Acute abdomen in gynecology

Медведєв Михайло Володимирович // 28 Февраля 2016

Вопросов в тесте: 20

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Acute abdomen in gynecology

Patient delivered in the gynecological department by the emergency. Two hours ago suddenly she felt an acute pain in the abdomen, nausea, vomiting. The last menstruation was two weeks ago. Patient is pale, pulse 116, soft, BP 70/40 mm Hg. An abdomen does not take part in breathing. Vaginally: the posterior fornix of vagina is painful, uterus of normal size, mobile, painful at palpation. Adnexa can not be palpated through the tension of abdominal wall. Blood test: leucocytes 8x10*9/l. A pregnancy test is negative. Diagnosis?

вопрос 1 из 20 //

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Acute abdomen in gynecology

A 22-year-old female patient complains of dull pain in her right iliac area that she has been experiencing for a week, morning sickness and appetite change. She has a histrory of menstruation delay for 3 weeks. Objectively: BP- 80/50 mm Hg, pulse is 78 bpm, body temperature is 37oC. Bimanual examination reveals that uterus is enlarged, soft, mobile and painless. Uterine appendages are palpable on the right, there is a dense, elastic and moderately painful formation 3x4 cm large. What is the most likely diagnosis?

вопрос 2 из 20 //

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Acute abdomen in gynecology

A 26 y.o. woman complains of sudden pain in the lower abdomen irradiating to the anus, nausea, giddiness, bloody dark discharge from vagina for one week, the delay of menses for 4 weeks. Signs of the peritoneum irritation are positive. Bimanual examination: Uterus and adnexa are not determined because of sharp pain. Douglas pauch is bulking and intensively painful. What is the most probable diagnosis?

вопрос 3 из 20 //

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Acute abdomen in gynecology

The patient 36 years complains on pain in lower parts of abdomen on the left side, which arose up suddenly. Objectively: external genital organs without pathology, the uterine cervix is cylindric, clean. The body of uterus is enlarged to 12-13 weeks of pregnancy, the mobility is limited. One of fibroids on the left near a fundus is acutely painful. Adnexa are not determined, their region is unpainful. Parametriums are free. Excretions are serous. Blood test: Haemoglobin — 120 g/l, leucocytes — 12x10*9 /l. What is the most reliable diagnosis?

вопрос 4 из 20 //

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Acute abdomen in gynecology

Patient 22 years old, complains on absence of pregnancy during 5 years of marriage. For the last 3 years conducted medical treatment. Two months ago metrosalpingography was done - tubal permeability is normal. The last menstruation was with the delay on 2 weeks, painful. 2 days ago bloody excretions in a small amount and pain in lower parts of abdomen appeared again. Objectively: the uterine cervix is cyanotic, external os is closed. The uterus in normal position, enlarged to 5 weeks of pregnancy, soft, mobile. Right adnexa are not determined. The left adnexa are enlarged in size to 6x3 cm, painful at palpation. Parametriums are free. Excretions are bloody, in a little quantity. Blood test: Haemoglobin — 90g/l, red cells — 3,0 h 10 /l, leucocytes— 8,6 h 10 /l. What is the most reliable diagnosis?

вопрос 5 из 20 //

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Acute abdomen in gynecology

A pregnant woman in her 8th week was admitted to the hospital for artificial abortion. In course of operation during dilatation of cervical canal by means of Hegar's dilator № 8 the doctor suspected uterus perforation. What is the immediate tactics for confirmation of this diagnosis?

вопрос 6 из 20 //

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Acute abdomen in gynecology

What is the most common complication of the ectopic pregnancy which is located in the isthmical part of tube?

вопрос 7 из 20 //

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Acute abdomen in gynecology

Patient D., 30 years old, delivered with complaints on periodic pain in lower abdomen which arose up suddenly, pain irradiates to sacrum and anus. Also patient noticed spotting bloody discharge. The last menstruation - 6 weeks ago. In anamnesis there were 1 birrth, 2 abortions. After the last abortion - acute bilateral adnexitis. Objectively: the patient’ condition is satisfactory, t-36,8 C. The symptoms of irritation of peritoneum are not revealed. Vaginal examination: uterine cervix is cyanotic, the uterus is enlarged in size, sensible to palpation; right adnexa - without changes. In the projection of the left adnexa – tumor which mobility is limited, consistency elastic, egg-like shape, size is 4х4х5 cm, acutely painful at palpation; vaginal discharge is bloody, moderate. Diagnosis?

вопрос 8 из 20 //

Варианты ответа:

Acute abdomen in gynecology

Patient D., 30 years old, delivered with complaints on pain in lower parts of abdomen of periodic character which arose up suddenly, irradiate in sacrum and anus, and also on spotting bloody excretions. The last menstruation - 6 weeks ago. In anamnesis there are 1 labor, 2 abortions. After the last abortion - acute bilateral adnexitis. Objectively: the patient’ condition is satisfactory, t-36,8 C. The symptoms of irritation of peritoneum are not exposed. Vaginal examination: uterine cervix is cyanotic, the uterus is enlarged in size, sensible at palpation; right adnexa - without changes. In the projection of the left adnexa – tumor which mobility is limited, consistency elastic, shape egg-like, size 4х4х5 cm, acutely painful at palpation; discharge is bloody, moderate. Diagnosis?

вопрос 9 из 20 //

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Acute abdomen in gynecology

What is the best method of treatment for unruptured ectopic pregnancy if diameter of the pelvic mass on ultrasound less than 3,5 cm?

вопрос 10 из 20 //

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Acute abdomen in gynecology

Patient 47 years old suffers from uterine cancer 8 years, not being treated over the past year, the tumor grew to the size of 15-week pregnancy. What is the plan of surgical treatment?

вопрос 11 из 20 //

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Acute abdomen in gynecology

A patient 30 years old has bilateral piosalpinx. Which surgery would you recommend?

вопрос 12 из 20 //

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Acute abdomen in gynecology

A 36-year-old female pesented to a gynecological hospital with a significant bleeding from the genital tract and a 1-month delay of menstruation. Bimanual examination revealed soft barrel-shaped cervix. Uterus was of normal size, somewhat softened. Appendages were unremarkable on both sides. Speculum examination revealed that the cervix was cyanotic, enlarged, with the the external orifice opened up to 0,5 cm. Urine HCG test was positive. What is the most likely diagnosis?

вопрос 13 из 20 //

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Acute abdomen in gynecology

Patient 29 years old, referred to emergency with complains on acute pain in lower parts of abdomen. Pain arose up suddenly after weight lifting. The last menstruation was 10 days ago, in the term. Births – 2, abortions – 2. The last time visited gynecologist half year ago with diagnosis ovarian cyst. Pulse 100 bpm, rhythmic, breathing 22 in a minute. Abdomen is rigid, acutely painful, especially on the left. Objectively: the uterine cervix is cylindric, clean. The uterine body is not determined due to tension of abdominal wall. Right adnexa are not palpated. A tumor without clear contours is palpated in the region of the left adnexa, elastic consistency, the mobility is limited, painful. Fornices are free. What is most reliable diagnosis?

вопрос 14 из 20 //

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Acute abdomen in gynecology

A 24-year-old female patient complains of acute pain in the lower abdomen that turned up after a physical stress. She presents with nausea, vomiting, dry mouth and body temperature 36,6 C. She has a right ovarian cyst in history. Bimanual examination reveals that uterus is dense, painless, of normal size. The left fornix is deep, uterine appendages aren't palpable, the right fornix is contracted. There is a painful formation on the right of uterus. It's round, elastic and mobile. It is 7х8 cm large. In blood: leukocytosis with the left shit. What is the most likely diagnosis?

вопрос 15 из 20 //

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Acute abdomen in gynecology

A woman, 26 years, appealed to the gynecologist with complaints on absence of menstruation (delay 26 days) and feeling of nausea, mostly in the morning. A pregnancy test is positive. Menstrual cycle was regular. Pregnancies were not present before. On objective exam: the cervix is cyanotic, uterine consistency is soft, uterus is enlarged. Ultrasonography – embrionic sac is not present in uterine cavity. Diagnosis?

вопрос 16 из 20 //

Варианты ответа:

Acute abdomen in gynecology

Patient delivered to the gynecological department. Two hours ago suddenly she felt acute pain in the abdomen, nausea, vomiting. The last menstruation was two weeks ago. Patient is pale, pulse 116, weak,BP 70/40 mm Hg. The abdomen does not take part in breathing. Vaginally: the posterior fornix of vagina is painful, uterus of normal size, mobile, painful at palpation. Adnexa can not be palpated through rigidity of abdominal wall. Blood test: leucocytes 8x10*9/l. Pregnancy test is negative. Diagnosis?

вопрос 17 из 20 //

Варианты ответа:

Acute abdomen in gynecology

Patient 38 years old, during last 5 years - uterine myoma (size of tumor up to 10 weeks of pregnancy), complains of heavy prolonged menstruations. In CBC hemoglobin dropped to 80 g\l. At the admission: abundant bloody discharege from vagina, patient is pale. What is the first step of treatment?

вопрос 18 из 20 //

Варианты ответа:

Acute abdomen in gynecology

In patient with molar pregnancy curettage of uterine cavity is conducted. Material was sent to histological examination. Bleeding was stopped. In 2 days patient discharged out under the supervision of doctor-gynecologist of out-patient clinic. Which obligatory examination must be conducted?

вопрос 19 из 20 //

Варианты ответа:

Acute abdomen in gynecology

Patient 34 years. The uterine myoma is diagnosed 2 years ago. Growth is not present. There is pain in lower parts of abdomen. Leucocytosis 17х10*9 /l. Symptoms of irritation of peritoneum are positive. At vaginal examination: the uterus is enlarged to 10 weeks of pregnancy, one of fibroids is mobile, painful. Excretions are mucous. Diagnosis?

вопрос 20 из 20 //

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Acute abdomen in gynecology

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A pregnant woman in her 8th week was admitted to the hospital for artificial abortion. In course of operation during dilatation of cervical canal by means of Hegar's dilator № 8 the doctor suspected uterus perforation. What is the immediate tactics for confirmation of this diagnosis?

What is the most common complication of the ectopic pregnancy which is located in the isthmical part of tube?

What is the best method of treatment for unruptured ectopic pregnancy if diameter of the pelvic mass on ultrasound less than 3,5 cm?

Patient 47 years old suffers from uterine cancer 8 years, not being treated over the past year, the tumor grew to the size of 15-week pregnancy. What is the plan of surgical treatment?

A patient 30 years old has bilateral piosalpinx. Which surgery would you recommend?

Patient 38 years old, during last 5 years - uterine myoma (size of tumor up to 10 weeks of pregnancy), complains of heavy prolonged menstruations. In CBC hemoglobin dropped to 80 g\l. At the admission: abundant bloody discharege from vagina, patient is pale. What is the first step of treatment?

In patient with molar pregnancy curettage of uterine cavity is conducted. Material was sent to histological examination. Bleeding was stopped. In 2 days patient discharged out under the supervision of doctor-gynecologist of out-patient clinic. Which obligatory examination must be conducted?