Крок 2 Загальна лікарська підготовка

Медичний профіль – Акушерство і гінекологія

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The 52-years woman suffering from obesity, *Excessive Hypersecretion of Poor aromatization of The increased contents Supersecretion of
complaints to bloody discharges from sexual paths transformation of estrogens by tissues of preandrogens owing to of FSH androgens by the
during 4 days. Last normal menses was 2 years preandrogens from the organism. hypothyroidism cortex of
ago. Histological investigation of biopsy of the fatty tissues. paranephroses.
endometrium has revealed adenomatous
hyperplasia. Which reasons from listed below
promoted the development of disease?

The data of a separate diagnostic curettage of the *Surgical treatments Surgical treatment + Surgical treatments Radial therapy Surgical treatments and
mucous of the uterus’s cervix and body made up and hormonetherapy chemotherapy and radial therapy hormonetherapy
in connection with bleeding in a postmenopausal
period: in the scraping of the mucous of the
cervical canal no pathology is revealed, at
endometrium - the highly differentiated
adenocarcinoma is found. Metastasises are not
found. Which method of treatment is the most
correct?
The woman of 27 years complaints of the disoders *Administration of an Operative treatment Dispensary Anti-inflammatory Chemotherapeutic
of menstrual function for 3 months, irregular pains estrogen–gestogen observation of the therapy treatment.
in the abdomen. In bimanual investigation: in the complexes within 3 patient
dextral appendages range of a uterus there is an months with repeated
elastic spherical formation, painless, diameter of survey
7 sm. USI: in a right ovary –a fluid formation,
diameter of 4 sm, unicameral, smooth. What
method of guiding is the most preferable?
The patient of 40 years complaints of colic pains *Operation: untwisting Hormonal hemostasis Fase by fase vitamin Supravaginal ablation Hysterectomy without
in the lower abdomen and abundant bloody of the borning nodes therapy of the uterus without appendages.
discharge from sexual paths. Last 2 years she had appendages.
menses for 15-16 days, abundant, with clots,
painful. In anamnesis – 2 medical abortions. In
bimanual investigation: from the canal of the
cervix of uterus - a fibromatous nodes, 3 sm in
diameter, on the thin crus. Discharges are bloody,
moderate.Choose correct
The patient of 40 years tactics: of discharges
complains *Treatment of specific Diathermocoagulation Specific treatment of Cervixectomy Cryolysis of cervix of
from the vagina of yellow colour. Bimanual colpitis and with the of the cervix of the Trichomonas colpitis the uterus.
investigation: without pathological variations. In subsequent biopsy uterus
smear – Trichomonas vagynalis and blended flora.
Colposcopy: two hazy fields on the front labium,
with a negative Iodum probing.Your tactics:

The 32 year old woman consulted a gynecologist *Surgical treatment Hormonetherapy Phytotherapy Radial therapy Fase by fase vitamin
concerning abundant long menses within 3 therapy
months. Bimanual investigation: the body of the
uterus is enlarged according to about 12 weeks of
pregnancy, distorted, tuberous, of dense
consistence. Appendages are not palpated.
Histological investigation of mucosa of the body of
the uterus: adenocystous hyperplasia of
endometrium.Optimum
The woman complaints of medical
slight tactics:
dark bloody *USI. Hysteroscopy. Hromogidrotubation Colposcopy Cystoskopy.
discharges and weak pains in the bottom of
abdomen within several days. Last menses were 7
weeks ago. The test for pregnancy is positive.
Bimanual investigation: the body of the uterus is
about 5-6 weeks of pregnancy, of softish
consistence, painless. In the left
appendages - a retortlike formation,
7х5sm, mobile, painless. What it is
The woman was hospitalised with full-term *Premature detachment Labor before term. Back occipital Acute hypoxia of a Hydramnion.
pregnancy. In survey: the uterus is morbid, the of the normally posed presentation. fetus.
abdomen is tense, cardiac tones of the fetus are not placenta.
auscultated. What is the most probable
complication of pregnancy?

By the end of the 1st period of physiological labor *Acute hypoxia of the Labors before term. Premature detachment Back occipital Hydramnion
the clear amniotic waters were given vent. fetus. of normally posed presentation
Contractions lasted 35-40 sec every 4-5min. placenta.
Palpitation of the fetus 100 beats per minute. The
AP is 140/90 mm Hg. Diagnosis.

In the 40 weeks pregnant woman in intrinsic *Laborstimulation after Strict bed regimen for Complex therapy of Cesarian section Complex therapy of
obstetric investigation: the cervix of a uterus is preparation 1 month. gestosis for 2 days immediately. gestosis for 7 days
undeveloped. The oxytocin test is negative. Upon
inspection at 32 weeks it is revealed: AP 140/90
mm. Hg, proteinuria 1 g/l, peripheric edemas.
Reflexes are normal. Choose the most correct
tactics of guiding the pregnant.

The 26-year old woman had the second for the last *Atony of the uterus. Failure of cervix of the Hysterorrhesis. Delay of the part of Hypotonia of the uterus
2 years labor with Oxytocin application.The the uterus placenta.
child’s weight - 4080 gr. After the placent birth
there was a massive bleeding, signs of
hemorrhagic shock.Despite the introduction of
contractive agents,good contraction of the uterus
and absence of any uterus cervix and the vagina
failures, the bleeding proceeds.Choose the most
probable cause of bleeding.
The woman is admitted to the maternity home *Hysterorrhesis. Presentation of the cord. Placental presentation Abjointing the mucous Premature expultion of
with discontinued patrimonial activity and slight fuse from cervix of the the amniotic waters.
bloody discharges from the vagina. The condition uterus
is serious, the skin is pale, consciousness is
confused. AP 80/40 mm Hg. The palpitation of the
fetus is not determined. In anamnesis there was a
Cesarian section a year ago. Establish the
diagnosis:
In the woman of the first day after labor *Metroendometritis Thrombophlebitis of Infected hematoma Infective contamination Apostatis of junctures
the rise of temperature up to 39?С was veins of the pelvis of the urinary system after the episiotomy.
registered. The breakage of the fetal
membranes has taken place 36 hours
prior to labors. The investigation of the
bacterial flora of cervix of the uterus
revealed – hemocatheretic streptococcus of a
group A. The uterus body is soft, tender.
Discharges
The womanare bloody,
from with
a groop of arisk
mixing of pus.
(chronic *Infection Thrombophlebitis of Infected hematoma. Endometritis. Apostatis of junctures
pyelonephritis in anamnesis) had labor through contamination of the veins of the pelvis. after episiotomy
natural patrimonial pathes. In day after labors she urinary system.
complains of fever and loin pains, often urodynia.
Establish the most probable complication.

The 24-years patient in 13 months after the first *Determination of the USI of organs of a small Progesteron assay Computer tomography Determination of the
labors has addressed with the complaint on level of Gonadotropins pelvis of the head contents of
amenorrhea. Pregnancy has concluded by a Testosteron-Depotum
Cesarian section concerning to a premature in Serum of blood.
detachment of normally posed placenta
hemorrhage has made low fidelity 2000 ml owing
to breakdown of coagulability of blood. Choose the
most suitable investigation:
In the woman of 24 years about earlier normal *Computer Determination of the USI of organs of a Progesteron assay. Determination of the
menstrual function, cycles became irregular, tomography of the level of Gonadotropins. small pelvis contents of
according to tests of function diagnostics- head. Testosteron-Depotum
anovulatory. The contents of Prolactinum in blood in Serum of blood.
is boosted. Choose the most suitable investigation.

The primapara M., 20 years, is in in time -labors *Prophylaxes of Laborinducing Prophylaxes of Antenatal preparation Treatments of delicacy
proceeding for 4 hours. Light amniotic waters were delicacy of patrimonial hypoxia of the fetus of patrimonial activity
given vent. The fetus’ head is pressed to the orifice activity.
in the small pelvis. Prospective mass of the fetus
4000,0 ± 200,0. Palpitation of the fetus is in norm.
Intrinsic investigation: cervix is absent, disclosure
– 2 cm, the fetal bladder is not present. The head is
in 1-st plane of the pelvis, a sagittal juncture is in
the
Theleft slantingof
Primapara dimension. A glucose-calcium-
22 years, was hospitalised for *Folliculinum Oxytocinum Partusistenum Prednisolonum. Zinci sulfas of
ante partum preparation concerning the pelvic magnesium
presentation. The position of the fetus is
longitudinal, breeches are pressed to the orifice of
a small pelvis. Palpitation of the fetus is clear,
rhythmical, 140 impacts per minute. Patrimonial
activity is not present. What it is necessary to
include into antenatal preparation
The 24 years old primapara, was hospitalised with *Antenatal expultion of Early expultion of the The beginning of the The end of the 1-st term The pathological
complains on expultion of the amniotic waters. The the amniotic waters. amniotic waters. 1-st term of the labor of the labor preliminary term.
uterus during palpation is tonic. The position of the
fetus is longitudinal, is pressed with the head to an
orifice in a small pelvis. Palpitation of the fetus is
rhythmical, 140 beats/min, auscultated at the left
below a belly-button. Intrinsic investigation: cervix
of the uterus is 2,5 cm long, dense, the externum
os is closed, leak light amniotic waters. Point a
The 29 year old patient has had a surgical *Hormonetherapy and Antibacterial therapy Lasertherapy and Magnitotherapy and Does not demand the
treatment concerning the benign serous epithelial proteolytic enzymes. and adaptogens enzymetherapy vitamin therapy further observation
tumour of the ovary. The postoperative term has
passed without complications.What is it necessary
to prescribe in the rehabilitational term:

The 34-years old woman on the 10-th week of *The test for tolerance Determination of the Bacteriological A cardiophonography USI of the fetus.
gestation /the second pregnancy / has consulted the to glucose contents of ?? investigation of of fetus
doctor of female consultation with the purpose of fetoproteinum discharge from the
statement on the dyspensary record. In the previous vagina
pregnancy there took place hydramnion, the child
was born with mass of yhe body of 4086. What
method of investigation is necessary for carrying
out, first of all?:
The puerpera is on the 4-th day after the normal *To appoint the agents Endometrial instillation Supravaginal ablation Tool revision of the HBO.
labor. The common state is satisfactory, stimulating reductions of antiseptics solutions. of the uterus cavity of the uterus
there are no complaints. The body of the uterus
temperature 36,5 °С; sphygmus is of 80
beats / minutes, satisfactory properties,
rhythmical; AP of 120/80 mm.Hg on both
humeral arterias. Mammas are mild,
painless, papillas are safe. The uterus is
dense,
The 26painless,
years old its bottom
woman is 6-8 cm of
complaints higher
the than *Broken tubal Apoplexy of the ovary Acute right-hand Torsion of the leg of the Acute appendicitis
subitaneously arisen pains in the bottom of the pregnancy adnexitis tumour of the ovary
abdomen, irradiating to the anus, a nausea,
giddiness, bloody dark discharge from sexual tract
within one week, the delay of menses for 4 weeks.
Signs of boring of the peritoneum are positive.
Bimanual investigation: borders of the body of the
uterus and its appendages are not determined
because of sharp morbidness. The diverticulum
At the gynecology department there is a patient of * Surgical dissecting, a Antibiotics, Surgical dissection, Antibiotic therapy Antibiotics,
32years with the diagnosis: "the acute drainage of an abscess Sulfanilamidums drainage of the abscess detoxication and
bartholinitis".The body temperature is of the gland, antibiotics of the gland biostimulants.
38,2 degrees, leucocytes = 10,4 Т/l, the
ESR = 24 mm / hour. In the area of big
gland of the vestibulum - a dermahemia,
the sign of the fluctuation, sharp
morbidness.What is the most correct
tactics
At of the doctor?:
the woman of 33 years during carrying out tool * Suturing of a Suturing of a punched Hysterectomy Antibiotics reducing Strict confinement to
revision of the uterus cavity concerning incomplete punched foramen after foramen agents, observation bed, observation.
infected abortion perforation of a wall of the cutting of the edges of
uterus at a bottom is made. What is the tactics of the wound
guiding?:

The primagravida with pregnancy of 37-38 weeks * Droperidolum of 0,25 Dibazolum of 1 \% - 6,0 A papaverine a Hexenalum of 1 \% - Pentaminum of 5 \% -
complaints of headache, nausea, pain in \% - 2,0 ml ml hydrochloride of 2 \% 2,0 ml 4,0 ml.
epigastriums. Objective: the skin is acyanotic. Face - 4,0 ml
is hydropic, there are short fibrillar bounces of
blepharons, muscles of the face and the inferior
extremities.The look is fixed. AP 200/110 mm.Hg;
sphygmus of 92 beats / minutes,
intense.Respiration frequency 32/min.Activity of
the heart
In the isrhythmical
primapara, Appreciable
30 years, edemas ofwith
intensive attempts the *Perineotomy Epiziotomija. Protection of the Vacuum - extraction of Waiting tactics.
an interval of 1-2 min, duration 50 sec have begun. perineum. the fetus.
In time of inclination of the head of the fetus in
the parturient woman complaints on the severe
pain in the perineum have developed. The
perineum, height= 4 sm, has turned pale. What is it
necessary to perform:
The pregnant woman of 29 years old has been *Threat of Threat of patrimonial Threat of bleeding Threat of delicacy of Threat of
suffering from urolithiasis, secondary-chronic development of a traumatism patrimonial activity isosensibilisation
pyelonephritis during 8 years. What group of risk gestosis
the occured complication of pregnancy should be
related to?

The patient of 23 years old has been registered in *Hepatosis pregnant Early gestosis Spontaneous abortion Anemia pregnant Dermatosis of pregnant
female consultation with 4 years ago undergone
contagious hepatitis, chronic
cholecystopancreatitis. Point one of the most
probable complication of pregnancy in the first
trimester.

The primagravida of 20 years old which has *Hyperglycemic coma Spontaneous abortion Hypoglycemic coma Bronchial asthma of the Anemia of the pregnant
diabetis for 8 years is hospitalised into the pregnant woman woman
gynaecology department with early gestosis of
average gravity. Point the most probable
complication.

Stool in children with salmonellosis is: *Green colored, Normal Pea-soup Discolored without Foamy, profuse, foul-
diarrheal, watery and mucus smelling and yellow
profuse with admixture colored
of mucus
In case of appearance of bleeding caused by * A tight tamponade of An amputation of a Clampation of side Laparotomy, ligation of Laparotomy, widened
infiltrable cancer of a uteral cervix , it's necessary vagina uteral cervix fornixis internal iliac artery extirpation of an uterus
to conduct: (parametriums) [Wertheim's
hysterectomy]

The clinical manifestations of the HELLP- *Everything that is Icterus Pains in the right Blood vomiting Bleeding at the spots of
syndrome are: enumerated below hypochondrium injections

Possible complications of gestosis can be: *Everything that is Anuria Cerebral hemorrhage Exfoliation of retina Blindness
enumerated below:

To render urgent help in time of an eclampsia *Everything that is Introduction of a gag The fixation of a Handling a patient in a The aspiration of
attack it's necessary to accomplish: enumerated below: tongue with tongue horisontal state contents out of
forceps respiratory tract and
oral cavity
Name the possible pathogenic mechanisms of *Everything that is Transplacental Uprising Transdecidual Descending
prenatal fetal contamination: enumerated below:

Clinical manifestations of antenatal infection * Everything Term of pregnancy Virulence as a Channels of infection Species of a causative
depends on: enumerated below when infection took causative agent agent
place

The teratogenic effect at time of early terms of * All enumerated The Virus of rubella Cytomegalovirus The virus of II type The chickenpox virus
pregnancy shows: virusses herpes simplex

For treatment of colpitis caused by Candid's fungus * All enumerated "Polyjnuks" "Clotreamazol" "Pymaphucin" The given answers are
it is used: below: wrong
These are characteristic signs of gonococcus * The intracellular The positive painting by A rounded shape Tropism for the Everything enumerated
position in a cytoplasm Gramm laminated flat above
of mononuclears epithelium

In case of tuberculosis of genital organs a primary * Lungs Bones Urinary excretory Lymph nodes At the peritoneum
focus is located most often in: system

In case of gonorrheal salpingitis, the following * The lack of an A debute of disease in Double affection of Of a quick effect of Of a multiple affection
listed below are correct except: activation of an early follicle stage of uterus'adnexa antibiotic therapy
sharpphased blood a menstrual cycle
indices

In order to define the true conjugate it is necessary: * From the value of the From the value of the To the value of the To the value of the An external conjugate
external conjugate to external conjugate to external conjugate to external conjugate to is equal to the real
take away 9 cm take away 11 cm add 9 cm add 11 cm conjugate
In order to define the size of true conjugate it is * From the value of the To the value of the From the value of the To the value of the The diagonal conjugate
necessary: diagonal conjugate to diagonal conjugate to external conjugate to external conjugate to is equal to the real one
take away 1,5 cm add 1,5 cm take away the value of add the value of the
the diagonal conjugate diagonal conjugate

The big slant size of a fetal head is defined * An occiput hump and An occiput hump and a A suboccipital fossa A suboccipital fossa A hypoglossal bonelet
between : chin bridge of nose and a front angle of a and the middle of a and the middle of a
great fontanel great fontanel great fontanel

The straight size of a fetal head is defined between: * An occiput hump and An occiput hump and a A suboccipital occiput A suboccipital fossa A hypoglossal bonelet
a bridge of nose chin fossa and the middle and a front angle of a and the middle of a
of a great fontanel great fontanel great fontanel

What disorders of a menstrual function are the * Hyperpolymenorrhea Oligomenorrhea Algomenorrhea Amenorrhea Metrorrhagia
most characteristic of an uterus myoma?
Which of the methods of examination is the most * Laparoscopy with Pertubation Hysterosalpingograph Transvaginal Bicontrast
informative in the diagnostics of a tube infertility? chromosalpingoscopy y echography pelviography

Making out the diagnosis of uteral cervix cancer * Histological Dilated colposcopy Cytological Hysterocervicoscopy Echography of the
with the detection of an initial stage is possible in investigation of the investigation of the organs of a small pevis
time of: biopsy material smears

The majority of innocent ovarian tumours are * Serous cystoadenoma Fibroma Mucinous Thecoma Teratoma
transformed: cystoadenoma

To the retentional cysts of the ovaries is attributed * Dermoid cyst Follicular cyst Yellow body's cyst Paraovarian cyst "Chocolate cyst"
everything that is enumerated, except for:
As premorbid background for development of a * Lung pathology Diabetes mellitus Hypertensive diseases Fatness Renal pathology
gestosis are all enumerated pathologic conditions,
except:

A true or an obstetric conjugate is a distance * An inner surface of The middle of the pubis Lower edge of the Lower edge of the pubis Upper and lower edge
between: the upper edge of a and the place of junction pubis and promontory and the pelvic bone of the pubis
pubis and a promontory of the 2nd and the 3rd
lumbosacral vertebras

A diagonal conjugate is measured between: *The lower edge of the The upper edge of the The lower edge of the The middle of the pubis Ischiococcygeal spines
pubis and the pubis and promontory pubis and pelvic bone and the place of
promontory junction of the 2nd and
the 3rd lumbosacral
vertebras

A parturient woman aged 32. After 3d fullterm * To fulfil the To repeat the fist To fulfil the uterus To fulfil the clampation To introduct the
delivery, in early afterbirth period there appeared laparotomy with the masage of the uterus tamponade of the parametriums by methylergometrine
bleeding caused by fetus, weigh 4,3 kg. To stop it, hysterectomy of the Henkel-Ticknadze intravenously
the external massage of uterus, introduction of uterus without adnexa
uterotonics, manual examination of uteral cavity
walls and a massage on a fist, an ester tampon into
the back fornix of vagina were fulfilled. The result
was absent, bleeding lasted, hemorrhage ran up to
1200 ml. Patient’s condition was bad: she was
A pregnant woman (35 weeks), aged 25, was * To fulfil a delivery To fulfil the To introduct the drugs To fulfil the stimulation To fulfil the
admitted to the hospital because of bleeding by means of Cesarean hemotransfusion and to increasing blood of delivery by observation for the
discharge. In her past history there were two section. prolong the pregnancy coagulation and intravenous intensity of
artificial abortions. In a period of 28-32 weeks continue observation introduction of oxytocin hemorrhage and at the
there was noted the onset of hemorrhage and USD moment of stopping
showed a placental presentation. The uterus was in the bleeding to prolong
normotonus, the fetus position was transversal (Ist the pregnancy
position). The heartbeats were clear, rhythmical,
140b\min. Show the
The first full-term further II
delivery, tactics of managing
period. The fetal the* An area of small That is pressed to the The area of opening The area of wide part of The area of narrow part
position is longitudinal, I position, a frontal view. pelvis outlet opening into a small into a small pelvis a cavity of a small of a cavity of a small
The heart beat is clear, rhythmical, 140 b/min. The pelvis pelvis pelvis
head presents, that it can't be determinated by
external manner. Outflowed liquid is clear. In time
of an internal inspection: the uteral cervix is
effaced , dilatation is full, membranes are absent.
The vertex presents sagittal suture which is in a
straight size,
In time of theavaginal
small fontanel is under
examination of athe pubis.
parturient * The 2nd position, the The 1st position, the The 1st position, the The 2nd position, the The high-riding sagittal
women it was determined: the cervix is effaced, back view front view back view front view suture
dilatation is 5 cm, the fetal head is occlused to a
small pelvis' opening. A sagittal suture is in the
right slant size, a small fontanel is left closer to a
sacral bone. Point to the position and the view of
the position of the fetus

A patient aged 35 with the presence of the right * Torsion of cyst Rupture of cyst Infection of cyst Malignant degeneration Bleeding into cyst
ovarian cyst after a sharp bending had strong pains
in an abdomen,on the right. At the moment of
admission to the hospital the condition is
satisfactory, the pulse is 86 b/min, AP – 115/80
mm Hg, to – 37,2oC. Abdomen is soft, painful at
the right illiohypogastric area where are noted
intension of muscles. A menstrual function is
normal. In the time of vaginal investigation the
The 3rd full-time pregnancy, the 2nd delivery. The * To fulfil a delivery To fulfil amniotomy To fulfil amniotomy Accelerate a delivery by Fulfil an observation of
anamnesis showed a spontaneous abortion by means of the with the following intravenous character of delivery
complicated by metroendotermitis. Following 26 cesarean operation applications of skin- introduction of oxytocin activity
weeks some bloody discharge was noted which headed forceps
was estimated as a threat of abortion. The
beginning of delivery labor caused some bleeding.
The uterus had clear circuits, the position of fetus
was longitudinal, the fetal head being slightly bent
to the opening
A patient aged into a small pelvis.
75 complains The fetala tumor-
of appearing * Median colporrhaphy Frontal and back Ventrosuspension Vaginal Hysterectomy Manchester operation
like mass from vagina at the time of small physical colporrhaphy
exertion and suppression of urine. In a lying
position the above-mentioned tumor can be easily
set into the vagina after which the urination
renews. Objectively: pudental fissure gapes at the
time of exertion, the whole uterus and vagina walls
with a urinary bladder and a rectum come out,
mucosa of the uterus is dry, atrophic.The patient