21) krok 2018

DISCIPLINE Obstetrics and Gynecology

TOPIC Placental dysfunction, hypotrophy of the fetus, fetal distress symptoms.
An infant has been born at the 41st week 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
assessed as a:
A. Full-term infant with intrauterine growth retardation
B. Premature infant
C. Immature infant
D. Postmature infant
E. Full-term infant with normal body weight

31) krok 2018

DISCIPLINE Obstetrics and Gynecology
TOPIC The physiology of pregnancy, labor and postpartum period. Perinatal protection of fetus.
Pharmacotherapy in obstetrics.
The pregnancy is full term. The body weight of the parturient woman is 62 kg. Fetus is in a
longitudinal lie, the head is engaged to the pelvic inlet. Belly circumference is 100 cm. Uterine
fundus height is 35 cm. What body weight of the fetus can be expected?
A. 3.5 kg
B. 4 kg
C. 2.5 kg
D. 3 kg
E. 4.5 kg

37) krok 2018

DISCIPLINE Obstetrics and Gynecology
TOPIC Anomalies of the contraction activity of the uterus. Birth and maternal traumatism.
Modern approaches to diagnostics and treatment of birth and maternal trauma.
The right arm of a newborn is stretched along the torso with all its joints extended; the shoulder
is rotated inwards, while the forearm is pronated, the hand is in the position of palmar flexion.
Spontaneous movements are absent in the shoulder and elbow joints, passive movements are
painless. What is the most likely diagnosis?
A. Duchenne-Erb palsy, superior proximal type
B. Dejerine-Klumpke palsy, inferior distal type
C. Total obstetric palsy
D. Osteomyelitis of the right humerus
E. Poliomyelitis

61) krok 2018

DISCIPLINE Obstetrics and Gynecology
TOPIC Anomalies of the contraction activity of the uterus. Birth and maternal traumatism.
Modern approaches to diagnostics and treatment of birth and maternal trauma.
A 22-year-old woman, gravida 1, para 0 arrived with complaints of sharply painful contractions
that occur every 4-5 minutes and last for 25-30 seconds. Amniotic fluid did not burst. The fetus
is in transverse lie, fetal heartbeats are not affected. Contraction ring is acutely painful, located
obliquely at the umbilicus. What is the most likely diagnosis?
A. Impending uterine rupture
B. Uterine tetany
C. Excessive uterine activity during labor
D. Discoordinated labor
E. Uterine rupture

69) krok 2018

DISCIPLINE Obstetrics and Gynecology
TOPIC Disorders of the menstrual function in reproductive age. Neuroendocrine syndromes in
gynecology. Physiological and pathological conditions in the perimenopausal period.
A 16-year-old girl has primary amenorrhea, no pubic hair growth, normally developed
mammary glands; her genotype is 46 ХY; uterus and vagina are absent. What is your diagnosis?
A. Testicular feminization syndrome
B. Mayer-Rokitansky-Kuster-Hauser syndrome
C. Cushing syndrome
D. Sheehan syndrome
E. Cushing disease

70) krok 2018

DISCIPLINE Obstetrics and Gynecology
TOPIC Anomalies of the contraction activity of the uterus. Birth and maternal traumatism.
Modern approaches to diagnostics and treatment of birth and maternal trauma.
6 hours ago the waters of a 30-year-old gravida 1, para 0, burst; her preliminary period was
pathologic and lasted for over 2 days; the term of pregnancy is 39 weeks. No labor activity is
observed. Fetal head presents above the pelvic inlet. Fetal heartbeats are 142/min., clear and
rhytmic. On vaginal examination the uterine cervix is not dilated. What further tactics should
the doctor choose?
A. Perform cesarean section
B. Induce cervical dilation with prostaglandins
C. Stimulate the labor with oxytocin
D. Wait for the onset of spontaneous labor
E. Prolong the pregnancy, while providing antibacterial treatment

73) krok 2018

DISCIPLINE Obstetrics and Gynecology
TOPIC The physiology of pregnancy, labor and postpartum period. Perinatal protection of fetus.
Pharmacotherapy in obstetrics.
A newborn has Apgar score of 9. When should the infant be put to the breast?
A. In the delivery room
B. After 12 hours
C. After 2 hours
D. On the 2nd day
E. On the 3rd day

77) krok 2018

DISCIPLINE Obstetrics and Gynecology
TOPIC Urgent conditions in gynecology.
A 23-year-old woman came the the gynecologist with complaints of blood smears from her
genital tracts that have been observed for a long time. Her menstruation has been delayed for 8
weeks. Examination shows the uterine body to be enlarged up to 14 weeks of pregnancy. US
detected a vesicular mole. What tactics should the doctor choose?
A. Curettage of the uterine cavity
B. Hormonal treatment
C. Hemostatic treatment
D. Supravaginal uterine amputation
E. Uterectomy

86) krok 2018

DISCIPLINE Obstetrics and Gynecology
TOPIC Urgent conditions in gynecology.
The gynecology unit received a patient with uterine bleeding that started 6 hours after induced
abortion at the term of 11-12 weeks. Objectively the skin is pale, pulse is 100/min., blood
pressure is 100/70 mm Hg. On vaginal examination the uterus is painless, its enlargement
corresponds to the 10th week of pregnancy; uterine cervix is dilated enough to let in one finger,
there are fragments of the fertilized ovum. What actions should be taken next:
A. Urgent repeated curettage of the uterine cavity
B. Uterotonic drugs
C. Treatment for acute anemia
D. Antibacterial agents
E. Prescribe rest and continue to monitor the patient’s condition

87) krok 2018

DISCIPLINE Obstetrics and Gynecology
TOPIC Disorders of the menstrual function in reproductive age. Neuroendocrine syndromes in
gynecology. Physiological and pathological conditions in the perimenopausal period.
A woman came to the general practitioner with complaints of fatigability, significant weight
loss, weakness, and loss of appetite. She has been presenting with amenorrhea for the last 8
month. One year ago she gave birth to a live full-term child. Blood loss during delivery was 2
liters. The woman received blood transfusion and blood components. What is the most likely
diagnosis?
A. Sheehan’s syndrome (postpartum hypopituitarism)
B. Stein-Leventhal syndrome (polycystic ovary)
C. Turner’s syndrome
D. Homologous blood syndrome
E. Somatoform autonomic dysfunction

89) krok 2018

DISCIPLINE Obstetrics and Gynecology
TOPIC . Female urogynecological inflammatory diseases.
A 22-year-old woman complains of itching and profuse discharge from her genital tracts. The
condition developed 10 days ago after a sexual contact. Bacterioscopy of a discharge sample
detected trichomonads. What drug should be prescribed for treatment in this case?
A. Metronidazole
B. Ampicillin
C. Erythromycin
D. Zovirax (Acyclovir)
E. Valcyclovir

92) krok 2018

DISCIPLINE Obstetrics and Gynecology
TOPIC The physiology of pregnancy, labor and postpartum period. Perinatal protection of fetus.
Pharmacotherapy in obstetrics.
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 tint to his skin. The child has no
problems with suckling, sleep is nondisturbed. 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?
A. Physiologic jaundice
B. Congenital hepatitis
C. Hemolytic disease of the newborn due to Rh incompatibility
D. Biliary atresia
E. Hemolytic disease of the newborn due to ABO incompatibility

94) krok 2018

DISCIPLINE Obstetrics and Gynecology
TOPIC Early gestosis. Hypertensive conditions during pregnancy. Preeclampsia. Eclampsia.
A multigravida on the 38th week of her pregnancy complains of increased BP up to 140/90 mm
Hg, edema of the shins for 2 weeks. In the last month she gained 3.5 kg of weight. Urine
analysis: protein - 0.033 g/L. Make the diagnosis:
A. Mild preeclampsia
B. Moderate preeclampsia
C. Pregnancy hypertension
D. Severe preeclampsia
E. Pregnancy edema

107) krok 2018

DISCIPLINE Obstetrics and Gynecology
TOPIC Gynecological diseases in children and teenagers. Methods of contraception for
teenagers.
A 15-year-old adolescent girl came the gynecologist with complaints of painful menstruations
that are accompanied by nausea, vomiting, and dizziness. Her menarche was at
12.Menstruations became painful since she was 14, remain regular. What treatment should be
prescribed in this case?
A. Analgesics, antispasmodics, antiprostaglandine therapy
B. Antiinflammatory treatment only
C. Antihemorrhagic agents
D. Antiandrogen therapy
E. Vitamin supplements

114) krok 2018

DISCIPLINE Obstetrics and Gynecology
TOPIC The physiology of pregnancy, labor and postpartum period. Perinatal protection of fetus.
Pharmacotherapy in obstetrics.
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 waters have not burst yet. The fetus is in longitudinal position. Fetal heartbeats are
136/min., clear and rhytmic. Major segment of the fetal head is engaged to the pelvic inlet.
Vaginal examination shows smooth cervix of 6cm, 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. Latent phase of the first stage of normal labor
C. The second stage of normal labor
D. Precursors of childbirth
E. Preliminary stage

122) krok 2018

DISCIPLINE Obstetrics and Gynecology
TOPIC The physiology of pregnancy, labor and postpartum period. Perinatal protection of fetus.
Pharmacotherapy in obstetrics.
It is the 3rd day after the normal term labor; the infant is roomingin with the mother and is on
breastfeeding. Objectively: the mother’s general condition is satisfactory. Temperature is
36.4oC , heart rate is 80/min., BP is 120/80 mm Hg. Mammary glands are soft and painless;
lactation is moderate, unrestricted milk flow. The uterus is dense, the uterine fundus is located
by 3 fingers width below the navel. Lochia are sanguinoserous, moderate in volume. Assess the
dynamics of uterine involution:
A. Physiological involution
B. Subinvolution
C. Lochiometra
D. Pathologic involution
E. Hematometra

133) krok 2018

DISCIPLINE Obstetrics and Gynecology
TOPIC Disorders of the menstrual function in reproductive age. Neuroendocrine syndromes in
gynecology. Physiological and pathological conditions in the perimenopausal period.
A 30-year-old woman complains of milk discharge from her breasts and no menstruation for the
last 5 months. One physiologic childbirth was 4 years ago. There are no maldevelopments of
mammary glands. Bimanual examination revealed diminished uterus and normal sized ovaries.
MRI-scan shows no brain pathologies. Thyroidstimulating hormone is within normal limits.
Serum prolactin is high. What is the most likely diagnosis?
A. Hyperprolactinemia
B. Hypothyroidism
C. Polycystic ovaries
D. Pituitary adenoma
E. Sheehan’s syndrome (postpartum hypopituitarism)

134) krok 2018

DISCIPLINE Obstetrics and Gynecology
TOPIC Benign tumors of the female genitalia. Dishormonal diseases of breasts. Endometriosis.
A 25-year-old woman during self-examination detected a tumor in the upper external quadrant
of her right mammary gland. On palpation: painless, dense, mobile growth 2 cm in diameter is
detected in the mammary gland; no changes in the peripheral lymph nodes are observed. On US
of the mammary glands: in the upper external quadrant of the right mammary gland there is a
spaceoccupying lesion of increased echogenicity 21х18 mm in size. The most likely diagnosis
is:
A. Fibrous adenoma
B. Breast cyst
C. Diffuse mastopathy
D. Breast cancer
E. Mastitis

140) krok 2018

DISCIPLINE Obstetrics and Gynecology
TOPIC Benign tumors of the female genitalia. Dishormonal diseases of breasts. Endometriosis.
A 45-year-old woman came to the maternity clinic with complaints of periodical pains in her
mammary glands that start 1 day before menstruation and stop after the menstruation begins.
Palpation of the mammary glands detects diffuse nodes predominantly in the upper outer
quadrants. What is the most likely diagnosis?
A. Fibrocystic mastopathy
B. Breast cancer
C. Mastitis
D. Hyperprolactinemia
E. Breast cyst

141) krok 2018

DISCIPLINE Obstetrics and Gynecology
TOPIC Urgent conditions in gynecology.
A woman complains of temperature increase up to 39 oC , 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
B. Endometritis
C. Acute adnexitis
D. Pyosalpinx
E. Metroendometritis

145) krok 2018

DISCIPLINE Obstetrics and Gynecology
TOPIC Рrecancerous diseases of the female genitalia. Malignant tumors of the genitalia.
A 55-year-old woman came to a gynecologist with complaints of leukorrhea and bloody
discharge from the vagina after 5 years of menopause. Anamnesis states no pregnancies.
Bimanual examination: the uterus and uterine appendages are without changes. During
diagnostic curettage of the uterine cavity the physician scraped off enchephaloid matter. What is
the most likely diagnosis in this case?
A. Endometrial carcinoma
B. Adenomyosis
C. Subserous uterine myoma
D. Cervical carcinoma
E. Ovarian carcinoma

154) krok 2018

DISCIPLINE Obstetrics and Gynecology
TOPIC Placental dysfunction, hypotrophy of the fetus, fetal distress symptoms.
A 24-year-old pregnant woman on her 37th week of pregnancy has been delivered to a
maternity obstetric service with complaints of weak fetal movements. Fetal heartbeats are
95/min. On vaginal examination the uterine cervix is tilted backwards, 2 cm long, external
orifice allows inserting a fingertip. Biophysical profile of the fetus equals 4 points. What
tactics of pregnancy management should be chosen?
A. Urgent delivery via cesarean section
B. Treatment of placental dysfunction and repeated analysis of the fetal biophysical profile on
the next day
C. Doppler measurement of blood velocity in the umbilical artery
D. Urgent preparation of the uterine cervix for delivery
E. Treatment of fetal distress, if ineffective, then elective cesarean section on the next day

155) krok 2018

DISCIPLINE Obstetrics and Gynecology
TOPIC Benign tumors of the female genitalia. Dishormonal diseases of breasts. Endometriosis.
During regular preventive gynecological examination a 30-year-old woman was detected to
have dark blue punctulated ”perforations” on the vaginal portion of the uterine cervix. The
doctor suspects endometriosis of the vaginal portion of the uterine cervix. What
investigation method would be most informative for diagnosis confirmation?
A. Colposcopy, target biopsy of the cervix
B. US of the lesser pelvis
C. Hysteroscopy
D. Curettage of the uterine cavity
E. Hormone testing

156) krok 2018

DISCIPLINE Obstetrics and Gynecology
TOPIC Benign tumors of the female genitalia. Dishormonal diseases of breasts. Endometriosis.
A 26-year-old woman came to a gynecologist for a regular check-up. She has no complaints. Per
vaginum: the uterus lies in anteflexion, not enlarged, dense, mobile, painless. On the left from
the uterus in the area of uterine appendages there is a mobile painless outgrowth that can be
moved independently from the uterus. On the right the appendages cannot be detected. What
additional investigation would be informative for diagnosis clarification?
A. Ultrasound of the lesser pelvis
B. Metrosalpingography
C. Examination for urogenital infection
D. Colposcopy
E. Colonoscopy

164) krok 2018

DISCIPLINE Obstetrics and Gynecology
TOPIC Postnatal septic diseases.
A postparturient woman, who has been breastfeeding for 3 weeks, made an appointment with the
doctor. For the last 6 days she has been feeling unwell, complains of body temperature of 38-
39oC , general weakness; within the last 2 days she developed pain and redness in the area of her
right mammary gland.Examination revealed her mammary gland to be significantly enlarged and
deformed; breast tissue fluctuations and lymphadenitis are observed. What type of mastitis is the
most likely?
A. Phlegmonous mastitis
B. Serous mastitis
C. Infiltrative mastitis
D. Lactostasis
E. Mammary edema

166) krok 2018

DISCIPLINE Obstetrics and Gynecology
TOPIC Postnatal septic diseases.
On the 9th day after childbirth the obstetric patient developed high fever up to 38oC . She
complains of pain in the right mammary gland. The examination revealed the following: 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?
A. Abscess of the right mammary gland
B. Mastopathy
C. Cancer of the right mammary gland
D. Serous mastitis
E. Fibrous cystic degeneration of the right mammary gland

192) krok 2018

DISCIPLINE Obstetrics and Gynecology
TOPIC Gynecological diseases in children and teenagers. Methods of contraception for
teenagers.
A 17-year-old girl has made an appointment with the doctor. She plans to begin her sex life. No
signs of gynecological pathology were detected. In the family history there was a case of cervical
cancer that occurred to the patient’s grandmother. The patient was consulted about the
maintenance of her reproductive health. What recommendation will be the most helpful for
prevention of invasive cervical cancer?
A. Vaccination against human papillomavirus (HPV)
B. Vitamins, calcium, omega-3
C. Immunomodulators
D. Antiviral and antibacterial drugs
E. Timely treatment of sexually transmitted diseases