Крок акушерство та гінекологія. КРОК 2021 акушерство и гинекология (1). Зниження рівня антигемофільного глобуліну
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КRОК 2021 1. A 37-year-old woman, chemist-technologist. Worries about the appearance of bruises on the abdomen, thighs, legs after minor injuries or for no reason. During the examination, numerous small and slightly larger bruises were found, which merge in places (from 1x1 to 4x5 cm). There are no other changes. Menstruation lasts up to 7 days. The spleen is not palpable. In the blood: Hb- 92 g / l, leukocytes - 7, 2 • 109 / l, platelets - 6 • 109 / l, erythrocyte sedimentation rate - 33 mm / h. What is the pathogenesis of this disease? • Decreased levels of antihemophilic globulin • Decreased blood prothrombin levels • Reduction of platelet life expectancy • Decreased fibrinogen levels • Increased fibrinolytic activity 2. A 38-year-old patient went to a women's clinic with complaints of moderate bloody discharge from the genital tract, which occurred after a delay of regular menstruation for 1.5 months. During the vaginal examination revealed: the cervix is not eroded, the symptom of "pupil" (+++); the uterus is not enlarged, dense, mobile, painless; appendages on both sides are not enlarged, painless; the vaults are deep. Which diagnosis is most likely? • Dysfunctional uterine bleeding • Cancer of the uterine body • Internal endometriosis of the uterine body • Ectopic pregnancy • Uterine pregnancy 3. The 29-year-old woman on the 3rd day after the caesarean section had vomiting, severe pain in the lower abdomen, then all over the abdomen, delayed stool and gas. The general condition is serious. The skin is pale, the lips and tongue are dry. Body temperature - 39.4 ° C. The abdomen is bloated, the symptoms of peritoneal irritation are positive in all departments. Intestinal motility is weakened. Diuresis is reduced. The uterus is large, painful on palpation, with an unpleasant odor of vaginal discharge. What pathology can you think of? • Metroendometritis • Pelvioperitonitis • Postoperative wound infection • peritonitis • Panmetritis 4. A 32-year-old pregnant woman was vaccinated against influenza with a non-living vaccine together with the whole family within 5-6 weeks. She did not know about the pregnancy at that time. Pregnancy is desirable. The patient consulted a family doctor for advice on the possible impact of the vaccine on the development and course of pregnancy, the occurrence of malformations in the fetus. What advice should be given to a pregnant woman? • Ultrasound to detect fetal malformations • Mandatory consultation with an infectious disease specialist and geneticist • Influenza vaccination is safe during pregnancy • Offer medical abortion • Test for antibodies to the flu virus 5. A 16-year-old girl came for a preventive medical examination. During the collection of anamnesis, she reported that at the age of 3 she contracted chickenpox. There are no other serious diseases in the anamnesis. Parents did not refuse vaccination, she was vaccinated in kindergarten and school in accordance with the National Calendar of preventive vaccinations. Physical examination without deviations. Which vaccines will be most appropriate now? • PDA • Hepatitis A • AaKDP • Hepatitis B. • ADP-M 6. A 52-year-old woman went to the doctor with complaints of rapid fatigue and shortness of breath during the last year with periodic dry cough. The patient notes that recently it has become difficult for her to raise both hands and comb her hair. During the physical examination, the body temperature was 37.4 C, the pulse was 76 / min, the blood pressure was 130/85 mm Hg, and SpO2 was 95% in room air. On neurological examination, a slight decrease in the strength of the deltoid muscle. At auscultation of lungs - dry rales are widespread. Erythematous rash on the cheeks, around the orbits and on the elbows. Which method is most likely to confirm the diagnosis in this patient? • Detection of antinuclear antibodies • UCP radiography • CT scan of the lungs • Lymph node biopsy • Muscle biopsy 7. In a woman in labor weighing 70 kg. 40 minutes after birth, a large fetus (4500 g) appeared significant bloody discharge from the genital tract. Bladder emptying and external uterine massage were performed; after which the uterus contracted, but within 5 minutes the bleeding resumed. After the introduction of uterotopics, manual examination of the uterine cavity blood loss was 1200 ml. What should be the next tactic? • Compression of the abdominal aorta • Curettage of the walls of the uterine cavity • Local hypothermia • Laparotomy. Uterine extirpation without appendages • Continue the introduction of uterotonics 8. A 22-year-old girl complains of irritability, tearfulness, headache, nausea, sometimes vomiting, palpitations, breast enlargement, swelling of the arms and legs, flatulence. Complaints appear 6-10 days before menstruation and disappear with the onset of menstruation. Bimanually installed: uterus and appendages without changes. What is the probable diagnosis? • Dysmenorrhea • Neurosis • Sheehan's syndrome • Premenstrual syndrome • Neuro-circulatory dystonia 9. A 45-year-old woman went to the doctor with complaints of general weakness, fatigue, irritability, anxiety, memory loss, repeated diarrhea, peeling and pigmentation of exposed areas of the body (neck, hands and soles). Which vitamin deficiency can be the cause of this condition of the patient? • Thiamine • Folic acid • Retinol • Nicotinic acid • Riboflavin 10. A 40-year-old patient was taken with complaints of cramping pains in the lower abdomen and excessive bloody discharge from the genital tract. The last two years of menstruation last up to 16 days, excessive, with clots, painful. During the bimanual examination, the presence of a nascent fibromatous node was established. Choose the right tactics: • Removal of a fibromatous node vaginally • Vitamin therapy • Hormonal hemostasis • Supravaginal amputation of the uterus without appendages • Uterine extirpation without appendages 11. An ambulance delivered a woman with cramp-like pain in the right iliac region, radiating to the rectum, bloody discharge from the genital tract, which arose after the delay of menstruation. Objectively established: heart rate - 100 / min., Blood pressure - 90/60 mm Hg. Art. The skin is pale. The abdomen is painful on palpation, a positive symptom of Schotkin-Blumberg. During the gynecological examination it is observed: the displacements of the neck are painful, the right appendages are enlarged, painful, the posterior arch is overhanging, the discharge is bloody. Make a preliminary diagnosis: • Acute right adnexitis • Aborted ectopic pregnancy • Abortion in progress • Apoplexy of the right ovary • Appendicitis 12. A 35-year-old patient complains of secretions from the nipple of the left breast. During the examination, palpation of the pathology was not detected. Which benign disease is characterized by this symptom? • Infiltrative mastitis • Breast cyst • Mastalgia • Intraductal papilloma • Fibroadenoma of the breast 13. The girl was born from the first pregnancy and the first vaginal birth at the gestational age of 39 weeks (weight - 3350 g, body length - 53 cm). The 17-year-old mother of the child is HIV-positive. The child's condition after birth is satisfactory. When can this child be vaccinated with BCG? • After clarifying the child's HIV status • On the 1st day • On the 3rd day • After the Mantoux test • Do not vaccinate under any circumstances 14. A 25-year-old woman applied to the gynecological department with complaints of fever up to 38.6 ° C, lower abdominal pain, and dysuric disorders. I fell ill 3 days ago, when these symptoms appeared after an abortion. During the gynecological examination revealed: the cervix is cylindrical, the eye is closed. The body of the uterus is slightly enlarged, painful, soft. Uterine appendages are not palpable. Purulent-bloody discharge. According to the results of blood tests: leukocytosis with a shift of the blood formula to the left, accelerated ESR. Which diagnosis is most likely? • Piosalpinx • Acute endometritis • Acute salpingo-oophoritis • Acute endocervicitis • Acute cystitis 15. In the woman in labor on the 12th day of the postpartum period, the body temperature suddenly rose to 38.2 ° C. There is a general weakness, pain in the right breast for 1 day. During the examination it was found: the breast is tense, hot, in the right upper quadrant is palpated infiltrate, painful, dense. Which diagnosis is most likely? • Mastopathy • Breast tumor • Lactational mastitis • Lactostasis • Anomalies in the development of the mammary glands 16. Pregnant at 35 weeks, severe condition. Complains of headache, blurred vision, flickering "flies" in front of the eyes. Examination revealed: general edema, AT -180/120 mm Hg. Art. Suddenly there were fibrillar twitching of facial muscles, tonic convulsions. Breathing stopped. In 1 minute breathing was restored. A significant amount of foam came out of his mouth. Amnesia. Proteinuria - 7 g / l. What is the probable diagnosis? • Severe preeclampsia • Traumatic brain injury • Eclampsia • Hypertensive crisis • Epilepsy 17. A 20-year-old patient is being treated for anemia (hemoglobin - 72 g / l). One and a half years ago, after a miscarriage at 16 weeks and blood loss, there was a decrease in memory, fatigue, loss of appetite, dry skin, brittle nails, swelling, menstrual dysfunction. Objectively established: blood pressure - 80/55 mm Hg. Art., pulse - 54 / min., height -168 cm, weight - 48 kg, genital hypoplasia. Which of the following drugs will be the most appropriate? • Hydrocortisone • Methotrexate • Infliximab • Hydroxychloroquine • Immunoglobulin lOD. otherwise normal 18. A girl weighing 3100 g was born from the third pregnancy at home. On the 3rd day, the mother noticed small hemorrhages in the umbilical cord, as well as "red spots" on the sclera of the eyes. The mother was not registered for pregnancy in the prenatal period. Breastfeeds the baby as needed. Subconjunctival hemorrhage is observed during physical examination. During the laboratory study, the hemoglobin concentration was -155 g / l. Blood group in mother B (III) Rh-positive, in child - A (II) Rh-negative. What tactics to prevent the progression of this condition in a child will be most appropriate? • Prescribe oral iron supplements • Transfusion of erythrocyte mass • Introduction of vitamin K. • Introduction of immunoglobulin antirhesus RhO (D) lOD. ini • Transition to artificial feeding with iron-containing mixtures 19. A 29-year-old woman applied to the Family Planning and Reproductive Health Center with complaints of infertility during 6 years of married life. Monthly from 14 years to 3-4 days, the number of discharges is insignificant, irregular. Objectively established: hirsutism, galactorrhea. Basal temperature -monophasic. What is the most likely cause of female infertility? • Tubular, peritoneal factors • Endocrine factors • Immunological factors • Unexplained genesis • Uterine factor 20. A pregnant woman was taken to the maternity hospital at 34 weeks due to bleeding from the genital tract, which appeared during sleep. The pain does not bother. Bleeding about 300 ml. What is the probable diagnosis? • Placenta previa • Premature detachment of the normally located placenta • Cervical cancer • Bleeding erosion • Rupture of umbilical cord vessels 21. A 37-year-old patient was diagnosed with diffuse mastopathy of both mammary glands after history taking and examination. Which instrumental research method is the most informative in this case? • Ultrasound of the mammary glands • Mammography • Breast biopsy • Pneumocystography • Ductography 22. A 20-year-old patient complains of delayed menstruation for ten days, menstrual dysfunction is noted for the first time. Sexual life is regular. Objectively established: the condition is satisfactory, the abdomen is soft, painless. AT - 120/80 mm Hg. Art., pulse - 72 / min. During the ultrasound, there was a suspicion of a progressive tubal pregnancy. What are the tactics of a women's clinic doctor? • Conduct examinations for functional diagnostic tests • Recommend a repeat visit in 1 week for follow-up ultrasound • Issue a medical certificate and refer the patient for determination of urinary hCG titer • Perform a puncture of the abdominal cavity through the posterior vault of the vagina • Urgently hospitalize the patient to clarify the diagnosis 23. A 35-year-old woman complained of lower abdominal pain that worsens during menstruation and intercourse and radiates to the vagina, smearing bloody discharge before and after menstruation for 5 days. Infertility for 9 years. Anti-inflammatory treatment did not work. During the bimanual examination revealed: the uterus is enlarged, dense, painful, smooth. During hysteroscopy in the area of the bottom of the uterus, dark red formations are visible, from which dark blood is secreted. Which diagnosis corresponds to this clinical picture? • Uterine fibroids • Endometrial hyperplasia • Uterine cancer • Endometritis • Internal endometriosis 24. A 49-year-old patient complains of irregular menstruation for 18 months, intermenstrual bleeding and "hot flashes", which are of great concern to her; insists on immediate treatment. What procedure should be performed before prescribing therapy? • Endometrial biopsy • Sequential therapy with estrogen and progestin • Hysterectomy • Use of estrogen cream • Prescribing medroxyprogesterone acetate 25. A 30-year-old woman stopped menstruating, and then began to decrease visual acuity. Primary optic nerve atrophy, bitemporal hemianopsia was detected. For 2 years, the patient was treated by ophthalmologists on an outpatient and inpatient basis, but vision progressively decreased. Ophthalmologist consultation: visual acuity OD = 0.02, OS = 0.03, severe primary atrophy of the optic nerves. What auxiliary method of examination can help in making a diagnosis? • Cerebrospinal fluid examination • Electroencephalography • Echoencephalography • Pneumoencephalography • MRI of the brain 26. For a 20-year-old pregnant woman for a period of 5 weeks, the doctor of the antenatal clinic prescribed good nutrition and the use of folic acid 0.4 mg. What complication is prevented? A. Malformations of the nervous system B. Delays in fetal development C. Fetal distress D. Preeclampsia E. Oversight of pregnancy 27. A 36-year-old woman consulted a gynecologist with complaints of irregular scanty menstruation over the past 6 months, increased hair growth on her face and coarsening of her voice. History of two miscarriages, one premature birth. According to the ultrasound data, the uterus and ovaries were normal. What examination is advisable to conduct to establish the cause of hormonal disorders? A. Conducting hysteroscopy B. Karyotyping C. Hormonal testing D. Taking an endometrial biopsy E. X-ray examination of the Turkish saddle 28. A 28-year-old patient complained of nausea, weakness, and decreased ability to work. The last period was 2 months ago. Married. Objective examination: the general condition is satisfactory. Pulse 74 / min., Rhythmic. BP - 110/70 mm Hg. On vaginal examination: the external genitals are developed correctly, hair growth is female. The vagina of a nulliparous woman. The cervix is not changed, cyanotic, conical in shape, the external pupil is closed. The uterus is mobile, painless, enlarged up to 9-10 weeks of pregnancy. The appendages of the uterus were unremarkable. The vaults are deep and free. The discharge is mucous, light. What is the preliminary diagnosis? A. Bubble drift B. Cancer of the body of the uterus C. Leiomyoma of the uterus D. Pregnancy I, 9-10 years E. Ectopic pregnancy 29. A 35-year-old woman consulted a doctor with complaints of increasing pain during menstruation for 1 year. The duration of the menstrual cycle is 28 days. Laparoscopic tubal ligation was performed 2 years ago. On palpation, the uterus is enlarged up to 8 weeks of pregnancy, soft, painful. The appendages on both sides are not enlarged, painless on palpation. What is the most likely diagnosis? A. Hydrosalpinx B. Adenomyosis C. Ectopic pregnancy D. Polycystic ovary E. External endometriosis 30. A 27-year-old woman in labor, on the 10th day after giving birth, turned to the antenatal clinic with complaints of recurrent cramping pain in the lower abdomen. First childbirth, due date, normal. When examining body temperature -36.80C, pulse - 68 / hv., AP- 115/75 mm Hg. The mammary glands are moderately swollen, the nipples are clean. The abdomen is soft and painless. The fundus of the uterus is at the level of the bosom. Lochia moderate serous-bloody. What is the diagnosis? |