woman consulted a local GP with complaints of
constant dry mouth, thirst, frequent urination, general weakness, itchy skin.
Considers himself ill for six months, when there was dry mouth, thirst.
A week ago, itchy skin appeared, which made me see a doctor.
He works as a cook in an institution. 5 years in history
pancreatitis
Mom suffered from diabetes.
On examination: satisfactory condition. BMI - 36 kg / m 2 . Waist circumference -
106 cm, hip circumference - 109 cm. The skin is clean, there are traces of scratches on the hands. IN
Light breathing is vesicular, no wheezing.
Heart tones are rhythmic. Heart rate - 70 beats per minute. HELL - 120/70 mm RT. Art.
The abdomen is soft, painless on palpation in all departments. Liver and spleen not
enlarged. There is no dysuria
In the analyzes: fasting blood glucose - 5.8 mmol / l, total cholesterol - 6.1 mmol / l,
TG - 2.7 mmol / l, HS-HDL - 1.0 mmol / l.
Questions:
1. Assume the most likely diagnosis.
2. Make a plan for an additional examination of the patient.
3. As a result of the study, it was found that the patient has glucose
fasting blood - 6.1 mmol / l, 2 hours after taking 75 g of glucose - 11.1 mmol / l;
HbA1c - 7.1%. Prescribe a treatment. Justify your choice.
4. Give the patient nutrition recommendations.
5. After 6 months, the patient again came to see a doctor. As a result
the treatment, the patient's weight decreased by 6 kg. HbA1c decreased by 0.5% and
an individual goal was achieved. What is your further therapeutic tactic?
Justify your choice.
Situational task 108 [K000430]
Instructions: READ THE SITUATION AND GIVE EXPLAINED
ANSWERS ON QUESTIONS
Main part
A 51-year-old man consulted a local GP with complaints of dryness,
thirst, polyuria, visual impairment.
Sick for 2 years. I did not follow a diet. Self-control of glycemia is not carried out.
At night he took Metformin 500 mg.
On examination: satisfactory condition, BMI - 26 kg / m 2 . Skin integument
regular coloring. In the lungs, vesicular breathing, no wheezing, BH - 16 per minute. Tones
heart rhythmic, muffled, accent II tone over the projection of the aorta. Heart rate - 70 beats per
minute, blood pressure - 160/100 mm RT. Art. The abdomen is soft, painless on palpation in all
departments. The liver and spleen are not enlarged. Symptom of lumbar effusion
areas are negative.
Examination by an ophthalmologist revealed non-proliferative retinopathy on
right eye.
In the analyzes: fasting glycemia - 9.0 mmol / L, postprandial - 12 mmol / L.
Total cholesterol - 6.9 mmol / L, TG - 2.7 mmol / L, HDL-C - 1.0 mmol / L; creatinine -
101 μmol / l, GFR (according to the formula CKD-EPI) - 70.8 ml / min; albuminuria - 100 mg / day.
Questions:
1. Assume the most likely diagnosis.
2. Justify your diagnosis.
3. Make and justify a plan for an additional examination of the patient.
4. Which group of drugs will you recommend to the patient for correction?
hyperglycemia? Justify your choice.
5. Which group of antihypertensive drugs would you
recommended to the patient as part of combination therapy? Justify your
a choice.
Situational task 109 [K000431]
Дата: 2019-12-10, просмотров: 264.