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ANSWERS ON QUESTIONS

Main part

A patient of 28 years old had diabetes mellitus 3 years ago. Since the moment of setting

the diagnosis is on intensified insulin therapy (daily dose 32-46 units),

actively uses means of self-control. The last 2 weeks the regime was broken

nutrition due to work. Often began to celebrate attacks of hunger, which were accompanied by

trembling in the body, palpitations, headache, aggressive behavior. At

blood glucose measurement with a glucometer at this moment is 2.8-3.5 mmol / l. These phenomena

I stopped myself by taking food containing a lot of carbohydrates.

Questions:

1. Assume the most likely diagnosis.

2. Justify your diagnosis.

3. Justify the cause of hypoglycemic conditions.

4. Justify the need to determine glycated hemoglobin (HbA1c).

5. Give recommendations to the patient to avoid hypoglycemic conditions.

 

Situational task 110 [K000432]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 25-year-old woman came to the outpatient clinic with a general practitioner

a complaint of a constant heartbeat unrelated to physical activity and

emotional stress. When questioned, the patient reported that during

last month lost 8 kg, notes unstable stool, worried

increased hair loss. On an ECG: sinus tachycardia 102 strokes in 1 minute. FROM

the purpose of clarifying the diagnosis is a study of thyroid hormones,

consultation with an endocrinologist, it is recommended to take Bisoprolol 2.5 mg 1 time per day.

According to the results of ultrasound examination revealed an increase in thyroid size

glands up to 23 cm 3 , diffuse decrease in echogenicity, heterogeneity of the echostructure,

increased vascularization. A hormonal study showed a decrease in TSH levels to

0.23 mU / L, increase in CT4 to 53.7 pmol / L. Endocrinologist delivered

preliminary diagnosis of autoimmune thyroiditis. Prescribed treatment: Tyrosol 10 mg

per day. Additionally, a study of the level of autoantibodies to the TSH receptor was prescribed.

Questions:

1. Formulate a preliminary diagnosis based on the clinical picture and

thyroid status test results.

2.

What kind

additional

research

is necessary

to appoint

for

differential diagnosis of thyrotoxicosis syndrome?

3. What tactical mistakes and unreasonable appointments were made at the stage

preliminary examination?

4. What therapeutic strategies can be implemented in this patient with

taking into account the diagnosis?

5. Justify the choice of the most effective and safe treatment method.

 

Situational task 111 [K000434]

Instructions: READ THE SITUATION AND GIVE EXPLAINED

ANSWERS ON QUESTIONS

Main part

A 39-year-old patient complains of weakness at an appointment with a local GP

frequent urination, sleep disturbance, weight loss. From the anamnesis it is known that the first

symptoms appeared about 2 months after a severe flu,

proceeding with a disorder of consciousness and convulsions, about which the patient was

hospitalized in an infectious diseases hospital. After discharge from the hospital

fatigue, increased weakness, insomnia, decreased appetite, decreased sweat

salivation, thirst appeared, because of which he began to drink daily up to 5-6 liters

fluid, lost 4 kg. When examining the pathology of the internal organs was not detected.

No impaired glucose metabolism. Urinalysis according to Zimnitsky:

daily diuresis - 7.5 l with a relative density of urine of 1001-1005 g / l.

Questions:

1. Formulate and justify the diagnosis.

2. A violation of the secretion of which hormone leads to the development of this disease,

What is its pathogenesis?

3. What surveys are needed to establish the final

the diagnosis?

4. Formulate and justify recommendations for observing the drinking regime for

a patient with such a disease.

5. What drug should be prescribed to the patient?

 

Situational task 112 [K000435]