Obstetrics & Gynecology 2019 Bases Krok 2 Explaned - Students Assistant

Students Assistant
Obstetrics & Gynecology 2019 Bases Krok 2

Explaned
Neni Emmanuel 3 years ago
obsetetrics and gynecology
KROK 2 Obstetrics and Gynecology BASES WITH

HIGHLIGHTS AND EXPLANATIONS
The bellow material is aimed to improve the study and understanding of the Krok 2
2019 Obstetrics and Gynecology Bases with the use of highlights for relevant key
works, links to relevant study materials, reference images and explanations to
individual questions aimed at making remembrance of questions easier and also
understanding of new questions for the upcoming Step 2 exam.
** Refer To Krok 2 Lab values Open table in new tab

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I. PEDIATRICS 2019 BASES KROK 2 EXPLANATIONS

II. Hygiene Bases 2019 Krok 2 Explanations
1. The 28 y.o. woman applied to doctor because of limited loss of the hair. In the
anamnesis – she had frequent headache indisposition, arthromyalgia, fever, irregular
casual sexual life, drug user. RW is negative. What examination must be done first?
A. * Examination for HIV
B. Examination for neuropathologycvx
C. Examination for gonorrhea
D. Examination for fungi
E. Examination for trichomoniasis
Exp:
RW – Reaction of Wasserman for syphilis+-
The Wassermann test or Wassermann reaction (WR) is an antibody test for syphilis,
named after the bacteriologist August Paul von Wassermann, based on complement
fixation.
2. The 28 y.o. woman applied to doctor because of limited loss of the hair. In the
anamnesis – she had frequent headache indisposition, arthromyalgia, fever, irregular
casual sexual life, drug user. RW is negative. What examination must be done first?
A. * Examination for HIV
B. Examination for neuropathology
C. Examination for gonorrhea
D. Examination for fungi
E. Examination for trichomoniasis
3. At term of a gestation of 40 weeks height of standing of a uterine fundus is less then

assumed for the given term. The woman has given birth to the child in weight of 2500 g,
a length of a body 53 cm, with an assessment on a scale of Apgar of 4-6 points. Labor
were fast. The cause of such state of the child were:
A. * Chronic placental dysfunction
B. Delay of an intrauterine fetation → (Fetation is the formation of a fetus)
C. Placental detachment → No bleeding or abdominal pain in qt
D. Infection of a fetus → No specific signs of infection
E. Prematurity → Gestation in term in pt
EXP:
Placental insufficiency (also called placental dysfunction or uteroplacental

vascular insufficiency) is an uncommon but serious complication of pregnancy. It
occurs when the placenta does not develop properly, or is damaged. This blood flow
disorder is marked by a reduction in the mother’s blood supply.
Symptoms
There are no maternal symptoms associated with placental insufficiency. However,
certain clues can lead to early diagnosis. The mother may notice that the size of her
uterus is smaller than in previous pregnancies. The fetus may also be moving less than
expected.
If the baby isn’t growing properly, the mother’s abdomen will be small, and the baby’s
movements will not be felt much.
4. A woman, aged 40, primigravida, with infertility in the medical history, on the 42-43
week of pregnancy. Labour activity is weak. Longitudinal presentation of the fetus, I
position, anterior position. The head of the fetus is engaged to pelvic inlet. Fetus heart
rate is 140 bmp, rhythmic, muffled. Cervix dilation is 4 cm. On amnioscopy: greenish
colour of amniotic fluid and fetal membranes. Cranial bones are dense, cranial sutures
and small fontanel are diminished. What should be tactics of delivery
A. * Caesarean section → Before the child aspirates and goes into distress
B. Amniotomy, labour stimulation, fetal hypoxia treatment
C. Fetal hypoxia treatment, in the II period – forceps delivery → Cervix is not dilated
D. Fetal hypoxia treatment, conservative delivery
E. Therapeutic rest, amniotomy, labour stimulation
5. The woman who has delivered twins has early postnatal hypotonic uterine bleeding
reached 1,5% of her body weight. The bleeding is going on. Conservative methods to
arrest the bleeding have been found ineffective. The conditions of patient are pale skin,
acrocyanosis, oliguria. The woman is confused. The pulse is 130 bpm, BP– 75/50 mm
Hg. What is the further treatment?
A. * Total hysterectomy
B. Subtotal hysterectomy
C. Uterine vessels ligation
D. Inner glomal artery ligation
E. Putting clamps on the uterine cervix
6. 26 y.o. woman complains of a mild bloody discharge from the vagina and pain in the
lower abdomen. She has had the last menstruation 3,5 months ago. The pulse is
100bpm. The blood pressure (BP) is 110/60 mm Hg and body temperature is 36, 6oC.
The abdomen is tender in the lower parts. The uterus is enlarged up to 12 weeks of
gestation, conceptus products in the cervix. What is your diagnosis?
A. * Inevitable abortion
B. Incipient abortion
C. Incomplete abortion
D. Complete abortion
E. Disfunctional bleeding
Exp:
Inevitable abortion is an early pregnancy with vaginal bleeding and dilatation of the
cervix. Typically, the vaginal bleeding is worse than with a threatened abortion, and
more cramping is present. No tissue has passed yet.
Incomplete abortion is a pregnancy that is associated with vaginal bleeding,

dilatation of the cervical canal, and passage of products of conception. Usually, the
cramps are intense, and the vaginal bleeding is heavy.
Complete abortion is a completed miscarriage. Typically, a history of vaginal

bleeding, abdominal pain, and passage of tissue exists. After the tissue passes, the
patient notes that the pain subsides and the vaginal bleeding significantly diminishes.
7. 18 y.o. woman complains of pain in the lower abdomen. Some minutes before she has
suddenly appeared unconscious at home. The patient had no menses within last 3
months. On examination: pale skin, the pulse- 110 bpm, BP- 80/60 mm Hg. The
Schyotkin’s sign is positive. Hb- 76 g/L. The vaginal examination: the uterus is a little
bit enlarged, its displacement is painful. There is also any lateral swelling of indistinct
size. The posterior fornix of the vagina is tender and overhangs inside. What is the most
probable diagnosis?
A. * Ruptured ectopic pregnancy
B. Ovarian apoplexy
C. Right uterine adnexa cystoma’ torsion
D. Acute salpingoophoritis
E. Acute appendicitis
Exp:
Blumberg’s sign (also referred to as rebound tenderness, Shyotkin-Blumberg sign) is a

clinical sign that is elicited during physical examination of a patient’s abdomen by a
doctor or other health care provider. It is indicative of peritonitis.
8. A 20 y.o. pregnant woman with 36 weeks of gestation was admitted to the obstetrical
hospital with complains of pain in the lower abdomen and bloody vaginal discharge.
The general condition of the patient is good. Her blood pressure is 120/80 mm Hg. The
heart rate of the fetus is 140 bpm, rhythmic. Vaginal examination: the cervix of the
uterus is formed and closed. The discharge from vagina is bloody up to 200 ml per day.
The head of the fetus is located high above the minor pelvis entry. A soft formation was
defined through the anterior fornix of the vagina. What is the probable diagnosis?
A. * Placental previa → occurs when a baby’s placenta partially or totally covers the
mother’s cervix — the outlet for the uterus
B. Placental abruption → Premature separation
C. Uterine rupture
D. Threatened premature labor
E. Incipient abortion
9. In the gynecologic office a 28 y.o. woman complains of sterility within three years.
The menstrual function is not impaired. There were one artificial abortion and chronic
salpingooophoritis in her case history. Oral contraceptives were not used. Her
husband’s analysis of semen is without pathology. From what diagnostic method will
you start the workup in this case of sterility?
A. * Hysterosalpingography
B. Hormone investigation → If oral contraceptives were used
C. Ultra sound investigation
D. Diagnostic scraping out of the uterine cavity → Age above 40
E. Hysteroscopia → For only history of Abortion
10. A 43 y.o. patient complains of mass and, pain in the right breast, elevation of
temperature to 37,2oC during 3 last months. Condition worsens before the

menstruation. On examination: edema of the right breast, hyperemia, retracted nipple.
Unclear painful infiltration is palpated in the lower quadrants. What is the most
probable diagnosis?
A. * Cancer of right mammary gland
B. Right side acute mastitis
C. Right side chronic mastitis
D. Premenstrual syndrome
E. Tuberculosis of right mammary gland
11. A 27 y.o. gravida with 17 weeks of gestation was admitted to the hospital. There was a
history of 2 spontaneous miscarriages. On bimanual examination: uterus is enlarged to
17 weeks of gestation, uterus cervix is shortened, isthmus allows to pass the finger tip.
The diagnosis is isthmico-cervical insufficiency. What is the doctor’s tactics?
A. * Cervical cerclage
B. Tocolytics prescription
C. Dexamethazome prescription
D. Spasmolytics prescription
E. Dilation and curretage
Exp:
Cervical weakness, also called cervical incompetence or cervical insufficiency,

is a medical condition of pregnancy in which the cervix begins to dilate (widen) and
efface (thin) before the pregnancy has reached term. … In a normal pregnancy, dilation
and effacement occurs in response to uterine contractions.
Cervical cerclage, also known as a cervical stitch, is a treatment

for cervical weakness, when the cervix starts to shorten and open too early during a
pregnancy causing either a late miscarriage or preterm birth.
12. A 27 y.o. woman turns to the maternity welfare centre because of infertility. She has
had sexual life in marriage for 4 years, doesn’t use contraceptives. She didn’t get
pregnant. On examination: genital development is without pathology, uterus tubes are
passable, basal (rectal) temperature is one-phase during last 3 menstrual cycles. What is
the infertility cause?
A. * Anovular menstrual cycle
B. Chronic adnexitis
C. Abnormalities in genital development
D. Immunologic infertility
E. Genital endometriosis
Exp:
During ovulation the body temperature changes and our pt had same temp for 3 months
indication absence of ovulation.
13. A 43 y.o. woman complains of contact hemorrhages during the last 6 months.
Bimanual exam: cervix of the uterus is enlarged, restricted in mobility. Speculum
examination showed the following: cervix of the uterus is in the form of cauliflower.
Chrobak and Schiller tests are positive. What is the most probable diagnosis?
A. * Cancer of uterine cervix
B. Cervical polyps
C. Cervical pregnancy
D. Protruded myoma
E. Leukoplakia
Exp:
Schiller’s test or Schiller’s Iodine test is a medical test in which iodine

solution is applied to the cervix in order to diagnose cervical cancer.
14. A gravida with 7 weeks of gestation is referred for the artificial abortion. On
operation while dilating cervical canal with Hegar dilator №8 a doctor suspected uterus
perforation. What is immediate doctors tactics to confirm the diagnosis?
A. * Probing of uterus cavity
B. Bimanual examination
C. Ultrasound examination
D. Laparoscopy
E. Metrosalpingography
15. 25 y.o. woman complains of profuse foamy vaginal discharges, foul, burning and
itching in genitalia region. She has been ill for a week. Extramarital sexual life. On
examination: hyperemia of vaginal mucous, bleeding on touching, foamy leucorrhea in
the urethral area. What is the most probable diagnosis?
A. * Trichomonas vaginitis
B. Gonorrhea
C. Chlamydiosis
D. Vagina candidomicosis
E. Bacterial vaginosis
Trichomonas vaginitis is a vaginal infection due to the protozoa Trichomonas

vaginalis. Trichomonas vaginitis is usually sexually transmitted. It can cause a
green or yellow discharge, which may be profuse, smell fishy, and be accompanied by
itching or irritation.
16. Girl, aged 13, consults the school doctor on account of moderate bloody discharge
from the genital tracts, which appeared 2 days ago. Secondary sexual characters are
developed. What is the most probable cause of bloody discharge?
A. * Menarche → the first occurrence of menstruation.
B. Juvenile haemorrhage
C. Haemophilia
D. Endometrium cancer
E. Werlhof’s disease
17. A 30 y.o. primipara has intensive labor pushings with an interval of 1-2 min and of
45-50sec duration. There is a appearing of the fetal head. Perineum is of 4 cm height,
has turned pale. What should be done in this case?
A. * Episiotomy → a surgical cut made at the opening of the vagina during childbirth, to
aid a difficult delivery and prevent rupture of tissues.
B. Perineum protection
C. Perineotomy
D. Vacuum extraction of the fetus
E. Observation
Episiotomy, also known as perineotomy, is a surgical incision of the perineum and the
posterior vaginal wall generally done by a midwife or obstetrician. Episiotomy is usually
performed during second stage of labor to quickly enlarge the opening for the baby to
pass through.
18. A 28 y.o. primagravida, pregnancy is 15-16 weeks of gestation, presents to the

maternity clinics with dull pain in the lower part of the abdomen and in lumbar area.
On vaginal examination: uterus cervix is 2,5 cm, external isthmus allows to pass the
finger tip. Uterus body is enlarged according to the pregnancy term. Genital discharges
are mucous, mild. What is the diagnosis?
A. * Threatened spontaneous abortion
B. Initial abortion
C. Missed pregnancy
D. Molar pregnancy
E. Placenta previa
Threatened abortion is vaginal bleeding without cervical dilation occurring during

this time frame and indicating that spontaneous abortion may occur in a woman
with a confirmed viable intrauterine pregnancy. Diagnosis is by clinical criteria and
ultrasonography.
19. A primapara with pelvis size 25-28-31-20 cm has active labor activity. Waters
poured out, clear. Fetus weight is 4500 g, the head is engaged to the pelvic inlet.
Vasten’s sign is positive. Cervix of uterus is fully dilated. Amniotic sac is absent. The
fetal heartbeat is clear, rhythmic, 136 bpm. What is the labor tactics?
A. * Caesarean section
B. Vacuum extraction of the fetus
C. Obstetrical forseps
D. Conservative tactics of labor
E. Stimulation of the labor activity
Exp:
Normal pelvic sign: mnemonic SCTE
D.Spinarum: 25-26
D.Cristarum: 28-29
D.Trocanterica: 31 -32
External conjugate: 20-21
Positive Vasten‘ sign (if disproportion between fetal head and symphisis pubis is
prominent – Vasten‘ sign is positive, if disproportion between fetal head and
symphisis pubis is absent – Vasten‘ sign is negative).
20. A 30 y.o. woman has second labor which lasts for 14 hours. The fetus heartbeat is
muffled, arrhythmic, 100 bpm. On vaginal examination: complete cervix dilatation,
fetus head is in the area of small pelvis outlet. Sagital suture is in the direct size. The
small fontanelle is at the symphis. What is the further tactics of the labor?
A. * Application of outlet forceps
B. Labor induction by oxytocyne
C. Ceasarian section
D. Application of craniodermal forceps by Ivanov’s
E. Application of mid forceps
21. A 45 y.o. woman complains of contact bleedings during 5 months. On speculum

examination: hyperemia of uterus cervix, looks like cauliflower, bleeds on probing. On
bimanual examination: cervix is of densed consistensy, uterus body isn’t enlarged,
mobile, nonpalpable adnexa, parametrium is free, deep fornixes. What is the most likely
diagnosis?
A. * Cancer of cervix of uterus
B. Cancer of uterine cavity
C. Fibromatous node which is being born
D. Cervical pregnancy
E. Polyposis of uterine cervix
22. A 27 y.o. woman suffers from pyelonephritits of the only kidney. She presents to the
maternity welfare center because of suppresion of menses for 2,5 months. On
examination pregnancy 11 weeks of gestation was revealed. In urine: albumine 3,3 g/L,
leucocytes cover the field of vision. What is doctor’s tactics in this case?
A. * Immediate pregancy interruption → has one kidney which is infected
B. Pregnancy interruption after urine normalization
C. Maintenance of pregnancy till 36 weeks
D. Pregnancy interruption at 24-25 weeks
E. Maintenance of pregnancy till delivery term
Exp:
Pt has only one kidney and is pregnant at 11 weeks of gestation
23. After delivery and revision of placenta there was found the defect of placental lobe.
General condition of woman is normal, uterine is firm, there is moderate bloody
discharge. Inspection of birth canal with mirrors shows absence of lacerations. What is
the following necessary action?
A. * Manual exploration of the uterine cavity
B. External massage of uterus
C. Use of uterine contracting agents
D. Use of uterine contracting agents
E. Use of hemostatic medications
Exp :
Steps to find and arrest postpertum bleeding:
I. External uterine massage

II. Speculum examination
III. Manual exploration of Uterus & Complete with Bi-manual uterine compression
IV. Insert bakri balloon
V. Aortal compression
VI. Surgical treatement
I. ligation of artries to uterus
II. Hysterectomy
III. Partial resection of uterus (in case of placental increta)
24. A woman is admitted to the maternity hospital with stopped birth activity and mild
bloody discharges from the vagina. The condition is serious, the skin is pale,
consciousness is confused. AP- 80/40 mm Hg. The palpitation of the fetus is not
determined. In medical history there was a Cesarean section a year ago. Make a
diagnosis:
A. * Hysterorrhesis
B. Presentation of the cord
C. Placental presentation → Placental previa (Usually indicated by bleeding at early 3rd

trimester about 24 weeks)
D. Abjointing of the mucous fuse from uterine cervix
E. Premature expultion of the amniotic waters
Exp:
Cesarean section a year ago indicates possibility for uterine rupture.
24a. A woman is admitted to maternity home with discontinued labor activity and slight
bloody discharges from vagina. The condition is severe, the skin is pale, consciousness
is confused. BP is 80/40 mm Hg. Heartbeat of the fetus is not heard. There was a
Cesarian section a year ago. Could you please determine the diagnosis?
A. * Hysterorrhesis
B. Cord Presentation
C. Placental presentation
D. Expulsion of the mucous plug from cervix uteri
E. Expulsion of the mucous plug from cervix uteri
25. A 26 y.o. woman complains of sudden pains in the bottom of abdomen irradiating to
the anus, nausea, giddiness, bloody dark discharges from sexual tracts for one week, the
delay of menses for 4 weeks. Signs of the peritoneum irritation are positive. Bimanual
examination: borders of the uterus body and adnexa are not determined because of
sharp painfullness. The diverticulum and painfullness of the back and dextral fornixes
of the vagina are evident. What is the most probable diagnosis?
A. * Ruptured tubal pregnancy
B. Apoplexy of the ovary
C. Acute right-side adnexitis
D. Torsion of the ovarian pedicle
See Qt 7
26. An employee had an abortion by medical indications on the 6.03.2001 and she
stayed in a hospital till 17.03.2001. What term is the medical sicklist issued for?
A. * For 12 days
B. For 3 days
C. For 4 days
D. For 10 days
E. For 11 days
27. A pregnant woman (35 weeks), aged 25, was admitted to the hospital because of
bloody discharges more than 300ml. In her medical history there were two
artificial abortions. In a period of 28-32 weeks there was noted the onset of hemorrhage
and USD showed a total placental presentation. The uterus is in normotonus, the fetus
position is transversal (Ist position). The heartbeats is clear, rhythmical, 140 bpm. What
is the further tactics of the pregnant woman care?
A. * To perform a delivery by Cesarean section
B. To perform the hemotransfusion and to prolong the pregnancy → Current bleeding >
250ml doesn’t allow for futher prolongation of pregnancy
C. To introduct the drugs to increase the blood coagulation and continue observation
D. Stimulate the delivery by intravenous introduction of oxytocin → Fetus is in

transverse presentation
E. To keep the intensity of hemorrhage under observation and after the bleeding is
controlled to prolong the pregnancy → 32 weeks of gestation is the mark for preterm
delivery but our patient is at 35 weeks so the fetus is relatively developed at this ga.
Exp:
NB: Gestiaational age, pregnancy was prolonged from 28 weeks to 35 already, bleeding
> 250ml and transverse position.
Placental presentation → Placental previa (Usually indicated by bleeding at early 3rd

trimester about 22 – 24 weeks)
28. Condition of a parturient woman has been good for 2 hours after live birth: uterus is
thick, globeshaped, its bottom is at the level of umbilicus, bleeding is absent. The clamp
put on the umbilical cord remains at the same level, when the woman takes a deep
breath or she is being pressed over the symphysis with the verge of hand, the umbilical
cord drows into the vagina. Bloody discharges from the sexual tracts are absent. What is
the doctor’s further tactics?
A. * To do manual removal of afterbirth
B. To apply Abduladze method
C. To apply Crede’s method
D. To do curettage of uterine cavity
E. To introduct oxitocine intravenously
Exp:
2 hours is too long as in current day cases doctor waits 30 min then performs manual
removal.
The abnormal placental adherence is diagnosed by:
1. Absence of the signs of placental separation during 30 minutes.

Signs of placental separation:
1. the uterus rises in the abdomen;

2. the shape of the uterus changes from discoid to globular
3. the umbilical cord lengthens.
4. External bleeding – in the case of partial adherence, absence of the bleeding – in the
case of total placenta accreta.
5. Manual removal of the placenta confirms the diagnosis of different types of abnormal
placental adherence. In the case of partial placental adhaerence it stops bleeding, but
in the case of placenta accreta, increta and percrata it increases bleeding. Attempts at
manual removal are futile. That’s why in these cases manual removal of the placenta
should be stopped immediately and hysterectomy should be performed.
Umbilical cord drows indicated the placenta is not separated so manual removal is
needed.
SIGNS OF PLACENTAL SEPARATION ARE FOLLOWS:
Alfeld’s sign – the umbilical cord lengthens outside the vagina, the clamp, applied on
an umbilical cord on the level of pudendal cleft, after placental separation comes down
on 10-12 cm.
Shreder’s sign – the uterine fundus rises up, the uterus becomes firm and globular.
Krede-Lasarevich’s sign/Kustner Thukalov’ sign – a doctor presses with his

palm above the patient’s pubis. Before placental separation umbilical cord comes/drows
inside a vagina (sign is negative), after separation – comes down (sign is positive).
29. A 27 y.o. woman complains of having the disoders of menstrual function for 3
months, irregular pains in abdomen. On bimanual examination: in the right adnexa
there is an elastic spherical formation, painless, 7 cm in diameter. At ultrasound: in the
right ovary – a fluid formation, 4 cm in diameter, unicameral, smooth. What method of
treatment is the most preferable?
A. * Prescription of an estrogen-gestogen complex for 3 months with repeated
examination
B. Operative treatment
C. Dispensary observation of the patient
D. Anti-inflammatory therapy
E. Chemotherapeutic treatment
30. A 40 y.o. patient complains of yellowish discharges from the vagina. Bimanual
examination: no pathological changes. The smear contains Trichomonas vaginalis and
blended flora. Colposcopy: two hazy fields on the front labium, with a negative Iodum
test. Your tactics:
A. * Treatment of specific colpitis and with the subsequent biopsy
B. Diathermocoagulation of the cervix of the uterus
C. Specific treatment of Trichomonas colpitis
D. Cervix ectomy
E. Cryolysis of cervix of the uterus
Exp:
Trichomonas vaginalis(Trichomoniasis) should be treated Specifically making C the

best option but the functional test which gave a negative iodum/iodine/lugol probing
which makes B the right option cause you’ll need to treat the infection and get a biopsy
to identify the change in cells.
Schiller’s test or Schiller’s Iodine test is a medical test in which iodine

solution is applied to the cervix in order to diagnose cervical cancer.
Age is indicated for biopsy as well
In normal Lugol’s iodine test probing should be positive indicating normal cells.
30a. A 40-year-old woman complains of yellow color discharges from the vagina.
Bimanual examination: no pathological changes. Smear test: Trichomonas vaginalis and
mixed flora. Colposcopy: two hazy fields on the front labium, with a negative Iodum
probing. What is your tactics?
A. Cryolysis of cervix uteri
B. *Treatment of specific colpitis with the subsequent biopsy
D. Diathermocoagulation of the cervix uteri
E. Cervix ectomy
31. A full-term newborn suffered from ante- and intranatal hypoxia, was born in
asphyxia (Apgar score 2-5 points). After birth baby’s excitation is progressing, occurs
vomiting, nystagmus, spasms, squint, spontaneous Babinski and Moro’s reflexes. What
is the most probable location of the intracranial hemorrhage in this case?
A. * Subarachnoid hemorrhages
B. Small hemorrhages in brain tissue
C. Subdural hemorrhages
D. Periventricular hemorrhages
E. Hemorrhages in ventricles of brain

Subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space—the
area between the arachnoid membrane and the pia mater surrounding the brain.
Symptoms may include a severe headache of rapid onset, vomiting, decreased level of
consciousness, fever, and sometimes seizures.
Subarachnoid hemorrhage
A subdural hemorrhage (or hematoma) is a type of bleeding that often occurs

outside the brain as a result of a severe head injury. It takes place when blood vessels
burst between the brain and the leather-like membrane that wraps around the brain
(the dura mater).
Symptoms of a subdural hematoma may include:
Headache
Confusion
Weakness, or numbness on one side of the body
Drowsiness
Speech and comprehension problems
Dizziness
Nausea or vomiting
Seizures
subdural hemorrhage
Periventricular hemorrhage (PVH) is the result of “temporary” fragile blood

vessels and unstable circulation in the brain of very premature infants. Antenatal
corticosteroids have substantially reduced PVH.
32. A 37 y.o. primigravida woman has been having labor activity for 10 hours. Labor
pains last for 20-25 seconds every 6-7 minutes. The fetus lies in longitude, presentation
is cephalic, head is pressed upon the entrance to the small pelvis. Vaginal examination
results: cervix of uterus is up to 1 cm long, lets 2 transverse fingers in. Fetal bladder is
absent. What is the most probable diagnosis?
A. * Primary uterine inertia
B. Secondary uterine inertia
C. Normal labor activity
D. Discoordinated labor activity
E. Pathological preliminary period
33. A 43 y.o. patient complains of formation and pain in the right mammary gland, rise
of temperature up to 37,2oC during the last 3 months. Condition worsens before the
menstruation. On examination: edema of the right breast, hyperemia, retracted nipple.
Unclear painful infiltration is palpated in the lower quadrants. What is the most
probable diagnosis?
A. * Cancer of the right mammary gland
B. Right-side acute mastitis
C. Right-side chronic mastitis
E. Tuberculosis of the right mammary gland
34. A 14 y.o. girl complains of profuse bloody discharges from genital tracts during 10
days after suppresion of menses for 1,5 month. Similar bleeding recur since years on the
background of disordered menstrual cycle. On rectal examination: no pathology of the
internal genitalia. In blood: Нb- 70 g/L, RBC- 2,3 * 1012/L, Ht-0,40. What is the most
probable diagnosis?
A. * Juvenile bleeding, posthemorrhagic anemia
B. Werlholf’s disease → Immune thrombocytopenia purpura (ITP)
C. Polycyst ovarian syndrome
D. Hormonoproductive ovary tumor
E. Noncomplete spontaneous abortion → No history to indicate pregnancy
Immune thrombocytopenia purpura (ITP), also known as idiopathic

thrombocytopenic purpura, is a type of thrombocytopenic purpura defined as an
isolated low platelet count with a normal bone marrow in the absence of other causes of
low platelets. It causes a characteristic red or purple bruise-like rash and an increased
tendency to bleed. Two distinct clinical syndromes manifest as an acute condition in
children and a chronic condition in adults. The acute form often follows an infection
and spontaneously resolves within two months. Chronic immune thrombocytopenia
persists longer than six months with a specific cause being unknown.
35. Examination of a just born placenta reveals defect 2×3 cm large. Hemorrhage is
absent. What tactic is the most reasonable?
B. Prescription of uterotonic medicines
C. External uterus massage → No bleeding
D. Parturient supervision
E. Uterine curretage
36. A patient was admitted to the hospital with complaints of occasional pains at the
bottom of abdomen that get worse during menses, weakness, indisposition,
nervousness, some dark bloody discharges from vagina on the day before and the day
after menses. Bimanual examination results: uterine body is enlarged, adnexa cannot be
determined, posterior fornix has tuberous surface. Laparoscopy results: ovaries,
peritoneum of rectouterine pouches and pararectal fat are covered with “cyanotic
spots”. What is the most probable diagnosis?
A. * Widespread form of endometriosis
B. Polycystic ovaries
C. Chronic salpingitis → inflammation of the fallopian tubes.
D. Genital organs tuberculosis
E. Ovarian cystoma → fluid-filled sac within the ovary
Exp:
Widespread form → ovaries, peritoneum of rectouterine pouches and pararectal fat are
covered with “cyanotic spots”.
Endometriosis is a condition in which cells similar to those in the endometrium, the

layer of tissue that normally covers the inside of the uterus, grow outside of it.
Polycystic ovary syndrome (PCOS) is a set of symptoms due to elevated androgens

(male hormones) in females. Signs and symptoms of PCOS include irregular or no
menstrual periods, heavy periods, excess body and facial hair, acne, pelvic pain,
difficulty getting pregnant, and patches of thick, darker, velvety skin.
Endometriosis
Polycystic ovary syndrome
37. An 18 y.o. woman consulted a gynecologist about the pain in the lower part of
abdomen, fever up to 37,5oC, considerable mucopurulent discharges from the genital

tracts, painful urination. Vaginal examination: the urethra is infiltrated, cervix of the
uterus is hyperemic, erosive. The uterus is painful, ovaries are painful, thickened;
fornixes are free. Bacterioscopy test revealed diplococcus. What diagnosis is the most
probable?
A. * Recent acute ascending gonorrhea
B. Trichomoniasis
C. Candydomycosis
D. Chronic gonorrhea
E. Chlamydiosis
38. A woman consulted a doctor on the 14th day after labor about sudden pain,
hyperemy and induration of the left mammary gland, body temperature rise up to 39o ,
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. * Lactational mastitis
B. Lacteal cyst with suppuration → Suppuration is the process of pus forming
C. Fibrous adenoma of the left mammary gland
D. Breast cancer
E. Phlegmon of mammary gland
39. A girl, aged 13, consulted the school doctor on account of moderate bloody discharge
from the genital tracts, which appeared 2 days ago. Secondary sexual characters are
developed. What is the most probable cause of bloody discharge?
A. * Menarche
B. Juvenile hemorrhage
C. Haemophilia
D. Endometrium cancer
E. Werlhof’s disease → See 34
40. A pregnant woman was registered in a maternity welfare clinic in her 11th week of
pregnancy. She was being under observation during the whole term, the pregnancy
course was normal. What document must the doctor give the pregnant woman to
authorize her hospitalization in maternity hospital?
A. * Exchange card
B. Appointment card for hospitalization
C. Individual prenatal record
D. Medical certificate
E. Sanitary certificate
41. A 30 y.o. primigravida woman has got intensive labor pains every 1-2 minutes that
last 50 seconds. The disengagement has started. The perineum with the height of 5 cm
has grown pale. What actions are necessary in this situation?
A. * Episiotomy → a surgical cut made at the opening of the vagina during childbirth, to
aid a difficult delivery and prevent rupture of tissues.
B. Perineum protection
C. Perineotomy
D. Vacuum extraction of fetus
E. Expectant management
42. Vaginal inspection of a parturient woman revealed: cervix dilation is up to 2 cm,
amniotic sac is intact. Sacral cavity is free, sacral promontory is reachable only with a
bent finger, the inner surface of the sacrococcygeal joint is accessible for examination.
The fetus has cephalic presentation. Sagittal suture occupies the transverse diameter of
pelvic inlet, the small fontanel to the left, on the side. What labor stage is this?
A. * Cervical stage
B. Preliminary stage
C. Prodromal stage
D. Stage of fetal expulsion
E. Placental stage
labor stage
First stage of labor (Cervical stage)
First stage of labor (Cervical stage)
Second Stage of Labor (Stage of fetal expulsion)

Second Stage of Labor (Stage of fetal expulsion)
Third Stage of Labor (Placental stage)

Third Stage of Labor (Placental stage)
43. After delivery and revision of placenta there was found the defect of placental lobe.
General condition of woman is normal, uterus is firm, there is bloody discharge till
450ml. Inspection of birth canal with mirrors shows absence of lacerations and
raptures. What action is nesessary?
D. Urine drainage, cold on the lower abdomen

44. A 25 y.o. patient complains of body temperature rise up to 37o , pain at the bottom
of her abdomen and vaginal discharges. Three days ago, when she was in her 11th week
of pregnancy, she had an artificial abortion. Objectively: cervix of uterus is clean, uterus
is a little bit enlarged in size, painful. Appendages cannot be determined. Fornixes are
deep, painless. Vaginal discharges are purulent. What is the most probable diagnosis?
A. * Postabortion endometritis
B. Hematometra
C. Pelvic peritonitis
D. Postabortion uterine perforation
E. Parametritis
45. A 25 y.o. pregnant woman in her 34th week was taken to the maternity house in
grave condition. She complains of headache, visual impairment, nausea. Objectively:
solid edemata, AP-170/130 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. * Eclampsia
B. Epilepsy
C. Cerebral hemorrhage
D. Cerebral edema
E. Stomach ulcer
Exp:
Tonic and clonic convulsions (Grand mal seizures) is absolutely indicative for eclampsia
46. A 51 y.o. patient complains of having intensive bloody discharges from vagina for 15
days after delay of menstruation for 2,5 months. In anamnesis: disorders of menstrual
function during a year, at the same time she felt extreme irritability and had sleep
disorders. US examination results: uterus corresponds with age norms, appendages
have no pecularities, endometrium is 14 mm thick. What is the doctor’s tactics?
A. * Diagnostic curettage of uterine cavity
B. Conservative treatment of bleeding
C. Hysterectomy
D. Subtotal hysterectomy without adnexa
E. TORCH-infection test
Exp:
the acceptable range of endometrial thickness is less well established in this group,
cut-off values of 8-11 mm have been suggested. the risk of carcinoma is ~7% if
the endometrium is >11 mm, and 0.002% if the endometrium is <11 mm.
47. An 18 y.o. patient complains of painfulness and swelling of mammary glands,

headaches, irritability, edemata of lower extremities. These symptoms have been
present since the begin of menarche, appear 3-4 days before regular menstruation.
Gynecological examination revealed no pathology. What is the most probable
diagnosis?
A. * Premenstrual syndrome
B. Neurasthenia
C. Renal disease
D. Mastopathy
E. Disease of cardiovascular system
Premenstrual syndrome (PMS) refers to physical and emotional symptoms that

occur in the one to two weeks before a woman’s period. Symptoms often vary between
women and resolve around the start of bleeding. Common symptoms include acne,
tender breasts, bloating, feeling tired, irritability, and mood changes.
48. A 32 y.o. woman consulted a gynecologist about having abundant long menses
within 3 months. Bimanual investigation: the body of the uterus is enlarged according
to about 12 weeks of pregnancy, distorted, tuberous, of dense consistence. Appendages
are not palpated. Histological test of the uterus body mucose: adenocystous hyperplasia
of endometrium. Optimal medical tactics:
A. * Surgical treatment
B. Hormonetherapy
C. Phytotherapy
D. Radial therapy
E. Phase by phase vitamin therapy

Exp:
Pt still has menses which rules out pregnancy and long duration explained by the
hyperplasia.
A mass in the uterus will enlarge the uterus link in pregnancy as seen in the pt above.
Mass bellow 12 weeks indicate conservative or Hormonetherapy but above 12 weeks is

surgical.
49. A woman was hospitalised with full-term pregnancy. At examination the uterus is
morbid, the abdomen is tense, heart sounds of the fetus are not auscultated. What is the
most probable complication of pregnancy?
A. * Placental abruption
B. Preterm labour
C. Back occipital presentation
D. Acute fetal dystress
E. Hydramnion
Exp:
Pt is term and symptoms indicate Placental abruption.
Fetal dystress would need more information about the fetus.
Placental abruption is when the placenta separates early from the uterus, in other
words separates before childbirth. It occurs most commonly around 25 weeks of
pregnancy. Symptoms may include vaginal bleeding, lower abdominal pain, and
dangerously low blood pressure.
Signs and symptoms of placental abruption include:
Vaginal bleeding, although there might not be any.
Abdominal pain.
Back pain.
Uterine tenderness or rigidity.
Uterine contractions, often coming one right after another.
49a. A woman was hospitalised with full-term pregnancy. Examination: the uterus is
tender, the abdomen is tense, cardiac tones of the fetus are not auscultated. What is the
most probable complication of pregnancy?
A. * Premature detachment of normally posed placenta → (Placental abruption)
B. Preterm labour
C. Back occipital presentation
D. Acute hypoxia of a fetus
E. Hydramnion
50. By the end of the 1st period of physiological labour the clear amniotic waters were
given vent. Contractions lasted 35-40 sec every 4-5 min. Fetal heart rate examination is
800 bpm. The AP is 140/90 mm Hg. Diagnosis:
A. * Acute fetal distress
B. Preterm labor
C. Placental abruption
D. Back occipital presentation
E. Hydramnion
50a. By the end of the 1st period of physiological labor clear amniotic fluid came off.
Contractions lasted 35-40 sec every 4-5min. Heartbeat of the fetus was 100 bpm. The
BP was 140/90 mm Hg. What is the most probable diagnosis?
A. * Acute hypoxia of the fetus
B. Preterm labor
C. Placental abruption
D. Back occipital presentation
E. Hydramnion
51. Which gestational age gives the most accurate estimation of weeks of pregnancy by
uterine size?
A. * Less that 12 weeks
B. Between 12 and 20 weeks
C. Between 21 and 30 weeks
D. Between 31 and 40 weeks
E. Over 40 weeks
Exp:
Gestational age is most accurate by funldal height only till 12 weeks.
52. A number of viable fetuses per 1000 women at the age between 15 and 44 is
determined by:
A. * Genital index
B. Reproductive level
C. Birth rate
D. Perinatal rate
E. Obstetric rate
53. A 34 y.o. woman in her 29-th week of pregnancy, that is her 4-th labor to come, was
admitted to the obstetric department with complaints of sudden and painful bloody
discharges from vagina that appeared 2 hours ago. The discharges are profuse and
contain clots. Cardiac funnction of the fetus is rhytmic, strokes in the minute, uterus
tone is normal. At ultrasound there is soft tissue at lower uterine segment. The most
probable diagnosis will be:
A. * Placental previa
B. Placental abruption
C. Vasa previa
D. Bloody discharges
E. Disseminated intravascular coagulation syndrome
See 8 & 24
54. A 40 y.o. woman has changes of mammary gland. What are the most often symtoms
that precede the malignization?
A. * Skin induration with inverted nipple → See 10 and 33 Or Retracted nipple

B. Painful movable induration
C. Painless movable induration
D. Bloody discharges from the nipple
E. Pure discharges from the nipple
55. A 40 weeks pregnant woman in intrinsic obstetric investigation: the cervix of a

uterus is undeveloped. The oxytocin test is negative. Upon inspection at 32 weeks it is
revealed: AP- 140/90 mm Hg, proteinuria 1 g/l, peripheric edemata. Reflexes are
normal. Choose the most correct tactics of guiding the pregnant:
A. * Labor’ induction after preparation
B. Strict bed regimen for 1 month → Not enough time
C. Complex therapy of gestosis for 2 days
D. Cesarean section immediately → Only in severe cases
E. Complex therapy of gestosis for 7 days
Exp:
Due to the gestational age of the patient being above 37 weeks (40 weeks in our
question) we could not pursue C&E Cause we need to deliver now given the AP- 140/90
mm Hg, proteinuria & peripheric edemata
Underdevelopment of cervix means we need to prep woman for delivery.
Oxytosin test is done to at women at post-term delivery e.g 40 weeks in this case to
check for oxytosin levels for possibility to get contractions
56. A woman had the rise of temperature up to 39o on the first day after labour. The
rupture of fetal membranes took place 36 hours before labour. The investigation of the
bacterial flora of cervix of the uterus revealed hemocatheretic streptococcus of group A.
The uterus body is soft, tender. Discharges are bloody, mixed with pus. Specify the most
probable postnatal complication:
A. * Metroendometritis
B. Thrombophlebitis of pelvic veins
C. Infected hematoma
D. Infection of the urinary system
E. Episiotomy’ stitches divirgence
Metroendometritis inflammation of the uterus involving inflammation of the

mucous membrane and muscular tunic of the uterus, causing infertility, miscarriage,
and chronic pain in the lower abdomen.
56a. A woman had the rise of temperature up to 390 on the first day after labour. The
rupture of fetal membranes took place 36 hours before labour. The investigation of the
bacterial flora of cervix of the uterus revealed hemocatheretic streptococcus of group A.
The uterus body is soft, tender. Discharges are bloody, mixed with pus. Specify the most
probable postnatal complication:
A. * Metroendometritis
B. Thrombophlebitis of pelvic veins
C. Infected hematoma
D. Infection of the urinary system

E. Episiotomy’ stitches divirgence
57. A 34 y.o. woman in the 10-th week of gestation (the second pregnancy) consulted a
doctor of antenatal clinic with purpose of statement on the dyspensary record. In the
previous pregnancy there took place hydramnion, the child’s birth weight was 4086g.
What method of examination is necessary for carrying out, first of all?
A. * The test for tolerance to glucose
B. Determination of the contents of fetoproteinum
C. Bacteriological investigation of discharge from the vagina
D. A cardiophonography of fetus
E. USI of the fetus
58. A 40 y.o. patient complains of yellowish discharges from the vagina. There is no
pathological changes at bimanual exam. The smear contains Trichomonas vaginalis and
blended flora. There are two hazy fields on the front labium, with a negative Iodum test
at colposcopy. Your tactics:
A. * Treatment of specific vaginitis and with the subsequent biopsy
B. Diathermocoagulation of the cervix of the uterus
D. Cervix ectomy
E. Cryolysis of uterine cervix
See No 30
59. A 43 y.o. woman complains of contact hemorrhages during the last 6 months. Cervix
of the uterus is enlarged, its mobility is reduced at at bimanual examination. Speculum
exam showed the following: cervix of the uterus is in the form of cauliflower. Chrobak
and Schiller tests are positive. What is the most probable diagnosis?
A. * Cancer of cervix of the uterus
B. Polypus of the cervis of the uterus
C. Cervical pregnancy
D. Nascent fibroid
E. Erythtoplakia
See No 13
60. A patient was admitted to the hospital with complaints of periodical pain in the
lower part of abdomen that gets worse during menses, weakness, malaise, nervousness,
dark bloody smears from vagina directly before and after menses. At bimanual
examination the uterine body is enlarged, adnexa cannot be palpated, posterior fornix
has tuberous surface. Ovaries, peritoneum of rectouterine pouch and pararectal fat have
“cyanotic eyes” at laparoscopy. What is the most probable diagnosis?
A. * Disseminated form of endometriosis
B. Polycystic ovaries
C. Chronic salpingitis
D. Tuberculosis of genital organs
E. Ovarian cystoma
See 36
Cyanotic eyes/Spots is Bluish discoloration of affected tissue
61. An 18 y.o. woman consulted a gynecologist about the pain in the lower part of
abdomen, fever up to 37, 50C, considerable mucopurulent discharges from the genital
tracts, painful urination. The urethra is infiltrated, cervix of the uterus is hyperemic,
erosive at vaginal examination. The uterus is painful, ovaries are painful, thickened;
fornixes are free. Bacterioscopy test revealed diplococcus. What diagnosis is the most
probable?
A. * Recent acute ascending gonorrhea → pt symptoms of pain, elevated temp and

discharge indicate of acute
B. Trichomoniasis
C. Candydomycosis
D. Chronic gonorrhea → Usually asymptomatic
E. Chlamydiosis
62. A woman consulted a doctor on the 14-th day after labor about sudden pain,
hyperemy and induration of the left mammary gland, body temperature rise up to 39o ,
B. Lacteal cyst with suppuration

D. Breast cancer
63. A 30 y.o. woman has the 2-nd labour that has been lasting for 14 hours. Heartbeat of
fetus is muffled, arrhythmic, 100/min. At vaginal examination the cervix of uterus is
completely dilated, fetus head is level with outlet from small pelvis. Saggital suture is in
the anteriposterior diameter, posterior fontanell is near symphysis. What is the further
tactics of delivery management?
A. * Use of obstetrical forceps
B. Stimulation of labour activity by oxytocin
C. Cesarean section
D. Cranio-cutaneous (Ivanov’s) forceps
E. Use of cavity forceps
See 20
Fetus is engaged and cervix is dilated so she needs assistance.
64. Defect of placental lobe was found after delivery. General condition of woman is
normal, uterus is firm, there is moderate bloody discharge. Inspection of birth canal
with mirrors shows absence of lacerations and raptures. What action is nesessary?

D. Urine drainage, cold on the lower abdomen
65. A 22 y.o. patient complains of having boring pain in the right iliac region for one
week, morning sickness, taste change. Delay of menstruation is 3 weeks. Objectively:
AP- 110/70 mm Hg, Ps- 78/min, t0-36,90. At bimanual examination the uterus is a little
enlarged, soft, movable, painless. At adnexa region there is a painful formation 3х4 cm
large on the right, dense and elastic, moderately movable. What is the most probable
diagnosis?
A. * Progressing tubal pregnancy
B. Interrupted tubal pregnancy → no bloody discharge in pt
C. Cyst of the right ovary → pt has signs of pregnancy
D. Uterine pregnancy
66. A 30 y.o. parturient woman was taken to the maternity house with complaints of
having acute, regular labour pains that last 25-30 seconds every 1,5-2 minutes. Labour
activity began 6 hours ago. Uterus is in higher tonus, head of the fetus is above the
opening into the small pelvis. Fetal heartbeat is 136/min. Cervical dilatation is 4 cm at
vaginal examination, uterine forces are spasming at a height of parodynia. Head is level
with opening into the small pelvis, it is being pushed off. What is the most probable
diagnosis?
A. * Discoordinated labour activity
B. Secondary uterine inertia
C. Pathological preliminary period

D. Primary uterine inertia
E. Normal labour activity
Exp:
In Normal labor beginning well have 3-5 contractions in every 10 mins and our pt has
very strong contraction in 2 min.
67. A 33 y.o. woman survived two operations on account of ectopic pregnancy, both
uterine tubes were removed. She consulted a doctor with a question about possibility of
having a child. What can be advised in this case?
A. * Extracorporal fertilization
B. Insemination with her husband’s semen
C. Substitutional maternity → Pt still has uterus
D. Artifical fertilization with donor’s semen → What is wrong with her husband
E. Induction of ovulation → Where will the egg pass
68. A woman complains of having slight dark bloody discharges and mild pains in the
lower part of abdomen for several days. Last menses were 7 weeks ago. The
pregnancy test is positive. Uterine body enlarghes to 5-6 weeks of pregnancy, it is
soft, painless. In the left adnexa there is a retort-like formation, 7 х 5 cm large, mobile,
painless. What examination is necessary for detection of fetus localization?
A. * Ultrasound
B. Hysteroscopy
C. Hromohydrotubation
D. Colposcopy
E. Cystoscopy
Exp:
Pt is pregnant from history but the bloody discharge is an indication for ectopic
pregnancy
Occasionally, the doctor may feel a tender mass during the pelvic examination. If
an ectopic pregnancy is suspected, the combination of blood hormone pregnancy
tests and pelvic ultrasound can usually help to establish the diagnosis. Transvaginal
ultrasound is the most useful test to visualize an ectopic pregnancy.
69. A pregnant woman in her 40th week of pregnancy undergoes obstetric examination:
the cervix of uterus is undeveloped. The oxytocin test is negative. Examination at 32
weeks revealed: AP 140/90 mm Hg, proteinuria 2 g/l, peripheral edemata. Reflexes are
normal. Choose the most correct tactics:
A. * Labour stimulation after preparation
B. Absolute bed rest for 1 month → Not enough time
D. Caesarian section immediately → Only in severe cases
Exp:
See 55
70. A 26 year old woman had the second labour within the last 2 years with oxytocin
application. The child’s weight is 4080 gr. There were massive bleeding, signs of
hemorrhagic shock after the placental birth. Despite the introduction of contractive
agents, good contraction of the uterus and absence of any cervical and vaginal disorders,
the bleeding with clots formation continues. Choose the most probable cause of
bleeding:
A. * Atony of the uterus
B. Injury of cervix of the uterus
C. Hysterorrhexis
D. Delay of the part of placenta
E. DIC syndrome
Exp:
Overuse of oxytosin has caused lazy uterus in pt
Main cause of bleeding in post partum patient is atony of uterus and from our pt’s
history we see she needed oxytosin for previous cases
71. A woman of a highrisk group (chronic pyelonephritis in anamnesis) had vaginal

delivery. The day after labour she complained of fever and loin pains, frequent
urodynia. Specify the most probable complication:
A. * Infectious contamination of the urinary system
B. Thrombophlebitis of veins of the pelvis

C. Infectious hematoma
D. Endometritis
E. Divergence of sutures after episiotomy
72. A woman in her 39th week of pregnancy, the second labour, has regular birth
activity. Uterine contractions take place every 3 minutes. What criteria describe the
beginning of the II labor stage the most precisely?
A. * Cervical dilatation 10cm
B. Cervical smoothing over 90%
C. Duration of uterine contractions over 30 seconds
D. Presenting part is in the lower region of small pelvis
E. Rupture of fetal bladder
See 42
73. A 24 years old primipara was hospitalized with complaints of discharge of the
amniotic waters. The uterus is tonic on palpation. The position of the fetus is
longitudinal, it is pressed with the head to pelvic outlet. Fetal heart rate is rhythmical,
140 bpm, auscultated on the left below the navel. Cervix of the uterus is 2,5 cm long,
dense, the external os is closed, light amniotic waters out of it at internal examination.
Point a correct component of the diagnosis:
A. * Antenatal discharge of the amniotic waters → when pt is not yet in labor
B. Early discharge of the amniotic waters → in labor but not fully dilated
C. The beginning of the 1st stage of labour
D. The end of the 1st stage of labour
E. Pathological preterm labour
Exp:
Cervix is not dilated in pt
74. A 29 year old patient underwent surgical treatment because of the benign serous
epithelial tumour of an ovary. There were no complications at postoperative period.
What is it necessary to prescribe for the rehabilitational period:
A. * Hormonotherapy and proteolytic enzymes
B. Antibacterial therapy and adaptogens
C. Lasertherapy and enzymotherapy
D. Magnitotherapy and vitamin therapy
E. The patient does not require further care
75. A primagravida with pregnancy of 37-weeks complains of headache, nausea, pain in

epigastrium. Objective: the skin is acyanotic. Face is hydropic, there is short fibrillar
twitching of blepharons, muscles of the face and the inferior extremities.
The look is fixed. AP- 200/110 mm Hg; sphygmus of 92 bpm, intense. Respiration rate
is 32/min. Heart activity is rhythmical. Appreciable edemata of the inferior extremities
are present. Urine is cloudy. What medication should be administered?
A. * Droperidolum of 0,25% – 2,0 ml

B. Dibazolum of 1% – 6,0 ml
C. Papaverine hydrochloride of 2% – 4,0 ml
D. Hexenalum of 1% – 2,0 ml
E. Pentaminum of 5% – 4,0 ml
Exp:
Eclampsia indicated by signs of tonic clonic seazures
First line of action in eclampsia is Sedative
Droperidol is an antidopaminergic drug used as an antiemetic and as an antipsychotic.

Droperidol is also often used as a sedative in intensive-care treatment
76. 40 year old woman has changes of mammary gland. What are the most often
symtomps that precede the malignization?
A. * Skin induration with inverted nipple
B. Painful movable induration
C. Painless movable induration
D. Bloody discharges from the nipple
E. Pure discharges from the nipple
77. An onset of severe preeclampsia at 16 weeks gestation might be caused by:
A. * Hydatidiform mole
B. Anencephaly
C. Twin gestation
D. Maternal renal disease
E. Interventricular defect of the fetus
Exp:
Pt has abnormal pregnamcy
Preeclampsia can only be diagnosed after 20 weeks of pregnancy but in molar

pregnancy, sign of preclampsia manifest before 20 weeks an in our pt.
A hydatidiform mole is growth of an abnormal fertilized egg or an overgrowth of

tissue from the placenta. Women appear to be pregnant, but the uterus enlarges much
more rapidly than in a normal pregnancy.
78. A 40 year old woman has a self-detected hard breast mass. The procedure of choice
for confirming the diagnosis is:
A. * Excision biopsy
B. Mammography
C. Thermography
D. Ultrasonography
E. Aspiration biopsy with cytology
79. A 34 year old woman in the 10th week of gestation (the second pregnancy) consulted
a doctor of antenatal clinic in order to be registered there. In the previous pregnancy
hydramnion was observed, the child’s birth weight was 4086 g. What examination
method should be applied in the first place?
A. * The test for tolerance to glucose
B. Determination of the contents of fetoproteinum
C. Bacteriological examination of di-scharges from vagina
D. A cardiophonography of fetus
E. US of fetus
80. An endometrial adenocarcinoma that has extended to the uterine serosa would
be classified as stage:
A. * I I I A
B. I C
C. I I A
D. I I B
E. I V AB
FIGO Surgical staging of Endometrial carcinoma

FIGO Surgical staging of Endometrial carcinoma
81. A 6 week old child is admitted because of tachypnea. Birth had been uneventful,
although conjunctivitis developed on the third day of life and lasted for about 2 weeks.
Physical examination reveals tachypnea, bilateral inspiratory crackles and single
expiratory wheezing. Bilateral pneumonia is evident on chest X-ray. The child is afebrile
and has no history of fever. White blood cell count is 15 · 109/l, with 28% of eosinophils.
The most likely cause of this child’s symptoms is:
A. * Clamydia trachomanis
B. Pneumocystis carinii
C. Mycoplasma pneumoniae
D. Visceral larva migrans
E. Varicella
82. A 14 year old girl complains of profuse bloody discharges from genital tracts during
10 days after suppresion of menses for 1,5 month. Similiar bleedings recur since 12
years on the background of disordered menstrual cycle. There is no pathology of the
internal genitalia at rectal examination. In blood: Нb – 70 g/l, RBC-2, 3 · 1012/l, Ht –
20. What is the most probable diagnosis?
A. * Juvenile bleeding, posthemorrhagic anemia
B. Werlholf’s disease → See 34
C. Polycyst ovarian syndrome
D. Hormonoproductive ovary tumor
E. Incomplete spontaneous abortion
83. A 26 year old woman who delivered a child 7 months ago has been suffering from
nausea, morning vomiting, sleepiness for the last 2 weeks. She suckles the child,
menstruation is absent. She hasn’t applied any contraceptives. What method should be
applied in order to specify her diagnosis?
A. * Ultrasonic examination
B. Roentgenography of small pelvis organs
C. Palpation of mammary glands and pressing-out of colostrum
D. Bimanual vaginal examination
E. Speculum examination
Symptoms of pregnancy while breast feeding without use of contraceptives indicates

pregnancy where mother expected to be safe due to physiological amenorrhea.
84. A 28 year old patient complained about prolongation of intermenstrual periods up

to 2 months, hirsutism. Gynaecological examination revealed that the ovaries were
enlarged, painless, compact, uterus had no pecularities. Pelvic ultrasound revealed that
the ovaries were 4-5 cm in diameter and had multiple enlarged follicles on periphery.
Roentgenography of skull base showed that sellar region was dilated. What is the most
probable diagnosis?
A. * Stein-Leventhal syndrome → AKA Polycystic ovary syndrome (PCOS) /

Sclerocystis of ovaries
B. Algodismenorrhea
C. Sheehan’s syndrome
E. Morgagni-Stewart syndrome
Polycystic ovary syndrome (PCOS) is a hormonal disorder common among

women of reproductive age. Women with PCOS may have infrequent or prolonged
menstrual periods or excess male hormone (androgen) levels. The ovaries may develop
numerous small collections of fluid (follicles) and fail to regularly release eggs
Common symptoms of PCOS include:

irregular periods or no periods at all.
difficulty getting pregnant (because of irregular ovulation or failure to ovulate)
excessive hair growth (hirsutism) – usually on the face, chest, back or buttocks.
weight gain.
thinning hair and hair loss from the head.
oily skin or acne.
The sella turcica is located in the sphenoid bone behind the chiasmatic groove and the
tuberculum sellae. It belongs to the middle cranial fossa. The sella turcica’s most
inferior portion is known as the hypophyseal fossa (the “seat of the saddle”), and
contains the pituitary gland (hypophysis).
Empty sella syndrome is a rare disorder characterized by enlargement or

malformation of a structure in the skull known as the sella turcica. The sella turcica is
a saddle-shaped depression located in the bone at the base of skull (sphenoid bone), in
which resides the pituitary gland
85. A parturient woman is 27 year old, it was her second labour, delivery was at term,
normal course. On the 3rd day of postpartum period body temperature is, 38oC, Ps –
72/min, AP – 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. * Physiological course of postpartum period
B. Uterine subinvolution
C. Postpartum metroendometritis
D. Remnants of placental tissue after labour
E. Lactostasis
86. A pregnant woman with 40th week pregnancy undergoes obstetric examination.
Uterine cervix was not ripe. The oxytocin test is negative. Examination at 32 weeks
revealed: AP 140/90 mm Hg, proteinuria 4 g/l, peripheral edema. Reflexes are normal.
Choose the most correct tactics:
A. * Labour induction after preparation
B. Absolute bed rest for 1 month
D. Caesarian section immediately
Exp:
See 55 & 69
87. 24 years old woman had normal menstrual function, now cycles became irregular.
According to tests of function diagnostics there is anovulation. There is considerable
proteinuria. Choose the most suitable investigation:
A. * Computer tomography of the head
B. Determination of the level of gonadotropins
C. USI of organs of small pelvis
D. Progesterone assay
E. Determination of testosteron in blood serum
88. A 40 year old woman has a selfdetected hard breast mass. The procedure of choice
for confirmation diagnosis is:
A. * Excision biopsy
B. Mammography
C. Thermography
D. Ultrasonography
E. Aspiration biopsy with cytology
89. 34- year old patient is suspected to have an abscess of Douglas space. Which
diagnostic method is to be chosen?
A. * Digital examination of rectum
B. Rectoromanoscopy
C. Laparoscopy
D. Percussion and auscultation of stomach
E. R-scopy of abdominal cavity
90. Which method of examination is the most informative in the diagnostics of a tubal
infertility?
A. * Laparoscopy with chromosalpingoscopy
B. Pertubation
C. Hysterosalpingography → Nothing is wrong with pt’s uterus
D. Transvaginal echography
E. Bicontrast pelviography
91. A 28 year old parturient complains of headache, vision impairment, psychical
inhibition. Objectively: AP-200/110 mm Hg, evident edema of legs and anterior
abdominal wall. Fetus head is in the area of small pelvis. Fetal heartbeats are clear,
rhythmic, 190/min. Internal investigation revealed complete cervical dilatation, fetal
head is in the area of small pelvis. What tactics of labor management should be chosen?
A. * Forceps operation
B. Cesarean
C. Embryotomy
D. Conservative labor management with episiotomy
E. Stimulation of labor activity
Normal fetal heart rate 140-170 bpm
Note the cervix is dilated fully, mother has psychical inhibition and possibly in distress,
and infant is engaged in small pelvis
Indications to use of Forceps

Cervix fully dilated.
Rupture of membranes.
Fetal head engaged (vertex presentation)
Knowledge of the fetal position.
Fetal weight has been estimated.
Maternal pelvis adequate for vaginal delivery.
Anesthesia administered.
The maternal bladder is empty.
92. A 48 year old female patient complains of contact haemorrhage. Speculum

examination revealed hypertrophy of uterus cervix. It resembles of cauliflower, it is
dense and can be easily injured. Bimanual examination revealed that fornices were
shortened, uterine body was nonmobile. What is the most probable diagnosis?
A. * Cervical carcinoma
B. Metrofibroma
C. Endometriosis
D. Cervical pregnancy
E. Cervical papillomatosis
93. A 59 year old female patient applied to a maternity clinic and complained of bloody
discharges from the genital tract. Postmenopause is 12 years. Vaginal examination
revealed that external genital organs had signs of age involution, uterus cervix was not
erosive, small amount of bloody discharges are from the cervical canal. Uterus is normal
size, uterine appendages are unpalpable. Fornices are deep and painless. Which method
should be applied for the diagnosis specification?
A. * Separated diagnosic curretage
B. Laparoscopy
C. Puncture of abdominal cavity through posterior vaginal fornix
D. Extensive colposcopy
E. Culdoscopy
94. A 26 year old woman who delivered a child 7 months ago has been suffering from
nausea, morning vomiting, sleepiness for the last 2 weeks. She feeds the child,
menstruation is absent. She hasn’t applied any contraceptives. What method should be
B. Roentgenography of small pelvis organs
See 83
95. A woman consulted a doctor on the 14th day after labour. She has sudden pain,
hyperemy and induration of the left mammary gland, body temperature is 39oC,
headache. Objectively: fissure of nipple, enlargement of the left mammary gland, pain
on palpation. What pathology would you think about in this case?
D. Breast cancer
See 38
96. Immediately after delivery a woman had profuse haemorrhage, blood loss exceeded
to postpartum haemorrhage and progressing. There were no symptoms of pacental
separation. What tactics should be chosen?
A. * Manual removal of placenta
B. Uterine tamponade
C. Instrumental revision of uterine cavity
D. Removal of afterbirth by Crede’s method → Credé maneuver is a technique used to

void urine from the bladder of an individual who, due to disease, cannot do so without
aid. The Credé maneuver is executed by exerting manual pressure on the abdomen at
the location of the bladder, just below the navel.
E. Intravenous injection of methylergometrine
97. A 28 year old woman has bursting pain in the lower abdomen during menstruation;
chocolatelike discharges from vagina. It is known from the anamnesis that the patient
suffers from chronic adnexitis. Bimanual examination revealed a tumourlike formation
of heterogenous consistency 7х7 cm large to the left side from the uterus. The formation
is restrictedly movable, painful when moved. What is the most probable diagnosis?
A. * Endometrioid cyst of the left ovary
B. Follicular cyst of the left ovary
C. Fibromatous node
D. Exacerbation of chronic adnexitis
E. Tumour of sigmoid colon
98. A 40 year old female patient has been observing excessive menstruation
accompanied by spasmodic pain in the lower abdomen for a year. Bimanual
examination performed during menstruation revealed a dense formation up to 5cm in
diameter in the cervical canal. Uterus is enlarged up to 5-6 weeks of pregnancy,
movable, painful, of normal consistency. Adnexa are not palpable. Bloody discharges
are profuse. What is the most probable diagnosis?
A. * Submucous fibromatous node
B. Abortion in progress → No signs pregnancy indicated
C. Cervical carcinoma → No curliflower in qt
D. Cervical myoma
E. Algodismenorrhea
99. A 48-year-old patient was delivered to a hospital inpatient unit with uterine
bleeding that occurred after the 2-week-long delay of menstruation. Anamnesis states
single birth. Examination of the uterine cervix with mirrors revealed no pathologies. On
bimanual examination: uterus is of normal size, painless, mobile; uterine appendages
have no changes. Discharge is bloody and copious. What primary hemostatic measure
should be taken in the given case?
A. * Fractional curettage of uterine cavity → Mainly because of patients age
B. Hormonal hemostasis
C. Hemostatics
D. Uterine tamponade
E. Uterotonics
100. A child is 1 day old. During delivery there had been problems with extraction of
shoulders. Body weight is 4300,0. Right arm hangs down along the body, hand is
pronated, movement in the arm is absent. “Scarf”symptom is positive. What is the most
probable diagnosis?
A. * Total right-sided obstetric palsy
B. Proximal right-sided obstetric palsy
C. Distal right-sided obstetric palsy
D. Hemiparesis
E. Tetraparesis
101. On the 5th day after labor body temperature of a parturient suddenly rose up to
38,7oC. She complains of weakness, headache, abdominal pain, irritability. Objectively:
BP- 120/70 mm Hg, Ps- 92 bpm, to- 38,7oC. Bimanual examination revealed enlarged,
firm uterus up to 12 weeks of pregnancy, slightly painful on palpation. Cervical
dilatation was 2 transverse fingers, discharges are moderate, with foul smell. Blood
analyses revealed leukocytosis, lymphopenia, ESR- 30 mm/h. What is the most
probable diagnosis?
A. * Endometritis → is inflammation of the inner lining of the uterus (endometrium).

Symptoms may include fever, lower abdominal pain, and abnormal vaginal bleeding or
discharge. It is the most common cause of infection after childbirth.
B. Parametritis → is an inflammation of the parametrium (connective tissue adjacent to

the uterus).
C. Pelviperitonitis → Generalized inflammation of the peritoneum surrounding the

uterus and fallopian tubes.
D. Metrophlebitis → Inflammation of the uterine veins, usually following childbirth.

E. Lochiometra → distention of the uterus by retained lochia.
Leukocytosis is white cells (the leukocyte count) above the normal range in the blood. It
is frequently a sign of an inflammatory response, most commonly the result
of infection, but may also occur following certain parasitic infections or bone tumors
as well as leukemia.
Lymphocytopenia is most often due to AIDS or undernutrition, but it also may be

inherited or caused by various infections, drugs, or autoimmune disorders. Patients
have recurrent viral, fungal, or parasitic infections. Lymphocyte subpopulations and
immunoglobulin levels should be measured.
102. A 25 year old woman complained of infertility within 3 years of regular sexual life.
Examination revealed weight gain, male type of hair growth on the pubis, excessive
hairs of thighs. Ovaries were dense and enlarged, basal temperature was monophase.
What is the most probable diagnosis?
A. * Sclerocystosis of ovaries → AKA Polycystic ovary syndrome (PCOS) / Stein-

Leventhal syndrome
B. Adnexitis
C. Adrenogenital syndrome
E. Gonadal dysgenesis
See Qt 84
103. A woman consulted a therapeutist about fatigability, significant weight loss,

weakness, loss of appetite. She has amenorrhea for 8 months. A year ago she born a full
term child. Bloodlost during labour was up to 2l. She got blood and blood substitute
transfusions. What is the most probable diagnosis?
A. * Sheehan’s syndrome
B. Stein-Leventhal syndrome
C. Shereshevsky-Turner’s syndrome
D. Homological blood syndrome
E. Vegetovascular dystonia
Sheehan’s syndrome, also known as postpartum pituitary gland necrosis, is

hypopituitarism (decreased functioning of the pituitary gland), caused by ischemic
necrosis due to blood loss and hypovolemic shock during and after childbirth.
Symptoms of Sheehan syndrome include:

difficulty breastfeeding or an inability to breastfeed.
irregular menstrual periods (oligomenorrhea) or no periods (amenorrhea)
weight gain.
intolerance to cold.
slowed mental function.
loss of pubic and underarm hair.
fatigue or weakness.
fine wrinkles around the eyes and lips.
104. A 26 year old woman complains of edema, swelling and painfulness of mammary
glands, headache, tearfulness, irritability. These signs turn up 5 days before
menstruation and disappear after its start. Which is clinical syndrome in that case?
B. Postcastration syndrome
D. Climacteric syndrome
E. Stein-Leventhal syndrome
105. A parturient woman is 27 year old, it was her second labour, delivery was at term,
normal course. On the 3rd day of postpartum period body temperature is 36,8oC, Ps –
72/min, AP – 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. * Physiological course of postpartum period
B. Subinvolution of uterus
D. Remnants of placental tissue after labour
E. Lactostasis
See 85
106. A woman is 34 years old, it is her tenth labor at full term. It is known from the
anamnesis that the labor started hours ago, labor was active, painful contractions
started after discharge of waters and became continuous. Suddenly the parturient got
knifelike pain in the lower abdomen and labor activity stopped. Examination revealed
positive symptoms of peritoneum irritation, ill-defined uterus outlines. Fetus was easily
palpable, movable. Fetal heartbeats wasn’t auscultable. What is the most probable
diagnosis?
A. * Rupture of uterus
B. Uterine inertia
C. Discoordinated labor activity
D. Risk of uterus rupture
E. II labor period
107. A 22 year old female patient complains of frequent and painful urination, urge to
urinate at night, enuresis, pain in the suprapubic and lumbar area. Her urine often has
beer colouring. She got married a month ago. Objectively: general state is satisfactory.
Lung examination revealed vesicular respiration. Heart sounds are rhythmic, heart rate
is 78/min, AP- 128/68 mm Hg. Abdomen is soft, painful in the suprapubic area. Urine
contains 12-18 erythrocytes and 12-15 bacteria within eyeshot. What is the most
probable diagnosis?
A. * Infection of inferior urinary tracts – cystitis
B. Urolithiasis
C. Infection of superior urinary tracts – pyelonephritis
D. Gonorrhoe
E. Primary syphilis
108. Examination of placenta revealed a defect. An obstetrician performed manual

investigation of uterine cavity, uterine massage. Prophylaxis of endometritis in the
postpartum period should involve following actions:
A. * Antibacterial therapy
B. Instrumental revision of uterine cavity
C. Haemostatic therapy
D. Contracting agents
E. Intrauterine instillation of dioxine
See 101
109. A 30 year old patient complains of inability to become pregnant over 3 years of
regular sexual life. The patient is of supernutrition type, she has hair along the median
abdominal line, on the internal thigh surface and in the peripapillary area. Menses
started at the age of 16, they are infrequent and nonprofuse. US revealed that the uterus
was of normal size, ovaries were 4х5х5 cm large and had a lot of cystic inclusions. What
is the most probable diagnosis?
A. * Polycystic ovaries
B. Ovarian cystoma
C. Chronic oophoritis
D. Menstrual irregularity
E. Bilateral ovarian tumours
110. A female patient consulted a doctor about weight gain, chill, edema, dry skin,
sleepiness, problems with concentration. Objectively: the patient’s height is 165 cm,
weight is 90 kg, gynoid body proportions, to- 35,8oC, ESR-58/min, AP- 105/60 mm Hg.
Heart sounds are weakened, bradycardia is present. Other internal organs have no
changes. Thyroid gland is not palpable. There are milk droplets in mammary glands.
Hormonal study revealed rise of TSH and prolactin concentration, reduction of T4.
What factor caused obesity?
A. * Primary hypothyroidism
B. Secondary hypothyroidism
C. Prolactinoma
D. Hypopituitarism
E. Adiposogenital dystrophy
111. A 40-year-old patient complains of colic pains in the lower abdomen and profuse
bloody discharges from the genital tracts. Over the last 2 years she has been having
menses for 15-16 days, profuse, with clots, painful. In anamnesis there are 2 medical
abortions. On bi-manual investigation: in the canal of the uterine cervix some
fibromatous nodes are palpable, they are 3 cm in diameter, on the thin crus. Discharges
are bloody, moderate. Choose the correct treatment tactics:
A. * Operation: untwisting of the nodes
B. Hormonal hemostasis
C. Step-by-step vitamin therapy
D. Supravaginal ablation of the uterus without appendages
E. Hysterectomy without appendages
Exp:
Fibromatous nodes on the thin crus/stem should be untwisted by operations.

112. 13 months after the first labor a 24-year-old patient complained of amenorrhea.
Pregnancy ended in Caesarian section because of placental abruption which resulted in
blood loss near 2000 ml owing to disturbance of blood clotting. Choose the most
suitable investigation:
A. * Estimation of gonadotropin
B. USI of small pelvis organs
C. Progesteron assay
D. Computer tomography of head
E. Estimation of testosteron level in blood serum
113. Apgar test done on a newborn girl at 1st and 5th minute after birth gave the result
of 7-8 scores. During the delivery there was a shortterm difficulty with extraction of
shoulder. After birth the child had the proximal extremity dysfunction and the arm
couldn’t be raised from the side. The shoulder was turned inwards, the elbow was
flexed, there was also forearm pronation, obstetric palsy of brachial plexus. What is the
clinical diagnosis?
A. * Duchenne-Erb palsy
B. Trauma of thoracic spine
C. Right hand osteomyelitis
D. Intracranial haemorrhage
E. Trauma of right hand soft tissues
Explanation:
Erb’s palsy or Erb–Duchenne palsy is a paralysis of the arm caused by injury to

the upper trunk C5–C6 nerves. They form part of the brachial plexus, comprising the
ventral rami of spinal nerves C5–C8 and thoracic nerve T1. These injuries arise most
commonly from shoulder dystocia during a difficult birth.
114. A 28-year-old patient underwent hysteroectomy as a result of incomplete abortion.
Blood loss was 900 ml. It was necessary to start hemotransfusion. After transfusion of
10 ml of erythrocytic mass the patient presented with lumbar pain and fever which
resulted in hemotransfusion stoppage. In some minutes later the patient’s condition got
worse: she developed adynamia, apparent skin pallor, acrocyanosis, profuse
perspiration. to- 38,5oC, Ps-110/min, AP- 70/40 mm Hg. What is the most likely
diagnosis?
A. * Hemotransfusion shock
B. Hemorrhagic shock → lose more than 20 percent (one-fifth) of your body’s blood or
fluid supply
C. Septic shock
D. Anaphylactic shock
E. DIC syndrome → Disseminated intravascular coagulation is a condition in which

small blood clots develop throughout the bloodstream, blocking small blood vessels.
The increased clotting depletes the platelets and clotting factors needed to control
bleeding, causing excessive bleeding.
115. A 28-year-old parturient complains of headache, vision impairment, psychic

inhibition. Objectively: AP-200/110 mm Hg, evident edemata of legs and anterior
abdominal wall. Fetus head is in the area of small pelvis. Fetal heartbeats is clear,
rhythmic, 190/min. Internal examination revealed complete cervical dilatation, fetus
head was in the area of small pelvis. What tactics of labor management should be
chosen?
B. Cesarean
C. Embryotomy
See Qt 91
116. A primagravida in her 20th week of gestation complains of pain in her lower
abdomen, blood smears from the genital tracts. The uterus has an increased tonus, the
patient feels the fetus movements. Bimanual examination revealed that the uterus size
corresponded the term of gestation, the uterine cervix till 0,5 cm length, the external os
was open by 2 cm. The discharges were bloody and smeary. What is the most likely
diagnosis?
A. * Initial abortion
B. Risk of abortion
C. Abortion in progress
D. Incomplete abortion
E. Missed miscarriage
117. A 68-year-old patient consulted by doctor about a tumour in her left breast.
Objectively: in the upper internal quadrant of the left breast there is a neoplasm up to
2,5 cm in diameter, dense, uneven, painless on palpation. Regional lymph nodes are not
enlarged. What is the most likely diagnosis?
A. * Cancer
B. Cyst
C. Fibroadenoma
D. Mastopathy
E. Lipoma
118. A 40-year-old female patient has been observing profuse menses accompanied by
spasmodic pain in the lower abdomen for a year. Bimanual examination performed
during menstruation revealed a dense formation up to 5 cm in diameter in the cervical
canal. Uterus is enlarged up to 5-6 weeks of pregnancy, movable, painful, of normal
consistency. Appendages are not palpable. Bloody discharges are profuse. What is the
most likely diagnosis?
A. * Nascent submucous fibromatous node

B. Abortion in progress
C. Cervical carcinoma
D. Cervical myoma
E. Algodismenorrhea
119. A 42-year-old woman has had hyperpolymenorrhea and progressing

algodismenorrhea for the last 10 years. Gynecological examination revealed no changes
of uterine cervix; discharges are moderate, of chocolate colour, uterus is slightly
enlarged and painful, appendages are not palpable, the fornices are deep and painless.
What is the most likely diagnosis?
A. * Uterine endometriosis
B. Uterine carcinoma
C. Subserous uterine fibromyoma
D. Endomyometritis
E. Adnexal endmetriosis
120. On the tenth day after discharge from the maternity house a 2-year-old patient
consulted a doctor about body temperature rise 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 illdefined induration, lactostasis,
fluctuation is absent. Lymph nodes of the right axillary region are enlarged and painful.
B. Abscess
C. Erysipelas
D. Dermatitis
E. Tumour
121. A 26-year-old woman complains of having bloody discharges from the genitals for
the last 14 days, abdominal pain, general fatiguability, weakness, weight loss, body
temperature rise, chest pain, obstructed respiration. 5 weeks ago she underwent
induced abortion in the 6-7 week of gestation. Objectively: the patient is pale and inert.
Bimanual examination revealed that the uterus was enlarges up to 8-9 weeks of
gestation. In blood: Hb- 72 g/l. Urine test for chorionic gonadotropin gave the positive
result. What is the most likely diagnosis?
A. * Chorioepithelioma → chorioepitheliomas or chorioepitheliomata A malignant

fast-growing tumor that develops from trophoblastic cells, generally in the uterus after
fertilization of an egg by a sperm.
B. Metroendometritis
C. Uterus perforation
D. Uterine fibromyoma
E. Uterine carcinoma
122. A 30-year old patient consulted a doctor about menstruation absence for 2 years
after labour, loss of hair, body weight loss. The labour was complicated by a
haemorrhage caused by uterus hypotonia. Objectively: the patient is asthenic,
external genitals are hypoplastic, the uterus body is small and painless. The appendages
are not palpaple. What is the most likely diagnosis?
B. Ovarian amenorrhea
C. Turner’s syndrome
D. Exhausted overy syndrome
E. Galactorrhea-amenorrhea syndrome
See 103
123. A 28-year-old patient has been admitted to the gynecological department three
days after a casual coitus. She complains about pain in her lower abdomen and during
urination, profuse purulent discharges from the vagina, body temperature rise up to 37,
8oC. The patient was diagnosed with acute bilateral adnexitis. Supplemental
examination revealed: the 4th degree of purity of the vaginal secretion, leukocytes
within the whole visual field, diplococcal bacteria located both intra and extracellularly.
What is the etiology of acute adnexitis in this patient?
A. * Gonorrheal
B. Colibacterial
C. Chlamydial
D. Trichomonadal
E. Staphylococcal
124. A 32-year-old gravida complains about episodes of unconsciousness, spontaneous

syncopes that are quickly over after a change of body position. A syncope can be
accompanied by epizode of bradycardia. There are no other complications of gestation.
What is the most likely reason for such condition?
A. * Postcava compression by the gravid uterus

B. Pressure rise in the veins of extremities
C. Pressure fall in the veins of extremities
D. Vegetative-vascular dystonia (cardial type)
E. Psychosomatic disorders
125. A fullterm infant has respiratory rate of 26/min, heart rate of 90/min, blue skin,
muscle hypotonia. During catheter suction of mucus and amniotic fluid from the nose
and mouth the child reacted with a grimace. Low reflexes. Auscultation revealed
weakened vesicular respiration above lungs. Heart sounds are loud. After 5 minutes the
respiration became rhythmic, at the rate of 38/min, heart rate of 120/min. What is the
A. * Asphyxia
B. Inborn pneumonia
C. Birth trauma
D. Bronchopulmonary dysplasia
E. Respiratory distress syndrome
126. A maternity house has admitted a primagravida complaining of irregular, intense

labour pains that have been lasting for 36 hours. The woman is tired, failed to fall asleep
at night. The fetus is in longitudinal lie, with cephalic presentation. The fetus heartbeat
is clear and rhythmic, 145/min. Vaginal examination revealed that the uterine cervix
was up to 3 cm long, dense, with retroflexion; the external os was closed; the discharges
were of mucous nature. What is the most likely diagnosis?
A. * Pathological preliminary period

B. Uterine cervix dystocia
C. Primary uterine inertia
D. Physiological preliminary period
E. Secondary uterine inertia
127. A 58-year-old female patient came to the clinic with complaints of bloody lightred
discharges from the genital tracts. Menopause is 12 years. Gynaecological examination
revealed external genitalia and vagina had age involution; uterine cervix was
unchanged, there were scant bloody discharges from uterine cervix, uterus was of
normal size; uterine appendages were not palpable; parametria were free. What is the
A. * Uterine carcinoma
B. Atrophic colpitis
C. Abnormalities of menstrual cycle with climacteric character
D. Cervical carcinoma
E. Granulosa cell tumor of ovary
128. A secundipara has regular birth activity. Three years ago she had cesarean section
for the reason of fetal hypoxia. During parodynia 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. Fetal bladder is intact. What is the tactics of
choice?
A. * Cesarean section
B. Augmentation of labour
C. Obstetrical forceps
D. Waiting tactics of labor management
E. Vaginal delivery
129. 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,
D. Breast cancer
See 38 & 95
130. 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. What condition is needed to conduct the internal examination in order
to make a diagnosis?
A. * In the operating room prepared for the operation
B. In the examination room of antenatal clinic
C. In the admission ward of maternity hospital
D. In the delivery room keeping to all the aseptics regulations

E. The examination is not to be conducted because of risk of profuse haemorrhage
131. 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 management:
A. * To make manual exploration of uterine cavity
B. To apply hemostatic forceps upon the uterine cervix
C. To introduce an ether-soaked tampon into the posterior fornix
D. To put an ice pack on the lower abdomen
E. To administer uterotonics
132. A 24 year- old female patient complains of acute pain in the lower abdomen that
turned up after a physical stress. She presents with nausea, vomiting, dry mouth and
body temperature 36, 6oC. She has a right ovarian cyst in history. Bimanual
examination reveals that uterus is firm, painless, of normal size. The left fornix is deep,
uterine appendages aren’t palpable, the right fornix is shorted. There is a painful
formation on the right of uterus. It’s round, elastic and mobile. It is 7х8 cm large. In
blood: leukocytosis with the left shit. What is the most likely diagnosis?
A. * Ovarian cyst with pedicle torsion
B. Right-sided pyosalpinx
C. Subserous fibromyoma of uterus
D. Acute metritis
E. Extrauterine pregnancy
133. A parturient woman is 23 years old. Vaginal obstetric examination reveals full
cervical dilatation. There is no fetal bladder. Fetal head is in the plane of pelvic outlet.
An anterior fontanel is closer to pubes. The fetal head diameter in such presentation will
be:
A. * Suboccipito-bregmaticus
B. Fronto-occipitalis recta
C. Biparietal
D. Suboccipitio-frontalis
E. Mento-occipitalis
algodismenorrhea for the last 10 years. Gynaecological examination revealed no
changes of uterine cervix; discharges are moderate, of chocolate colour, uterus is
slightly enlarged and painful, appendages are not palpable, the fornices are deep and
painless. What is the most likely diagnosis?
D. Endomyometritis
135. A 26-year-old woman complains of having bloody discharges from the genitals for
the last 14 days, abdominal pain, general fatiguability, 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?
A. * Chorioepithelioma
B. Metroendometritis
C. Uterus perforation
D. Uterine fibromyoma
E. Uterine carcinoma
136. 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 84 per min.
Body temperature is 37, 2oC. Diuresis is low. USI shows 5-6 weeks of pregnancy. What
is the most likely diagnosis?
A. * Moderate vomiting of pregnancy
B. Mild vomiting of pregnancy
C. I degree preeclampsia
D. Premature abortion
E. Food poisoning
137. 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. * First 30 minutes
B. First 6 hours
C. First 24 hours
D. First 48 hours
E. After 48 hours
138. A 22-year old female patient complains of dull pain in her right iliac area that she
has been experiencing for a week, morning sickness and gustatory change. She has a
histrory of menstruation delay for 3 weeks. Objectively: AP-80/50 mm Hg, pulse is 78
bpm, body temperature is 37oC. Bimanual examination reveals that uterus is enlarged,
soft, mobile and painless. Uterine appendages are palpable on the right, there is a
dense, elastic and moderately painful formation 3×4 cm large. What is the most likely
diagnosis?
A. * Progressing fallopian pregnancy
B. Interrupted fallopian pregnancy → No bleeding
C. Right ovarian cyst
D. Uterogestation
139. A 25-year-old female patient complains of having amenorrhea for 3 years. She
associates it with difficult labour complicated by massive hemorrhage. She also
complains of loss of weight, hair fragility and loss, lack of appetite and depression.
Objective examination reveals no pathological changes of uterus and its appendages.
What is the desease pathogenesis?
A. * Hypoproduction of gonadotropin
B. Hyperproduction of estrogens
C. Hyperproduction of androgens
D. Hypoproduction of progesterone
E. Hyperproduction of prolactin
140. A 54-year-old female patient consulted a gynaecologist about bloody discharges

from the vagina for 1 month. Last menstruation was 5 years ago. Gynaecological
examination revealed no pathological changes. What is the tactics of choice?
A. * Diagnostic fractional curettage of uterine cavity
B. Colposcopy
C. USI
D. Cytosmear
E. Symptomatic therapy
141. An ambulance delivered a 21-year-old woman to the gynaecological department

with complaints of colicky abdominal pain and bloody discharges from the genital
tracts. Bimanual examination revealed that uterus was soft, enlarged to the size of 6
weeks of gestation, a gestational sac was palpated in the cervical canal. Uterine
appendages weren’t palpable. Fornices are free, deep and painless. Discharges from the
genital tracts are bloody and profuse. What is the most likely diagnosis?
A. * Inavitable abortion
B. Cervical pregnancy
C. Threat of abortion
D. Incipient abortion
E. Interrupted fallopian pregnancy
See Qt 6
142. A 30-year-old female patient has been delivered to the gynaecological department
with complaints of acute pain in the lower abdomen and body temperature 38,8oC. In
history: sexual life out of wedlock and two artificial abortions. Gynaecological
examination reveals no changes of uterine. The appendages are enlarged and painful on
both sides. Vaginal discharges are purulent and profuse. What study is required to
confirm a diagnosis?
A. * Bacteriological and bacterioscopic analysis
B. Hysteroscopy
C. Curettage of uterine cavity
D. Colposcopy
E. Laparoscopy
143. On the fifth day after a casual sexual contact a 25-year-old female patient
consulted a doctor about purulent discharges from the genital tracts and itch. Vaginal
examination showed that vaginal part of uterine cervix was hyperemic and edematic.
There was an erosive area around the external orifice of uterus. There were
mucopurulent profuse discharges from the cervical canal, uterine body and appendages
exhibited no changes. Bacterioscopic examination revealed beanshaped diplococci that
became red after Gram’s staining. What is the most likely diagnosis?
A. * Acute gonorrheal endocervicitis
B. Trichomonal colpitis
C. Candidal vulvovaginitis
D. Clamydial endocervicitis
E. Bacterial vaginism
144. A 32-year-old patient consulted a doctor about being inable to get pregnant for 5-6
years. 5 ago the primipregnancy ended in artificial abortion. After the vaginal
examination and USI the patient was diagnosed with endometrioid cyst of the right
ovary. What is the optimal treatment method?
A. * Surgical laparoscopy
B. Anti-inflammatory therapy
C. Conservative therapy with estrogen-gestagenic drugs
D. Hormonal therapy with androgenic hormones
E. Sanatorium-and-spa treatment
145. 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:
A. * Bloody
B. Sanguino-serous
C. Mucous
D. Purulent
E. Serous
See 85
146. A pregnant woman was delivered to the gynecological unit with complaints of pain
in the lower abdomen and insignificant bloody discharges from the genital tracts for 3
hours. Last menstruation was 3 months ago. Vaginal examination showed that uterus
body was enlarged to 10th week of gestation, a fingertip could be inserted into the
external orifice of uterus, bloody discharges were insignificant. USI showed small
vesicles in the uterine cavity. What is the most likely diagnosis?
A. * Molar pregnancy → Amount of missed menses is more than ga
B. Abortion in progress
C. Incipient abortion
D. Threat of spontaneous abortion
E. Incomplete abortion
147. 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. * Once a week
B. Once in two weeks
C. Once in three weeks
D. Montly
E. There is no need in further checks
148. A 14-year-old girl complains of pain in vaginal area and lower abdomen that last
for 3-4 days and have been observed for 3 months about the same time. Each time pain
is getting worse. Objectively: mammary glands are developed, hairiness corresponds to
the age. The virginal membrane is intact, cyanotic and protruded. She has never had
menstruation. She has been diagnosed with primary amenorrhea. What is the reason of
amenorrhea?
A. * Hymen atresia
B. Turner’s syndrome
C. Babinski-Frohlich syndrome
D. Pregnancy
E. Sexual development delay
149. A neonate was born from the 1st gestation on term. The jaundice was revealed on
the 2nd day of life, then it became more acute. The adynamia, vomiting and
hepatomegaly were observed. Indirect bilirubin level was 275µmol/L, direct bilirubin
level – 5µmol/L, Hb- 150 g/l. Mother’s blood group – 0(I), Rh+, child’s blood group –
A(II), Rh+. What is the most probable diagnosis?
A. * Hemolytic disease of the neonate (АВ0 incompatibility), icteric type
B. Jaundice due to conjugation disorder
C. Hepatitis
D. Physiological jaundice
E. Hemolytic disease of the neonate (Rh – incompatibility)
The normal hemoglobin concentration for a term newborn is 19.3±2.2 g/dL

(193±220 g/L), with a hematocrit of 61%±7.4% (0.61±0.074), values that continue to
rise until they reach a maximum at about 2 hours after birth.
150. A woman, primagravida, consults a gynecologist on 05.03.2012. A week ago she felt
the fetus movements for the first time. Last menstruation was on 01.2012. When should
she be given maternity leave?
A. * 8 August
B. 25 July
C. 22 August
D. 11 July
E. 5 September
151. A 28-year-old parturient complains of headache, vision impairment, psychic

inhibition. 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 dilatation, fetus head was in the area of small pelvis. What
tactics of labor management should be chosen?
B. Cesarean
C. Embryotomy
See Qt 91
152. A 27-year-old woman presents at the maternity welfare centre because of infertility.
She has had sexual life in marriage for 4 years, doesn’t use contraceptives. She hasn’t
get pregnant. On examination: genital development is without pathology, uterine tubes
are passable, basal (rectal) temperature is monophase during last 3 menstrual cycles.
What is the infertility cause?
A. * Anovular menstrual cycle
B. Chronic adnexitis
C. Abnormalities in genital development
D. Immunologic infertility
E. Genital endometriosis
See 12
153. A 25-year-old woman complains of profuse foamy vaginal discharges, foul, burning
and itching in genitalia region. She has been ill for a week. Extramarital sexual life. On
examination: hyperemia of vaginal mucous, bleeding on touching, foamy leucorrhea in
the urethral area. What is the most probable diagnosis?
A. * Trichomonas colpitic
B. Gonorrhea
C. Chlamydiosis
D. Vagina candidomicosis
154. 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?
D. Breast cancer
See 38, 95 & 129
155. A 68-year-old patient consulted a doctor about a tumour in her left mammary
gland. Objectively: in the upper internal quadrant of the left mammary gland there is a
neoplasm up to 2,5 cm in diameter, dense, uneven, painless on palpation. Regional
lymph nodes are not enlarged. What is the most likely diagnosis?
A. * Cancer
B. Cyst
C. Fibroadenoma
D. Mastopathy
E. Lipoma

algodismenorrhea for the last 10 years. Gynaecological examination revealed no
changes of uterine cervix; discharges are moderate, of chocolate colour, uterus is
slightly enlarged and painful, appendages are not palpable, the fornices are deep and
painless. What is the most likely diagnosis?
D. Endomyometritis
157. On the tenth day after discharge from the maternity house a 26 year-old patient
consulted a doctor about body temperature rise 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 illdefined induration, lactostasis,
fluctuation is absent. Lymph nodes of the right axillary region are enlarged and painful.
B. Abscess
C. Erysipelas
D. Dermatitis
E. Tumour
158. During the dynamic observation over a parturient woman in the second stage of
labor it was registered that the fetal heart rate fell down to 90-100/min and didn’t come
to normal after contractions. Vaginal examination revealed the complete cervical
dilatation, the fetal head filling the entire posterior surface of the pubic symphysis and
sacral hollow; the sagittal suture lied in the anteroposterior diameter of the pelvic
outlet, the posterior fontanelle was in front under the pubic arch. What plan for further
labour management should be recommended?
A. * Application of forceps
B. Caesarean section
C. Episiotomy
D. Application of cavity forceps
E. Stimulation of labour activity by intravenous injection of oxytocin
159. A 28-year-old patient complains of discomfort, acute pain in the lower third of the
left labia majora. The disease began suddenly after menstruation. Objectively: body
temperature is 38oC . The left labia majora has a formation to 3 cm diameter, with
hyperemic surface, extremely painful to the touch, with symptoms of fluctuation. What
A. * Acute bartholinitis
B. Vulvar cancer
C. Vulvar fibroid
D. Bartholin gland cyst
E. Hypertrophy of the labia
160. A 40 week pregnant secundipara is years old. Contractions are very active.
Retraction ring is at the level of navel, the uterus is hypertonic, in form of hourglass. On
auscultation the fetal heart sounds are dull, heart rate is 100/min. AP of the parturient
woman is 130/80 mm Hg. What is the most likely diagnosis?
A. * Risk of hysterorrhexis
B. Mazolysis
C. Disturbed labour
D. Complete hysterorrhexis
E. Attack of eclampsia
161. A 51-year-old patient complains of having intensive bloody discharges from

vagina for 15 days after delay of menstruation for 2,5 months. In anamnesis: disorders
of menstrual function during a year, at the same time she felt extreme irritability and
had sleep disorders. US examination results: uterus corresponds with age norms,
appendages have no pecularities, endometrium is 14 mm thick. What is the doctor’s
tactics?
A. * Diagnostic curettage of uterine cavity → Nomal endometrium till 11mm
B. Conservative treatment of bleeding
C. Hysterectomy
D. Supravaginal amputation of uterus without appendages
E. TORCH-infection test
162. A 25-year-old female patient complains about having amenorrhea for 3 years. She
associates it with difficult labour complicated by massive hemorrhage. She also
complains of loss of weight, hair fragility and loss, lack of appetite and depression.
Objective examination reveals no pathological changes of uterus and its appendages.
What is the desease pathogenesis?
A. * Hypoproduction of gonadotropin
B. Hyperproduction of estrogens
C. Hyperproduction of androgens
D. Hypoproduction of progesterone
E. Hyperproduction of prolactin
163. A 54-year-old female patient consulted a gynaecologist about bloody discharges

from the vagina for 1 month. Last menstruation was 5 years ago. Gynaecological
examination revealed no pathological changes. What is the tactics of choice?
A. * Diagnostic fractional curettage of uterine cavity and cervical canal
B. Colposcopy
C. USI
D. Cytosmear
E. Symptomatic therapy
164. 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 of a girl
weighing 3100 g. Objectively: the uterus is enlarged to 9-10 weeks, mobile, painless, of
heterogenous consistency. Examination reveals vaginal cyanosis, anaemia and body
temperature rise up to 37, 8oC . There is a significant increase in hCG concentration in

the urine. What is your provisional diagnosis?
A. * Uterine chorionepithelioma
B. Pregnancy
C. Hydatidiform mole
D. Endometritis
E. Uterine fibromyoma
Human chorionic gonadotropin (hCG) is a hormone produced by the placenta after

implantation. The presence of hCG is detected in some pregnancy tests
(HCG pregnancy strip tests)
165. A 32-year-old patient consulted a doctor about being inable to get pregnant for 5-6
years. 5 ago the primipregnancy ended in artificial abortion. After the vaginal
examination and USI the patient was diagnosed with endometrioid cyst of the right
ovary. What is the optimal treatment method?
A. * Surgical laparoscopy
B. Anti-inflammatory therapy
C. Conservative therapy with estrogen-gestagenic drugs
D. Hormonal therapy with androgenic hormones
E. Sanatorium and spa treatment

166. Examination of placenta revealed a defect. An obstetrician performed manual
investigation of uterine cavity and uterine massage. Prophylaxis of endometritis in the
postpartum period should involve following actions:
A. * Antibacterial therapy
B. Instrumental revision of the uterine cavity
C. Haemostatic therapy
D. Contracting agents
E. Intrauterine instillation of dioxine
167. 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. * Curettage of the uterus
B. Pregnancy maintenance therapy
C. Expectant management, surveillance
D. Hysterectomy
E. Antiviral therapy
168. A 29-year-old patient complains of absent menstruation for a year, milk discharge
from the nipples when pressed, loss of lateral visual fields. X-ray shows an expansion of
the sella turcica. What is the most likely cause of this condition?
A. * Pituitary tumour
B. Mammary tumour
C. Functional disorder of the hypothalamic-pituitary-ovarian system
D. Ovarian tumor
E. Pregnancy
169. A patient with uterine fibromyoma sized up to 8-9 weeks of pregnancy consulted a
gynaecologist about acute pain in the lower abdomen. Examination revealed
pronounced positive symptoms of peritoneal irritation, high leukocytosis. Vaginal
examination revealed that the uterus was enlarged up to 9 weeks of pregnancy due to
the fibromatous nodes, one of which was mobile and extremely painful. Appendages
were not palpable. Discharges were mucous, coming in moderate amounts. What is the
treatment tactics?
A. * Urgent surgery (laparotomy)
B. Surveillance and spasmolytic therapy
C. Fractional diagnostic curettage of the uterine cavity
D. Surgical laparoscopy
E. Surveillance and antibacterial therapy
Pt has Subserosal Fibromyoma cause on bimanuel examination the node is mobile and
painfull
leucocytosis and peritonitis
170. A multigravida with Rh sensitization 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. * Premature delivery
B. Course of desensitizing therapy
C. Plasmapheresis
D. Repeated (after 2 weeks) ultrasonography
E. Administration of anti-Rh gamma globulin
171. A 27-year-old patient complains of irritability, tearfulness, depression, and

sometimes aggressiveness, headache, nausea, vomiting, swelling of the mammary
glands. The mentioned problems arise 5-6 days before menstruation and gradually
progress until menstruation. That problems disappear 3 days after menstruation. What
B. Premature menopause
C. Secondary psychogenic amenorrhea
D. Preclimacterium syndrome
E. Algomenorrhea
172. On the 10th postpartum day, a puerperant woman complains of pain and heaviness
in the left mammary gland. Body temperature is 38, 8oC , Ps- 94 bpm. The left
mammary gland is edematic, the superoexternal quadrant of skin is hyperemic.
Fluctuation symptom is absent. The nipples discharge drops of milk when pressed.
What is a doctor’s further tactics?
A. * Antibiotic therapy, immobilization and expression of breast milk
B. Compress to both mammary glands
C. Inhibition of lactation
D. Physiotherapy
E. Opening of the abscess and drainage of the mammary gland
173. A 30-year-old female patient complains of milk discharge from the mammary
glands, 5-month absence of menstruation. She had one physiological labour four years
ago. Objectively: mammary glands are normally developed. Bimanual examination
reveals that the uterus is decreased in size, the ovaries are of normal size. MRI-scan
shows no cerebral pathologies. Concentration of thyroid-stimulating hormone is
normal. The serum prolactin level is increased. What is the most likely diagnosis?
A. * Hyperprolactinemia
B. Hypothyroidism
C. Polycystic ovary syndrome
D. Pituitary adenoma
E. Sheehan syndrome
174. During self-examination a 22-year-old patient revealed a mammary tumour.

Palpation revealed a firm, painless, freely mobile formation up to 2 cm, peripheral
lymph nodes were not changed. USI results: in the superior external quadrant of the
right mammary gland there was a big formation of increased echogenicity, sized 18×17
mm. The patient was provisionally diagnosed with fibroadenoma. What is a doctor’s
further tactics?
A. * Surgical removal of the tumour prior to pregnancy
B. Dynamic follow-up
C. Surgical treatment after pregnancy
D. Radical mastectomy
E. Nonsteroid anti-inflammatory drugs, oral contraceptives
175. Preventive examination of a 50-year-old woman revealed a dense tumour of the

right mammary gland up to 5 cm in diameter without distinct outlines. The skin over
the tumour looked like lemon peel. Palpation revealed a lymph node in the axillary
region. What is the most likely diagnosis?
A. * Breast cancer
B. Lactocele
C. Diffuse mastopathy
D. Mastitis
E. Breast lipoma
176. A 28-year-old patient complains of infertility. The patient has been married for 4
years, has regular sexual life and does not use contraceptives, but has never got
pregnant. Examination revealed normal state of the genitals, fallopian tubes are open
and unobstructed. Basal body temperature recorded over the course of 3 consecutive
menstrual cycles appeared to have a single phase. What is the most likely cause of
infertility?
A. * Anovulatory menstrual cycle
B. Immunological infertility
C. Genital endometriosis
D. Chronic salpingoophoritis
E. Ovulatory menstrual cycle
See 12
177. A 28-year-old patient has been taken to a hospital for acute pain in the lower
abdomen. There was a brief syncope. The delay of menstruation is 2 months.
Objectively: the patient has pale skin, AP- 90/50 mm Hg, Ps- 110/min. Lower abdomen
is extremely painful. Vaginal examination reveals uterus enlargement. There is positive
Promtov’s sign. Right appendages are enlarged and very painful. Posterior vault hangs
over. What is the most likely diagnosis?
A. * Right-sided tubal pregnancy
B. Right ovary apoplexy
C. Acute right-sided salpingoophoritis
D. Pelvioperitonitis
E. Complete abortion
Promtov’s sign, also known as “Promtov’s symptom” or “Promptov symptom” is

diagnostic symptom in gynecology. In case of Pelvic Inflammatory Disease (PID),
performing a bimanual gynecological examination is painful for patient. The patient
during the examination complains of pain in the lower abdomen.
Promtov’s sign
178. A 58-year-old female patient came to the antenatal clinic complaining of bloody
lightred discharges from the genital tracts. Menopause is 12 years. Gynaecological
examination revealed age involution of external genitalia and vagina; uterine cervix was
unchanged, there were scant bloody discharges from uterine cervix, uterus was of
normal size; uterine appendages were not palpable; parametria were free. What is the
A. * Uterine carcinoma
B. Atrophic colpitis
C. Abnormalities of menstrual cycle of climacteric nature
D. Cervical carcinoma
E. Granulosa cell tumor of ovary
179. Full-term pregnancy. Body weight of the pregnant woman is 62 kg. The fetus is in
a longitudinal lie and the head enters the pelvis first. Abdominal circumference is 100
cm. Fundal height is 35 cm. What is the approximate weight of the fetus?
A. * 3 kg 500 g
B. 4 kg
C. 2 kg 500 g
D. 3 kg
E. 4 kg 500 g
Fomula: Fundal height * Abdominal circumerence
180. A newborn’s head has dolichocephalic shape, that is front-to-back elongated.

Examination of the occipital region revealed a labour tumour located in the middle
between the prefontanel and posterior fontanel. Specify the type of fetal presentation:
A. * Posterior vertex presentation
B. Anterior vertex presentation
C. Presentation of the bregma
D. Brow presentation
E. Face presentation
Dolichocephaly (derived from the Ancient Greek δολιχός, meaning “long”) is a
condition where the head is longer than would be expected, relative to its width. In
humans, scaphocephaly is a form of dolichocephaly.
181. A 30-year-old multigravida has been in labour for 18 hours. 2 hours ago the
pushing stage began. Fetal heart rate is clear, rhythmic, 136/min. Vaginal examination
reveals the complete cervical dilatation, the fetal head in the pelvic outlet plane. Sagittal
suture in line with obstetric conjugate, the occipital fontanel is near the pubis. The
patient has been diagnosed with primary uterine inertia. What is the further tactics of
labour management?
A. * Outlet forceps
B. Labour stimulation
C. Cesarean section
D. Skin-head Ivanov’s forceps
E. Vacuum extraction of the fetus
182. A 28-year-old patient complains of profuse, painful and prolonged menstruation.

Before and after the menstrual period there is spotting lasting for 4-6 days. Vaginal
examination reveals that the uterus is painful and enlarged corresponding to 5-6 weeks
of pregnancy, has limited mobility. Appendages are not palpable. On the 15th day of the
menstrual cycle, the uterus was of normal size, painless. On account of stated problems
and objective examination the patient has been diagnosed with internal endometriosis.
Which drug should be used for the efective treatment of this patient?
A. * Duphaston
B. Synoestrol → Hexestrol (INN; brand

names Synestrol, Synoestrol, Estrifar, Estronal, and numerous others; also
known as hexanestrol, hexoestrol, and dihydrodiethylstilbestrol) is
a synthetic nonsteroidal estrogen of the stilbestrol group related
to diethylstilbestrol which was used to treat estrogen deficiency.[
C. Parlodel → Bromocriptine is an ergoline derivative and dopamine agonist that is

used in the treatment of pituitary tumors, Parkinson’s disease, hyperprolactinaemia,
neuroleptic malignant syndrome, and type 2 diabetes.
D. Ovidon
E. Oxytocin
Dydrogesterone, sold under the brand name Duphaston and Femoston (as Menopausal
Hormone Therapy), is a progestin medication which is used for a variety of indications,
including threatened or recurrent miscarriage during pregnancy, dysfunctional
bleeding, infertility due to luteal insufficiency, dysmenorrhea,
Duphaston is used with an estrogen to treat the signs of your menopause. These signs
vary from woman to woman. Duphaston is used to treat problems which you may get
when your body is not making enough of its own progestogen hormone. This is
normally produced in your ovaries from puberty until your menopause.
183. A 27-year-old sexually active female complains of numerous vesicles on the right
sex lip, itching and burning. Eruptions regularly turn up before menstruation and
disappear 8-10 days later. What is the most likely diagnosis?
A. * Herpes simplex virus
B. Bartholinitis
C. Primary syphilis
D. Cytomegalovirus infection
E. Genital condylomata
184. A 40 week pregnant secundipara is 41 years old. Contractions are very active.
Retraction ring is at the level of navel, the uterus is hypertonic, in form of hourglass. On
auscultation the fetal heart sounds are dull, heart rate is 100/min. AP of the parturient
woman is 130/80 mm Hg. What is the most likely diagnosis?
A. * Risk for uterine rupture
B. Abruption of placenta
C. Disturbed labour
D. Complete uterine rupture
E. Attack of eclampsia
185. A 37-year-old patient complains of acute pain in the region of genitals, swelling of
the right labia, pain during walking. Objectively: body temperature is 37oC , Ps- 98/min.
In the interior of the right labia there is a dense, painful tumourlike formation 5,0×4,5
cm large, the skin and mucous membrane of genitals is hyperemic, there are profuse
foul smelling discharge. What is the most likely diagnosis?
A. * Acute bartholinitis
B. Labial furuncle
C. Acute vulvovaginitis
D. Bartholin’s gland cyst
E. Carcinoma of vulva
186. A multigravida at 39 weeks of gestation has been delivered to a hospital having a
regular labour activity for 8 hours, the waters burst an hour ago. She complains of
headache, seeing spots. AP is of 180/100 mm Hg. Urine test results: protein – 3,3 g/l,
hyaline cylinders. Fetal heart rate is 140/min, rhythmical. Vaginal examination reveals
complete cervical dilatation, the fetal head is on the pelvic floor, sagittal suture is in line
with obstetric conjugate, the occipital fontanel is under the pubis. What is the optimal
tactics of labour management?
A. * Outlet forceps
B. Cavity forceps
C. Cesarean section
E. Conservative labour management
187. A patient complains of being unable to get pregnant for 5 years. A complete clinical
examination gave the following results: hormonal function is not impaired, urogenital
infection hasn’t been found, on hysterosalpingography both tubes were filled with the
contrast medium up to the isthmic segment, abdominal contrast was not visualized. The
patient’s husband is healthy. What tactics will be most effective?
A. * In-vitro fertilization
B. Insemination with husband’s sperm
C. Stimulation of ovulation
D. Hydrotubation → Could work but question asks what could me most effective
E. Laparoscopic tubal plasty → Could work but question asks what could me most
effective
188. A 13-year-old girl was admitted to the gynecological department with heavy
bleeding, which appeared after a long delay of menstruation. Shortly before, the girl
suffered a serious psychotrauma. Her menarche occurred at the age of 11, she had a 30-
day cycle with 5 to 6 days of moderate, painless bleeding. The patient is somatically
healthy, of normosthenic constitution with height of 160 cm, weight of 42 kg. The
patient is pale. Rectoabdominal examination revealed that the uterus was of normal size
and consistency, anteflexioversio, the appendages were not changed. What is the most
likely diagnosis?
A. * Juvenile bleeding
B. Ovarian cyst
C. Hysteromyoma
D. Girl is healthy
E. Amenorrhea
189. A 22-year-old patient complains of amenorrhea for 8 months. Menarche occured at

the age of 12,5. Since the age of 18 the patient has a history of irregular menstruation.
The patient is nulligravida. The mammary glands are developed properly, nipples
discharge drops of milk when pressed. Gynecological study results: prolactin level is 2
times higher than normal. CT reveals a bulky formation with a diameter of 4 mm in the
region of sella. What is the most likely diagnosis?
A. * Pituitary tumour
B. Lactational amenorrhea
C. Stein-Leventhal syndrome
D. Sheehan’s syndrome
E. Early pathological menopause

190. A 38-year-old female patient complains of hot flashes and feeling of intense heat
rising up to 5 times a day, headaches in the occipital region along with high blood
pressure, palpitations, dizziness, fatigue, irritability, memory impairment. 6 months ago
the patient underwent total hysterectomy with its appendages. What is the most
likely diagnosis?
A. * Post-castration syndrome
B. Premenstrual syndrome
C. Early pathological menopause
D. Secondary psychogenic amenorrhea
E. Physiological premenopause
191. A 55-year-old patient whose menstruation stopped 5 years ago, complains of

vaginal dryness, frequent and painful urination. Gynecologist revealed signs of atrophic
colpitis. Urine analysis revealed no peculiarities. Which locally acting product will
provide the proper therapeutic effect?
A. * Vaginal suppositories “Ovestin” → Ovestin Pessaries is a Hormone Replacement

Therapy (HRT). It contains the female hormone oestriol (an oestrogen). Ovestin is
used in postmenopausal women with at least 12 months since their last natural
period. Ovestin is used for relief of symptoms occurring after menopause.
B. Vaginal tablets “Tergynan” → Tergynan® is commonly used for bacterial vaginitis

such as banal pyogenic germs, desquamative leucorrhea, trichomonas, fungal due to
Candida albicans, mixed between trichomonas and yeasts
C. Vaginal cream “Meratin Combi” → 1 tablet contains: ornidazole 500 mg, neomycin
sulfate 100 mg, nystatin 100,000 IU, prednisolone 3 mg;
D. Vaginal gel “Metronidazole”
E. Vaginal cream “Dalacin” → Clindamycin is an antibiotic used for the treatment of a

number of bacterial infections, including bone or joint infections, pelvic inflammatory
disease, strep throat, pneumonia, middle ear infections, and endocarditis. It can also be
used to treat acne, and some cases of methicillin-resistant Staphylococcus aureus.
Maratin Combi is used:
for the treatment of gynecological diseases such as bacterial vaginosis and vaginitis,
trichomonas vaginitis, fungal vaginitis caused by Candida albicans ; vaginitis caused
by mixed infections (trichomonads, anaerobic flora, including gardenia and yeast);
for prophylactic purposes before surgical treatment of gynecological diseases, for the
repair of the vagina before childbirth or abortion, before and after the introduction of
intrauterine contraceptives, before and after diathermocoagulation of erosion of the
cervix, before intrauterine examination.
192. A 49-year-old patient complains of itching, burning in the external genitals,

frequent urination. The symptoms has been present for the last 7 months. The patient
has irregular menstruation, once every 3-4 months. Over the last 2 years she presents
with hot flashes, sweating, sleep disturbance. Examination revealed no pathological
changes of the internal reproductive organs. Complete blood count and urinalysis
showed no pathological changes. Vaginal smear contained 20-leukocytes in the field of
vision, mixed flora. What is the most likely diagnosis?
A. * Menopausal syndrome
B. Cystitis
C. Trichomonas colpitis
D. Vulvitis
193. 2 weeks after labour a parturient women developed breast pain being observed for
3 days. Examination revealed body temperature at the rate of 39oC , chills, weakness.
Locally: hyperaemia, enlargement, pain and deformity of the mammary gland. On
palpation: the infiltrate has an area of softening and fluctuation. What is the most likely
diagnosis?
A. * Infiltrative-purulent mastitis
B. Phlegmonous mastitis
C. Lactostasis
D. Serous mastitis
E. Mastopathy
194. A puerpera breastfeeding for 1,5 weeks consulted a doctor about uniform breast
engorgement. Breasts are painful. The body temperature is 36, 6oC . Milk expressing is
difficult. What is the most likely diagnosis?
A. * Lactostasis
B. Infiltrative mastitis
C. Purulent mastitis
D. Fibrocystic mastopathy
E. Gangrenous mastitis
195. Examination of a Rh-negative pregnant woman at 32 weeks of gestation revealed a

fourtime 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. Delivery at 37 weeks of gestation
C. Screening for Rh-antibodies 2 weeks later and early delivery in case of further titer
rise
D. Introduction of anti-Rh (D) immunoglobulin
E. Ultrasound for signs of hemolytic disease of the fetus
196. A 50-year-old female patient complains of aching pain in the lower abdomen. She
has a history of normal menstrual cycle. At the age of 40, the patient underwent a
surgery for gastric ulcer. Examination findings: abdomen is soft, in the hypogastrium
there is a welldefined nodular tumor of limited mobility. Vaginal examination findings:
the cervix is clean, has cylindrical shape. Body of the uterus cannot be palpated
separately. On both sides of the uterus palpation reveals tight tumors with an uneven
surface. The tumors are immobile and fill the whole pelvic cavity. What is the most
likely diagnosis?
A. * Krukenberg tumor
B. Ovarian fibroid
C. Ovarian granulosa cell tumor
D. Tubo-ovarian abscesses
E. Subserous fibroid
197. A 13-year-old girl was admitted to the gynecology department for having a
significant bleeding from the genital tract for 10 days. The patient has a history of
irregular menstrual cycle since menarche. Menarche occurred at the age of 11.
Rectoabdominal examination revealed no pathology. What is the provisional diagnosis?
A. * Juvenile uterine bleeding
B. Adenomyosis
C. Injury of the external genitalia

D. Werlhof’s disease
E. Endometrial polyp
198. Within a year, in a maternity hospital there were 616 livebirths, one stillbirth, one
infant died on the 5th day of life. What index can most accurately describe this
situation?
A. * Perinatal mortality
B. Total mortality
C. Birthrate
D. Infant mortality
E. Natural increase
199. A 21-year-old female patient consulted a gynecologist about itching, burning,

watery vaginal discharges with a fishlike smell. Speculum examination revealed that the
cervical and vaginal mucosa was of a normal pink color. Vaginal examination revealed
no alterations of the uterus and appendages. Gram-stained smears included clue cells.
What is the most likely pathology?
A. * Bacterial vaginosis (gardnerellosis)
B. Chlamydiosis
C. Gonorrhea
D. Trichomoniasis
E. Candidiasis
200. A 26-year-old secundipara at 40 weeks of gestation arrived at the maternity ward
after the beginning of labor activity. 2 hours before, bursting of waters occurred. The
fetus was in a longitudinal lie with cephalic presentation. Abdominal circumference was
100 cm, fundal height – 42 cm. Contractions occurred every 4-5 minutes and lasted 25
seconds each. Internal obstetric examination revealed cervical effacement, 4 cm
dilatation. Amniotic sac was absent. Fetal head was pressed against the pelvic inlet.
What complication arose in childbirth?
A. * Premature rupture of membranes
B. Primary uterine inertia
C. Secondary uterine inertia
D. Discoordinated labor
E. Clinically narrow pelvis
201. A 28-year-old female patient has been admitted to the gynecology department with
abdominal pain, spotting before and after menstruation for 5 days. The disease was
associated with the abortion which she had 2 years ago. Anti-inflammatory treatment
had no effect. Bimanual examination findings: the uterus is enlarged, tight, painful,
smooth. Hysteroscopy reveals dark red holes in the fundus with dark blood coming out
of them. What diagnosis can be made on the grounds of these clinical presentations?
A. * Inner endometriosis
B. Polymenorrhea
C. Hypermenorrhea
D. Submucous fibromatous node
E. Dysfunctional uterine bleeding

Exp:
Abortion in history think of endometritis
Dark Blood or Chocolate discharge
dark red holes of blue spots
202. 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
enlarged to 9 weeks of pregnancy, the cervical canal was opened for 1 finger. Fetal
tissues were palpated in the cervical canal. There was moderate vaginal bleeding. What
is the tactics of choice?
A. * Instrumental extraction of fetal tissue
B. Surveillance
C. Administration of hormones
D. Hemostatic and antianemic therapy
E. Therapy for the maintenance of pregnancy

Fetal tissues were palpated in the cervical canal indicates inevitable abortion
203. 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. Appendages
were unremarkable on both sides. Speculum examination revealed that the cervix was
cyanotic, enlarged, with opening of the external os up to 0,5 cm. Urine hCG test was
positive. What is the most likely diagnosis?
A. * Cervical pregnancy → soft barrel shaped cervix Treatment is total hysterectomy
B. Complete abortion
C. Abortion in progress
D. Threatened miscarriage
E. Ectopic pregnancy
204. An 18-year-old girl complains of breast pain and engorgement, headaches,

irritability, swelling of the lower extremities. These symptoms have been observed since
menarche and occur 3-4 days before the regular menstruation. Gynecological
examination revealed no pathology. Make a diagnosis:
B. Neurasthenia
C. Renal disease
D. Mastopathy
E. Cardiovascular disorder
205. A 25-year-old female presented to a women’s welfare clinic and reported the
inability to get pregnant within 3 years of regular sexual activity. Examination revealed
increased body weight, male pattern of pubic hair growth, dense enlarged ovaries,
monophasic basal temperature. What is the most likely diagnosis?
A. * Polycystic ovarian syndrome
B. Adnexitis
E. Gonadal dysgenesis
206. A 23-year-old female consulted a gynecologist on the 20th day postpartum peri-od
about pain in the left breast, purulent discharge from the nipple. Objectively: Ps-
120/min, t – 39 C . The left breast is painful, larger than the right one, hyperemic. In the
upper quadrant there is an infiltrate sized 10×15 cm with a softening inside. Blood test
results: ESR- 50 mm/h, WBC- 15, 0 · 109/l. What is the tactics of choice?
A. * Refer to the surgical department for operative treatment
B. Refer to the gynecology department
C. Refer to the postpartum department
D. Refer to a polyclinic surgeon for conservative treatment
E. Lance the breast abscess in the women’s health clinic
207. A puerperant is 28 years old. It’s the 3rd postpartum day after a second,
normal, term delivery. The body temperature is 36, 8o C , Ps- 72/min, BP- 120/80 mm
Hg. Mammary glands are moderately engorged, the nipples are clean. Abdomen is soft,
painless. The fundus of uterus is 3 fingers’ below of umbilicus. Lochia are bloody,
moderate. What is the most probable diagnosis?
A. * Physiological postpartum period
B. Subinvolution of uterus
D. Remains of placental tissue after childbirth
E. Lactostasis
See 85
208. A puerperant is 32 year old, it’s her first childbirth, term precipitate 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. Hemorrhoids
D. Hysterorrhesis
E. Hypotonic bleeding
209. A 31-year-old female patient complains of infertility, amenorrhea for 2 years after
the artificial abortion that was complicated by endometritis. Objectively: examination of
the external genitalia revils no pathology, there is female pattern of hair distribution.
According to the functional tests, the patient has biphasic ovulatory cycle. What form of
infertility in this case?
A. * Uterine
B. Ovarian
C. Pituitary
D. Hypothalamic
E. Immunological
210. A 19-year-old primiparous woman with a body weight of 54,5 kg gave birth at
weeks gestation to a full-term live girl after a normal vaginal delivery. The girl’s weight
was 2180,0 g, body length – 48 cm. It is known from history that the woman has been a
smoker for 8 years, and kept smoking during pregnancy. Pregnancy was complicated by
moderate vomiting of pregnancy from 9 to 12 weeks pregnant, edemata of pregnancy
from 32 to 38 weeks. What is the most likely cause of low birth weight?
A. * Fetoplacental insufficiency
B. Low weight of the woman
C. Woman’s age
D. First trimester preeclampsia
E. Third trimester preeclampsia

211. A 23-year-old primigravida at 39 weeks gestation has been admitted to the
maternity ward with irregular contractions. The intensity of uterine ontractions is not
changing, 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, preliminary period
B. Pregnancy I, 39 weeks, labor I, 1 period, the latent phase
C. Pregnancy I, 39 weeks, labor I, period 1, the active phase
D. Pregnancy I, 39 weeks, birth I, 1 period, the acceleration phase
E. Pregnancy I, 39 weeks, pathological prelimi-nary period
212. During the breast self-exam a 37-years-old female patient revealed a lump in the
lower inner quadrant of her left breast. Palpation confirms presence of a mobile
welldefined neoplasm up to 2 cm large. Peripheral lymph nodes are not changed. What
is the way of further management?
A. * Ultrasound examination of breasts, mammography, needle aspiration biopsy
B. Anti-inflammatory therapy, physiotherapy
C. Radical mastectomy
D. Ultrasound monitoring of genitals during the entire course of antiestrogens therapy,

systemic enzyme therapy, phytotherapy
E. Case follow-up
213. A 25-year-old female has a self-detected tumor in the upper outer quadrant of her
right breast. On palpation there is a painless, firm, mobile lump up to 2 cm in diameter,
peripheral lymph nodes are not changed. In the upper outer quadrant of the right breast
ultrasound revealed a massive neoplasm with increased echogenicity sized 21×18 mm.
A. * Fibroadenoma
B. Lactocele
D. Mammary cancer
E. Mastitis
214. On admission a 35-year-old female reports acute abdominal pain, fever up to 38,
8o C , mucopurulent discharges. The patient is nulliparous, has a history of 2 artificial
abortions. The patient is unmarried, had sexual contacts. Gynecological examination
reveals no uterus changes. Appendages are enlarged, bilaterally painful. There is
profuse purulent vaginal discharge. What study is required to confirm the diagnosis?
A. * Bacteriologic and bacteriascopic studies
B. Hysteroscopy
C. Curettage of uterine cavity
D. Vaginoscopy
E. Laparoscopy
215. A 20-year-old female consulted a gynecologist about absence of menstrual period

for 7 months. Menarche since 13 years, regular monthly menstrual cycle of 28 days,
painless menstruation lasts for 5-6 days. 7 months ago the patient had an emotional
stress. Gynecological examination revealed no alterations in the uterus. What is the
A. * Secondary amenorrhea
B. Primary amenorrhea
C. Algomenorrhea
D. Spanomenorrhea
E. Cryptomenorrhea
216. A 48-year-old female has been admitted to the gynecology department with pain in
the lower right quadrant of abdomen and low back pain, constipations. Bimanual
examination findings: the uterus is immobile, the size of a 10-week pregnancy, has
uneven surface. Aspirate from the uterine cavity contains atypical cells. What diagnosis
can be made?
A. * Hysterocarcinoma
B. Cervical cancer
C. Metrofibroma
D. Colon cancer
E. Chorionepithelioma
217. 13 months after the first labor, a 24-year-old patient complained of amenorrhea.
Pregnancy ended in Caesarian section due to abruption of placenta which resulted in
blood loss at the rate of 2000 ml due to disturbance of blood clotting. Choose the most
suitable investigation:
A. * Estimation of gonadotropin rate

B. US of small pelvis
C. Progesteron assay
D. Computer tomography of head
E. Estimation of testosteron rate in blood serum
218. A 24-year-old primipara was hospitalised with complaints of discharge of the

amniotic waters. The uterus is tonic on palpation. The lie of the fetus is longitudinal, it
is pressed with the head to pelvic outlet. Fetul 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, light amniotic waters are discharged. Point out
the correct component of the diagnosis:
A. * Premature rupture of membranes
B. Early discharge of the amniotic waters
C. The beginning of the 1st stage of labour
D. The end of the 1st stage of labour
E. Pathological preterm labour
219. A primagravida with pregnancy of 37-38 weeks complains of headache, nausea,

pain in epigastrium. Objectively: the skin is acyanotic. 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; sphygmus is of 92 bpm, intense. Respiration rate is
32/min. Heart activity is rhythmical. Appreciable edemas of the inferior extremities are
present. Urine is cloudy. What medication should be administered?
A. * Droperidolum of 0,25% – 2,0 ml

B. Dibazolum (Bendazole hydrochloride) of 1% – 6,0 ml
C. Papaverine hydrochloride of 2% – 4,0 ml
D. Hexenalum of 1% – 2,0 ml
E. Pentaminum of 5% – 4,0 ml
See 75
220. A 59-year-old female patient attended a maternity welfare clinic with complains of
bloody discharge from the genital tracts. Postmenopause is 12 years. Vaginal
examination revealed that external genital organs had signs of age involution, cervix of
the uterus was not erosive, small amount of bloody discharge came from the cervical
canal. Uterus is of normal size, uterine appendages are unpalpable. Fornices were deep
and painless. What method should be applied for the diagnosis specification?
A. * Separated diagnosic curretage
B. Laparoscopy
C. Puncture of abdominal cavity through posterior vaginal fornix
D. Extensive colposcopy
E. Culdoscopy
221. A 26-year-old woman, who delivered a child 7 months ago, has been suffering from
nausea, morning vomiting, sleepiness for the last 2 weeks. She breastfeeds the child,
menstruation is absent. She has not applied any contraceptives. What method should be
B. X-ray of small pelvis

222. A 28-year-old woman has bursting pain in the lower abdomen during
menstruation; chocolate-like discharges from vagina are observed. It is known from the
anamnesis that the patient suffers from chronic adnexitis. Bimanual examination
revealed a tumour-like formation of heterogenous consistency 7х7 cm large to the left
from the uterus. The formation is restrictedly movable, painful when moved. What is
the most probable diagnosis?
A. * Endometrioid cyst of the left ovary
B. Follicular cyst of the left ovary
C. Fibromatous node
D. Exacerbation of chronic adnexitis
E. Tumour of sigmoid colon
223. 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 90/60 mm Hg. 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. * Uterine rupture
B. Initial uterine rupture
C. Threatened uterine rupture

D. Abruption of placenta
E. Compression of inferior pudendal vein
224. A baby was born by a young smoker. The labour was complicated by uterine
inertia, difficult delivery of the baby’s head and shoulders. The baby’s Apgar score was
4. Which of the following is a risk factor for a spinal cord injury?
A. * Difficult delivery of the head and shoulders
B. Young age of the mother
C. Pernicious habits
D. Uterine inertia
E. Chronic hypoxia
225. A 28-year-old woman complains of increased intermenstrual periods up to 2

months, hirsutism. Gynaecological examination revealed that the ovaries were enlarged,
painless, compact, uterus had no pecularities. Pelvic ultrasound revealed that the
ovaries were 4-5 cm in diameter and had multiple enlarged follicles on periphery. X-ray
of skull base showed that sellar region was dilated. What is the most probable
diagnosis?
A. * Stein-Leventhal syndrome (Polycystic ovary syndrome)
B. Algodismenorrhea
C. Sheehan’s syndrome
E. Morgagni-Stewart syndrome
See Qt 84
226. A woman consulted a therapeutist about fatigability, significant weight loss,

weakness, loss of appetite. She has been having amenorrhea for 8 months. A year ago
she born a full-term child. Delivery was complicated by severe haemorrhage. She got
blood and blood substitute transfusions. What is the most probable diagnosis?
B. Stein-Leventhal syndrome
C. Shereshevsky-Turner’s syndrome
D. Homological blood syndrome
E. Vegetovascular dystonia
See 103
227. A 35-year-old female patient has gained kg weight within a year with the normal
diet. She complains of chill, sleepiness, dyspnea. The patient’s mother and sister are
corpulent. Objectively: height – 160 cm, weight – 92 kg, BMI – 35,9. Obesity is uniform,
there are no striae. The face is amimic. The skin is dry. The tongue is thickened. Heart
sounds are muffled. Heart rate – 56/min, BP – 140/100 mm Hg. The patient has
constipations, amenorrhea for 5 months. TSH – 28 mkME/l (normal rate – 0,32-5).
Craniogram shows no pathology. What is the etiology of obesity?
A. * Hypothyroid
B. Hypoovarian
C. Hypothalamic-pituitary
D. Alimentary and constitutive

E. Hypercorticoid
228. A 20-year-old parturient woman has the I labor stage. The pregnancy is full-term.
Labors occur every 3 minutes and last for 55 seconds. Fetus presentation is polar, the
head is pressed to the small pelvis entrance. Heart rate of the fetus is 150/min, distinct
and rhythmic. Vaginal examination: uterus cervix is effaced for 30%; dillatated for 2
cm; amniotic sac is intact; station is -3; moderate mucous-bloody discharge is observed.
What phase of the I labor stage is it?
A. * Latent
B. Active
C. Slowing-down
D. Physiological preliminary period
E. Primary uterine inertia
229. A 6-year-old girl visited a general practitioner with her mother. The child
complains of burning pain and itching in her external genitalia. The girl took antibiotics
the day before due to her suffering from acute bronchitis. On examination: external
genitalia are swollen, hyperemic, there is white deposit accumulated in the folds. The
most likely diagnosis is:
A. * Candidal vulvovaginitis
B. Trichomoniasis
C. Nonspecific vulvitis
D. Helminthic invasion
E. Herpes vulvitis
230. A 22-year-old patient complains of 8-months-long delay of menstruation.

Anamnesis: menarche since the age of 12,5. Since the age of 18 menstruations are
irregular. No pregnancies. Mammary glands have normal development; when the
nipples are pressed, milk drops are discharged. On gynecological examination:
moderate uterine hypoplasia. On hormonal examination: prolactin level exceeds the
norm two times. On computed tomogram of the sellar region: a space-occupying lesion
4 mm in diameter is detected. The most likely diagnosis is:
A. * Pituitary tumor
B. Lactation amenorrhea
C. Stein–Leventhal syndrome (Polycystic ovarian syndrome)
D. Sheehan’s syndrome
E. Cushing’s disease
231. A 25-year-old patient during self-examination detected a tumor in the upper

external quadrant of the 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 mammary glands US: in the upper external
quadrant of the right mammary gland there is a space-occupying lesion of increased
echogenicity 21х18 mm in size. The most likely diagnosis is:
A. * Fibroadenoma
B. Lacteal cyst
D. Breast cancer
E. Mastitis
232. An Rh-negative woman with 32-week-long term of pregnancy has been examined.
It was observed that 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. * Preterm delivery
B. Delivery at 37 weeks term
C. Rh-antibody test in 2 weeks; if Rh-antibodies increase in number conduct delivery
D. Introduction of anti-Rh immunoglobulin
E. US examination to determine signs of fetal erythroblastosis
233. A 30-year-old woman complains of irregular copious painful menstruations, pain

irradiates to the rectum. Anamnesis states 10-year-long infertility. On bimanual
examination: uterus is of normal size; uterine appendages on the both sides are corded,
with restricted mobility, painful; there are dense nodular painful growths detected in
the posterior fornix. A doctor suspects endometriosis. What method allows to verify this
diagnosis?
A. * Laparoscopy
B. Diagnostic curettage of uterine cavity
C. Paracentesis of posterior fornix
D. Uterine probing
E. Hysteroscopy
234. A 30-year-old woman complains of infertility during her 10-year-long married life.
Menstruations occur since she was 14 and are irregular, with delays up to a month and
longer. Body mass is excessive. Hirsutism is observed. On bimanual examination:
uterine body is decreased in size; ovaries are increased in size, dense, painless, and
mobile. The most likely diagnosis is:
A. * Stein-Leventhal syndrome (Polycystic ovarian syndrome)
B. Follicular cyst of ovaries
C. Genital endometriosis
D. Genital tuberculosis
E. Inflammatory tumor of ovaries
See Qt 84
235. A 23-year-old woman came to the gynecological clinic. She complains of pain,
itching, and burning in her vulva, general weakness, indisposition, elevated body
temperature up to 37,2*C, and headache. On examination in the vulva there are
multiple vesicles up to 2-3 mm in diameter with clear contents against the background
of hyperemia and mucosal edema. Make the provisional diagnosis:
A. Cytomegalovirus infection
B. Vulvar cancer
C. Primary syphilis
D. * Genital herpes infection
E. Papillomavirus infection
236. During regular preventive gynecological examination a 30-year-old woman was

detected to have dark blue punctuated “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. US of the lesser pelvis

B. Hormone testing
C. Hysteroscopy
D. Curettage of the uterine cavity
E. * Colposcopy, target biopsy of the cervix
237. A 30-year-old woman came to the gynecological department. She complains of

sharp pain in the her lower abdomen and temperature of 38,8*C. She has a history of
extramarital sexual activity and 2 artificial abortions. On gynecological examination the
uterus is unchanged. The appendages are bilaterally enlarged and painful. Profuse
purulent discharge is being produced from the vagina. What examination needs to be
conducted to clarify the diagnosis?
A. Hysteroscopy
B. Colposcopy
C. Laparoscopy
D. * Bacteriology and bacterioscopy of discharge
E. Curettage of the uterine cavity
238. On the day 4 after the cesarean section a woman developed fever with body
temperature up to 39*C and abdominal pain. Pulse – 104/min. She vomited twice. The
patient is sluggish; her tongue is dry and has gray coating. The abdomen is distended.
Signs of peritoneal irritation are positive in all segments. Peristalsis cannot be
auscultated. No passage of gas occurs. Uterine fundus is located at the level of the navel.
The uterus is painful on palpation. The discharge is moderate and contains blood and
pus. What is the most likely diagnosis?
A. Progressive thrombophlebitis
B. * Pelvic peritonitis
C. Parametritis
D. Diffuse peritonitis
E. Metroendometritis
239. A 27-year-old woman complains of foul-smelling discharge from her genital tracts,
pain in her lower abdomen, and elevated temperature. The complaints arose 2 days ago.
She has a history of surgical abortion at the of 8 weeks one week ago. Speculum
examination: the uterine cervix is clear, external orifice produces foul-smelling
discharge. Vaginal examination: the uterus lies in anteflexion, is mobile, painful slightly
enlarged. The appendages are without changes. Make the provisional diagnosis:
A. Acute respiratory disease
B. Enterocolitis
C. * Postabortal endometritis
D. Appendicitis
E. Salpingoophoritis
240. A 58-year – old woman came to the gynecological clinic. She complains of bloody
discharges from her genital tracts. Menopause is 8 years. Gynecological examination:
the uterus is slightly and enlarged, dense to touch, with limited mobility; the uterine
appendages cannot be detected; parametrium is free. Fractional curettage of the uterine
cavity yields a significant amount of the medullary substance is the scrape. What is the
A. * Uterine corpus cancer
B. Uterine cervix cancer
C. Choriepithelioma
D. Adenomyosis
E. Hormone-produsing ovarian tumor

241. A 26-year-old woman presents with amenorrhea. 10 months ago she gave birth for
a second time. In her early postpartum period she developed a massive hypotonic
hemorrhage. Now breastfeeding. Lately she has been presenting with loss of weight, loss
of hair, and indisposition. Gynecological examination revealed atrophy of the external
genitals, the uterus is abnormally small, no uterine appendages can be detected. What is
the most likely diagnosis?
A. Galactorrhea-amenorrhea syndrome
B. Phisiological amenorrhea
C. Stein-Leventhal syndrome(polycystic ovary syndrome)
D. * Sheehan syndrome(postpartum pituitary gland necrosis)
E. Suspected progressing ectopic pregnancy
See 103
242. A 17-year-old 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 the
patient’s grandmother had cervical cancer. The patient was consulted about the
maintenance of her reproductive heaths. What recommendation will be the most
helpful for prevention of invasive cervical cancer?
A. Immunomodulators
B. Timely treatment of sexually transmitted disease
C. Antiviral and antibacterial drugs
D. Vitamins, calcium, omega-3
E. * Vaccination against human papillomavirus(HPV)

243. A 46-year-old woman came to the maternity clinic with complains of moderate
blood discharge from the vagina, which developed after the menstruation delay of 1,5
months. On vagina examination: the cervix is clean; the uterus is not enlarged, mobile,
painless; appendages without changes. Make the diagnosis:
A. Adenomyosis
B. Cancer of the uterine body
C. Ectopic pregnancy
D. Submucous uterine myoma
E. * Dysfunctional uterine bleeding
244. A 25-year-old woman was brought into the gynecological department with profuse
bloody discharge from her genital tracts. She is 12 weeks pregnant, the pregnancy is
planned. Within the 3 days she was experiencing pains in her lower abdomen that
eventually started resembling cramps, she developed bleeding. Her skin is pale, pulse-
88/min., blood pressure – 100/60mm Hg, body temperature – 36,8*C. Vaginal
examination: the uterus size corresponds with 11 weeks of pregnancy, the cervical canal
allows inserting 1 finger and contains fragments of the fertilized ovum, the discharge is
bloody and profuse. What is the most likely diagnosis?
A. Disturbed menstrual cycle, hyperpolymenorrhea
B. Disturbed menstrual cycle, amenorrhea
C. Full-term pregnancy, term labor
D. * 12-week pregnancy, spontaneous abortion in progress
E. 12-week pregnancy, threatened spontaneous abortion
245. A 18-year-old girl was brought into the gynecology department with complains of
elevated body temperature up to 37,8*C, sharp pain in her lower abdomen, more
intense on the right , and difficult defecation. Vaginal examination detected a painful
dense elastic formation 5×6 cm in the area of her right ovary. Pregnancy test is negative.
A. Ovarian appoplexy
B. * Ovarian cyst rupture
C. Appendicitis
D. Ectopic pregnancy
E. Torsion of ovarian tumor pedicle
246. A 28-year-old woman complaining of irregular menstruations and infertility came

to gynecological clinic. Menstruations occur since the age of 15, irregular, with delays up
to 2 months. On examination she presents with marked hirsutism and excessive body
weight. On vaginal examination the uterus is reduced in size and painless. The ovaries
on the both sides are dense and enlarged. Ultrasound shows microcystic changes in the
ovaries, the ovaries 5×4 cm and 4,5×4 cm in size with dense ovarian capsule. Basal body
temperature is monophasic. What is the most likely diagnosis?
A. Bilateral adnexitis
B. * Polycystic ovary syndrome
C. Endometrioid cysts
D. Ovarian carcinoma
E. Krukenberg tumor
See qt 84
247. A 48-year-old woman complains of disturbed menstrual cycle: her periods last for
7-9 days and are excessively profuse throughout the last half- year She notes occasional
hot flashes in her head, insomnia, irritability, and headaches. Her skin is normal color.
Blood pressure – 150/90 mm Hg pulse – 90/min., rhythmic. The abdomen is soft and
painless. Bimanual examination shows no uterine enlargement, the appendages cannot
be detected. The vaginal fornices are free. What is the most likely diagnosis?
A. Premenstrual syndrom
B. * Climacteric syndrome
C. Adrenogrnital syndrom
D. Stein-Leventhal syndrome(polycystic ovary syndrome)
E. Uterine myoma
248. A 14-year-old girl came to the general practitioner with complaints of weakness,
loss appetite, headache, rapid fatigability. Her last menstruation was profuse and lasted
for 14 days after previous delay of 2 months. Objectively: the skin is pale, heart rate is
90/min., BP is 110/70 mm Hg, Hb is 80 g/l. Rectal examination: the uterus and its
appendages are without changes, no discharge from the genital tracts. What
complication occurred in the patient?
A. Gastritis
B. Migraine
C. * Posthemorrhagic anemia
D. Dysmenorrhea
E. Somatoform autonomic dysfunction of hypotonic type
249. 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 the most likely diagnosis?
A. * Fibrocystic mastopathy
B. Hyperprolactinemia
C. Breast cancer
D. Breast cyst
E. Mastitis
250. A parturient woman is 30 years old, stage I of the labor is ongoing. The fetus is in
the cephalic presentation. Auscultation of the fetal heart sounds detects bradycardia.
Evaluation of cardiotocogram yielded the following data: decrease of basal heart rate
down to 90/min., variability – monotonous (2 and less): late deceleretions with
amplitude of 50/min. Make the diagnosis and choose the obstetrical tactics necessary in
this case:
A. Fetal distress. Forceps delivery
B. Fetal distress. Vacuum extraction delivery
C. Normal condition of the fetus. Vaginal birth
D. * Fetal distress. Urgent cesarean section delivery
E. Fetal distress. Stimulation of uterine contractions
Baseline FHR Variability

Baseline variability is defined as fluctuations in the fetal heart rate of more than 2
cycles per minute. No distinction is made between short-term variability (or beat-to-
beat variability or R-R wave period differences in the electrocardiogram) and long-
term variability.
251. A woman is 40 weeks pregnant. The fetus is in the longitudinal lie and cephalic
presentation. Pelvic size: 26-29-31-20. Expected weight of the fetus is 4800gram. The
labor contractions has been lasting for 12 hours, within the last 2 hours they were
extremely painful, the parturient woman is anxious. The waters broke 4 hours ago. On
external examination the contraction ring is located 2 finger widths above the navel,
Henkel-Vasten sign is positive. Fetal heart rate is 160/min., muffled. On internal
examination the uterine cervix is fully opened, the head is engaged and pressed to the
entrance into the lesser pelvis. What is the most likely diagnosis?
A. Hyperactive uterine contractions
B. Abruption of the normally positioned placenta
C. Complete uterine rupture
D. * Threatened uterine rupture
E. Anatomically contracted pelvis
Pt could be diagnosed for cephalo-pelvic disproportion but given we don’t have

that option, Threatened uterine rupture is indicated due to the size of child and
normal pelvic diameters
Normal pelvic sign: mnemonic SCTE
D.Spinarum: 25-26
D.Cristarum: 28-29
D.Trocanterica: 31 -32
External conjugate: 20-21
Vasten-Henkel sign — an obstetrician puts his hand on the pubic symphysis of the
woman lying on her back, and leads it up the abdominal wall.
If the head of the fetus is lower than the symphysis (negative Vasten sign, Figure B) —
so the forecast of delivery is good.
If the head is determined at the same level as the symphysis — so the delivery is
conditionally possible (Vasten intermediate, Figure b).
But if the head of the fetus is elevated above the symphysis — the delivery is not possible
(Vasten positive, Figure A).
Symptoms of cephalo-pelvic disproportion are:

• painful ineffective bearing-down efforts;
• absence of descent of the head;
• configuration, asynclitism, moulding of the head;
• fetal hypoxia;
• symptoms of pelvic organs pressing;
• threatening uterine rupture;
• positive Vasten’s and Zangemeister signs.
Read More on cephalo-pelvic disproportion at page 45-46
252. It is the 3rd day after the first normal term labor; the infant is rooming-in with the
mother and is on breastfeeding. Objectively: the mother’s general condition is
satisfactory. Temperature is 36,4*C, 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 3 finger widths below the navel.
Lochia are sanguine-serous, moderate in volume. Assess the dynamics of uterine
involution:
A. Hematometra
B. Subinvolution
C. * Physiological involution
D. Pathological involution
E. Lochiometra
See 85
sanguine-serous → blood-red.
253. A 30-year-old multigravida has been in labour for 18 hours. 2 hours ago the
pushing stage began. Fetal heart rate is clear, rhythmic, 136/min. Vaginal examination
reveals complete cervical dilatation, the fetal head in the pelvic outlet plane. Sagittal
suture is in line with obstetric conjugate, the occipital fontanel is near the pubis. The
patient has been diagnosed with primary uttering inertia. What is the further tactics of
labor management?
A. * Outlet forceps
B. Cesarean section
C. Labour stimulation
E. Skin-head Ivanov’s forceps
See 181
254. A newborn has Apgar score has 9. When should this infant be put to the breast?
A. On the 3rd day
B. On the 2nd day
C. * In the delivery room
D. After 2 hours
E. After 12 hours
255. A 24-year-old pregnant woman on her 37th week of pregnancy has been brought to
the maternity obstetric service with complaints of week fetal movements. Fetal heart
beats are 95/min. On vaginal examination the uterine cervix is tilted backwards, 2cm
long, external orifice allows inserting a fingertip. Biophysical profile of the fetus equals
4 points. What tactics of pregnancy management should be chosen?
A. Treatment of fetal distress; if ineffective, them elective cesarean section on the next
day
B. * Urgent delivery via a cesarean section
C. Treatment of placental dysfunction and repeated analysis of the fetal biophysical

profile on the next day
D. Doppler measurement of blood velocity in the umbilical artery
E. Urgent preparation of the uterine cervix for delivery
A fetal biophysical profile is a prenatal test used to check on a baby’s well-being.

The test combines fetal heart rate monitoring (nonstress test) and fetal ultrasound to
evaluate a baby’s heart rate, breathing, movements, muscle tone and amniotic fluid level
256. A 52-year-old woman kk suffering from obesity, complains of bloody discharges
from sexual paths during 4 days. Last normal menses were 2 years ago. Histological
investigation of biopsy of the endometrium has revealed adenomatous hyperplasia.
What reason from the mentioned below caused the development of disease?
A. Poor aromatization of preandrogens due to hypothyroidism
B. Hypersecretion of estrogens by tissues of the organism.
C. *Excessive transformation of preandrogens from adipose tissues
D. The increased contents of follicle-stimulating hormone
E. Supersecretion of androgens by the cortex of paranephroses.

Exp:
Postmenopausal and obese patients is predisposed to having estrogenemia and the

growth of the endometrium is directly proportional to the amount of estrogen in blood
which should decrease after menopause.
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I. PEDIATRICS 2019 BASES KROK 2 EXPLANATIONS

II. Hygiene Bases 2019 Krok 2 Explanations
Categories: Bases, Exam Preparation, Krok, Krok 2
Tags: Bases, Gynecology, krok, Krok 2, Obstetrics
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Obstetrics & Gynecology 2019 Bases Krok 2

obsetetrics and gynecology

KROK 2 Obstetrics and Gynecology BASES WITH

** Refer To Krok 2 Lab values Open table in new tab

I. PEDIATRICS 2019 BASES KROK 2 EXPLANATIONS

A. * Examination for HIV

B. Examination for neuropathologycvx

C. Examination for gonorrhea

D. Examination for fungi

E. Examination for trichomoniasis

RW – Reaction of Wasserman for syphilis+-

B. Examination for neuropathology

C. Examination for gonorrhea

D. Examination for fungi

E. Examination for trichomoniasis

3. At term of a gestation of 40 weeks height of standing of a uterine fundus is less then

A. * Chronic placental dysfunction

B. Delay of an intrauterine fetation → (Fetation is the formation of a fetus)

C. Placental detachment → No bleeding or abdominal pain in qt

D. Infection of a fetus → No specific signs of infection

E. Prematurity → Gestation in term in pt

Placental insufficiency (also called placental dysfunction or uteroplacental

B. Amniotomy, labour stimulation, fetal hypoxia treatment

D. Fetal hypoxia treatment, conservative delivery

E. Therapeutic rest, amniotomy, labour stimulation

D. Inner glomal artery ligation

E. Putting clamps on the uterine cervix

Incomplete abortion is a pregnancy that is associated with vaginal bleeding,

Complete abortion is a completed miscarriage. Typically, a history of vaginal

A. * Ruptured ectopic pregnancy

C. Right uterine adnexa cystoma’ torsion

Blumberg’s sign (also referred to as rebound tenderness, Shyotkin-Blumberg sign) is a

B. Placental abruption → Premature separation

D. Threatened premature labor

B. Hormone investigation → If oral contraceptives were used

C. Ultra sound investigation

D. Diagnostic scraping out of the uterine cavity → Age above 40

E. Hysteroscopia → For only history of Abortion

temperature to 37,2oC during 3 last months. Condition worsens before the

A. * Cancer of right mammary gland

B. Right side acute mastitis

C. Right side chronic mastitis

E. Tuberculosis of right mammary gland

E. Dilation and curretage

Cervical weakness, also called cervical incompetence or cervical insufficiency,

Cervical cerclage, also known as a cervical stitch, is a treatment

A. * Anovular menstrual cycle

C. Abnormalities in genital development

A. * Cancer of uterine cervix

Schiller’s test or Schiller’s Iodine test is a medical test in which iodine

A. * Probing of uterus cavity

Trichomonas vaginitis is a vaginal infection due to the protozoa Trichomonas

A. * Menarche → the first occurrence of menstruation.

D. Vacuum extraction of the fetus

18. A 28 y.o. primagravida, pregnancy is 15-16 weeks of gestation, presents to the

A. * Threatened spontaneous abortion

Threatened abortion is vaginal bleeding without cervical dilation occurring during

B. Vacuum extraction of the fetus

D. Conservative tactics of labor