Крок 2 Medicine
	
4. Акушерство і гінекологія
	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	Hypersecretion of estrogens by tissues of the organism.   
C	Poor aromatization of preandrogens due to hypothyroidism  
D	The increased contents of follicle-stimulating hormone    
E	Supersecretion of androgens by the cortex of paranephroses.    

 	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	Phase by phase vitamin therapy  
D	Supravaginal ablation of the uterus without ovaries
E	Hysterectomy without ovaries

 	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	Specific treatment of Trichomonas colpitis   
D	Cervix ectomy   
E	Cryolysis of cervix uteri

 	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	Hormonetherapy  
C	Phytotherapy  
D	Radial therapy  
E	Phase by phase vitamin therapy  

 	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, 7х5 cm large, mobile, 
	painless. What examination is necessary for detection of fetus localization?   
A	Ultrasound  
B	Hysteroscopy   
C	Hromohydrotubation  
D	Colposcopy  
E	Cystoscopy  

 	6

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

 	7
	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	Ultrasound of organs of a small pelvis  
C	Progesteron test
D	Computer tomography of the head  
E	Determination of the contents of testosteron-depotum in blood serum.

 	8
	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	USI of organs of small pelvis  
D	Progesterone assay  
E	Determination of the contents of testosteron-depotum in blood serum  

 	9
	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	Antibacterial therapy and adaptogens  
C	Lasertherapy and enzymotherapy  
D	Magnitotherapy and vitamin therapy  
E	The patient does not require further care  

 	10
	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	Apoplexy of the ovary  
C	Acute right-side adnexitis  
D	Torsion of the crus of the ovary tumour  
E	Acute appendicitis   

 	11
	At the gynaecological department there is a patient of 32 years with the diagnosis: "acute 
	bartholinitis".Body temperature is 38,2°C, leucocytes count  10,4*10^9/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	Antibiotics, Sulfanilamidums  
C	Surgical dissection, drainage of the abscess of the gland  
D	Antibiotic therapy  
E	Antibiotics, detoxication  and biostimulants.   

 	12
	An endometrial adenocarcinoma that has extended to the uterine serosa would be classified 
	as stage:  
A	IIIA  
B	IC     
C	IIA   
D	IIB  
E	IVAB  

 	13
	Which of the methods of examination is the most informative in the diagnostics of a tube 
	infertility?   
A	Laparoscopy with chromosalpingoscopy  
B	Pertubation  
C	Hysterosalpingography  
D	Transvaginal echography  
E	Bicontrast pelviography     
 
		14
	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 36,6°C. 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	Incipient abortion      
C	Incomplete abortion    
D	Complete abortion      
E	Disfunctional bleeding    

 	15
	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 tendern and overhangs inside. What is the most  probable diagnosis?   
	  
A	Impaired extrauterine pregnancy    
B	Ovarian apoplexy   
C	Twist of cystoma of right uterine adnexa     
D	Acute salpingoophoritis     
E	Acute appendicitis     

 	

 	16
	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 husband's 
	analysis of semen is without pathology. What diagnostic method will you start from the 
	workup in this case of sterility?     
A	Hysterosalpingography   
B	Hormone investigation   
C	Ultra sound investigation   
D	Diagnostic scraping out of the uterine cavity   
E	Hysteroscopia   

 	17
	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 patient's condition got worse: she developed
	 adynamia, apparent skin pallor, acrocyanosis, profuse perspiration. T 38,5°C, Ps- 
	110/min, AP- 70/40 mm Hg. What is the most likely diagnosis?    
A	Hemotransfusion shock  
B	Hemorrhagic shock   
C	Septic shock   
D	Anaphylactic shock   
E	DIC syndrome   

 	18
	A 58-year-old female patient came to the antenatal clinic with complaints of bloody light-red 
	discharges from the genital tracts. Menopause is 12 years. Gynaecological examination 
	found externalia and vagina to have 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 most likely diagnosis?   
A	Uterine carcinoma   
B	Atrophic colpitis   
C	Abnormalities of menstrual cycle with climacteric character   
D	Cervical carcinoma  
E	Granulosa cell tumor of ovary  

 	19
	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	Surgical treatment and radial therapy   
D	Radial therapy   
E	-

 	20
	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	Operative treatment   
C	Dispensary observation of the patient   
D	Anti-inflammatory therapy   
E	Chemotherapeutic treatment   

 	21
	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	Diathermocoagulation of the cervix of the uterus   
C	Specific treatment of Trichomonas colpitis    
D	Cervix ectomy    
E	Cryolysis of cervix of the uterus   

 	22
	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	Metrofibroma  
C	Endometriosis  
D	Cervical pregnancy  
E	Cervical papillomatosis  

 	23
	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	Biopsy of omentum   
C	Biopsy of an ovary  
D	Ablation of an ovary and omental metastases    
E	Ablation of omentum and both ovaries with tubes  
 	
 	24
	A 43 y.o. patient complains of formation and pain in the right mammary gland, rise of 
	temperature up to $37,2^0C$ 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   
D	Premenstrual syndrome     
E	Tuberculosis of the right mammary gland   

		25
	A parturient complains about pain in the mammary gland. Palpation revealed a 3х4 cm large 
	infiltration, soft in the centre. Body temperature is $38,5^oC$. What is the most probable 
	diagnosis?  
A	Acute purulent mastitis  
B	Pneumonia  
C	Pleuritis  
D	Retention of milk  
E	Birth trauma  

 	26
	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: Нb - 70 g/l, RBC- 2,3 cdot10^{12}/l, Ht - 20. What is the most probable 
	diagnosis?   
A	Juvenile bleeding, posthemorrhagic anemia    
B	Werlholf's disease    
C	Polycyst ovarian syndrome     
D	Hormonoproductive ovary tumor   
E	Incomplete spontaneous abortion   

 	27
	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- $36,6^OC$, 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	Acute appendicitis
C	Intestinal obstruction
D	Abdominal pregnancy
E	Renal coli 

 	28
	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	Contracting drugs   
D	Estrogenic haemostasia   
E	Hysterectomy   

		29
	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   

 	30
	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	Cervical pregnancy  
D	Nascent fibroid  
E	Leukoplakia  

 	31
	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	Gestation 
D	Asherman's syndrome
E	Sheehan's syndrome

 	32
	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	Polycystic ovaries  
C	Chronic salpingitis  
D	Tuberculosis of genital organs   
E	Ovarian cystoma   

		33
	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	Laparoscopy  
C	Puncture of abdominal cavity through posterior vaginal fornix  
D	Extensive colposcopy  
E	Culdoscopy  

 	34
	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   
E	Bacterial vaginosis   

 	35
	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  

 	36
	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	Juvenile hemorrhage   
C	Haemophilia   
D	Endometrium cancer   
E	Werlhof's disease   

 	37
	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	Operation only   
C	Operation + radiation therapy   
D	Radiation therapy only   
E	Chemotherapy only   

 	38
	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	Cryodestruction of condyloms
C	Surgical ablation of condyloms
D	Chemical coagulator treatment
E	Antiviral  treatment

 	39
	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	Fibromatous node  
D	Exacerbation of chronic adnexitis  
E	Tumour of sigmoid colon  

 	40
	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   

 	41
	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  

 	42
	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	Chronic adnexitis
C	Anomalies of genitals development 
D	Immunologic sterility
E	Genital endometriosis

 	43
	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 body of uterus     
C	Fibromatous node which is being born   
D	Cervical pregnancy   
E	Polypose of cervix of uterus    

 	44
	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	Turner's syndrome  
C	Stein-Levental's syndrome  
D	Shichan's syndrome  
E	Babinski-Froehlich syndrome   

 	45
	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 aren't 
	palpable, the right fornix is contracted. 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   

 	46
	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	Subserous uterine fibromyoma   
D	Endomyometritis   
E	Adnexal endmetriosis   

 	47
	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	Uterus perforation   
D	Uterine fibromyoma   
E	Uterine carcinoma   

		48
	A 25 y.o. patient complains of body temperature rise up to 37°С, 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	Pelvic peritonitis  
D	Postabortion uterus perforation  
E	Parametritis   

 	49
	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   
B	Conservative treatment of bleeding  
C	Hysterectomy  
D	Supravaginal amputation of uterus without appendages  
E	TORCH-infection test   

 	50
	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  

 	51
	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	Interrupted fallopian pregnancy   
C	Right ovarian cyst   
D	Uterogestation   
E	Acute appendicitis   

 	52
	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, t- 37,0°С. Bimanual examination revealed that uterus is a little 
	enlarged, soft, movable, painless. Appendages palpation: a painful formation 3х4 cm large on
	 the right, it is dense and elastic, moderately movable. What is the most probable diagnosis? 
	 
A	Progressing tubal pregnancy  
B	Interrupted tubal pregnancy  
C	Cyst of the right ovary  
D	Uterine pregnancy  
E	Acute appendicitis  

 	53
	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  

 	54
	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	Sheehan's syndrome   
B	Ovarian amenorrhea   
C	Turner's syndrome   
D	Exhausted overy syndrome   
E	Galactorrhea-amenorrhea syndrome   

 	55
	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 $37,8^oC$. 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   

 	56
	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	Tubo-ovaritis  
C	Adrenogenital syndrome  
D	Premenstrual syndrome  
E	Gonadal dysgenesis   

 	57
	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	Algodismenorrhea  
C	Sheehan's syndrome   
D	Premenstrual syndrome  
E	Morgagni-Stewart syndrome  

 	58
	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	Sheehan's syndrome  
B	Stein-Leventhal syndrome   
C	Shereshevsky-Turner's syndrome   
D	Homological blood syndrome  
E	Vegetovascular dystonia  

 	59
	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   

 	60
	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	Abortion in progress  
B	Cervical pregnancy   
C	Threat of abortion   
D	Incipient abortion   
E	Interrupted fallopian pregnancy   

 	61
	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	Substitutional maternity  
D	Artifical fertilization with donor's semen  
E	Induction of ovulation  

 	62
	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 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  

 	63
	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	Postcastration syndrome  
C	Adrenogenital syndrome  
D	Climacteric syndrome   
E	Stein-Leventhal syndrome   

 	64
	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	Premenstrual syndrome   
C	Vegetative-vascular dystonia   
D	Arterial hypertension   
E	Postcastration syndrome   

 	65
	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 $38,8^oC$. 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   
 
 	66
	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   

		67
	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	Ovarian cystoma  
C	Chronic oophoritis  
D	Menstrual irregularity  
E	Bilateral ovarian tumours  

 	68
	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	Further surveillance   
D	Embolization of uterine arteries   
E	Treatment with prostaglandin inhibitors   

 	69
	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   

     	70
 A 58-year-old female patient cameto the antenatal clinic with complaintsof bloody light-red discharges fromthe genital tracts. Menopause is 12years. Gynaecological examination foundexternalia and vagina to have age involution;uterine cervix was unchanged, therewere scant bloody discharges from uterinecervix, uterus was of normal size;uterine appendages were not palpable;parametria were free. What is the most
likely diagnosis?
A Uterine carcinoma
B Atrophic colpitis
C Abnormalities of menstrual cycle with climacteric character
D Cervical carcinoma
E Granulosa cell tumor of ovary