Module 3.

Pathology of pregnancy, labor and puerperium

Ви зайшли під ім'ям Шеікх Прінс (Вихід)

Буковинський державний медичний

університет
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Test for topic 4

Огляд спроби 1
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Тест початий Friday 5 March 2021 08:46 AM

Завершено Friday 5 March 2021 08:46 AM
Пройшло часу 5 сек
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Оцінка 0 з можливих 100 (0%)

1 The 36 weeks of gestation pregnant woman was admitted to the obstetric in-
Балів: patient department. She has previous history of arterial hypertension, now
1 complains of a headache, aching pains in the lower abdomen and bloody
discharge from vagina. The main clinical features are blood pressure 180/100 mm
Hg and hypertonic uterus. During investigation about 300 ml of dark blood was
discharged from vagina. The fetal heartbeats are not heard. What is the
diagnosis?

Виберіть a. Placental presentation

одну
правильну b. Premature delivery threa
відповідь c. Premature placental separation
d. Embolism caused by amniotic fluid
e. Uterine rupture

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2 Immediately after delivery a woman had haemorrhage, blood loss exceeded

Балів: postpartum haemorrhage rate and was progressing. There were no symptoms of
placenta detachment. What tactics should be chosen?
1
 Виберіть a. Removal of afterbirth by Crede's method
одну
правильну b. Intravenous injection of methylergometrine with glucose
відповідь c. Instrumental revision of uterine cavity walls
d. Uterus tamponade
e. Manual removal of placenta and afterbirth

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3 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,
Балів:
1 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?

Виберіть a. 400 ml
одну
b. 300 ml
правильну
відповідь c. 500 ml
d. 1000 ml
e. 650 ml

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4 Secundapara of 25 years. In the third period of delivery the bleeding has appeared.
Балів: The attributes of placenta’ detachment are absent. At manual detachment of
placenta it was revealed that a placenta is fixed, with growing into a myometrium.
1
Tactics of the doctor?

Виберіть a. Laparotomy, a hysterectomy

одну
правильну b. Application of uterotonic agents
відповідь c. Tool secretion of an afterbirth
d. Laparotomy, supravaginal amputation of uterus
e. A hemotransfusion

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5 10 minutes after delivery a woman discharged placenta with a tissue defect 5х6
Балів: cm large.Discharges from the genital tracts were profuse and bloody. Uterus tonus
1 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:

Виберіть a. To introduce an ether-soaked tampon into the posterior

одну fornix
правильну b. To apply hemostatic forceps upon the uterine cervix
відповідь
c. To make manual examination of uterine cavity
d. To administer uterotonic
e. To put an ice pack on the lower abdomen

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6 Examination of a just born placenta reveals defect 2x3 cm large. Hemorrhage is

Балів: absent. What tactic is the most reasonable?
1
Виберіть a. Parturient supervision
одну
правильну b. Instrumental uterus cavity revision
відповідь c. Manual uretus cavity revision
d. External uterus massage
e. Prescription of uterotonic medicines

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7 A 22 y.o. patient complains of having boring pain in the right iliac region for one
Балів: week, morning sickness, taste change. Delay of menstruation is 3 weeks.
1 Objectively: AP- 110/70 mm Hg, Ps- 78/min, t - 370С. 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?

Виберіть a. Progressing tubal pregnancy

одну
правильну b. Interrupted tubal pregnancy
відповідь c. Uterine pregnancy
 d. Acute appendicitis
e. Cyst of the right ovary

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8 A pregnant woman was delivered to the gynecological unit with complaints of pain
Балів: in the lower abdomen and insignificant bloody discharges from the genital tracts
1 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?

Виберіть a. Abortion in progre

одну
правильну b. Threat of spontaneous abortion
відповідь c. Incomplete abortion
d. Grape mole
e. Incipient abortion

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9 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
Балів:
1 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:

Виберіть a. Placental presentation

одну
правильну b. Vasa previa
відповідь c. Disseminated intravascular coagulation syndrome
d. Detachment of normally located placenta
e. Bloody discharges

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10 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
Балів: has a histrory of menstruation delay for 3 weeks. Objectively: AP - 80/50 mm Hg,
1 pulse is 78 bpm, body temperature is 37oC. Bimanual examination reveals that
uterus is enlarged, soft, mobile and painless. Uterine appendages are palpable on
the right, there is a dense, elastic and moderately painful formation 3x4 cm large.
What is the most likely diagnosis?

Виберіть a. Progressing fallopian pregnancy

одну
b. Acute appendicitis
правильну
відповідь c. Right ovarian cyst
d. Interrupted fallopian pregnancy
e. Uterogestation

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11 A woman is 34 years old, it is her tenth labor at full term. It is known from the
Балів: anamnesis that the labor started 11 hours ago, labor was active, painful
1 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 wasn't auscultable.
What is the most probable diagnosis?

Виберіть a. Uterine inertia

одну
правильну b. II labor period
відповідь c. Risk of uterus rupture
d. Rupture of uteru
e. Discoordinated labor activity

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12 A 26 y.o. woman complains of sudden pains in the bottom of abdomen irradiating

Балів: to the anus, nausea, giddiness, bloody dark discharges from sexual tracts for one
1 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?

Виберіть a. Acute right-side adnexitis

одну
 правильну b. Torsion of the crus of the ovary tumour
відповідь
c. Acute appendiciti
d. Apoplexy of the ovary
e. Broken tubal pregnancy

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13 At the puerpera of 26 years old, for 4 day after labour the incessant parent
Балів: bleeding began. The haemorrhage has made 400 ml. The common state is
1 worsened - a body temperature 36, 7оС, pulse of 94 beets / mines, the AP of
90/70 mm.Hg. The uterus is intense, morbid, its bottom is at a level of a umbilicus.
The diagnosis is: "Delivery in time. A bleeding of the 4th day of puerperal term". It
is necessary:

Виберіть a. Supravaginal ablation of a uterus

одну
правильну b. Outside massage of a uterus after bleeding urinary bladder
відповідь
c. Tool revision of a cavity of the uterus
d. To enter drugs reducing a uterus
e. Manual inspection of a cavity of the uterus and erasion of
the delayed parts of a placenta

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14 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
Балів:
vaginal discharge. The general condition of the patient is good. Her blood pressure
1
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?

Виберіть a. Incipient abortion

одну
правильну b. Placental presentation
відповідь c. Uterine rupture
d. Premature placental separation
e. Threatened premature labor
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15 18 y.o. woman complains of pain in the lower abdomen. Some minutes before she
Балів: has suddenly appeared unconscious at home. The patient had no menses within
1 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?

Виберіть a. Impaired extrauterine pregnancy

одну
правильну b. Ovarian apoplexy
відповідь c. Twist of cystoma of right uterine adnexa
d. Acute appendicitis
e. Acute salpingoophoritis

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16 After delivery and revision of placenta there was found the defect of placental
Балів: lobule. General condition of woman is normal, uterus is firm, there is moderate
1 bloody discharge. Speculum inspection of birth canal shows absence of
lacerations and raptures. What action is nesessary?

Виберіть a. Introduction of hemostatic medications

одну
правильну b. Introduction of uterine contracting agents
відповідь c. Manual exploration of the uterine cavity
d. Urine drainage, cold on the lower abdomen
e. External massage of uteru

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17 A 26 y.o. woman complains of a mild bloody discharge from the vagina and pain in
Балів: the lower abdomen. She has had the last menstruation 3,5 months ago. The pulse
1 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?
 Виберіть a. Inevitable abortion
одну
правильну b. Incomplete abortion
відповідь c. Disfunctional bleeding
d. Incipient abortion
e. Complete abortion

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18 A pregnant woman (35 weeks), aged 25, was admitted to the hospital because of
Балів: bloody discharges. In her medical history there were two artificial abortions. In a
1 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?

Виберіть a. To introduct the drugs to increase the blood coagulation and

одну continue observation
правильну b. To perform the hemotransfusion and to prolong the
відповідь pregnancy
c. Stimulate the delivery by intravenous introduction of
oxytocin
d. To perform a delivery by means of Cesarean section
e. To keep the intensity of hemorrhage under observation and
after the bleeding is controlled to prolong the pregnancy

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19 The woman delivered twins has early postnatal hypotonic uterine bleeding
Балів: reached 1.5\% of her bodyweight. The bleeding is going on. Conservative methods
1 to arrest the bleeding have been found ineffective. The conditions of patient are
pale skin, acrocyanosis, oliguria. The woman is confused. The pulse rate is 130
beats per min, BP – 75/50 mm Hg. What is the further treatment?

Виберіть a. To put clamps on the uterine cervix

одну
правильну b. Inner glomal artery ligation
відповідь c. Uterine extirpation
d. Uterine vessels ligation
e. Supravaginal uterine amputation
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20 A 30-year-old gravida consulted a gynecologist about bright red bloody discharges

Балів: from the vagina in the 32 week of gestation. She was hospitalized with a suspicion
1 of placental presentation. Under what conditions is it rational to conduct the
internal examination in order to make a diagnosis?

Виберіть a. In the operating room prepared for the operation

одну
правильну b. In the delivery room keeping to all the aseptics regulation
відповідь c. The examination is not to be conducted because of risk of
profuse haemorrhage
d. In the admission ward of maternity hospital
e. In the examination room of antenatal clinic

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