Krok 2 – 2013 Gynecology Base

1. A 52-year-old woman 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. Excessive transformation of preandrogens from adipose tissues
B. Supersecretion of androgens by the cortex of paranephroses.
C. Poor aromatization of preandrogens due to hypothyroidism
D. Hypersecretion of estrogens by tissues of the organism
E. The increased contents of follicle-stimulating hormone

2. A 40-year-old woman complains of colic pains in the lower part of abdomen

and abundant bloody discharges from genital tract. Last 2 years she had
menses for 15-16 days, abundant, with clots, painful. Had 2 medical abortions.
In bimanual investigation: from the canal of the cervix uteri - a fibromatous
node, 3 cm in diameter, on the thin stem. Discharges are bloody,
moderate.Choose the correct tactics
A. Operation: untwisting of born node
B. Hormonal hemostasis
C. Supravaginal ablation of the uterus without ovaries
D. Hysterectomy without ovaries
E. Phase by phase vitamin therapy

3. 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. Treatment of specific colpitis with the subsequent biopsy
B. Diathermocoagulation of the cervix uteri
C. Cervix ectomy
D. Cryolysis of cervix uteri
E. Specific treatment of Trichomonas colpitis

4. 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
mucosa: adenocystous hyperplasia of endometrium. Optimal medical tactics:
A. Surgical treatment
B. Radial therapy
C. Phase by phase vitamin therapy
D. Hormonetherapy
E. Phytotherapy

5. 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. Bimanual investigation: the body of the uterus
indicates for about 5-6 weeks of pregnancy, it is soft, painless. In the left
appendage there is a retort-like formation, 7x5 cm large, mobile, painless.
What examination is necessary for detection of fetus localization?
A. Ultrasound
B. Hromohydrotubation
C. Cystoscopy
D. Colposcopy
E. Hysteroscopy

6. 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
B. Hydramnion
C. Back occipital presentation
D. Premature labor
E. Acute hypoxia of a fetus

7. 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. Premature detachment of normally posed placenta
C. Premature labor
D. Back occipital presentation
E. Hydramnion

8. 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 1
g/l, peripheral edemata. Reflexes are normal. Choose the most correct tactics:
A. Labour stimulation after preparation
B. Complex therapy of gestosis for 7 days
C. Complex therapy of gestosis for 2 days
D. Absolute bed rest for 1 month
E. Caesarian section immediately
9. A 26 year old woman had the second labour within the last 2 years with
oxytocin application. The childs weight is 4080 g. After the placent birth there
were massive bleeding, signs of hemorrhagic shock. Despite the injection of
contractive agents, good contraction of the uterus and absence of any cervical
and vaginal disorders, the bleeding proceeds. Choose the most probable cause
of bleeding:
A. Atony of the uterus
B. Hypotonia of the uterus
C. Hysterorrhexis
D. Injury of cervix of the uterus
E. Delay of the part of placenta

10. Which gestational age gives the most accurate estimation of weeks of
pregnancy by uterine size?
A. Less than 12 weeks
B. Between 12 and 20 weeks
C. Between 31 and 40 weeks
D. Over 40 weeks
E. Between 21 and 30 weeks

11. 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. Placental presentation
C. Cord presentation
D. Expulsion of the mucous plug from cervix uteri
E. Premature expulsion of amniotic fluid

12. Rise in temperature up to 39°C was registered the next day after a woman had
labor. Fetal membranes rupture took place 36 hours prior to labors. The
examination of the bacterial flora of cervix uteri revealed the following:
haemolytic streptococcus of group A. The uterus tissue is soft, tender.
Discharges are bloody, with mixing of pus. Establish the most probable
postnatal complication
A. Metroendometritis
B. Infected hematoma
C. Thrombophlebitis of veins of the pelvis
D. Infective contamination of the urinary system
E. Apostatis of stitches after the episiotomy
13. On the first day after labour a woman had the rise of temperature up to 39°C.
Rupture of fetal membranes took place 36 hours before labour. Examination
of the bacterial flora of cervix of the uterus revealed hemocatheretic
streptococcus of A group. The uterus body is soft, tender. Discharges are
bloody, with admixtures of pus. Specify the most probable postnatal
complication:
A. Metroendometritis
B. Infectious hematoma
C. Apostasis of sutures after the episiotomy
D. Infective contamination of the urinary system
E. Thrombophlebitis of veins of the pelvis

14. A woman of a high-risk 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. Infectious hematoma
C. Thrombophlebitis of veins of the pelvis
D. Endometritis
E. Apostasis of sutures after episiotomy

15. 13 months after the first labor a 24-year-old patient complained of

amenorrhea. Pregnancy ended in Caesarian section because of premature
detachment of normally positioned placenta which resulted in blood loss at
the rate of 2000 ml owing to disturbance of blood clotting. Choose the most
suitable investigation:
A. Estimation of gonadotropin rate
B. USI of small pelvis organs
C. Computer tomography of head
D. Estimation of testosteron rate in blood serum
E. Progesteron assay

16. In 13 months after the first labor a 24-year-old woman complains of

amenorrhea. Cesarian section was conducted as a result of premature
detachment of normally posed placenta. Hemorrhage has made low fidelity of
2000 ml due to breakdown of coagulation of blood. Choose the most suitable
investigation
A. Determination of the level of gonadotropin
B. Determination of the contents of testosteron-depotum in blood serum
C. Progesteron test
D. Ultrasound of organs of a small pelvis
E. Computer tomography of the head
17. In the woman of 24 years about earlier normal menstrual function, cycles
became irregular, according to tests of function diagnostics - anovulatory. The
contents of prolactin in blood is boosted. Choose the most suitable
investigation:
A. Computer tomography of the head
B. Determination of the level of gonadotropins
C. Progesterone assay
D. Determination of the contents of testosteron-depotum in blood serum
E. USI of organs of small pelvis

18. A 20-year-old woman is having timed labor continued for 4 hours. Light
amniotic fluid came off. The fetus head is pressed to the orifice in the small
pelvis. The anticipated fetus mass is 4000,0 gpm 200,0 g. Heartbeat of the
fetus is normal. Intrinsic examination: cervix is absent, disclosure – 2 cm, the
fetal membranes are not present. The head is in 1-st plane of the pelvis, a
sagittal suture is in the left slanting dimension. What is the purpose of
glucose-calcium-hormone - vitaminized background conduction?
A. Prophylaxes of weakness of labor activity
B. Labor stimulation
C. Antenatal preparation
D. Treatment of weakness of labor activity.
E. Fetus hypoxia prophylaxes

19. 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 by no less than 4 cm
B. Rupture of fetal bladder
C. Duration of uterine contractions over 30 seconds
D. Cervical smoothing over 90%
E. Presenting part is in the lower region of small pelvis

20. A 24 years old primipara was hospitalised with complaints about 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. Palpitation of the
fetus 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 out of it. Point a correct component of the
diagnosis:
A. Antenatal discharge of the amniotic waters
B. The beginning of the 1st stage of labour
C. Pathological preterm labour
D. The end of the 1st stage of labour
E. Early discharge of the amniotic waters

21. A 29 year old patient underwent surgical treatment because of the benign
serous epithelial tumour of an ovary. The postoperative period has elapsed
without complications. What is it necessary to prescribe for the
rehabilitational period:
A. Hormonotherapy and proteolytic enzymes
B. Lasertherapy and enzymotherapy
C. Antibacterial therapy and adaptogens
D. Magnitotherapy and vitamin therapy
E. The patient does not require further care

22. 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 grumes. Cardiac funnction of the fetus is
rhytmic, 150 strokes in the minute, uterus tone is normal. The most probable
provisional diagnosis will be:
A. Placental presentation
B. Bloody discharges
C. Disseminated intravascular coagulation syndrome
D. Detachment of normally located placenta
E. Vasa previa

23. A 34-year-old woman with 10-week pregnancy (the second pregnancy) has
consulted gynaecologist to make a record in patient chart. There was a
hydramnion previous pregnancy, the birth weight of a child was 4086 g. What
tests are necessary first of all?
A. The test for tolerance to glucose
B. Ultrasound of the fetus
C. Bacteriological test of discharge from the vagina
D. Determination of the contents of alpha fetoprotein
E. Fetus cardiophonography

24. 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
its appendages 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. Broken tubal pregnancy
B. Acute appendicitis
C. Acute right-side adnexitis
D. Apoplexy of the ovary
E. Torsion of the crus of the ovary tumour

25. At the gynaecological department there is a patient of 32 years with the

diagnosis: "acute bartholinitis".Body temperature is 38,20C, leucocytes count
10,4109/L, the ESR is 24 mm/hour. In the area of big gland of the vestibulum
- the dermahemia, the sign of the fluctuation, sharp tenderness (pain). What is
the most correct tactics of the doctor?
A. Surgical dissecting, a drainage of an abscess of the gland,
antibiotics
B. Surgical dissection, drainage of the abscess of the gland
C. Antibiotics, detoxication and biostimulants.
D. Antibiotic therapy
E. Antibiotics, Sulfanilamidums

26. A primagravida with pregnancy of 37-38 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. Papaverine hydrochloride of 2% - 4,0 ml
C. Dibazolum of 1% - 6,0 ml
D. Hexenalum of 1% - 2,0 ml
E. Pentaminum of 5% - 4,0 ml

27. An onset of severe preeclampsia at 16 weeks gestation might be caused by:

A. Hydatidiform mole
B. Twin gestation
C. Anencephaly
D. Maternal renal disease
E. Interventricular defect of the fetus

28. A woman had the rise of temperature up to 39°C 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. Infected hematoma
C. Thrombophlebitis of pelvic veins
D. Infection of the urinary system
E. Apostatis of junctures after the episiotomy

29. A 24 y.o. patient 13 months after the first labour consulted a doctor about
amenorrhea. Pregnancy has concluded by a Cesarean section concerning to a
premature detachment of normally posed placenta hemorrhage has made low
fidelity 2000 ml owing to breakdown of coagulability of blood. Choose the
most suitable investigation:
A. Determination of the level of Gonadotropins
B. Progesteron assay
C. USI of organs of a small pelvis
D. Computer tomography of the head
E. Determination of the contents of Testosteron-Depotum in Serum of blood

30. 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 childs birth weight was
4086 g. What examination method should be applied in the first place?
A. The test for tolerance to glucose
B. A cardiophonography of fetus
C. US of fetus
D. Determination of the contents of fetoproteinum
E. Bacteriological examination of discharges from vagina

31. A 10 y.o. boy was ill with angina 2 weeks ago, has complaints of joint pain and
stiffness of his left knee and right elbow. There was fever (38,50) and ankle
disfunction, enlargement of cardiac dullness by 2 cm, tachycardia, weakness
of the 1st sound, gallop rhythm, weak systolic murmur near apex. What
diagnosis corresponds with such symptoms?
A. Acute rheumatic fever
B. Systemic lupus erythematosis
C. Reiters disease
D. Reactive arthritis
E. Juvenile rheumatoid arthritis

32. The disease began acutely. The frequent watery stool developed 6 hours ago.
The bodys temperature is normal. Then the vomiting was joined. On
examination: his voice is hoarse, eyes are deeply sunken in the orbits. The
pulse is frequent. Blood pressure is low. There is no urine. What is the
preliminary diagnosis?
A. Cholera
B. Salmonellosis
C. Toxic food-borne infection
D. Dysentery
E. Typhoid fever

33. 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 fetoplacental insufficiency
B. Placental detachment
C. Prematurity
D. Infection of a fetus
E. Delay of an intra-uterine fetation

34. A pregnant woman may be diagnosed with hepatitis if it is confirmed by the

presence of elevated:
A. SGOT (ALT)
B. WBCs
C. BUN
D. Alkaline phosphatase
E. Sedimentation rates

35. 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
B. Amniotomy, labour stimulation, fetal hypoxia treatment
C. Fetal hypoxia treatment, conservative delivery
D. Medication sleep, amniotomy, labour stimulation
E. Fetal hypoxia treatment, in the ?? period - forceps delivery

36. An endometrial adenocarcinoma that has extended to the uterine serosa

would be classified as stage:
A. IIIA
B. IIA
C. IVAB
D. IIB
E. IC

37. Which of the methods of examination is the most informative in the

diagnostics of a tube infertility?
A. Laparoscopy with chromosalpingoscopy
B. Transvaginal echography
C. Bicontrast pelviography
D. Pertubation
E. Hysterosalpingography

38. A pregnant woman (35 weeks), aged 25, was admitted to the hospital because
of bloody discharges. 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 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 means of Cesarean section
B. To introduct the drugs to increase the blood coagulation and continue
observation
C. To keep the intensity of hemorrhage under observation and after the bleeding
is controlled to prolong the pregnancy
D. Stimulate the delivery by intravenous introduction of oxytocin
E. To perform the hemotransfusion and to prolong the pregnancy

39. 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
10.01.2012. When should she be given maternity leave?
A. 8 August
B. 11 July
C. 5 September
D. 25 July
E. 22 August

40. Condition of a parturient woman has been good for 2 hours after live birth:
uterus is thick, globe-shaped, 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 doctors
further tactics?
A. To do manual removal of afterbirth
B. To apply Abduladze method
C. To do curettage of uterine cavity
D. To introduct oxitocine intravenously
E. To apply Credes method

41. The woman who has delivered twins has early postnatal hypotonic uterine
bleeding reached 1,5% of her bodyweight. 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. Uterine extirpation
B. Uterine vessels ligation
C. Supravaginal uterine amputation
D. Inner glomal artery ligation
E. Putting clamps on the uterine cervix

42. A 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 80 bpm. The blood pressure (BP) is 110/60 mm Hg and body
temperature is 36,60C. The abdomen is tender in the lower parts. The uterus
is enlarged up to 12 weeks of gestation. What is your diagnosis?
A. Inevitable abortion
B. Disfunctional bleeding
C. Incomplete abortion
D. Incipient abortion
E. Complete abortion

43. 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 Schyotkins 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 tendern and overhangs inside. What is the most probable diagnosis?
A. Impaired extrauterine pregnancy
B. Acute salpingoophoritis
C. Acute appendicitis
D. Ovarian apoplexy
E. Twist of cystoma of right uterine adnexa

44. 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 presentation
B. Incipient abortion
C. Uterine rupture
D. Premature placental separation
E. Threatened premature labor

45. 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 salpingo-oophoritis in her case history. Oral
contraceptives were not used. Her husbands analysis of semen is without
pathology. What diagnostic method will you start from the workup in this case
of sterility?
A. Hysterosalpingography
B. Diagnostic scraping out of the uterine cavity
C. Hysteroscopia
D. Hormone investigation
E. Ultra sound investigation

46. A 28-year-old patient underwent endometrectomy as a result of incomplete

abortion. Blood loss was at the rate of 900 ml. It was necessary to start
hemotransfusion. After transfusion of 60 ml of erythrocytic mass the patient
presented with lumbar pain and fever which resulted in hemotransfusion
stoppage. 20 minutes later the patients condition got worse: she developed
adynamia, apparent skin pallor, acrocyanosis, profuse perspiration. to-
38,5°C, Ps- 110/min, AP- 70/40 mm Hg. What is the most likely diagnosis?
A. Hemotransfusion shock
B. Septic shock
C. Hemorrhagic shock
D. Anaphylactic shock
E. DIC syndrome

47. A 58-year-old female patient came to the antenatal clinic complaining of

bloody light-red discharges from the genital tracts. Menopause is 12 years.
Gynaecological examination revealed age involution of externalia 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 most likely diagnosis?
A. Uterine carcinoma
B. Abnormalities of menstrual cycle of climacteric nature
C. Atrophic colpitis
D. Cervical carcinoma
E. Granulosa cell tumor of ovary

48. The results of a separate diagnostic curettage of the mucous of the uterus
cervix and body made up in connection with bleeding in a postmenopausal
period: the scrape of the mucous of the cervical canal revealed no pathology,
in endometrium - the highly differentiated adenocarcinoma was found.
Metastases are not found. What method of treatment is the most correct?
A. Surgical treatment and hormonotherapy
B. Surgical treatment + chemotherapy
C. Radial therapy
D. Surgical treatment and radial therapy

49. 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 dextral
appendage range of uterus there is an elastic spherical formation, painless, 7
cm in diameter. USI: 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. Dispensary observation of the patient
C. Operative treatment
D. Anti-inflammatory therapy
E. Chemotherapeutic treatment

50. A 40 year old patient complains of yellowish discharges from the vagina.
Bimanual examination revealed no pathological changes. The smear contains
Trichomonas vaginalis and blended flora. Colposcopy revealed two hazy fields
on the frontal labium, with a negative Iodine test. Your tactics:
A. Treatment of specific colpitis and subsequent biopsy
B. Cervix ectomy
C. Cryolysis of cervix of the uterus
D. Diathermocoagulation of the cervix of the uterus
E. Specific treatment of Trichomonas colpitis

51. A 28-year-old parturient complains about 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?
A. Forceps operation
B. Embryotomy
C. Stimulation of labor activity
D. Conservative labor management with episiotomy
E. Cesarean

52. A 28 year old woman had the second labour and born a girl with
manifestations of anemia and progressing jaundice. The child’s weight was
3400 g, the length was 52 cm. The womans blood group is B (III) Rh-, the
fathers blood group is A (III) Rh+, the child’s blood group is B (III) Rh+. What
is the cause of anemia?
A. Rhesus incompatibility
B. Intrauterine infection
C. Antigen B incompatibility
D. Antigen A incompatibility
E. Antigen AB incompatibility

53. A 48 year old female patient complains about 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. Cervical pregnancy
C. Cervical papillomatosis
D. Metrofibroma
E. Endometriosis

54. 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. Discoordinated labor activity
D. Pathological preliminary period
E. Normal labor activity

55. Laparotomy was performed to a 54 y.o. woman on account of big formation in

pelvis that turned out to be one-sided ovarian tumor along with considerable
omental metastases. The most appropriate intraoperative tactics involves:
A. Ablation of omentum, uterus and both ovaries with tubes
B. Ablation of omentum and both ovaries with tubes
C. Biopsy of an ovary
D. Biopsy of omentum
E. Ablation of an ovary and omental metastases

56. A parturient complains about pain in the mammary gland. Palpation revealed
a 3?4 cm large infiltration, soft in the centre. Body temperature is 38,5°C.
What is the most probable diagnosis?
A. Acute purulent mastitis
B. Pneumonia
C. Retention of milk
D. Birth trauma
E. Pleuritis

57. A 43 y.o. patient complains of formation and pain in the right mammary
gland, rise of temperature up to 37,20C 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 chronic mastitis
C. Right-side acute mastitis
D. Premenstrual syndrome
E. Tuberculosis of the right mammary gland

58. 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. On
rectal examination: no pathology of the internal genitalia. In blood: ?b - 70
g/l, RBC- 2,3×1012/l, Ht - 20. What is the most probable diagnosis?
A. Juvenile bleeding, posthemorrhagic anemia
B. Polycyst ovarian syndrome
C. Incomplete spontaneous abortion
D. Hormonoproductive ovary tumor
E. Werlholfs disease

59. A 33-year-old woman was urgently brought to clinic with complaints of the
pain in the lower part of the abdomen, mostly on the right, irradiating to
rectum, she also felt dizzy. The above mentioned complaints developed
acutely at night. Last menses were 2 weeks ago. On physical exam: the skin is
pale, Ps - 92 bpm, t- 36,6OC, BP- 100/60 mm Hg. The abdomen is tense,
slightly tender in lower parts, peritoneal symptoms are slightly positive. Hb-
98 g/L. What is the most probable diagnosis?
A. Apoplexy of the ovary
B. Abdominal pregnancy
C. Renal colic
D. Acute appendicitis
E. Intestinal obstruction

60. A secundipara has regular birth activity. Three years ago she had cesarean
section for the reason of acute intrauterine 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. Waiting tactics of labor management
C. Vaginal delivery
D. Augmentation of labour
E. Obstetrical forceps

61. A 54-year-old female patient consulted a doctor about bloody discharges from
the genital tracts after 2 years of amenorrhea. USI and bimanual examination
revealed no genital pathology. What is the tactics of choice?
A. Fractional biopsy of lining of uterus and uterine mucous
membranes
B. Styptic drugs
C. Estrogenic haemostasia
D. Hysterectomy
E. Contracting drugs

62. Examination of a just born placenta reveals defect 2x3 cm large. Hemorrhage
is absent. What tactic is the most reasonable?
A. Manual uretus cavity revision
B. Instrumental uterus cavity revision
C. External uterus massage
D. Prescription of uterotonic medicines
E. Parturient supervision

63. 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 doctors tactics?
A. To place suture on the uterus cervix
B. To administer hormonal treatment
C. To perform amniocentesis
D. To administer tocolytic therapy
E. To interrupt pregnancy

64. A 27-year-old woman presents at the maternity welfare centre because of

infertility. She has had sexual life in marriage for 4 years, doesnt use
contraceptives. She hasnt get pregnant. On examination: genital development
is without pathology, uterine tubes are passable, basal (rectal) temperature is
one-phase during last 3 menstrual cycles. What is the infertility cause?
A. Anovular menstrual cycle
B. Abnormalities in genital development
C. Chronic adnexitis
D. Immunologic infertility
E. Genital endometriosis

65. A 43 y.o. woman complains of contact hemorrhages during the last 6 months.
Bimanual examination: cervix of the uterus is enlarged, its mobility is
reduced. Mirrors 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. Nascent fibroid
D. Leukoplakia
E. Cervical pregnancy

66. A 26-year-old woman gave birth to a child 6 months ago. She applied to
gynecologist complaining of menstruation absence. The child is breast-fed.
Vagina exam: uterus is of normal form, dense consistence. What is the most
probable diagnosis?
A. Physiological amenorrhea
B. Pseudoamenorrhea
C. Ashermans syndrome
D. Sheehans syndrome
E. Gestation

67. A primagravida in her 20th week of gestation complains about 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 was contracted down to 0,5 cm, the external orifice was open by 2 cm.
The discharges were bloody and smeary. What is the most likely diagnosis?
A. Incipient abortion
B. Abortion in progress
C. Risk of abortion
D. Incomplete abortion
E. Missed miscarriage

68. Full-term pregnancy. Body weight of the pregnant woman is 62 kg. The fetus
has the longitudinal position, the fetal head is pressed against the pelvic inlet.
Abdominal circumference is 100 cm. Fundal height is 35 cm. What is the
approximate weight of the fetus?
A. 3 kg 500 g
B. 2 kg 500 g
C. 4 kg
D. 3 kg
E. 4 kg 500 g

69. 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. Bimanual examination revealed that uterus body is enlarged,
appendages cannot be palpated, posterior fornix has tuberous surface.
Laparoscopy revealed: ovaries, peritoneum of rectouterine pouch and
pararectal fat have "cyanotic eyes". What is the most probable diagnosis?
A. Disseminated form of endometriosis
B. Tuberculosis of genital organs
C. Ovarian cystoma
D. Polycystic ovaries
E. Chronic salpingitis

70. A gravida with 7 weeks of gestation is referred for the artificial abortion. On
operation while dilating cervical canal with Hegar dilator No.8 a doctor
suspected uterus perforation. What is immediate doctors tactics to confirm
the diagnosis?
A. Probing of uterus cavity
B. Ultrasound examination
C. Bimanual examination
D. Laparoscopy
E. Metrosalpingography

71. A pregnant woman in her 8th week was admitted to the hospital for artificial
abortion. In course of operation during dilatation of cervical canal of uterus by
means of Hegars dilator No.8 the doctor suspected uterus perforation. What is
the immediate tactics for confirmation of this diagnosis?
A. Uterine probing
B. Bimanual examination
C. Laparoscopy
D. Metrosalpingography
E. US examination

72. A 59 year old female patient applied to a maternity welfare clinic and
complained about bloody discharges from the genital tracts. 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 came from the cervical canal. Uterus was of normal size, uterine
appendages were unpalpable. Fornices were deep and painless. What method
should be applied for the diagnosis specification?
A. Separated diagnosic curretage
B. Puncture of abdominal cavity through posterior vaginal fornix
C. Laparoscopy
D. Extensive colposcopy
E. Culdoscopy

73. 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. Vagina candidomicosis
D. Bacterial vaginosis
E. Chlamydiosis

74. 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. Speculum examination
C. Palpation of mammary glands and pressing-out of colostrum
D. Roentgenography of small pelvis organs
E. Bimanual vaginal examination

75. A newborns head is of 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. Presentation of the bregma
C. Face presentation
D. Brow presentation
E. Anterior vertex presentation

76. 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 39°C, 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. Phlegmon of mammary gland
C. Fibrous adenoma of the left mammary gland
D. Lacteal cyst with suppuration
E. Breast cancer

77. A young woman applied to gynecologist due to her pregnancy of 4-5 weeks.
The pregnancy is desirable. Anamnesis stated that she had rheumatism in the
childhood. Now she has combined mitral heart disease with the priority of
mitral valve deficiency. When will she need the inpatient treatment (what
periods of pregnancy)?
A. 8-12 weeks, 28–32 weeks, 37 weeks
B. 16 weeks, 34 weeks, 39-40 weeks
C. 6-7weeks, 16 weeks, 38 weeks
D. 10-12 weeks, 24 weeks, 37-38 weeks
E. 12-16 weeks, 27-28 weeks, 37-38 weeks

78. A woman in the first half of pregnancy was brought to clinic by an ambulance.
Term of pregnancy is 36 weeks. She complains of intensive pain in the
epigastrium, had vomiting for 2 times. Pain started after the patient had eaten
vinaigrette. Swelling of lower extremities. BP - 140/100 mm Hg. Urine became
curd after boiling. What is the most probable diagnosis?
A. Preeclampsia
B. Dropsy of pregnant women
C. Exacerbation of pyelonephritis
D. Nephropathy of the 3rd degree
E. Food toxicoinfection

79. A 13 year old girl 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. Haemophilia
C. Juvenile hemorrhage
D. Endometrium cancer
E. Werlhofs disease

80.In 10 min after childbirth by a 22-year-old woman, the placenta was

spontaneousely delivered and 100 ml of blood came out. Woman weight - 80
kg, infant weight - 4100 g, length - 53 cm. The uterus contracted. In 10
minutes the hemorrhage renewed and the amount of blood constitued 300 ml.
What amount of blood loss is permissible for this woman?
A. 400 ml
B. 500 ml
C. 300 ml
D. 650 ml
E. 1000 ml

81. 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. Sanitary certificate
C. Individual prenatal record
D. Appointment card for hospitalization
E. Medical certificate

82. After examination a 46-year-old patient was diagnosed with left breast cancer
T2N2M0, cl. gr. II-a. What will be the treatment plan for this patient?
A. Radiation therapy + operation + chemotherapy
B. Radiation therapy only
C. Chemotherapy only
D. Operation only
E. Operation + radiation therapy

83. Immediately after delivery a woman had haemorrhage, blood loss exceeded
postpartum haemorrhage rate and was progressing. There were no symptoms
of placenta detachment. What tactics should be chosen?
A. Manual removal of placenta and afterbirth
B. Instrumental revision of uterine cavity walls
C. Uterus tamponade
D. Removal of afterbirth by Credes method
E. Intravenous injection of methylergometrine with glucose
84. A 30 y.o. primigravida woman has got intensive labor pain every 1-2 minutes
that lasts 50 seconds. The disengagement has started. The perineum with the
height of 4 cm has grown pale. What actions are necessary in this situation?
A. Episiotomy
B. Perineum protection
C. Vacuum extraction of fetus
D. Expectant management
E. Perineotomy

85. 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 placental presentation. Under what conditions is it rational
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 delivery room keeping to all the aseptics regulations
D. The examination is not to be conducted because of risk of profuse
haemorrhage
E. In the admission ward of maternity hospital

86. A 28 y.o. primagravida, pregnancy is 15-16 weaks 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. Stopped pregnancy
C. Placenta presentation
D. Hydatid molar pregnancy
E. Spontaneous abortion which has begun

87. 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 small
pelvis inlet. Vastens sign as positive. Cervix of uterus is fully dilated. Amniotic
sac is absent. The fetus heartbeat is clear, rhythmic, 136 bpm. What is the
labor tactics?
A. Caesarean section
B. Stimulation of the labor activity
C. Obstetrical forseps
D. Vacuum extraction of the fetus
E. Conservative tactics of labor
88. Internal obstetric examination of a parturient woman revealed that the
sacrum hollow was totally occupied with fetus head, ischiadic spines couldnt
be detected. Sagittal suture is in the straight diameter, occipital fontanel is
directed towards symphysis. In what plane of small pelvis is the presenting
part of the fetus?
A. Plane of pelvic outlet
B. Plane of pelvic inlet
C. Over the pelvic inlet
D. Wide pelvic plane
E. Narrow pelvic plane

89. A 30 y.o. woman has the 2-nd labour that has been lasting for 14 hours.
Hearbeat of fetus is muffled, arrhythmic, 100/min. Vaginal examination:
cervix of uterus is completely opened, fetus head is level with outlet from
small pelvis. Saggital suture is in the straight diameter, small crown is near
symphysis. What is the further tactics of handling the delivery?
A. Use of obstetrical forceps
B. Cesarean section
C. Stimulation of labour activity by oxytocin
D. Cranio-cutaneous (Ivanovs) forceps
E. Use of cavity forceps

90. During examination of a patient, masses in the form of condyloma on a broad

basis are found in the area of the perineum. What is the tactics of the doctor?
A. To send a woman into dermatological and venerological centre
B. Antiviral treatment
C. Surgical ablation of condyloms
D. Cryodestruction of condyloms
E. Chemical coagulator treatment

91. A 28 year old woman has bursting pain in the lower abdomen during
menstruation; chocolate-like discharges from vagina. 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. Exacerbation of chronic adnexitis
D. Tumour of sigmoid colon
E. Fibromatous node
92. Vaginal inspection of a parturient woman revealed: cervix dilation is up to 2
cm, fetal bladder 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. Cervix dilatation stage
B. Prodromal stage
C. Placental stage
D. Stage of fetus expulsion
E. Preliminary stage

93. 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. Fibroadenoma
C. Cyst
D. Mastopathy
E. Lipoma

94. 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. Cervical carcinoma
C. Algodismenorrhea
D. Cervical myoma
E. Abortion in progress

95. A 29-year-old patient complains of sterility. Sexual life is for 4 years being
married, does not use contraception. There was no pregnancy before. On
physical examination, genitals are developed normally. Uterine tubes are
passable. Rectal temperature during three menstrual cycles is monophase.
What is the most probable reason for sterility?
A. Anovulatory menstrual cycle
B. Genital endometriosis
C. Anomalies of genitals development
D. Chronic adnexitis
E. Immunologic sterility

96. 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 isnt enlarged, mobile, nonpalpable adnexa, parametrium is free,
deep fornixes. What is the most likely diagnosis?
A. Cancer of cervix of uterus
B. Fibromatous node which is being born
C. Cancer of body of uterus
D. Cervical pregnancy
E. Polypose of cervix of uterus

97. 10 minutes after delivery a woman discharged placenta with a tissue defect
5х6 cm large. Discharges from the genital tracts were profuse and bloody.
Uterus tonus was low, fundus of uterus was located below the navel.
Examination of genital tracts revealed that the uterine cervix, vaginal walls,
perineum were intact. There was uterine bleeding with following blood
coagulation. Your actions to stop the bleeding:
A. To make manual examination of uterine cavity
B. To introduce an ether-soaked tampon into the posterior fornix
C. To administer uterotonics
D. To put an ice pack on the lower abdomen
E. To apply hemostatic forceps upon the uterine cervix

98. On the 5th day after labor body temperature of a 24-year-old parturient
suddenly rose up to 38,7°C. She complains about weakness, headache,
abdominal pain, irritability. Objectively: AP- 120/70 mm Hg, Ps- 92 bpm, to-
38,7°C. Bimanual examination revealed that the uterus was enlarged up to 12
weeks of pregnancy, it was dense, slightly painful on palpation. Cervical canal
lets in 2 transverse fingers, discharges are moderate, turbid, with foul smell.
In blood: skeocytosis, lymphopenia, ESR - 30 mm/h. What is the most likely
diagnosis?
A. Endometritis
B. Pelviperitonitis
C. Lochiometra
D. Metrophlebitis
E. Parametritis

99. A 20 y.o. patient complains of amenorrhea. Objectively: hirsutism, obesity

with fat tissue prevailing on the face, neck, upper part of body. On the face
there are acne vulgaris, on the skin - striae cutis distense. Psychological and
intellectual development is normal. Gynecological condition: external genitals
 are moderately hairy, acute vaginal and uterine hypoplasia. What diagnosis is
the most probable?
A. Itsenko-Cushing syndrome
B. Shichans syndrome
C. Babinski-Froehlich syndrome
D. Turners syndrome
E. Stein-Leventals syndrome

100. A 27 y.o. woman suffers from pyelonephritits of the only kidney. She
presents to the maternity welfare centre 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 doctors
tactics in this case?
A. Immediate pregnancy interruption
B. Pregnancy interruption after urine normalization
C. Pregnancy interruption at 24-25 weeks
D. Maintenance of pregnancy till delivery term
E. Maintenance of pregnancy till 36 weeks

101. An 18-year-old primigravida in her 27-28 week of gestation underwent

an operation on account of acute phlegmonous appendicitis. In the
postoperative period it is necessary to take measures for prevention of the
following pregnancy complication:
A. Noncarrying of pregnancy
B. Late gestosis
C. Fetus hypotrophy
D. Intestinal obstruction
E. Premature placenta detachment

102. 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 36,6°C. She has a right ovarian
cyst in history. Bimanual examination reveals that uterus is dense, painless, of
normal size. The left fornix is deep, uterine appendages arent palpable, the
right fornix is contracted. There is a painful formation on the right of uterus.
Its 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. Subserous fibromyoma of uterus
C. Extrauterine pregnancy
D. Acute metritis
E. Right-sided pyosalpinx
103. 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. Sagittal suture is in mesatipellic pelvis, anterior fontanel
is closer to pubes. The fetal head diameter in such presentation will be:
A. Suboccipito-bregmaticus
B. Fronto-occipitalis recta
C. Suboccipitio-frontalis
D. Mento-occipitalis
E. Biparietal

104. A 42-year-old woman has had hyperpolymenorrhea and progressing

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?
A. Uterine endometriosis
B. Uterine carcinoma
C. Endomyometritis
D. Adnexal endmetriosis
E. Subserous uterine fibromyoma

105. On the tenth day after discharge from the maternity house a 2-year-old
patient consulted a doctor about body temperature rise up to 39°C, pain in the
right breast. Objectively: the mammary gland is enlarged, there is a
hyperemized area in the upper external quadrant, in the same place there is an
ill-defined induration, lactostasis, fluctuation is absent. Lymph nodes of the
right axillary region are enlarged and painful. What is the most likely
diagnosis?
A. Lactational mastitis
B. Tumour
C. Erysipelas
D. Abscess
E. Dermatitis

106. 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 minor
B. Stimulation of labour activity by intravenous injection of oxytocin
C. Episiotomy
D. Caesarean section
E. Application of cavity forceps

107. A 27-year-old sexually active female complains of numerous vesicles on

the right sex lip, itch 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. Primary syphilis
C. Genital condylomata
D. Cytomegalovirus infection
E. Bartholinitis

108. 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
B. Metroendometritis
C. Uterine fibromyoma
D. Uterine carcinoma
E. Uterus perforation

109. 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 38°C. The left labia majora has a formation
to 3 cm diameter, with hyperemic surface, extremely painful to the touch, with
symptoms of fluctuation. What is the most likely diagnosis?
A. Acute bartholinitis
B. Hypertrophy of the labia
C. Vulvar fibroid
D. Vulvar cancer
E. Bartholin gland cyst

110. A 28-years-old woman complains of nausea and vomiting about 10

times per day. She has been found to have body weight loss and xerodermia.
The pulse is 100 bpm. Body temperature is 37,2°C. Diuresis is low. USI shows
5-6 weeks of pregnancy. What is the most likely diagnosis?
A. Moderate vomiting of pregnancy
B. I degree preeclampsia
C. Food poisoning
D. Premature abortion
E. Mild vomiting of pregnancy

111. A 40 week pregnant secundipara is 28 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. RIisk of hysterorrhexis
B. Attack of eclampsia
C. Disturbed labour
D. Mazolysis
E. Complete hysterorrhexis

112. After delivery and revision of placenta there was found the defect of
placental lobule. General condition of woman is normal, uterus is firm, there
is moderate bloody discharge. Speculum inspection of birth canal shows
absence of lacerations and raptures. What action is necessary?
A. Manual exploration of the uterine cavity
B. Urine drainage, cold on the lower abdomen
C. Introduction of hemostatic medications
D. External massage of uterus
E. Introduction of uterine contracting agents

113. A 25 y.o. patient complains of body temperature rise up to 37°C, 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. Objectibely:
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 sanguinopurulent. What is the most probable diagnosis?
A. Postabortion endometritis
B. Hematometra
C. Postabortion uterus perforation
D. Parametritis
E. Pelvic peritonitis

114. 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 mm Hg. Suddenly there
appeared fibrillary tremor of face muscles, tonic and clonic convulsions,
 breathing came to a stop. After 1,5 minute the breathing recovered, there
appeared some bloody spume from her mouth. In urine: protein - 3,5 g/L.
What is the most probable diagnosis?
A. Eclampsia
B. Epilepsy
C. Cerebral edema
D. Stomach ulcer
E. Cerebral hemorrhage

115. 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 doctors tactics?
A. Diagnostic curettage of uterine cavity
B. Hysterectomy
C. TORCH-infection test
D. Supravaginal amputation of uterus without appendages
E. Conservative treatment of bleeding

116. 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. Renal disease
C. Neurasthenia
D. Mastopathy
E. Disease of cardiovascular system

117. 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 37°C.
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 3x4 cm large. What is the most likely
diagnosis?
A. Progressing fallopian pregnancy
B. Right ovarian cyst
C. Interrupted fallopian pregnancy
D. Uterogestation
E. Acute appendicitis

118. 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. P.V: cervical dilatation is 4 cm, uterine fauces is 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. Pathological preliminary period
C. Normal labour activity
D. Primary powerless labour activity
E. Secondary powerless labour activity

119. A primigravida woman appealed to the antenatal clinic on the 22.03.03

with complaints of boring pain in the lower part of abdomen. Anamnesis
registered that her last menstruation was on the 4.01.03. Bimanual
examination revealed that uterine servix is intact, external fauces is closed,
uterus is enlarged up to the 9-th week of pregnancy, movable, painless. What
complication can be suspected?
A. Risk of abortion in the 9-th week of pregnancy
B. Vesicular mole
C. Abortion that started in the 9-th week of pregnancy
D. Hysteromyoma

120. 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. Hypoproduction of progesterone
C. Hyperproduction of prolactin
D. Hyperproduction of estrogens
E. Hyperproduction of androgens

121. 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?
A. Sheehans syndrome
B. Turners syndrome
C. Ovarian amenorrhea
D. Exhausted overy syndrome
E. Galactorrhea-amenorrhea syndrome

122. 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 37,8°C. 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. Trichomonadal
C. Staphylococcal
D. Colibacterial
E. Chlamydial

123. A 25-year-old woman came to a maternity welfare clinic and

complained about being unable to conceive within 3 years of regular sexual
life. Examination revealed weight gain, male pattern of hair distribution on
the pubis, excessive pilosis of thighs. Ovaries were dense and enlarged, basal
temperature was monophase. What is the most likely diagnosis?
A. Sclerocystosis of ovaries
B. Gonadal dysgenesis
C. Adrenogenital syndrome
D. Tubo-ovaritis
E. Premenstrual syndrome

124. 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
B. Premenstrual syndrome
C. Morgagni-Stewart syndrome
D. Algodismenorrhea
E. Sheehans syndrome
125. A 32-year-old gravida complains of episodes of unconsciousness,
spontaneous syncopes that are quickly over after a change of body position. A
syncope can be accompanied by quickly elapsing bradycardia. There are no
other complications of gestation. What is the most likely reason for such
condition?
A. Postcava compresseion by the gravid uterus
B. Psychosomatic disorders
C. Pressure fall in the veins of extremities
D. Pressure rise in the veins of extremities
E. Vegetative-vascular dystonia (cardiac type)

126. A woman consulted a therapeutist about fatigability, significant weight

loss, weakness, loss of appetite. She has had amenorrhea for 8 months. A year
ago she born a full-term child. Haemorrhage during labour made up 2 L. She
got blood and blood substitute transfusions. What is the most probable
diagnosis?
A. Sheehans syndrome
B. Shereshevsky-Turners syndrome
C. Stein-Leventhal syndrome
D. Homological blood syndrome
E. Vegetovascular dystonia

127. 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. Cytosmear
D. Symptomatic therapy
E. USI

128. A 28-year-old female patient complains of having haemorrhage from

the genital tracts for 1 month. 6 months ago she had natural delivery and gave
birth to a girl weighing 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 37,8°C. There is a
significant increase in hCG concentration in the urine. What is your
provisional diagnosis?
A. Uterine chorionepithelioma
B. Uterine fibromyoma
C. Hydatidiform mole
D. Pregnancy
E. Endometritis
129. 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 werent palpable. Fornices are free,
deep and painless. Discharges from the genital tracts are bloody and profuse.
What is the most likely diagnosis?
A. Abortion in progress
B. Threat of abortion
C. Interrupted fallopian pregnancy
D. Incipient abortion
E. Cervical pregnancy

130. A 33 y.o. woman survived two operations on account of extrauterine

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. Artificial fertilization with donor’s semen
D. Induction of ovulation
E. Substitutional maternity

131. 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 bean-shaped diplococci that became red
after Grams staining. What is the most likely diagnosis?
A. Acute gonorrheal endocervicitis
B. Candidal vulvovaginitis
C. Bacterial vaginism
D. Clamydial endocervicitis
E. Trichomonal colpitis

132. A 26 year old woman complains about edemata, swelling and

painfulness of mammary glands, headache, tearfulness, irritability. These
signs turn up 5 days before menstruation and disappear after its start. What
clinical syndrome is it?
A. Premenstrual syndrome
B. Adrenogenital syndrome
C. Postcastration syndrome
D. Climacteric syndrome
E. Stein-Leventhal syndrome

133. A 49-year-old woman complains about headache, head and neck going
hot, increased perspiration, palpitation, arterial pressure rise up to 170/100
mm Hg, irritability, insomnia, tearfulness, memory impairment, rare and
scarce menses, body weight increase by 5 kg over the last half a year. What is
the most likely diagnosis?
A. Climacteric syndrome
B. Arterial hypertension
C. Postcastration syndrome
D. Premenstrual syndrome
E. Vegetative-vascular dystonia

134. 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 38,8°C. 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. Curettage of uterine cavity
C. Laparoscopy
D. Colposcopy
E. Hysteroscopy

135. 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 36,8°C, 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. Lactostasis
C. Postpartum metroendometritis
D. Subinvolution of uterus
E. Remnants of placental tissue after labour

136. 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. Mucous
C. Sanguino-serous
D. Purulent
E. Serous

137. 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. Conservative therapy with estrogen-gestagenic drugs
C. Anti-inflammatory therapy
D. Hormonal therapy with androgenic hormones
E. Sanatorium-and-spa treatment

138. A woman is 34 years old, it is her tenth labor at full term. It is known
from the anamnesis that the labor started 11 hours ago, labor was active,
painful contractions started after discharge of waters and became continuous.
Suddenly the parturient got knife-like 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 wasnt auscultable. What is the most probable diagnosis?
A. Rupture of uterus
B. Risk of uterus rupture
C. II labor period
D. Uterine inertia
E. Discoordinated labor activity

139. 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. Haemostatic therapy
C. Intrauterine instillation of dioxine
D. Contracting agents
E. Instrumental revision of uterine cavity

140. 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. Hysterectomy
D. Antiviral therapy
E. Expectant management, surveillance

141. A 30 year old patient complains about inability to become pregnant

over 3 years of married 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
non-profuse. 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. Menstrual irregularity
C. Bilateral ovarian tumours
D. Ovarian cystoma
E. Chronic oophoritis

142. 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. Ovarian tumor
D. Pregnancy
E. Functional disorder of the hypothalamic-pituitary-ovarian system

143. A patient with fibromyoma of uterus 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
corresponding to 9 weeks of pregnancy due to the fibromatous nodes, one of
which was mobile and extremely painful. Appendages were not palpable.
There were moderate mucous discharges. What is the optimal treatment
tactics?
A. Urgent surgery (laparotomy)
B. Surveillance and spasmolytic therapy
C. Surgical laparoscopy
D. Surveillance and antibacterial therapy
E. Fractional diagnostic curettage of the uterine cavity
144. 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 body of womb was in the 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. Grape mole
B. Incipient abortion
C. Abortion in progress
D. Threat of spontaneous abortion
E. Incomplete abortion

145. A 49-year-old patient undergoes regular medical check-up for uterine

fibromyoma. Within the last year the uterus has enlarged up to 20 weeks of
gestation. What is the rational way of treatment?
A. Surgical treatment
B. Hormonal therapy
C. Embolization of uterine arteries
D. Treatment with prostaglandin inhibitors
E. Further surveillance

146. 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 didnt reveal them at 35 weeks of pregnancy as well. How
often should the antibodies be determined hereafter?
A. Once a week
B. Once in three weeks
C. Once in two weeks
D. Monthly
E. There is no need in further checks

147. 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 orifice was closed; the discharges were of
mucous nature. What is the most likely diagnosis?
A. Pathological preliminary period
B. Secondary uterine inertia
C. Primary uterine inertia
D. Uterine cervix dystocia
E. Physiological preliminary period
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. Sexual development delay
C. Babinski-Frohlich syndrome
D. Turners syndrome
E. Pregnancy

149. A multigravida with Rh-isosensitization was found to have a decrease

in anti-Rh titer from 1:32 to 1:8 at 33-34 weeks of gestation. Ultrasound
revealed double contour of head, ebnlargement of fetal liver, placental
thickness of 50 mm. The patient has indication for:
A. Premature delivery
B. Repeated (after 2 weeks) USI
C. Administration of anti-Rh gamma globulin
D. Course of desensitizing therapy
E. Plasmapheresis

150. 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 has 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,
anteflexio-versio, the appendages were not changed. What is the most likely
diagnosis?
A. Juvenile bleeding
B. Amenorrhea
C. Hysteromyoma
D. Ovarian cyst
E. Girl is healthy

151. A 38-year-old female patient complains about hot flashes and feeling of
intense heat arising 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 extirpation of the
uterus with its appendages. What is the most likely diagnosis?
A. Post-castration syndrome
B. Secondary psychogenic amenorrhea
C. Physiological premenopause
D. Premenstrual syndrome
E. Early pathological menopause

152. 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, 3 days after it the
problems disappear. What is the most likely diagnosis?
A. Premenstrual syndrome
B. Secondary psychogenic amenorrhea
C. Premature pathological climacterium
D. Preclimacterium syndrome
E. Algomenorrhea

153. 20 minutes after a normal delivery at 39 weeks a puerpera had a single

temperature rise up to 38°C. Objectively: the uterus is dense, located between
the navel and the pubis, painless. Lochia are bloody, of small amount. Breasts
are moderately soft and painless. What is the optimal tactics?
A. Further follow-up
B. Manual examination of the uterine cavity
C. Expression of breast
D. Antibiotic therapy
E. Appointment antipyretic

154. On the 10th day postpartum a puerperant woman complains of pain

and heaviness in the left mammary gland. Body temperature is 38,8°C, Ps- 94
bpm. The left mammary gland is edematic, the supero-external quadrant of
skin is hyperemic. Fluctuation symptom is absent. The nipples discharge
drops of milk when pressed. What is a doctors further tactics?
A. Antibiotic therapy, immobilization and expression of breast milk
B. Inhibition of lactation
C. Opening of the abscess and drainage of the mammary gland
D. Physiotherapy
E. Compress to both mammary glands

155. 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. Polycystic ovary syndrome
C. Sheehan syndrome
D. Pituitary adenoma
E. Hypothyroidism

156. During self-examination a 22-year-old patient revealed a mammary

tumour. Palpation revealed a firm, painless, 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 18x17 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. Radical mastectomy
C. Nonsteroid anti-inflammatory drugs, oral contraceptives
D. Dynamic follow-up
E. Surgical treatment after pregnancy

157. 2 weeks after labour a parturient woman developed breast pain being
observed for 3 days. Examination revealed body temperature at the rate of
39°C, chills, weakness, hyperaemia, enlargement, pain and deformity of the
mammary gland. On palpation the infiltrate was found to have an area of
softening and fluctuation. What is the most likely diagnosis?
A. Infiltrative-purulent mastitis
B. Lactostasis
C. Mastopathy
D. Serous mastitis
E. Phlegmonous mastitis

158. 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. Breast lipoma
C. Diffuse mastopathy
D. Lactocele
E. Mastitis