Situational problems:
Problem 1
The patient of 24 years is delivered in a hospital by a first aid brigade in connection with
complaints to colicy pains in the bottom of a gaste, abundant, with clots bloody excretions from
sexual paths, delicacy. A BP of 100/60 mm hCG, pulse 90 in 1 mines, body temperature 37 °s.
Last normal menses 2 mes back. At a vaginal examonation: the uterus nick not erozirovana,
tsianotichna, outside shed passes a dactyl. The uterus is enlarged to 6 ned pregnancy, painless.
Appendages from both sides are not spotted. Crests deep, painless
1. What diagnosis is most probable?
dysfunctional a uterine bleeding
The Broken extrauterine pregnancy
Inflammation of appendages of a uterus
Hysteromyoma
Incomplete аборт*
2. Optimum volume of pressing medical aid?
Emergency laparotomy, tubectomy, infuzionno-transfuzionnaja therapy
Hormonal hemostasis an estrogen-gestagennymi drugs, infusionally-transfusion and uterotonic
therapy
Emergency abdominal section, over vulval ablation of a uterus, a hemotransfusion
Partite diagnostic currettage under hysteroscope control, a hemotransfusion
Instrumental excision of the residual of foetal egg, infusional and uterotonic терапия*
Problem 2
The patient of 20 years shows complaints to a delay of the next menses to 10 days. A BP of
120/80 mm hCG, pulse 72 1 minute At transvaginal echography progressing tubal pregnancy is
suspected.
1. The correct tactics of the doctor of female consultation
Urgently to hospitalise the patient for improvement of the diagnosis and the solution of a
question on tactics лечения*
To Give away the sick list and to refer the patient for definition of titre hCG in a blood or urine.
To recommend to be repeated in ZHK after reception of findings of investigation
To Recommend to be repeated in a week for control ultrasonic investigation.
To carry investigation under tests of the functional diagnostics
To Manufacture a puncture of an abdominal lumen through a back vault of the vagina. In case of
lack of a punctate to give away the sick list and to recommend a repeated appearance in female
consultation in 5 days
2. What optimum tactics of the doctor in the conditions of a hospital?
Medical-diagnostic лапароскопия*
Emergency abdominal section
Puncture of an abdominal lumen through a back vault of the vagina under Ouse-data unit control.
Hysteroscopy with the subsequent examination of a scrape endometrija.
abdominal section in planned order
Problem 3
At sick 21 years in the conditions of a gynecologic hospital tubal pregnancy is diagnosed. The
state of the patient satisfactory, is not present complaints. Pulse 72 in 1 mines, a BP of 120/80
mm hCG, haemoglobin level in a blood 130 g/l
1. What methods of treatment of an extrauterine pregnancy are possible in this case?
Emergency abdominal section, excision of a uterine tube.
Laparoscopy, excision of a uterine tube.
Resection of a uterine tube with the subsequent superposition of a tubal anastomosis by means of
microsurgical technics.
Methotrexatum Introduction in foetal egg under control of transvaginal echography or a
laparoscopy.
All перечисленные*
2. What of the numbered states lead to extrauterine pregnancy occurrence
Inflammatory diseases of appendages of a uterus
Genital infantilism
Endometriosis of uterine tubes
All numbered верно*
All numbered untruely
Problem 4
Last menses 6 weeks ago. The patient considers itself as the pregnant woman. One week ago
there were colicy pains in the bottom of a gaste with an irradiation in the right foot. There was
transient a loss of consciousness. Next day from sexual paths there were bloody excretions. The
patient has been hospitalised in a hospital with the diagnosis a misbirth and the currettage of a
cavity of the uterus is effected. In posleabortnom the season the subfebrile temperature, smeared
bloody excretions was observed. At a vaginal examonation it is revealed 2х extraneous
augmentation of appendages of a uterus, it is more on the right. At sick again there were colicy
pains in the bottom of a gaste.
1. What diagnosis?
Ovary apoplexy
Broken tubal pregnancy*
Bilateral adnexitis
Uterine pregnancy
Erosion of nick of a uterus
2. Conducting tactics.
laporotomija *
Currettage of a cavity of the uterus
Puncture of a back crest
Symptomatic therapy
Antibacterial therapy
Problem 5
The patient of 27 years is delivered by ambulance car in regional hospital in a grave condition. In
the anamnesis a bilateral inflammation of appendages of a uterus with a periodic exacerbation.
Last menses has come for 10 days later. In the morning at uprise from bed there were sharp pains
in the bottom of a gaste and in an anus. The woman has transiently fainted. Shared state serious.
Sharp pallor of integuments becomes perceptible. Pulse 120 in minute, a BP 90/60. Tongue pure
damp, a gaste overblown is sharply exerted in the inferior departments. At a vaginal
examonation a uterus because of sharp morbidity do not manage to palpate. On the right in the
field of appendages it is spotted testovatost. Excursion of nick of a uterus is sharply painful.
1. What diagnosis?
Extrauterine pregnancy*
Ovary apoplexy
Torsion of a leg of a cyst
The begun abortion
Parametritis
2. Sequence of activities
Laparotomy
Puncture of a back crest
Truly and And
To anaesthetise
Truly G, А*