3. The syndrome of insulin deficiency:

REASONS: absolute for type 1 diabetes (insufficiency of insulin secretion, a decrease in blood insulin due to the death of 100% beta cells) or relative for type 2 diabetes (defects in the receptor apparatus of insulin-dependent tissues - insulin resistance, normal or high insulin levels in the blood) , violation of insulin secretion by beta cells of the pancreas.

SYMPTOMS: "Large" - polydipsia, polyphagy, polyuria, weight loss, hyperglycemia, glucosuria, ketoacidosis. Weight loss and ketoacidosis are observed with absolute and pronounced relative insulin deficiency. Overweight and polyphagy are characteristic of insulin resistance.

"Small" - weakness, skin itching, especially in the perineum and genital area, furunculosis, tendency to infectious diseases, frequent lesions of the oral mucosa, periodontal disease, visual impairment, gastrointestinal function, large fetus, decreased body temperature.

Typical complications of diabetes.

Systemic damage to the whole organism in connection with a violation of carbohydrate and other types of metabolism and develops against their background:

• poleneuropathy

• macroangiopathies

• microangiopathies

Diabetic coma.

1. Ketoacidotic

2. Hyperosmolar

3. Lactic acid (lactocidemic)

4. Hypoglycemic

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6.1. TEST TASKS

(Choose one or more correct answers)

1. What is not typical for thyrotoxicosis?

1) exophthalmos;

2) bradycardia;

3) fussiness;

4) hand tremor;

5) sweating.

2. What symptom is not characteristic of hypothyroidism?

1) weight loss;

2) dry skin;

3) slowing down speech;

4) hair loss.

3. What is not typical for type 1 diabetes?

1. development at a young age;

2. development in old age;

3. development in childhood.

4. What is typical for type 2 diabetes?

1) development at a young age;

2) development in old age;

3) development in childhood.

4. For what disease is bronze color of the skin characteristic?

1) diabetes mellitus;

2) addison's disease;

3) hypothyroidism;

4) acromegaly.

4. The symptom of Dalrymple is:

1. Expansion of the palpebral fissure when fixing the gaze (surprised look)

2. A strip of sclera when looking down between the upper eyelid and the iris

3. A strip of sclera when looking up between the upper eyelid and the iris

4. Small tremor of drooping or slightly closed eyelids

7. The symptom of Gref is:

1. Expansion of the palpebral fissure when fixing the gaze (surprised look)

2. A strip of sclera when looking down between the upper eyelid and the iris

3. A strip of sclera when looking up between the upper eyelid and the iris

4. Small tremor of drooping or slightly closed eyelids

8. The symptom of Kocher is:

1. Expansion of the palpebral fissure when fixing the gaze (surprised look)

2. A strip of sclera when looking up between the lower eyelid and the iris

3. A strip of sclera when looking up between the upper eyelid and the iris

4. Small tremor of drooping or slightly closed eyelids

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9. Symptom of Moebius:

1. Expansion of the palpebral fissure when fixing the gaze (surprised look)

2. A strip of sclera when looking down between the upper eyelid and the iris

3. A strip of sclera when looking up between the upper eyelid and the iris

4. Violation of convergence

10. Rosenbach's symptom is:

1. Expansion of the palpebral fissure when fixing the gaze (surprised look)

2. A strip of sclera when looking down between the upper eyelid and the iris

3. A strip of sclera when looking up between the upper eyelid and the iris

4. Small tremor of drooping or slightly closed eyelids

11. What does not apply to the clinical signs of diffuse toxic goiter:

1. Tachycardia

2. Exophthalmos

3. Constipation

4. Weight Loss

5. Increase in body temperature

12. Signs of hypothyroidism include:

1. Tachycardia

2. Exophthalmos

3. Constipation

4. Weight Loss

5. Increase in body temperature

13. What does not apply to the clinical signs of thyrotoxic crisis:

1. Hyperthermia up to 38-40С

2. Dry skin

3. Vomiting, diarrhea

4. Mental and motor anxiety

14. What does not apply to the characteristic complaints of patients with hypothyroidism:

1. Drowsiness

2. Chilliness

3. Diarrhea

3. Decrease in memory

5. Dry skin

15. What concerns characteristic complaints of patients with hypothyroidism:

1. Drowsiness

2. hair loss

3. Diarrhea

4. Insomnia

5. Weight Loss

16. What relates to characteristic complaints of patients with hypothyroidism:

1. Coarsening of the voice

2. Constipation

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3. The increase in body temperature

4. Insomnia

5. Weight Loss

17. Clinical signs not characteristic of hypothyroid coma:

1. Arterial hypotension

2. Hypothermia

3. Diarrhea

4. Severe bradycardia

5. Oliguria, anuria

18. Hypoglycemic coma is characterized by all of the following, except:

1. The rapid development of coma

2. Slow development of coma

3. Tonic and clonic seizures

4. Tachycardia

19. Ketoacidotic coma is characterized by all of the following, except:

1. The rapid development of coma

2. Dehydration

3. Smell of acetone in exhaled air

4. The breath of Kussmaul

20. Autoimmune is diabetes:

1.1 types

2.2 types

3. Gestational diabetes

21. Insulin resistance plays a role in the development of:

1. Type 1 diabetes

2. Type 2 diabetes

22. Treatment of type 1 diabetes:

1. Diet and regular exercise

2. Oral hypoglycemic drugs

3. Insulin therapy

4. All of the above

23. Treatment of type 2 diabetes:

1. Diet and regular exercise

2. Oral hypoglycemic drugs

3. Insulin therapy

4. All of the above

24. In diabetes mellitus, the following plasma glucose values are detected during the oral glucose tolerance test:

1. Fasting ≥ 7.0 mmol / L

2. Fasting ≥6.1 <7 mmol / L

3. After 2 hours ≥11.1 mmol / L

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4. After 2 hours ≥ 7.8 <11.1 mmol / L

25. In case of impaired glucose tolerance, the following plasma glucose values are detected during the oral glucose tolerance test:

1. Fasting ≥7.0 mmol / L

2. Fasting <7 mmol / L

3. After 2 hours ≥11.1 mmol / L

4. After 2 hours ≥ 7.8 <11.1 mmol / L

02

6.2 Situational tasks for the section "Endocrinology"

Task 1

Patient M., 29 years old, came to the clinic with complaints of thickening of the neck, palpitations, increased irritability, tearfulness, sleep disturbance, general sweating, trembling of the fingers, weight loss of 6 kg over the past six months, despite increased appetite. The above symptoms appeared a year ago after returning from the south. On examination: some fussiness, hasty speech pays attention. The skin is moist, hot to the touch. When examining the neck, its thickening is revealed. Symptoms of Shtelvag, Grefe - positive. Severe exophthalmos. During auscultation of the heart I, the tone at the apex is loud, there is also a gentle systolic murmur. The heart rate is 110 per min., The heart rate is incorrect: atrial fibrillation, there is no pulse deficiency.

1. What syndromes can be distinguished on the basis of this clinical picture?

2. The presence of a disease can be assumed based on available data?

Task 2

Patient L., 55 years old, was admitted to the hospital with complaints of dry mouth, thirst, skin itching, general weakness, excretes more than 2 liters of urine per day.

The above symptoms appeared 2 months ago.

On examination, it is noteworthy that the patient is of increased nutrition. The skin is dry scaly, severe rubeosis, pustular rashes.

In the study of blood tests: hemoglobin 120 mg%, red blood cells - 4.5 x 1012 / l, white blood cells - 6.0 x 109 l, ESR - 18 mm / h, glucose -12 mmol / l (240 mg%). Urinalysis: quantity - 450 ml, relative density - 1,030, protein - not available, leukocytes - 2-4 in n / a, glucose - 0.8 g / l, ketone bodies - are absent.

1. What disease are we talking about in this task, and what clinical symptoms are most significant for

diagnosis?

2. What laboratory symptoms confirm the preliminary diagnosis?

Task 3

A 25-year-old patient was delivered to the hospital ward with complaints of severe weakness, lethargy, thirst, epigastric pain, and vomiting. Deterioration after acute respiratory illness.

Objectively: inhibited, lethargic, smell of acetone from the mouth, dry skin, tongue coated with a dirty brown coating. Pulse - 100 per minute, blood pressure - 100/60 mm RT. Art. Palpation of the abdomen is painful in the epigastric region, there are no symptoms of peritoneal irritation.

1. Highlight syndromes

2. What diagnosis can be suspected?

Task 4

Patient R., 26 years old, has been suffering from diabetes since 16 years. Receives insulin therapy. After intense physical activity in the morning at 11.00 a weakness, hand tremor, sweating, restlessness, inability to concentrate appeared. The patient tried to overcome the condition by eating himself, but lost consciousness. A few minutes later came to his senses. An ambulance was called.

1. What condition did the patient develop?

2. The plan of medical measures.

Task 5

Patient., 46 years old, complains of hair loss, weakness, drowsiness, swelling of the face and limbs, coarsening of the voice, weight gain, constipation.

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An objective examination of the face puffy, amymic. The speech is slow, "languid". The skin is dry, peeling. The thyroid gland is palpated, not enlarged. Eye symptoms are negative. Heart rate 55 per minute. HELL 100/80 mm Hg

1. What syndrome do you suggest?

2. What is the most probable reason for it?

Answers to the tasks to the section "Endocrinology"

Task 1

1. Thyrotoxicosis syndrome with the formation of thyrotoxic cardiomyopathy and ophthalmopathy.

2. Diffuse toxic goiter.

Task 2

1. Diabetes in favor of which they say: polydipsia, polyuria, skin itching and skin changes

2. Hyperglycemia, glucosuria.

Task 3

1. Insulin deficiency syndrome

2. Type 1 diabetes. Diabetic ketoacidosis

Task 4

1. Hypoglycemic condition

2. Severe hypoglycemia, characterized by impaired consciousness, requires intravenous administration of 20-100 ml of a 40% glucose solution. Alternative 1 ml glucagon solution s / c or / m

Task 5

3. Hypothyroidism syndrome

4. The most common cause of hypothyroidism is autoimmune thyroiditis.

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7. HEMATOLOGY