12/21/22, 8:49 PM Emergency conditions in gynecology. Surgery in gynecology.
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Question 1
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A 23-year-old female patient was brought urgently with complaints of pain in the lower abdomen, more on the right side, with irradiation in
the rectum, dizziness. The above complaints appeared suddenly at night. Last menstruation 2 weeks ago. Objectively: the skin is pale, pulse -
92 bpm, t - 36.60, blood pressure 100/60 mm Hg. Art. The abdomen is slightly tense, slightly painful in the lower parts. The symptoms of
peritoneal irritation are weakly positive. Hemoglobin 98 g/l. The most likely preliminary diagnosis:
a. Intestinal obstruction
b. Ectopic pregnancy
c. Ovarian apoplexy
d. Acute appendicitis
e. Renal colic
Question 2
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A woman turned to a gynecologist complaining of acute abdominal pain. The gynecologist regularly observes uterine fibroids. The
examination revealed pronounced positive symptoms of peritoneal irritation, high leukocytosis. During vaginal examination, the uterus up to
10 weeks of pregnancy is enlarged due to fibromatous nodes, one of which is mobile and very painful. The appendages are not palpable.
Mucous discharge, moderate amount. What is the treatment strategy?
a. Observation and antibacterial therapy
b. take swabs to detect STIs
c. Fractional diagnostic scraping of the uterine cavity
d. Emergency operation (laparotomy)
e. Observation and antispasmodic therapy
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12/21/22, 8:49 PM Emergency conditions in gynecology. Surgery in gynecology.
Question 3
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A 36-year-old patient complains of sudden pain in the lower abdomen. Objectively: external genital organs without pathology, the cervix is
cylindrical, clean. The body of the uterus is enlarged up to 12-13 weeks of pregnancy, limited mobility, and uneven surface, sharply painful.
Last period 3 weeks ago. There is a history of uterine myoma. The appendages are not defined, their area is painless. Parameters are free. The
secretions are serous. Blood analysis: hemoglobin – 120 g/l, leukocytes – 12x109/l, rod nuclear leukocytes – 10%. What is the most likely
diagnosis?
a. Destructive form of bubble drift
b. Chorioepithelioma
c. Necrosis of a fibromatous node
d. Disturbed pregnancy in the interstitial part of the tube
e. Spontaneous rupture of the pregnant uterus
Question 4
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A 27-year-old woman who is planning a pregnancy turned to a gynecologist with complaints of aching pains in the lower abdomen, which
have been bothering her recently. Objectively: the uterus is enlarged to the 8-week effect, the contour is uneven, painful in the area of the
bottom. An ultrasound examination revealed a uterine myoma with a softening area. What will be the doctor's tactics?
a. Therapy of oral contraceptive
b. Embolization of uterine vessels
c. Therapy with ulipristal acetate (Esmia)
d. Myomectomy
e. Hysterectomy
Question 5
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Which of the following does not apply to risk factors that increase the frequency of HIV transmission from mother to child:
a. Antiretroviral therapy during pregnancy, childbirth and for the newborn
b. Progressive stage of HIV infection
c. Breast feeding
d. Lack of antiretroviral therapy during the disease
e. The presence of infections transmitted by infectious means
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12/21/22, 8:49 PM Emergency conditions in gynecology. Surgery in gynecology.
Question 6
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A 42 year old woman consulted a gynecologist about having abundant long menses within 3 months. Bimanual investigation: the body of the
uterus is enlarged according to about 12 weeks of pregnancy, distorted, tuberous, of dense consistency. Appendages are not palpated.
Histological test of the uterus body mucosa: adenocystous hyperplasia of the endometrium. Optimal medical tactics:
a. Phase by phase vitamin therapy
b. Surgical treatment
c. Phytotherapy
d. Radial therapy
e. Hormonetherapy
Question 7
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A large cystic ovarian tumor was detected in a woman during a routine prenatal examination. The most common complication that she may
face is;
a. Gap
b. Degeneration
c. Torsion
d. Bloodshed
e. Infection
Question 8
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A 10 week pregnant woman was admitted to a hospital for recurrent pain in the lower abdomen, bloody discharges from the genital tracts.
The problems turned up after ARVI. The woman was registered for antenatal care. Speculum examination revealed cyanosis of vaginal
mucosa, clean cervix, open cervical canal discharging blood and blood clots; the lower pole of the gestational sac was visible. What tactics
should be chosen?
a. Pregnancy maintenance therapy
b. Curettage of the uterus
c. Hysterectomy
d. Expectant management, surveillance
e. Antiviral therapy
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12/21/22, 8:49 PM Emergency conditions in gynecology. Surgery in gynecology.
Question 9
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A 32-year-old woman was admitted to a gynecological hospital with significant bleeding from the genital tract and delayed menstruation for
1 month. During bimanual examination, the cervix is soft, barrel-shaped. The uterus is of normal size, somewhat softened. The appendages
were inconspicuous on both sides. When examined in mirrors, the cervix is cyanotic, enlarged, the external opening is open to 0.5 cm. The
analysis of hCG in the urine is positive. What is the most likely diagnosis?
a. Uterine pregnancy
b. Violated tubal pregnancy
c. Threat of miscarriage
d. Abortion in progress
e. Cervical pregnancy
Question 10
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A 19-year-old girl complains of lower abdominal pain. A few minutes before, she suddenly found herself at home unconscious. During the
last 3 months, the patient did not have menstruation. During the examination: the skin is pale, pulse - 110 bpm, blood pressure - 80/60 mm
Hg. Shchotkin's symptom is positive. Hb76 g/l. During vaginal examination: the uterus is slightly enlarged, mobility is limited due to pain. In
the area of the appendages, a formation without clear contours is noted, which is painful when palpated. The back vault of the vagina is
tender and hangs inwards. What is the most likely diagnosis?
a. Impaired extrauterine pregnancy
b. Acute salpingoophoritis
c. Acute appendicitis
d. Twist of cystoma of right uterine adnexa
e. Ovarian apoplexy
Question 11
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A woman complains of having slight dark bloody discharges and mild pains in the lower part of abdomen for several days. Last menses were
8 weeks ago. The pregnancy test is positive. Bimanual investigation: the body of the uterus indicates for about 6-7 weeks of pregnancy, it is
soft, painless. In the left appendage there is a retort-like formation, 14 х 9 mm large, mobile and painless. What examination is necessary for
detection of fetus localization?
a. Ultrasound
b. Colposcopy
c. Cystoscopy
d. Hromohydrotubation
e. Hysteroscopy
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12/21/22, 8:49 PM Emergency conditions in gynecology. Surgery in gynecology.
Question 12
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A 35 years old woman was admitted to gynecological department due to acute abdominal pain, that had occurred suddenly, nausea,
vomiting. In anamnesis — uterine subserosal fibroid diagnosed 7 years ago. Objective data: t 37.5, pulse 100/min, BP 110/65. Abdomen
painful in lower part where are noted muscle tension and positive Schotkin-Blumberg sign. The vaginal examination revealed: uterine slightly
enlarged. Painful tumor-like mass 9x8 cm is palpated in front of the uterus. Appendages without peculiarities. Doctor’s tactics?
a. Conservative treatment
b. Myomectomy
c. Hysterectomy without appendages
d. Embolization of uterine vessels
e. Hysterectomy with appendages
Question 13
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The patient, 24 years old, complains of pain in the lower abdomen, smearing bloody discharge from the genital tract. Menstruation is regular;
menstruation is delayed for 3 weeks. The pregnancy test is positive. Ob-but: sharp pain when shifting the cervix. The uterus is slightly
enlarged. In the area of the left appendages, the elongated formation is soft, painful on palpation. Minor bleeding from the genital tract. Your
diagnosis?
a. Disturbed uterine pregnancy
b. Acute adnexitis
c. Acute appendicitis
d. Disrupted tubal pregnancy
e. Ovarian apoplexy
Question 14
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A 36-year-old woman was admitted to a gynecological hospital with significant bleeding from the genital tract and delayed menstruation for
1 month. During bimanual examination, the cervix is soft, barrel-shaped. The uterus is of normal size, somewhat softened. The appendages
were inconspicuous on both sides. When examined in mirrors, the cervix is cyanotic, enlarged, the external opening is open to 0.5 cm. The
analysis of hCG in the urine is positive. Cervical pregnancy was diagnosed. What is a tactic?
a. Medical abortion
b. Hysterectomy
c. Curettage
d. Methotrexate treatment
e. Subtotal hysterectomy
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12/21/22, 8:49 PM Emergency conditions in gynecology. Surgery in gynecology.
Question 15
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A 28-year-old patient was brought with complaints of acute pain in the lower abdomen. There was short-term dizziness. Delay of
menstruation for 3 weeks. The skin is pale, BP-90/50 mm Hg. art., pulse-110 bpm. The abdomen is sharply painful in the lower parts. During
vaginal examination: the uterus is enlarged. Promtov's positive symptom. In the case of applications enlarged sharply painful. The back vault
overhangs. What is the most likely diagnosis?
a. Acute right-sided salpingo-oophoritis
b. Apoplexy of the right ovary
c. Abortion that has started
d. Right-sided tubal pregnancy
e. Pelvioperitonitis
Question 16
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A 22-year-old female patient was brought urgently with complaints of pain in the lower abdomen, dizziness. At first, the pain was in the right,
and then it spread to the lower abdomen, radiating into the rectum. The above-mentioned complaints arose after sexual life. The menstrual
cycle is not regular, the last menstruation was 2 weeks ago. Objectively: skin is pale, tachycardia, body temperature – 36.6°C, blood pressure
100/60 mm Hg. Art. The abdomen is sharply tense, slightly painful in the lower parts; symptoms of irritation of the peritoneum are weakly
positive. What is the likely diagnosis?
a. Violated ectopic pregnancy
b. Renal colic
c. Ovarian apoplexy
d. Acute appendicitis
e. Cat impassability
Question 17
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A 23-year-old patient complains of aching pain in the right iliac region for a week, morning sickness, and a change in taste. Delay of
menstruation for 4 weeks. Objectively: BP - 110/70 mm Hg, Ps - 78/min, t 37,3. During bimanual examination, the uterus is slightly enlarged,
soft, mobile and painless. During palpation of the appendages: on the right, a painful mass measuring 3x4 cm and dense-elastic, moderately
mobile. What is the most likely diagnosis?
a. Acute appendicitis
b. Uterine pregnancy
c. Interrupted tubal pregnancy
d. Cyst of the right ovary
e. Progressive tubal pregnancy
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12/21/22, 8:49 PM Emergency conditions in gynecology. Surgery in gynecology.
Question 18
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A 47-year-old woman complains of heavy bleeding from the vagina, which appears after a delay of menstruation for 2 months. Anatomical
changes were not detected during vaginal examination. The pregnancy test is negative. Proposed method of treatment?
a. Dilatation and curettage
b. Hysterectomy without appendix
c. Subtotal hysterectomy
d. Hysterectomy with appendages
e. Conservative treatment
Question 19
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A woman addressed a gynecologist on the 20th day of puerperal period with complaints of pain in the left mammary gland, puruent
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 there is hyperemic; in the upper quadrant there is an infiltrate 10x15 cm in size with soft center. Blood test: ESR50 mm/hour,
leukocytes - 15, 0 • 109/l. What would be the treatment tactics?
a. Refer to a postnatal department
b. Refer to a surgeon for conservative treatment
c. Transfer to a surgical department for surgical treatment
d. Lance the mammary gland abscess in a maternity department
e. Refer to a gynecology department
Question 20
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A 22-year-old women, with endometriosis continues to have disabling dysmenorrhea for 3 days at the time of menses despite cyclic oral
contraceptives (OCs). What is the BEST management option?
a. GnRH agonist (Lupron)
b. Continuous OCs
c. Danazol/gestrinone
d. Endometrial ablation
e. Uterine artery embolization
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