Gynecology 2
問題一覧
1
A 54-year-old female patient consulted a gynaecologist about bloody discharges from the vagina for 1 month. Last menstruation was 5 years ago. Gynaecological examination revealed no pathological changes. What is the tactics of choice?
Diagnostic fractional curettage of uterine cavity
2
A 28-year-old female patient complains of having haemorrhage from the genital tracts for 1 month. 6 months ago she had natural delivery and gave birth to a girl weighing 3100 g. Objectively: the uterus is enlarged to 9-10 weeks, mobile, painless, of heterogenous consistency. Examination reveals vaginal cyanosis, anaemia and body temperature rise up to $37,8^oC$. There is a significant increase in hCG concentration in the urine. What is your provisional diagnosis?
Uterine chorionepithelioma
3
A pregnant woman may be diagnosed with hepatitis if it is confirmed by the presence of elevated:
SGOT (ALT)
4
A 29-year-old patient complains of absent menstruation for a year, milk discharge from the nipples when pressed, loss of lateral visual fields. X-ray shows an expansion of the sella turcica. What is the most likely cause of this condition?
Pituitary tumour
5
A 25-year-old female patient complains about having amenorrhea for 3 years. She associates it with difficult labour complicated by massive hemorrhage. She also complains of loss of weight, hair fragility and loss, lack of appetite and depression. Objective examination reveals no pathological changes of uterus and its appendages. What is the desease pathogenesis?
Hypoproduction of gonadotropin
6
A 30-year-old female patient complains of milk discharge from the mammary glands, 5-month absence of menstruation. She had one physiological labour four years ago. Objectively: mammary glands are normally developed. Bimanual examination reveals that the uterus is decreased in size, the ovaries are of normal size. MRI-scan shows no cerebral pathologies. Concentration of thyroid-stimulating hormone is normal. The serum prolactin level is increased. What is the most likely diagnosis?
Hyperprolactinemia
7
A 28-year-old patient complains of discomfort, acute pain in the lower third of the left labia majora. The disease began suddenly after menstruation. Objectively: body temperature is $38^oC$. The left labia majora has a formation to 3 cm diameter, with hyperemic surface, extremely painful to the touch, with symptoms of fluctuation. What is the most likely diagnosis?
Acute bartholinitis
8
In 13 months after the first labor a 24-year-old woman complains of amenorrhea. Cesarian section was conducted as a result of premature detachment of normally posed placenta. Hemorrhage has made low fidelity of 2000 ml due to breakdown of coagulation of blood. Choose the most suitable investigation.
Determination of the level of gonadotropin
9
13 months after the first labor a 24-year-old patient complained of amenorrhea. Pregnancy ended in Caesarian section because of premature detachment of normally positioned placenta which resulted in blood loss at the rate of 2000 ml owing to disturbance of blood clotting. Choose the most suitable investigation:
Estimation of gonadotropin rate
10
A 14-year-old girl complains of pain in vaginal area and lower abdomen that last for 3-4 days and have been observed for 3 months about the same time. Each time pain is getting worse. Objectively: mammary glands are developed, hairiness corresponds to the age. The virginal membrane is intact, cyanotic and protruded. She has never had menstruation. She has been diagnosed with primary amenorrhea. What is the reason of amenorrhea?
Hymen atresia
11
By the end of the 1st period of physiological labor clear amniotic fluid came off. Contractions lasted 35-40 sec every 4-5min. Heartbeat of the fetus was 100 bpm. The BP was 140/90 mm Hg. What is the most probable diagnosis?
Acute hypoxia of the fetus
12
A 51 y.o. patient complains of having intensive bloody discharges from vagina for 15 days after delay of menstruation for 2,5 months. In anamnesis: disorders of menstrual function during a year, at the same time she felt extreme irritability and had sleep disorders. US examination results: uterus corresponds with age norms, appendages have no pecularities, endometrium is 14 mm thick. What is the doctor's tactics?
Diagnostic curettage of uterine cavity
13
The results of a separate diagnostic curettage of the mucous of the uterus' cervix and body made up in connection with bleeding in a postmenopausal period: the scrape of the mucous of the cervical canal revealed no pathology, in endometrium - the highly differentiated adenocarcinoma was found. Metastases are not found. What method of treatment is the most correct?
Surgical treatment and hormonotherapy
14
A 45 y.o. woman complains of contact bleedings during 5 months. On speculum examination: hyperemia of uterus cervix, looks like cauliflower, bleeds on probing. On bimanual examination: cervix is of densed consistensy, uterus body isn't enlarged, mobile, nonpalpable adnexa, parametrium is free, deep fornixes. What is the most likely diagnosis?
Cancer of cervix of uterus
15
A 43 y.o. patient complains of formation and pain in the right mammary gland, rise of temperature up to 37,20C during the last 3 months. Condition worsens before the menstruation. On examination: edema of the right breast, hyperemia, retracted nipple. Unclear painful infiltration is palpated in the lower quadrants. What is the most probable diagnosis?
Cancer of the right mammary gland
16
A 68-year-old patient consulted a doctor about a tumour in her left breast. Objectively: in the upper internal quadrant of the left breast there is a neoplasm up to 2,5 cm in diameter, dense, uneven, painless on palpation. Regional lymph nodes are not enlarged. What is the most likely diagnosis?
Cancer
17
A 23-year-old female consulted a gynecologist on the 20th day postpartum period about pain in the left breast, purulent discharge from the nipple. Objectively: Ps- 120/min, tо- 39оC. The left breast is painful, larger than the right one, hyperemic. In the upper quadrant there is an infiltrate sized 10x15 cm with a softening inside. Blood test results: ESR- 50 mm/h, WBC- 15,0*109 /l. What is the tactics of choice?
Refer to the surgical department for operative treatment
18
At the gynaecological department there is a patient of 32 years with the diagnosis: "acute bartholinitis".Body temperature is 38,20C, leucocytes count 10,4*109 /L, the ESR is 24 mm/hour. In the area of big gland of the vestibulum - the dermahemia, the sign of the fluctuation, sharp tenderness (pain). What is the most correct tactics of the doctor?
Surgical dissecting, a drainage of an abscess of the gland, antibiotics
19
A patient was admitted to the hospital with complaints of periodical pain in the lower part of abdomen that gets worse during menses, weakness, malaise, nervousness, dark bloody smears from vagina directly before and after menses. Bimanual examination revealed that uterus body is enlarged, appendages cannot be palpated, posterior fornix has tuberous surface. Laparoscopy revealed: ovaries, peritoneum of rectouterine pouch and pararectal fat have "cyanotic eyes". What is the most probable diagnosis?
Disseminated form of endometriosis
20
A 42-year-old woman has had hyperpolymenorrhea and progressing algodismenorrhea for the last 10 years. Gynaecological examination revealed no changes of uterine cervix; discharges are moderate, of chocolate colour, uterus is slightly enlarged and painful, appendages are not palpable, the fornices are deep and painless. What is the most likely diagnosis?
Uterine endometriosis
21
A 28-year-old female patient has been admitted to the gynecology department for abdominal pain, spotting before and after menstruation for 5 days. The disease is associated with the abortion which she had 2 years ago. Anti-inflammatory treatment had no effect. Bimanual examination findings: the uterus is enlarged, tight, painful, smooth. Hysteroscopy reveals dark red holes in the fundus with dark blood coming out of them. What diagnosis can be made on the grounds of these clinical presentations?
Inner endometriosis
22
A 32 y.o. woman consulted a gynecologist about having abundant long menses within 3 months. Bimanual investigation: the body of the uterus is enlarged according to about 12 weeks of pregnancy, distorted, tuberous, of dense consistence. Appendages are not palpated. Histological test of the uterus body mucosa: adenocystous hyperplasia of endometrium. Optimal medical tactics:
Surgical treatment
23
A 52-year-old woman suffering from obesity, complains of bloody discharges from sexual paths during 4 days. Last normal menses were 2 years ago. Histological investigation of biopsy of the endometrium has revealed adenomatous hyperplasia. What reason from the mentioned below caused the development of disease?
Excessive transformation of preandrogens from adipose tissues
24
On the 10th day postpartum a puerperant woman complains of pain and heaviness in the left mammary gland. Body temperature is $38,8^oC$, Ps- 94 bpm. The left mammary gland is edematic, the supero-external quadrant of skin is hyperemic. Fluctuation symptom is absent. The nipples discharge drops of milk when pressed. What is a doctor's further tactics?
Antibiotic therapy, immobilization and expression of breast milk
25
A 13-year-old girl was admitted to the gynecological department with heavy bleeding, which appeared after a long delay of menstruation. Shortly before, the girl suffered a serious psychotrauma. Her menarche occurred at the age of 11, she has a 30-day cycle with 5 to 6 days of moderate, painless bleeding. The patient is somatically healthy, of normosthenic constitution with height of 160 cm, weight of 42 kg. The patient is pale. Rectoabdominal examination revealed that the uterus was of normal size and consistency, anteflexio-versio, the appendages were not changed. What is the most likely diagnosis?
Juvenile bleeding
26
A 13-year-old girl was admitted to the gynecology department for having a significant bleeding from the genital tract for 10 days. The patient has a history of irregular menstrual cycle since menarche. Menarche occurred at the age of 11. Recto-abdominal examination revealed no pathology. What is the provisional diagnosis?
Juvenile uterine bleeding
27
A 48-year-old female has been admitted to the gynecology department for pain in the lower right abdomen and low back pain, constipations. Bimanual examination findings: the uterus is immobile, the size of a 10-week pregnancy, has uneven surface. Aspirate from the uterine cavity contains atypical cells. What diagnosis can be made?
Hysterocarcinoma
28
Examination of placenta revealed a defect. An obstetrician performed manual investigation of uterine cavity, uterine massage. Prophylaxis of endometritis in the postpartum period should involve following actions:
Antibacterial therapy
29
A 42-year-old woman has had hyperpolymenorrhea and progressing algodismenorrhea for the last 10 years. Gynecological examination revealed no changes of uterine cervix; discharges are moderate, of chocolate colour, uterus is slightly enlarged and painful, appendages are not palpable, the fornices are deep and painless. What is the most likely diagnosis?
Uterine endometriosis
30
A 24-year-old female patient complains of acute pain in the lower abdomen that turned up after a physical stress. She presents with nausea, vomiting, dry mouth and body temperature $36,6^oC$. She has a right ovarian cyst in history. Bimanual examination reveals that uterus is dense, painless, of normal size. The left fornix is deep, uterine appendages aren't palpable, the right fornix is contracted. There is a painful formation on the right of uterus. It's round, elastic and mobile. It is 7х8 cm large. In blood: leukocytosis with the left shit. What is the most likely diagnosis?
Ovarian cyst with pedicle torsion
31
A 13 year old girl consulted the school doctor on account of moderate bloody discharge from the genital tracts, which appeared 2 days ago. Secondary sexual characters are developed. What is the most probable cause of bloody discharge?
Menarche
32
A 49-year-old female patient complains of itching, burning in the external genitals, frequent urination. The symptoms have been present for the last 7 months. The patient has irregular menstruation, once every 3-4 months. Over the last two years she has had hot flashes, sweating, sleep disturbance. Examination revealed no pathological changes of the internal reproductive organs. Complete blood count and urinalysis showed no pathological changes. Vaginal smear contained 20-25 leukocytes per HPF, mixed flora. What is the most likely diagnosis?
Menopausal syndrome
33
A parturient complains about pain in the mammary gland. Palpation revealed a 3х4 cm large infiltration, soft in the centre. Body temperature is 38,5oC. What is the most probable diagnosis?
Acute purulent mastitis
34
A woman consulted a doctor on the 14th day after labour about sudden pain, hyperemy and induration of the left mammary gland, body temperature rise up to $39^oC$, headache, indisposition. Objectively: fissure of nipple, enlargement of the left mammary gland, pain on palpation. What pathology would you think about in this case?
Lactational mastitis
35
2 weeks after labour a parturient woman developed breast pain being observed for 3 days. Examination revealed body temperature at the rate of $39^oC$, chills, weakness, hyperaemia, enlargement, pain and deformity of the mammary gland. On palpation the infiltrate was found to have an area of softening and fluctuation. What is the most likely diagnosis?
Infiltrative-purulent mastitis
36
An 18-year-old girl complains of breast pain and engorgement, headaches, irritability, swelling of the lower extremities. These symptoms have been observed since menarche and occur 3-4 days before the regular menstruation. Gynecological examination revealed no pathology. Make a diagnosis:
Premenstrual syndrome
37
A woman consulted a therapeutist about fatigability, significant weight loss, weakness, loss of appetite. She has had amenorrhea for 8 months. A year ago she born a full-term child. Haemorrhage during labour made up 2 l. She got blood and blood substitute transfusions. What is the most probable diagnosis?
Sheehan's syndrome
38
A 26 year old woman had the second labour within the last 2 years with oxytocin application. The child's weight is 4080 g. After the placent birth there were massive bleeding, signs of hemorrhagic shock. Despite the injection of contractive agents, good contraction of the uterus and absence of any cervical and vaginal disorders, the bleeding proceeds. Choose the most probable cause of bleeding:
Atony of the uterus
39
A 38-year-old female patient complains about hot flashes and feeling of intense heat arising up to 5 times a day, headaches in the occipital region along with high blood pressure, palpitations, dizziness, fatigue, irritability, memory impairment. 6 months ago the patient underwent extirpation of the uterus with its appendages. What is the most likely diagnosis?
Post-castration syndrome
40
On admission a 35-year-old female reports acute abdominal pain, fever up to 38,8 oC, mucopurulent discharges. The patient is nulliparous, has a history of 2 artificial abortions. The patient is unmarried, has sexual contacts. Gynecological examination reveals no uterus changes. Appendages are enlarged, bilaterally painful. There is profuse purulent vaginal discharge. What study is required to confirm the diagnosis?
Bacteriologic and bacteriascopic studies
41
A 26 year old woman complains about edemata, swelling and painfulness of mammary glands, headache, tearfulness, irritability. These signs turn up 5 days before menstruation and disappear after its start. What clinical syndrome is it?
Premenstrual syndrome
42
A 27-year-old patient complains of irritability, tearfulness, depression, and sometimes aggressiveness, headache, nausea, vomiting, swelling of the mammary glands. The mentioned problems arise 5-6 days before menstruation and gradually progress until menstruation, 3 days after it the problems disappear. What is the most likely diagnosis?
Premenstrual syndrome
43
A 40-year-old woman complains of yellow color discharges from the vagina. Bimanual examination: no pathological changes. Smear test: Trichomonas vaginalis and mixed flora. Colposcopy: two hazy fields on the front labium, with a negative Iodum probing. What is your tactics?
Treatment of specific colpitis with the subsequent biopsy
44
A 25 y.o. woman complains of profuse foamy vaginal discharges, foul, burning and itching in genitalia region. She has been ill for a week. Extramarital sexual life. On examination: hyperemia of vaginal mucous, bleeding on touching, foamy leucorrhea in the urethral area. What is the most probable diagnosis?
Trichomonas colpitic
45
A 14 year old girl complains of profuse bloody discharges from genital tracts during 10 days after suppresion of menses for 1,5 month. Similiar bleedings recur since 12 years on the background of disordered menstrual cycle. On rectal examination: no pathology of the internal genitalia. In blood: Нb - 70 g/l, RBC- 2,3*1012/l, Ht - 20. What is the most probable diagnosis?
Juvenile bleeding, posthemorrhagic anemia
46
A 24 y.o. patient 13 months after the first labour consulted a doctor about amenorrhea. Pregnancy has concluded by a Cesarean section concerning to a premature detachment of normally posed placenta hemorrhage has made low fidelity 2000 ml owing to breakdown of coagulability of blood. Choose the most suitable investigation:
Determination of the level of Gonadotropins
47
In the woman of 24 years about earlier normal menstrual function, cycles became irregular, according to tests of function diagnostics - anovulatory. The contents of prolactin in blood is boosted. Choose the most suitable investigation:
Computer tomography of the head
48
A 20 y.o. patient complains of amenorrhea. Objectively: hirsutism, obesity with fat tissue prevailing on the face, neck, upper part of body. On the face there are acne vulgaris, on the skin - striae cutis distense. Psychological and intellectual development is normal. Gynecological condition: external genitals are moderately hairy, acute vaginal and uterine hypoplasia. What diagnosis is the most probable?
Itsenko-Cushing syndrome
49
A 40-year-old woman complains of colic pains in the lower part of abdomen and abundant bloody discharges from genital tract. Last 2 years she had menses for 15-16 days, abundant, with clots, painful. Had 2 medical abortions. In bimanual investigation: from the canal of the cervix uteri - a fibromatous node, 3 cm in diameter, on the thin stem. Discharges are bloody, moderate.Choose the correct tactics.
Operation: untwisting of born node
50
A 40 year old patient complains of yellowish discharges from the vagina. Bimanual examination revealed no pathological changes. The smear contains Trichomonas vaginalis and blended flora. Colposcopy revealed two hazy fields on the frontal labium, with a negative Iodine test. Your tactics:
Treatment of specific colpitis and subsequent biopsy
51
A 33-year-old woman was urgently brought to clinic with complaints of the pain in the lower part of the abdomen, mostly on the right, irradiating to rectum, she also felt dizzy. The above mentioned complaints developed acutely at night. Last menses were 2 weeks ago. On physical exam: the skin is pale, Ps - 92 bpm, t- 36,6OC, BP- 100/60 mm Hg. The abdomen is tense, slightly tender in lower parts, peritoneal symptoms are slightly positive. Hb- 98 g/L. What is the most probable diagnosis?
Apoplexy of the ovary
52
A 29-year-old patient complains of sterility. Sexual life is for 4 years being married, does not use contraception. There was no pregnancy before. On physical examination, genitals are developed normally. Uterine tubes are passable. Rectal temperature during three menstrual cycles is monophase. What is the most probable reason for sterility?
Anovulatory menstrual cycle
53
A 27 y.o. woman turns to the maternity welfare centre because of infertility. She has had sexual life in marriage for 4 years, doesn't use contraceptives. She didn't get pregnant. On examination: genital development is without pathology, uterus tubes are passable, basal (rectal) temperature is onephase during last 3 menstrual cycles. What is the infertility cause?
Anovular menstrual cycle
54
Which of the methods of examination is the most informative in the diagnostics of a tube infertility?
Laparoscopy with chromosalpingoscopy
55
A 28-year-old parturient complains about headache, vision impairment, psychic inhibition. Objectively: AP- 200/110 mm Hg, evident edemata of legs and anterior abdominal wall. Fetus head is in the area of small pelvis. Fetal heartbeats is clear, rhythmic, 190/min. Internal examination revealed complete cervical dilatation, fetus head was in the area of small pelvis. What tactics of labor management should be chosen?
Forceps operation
56
A 43 y.o. woman complains of contact hemorrhages during the last 6 months. Bimanual examination: cervix of the uterus is enlarged, its mobility is reduced. Mirrors showed the following: cervix of the uterus is in the form of cauliflower. Chrobak and Schiller tests are positive. What is the most probable diagnosis?
Cancer of cervix of the uterus
57
A 28 year old woman had the second labour and born a girl with manifestations of anemia and progressing jaundice. The child's weight was 3 400 g, the length was 52 cm. The woman's blood group is B (III) Rh- , the father's blood group is A (III) Rh+ , the child's blood group is B (III) Rh+ . What is the cause of anemia?
Rhesus incompatibility
58
Laparotomy was performed to a 54 y.o. woman on account of big formation in pelvis that turned out to be one-sided ovarian tumor along with considerable omental metastases. The most appropriate intraoperative tactics involves:
Ablation of omentum, uterus and both ovaries with tubes
59
A 27 y.o. woman complains of having the disoders of menstrual function for 3 months, irregular pains in abdomen. On bimanual examination: in the dextral appendage range of uterus there is an elastic spherical formation, painless, 7 cm in diameter. USI: in the right ovary - a fluid formation, 4 cm in diameter, unicameral, smooth. What method of treatment is the most preferable?
Prescription of an estrogen-gestogen complex for 3 months with repeated examination
60
A 29 year old patient underwent surgical treatment because of the benign serous epithelial tumour of an ovary. The postoperative period has elapsed without complications. What is it necessary to prescribe for the rehabilitational period:
Hormonotherapy and proteolytic enzymes
61
An endometrial adenocarcinoma that has extended to the uterine serosa would be classified as stage:
IIIA
62
A 48 year old female patient complains about contact haemorrhage. Speculum examination revealed hypertrophy of uterus cervix. It resembles of cauliflower, it is dense and can be easily injured. Bimanual examination revealed that fornices were shortened, uterine body was nonmobile. What is the most probable diagnosis?
Cervical carcinoma
63
An onset of severe preeclampsia at 16 weeks gestation might be caused by:
Hydatidiform mole
64
A 27 y.o. woman suffers from pyelonephritits of the only kidney. She presents to the maternity welfare centre because of suppresion of menses for 2,5 months. On examination pregnancy 11 weeks of gestation was revealed. In urine: albumine 3,3 g/L, leucocytes cover the field of vision. What is doctor's tactics in this case?
Immediate pregancy interruption
65
On the fifth day after a casual sexual contact a 25-year-old female patient consulted a doctor about purulent discharges from the genital tracts and itch. Vaginal examination showed that vaginal part of uterine cervix was hyperemic and edematic. There was an erosive area around the external orifice of uterus. There were mucopurulent profuse discharges from the cervical canal, uterine body and appendages exhibited no changes. Bacterioscopic examination revealed bean-shaped diplococci that became red after Gram's staining. What is the most likely diagnosis?
Acute gonorrheal endocervicitis
66
A 36 y.o. woman is in the 12-th week of her first pregnancy. She was treated for infertility in the past. She contacted a child who fell ill with rubella 2 days after their meeting. Woman doesn't know if she has ever been infected with rubella. What is the adequate tactics?
Monitoring of the specific IgG IgM with the ELISA
67
A 27-year-old sexually active female complains of numerous vesicles on the right sex lip, itch and burning. Eruptions regularly turn up before menstruation and disappear 8-10 days later. What is the most likely diagnosis?
Herpes simplex virus
68
A 21-year-old female patient consulted a gynecologist about itching, burning, watery vaginal discharges with a fish-like smell. Speculum examination revealed that the cervical and vaginal mucosa was of a normal pink color. Vaginal examination revealed no alterations of the uterus and appendages. Gram-stained smears included clue cells. What is the most likely pathology?
Bacterial vaginosis (gardnerellosis)
69
A 28 y.o. primagravida, pregnancy is 15-16 weaks of gestation, presents to the maternity clinics with dull pain in the lower part of the abdomen and in lumbar area. On vaginal examination: uterus cervix is 2,5 cm, external isthmus allows to pass the finger tip. Uterus body is enlarged according to the pregnancy term. Genital discharges are mucous, mild. What is the diagnosis?
Threatened spontaneous abortion
70
A primagravida in her 20th week of gestation complains about pain in her lower abdomen, blood smears from the genital tracts. The uterus has an increased tonus, the patient feels the fetus movements. Bimanual examination revealed that the uterus size corresponded the term of gestation, the uterine cervix was contracted down to 0,5 cm, the external orifice was open by 2 cm. The discharges were bloody and smeary. What is the most likely diagnosis?
Incipient abortion
71
A 26 y.o. 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 is 80 bpm. 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
72
An ambulance delivered a 21-year-old woman to the gynaecological department with complaints of colicky abdominal pain and bloody discharges from the genital tracts. Bimanual examination revealed that uterus was soft, enlarged to the size of 6 weeks of gestation, a gestational sac was palpated in the cervical canal. Uterine appendages weren't palpable. Fornices are free, deep and painless. Discharges from the genital tracts are bloody and profuse. What is the most likely diagnosis?
Abortion in progress
73
A 34 year old woman in the 10th week of gestation (the second pregnancy) consulted a doctor of antenatal clinic in order to be registered there. In the previous pregnancy hydramnion was observed, the child's birth weight was 4086 g. What examination method should be applied in the first place?
The test for tolerance to glucose
74
A 34-year-old woman with 10-week pregnancy (the second pregnancy) has consulted gynaecologist to make a record in patient chart. There was a hydramnion previous pregnancy, the birth weight of a child was 4086 g. What tests are necessary first of all?
The test for tolerance to glucose
75
A 20-year-old female consulted a gynecologist about not having menstrual period for 7 months. History abstracts: early childhood infections and frequent tonsillitis, menarche since 13 years, regular monthly menstrual cycle of 28 days, painless menstruation lasts 5-6 days. 7 months ago the patient had an emotional stress. Gynecological examination revealed no alterations in the uterus. What is the most likely diagnosis?
Secondary amenorrhea
76
A 26-year-old secundipara at 40 weeks of gestation arrived at the maternity ward after the beginning of labor activity. 2 hours before, bursting of waters occurred. The fetus was in a longitudinal lie with cephalic presentation. Abdominal circumference was 100 cm, fundal height - 42 cm. Contractions occurred every 4-5 minutes and lasted 25 seconds each. Internal obstetric examination revealed cervical effacement, opening by 4 cm. Fetal bladder was absent. Fetal head was pressed against the pelvic inlet. What complication arose in childbirth?
Early amniorrhea
77
A 28-year-old patient has been admitted to the gynecological department three days after a casual coitus. She complains about pain in her lower abdomen and during urination, profuse purulent discharges from the vagina, body temperature rise up to 37,8oC. The patient was diagnosed with acute bilateral adnexitis. Supplemental examination revealed: the 4th degree of purity of the vaginal secretion, leukocytes within the whole visual field, diplococcal bacteria located both intra- and extracellularly. What is the etiology of acute adnexitis in this patient?
Gonorrheal
78
A gravida with 7 weeks of gestation is referred for the artificial abortion. On operation while dilating cervical canal with Hegar dilator №8 a doctor suspected uterus perforation. What is immediate doctors tactics to confirm the diagnosis?
Probing of uterus cavity
79
An 18-year-old primigravida in her 27-28 week of gestation underwent an operation on account of acute phlegmonous appendicitis. In the postoperative period it is necessary to take measures for prevention of the following pegnancy complication:
Noncarrying of pregnancy
80
A pregnant woman was registered in a maternity welfare clinic in her 11th week of pregnancy. She was being under observation during the whole term, the pregnancy course was normal. What document must the doctor give the pregnant woman to authorize her hospitalization in maternity hospital?
Exchange card
81
A newborn's head is of dolichocephalic shape, that is front-to-back elongated. Examination of the occipital region of head revealed a labour tumour located in the middle between the prefontanel and posterior fontanel. The delivery tok place with the following type of fetus head presentation:
Posterior vertex presentation
82
A woman, primagravida, consults a gynecologist on 05.03.2002. A week ago she felt the fetus movements for the first time. Last menstruation was on 10.01.2002. When should she be given maternity leave?
8 August
83
A 49-year-old woman complains about headache, head and neck going hot, increased perspiration, palpitation, arterial pressure rise up to 170/100 mm Hg, irritability, insomnia, tearfulness, memory impairment, rare and scarce menses, body weight increase by 5 kg over the last half a year. What is the most likely diagnosis?
Climacteric syndrome
84
A 40-year-old female patient has been observing profuse menses accompanied by spasmodic pain in the lower abdomen for a year. Bimanual examination performed during menstruation revealed a dense formation up to 5 cm in diameter in the cervical canal. Uterus is enlarged up to 5-6 weeks of pregnancy, movable, painful, of normal consistency. Appendages are not palpable. Bloody discharges are profuse. What is the most likely diagnosis?
Nascent submucous fibromatous node
85
A 27 y.o. gravida with 17 weeks of gestation was admitted to the hospital. There was a history of 2 spontaneous miscarriages. On bimanual examination: uterus is enlarged to 17 weeks of gestation, uterus cervix is shortened, isthmus allows to pass the finger tip. The diagnosis is isthmicocervical insufficiency. What is the doctor's tactics?
To place suture on the uterus cervix
86
A 32-year-old gravida complains about episodes of unconsciousness, spontaneous syncopes that are quickly over after a change of body position. A syncope can be accompanied byquickly elapsing bradycardia. There are no other complications of gestation. What is the most likely reason for such condition?
Postcava compresseion by the gravid uterus
87
A 25-year-old female has a self-detected tumor in the upper outer quadrant of her right breast. On palpation there is a painless, firm, mobile lump up to 2 cm in diameter, peripheral lymph nodes are not changed. In the upper outer quadrant of the right breast ultrasound revealed a massive neoplasm with increased echogenicity sized 21x18 mm. What is the most likely diagnosis?
Fibroadenoma
88
After examination a 46-year-old patient was diagnosed with left breast cancer T2N2M0, cl. gr. II-a. What will be the treatment plan for this patient?
Radiation therapy + operation + chemotherapy
89
A 19-year-old primiparous woman with a body weight of 54,5 kg gave birth at 38 weeks gestation to a full-term live girl after a normal vaginal delivery. The girl's weight was 2180,0 g, body length - 48 cm. It is known from history that the woman has been a smoker for 8 years, and kept smoking during pregnancy. Pregnancy was complicated by moderate vomiting of pregnancy from 9 to 12 weeks pregnant, edemata of pregnancy from 32 to 38 weeks. What is the most likely cause of low birth weight?
Fetoplacental insufficiency
90
A 36-year-old female pesented to a gynecological hospital with a significant bleeding from the genital tract and a 1-month delay of menstruation. Bimanual examination revealed soft barrel-shaped cervix. Uterus was of normal size, somewhat softened. Appendages were unremarkable on both sides. Speculum examination revealed that the cervix was cyanotic, enlarged, with the the external orifice disclosed up to 0,5 cm. Urine hCG test was positive. What is the most likely diagnosis?
Cervical pregnancy
91
A pregnant 26-year-old woman was admitted to a hospital for abdominal pain and bleeding from the genital tract. Bimanual examination revealed that uterus was the size of 9 weeks of pregnancy, the cervical canal let a finger through. Fetal tissues could be palpated in the orifice. There was moderate vaginal bleeding. What is the tactics of choice?
Instrumental extraction of fetal tissue
92
A woman at 30 weeks pregnant has had an attack of eclampsia at home. On admission to the maternity ward AP is 150/100 mm Hg. Predicted fetal weight is 1500 g. There is face and shin pastosity. Urine potein is 0,66o /oo. Parturient canal is not ready for delivery. An intensive complex therapy has been started. What is the correct tactics of this case management?
Delivery by cesarean section
93
A primigravida woman appealed to the antenatal clinic on the 22.03.03 with complaints of boring pain in the lower part of abdomen. Anamnesis registered that her last menstruation was on the 4.01.03. Bimanual examination revealed that uterine servix is intact, external fauces is closed, uterus is enlarged up to the 9-th week of pregnancy, movable, painless. What complication can be suspected?
Risk of abortion in the 9-th week of pregnancy
94
A 34 y.o. woman in her 29-th week of pregnancy, that is her 4-th labor to come, was admitted to the obstetric department with complaints of sudden and painful bloody discharges from vagina that appeared 2 hours ago. The discharges are profuse and contain grumes. Cardiac funnction of the fetus is rhytmic, 150 strokes in the minute, uterus tone is normal. The most probable provisional diagnosis will be:
Placental presentation
95
Rise in temperature up to 390С was registered the next day after a woman had labor. Fetal membranes rupture took place 36 hours prior to labors. The examination of the bacterial flora of cervix uteri revealed the following: haemolytic streptococcus of group A. The uterus tissue is soft, tender. Discharges are bloody, with mixing of pus. Establish the most probable postnatal complication.
Metroendometritis
96
A woman is admitted to maternity home with discontinued labor activity and slight bloody discharges from vagina. The condition is severe, the skin is pale, consciousness is confused. BP is 80/40 mm Hg. Heartbeat of the fetus is not heard. There was a Cesarian section a year ago. Could you please determine the diagnosis?
Hysterorrhesis
97
A 10 week pregnant woman was admitted to a hospital for recurrent pain in the lower abdomen, bloody discharges from the genital tracts. The problems turned up after ARVI. The woman was registered for antenatal care. Speculum examination revealed cyanosis of vaginal mucosa, clean cervix, open cervical canal discharging blood and blood clots; the lower pole of the gestational sac was visible. What tactics should be chosen?
Curettage of the uterus
98
During the dynamic observation over a parturient woman in the second stage of labor it was registered that the fetal heart rate fell down to 90-100/min and didn't come to normal after contractions. Vaginal examination revealed the complete cervical dilatation, the fetal head filling the entire posterior surface of the pubic symphysis and sacral hollow; the sagittal suture lied in the anteroposterior diameter of the pelvic outlet, the posterior fontanelle was in front under the pubic arch. What plan for further labour management should be recommended?
Application of forceps minor
99
A 37 y.o. primigravida woman has been having labor activity for 10 hours. Labor pains last for 20-25 seconds every 6-7 minutes. The fetus lies in longitude, presentation is cephalic, head is pressed upon the entrance to the small pelvis. Vaginal examination results: cervix of uterus is up to 1 cm long, lets 2 transverse fingers in. Fetal bladder is absent. What is the most probable diagnosis?
Primary uterine inertia
100
A woman is 34 years old, it is her tenth labor at full term. It is known from the anamnesis that the labor started 11 hours ago, labor was active, painful contractions started after discharge of waters and became continuous. Suddenly the parturient got knife-like pain in the lower abdomen and labor activity stopped. Examination revealed positive symptoms of peritoneum irritation, ill-defined uterus outlines. Fetus was easily palpable, movable. Fetal heartbeats wasn't auscultable. What is the most probable diagnosis?
Rupture of uterus
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51問 • 2年前問題一覧
1
A 54-year-old female patient consulted a gynaecologist about bloody discharges from the vagina for 1 month. Last menstruation was 5 years ago. Gynaecological examination revealed no pathological changes. What is the tactics of choice?
Diagnostic fractional curettage of uterine cavity
2
A 28-year-old female patient complains of having haemorrhage from the genital tracts for 1 month. 6 months ago she had natural delivery and gave birth to a girl weighing 3100 g. Objectively: the uterus is enlarged to 9-10 weeks, mobile, painless, of heterogenous consistency. Examination reveals vaginal cyanosis, anaemia and body temperature rise up to $37,8^oC$. There is a significant increase in hCG concentration in the urine. What is your provisional diagnosis?
Uterine chorionepithelioma
3
A pregnant woman may be diagnosed with hepatitis if it is confirmed by the presence of elevated:
SGOT (ALT)
4
A 29-year-old patient complains of absent menstruation for a year, milk discharge from the nipples when pressed, loss of lateral visual fields. X-ray shows an expansion of the sella turcica. What is the most likely cause of this condition?
Pituitary tumour
5
A 25-year-old female patient complains about having amenorrhea for 3 years. She associates it with difficult labour complicated by massive hemorrhage. She also complains of loss of weight, hair fragility and loss, lack of appetite and depression. Objective examination reveals no pathological changes of uterus and its appendages. What is the desease pathogenesis?
Hypoproduction of gonadotropin
6
A 30-year-old female patient complains of milk discharge from the mammary glands, 5-month absence of menstruation. She had one physiological labour four years ago. Objectively: mammary glands are normally developed. Bimanual examination reveals that the uterus is decreased in size, the ovaries are of normal size. MRI-scan shows no cerebral pathologies. Concentration of thyroid-stimulating hormone is normal. The serum prolactin level is increased. What is the most likely diagnosis?
Hyperprolactinemia
7
A 28-year-old patient complains of discomfort, acute pain in the lower third of the left labia majora. The disease began suddenly after menstruation. Objectively: body temperature is $38^oC$. The left labia majora has a formation to 3 cm diameter, with hyperemic surface, extremely painful to the touch, with symptoms of fluctuation. What is the most likely diagnosis?
Acute bartholinitis
8
In 13 months after the first labor a 24-year-old woman complains of amenorrhea. Cesarian section was conducted as a result of premature detachment of normally posed placenta. Hemorrhage has made low fidelity of 2000 ml due to breakdown of coagulation of blood. Choose the most suitable investigation.
Determination of the level of gonadotropin
9
13 months after the first labor a 24-year-old patient complained of amenorrhea. Pregnancy ended in Caesarian section because of premature detachment of normally positioned placenta which resulted in blood loss at the rate of 2000 ml owing to disturbance of blood clotting. Choose the most suitable investigation:
Estimation of gonadotropin rate
10
A 14-year-old girl complains of pain in vaginal area and lower abdomen that last for 3-4 days and have been observed for 3 months about the same time. Each time pain is getting worse. Objectively: mammary glands are developed, hairiness corresponds to the age. The virginal membrane is intact, cyanotic and protruded. She has never had menstruation. She has been diagnosed with primary amenorrhea. What is the reason of amenorrhea?
Hymen atresia
11
By the end of the 1st period of physiological labor clear amniotic fluid came off. Contractions lasted 35-40 sec every 4-5min. Heartbeat of the fetus was 100 bpm. The BP was 140/90 mm Hg. What is the most probable diagnosis?
Acute hypoxia of the fetus
12
A 51 y.o. patient complains of having intensive bloody discharges from vagina for 15 days after delay of menstruation for 2,5 months. In anamnesis: disorders of menstrual function during a year, at the same time she felt extreme irritability and had sleep disorders. US examination results: uterus corresponds with age norms, appendages have no pecularities, endometrium is 14 mm thick. What is the doctor's tactics?
Diagnostic curettage of uterine cavity
13
The results of a separate diagnostic curettage of the mucous of the uterus' cervix and body made up in connection with bleeding in a postmenopausal period: the scrape of the mucous of the cervical canal revealed no pathology, in endometrium - the highly differentiated adenocarcinoma was found. Metastases are not found. What method of treatment is the most correct?
Surgical treatment and hormonotherapy
14
A 45 y.o. woman complains of contact bleedings during 5 months. On speculum examination: hyperemia of uterus cervix, looks like cauliflower, bleeds on probing. On bimanual examination: cervix is of densed consistensy, uterus body isn't enlarged, mobile, nonpalpable adnexa, parametrium is free, deep fornixes. What is the most likely diagnosis?
Cancer of cervix of uterus
15
A 43 y.o. patient complains of formation and pain in the right mammary gland, rise of temperature up to 37,20C during the last 3 months. Condition worsens before the menstruation. On examination: edema of the right breast, hyperemia, retracted nipple. Unclear painful infiltration is palpated in the lower quadrants. What is the most probable diagnosis?
Cancer of the right mammary gland
16
A 68-year-old patient consulted a doctor about a tumour in her left breast. Objectively: in the upper internal quadrant of the left breast there is a neoplasm up to 2,5 cm in diameter, dense, uneven, painless on palpation. Regional lymph nodes are not enlarged. What is the most likely diagnosis?
Cancer
17
A 23-year-old female consulted a gynecologist on the 20th day postpartum period about pain in the left breast, purulent discharge from the nipple. Objectively: Ps- 120/min, tо- 39оC. The left breast is painful, larger than the right one, hyperemic. In the upper quadrant there is an infiltrate sized 10x15 cm with a softening inside. Blood test results: ESR- 50 mm/h, WBC- 15,0*109 /l. What is the tactics of choice?
Refer to the surgical department for operative treatment
18
At the gynaecological department there is a patient of 32 years with the diagnosis: "acute bartholinitis".Body temperature is 38,20C, leucocytes count 10,4*109 /L, the ESR is 24 mm/hour. In the area of big gland of the vestibulum - the dermahemia, the sign of the fluctuation, sharp tenderness (pain). What is the most correct tactics of the doctor?
Surgical dissecting, a drainage of an abscess of the gland, antibiotics
19
A patient was admitted to the hospital with complaints of periodical pain in the lower part of abdomen that gets worse during menses, weakness, malaise, nervousness, dark bloody smears from vagina directly before and after menses. Bimanual examination revealed that uterus body is enlarged, appendages cannot be palpated, posterior fornix has tuberous surface. Laparoscopy revealed: ovaries, peritoneum of rectouterine pouch and pararectal fat have "cyanotic eyes". What is the most probable diagnosis?
Disseminated form of endometriosis
20
A 42-year-old woman has had hyperpolymenorrhea and progressing algodismenorrhea for the last 10 years. Gynaecological examination revealed no changes of uterine cervix; discharges are moderate, of chocolate colour, uterus is slightly enlarged and painful, appendages are not palpable, the fornices are deep and painless. What is the most likely diagnosis?
Uterine endometriosis
21
A 28-year-old female patient has been admitted to the gynecology department for abdominal pain, spotting before and after menstruation for 5 days. The disease is associated with the abortion which she had 2 years ago. Anti-inflammatory treatment had no effect. Bimanual examination findings: the uterus is enlarged, tight, painful, smooth. Hysteroscopy reveals dark red holes in the fundus with dark blood coming out of them. What diagnosis can be made on the grounds of these clinical presentations?
Inner endometriosis
22
A 32 y.o. woman consulted a gynecologist about having abundant long menses within 3 months. Bimanual investigation: the body of the uterus is enlarged according to about 12 weeks of pregnancy, distorted, tuberous, of dense consistence. Appendages are not palpated. Histological test of the uterus body mucosa: adenocystous hyperplasia of endometrium. Optimal medical tactics:
Surgical treatment
23
A 52-year-old woman suffering from obesity, complains of bloody discharges from sexual paths during 4 days. Last normal menses were 2 years ago. Histological investigation of biopsy of the endometrium has revealed adenomatous hyperplasia. What reason from the mentioned below caused the development of disease?
Excessive transformation of preandrogens from adipose tissues
24
On the 10th day postpartum a puerperant woman complains of pain and heaviness in the left mammary gland. Body temperature is $38,8^oC$, Ps- 94 bpm. The left mammary gland is edematic, the supero-external quadrant of skin is hyperemic. Fluctuation symptom is absent. The nipples discharge drops of milk when pressed. What is a doctor's further tactics?
Antibiotic therapy, immobilization and expression of breast milk
25
A 13-year-old girl was admitted to the gynecological department with heavy bleeding, which appeared after a long delay of menstruation. Shortly before, the girl suffered a serious psychotrauma. Her menarche occurred at the age of 11, she has a 30-day cycle with 5 to 6 days of moderate, painless bleeding. The patient is somatically healthy, of normosthenic constitution with height of 160 cm, weight of 42 kg. The patient is pale. Rectoabdominal examination revealed that the uterus was of normal size and consistency, anteflexio-versio, the appendages were not changed. What is the most likely diagnosis?
Juvenile bleeding
26
A 13-year-old girl was admitted to the gynecology department for having a significant bleeding from the genital tract for 10 days. The patient has a history of irregular menstrual cycle since menarche. Menarche occurred at the age of 11. Recto-abdominal examination revealed no pathology. What is the provisional diagnosis?
Juvenile uterine bleeding
27
A 48-year-old female has been admitted to the gynecology department for pain in the lower right abdomen and low back pain, constipations. Bimanual examination findings: the uterus is immobile, the size of a 10-week pregnancy, has uneven surface. Aspirate from the uterine cavity contains atypical cells. What diagnosis can be made?
Hysterocarcinoma
28
Examination of placenta revealed a defect. An obstetrician performed manual investigation of uterine cavity, uterine massage. Prophylaxis of endometritis in the postpartum period should involve following actions:
Antibacterial therapy
29
A 42-year-old woman has had hyperpolymenorrhea and progressing algodismenorrhea for the last 10 years. Gynecological examination revealed no changes of uterine cervix; discharges are moderate, of chocolate colour, uterus is slightly enlarged and painful, appendages are not palpable, the fornices are deep and painless. What is the most likely diagnosis?
Uterine endometriosis
30
A 24-year-old female patient complains of acute pain in the lower abdomen that turned up after a physical stress. She presents with nausea, vomiting, dry mouth and body temperature $36,6^oC$. She has a right ovarian cyst in history. Bimanual examination reveals that uterus is dense, painless, of normal size. The left fornix is deep, uterine appendages aren't palpable, the right fornix is contracted. There is a painful formation on the right of uterus. It's round, elastic and mobile. It is 7х8 cm large. In blood: leukocytosis with the left shit. What is the most likely diagnosis?
Ovarian cyst with pedicle torsion
31
A 13 year old girl consulted the school doctor on account of moderate bloody discharge from the genital tracts, which appeared 2 days ago. Secondary sexual characters are developed. What is the most probable cause of bloody discharge?
Menarche
32
A 49-year-old female patient complains of itching, burning in the external genitals, frequent urination. The symptoms have been present for the last 7 months. The patient has irregular menstruation, once every 3-4 months. Over the last two years she has had hot flashes, sweating, sleep disturbance. Examination revealed no pathological changes of the internal reproductive organs. Complete blood count and urinalysis showed no pathological changes. Vaginal smear contained 20-25 leukocytes per HPF, mixed flora. What is the most likely diagnosis?
Menopausal syndrome
33
A parturient complains about pain in the mammary gland. Palpation revealed a 3х4 cm large infiltration, soft in the centre. Body temperature is 38,5oC. What is the most probable diagnosis?
Acute purulent mastitis
34
A woman consulted a doctor on the 14th day after labour about sudden pain, hyperemy and induration of the left mammary gland, body temperature rise up to $39^oC$, headache, indisposition. Objectively: fissure of nipple, enlargement of the left mammary gland, pain on palpation. What pathology would you think about in this case?
Lactational mastitis
35
2 weeks after labour a parturient woman developed breast pain being observed for 3 days. Examination revealed body temperature at the rate of $39^oC$, chills, weakness, hyperaemia, enlargement, pain and deformity of the mammary gland. On palpation the infiltrate was found to have an area of softening and fluctuation. What is the most likely diagnosis?
Infiltrative-purulent mastitis
36
An 18-year-old girl complains of breast pain and engorgement, headaches, irritability, swelling of the lower extremities. These symptoms have been observed since menarche and occur 3-4 days before the regular menstruation. Gynecological examination revealed no pathology. Make a diagnosis:
Premenstrual syndrome
37
A woman consulted a therapeutist about fatigability, significant weight loss, weakness, loss of appetite. She has had amenorrhea for 8 months. A year ago she born a full-term child. Haemorrhage during labour made up 2 l. She got blood and blood substitute transfusions. What is the most probable diagnosis?
Sheehan's syndrome
38
A 26 year old woman had the second labour within the last 2 years with oxytocin application. The child's weight is 4080 g. After the placent birth there were massive bleeding, signs of hemorrhagic shock. Despite the injection of contractive agents, good contraction of the uterus and absence of any cervical and vaginal disorders, the bleeding proceeds. Choose the most probable cause of bleeding:
Atony of the uterus
39
A 38-year-old female patient complains about hot flashes and feeling of intense heat arising up to 5 times a day, headaches in the occipital region along with high blood pressure, palpitations, dizziness, fatigue, irritability, memory impairment. 6 months ago the patient underwent extirpation of the uterus with its appendages. What is the most likely diagnosis?
Post-castration syndrome
40
On admission a 35-year-old female reports acute abdominal pain, fever up to 38,8 oC, mucopurulent discharges. The patient is nulliparous, has a history of 2 artificial abortions. The patient is unmarried, has sexual contacts. Gynecological examination reveals no uterus changes. Appendages are enlarged, bilaterally painful. There is profuse purulent vaginal discharge. What study is required to confirm the diagnosis?
Bacteriologic and bacteriascopic studies
41
A 26 year old woman complains about edemata, swelling and painfulness of mammary glands, headache, tearfulness, irritability. These signs turn up 5 days before menstruation and disappear after its start. What clinical syndrome is it?
Premenstrual syndrome
42
A 27-year-old patient complains of irritability, tearfulness, depression, and sometimes aggressiveness, headache, nausea, vomiting, swelling of the mammary glands. The mentioned problems arise 5-6 days before menstruation and gradually progress until menstruation, 3 days after it the problems disappear. What is the most likely diagnosis?
Premenstrual syndrome
43
A 40-year-old woman complains of yellow color discharges from the vagina. Bimanual examination: no pathological changes. Smear test: Trichomonas vaginalis and mixed flora. Colposcopy: two hazy fields on the front labium, with a negative Iodum probing. What is your tactics?
Treatment of specific colpitis with the subsequent biopsy
44
A 25 y.o. woman complains of profuse foamy vaginal discharges, foul, burning and itching in genitalia region. She has been ill for a week. Extramarital sexual life. On examination: hyperemia of vaginal mucous, bleeding on touching, foamy leucorrhea in the urethral area. What is the most probable diagnosis?
Trichomonas colpitic
45
A 14 year old girl complains of profuse bloody discharges from genital tracts during 10 days after suppresion of menses for 1,5 month. Similiar bleedings recur since 12 years on the background of disordered menstrual cycle. On rectal examination: no pathology of the internal genitalia. In blood: Нb - 70 g/l, RBC- 2,3*1012/l, Ht - 20. What is the most probable diagnosis?
Juvenile bleeding, posthemorrhagic anemia
46
A 24 y.o. patient 13 months after the first labour consulted a doctor about amenorrhea. Pregnancy has concluded by a Cesarean section concerning to a premature detachment of normally posed placenta hemorrhage has made low fidelity 2000 ml owing to breakdown of coagulability of blood. Choose the most suitable investigation:
Determination of the level of Gonadotropins
47
In the woman of 24 years about earlier normal menstrual function, cycles became irregular, according to tests of function diagnostics - anovulatory. The contents of prolactin in blood is boosted. Choose the most suitable investigation:
Computer tomography of the head
48
A 20 y.o. patient complains of amenorrhea. Objectively: hirsutism, obesity with fat tissue prevailing on the face, neck, upper part of body. On the face there are acne vulgaris, on the skin - striae cutis distense. Psychological and intellectual development is normal. Gynecological condition: external genitals are moderately hairy, acute vaginal and uterine hypoplasia. What diagnosis is the most probable?
Itsenko-Cushing syndrome
49
A 40-year-old woman complains of colic pains in the lower part of abdomen and abundant bloody discharges from genital tract. Last 2 years she had menses for 15-16 days, abundant, with clots, painful. Had 2 medical abortions. In bimanual investigation: from the canal of the cervix uteri - a fibromatous node, 3 cm in diameter, on the thin stem. Discharges are bloody, moderate.Choose the correct tactics.
Operation: untwisting of born node
50
A 40 year old patient complains of yellowish discharges from the vagina. Bimanual examination revealed no pathological changes. The smear contains Trichomonas vaginalis and blended flora. Colposcopy revealed two hazy fields on the frontal labium, with a negative Iodine test. Your tactics:
Treatment of specific colpitis and subsequent biopsy
51
A 33-year-old woman was urgently brought to clinic with complaints of the pain in the lower part of the abdomen, mostly on the right, irradiating to rectum, she also felt dizzy. The above mentioned complaints developed acutely at night. Last menses were 2 weeks ago. On physical exam: the skin is pale, Ps - 92 bpm, t- 36,6OC, BP- 100/60 mm Hg. The abdomen is tense, slightly tender in lower parts, peritoneal symptoms are slightly positive. Hb- 98 g/L. What is the most probable diagnosis?
Apoplexy of the ovary
52
A 29-year-old patient complains of sterility. Sexual life is for 4 years being married, does not use contraception. There was no pregnancy before. On physical examination, genitals are developed normally. Uterine tubes are passable. Rectal temperature during three menstrual cycles is monophase. What is the most probable reason for sterility?
Anovulatory menstrual cycle
53
A 27 y.o. woman turns to the maternity welfare centre because of infertility. She has had sexual life in marriage for 4 years, doesn't use contraceptives. She didn't get pregnant. On examination: genital development is without pathology, uterus tubes are passable, basal (rectal) temperature is onephase during last 3 menstrual cycles. What is the infertility cause?
Anovular menstrual cycle
54
Which of the methods of examination is the most informative in the diagnostics of a tube infertility?
Laparoscopy with chromosalpingoscopy
55
A 28-year-old parturient complains about headache, vision impairment, psychic inhibition. Objectively: AP- 200/110 mm Hg, evident edemata of legs and anterior abdominal wall. Fetus head is in the area of small pelvis. Fetal heartbeats is clear, rhythmic, 190/min. Internal examination revealed complete cervical dilatation, fetus head was in the area of small pelvis. What tactics of labor management should be chosen?
Forceps operation
56
A 43 y.o. woman complains of contact hemorrhages during the last 6 months. Bimanual examination: cervix of the uterus is enlarged, its mobility is reduced. Mirrors showed the following: cervix of the uterus is in the form of cauliflower. Chrobak and Schiller tests are positive. What is the most probable diagnosis?
Cancer of cervix of the uterus
57
A 28 year old woman had the second labour and born a girl with manifestations of anemia and progressing jaundice. The child's weight was 3 400 g, the length was 52 cm. The woman's blood group is B (III) Rh- , the father's blood group is A (III) Rh+ , the child's blood group is B (III) Rh+ . What is the cause of anemia?
Rhesus incompatibility
58
Laparotomy was performed to a 54 y.o. woman on account of big formation in pelvis that turned out to be one-sided ovarian tumor along with considerable omental metastases. The most appropriate intraoperative tactics involves:
Ablation of omentum, uterus and both ovaries with tubes
59
A 27 y.o. woman complains of having the disoders of menstrual function for 3 months, irregular pains in abdomen. On bimanual examination: in the dextral appendage range of uterus there is an elastic spherical formation, painless, 7 cm in diameter. USI: in the right ovary - a fluid formation, 4 cm in diameter, unicameral, smooth. What method of treatment is the most preferable?
Prescription of an estrogen-gestogen complex for 3 months with repeated examination
60
A 29 year old patient underwent surgical treatment because of the benign serous epithelial tumour of an ovary. The postoperative period has elapsed without complications. What is it necessary to prescribe for the rehabilitational period:
Hormonotherapy and proteolytic enzymes
61
An endometrial adenocarcinoma that has extended to the uterine serosa would be classified as stage:
IIIA
62
A 48 year old female patient complains about contact haemorrhage. Speculum examination revealed hypertrophy of uterus cervix. It resembles of cauliflower, it is dense and can be easily injured. Bimanual examination revealed that fornices were shortened, uterine body was nonmobile. What is the most probable diagnosis?
Cervical carcinoma
63
An onset of severe preeclampsia at 16 weeks gestation might be caused by:
Hydatidiform mole
64
A 27 y.o. woman suffers from pyelonephritits of the only kidney. She presents to the maternity welfare centre because of suppresion of menses for 2,5 months. On examination pregnancy 11 weeks of gestation was revealed. In urine: albumine 3,3 g/L, leucocytes cover the field of vision. What is doctor's tactics in this case?
Immediate pregancy interruption
65
On the fifth day after a casual sexual contact a 25-year-old female patient consulted a doctor about purulent discharges from the genital tracts and itch. Vaginal examination showed that vaginal part of uterine cervix was hyperemic and edematic. There was an erosive area around the external orifice of uterus. There were mucopurulent profuse discharges from the cervical canal, uterine body and appendages exhibited no changes. Bacterioscopic examination revealed bean-shaped diplococci that became red after Gram's staining. What is the most likely diagnosis?
Acute gonorrheal endocervicitis
66
A 36 y.o. woman is in the 12-th week of her first pregnancy. She was treated for infertility in the past. She contacted a child who fell ill with rubella 2 days after their meeting. Woman doesn't know if she has ever been infected with rubella. What is the adequate tactics?
Monitoring of the specific IgG IgM with the ELISA
67
A 27-year-old sexually active female complains of numerous vesicles on the right sex lip, itch and burning. Eruptions regularly turn up before menstruation and disappear 8-10 days later. What is the most likely diagnosis?
Herpes simplex virus
68
A 21-year-old female patient consulted a gynecologist about itching, burning, watery vaginal discharges with a fish-like smell. Speculum examination revealed that the cervical and vaginal mucosa was of a normal pink color. Vaginal examination revealed no alterations of the uterus and appendages. Gram-stained smears included clue cells. What is the most likely pathology?
Bacterial vaginosis (gardnerellosis)
69
A 28 y.o. primagravida, pregnancy is 15-16 weaks of gestation, presents to the maternity clinics with dull pain in the lower part of the abdomen and in lumbar area. On vaginal examination: uterus cervix is 2,5 cm, external isthmus allows to pass the finger tip. Uterus body is enlarged according to the pregnancy term. Genital discharges are mucous, mild. What is the diagnosis?
Threatened spontaneous abortion
70
A primagravida in her 20th week of gestation complains about pain in her lower abdomen, blood smears from the genital tracts. The uterus has an increased tonus, the patient feels the fetus movements. Bimanual examination revealed that the uterus size corresponded the term of gestation, the uterine cervix was contracted down to 0,5 cm, the external orifice was open by 2 cm. The discharges were bloody and smeary. What is the most likely diagnosis?
Incipient abortion
71
A 26 y.o. 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 is 80 bpm. 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
72
An ambulance delivered a 21-year-old woman to the gynaecological department with complaints of colicky abdominal pain and bloody discharges from the genital tracts. Bimanual examination revealed that uterus was soft, enlarged to the size of 6 weeks of gestation, a gestational sac was palpated in the cervical canal. Uterine appendages weren't palpable. Fornices are free, deep and painless. Discharges from the genital tracts are bloody and profuse. What is the most likely diagnosis?
Abortion in progress
73
A 34 year old woman in the 10th week of gestation (the second pregnancy) consulted a doctor of antenatal clinic in order to be registered there. In the previous pregnancy hydramnion was observed, the child's birth weight was 4086 g. What examination method should be applied in the first place?
The test for tolerance to glucose
74
A 34-year-old woman with 10-week pregnancy (the second pregnancy) has consulted gynaecologist to make a record in patient chart. There was a hydramnion previous pregnancy, the birth weight of a child was 4086 g. What tests are necessary first of all?
The test for tolerance to glucose
75
A 20-year-old female consulted a gynecologist about not having menstrual period for 7 months. History abstracts: early childhood infections and frequent tonsillitis, menarche since 13 years, regular monthly menstrual cycle of 28 days, painless menstruation lasts 5-6 days. 7 months ago the patient had an emotional stress. Gynecological examination revealed no alterations in the uterus. What is the most likely diagnosis?
Secondary amenorrhea
76
A 26-year-old secundipara at 40 weeks of gestation arrived at the maternity ward after the beginning of labor activity. 2 hours before, bursting of waters occurred. The fetus was in a longitudinal lie with cephalic presentation. Abdominal circumference was 100 cm, fundal height - 42 cm. Contractions occurred every 4-5 minutes and lasted 25 seconds each. Internal obstetric examination revealed cervical effacement, opening by 4 cm. Fetal bladder was absent. Fetal head was pressed against the pelvic inlet. What complication arose in childbirth?
Early amniorrhea
77
A 28-year-old patient has been admitted to the gynecological department three days after a casual coitus. She complains about pain in her lower abdomen and during urination, profuse purulent discharges from the vagina, body temperature rise up to 37,8oC. The patient was diagnosed with acute bilateral adnexitis. Supplemental examination revealed: the 4th degree of purity of the vaginal secretion, leukocytes within the whole visual field, diplococcal bacteria located both intra- and extracellularly. What is the etiology of acute adnexitis in this patient?
Gonorrheal
78
A gravida with 7 weeks of gestation is referred for the artificial abortion. On operation while dilating cervical canal with Hegar dilator №8 a doctor suspected uterus perforation. What is immediate doctors tactics to confirm the diagnosis?
Probing of uterus cavity
79
An 18-year-old primigravida in her 27-28 week of gestation underwent an operation on account of acute phlegmonous appendicitis. In the postoperative period it is necessary to take measures for prevention of the following pegnancy complication:
Noncarrying of pregnancy
80
A pregnant woman was registered in a maternity welfare clinic in her 11th week of pregnancy. She was being under observation during the whole term, the pregnancy course was normal. What document must the doctor give the pregnant woman to authorize her hospitalization in maternity hospital?
Exchange card
81
A newborn's head is of dolichocephalic shape, that is front-to-back elongated. Examination of the occipital region of head revealed a labour tumour located in the middle between the prefontanel and posterior fontanel. The delivery tok place with the following type of fetus head presentation:
Posterior vertex presentation
82
A woman, primagravida, consults a gynecologist on 05.03.2002. A week ago she felt the fetus movements for the first time. Last menstruation was on 10.01.2002. When should she be given maternity leave?
8 August
83
A 49-year-old woman complains about headache, head and neck going hot, increased perspiration, palpitation, arterial pressure rise up to 170/100 mm Hg, irritability, insomnia, tearfulness, memory impairment, rare and scarce menses, body weight increase by 5 kg over the last half a year. What is the most likely diagnosis?
Climacteric syndrome
84
A 40-year-old female patient has been observing profuse menses accompanied by spasmodic pain in the lower abdomen for a year. Bimanual examination performed during menstruation revealed a dense formation up to 5 cm in diameter in the cervical canal. Uterus is enlarged up to 5-6 weeks of pregnancy, movable, painful, of normal consistency. Appendages are not palpable. Bloody discharges are profuse. What is the most likely diagnosis?
Nascent submucous fibromatous node
85
A 27 y.o. gravida with 17 weeks of gestation was admitted to the hospital. There was a history of 2 spontaneous miscarriages. On bimanual examination: uterus is enlarged to 17 weeks of gestation, uterus cervix is shortened, isthmus allows to pass the finger tip. The diagnosis is isthmicocervical insufficiency. What is the doctor's tactics?
To place suture on the uterus cervix
86
A 32-year-old gravida complains about episodes of unconsciousness, spontaneous syncopes that are quickly over after a change of body position. A syncope can be accompanied byquickly elapsing bradycardia. There are no other complications of gestation. What is the most likely reason for such condition?
Postcava compresseion by the gravid uterus
87
A 25-year-old female has a self-detected tumor in the upper outer quadrant of her right breast. On palpation there is a painless, firm, mobile lump up to 2 cm in diameter, peripheral lymph nodes are not changed. In the upper outer quadrant of the right breast ultrasound revealed a massive neoplasm with increased echogenicity sized 21x18 mm. What is the most likely diagnosis?
Fibroadenoma
88
After examination a 46-year-old patient was diagnosed with left breast cancer T2N2M0, cl. gr. II-a. What will be the treatment plan for this patient?
Radiation therapy + operation + chemotherapy
89
A 19-year-old primiparous woman with a body weight of 54,5 kg gave birth at 38 weeks gestation to a full-term live girl after a normal vaginal delivery. The girl's weight was 2180,0 g, body length - 48 cm. It is known from history that the woman has been a smoker for 8 years, and kept smoking during pregnancy. Pregnancy was complicated by moderate vomiting of pregnancy from 9 to 12 weeks pregnant, edemata of pregnancy from 32 to 38 weeks. What is the most likely cause of low birth weight?
Fetoplacental insufficiency
90
A 36-year-old female pesented to a gynecological hospital with a significant bleeding from the genital tract and a 1-month delay of menstruation. Bimanual examination revealed soft barrel-shaped cervix. Uterus was of normal size, somewhat softened. Appendages were unremarkable on both sides. Speculum examination revealed that the cervix was cyanotic, enlarged, with the the external orifice disclosed up to 0,5 cm. Urine hCG test was positive. What is the most likely diagnosis?
Cervical pregnancy
91
A pregnant 26-year-old woman was admitted to a hospital for abdominal pain and bleeding from the genital tract. Bimanual examination revealed that uterus was the size of 9 weeks of pregnancy, the cervical canal let a finger through. Fetal tissues could be palpated in the orifice. There was moderate vaginal bleeding. What is the tactics of choice?
Instrumental extraction of fetal tissue
92
A woman at 30 weeks pregnant has had an attack of eclampsia at home. On admission to the maternity ward AP is 150/100 mm Hg. Predicted fetal weight is 1500 g. There is face and shin pastosity. Urine potein is 0,66o /oo. Parturient canal is not ready for delivery. An intensive complex therapy has been started. What is the correct tactics of this case management?
Delivery by cesarean section
93
A primigravida woman appealed to the antenatal clinic on the 22.03.03 with complaints of boring pain in the lower part of abdomen. Anamnesis registered that her last menstruation was on the 4.01.03. Bimanual examination revealed that uterine servix is intact, external fauces is closed, uterus is enlarged up to the 9-th week of pregnancy, movable, painless. What complication can be suspected?
Risk of abortion in the 9-th week of pregnancy
94
A 34 y.o. woman in her 29-th week of pregnancy, that is her 4-th labor to come, was admitted to the obstetric department with complaints of sudden and painful bloody discharges from vagina that appeared 2 hours ago. The discharges are profuse and contain grumes. Cardiac funnction of the fetus is rhytmic, 150 strokes in the minute, uterus tone is normal. The most probable provisional diagnosis will be:
Placental presentation
95
Rise in temperature up to 390С was registered the next day after a woman had labor. Fetal membranes rupture took place 36 hours prior to labors. The examination of the bacterial flora of cervix uteri revealed the following: haemolytic streptococcus of group A. The uterus tissue is soft, tender. Discharges are bloody, with mixing of pus. Establish the most probable postnatal complication.
Metroendometritis
96
A woman is admitted to maternity home with discontinued labor activity and slight bloody discharges from vagina. The condition is severe, the skin is pale, consciousness is confused. BP is 80/40 mm Hg. Heartbeat of the fetus is not heard. There was a Cesarian section a year ago. Could you please determine the diagnosis?
Hysterorrhesis
97
A 10 week pregnant woman was admitted to a hospital for recurrent pain in the lower abdomen, bloody discharges from the genital tracts. The problems turned up after ARVI. The woman was registered for antenatal care. Speculum examination revealed cyanosis of vaginal mucosa, clean cervix, open cervical canal discharging blood and blood clots; the lower pole of the gestational sac was visible. What tactics should be chosen?
Curettage of the uterus
98
During the dynamic observation over a parturient woman in the second stage of labor it was registered that the fetal heart rate fell down to 90-100/min and didn't come to normal after contractions. Vaginal examination revealed the complete cervical dilatation, the fetal head filling the entire posterior surface of the pubic symphysis and sacral hollow; the sagittal suture lied in the anteroposterior diameter of the pelvic outlet, the posterior fontanelle was in front under the pubic arch. What plan for further labour management should be recommended?
Application of forceps minor
99
A 37 y.o. primigravida woman has been having labor activity for 10 hours. Labor pains last for 20-25 seconds every 6-7 minutes. The fetus lies in longitude, presentation is cephalic, head is pressed upon the entrance to the small pelvis. Vaginal examination results: cervix of uterus is up to 1 cm long, lets 2 transverse fingers in. Fetal bladder is absent. What is the most probable diagnosis?
Primary uterine inertia
100
A woman is 34 years old, it is her tenth labor at full term. It is known from the anamnesis that the labor started 11 hours ago, labor was active, painful contractions started after discharge of waters and became continuous. Suddenly the parturient got knife-like pain in the lower abdomen and labor activity stopped. Examination revealed positive symptoms of peritoneum irritation, ill-defined uterus outlines. Fetus was easily palpable, movable. Fetal heartbeats wasn't auscultable. What is the most probable diagnosis?
Rupture of uterus