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 |
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