Question text
A primagravida comes for the next prenatal visit on 28.05.2020. The day before she felt the fetus
movements for the first time. Last menstruation was on 10.01.2020. Calculate expected date of
labor.
a. 5 September
b. 22 August
c. 11 July
d. 17 Oktober
e. 25 July
Question 2
Time to give anti-D-imunohlobulyn in puerperium period is:
a.During the first 96 hours.
b.During the first 72 hours
c.After 1 month postpartum.
d.In the early postnatal period.
e.In the first 24 hours after birth.
Question 3
A 45 year old woman had pointed condyloma of the genitals. Cytologic test of vaginal smears did
not reveal pathology. Determine the conducting tactics:
a.Electrocauterizing conization.
b.Fractional curettage of the uterus mucous membrane.
c.Annual cytological test of vaginal smears.
d.Colposcopy.
e.Biopsy.
Question 4
A 35-year-old woman was addressed to the doctor 3 months ago with complaints of irregular
profuse menstrual bleeding. The doctor administered oral contraceptives for 2 months. Despite of
using oral contraceptives, bleeding continued. What is the conducting tactics?
a.Estrogen.
b.Curettage of the uterus mucous membrane.
c.Oral contraceptives.
d.Nonspecific anti-inflammatory treatment.
e.Progestin.
Question 5
A breastfeeding for 1,5 weeks woman has attended a doctor. She considers the onset of her
disease to be when proportional breast engorgement occurred. Mammary glands are painful.
Body temperature is 36,6oC. Expression of breastmilk is hindered. The most likely diagnosis is:
a.Infiltrative mastitis
b.Gangrenous mastitis
c.Suppurative mastitis
d.Lactostasis
e.Chronic cystic mastitis
Question 6
Pregnant , 31 y.o. came with complaints about dyspnoea, the rapid increase of the abdomen's
size. The gestational age is 29-30 weeks. Abdominal circumference 120 cm, height of uterine
fundus standing 38 cm. The uterus is tense, palpation of the fetus fails. Fetal heartbeat dull, 140
b.p.m. The most likely component of the diagnosis?
a.Polyhydramnion
b.Uterine rupture.
c.Multiple pregnancy
d.Premature detachment of normally situated placenta.
e.Big fetus
Question 7
At the end of the first day of postpartum period the Uterine cervix internal orifice :
a.Passes 3-4 cm fingers
b.None of the above.
c.Closed.
d.Passes 1-2 cm.
e.Passes 8-9 cm
Question 8
A 30 year old patient was hospitalized in the gynecological department with complaints of aching
pain in the lower abdomen, irradiating to the back, increase in body temperature - 37,3°С.
Objectively: cervix uterus has cylindrical form, the pharynx is closed. The corpus uterus has a
normal size, painless, mobile. The appendages are a little enlarged, limited in mobility, painful. The
fornix is free. Discharge is leucorrhoea. What is the most probable diagnosis?
a.Pelvioperitonitis.
b.Polycystic ovarian disease.
c.Endometritis.
d.Chronic salpingootitis in the acute stage.
e.Ovarian cyst.
Question 9
A 12 year old girl arrived at the gynecological department with complaints of bleeding from the
genital tract for 2 weeks, after a delay in menstruation for 3 months, weakness, headache,
dizziness. Menstruation since the age of 10. At the age of 10, she had scarlet fever. Objectively:
skin is pale, tachycardia, BP - 100/60. In the bloody analysis: Нb=100 gr./l, amount of
thrombocytes - 200 thousand. Gynecological exam: vіrgo. Rectal exam: the corpus uterus and
appendages are normal. What is the preliminary diagnosis?
a.Sclerocystic ovarian syndrome.
b.Werlhof's disease (idiopathic (thrombocytopenic) purpura).
c.Juvenile bleeding.
d.Hemorrhagic diathesis.
e.Miscarriage.
Question 10
A 38 year old woman came to the female consultation with complaints of long and profuse
menstruations for half a year, nagging pains in the lower abdomen, weakness. Gynecological
examination showed that the corpus uterus is increased to 11-12 week pregnancy, dense, mobile,
painless. In the blood analysis: anemia Hb = 90 g/l. What pathology can be suspected?
a.Myoma of the uterus.
b.Dysfunctional uterine bleeding.
c.Pregnancy.
d.Ovarian cystoma.
e.Cancer of the corpus uterus.
Question 11
A patient, 22 years old, has visited the maternity hospital with complaints of delay of menses for 2
months, appeared attraction to a spicy food, nausea, sleepiness, aversion for a tobacco smoke. At
bimanual exam: hyperanteflexion of the uterus and enlarged according to a goose egg sizes, in the
area of the left angle - asymmetry. What are the probable simptoms of pregnancy?
a.The appeared attraction to a spicy food.
b.Nausea.
c.Delay of menses, hyperanteflexion and asymmetry of the uterus
d.Sleepiness.
e.Aversion for a tobacco smoke.
Question 12
The examination of the cervix uterus in mirrors of a 32 year old woman shows hyperemia of the
cervical canal and vaginal part of the uterus. With the help of what method is it possible to
determine the pathology of the cervix?
a.Culdoscopy
b.Ultrasound
c.Сolpocytology
d.Colposcopy with a biopsy and subsequent histological analysis
e.Separate diagnostic curettage of the uterus mucous membrane
Question 13
Pap-test in a woman, 45 y.o., revealed LSIL (low grade squamous intraepithelial lesion).
Colposcopy with target biopsy revealed CIN I on exocervix, transformation zone is fully visible.
What is the optimal treatment tactics?
a.Cryotherapy
b.Chemical coagulation of cervix
c.Conization of cervix
d.Amputation of cervix
e.Loop excision of cervix
Question 14
A 47 year old woman has had a uterine myoma for 8 years; she has not been treated. For the past
year the tumor has grown to the size of a 15 week pregnancy. What are the tactics of the doctor?
a.Ultrasound, regular medical check-ups.
b.Perform diagnostic curettage of the uterus mucous membrane, prophylactic medical check-ups.
c.Hormonal therapy.
d.Perform a diagnostic curettage of the uterus mucous membrane, operative treatment after
histological conclusion.
e.Emergency operative treatment.
Question 15
A 24 year old woman, who has not been pregnant before, stopped taking oral contraceptives.
After the last one, she had one menstruation and then for 6 months she had amenorrhea. Specify
the necessary tests:
a.Determining the level of gonadotropin.
b.Progesterone test.
c.Determining the amount of testosterone in the blood serum.
d.Computer tomography of the head.
e.Ultrasound of the organs of the small pelvis.
Question 16
A woman came to the hospital in 4 hours from the start of regular contractions. The pregnancy is
3rd , 38-39 weeks, labor is 2 nd. The size of the pelvis is normal. During external obstetric
examination has found a small parts and head of fetus above pelvic inlet, there are clearly
palpable two major parts of fetus, one of which is the head in the fundus of uterus. Heartbeat of
fetus are clearly heard on the left below the navel, 136 beats / min and right above the navel 150
beats / min. Circumferences of the abdomen is 119 cm . The height of uterus fundus is 42 cm.
The most likely component of the diagnosis?
a.intrauterine growth retardation.
b.oligohydramnion.
c.Congenital malformations of the fetus.
d.Twins.
e.macrosomia.
Question 17
A 26 year old woman addressed the doctor at the female consultation with complaints of general
indisposition, nausea, vomiting once a day, drowsiness, delay in menses for 2 months. Bimanual
examination: cyanosis of the vaginal and cervix uterus mucous. The uterus is enlarged to the sizes
of a female fist, soft, especially in the area of the isthmus, however during examination is
becomes more dense, painless. Appendages are not palpated. Discharge is mucous. Establish the
most correct diagnosis.
a.Extra-uterine pregnancy
b.8 week pregnancy
c.Menstrual dysfunction
d.Uterine fibromyoma
e.Gastritis
Question 18
The most worrisome sign or symptom of potentially serious pathology in late pregnancy is which
of the following?
a.visual changes
b.constipation
c.nocturia
d.heartburn
e.swollen ankles
Question 19
On the 10th day after delivery a 26-y.o. patient consulted a doctor about rise of body temperature
up to 39oC, pain in the right breast. Objectively: the mammary gland is enlarged, there is a
hyperemized area in the upper external quadrant, in the same place there is an ill-defined
induration, lactostasis, fluctuation is absent. Lymph nodes of the right axillary region are enlarged
and painful. What is the most likely diagnosis?
a.Erysipelas
b.Dermatitis
c.Abscess
d.Lactational mastitis
e.Tumour
Question 20
A woman arrived at the gynecological hospital with complaints of acute pain in the lower
abdomen. One year ago during a routine check-up, a tumor of the right ovary was diagnosed. She
refused an operation. During examination, positive symptoms of irritation of the peritoneum.
Bimanual exam - the uterus is usual in size, painless, to the right a formation 8 cm in size is
determined, sharply painful, dense, with accurate contours. What is the possible diagnosis?
a.Acute right sided adnexitis
b.Torsion of the leg of a cyst of an ovary
c.Pelviperitonitis
d.Extra-uterine pregnancy
e.Ruptured ovarian cyst
Question 21
Vaginal examination in 6 hours after the onset of labor revealed: the cervix is 5 cm open, the fetal
head is pressed to the pelvic inlet. The sagittal suture is in the right oblique diameter, the small
fontanel is to the left anterior side. What moment of the biomechanism of labor is described?
a.Flexion of the head
b.Extension of the head
c.Internal rotation of the shoulders
d.Internal rotation of the head
e.Additional flexion of the head
Question 22
A Secundipara was admitted to the hospital at 18 weeks of gestation with complaints about
recurrent pulling pain in the abdomen and in the lumbar region, dark bloody discharge from
vagina, nausea, weakness. Vaginal examination: uterus is increased up to 12 weeks of pregnancy
size. There is no fetal cardiac activity visualized by ultrasound. What is the most likely diagnosis?
a.missed abortion
b.Threatened abortion
c.Inevitable abortion
d.Complete abortion
e.incomplete abortion
Question 23
A 24 year old patient complains of a fever of 37,2°С; frequent, painful urinations; pain in the lower
abdomen, serous discharge from the vagina. Her sex life is chaotic. The cervix uterus has a conic
form, with signs of endocervicitis; the discharge is serous. The uterus is not enlarged, painful
during palpation. The appendages on both sides are enlarged, painful. The fornix is deep, painful.
The immune-enzyme analysis revealed clamidiosis. Antibiotics of what group will most likely be
prescribed?
a.Tetracycline
b.Aminoglycoside
c.Penicillin
d.Cephalosporin
e.Carbapenems
Question 24
Second gravida C., at 28 weeks of pregnancy, has the Rh- antibodies titer 1: 8. She gave birth child
with symptoms of hemolytic disease. When should you check Rh-antibodies titer?
aRe-determination of antibodies in 3 weeks
b.Re-determination of antibodies in 1 month
c.Re-determination of antibodies after 2 weeks
d.Re-determination of antibodies in 1 week
e.Re-determination of antibodies in 1 day
Question 25
A patient has an uncomplicated vaginal delivery of a 3,500-g infant. The placenta delivers
spontaneously in 15 minutes. Forty-five minutes after this delivery, you are notified by a nurse that
the patient has an unusual amount of bleeding but that vital signs are stable. What is the best
course of action?
a.perform D&C
b.have the nurse call you back in 1 hour if bleeding persists
c.reassure the nurse and wait
d.order 10 IU of oxytocin IV
e.type and crossmatch 2 units of blood
Question 26
A 46 year old woman was delivered to the gynecological department with dysfunctional uterine
bleed after a delay in menstruation for 2 weeks. What is the necessary treatment to begin with?
a.Fractional medical-diagnostic curettage of the uterus mucous membrane.
b.Cyclic hormonal therapy.
c.Non-hormonal hemostasis.
d.Amputation of the uterus.
e.Hormonal hemostasis.
Question 27
A 32 year old patient complains of the absence of pregnancies during 5 years of married life. The
basal temperature is diphasic. The husband spermogram reveled no pathological findings. During
metrosalpingography - the uterine tubes are filled with contrast liquid up to the ampular part.
Threre is no contrast in the abdominal. What is best way for treating this patient?
a.Insemination of sperm of a donor
b.Stimulation of ovulation
c.Course of hydrotubation
d.Laparoscopic reconstruction of the uterine tubes
e.Extracorporal fertilization
Question 28
A 46 year old woman was delivered to gynecological department with abnormal uterine bleeding
after menstruation delay for 2 weeks. On USE thickness of endometrium considerably exceeds
the norm. What is the optimal method of treatment?
a.Non-hormonal hemostasis (procoagulants).
b.Pipelle biopsy of endometrium.
c.Dilation and curretage of endocervix and endometrium or hysteroscopy.
d.Combined oral contraceptives for 3 months
e.Hormonal hemostasis.
Question 29
A 24-year-old woman (gravida 1, para 0) at 37 weeks’ gestation was noted to have a 2500 g
weight gain and an increase in blood pressure to 140/95 mm Hg in the past week. She also has
1+ proteinuria. The examination was repeated 4 hours later and the same results were obtained.
Which of the following is the best diagnosis?
a.preeclampsia
b.transient hypertension of pregnancy
c.pregnancy-induced hypertension
d.normal pregnancy
e.eclampsia
Question 30
A woman complains of a small amount of dark-bloody discharge from the genital tract and weak
pain in the lower abdomen for several days. Last menstruation - 7 weeks ago. Pregnancy test is
positive. Bimanual examination: the uterus body is enlarged to 5-6 week pregnancy, soft
consistency, painless. To the left in the area of the uterine appendages a retor-shaped formation
is found with a size of 7х5 cm, mobile, painless. What is necessary to determine the location of
the definition fetal egg?
a.Cystoscopy.
b.Hysteroscopy.
c.Colposcopy.
d.Chromohydrotubation.
e.Ultrasound of the organs of the small pelvis.
Question 31
A 33 year old woman had her first sexual intercourse at the age of 13, had 2 childbirth at the age
of 15 and 22. She confirms having more than 10 sexual partners during lifetime, currently she has
no constant partner, for contraception uses calendar method and interrupted intercourse. She had
chlamydial infection and genital herpes in anamnesis. What malignancy is she at risk for?
a.Precancer and cancer of cervix
b.Sarcoma of uterus
c.Breast cancer
d.Precancer and cancer of endometrium
e.Cancer of ovaries
Question 32
Examination of a Rh-negative pregnant woman at 32 weeks of gestation revealed a four-time rise
of Rh-antibody titer within 2 weeks, the titer was 1:64. In the first two pregnancies the patient had
experienced antenatal fetal death due to hemolytic disease. What is the optimal tactics of
pregnancy management?
a.Early delivery
b.Ultrasound for signs of hemolytic disease of the fetus
c.Introduction of anti-Rh (D) immunoglobulin
d.Delivery at 37 weeks of gestation
e.Screening for Rh-antibodies 2 weeks later and early delivery in case of further titer rise
Question 33
A 32 year old patient is in the gynecological department concerning acute bartholinitis. Body
temperature is 38,2°C, blood leukocytes are 10,4 Т/l, ESR is 24 mm/hr. By the Bartholin's gland hyperemia of the skin, fluctuation symptom, acute morbidity. What are the most correct tactics for
the doctor?
a.Opening and draining the gland abscess
b.Antibiotics + disintoxication + biostimulators.
c.Opening and draining the gland abscess + antibiotics.
d.Antibiotics + sulfonamides.
e.Antibiotic therapy.
Question 34
A 10 week pregnant woman was admitted to a hospital for recurrent pain in the lower abdomen,
bloody discharges from the genital tracts. 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?
a.Pregnancy maintenance therapy
b.Curettage of the uterus
c.Antiviral therapy
d.Hysterectomy
e.Expectant management, surveillance
Question 35
A 18 year old patient complains of an itch in the vagina, profuse discharge. She has been ill for 3
days. She had acute respiratory disease and was treated with antibiotics. Objectively: the
vestibule of the vagina, labia minoris and majoris are edematic, hyperemic. The mucous
membrane is hyperemic, edematic, covered with a whitish film, which is easily taken off.
Leucorrhoea is profuse, white color, dense "cottage cheese like character". The uterus and
appendages are without features. What is the possible diagnosis?
a.Clamidiosis
b.Сandidiasis
c.Genital herpes
d.Trichomonas colpitis
e.Acute gonorrhea
Question 36
10 minutes after delivery a woman discharged placenta with a tissue defect 5х6 cm large.
Discharges from the genital tracts were profuse and bloody. Uterus tonus was low, fundus of
uterus was located below the navel. Examination of genital tracts revealed that the uterine cervix,
vaginal walls, perineum were intact. There was uterine bleeding with following blood coagulation.
Your actions to stop the bleeding:
a.To put an ice pack on the lower abdomen
b.To make manual examination of uterine cavity
c.To apply hemostatic forceps upon the uterine cervix
d.To administer uterotonics
e.To introduce an ether-soaked tampon into the posterior fornix
Question 37
A Secondipara, 34 y.o., was admitted to the hospital with a full-term pregnancy and
polyhydramnion. The circumference f the abdoman is 112 cm, the hight of uterine fundus is 38
cm, the uterus is firm, there are signs of fluctuations, fetal parts palpable unclear. Fetal heartbeat
is muted. Contractions are regular. During vaginal examination, the cervix is soft , thin edge,
opened up to 4 cm, amniotic sac is present , intense, the presenting part is head, movable above
the entrance to a small pelvis. What tactic of the childbirth?
a.Amniotomy followed by extraction of the fetus for pelvic end.
b.obstetric dream to merge amniotic fluid.
c.labor induction with the introduction Prostoglandin.
d.Amniotomy , delivery by natural way.
e.Caesarean section.
Question 38
Examination of the cervix of a 32 year old woman in the mirrors revealed hyperemia of the
cervical canal and vaginal part of the cervix uterus. Which method is possible to establish the
pathology of the cervix uterus?
a.Separate diagnostic curettage of the uterus mucous membrane
b.Culdoscopy
c.Colposcopy with biopsy and subsequent histological testing
d.Colpycytology
e.Ultrasound
Question 39
A 32-year-old pregnant woman at the term of 5-6 weeks was vaccinated against influenza along
with her whole family. At that time she was not aware of her pregnancy. The woman needs an
advice from the family doctor regarding the maintenance of her pregnancy, namely whether there
is a risk of fetal malformations because of received vaccination.What advice should the doctor
give in this case?
a.Therapeutic abortion is recommended
b.Vaccination against influenza is safe during pregnancy
c.Test for antibodies against influenza virus is necessary
d.An infectious diseases specialist must be consulted
e.Immediate ultrasound of the lesser pelvis is necessary
Question 40
A woman, 34 weeks of pregnancy at her visit to the maternity hospital, height is 175 cm, weight is
74 kg. She has no complaints. The circumference of the wrist joint is 16 cm. Sizes of the pelvis:
25-28-31-21 cm. The fundal height is 35 cm, the circumference of the abdomen is 90 cm.
Determine the estimated fetal weight in g:
a.2850 ± 200 g.
b.4100 ± 200 g.
c.3150 ± 200 g.
d.1850 ± 200 g.
e.2500 ± 200 g.
Question 41
А 34 year old woman complains of bloody spotting discharge from the genital tract for a couple of
days prior to menses. In the anamnesis - diathermocoagulation 2 years ago. Examination of the
cervix uterus in the mirrors revealed cyanotic cysts in the form of "eyes". What should be
appointed for confirmation of the diagnosis?
a.Laparoscopy.
b.Ultrasound of the organs of the pelvis.
c.Smear for cytological testing.
d.Biopsy of the cervix uterus.
e.Colposcopy.
Question 42
What is necessary to determine at 9 - 13 weeks of pregnancy?
a.Thophoblast β – globulin;
b.Placental Alpha Microglobulin (PAMG);
c.α- fetoprotein;
d.PAPP – A and free β - chorionic gonadotropic hormone;
e.Progesterone;
Question 43
Patient 22 y.o. admitted to the gynecology department with complaints about recurrent pulling
pain in the abdomen and in the lumbar region, heavy vaginal bleeding . Vaginal study: cervix length
is 2.5 cm, it is cyanotic, the external oss opening is about fingertip size , uterus is soft, its size is
increased up to 6-7 weeks of pregnancy. The adnex is not palpable bilateraly, the fornix is deep.
Last menstruation was 2 months ago. What is the most likely diagnosis?
a.menstrual disorders
b.Threatened abortion
c.Ectopic Pregnancy
d.Inevitable abortion
e.Incomplete abortion
Question 44
A 29 year old woman arrived at the hospital with complaints of progressing strong pains in the
lower abdomen and vomiting for the past 2 days. She marks a delay in menses for 6 days. Active
sex life and does not use contraceptives. Temperature is 38,3°C. During examination, tension of
the anterior abdominal wall in inferior area is marked. During vaginal exam leukoria from the
cervical canal and a tight uterus is marked during bimanual exam. The area around the
appendages is slightly tense, but no hardenings were palpated. What test is most needed for
determining the diagnosis?
a.Laparoscopy
b.Ultrasound of the organs of the small pelvis
c.Puncture of the posterior fornix
d.Inoculation from the cervical canal
e.Determining the level of chorionic gonadotropin
Question 45
A 28 year old patient was delivered to the gynecological ward with complaints of a sharp pain in
the right iliac area, which occurred after lifting something heavy. Last menstruation was 10 days
ago, on time. During examination in the mirrors: the vagina and cervix uterus are without
characteristics. During vaginal examination the uterus body and appendages are not accessible
for palpation because of acute pain and tension in the muscles of the anterior abdominal wall.
The posterior fornix hangs and is painful. What is necessary to specify the diagnosis?
a.Сuldoscopy.
b.Colposcopy.
c.Hysteroscopy.
d.Puncture of the abdominal cavity through the posterior vaginal fornix
e.Determine chorionic gonadotropin.
Question 46
A 34 year old patient arrived at the gynecological department with complaints of sharp pain in the
lower abdomen, which started acutely, with nausea and vomiting. Bimanual examination: uterus is
normal in size, its movement is painful, the right ovary is a little enlarged, round, painful. The
vaginal fornix is deep, it palpation is painful. In the mirrors: the cervix uterus and vaginal mucous
membrane are not changed. There is no discharge. Which method is most informative?
a.Bimanual exam.
b.Culdoscopy.
c.Ultrasound of the organs of the small pelvis.
d.Puncture of the abdominal cavity through the posterior vaginal fornix.
e.Laparoscopy.
Question 47
A 30-year-old parturient woman was delivered to a maternity hospital with full-term pregnancy.
She complains of severe lancinating pain in the uterus that started 1 hour ago, nausea, vomiting,
cold sweat. Anamnesis states cesarean section 2 years ago. Uterine contractions stopped. Skin
and mucous membranes are pale. Heart rate is 100/min., BP is 90/60mmHg.Uterus has no clear
margins, is sharply painful. No heartbeat can be auscultated in the fetus. Moderate bloody
discharge from the uterus can be observed. Uterus cervix is 4 cm open. Presenting part is not
visible. The most likely diagnosis is:
a.Compression of inferior pudendal vein
b.Premature detachment of normally positionedplacenta
c.Initial uterine rupture
d.Uterine rupture
e.Threatened uterine rupture
Question 48
During the dynamic observation of a parturient woman in the second stage of labor it was
registered that the fetal heart rate decreased to 90-100/min and did not normalize after
contractions. Vaginal examination revealed the complete cervical dilatation, the fetal head filling
the entire posterior surface of the pubic symphysis and sacral concave; the sagittal suture was 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?
a.Application of outlet forceps
b.Caesarean section
c.Stimulation of labour activity by oxytocin
d.Application of low forceps
e.Episiotomy
Question 49
A 33 year old woman had her first childbirth at the age of 15; she suffers from genital herpes.
What is she at risk for?
a.Cancer of the endometrium
b.Vulva cancer
c.Cancer of the ovaries
d.Cancer of the cervix uterus
e.Chorioepithelioma
Question 50
A pregnant woman is 28 years old. Anamnesis: precipitous labor complicated by the II degree
cervical rupture. The following 3 pregnancies resulted in spontaneous abortions at the terms of
12, 14 and 18 weeks. On examination: the uterine cervix is scarred from previous ruptures at 9
and 3 hours, the cervical canal is gaping. On vaginal examination: the cervix is 2 cm long, the
external os is open 1 cm wide, the internal os is half-open; the uterus is enlarged to the 12th week
of pregnancy, soft, mobile, painless, the appendages are without changes. What diagnosis would
you make?
a.Threatened spontaneous abortion
b.Cervical hysteromyoma, habitual non carrying of pregnancy
c.Cervical pregnancy, 12 weeks
d.Isthmico-cervical insufficiency, habitual non carrying of pregnancy
e.Incipient abortion, habitual non carrying of pregnancy
Question 51
The main complains of pregnant women with acute polyhydramnion:
a. Fatigue
b. The feeling of heaviness and pain in the abdomen and lower back.
c. Dyspnea.
d. Loss of appetite.
e. all mentioned.
Question 52
A 15 year old girl complains of bloody discharge from the vagina for 2 weeks, which began after a
3 month delay of menstruation. Menarche at 13 years. Irregular menstrual cycle. Blood analysis:
Нb - 90 gr/l, erythrocytes - 2,0х1012/l, leukocytes - 5,6х109/l. Rectal exam: the uterus has a
normal size, the appendages are not palpated. What diagnosis is most probable?
a. Polyp of the endometrium
b. Cancer of the endometrium
c. Blood clotting disorder
d. Juvenile bleeding
e. Incomplete abortion
Question 53
A woman develops bleeding at 5-cm dilation with fetal distress. You perform a cesarean birth and
find a Couvelaire uterus. Which of the following causes a Couvelaire uterus?
a. intrauterine infection
b. enlargement and invasion by placental tissue into the uterus
c. a congenital anomalous development of the uterus
d. uterine retroflexion, and adherence to the cul-de-sac peritoneum of the uterine serosa
e. intramyometrial bleeding
Question 54
А 32 year old woman complains of a sudden pain in right iliac areas, irradiating to the rectum and
right leg. The patient is pale, BP - 95/50 mm hg on both hands, pulse - 105 b.p.m. 16th day of the
menstrual cycle. Blumberg's sign is positive. Bimanual examination: the uterus has a normal size,
morbidity is determined in the area of the right appendages, the left appendages are without
features. Movement of the cervix uterus is painful, the posterior vaginal fornix is painful, tense.
Discharge is bloody, moderate. What is the preliminary diagnosis?
a. Apoplexy of an ovary
b. Acute right sided adnexitis
c. Pelviperitonitis
d. Appendicitis
e. Extra-uterine pregnancy
Question 55
A primigravida is 22 years old. She has Rh(-), her husband has Rh(+). Antibodies to Rh weren’t
found at 32 weeks of pregnancy. Redetermination of antibodies to Rh didn’t reveal them at 35
weeks of pregnancy as well. How often should the antibodies be determined hereafter?
a. Monthly
b. Once in two weeks
c. Once in three weeks
d. There is no need in further checks
e. Once a week
Question 56
A 32 year old woman addressed the gynecologist with complaints of profuse, long menstruations
for last 3 months. Bimanual examination: the corpus uterus is enlarged like a 12 week pregnancy,
deformed, tuberculous, dense consistency. The appendages are not palpated. Results of a biopsy:
glandular - cystic hyperplasia of the endometrium. What are the optimum medical tactics:
a. Hormone therapy.
b. Cyclic vitamin therapy.
c. Radiation therapy.
d. Phytotherapy.
e. Surgical treatment.
Question 57
A pregnant is 22 years old. Pregnancy is first. The examination determined Rh negative blood type
A (II) in December. From history was found that as a child she had a blood transfusion. A husband
has Rh-positive blood type 0 (I). How often should rhesus antibodies be determined in the blood
of pregnant ?
a. Determination of antibody every two weeks.
b. Determination of antibodies in the blood of pregnant women during her first visit , at 20 weeks
term, then every 4 weeks
c. Definition of antibodies in the blood of pregnant each month.
d. Determination of antibody 1 per month in the first half of pregnancy and 2 times a month in the
second half.
e. Determination of antibodies twice during pregnancy.
Question 58
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 the following actions:
a. Instrumental revision of uterine cavity
b. Haemostatic therapy
c. Antibacterial therapy
d. Intrauterine instillation of dioxine
e. Uterotonic therapy
Question 59
A 47 year old woman complains of moderate bloody discharge from the genital tract, which
appeared after a delay in menstruation for 2 months and lasted 3 weeks. Vaginal exam: the cervix
is clean, the uterus is not enlarged, mobile, painless, appendages are not palpated, the fornix is
deep, painless. What is the most possible diagnosis?
a. Dysfunctional uterine bleeding
b. Cancer of the corpus uterus
c. Submucous fibromyoma
d. Abortion
e. Adenomyosis
Question 60
Which type of lohia should be in woman on the 5th day of pospartum stage?
a. Bloody-serous.
b. Sero-bloody.
c. No vaginal discharge.
d. Serous.
e. Bloody.
Question 61
A 15 year old girl complains of bloody discharge from vagina during 2 weeks, which began after a
3 months menstruation delay. Menarche at the age of 13 years. Has irregular menstrual cycles.
Blood count: Нb - 90 g/l, RBC - 3.2 T/l, WBC - 5,6 G/l. Rectovaginal examination: uterus is of
normal size, appendages are not palpated. What diagnosis is the most probable?
a. Coagulopathy
b. Cancer of endometrium
c. Incomplete abortion
d. Polyp of endometrium
e. Juvenile bleeding
Question 62
A primagravida with pregnancy of 37-38 weeks complains of headache, nausea, pain in
epigastrium. Objectively: the skin is cyanotic. Face is hydropic, there is short fibrillar twitching of
blepharons, muscles of the face and the inferior extremities. The stare is fixed. BP - 200/110 mm
Hg; pulse rate is 102 bpm, intense. Respiration rate is 32/min. Proteinuria +++. What medication
should be administered?
a. Pentaminum of 5% - 4,0 ml
b. Hexenalum of 1% - 2,0 ml
c. Papaverine hydrochloride of 2% - 4,0 ml
d. Magnesium sulfate 25% - 16,0 ml IV
e. Dibazolum (Bendazole hydrochloride) of 1% - 6,0 ml
Question 62
A 40 year old patient for a year has marked profuse menstruations, accompanied by cramping
pains in the lower abdomen. During the next menstruation, vaginal exam was performed: a mass
with a diameter of 5 cm, dense consistency was found in the cervix canal. The uterus is enlarged
like a 5-6 week pregnancy, usual consistency, mobile, painful. The appendages are not
determined. Discharge is bloody, profuse. What diagnosis can be assumed?
a. Algodismenorrhea
b. Born submucous fibromatous node
c. Cervical myoma
d. Cancer of the cervix uterus
e. Abort in course
Question 63
During the postpartum period the uterus undergoes the process of:
a. Growth
b. Subinvolution
c. No change happens
d. Involution
e. Atrophy
Question 64
A 46 year old patient is disturbed by frequent urination. Pathologies of the urinary system are not
revealed. Bimanual exam: the uterus is enlarged to a 14 week pregnancy, multiple myomatous
nodes are determined; on the anterior uterine wall - a node 8 cm in diameter is determined. The
appendages are not determined. Discharge is mucous, moderate. Data from the histological test
of the mucous of the cervical canal shows glandulo-fibrous polyp: the corpus uterus - polyposis of
the endometrium. Colposcopy revealed ectropion of the cervix. Treatment?
a. Supravaginal amputation of the uterus without the appendages.
b. Extirpation of the uterus with appendages.
c. Extirpation of the uterus without appendages.
d. Supravaginal amputation of the uterus with appendages.
e. Expanded extirpation of the uterus.
Question 65
A woman at 30 weeks pregnant has had an attack of eclampsia at home. On admission to the
maternity ward AP- 150/100 mm Hg. Estimateded fetal weight is 1500 g. There is face and shin
edema. Urine potein is 0,66 o/oo. Cervix is unripe, 2 points according Bishop's scale. An intensive
therapy has been started. What is the correct tactics of this case management?
a. Treat preeclampsia and achieve the delivery by way of conservative management
b. Continue therapy and prolong pregnancy for 3-4 weeks
c. Delivery by cesarean section
d. Labor induction by intravenous oxytocin or prostaglandins
e. Continue therapy and prolong pregnancy for 1-2 weeks
Question 66
A woman was delivered to the gynecological hospital with complaints of sharp pain in the lower
abdomen, increase in body temperature to 38°C, purulent discharge from the vagina. Sex life is
chaotic. During bimanual examination the uterine appendages are painful, purulent leucorrhoea.
What is needed to establish the diagnosis:
a. Bacteriological test of the discharge from the genital tract.
b. Hysterometry.
c. Curettage of the uterus mucous membrane.
d. Colposcopy.
e. Cytological test of the vaginal leucorrhoea.
Question 67
A 34 year old patient complains of painful menstruations, chropic pelvic pain, painful intercourse
and infertility during 8 years. Sperm count of a husband is without pathology. The doctor
suspected endometriosis. What method of examination would be the most informative in this
patient?
a. Ultrasonic examination of organs of small pelvis
b. Bimanual examination
c. MRI
d. Pap-smear
e. Laparoscopy
Question 68
Multipara with placenta previa is presented with vaginal bleeding. Total bloodloss – 700 ml, BP
100/60 mm, Ps – 100 in 1 min, pale skin. Determine the shock index:
a. 0.5
b. 2.0
c. 1.0
d. 1,5
e. 0.8
Question 69
A 40 year old patient complains of cramping pains in the lower abdomen and profuse bloody
discharge from the genital tract. For the past 2 years, menstruation has been 16 days, profuse,
with clots, painful. Bimanual examination showed a fibromatous node in the cervical canal with a
diameter of 3 cm, on a thin leg, retrieving into the uterine cavity. The uterus is little bit larger than
normal, dense, painless. The uterine appendages on both sides are not changed. Discharge is
bloody, moderate. Choose the correct tactics:
a. Supravaginal amputation of the uterus without the appendages.
b. Hormonal hemostasis.
c. Twisting the born node.
d. Extirpation of the uterus without the appendages.
e. Cyclic vitamin therapy
Question 70
A 38 year old woman arrived at the hospital with uterine bleed, intensive pain in the lower
abdomen. Examination showed: a myomatous node, with a leg that leaves the uterus cavity, is
located in the cervical canal; the uterus is spherical, the size of a 5 week pregnancy; the
appendages are not palpated. What is the plan of treatment?
a. Amputation of cervix uterus together with the node
b. Supravaginal amputation of the uterus
c. Extirpation of the uterus
d. Biopsy of the node
e. Removal of node with histological testing
Question 71
A 26 year old woman complains of infertility for 3 years. Anamnesis: menstruation since the age
of 14, painless, moderate. Cycle 4-5/28, regular. At the age of 16 years, she had an appendectomy.
Postcoital test and the husband’s sperm analysis were normal. According to the basal
temperature, the cycles are ovulatory, the lutein phase is 12-14 days. What diagnostic evaluation
will be the most informative in this case?:
a. Biopsy of the endometrium
b. Colposcopy
c. Hysterosalpingography
d. Hysteroscopy
e. Laparoscopy and chromosalpingoscopy
Question 72
Preterm rupture of the membranes is most strictly defined as spontaneous rupture at any time
prior to which of the following?
a. the 37th week of gestation
b. the 32nd week of gestation
c. the second stage of labor
d. the onset of labor
e. a stage of fetal viability.
Question 73
In what diameter of the pelvic plane is the sagittal suture of the fetal head positioned in case of
occipital posterior presentation , position I , after flexion of the head?
a. Left diagonal or transverse.
b. Right diagonal or transverse.
c. Right diagonal or direct.
d. Left diagonal or direct.
e. Direct
Question 74
47 year old woman complains of heavy long menstruations, which last 10-13 days, during the last
1.5 years. Objectively: obesity I degree. BP is 140/95 mm Hg, haemoglobin is 90 g/l, diabetes
mellitus type II. Bimanual examination did not reveal any pathology. Pap-smear is normal. USE of
pelvic organs did not reveal any specific pathology, endometrium is thickened due to presense of
blood and clots in uterine cavity. Determine the further tactics:
a. Combined oral contraceptives (COCs) prescription
b. Nonsteroid antiinflammatory drugs (NSADs) prescription
c. D&C (Dilation and curretage)
d. Progestins prescription
e. estrogen proscription
Question 75
You have delivered a 28-year-old woman (gravida 1, para 0). After 45 minutes, the patient has lost
1200 ml of blood. The uterus is very “boggy” and does not contract well. Pulse is 105 bpm, blood
pressure is 95/58, and oxygenation is 98%. Studies show a hemoglobin of 72 g/L with a
hematocrit of 22%, a platelet count of 95,000. What should be your next step?
a. perform laparotomy
b. recheck of the hematocrit
c. evaluate for HELLP syndrome
d. transfer 2 units packed cells and 2 units fresh frozen plasma
e. evaluate for von Willebrand’s disease
Question 76
Patient 24 y.o. delivered to hospital by ambulance with complaints about cramping abdominal
pain, heavy vaginal bleeding , weakness. BP 100/60 mm Hg.., pulse is 90 b.p.m.. Last normal
menstruation was 2 months ago. During examination of the cervix with speculum defined
remnants of embryonic tissue. Bimanual examination: uterus size is increased up to 6 weeks of
pregnancy, painless, uterine cervix is opened up to 2 cm. What is the most likely diagnosis?
a. Complete abortion
b. Incomplete abortion
c. Inevitable abortion
d. cervical abortion
e. dysfunctional uterine bleeding
Question 77
In 1 min after birth a child was pale and had arrhythmical breathing. Oxygen therapy didn’t have
any effect. Pulse was weak and rapid. It was difficult to measure arterial pressure accurately.
There were no edema. What is the most likely reason for these symptoms?
a. Congestive heart failure
b. Intrauterine sepsis
c. Intracranial haematoma
d. Asphyxia
e. Congenital pneumonia
Question 78
The safest, most precise, and simplest method of placental localization is which of the following?
a. radioisotope study
b. ultrasonography
c. abdominal palpation
d. auscultation
e. soft tissue X-ray
Question 79
A 23-year-old primigravida at 39 weeks gestation has been admitted to the maternity ward with
irregular painless contractions. The intensity of uterine contractions is not changing and weak, the
intervals between them stay long. Bimanual examination reveals that the cervix is centered, soft,
up to 1,5 cm long. There is no cervical dilatation. What diagnosis should be made?
a. Pregnancy I, 39 weeks, labor I, 1 period, the latent phase
b. Pregnancy I, 39 weeks, labor I, period 1, the active phase
c. Pregnancy I, 39 weeks, pathological preliminary period
d. Pregnancy I, 39 weeks, birth I, 1 period, the acceleration phase
e. Pregnancy I, 39 weeks, preliminary period
Question 80
A 20-year-old primigravida presents at 40 weeks. She has been healthy up to this point. She has a
headache and sight disturbances. Her face and hands are swollen, and she cannot wear her rings.
Her BP is 168/95 mm Hg, and she has 1+ protein. The fetus has a reassuring monitoring strip.
Which of the following is the best treatment for her preeclampsia?
a. magnesium sulfate
b. an antihypertensive drug that does not affect uterine blood flow
c. modified bed rest
d. gentle diuresis, with careful monitoring of intake and output
e. elivery either by cesarean or by vaginal
Question 81
A 23 year old woman complains of serous-purulent vaginal discharge, pain in the lower abdomen,
increase in body temperature at the end of menstruation. What is the most probable reason?
a. Gonorrhea.
b. Chlamydiosis.
c. Granuloma of the inguinal region.
d. Chancroid.
e. Gardnerelles
Question 81
Upon speculum examination in a pregnant woman, 30 y.o., was revealed a crimson spot of
anterior lip of cervix 1 cm in diameter, that doesn't color upon application of Lugol’s solution and
doen't bleed when touched. What further examination should a doctor prescribe?
a. No further examination needed
b. Colposcopy with biopsy
c. Pap-test according to screening schedule
d. Further examination is possible only after delivery
e. Loop excision of pathological area of cervix
Question 82
A parturient woman is 27 year old, it was her second labour, delivery was at full-term, normal
course. On the 3rd day of postpartum period body temperature is 36, 8oC, heart rate - 72/min, BP 120/80 mm Hg. Mammary glands are moderately swollen, nipples are clean. Abdomen is soft and
painless. Fundus of uterus is 3 fingers below the umbilicus. Lochia are bloody, moderate. What is
the most probable diagnosis?
a. Subinvolution of uterus
b. Lactostasis
c. Postpartum metroendometritis
d. Remnants of placental tissue after labour
e. Physiological course of postpartum period
Question 83
A 28 year old women came to the doctor at the female consultation with complaints of periodic
aching pains in the lower abdomen, low grade fever, night sweats, oligomenorrhea,
algodismenorrhea, infertility for 7 years. The woman has lost 7 kg. During bimanual examination:
the uterus is not enlarge, mobile, painless, the appendages are cord-like, painless. What tests
should be first to establish the diagnosis?
a. X-ray of the lungs
b. Hysterosalpingography
c. Urine inoculation
d. Inoculation of the menstrual blood three times during one menstruation
e. Analysis of the discharge
Question 84
A primagravida 30 y.o. adressed to the antenatal depatment. The gestational age according to the
last menstrual period is 20 weeks. From history revealed that she suffered from high fever SARS
in early pregnancy and took treatment (antibiotics, antipyretic drugs). During screening ultrasound
was diagnosed microcephaly. Identify tactics.
a. follow-up, ultrasound control after 1 month.
b. To do cordocentez.
c. It is necessary to do a biopsy of the placenta.
d. Abortion.
e. Hold amniocentesis.
Question 85
A 28-year-old primipara at labor ward complains of a headache, vision disorders. Objectively: AP
200/110 mm Hg, evident edema of legs and anterior abdominal wall. Fetal heartbeats is clear,
rhythmic, 190/min. Internal examination revealed complete cervical dilation, no amniotic sac, fetal
head is on the pelvic floor. What tactics of labor management should be chosen?
a. Cesarean section
b. Embryotomy
c. Forceps operation
d. Conservative labor management with episiotomy
e. Stimulation of labor activity
Question 86
During smears taking in a 30 year old pregnant woman, 16 weeks of pregnancy, a doctor noticed a
crimson spot of 1 cm in diameter on her cervix, which does not bleed when touched and stains
white on visual acetic inspection (VIA). Pap-test was taken 6 months before, without pathology.
What should be the further tactics?
a. No additional actions needed until 6 weeks after delivery
b. Cryotherapy immidiately
c. HPV testing
d. Pap-smear repeat
e. Colposcopy with target biopsy
Question 87
A 25 year old woman addressed the female consultation with complaints of infertility. She has
been married for 1 year and had not used contraceptives during this period. From the anamnesis
it is known, that she has been repeatedly treated in the gynecologic department for chronic
adenxitis and had no pregnancies. What diagnosis which better describes fertility status of the
patient?
a. Chronic adnexitis
b. Pelviperitonitis
c. Secondary infertility
d. Apoplexy of the ovary
e. Primary infertility
Question 88
A 26-year-old woman whose last menstrual period (LMP) was 2½ months ago develops bleeding,
uterine cramps, and passes tissue per vagina. Two hours later, she is still bleeding heavily. What is
the indicated procedure?
a. vaginal packing
b. compression of the hemorrhoids
c. uterine curettage
d. hysterectomy
e. intravenous (IV) fibrinogen
Question 89
During normal pregnancy a lowered hemoglobin is a physiologic finding. What is its major cause?
a. low iron stores
b. increased cardiac output resulting in greater red-cell destruction
c. increased plasma volume
d. decreased reticulocytosis
e. blood lost to the placenta and fetus
Question 90
A 46 year old woman addressed the doctor with the diagnosis myoma of the uterus. Menstrual
cycle has duration of 30-50 days, 7 days of profuse bleeding, border menstrual blood discharge.
What method of examination is not informative for determining the doctor’s tactics?
a. Intravenous pyelography
b. General blood analysis
c. Biopsy of the endometrium
d. Hysterosalpinogography
e. Ultrasound of the pelvis
Question 91
An onset of severe preeclampsia at 26 weeks gestation might be caused by:
a. Anencephaly
b. Twin gestation
c. Hydatidiform mole
d. Maternal renal disease
e. Interventricular defect of the fetus
Question 92
What is the implantation of a placenta in which there is a defect in the fibrinoid layer at the
implantation site, allowing the placental villi to invade and penetrate into but not through the
myometrium called?
a. placenta previa
b. placenta percreta
c. placental infarct
d. placenta increta
e. placenta accreta
Question 93
A 25 year old patient complains of an increase in leucorrhea discharge from the genital tract for
the last 2 months. From anamnesis, 2 years ago she had a baby; childbirth was complicated by a
rupture of cervix uterus. Examination in the mirrors: the cervix uterus has a cylindrical form. On
the anterior lip, there is an area of bright erosive surface. Upon touch, it does not bleed. Bimanual
examination - movement of the cervix uterus is not painful. The external os passes a finger tip.
The uterus has a normal size, mobile, painless. What is the possible diagnosis?
a. Leukoplakia
b. Erosion of the cervix uterus
c. Decubital ulcer
d. Polyp of the cervix uterus
e. Cancer of the cervix uterus
Question 94
A puerperant is 32 years old, it’s her first childbirth, term precipitous labor, the III period is
unremarkable, the uterus is contracted, tight. Examination of the birth canal revealed a rupture in
the left posterior vaginal wall that was closed with catgut. Two hours later, the patient complained
of a feeling of pressure on the anus, pain in the perineum, minor vaginal discharges, edema of the
vulva. These clinical presentations are indicative most likely of:
a. Vaginal hematoma
b. Hysterocervicorrhexis
c. Hypotonic bleeding
d. Hemorrhoids
e. Hysterorrhesis
Question 95
A 27 year old patient complains of irregular menstruation, infertility for 4 years. Obesity,
hypertrichosis. During bimanual examination: the uterus is small, the ovaries on both sides are
enlarged, firm. Discharge - leucorrhoea. Examination showed that the basal temperature is
monophase. What is the diagnosis?
a. Shiana syndrome
b. Polycystic ovarian syndrome
c. Genital tuberculosis
d. e. Simmonds syndrome
Question 96
A 36 year old women had a cytological test of a smear which showed that from the vaginal part of
the cervix uterus atypical cells were found along with colpitits. Colposcopic test and histologic
test of the scrape of the uterus mucous membrane and cervical canal did not reveal any
pathological changes. Determine the medical tactics:
a. Repeat the fractional diagnostic curettage of the uterus mucous membrane.
b. It does not demand additional supervision.
c. Anti-inflammatory therapy.
d. Conduct diathermo-coagulation of the cervix uterus.
e. Repeat the cytological test after anti-inflammatory therapy
Question 97
Normal amount of amniotic fluid in full-term pregnancy is
a. 2000-2300 ml.
b. 1600-2000 ml.
c. 500-600 ml.
d. 600-1500 ml.
e. 2000-2500 ml.
Question 98
A 23 year old patient complains of menstruation delays for 2-6 months, infertility. For the past
year she has considerably gained weight. Examination shows male type of hair growth on pubis
and hips; uterus is of normal sizes, ovaries are enlarged and dense, painless. Basal temperature is
monophase. What is the probable diagnosis?
a. Adrenogenital syndrome
b. Inflammation of uterine appendages
c. Gonadal dysgenesis
d. Polycystic ovarian syndrome
e. Itsenko-Cushing syndrome
Question 99
A 35 year old woman noticed that 6 months ago her menstrual cycle became disordered; menses
became profuse, with inter-menstrual smears of dark-bloody discharge. Two months ago the
doctor prescribed oral contraceptives. In the anamnesis - 5 pregnancies, of them 2 births, 3
medical abortions without complications. Choose the conducting tactics:
a. Supravaginal uterectomy.
b. Prescribing gestagen.
c. Fractional therapeutic-diagnostic curettage of the uterus mucous membrane.
d. Change the oral contraceptive.
e. Prescribing estrogen.
Question 100
In case of polyhydramnios, what is the volume of amniotic fluid:
a. 500-600 ml.
b. 600-1500 ml.
c. More than 1500 ml.
d. More than 2,000 ml.
e. More than 2500 ml.
Question 101
A 52 year old woman, suffering from obesity, complains of bloody discharge from the genital tract
for the last 4 days. The last normal menstruation was 2 years ago. The result of biopsy revealed
adenomatoid hyperplasia of endometrium. What is reason of development of the disease?
a. Excessive transformation of pre-androgen from fat tissue.
b. Excess amount of secretion of androgens by the cortex of the adrenal glands.
c. Secretion of estrogen by the organism’s cells.
d. Not enough aromatization of pre-androgens due to hypothyroidism.
e. Increased amount of follicle-stimulating hormone.
Question 102
A 24 year old woman, married, decided to conceive and stopped taking oral contraceptives. After
the last one, she had one menstruation and then for 2 months she has amenorrhea. With what
test should a doctor begin her examination?
a. Computer tomography of the head
b. Serum testosterone
c. Progesterone test
d. Ultrasound of the organs of small pelvis and mammary glands
e. HCG (human chorionic gonadotropin)
Question 103
A patient and her husband are extremely anxious about your suggestion that she be given
magnesium sulfate for seizure prophylaxis. In assuring her about the safety of the drug, you can
emphasize which of the following?
a. As a central nervous system (CNS) stimulant it should not deprive her of the awareness of her
delivery, unlike barbiturates
b. It is a mild smooth-muscle constrictor and thus safe for the infusion
c. The drug does not cross the placenta and thus should not affect her fetus/infant
d. The drug is rapidly excreted via the kidney
e. The drug has a narrow margin of safety so that we start off with a lower dose in preeclamptics,
and administer it by an IV pump
Question 104
A patient, 27 years old, has visited the maternity hospital with complaints of delay of menses for 5
months, sleepiness, increase the abdomen. General condition of the patient is satisfactory.
Extragenital diseases are absent. The fundus of the uterus is soft, painless during palpation and
situated near the umbilicus. Fetal movements feel good. What are the absolute simptoms of
pregnancy described in the case?
a. Fetal movements
b. Increase the uterus
c. Delay of menses
d. Increase the abdomen
e. Sleepiness
Question 105
A 29 year old woman arrived at the hospital with complaints of progressing strong pain in the
lower abdomen and vomiting for the past 2 days. She is sexually active, not married, has casual
sex and does not use contraceptives. Body temperature is 38,3°C. On examination tension of
anterior abdominal wall in the lower abdomen is marked. On vaginal examination multiple
purulent discharge from external os. On both sides of uterus there are sharply painful dense
immobile enlarged appendages. What additional method of examination are needed?
a. Laparoscopy
b. Ultrasonic examination of organs of small pelvis
c. Culture test
d. Hysteroscopy
e. Microflora test, culture test, USE
Question 106
Second gravida, in term 34 weeks of gestation during routine visit complained about dyspnoea
and a rapid increase in the abdomen's size. OBJECTIVLY: height of fundus of the uterus is 40 cm,
abdominal circumference is 102 cm. Presenting part is head, its movabale above the pelvic inlet,
fetal heartbeat is 132 b.p.m. During ultrasound examination was diagnosed polyhydramnion,
ascites and hydrothorax in the fetus, placenta is thick. Choose tactic of the pregnancy
management.
a. ECG
b. amniocentesis is necessary to do
c. Determine fetal biophysical profile
d. Determine blood flow in the vessels of the umbilical cord with dopplerometry
e. Labor induction
Question 107
A patient has entered spontaneous premature labor at 28 weeks’ gestation. During the vertex
delivery, one should do which of the following?
a. use prophylactic forceps
b. recommend epidural anesthesia to control delivery
c. perform an episiotomy
d. use vacuum extraction
e. allow spontaneous vaginal birth
Question 108
A woman complains of sharp pain in the abdomen, increase in body temperature to 38,0°С. She
knows about the presence of a hysteromyoma for 3 years. Symptoms of irritation of the
peritoneum are positive in the lower parts of the abdomen. Leukocytes 10,2 Т/l, ESR 28 mm/hour.
Bimanual examination: the corpus uterus is enlarge to the size of 8 - 9 week pregnancy, on the
anterior surface - sharply painful myomatous node 4 х 4 cm in size, the uterine appendages are
not changed. Ultrasound confirms the presence of subserous myomatous node. What diagnosis
is most probable?
a. Perimetritis.
b. Tuboovarian tumor.
c. Internal endometriosis.
d. Necrosis of the myomatous node.
e. Acute adnexitis
Question 109
A 24 year old women has not had menstruation for 4 months. She is not pregnant. Before her
menstrual cycle was regular. But since then, she has been playing sports intensively. Specify the
type of amenorrhea:
a. Hypergonadotropic amenorrhea.
b. Eugonadotropic amenorrhea.
c. Physiological amenorrhea.
d. Amenorrhea, caused by hyerandrogenia.
e. Hypogonadotric amenorrhea
Question 110
Postpartum discharge from the genital tract in women after physiological labor are bloody ,
microscopy has shown almost entirely amount of red blood cells. On which day of postpartum
period is present such a lohia?
a. Second.
b. Fourth.
c. Tenth.
d. Eighth.
e. Sixth.
Question 111
Patient 30 y.o. admitted to the gynecology department with complaints about recurrent pulling
abdominal pain, blood spotting from the genital tract. In the past had two spontaneous abortions.
Vaginal examination: cervix is up to 3 cm, cyanotic, the external oss is opened up to fingertip 's
size, uterus is soft, increased to 6-7 weeks of pregnancy, adnexes are not palpable, the fornix is
deep. Last menstruation was 2 months ago. Which method of examination could help to put an
accurate diagnosis?
a. pelvic ultrasound
b. Determine the contents of hCG in urine
c. Measurement of basal temperature
d. All of the above
e. Identify the 17 level in the urine ketosteroids
Question 112
A Secundipara was admitted to the maternity hospital in 6 hours after the beginning of labour.
Contractions last 30-35 seconds, occur every 4 minutes, with satisfaiA Secundipara was delivered
to the maternity hospital in 6 hours after the beginning of labour. Contractions last 30-35 seconds,
occur every 4 minutes, with satisfactory force. BP is 120/80 mm hg. Pulse is 80 b.p.m.,
rhythmical, of satisfactory properties. The fetal heart beat is 146 b.p.m. The fetal position is
longitudinal, head presentation, I position, anterior type of position. The small segment of the fetal
head is in the plane of the pelvic inlet. The contraction ring is 5 cm over the pubis. When the
internal obstetrical examination should be performed?ng force. BP is 120/80 mm hg. Pulse is 80
b.p.m., rhythmical, of satisfactory properties. The fetal heart beat is 146 b.p.m. The fetal position
is longitudinal, head presentation, I position, anterior type of position. The small segment of the
fetal head is in the plan of the pelvic inlet. The contraction ring is 5 cm over the pubis. When
should internal obstetrical examination be performed?
a. At the end of the I period of birth.
b. At the beginning of the II period of birth.
c. on admission and after rupture of amniotic membrane.
d. When transferred to the postnatal unit.
e. Every 2 hours
Question 113
A 18 year old women with infertility in her anamnesis came to the gynecologist to be examined for
clamidiosis. The patient’s sexual partner recently finished treatments for clamidiosis. Appoint "the
gold standard" in the diagnostics of urinogenital chlamydiosis:
a. Serological.
b. Cytological.
c. Cultural.
d. Polymerase chain reaction.
e. Immune-enzyme analysis
Question 114
A 28 year old patient came to the gynecologic department with complaints of infertility during 2
years. Anamnesis: 3 artificial abortions, normal menstrual cycle. Husband spermogram is normal.
Which test should be appointed first?
a. Test with clomifen citrate
b. Laparoscopy
c. Course of hydrotubation
d. Metrosalpingography
e. Insemination of sperm of a donor
Question 115
A friend mentions to you she just had a positive pregnancy test and wonders if you can tell her
when she is likely due. The LMP was June 30. Her expected date of labor is approximately which
of the following?
a. March 7
b. March 28
c. April 7
d. April 23
e. March 23
Question 116
A woman, 30 y.o., addressed a gynecologist with complaints of plentiful menstruations during the
last 6 months. During the last year she was trying to conceive with no success. On speculum
examination a doctor revealed a polyp growing from cervical channel. On colposcopy a doctor
was unable to locate the peduncle of a polyp. Pap-test 6 months ago was without pathology. What
is the optimal further tactics?
a. USE to reveal peduncle of a polyp, hysteroscopy
b. Polypectomy immidiately
c. Observation, repeat Pap-test in 6 months
d. No action needed, repeat speculum examination in 3 months
e. Dilation and curretage of endocervix and endometrium
Question 117
A crimson spot the sizes of 1 cm, which does not stain with Lugol’s solution, at touch does not
bleed, was found on the cervix uterus in a 30 year old pregnant women. What additional test is
indicated?
a. Testing is not indicated
b. Biopsy
c. Diagnostic excision of the cervix uterus
d. Testing is possible only after delivery
e. Colposcopy
Question 118
A 43 year old patient complains of constant dull pain in the lower abdomen, more to the left,
increase in body temperature to 38°C. For the past 5 years she has been observed for subserous
fibromyoma of the uterus. Bimanual examination: the uterus is enlarged like a 10 week pregnancy,
dense, tubercular. At the left of the uterus, a mass which comes out of the uterus, with sizes 6 х 8
cm, elastic consistency, sharply painful is determined during palpation. The appendages on both
sides are without features. What is the possible diagnosis?
a. Necrosis of a fibromatous node
b. Pyosalpinx
c. Suppurative cyst of the left ovary
d. Uterine sarcoma
e. Extra-uterine pregnancy
Question 118
A 24 year old patient complains of amenorrhea. She had labor 13 months ago. Delivery was by
cesarian section due to premature detachment of a normally located placenta and intrauterine
asphyxia of the fetus. Labor was complicated with a massive blood loss of approximately 2000
ml due to coagulopathy. What test is indicated in this patient?
a. Progesterone test
b. Computer tomography of the head
c. Testosterone blood test
d. Ultrasound of the organs of the small pelvis
e. Gonadotropins test
Question 119
Primipara, 20 years old, is in the beginning of the I period of physiological labor. Contractions are
weak , last 15-20 sec., occur every 10-15 min. Fetal palpitation has done, no features. How much
should the cervix be opened for the amniotic discharge to be timely?
a. 2-4.
b. 8-10.
c. 1,5-2.
d. 6-8.
e. 4-6
Question 120
A 36 year old patient came to the female consultation with complaints of increased irritability,
tearfulness, headache, palpitation, edema of the hands and feet, decreased urination,
engorgement of the mammary glands. These symptoms occur and gradually increase some days
before menstruation and disappear at the beginning of menstruation. The menstruation cycle is
not dysfunctional. The listed complaints began last year. What is the diagnosis?
a. Shihana syndrome (postnatal hypopituitarism)
b. Climacteric syndrome
c. Adrenogenital syndrome
d. Premenstrual syndrome
e. Stein-Leventhal syndrome
Question 120
A 27 year old patient for 5 years has been treated for chronic adnexitis; she arrived at
gynecological ward with signs of pelviperitonitis. The husband has chronic urethritis. What tests
are needed to determine causative agents of the condition?
a. Examiation of a husband by urologist
b. Bacterioscopic test (microflora smear)
c. Culture test of vaginal discharge
d. Culture test after provocation
e. Culture test, PCR for chlamydia and gonococcus
Question 121
You are taking care of a 29-year-old primigravida with an uncomplicated history, having a
postpartum hemorrhage. The placenta delivered spontaneously and intact. Labor was 9 hours
and 45 minutes and was unremarkable. There are no obvious lacerations. The infant weighed
4400 g. What is your next best step of management?
a. ultrasound for retained placental parts
b. add oxytocin to her IV solution
c. order coagulation studies
d. blood transfusion
e. uterine curettage with a large “banjo” curette
Question 122
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 3100g. 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, 8oC. There is a significant
increase in hCG concentration in the urine. What is the likely diagnosis?
a. Uterine fibromyoma
b. Pregnancy
c. Hydatidiform mole
d. Endometritis
e. Uterine chorionepithelioma
Question 122
A 26-year-old woman whose last menstrual period (LMP) was 2½ months ago develops bleeding,
uterine cramps, and passes tissue per vagina. Two hours later, she is still bleeding heavily. What is
the most likely diagnosis?
a. incomplete abortion
b. threatened abortion
c. inevitable abortion
d. premature labor
e. twin pregnancy
Question 123
An unconscious obstetric patient is admitted to the emergency department in the eighth month of
pregnancy with a BP of 60/20 mm Hg and a pulse of 120 per minute. If there has been no vaginal
bleeding, which diagnosis may be excluded?
a. amniotic fluid embolism
b. abruptio placentae
c. premature rupture of membranes with septic shock
d. eclampsia
e. placenta previa
Question 124
A 20 year old patient complains of delay in menses for 10 days. Menstrual dysfunction is marked
for the first time. Sex life is regular, and no pregnancy has occurred. During examination: condition
is satisfactory, stomach is soft, painless, BP is 120/80 mm hg, pulse is 72 bpm, of satisfactory
properties. During transvaginal echography a progressing tubal pregnancy was suspected. What is
the correct tactics of the doctor at the female consultation?
a. Give a medical certificate and direct the patient to determine the titer of CG in the blood or
urine. Recommend another visit to the female consultation after receiving results from the exams.
b. Urgent hospitalization of the patient for specification of the diagnosis and deciding treatment
tactics.
c. Recommend another visit in a week for a control ultrasound.
d. Conduct tests of functional diagnostics.
e. Perform a puncture of the abdominal cavity through the posterior vaginal fornix
Question 124
A 26 year old woman was delivered to the hospital with complaints of a sudden pain in the lower
part of the abdomen, weakness, loss of consciousness at the house. Last menses was 2 months
ago. Hb 106 gr/l, pulse 120 b.p.m., BP 80/50 mm hg. Morbidity and symptoms of irritation of the
peritoneum are positive in the lower right area. What diagnosis is most probable?
a. Acute appendicitis.
b. Acute adnexitis.
c. Torsion of the leg of a cyst of an ovary.
d. Ruptured tubal pregnancy.
e. Apoplexy of an ovary.
Question 125
In the early postpartum period the fundus of the uterus is determined :
a. At the navel level.
b. At 4 cm above the navel.
c. Middle between the navel and the pubic symphysis.
d. 7.5 cm above the pubic symphysis.
e. The uterine fundus is not palpable through the anterior abdominal wall.
Question 126
The postpartum nurse calls about a patient who had an uncomplicated vaginal delivery 12 hours
ago. She is concerned that the patient has the following findings. Which of them should be of
most concern to you?
a. a single temperature of 38,0°С
b. a pulse rate of 60
c. abdominal rigidity
d. proteinuria
e. leukocytosis of 16,000
Question 127
A 34 year old patient has the diagnosis of primary infertility for 7 years. The basal temperature is
single-phase and diphasic cycles with the second phase shortened to 4-5 days. During
hysterosalpingography, uterine tubes are filled with contrast substance up to the ampular part,
there is no traces of contrast in the abdominal cavity. During a spermogram of the husband,
astenooligozoospermia of the second degree was revealed. After treatment of the husband with
andrologist, astenozoospermia still remains. What is the most rational way of infertility treatment
in this case?
a. Artificial insemination of donor sperm
b. Extracorporal fertilization with the transfer of the embryo
c. No treatment is needed
d. Appointing stimulators of ovulation in combination with medical hydrotubation
e. Microsurgical plastic of the uterine tubes
Question 127
A 32-year-old G2P1 presents to labor and delivery at 35 weeks of gestation, complaining of
regular uterine contractions about every 5 min for the past several hours. She has also noticed the
passage of a clear fluid per vagina. The external fetal monitor demonstrates a reactive fetal heart
rate tracing, with regular uterine contractions occurring about every 3 to 4 min. On sterile
speculum exam, the cervix is visually closed. A sample of pooled amniotic fluid seen in the
vaginal vault is fern and nitrazine-positive. The patient has a temperature of 38,2°C, PR - 102, WBC
of 19,000. You perform a bedside sonogram, which indicates oligohydramnios and a fetus whose
size is appropriate for gestational age and with a cephalic presentation. What is the next
appropriate step in the management of this patient?
a. Perform emergent cesarean section
b. Administer tocolytics
c. Administer antibiotics
d. Administer betamethasone
e. Place a cervical cerclage
Question 128
Which of the following is NOT a presumptive symptom/sign of pregnancy?
a. quickening
b. cessation of menses
c. darkening of the skin on the palms of the hands
d. breast changes
e. nausea and vomiting
Question 129
A full term baby born from the 1st noniventful pregnancy with complicated labor was diagnosed
with cephalohematoma. On the 2nd day of life the child developed jaundice; on the 3rd day of life
there appeared neurological changes: nystagmus, Graefe syndrome. Urine is yellow, feces are
goldenyellow. The mother’s blood group is А (II) Rh−, the child’s - А (II) Rh+. On the 3rd day the
results of the child’s blood test are as follows: Hb- 200 g/l, erythrocytes - 6, 1 · 1012/l, blood
bilirubin - 58 mcmol/l due to the presence of its unconjugated fraction, Ht- 0,57. In this case the
jaundice is caused by:
a. Physiologic jaundice
b. Fetal hepatitis
c. Hemolytic disease of newborn
d. Cephalohematoma
e. Atresia of bile passages
Question 130
These functional condition of the baby at birth: the heartbeat is clear, 136 b.p.m., the newborn can
breath by it own , but does not cry, the face and body are pink, extremities are blue, there are actve
movements , during the stimulation of the soles, the child bends the legs, there was a grimace on
the face and began to cry loudly. Evaluate the condition of the baby according to the Apgar score:
a. 6 points.
b. 9 points.
c. 8 points.
d. 5 points.
Question 130
A 28 year old woman complains of watery discharge from the vagina with a fetid fish smell.
Microscopy of the discharge from the genital tract found key cells. Amine test is positive. What is
your diagnosis?
a. Clamidiosis.
b. Gonorrhea.
c. Candidiasis.
d. Bacterial vaginosis.
e. Trichomoniasis
Question 131
A woman who uses an intrauterine contraceptive has a tubal-ovarian abscess. What causative
agent is the most probable?
a. Streptococcus.
b. Ray fungus.
c. Gonococcus.
d. Chlamydia.
e. Mycoplasma.
Question 131
You are examining a term patient in the labor and delivery (L&D) suite. Which of the following
signs and symptoms is most likely to indicate ruptured membranes?
a. ferning on a specimen from the vaginal pool
b. vaginal pool pH of 4.5
c. copious leakage on pants or underwear
d. superficial squamous cells in the vaginal pool
e. yellow-green color on nitrazine test
Question 132
A woman addressed a gynecologist on the 20th day of puerperal period with complaints of pain in
the left mammary gland, purulent discharge from the nipple. Objectively: Ps- 120/min., body
temperature is 39oC. The left mammary gland is painful, larger than the right one, the skin is
hyperemic; in the upper quadrant there is an infiltrate 10x15 cm in size with soft center. Blood test:
SR- 50 mm/hour, leukocytes - 15,0 · 109/l. What would be the treatment tactics?
a. Transfer to a surgical department for surgical treatment
b. Refer to a postnatal department
c. Refer to a surgeon for conservative treatment
d. Lance the mammary gland abscess in a maternity department
e. Refer to a gynecology department
Question 133
А 25 year old patient addressed the doctor with complaints of long painful menses, with long
premenstrual discharge, infertility for 5 years. Examination of the cervix uterus in the mirrors inclusions like "eyes". What is the preliminary diagnosis?
a. Menstrual dysfunction
b. Endometriosis
c. Cancer of the cervix uterus
d. Polyp of the cervical canal
e. Erosion of the cervix uterus
Question 134
The physiological features of the first day of puerperal period is not:
a. The case of intestine.
b. Fever about 38-39˚C
c. Atony bladder.
d. Lability pulse.
e. Reducing body weight.
Question 135
A 30 year old patient complains of the absence of menses for 2 years after birth. Childbirth was
complicated by massive bleeding. After birth the patient noted hair losses, weight loss. Bimanual
examination shows that the corpus uterus is small, the pudendal lips are hypoplastic. Specify the
etiology factor of the complication:
a. Hereditary factor.
b. Prolonged stimulation of ovulation.
c. Age involution of the hypothalamic structures
d. Single dysfunction of the ovaries.
e. Necrotic changes in the adenohypophysis due to hemorrhagic shock during birth
Question 136
Primipara gave birth to a live mature baby boy with an estimation by the Apgar score is 9
points. At the present moment, the umbilical cord vessels are not pulsating, the umbilical cord
was cut. Bloody discharge from the genital tract are absent. Specify the period of birth:
a. Early postnatal period.
b. Expulsion of fetus.
c. Opening.
d. Late postnatal period.
e. Placental stage.
Question 137
A 38 year old patient for 3 years complains of painful menses, spotting of bloody discharge with a
brown colour before and after menses. In the anamnesis: 5 artificial abortions. During
examination, the uterus has a soft consistency, painful, a little enlarged, limited in mobility.
Ultrasound showed that the myometrium is granular, cystic. What is the diagnosis?
a. Hysteromyoma.
b. Poliposis of the endometrium.
c. adenomyosis.
d. Endometritis.
e. Dysfunctional uterine bleeding.
Question 138
A 29 year old patient was admitted by emergency car to gynecological ward due suspicion of
acute adnexitis. What examination method should be perform primarily upon arrival of a patient?
a. Bimanual examination
b. Culture test
c. Ultrasound examination
d. Pap-smear, colposcopy
e. Blood count and urinalisys
Question 139
Multipara is in the 1st stage of labor for 7 hours. Contractions last 25 sec , occur every 5-6 min,
they are painful and spread from lower segment upwards. . Auscultation of the fetus is clear,
rhythmical, 160 b.p.m. During internal obstetric examination was found out that uterine cervix is 1
cm long, opened up to 3 cm. Head of the fetus is above the entrance of the small pelvis. What is
likely complication of labor?
a. Strong labor activity
b. Discoordination of labor activity
c. Distocia of uetrine cervix
d. Threaten hysterorrhesis
e. Uterine inertia
Question 139
The most efficacious treatment of persistent uterine hemorrhage in the second to fourth week of
the puerperium is which of the following?
a. oxytocin
b. high doses of estrogen
c. dilation and curettage (D&C)
d. high doses of progesterone
e. uterine packing
Question 140
A premature birth has been defined as a fetus born
a. weighing more than 1000 g but less than 2500 g
b. before 37 weeks’ gestation
c. weighing less than 1000 g
d. prior to the period of viability
e. none of the above
Question 141
A 30 year old patient has primary infertility for 7 years. Menses since the age of 14, for 5-7 days,
every 35-45 days, moderate, painless. The woman is obese. The external genitals are developed
correctly, hair distribution by the female type, the corpus uterus is small in size, the ovaries on
both sides are 3x4x4 cm, dense, mobile, painless. According to the results of functional
diagnostics tests, basal temperature is monophase, the cariopicnotic index is 60-70%. The
husband’s spermogram is without pathological changes. What is the most probable diagnosis?
a. Bilateral dermoid ovarian cysts
b. Infertility of unknown geneses
c. Polycystic ovarian syndrome
d. Tuberculosis of the genitals
e. Genital infantilism
Question 142
A 20-year-old woman (gravida 1) has just delivered. After expression of the placenta, a red, raw
surface is seen at the vaginal introitus. Simultaneously, the nurse states that the patient is pale
and her BP is 70/40 mm Hg. External bleeding has been of normal amount. Which of the following
would be the most likely diagnosis?
a. ruptured uterus
b. uterine inversion
c. ovarian cyst
d. vaginal rupture
e. second twin
Question 143
A 25 year old woman addressed a gynecologist for routine examination. She has no complaints.
She has her gynecological check-ups regularly, yearly. Gynecological anamnesis is without
specifics. She is married, uses condoms for contraception. On examination and ultrasound no
pathology was found. What other test is necessary to perform whithin her check-up?
a. HIV test
b. Microflora test, vaginal culture test, Pap-smear
c. Pap-test
d. USE of mammary glands
e. PCR for chlamydia, trichomonas and gonococcus
Question 143
Primagravida at term of gestation 5-6 weeks. There was spontaneous abortion at home. Vaginal
examination: external genitalia are developed , female type, with no signs of inflammation, free
vagina, cervix is formed, the cervical canal is opened up to 1 cm, uterus is firm, painless, enlarged.
Adnexes are not palpable. What is the most likely diagnosis?
a. Cervical pregnancy
b. incomplete abortion
c. Threatened abortion
d. inevitable abortion
e. Complete abortion
Question 144
A 45 year old patient addressed the female consultation with complaints of moderate bloody
discharge from the genital tract, which appeared after a delay in menstruation for 1,5 months.
Gynecological exam: the cervix is epithelized, the "pupil" symptom (++), the uterus is not enlarged,
dense, mobile, painless; the appendages on both sides are not enlarged, painless, the fornix is
deep. What are the tactics of the doctor at the female consultation?
a. Refer the patient to an ultrasound of the pelvic organs; if there are no pathological changes,
prescribe hormonal hemostasis.
b. Refer the patient to the gynecologic hospital.
c. Cytological test of the aspirate from the uterine cavity, refer the patient to an oncologist. d.
Register the patient for dispensary observation, prescribe hemostatic and uterotonic means. e.
Perform hormonal hemostasis under the supervision of a doctor at the female consultation, in
case of no effect - planned hospitalization.
Question 145
A 25 year old patient complains of pain in right iliac area for 10-12 days. A delay in menses for 7-8
weeks. During palpation pain occurs in right iliac area. Gynecological exam: uterus and ovaries
are not enlarged, pain in the right vaginal fornix. Discharge from the genital tract is mucous,
moderate. What is the optimal method of examination:
a. Ultrasound of the organs of the small pelvis.
b. Hysteroscopy.
c. Curettage of the uterus mucous membrane.
d. Bacteriological inoculation of the vaginal discharge.
e. X-ray of the organs of the small pelvis
Question 146
A 19-year-old woman without prenatal care (gravida 1, para 0) in the third trimester of pregnancy
arrives in the emergency department. She has presented because of headache and visual change.
While being examined, she had a convulsion. You should do which of the following while waiting
for the magnesium sulfate bolus?
a. obtain a chest film
b. protect the patient from self-harm
c. obtain an ultrasound to rule out molar pregnancy
d. prepare to perform an emergency cesarean delivery
e. give intravenous (IV) phenytoin
Question 147
Pregnant 29 y.o. admitted to hospital with labor activities. Full-term pregnancy, polyhydramnion is
diagnosted, amniotic fluid is clear. Circumference of the abdomen is 114 cm, height of uterine
fundus is 31 cm. The uterus is tense, determined symptom fluctuations. Presenting part is head
pressed to the pelvic inlet with a small segment. Fetal heartbeat is muted, rhythmic, 140 b.p.m.
What is the plan of delivery:
a. labor per vias naturalis.
b. Caesarean section.
c. Early amniotomy , slow discharge of amniotic fluid. Prevention weakness of labor and delivery
and postpartum bleeding
d. Labor induction
e. Medication dream vacation
Question 147
Newborn girls had mild blood disscharge from the genital tract. What is the most likely reason?
a. Congenital malformation.
b. Vulva injury.
c. Inflammatory process.
d. The usual reaction.
e. Hormonal crises
Question 148
A 32-year-old G2P1 female presents for routine prenatal visit at 36 weeks’ EGA. You note a 3,5-kg
weight gain in the last 2 weeks? Which of the following should be your first priority?
a. place her on bed rest
b. encourage vigorous exercise
c. assess for signs and symptoms of preeclampsia
d. give the patient diuretics
e. markedly restrict her diet
Question 148
On her first prenatal visit, a 17-year-old single woman (gravida 1, para 0), 32 weeks by good dates,
is found to have vital signs as follows: BP135/85; Ps-84; T-36,6°C; and RR-20. She also has ankle
and hand edema and a uterine fundus measuring 42 cm with breech concordant twins on
ultrasound. She has normal pelvic measurements and the cervix is closed and soft, with the
presenting part at station −1. Her UA revealed no WBCs or bacteria with 2+ protein. Her
hematocrit is 38, and her WBC count is 9800. The next step in care of this patient should include
which of the following?
a. antihypertensive drugs
b. cesarean section because of the twins
c. hospitalization with bed rest and frequent vital signs
d. trial of home bed rest for 24 hours, with repeat evaluation at that time
e. oxytocin induction of labor
Question 149
On the 1st day of life a full-term girl (2nd labour) weighing 3500g, with Apgar score of 8 points,
presented with jaundice. Indirect bilirubin of blood - was 80 micromole/ l, 6 hours later - 160
micromole/l. What is the optimal method of treatment?
a. Enterosorbents
b. Infusion therapy
c. Phototherapy
d. Phenobarbital treatment
e. Exchange blood transfusion
Question 149
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 39oC, headache, indisposition.
Objectively: fissure of nipple, enlargement of the left mammary gland, pain on palpation. What
pathology would you think about in this case?
a. Lacteal cyst with suppuration
b. Lactational mastitis
c. Breast cancer
d. Fibrous adenoma of the left mammary gland
e. Phlegmon of mammary gland
Question 150
A 24 year old woman addressed adoctor with complaints of irregular menstruations. In the past
she l cycle. The level of prolactin in the blood is increased. What is the most informative method
of testing?
a. Determine the level of thyrotrophic hormone.
b. Determine the level of gonadotropin.
c. Determine the level of prolactin in the blood.
d. Progesterone test.
e. Determine of level of testosterone in the blood
Question 151
An infant has been born at 38 weeks of gestation. The pregnancy was complicated with severe
gestosis of the second semester. The weight of the baby is 2400 g, the height is 50 cm.
Objectively: the skin is flabby, the layer of subcutaneous fat is thin, hypomyotonia, neonatal
reflexes are weak. The internal organs are without pathologic changes. This newborn can be
estimated as a:
a. Full-term infant with normal body weight
b. Premature infant
c. Full-term infant with prenatal growth retardation
d. Postmature infant
e. Immature infant
Question 152
A 30 year old patient has primary infertility for 7 years. Menses since the age of 14, for 5-7 days,
every 35-45 days, moderate, painless. The woman is obese. The external genitals are developed
correctly, hair distribution by the female type, the corpus uterus is small in size, the ovaries on
both sides are 3x4x4 cm, dense, mobile, painless. According to the results of functional
diagnostics tests, basal temperature is monophase, the cariopicnotic index is 60-70 %. The
husband’s spermogram is without pathological changes. What is the most appropriate treatment?
a. Cyclic hormonal therapy for 6-12 months
b. Bilateral cone resection of the ovaries with subsequent hormonal therapy
c. Extracorporal fertilization
d. Laparotomy, bilateral resection of the ovaries
e. Antibacterial therapy from the group of rifampicin and immunomodulators
Question 153
Patients with severe preeclampsia, when compared with pregnant women without
preeclampsia, will have a decrease in which of the following?
a. serum liver ferments
b. total body sodium
c. uric acid
d. plasma volume
e. response to pressor amines
Question 154
The purpose of the first manoeuvres according to Leopold.
a. Determine the position of the fetal head in the pelvic planes
b. The first manoeuvre to determine the level of the presenting part.
c. The first manoeuvre demonstrates which of the fetal poles is in the uterine fundus.
d. The first manoeuvre is used to identify the back and smaller parts of the foetus. e.
The first manoeuvre is designed to identify the presenting part.
Question 155
A 19-year old primа gravida is in the gestational term of 25-26 weeks. Objective: the skin and
visible mucous have usual color. ABP is 115/70 mmHg, pulse is 108 beats/min, does not vary
during her sleeping, functional systolic murmur is auscultated. Borders of the heart are not
modified, in ECG there is a vertical position of electrical axis of heart, sinus tachycardia, slight
hypertrophy of the myocardium of the left ventricle. Clinical analysis of the blood and urine
are
without pathological variations. What is the most probable cause of the condition of pregnant
women?
a. Congenital heart disease.
b. Aquired heart disease.
c. Adaptation to pregnancy
d. Active phase of the rheumatic process.
e. Disease of the thyroid gland.
Question 156
The purpose of the second manoeuvres according to Leopold.
a. The second manoeuvre demonstrates which of the foetal parts is in the uterine fundus.
b. Determine the position of the fetal head in the pelvic planes
c. The second manoeuvre to determine the level of the presenting part.
d. The second manoeuvre is designed to identify the presenting part.
e. The second manoeuvre is used to identify the back and smaller parts of the fetus.
Question 156
A 27 year old patient for 5 years has been treated for chronic adnexitis; she arrived at the
gynecological ward with signs of pelviperitonitis. The husband has chronic urethritis. What tests
should be prescribed for diagnostics of the causative agent of the disease?
a. Clinical blood analysis, bacterial inoculation of the blood
b. Puncture of the abdominal cavity through the back vaginal fornix, bacterial inoculation of the
puncture sample for gonococcus.
c. Bacteriological test after provocation
d. Bacteriological test of the vaginal contents
e. Bacterioscopic test of the vaginal contents
Question 157
A Primipara overall length of labor is 10 hours and 15 minutes. She gave birth to alive mature baby
girl weighing 3200 g, length 51 cm. The skin of a newborn is pink, cyanotic hands and feet,
shouting loud, adequate breaths, reflexes alive, active movements. The heartbeat: 130 b.p.m.,
rhythmical. After 5 minutes, has turned pink of the extremities skin, were sucking motions, the
child is attached to his chest.However, neonatologists appreciate newborn Apgar score:
a. 6 - 7 points.
b. 9 - 9 points.
c. 9 - 10 points.
d. 7 - 8 points.
e. 8 - 9 points.
Question 157
A 28 year old woman arrived at the gynecological ward with complaints of pain in the lower
abdomen to the left and a small amount of bloody discharge for the last 2 days. In the anamnesis
- ІІ births. Last menstruation - 6 weeks ago. Dysfunctions of the menstrual cycle before this time
were not noticed. She protected from pregnancy with the help of intrauterine contraceptive. BP
upon arrival was 110/70 mm hg, hemoglobin 124 gr/l. What test method is most informative?
a. Transvaginal echography.
b. Determining the level of chorionic gonadotropin in the urine.
c. X-ray of the ephippium.
d. Diagnostic curettage of the uterus mucous membrane.
e. Functional diagnostic test.
Question 157
A 25 y.o. pregnant woman in her 34th week was delivered to the maternity house with complaints
of headache, visual disorders, nausea. Objectively: generalized edema, AP-170/130 mm Hg.
Suddenly there appeared fibrillary tremor of face muscles, tonic and clonic convulsions, breathing
came to a stop. After 1,5 minute the breathing recovered, there appeared some bloody spume
from her mouth. In urine: protein - 3,5 g/L. What is the most probable diagnosis?
a. Cerebral hemorrhage
b. Eclampsia
c. Epilepsy
d. Stomach ulcer
e. Cerebral edema
Question 158
A 36 year old woman went to the doctor for her annual Pap-smear. Besides that the patient
complains of plentiful whitish discharge from vagina with fishy smell. The doctor took Pap-test
and microflora test. Analysis revealed multiple leukocytes and mixed flora in cervix and vagina.
Pap-test result is ASC-US (atypical squamous cells of undetermined significance). What should be
the further tactics in this patient?
a. HPV test
b. Cryotherapy of cervix
c. Colposcopy
d. Targeted antibacterial treatment, after cryotherapy
e. Targeted antibacterial treatment, 3 months after repeat Pap-test
Question 159
A 30-year-old gravida consulted a gynecologist about bright red bloody discharges from the
vagina in the 32 week of gestation. She was hospitalized with a suspicion of placenta previa.
Under what conditions is it rational to perform the internal examination in order to make a
diagnosis?
a. In the delivery room keeping to all the aseptics regulations
b. In the admission ward of maternity hospital
c. In the operating room prepared for the operation
d. In the examination room of antenatal clinic
e. The examination is not to be conducted because of risk of profuse haemorrhage
Question 160
Primagravida admitted to the gynecology department with complaints about recurrent abdominal
pain and moderatevaginal bleeding . Vaginal examination: cervix length is 2.5 cm, it is cyanotic,
the external oss is opened up to 1 cm, uterus is soft, the size of uterus is increased up to 6 -7
weeks of pregnancy, ovaries are not defined, the fornix of vagina are free. The futher managment?
a. To prescribe hormone therapy and spasmolitic
b. Assign uterotonic therapy
c. To appoint sedative therapy
d. Dilation and curettage (D&C)
e. Assign antibacterial therapy
Question 161
A 22 year old woman was hospitalized in the gynecological department with complaints of pain in
the lower abdomen, an increase in body temperature to 39,5°С. Objectively: pulse is 108 bpm, BP
is 120/80 mm hg. The stomach is bloated, sharply painful in the hypogastria area. Shetkin Blumberg symptom is positive in the hypogastria area. Vaginal examination: the uterus and
appendages are not palpated due tension of the anterior abdominal wall, the posterior vaginal
fornix hangs, is sharply painful. What is the most probable diagnosis?
a. Extra-uterine pregnancy.
b. Acute endometritis.
c. Acute adnexitis.
d. Pelviperitonitis.
e. Apoplexy of the ovary
Question 162
A 28 year old patient complains of the absence of menstruation, hair growth on the face and
extremities. Married. Menses since the age of 14, poor; two years ago it stopped. Objectively:
height - 160 cm, weight - 65 kg. Constitution - female type. The skin has a usual color and
moisture. Hair growth is man's type: on the face in the area of sideburns, on the upper lip, chin,
forearms, hips, shins, between the navel and pubis. The external genitals have a normal structure.
The uterus has usual sizes, the ovaries during palpation are a little enlarged. What is the
diagnosis?
a. Adreno-genital syndrome.
b. Stein-Leventhal syndrome.
c. Itsenko-Cushing disease.
d. Androsteroma.
e. Cortico-androsteroma
Question 163
A patient calls your clinic complaining of continued heavy vaginal bleeding. She had an
“uncomplicated” vaginal birth 2 weeks ago of her second child. What is the most likely diagnosis
from the following differentials?
a. coagulopathies
b. uterine atony
c. uterine rupture
d. retained placental fragments
e. vaginal lacerations
Question 164
A 35-year-old married woman (gravida 4, para 3, abortus 0), who now is at approximately 36
weeks’ gestation, developed copious, painless, vaginal bleeding 2 hours prior to admission. On
examination, the uterus appears soft and nontender. FHTs are 140 and regular, the vertex is
floating, and there is no evident bleeding or signs of ruptured membranes. Maternal vital signs are
stable. What is the most likely diagnosis?
a. placenta previa
b. abruptio placentae
c. carcinoma of the cervix
d. hematuria
e. vasa previa
Question 165
A healthy 30-year-old primigravida presents at 34 weeks’ gestation. She reports that she has been
experiencing abdominal discomfort that increases after eating, especially when in the recumbent
position. A series of tests is performed. She has normal vital signs, an unremarkable examination,
a fundal height of 33 cm, and a negative urinalysis. Which one of the following represents
abnormal test results?
a. serum albumin of 35 g/L
b. serum creatinine level of 80 mmol/L
c. alkaline phosphatase double that of the reference range
d. WBC count of 11, 000/mL
e. hemoglobin of 90 g/L
Question 165
A 18-year-old girl with normal development of secondary sexual characters complains of primary
amenorrhea. Examination revealed that vagina is underdeveloped, uterus is absent. Specify the
type of amenorrhea:
a. Hypergonadotropic amenorrhea
b. Hypogonadotric amenorrhea
c. Amenorrhea caused by hyperandrogenism
d. Eugonadotropic amenorrhea
e. Physiological amenorrhea
Question 166
The purpose of the fourth manoeuvre according to Leopold.
a. The fourth manoeuvre is used to identify the back and smaller parts of the fetus.
b. Determine the position of the fetal head in the pelvic planes
c. The fourth manoeuvre demonstrates which of the fetal parts is in the uterine fundus.
d. The fourth manoeuvre is aimed to determine the level of the presenting part. e. The
fourth manoeuvre is designed to identify the presenting part
Question 167
A 35 year old women, who is not married, came to the gynecologist with complaints of the
occurrence of purulent discharge, frequent desires to urinate, pain during urination and an itch in
area of the urethra which occurred 5 day after casual sexual contact. Objectively: the labia of the
urethra are hyperemic, edematic, purulent discharge from the urethra. What is the preliminary
diagnosis?
a. Acute gonorrheal urethritis
b. Ureaplasmosis
c. Bacterial vaginosis
d. Chronic gonorrheal urethritis
e. Clamidiosis
Question 168
On the 2nd day of postpartum period the general conditionIn of mother is satisfactory, body
temperature is 36,6oC , pulse - 82 b.p.m., good properties. Tongue is moist, not coated. The size
of mammary glands are incrised, nipples are soft. The uterus is hard, painless, hight of uterus
fundus is 12 cm above the pubis. Lochia are bloody, moderate. Physiological functions are
normal. To determine the lochia nature is enough to do:
a. Bacteriological examination of lochia.
b. Microscopy test.
c. Visual observation.
d. Ultrasound examination of the pelvis.
e. Fluorescent microscopy test.
Question 169
A 23 year old patient complains of a delay in menstruation for 2-6 months, infertility. For the past
year, she has considerably gained weight. Examination shows hair growth on the pubis to be
man's type, superfluous hair growth on the hips; the uterus is of normal sizes, the ovaries are
enlarged, dense during bimanual examination, painless. The basal temperature is monophase,
pupil and fern symptoms are positive. What is the probable diagnosis?
a. Inflammation of the uterine appendages
b. Adrenogenital syndrome
c. Itsenko-Cushing syndrome
d. Gonadal dysgenesis
e. Sclerocystic ovaries
Question 170
A woman addressed the doctor with complains on infertility. The basic symptoms: obesity,
hirsutism, hypomenstrual syndrome. An ultrasound of the organs of the small pelvis revealed
hyperplasia of the endometrium. The conclusion is a sign of what condition?
a. Persistence of the yellow body
b. Hypothyroidism
c. Inflammatory process in the endometrium
d. Chronic anovulation
e. Normal condition for the endometrium
Question 171
A patient was hospitalized with complaints of periodic pain in the lower abdomen, increasing
during menses, weakness, nervousness, spotting dark blood discharge from the vagina the day
before and after menses. Bimanual exam: the corpus uterus is enlarged, the appendages are not
determined, a tuberous surface is in the posterior fornix. Laparoscopy: on the ovaries, peritoneum,
sacrouterine recess and pararectal tissue- «cyanotic eyes». What is the most probable diagnosis?
a. Tuberculosis of the genitals
b. Widespread form of endometriosis
c. Cystoma of the ovaries
d. Chronic salpingitis
e. Policytosis of the ovaries
Question 172
A 30 year old patient, suffering from infertility for 10 years, complains of profuse, long
menstruations, accompanied by cramping pains. Bimanual examination: the uterus is enlarged
according to a 8 week pregnancy, the appendages are not determined. Hysterometry showed a
deformation of the uterus. What is the most probable diagnosis?
a. Metrorrhagia
b. Chronic endometritis
c. Submucous myoma of the uterus
d. Uterine pregnancy
e. Algodismenorrhea
Question 173
After a significant period of hypovolemic shock, the bleeding was controlled and the vascular
volume replaced. Estimates of blood loss were over 2,500 ml. The patient apparently recovered
well. However, she was unable to breast-feed and gradually noted breast atrophy and no
resumption of menses. Later, she developed constipation, slurred speech, and moderate
nonpitting edema. Which of the following is the most likely diagnosis?
a. acute tubular necrosis (ATN)
b. pituitary tumor
c. amenorrhea-galactorrhea syndrome
d. Asherman’s syndrome (uterine synechiae)
e. Sheehan’s syndrome (pituitary necrosis)
Question 174
A 35 year old woman complains of intensive pain in the lower abdomen, fever. The pain exists for
3 days, recently it strengthened, the body temperature is 38,8°C. A medical abortion at 10 weeks
pregnancy was performed 6 days ago. Objectively: the skin is clean, the tongue is dry, tension of
the muscles of the anterior abdominal wall, acute morbidity in the lower areas of the abdomen,
Shetkin - Blumberg symptom is positive, peristalsis of the intestines is weak. What is the most
likely diagnosis?
a. Gastritis.
b. Cholecystitis.
c. Pelviperitonitis.
d. Salmonellosis.
e. Hepatitis
Question 175
The cytological test of vaginal smears of a 45 year old woman revealed squamous cell
metaplasia. Determine the conducting tactics:
a. Colposcopy with aim biopsy.
b. Annual cytological test of vaginal smears.
c. Colposcopy.
d. Fractional curettage of the uterus mucous membrane.
e. Electrocauterizing conization.
Question 176
A multigravida with Rh-isosensitization was found to have a decrease in anti-Rh titer from 1:32 to
1:8 at 33-34 weeks of gestation. Ultrasound revealed double contour of head, enlargement of
fetal liver, placental thickness of 50 mm. The patient has indication for:
a. Repeated (after 2 weeks) USI
b. Course of desensitizing therapy
c. Plasmapheresis
d. Premature delivery
e. Administration of anti-Rh gamma globulin
.
Question 177
A 46 year old patient complains of pain in the lower abdomen, nausea, vomiting, body
temperature of 39,5°С. For the past 12 years she has an intrauterine spiral. Her condition is
moderate severity, pulse is 120 bpm, BP is 120/80 mm hg. The tongue is dry, has a white film on
it. The stomach is bloated, sharply painful in all areas, dullness of percussion sound, Shetkin Blumberg symptom is positive. During bimanual exam, a painful, motionless conglomerate,
12x14x18 is determined. Discharge from the sex path is purulent. What is the most probable
diagnosis?
a. Endometritis while using an intrauterine spiral, acute bilateral salpingitis; pelviperitonitis.
b. Endometritis while using an intrauterine spiral; suppuration of a ovarian cystoma. c.
Ovarian cancer ІV stage.
d. Uterine myoma with necrosis of one of the knots; acute purulent salpingitis; diffuse peritonitis.
e. Endometritis while using an intrauterine spiral; perforation of a tuboovarian abscess; diffuse
peritonitis
Question 178
A 26 year old woman addressed the female consultation with complaints of mucous-purulent
discharge from the genital tract, dull periodic pain in the lower abdomen, frequent, painful
urination. During examination of the cervix uterus in the mirrors, hyperemia around the external
os, the mucous is swollen, and there is a lot of mucouspurulent discharge. What is the preliminary
diagnosis?
a. Colpitis.
b. Erosion of the cervix uterus.
c. Endometritis.
d. Endocervicitis.
e. Cervicitis.
Question 179
A 30 year old woman addressed the doctor with complaints of the absence of menstruation for 2
years after her second childbirth. Childbirth was complicated with massive bleeding. After birth,
the patient had hair loss, loss of body weight. Objectively: the patient is adynamic, the external
genitals are hypoplasic, the cervix has a cylindrical form, the corpus uterus is small, painless. The
uterine appendages are not determined. What is the most probable diagnosis?
a. Shtein - Leventhal’s syndrome.
b. Tumour of the hypophysis (Itsenko - Cushing disease).
c. Uterine pregnancy.
d. Primary amenorrhea.
e. Hypophysial [pituitary] amenorrhea (Shihan’s syndrome).
Question 180
47 year old woman complains of long menstruations /10-13 days / with increased blood loss,
decrease in the level of Hb to 10-15 gr/l throughout the past 1,5 years. Objectively: I degree
obesity. BP is 140/95 mm hg, haemoglobin 90 gr/l, I degree diabetes. Bimanual exam: the size of
the uterus, consistency and its form and the uterine appendages are normal. Determine the
medical tactics:
a. Fractional diagnostic curettage of the uterus mucous membrane
b. Appoint non-steroid anti-inflammatory therapy.
c. Appoint combined oral contraceptives.
d. Appoint progestin прогестинов.
e. Appoint estrogen.
Question 181
A multipara woman was admitted to hospital with a diagnosis of multiple pregnancy. Possible
complications of pregnancy and childbirth:
a. Occipital fetal presentation
b. Preterm labor
c. Acute fetal distress
d. Polyhydramnios
e. Premature detachment of normally situated placenta
Question 182
A 25-year old prima gravida the first day of the last menstruation: 03.03.2018. Fetal movements:
02.08.2018. Determine the estimated date of delivery:
a. 30 January
b. 10 December
c. 10 November
d. 10 January
e. 30 December
Question 183
A patient at 34 weeks’ gestation develops marked pruritus especially on her palms and soles, and
mildly elevated liver function tests and elevated bile acids. Which of the following diagnostic
possibilities is most consistent with the clinical presentation?
a. hyperthyroidism
b. diabetes insipidus
c. pancreatitis
d. cholestasis of pregnancy
e. progesterone allergy
Question 184
A secundipara, 32 weeks, arrived at the maternity hospital. The uterus is in normal tone and
increased in size according to gestational age. Where should be the fundus of the uterus?
a. near the xiphoid process
b. near the navel
c. 4 cm below the xiphoid process
d. near the pubis
e. in the middle distance between xyphoid process and the navel
Question 185
Primapara 20 y.o. has twins . Labor activity has been lasting for an hours. Contractions are good.
One fetus is present, presenting part is fetus head. The heartbeat of the fetus is 140 b.p.m.. Cervix
of uterus is opened up to 4 cm. The amniotic sac is out intense contractions. Determine the
tactics of delivery:
a. induction of the labor with prostaglandins .
b. The dream vacation.
c. expectant management.
d. Caesarean section.
e. Amniotomy.
Question 186
An Rh-negative woman at 32-week of pregnancy has been examined. Rh-antibodies titer had
increased four times within the last 2 weeks and was 1:64. First two pregnancies ended in
antenatal death of fetus caused by hemolytic disease. What tactics of pregnancy management
should be chosen?
a. Delivery at 37 weeks term
b. US examination to determine signs of fetal erythroblastosis
c. Rh-antibody test in 2 weeks; if Rh-antibodies increase in number conduct delivery
d. Preterm delivery
e. Introduction of anti-Rh immunoglobulin
Question 187
A 20 year old patient complains of delay in menses for 10 days. Menstrual dysfunction is marked
for the first time. Sex life is regular, and no pregnancy has occurred. During examination: condition
is satisfactory, stomach is soft, painless, BP is 120/80 mm hg, pulse is 72 bpm, of satisfactory
properties. During transvaginal echography a progressing tubal pregnancy was suspected. What
are the most optimal tactics of the doctor in the conditions of a hospital?
a. Planned appendectomy.
b. Puncture of the abdominal cavity through the posterior vaginal fornix under the control of an
ultrasound.
c. Emergency appendectomy.
d. Medical-diagnostic laparoscopy.
e. Hysteroscopy with subsequent testing of a smear from the endometrium
Question 188
A 20 year old patient arrived at the gynecological department with complaints of sharp pain in the
lower abdomen after physical activity. Last menses was 2 weeks ago. Vaginal exam: the uterus is
not enlarged, painless, the left appendage is sharply painful during palpation, which complicates
the exam. Promtov symptom is positive. The posterior fornix hangs, painful. Pulse is 96 b.p.m., BP
is 100/60 mm hg. What pathology is being described?
a. Tumor of the left ovary.
b. Acute left sided salpingo-oophoritis.
c. Pyosalpingx to the left.
d. Ruptured left-sided tubal pregnancy.
e. Apoplexy of the left ovary
Question 189
Postpartum period lasts:
a. 5-6 days
b. 42 days
c. 10-14 days.
d. 6 months.
e. 2 hours.
Question 190
Secondipara has blood group B (III) Rh (-) at 24 weeks of pregnancy revealed titer Rh antibody 1:
8. The first pregnancy ended antenatal fetal death due to Rh-immunization. The general condition
is satisfactory. Tonus of uterus is normal. Position of the fetus is longitudinal, presenting part is
head, heart rate - 146 b.p.m. No edema. Your tactics?
a. Send for consultation to therapist.
b. Send for consultation to immunologist.
c. Delivery by natural way, conservative tactic
d. Repeat analysis for Rh antibodies after 2 weeks
e. Dynamic observation in antenatal clinic.
Question 191
A 20-year-old woman, gravida 2, para 1 has been in labor for 4 hours. Her condition is satisfactory.
Moderately painful contractions occur every 3 minutes and last for 35-40 seconds. The fetus is in
longitudinal position. Fetal heartbeats are 136/min., clear and rhytmic. Fetal head is engaged into
pelvic inlet. Vaginal examination revealed fully effaced and 6 cm open cervix, amniotic sac is
intact, sagittal suture is in the left oblique diameter, occipital fontanel is on the right near the
symphysis pubis. What stage of the labor is it?
a. Active phase of the first stage of normal labor
b. The second stage of normal labor
c. Precursors of childbirth
d. Preliminary stage
e. Latent phase of the first stage of normal labor
Question 192
A 29-year-old primigravida at 36 weeks’ gestation complains of dizziness and nausea when
reclining to read in bed before retiring at night. Suspecting that her symptoms are the result of
normal physiologic changes of pregnancy, you recommend which of the following?
a. improved room lighting
b. elevation of both her feet while lying in bed
c. rolling toward the right or left hip while reading
d. mild exercise before retiring to bed
e. small late night snack
Question 192
In woman at 2 days after normal delivery the uterine fundus is 10 cm above the pubis. The
general condition is satisfactory, body temperatur is 36,5oC , pulse is 80 b.p.m., satisfactory
properties. Mammary glands are enlarged, no hyperemy, nipples goals. Uterine іs soft, painless.
Lochia are blood, mild. Physiological functions are normal. To determine the dynamics involution
of the uterus after childbirth enough:
a. Determine the sight of the abdomen.
b. Identify vaginal ring height above the vagina.
c. Daily determine the height of uterine fundus above the pubis.
d. Conduct a radiological examination.
e. To conduct ultrasound of the pelvis.
Question 193
A 40 year old patient complains of contact bloody discharge from the sexual tract. In speculum:
cervix is hypertrophied and deformed due to postnatal ruptures, external os is not completely
closed. Bimanual examination did not reveal any pathology. Pap-test: NILM (negative for
intraepithelial lesions or malignancy). On colposcopy: a large transformation zone with a
considerable amount of open and closed glands, locus of ectropion on anterior lip and leukoplakia
2 cm in diameter on posterior lip. What should be the further tactics of a gynecologist?
a. Cryotherapy, lazer ablation or cold coagulation immidiately
b. A course of vaginal suppositoria containing antibiotics and healing agents
c. No treatment needed, follow-up in 3 months
d. Biopsy of ectropion area, ablation of cervix if negative for CIN
e. Biopsy of leukoplakia, ablation of cervix if negative for CIN
Question 194
The cytological test of vaginal smear of a 38 year old woman did not revealed any atypism.
Smears from the cervical canal revealed atypical cells. What are the doctor’s tactics?
a. Repeat the colposcopy in 3 months.
b. Conization of the cervix.
c. Further supervision is not obligatory.
d. Repeat the smear for atypical cells 3 months.
e. Vaginal hysterectomy
Question 195
During external obstetrical examination the abdomen of a pregnant woman has a transverse oval form, at the left lateral uterine wall a round, dense, balloting fetal part is palpated; to the right
a voluminous soft, not balloting fetal part is palpated and the presenting part is absent. Fetal
palpitation is heard at the umbilical level. Establish the diagnosis.
a. Longitudinal lie, right breech anterior presentation
b. Oblique lie, left position
c. Longitudinal lie, left breech posterior presentation
d. Transverse lie, left position
e. Longitudinal lie, cehpalic anterior presentation
Question 196
A 20-year-old parturient woman is in the I labor stage. The pregnancy is full-term. Contractions
occur every 3 minutes and last for 55 seconds. Fetus presentation is cephalic, the head is pressed
to the pelvic inlet. Heart rate of the fetus is 150/min, distinct and rhythmic. Vaginal examination:
cervix is fully effaced and 2 cm open; amniotic sac is intact; moderate mucous-bloody discharge
is observed. What phase of the I labor stage is it?
a. Active
b. Physiological preliminary period
c. Primary uterine inertia
d. Latent
e. Slowing-down
Question 197
A 34 year old woman, who had 4 pregnancies, without any gynecological diseases in the
anamnesis, on the 17th day of the menstrual cycle, had uterine bleeding. Which of the exams is
most important in this case?
a. Hysterosalpingography
b. Colpocytology
c. Colposcopy
d. Determining the thyroid profile
e. Diagnostic curettage of the uterine cavity
Question 198
A 23 year old patient came to the doctor of the female consultation with complaints of profuse
foamy discharge from the vagina with an unpleasant smell, burning and itching around the
external genitals. She lives a chaotic sex life. Gynecological examination: the vagina mucous
membrane is hyperemic, when touched it bleeds, leucorrhoea are profuse green, foamy. What is
the most probable diagnosis?
a. Trichomonas colpitis
b. Bacterial vaginosis
c. Gonorrhea of the lower department of the genital tract
d. Сandidiasis
e. Chlamydia
Question 199
A full-term baby was born with body weight of 3200 g, body length of 50 cm, Apgar score - 8-10
points. What is the optimum time for the first breast-feeding?
a. After 48 hours
b. First 48 hours
c. First 24 hours
d. First 6 hours
e. First 30 minutes
Question 200
73. A 18 year old patient complains of pain in the lower abdomen, an increase in body
temperature to 37,5°С, purulent discharge from the genital tract, pain during urination. She
became ill sharply, on the 7th day of the menstrual cycle when the listed symptoms occurred. The
urethra is infiltrated, the cervix uterus is hyperemic, edematic, with extensive erosion, from the
cervical canal - profuse mucous - purulent discharge. The uterus is not enlarge, painful, the
appendages are thickened, painful. In the smears for flora - extra- and endocellular gonococcus.
What are the tactics of the doctor at the female consultation?
a. Hospitalize the patient in a gynecological hospital for examination and treatment.
b. Direct to the dermatovenerologic clinic for further examination and treatment. c.
Hospitalization in the dermatovenerologic clinic.
d. Prescribe an out-patient course of antibacterial therapy.
e. Recommend planned hospitalization in a gynecological hospital after receiving the results of
lab tests (general blood and urine analysis, Wassermann test, blood test for the presence of
antibodies to HIV), consultation at the venereologist, urologist.
Question 201
A 32 year old woman complains of pain in the lower abdomen, an increase in body temperature,
fever, heavy discharges from the genital tract. 4 days ago she had a medical abortion. During
examination the stomach is soft, painful during palpation in the lower areas, symptoms of
irritation of the peritoneum are negative. The uterus is slightly enlarged, painful during
palpation,
has a non-uniform consistency. The uterine appendages are without features, discharge from the
genital tract is serous-purulent. What is the prospective diagnosis?
a. Acute salpingootitis.
b. Endometriosis
c. Acute endometritis.
d. Bacterial vaginosis.
e. Urogenital candidiasis
Question 202
A 24 year old woman carries an intrauterine spiral for 2 years. When she arrived at the hospital
she complains of sharp pain in the lower abdomen. During bimanual exam, condensed, painful
uterine appendages were found. The IUS was removed, a smear was sent for histologic testing.
Treatment with penicillin was begun. What is the most probable causative agent :
a. Chlamіdіa trachomatіs.
b. Bacteroіdіs fragіlіs.
c. Neіsserіa gonorrhoеае.
d. Actіnomіcea іsraelіі.
e. Staphylococcus aureus
Question 203
A 32 year old woman complains of primary infertility during 6 years. Sperm count of her husband
is without pathology. Her menstrutions are regular, menstrual cycles are ovulatory, no hormonal
pathology was found. USE of pelvic organs is without pathology. She has chronic bilateral
adnexitis in anamnesis. The doctor suspected tubal factor of infertility. What method of
examination would confirm this diagnosis?
a. Hysteroscopy
b. Metrosalpingography
c. D&C (dilation and curretage)
d. Culture test of vaginal mucous
e. Colposcopy
Question 204
A 24 year old patient, 13 months after her first birth, complains of amenorrhea. She delivered by
cesarian section because of premature detachment of a normally located placenta and
intrauterine asphyxia of the fetus; there was approximately 2000 ml of blood lose due to
abnormalities of blood coagulability. What test is indicated for the patient?
a. Determining the level of gonadotropin.
b. Ultrasound of the organs of the small pelvis.
c. Progesterone test.
d. Computer tomography of the head.
e. Determining the amount of testosterone in the blood serum.
Question 205
A 40 year old patient complains of contact bloody discharge from the sexual tract; during
gynecological examination, the cervix uterus is erosive, hypertrophied, deformed due to postnatal
ruptures, the external os is not completely closed. The uterus and appendages are without
pathological changes, the parametrium is free. Expanded colposcopy revealed an extensive zone
of transformation with a considerable amount of open and closed glands, a site of ectopia on the
anterior lip, leukoplakia at 12 o'clock. What treatment should be recommended to the patient?
a. Processing the cervix uterus with a beam of helium - neon laser.
b. Local application of tampons with ointments, containing antibiotics and preparations
increasing the regenerative ability of epithelium.
c. Surgical treatment.
d. Supervision.
e. Electro-surgical or cryogenic influence
Question 206
A 42 year old women for the past 10 years has had menses like hyperpolymenorrhea and
progressing algodysmonorrhea. Vaginal examination: the cervix uterus is clear, discharge is
moderate, "chocolate" colour, the uterus is a little enlarged, tuberous, a little painful, the
appendages are not palpated, the fornix is deep, painless. What is the most probable diagnosis?
a. Endometriosis of the appendages
b. Endometritis
c. Submucous fibromyoma of the uterus
d. Endometriosis of the uterus
e. Uterine cancer
Question 207
A woman, 27 y.o, on 3d day postpartum, there has been noticed a significant breast engorgement.
In this regard it should recommend:
a. Cancel use bra.
b. Cancellation of breastfeeding.
c. Pumping breast.
d. Continue breastfeeding on demand.
e. Warming a compress on the breast.
Question 208
A patient complains of intolerable itching and burning in the vagina, increasing at night.
Examination revealed acute hyperemia of the vulvas, vaginal mucous and vaginal part of cervix
uterus. The discharge is liquid, profuse, foamy with a greenish shade. During examination of the
uterus and appendages, no pathology was revealed. What disease should the doctor suspect?
a. Urogenital herpes.
b. Urogenital candidiasis.
c. Urogenital trichomoniasis.
d. Gonococci infection.
e. Bacterial vaginosis
Question 209
A 20 year old patient complains of periodic menstruation delays for 2-4 months during the last 2
years. She noticed excessive hair growth on the anterior abdominal wall, mammary glands, lower
extremities. During the last year she gained 14 kg weight. Speculum examination: cervix is conic,
external os is closed, epithelium is whole. Body of uterus is in anteflexіo, small, mobile, painless.
Ovaries are palpated on both sides of the uterus, 4х6 cm, painless, firm. Posterior fornix is deep.
Discharge is mucous. What is the most probable diagnosis?
a. Adenoblastoma of ovaries
b. Itsenko-Cushing syndrome
c. Adrenogenital syndrome
d. Sheehan's syndrome
e. Stein - Leventhal syndrome (Polycystic ovarian syndrome)
Question
Colposcopy of a patient revealed endometriosis in the vaginal part of the cervix uterus. What,
in your opinion, are the most justified medical tactics?
a.Laser vaporization of the loci of endometriosis
B. Supravaginal amputation of the uterus
c.Hysterectomy with the appendages
d.Anti-inflammatory treatment
E. diathermocoagulation of the cervix uterus
Question
A patient, 20 years old, thinks that she is pregnant. She does not remember the first day of the
last menstruation. Patient complaints: weakness, nausea, vomiting, an aversion to meat
during 10 days. Bimanual examination revealed: cyanosis of the cervical and vaginal mucous.
The uterus is in hyperanteflexion, enlarged till the sizes of a female fist; softened, especially in
the isthmic area, however, during inspection became denser, painless. Appendages are not
palpated. What are the symptoms indicate the presence of pregnancy?
a.
Cyanosis of the cervical and vaginal mucous
Question
Multipara, 32 y.o., is in the I stage of labor within 5 hours. Clear amniotic fluid has flown out 1
hour ago. Signs of clinical disproportion are absent. During internal obstetric examination
head of the fetus is pressed to inlet of the small pelvis, bith tumor is absent. The uterine cervix
is opened up to 2 cm. Choose the right labor management?
a.Labor induction
Question
Vaginal examination is contraindicated in which situation during pregnancy?
Placenta pervia
Question
A 24 year old patient, not married, has a chaotic sex life. She arrived at the gynecological
department concerning pelviperitonitis. A lightly positive symptoms of irritation of the
peritoneum in the lower abdomen are marked. The external orifice of the urethra are
hyperemic. Smears from the urethra and cervical canal discharge show gonococcus. What
treatment is necessary?
a. Cold on the lower abdomen, supervision.
B. Urgent laparotomy, supravaginal amputation of the uterus.
C. Vaginal sprays with hydrogen peroxide.
D. Intensive antibiotic therapy.
E. Urgent laparotomy, drain the abdominal cavity.
Question
A 47 year old woman who suffers from moderate severity diabetes was diagnosed with
microinvasive cervical cancer (depth of defect - 3 mm). Appoint treatment:
Electrocauterizing conization of cervix uterus.
Question
Primagravida is in I stage of labor for 9 hours. Head of the fetus is engaged to inlet of the
small pelvis. Contractions are weak, irregular. . Auscultation of the fetus is clear, rhythmical,
136 bp.m. At vaginal examination uterine cervix is flattened, thickened, opened up to 4 cm.
The amniotic membranes are present. During of internal examination, situation are the same
in 4 hours . The most likely diagnosis?
a. Uterine inertia
Question
A secundipara has regular birth activity. Three years ago she had cesarean section for the
reason of acute intrauterine hypoxia. During contractions she complains of extended pain in
the area of postsurgical scar. Objectively: fetus pulse is rhythmic - 140 bpm. Vaginal
examination shows 5 cm cervical dilatation. Amniotic sac is intact. What is the tactics of
choice?
Cesarean section
Question
A patient complains of an irregular menstrual cycle, substantial weight gain, hirsutism,
infertility. Bimanual examination shows that the uterus is smaller than normal; dense, mobile
ovaries with sizes 4 х 5 х 4 cm, painless are found on both sides. What pathology is being
described?
Polycystic ovarian syndrome.
Question
A 18 year old women who has not given birth, found gonorrhoea 6 months ago. She received
ampenicillin per os. For the past month she has also been taking ampenicillin for
inflammatory process of organs of the small pelvis. During palpation, expressed morbidity in
the lower area of the abdomen is marked. The concentration level of chorionic gonadotropin
is normal. Prescribe treatment:
a.
Cefotoxin and doxycycline in the hospital.
Question
A 24-year-old primipara was hospitalized with complaints of leakage of fluid. On exam there
are no uterine contractions. Baby is in longitudinal lie, head is pressed to the pelvic inlet.
Fetal heart rate is rhythmical, 140 bpm, auscultated on the left below the navel. Internal
examination: cervix of the uterus is 2,5 cm long, dense, the external os is closed, clear
amniotic waters are discharged. Point out the correct component of the diagnosis:
Prelabor rupture of the amniotic membranes
Question
The relationship of the long axis of the fetus to the long axis of the mother is called which of
the following?
LIE
Question
A 24 year old woman, with earlier normal menstruation function, has irregular cycles;
according to functional diagnostics tests - anovulatory. The level of prolactin in blood is
increased. What test is indicated for the patient?
a. Computer tomography of the head.
Question
In what size of the pelvic inlet plane is the sagittal suture in case of occipital anterior
presentation, I position after performing flexion of the head?
Right diagonal or transverse.
Question
A 43 year old woman came for check-up 6 months after completion of hormonal treatment
for atypical endometrial hyperplasia. Her previuos check-up was without pathology. Her
doctor performed USE of pelvic organs where recurrency of hyperplasia was suspeted. How
could a doctor determine whether there is atypy or no?
a. Biopsy of endometrium
Question
The placenta is essential in the growth and development of a healthy fetus. It allows
transport of certain things, facilitates transports of others, and is hormonally active. Which
of the following statements regarding the placenta is true?
a.
The placenta fulfills some of the functions of lung, kidney, and intestine for the fetus
Question
On the 3rd day after labor a woman complaines about mild pain in the breast. What is the
most likely reason?
Development of milk
Question
A premature newborn exhibits rapid grunting respiration, chest retraction, and a diffuse
infiltrate in the lung fields demonstrated on chest X-ray. What is the most likely cause for
these findings?
respiratory distress syndrome (RDS)
Question
A 26-year-old woman complains of bloody discharges from the genitals for the last 14 days,
abdominal pain, general fatigue, weakness, weight loss, fever, chest pain, obstructed
respiration. 5 weeks ago she underwent an induced abortion in the 6-7 week of gestation.
Objectively: the patient is pale and inert. Bimanual examination revealed that the uterus was
enlarged up to 8-9 weeks of gestation. In blood: Hb - 72 g/l. Urine test for chorionic
gonadotropin gave the apparently positive result. What is the most likely diagnosis?
Chorioepithelioma
Question
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 os open up to 0,5 cm. Urine hCG test was positive. What is the
most likely diagnosis?
a. Cervical pregnancy
Question
Primagravida is in I stage of labor for 9 hours. Head of the fetus is engaged to inlet of the
small pelvis. Contractions are weak, irregular. . Auscultation of the fetus is clear, rhythmical,
136 bp.m. At vaginal examination uterine cervix is flattened, thickened, opened up to 4 cm.
The amniotic membranes are present. During of internal examination, situation are the same
in 4 hours . The most likely diagnosis?
a.
Uterine inertia
Question
What is the implantation of a placenta in which there is a defect in the fibrinoid layer at the
implantation site, allowing the placental villi to invade and penetrate into but not through the
myometrium called?
placenta increta
Question
3 days after canceling klomifen - citrate, the patient began to have pain in the abdomen,
nausea, vomiting, meteorism, indisposition, shortness of breath. Objectively - tension of the
muscles of the anterior abdominal wall, enlarged ovaries, their morbidity. Decrease BP,
tachycardia was noticed. Specify the pathogenesis of the complications:
a.Hyperstimulation of the ovaries.
Question
In what plane of the pelvis does the fetus finishing the internal turn of its head in case of
occipital anterior presentation, II position?
The pelvic outlet.
Question
A woman, 27 y.o, on 3d day postpartum, there has been noticed a significant breast
engorgement. In this regard it should recommend:
Continue breastfeeding on demand.
Question
A 22 year old patient addressed the female consultation with complaints of contact bloody
discharge from the genital tract, which she noticed after sexual intercourse during the last
two weeks. Examination of the cervix and vagina in the mirrors: the cervix uterus has a conic
form, the external os is a spot, discharge is mucous - bloody. On the anterior lip of the cervix
was founded erosive surface with sizes 0,5 х 1 cm; when touched it bleeds. Cytology - type
ІІ. ІІ degree vaginal cleanliness. What are the treatment methods?
Cryodestruction
Question
A 28-year-old G2P0 at 39 weeks is in early labor. She is 2 cm dilated and 90% effaced, with
contractions every 4 to 5 minutes. The fetal heart tones are reassuring. Her nurse steps out
for a moment and returns to find her having a seizure. What would your first therapy be
aimed at?
giving a 4-g magnesium sulfate bolus
Question
A 35-year-old woman (gravida 5, para 4) now at 32 weeks’ gestation with a BP of 180/120,
no proteinuria or edema, but retinal exudates and hemorrhage, as well as a history of
hypertension for 8 years. Which of the following is the best diagnosis?
chronic hypertensive disease
Question
A 14 year old girl was delivered to gynecologic department with complaints of profuse
bloody discharge for 3 days. From the anamnesis: menstruation since the age of 12,
irregular, with periodic delays up to 10-15 days. She is not sexually active. No extragenital
pathologies were revealed. The ultrasound showed that the uterus is of normal size, the
ovaries are normal. What is the diagnosis?
Dysfunctional uterine bleeding of the juvenile period.
Question
A 23-year-old woman (gravida 1) at about 12 weeks’ gestation develops persistent nausea
and vomiting that progresses from an occasional episode to a constant retching. She has no
fever or diarrhea but lost 3 kg in 1 week and appears dehydrated. What is your diagnosis?
hyperemesis gravidarum
Question
A woman complains of increasing temperature up to 39oC, sharp pains in her lower
abdomen, and sanguinopurulent discharge from her genital tracts. From her case history it is
known that 6 days ago she underwent illegal abortion. Objectively her blood pressure is
100/60 mm Hg, pulse is 110/min. Abdominal rigidity, rebound tenderness (Bloomberg’s
sign), and painful palpation of the lower abdomen are observed. On bimanual examination
the uterus is enlarged up to 7 weeks of pregnancy, painful, and soft; posterior vaginal fornix
overhangs. Make the diagnosis:
a.
Pelviperitonitis
Question
A 24 year old woman stopped using oral contraceptives so that she could become pregnant.
Earlier she had no pregnancies. After she took the last pill, she had one menstruation, after
which she had amenorrhea for 6 months. What is the most suitable method of laboratory
examination?
Determining the level of prolactin in the blood.
Question
A 32-year-old gravida complains of episodes of unconsciousness, spontaneous syncopes
that are quickly over after a change of body position. A syncope can be accompanied by
quickly elapsing bradycardia. There are no other complications of gestation. What is the
most likely reason for such condition?
Supine hypotensive syndrome
Question
A 14 year old girl was delivered to gynecologic department with complaints of profuse
bloody discharge from vagina during 3 days. From the anamnesis: menstruation since the
age of 12, irregular, with periodic delays up to 10-15 days. She is not sexually active. No
extragenital pathology was revealed.USE showed that uterus is of normal size, ovaries are
normal. What is the diagnosis?
Dysfunctional uterine bleeding of the juvenile period
Question
During a pregnant woman examination at the female consultation center, the doctor found
out enlarged uterus according to size of 5-6 weeks of pregnancy, in the left angle of the
uterus a protrusion is palpated. The uterus has soft consistence, but during examination has
rendered firm. After seizing the pressure, the uterus became soft again. What signs of
pregnancy were found out by the doctor?
Snegiryov and Genter’s
Question
The purpose of the third manoeuvres according to Leopold.
The third manoeuvre is designed to identify the presenting part.
Question
25 y.o. woman is in labor, in stage I of labor for 14 hours with normal contraction activity.
Sizes of the pelvis 26-28-30-18 cm. Auscultation of the fetus is muted, rhythmical, 85 bpm.
Estimated weight of the fetus 3200.0+200 gr. Internal obstetric examination: opening of
uterine cervix is complete, head of the fetus is in the pelvic cavity. What is the tactic of
current labor management?
a. Applying of cavity obstetric forceps
Question
A 25 year old patient complains of plentiful mucous discharge from genital tract for the last
2 months. From anamnesis, 2 years ago she had a childbirth, which was complicated by
rupture of cervix. Pap-test did not reveal any pathology. In speculum: cervix has a cylindrical
shape, on the anterior lip there is an area of red epithelium, upon touch it does not bleed,
external os is open. Bimanual examination did not reveal any pathology. What is the probable
diagnosis?
Ectropion
Question
You have just delivered an 18-year-old woman (gravida 1, para 0). She is preeclamptic. Her
uterus is soft with moderate-to-heavy bleeding. Examination reveals no laceration. You
diagnose uterine atony. Which of the following is the best management option?
10 units of IV oxytocin
Question
A 45 year old patient complains of abundant, painful menses, smearing bloody discharge
from the genital tract before and after menses. The uterus is in retroinflection, enlarged to
the size of 8-9 week pregnancy, dense, limited in mobility; the appendages on both sides are
not determined, parametrium is free, discharges mucous, light. On what day of the menstrual
cycle is it necessary to perform hysterosalpingography?
During the follicular phase of the cycle (on the 7th day of the menstrual cycle).
Question
A 25 year old patient was hospitalized in the gynecology department with complaints of pain
in the lower abdomen, increase in body temperature to 39,7°С. Objectively: BP -120/80 mm
hg, Pulse - 108 b.p.m. of satisfactory properties. The stomach is bloated moderately, sharply
painful in the lower area. Blumberg's sign is positive in the hypogastric area. Vaginal
examination: the uterus and appendages are not palpated due to the tense anterior
abdominal wall. The posterior vaginal fornix hangs, sharply painful. Specify the most
probable diagnosis.
Pelviperitonitis
Question
A 27 year old patient for 5 years has been treated for chronic adnexitis; she arrived at the
gynecological ward with signs of pelviperitonitis. The husband has chronic urethritis. What
tests should be prescribed for diagnostics of the causative agent of the disease?
Puncture of the abdominal cavity through the back vaginal fornix, bacterial inoculation of the
puncture sample for gonococcus.
Question
A 18 year old patient complains of pain in the lower abdomen, an increase in body
temperature to 37,5°С, purulent discharge from the genital tract, pain during urination. She
became ill sharply, on the 7th day of the menstrual cycle when the listed symptoms
occurred. The urethra is infiltrated, the cervix uterus is hyperemic, edematic, with extensive
erosion, from the cervical canal - profuse mucous - purulent discharge. The uterus is not
enlarge, painful, the appendages are thickened, painful. In the smears for flora - extra- and
endocellular gonococcus. What is your diagnosis?
Acute recent ascending gonorrhea.
Question
A 28-years-old woman complains of nausea and vomiting about 10 times per day. She has
been found to have body weight loss and xerodermia. The pulse is 100 bpm. Body
temperature is 37,2oC. Diuresis is low. USI shows 5-6 weeks of pregnancy. What is the most
likely diagnosis?
Moderate vomiting of pregnancy
Question
A parturient woman is 25 years old, it is her second day of postpartum period. It was her first
full-term uncomplicated labour. The lochia should be:
Bloody
Question
A 33 year old woman previously undergone two operations for extra-uterine pregnancy, both
uterine tubes were removed. She addressed doctor with a question about the possibility of
having a child. What should be recommended for a pregnancy to occur in this case?
Extracorporal fertilization (IVF)
Question
In what diameter of the pelvic outlet plane does the fetal shoulders cut through and are born
during the anterior type of position, occipital presentation, I position?
Direct.
Question
A pregnant 26-year-old woman was admitted to a hospital with 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 removal of fetal tissue
Question
A 27 year old woman, who lives an active sexual life, complains of the presence of numerous
vesicles on the right labia majoris, itching and burning. The rash periodically appears before
menstruation and disappears in about 8-10 days. What is the probable diagnosis?
Simple herpes virus.
Question
A 24-year-old patient (gravida 2, para 2) has just delivered vaginally an infant weighing
4,300 g after a spontaneous uncomplicated labor. She has had no problems during the
pregnancy and labor. The placenta delivers spontaneously. There is immediate brisk vaginal
bleeding of greater than 500 ml. Although all of the following can be the cause for
postpartum hemorrhage, which is the most frequent cause of immediate hemorrhage as
seen in this patient?
uterine atony
Question
The 31-year-old woman has uterine bleeding in the early postpartum period. She gave birth
to twins per vagina. The most likely cause of bleeding is:
uterine atony.
Question
Certain patients are more likely than others to have uterine atony and hemorrhage after
delivery. Circumstances that predict possible increased bleeding postpartum include which
of the following situations?
prolonged labor
Question
During examination of the patient in the women's clinic, the doctor discovered that the uterus
size is increased up to 5-6 weeks of pregnancy, in the left corner of the uterus is palpable
protrusion . Uterus is soft , but during the study it is becaming hard and then again become
soft. What is the most likely diagnosis?
The uterine pregnancy
Question
A patient develops excessive salivation during pregnancy. What is this called?
ptyalism
Question
A 19-year-old woman at 36 weeks’ gestation with a BP of 150/100, 2+ edema, and 2+
proteinuria with no other symptoms. Which of the following is the best diagnosis?
severe preeclampsia
Question
A 52 year old woman, suffering from obesity, complains of bloody discharge from the genital
tract for the last 4 days. The last normal menstruation was 2 years ago. She underwent
dilation and curretage of endocervix and endometrium, biopsy result revealed endometrial
intraepithelial neoplasia (atypical hyperplasia of endometrium). What is the most probable
cause of the revealed pathology?
a. Excessive transformation of pre-androgen from fat tissue.
Question
A 30 year old patient complains of the absence of menstruation for 5 months. She marks the
discharge of colostrum from the mammary glands. Bimanual examination: the uterus is
small, mobile, painless. The uterine appendages are without features. On the x-ray of the
skull, no pathology was revealed. An increase in prolactin in blood serum was revealed. What
is the diagnosis?
Hyperprolactinemia
Question
A 29 year old woman arrived at the hospital with complaints of progressing strong pain in
the lower abdomen and vomiting for the past 2 days. She is sexually active, not married, has
casual sex and does not use contraceptives. Body temperature is 38,3°C. On examination
tension of anterior abdominal wall in the lower abdomen is marked. On vaginal examination
multiple purulent discharge from external os. On both sides of uterus there are sharply
painful dense immobile enlarged appendages. What additional method of examination are
needed?
Microflora test, culture test, USE
Question
A woman with blood group B(III) Rh(+) gave birth to a full-term healthy boy. Examination on
the 3rd day of the infant’s life shows him to have icteric colour of his skin. The child has no
problems with suckling, sleep is not disturbed. The abdomen is soft, the liver protrudes by 2
cm from under the costal margin. Complete blood count: hemoglobin -200 g/L, erythrocytes
- 5.5 · 1012/L, total bilirubin – 62 mcmol/L, indirect bilirubin – 52 mcmol/L. What condition
can be suspected?
Physiologic jaundice
Question
A primigravida, addressed to a gynaecologist for consultation. Hemodynamic is stable.
Tongue is clean, damp. Skin and visible mucous membranes are pale-pink. Abdomen is soft,
painless during palpation. During the vaginal examination: external genitals are developed
properly, with no visible signs of inflammation. The cervix has a conical shape, length about
3 cm, the epithelium is intact, clean and external os is closed. The body of the uterus is in
anteflexio-versio, enlarged to the size of 8 week pregnancy, the isthmus is soft. The uterine
appendages on both sides are not enlarged, painless. Vaults of the vagina are free.
Discharge is mucous. What is the most possible diagnosis?
8 weeks
Question
On the 9th day after childbirth the patient complains about high fever - 38oC, pain in the
right mammary gland. The examination revealed : a sharply painful infiltrate can be palpated
in the right mammary gland, the skin over the infiltrate is red, subareolar area and nipple are
swollen and painful. What is your diagnosis?
Abscess of the right mammary gland
Question
The cytological test of vaginal smear of a 45 year old woman revealed dysplasia of the light
degree, colposcopy showed - transformation zone, clinic of colpitis is not present. Appoint
treatment:
Cryodestruction of the cervix uterus.
Question
Second gravida has the blood group 0 (I) Rh (-), at term 35 weeks of pregnancy was
diagnosed antenatal fetal death. Three days ago determined titer Rh antibodies 1: 128,
There were present ultrasound signs of hepatosplenomegaly, ascites of the fetus, edema of
the placenta, non-stress test was abnormal. A pregnant refused from the proposed delivery .
What is the reason antenatal fetal death?
Rh - immunization
Question
Emergency treatment of uterine inversion would initially consist of which of the following?
immediate replacement of the fundus
Question
A 35 year old woman complains of plentiful whitish discharge from vagina with unpleasant
smell. In anamnesis 2 pregnancies which ended with livebirths, no history of gynecological
pathology or STIs. The patient is married, denies any sexual contact outside of her marriage.
On examination mucous of vagina and cervix is reddened, plentiful whitish discharge in
posterior fornix, uterus and appendages are without pathology. Microflora test
(bacterioscopy) revealed multiple leukocytes and cocci bacteria. What should be the further
tactics?
Culture test
Question
A 46 year old woman addressed a doctor with complaints of plentiful menstruation and
bloody spotting the middle of the menstrual cycle. Bimanuan examination and Pap-test are
without pathology. Repeated USE revealed a formation 1.5x1 cm in the uterine cavity. What
is the optimal further tactics?
Hysteroscopy
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