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ЗмістII. Aim of study
Principal aims- to know
The sum test control
M. Gorky Donetsk National Medical University
Methodical guidance for learning “Metabolic syndrome” for students of 5 –th course.
Turovskaya Т. V., d. of med. s.., professor of Department of internal medicine #3 of M. Gorkiy Donetsk national medical University
Mitchenko E.I., d. of med. s., professor head of Department of dislipidemia NNC “Institute of cardiology by N.D. Stragesko AMN of Ukraine ”, Kiev.
Parhomenko T.A., assistant professor of Department of internal medicine #2 DonNMU
Basiy R.V., assistant professor of Department of Human Anatomy, Head of the methodical department of DonNMU.
I. Urgency of the topic:
According to the statistic data more then 50 % of the patients of cardiologist have the syndrome of insulin resistance. But in the structure of death of people with diabetes mellitus (DM), cardiac disease are 55 %, and the presence of arterial hypertension in this patient leads to the high risk of cardio-vascular disease and death. This prognosis became worst in the patient with AG or DM cause of presence of dislipidemia or overweight, which registered in more then 50 % of cardiac patients.
More often in the clinical practice there are patient with combination 2 or more factors of risk of development CVD, which leads to enlarge of negative influence and makes prognosis worst..
That’s why we have to give an especial attention to the patient with metabolic syndrome (MS), which characterize of presence of abdominal overweight ( volume of waist for men ≥ 94 cm, for women ≥ 80 cm), and also the presence 2 from 4 listed factors: high level of triglyceride (TG ≥ 1,7 mmol/l); low level of cholesterol lipoproteid of high density (< 1,03 mmol/l in a men and < 1,29 mmol/l in woman) or specific treatment in a patient with dislipidemia; АG (level of systolic pressure ≥ 130 mm.hg.cl., or level of diastolic pressure ≥ 85 mm.hg.cl.) or hypotension treatment in a patient with AG; high level of glucose in blood on an empty stomach ≥ 5,6 mmol/l ( or before diagnosed diabetes mellitus of second type (DM2) типа).
In the end the presence of such a different of clinical syndromes, the specialist of any profile can meet a metabolic syndrome.
Common aim to know how to make a differential diagnosis of MS and other diseases, which have common clinical symptoms ( arterial hypertension, overweight, hyperglycemia, dislipidemia) to determine tactic of leading of the patient with MS and to argument principal of treating.
Information which is need to make the basic level of knowledge-tools higher, you can find in next literature isuues :
Tasks for self-control and self control of basic level knowledge- tools
A patient K., a doctor determine the presence of overweight of central type, high level of triglyceride, low level of CLHD, high level of glucose in blood plasma on an empty stomach, arterial hypertension..
What is the symptom between listed is a main in determination of diagnosis of metabolic syndrome, according the criteria IDF.
А. Overweight of central type.
B. High level of triglyceride .
C. Low of level of CLHD
D. High level of glucose in plasma blood on an empty stomach..
E. Arterial hypertension.Артериальная гипертензия.
In a patient with metabolic syndrome was made lot of examination: measured the circumfluence of waist, measured BP, examined a lipid profile, the level of glucose on an empty stomach, leaded per oral glucose tolerant test. What is the examination which was leaded is not necessary for determination of presence of metabolic syndrome:
А. Measuring of circumfluence of waist
B. Measuring of BP
C. Measuring of lipid profile.
D. Determination of glucose level on an empty stomach.
E. Measuring of glucose tolerant test per oral.
In a patient D, theraputist determined the presence of break of hydrocarbon changes. What is the criteria of metabolic syndrome among the laboratory measuring in this patient :
А. High level of glucose in blood plasma on an empty stomach.
B. High level of postproindial glucose in blood plasma.
C. High level of basal insulin in blood plasma on an empty stomach.
D. High level of glycated hemoglobin in blood plasma on an empty stomach.
E. High level of rennin in blood plasma on an empty stomach.
In a patient N, 58 years old, who suffer from diabetes mellitus of 2 type on the background of metabolic syndrome developed hypoglycemic coma.What kind of breath was determined in a patient during objective examination?
In a patient D. who has overweight, a doctor diagnosed diabetes mellitus of II type. Which medicine is the first treatmen for this patient?
B. Basal insulin
C. Diabeton MR
III. Contains of study
For reach of knowledge aims it is necessary to learn next theoretical questions.:
Information which is needed for learning the theoretical questions, you can find in next literature issues:
Then you have to solve some tasks and to check right answers on the example.
Patient K., who has in anamnesis diabetes mellitus and arterial hypertension, a doctor thinks about metabolic syndrome. What kind of additional examination we have to make for determination of presence of abdominal overweight:
А. Determine the weight of the patient
B. To measure the circumfluence of waist.
C. To measure the circumfluence of hips.
D. To solve the coefficient of volume of waist/hips
E. To solve the index of weight
In a patient M, during the examination, determined metabolic syndrome. Which combination of 3 clinical symptoms which take place in a patient let us diagnosis metabolic syndrome.
А. Overweight of central type + anemia + hypertriglyceridemia.
B. Overweight of central type + hypertriglyceridemia. + hyperglycemia.
C. Hypertriglyceridemia+ arterial hypertension + hyperglycemia .
D. Hypertriglyceridemia + arterial hypertension + anemia.
E. Overweight of central type + arterial hypertension + anemia.
Patient 48 years old , entered to thee hospital Больная 48 лет, complaints on headache, high fatigability, breathless and heart beat during fast walking, break of menstrual cycle. She feels bad after nervous-emotional stress. During objective examination – hight =172 cm, weight 100 kg. Distribution of fat tissues is irregular – with predomination on the abdominal part. BP 160/90 mm. hg.cl. Data of lipidogramma: cholesterol common 7,0 mmol/l, triglyceride 2,4 mmol/l, cholesterol of lipoprotein of high density – 0,86 mmol/l.
What kind of syndrome take place in this patient?
А. Alimentary-constitutional overweight of II degree
B. Neurocirculatory dystonia on hypertonic type
C. Hypotalamic puberties syndrome.
D. Metabolic syndroem
E. Break of ovarian-menstrual cycle
A patient, who suffer from metabolic syndrome with the diabetes mellitus 2 type, took glibenklamid 15 mg per day for a long time . He felt good. Suddenly, at 11 a.m. he felt bad: appeared cold sweat, tremor of extremities, and a patient lost confidence. What a doctor has to do first of all?
А. To insert insulin
B. To insert 40% solution of glucose intravenously stream
C. To start intravenous introduction of insulin with glucose
D. To call the laborant and waits for results of blood analisis
E. To give oxygen
During the prescription of therapy to the patient with metabolic syndrome, a doctor out 5 main aims:
1. Normalization of weight
2. To increase physical activity
3. Antihypertension therapy
4. Low lipid therapy
5. Hypoglycemic therapy
Which aim is not necessary and we can do it later?
А. – 1
B. – 2
C. – 3
D. – 4
E. – 5
An example of answer to the task №1.
The right answer is B.To measure the circumfluence of waist. An overweight related with insulin resistance and metabolic syndrome. But, overweight on abdominal type in a main korrelirate with metabolic syndrome, then increasing of index of weight. That’s why usual measuring of circumfluence of waist is recommended for determination of “weight” component of metabolic syndrome.
Short methodical review to the guidance of lesson on the topic “Metabolic syndrome”
In the beginning of the lesson the professor leads checking of correction of level of knowledge by tests. Then students make self examination of patient, after this you make the discussion of the patient and correction by the professor of a lesson.
For the strengthening of knowledge the professor makes the conclusion of self work of students.
Structure-logical net of «Metabolic syndrome»
Diagnostical algorithm with syndrome «Overweight»
Criteria of metabolic syndrome, recommended by International Diabetic federation (IDF) 2007 year.
Algorithm of examination of a patient with DM, MS and IDH
Algorithm of treatment of metabolic syndrome DM 2 type
Diagnosis (2 type DM)
Modification of life style and metformin
add basal insulin
add basal insulin
Add basal insulin or intensive insulinotherapy
Patient C. Has a metabolic syndrome was determined the break of results of lipid changes. Changes of which 2 main results of lipid changes confirmed the diagnosis of a doctor?
А. OH + CH LHD
B. OH + TG
C. TG + CH LLD
D. TG + CH LHD
E. CH LLD + CH LHD
During the screening of the patient with arterial hypertension in a quantity of man and woman was determined a metabolic syndrome. Which results of level of CH LHD were taken by the doctor to determine the diagnosis?
А. < 0,9 mmol/l in man and < 1,0 mmol/l in woman
B. < 0,9 mmol/l in man and < 1,29 mmol/l in woman
C. < 1,03 mmol/l in man and< 1,0 mmol/l in woman
D. < 1,03 mmol/l in man and< 1,29 mmol/l in woman
E. < 1,0 mmol/l in man and< 1,29 mmol/l in woman
During the examination of a patient В was found 4 cardiometabolic factors of risk. Which factor from listed below is not a factor of risk of metabolic syndrome?
D. Arterial hypertension
D. Break of tolerance of glucose.
In patient D. determined the abdominal type of overweight. What the minimal results of circumflex of waist in man could prove the presence of abdominal overweight?
А. > 80 cm
B. > 88 cm
C. > 94 cm
D. > 102 cm
E. > 112 cm
In patient М. with metabolic syndrome during the examination was determined an overweight. After the counting of IWB, doctor determined that it is 35 kg/m². What could be the reason of such a weight in a patient?
During the examination of the patient BP= 170/100 mm.hg.cl., IWB =30 kg/m². During next examination of blood OH - 6,5 mmol/l,CH LHD – 0,9 mmol/l, glucose of blood – 6,5 mmol/l. About what disease we havt to think?
А. Arterial hypertension
B. Metabolic syndrome
C. Cerebral aterosclerosis
D. Diabetes melitus
E. Kon disease
A patient D., with metabolic syndrome and DM 2 type was determined next symptoms: hyperglycemia, hyperinsulinemia, glucosuria, poliuria, polidipsia..What the symptom is not main for DM 2 type?
During the examination of a patient B., 57 years old, was found an abdominal type of overweight and increase BP up to 180/100 mm.hg.cl. A doctor decided to determine the level of hormones in blood for determination of metabolic syndrome in a patient. The increasing of which hormone in blood could prove the diagnosis of a doctor?
In a patient D. 20 years old, who has IWB = 32 kg/m², was diabetes mellitus 2 type under a question. But, during the examination was found that a patient suffer from diabetes mellitus of second type. What is a main pathophisiology difference between DM 1 type and DM 2 type?
A. Low level of C-peptide
B. Pathology of insulin receptors.
C. Resistance to the ketoacidosis
D. Resistance to the insulin
E. Absolute deficit of insulin
In a patient D., 46 years old, who has an abdominal type of overweight, arterial hypertension and hypertrigliceridemia, level of glucose in blood on an empty stomach during mutual examination was in normal. In what interval was the concentration of glucose in the patient?
А. 2,5 – 3,5 mmol/l
B. 3,6 – 5,5 mmol/l
C. 5,6 – 7,5 mmol/l
D. 6,6 – 8,5 mmol/l
E. 7,6 – 8,5 mmol/l
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