Topic 3. Benign nd precncerous diseses of femle reproductive orgns.
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Topic 3. Benign and precancerous diseases of female reproductive organs. Malignant tumors of female genitalia. Trophoblastic disease.
- Patient 40 y.o. entered the gynecological department with complaints of heavy bloody discharge from vagina after a delay of menses for 2 weeks. Vaginal examination: uterus is not enlarged, movable, painless, adnexa are not palpating, cervical os is closed, vaults and parametria are free. What should be the treatment?
- Uterotonic and hemostatic drugs
- hormonal hemostasis (synthetic gestagens)
- hormonal hemostasis (androgen)
- D&C
- hormonal hemostasis (progesterone)
2. In patient 54 y.o. recurrent menopausal bleeding was stopped by endometrial curettage. Histologically: endometrial hyperplasia. What should be further therapeutic tactics?
A. Hysterectomy with adnexectomy
B. Observation in gynecologist
C. Treatment with vikasol, aminocaproic acid
D. Treatment with gestagens
E. Treatment with 17-oksiprogesteron capronate 12.5%
3. Patient 50 y.o. entered to the gynecological department for treatment of uterine myoma with hemorrhagic syndrome and ithmico-cervical location of tumor, size 14x12x10 cm. What’s the optimal surgical treatment?
A. Conservative myomectomy
C. Subtotal hysterectomy
B. hysterectomy
D. Histeroscopic removal of leiomyoma
E. Surgical treatment is not indicated
4. Patient 55 years old, entered gynecological department with complaints of subfebrile body temperature, general weakness, rapid fatigue, unpleasant sensations beneath the abdomen, abdominal pain. Menopause 5 years. A history of chronic inflammation of adnexa. During examination abdomen in shape like a “frog’s belly”, ascites. Vaginal examination: uterus of normal size, declined to the right. In the left palpated limited mobile, dense work tumor 15 cm in diameter, painful. What is probable diagnosis?
A. ovarian cyst
B. cyst of left ovary
C. Subserous uterine leiomyoma
D. Tuboovarial tumor
E. Ovarian Cancer
5. Patient 34 years old. In history 4 pregnancies. Gynecological diseases denies. At 17 day of menstrual cycle, uterine bleeding occurred. What test should be conducted in the first place?
A. Thyreoid profile
B. Diagnostic endometrial curettage
C. HSG
D. Colpocytology
E. Measurement of basal temperature
6. Patient 48 y.o. entered to gynecological department with bleeding after a delay menstruation for 3 months. A diagnostic curettage of uterine cavity has been done. Histologic examination - endometrial hyperplasia. What is the cause of this pathology?
A. increase of FSH
B. Increase of LH
C. Increased prolactin
D. lowered LH production
E. Decreased production of FSH
7. Patien 45 years old complains of periodic bloody discharge from the vagina that are not associated with menstruation, occurs after sexual intercourse. Over the past 2 years, notes the presence of vaginal discharge of watery nature. Last gynecological examination 5 years ago, erosion of cervix was diagnosed, treatment with fat tampons. Speculum examination: cervix hypertrophic. On the rear and front lips appear growths of pathological tissues that bleed to the touch. Vaginal study: the body of the uterus somewhat enlarged, movable, painless. Adnexa are not defined. Vaults of vagina, parametria free. Bloody discharge after examination. Which methods are most valuable to confirm the diagnosis?
A. Schiller test
B. Colposcopy
C. Cytological study smears
D. Histologic examination of cervical biopsy
E. Limfography and vasography of pelvis
8. Patient 40 y.o. entered to gynecological department for surgical treatment due to the presence of submucous uterine myoma, which is accompanied by significant menorragia. During vaginal examination cervix hypertrophic, deformed by old scar, body of the uterus enlarged to 10 weeks of pregnancy, dense, painless, movable. Adnexa on both sides are not defined. Discharge moderate, odorless. What surgery is best?
A. Defundation of uterus
B. Subtotal hysterectomy without adnexa
C. Total hysterectomy
D. Conservative myomectomy
E. hysterectomy without adnexa
9. Patient 70 y.o. for many years complained of itching vulva, on labia majora was found a large ulcer with dense edges and necrotic bottom. For which disease following picture is characteristic?
A. Tuberculosis of vulva
B. Infected irritations in lichen sclerosis
C. Syphilis
D. leukoplakia
E. Cancer vulva
10. To the hospital entered 38-year-old woman with heavy uterine bleeding, intense abdominal pain at the lover regions. During examination: in cervical canal visualized tumor, stalk of which comes out from uterine cavity, uterus ball-shaped, sized of 5-weeks pregnancy, adnexa are not palpated. What is the treatment plan?
A. Remove tumor with histological study
B. Biopsy of tumor
C. hysterectomy
D. Subtotal hysterectomy
E. Amputation of uterine cervix with tumor
11. Patient, 43 years old, addressed with complaints of constant pain below the stomachm dull , more to the left, raising of the temperature to 380C. During the last 5 years subserous leiomyoma was observed. Vaginal examination: uterus enlarged to 10 weeks of pregnancy, dense. To the left from the uterus tumor, associated with uterus, size 6x8 cm, elastic consistency, dramatically painful with palpation. What is the most probable diagnosis?
A. Pyosalpincs
B. ectopic pregnancy
C. Necrosis of leiomyoma
D. left ovarian purulent cyst
E. Sarcoma of the uterus
12. Patient, 37 years old, came to the gynecological department with complaints of crampy pain in lover abdomen, bleeding from vagina. Over the past 4 years the patient noted heavy menstruation, which sometimes transformed to bleeding. Was not referred to gynecologist. Vaginal examination: cervix effaced, external os opened to 4 cm, in the cervical canal palpated dense tumor like formation. Uterus enlarged, dense. Possible diagnosis?
A. Necrosis of leiomyoma
B. Abortion in progress
C. Molar pregnancy
D. Delivery of leiomyoma
E. Cancer of the uterus
13. Patient, 63 years old, complaints of bloody discharge from vagina during the last 2 weeks, dull constant pain below the stomach. Menopause 8 years. Pain was about 4 months ago, lost appetite, patient began to lose weight. Over the past 8 months, notes watery white liquid from vagina in small quantities. Speculum examination: cervix formed, normal epithelium, external os closed. Vaginal exam: cervix cylindrical, normal density. Uterus slightly enlarged, dense consistency, barely movable, painful. What is probable diagnosis?
A. Endometritis
B. DUB
C. Cancer of the uterus
D. chorioncarcinoma
E. Delivery of leiomyoma
14. Patient, 42 years old, complains of dull pain in the lower abdomen, weakness, decreased appetite and decrease body weight in the last 3 months in 18 kg, increased belly. On examination was found: ascitis, on the right side palpating dense irregular slightly movable tumor. On clinical blood analisis: ESR increased to 50 mm per hour. Possible diagnosis?
A. Leiomyoma of uterus
B. ectopic pregnancy
C. Ovarian Cancer
D. ovarian cyst
E. right sided adnexitis
15. The patient, 68 y.o. complains of pain in the lower abdomen, loss of body weight, increased abdominal volume, significant weakness. Vaginal examination: uterus and adnexa are not clearly defined because of increased belly. On ultrasound in the area of right adnexa revealed the formation of up to 10 cm in diameter, without clear contours, a large number of free liquid in abdomen. Your diagnosis?
A. Acute adnexitis
B. leiomyoma of the uterus
C. Endometriosis
D. uterine sarcoma
E. Ovarian Cancer
16. Female 59 y.o. complains of aching pain in the left inguinal section of abdomen and foot, especially at night. In urine and stool blood was found. Vaginal study: shortened vagina, on site of the cervix can be seen crater with necrotic masses. Discharge color as meat slop. In the small pelvis determined conglomerate of tumors of dense consistency that comes to the pelvic bones, painful, not movable. What is the most likely diagnosis?
A. Bladder Cancer
B. Cervical cancer stage II
C. rectal cancer
D. Cervical cancer stage III
E. Cervical cancer stage IV
17. Patient 47 y.o. has uterine myoma for 8 years, no medical treatment. Last year, the tumor grew from 9 weeks to a 15-week pregnancy. Q: What is the surgical treatment?
A Myomectomy
B. hysterectomy with adnexa.
C. subtotal hysterectomy without adnexa.
D. subtotal hysterectomy with adnexa
E. hysterectomy without adnexa.
18. 52 y.o. patient hospitalized in the gynecology department complaining of general weakness, pain below the stomach. 2 years postmenopause. In the history P1, 2 abortions, chronic inflammation of adnexa. During examination an increased size of abdomen, signs of ascites. Vaginal examination: cervix cylindrical, clear. Uterine body of normal size, declined to the right. To left and behind the uterus palpating irregular, painless, non movable tumor of dense consistency, size 12x15 cm What is the most likely diagnosis?
A. genital endometriosis
B. Uterine leiomyoma
C. left ovarian cyst
D. PID
E. Ovarian Cancer
19. To which histological classification applies simple leukoplakia of cervix?
A. Background disease
B. precancer disease
C. Cervical cancer
D. adenomatosis
E. adenomyosis
20. Choose the correct treatment tactics in benign polipoid formations of uterine cervix
A. Observation
B. Colposcopy, cytology, bacterioscopy
C. Local therapy
D. Polypectomy, separate diagnostic curettage
E. Antibacterial therapy
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