Gynae Lugansk

Крок 2 Загальна лікарська підготовка_2004-2005

4 профиль 

№	ItemText	DistrA	DistrB	DistrC	DistrD	DistrE
1.	The 25 years old patient has complaints about suppression of mensis during 3 months, vomiting. According internal genicological investigation – cyanosis of vaginae and cervix uteri, body of uterus is increased. Fundus of the uterus on the 3 sm under the symphisis, consistens of uterus is soft, during the internal investigation it is tioghtly.Adnexa uterus are not palpable. Discharges – is mucosae. What is the most probably diagnosis?	*Pregnancy in gestation time – 12 weeks	Fibromyoma of uterus	Horionepithelioma	Disturbances of the menstrual cycle	Amenorhea
2.	On the fifth day after  the normal  delivery the height of the fundus uteri above pubis equals	*7 – 8 cm	5 – 7 cm	9 – 10 cm	11 – 12 cm	12 - 14 cm
3.	The beginning of delivery is signed with	*The beginning of regular birth contraction	Rupture of water bag	Discharges of mucus from the vagina	Desccendingof the uterus fundus	Placing the fetus head or the pelvis in the aditis ad pelvis minor
4.	Deliveri is finished	*With the birth of placenta	Rupture of water bag	Complete opening of the ostium of the uterus	The birth of the fetus	Separation of the placenta
5.	A 28years-old pregnant at 20 weeks of gestation. In analysis of urine - level of glucosuria is 1.5\%, diuresis – 2 l. Fasting blood sugar : 5,2 mmol/l; 2 hours after  75 g glucose load – 6,2 mmol/l. Height is 160 sm, weight is 78 kg. What is the most probable reason of glucosuria?	*Glucosuria of pregnants	Diabetes mellitus	Disturbances of tolerants to glucosae	Obesity	Diabetes mellitus of the 1st type
6.	A pasurient has atonic bleeding in early postpartum period. Postpartum hemorrhage is 1500ml (1,8\%). Status is hard, the consciousness is confusional, stupor, motor anxiety, temperature of 37C, pail skin, periphery cyanosis. Tachycardia of 130-140 b/min , AP 70/40 mm. Hg., CVP – 20mm. Hg, dyspnea – 40 per min, hour diuresis 15-20 ml/hour, haemotocrytis 0.25 , shock index 1.4, hemoglobin concentration 70 g/l. Doctor’s tactics?	*Laporotomy. Extirpation of uterus without adnexae uteri. Infusion therapy	Manual control of cavum uteri and massage on the fist after Baksheyev	Applying the clames to parametrium, claming the cervix uteri	Putting the tampone with etherus in the back fornix	Cold on beneath the abdomen
7.	A woman in birth for the first time of 29 years old. Pregnancy of 40 weeks. The sizes of the pelvis are: 25 – 28 – 30 – 20 cm. The presumable weight of the fetus is 4.900 +- 200 g. Position of the fetus is longitudinal. Head presentation. Heart beating of the fetus is 140 per minute. Rhythmical. Vaginal investigation: cervix uteri is shortened. It let’s 2 fingers go through. The water bag has not been open harmed. The head balloting above the aditus ad pelvis minor. Promontorium of the sacrum is not reachable with the finger. What is the tactics of leading the delivery.	*Cesarian section	Conservative leading of the childbirth	Stimulation of the delivery activities	Obstetrics forceps	Amniotomy
8.	Patient after the operation of the caesarian section has sharp pains in abdomen, vomiting, nausea, diarrhea, tachycardia, tachypnoe, enteroparesis, symptoms of irritation of peritoneum are positive. Temperature is 39 C. In the blood formula is leucocytosis. What is the main difference between pelvioperitonitis and parametritis?	*Positive symptoms of irritation of peritoneum	Type of the pulse	Type of the temperature	Type of the pain	Clinical analysis of blood
9.	The first and the second periods of delivery – are without complications. It is an uterus bleeding after 10 minutes after childbirth, hemorrhage is 200 ml. After separation and birth of placenta by Krede-Lazorevitch’s method bleeding is not stopping it is increasing. Maternal passages are not traumated. According examination of placenta it is a defects of placental tissue with size 3x4sm. Uterus bleeding is continuing. What is the most probably reason of the bleeding?	*Defect of the placental tissue	Hypotonia of the uterus	Adherent placenta	Vegetative placenta	Ingrowing placenta
10.	22 years old patient has complaints about profuse bloody discharges with clots from genitals, hard pains in abdomen, like contractions. Last mensis was 3 months ago. According bimanual investigations : in vagina - a lot of clots of blood, cervix uteri is open at 2 sm, in the canal of cervix uteri – elements of fetal ovum, uterus is enlarged to 12 weeks of pregnancy, adnexa uterus are not palpable. What is the most probably diagnosis?	*Incipient abortion	Treatened abortion	Complete abortion	Late abortion	Incomplete abortion
11.	33 years-old woman in childbirth (2nd labors). Sizes of pelvis  25-28-31-20.  Fundal height – 40 sm, circumferentia of abdomen – 100 sm. Stage of pushing. Passive segment of the uterus is hard painful. Uterine contractions are  painful, edema of external genitals and muscles  of the pelvic floor. Contrant ring on the line of umbilicus. The sagital suture of the fetus head is in the direct size at the first plate of the pelvis. Symptom of Henkel-Vasten is positive. What must be a doctor’s tactics?	*Anaesthesia, cesarian section	Injection of spasmolytics	Obstetric forceps	Vacuum-extraction of fetus	Infusion of uterotonics
12.	The 30 years-old pregnant arrived to the maternity home in 37’s gestation term, head presentation of the fetus. She has complaints about headache, vomiting, pains in the epigastric area, disturbances of vision. Artherial blood pressure 180/110 mm Hg, proteinuria – 1,66 g/l. The tonus of uterus is normal. Fetal heart sounds – 140 beat/min, rhythm is normal. What is the doctor’s tactics in this clinical case?	*Intravenous injection of Magnesii sulphatis, Droperidol, Euphillin	Gastric lavage	Intravenous injection of Dibasol, Papaverin	Anaestethia with Ether	Intravenous injection of Analgin
13.	On the second day after the normal  delivery the height of the fundus uteri above pubis equals	*12 – 15 cm	15 – 16 cm	9 – 11 cm	7 – 9 cm	5 – 7 cm
14.	A woman of 18 years old applied to the female dispensary at the term of 11 – 12 weeks. One month ago  a woman suffered from rubella. What influence on the fetus is the most probable in this woman?	*Congenital embryopathy	Hemolytic disease of the newborn	Delivery trauma of the newborn	Disease of the gyalynum membranes	Chromosomal abnormalities of the fetus
15.	A woman is in delivery for the first time. Arrived to hospital in the second period of the delivery in the term. Wasn’t observed in the famine dispensary during pregnancy. The head of the fetus is in the thin part of the cavity minor pelvis. The state of the fetus is satisfactory. Small febrilar trembling of eyelids , which spreader to the face and upper extremities. What is the tactics of leading the delivery.	*Obstretrics forceps	Cesarian section	Fetus destructive operation	Conservative leading of delivery with epysiotomy	Vacuum extraction of the fetus
16.	On the seventh day after  the normal  delivery the height of the fundus uteri above pubis equals	*5 – 7 cm	7 – 8 cm	9 – 10 cm	11 – 12 cm	13 – 14 cm
17.	From what time of pregnance fetal heart beating starts to be heard.	*25 weeks	18 weeks	20 weeks	22 weeks	30 weeks
18.	A 23 years-old pregnant at the 10 weeks of gestation has complaints about enlarged thyroid gland. Ps is 72 b/min, artherial blood pressure 110/70 mm/Hg. Thyroid gland is enlarger in all parts, painless, mobile, is not fused with underlying tissue. What analysis  are necessary to do for marking of thyroid gland function?	*Registration of the TTG content in the blood	Registration of T 4 in the blood	Uptake II 31 by the tyroid gland	Ultrasound examination	Nucleo-magnetic resonans examination
19.	During investigation of the 25 years-old pregnant in the term of gestation 34 weeks  by the doctor of the female dispensary are registrated edema of legs, AP on the right hand 140/90mm Hg , on the left – 130/90 mm Hg, proteinuria – 0,66 g/l , level of blood protein – 56 g/l. State of the fetus is satisfactory. What is the most probably diagnosis?	*Preeclampsia of light degree	Preeclanpsia of the hard degree	Edema of pregnants	Hypertonic diseases	Pyelonephritis of pregnants
20.	In a woman in delivery with preecplampsia of the middle degree occasionally dyspnea and drey cough, motor anxiety, pain in thorax, hemoptysis, tachypnoe, tachycardia, cianosis of the lips appeared. During the aucultation: accent of the second tone above the lung artery, multiple rales in lungs. What is the most probable complication appeared?	*Tromboembolia of the lung artery	Eclampsia	Embolia with amneotic liquid	Edema of the lungs	Attack of the bronchal asthma
21.	Pregnant of 23 years old applying to female dispensary complained of infections hepatitis, holycistopancreatitis, which she suffered from 2 years ago. Appoint the most probable complication of pregnancy in this woman:	*Hestosis	Preliminary childbirth	Hemorrhage	Rupture uteri	Weakness of the delivery activities
22.	The 19 years -old woman is in the delivery first time. It is the begining of the first period of labors. In her anamnesis – metral cardiac defect in the stage of compensation. Her state is satisfactory. Amniotic bag is not break. What is the doctor’s tactics in this delivery?	*Active-waiting tactics with presents of therapeutist and maximum analgesia	Cesarean section	Obstetrics forceps	Vacuum-extraction of fetus	Stimulation of the labor activity
23.	On the forth day after  the normal delivery the height of the fundus uteri above pubis equals	*9 – 11 cm	5 - 7 cm	7 – 9 cm	12 – 14 cm	14 – 16 cm
24.	On the third day after  the normal  delivery the height of the fundus uteri above pubis equals	*12 – 14 cm	5 - 7 cm	7 – 9 cm	9 – 11 cm	14 – 16 cm
25.	The woman in birth for the first time of 20 years old with plenty of amniotic fluid is being in delivery for 3 hours. Delivery activities are active. In uterus there is one fetus with head presentation. Heartbreaking of the fetus is normal. Opening of the cervix uteri is 4 cm. Water bag is strained between the contractions. Appoint the tactics of leading the childbirth.	*Amniotomy	Waiting tactics	Cesarian section	Sleep, relaxation	Stimulation the childbirth with prostaglandins
26.	A woman is in the third in - time childbirth. The weight of the woman body is 80 kg. A boy with 4.200 kg. and the length of the body of  50cm was born. General blood loss is 450 ml. Physiological volume of blood loss for this woman equals :	*400 ml	450 ml	500 ml	550 ml	600 ml
27.	A woman of 30 years old in birth for the first time has the beginning of intensive pushing with the interval of 1 – 2 minutes, lasting 45 seconds. During the birth of the  fetal head, extraordinary pain in the perineum appeared. The perineum 4 cm high, is pail. Heart beating of the fetus is not affected. What is to be done:	*Perineotomy	Episiotomy	Protection of the perineum	Waiting tactics	Pudendal anesthesia
28.	When can a woman stand up and walk after childbirth?	*In 6 – 8 hours	In 24 hours	In 2 hours	In 3 days	Right away after childbirth
29.	The woman of 25 years has addressed to the doctor with complaints of a nausea, vomiting 1 times in a day, a sleepiness, a delay of a menses for 2 months. At bimanual inspection: cyanosis of the mucosa of the vagina and uterine  cervix. The uterus is enlarged, softened, especially in a region of an isthmus, however during inspection began more dense, painless. Appendages are not palpated.  Discharge are mucous.  The most  relible diagnosis.	Pregnancy	Myoma of uterus	A salpingocuesis	Infringement of a menstrual cycle	Ovarian tumor
30.	The 24-years old woman, earlier not pregnant, terminated to accept oral contraceptives. After last reception of a drug she had one menses, and then within 6 months the amenorrhea was observed. Choose the most suitable investigation:	*USE of the organs of the small pelvis	Determination of the level of Gonadotropins	Determination of the level of Progesteron	Determination of the level of Testosteron	Computer tomography of the head
31.	The puerpera of 24 years old, the 2d day after laborC. A common state is satisfactory, a body temperature is 36,6 degrees , sphygmus 82 beets / mines, satisfactory propertieC. There is no pathology from internals . Mammas are enlarged in the dimensions, mild, papillas are whole. The uterus is dense, painless, a bottom of it is on 5 sm above a bosom. A lochia are serouse-bloody, in a small amount. Physiological functions are normal. It is enough for determination of character of lochia:	* A sighting	Microscopies lochia	A luminescent microscopy of lochia	Bacteriological investigation of lochia	Vaginoskopy.
32.	The puerpera of 22 years old for 2 day after normal laborC. A common state is satisfactory, a body temperature is 36,5 degrees,  puls of 80 beets / mines, satisfactory properties. Mammas are enlarged,   papillas are whole. The uterus is dense, painless, a bottom is on 8 cm above a bosom. A lochia are bloody, in a small amount. Physiological functions are normal. In a puerperal period it is enough for determination of dynamics of reduction of a uterus:	*Palpation to define a level of standing of a uterine fundus	USE	X-ray inspection	To meter a circle of an abdomen.	Palpation to define a level of standing of contractive rings of a uterus
33.	The puerpera of 25 years old, 7 day after labor. The common state is satisfactory, there are no complaints A body temperature is 36,6 degrees, puls is 76 beets / mines, satisfactory properties. The BP of 120/80 mm.Hg on both humeral arterias. Mammas are mild, painless, papillas are whole. The uterus is dense, painless, a bottom of it is defined at symphisis level. A lochia of serous-mucous character, scanty. . Physiological functions are normal What Hormon  secreted by a pituitary gland, stimulates reductions of a uterus in a puerperal period?:	* Oxytocinum	Folliculinum	Progesteronum	Chorionic Gonadotropinum	Prolactinum
34.	At the puerpera of 26 years old, for 4 day after labour the incessant parent bleeding began. The haemorrhage has made 400 ml. The common state is worsened - a body temperature 36, 7о С, pulse of 94 beets / mines, the AP of 90/70 mm.Hg. The uterus is intense, morbid, its bottom is at a level of a umbilicus. The diagnosis is : " Delivery in time. A bleeding of the 4th  day of puerperal term. ". It is necessary:	*Tool revision of a cavity of the uterus	Manual inspection of a cavity of the uterus and erasion of the delayed parts of a placenta	Outside massage of a uterus after bleeding urinary bladder	To enter drugs reducing a uterus	Supravaginal ablation of a uterus
35.	A 5  years old girl who attends a kindergarden has an atypical pneumonia. What antibacterial drug should be prescribed?	* Macrolides	Quinolones	Cephalospores of the 1-st generation	Cephalosporines of the 2-st generation	Cephalosporines of the 3-st generation
36.	The pregnant woman, aged 25 yr with 36 weeks gestational term complains of upper abdomen pain, nausea, vomiting and blurred vision. There is also generalized edema.  BP on both arms is 170/100 mm Hg. What is the most probable diagnosis?	*severe preeclampsia	moderate preeclampsia	eclampsia	retinal detachment	epileptic coma
37.	A 25 years old woman in labor has the second timely labor. The contractions appear every 5-6 minutes and last 20-25 seconds . The longitudinal fetal position and occipital presentation of the fetal head are found   against the small pelvis entry. What is the stage of labor?	*Opening of the uterine cervix	Expulsion of the fetus	Afterbirth period	Preliminary period	Postnatal period
38.	A 20 years old 36 weeks of gestation pregnant woman was admitted to the obstetrical hospital with complains of the pain in the lower abdomen and bloody vaginal discharge. The general condition of the patient  is good. Her blood pressure is 120/80 mm Hg. The heart rate of the fetus is 140 beats per minute and rhythmic. By vaginal examination the cervix of the uterus is formed and closed. The discharge from vagina is bloody up to 200 ml per day. The head of the fetus is located high above the minor pelvis entry. A soft formation was defined through the anterior fornix of the vagina. What is the probable diagnosis?	*Placental presentation	Premature placental separation	Uterine rupture	Загроза передчасних пологів	Incipient  abortion
39.	The woman on the seventh day after delivery complicated by uterine bleeding and manual investigation of the uterine cavity started to be  feverish up to 38,70C and  complains of the  bloody purulent vaginal  discharge with unpleasant smell. The uterine upper border  is located between the pubis and omphalus. The uterus is tenderness and has a dough-like consistency. What is the most probable diagnosis?	*Puerperal (postpartum) endometritis	Uterine postpartum subinvolution	Pelvioperitonitis	Sepsis	Physiological puerperal (afterbirth) period
40.	18-years-old PG (prima gravida) woman is in fully term labor lasting  12 hours. The woman fills her self  tired and dozes between the contractions. The general conditions of woman and fetus are good. The obstetric sizes of  pelvis are 25-28-31-20 cm. The labor activity is mild to moderated. On vaginal examination  the  uterine cervix is smooth and up to 4 cm dilated. Amniotic sac is intact. Fetal head is presented against the small pelvis entry in sacrum right posterior position (SRP). What is the correct   management of labor?	* Obstetrics sleep-rest	Amniotomy	Oxytocin test	Labor stimulation	Cesarean section.
41.	After the labor the vaginal examination did not reveled the uterine cervix damage. In the perineal region a deep skin laceration up to the anus and muscular breakage of  vagina posterior wall including  external sphincter were noted. What kind of complications was happened ?	* II degree perineal rupture	I degree perineal rupture	III degree perineal rupture	Groin rupture of the III degree
42.	The 27 years old PG (prima gravida) woman  delivered the full term newborn with big waight. The placenta was separated spontaneously. Within 20 minutes after labor the patient lost 300 ml of blood clots from vagina. During the external massaging the dough-like hypotonic uterus and additional 200 ml blood loss were noted. The correct subsequent treatment is:	*manual examination of the uterine cavity	curettage of the uterine cavity	cold on the lower portion of abdomen	uterine extirpation	supragroinal uterine extirpation
43.	At term of a gestation of 40 weeks height of standing of a uterine fundus is less then assumed for the given term. The woman has given birth to the child in weight of 2500 g, a length of a body 53 cm, with an assessment on a scale of Apgar of 4-6 points. Labor were fast. The cause of such state of the child were:	* Chronic fetoplacental insufficiency	Delay of an intra-uterine fetation	Placental detachment	Infection of a fetus	Pprematurity
44.	A 26 year old woman complains of a mild bloody discharge from the vagina and pain in the lower  abdomen. She has had the last menstruation  3,5 months ago. The pulse rate is 80  per min. The blood pressure (BP) is  110/60 mm Hg and body  temperature  is 36,60C. The abdomen is tender in the lower parts. The uterus is enlarged up to 12 weeks of gestation. What is your diagnosis?	*Inevitable abortion	Incipient abortion	Incomplete abortion	Complete abortion	Disfunctional bleeding
45.	Primapara, 24 years with a normal pelvis. After 8 hours of normal patrimonial activity spasms became weak, ineffective. Vaginal research: disclosing of a uterine cervix is 8 sm, the head of a fetus is with its the big segment in an inlet into a small  pelvis. The amniotic membrane is absent. Palpitation of a fetus a clear, rhythmical 130 heart-rate. Tactics?	*Stimulation of patrimonial activity	Obstetric forceps	Medicament dream - rest	Caesarian section	Spasmolyticses
46.	A 2 years-old child suffering from food allergy became acutely ill. The spasmodic  cough, prolonged expiration and expiratory wheezing are presented. The respiratory rate is 60 per min. The mild respiratory distress mast be noted  because   of  chest additional muscles participation  in breathing. The wheezing  chest is hyperinflated. Choose the treatment  which mast be done to the patient   by intravenous  infusion.	*Euphyllinum, predisolon	Penicillin	Berodual	Lasolvan	Calcium gluconate
47.	At multipara, in a duration of gestation of 40 weeks, at survey a spherical, balloting formation is defined to the left of an umbilicus, the palpitation of a fetus is auscultated closer to an umbilicus, about one 140/minutes. It is possible to think of what position of a fetus in this case?	*Transversal position of a fetus, left position	Transversal position of a fetus, right  position	Longitudinal position of a fetus, a head presentation	Pelvic presentation	Slanting position of a fetus
48.	At a vaginal examination at primapara: disclosing of a cervix of a uterus up to 8 sm, vertex presentation, a sagittal suture is in the transversal size of the inlet plane, is posed closer to a  promontorium, the big and small fontanels are at the same level. What insertion of the head of a fetus takes place in this case?	*Anterior asynclitism	Average transversal standing of head	High direct standing of head	Low transversal standing of head	Posterior asynclitism
49.	The data of a functional condition of the child after delivery: palpitation is 134 heart-rate; respiration is  independent, but without the first cry; a skin of the  face and a  trunk is pink, extremities - dark blue; movements are active, cry is loud. A condition of a newborn according to a scale of Apgar?	*8 points	5 points	6 points	10 points	9 points
50.	Puerpera, the 3-d day of the postnatal period, complaints to a fever up to 38,2(С, a pain in the  lower part of abdomen, purulent discharge from vagina, delicacy have appeared. Objectively: pulse - 98 heart-rate, the BP – 120/80 mm.Hg, a skin is   pale. The abdomen is soft, painless. The uterine fundus is lower than umbilicus  up to one transversal finger, has a soft consistence, morbid. At vaginal research: the uterus enlarged till 17 weeks of pregnancy, softened, painful. Appendages of a uterus and vaults of the vagina are without features.  Discharge are purulent, in moderate quantity. The analysis of a blood: a leukocytosis 13,5(10 9/l, ESR - 32 mm/h. Establish the preliminary diagnosis.	Postnatal acute endometritis	A postnatal thrombophlebitis	A postnatal adnexitis	A postnatal parametritis	A postnatal pelviperitonitis
51.	Menstrual function of the 42 years-old woman as hyperpolymenorrhea and progressiv algodysmenorrhea withing last 10 years. Vaginal dascharge like chokolade, uterine size is enlarged, tuberous, little morbid, uterine adnexa are not palpable, fornix are not painful, deep. What is the most probably diagnosis?	*Endometriosis of uterus	Cancer of uterus	Submucous fibromyoma of uterus	Endometritis	Endometriosis of adnexa uterus
52.	In gynecological department a woman complaining about acute pains beneath the abdomen, increased body temperature up to 38 deg., complaining about purulent discharges from the vagina, arrived. Sexual life is discursive. During the bimanual investigation: adnexae uteri are painful, purulent leucorrhea. For making a diagnosis it’s necessary:	*Bacteriological investigation of discharges from the genitals	Colposcopy	Probing the uterus	Curettage of the uterine cavity	Cytological investigation of the vaginal leucorrhea
53.	A woman of 27 years old leading an active sexual life, complaining about numerous vesicules on the right major lip, scratching and irritation. Rash appears periodically before mensis and finished in 8 – 10 day. Possible diagnosis.	*Virus if Herpes Simplex	Bartolinitis	Primary syphilys	Genital condilomatosis	Cytomegalovirus infection
54.	A 60 years old and 10 years  menopausal woman complains of the abdomen enlargment, weight lost, asthenia, bloody discharge from vagina. The uterus is enlarged like up to 16 weeks of gestation  and hard. The salpinxes   are not defined. What method of diagnostics is it necessary to carry out?	*Consequent  diagnostic curettage   of the uterine cavity and cervical canal	Ultra sound investigation	Laporoscopia	Hysterosalpingographia	Sexual hormone investigation
55.	During the colposcopia endometriosis of the vaginal part of the cervix uteri was found out in a patient M. Choose the method of treatment.	*Laser vaporisation	Dyathermocogulation	Еxterpation of uterus	Supervaginal amputation	Antiinflamation treatment
56.	A woman of 35 years old complaints of amenorrhea during a year after a hard fright. Diagnosis.	*Psychogene amenorrhea	Hypomenstrual syndrome	Hyperpolymenorrhea	Proyomenorrhea	Algodysmenorrhea
57.	11 years -old girl arrived to the hospital with uterus bleeding after suppression of mensis. Anaemia is absent. Genital formula is Ax2 P3 Mg2 Me+. Virgin. Investigation per rectum – no pathology. The treatment of this patient should be start from	*Infusion therapy with using of uterotonics	Abrasio cavi uteri	Hormonal homeostasis	Antyanaemical therapy	Intramuscular injections of uterotonics
58.	A woman of 45 years old is working as a painter and a builder. During bimanual investigation elytroptosis of the second degree was find out. What is the reason of the disease?	*Hard physical work	Delivery trauma	General disease of the vagina	Errosion of the cervix uteri	Disturbance of the bowels function
59.	A 20 years old woman was admitted to the reception room of the central district hospital. The patient  complains of a lower  abdomen cramping pain   ascending upward, dizziness and  vomiting within painful attack.  She recalls the last menses haven 6 weeks ago. On clinical examination a cheeks skin hyperpigmentation is  noted. The mucous membranes are pale. Chest is clear.  The heart beats are rhythmic.  The pulse is soft and  weak 108  per minute. The body temperature is 36,3 oC. The extremities are cold in touch. Abdomen is tense, considerably distended  and painful. On percussion in the lower  abdomen dullness is found. There is not any vaginal bloody discharge. What method of clinical investigation could  help the surgeon to make a correct diagnosis ?	*Abdominal cavity punction through the posterior fornix of  vagina	Laporoscopia	Ultra sound investigation of the abdominal cavity	Roentgenoscopy.	General blood analysis.
60.	In a woman of 28 years old with complaints about infertility during 3 years . In the laporoscopy internal  endometriosis was found. In anamnesis is chronical salpingoophoritis. The most probable pathogenital cause of infertility in this woman is:	*Local secretion of prostoglandines	Disturbance of synthesis of cortisolum in adrenal glands	Thickening of the albumine coverage of ophorons	Congenital hypoplasia of genitals	Increasing of viscousity of cervical mucus
61.	A woman of 18 years old complaints on the absence of pregnancy during regular genital life within 1 year. Contraception is not being used. Pregnancy never took place. During the bimanual investigation no pathology is found out. With what method should the investigation of this couple be started?	*Spermogram	Hysterosalpingography	Laporoscopy	Test of the functional diagnostics	Bacteriological inoculation
62.	A mother with a girl of 6 years old with pruritus in perineum area and outer genitals applied to the doctor. Objectively: general condition is satisfactory. Multiple of scratches of vulva and perineum, around the anus, hyperemia, edema. What investigation should be carried out?	*Analysis of feces for helmints	Bacteriological inoculation	Stear for flora	General analysis of urine	Glucose of the blood
63.	In a girl of 3 weeks of age fountain vomiting not connected with feeding is registered many times a day. Periodical liquid defecations. Decrease of the body weight. During the examination the child is rigid and has dehydratation. Hypertrophy of clytoris is obviously seen. What disease takes place?	*Congenital adrenogenital syndrome	Pylorosthenosis	High bowel impaction	Real hermophroditism	Occute bowel infection
64.	A 13-years old girl complains of vaginal bleeding. The last menses was 4 months ago. The patient complains of weakness and dizziness. Her blood analysis shows the hemoglobin 64 g/l, erythrocytes count 1,8 x 1012/l, platelet count 280 x 109/l.   By vaginal examination  the uterus is not enlarged, the salpinxes  are  not affected.	*Juvenile uterine bleeding	Incipient abortion	Willibrandt’s disease	Thrombocytopenic purpura	Vulvovaginitis
65.	In a 32-year old woman during the bimanual examination a tumor-like firm to hard consistency swelling was revealed  on the left of the uterus. It is displaceable  and painless. Its diameter  is about 10 cm. The uterus and adnexia are not changed. The  menstrual  function is not impaired. The patient looks healthy. What is the probable diagnosis?	*cyst of the left ovary	Cystoma of the left ovary	Dermoid cyst of the left ovary	Ovarian cancer	Extrauterine pregnancy
66.	A 42-year old woman consulted by a doctor  complais of the gnawing-like  pain in the lower  abdomen, weakness, long abundant  menses. The general condition is good. By bimanual examination the enlarged uterus sized about 10 weeks of gestation being hard, painless and having  irregular contours was revealed. What is the probable diagnosis?	*Uterine myoma	Dysfunctional uterine bleeding	Ovarian cystoma	Uterine body cancer	Uterine pregnancy
67.	A patient complaints of the pains beneath the abdomen, radiating to the vagina. strengthening during menses, sexual intercourse. Anamnesis: two years ago there was a suspect for endometriosis. Vaginal investigation: to the back of uterus a painful nodular conformation is found out. Diagnosis.	*Retrocervical endometriosis	Adenomyosis	Chronically inflammation of tne adnexae uteri	Parametritis	Endometriosis of the cervix uteri
68.	A 27 years old woman being treated concerning a chronic adnexitis for 5 years, is delivered in a gynecology department with attributes of  pelviperitonitis. Her husband  is suffering from chronic urethritis. What researches should be appointed for precising of treatment tactics?	*Bacteriological research of a vaginal content and determination of sensitivity to antibiotics	Bacterioscopic research of a vaginal content	A puncture of an abdominal cavity through a back vault of the vagina, bacteriological sowing of an obtained punctate on gonococcus	Clinical and bacteriological analysis of a blood	Bacteriological research after provocation
69.	In a gynecology department the woman with complaints on bloody allocation from a vagina has addressed. Last menses was 3,5 months ago. Ultrasonic did not pass. A uterus at a palpation of a paste consistence, painless, height of standing of a uterine fundus - 24  sm. Parts of a fetus are not palpated, palpitation is not listened, the movement does not feel. From both sides of a uterus are palpated the ovoid form of formation 5( 6  sm. What is the most authentic diagnosis?	Hydatiform mole	Threat of abortion	A placental presentation	A premature placental detachment	Antenatal destruction of a fetus
70.	In a gynecology department there is a 47 years old woman with dysfunctional uterine bleeding after a delay of a menses of about 10 days. With what it is necessary to start the treatment?	*A fractional medical-diagnostic curettage of a mucous of uterus	Hormonal hemostasis	Nonhormonal hemostasis.	Cyclic hormonal therapy	Ablations of the uterus
71.	On the 3rd day after the artificial abortion the patient felt a dull pain  in all abdomen, fever  up to 39,90 C, nausea  and one time   vomiting . The pulse is 120 beats per minute and weak. A marked abdomen distention and painful  voiding  are defined.  Morton, Schyotkin – Blumberg’s symptoms are not clear positive. After  24 hours of observation  the patient’s  condition become better but lower abdomen distention  and  tenderness are still  presented . The pulse and body  temperature are normal. On vaginal  examination  there is any effusion   defined in  the space between uterus and rectum. . The  uterine cervix    upward shift provokes severe pain. Salpinx is  enlarged  and  also painful. An   abdominal cavity  puncture through  the posterior vaginal fornix did not reveal a blood. What is the  diagnosis of this woman?	*Pelvioperitonits	Diffuse peritonitis	Extrauterine pregnancy	Acute appendicitis	Ovarian apoplexy
72.	The patient of 24 years was admitted  into a gynecology department due to a disharmony of the sizes of a uterus to a duration of gestation. Last menses were 4 months ago. At vaginal examination: the uterus is enlarged according to 10 weeks of pregnancy. What diagnosis the most probable?	*Missed abortion	Beginning abortion	Abortion at a course	Incomplete abortion	Menacing abortion
73.	At vaginal examination: the uterus is enlarged by a chorionepithelioma up 12-13 week pregnancy, the patient complains of a strong uterine bleeding; a haemoglobin is 52 g/L. What treatment should be appointed to this patient?	*Hysterectomy with appendages and the subsequent chemotherapy	Ablation of a uterus	A chemotherapy	Anemia treatment	A hormonetherapy
74.	The 24-years old woman, earlier not pregnant, terminated to accept oral contraceptives. After last reception of a drug she had one menses, and then within 6 months the amenorrhea was observed. Choose the most suitable investigation:	*USE of the organs of the small pelvis	Determination of the level of Gonadotropins	Determination of the level of Progesteron	Determination of the level of Testosteron	Computer tomography of the head
75.	47 years- old patient is complainting to bloodish discharge from genitals withing 3 weeks after suppression of menses during 2 months. According bimanual vaginal investigation sise of uterus is nornal, it is’nt painful, fornix are deep, palpatia is painless. Uterine adnexa are not palpable.What is the most probably diagnosis?	*Dysfunctional uterine bleeding	Adenomyosis	Uterine body cancer	Vaginal tumour	Submucosal fibromyoma of uterus
76.	Patient has complaints about pain in her abdomen, metheorism, nausea, and vomiting, nervous irritation. Symptoms are registered on the 3rd day after abolishing of clomiphen-cytratis. Objective state – bracing of musk’s of the abdominal wall, adnexa uterus are enlarged, painful. The level of AP is low, tachycardia. What is the pathogenesis of such complication?	*Hyperstimulaton of ovaries	Inflamation of ovaries	Yellow body persistency	Ovulation	Bleeding to the intestinal cavity
77.	12 years -old girl is complaining to the strong pains in the right iliounguinal area of abdomen after physical tension, vomiting, body temperature is 38 C. Palpation of abdomen - symptom of Schotkin is positive in the right iliounguinal area. What is a main type of investigation in this case?	*Ultrasound investigation	Clinical blood examination	General analysis of urea	Rectal examination	X- ray investigation of the organs of abdominal cavity
78.	In the gynecologic office a 28-years old woman  complains of sterility within three years. The menstrual function is not impaired. There were one artificial abortion and chronic salpingo-oophoritis  in her case history. Oral contraceptives were not used. Her husband’s analysis of semen is without pathology. From what diagnostic method will you start the workup  in this case of sterility?	*Hysterosalpingography	Hormone investigation	Ultra sound investigation	Diagnostic scraping out of the uterine cavity	Hysteroscopia
79.	A patient complaints on dark spready discharges from genitals before and after the mensis. During the colposcopy cianosis inclusions are visualised on the cervix uteri. Diagnosis.	*Endometriosis of uterus wall	Adenomiosis	Errosion of the uterus wall	Endocervicitis	Polyp of the cervical canal
80.	The 31 year old female  patient complains of the  lower abdomen pain, fever up to 38,80C. The patient is ill within 4 days. She has had her last menstrual period one week ago. Besides it is known that she has a history of chronic salpingitis (pelvic inflammatory disease – PID). The patient`s skin is pale, the tongue is dry, the blood pressure is 120/80 mm Hg, the pulse rate is 100. The Schyotkin’s sign is (+)-ve. By bimanual  examination  the 10 cm sized  painfully sharp swelling has been noted in the right side from uterus. The  WBC (leukocyte count) is 16*109/l. What is the previous diagnosis?	*pyosalpinx	Acute salpingo-oophoritis	Parametritis	Appendicitis	Endometritis
81.	A 27 years old woman being treated concerning a chronic adnexitis for 5 years, is delivered in a gynecology department with attributes of  pelviperitonitis. Her husband  is suffering from chronic urethritis. What researches should be appointed for precising of treatment tactics?	*Bacteriological research of a vaginal content and determination of sensitivity to antibiotics	Bacterioscopic research of a vaginal content	A puncture of an abdominal cavity through a back vault of the vagina, bacteriological sowing of an obtained punctate on gonococcus	Clinical and bacteriological analysis of a blood	Bacteriological research after provocation
82.	A 26 years old woman is delivered in a gynecology department with complaints on a sharp pain in right ileac range. Last menses 16 days ago, in time. At survey in specula: a vagina and uterine cervix are without changes. At a vaginal examination the body of the uterus and appendages are not accessible to a palpation because of sharp morbidity and a strain of muscles of a frontal abdominal wall. The back vault  is morbid. What it is necessary to make for specification of the diagnosis?	*Puncture of an abdominal cavity through a  posrerior vault of the vagina	Colposcopy	Laparotomy	Define horionic gonadotropinum level	Hysteroscopy
83.	A 18 years old woman complains of acute pain in the external  genitals  particularly in walking and labia majora swelling. Body temperature is 370C, pulse rate is 98 beats per minute. The examination revealed  the thickness of the right labia majora  and severely  painful swelling 5,0x4,5 cm in it The local skin and mucous membranes are hyperemic. There is an abundant smelly discharge. What is the most probable diagnosis ?	*acute bartholinitis	furuncle of the major genital lip	acute vulvovaginitis	cyst of the Bartholin’s gland	acute vulvitis
84.	A woman of 28 years old complains about periodical aching pains beneath the abdomen, subfebral temperature. Night sweating, olygomenorrhea, algodysmenorrhea, infertility during 7 years. Woman lost 7 kg of weight. Bimanual investigation: uterus is not enlarged, mobile, painless, adnexae uteri have numerous bands, painless. What primary investigation should be carried out for making a diagnosis?	*Inoculation of menstrual blood three times during one menstruation	Inoculation of the urine	Hysterosalpinogography	Analyses of discharges	X-ray investigation of lunges
85.	Secundapara of 25 years. In the third period of delivery the bleeding has appeared.  The attributes of placenta’ detachment are absent. At manual   detachment of a placenta it was revealed that a placenta is fixed, with growing into a myometrium. Tactics of the doctor?	Laparotomy, a hysterectomy	Application of uterotonic agents	A hemotransfusion	Laparotomy, supravaginal amputation of uterus	Tool secretion of an afterbirth
86.	A 37-year old woman was admitted to the gynecological department by the ambulance. She complains of acute pain in the lower part of abdomen, weakness, nausea, vomiting. Menstrual and genital functions are not impaired. Ultra sound investigation a week ago revealed the cyst of the right ovary. The patient`s conditions are the body temperature 36,6 0C, the pulse  88 beats per minute, the blood pressure 90/60 mmHg. The acute tenderness in the lower abdomen and   positive Schyotkin-Blumberd’s symptom are noted. Uterus and left adnexia are normal. A displaceable  firm to hard consistency  swelling was defined on the right side from the uterus. It is severely painful on palpation. What is the diagnosis?	*Twist of ovarian cyst pedicle	Acute salpigooophoritis	Ovarian apoplexy	Cyst rupture	Pyosalpinx
87.	18-year old woman complains of the pain in the lower  abdomen. Some minutes before   suddenly she was appeared unconsciousness at home. The patient has not had a menses within last  3 months. The main features of this case are  pale skin, the pulse rate  110 beats per minute,  Hb (hemoglobin)  76 g/l, BP  80/60 mm Hg. The Schyotkin’s sign is (+)-ve. The vaginal examination revealed following features.  The uterus  is a little bit enlarged. Its displacement is painful. There is also any lateral swelling with  indistinct size. The posterior fornix of the vagina is tenderness and overhangs inside.  What is the most  probable diagnosis?	*impaired extrauterine pregnancy	ovarian apoplexy	twist of cystoma of right uterine adnexa	acute salpingoophoritis	acute appendicitis
88.	The 36 weeks of gestation pregnant woman  was admitted to the obstetric in-patient department. She has previous history of arterial hypertension, now complains of a headache, aching pains in the lower  abdomen and bloody discharge from vagina. The main clinical features are blood pressure 180/100 mm Hg  and hypertonic uterus. During investigation  about 300 ml of dark blood was discharged from vagina. The fetal heartbeats are not heard. What is the diagnosis?	*premature placental separation	Placental presentation	premature delivery threat	uterine rupture	Embolism caused by amniotic fluid
89.	The woman delivered twins has early postnatal hypotonic uterine bleeding reached 1.5\% of her bodyweight. The bleeding is going on. Conservative methods to arrest the bleeding have been found ineffective. The conditions of patient are pale skin, acrocyanosis, oliguria. The woman is confused.  The pulse rate  is 130 beats per min, BP – 75/50 mm Hg. What is the further treatment?	*Uterine extirpation	Supravaginal uterine amputation	Uterine vessels ligation	Inner glomal artery ligation	To put clamps on the uterine cervix
90.	Primapara with a preeclampsia of a serious degree. The sizes of a pelvis: 23-25-29-19  sm. The position of a fetus is longitudinal,  vertex presentation. Palpitation of a fetus is not  auscultated. An attack of an eclampsia. Vaginal examination:  disclosure of uterine  cervix is complete, the head is in a narrow part of a pelvic cavity. Tactics of delivery’s conducting?	*Embryotomy	Applying of obstetric forcepses	Vacuum extraction of a fetus.	Caesarian sections.	Skin-head forcepses by Ivanov
91.	Primapara 26 years, in-time labor, began 8 hours ago. Amniotic fluid has flown away 3 hours ago.  Spasms for 30-40 sec., in 5-6 minutes, regular, painful. The position of a fetus is longitudinal, head presentation; fetus’ head is pressed to an inlet into a small pelvis. Palpitation of a fetus precise, 136 hits in one minutes. At a vaginal examination: disclosure of uterine cervix is 8 sm, a forehead, superciliary arches of a fetus are palpated, a frontal  suture is in the right slanting size. The    amniotic membrane is not present. What from the listed below is the most rational?	*Caesarian section	Embryotomy operation	Cavitary obstetric forcepses	Uterotonics	Dream - rest, spasmolyticses
92.	The 20 years old patient shows complaints on a delay of menses to 10 days. Infringement of menstrual function marks for the first time. Sexual life is regular, is not preserved from pregnancy. At survey: a state is  satisfactory, an abdomen is painless, the AP of 120/80 mm.Hg. The pulse is 72 per minute, of satisfactory properties. At transvaginal echograpphy: progressing tubal pregnancy is suspected. Correct tactics of the doctor?	*Urgent hospitalization	General laboratory examination in polyclinic	Ultrasound scanning in one week	Examination according to the tests of function diagnostics	Puncture of an abdominal cavity through a  posterior vault of the vagina
93.	In a gynecology department there is a 34 years old patient with complaints of acute pains in the bottom of abdomen on the right which have begun suddenly, nausea, vomiting. Bimanual research: the uterus of the normal sizes, its shifting is morbid, the right ovary a little bit enlarged, spherical, morbid. Vaults of the vagina are protruding; the palpation on the right is morbid. In  specula: the uterine neck and mucous of vagina are not changed.  Discharges are not present. What method of research is most informative?	*Laparoscopy	A puncture of an abdominal cavity through a back vault of the vagina	Ultrasonic investigation of organs of a small pelvis	A colposcopy	Bimanual research
94.	In a gynecology department there is a 47 years old woman with dysfunctional uterine bleeding after a delay of a menses of about 10 days. With what it is necessary to start the treatment?	*A fractional medical-diagnostic curettage of a mucous of uterus	Hormonal hemostasis	Nonhormonal hemostasis.	Cyclic hormonal therapy	Ablations of the uterus
95.	A 26 years old woman is delivered in a gynecology department with complaints on a sharp pain in right ileac range. Last menses 16 days ago, in time. At survey in specula: a vagina and uterine cervix are without changes. At a vaginal examination the body of the uterus and appendages are not accessible to a palpation because of sharp morbidity and a strain of muscles of a frontal abdominal wall. The back vault  is morbid. What it is necessary to make for specification of the diagnosis?	Puncture of an abdominal cavity through a  posrerior vault of the vagina	Colposcopy	Laparotomy	Define horionic gonadotropinum level	Hysteroscopy
96.	Multipara, 35 years, 1 period of the second labor.  Spasms are of average force. Three medical abortions and caesarian section concerning a placental presentation in anamnesis. Suddenly the parturient woman complaints of strong abdominal pains, weakness have appeared. The BP - 80\50 mm Hg. From a vagina - moderate bloody discharge. Palpitation of a fetus is not auscultated.    Parts of a fetus are palpated to the left of an middle line of abdomen. Patrimonial activity is absent. The preliminary diagnosis?	Rupture of uterus	Premature detachment of normally posed placenta	Placental presentation, bleeding	Uterine’ cervix rupture,  ІІІ degree	Embolism with amniotic  fluid
97.	A pregnant woman having 20 weeks gestation term began to complain of weakness, fatigue, dizziness. The  hemoglobin is 80 g/l,  pulse rate 86 beats per minute, blood pressure  120/80 mm Hg. The skin and mucous membranes are pale. What is the diagnosis?	*Anemia of pregnan woman	Neurocirculatory dystonia	Endocrinopathy	Chronic arterial hypertension	Preeclampsia
98.	Patient has complaints about non-regular manses, obesity, girsutism, she suffers from sterility. According bimanual investigation – size of the uterine body is smaller then  normal one . The left and right ovaries are mobile, painful. Sizes of ovaries are 4 x 5 x 4 sm. What can be a pathology in this case?	*Disease of polycystose ovaries	Chronical adnexitis	Tuberculosis of adnexa uterus	Kysts of ovaries	Endomerriosis of ovaries
99.	A 26 years old woman, delivery has taken place 12 months ago, complicated by hemorrhage  and DIC-syndrome in an early puerperal period. A patient complaints on a headache, giddiness, sleepiness, abasement of hair on a head and pubis. The BP is  90/50 mm. Hg. Menstrual function after delivery is not iterated. The uterus is diminished, ovaries are not palpated and dryness of mucous of vagina is marked. The basal temperature is monophasic, lower than 37(C, signs of pupil and fern are negative. What is the pathogenesis of disease?	* A depression of function of a pituitary  gland	Excessive production of prolactinum	Depression of function of ovaries	Infringement of function of paranephroses	Hyperproduction of androgens
100.	A 26 years old woman, delivery has taken place 12 months ago, complicated by hemorrhage  and DIC-syndrome in an early puerperal period. A patient complaints on a headache, giddiness, sleepiness, abasement of hair on a head and pubis. The BP is  90/50 mm. Hg. Menstrual function after delivery is not iterated. The uterus is diminished, ovaries are not palpated and dryness of mucous of vagina is marked. The basal temperature is monophasic, lower than 37(C, signs of pupil and fern are negative. What is the pathogenesis of disease?	* A depression of function of a pituitary  gland	Excessive production of prolactinum	Depression of function of ovaries	Infringement of function of paranephroses	Hyperproduction of androgens
101.	The 46 years-old woman has copmplaints about prolonged menstruation, polymenorrhea within 2 years. She has hypertonic diseases, obesity of 2nd degree. In the hystological investigaion in the scrap of endomethrium – numerous big glands with cists.What is the link of the pathogenesis of such state?	*Aromatisation of androstendiol in estrone	Hyperprolactinaemia	High secretion level of adrenocorticopripical hormone	Low level of glucocorticoids	Hyperandrogenia
102.	28 years-old patient has complaints about absense of menorrhea, growth of hair as of men’s type. Married. Menarche since 14 years- age – hypomenorrthea and finished after 2 years. Height is 160 sm, weight is 65 kg. Female constitution. Colour and humidity of skin are normal. External genitals of the female are normal. Uterine size is normal to. Uterine adnexa are enlarged according palpation. What is the most probably diagnosis?	*Syndrome of Shtein-Levental	Disease of Itsenko-Kushing	Adreno-genital syndrome	Adrenosteroma	Corticoadrenosteroma
103.	30 years old patient has complaints about  amenorrhea during 2 years after delivery. Labor was complicated with massive bleeding. After delivery woman lost a body weight, has alopecia. According of  bimanual investigation – the size of uterine body is small, hypoplasia of minor and major lips . What is the etiological factor of this changes	*Necrosis of adenohypophis after haemorragical shok	Stimulation of ovulation	Momental turning of the ovarial function	Involutia of hypothalamus	Pathological clymacs