4. Акушерство І гінекологія icon

4. Акушерство І гінекологія




Назва4. Акушерство І гінекологія
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Дата25.09.2012
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Крок 2 Medicine

4. Акушерство і гінекологія

1

A 52-year-old woman suffering from obesity, complains of bloody discharges from sexual

paths during 4 days. Last normal menses were 2 years ago. Histological investigation of

biopsy of the endometrium has revealed adenomatous hyperplasia. What reason from the

mentioned below caused the development of disease?

A Excessive transformation of preandrogens from adipose tissues

B Hypersecretion of estrogens by tissues of the organism.

C Poor aromatization of preandrogens due to hypothyroidism

D The increased contents of follicle-stimulating hormone

E Supersecretion of androgens by the cortex of paranephroses.


2

A 40-year-old woman complains of colic pains in the lower part of abdomen and abundant

bloody discharges from genital tract. Last 2 years she had menses for 15-16 days, abundant,

with clots, painful. Had 2 medical abortions. In bimanual investigation: from the canal of the

cervix uteri - a fibromatous node, 3 cm in diameter, on the thin stem. Discharges are bloody,

moderate.Choose the correct tactics.

A Operation: untwisting of born node

B Hormonal hemostasis

C Phase by phase vitamin therapy

D Supravaginal ablation of the uterus without ovaries

E Hysterectomy without ovaries


3

A 40-year-old woman complains of yellow color discharges from the vagina. Bimanual

examination: no pathological changes. Smear test: Trichomonas vaginalis and mixed flora.

Colposcopy: two hazy fields on the front labium, with a negative Iodum probing. What is your

tactics?

A Treatment of specific colpitis with the subsequent biopsy

B Diathermocoagulation of the cervix uteri

C Specific treatment of Trichomonas colpitis

D Cervix ectomy

E Cryolysis of cervix uteri


4

A 32 y.o. woman consulted a gynecologist about having abundant long menses within 3

months. Bimanual investigation: the body of the uterus is enlarged according to about 12

weeks of pregnancy, distorted, tuberous, of dense consistence. Appendages are not

palpated. Histological test of the uterus body mucosa: adenocystous hyperplasia of

endometrium. Optimal medical tactics:

A Surgical treatment

B Hormonetherapy

C Phytotherapy

D Radial therapy

E Phase by phase vitamin therapy


5

A woman complains of having slight dark bloody discharges and mild pains in the lower part

of abdomen for several days. Last menses were 7 weeks ago. The pregnancy test is positive.

Bimanual investigation: the body of the uterus indicates for about 5-6 weeks of pregnancy, it

is soft, painless. In the left appendage there is a retort-like formation, 7х5 cm large, mobile,

painless. What examination is necessary for detection of fetus localization?

A Ultrasound

B Hysteroscopy

C Hromohydrotubation

D Colposcopy

E Cystoscopy


6

A woman was hospitalised with full-term pregnancy. Examination: the uterus is tender, the

abdomen is tense, cardiac tones of the fetus are not auscultated. What is the most probable

complication of pregnancy?

A Premature detachment of normally posed placenta

B Premature labor

C Back occipital presentation

D Acute hypoxia of a fetus

E Hydramnion


7

By the end of the 1st period of physiological labor clear amniotic fluid came off. Contractions

lasted 35-40 sec every 4-5min. Heartbeat of the fetus was 100 bpm. The BP was 140/90 mm

Hg. What is the most probable diagnosis?

A Acute hypoxia of the fetus

B Premature labor

C Premature detachment of normally posed placenta

D Back occipital presentation

E Hydramnion


8

A pregnant woman in her 40th week of pregnancy undergoes obstetric examination: the cervix

of uterus is undeveloped. The oxytocin test is negative. Examination at 32 weeks revealed: AP

140/90 mm Hg, proteinuria 1 g/l, peripheral edemata. Reflexes are normal. Choose the most

correct tactics:

A Labour stimulation after preparation

B Absolute bed rest for 1 month

C Complex therapy of gestosis for 2 days

D Caesarian section immediately

E Complex therapy of gestosis for 7 days


9

A 26 year old woman had the second labour within the last 2 years with oxytocin application.

The child's weight is 4080 g. After the placent birth there were massive bleeding, signs of

hemorrhagic shock. Despite the injection of contractive agents, good contraction of the uterus

and absence of any cervical and vaginal disorders, the bleeding proceeds. Choose the most

probable cause of bleeding:

A Atony of the uterus

B Injury of cervix of the uterus

C Hysterorrhexis

D Delay of the part of placenta

E Hypotonia of the uterus


10

Which gestational age gives the most accurate estimation of weeks of pregnancy by uterine

size?

A Less that 12 weeks

B Between 12 and 20 weeks

C Between 21 and 30 weeks

D Between 31 and 40 weeks

E Over 40 weeks


11

A woman is admitted to maternity home with discontinued labor activity and slight bloody

discharges from vagina. The condition is severe, the skin is pale, consciousness is

confused. BP is 80/40 mm Hg. Heartbeat of the fetus is not heard. There was a Cesarian

section a year ago. Could you please determine the diagnosis?

A Hysterorrhesis

B Cord presentation

C Placental presentation

D Expulsion of the mucous plug from cervix uteri

E Premature expulsion of amniotic fluid


12

Rise in temperature up to $39^0С$ was registered the next day after a woman had labor.

Fetal membranes rupture took place 36 hours prior to labors. The examination of the bacterial

flora of cervix uteri revealed the following: haemolytic streptococcus of group A. The uterus

tissue is soft, tender. Discharges are bloody, with mixing of pus. Establish the most probable

postnatal complication.

A Metroendometritis

B Thrombophlebitis of veins of the pelvis

C Infected hematoma

D Infective contamination of the urinary system

E Apostatis of stitches after the episiotomy


13

On the first day after labour a woman had the rise of temperature up to $39^oC$. Rupture of

fetal membranes took place 36 hours before labour. Examination of the bacterial flora of

cervix of the uterus revealed hemocatheretic streptococcus of A group. The uterus body is soft,

tender. Discharges are bloody, with admixtures of pus. Specify the most probable postnatal

complication:

A Metroendometritis

B Thrombophlebitis of veins of the pelvis

C Infectious hematoma

D Infective contamination of the urinary system

E Apostasis of sutures after the episiotomy


14

A woman of a high-risk group (chronic pyelonephritis in anamnesis) had vaginal delivery. The

day after labour she complained of fever and loin pains, frequent urodynia. Specify the most

probable complication:

A Infectious contamination of the urinary system

B Thrombophlebitis of veins of the pelvis

C Infectious hematoma

D Endometritis

E Apostasis of sutures after episiotomy


15

In 13 months after the first labor a 24-year-old woman complains of amenorrhea. Cesarian

section was conducted as a result of premature detachment of normally posed placenta.

Hemorrhage has made low fidelity of 2000 ml due to breakdown of coagulation of blood.

Choose the most suitable investigation.

A Determination of the level of gonadotropin

B Ultrasound of organs of a small pelvis

C Progesteron test

D Computer tomography of the head

E Determination of the contents of testosteron-depotum in blood serum.


16

13 months after the first labor a 24-year-old patient complained of amenorrhea. Pregnancy

ended in Caesarian section because of premature detachment of normally positioned

placenta which resulted in blood loss at the rate of 2000 ml owing to disturbance of blood

clotting. Choose the most suitable investigation:

A Estimation of gonadotropin rate

B USI of small pelvis organs

C Progesteron assay

D Computer tomography of head

E Estimation of testosteron rate in blood serum


17

In the woman of 24 years about earlier normal menstrual function, cycles became irregular,

according to tests of function diagnostics - anovulatory. The contents of prolactin in blood is

boosted. Choose the most suitable investigation:

A Computer tomography of the head

B Determination of the level of gonadotropins

C USI of organs of small pelvis

D Progesterone assay

E Determination of the contents of testosteron-depotum in blood serum


18

A 20-year-old woman is having timed labor continued for 4 hours. Light amniotic fluid came

off. The fetus head is pressed to the orifice in the small pelvis. The anticipated fetus mass is

$4000,0 g\pm 200,0 g$. Heartbeat of the fetus is normal. Intrinsic examination: cervix is

absent, disclosure – 2 cm, the fetal membranes are not present. The head is in 1-st plane of

the pelvis, a sagittal suture is in the left slanting dimension.

What is the purpose of glucose-calcium-hormone - vitaminized background conduction?

A Prophylaxes of weakness of labor activity

B Labor stimulation

C Fetus hypoxia prophylaxes

D Antenatal preparation

E Treatment of weakness of labor activity.


19

A woman in her 39th week of pregnancy, the second labour, has regular birth activity. Uterine

contractions take place every 3 minutes. What criteria describe the beginning of the II labor

stage the most precisely?

A Cervical dilatation by no less than 4 cm

B Cervical smoothing over 90\%

C Duration of uterine contractions over 30 seconds

D Presenting part is in the lower region of small pelvis

E Rupture of fetal bladder


20

A woman in her 39-th week of pregnancy, the second labor, has regular birth activity. Uterine

contractions take place every 3 minutes. What criteria describe the beginning of the II labor

stage the most precisely?

A Cervical dilatation no less than 4 cm

B Cervical smoothing over 90\%

C Duration of uterine contractions more than 30 seconds

D Presenting part is in the lower region of small pelvis

E Rupture of membranes


21

A 24 years old primipara was hospitalised with complaints about discharge of the amniotic

waters. The uterus is tonic on palpation. The position of the fetus is longitudinal, it is pressed

with the head to pelvic outlet. Palpitation of the fetus is rhythmical, 140 bpm, auscultated on

the left below the navel. Internal examination: cervix of the uterus is 2,5 cm long, dense, the

external os is closed, light amniotic waters out of it. Point a correct component of the

diagnosis:

A Antenatal discharge of the amniotic waters

B Early discharge of the amniotic waters

C The beginning of the 1st stage of labour

D The end of the 1st stage of labour

E Pathological preterm labour


22

A 34 y.o. woman in her 29-th week of pregnancy, that is her 4-th labor to come, was admitted

to the obstetric department with complaints of sudden and painful bloody discharges from

vagina that appeared 2 hours ago. The discharges are profuse and contain grumes. Cardiac

funnction of the fetus is rhytmic, 150 strokes in the minute, uterus tone is normal. The most

probable provisional diagnosis will be:

A Placental presentation

B Detachment of normally located placenta

C Vasa previa

D Bloody discharges

E Disseminated intravascular coagulation syndrome


23

A 29 year old patient underwent surgical treatment because of the benign serous epithelial

tumour of an ovary. The postoperative period has elapsed without complications. What is it

necessary to prescribe for the rehabilitational period:

A Hormonotherapy and proteolytic enzymes

B Antibacterial therapy and adaptogens

C Lasertherapy and enzymotherapy

D Magnitotherapy and vitamin therapy

E The patient does not require further care


24

A 34-year-old woman with 10-week pregnancy (the second pregnancy) has consulted

gynaecologist to make a record in patient chart. There was a hydramnion previous pregnancy,

the birth weight of a child was 4086 g. What tests are necessary first of all?

A The test for tolerance to glucose

B Determination of the contents of $\alpha$ fetoprotein

C Bacteriological test of discharge from the vagina

D Fetus cardiophonography

E Ultrasound of the fetus


25

A 26 y.o. woman complains of sudden pains in the bottom of abdomen irradiating to the anus,

nausea, giddiness, bloody dark discharges from sexual tracts for one week, the delay of

menses for 4 weeks. Signs of the peritoneum irritation are positive. Bimanual examination:

borders of the uterus body and its appendages are not determined because of sharp

painfullness. The diverticulum and painfullness of the back and dextral fornixes of the vagina

are evident. What is the most probable diagnosis?

A Broken tubal pregnancy

B Apoplexy of the ovary

C Acute right-side adnexitis

D Torsion of the crus of the ovary tumour

E Acute appendicitis


26

At the gynaecological department there is a patient of 32 years with the diagnosis: "acute

bartholinitis".Body temperature is $38,2^0C$, leucocytes count $10,4*10^9/L$, the ESR is 24

mm/hour. In the area of big gland of the vestibulum - the dermahemia, the sign of the

fluctuation, sharp tenderness (pain). What is the most correct tactics of the doctor?

A Surgical dissecting, a drainage of an abscess of the gland, antibiotics

B Antibiotics, Sulfanilamidums

C Surgical dissection, drainage of the abscess of the gland

D Antibiotic therapy

E Antibiotics, detoxication and biostimulants.


27

A primagravida with pregnancy of 37-38 weeks complains of headache, nausea, pain in

epigastrium. Objective: the skin is acyanotic. Face is hydropic, there is short fibrillar twitching

of blepharons, muscles of the face and the inferior extremities. The look is fixed. AP- 200/110

mm Hg; sphygmus of 92 bpm, intense. Respiration rate is 32/min. Heart activity is rhythmical.

Appreciable edemata of the inferior extremities are present. Urine is cloudy. What medication

should be administered?

A Droperidolum of 0,25\% - 2,0 ml

B Dibazolum of 1\% - 6,0 ml

C Papaverine hydrochloride of 2\% - 4,0 ml

D Hexenalum of 1\% - 2,0 ml

E Pentaminum of 5\% - 4,0 ml


28

An onset of severe preeclampsia at 16 weeks gestation might be caused by:

A Hydatidiform mole

B Anencephaly

C Twin gestation

D Maternal renal disease

E Interventricular defect of the fetus


29

A woman had the rise of temperature up to $39^0С$ on the first day after labour. The rupture

of fetal membranes took place 36 hours before labour. The investigation of the bacterial flora

of cervix of the uterus revealed hemocatheretic streptococcus of group A. The uterus body is

soft, tender. Discharges are bloody, mixed with pus. Specify the most probable postnatal

complication:

A Metroendometritis

B Thrombophlebitis of pelvic veins

C Infected hematoma

D Infection of the urinary system

E Apostatis of junctures after the episiotomy


30

A 24 y.o. patient 13 months after the first labour consulted a doctor about amenorrhea.

Pregnancy has concluded by a Cesarean section concerning to a premature detachment of

normally posed placenta hemorrhage has made low fidelity 2000 ml owing to breakdown of

coagulability of blood. Choose the most suitable investigation:

A Determination of the level of Gonadotropins

B USI of organs of a small pelvis

C Progesteron assay

D Computer tomography of the head

E Determination of the contents of Testosteron-Depotum in Serum of blood


31

A 34 year old woman in the 10th week of gestation (the second pregnancy) consulted a doctor

of antenatal clinic in order to be registered there. In the previous pregnancy hydramnion was

observed, the child's birth weight was 4086 g. What examination method should be applied in

the first place?

A The test for tolerance to glucose

B Determination of the contents of fetoproteinum

C Bacteriological examination of discharges from vagina

D A cardiophonography of fetus

E US of fetus


32

A 10 y.o. boy was ill with angina 2 weeks ago, has complaints of joint pain and stiffness of his

left knee and right elbow. There was fever ($38,5^0$) and ankle disfunction, enlargement of

cardiac dullness by 2 cm, tachycardia, weakness of the 1st sound, gallop rhythm, weak

systolic murmur near apex. What diagnosis corresponds with such symptoms?

  1   2   3   4   5

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