(1) Patient K.

aged 19 years, 3 hours ago after physical culture lesson developed pain in the
lower abdomen in the left, dryness in the mouth. Menstruation was 2 weeks ago. Pulse rate – 92
beats/min., rhythmic one. Arterial pressure – 95/55 mm Hg. Tongue is dry and coated. Abdomen
“breathes”, but is painful in the right iliac area and suprapubic junction, doubtful symptoms of
peritoneal irritation are noted. What diagnosis should be made?
Answer; Apoplexy of ovaries

(2) Patient S., aged 41 years appealed for doctor’s advice complaining of periodic pains in the
lower abdomen, painful profuse, prolonged menstruation. On bimanual examination: uterine was
enlarged to 9 weeks of pregnancy, along the posterior wall a node, sizes 3x3 cm is palpable,
uterine body is movable, painful, appendages are without peculiarities. What disease should be
thought of?
Answer; Ischemia of fibromatous node

(3) Woman, aged 30 years, was admitted to the gynecologic unit for planned surgical
intervention because of tumor-like formation in the area of the right appendages, sizes 9x8 cm.,
of dense-elastic consistency, movable, painless. while performing physical work, severe pain
developed, and the woman lost consciousness. during surgical intervention a thin-walled
formation on the long pedicle, containing hair and teeth was removed. what diagnosis should be
made?
Answer; Torsion of the dermoid ovarian cyst

(4) Patient, aged 28 years, complains of pain in the lower abdomen, loss of consciousness
developed at home. Menstruation is on time. Skin is pale, pulse rate – 110 beats/min., Hb. – 76
g/l., arterial pressure is 80/60. Schyotkin’s symptoms are positive. On vaginal examination:
uterine body is not enlarged, painful on ectopia, appendages are not palpable. Posterior fornix of
the vagina hangs over, painful. On abdominal paracentesis through the posterior crypt, bright
blood, which coagulates, was obtained. What is the most probable diagnosis?
Answer; Ovarian apoplexy

(5) Patient, aged 23 years, married. Menstruation has been regular for 16 years, regular one.
Last menstruation was 7 weeks ago. Regular sexual life. Patient does not use means of
contraception. In the past history: chronic adnexitis,, patient is followed up at the prenatal center,
received treatment several times due to exacerbation of the inflammatory process of the small
pelvis organs. By the data of ultrasonic examination, a formation, sizes - 7x3x4 cm in the area of
the right appendages was revealed. Diagnosis of hydrosalpinx was made. On her way to work the
patient experienced sharp pain in the lower abdomen, and lost consciousness. She was delivered
to the gynecologic unit by an ambulance in a severe state. Skin and mucous membranes are pale,
arterial pressure – 75/40 mm Hg. Pulse rate is 116 beats/min., body temperature – 38*C,
symptom of irritation of the peritoneum is positive. What is the most probable diagnosis?
Answer; Ruptured ectopic pregnancy
(6) Patient with uterine fibromyoma (first revealed 4 years ago). During observation uterine
sizes are stable (correspond to 8-9 weeks of pregnancy. Patient appealed for doctor’s advice,
complaining of sharp pains in the lower abdomen. On examination: sharply positive symptoms of
irritation of the peritoneum, high leucocytosis. On vaginal examination: the uterine is enlarged to
9 weeks of pregnancy term at the expense of fibromatous nodes, one of them is movable,
sharply painful. Appendages are not palpable. Discharge is mucous, moderate one. What are
treatment tactics?
Answer; Surgical laparoscopy

(7) Patient, aged 28 years was admitted to the gynecologic unit complaining of sharp pain in the
lower portions of the abdomen, pain developed suddenly on the 4-th week of menstruation
delay. Skin integuments are pale, pulse rate – 110 beats/min., arterial pressure – 90/60.
Abdomen is sharply painful on palpation in the lower portions, a positive symptom of irritation of
the peritoneum. On vaginal examination: uterine is enlarged, deviated to the right, in the left –
oblong formation, painful palpation is revealed, posterior fornix is sharply painful, hangs over.
What is the most informative method of investigation?
Answer; paracentesis of the posterior fornix

(8) Patient, aged 43 years, complains of constant dull pains in the lower abdomen, mostly in the
left side, elevation of body temperature up to 38*C. During the last 5 years patient is followed up
due to subserous uterine fibromyoma. On bimanual examination: uterine is enlarged to 10 weeks
of gestation term, solid, tuberous one. In the left side of the uterine, formation coming out of the
uterine, size 6x8 cm., of elastic consistency, sharply painful on palpation is observed. What is the
most probable diagnosis?
Answer; Necrosis of myomatous node

(9) Patient, aged 37 years, was admitted to the gynecologic unit complaining of intensive
cramp-like pains in the lower abdomen, bleeding from reproductive passages. Over the period of
the last 4 years patients experienced profuse menstruation, sometimes transitory into bleeding.
Patient was not followed up at gynecologist’. On bimanual examination: uterine cervix is
smoothened, external fauces are opened up to 4 cm., in the cervical canal a dense tumor-like
formation is palpable. Uterine is enlarged, dense. What is the most probable diagnosis?
Answer; Protuding myoma

(10) Patient, aged 23 years was admitted to the gynecologic unit complaining of pain in the lower
abdomen, general weakness, collaptoid state, blood-tinged discharge from the reproductive
passages. In the past history: patient had chronic adnexitis; last 2 months – no menstruation,
sometimes bloody discharge was noted. Objectively: skin and mucous membranes are pale.
Arterial pressure – 90/60, pulse rate – 100 beats/min. Abdomen is swollen a little, painful in the
lower portions. Schyotkin’s symptoms are positive. Vaginal examination: uterine is enlarged up to
5-6 weeks, soft, painful one on palpation. Appendages are not palpable clearly due to a sharp
tension of the anterior abdominal wall. Posterior fornix hangs over, painful one. Dark blood-
tinged discharge continues. What method of investigation is the most informative?
Answer; Abdominal paracentesis