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Topic 4. Inflmmtory diseses of femle genitls

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Topic 4. Inflammatory diseases of female genitals.

1. Patient S., 21 y.o., appealed to women's consultation with complaints of significant malaise, pain in the vulvar area, irritation, itching, rapid urination. In history 10 days ago had extramarital sexual contact. When review external genitals were found: on congested, swollen mucosa of labia majora numerous vesicles 2-3 mm in diameter. After further investigations revealed herpes simplex virus. Which group of drugs used to treat this disease?

 

A. Progesterone

B. Tetracycline

C. Sulfadymizyn

D. Metranidazol

E. acyclovir

2. To the gynecological department entered patient complaining of an increase in temperature to 390C, sharp pain in lower abdomen, purulent bloody discharge from vagina. From anamnesis: 6 days ago was made criminal abortion. OBJECTIVE: BP 100/60 mmHg, PR 110 bpm. Abdomen tense, aching in the lower divisions with palpation, Blumberg symptom positive. Vaginal examination: uterus increased to 7 weeks of pregnancy, painful, soft, posterior vault painful shortened. Your diagnosis?

  1.  Pelvioperitonitis
  2.  Perforation of the uterus
  3.  Acute adnexitis
  4.  Pyosalpincs
  5.  Metroendometrytis

3. In the gynecological department entered patient 30 years with complaints of sharp pain in lower abdomen, fever up to 38.80 C, discharge mucopurulent. P0, 2 artificial abortions. Sexual life outside marriage. At gynecological examination: Uterus not changed. Adnexa are enlarged, painful on both sides. Discharge from the vagina purulent, significant. What studies do you need to confirm the diagnosis?

  1.  Colposcopy
  2.  hysteroscopy
  3.  D&C
  4.  bacteriological research and microscopy
  5.  Laparoscopy

4. Patient S., 20 y.o., entered to the gynecological department with complaints of weakness, t-38, 5 ° C, pain in the lower abdomen, purulent discharge from the vagina. Sick 4 days after medical abortion. Overall condition of medium severity. Pulse 100 bpm, BP 130/90, t-38, 2 ° C. Belly aching in the lower divisions, no symptoms of peritoneal irritation. PV: cervix normal, external os closed. The body of the uterus is increased to 7-8 weeks of pregnancy, soft consistency, painful. Adnexa are not palpating. Discharge purulent. What tactics would you choose?

 

  1.  D&C and antibiotics
  2.  D&C
  3.  therapy  of endometritis
  4.  Total hysterectomy with tubes
  5.  antibacterial uterine lavage.

 5. Mother have led to a gynecologist girl 5 years old with complaints of pain and heartburn in the area of perineum. Sexual formula: Ax 0, P 0, Ma 0 Me 0. There is hyperemia in the perineal area and the entrance to the vagina. Discharge from the genital tract cottage-cheese-like. What investigation is primarily to help clarify the diagnosis?

  

  1.  smear on flora
  2.  Total urine
  3.  Total blood
  4.  A smear on colpocytology
  5.  Analysis of excrement on the worm eggs

6. Patient 25 y.o. appealed to women's consultation with complaints of lack of pregnancy for 5 years, general weakness. Periods since 17 years, irregular, poor, with delays of up to 20 - 25 days. With a history: frequent acute respiratory viral infections, pneumonia, excudative pleuritis, body temperature is 37.20C. PV: uterus decreased in size, limited movement, painless, with both sides of uterus determined  formations of dense consistency, irregular shape, size 5 x 6 and 7 x 5 cm sensitive to palpation. What is the most likely diagnosis?

  1.  Tuberculosis of genitals
  2.  Krukenberg tumor.
  3.  PCOS
  4.  External genital endrometriosis
  5.  Genital Chlamydia infection.

7. Patient, 23 years old, turned to gynecologist complaining of significant foamy discharge from the vagina with an unpleasant odor, burning in the field of external genital organs. She has messy sex life. PV: vaginal mucosa congested, during touch bleeds, discharge abundant greenery foamy. What is the most likely diagnosis?

  

  1.  Chlamydia infection
  2.  Bacterial vaginosis
  3.  Candidosis
  4.  Gonorrhea
  5.  Trichomonas infection

8. Patient, 20 years old, appealed to gynecologist complaining of itching, pain and burning area of external genitals, increased body temperature, irritation, problems with sleep, headache. Patient isn’t married, has an indiscriminate sexual activity.

During the inspection of external genitalia on hyperemic and swollen mucous were found vesicles. Diagnosis?

  1.  HPV infection.
  2.  Condyloma.
  3.  Herpetic infection\
  4.  Primary sifilis.
  5.  CMV infection.

9. Patient is a 20 y.o. complained of sharp pain in the area of external genital organs, swelling of the labia, pain in during walking. Body temperature 38,7 ° C, pulse 98 bpm. During examination in right labia majora is determined  tight, painful  tumor 5,0x4,5 cm, the skin and mucous membranes of external genital organs congested, discharge with significant unpleasant odor. What is the most likely diagnosis?

 

  1.  Bartoline gland cyst
  2.  Furuncul of labia majora
  3.  Acute vulvovaginitis
  4.  Acute bartolinitis
  5.  Acute vulvitis

10. Female 28 y.o. complained of watery discharge with fish smell, accompanied by slight itching and burning. Menstruation from 13 years to 5-6 days in 28 days. Vaginal examination revealed "clue cells”. Your diagnosis?

  1.  Gonorrhea
  2.  Trihomoniasis
  3.  bacterial vahinosis
  4.  Candidiasis
  5.  chlamydia

11. Ambulance transported patient complaining of short-term loss of consciousness, vertigo, acute abdominal pain at right inguinal area, last periods was 2 weeks ago. Pale skin of the patient. Pulse bpm, Hb 76 g/l, temp. 36,8°C. BP 80/60 mmHg, when breathing abdomen is not moving in the lower divisions, lower abdomen is painful during palpation. PV: the cervix normal, cervical canal - closed. The body of the uterus is not increased during palpation. Right adnexa’re painful at palpation, ovary increased. Rear fornix hanging and painful. What is the most likely diagnosis?

  1.  Ruptured abdominal pregnancy
  2.  Acute appendicitis
  3.  Ovarian rupture
  4.  Acute salpingitis
  5.  Torsion of right ovarian cyst

12. Female 28 y.o. asked doctor complaining of acute pain in the left inguinal region and delay of menstruation. According to ultrasound 2 months ago revealed the left ovarian cyst. A woman refused from hospitalization. During vaginal examination determined tumor size 5x7 cm, aching, swelling, very movable. What is most likely diagnosis?

 

  1.  Extrauterine pregnancy
  2.  Ovarian rupture
  3.  imminent abortion
  4.  Ovarian cyst torsin
  5.  Molar pregnancy

13. Patient K, 19 y.o., 3 hours ago, after physical activity felt pain in the right inguinal region, dry mouth. Periods 2 weeks ago. PR-82 bpm, rhythmic. Tongue dry, furred. Abdomen "breathing", but aching in right lover quadrant, symptoms of peritoneum irritation questionable. Your diagnosis?

 

  1.  ovarian rupture
  2.  Acute appendicitis
  3.  Acute adnexitis
  4.  Ruptured extrauterine pregnancy
  5.  Right renal colic

 

14. To gynecologist referred patient S., 41 y.o. complaining of periodic pain in lower abdomen, painful, large, long menstruations. PV: uterus increased to 9 weeks of pregnancy, on the back wall of the uterus palpated nodule 3x3 cm in size, movable body of the uterus, painful. Adnexa are normal. Your diagnosis?

 

  1.  ovarian tumor
  2.  adenomyosis
  3.  intrauterine pregnancy
  4.  Chronic endometritis
  5.  ischemia of leiomyomatous node

15. Female 30 y.o. entered to the office for plannd gynecological surgery with tumor formation in the largest segment of the right adnexa 9x8 cm, dense, of elastic consistency, movable, painless. During the hard work, pain appeared, woman lost consciousness. During surgery was found thin-walled neoplasm with long stem, which contains hair and teeth. Your diagnosis:

 

  1.  Torsion of dermoid ovarian cyst
  2.  Fibroid
  3.  Ovarian Cancer
  4.  Hydrosalpinx
  5.  Piovarum

 

16. 45 y.o. patient complains of moderate blood discharge from vagina, crampy pain that began after the physical load, general weakness, dizziness. The woman is 5 years sick with fibroid, uterine size is 7 week pregnancy. Blood: Hb-65 g/liter. What is the most likely diagnosis based on anamnestic data?

  1.  bleeding cervical polyp
  2.  Cervical cancer
  3.  Bleeding cervical erosion
  4.  Delivery of leiomyoma
  5.  endometriosis of cervix

17. Patient 28 years old. Complains of pain in the lower abdomen, loss of consciousness was at home. Regular menses. Skin is pale. Pulse 110 bpm, Hb 76 g/l, BP 80/60 mm Hg. Blumberg’s symptom positive. Vaginal examination: uterine body is enlarged, painful to the displacement, adnexa failed to palpate. Rear vault hangs, painfull. During puncture of the abdominal cavity through the Doughlas pouch received blood that is not clotting. What is the most likely diagnosis?

 

  1.  broken abdominal pregnancy
  2.  Ovarian cyst rupture
  3.  Torsion of right ovarian cyst
  4.  Acute salpingitis
  5.  Acute appendicitis

 

 

18. In the girl 15 years old on the lesson of physical education during the jump was felt a sharp pain in lower abdomen and was loss of consciousness. Menstruation is normal, don’t have sexual life. During rectal examination doctor revealed benign ovarian tumor. What tactics should be?

  1.  Surgical treatment
  2.  Clinical supervision
  3.  Chemotherapy
  4.  Nonoperative treatment
  5.  Treatment with estrogen-gestagen drugs

 

19. Patient 23 years old, married. Periods since 16 years, regular. Last menstruation was 7 weeks ago. Regular sexual activity, contraceptive method does not use. In history: chronic adnexitis. According to the ultrasound 1 month ago found hydrosalpincs 7x3x4 cm. On the way to work there was a sharp pain below the stomach, unconsciousness. Ambulance delivered to the gynecological department in a serious condition: skin and mucous membranes pale, BP-75/40 mm Hg. Pulse 116 bpm, temperature 38˚C. Peritoneal irritation symptom positive. What is the most likely diagnosis?

 

  1.  broken abdominal pregnancy;
  2.  abortion in progress;
  3.  rupture of ovarian cyst
  4.  Pelvioperitonitis;
  5.  Perforation of stomach ulcer.

20. Patient with uterine fibroid (first discovered 4 years ago), during monitoring the size of the uterus stable (8-9 weeks of pregnancy), turned to the gynecological department complaining of sharp pain in lower abdomen. Dramatically positive symptoms of peritoneal irritation, high leukocytosis. At vaginal examination: enlarged uterus up to 9 weeks of pregnancy due to fibromatous nodes, one of which is movable, sharply painful. Adnexa are not palpating. Discharge moderate. What tactics of treatment?

 

  1.  prompt surgical treatment (laparotomy);
  2.  Monitoring and spasmolytic therapy;
  3.  diagnostic curettage of the uterine cavity;
  4.  Surgical Laparoscopy;
  5.  Observation and antibacterial therapy

 

 




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