(ong)situational + standart +task A +task B

Situation task No 1

Patient, 16 years old. She consulted a doctor about acute pain in her abdomen that had appeared while training in gym. Menstruation lasts 3-4 days every 28 days, painless, regular since she was 13 years old. Lat menstruation was 2 weeks ago. She doesn’t have sexual life.

Through rectum: Body of womb (corpus uteri) corresponds to her age, painless during palpation. Appendages on the left are not palpated, on the right of the womb there is painful (algogenic) enlarged ovary in 4x4 cm is palpated. Serous discharge.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №1

1. Ovarian apoplexy.

2. Puncture of abdominal cavity through posterior vaginal fornix, after receiving blood – laparotomy, resection of ovary, suture placation for hemostasis.

Situation task No 2

A woman, 20 years old, was taken to gynecology department. She complained of cramp-like (spasmodic) pain in the lower part of (below) abdomen that had been lasting for 2 days. Last menstruation was 2 months ago. Blood-smearing was observed within the period of would-be menstruation. General state is satisfactory. Arterial blood pressure (ABP) – 110-80 mm of mercury, pulse – 84 strokes/min. Abdomen is soft, painful in lower parts. Womb is a bit larger than the norm is, appendages on the right are enlarged up to 6-7 cm in diameter, they are painful during examination. Promptov’s symptom is positive, posterior fornix hangs over slightly.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №2

1. The right-side tubal pregnancy.

2. Puncture of abdominal cavity through posterior vaginal fornix, after receiving blood – laparotomy, right-side tubectomy

Situation task No 3

Patient P., 20 years old. For the last two weeks she has lost 2 kg. There is acetone and acetone bodies in her urine.

Anamnesis: Menstruations since she was 12 years old, every 30 days, moderate. Last menstruation was 6 weeks ago. It is her first pregnancy.

For the last 24 hours vomiting has taken place 19 times. Temperature – 37,4; P – 100 strokes/min., ABP –100/60 mm of mercury. Skin is pale with icteric tint. Palpatory acute pain (tenderness) is defined (palpated) in the region of right hypochondrium.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №3

1. Acute fatty hepatosis of pregnancy.

2. Therapeutic abortion.

Situation task No 4

A patient, 27 years old, complained of acute pain (below) in the lower part of abdomen. Abortion was made a month ago. By the time of would-be menstruation there was no bloody discharge,

cramp-like (spasmodic) pain appeared.

Vaginally: womb is enlarged up to 12-13 weeks of pregnancy, tight and elastic, appendages are not defined (palpated).

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №4

1. Hematometra.

2. Curettage of uterine cavity

Situation task No 5

A patient, 29 years old. Was taken to gynecology department. She complained of rise in temperature, general weakness, pain (below) in the lower part of abdomen.

Anamnesis: she has had menstruations since she was 12 years old, that from the very beginning last during 5 days, cycle – 26 days, medium painful, last menstruation took place 3 months ago.

A patient had 4 deliveries, two of them finished with normal deliveries and two – with artificial abortions. Last abortion was made 8 days ago. She was discharged from hospital the next day after abortion.

Objectively: General state is satisfactory. P – 92 strokes/min., ABP– 120/80 mm of mercury. T- 38,2. Tongue is moist, slightly coated white. Abdomen is soft, rather painful over pubis.

There is profuse purulent discharge from the cervical canal.

PV: neck of womb is of cylindrical form, external fauces is closed, body of the womb is a bit more than a norm is, of soft consistency, painful during palpation. Appendages are not palpated.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №5

1. Postabortion endometritis.

2. Antibiotic therapy, anti-inflammatory therapy, infusion therapy, disintoxication therapy, uterotonics. Ultrasound uterine cavity control.

Situation task No 6

A patient, 29 years old, complained of bleeding, cramp-like (spasmodic) pain in the lower part of (below) abdomen. She has been on the books for 3 years because of hysteromyoma. Menstruations are regular. Last menstruation began 3 days ago.

Vaginally: neck of womb (cervix uteri) is smoothed (flat). Myomatous node up to 5 weeks of pregnancy is seen from the cervical canal.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №6

1. The myomatous node is born.

2. To turn off the node, after - curettage of uterine cavity

Situation task No 7

A patient, 47 years old, was taken to gynecology department. She complained of voluminous (profuse) bleeding and acute pain in the lower part of abdomen.

Anamnesis: she has had menstruations since she was 13 years old during 5-6 days, every 28 days, painless but profuse. She had 2 deliveries, 2 abortions without complications.

General state is of medium severity. Skin is pale, P – 90 strokes/min., ABP– 100/60 mm of mercury.

PV: vagina of parous, neck of uterus is cylindrical, body of womb is enlarged up to 15 weeks of pregnancy with multiple myomatous nodes, along posterior wall there is a node in 4x6 cm on crus, very painful during palpation and displacement.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №7

1. The nodose hysteromyoma has great dimensions. Necrosis of myomatous node. Hemorrhagic syndrome. Posthemorrhagic anemia.

2. Surgical treatment, blood volume replacement

Situation task No 8

A patient, 39 years old, complained of acute pain in the lower part of abdomen, vomiting, quickened urination. During examination: abdomen is rather (moderate) swollen, Szczyotkin and Blumberg's sign is positive. P – 90 strokes/min., T – 38,0.

Vaginally: body of womb is not enlarged, firm, active, painless, on the left and ahead of the womb tight and elastic mass (lump) in 6x9 cm is palpated. It is very painful while displacing, appendages on the right are not defined (palpated).; mucous (mucilaginous) discharge.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №8

1. Left-side pyosalpingo-oophoritis, pelviperitonitis.

2. Surgical treatment. Left-side salpingo-oophorectomy, drainage of abdominal cavity.

Situation task No 9

A patient, 28 years old. She complained of acute pain in the lower part of abdomen that is felt in anus. There was short loss of consciousness. Last menstruation took place 6 weeks ago.

Anamnesis: she’s had menstruations since she was 12 years old during 3-4 days, moderate, painless. She had 2 deliveries, 1 abortion that was complicated with oophoritis.

General state is satisfactory. P – 80 strokes/min., ABP– 105/60 mm of mercury. T- 36,5.

PV: vagina of parous, neck of uterus is cylindrical, body of womb is slightly enlarged, soft by consistency, external fauces is closed. Painful mass in 4-5 cm is defined to the right in the region of appendages, appendages to the left are not defined (palpated), their region is painless. Discharge is poor, smearing.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №9

1. The right-side tubal pregnancy, rupture of uterine tube.

2. Laparotomy, right-side tubectomy, blood volume replacement.

Situation task No 10

A woman in childbirth, 20 years old, had attack of spasms during the second period of term labor (partus matures) when fetal head was situated in the narrow part of pelvis minor cavity.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №10

1. Eclampsy (epilepsy-?).

2. Urgent delivery: high (cavitary, atypical) forceps delivery.

Situation task No 11

A patient F., 26 years old. She complained of voluminous (profuse) bloody discharge from genital tracts and cramp-like pain in the lower part of abdomen. Last menstruation took place 8 weeks ago.

Out of anamnesis: She had 2 normal deliveries and one spontaneous miscarriage (abortion).

General state is satisfactory. P – 84 strokes/min., ABP– 110/70 mm of mercury, T – 36,2.

PV: vagina of parous, neck of uterus is cylindrical, external fauces is patulous for 1cm. Body of womb is enlarged up to 7-8 weeks of pregnancy, rather soft, sensitive during palpation. There is profuse bloody discharge with grumes.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №11

1. Abortion in progress at term of pregnancy 7-8 weeks.

2. Curettage of uterine cavity.

Situation task No 12

A pregnant woman, 25 years old, was taken for delivery. At home amniotic fluid was poured out an hour ago. There is no birth activity. It is first pregnancy, first delivery at term (partus matures).

While examining: fetal lie is longitudinal, its head is defined at the fundus of uterus; over the opening into small pelvis there is large, rather soft, not balloting part.

Vaginally: neck of womb is shortened up to 1cm, cervical canal is patulous for 2cm out of which the pulsatile loop of cord is hanging down.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №12

1. First delivery at term. Preterm discharge of amniotic fluid. Pelvic presentation. Prolapse of umbilical cord.

2. Urgent cesarean section in case of alive fetus

Situation task No 13

A patient D., 28 years old, was taken to gynecology department for abortion, term of pregnancy – 8-9 weeks.

Gynecological state: womb is in anteflexion, body of womb corresponds to 8-9 weeks of pregnancy, appendages are not defined (palpated). .

During abortion under local anaesthesia curette No6 “fell in” the cavity of small pelvis. Woman complains of severe pain in the lower part of abdomen. Skin is pale, ABP– 90/60 mm of mercury, P – 90 strokes/min.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №13

1. Uterine perforation during therapeutic abortion. Internal (intra-abdominal) hemorrhage.

2. Laparotomy, suture plication.

Situation task No 14

A pregnant woman, 30 years old, was taken for delivery. Pregnancy – 4, delivery – 2 at term, (partus maturus), there are 2 medical abortions in anamnesis. First delivery did not have any complications, fetus weight – 3800,0. Medical abortions were complicated with metroendometritis.

While examining: fetal lie is longitudinal, its head presents, pressed to the opening into small pelvis. Fetal heartbeats are distinct, rhythmical up to 140 stroke s/minute. Birth pangs occur every 1-2 minutes / 50-55 seconds, painful; they have been lasting for 8 hours, amniotic fluid poured out 4 hours ago, light. abdominal circumference – 105 cm, height of elevation of fundus of uterus- 42cm. She felt sharp pain at the height of one of labor pains, weakness, sickness, cold sweat stood out, skin is pale.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №14

1. Hystopathologic hysterorrhexis. Big fetus.

2. Urgent laparotomy, hysterectomy with uterine tubes, blood volume replacement, prophylaxis of DIC-syndrome

Situation task No 15

A patient A., 27 years old. She went to hospital with the complaints of delay (suppression) of menstruation during 8 weeks. Profuse bloody discharge that stopped abruptly after the birth of

roundish form of dense formation.

Pregnancy is longed-for because 5 years of sterility is pointed in anamnesis. Time and again its treatment has been undergone.

PV: vagina of nullipara, neck of uterus is distinctly shortened, easily patulous for 2 cm, body of womb is slightly enlarged. Appendages are not defined (palpated), their region is painless. Discharge is bloody, moderate.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №15

1. Incomplete spontaneous abortion.

2. Curettage of uterine cavity

Situation task No 16

A woman in childbirth, 25 years old. Pregnancy – 2, deliveries – 2, at term (partus matures).

Delivery finished 30 minutes ago with alive mature fetus. At this moment bleeding began. There are no signs of removal of afterbirth (placenta). Hemorrhage made 400,0 by the weight of the woman of 80 kg.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №16

1. Anomaly of placentation (false, incomplete).

2. Manual removal of afterbirth.

Situation task No 17

A patient was taken to gynecology department. She complained of acute pain in all abdomen that had appeared after physical activity, sickness, vomiting. Skin is pale, pulse – 96 strokes /min. During bimanual examination very painful formation of tight and elastic consistency was palpated on the right of the womb. It took a great deal of trouble because of muscle tension of anterior abdominal wall.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №17

1. Ovarian apoplexy-? (Interruption of tubal pregnancy-?)

2. Laparotomy, suture plication

Situation task No 18

A pregnant woman, 29 years old, was taken for delivery with regular labor activity, birth pangs occur every 3-4 minutes / 35-40 seconds, amniotic fluid is intact, bloody discharge with grumes. Pregnancy - 3, deliveries -1. Previous pregnancies finished with medical abortions, without any complications. Fetal lie is longitudinal, its head presents high over the opening into small pelvis. Vaginally: neck of womb (cervix uteri) is smoothed (flat), cervical dilatation is up to 4-5cm, fetal bladder is intact. From behind and on the left the edge of placenta is defined (palpated), there are grumes in vagina, head is high over the opening into small pelvis, mobile.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №18

1. Marginal placental presentation. Haemorrhage.

2. Amniotomy

Situation task No 19

A patient, 18 years old, was taken to gynecology department. She complained of acute pain in the lower part of abdomen, sickness, vomiting, rapid pulse, deterioration of general state. Aforesaid complaints appeared during physical activity. She has had menstruation since she was 14 years old, every 28 days, last menstruation took place 2 weeks ago. During vagina examination: womb is of normal size, appendages on the right are not defined (palpated), appendages on the left are impossible to palpate because of sharp pain. Overhang of posterior fornix is marked.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №19

1. Ovarian apoplexy.

2. Puncture of abdominal cavity through posterior vaginal fornix, after receiving blood – laparotomy, suture plication.

Situation task No 20

Primigravida, 23 years old was taken to maternity hospital. She complained of headache, pain in epigastric region, sickness, unclear sight. There was a fit of spasms at home. Pregnancy – 1, term – 36 weeks. Examination detected: ABP –180/100 mm of mercury, P – 90 strokes /min., protein in urine 5g/l, anasarca. Soon after being taken to hospital fits of spasms began to recur one after another. Between spasms her consciousness is black-out.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №20

1. Pregnancy 36 weeks. Status eclampticus.

2. Urgent delivery by cesarean section. Prolonged artificial lung ventilation, treatment for gestosis in resuscitation department

Situation task No 21

A pregnant woman, 25 years old, was taken for delivery. Pregnancy - 2, deliveries -2. Birth pains has been lasting for 4 hours. Amniotic fluid is intact. ABP –170/90 mm of mercury, there is edema on lower extremities, protein in urine – 2g/l. Suddenly she began complaining of pains in abdomen “causing to burst”. Woman turned pale. P – 110 strokes /min. Presentating (presentation) part and small parts of fetus are impossible to palpate because of increased womb tonus and palpatory tenderness.

Fetal heartbeats are 100 strokes/min., muffled, arrhythmic. No bleeding.

Vaginally: opening of uterine fauces is 3-4 cm, fetal bladder is tense. Head presents.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №21

1.2^nd delivery at term, 1^st stage delivery, mod. Preeclampsia,premature placenta detach, intrauterine hypoxia

2.c sec to prevent DIC complication

Situation task No 22

A pregnant woman, 30 years old, was taken to hospital. She complained of profuse bloody discharge with grumes that suddenly appeared. No labor activity. Pregnancy - 3, deliveries -3. Time of pregnancy – 36 weeks.

Objective observation: skin is pale, ABP –100/60 mm of mercury, P – 100 strokes /min. Fetal lie is longitudinal, its head presents over the opening into small pelvis. Fetal heartbeats are120 strokes/min., rhythmic.

Vaginally: neck is shortened, cervical canal is patulous for a finger, sponge tissue is defined (palpated) behind internal fauces, bleeding became stronger.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №22

1.Preg 36 wks, pacental presentation, hemorrhage

2.

Situation task No 23

A patient, 48 years old, was taken to gynecology department. She complained of voluminous (profuse) bleeding with clots from genital tracts after menstruation delay for 3 months.

In anamnesis: She had 2 deliveries, 1 abortion without complications. Cycle has been disturbed for the last 2 years.

Vaginally and in speculum there is no pathology.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №23

1.Climacteric bleed

2.replacement hormonal therapy 0.6525 mg of conjugated estrogen/1mg of estradiol for 25days each mnth

medroprogesterone acetate 5-10 mg for 10-13 days

Situation task No 24

A patient, 25 years old. She complained of delay of menstruation for 3 weeks. Once at home she fainted. ABP– 90/50 mm of mercury, P –100 strokes/min., skin is pale.

Vaginally: womb is slightly enlarged, appendages to the left are not defined (palpated), to the right they are enlarged up to 6x5 cm, painful during palpation.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №24

1.Right side interrupted tubal preg.hemorrhage 1^st degree

2.immediate lapratomy.tubectomy or tube reconstruction

Situation task No 25

A patient, 25 years old. She complained of pain in left iliac region, giddiness. Pains appeared after sexual contact. Last menstruation is in time. Objectively: skin is pink and pale. ABP– 105/60 mm of mercury, P –90 strokes/min.

Vaginally: womb is not enlarged, enlarged up to 5x4 cm appendages to the left are palpated, they are painful. Puncture of posterior fornix was made: 20,0 incoagulable blood was obtained.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №25

1.Left ovarian apoplexy

2conservative treatment (bed rest,cold applicationonto low abdomen,hemostatic and anti inflammatory therapy

if bleeding laparotomy or ovarian resection

Situation task No 26

A patient, 27 years old. She complained of sharp pain in the region of large genital lip, rise in temperature up to 38,9.

During examination: tumor-like mass is palpated in the region of Bartholin’s gland, very painful, skin is hyperemic. Fluctuation is defined (palpated).

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №26

1.Abscess batholin gland

2.excision of abscess,drainage.later instillation with 5% iodine every 2 days.

Situation task No 27

A patient, 26 years old, complained of cramp-like (spasmodic) pains in the lower part of abdomen after 2 week of menstruation delay, bloody discharge from genital tracts. Curettage of uterine cavity was made, fetal egg in womb was not revealed.

Cytohistology: decidual tissue without chorionic villi.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №27

1.Ectopic preg

2.immediate laparotomy.if ectopic at tube do tubectomy/tube reconstruction

Situation task No 28

A pregnant woman, 22 years old. Pregnancy – 1, full-term. She’s had headache, ear noise

(tinnitus), stuffiness in nose for 2 days. Fetal lie is longitudinal, pelvic extremity presents.

Fetal heartbeats are distinct, up to 140 strokes/min., rhythmic. Birth pangs occur every 5-6 minutes / 30-35 seconds. A fit of cramps began at the attempt of internal examination.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №28

1.1^st delivery at term, eclampsia

2.droperidol 4.0-0.25%diazepam 2.0-0.5% → iv 4 hrs,rpt 2/3 of dose in 4 hrs.later½dose

promedolum 1.0-2.0% dimedrolum 1%-2%

-30 ml 25% mgso4 400 ml rheopolyglucin repeat after 4 hrs IM or iv in drops 15-35 drps/min

-hypotension drugs 1%hexonal iv/40 ml 2.5% vladnil/predion 10ml 3.4% euphllinum, 2-4ml 2%papaverine

Situation task No 29

A pregnant woman, 24 years old, was taken for delivery. Pregnancy – 1, full-term. Birth pangs occur every 2-3 minutes / 50-55 seconds, painful; parturient woman behaves uneasily. abdominal circumference – 102 cm, height of elevation of fundus of uterus- 39cm. Pelvis size: 24-24-30-17. Examination showed: womb is of wrong form, hourglass-like, very painful during palpation, head presents, pressed to the opening into small pelvis. Fetal heartbeats are 160 strokes/minute, fetal bladder is intact.

Vaginally: cervix of the uterus is shortened, edematic, opening is 2 cm, head is pressed. Arrow-shaped suture in transverse incision is closer to pubis. Small fontanel is on the left, large one is on the right. Amniotic fluid is intact. Diagonal conjugate is 10 cm.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №29

1.1^st delivery, 1^st stage, big fetus-flat rachitic, threaten hysterorhesis

2.halothane or nitrous oxide inhalation.immediate c-sec.prevention of hypotonic hemorrage.

Situation task No 30

A pregnant woman, 23 years old, was taken to hospital with complaints of bloody discharge from genital tracts and acute pains in the lower part of abdomen. Pregnancy – 1. Term of pregnancy – 36 weeks. During pregnancy she put on the weight 16 kg. General state is grave, skin is pale, ABP –90/60 mm of mercury, P – 100 strokes /min. Womb is tense, painful, of wrong form, parts of fetus are not determined because of the tension of walls of the womb. Fetal heartbeats are failed to hear.

Vaginally: there is cervix of the uterus, canal is patulous for one finger, fetal bladder is tense, tissue of placenta is not defined.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №30

1.Preg 36wks, placenta premature detach, hypoxia,hemorrhage shock

2.c sec to prevent DIC

Situation task No 31

A pregnant woman, 26 years old, was taken for delivery with regular labor activity. Amniotic fluid poured out 2 hours ago at home. Second delivery, at term (partus maturus). Fetal lie is transversal, head is on the left, pelvic extremity (end) is on the right. Fetal heartbeats are distinct, rhythmical up to 120 strokes/minute.

While vaginal examining: a hand is hanging down into vagina, opening of uterine fauces is full,

light amniotic fluid is running.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №31

1. 2 delivery,2 stage, transverse lie, prolapse hand

2.immediate vaginal examination ,turned the fetus and extracted.csection

Situation task No 32

A pregnant woman, 28 years old, was taken with complaints of weak birth pangs every 8-10 minutes / 20 seconds. Pregnancy – 3, delivery – 3^rd at term (partus maturus). First pregnancy finished with transformation, the second one – with Cesarean section (operation). abdominal circumference – 98 cm, height of elevation of fundus of uterus- 36cm. Fetal lie is longitudinal, head presents high over the opening into small pelvis. Pelvis size: 23-26-29-17. After one of the pangs acute pain appeared in abdomen, cold sweat, small rapid pulse,

adynamy. Womb’s form has changed – to the left of medial line there is rounded body of the womb, to the right there is fetus.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №32

1. 3 delivery, uterine scar-rupture

2.emergency laparotomy with csec delivery

fluid and blood transfusion

cesarean hysterectomy

Situation task No 33

A patient, 28 years old was taken with complains of acute pain in the lower part of abdomen that is felt in anus. She lost consciousness. In anamnesis: there are 2 deliveries, 2 medical abortions.

Last menstruation took place 6 weeks ago. General state is satisfactory. P – 90 strokes/min., ABP– 105/60 mm of mercury.

Vaginally: womb is slightly enlarged. Over right fornix there are enlarged and painful appendages. They are badly bordered because of tension and painfulness of posterior fornix. Discharge is dark, bloody and poor.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №33

1.Right tubal preg, rupture, intraabd hemorrhage

2..immediate lapratomy.tubectomy or tube reconstruction drainage of hemorrage

Situation task No 34

A woman, 34 years old, complained of profuse bloody discharge with grumes. She is on the books because of cervical erosion. She hasn’t consulted a doctor for 15 years. She has had sexual life since 20 years old. There were no pregnancies. She didn’t preserve. While examining in speculum: on the neck of uterus there are a great number of cups bleeding profusely.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №34

1.Cervix carcinoma,hemorrhage

2.in case ofabsence of doctor insert tampons soaked with hydrogen peroxide in to vagina

< 50 yo electroconization of the cervix

if >50 yr old extirpation of uterus

Situation task No 35

A patient, 29 years old, complained of acute pain in the lower part of abdomen after physical activity. She is on the books because of cyst of left ovary.

Examination showed: tension of anterior abdominal wall, Blumberg's sign is positive.

Vaginally: body of womb is of normal size, appendages on the right are not enlarged,

tumor-like mass in 7x9 cm on the left is defined, very painful during palpation.

1. Diagnostics of urgent state

2. Tactics determination and rendering of emergency medical aid.

Situation Task №35

1.Left ovarian cyst rupture

Situation task No 36

Patient 57 years old address to gynecologist with complains of acute pains are progresses in the low parts of abdomen, body temperature increase up to 38.0º С, general weakness.

In anamnesis: was registered on the gynecologist’s books due to hysteromyoma. Did not address to doctor last 3 years.

Objectively: tongue is clear, dry, abdomen is a little tympanitic, painful in palpation in low regions of abdomen. Peritoneal symptoms are positive.

Per vaginum: uterine corpus is enlarged to 11-12 weeks of pregnancy due to plural nodes of myoma, sharply painful in palpation and movement. Both side appendages are not palpable.

Formulate the diagnosis of urgent state.

Determine the tactics of first aid.

Situation Task №36

1.Necrosis of myomatous node

2. Removal (twist off) of the nascent submucous node would be indicated.

Situation task No 37

Woman E. in conferment, 23 years old, was hospitalized for delivery with good labor activity. Delivery – 1^st, pregnancy – 3^rd. Previous pregnancies were interrupted by therapeutic abortion without complications.

Hemodynamics is stable. Body height – 148 cm, circumference of abdomen – 100 cm, uterine fundus high – 37 cm. Sizes of pelvis: 22-25-28-17 cm.

Labor pains are present during 5 hours, regular, intensive. Amniotic fluid has discharged 3 hours ago.

Complains of pain in low part of abdomen between labor pains.

Position of fetus is longitudinal, presenting head is crowded to pelvic inlet.

Fetal heart rate is muted, rhythmic, 110 per minute.

Per vaginum: cervix is 2 cm dilated, is smoothed not completely, dense, low-elastic. Presenting head push itself off. Light amniotic waters leak. Promontory is palpable.

Formulate the diagnosis of urgent state.

Determine the tactics of first aid.

Situation Task №37

1.Preg 3^rd, 1^st delivery, threaten uterine rupture.contracted pelvis 2 degree

2.Urgent cesarean section is indicated.

Situation task No 38

Woman D. in conferment was hospitalized with active labor activity.

Delivery – 2^nd, pregnancy – 2^nd. First delivery - without complications.

Hemodynamics is stable. Birth pains in 45-50’’, intervals – 3-4 minutes, strong. Labor activity is present during 6 hours. Amniotic fluid has discharged during hospitalization.

Position of fetus is longitudinal, breech presentation. Fetal heart rate is 140 per minute, clear, rhythmic.

Per vaginum: cervical dilatation is complete. Amniotic sac is absent. There is a leg of fetus and pulsing loop of umbilical cord inside the vagina. Buttocks are compressed to pelvic inlet.

Formulate the diagnosis of urgent state.

Determine the tactics of first aid.

Situation Task №38

1.Beginning 2 stage delivery, breech presentation, umbilical cord prolapse

2.artificial amniotomy.managment of labor by tsovianov

Situation task No 39

Woman K. in conferment, 35 years old. Was hospitalized to maternity home with active labor activity during 10 hours. Amniotic fluid has discharged 2 hours ago.

Delivery – 5^th, pregnancy – 9^th. Circumference of abdomen – 105 cm, uterine fundus high – 39 cm.

Position of fetus is longitudinal, presenting head is crowded to pelvic inlet.

During one of labor pains acute pain in the abdomen, cold sweat, rapid pulse have come.

Objectively: skin is pale, weak pulse – 98 per minute. Tympanitic abdomen, peritoneal symptoms are positive and full-blown.

Formulate the diagnosis of urgent state.

Determine the tactics of first aid.

Situation Task №39

1.1 period labor, big fetus, uterus rupture, hemorrhage shock

2)emergency laparotomy with csec delivery

fluid and blood transfusion

cesarean hysterectomy

Situation task No 40

Woman in conferment, 28 years old, was hospitalized to maternity home for delivery. Delivery – 1^st, pregnancy – 1^st, mature.

Birth activity is present during 8 hours. Amniotic fluid has discharged 6 hours ago at home.

Objectively: general status of the woman is good, pulse rate – 72 per minute, blood pressure – 120/70 mm.Hg. Sizes of pelvis: 25-27-30-19 cm.

Position of fetus is transverse. Head is on the left, pelvic part of fetus is on the right. Presenting part is absent. Fetal heart rate is not auscultated.

Per vaginum: cervical dilatation is complete. Amniotic sac is absent. Shoulder of the fetus is determined inside the pelvic inlet. Promontory is not palpable.

Formulate the diagnosis of urgent state.

Determine the tactics of first aid.

Situation Task №40

1.End 1 stge, transverse lie, fetus death

2.destructive operation-decaptitation and cleidotomy.,csec

Situation task No 41

Woman in conferment, 24 years old. Was hospitalized to maternity home with good labor activity. Pregnancy – 3^rd, delivery – 3^rd. First delivery was ended by embryotomy, second delivery – by operation of cesarean section.

Circumference of abdomen – 105 cm, uterine fundus high – 37 cm. Sizes of pelvis: 23-26-29-17 cm.

Position of fetus is longitudinal, presenting head is movable above the pelvic inlet.

Fetal heart rate is 140 per minute, clear, rhythmic. Birth pains in 45-50’’, intervals – 2-3 minutes. Amniotic sac is whole.

Per vaginum: cervix is smoothed, cervical dilatation is 5 cm. Presenting head push itself off. Amniotic sac is whole. Promontory is palpable. Diagonal conjugate is 11 cm long.

During one of labor pains acute pain in the abdomen, cold sweat, rapid pulse have come. Shape of uterus has changed: in the left of centerline – roundish corpus of uterus, in the right – fetus.

Formulate the diagnosis of urgent state.

Determine the tactics of first aid.

Situation Task №41

1. 3 preg. 3 deliver, 1stage deliver, big fetus, juxta minor 2 degree, hemorrhage, fetus death, uterine rupture

2. immediate laparotmy.extirpation of the uterus.replacement of blood loss.prevention of DIC.

Situation task No 42

Woman in conferment, 28 years old. Was hospitalized with mature pregnancy and good labor activity.

Pregnancy – 5^th, delivery – 3^rd, there are two therapeutical abortions without complications in anamnesis. Labor pains continue during 12 hours, waterless period – 6 hours.

General status of the woman is good, Body temperature is 37,5°С, pulse rate – 94 per minute, rhythmic.

Position of fetus is longitudinal, presenting part is not palpated. Fetal heartbeats are not auscultated.

Per vaginum: cervical dilation is complete, there is a hand and not-pulsing loop of cord inside the vagina.

Formulate the diagnosis of urgent state.

Determine the tactics of first aid.

Situation Task №42

1.End 1 stage n begin 2 stage, cord prolapse, fetal death

2.destructive operation-decaptitation and cleidotomy.

Situation task No 43

Patient, 26 years old. Was hospitalized to gynecological department with complains of profuse bleeding with grumes from genitals. Woman considers herself pregnant, last menstruation was 8 weeks ago.

General status of patient is good. Body temperature is normal, pulse rate – 78 per minute, rhythmic.

Per vaginum: non-parous, narrow vagina. Cervical canal is passable for 2 cm, corpus of uterus is enlarged to 6-7 weeks of pregnancy. Discharges are profuse, bloody with grumes.

Formulate the diagnosis of urgent state.

Determine the tactics of first aid.

Situation Task №43

1.Spontaneous abort, incomplete abort

2.curretage of the cervical canal and uterine cavity.give uterotonics and antibiotikcs.replacement of blood loss

Situation task No 44

Woman in conferment, 29 years old. The third delivery continues 7 hours.

Complains of bloody discharges with grumes.

General status of patient is good. Skin and visible mucous tunics have usual color. Body temperature is normal. Blood pressure – 100/70 mm.Hg., pulse rate – to 94 per minute, rhythmic.

Position of fetus is longitudinal, presented head is situated high above the pelvic inlet.

Fetal heart rate is 134 per minute, clear, rhythmic.

Per vaginum: cervix is dilated to 5 cm. In the right-posterior side placental tissue is determined. Amniotic sac is whole. Head is high above the pelvic inlet. There are grumes in vagina.

Formulate the diagnosis of urgent state.

Determine the tactics of first aid.

Situation Task №44

1. 3 deliver, 1 stage, lat PP

2.amniotomy and urgent csec

Situation task No 45

Pregnant woman K., 23 years old, was hospitalized into maternity home for delivery. The first mature pregnancy. Blood pressure arise up to 140/100 mm.Hg. repeatedly during the pregnancy, woman did not ask for help. She visited the maternity welfare centre infrequently.

Complains of head ache, stuffiness in nose, blurred vision, pain in epigastric region.

Objectively: body temperature is normal, pulse rate – 90 per minute, blood pressure – 180/110 mm.Hg., edema of legs and anterior abdominal wall. Urine protein – 6 g/l. Attack of convulsions happened at home.

Position of fetus is longitudinal, cephalic presentation, fetal heart rate is 100 per minute, muted.

Formulate the diagnosis of urgent state.

Determine the tactics of first aid.

Situation Task №45

1. 1 preg, eclampsia, antenatal fetal distress syn

2 droperidol 4.0-0.25%diazepam 2.0-0.5% → iv 4 hrs,rpt 2/3 of dose in 4 hrs.later½dose

promedolum 1.0-2.0% dimedrolum 1%-2%

-30 ml 25% mgso4 400 ml rheopolyglucin repeat after 4 hrs IM or iv in drops 15-35 drps/min

-hypotension drugs 1%hexonal iv/40 ml 2.5% vladnil/predion 10ml 3.4% euphllinum, 2-4ml 2%papaverine

kiv--> halothane or nitrous oxide inhalation.immediate csec.resus measurements according to protocol

Situation task No 46

Pregnant woman C. was hospitalized for delivery with mature pregnancy. Labor activity is absent. Pregnancy is the first.

Woman complains of head ache, sickness, “scales in front of her eyes”, there were one vomiting at home.

Objectively: General status of patient is moderate, Blood pressure – 170/110 mm.Hg., urine protein – 3 g/l, edema of legs and anterior abdominal wall.

Presenting part is not palpated, head of fetus is on the right, back is on the left, fetal heartbeats are auscultated on the level of navel, dull, to 130 per minute, rhythmical.

Attack of convulsions has started 20 minutes after admission.

Formulate the diagnosis of urgent state.

Determine the tactics of first aid.

Situation Task №46

1. Pre-eclampsia severe, transverse position(eclampsia)

2.droperidol 4.0-0.25%diazepam 2.0-0.5% → iv 4 hrs,rpt 2/3 of dose in 4 hrs.later½dose

promedolum 1.0-2.0% dimedrolum 1%-2%

-30 ml 25% mgso4 400 ml rheopolyglucin repeat after 4 hrs IM or iv in drops 15-35 drps/min

-hypotension drugs 1%hexonal iv/40 ml 2.5% vladnil/predion 10ml 3.4% euphllinum, 2-4ml 2%papaverine

immediate csec.resus measurements according to protocol

Situation task No 47

Patient A., 28 years old, was hospitalized into gynecological department with complains of profuse bloody discharges with grumes.

Last menstruation was 2.5 months ago. Woman is registered on the books with pregnancy, pregnancy is desired. She thinks her condition has the cause in psycho-emotional stress.

Objectively: general status of patient is good. Pulse rate – 120 per minute, blood pressure – 90/60 mm.Hg. Skin and mucous tunics have usual color.

Per vaginum: cervix is shortened up to 1.5 cm, cervical canal is opened, embryo is situated there. Uterus is enlarged up to 4-5 weeks of pregnancy, discharges are bloody, profuse, with grumes.

Formulate the diagnosis of urgent state.

Determine the tactics of first aid.

Situation Task №47

1.Spontaneous abort in progress, profuse bleed,

2.curretage of the cervical canal and uterine cavity.give uterotonics and antibiotikcs.replacement of blood loss

Situation task No 48

Patient B., 35 years old. Was hospitalized with complains of bloody discharges from genital tracts after coitus.

In anamnesis: menstruations since 11 years, every 28 days, moderate. There were one pregnancy was ended by therapeutic abortion without complications.

Per speculum: there is a cup (crater) on the cervix, which bleeds profusely. Uterus has normal sizes, appendages are not palpated.

After the doctor’s manual examination profuse bleeding has started.

Formulate the diagnosis of urgent state.

Determine the tactics of first aid.

Situation Task №48

1.Malignant of cervix, 2 stage

2.Hysterectomy (extirpation of uterus with adnexa) ,combined radiotherapy and chemotherapy

Situation task No 49

Patient N., 25 years old. Complains of low abdominal pains, nausea, vomiting. Therapeutic abortion in term 3 weeks of pregnancy was done day before.

Objectively: general condition is severe, pulse rate – 120 per minute, body temperature – 37.5°C, Blood pressure – 90/60 mm.Hg., skin is pale. Abdomen is tensed, peritoneal signs are positive. Dullness on percussion in low regions of abdomen is revealed.

Per vaginum: cervix is passable for 2 cm, uterus is enlarged up to 7-8 weeks of pregnancy, soft, painful, fornicis of vagina are tensed, painful. Discharges are bloody, moderate.

Formulate the diagnosis of urgent state.

Determine the tactics of first aid.

Situation Task №49

1.Uterus perforation( acute abd)(? Peritonitis)

2.Urgent explorative laparotomy; removal of the source of peritonitis; revision, sanitization and drainage of the abdominal cavity would be indicated.

Situation task No 50

A girl, 12 years old, complains of spastic pain 4-5 days every week in the course of half a year. During admission to hospital: severe pain in is resistant to analgesics.

In examination of external genitals: there are protrusion between leafs of small lips of pudendum throw what the violet fluid is seen.

The foramen of hymen is absent.

Formulate the diagnosis of urgent state.

Determine the tactics of first aid.

Situation Task №50

1.Inpeforated( aplasia) hymen

2hymenectomy

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Standard task No 1
A patient O., 29 years old, was taken to gynecology department. She complained of temperature rise, general weakness, pain in the lower part of abdomen.
Anamnesis: Last menstruation was 3 months ago. The patient had 4 pregnancies, two of them finished with easy delivery and two ones - with artificial abortions. Last abortion was done 8 days ago. She was discharged from hospital the next day after abortion.
Objective observation: general state is satisfactory, P-100 strokes/minute, rhythmical.
Arterial blood pressure (ABP) – 120/80 mm of mercury, T – 38,2 C. Her tongue is moist, slightly coated white. Abdomen is soft, rather painful over pubis. There is profuse purulent discharge from cervical canal.
PV: cervix of the uterus is of cylindrical form, external fauces is closed, body of womb is a bit larger than the norm is, of soft consistency, palpatory tenderness. Appendages are not palpated.
Diagnosis?
What treatment is necessary?

1.Ac. Endometritis after abortion
2.Conservative treatment of endometriosis- bed rest,antibiotic cefoxitin 2g IV every 6 hrs; doxycycline 100mg IV every 12 hours,vitamins,cold compressed at lower abdomen

Standard task No 2
A patient Z., 38 years old, was taken to clinic. She complained of constant pain in the lower part of abdomen irradiating in loin, temperature rise up to 38C.
Anamnesis: Last menstruation was 11 days ago. She’s had sexual life since she was 26 years old. There were no pregnancies. She hasn’t preserved. Time and again she’s undergone treatment for oophoritis. Twice the puncture of posterior fornix was done, there was pus in punctate. Antibacterial therapy was undergone.
Objective observation: General state is of medium severity, PS-104 strokes/minute, satisfactory.
Arterial blood pressure (ABP) – 120/70 mm of mercury, T of body – 39,4 C. While examining: abdomen is swollen, takes part in the act of breathing, during palpation it is tense and painful in lower parts. Blumberg-Shchyotkin’s symptom is positive.
In speculum: cervix of the uterus is clean, pus is oozing from cervical canal of uterus.
PV: body of womb is not well-contoured because of acute painfulness of abdomen. Left appendages are not palpated. Mass in 12x7cm is palpated to the left and from behind of the womb; it is sharply restricted in mobility, painful. The puncture of posterior fornix was done, 20 ml of pus was obtained.
Diagnosis?
What is the plan of further treatment of the patient?
1. Tubo-ovarian abscess.Pelvioperitonitis
2. Surgical intervention,anti bacterial,ice bag,desintoxication therapy,vitamins



Standard task No 3
A patient D, 36 years old, complained of excessive (profuse) menstruation. She is on the books because of hysteromyoma. Womb was enlarged up to 6-7 weeks of pregnancy. Bleeding began 10 days ago and has been continuing till now. She’s had menstruations since she was 10 years old, regular; for the last year they have been profuse and lasted for 7-10 days. She’s had sexual life since she was 20 years old. There were two pregnancies finished with medical abortions without any complications.
Objective observation: general state is satisfactory, PS- 76 strokes/minute.
Arterial blood pressure (ABP) – 120/80 mm of mercury, T – 39,4 C. Abdomen is soft, painless.
PV: body of womb is enlarged up to 11 weeks of pregnancy, dense, painless, appendages from both sides are not enlarged, discharge is bloody and profuse.
Diagnosis?
What is doctor’s approach?
1.Rapid growth uterus myoma+hemorrhagic syndrome
2.Seperate diagnostic D&C.Surgical intervention(hysteromyoma,hysterectomy + myomectomy) ,hormone therapy

Standard task No 4
A patient Z., 40 years old, was taken to gynecology department. She complained of cramp-like (spasmodic) pain in the lower part of abdomen and profuse bloody discharge from genital tracts. She is inclined to believe that she has been ill for the last 4 years when excessive menstruations with grumes and pain in the lower part of abdomen began. She has suffered from anemia for 3 years, twice she was treated in the hospital. She’s had menstruations since she was 12, regular. For the last 2 years they have lasted for 15-16 days, profuse, painless. There were two pregnancies that finished with medical abortions.
Objective observation: general state is satisfactory, PS- 92 strokes/minute.
Arterial blood pressure (ABP) – 110/60 mm of mercury. Skin and visible mucous tunic are pale, there is systolic murmur on the apex of heart. Abdomen is soft, painless.
PV: node of myoma comes from cervical canal of the uterus, its diameter is up to 3 cm, on thin limb (foot); womb is a bit larger than the norm is, dense, painless. Appendages are not palpated. Discharge is bloody, profuse.
Diagnosis?
What is doctor’s approach?
1.Pedunculated submucous node
2.surgery due to excessive bleeding(myomectomy,hysterectomy,laparoscopic hysterectomy,laparoscopic myomectomy,laparotomy myomectomy,hysteroscopy myomectomy)

Standard task No 5
A patient N., 37 years old, complained of pain in abdomen in the region of postoperative cicatrix and bloody discharge out of it, especially before and after menstruation, pain in the lower part of abdomen, especially on the right.
Anamnesis: She’s had menstruations since she was 13, regular. For the last 4 years they have been long-lasting, profuse and painful. There were 5 pregnancies: 2 easy deliveries, 2 medical abortions without any complications and one abdominal pregnancy.
Objective observation: general state is satisfactory, PS- 80 strokes/minute.
Arterial blood pressure (ABP) – 120/80 mm of mercury. Dense painful nodules are palpated in the thickness of postoperative cicatrix. Cicatrix and skin above it is of cyanotic color. Abdomen is soft, rather painful on the right.
PV: womb is of normal size, dense, painless, appendages on the left are not palpated, to the right of the womb painful mass in 7x8cm is palpated, it’s limited in mobility, Discharge is mucous.
Diagnosis?
Treatment?
1.Ext. endometriosis,endometrial cyst right ovary
2.cystectomy, hormonal therapy??(NSAID,pregesteron,antigonadotropin-donazol,GnRH agonist-Zoledex)



Standard task No 6
A patient I., 29 years old, consulted about the lack of menstruation during 8 weeks.
Anamnesis: She’s had menstruations since she was 14, regular. There were 4 pregnancies: 2 of them finished with delivery at term (partus matures), 2 - with medical abortions without any complications. The patient mentions aching (dull) pain in the lower part of abdomen for the last week; there was no bloody discharge.
Objective observation: no pathology in organs and systems.
PV: while palpating womb is of rounded form, painful, tense, enlarged up to 10-11 weeks of pregnancy. From both sides enlarged appendages are palpated. Discharge is light, moderate.
Provisional (working) diagnosis?
US (ultrasonic scanning) shows: elements of cystic (grape) mole occupy all cavity of uterus.
Diagnosis?
Plan of patient’s management? Treatment?
1.Gestational throphoblastic disease.Total/complete Hydatiform Mole
2.D&C,chemotherapy-methotrexate 2-3 course

Standard task No 7
A patient K., 27 years old, went to antenatal (maternity welfare) clinic with complaints of general weakness, dyspnea (short breath), palpitation, cough and dark discharge from vagina.
Anamnesis: She’s had menstruations since she was 14, regular. Last menstruation was 5 months ago. There were 3 pregnancies: 1- finished with easy delivery, 2 - with medical abortions without any complications. Three months ago there was spontaneous miscarriage in the term of 6-7 weeks; curettage of uterine cavity was made. 2 weeks later the patient consulted about bloody discharge. Repeated curettage of uterine cavity was made. Elements of fetal egg were not discovered in the scrape. A week later after curettage dyspnea (short breath), cough appeared.
Objective observation: general state is of medium severity, PS- 98 strokes/minute.
Arterial blood pressure (ABP) – 100/70 mm of mercury, hemoglobin – 47g/l, erythrocyte sedimentation rate (ESR) – 47 mm/hour.
PV: womb is enlarged up to 14 weeks of pregnancy, has uneven surface. Appendages are palpated. Discharge is dark, bloody.
Pneumonography shows: metastatic involvement of lungs.
Final diagnosis?
Treatment?
1.Chorioepithelioma,early metastasis to lung , anemia
2.Hysterectomy,chemotherapy(methotrexate po 15-30 mg/d 5 days-stop for 7 days-repeat(3-5 course),mercaptopurine,rubomycin)
Standard task No 8
A patient V., 45 years old, complained of bloody discharge from the vagina after coitus.
Anamnesis: Inheritance is not overburdened. There were 5 pregnancies: 2 of them finished with easy delivery, 3 - with medical abortions without any complications
In speculum: cervix is hypertrophied. There is tuberous cauliflower-like tumor on its anterior lip in 2x2, it bleeds when touching.
PV: body of womb is of normal size, appendages are palpated. Through rectum: supravaginal part of womb is firm (dense), there is tumor-like pelvic mass, infiltrates are not detected.

Diagnosis?
What is to be done to make the diagnosis more exact.
Method of the patient’s treatment?
1.Cervix cancer 1st degree/ maybe exopyhtic form of cervical cancer stage 2B(vaginal variant)
2.Hysterectomy (extirpation of uterus with adnexa) ,combined radiotherapy and chemotherapy

Standard task No 9
A patient A., 60 years old, complains of pains in the left inguinal region and left hip, especially at night pain is of “gnawing” character. Painful urination (strangury). Obstructed defecation. There is blood in urine and feces (stool). She has been ill for more than a year. Her state is grave. PS- 90 strokes/minute. Arterial blood pressure (ABP) – 90/60 mm of mercury, T – 37,2C, emaciated. Immobile dense mass is palpated in epigastric region.
In speculum: In the cupula of vagina there is crater with necrotic incrustation. Discharge is “meat slops-like”.
PV: 2/3 of walls of vagina are infiltrated. In small pelvis there is conglomeration of dense consistency coming to walls of pelvis from both sides, immobile, painful.
Through rectum: mucous tunic of rectum is immobile. Infiltrates are seen (marked) in parametrias from both sides reaching the walls of pelvis. Bloody discharge.
Diagnosis?
Necessary treatment?
How can you explain pains in left hip?
1.Cervix cancer 3-4 degree(endopyhtic form of cervical cancer-disintergration
2.symptomatic treatment-vaginal tamponade soaked in water/CaCl2 for 6-8 hours.if bleeding continues repeat again
3.pain due to metastasis to kidney


Standard task No 10
A patient Zh., 53 years old, was taken to gynecological clinic. She complains of bloody discharge from vagina.
Anamnesis: Inheritance is not overburdened. Menopause – 3 years. There were 4 pregnancies: 3 of them finished at term, 1 - with artificial abortion without any complications. She denies gynecological disorder (disease). Periodically moderate bloody discharge appears from vagina for the last 3 months.
Provisional diagnosis?
Histological study: multiple polyps of endometrium without signs of malignization.
Final diagnosis?
Plan of the patient’s management?
1) Endometrial polyps( polypoid form of glandular-cystic hyperplasia)
2) conservative tx 1)infecundin(estrogen-gestogen) biscecurin norquest 1 tab daily for d5-25 of cycle for 4-12 months
2)hydroxyprogesterone caproate IM 250-500 2t/wk 6-12 months
norcolut 5-10 mg daily
3) androgen(methyltestosterone,tesnatel)in older women

Examination task No 11
A pregnant woman, 21 years old, was taken for delivery. Pregnancy – 1, at full term (partus matures), duration of delivery – 12 hours. Amniotic fluid moved away 2 hours ago. Active labor pains began, for 55-60 seconds every 2-3 minutes.
Pelvis size: 27-28-32-18. Abdominal circumference – 95 cm, height of elevation of fundus of uterus- 35cm. Back is on the right, small parts of fetus are on the left. Head is pressed to the opening into small pelvis. Fetal heartbeats are distinct, up to 140 strokes/min., rhythmic.
Vaginally: opening is full, there is no fetal bladder, cephalic presentation, head is pressed to the opening into small pelvis. Arrow-shaped suture in transverse incision is 2 cm closer to promontory. Small fontanel is on the right, large one is on the left. Diagonal conjugate is 11cm.
Diagnosis?
Define head’s fitting and doctor’s approach.
1)1st pregnancy+labor.end of 1st stage beginning of 2nd stage of labor.Flat rachitic
2)csec
Standard task No 12
A patient, 12 years old, complained of excessive (profuse) bloody discharge from genital tracts. She’s had menstruations since she was 11 years old, irregular; there is delay of menstruation for 2-3 weeks whereupon bleeding is observed. She denies sexual life.
General state is satisfactory, P- 80 strokes/minute, skin is pale.
Arterial blood pressure (ABP) – 100/60 mm of mercury.
External inspection: external genitals are hypoplastic, adult woman pattern of hair distribution.
Hymen is intact.
Through rectum: body of womb is small, mobile and painless. Appendages are not palpated. Discharge is bloody and profuse.
Diagnosis?
What is doctor’s approach?
1)DUB(juvenile uterine bleeding)
2)hormonal hemostatic estrogen
-1ml 0.1%dihydrostillbesterol sol IM every 2-4 hours
-folliculin 10000-20000 u po every 2-4 hours
-progesterone cyclogest 200mg-400 mg/day PR/supp
3)tx for anemia
Standard task No 13
A patient, 40 years old, complained of excessive (profuse) menstruation. She’s been on the books because of hysteromyoma for 6 years. Last time she went to gynaecologist a year ago. Size of myoma is 8 weeks.
In speculum cervix of the uterus has no pathology.
Vaginally: Womb is enlarged up to 10 weeks of pregnancy, nodular, appendages are not palpated. Discharge is mucinous.
Diagnosis?
What is doctor’s approach?
1.myoma of uterus
2.stop bleeding-hormonal hemostasis
cbc coagulogram
anemia->surgical tx-myomectomy
Standard task No 14
A patient has temperature rise up to 39C three days later after Cesarean section (operation), tachycardia up to 120 strokes/minute. In general blood analysis there is leukocytosis and formula shift to the left. Diagnosis: peritonitis after Cesarean operation. Relaparotomy was made. There is
serous effusion in abdominal cavity, intestinal loops are swollen, injected. Womb is not changed,
postoperative cicatrix (scar) is in good (normal) state.
What is doctor’s approach under this pathology
1.postoperation peritonitis
2.treatment and drainange of abdominal cavity







Standard task No 15
A patient E., 21 years old, has complained of pain and bloody discharge after sexual connection for the last 4 months. She’s had menstruations since she was 11, during 3-4 days, moderate, painless, every 28 days. In anamnesis there is one artificial abortion and one easy delivery.
In speculum: on the cervix of the uterus there is ruby (scarlet) erosion (cervical erosion), granular, 2x2 cm, it bleeds when palpating.
PV: vagina is capacious, cervix of the uterus is cylindrical, dense, external fauces is closed. Body of womb is of normal size, dense, mobile, painless. Fornixes (vaults) are high. Appendages are not palpated, discharge is sanious.
Diagnosis?
What examination methods are necessary? Doctor’s approach”
1.cervix precancer
2.vagotil,tampon with cod liver oil,ointment plus antibiotics
colposcopy,biopsy then electrocoagluation/transcoplasty

Standard task No 16
A girl, 11 years old. She complains of crampy abdominal pains. Pains recur every 3,5-4 weeks and last for 3-4 days, then pains disappear.
When examining pudendum it was detected: there is outpouching (protrusion) between leaves of
small lips of pudendum through which violet contents is seen. There is no opening in hymen.
US (ultrasonic scanning) detected haematometra
Doctor’s approach?
1.atresia of hymen
2.hymenectomy
Standard task No 17
A patient B., 48 years old, complains of dull ache in the lower part of abdomen, mostly on the left.
There are hot flushes, headache. Anamnesis: She’s had menstruations since she was 13, every 28 days, regular, painless. There was 1 delivery, 3 abortions without any complications.
PV: vagina is capacious, cervix of the uterus is of cylindrical form, body of womb is not enlarged, of usual (common) consistence, mobile, painless. Right appendages are not palpated. On the left and from behind tight and elastic mass in 10 x 12cm is palpated; it is mobile and painless. Serous discharge.
Diagnosis?
Doctor’s approach?
1.right ovary cyst
2.cystectomy
Standard task No 18
A patient Y., 30 years old. She complains of poor (scanty) bloody discharge from genital tracts.
Anamnesis: She’s had menstruations since she was 12, for 3-4 days, every 28 days. They are regular, painless. Last menstruation was 6 weeks ago. There were 2 deliveries, 2 abortions without any complications.
General state is satisfactory, P- 80 strokes/minute, Arterial blood pressure (ABP) – 120/80 mm of mercury. Skin and visible mucous tunics are of usual color.
PV: vagina of parous, capacious. Cervix of the uterus is of cylindrical form, rather soft, fauces admits (is patulous for) cupula of a finger. Body of womb is enlarged up to 6 weeks of pregnancy. While palpating it gets into tonus, mobile, sensitive. Appendages are not palpated. Poor (scanty), sanious discharge.
Diagnosis?
Plan of management? Treatment?
1.Abortion beginning, coz isthmocervico insuff(6th week pregnancy.imminent abortion)
2.bed rest,progesteron 5-10 mg/day IM for 10 days ,turinal 1-2 tabs,urogesteron 200-300 mg po/dy

Standard task No 19
A patient D., 20 years old. She complains of lack of menstruation. Sexual life during one year. There have been no pregnancies.
Genital state: external genitals are hypoplastic. Vagina of nullipara, narrow. Fornixes are not evident (feebly marked). Cervix of the uterus is conical, long, is ½ larger than the body of womb. Womb is dense, painless, mobile in retroflexion. Appendages are not palpated, discharge is scanty, serous.
Diagnosis?
Doctor’s approach under this pathology?
1.hypoplasia of uterus.infertility
2.normal treatment

Standard task No 20
A patient D, 45 years old. She is on the books because of hysteromyoma. She hasn’t been examined by gynaecologist for the last 3 years. She complains of excessive (profuse) menstruation with grumes for the last 2 years. Anamnesis: She’s had menstruations since she was 12 years old, duration - for 3-4 days, moderate, painless. She’s had sexual life since she was20 years old. There were 3 deliveries, 3 abortions without any complications.
PV: vagina is capacious. Cervix of the uterus is of cylindrical form, body of womb is enlarged up to 15-16 weeks of pregnancy, painless when palpating, limited in mobility, tuberous. Discharge is usual.
Diagnosis?
What is doctor’s approach?
1.sarcomatous degeneration(hysteromyoma submucous/intramural)
2.surgical treatment
Standard task No 21
A pregnant woman, 23 years old, was taken for delivery. Pregnancy – 1, full-term. Labor pains has been lasting for 5 hours, amniotic fluid is intact. Growth – 148cm. Abdominal circumference – 100 cm, height of elevation of fundus of uterus- 37cm. Pelvis size: 23-25-28-17. Labor pains are regular, intense for 45-50 seconds every 2-3 minutes. Between birth pangs pains appeared in the lower part of abdomen. Fetal lie is longitudinal, cephalic presentation, head is pressed to the opening into small pelvis. Urination is difficult. Fetal heartbeats are up to132 strokes/min., distinct, rhythmic.
Diagnosis?
Doctor’s approach?
1. 1st pregnancy,labor.active phase of 1st stage.Justo minoe pelvis
2. 2.c-sec





Standard task No 22
A pregnant woman, 25 years old, was taken for delivery with regular birth activity. Labor pains has been lasting for 8 hours. Amniotic fluid moved away 8 hours ago. Pregnancies -2, deliveries – 2.
Pelvis size: 26-29-33-21. Fetal lie is longitudinal, large balloting head is palpated at the bottom of the womb, pelvic end is palpated over the opening into small pelvis.
Vaginally: opening of uterine fauces is full. There is no fetal bladder. Leg of fetus and pulsatile (beating) loop of cord are palpated in vagina. Light fluid is running.
Diagnosis?
Doctor’s approach in this situation?
1)the 2nd labor,at term.the 2nd stage labor.breech presentation complete footling
2)artificial amniotomy.managment of labor by tsovianov-retain leg in vagina until uterine os has completely opened.cover ext genetalia with sterile napkin.place hand on it to avoid premature expulsion—fetus squats to assume complete breech presentation
-complete opening of cervical os protusion of perineal area under thrust of fetal hips

Standard task No 23
A pregnant woman, 28 years old, was taken for delivery with regular birth activity and complaints of bloody discharge from genital tracts. Amniotic fluid is intact. Pregnancies -3, delivery – 1. Two pregnancies finished with medical abortions.
General state is satisfactory, P-90 strokes/minute. Arterial blood pressure (ABP) – 100/70 mm of mercury. Skin is pale. Fetal lie is longitudinal, cephalic presentation, head is pressed to the opening into small pelvis. Fetal heartbeats are distinct, rhythmic, up to140 strokes/min.
Vaginally: opening of uterine fauces is 8cm, fetal bladder is intact, to the left and from behind margin of placenta is palpated. Head pushes off. There are grumes in vagina.
Diagnosis?
Doctor’s approach?
1.placenta previa marginal/lateral
2. rupture of amniotic membrane(amnioectomy)
observe n count blood loss *if blood lost more than 300ml do csec
symptomatic treatment-blood replacement.


Standard task No 24
A pregnant woman, 24 years old, was taken for delivery. Delivery – 1, at full term. It has been lasting for 14 hours. Labor pains became weaker. Amniotic fluid moved away 2 hours ago.
Pelvis size: 26-29-31-21. Fetal lie is longitudinal. Fetal heartbeats are up to180 strokes/min., muffled. Head with a large segment is in the cavity of small pelvis.
Vaginally: opening of uterine fauces is full. Arrow-shaped suture is in left oblique incision. Small fontanel is on the right ahead. Discharge is light fluid.
Diagnosis?
Doctor’s approach in this pathology?
1.Premature rupture amniotic fluid, 2” labor weakness
2.augmentation of labor with oxytoxin-- 8 unit oxytoxin + 400 ml glucose-6.5 rops/min (<4 drops to avoid tetanus)-->uterine rupture
enzaprost 5mg + 500ml of glucose OR
2.5 U oxytoxin +2.5mg prostaglandin in 500ml 5% glucose
if no effect... c-sec

Standard task No 25
A pregnant woman, 22 years old, was taken for delivery with regular birth activity that has been lasting for 8 hours. Amniotic fluid is intact. Delivery -1 at full term (partus matures). State is satisfactory. P – 80 strokes /min. ABP –115/70 mm of mercury.
Pelvis size: 23-25-28-18. Abdominal circumference – 95 cm, height of elevation of fundus of uterus- 35cm. Supposed fetus mass according to US – 3200,0.
Fetal lie is longitudinal, cephalic presentation, head is pressed to the opening into small pelvis. Fetal heartbeats are distinct, rhythmic, up to140 strokes/min. Labor pains are good, for 40-45 seconds, every 3-4 minutes.
Vaginally: cervix of the uterus is smoothed, opening of uterine fauces is up to 6 cm, fetal bladder is intact, head is pressed to the opening into small pelvis. Arrow-shaped suture is in the left oblique incision. Small fontanel is on the right ahead. Promontory of sacral bone (sacrum) is accessible. Diagonal conjugate is 11cm.
Diagnosis?
Doctor’s approach? The size of real conjugate?
1 Transverse contracted pelvic(full term pregnancy.primagravida.1st stage of labor.justo minor pelvis
2 c section size of real conjugate 18-9 =9

Standard task No 26
A primigravida, 19 years old, was taken to maternity ward for delivery. Pregnancy – 1, term of pregnancy – 37 weeks. There were two fits of convulsions (spasms) at home. No birth activity.
Objective observation: state is grave. A pregnant woman is slowed-down. ABP –180/120 mm of mercury. P – 90 strokes /min. Evident general (diffuse) edema. Womb is out of (has no) tonus. Fetal lie is longitudinal, cephalic presentation. Fetal heartbeats are distinct, rhythmic, up to136 strokes/min.
Vaginally: cervix of the uterus exists, external fauces is closed, head is palpated through fornixes. It is mobile over the opening into small pelvis. Discharge is mucous, moderate.
Diagnosis?
Doctor’s approach under this pathology?
1)37 week pregnancy.primapara.Preeclampsia,ac. Hypoxia
2)halothane narcosis.nitrous oxide.immediate c-sec.catherization of 2 veins.treatment of generalized vasospasm(mgso4 iv 4 g bolus over 10-15 mins,followed by maintanenc infusion of 1g/hr for at least 24 hours after last convulsion.lavetolol iv 10 mg over 1 min and repeat at 5 mins interval with max dose 200mg.maintanence : effective dose 20- 50 mg/hr
treat for hypovolemia and multiple organ failure
Standard task No 27
A pregnant woman, 26 years old, was taken for delivery with regular birth activity that has been lasting for 3 hours. Pregnancy -3, delivery -3. First two pregnancies finished with easy deliveries.
Objective observation: state is satisfactory. Form of abdomen is elongated in transverse size. Abdominal circumference – 110 cm, height of elevation of fundus of uterus- 28cm. head is palpated on the right, on the left in the lateral part of womb there is pelvic end. Labor pains – for 30-35 seconds every 4-5 min.
Pelvis size: 26-29-31-21.
Vaginally: cervix of the uterus is smoothed, opening of uterine fauces is up to 6 cm, fetal bladder is intact, presenting part is not palpated. Promontory of sacral bone (sacrum) is not accessible.
Diagnosis?
Doctor’s approach at this stage of delivery?
1. full term pregnancy.third para plus gravida.active phase of 1st stage of labor.transverse lie 2nd position
2. c-section

Standard task No 28
A pregnant woman, 32 years old, was taken for delivery with mature fetus. There is no birth activity. Amniotic fluid has been leaking for 2 days. Pregnancies -4, deliveries – 4.
Objective observation: general state is of medium gravity. P-96 strokes/minute. Arterial blood pressure (ABP) – 120/80 mm of mercury. T – 38C. Womb is out of tonus.
Fetal lie is longitudinal, cephalic (cranial) presentation, fetal heartbeats are not heard.
Vaginally: Cervix of the uterus is shortened up to 1,5cm, external fauces is patulous for 2 cm. There is no fetal bladder. Head is pressed to the opening into small pelvis. Discharge is putreform.
Diagnosis?
Doctor’s approach?
1. multipara.full term pregnancy.fetal lie longitudinal,cephalic presentation.absent of labor process.preterm rupture of water bag.chorionamnionitis.intrauterine fetal death
2. antibacterial treatment.augmentation of labor.craniotomy(when possible)

Standard task No 29
A primipara, 21 years old, was taken for delivery with active birth activity that has been lasting for 16 hours. Amniotic fluid moved away 2 hours ago.
Objective observation: labor pains occur every 1-2 minutes, of expulsive character for 55-60 seconds. Fetal lie is longitudinal, cephalic (cranial) presentation, head is pressed to the opening into small pelvis. Fetal heartbeats are muffled, up to110 strokes/min.
Vaginally: opening of uterine fauces is full, head cuts in, arrow-shaped suture is in square cut. Leading point is small fontanel. High perineum is paid attention to.
Diagnosis?
Doctor’s approach?
1.perineal injury
2.operative.the rectum must be disected from the vagina by incising the intervening scar tissue,and by dissecting upwards in the rectovaginal septum
antiseptic solution after operation.betadine sol,antibacterial therapy

Standard task No 30
A pregnant woman, 28 years old, was taken for delivery with mature fetus. She complains of profuse bloody discharge from genital tracts. There is no birth activity. Pregnancy-4th, 39-40 weeks. In anamnesis there are three medical abortions complicated with haematometra and endometritis.
Objective observation: general state is of medium gravity. P-90 strokes/minute. Arterial blood pressure (ABP) – 100/60 mm of mercury. Fetal lie is longitudinal, cephalic (cranial) presentation, head is pressed to the opening into small pelvis. Fetal heartbeats are muffled, up to 105-110 strokes/min.
Vaginally: maternal (generative) passages are closed. Through fornixes along the whole length pasty mass (consistence) is palpated. Head is high over the opening into small pelvis. Bloody discharge.
Diagnosis?
Doctor’s approach? Peculiarities of examination of pregnant women having this pathology?
1.pregnancy at 39 weeks.central placenta previa
2.urgent c-sec.blood replacement.prophylactic of DIC syndrome
Standard task No 36
Patient 29 years old was hospitalized into gynecological department with complains of bloody discharges from genital tracts last three weeks, pain in low region of abdomen, general weakness, fatigue, loss of weight, body temperature increase, chest pain, heavy breathing.
Objectively: skin and visible mucous tunics have usual color.
Hemodynamics is stable. In indices of red blood – mild anemia.
In anamnesis: there was a therapeutic abortion in term 6-7 weeks of pregnancy 5 weeks ago.
Per vaginum: uterus is enlarged to 7-8 weeks of pregnancy, soft. Both side appendages are enlarged: in the right - 6×7 cm, in the left - 8×9 cm. HCG-test is positive.
What is the diagnose?
What must be the doctor’s tactics?
1.chorioncarcinoma
2.conservative therapy(chemotherapy-methotrexate,mercaptopurine,rubomycin) and surgical(extirpation of uterus)
Standard task No 37
Patient 27 years old complains of sterility, menstrual disorders. Sterility 5 years.
Objectively: obesity, hypertrichosis.
Per vaginum: uterus is smaller than standard, both-side appendages are enlarged, dense.
Basal temperature is monophase.
In ultrasound examination: cystic degeneration of both ovaries, they are enlarged: right ovary - 4×6 cm, left ovary - 4×5 cm.
What is the diagnose?
What must be the doctor’s tactics?
1)cyst ovary.infertility
2)if small....anti infalmmatory therapy for 4-6weeks
if not..give cystectomy
Standard task No 38
Pregnant woman, 2nd pregnancy, was hospitalized into department of pathology of pregnancy in term 34 weeks with complains of weakness, dizziness, rapid fatigability, exercise dyspnea.
Pregnancy – 5th, delivery – 5th. Last delivery were complicated by bleeding.
Objectively: skin and visible mucous tunics have usual color. Pulse rate – 100 per minute, rhythmic, blood pressure – 100/60 mm.Hg.
Labor activity is absent. Position of fetus is longitudinal, head presents, fetal heartbeats are clear, rhythmic, 140 per minute.
General blood test: Hb – 82 g/l, Er – 2.5×1012/l, color index – 0.6, serum iron – 8.0 mmol/l.
What is the diagnose?
What must be the doctor’s tactics?
1.Anemia gravidarum 2 degree
2.anti anemic drug


Standard task No 39
Woman U. in conferment, 32 years old was hospitalized to maternity home with regular labor activity during 6 hours, amniotic fluid has discharged 4 hours ago.
Pregnancy – 2nd, delivery – 1st. The first pregnancy was terminated by therapeutic abortion.
Objectively: general status of the woman is good, Hemodynamics is stable. Circumference of abdomen – 110 cm, uterine fundus high – 42 cm. Sizes of pelvis: 25-28-30-19 cm.
Birth pains in 45-50’’, intervals – 3-4 minutes, strong.
Position of fetus is longitudinal, presenting head is crowded to pelvic inlet. Fetal heartbeats are clear, rhythmical, 140 per minute.
Vasten’s symptom is positive.
Per vaginum: non-parous, narrow vagina, cervix is smoothed, cervix is dilated up to 8 cm, presenting head push itself off, discharges – light amniotic waters.
What is the diagnose?
What must be the doctor’s tactics?
1)1st preg,1st stage labor, cephalic presentation, CP disproportion
2) forceps removal of fetus***
Standard task No 40
Primipara, 25 years old, was hospitalized into department of pathology of pregnancy with complains of active movements of the fetus.
Term of pregnancy – 35 weeks. There was threatened abortion during this pregnancy, woman received repeatedly therapy for it.
Objectively: general status of the woman is good, Hemodynamics is stable. Uterus has normal tone. Position of fetus is longitudinal, head presentation.
Fetal heartbeats is rhythmic, muted, 130 per minute.
Data of ultrasound examination: hyperplasia of placenta.
Data of cardiotocography: basal rhythm is 100 per minute, PSP-index – 2.0.
What is the diagnose?
What must be the doctor’s tactics?
1.Gestational DM
2.immediate c-sec
Standard task No 41
Pregnant woman 25 years old, 9 weeks of pregnancy. Glycosuria was revealed during woman is registered on the books in maternity welfare centre.
In anamnesis: woman’s mother and grandmother suffer from diabetes mellitus.
Objectively: Skin and visible mucous tunics have usual color, clean. Body height is 160 cm, body weight – 80 kg. Hemodynamics is stable.
Per vaginum: uterus is enlarged up to 9-10 weeks of pregnancy, has no tone, soft, both-side appendages are without complications. Discharges are mucous.
Data of laboratory examination: glucose level in blood on an empty stomach is 6.9 mmol/l, two hours after load – 7.8 mol/l.
What is the diagnose?
What must be the doctor’s tactics?


Standard task No 42
Woman in conferment, 23 years old. 30 minutes ago delivery of mature girl has body weight 4000.0 g took place. Condition of newborn is 9-10 points of Apgar score.
Symptoms of placental separation are negative. Bleeding is absent.
What is the diagnose?
What must be the doctor’s tactics?
1.
2.To carry out the manual separation of a placenta by external massage of the uterus
Standard task No 43
Woman in conferment, 30 years old, was hospitalized for delivery. Pregnancy – 3rd, delivery – 3rd, at term. Labor activity takes place last 3 hours, amniotic sac is whole.
Objectively: presenting part is absent. On the right the big dense roundish ballotable part of fetus, on the left – big softish non-ballotable part of fetus is founded. Fetal heartbeats are 134 per minute, auscultated on the level of navel, clear, rhythmical.
Per vaginum: cervix is 5 cm dilated, amniotic sac is whole. Presenting part is not determinable. Promontory is not palpable.
What is the diagnose?
What must be the doctor’s tactics?
1.full term pregnancy.third para plus gravida.active phase of 1st stage of labor.transverse lie 2nd position
2.c-section
Standard task No 44
Woman C. in conferment, 21 years old, was hospitalized with labor activity continues during 12 hours. Discharge of amniotic fluid took place 3 hours ago.
Body temperature is normal.
Sizes of the pelvis: 25-27-31-18 cm.
Position of fetus is longitudinal, presenting head is crowded to pelvic inlet. Fetal heartbeats are 134 per minute, clear, rhythmical.
Per vaginum: complete cervical dilation, amniotic sac is absent. Head is crowded to pelvic inlet. Sagittal suture is in transverse diameter, 2 cm closer to promontory. Small fontanel is on the right, big fontanel is on the left. Promontory is palpable, the diagonal conjugate is 10 cm long.
What is the diagnose?
What must be the doctor’s tactics?
1.2nd stage labor, term delivery.fetal lie longitudinal,cephalic presentation
2.managment of the 2nd stage of labor
-monitoring of the general condition of woman in childbirth (pulse rate,bp,skin color,complains)
-character of bearing down effort
-fetal heart sound
-fetal descent (crowning,disengagement)
-prevention of perineal laceration
Standard task No 45
Woman in conferment, 25 years old, was hospitalized for delivery. Pregnancy – 1st, delivery – 1st. Labor activity takes place last 5 hours, amniotic sac is whole.
Objectively: presenting part is absent. On the left the big dense roundish ballotable part of fetus, on the right – big softish non-ballotable part of fetus is founded. Fetal heartbeats are 134 per minute, auscultated on the level of navel, clear, rhythmical.
Per vaginum: cervix is 7 cm dilated, amniotic sac is whole. Presenting part is not determinable. Promontory is not palpable.
What is the diagnose?
What must be the doctor’s tactics?
1) 1st stage of labor
2)
Standard task No 46
Pregnant woman E. was hospitalized for delivery with mature pregnancy. Delivery is the first. Labor activity is absent. Discharge of amniotic fluid took place 6 hours ago.
Body temperature is normal, pulse rate is 72 per minute, has good characteristics.
Sizes of the pelvis: 26-26-32-20 cm. Circumference of abdomen is 95 cm, uterine fundus high - 36 cm.
Position of fetus is longitudinal, presenting head is crowded to pelvic inlet.
Fetal heartbeats are 134 per minute, clear, rhythmical.
Light amniotic waters leak.
Per vaginum: cervix is shortened up to 1.5 cm, soft. An external os is passable to 1 cm. Amniotic sac is absent. Fetal head push itself off the pelvic inlet. Light amniotic waters discharges. Promontory is not palpable.
What is the diagnose?
What must be the doctor’s tactics?
1)Ist stage labor, premature rupture sac
2)augmentation of labor-oxytoxin iv 10 u diluted in 1000ml of 0.9% nacl introduce in 6-8 /min OR
5u oxytoxin in 500 ml 5%dextrose 6-8 drops /min
Standard task No 47
Pregnant woman C., 21 years old, was hospitalized with good labor activity continues 12 hours. Discharge of amniotic fluid took place 3 hours ago.
Body temperature is normal.
Sizes of the pelvis: 25-27-31-17 cm.
Position of fetus is longitudinal, presenting head is crowded to pelvic inlet.
Fetal heartbeats are 138 per minute, clear, rhythmical.
Per vaginum: complete cervical dilation, amniotic sac is absent. Head is crowded to pelvic inlet. Sagittal suture is in transverse diameter, 2 cm closer to promontory. Small fontanel is on the right, big fontanel is on the left. Promontory is palpable, the diagonal conjugate is 11 cm long.
What is the diagnose?
What must be the doctor’s tactics?
1)Ist stage labor, flat pelvis
2) c-sec
Standard task No 48
Patient A., 22 years old, complains of absence of menstruations. Woman has sexual life during 2 years, had no pregnancies.
Genital status: external genital organs are hypoplastic. Non-parous external opening of vagina. Corpus of uterus is greatly lesser then cervix, dense, painless, in position “retroflexion”. Appendages are not palpable. Discharges are serous, poor.
What is the diagnose?
What must be the doctor’s tactics?
1)Infertile, uterus hypoplasia
2)hormonal therapy HMG or GnRH agonist
Standard task No 49
Patient E., 23 years old, was hospitalized with complains of sickness and vomiting. Woman loose 4 kg last two weeks. Last menstruation was 9 weeks ago.
Last day the patient have had vomiting about 15 times a day.
Objectively: Skin is pale with icteritiousness. Body temperature – 37.5°C, pulse rate – 100 per minute, blood pressure – 90/60 mm.Hg. Palpatory tenderness in right hypochondrium is revealed.
Per vaginum: sizes of uterus corresponds to term of pregnancy, vaginal discharges are usual.
What is the diagnose?
What must be the doctor’s tactics?
1)Severe gestosis
2) droperidol 4.0-0.25%diazepam 2.0-0.5% → iv 4 hrs,rpt 2/3 of dose in 4 hrs.later½dose
promedolum 1.0-2.0% dimedrolum 1%-2%
-30 ml 25% mgso4 400 ml rheopolyglucin repeat after 4 hrs IM or iv in drops 15-35 drps/min
-hypotension drugs 1%hexonal iv/40 ml 2.5% vladnil/predion 10ml 3.4% euphllinum, 2-4ml 2%papaverine
Standard task No 50
Patient U., 28 years old, was hospitalized with complains of bloody discharges, persistent pain in lower part of abdomen. Last menstruation was 12 weeks ago. Pregnancy is long wished for. In anamnesis – sterility during 7 years.
Objectively: hemodynamics is stable.
Per vaginum: non-parous vagina, cervix is formed, an external fauces is passable for a tip of finger. Uterus is enlarged up to 12 weeks of pregnancy, has an increased tone, tender at palpation. Appendages are not enlarged. Discharges are bloody, moderate.
1)pregnancy at 12 weeks.inevitable abortion (spontaneous abortion in progress)
2) curettage of the cervical canal and uterine cavity.give uterotonics and antibiotics.replacement of blood lost if needed.
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Task №1-A
Sick woman with severe preeclampsia has applied to pathological department of maternity hospital.
General blood test: Hb – 128g/l, L – 7.5*109/l, Ht – 42%, platelets – 150000. General urine analysis: protein 4g/l, L – 3-4 in field of vision.
Whole blood protein – 50g/l.
Creatinine – 300mmol/l.
Oculist’s consultation: retina’s vessels spasm and edema.
1. Estimate the results of laboratory tests.
2. Estimate the data of oculist’s consultation.
Answer Task 1-A
1.Estimate the results of laboratory tests.
Hematocrit increase (42%), platelets decrease (150000) in general blood test; proteinuria (4 g/l) in general urine analysis; hypoproteinemia (50 g/l), creatinine increase (300 mmol/l) in biochemical blood analysis – prove true diagnosis of severe preeclampsia.
2.Estimate the data of oculist’s consultation.
Retina’s vessels spasm and edema prove an initial signs of brain edema what results in encephalopathy.

Task №2-A
Pregnant woman with placenta previa and bleeding is conveyed to maternity hospital.
General blood test: Hb – 87g/l, E – 2.5*1012/l, L – 8.5*109/l.
Whole blood protein – 57g/l.
On ultrasonic examination: the placenta is situated in low segment and covers the internal fauces.
1. Estimate the results of laboratory tests.
2. Estimate the data of ultrasonic examination.
Answer Task 2-A
1.Estimate the results of laboratory tests.
Hemoglobin (87 g/l), erythrocytes (2.5×1012/l) decrease in general blood test, whole blood protein decrease (57 g/l) in biochemical blood analysis – prove true presence of anemia in woman.
2.Estimate the data of ultrasonic examination.
Localization of placenta in low segment of uterus which covers all internal fauces, prove true diagnosis of central type of placental presentation.


Task №3-A
Sick woman with severe preeclampsia has applied to gynecological department. of maternity hospital.
General blood test: Hb – 125g/l, L – 7.3*109/l, Ht – 42%, platelets – 150000. General urine analysis: protein 4g/l, L – 3-4 in field of vision.
Whole blood protein – 52g/l.
Creatinine – 300mmol/l.
Cardiotocography of the fetus: not- stressful test is positive. Indicator of condition of fetus is 3.0.
Oculist’s consultation: retina’s vessels spasm and edema.
1. Estimate the results of laboratory tests.
2. Estimate the data of instrumental methods of examination.
Answer Task 3-A
1.Estimate the results of laboratory tests.
Hematocrit increase (42%), platelets decrease (150000) in general blood test; proteinuria (4 g/l), cilindruria (2-3 in field of vision) in general urine analysis; hypoproteinemia (52 g/l), creatinine increase (300 mmol/l) in biochemical blood analysis – prove true diagnosis of severe preeclampsia.
2.Estimate the data of instrumental methods of examination.
Indicator of condition of fetus increase (2.5) in cardiotocography, prove about intrauterine hypoxy and severe preeclampsia presence.
Task №4-A
Woman with incomplete abortion in 10-11 weeks of pregnancy has conveyed to gynecological department.
General blood test: Er – 2.5*1012/l, Hb – 82g/l, L – 6.5*109/l, ESR – 10mm/h. General urine analysis: protein and glucose are not found, L – 3-4 in field of vision, urates.
Ultrasound examination: echo-free structure 2×3 cm is visualize inside the uterine cavity.
1. Estimate the results of laboratory tests.
2. Estimate the data of ultrasound examination.
Answer Task 4-A
3. Estimate the results of laboratory tests.
Hemoglobin (82 g/l), erythrocytes (2.5×1012/l) decrease in general blood test prove about anemia due to haemorrhage .
4. Estimate the data of ultrasound examination.
Echo-free structure 2×3 cm is visualize inside the uterine cavity finding proves about rest of fetal egg and haemorrhage due to it.
Task №5-A
Pregnant woman in 43 weeks of pregnancy is conveyed to pathological department of maternity hospital.
maternity hospital.
General blood test: Er – 4.5*1012/l, Hb – 135g/l, L – 3.5*109/l, ESR – 12mm/h, reticulocytes - 2%.
General urine analysis: protein –0.033g/l, L – 2-3 in field of vision, hyaline cylinders – 2-3 in field of vision, solitary oxalates.
Colpocytology: superficial cells – 42%, intermediate cells – 58%.
Ultrasound examination: there are petrifaction regions and hyalinoses in placenta.
Cardiotocography of the fetus: not- stressful test is positive. Indicator of condition of fetus is 3.0.
1. Estimate the results of laboratory tests.
2. Estimate the data of ultrasound examination and cardiotocography of the fetus.
Answer Task 5-A
3. Estimate the results of laboratory tests.
Reticulocytes increase (2%) in general blood test, intermediate cells prevail in colpocitology prove true diagnosis of postmaturity.
4. Estimate the data of ultrasound examination and cardiotocography of the fetus.
Petrifaction regions and hyalinoses in placenta finding in ultrasound examination, indicator of condition of fetus increase (before 3.5) in cardiotocography of the fetus prove true diagnosis of postmaturity and intrauterine hypoxia which is typical for present pathology.
Task №6-A
Intrauterine hypoxia of the fetus due to gestational anemia was diagnosed in pregnant woman at 30 weeks of pregnancy during reception at doctor of maternity welfare center.
General blood test: Er – 2.5*1012/l, Hb – 90g/l, L – 3.5*109/l, ESR – 8mm/h, anisocytosis, poikilocytosis.
General urine analysis: protein –0.5g/l, L – 3-4 in field of vision, glucose was not found.
Whole blood protein – 58g/l.
Cardiotocography of the fetus: not- stressful test is positive. Indicator of condition of fetus is 2.8.
Ultrasound examination: II degree of maturity of placenta.
1. Estimate the results of laboratory tests.
2. Estimate the data of ultrasound examination and cardiotocography of the fetus.

Answer Task 6-A
1. Estimate the results of laboratory tests.
Decrease of erythrocytes (2.5×1012/l), hemoglobin (90 g/l), anysocytosis and poikilocytosis appearance in general blood test, whole blood protein decrease (58 g/l) in biochemical blood analysis proofs presence of anemia gravidarum.
2. Estimate the data of ultrasound examination and cardiotocography of the fetus.
Indicator of condition of fetus increase (2.8), II degree of placenta maturity also proofs about anemia and intrauterine hypoxy of the fetus.
Task №7-A
Pregnant woman with diagnosis: pregnancy 36 weeks; multiply pregnancy (twins); mild preeclampsia, has applied to pathological department of maternity hospital.
General blood test: Er – 2.8*1012/l, Hb – 92g/l, L – 7.3*109/l, ESR – 12mm/h, Ht – 38, platelets – 150*109/l.
General urine analysis: protein –1g/l, L – 3-4 in field of vision, glucose was not found.
Whole blood protein – 65g/l.
Cardiotocography of the first fetus: not- stressful test is positive. Indicator of condition of fetus is 0.5.
Cardiotocography of the second fetus: not- stressful test is positive. Indicator of condition of fetus is 2.5.
1. Estimate the results of laboratory tests.
2. Estimate the data of cardiotocography of the fetuses.
Answer Task 7-A
1. Estimate the results of laboratory tests.
Decrease of erythrocytes (2.8×1012/l), hemoglobin (92 g/l), platelets (150×109/l), haematocritis level increase ( in general blood test, proteinuria (1 g/l) in general urine analysis, whole blood protein decrease (65 g/l) in biochemical blood analysis proofs the diagnosis of mild preeclampsia and anemia.
2. Estimate the data of ultrasound examination and cardiotocography of the fetus.
Indicator of condition of the second fetus increase (2.5) is evidence of an intrauterine hypoxy.


Task №8-A
Pregnant woman has sent to the maternity hospital by doctor of maternity welfare centre with diagnosis: pregnancy 36 weeks; rhesus incompatibility.
General blood test: Er – 3.7*1012/l, Hb – 128g/l, L – 6.8*109/l, ESR – 11mm/h. Blood test for Rh-antibodies – titre of Rh-antibodies 1:64.
Ultrasound examination: symptom of “crown”, pose of Buddha have revealed, placenta - 21×22mm, it’s thickness is 6cm.
Cardiotocography of the fetus: not- stressful test is negative. Indicator of condition of fetus is 3.5.
1. Estimate the results of laboratory tests.
2. Estimate the data of cardiotocography of the fetuses.
Answer Task 8-A
1. Estimate the results of laboratory tests.
Rh-antibodies have revealed in antibody titer 1:32 confirm the diagnosis of Rh- sensibilizing.
2. Estimate the data of ultrasound examination and cardiotocography of the fetus.
Symptom of “crown” and pose of “Buddha” reveal, dimension and thickness of placenta, indicator of condition of the fetus increase (3.5) confirm the diagnosis rhesus incompatibility.


Task №9-A
Pregnant woman has applied to the department of extragenital pathology of maternity hospital with diagnosis: pregnancy 32 weeks; moderate degree of diabetes mellitus, I type.
General blood test: Er – 4.1*1012/l, Hb – 130g/l, L – 3.8*109/l, ESR – 12mm/h.
Blood glucose – 11.5 mmol/l.
General urine analysis: protein –0.033g/l, glucose – 1.5%, L – 35-40 in field of vision.
Cardiotocography of the fetus: not- stressful test is positive. Indicator of condition of fetus is 1.5. Basal rhythm – 175 st/min.
1. Estimate the results of laboratory tests.
2. Estimate the data of cardiotocography of the fetuses.
Answer Task 9-A
1. Estimate the results of laboratory tests.
Increased glycemia (11.5 mmol/l) in biochemical blood test, glycosuria (1.5%) and leukocyturia (35-40) – in general urine analysis confirm diagnosis the diabetes mellitus.
2. Estimate the data of ultrasound examination and cardiotocography of the fetus.
Indicator of condition of the fetus increase and (1.5) and of the basal rhythm – 175 per min in cardiotocography proves an intrauterine hypoxia of the fetus.
Task №10-A
Pregnant woman in 37 weeks of pregnancy with placenta previa and bleeding has conveyed by ambulance car to maternity hospital.
maternity hospital.
General blood test: Hb – 90g/l, E – 2.3*1012/l, L – 7.3*109/l, ESR – 13mm/h.
General urine analysis: protein and glucose are not found, L – 3-4 in field of vision, urates.
On ultrasonic examination: echo-free tissue covers an internal fauces completely.
Cardiotocography of the fetus: not- stressful test is positive. Indicator of condition of fetus is 1.5. Basal rhythm – 175 st/min.
1. Estimate the results of laboratory tests.
2. Estimate the data of ultrasonic examination and cardiotocography of the fetus.
Answer Task 10-A
1. Estimate the results of laboratory tests.
Decrease of erythrocytes (2.3×1012/l), hemoglobin (90 g/l) in general blood test proofs diagnosis of haemorrhage.
2. Estimate the data of ultrasound examination and cardiotocography of the fetus.
Echo-free tissue completely cover an internal fauces reveale, indicator of condition of the fetus increase (1.5) and basal rhythm increase (175 per minute) proof the central placental presentation and intrauterine hypoxia of fetus.
Task 11-A
Pregnant woman has applied to the pathological department of maternity hospital with acute pyelonephritis gravidarum and intrauterine hypoxia of fetus.
General blood test: Er – 4.2*1012/l, Hb – 105g/l, L – 15.7*109/l, ESR – 27mm/h.
General urine analysis: protein –0.33g/l, glucose was not found, L – 35-40 in field of vision.
Nechiporenco urine analysis: L - 12×106/l, Er – 4.1×106/l.
Ultrasound examination: placenta 16×16.5cm, it’s thickness – 2cm.
Cardiotocography of the fetus: basal rhythm – 180 st/min. Indicator of condition of fetus is 2.7.
1. Estimate the results of laboratory tests.
2. Estimate the data of cardiotocography of the fetuses.
Answer Task 11-A
1. Estimate the results of laboratory tests.
Haemoglobin decrease (105 g/l), leucocytes increase (15.7×109/l), accelerated ESR (27 mm/h) in general blood test; proteinury (0.033 g/l) leucocytury (35-40) in general urine analysis; leucocytury in Nechiporenco urine analysis proofs inflammatory process in kidneys (pyelonephritis).
2. Estimate the data of ultrasound examination and cardiotocography of the fetus.
Dimensions (16×16.5 cm) and thickness (2 cm) of placenta increase, indicator of condition of the fetus increase (2.7) and basal rhythm increase (180 per minute) proofs the intrauterine hypoxia of fetus.

Task 12-A
Pregnant woman with acute viral hepatitis A has applied to the observation department of maternity hospital.
General blood test: Er – 3.2*1012/l, Hb – 126g/l, L – 13.0*109/l, ESR – 18mm/h.
Bilirubin – 26.2 mcmol/l
ALT – 2.86 mcmol/l
AST – 3.42 mcmol/l
Cardiotocography of the fetus: basal rhythm – 180 st/min. Indicator of condition of fetus is 2.8.
1. Estimate the results of laboratory tests.
2. Estimate the data of cardiotocography of the fetuses.
Answer Task 12-A
1. Estimate the results of laboratory tests.
Leucocytes increase (13.0×109/l), accelerated ESR (18 mm/h) in general blood test; bilirubin (26.2 mcmol/l), ALT (2.86 mcmol/l) and AST (3.42 mcmol/l) increase proofs diagnosis of acute viral hepatitis.
2. Estimate the data of cardiotocography of the fetus.
Indicator of condition of the fetus increase (2.8) and basal rhythm increase (180 per minute) proof intrauterine hypoxia of fetus.

Task №13-A
Pregnant woman has sent to the maternity hospital by doctor of maternity welfare centre with diagnosis: pregnancy 34 weeks; edema gravidarum.
General blood test: Er – 3.2*1012/l, Hb – 138g/l, L – 7.3*109/l, ESR – 12mm/h.
General urine analysis: protein and glucose were not found, L – 3-5 in field of vision.
Whole blood protein – 52 g/l.
Blood electrolytes: K – 4.23 mmol/l,
Na – 164.3 mmol/l,
Cl – 124 mmol/l.
Ultrasound examination: monochorionic biamniotic twins are revealed inside the uterine cavity.
1. Estimate the results of laboratory tests.
2. Estimate the data of ultrasound examination.
Answer Task 13-A
1. Estimate the results of laboratory tests.
Na (164.3 mmol/l) and Cl (124 mmol/l) increase and whole blood protein decrease (52 g/l) in biochemical blood examination proofs diagnosis of gestational edema.
2. Estimate the data of ultrasound examination.
Twins reveal inside the uterus proofs a multiple pregnancy.
Task №14-A
Pregnant woman has applied to the pathological department of maternity hospital with exacerbation of chronic pyelonephritis.
General blood test: Er – 3.7*1012/l, Hb – 127g/l, L – 17.3*109/l, ESR – 25mm/h.
General urine analysis: protein –0.033g/l, L – 50-60 in field of vision, urates.
Nechiporenco urine analysis: L - 14×106/l, Er – 2.0×106/l.
Blood urea – 7.5 mcmol/l
Blood creatinine – 110 mmol/l
Cardiotocography of the fetus: basal rhythm – 140 st/min. Indicator of condition of fetus is 0.5.
1. Estimate the results of laboratory tests.
2. Estimate the data of cardiotocography of the fetuses.
Answer Task 14-A
1. Estimate the results of laboratory tests.
Leucocytosis (17.3×109/l), accelerated ESR (25 mm/h) in general blood test; proteinury (0.033 g/l) leucocytury (50-60) in general urine analysis; leucocytury (14.0×106/l) in Nechiporenco urine analysis; blood urea (7.5 mcmol/l) and creatinine (110 mmol/l) increase proof the diagnosis of exacerbation of chronic pyelonephritis.
2. Estimate the data of cardiotocography of the fetus.
Normal indicator of condition of the fetus (0.5) and basal rhythm (140 per minute) proofs normal condition of a fetus.

Task №15-A
Puerpera has applied to the observation department of maternity hospital with puerperal sepsis.
General blood test: Er – 2.3*1012/l, Hb – 87g/l, L – 25.3*109/l, left shift of leukocytic formula, ESR – 42 mm/h.
General urine analysis: protein –0.165g/l, glucose was not found, L – 3-5 in field of vision.
Blood urea – 9.3 mcmol/l Blood bilirubin – 30 mmol/l.
Zimnitsky urine analysis: daily diuresis prevails nocturnal diuresis, specific gravity of urine – from 1010 to 1210, diuresis – 1200 ml.
Electrocardiography – sinus rhythm, electric axis of heart is horizontal, systolic cardiac murmur on the apex of heart.
1. Estimate the results of laboratory tests.
2. Estimate the data of ECG.
Answer Task 15-A
1. Estimate the results of laboratory tests.
Decrease of erythrocytes (2.3×1012/l) and haemoglobin (87 g/l), leucocytosis (25.1×109/l), accelerated ESR (42 mm/h), left shift of lecocytes formula in general blood test; proteinury (0.165 g/l) in general urine analysis, increase of blood urea (9.3 mcmol/l) and bilirubin (30 mmol/l) in biochemical blood examination; prevalence of nocturnal diuresis, isosthenuria (1010-1020) in Zimnitsky urine analysis proof the diagnosis of sepsis.
2. Estimate the data of electrocardiography.
Sinus rhythm, change of electrical axis of heart, systolic murmur on apex of heart also proof the diagnosis of sepsis
Task №16-A
Sick woman with diagnosis: left-side hydrosalpinx has applied to gynecological department.
General blood test: Er – 4.5*1012/l, Hb – 135g/l, L – 15.0*109/l, ESR – 30 mm/h, stab neutrophils – 15%.
Ultrasound examination: formation (salpinx) on the left of uterus with dimensions 4×9 cm, uneven echodensity, crowded by fluid (puss - ?) is founded.
1. Estimate the results of laboratory tests.
2. Estimate the data of ultrasound examination.
Answer Task 16-A
1. Estimate the results of laboratory tests.
Leucocytosis (15.0×109/l), accelerated ESR (30 mm/h), increase of stab neutrophils (15%) proof presence of a purulent process.
2. Estimate the data of ultrasound examination.
Tumor-like formation on the left of uterus with not equal echodensity crowded with fluid proofs the diagnosis of pyosalpinx.


Task №17-A
Sick woman has applied to the gynecological department with diagnosis: chronic double-sided salpingitis, focal tuberculous endometritis, initial infertility.
Blood and urine tests: without peculiarities.
Pirquet's reaction is positive, Mantoux test – negative. Microbiological examination: positive result of menstrual blood inoculation for tuberculous mycobacteria.
X-ray examination: organs of thoracic cavity without peculiarities.
Data of metrosalpingography: uterine tubes are impassable, have beaded look.
1. Estimate the results of laboratory tests.
2. Estimate the data of X-ray examination.
Answer Task 17-A
1. Estimate the results of tuberculin tests and of menstrual blood inoculation.
Positive Pirquet's reaction, reveal of mycobacteria of tuberculosis proof the diagnosis of tuberculous endometritis.
2. Estimate the results of metrosalpingography.
Impassability of uterine tubes, their beaded view also proofs the tuberculosis of uterine tubes.

Task №18-A
Sick woman has applied to the gynecological department with dysfunctional uterine bleeding in menopause.
General blood test: Er – 2.5*1012/l, Hb – 90g/l, L – 3.5*109/l, ESR – 8 mm/h, anisocytosis, poikilocytosis.
Histological study: during the scrape of uterine mucus hyperplasia glandulocystica were established.
1. Estimate the results of laboratory tests.
2. Estimate the data of histological study.
Answer Task 18-A
1. Estimate the results of laboratory tests.
Decrease of erythrocytes (2.3×1012/l) and haemoglobin (87 g/l), anisocytosis and poikilocytosis in general blood test proof the diagnosis of anemia.
2. Estimate the results of pathogystologycal examination of scrape of endometrium.
Hyperplasia glandulocystica of endometrium proofs the dysfunctional uterine bleeding
Task №19-A
Sick woman has applied to the gynecological department with symptomatic hysteromyoma and secondary anemia.
General blood test: Er – 1.3*1012/l, Hb – 60g/l, L – 6.2 *109/l, ESR – 23 mm/h.
Colposcopy: cervical mucus is without changes.
Histological study: during the scrape from cervix the mucus of cervical canal were found, from uterine cavity - hyperplasia cystica of endometrium were established.
1. Estimate the results of laboratory tests.
2. Estimate the data of histological study of scrape from cervix and from uterine cavity.
Answer Task 19-A
1. Estimate the results of laboratory tests.
Decrease of erythrocytes (1.3×1012/l) and haemoglobin (60 g/l) in general blood test proof the diagnosis of secondary anemia.
2. Estimate the results of pathogystologycal examination of scrape of endometrium.
Hyperplasia glandulocystica of endometrium proofs the hormonal disorders (hyperestrogenemia).
Task №20-A
Sick woman has applied to the gynecological department with diagnosis: hysteromyoma with hemorrhagic syndrome.
General blood test: Er – 3.1*1012/l, Hb – 82g/l, L – 7.8*109/l, ESR – 12 mm/h.
Ultrasound examination: uterus has dimensions 124×78×69, it’s cavity is deformed by submucous myomas with eccentric growth.
Histological study: during the scrape from cervix cilindrical epithelium were found, from uterine cavity - hyperplasia glandulocystica of endometrium were established.
1. Estimate the results of laboratory tests.
2. Estimate the data of ultrasound and histological study of scrape from cervix and from uterine cavity.
Answer Task 20-A
1. Estimate the results of laboratory tests.
Decrease of erythrocytes (3.1×1012/l) and haemoglobin (82 g/l) in general blood test proof the diagnosis of haemorrhage.
2. Estimate the data of ultrasound examination and of pathogystologycal examination of scrape of endometrium.
Uterus increase (124×78×69 mm), it’s cavity deformation by submucus and intramural myomas; hyperplasia glandulocystica of endometrium also proofs the presence of hysteromyoma.


Task №21-A
Sick woman has applied to the gynecological department with hydatidiform mole in 10 weeks of pregnancy.
Urine analysis for chorionic gonadotropin(CH): titre of CG – 1000Un.
X-ray examination of thorax: lung fields are transparent, sinuses are free.
Ultrasound examination: uterus has dimensions 75×45×61, inside it’s cavity there is heterogeneous contents with line hyperechoic inclusions (symptome of snowstorm); thecalutein cysts in bough ovaries.
1. Estimate the results of laboratory tests.
2. Estimate the data of ultrasound examination.
Answer Task 21-A
1. Estimate the results of laboratory tests.
Titre of human chorionic gonadotropin in urine increase (1000) proofs the diagnosis of hydatidiform mole.
2. Estimate the data of ultrasound examination.
Uterus increase (75×45×61 mm), hyperechoic inclusions in uterine cavity and thecalutein cysts in both ovaries reveal also proofs the diagnosis of hydatidiform mole.

Task №22-A
Sick woman has applied to the gynecological department with chorioepithelioma, metastatic variant.
General blood test: Hb – 47g/l, blood formula is not changed, ESR – 12 mm/h.
Urine analysis for chorionic gonadotropin(CH) is negative.
X-ray examination of thorax: there are plural, round shape, small metastatic nodes with diameter before 1 cm.
1. Estimate the results of laboratory tests.
2. Estimate the data of X-ray examination of thorax.

Answer Task 22-A
1. Estimate the results of laboratory tests.
Haemoglobin decrease (47 g/l), positive urine test of human chorionic gonadotropin proofs the diagnosis of chorioepithelioma.
2. Estimate the data of X-ray examination of thorax.
Plural rounded small lymph nodes reveal proofs the metastatic variant of chorioepithelioma.



Task №23-A
Woman with cervical leukoplakia and Trichomonas colpitis has reduced to maternity welfare center.
Microbiological examination: in vaginal smear mixed flora and Trichomonas vaginalis were revealed.
Colposcopy: two whitish areas were revealed with dimensions 1×1.5 cm are situated on the anterior and posterior lips of cervix utery, which has showed negative reaction with iodine after the processing of mucous coat by Lugol's iodine solution.
1. Estimate the results of microbiological examination.
2. Estimate the data of Colposcopy.
Answer Task 23-A
1. Estimate the results of laboratory tests.
Microbiological reveal of the Trichomonas vaginalis in vaginal discharges on the background of mixed flora proofs the diagnosis of Trichomonas colpitis.
2. Estimate the data of colposcopy.
Whitish regions on the cervix reveal, negative iodine test proofs presence of leukoplakia
Task №24-A
Sick woman has applied to the gynecological department with uterine bleeding in menopause.
Ultrasound examination: uterus has dimensions 56×30×41, thickness of endometrium – 12 mm, with heterogeneous echostructure.
Histological study: during the scrape from cervical canal examination scraps of mucus and grumes are founded, from uterine cavity – plural endometrial polyps without symptoms of malignization are found.
1. Estimate the results of ultrasound examination.
2. Estimate the data of histological study of scrape from uterine cavity.
Answer Task 24-A
1. Estimate the data of ultrasound examination.
Uterus increase (56×30×41 mm), enlarged thickness of endometrium (12 mm) with nonuniform structure proofs the hyperplastic process of endometrium.
2. Estimate the data of pathogystologycal examination of scrape of endometrium.
Plural polyps of endometrium without signs of malignance also proofs the hormonal disorders (hyperestrogenemia).

Task №25-A
Sick woman has applied to the gynecological department with suspicion of cancer of corpus utery.
Ultrasound examination: uterus has dimensions 54×34×42, it’s cavity is dilated; thickness of endometrium – 14 mm, it’s echodenicity is increased.
Histological study: during the scrape examination adenomatous hyperplasia of endometrium is found.
1. Estimate the results of ultrasound examination.
2. Estimate the data of histological study of scrape of endometrium.
Answer Task 25-A
1. Estimate the data of ultrasound examination.
Uterine cavity dilatation with thickness of increased echo-free endometrium 14 mm proofs the dyshormonal disorders.
2. Estimate the data of pathogystologycal examination of scrape of endometrium.
Adenomatous hyperplasia of endometrium has revealed proofs the diagnosis of precancerous condition of endometrium
Task №26-A
Sick woman has applied to the gynecological department with suspicion of cancer of corpus utery, anemia.
General blood test: Hb – 62 g/l, Er – 2.4*1012/l.
Whole blood protein – 48 g/l.
Ultrasound examination: uterus has dimensions 55×31×41, thickness of endometrium – 12 mm, has heterogeneous echostructure.
Histological study: adenocarcinoma.
1. Estimate the results of laboratory tests.
2. Estimate the results of ultrasound examination.
3. Estimate the data of histological study of scrape of endometrium.

Answer Task 26-A
1. Estimate the results of laboratory tests.
Erythrocytes (2.4×1012/l) and haemoglobin (82 g/l) in general blood test decrease, hypoproteinemia (48 g/l) in biochemical blood examination proofs an anemia.
2. Estimate the data of ultrasound examination and pathogystologycal examination of scrape of endometrium.
Increase of thickness of endometrium (12 mm), it’s nonuniform structure, signs of adenocarcinoma proofs the diagnosis of uterine cancer.



Task №27-A
Sick woman has applied to the gynecological department with torsion of left-side ovarian cystoma pedicle.
General blood test: L – 12.0*109/l, ERS – 24 mm/h.
X-ray examination of gastrointestinal tract (irrigography, rontgenoscopy of stomach and bowels) – pathology was not revealed.
Ultrasound examination: on the left of uterus multicellular formation has dimensions 70×80 mm with heterogeneous contents is found.
1. Estimate the results of laboratory tests.
2. Estimate the results of ultrasound examination.
Answer Task 27-A
1. Estimate the data of ultrasound examination.
Multicellular formation 70×80 mm with heterogeneous contents reveal on the left of uterus proofs the ovarian cystoma.
2. Estimate the results of laboratory tests.
Leucocytosis (12.0×109/l), accelerated ESR (24 mm/h), proofs the diagnosis of torsion of ovarian tumor pedicle.
Task №28-A
Sick woman has applied to the gynecological department with suspicion of cancer of ovaries.
General blood test: Hb – 85 g/l, Er – 2.7*1012/l.
Whole blood protein – 50 g/l.
X-ray examination of gastrointestinal tract: stomach ulcer.
Ultrasound examination: on the right of uterus multicellular formation has dimensions 110×80 mm with fragmentary incrassated septa and presence of papillary excrescences on walls and septa. There is accumulation of fluid in retrouterine space.
1. Estimate the results of laboratory tests.
2. Estimate the results of ultrasound examination.
Answer Task 28-A
1. Estimate the results of laboratory tests.
Erythrocytes (2.3×1012/l) and haemoglobin (85 g/l) decrease, toxic granulosity in general blood test, hypoproteinemia (50 g/l) in biochemical blood examination proofs an intoxication.
2. Estimate the data of ultrasound examination.
Multicellular formation 110×80 mm reveal on the right of the uterus with septums and capillary excrescence in walls and septums of tumor, presence of fluid in retrouterine space proofs the diagnosis of malignant tumor.
Task №29-A
Sick woman has applied to the gynecological department with terminated extra-uterine pregnancy (tubal abortion).
General blood test: Hb – 86 g/l, Er – 2.3 *1012/l.
Whole blood protein – 52 g/l.
Histological study: during the scrape from uterine cavity – elements of chorion were not found in scrape.
Ultrasound examination: on the left of uterus formation has dimensions 70×30 mm with heterogeneous contents is founded. There is accumulation of fluid in retrouterine space.
1. Estimate the results of laboratory tests.
2. Estimate the results of ultrasound examination.
3. Estimate the data of histological study of scrape of endometrium.
Answer Task 29-A
1. Estimate the results of laboratory tests.
Erythrocytes (2.3×1012/l) and haemoglobin (85 g/l) decrease in general blood test, hypoproteinemia (50 g/l) in biochemical blood examination proofs an anemia.
2. Estimate the data of ultrasound examination and of pathogystologycal examination of scrape of endometrium.
Presence of multicellular formation 70×30 mm on the right of the uterus with heterogeneous contents, presence of fluid in retrouterine space, absence of parts of chorion in scrape of uterine cavity proofs the diagnosis of extrauterine pregnancy.


Task №30-A
Sick woman has applied to the gynecological department with extra-uterine pregnancy in progress.
Urine analysis for chorionic gonadotropin(CH) is positive.
Ultrasound examination: fetal egg is visualized inside the left uterine tube; inside the uterine cavity fetal egg is not visualized.
1. Estimate the results of laboratory tests.
Estimate the results of ultrasound examination
Answer Task 30-A
1. Estimate the results of laboratory tests.
Positive result of urine test for human chorionic gonadotropin proofs presence of pregnancy.
2. Estimate the data of ultrasound examination.
Fetal egg reveal in the left uterine tube and it’s absence in the uterine cavity proofs the extrauterine pregnancy.

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II-B
Task №1-B
Sick woman with acute pyelonephritis gravidarum at 34 weeks of pregnancy has applied to pathological department of maternity hospital.
General blood test: Er - 3.2*1012/l, Hb – 108g/l, L – 12.7*109/l, ESR – 27 mm/h. General urine analysis: protein 0.133g/l, glucose is not found, L – 25-30 in field of vision.
Nechiporenco urine analysis: L - 10×106/l, Er – 3.1×106/l.
Ultrasound examination: placenta 16×16.5 cm, it’s thickness is 2 cm.
Cardiotocography of the fetus: basal rhythm – 180 st/min. Indicator of condition of fetus is 2.7.
1. Estimate the results of examination.
Task 1-B
Estimate the results of examination.
Haemoglobin decrease (108 g/l), leucocytes increase (18.7×109/l), accelerated ESR (37 mm per h) in general blood test; proteinury (0.038 g/l), leucocytury (40-50) in general urine examination; leucocytury (15×109/l) in Nechiporenco urine analysis, decrease of dimensions (15×16.5cm) ant thickness (3 cm) of placenta, indicator of condition of the fetus increase (2.6) and basal rhythm increase (160 per minute) proof the diagnosis of intrauterine hypoxia of fetus and gestational pyelonephritis.

Task №2-B
Pregnant woman with viral hepatitis A has applied to the observation department of maternity hospital.
General blood test: Er – 3.1*1012/l, Hb – 120g/l, L – 12.0*109/l, ESR – 30mm/h.
Bilirubin – 46.2 mcmol/l
ALT – 3.86 mcmol/l
AST – 4.42 mcmol/l
Cardiotocography of the fetus: basal rhythm – 180 st/min. Indicator of condition of fetus is 2.8.
1. Estimate the results of examination.
Task 2-B
Estimate the results of examination.
Leucocytes increase (12.0×109/l), accelerated ESR (30 mm per h) in general blood test; bilirubin (46.2 mcmol/l), ALT (3.86 mcmol/l) and AST (4.42 mcmol/l) increase, indicator of condition of the fetus increase (2.4) and basal rhythm increase (160 per minute) proof intrauterine hypoxia of fetus and acute viral hepatitis.


Task №3-B
Pregnant woman has sent to the maternity hospital by doctor of maternity welfare centre at 38 weeks of pregnancy with edema gravidarum.
General blood test: Er – 3.1*1012/l, Hb – 128g/l, L – 5.3*109/l, ESR – 12 mm/h.
General urine analysis: protein and glucose were not found, L – 8-10 in field of vision.
Blood electrolytes: K – 4.23 mmol/l,
Na – 164.3 mmol/l,
Cl – 124 mmol/l.
1. Estimate the results of examination.
Task 3-B
Na (164.3 mmol/l) and Cl (142 mmol/l) increase and whole blood protein decrease (56 g/l) in biochemical blood examination proofs the diagnosis of gestational edema.


Task 4-B
Pregnant woman has applied to the pathological department of maternity hospital with acute pyelonephritis gravidarum at 20 weeks of pregnancy.
General blood test: Er – 3.4*1012/l, Hb – 120g/l, L – 18.3*109/l, ESR – 30mm/h.
General urine analysis: protein –0.033g/l, glucose was not found, L – 50-60 in field of vision, urates.
Nechiporenco urine analysis: L - 24×106/l, Er – 3.0×106/l.
Blood urea – 7.0 mcmol/l
Blood creatinine – 110 mmol/l
Cardiotocography of the fetus: basal rhythm – 140 st/min. Indicator of condition of fetus is 0.5.
1. Estimate the results of examination.
Task 4-B
Estimate the results of examination.
Leucocytosis (18.3×109/l), accelerated ESR (30 mm/h) in general blood test; proteinury (0.033 g/l) leucocytury (50-60) in general urine analysis; leucocytury (4.0×106/l) in Nechiporenco urine analysis; blood urea (7.0 mcmol/l) and creatinine (100 mmol/l) increase proof the diagnosis of exacerbation of chronic pyelonephritis. Normal indicator of condition of the fetus (0.5) and basal rhythm (140 per minute) proofs normal condition of a fetus.


Task №5-B
Puerpera has applied to the observation department of maternity hospital with puerperal sepsis.
General blood test: Er – 1.8*1012/l, Hb – 77g/l, L – 28.3*109/l, left shift of leukocytic formula, ESR – 62 mm/h.
General urine analysis: protein –0.165g/l, glucose was not found, L – 3-5 in field of vision.
Blood urea – 9.3 mcmol/l
Blood bilirubin – 80.6 mmol/l.
Zimnitsky urine analysis: daily diuresis prevails nocturnal diuresis, specific gravity of urine – from 1010 to 1210, diuresis – 1200 ml.
Electrocardiography – sinus rhythm, electric axis of heart is horizontal, systolic cardiac murmur on the apex of heart.
1. Estimate the results of examination.

Tas Task 5-B
Estimate the results of examination.
Decrease of erythrocytes (1.8×1012/l) and haemoglobin (77 g/l), leucocytosis (28.1×109/l), accelerated ESR (62 mm/h), left shift of lecocytes formula in general blood test; proteinury (0.265 g/l) in general urine analysis, increase of blood urea (9.3 mcmol/l) and bilirubin (80.6 mmol/l) in biochemical blood examination; prevalence of nocturnal diuresis, isosthenuria (1010-1020) in Zimnitsky urine analysis, sinus rhythm, change of electrical axis of heart, systolic murmur on apex of heart proof the diagnosis of sepsis.
k №6-B
Sick woman with severe preeclampsia has applied to gynecological department of maternity hospital.
General blood test: Hb – 138g/l, L – 8.5*109/l, Ht – 43%, platelets – 150000. General urine analysis: protein 5g/l, L – 3-4 in field of vision.
Whole blood protein – 52g/l.
Creatinine – 300mmol/l.
Oculist’s consultation: retina’s vessels spasm and edema.
1. Estimate the results of examination.
Task 6-B
Estimate the results of examination.
Hematocrit increase (43%), platelets decrease (150000) in general blood test; proteinuria (5 g/l) in general urine analysis; hypoproteinemia (52 g/l), creatinine increase (300 mmol/l) in biochemical blood analysis, retina’s vessels spasm and edema prove true diagnosis of severe preeclampsia.

Task №7-B
Pregnant woman with placenta previa and bleeding is conveyed to maternity hospital by ambulance.
General blood test: Hb – 97g/l, E – 2.5*1012/l, L – 7.5*109/l, ESR – 20 mm/h.
Whole blood protein – 52g/l.
Ultrasound examination: the placenta is situated in low segment and covers the internal fauces.
1. Estimate the results of examination.

Ta Task 7-B
Estimate the results of examination.
Hemoglobin (97 g/l), erythrocytes (2.5×1012/l) decrease in general blood test, whole blood protein decrease (52 g/l) in biochemical blood analysis – prove true presence of anemia in woman.
Localization of placenta in low segment of uterus which covers all internal fauces, prove true diagnosis of central type of placental presentation.
task №8-B
Sick woman with severe preeclampsia has applied to gynecological department of maternity hospital.
General blood test: Er – 3.8*1012/l, Hb – 130g/l, L – 8.3*109/l, Ht – 43%, platelets – 120000.
General urine analysis: protein 5g/l, L – 3-5 in field of vision, hyaline cylinders – 2-3 in field of vision.
Whole blood protein – 50g/l.
Creatinine – 300mmol/l.
Cardiotocography of the fetus: not- stressful test is positive. Indicator of condition of fetus is 3.5.
1. Estimate the results of examination.
Task 8-B
Estimate the results of examination.
Hematocrit increase (43%), platelets decrease (120000) in general blood test; proteinuria (5 g/l), cilindruria (2-3 in field of vision) in general urine analysis; hypoproteinemia (52 g/l), creatinine increase (300 mmol/l) in biochemical blood analysis, indicator of condition of fetus increase (3.5) in cardiotocography, prove about intrauterine hypoxy and severe preeclampsia presence

Task №9-B
Woman with incomplete abortion in 10-11 weeks of pregnancy has conveyed to gynecological department.
General blood test: Er – 2.8*1012/l, Hb – 72g/l, L – 4.5*109/l, ESR – 10mm/h. General urine analysis: protein and glucose are not found, L – 2-4 in field of vision, urates.
Ultrasound examination: echo-free structure 2×3 cm is visualizes inside the uterine cavity.
1. Estimate the results of examination.
Task 9-B
Estimate the results of examination.
Hemoglobin (72 g/l), erythrocytes (2.8×1012/l) decrease in general blood test, echo-free structure 2×3 cm is visualize inside the uterine cavity finding proves about rest of fetal egg and haemorrhage due to it.


Task №10-B
Pregnant woman at 43 weeks of pregnancy is conveyed to pathological department of maternity hospital.
General blood test: Er – 3.5*1012/l, Hb – 130g/l, L – 4.5*109/l, ESR – 10mm/h, reticulocytes - 2%.
General urine analysis: protein –0.0233g/l, L – 2-3 in field of vision, hyaline cylinders – 2-3 in field of vision, oxalates.
Colpocytology: superficial cells – 32%, intermediate cells – 68%.
Ultrasound examination: there are petrifaction regions and hyalinosis in placenta.
Cardiotocography of the fetus: not- stressful test is positive. Indicator of condition of fetus is 3.2.
1. Estimate the results of examination.
Task 10-B
Estimate the results of examination.
Reticulocytes increase (2.5%) in general blood test, intermediate cells prevail (68%) in colpocitology, petrifaction regions and hyalinoses in placenta finding in ultrasound examination, indicator of condition of fetus increase (before 3.5) in cardiotocography of the fetus prove true diagnosis of postmaturity and intrauterine hypoxia


Task №11-B
Intrauterine hypoxia of the fetus was diagnosed in pregnant woman at 34 weeks of pregnancy during reception at doctor of maternity welfare center.
General blood test: Er – 2.8*1012/l, Hb – 88g/l, L – 4.5*109/l, ESR – 18mm/h, anisocytosis, poikilocytosis.
General urine analysis: protein –0.3g/l, L – 3-4 in field of vision, glucose was not found.
Whole blood protein – 52g/l.
Cardiotocography of the fetus: not- stressful test is positive. Indicator of condition of fetus is 2.8.
Ultrasound examination: II degree of maturity of placenta.
1. Estimate the results of examination.
Task 11-B
Estimate the results of examination.
Decrease of erythrocytes (2.8×1012/l), hemoglobin (88 g/l), anysocytosis and poikilocytosis appearance in general blood test, whole blood protein decrease (52 g/l) in biochemical blood analysis, indicator of condition of fetus increase (2.6), II degree of placenta maturity also proofs about anemia and intrauterine hypoxy of the fetus.



Task №12-B
Pregnant woman with diagnosis: pregnancy 38 weeks; multiply pregnancy (twins); mild preeclampsia, has applied to pathological department of maternity hospital.
General blood test: Er – 2.6*1012/l, Hb – 98g/l, L – 6.3*109/l, ESR – 18mm/h, Ht – 32, platelets – 160*109/l.
General urine analysis: protein –0.5g/l, L – 3-4 in field of vision, glucose was not found.
Whole blood protein – 55g/l.
Cardiotocography of the first fetus: not- stressful test is positive. Indicator of condition of fetus is 0.5.
Cardiotocography of the second fetus: not- stressful test is positive. Indicator of condition of fetus is 2.5.
1. Estimate the results of examination.
Task 12-B
Estimate the results of examination.
Decrease of erythrocytes (2.6×1012/l), hemoglobin (98 g/l), platelets (160×109/l), haematocritis level (32%) increase in general blood test, proteinury (0.5 g/l) in general urine analysis, whole blood protein decrease (55 g/l) in biochemical blood analysis indicator of condition of the second fetus increase (2.5) is evidence of an intrauterine hypoxy.


Task №13-B
Pregnant woman has sent to the maternity hospital by doctor of maternity welfare center with diagnosis: pregnancy 38 weeks, rhesus incompatibility, intrauterine hypoxia of the fetus.
General blood test: Er – 3.4*1012/l, Hb – 120g/l, L –5.8*109/l, ESR – 10mm/h. Blood test for Rh-antibodies – titre of Rh-antibodies 1:32.
Ultrasound examination: symptom of “crown”, pose of Buddha have revealed, placenta - 20×21 cm, it’s thickness is 6cm.
Cardiotocography of the fetus: not- stressful test is negative. Indicator of condition of fetus is 3.5.
1. Estimate the results of examination.
Task 13-B
Estimate the results of examination.
Rh-antibodies have revealed in antibody titer 1:32 symptom of “crown” and pose of “Buddha” reveal, increase of dimension and thickness of placenta, indicator of condition of the fetus increase (4.5) in cardiotocography of the fetus confirm the diagnosis of rhesus incompatibility and intrauterine hypoxy of the fetus.


Task №14-B
Pregnant woman has applied to the department of extragenital pathology of maternity hospital with diagnosis: pregnancy 33 weeks; moderate degree of diabetes mellitus, I type.
General blood test: Er – 3.1*1012/l, Hb – 136g/l, L – 3.8*109/l, ESR – 18mm/h.
Blood glucose – 10.5 mmol/l.
General urine analysis: protein –0.033g/l, glucose – 2.5%, L – 35-40 in field of vision.
Cardiotocography of the fetus: not- stressful test is positive. Indicator of condition of fetus is 1.5. Basal rhythm – 175 st/min.
1. Estimate the results of examination.
Task 14-B
Estimate the results of examination.
Increased glycemia (10.5 mmol/l) in biochemical blood test, glycosuria (2.5%) and leukocyturia (35-40) – in general urine analysis confirm diagnosis the diabetes mellitus, indicator of condition of the fetus increase and (1.6) and of the basal rhythm – 165 per min in cardiotocography proves an intrauterine hypoxia of the fetus.


Task №15-B
Pregnant woman with lateral type of placental presentation and bleeding is conveyed to maternity hospital by ambulance at 38 weeks of pregnancy.
General blood test: Hb – 80g/l, E – 2.2*1012/l, L – 6.3*109/l, ESR – 12 mm/h.
General urine analysis: protein and glucose were not found, L – 2-4 in field of vision, urates.
On ultrasound examination: echo-free tissue covers all internal fauces.
Cardiotocography of the fetus: not- stressful test is positive. Indicator of condition of fetus is 1.5. Basal rhythm – 165 st/min.
1. Estimate the results of examination.
Task 15-B
Estimate the results of examination.
Decrease of erythrocytes (2.8×1012/l), hemoglobin (88 g/l) in general blood test, echo-free tissue completely covers an internal fauces reveale, indicator of condition of the fetus increase (1.8) and basal rhythm increase (165 per minute) proof the central placental presentation and intrauterine hypoxia of fetus.

Task №16-B
Sick woman with diagnosis: left-side pyosalpinx has applied to gynecological department.
General blood test: Er – 5.5*1012/l, Hb – 125g/l, L – 18.0*109/l, ESR – 32 mm/h, stab neutrophils – 15%.
Ultrasound examination: formation (salpinx) on the left of uterus with dimensions 4×9 cm, uneven echodensity, crowded by fluid is founded.
1. Estimate the results of examination.
Task 16-B
Estimate the results of examination.
Leucocytosis (18.0×109/l), accelerated ESR (32 mm/h), increase of stab neutrophils (26%), tumor-like formation on the left of uterus with not equal echodensity in ultrasound examination crowded with fluid proofs the diagnosis of pyosalpinx.


Task №17-B
Sick woman has applied to the gynecological department with diagnosis: chronic double-sided salpingitis, focal tuberculous endometritis, initial infertility.
Blood and urine tests: without peculiarities.
Pirquet's reaction is positive, Mantoux test – negative. Microbiological examination: positive result of menstrual blood inoculation for tuberculous mycobacteria.
X-ray examination: organs of thoracic cavity without peculiarities.
Data of metrosalpingography: uterine tubes are impassable, have beaded look.
1. Estimate the results of examination.
Task 17-B
Estimate the results of examination.
Positive Pirquet's reaction, reveal of mycobacteria of tuberculosis, impassability of uterine tubes, their beaded view in methrosalpingography proof the tuberculosis of uterine tubes.


Task №18-B
Sick woman has applied to the gynecological department with dysfunctional uterine bleeding in menopause.
General blood test: Er – 2.3*1012/l, Hb – 88g/l, L – 4.5*109/l, ESR – 12 mm/h, anisocytosis, poikilocytosis.
Histological study: during the scrape of uterine mucus hyperplasia glandulocystica were established.
1. Estimate the results of examination.
Task 18-B
Estimate the results of examination.
Decrease of erythrocytes (2.3×1012/l) and haemoglobin (88 g/l), anisocytosis and poikilocytosis in general blood test, hyperplasia glandulocystica of endometrium proofs the anemia due to dysfunction uterine bleeding.


Task №19-B
Sick woman has applied to the gynecological department with symptomatic hysteromyoma and secondary anemia.
General blood test: Er – 2.3*1012/l, Hb – 80g/l, L – 8.2 *109/l, ESR – 23 mm/h.
Ultrasound examination: uterus has dimensions 13×10×8 cm, heterogeneous echostructure.
Colposcopy: mucus of cervix is without pathological changes.
Histological study: during the scrape from cervix the mucus of cervical canal were found, from uterine cavity - hyperplasia glandulocystica of endometrium were established.
1. Estimate the results of examination.
Task 19-B
Estimate the results of examination.
Decrease of erythrocytes (2.3×1012/l) and haemoglobin (80 g/l) in general blood test uterus increase in ultrasound examination, hyperplasia glandulocystica of endometrium proofs the presence of hysteromyoma and anemya.


Task №20-B
Sick woman has applied to the gynecological department with diagnosis: hysteromyoma with hemorrhagic syndrome.
General blood test: Er – 2.8*1012/l, Hb – 78g/l, L – 7.8*109/l, ESR – 22 mm/h.
Ultrasound examination: uterus has dimensions 130×80×60, it’s cavity is deformed by interstitial myomas with centripital growth.
Histological study: during the scrape from cervix cilindrical epithelium were found, from uterine cavity - hyperplasia glandulocystica of endometrium were established.
1. Estimate the results of examination.
Task 20-B
Estimate the results of examination.
Decrease of erythrocytes (2.8×1012/l) and haemoglobin (78 g/l) in general blood test, uterus increase (130×80×70 mm), it’s cavity deformation by submucus and intramural myomas in ultrasound examination; hyperplasia glandulocystica of endometrium proofs the diagnosis of hysteromyoma with haemorrhage syndrome
Task №21-B
Sick woman has applied to the gynecological department with suspicion of cancer of corpus utery, anemia.
General blood test: Hb – 72 g/l, Er – 2.6 *1012/l.
Whole blood protein – 58 g/l.
Ultrasound examination: uterus has dimensions 60×30×21, thickness of endometrium – 12 mm, has heterogeneous echostructure.
Histological study: adenocarcinoma.
1. Estimate the results of examination.
Task 21-B
Estimate the results of examination.
Erythrocytes (2.6×1012/l) and haemoglobin (72 g/l) in general blood test decrease, hypoproteinemia (58 g/l) in biochemical blood examination, increase of thickness of endometrium (16 mm), it’s nonuniform structure, signs of adenocarcinoma proofs the diagnosis of uterine cancer.

Task №22-B
Sick woman has applied to the gynecological department with torsion of left-side ovarian cyst’s pedicle.
General blood test: L – 18.0*109/l, ERS – 34 mm/h.
Ultrasound examination: on the left of uterus multicellular formation has dimensions 80×60 mm with heterogeneous contents is found.
1. Estimate the results ofexamination.
Task 22-B
Estimate the results of examination.
Leucocytosis (18.0×109/l), accelerated ESR (34 mm/h), multicellular formation 80×60 mm with heterogeneous contents reveal on the left of uterus proofs the ovarian cystoma.

Task №23-B
Sick woman has applied to the gynecological department with suspicion of cancer of ovaries.
General blood test: Hb – 95 g/l, Er – 2.6*1012/l, toxic granulosity.
Whole blood protein – 52 g/l.
Ultrasound examination: on the right of uterus multicellular formation has dimensions 100×90 mm with presence of papillary excrescences on walls and septa. There is accumulation of fluid in retrouterine space.
1. Estimate the results of examination.
Task 23-B
Estimate the results of examination.
Erythrocytes (2.6×1012/l) and haemoglobin (96 g/l) decrease, toxic granulosity in general blood test, hypoproteinemia (52 g/l) in biochemical blood examination multicellular formation 100×90 mm reveal on the right of the uterus with septums and capillary excrescence in walls and septums of tumor, presence of fluid in retrouterine space proofs the diagnosis of malignant tumor.

Task №24-B
Sick woman has applied to the gynecological department with terminated extra-uterine pregnancy.
General blood test: Hb – 98 g/l, Er – 2.4 *1012/l, ERS – 12 mm/h.
Whole blood protein – 54 g/l.
Histological study: during the scrape from uterine cavity – elements of chorion were not found in scrape.
Ultrasound examination: on the left of uterus formation has dimensions 60×38 mm with heterogeneous contents is founded. There is accumulation of fluid in retrouterine space.
1. Estimate the results of examination.
Task 24-B
Estimate the results of examination.
Erythrocytes (2.4×1012/l) and haemoglobin (96 g/l) decrease in general blood test, hypoproteinemia (54 g/l) in biochemical blood examination presence of multicellular formation 60×38 mm on the left of the uterus with heterogeneous contents, presence of fluid in retrouterine space in ultrasound examination, absence of parts of chorion in scrape of uterine cavity proofs the diagnosis of extrauterine pregnancy.



Task №25-B
Sick woman has applied to the gynecological department with extra-uterine pregnancy in progress.
Histological study: during the examination of scrape from uterine cavity – decidual metamorphosis of endometrium, elements of chorion were not found in scrape.
Ultrasound examination: fetal egg is visualized inside the left uterine tube.
1. Estimate the results of examination.
Task 25-B
Estimate the results of examination.
Positive result of urine test for human chorionic gonadotropin, fetal egg reveal in the left uterine tube and it’s absence in the uterine cavity proofs the extrauterine pregnancy in progress.


Task №26-B
Sick woman has applied to the gynecological department with hydatidiform mole in 8 weeks of pregnancy.
Urine analysis for chorionic gonadotropin(CH): titre of CG – 2000Un.
X-ray examination of thorax: lung fields are transparent, sinuses are free.
Ultrasound examination: uterus has dimensions 85×40×60, inside it’s cavity there is heterogeneous contents with line hyperechogenic inclusions (symptome of snowstorm); thecalutein cysts in bough ovaries.
1. Estimate the results of examination.
Task 26-B
Estimate the results of examination.
Titre of human chorionic gonadotropin in urine increase (2000), uterus increase (85×40×60 mm), hyperechoic inclusions in uterine cavity and thecalutein cysts in both ovaries reveal also proofs the diagnosis of hydatidiform mole.


Task №27-B
Sick woman has applied to the gynecological department with chorioepithelioma, metastatic variant.
General blood test: Hb – 67g/l, blood formula is not changed, ESR – 22 mm/h.
Urine analysis for chorionic gonadotropin(CH) is positive.
X-ray examination of thorax: there are plural, round shape, small metastatic nodes with diameter before 1 cm.
1. Estimate the results of examination.
Task 27-B
Estimate the results of examination.
Haemoglobin decrease (67 g/l), positive urine test of human chorionic gonadotropin plural rounded small lymph nodes reveal proofs the metastatic variant of chorioepithelioma.

Task №28-B
Woman with cervical leukoplakia and Trichomonas colpitis has reduced to maternity welfare center.
Microbiological examination: in vaginal smear mixed flora and Trichomonas vaginalis were revealed.
Colposcopy: two whitish areas were revealed with dimensions 2.0×1.5 cm are situated on the posterior lip of cervix utery, which has showed negative reaction with iodine after the processing of mucous coat by Lugol's iodine solution.
1. Estimate the results examination.
Task 28-B
Estimate the results of examination.
Microbiological reveal of the Trichomonas vaginalis in vaginal discharges on the background of mixed flora whitish regions on the cervix reveal in colposcopy, negative iodine test proofs presence of leukoplakia and trochomonas incompartybility.


Task №29-B
Sick woman has applied to the gynecological department with uterine bleeding in menopause.
General blood test: Er – 3.5*1012/l, Hb – 89 g/l.
Ultrasound examination: uterus has dimensions 66×40×61, thickness of endometrium – 17 mm, with heterogeneous echostructure.
Histological study: during the scrape from cervical canal examination scraps of mucus and grumes are founded, from uterine cavity – plural endometrial polyps without symptoms of malignization are found.
1. Estimate the results of examination.
Task 29-B
Estimate the results of examination.
Decrease of erythrocytes (3.5×1012/l) and haemoglobin (89 g/l), dimensions of uterus (56×40×61 mm) thickness of endometrium increase (17 mm) with nonuniform echo-structure in ultrasound examination, plural polyps of endometrium without symptoms of malignisation proofs the dysfunctional uterine bleeding in postmenopausal period.

Task №30-B
Sick woman has applied to the gynecological department with suspicion of cancer of corpus utery.
Ultrasound examination: uterus has dimensions 64×44×32, it’s cavity is dilated; thickness of endometrium – 16 mm, it’s echodenicity is increased.
Histological study: during the scrape examination adenomatous hyperplasia of endometrium is found.
1. Estimate the results of examination.

Task 30-B
Estimate the results of examination.
Uterine cavity dilatation with thickness of increased echo-free endometrium 16 mm, adenomatous hyperplasia of endometrium has revealed proofs the diagnosis of precancerous condition of endometrium