Diseases of cardiovascular, respiratory and digestive systems of pregnant women.The management of pregnancy and childbirth.

! At rest the cardiac output during pregnancy increases maximum to (%)

* 10-20

* 20-30

* +30-40

* 40-50

* 50-60

! At physiological progress of pregnancy in the III trimester the heart rate of pregnant increases by following number of beats per minute

* 5-10

* 10-15

* +15-20

* 20-25

* 25-30

! A minimal risk of activation of rheumatic process of pregnant women with rheumatic disease is found in the following weeks of pregnancy

* 12-16

* 22- 28

* 30-32

* 34-36

* +38-40

! A more favorable prognosis for pregnancy and delivery is possible with the following acquired rheumatic heart disease

* +Mitral insufficiency without hemodynamic disorders

* Mitral stenosis with hemodynamic disorders

* Aortic malformation without hemodynamic disorders

* Aortic malformation with ciliary arrhythmia

* Decompensated heart disease

! A more favorable prognosis for pregnancy and delivery is possible with the following congenital heart disease

* Tetralogy of Fallot

* Coarctation of the aorta

* Eisenmenger Complex

* +Atrial septal defect

* Ventricular septal defect

! In pregnant women with diseases of the cardiovascular system the pulmonary edema most commonly develops in the next period of pregnancy and delivery

* I-st half of pregnancy

* II-nd half of pregnancy

* 1st and/or 3rd stage of labor

* +2nd stage of labor and/or in the early postpartum period

* 3rd stage of labor and/or in the late postpartum period

! The disease of the myocardium in which the carrying of a pregnancy is possible

* acute forms of myocarditis of any etiology

* subacute forms of myocarditis of any etiology

* myocardiodystrophy and myocardiosclerosis with arrhythmia

* +myocardiodystrophy without arrhythmias and insufficiency of blood circulation

* chronic myocarditis with cardiac arrhythmias and insufficiency of blood circulation

! The 1 stage insufficiency of blood circulation of pregnant women is characterized by the following clinical signs

* breathlessness, palpitations, edema

* breathlessness and palpitations at rest

* +breathlessness and palpitations after physical activity

* breathlessness, palpitations, developments of stagnation in the lungs

* breathlessness, palpitations, edema, enlargement of the liver, developments of stagnation in the lungs

! The delivery of pregnant woman with the open form of tuberculosis should be taken in a special box of the

* +Maternity Hospital

* Women's clinic

* Infectious Disease Hospital

* Tuberculosis dispensary

* Multidisciplinary hospital

! The delivery of pregnant woman with the acute dysentery should be taken in a special box of the

* +Maternity Hospital

* Women's clinic

* Infectious Disease Hospital

* Tuberculosis dispensary

* Multidisciplinary hospital

! The nonspecific infectious-inflammatory process with mainly affecting of the interstitial tissue, tubular device and walls of the pyelocaliceal system is called

* cystitis

* urethritis

* +pyelonephritis

* glomerulonephritis

* urolithiasis disease

! The frequent occurrence of the right pyelonephritis in pregnant women due of compression of the right ureter with the

* enlarged uterus

* diorder of the urodynamics

* rotated uterus to the right

* varicose expanding the left ovarian vein

* +varicose expanding the right ovarian vein

! A pregnant woman with chronic pyelonephritis at her 24 week of pregnancy has an increase in temperature to 38 ° C, frequent urination, leukocyturia - 25 in sight, bacteriuria. The clinical picture is

* Urolithiasis

* Acute pyelonephritis

* Gestational pyelonephritis

* Chronic glomerulonephritis

* +Exacerbation of chronic pyelonephritis.

! One of the contraindications for prolongation of pregnancy is the following kidney disease

* urolithiasis disease

* Gestational pyelonephritis

* +Pyelonephritis of single kidney

* Exacerbation of chronic pyelonephritis

* Exacerbation of chronic calculous pyelonephritis

! The form of chronic glomerulonephritis, in which the prognosis for life is less favorable

* hypertension

* nephrotic

* +mixed

* latent

* acute

! At the first visit in the analysis of bacteriological tests of midstream urine of the somatic healthy pregnant woman was found 10⁶ microbial bodies in 1 ml. The clinical picture is

* Urolithiasis

* Acute pyelonephritis

* Gestational pyelonephritis

* +Asymptomatic bacteriuria

* Exacerbation of chronic pyelonephritis.

! The pregnant with right nephrectomy in anamnesis about hydronephrosis came to women's clinic at 8 week of pregnancy. The examination to address the issue about prolongation of pregnancy should be at the

* polyclinics

* the day hospital

* women’s clinic

* +Department of Neurology

* Department of Pathology of pregnant

! In the laboratory analysis of urine by the Nechiporenko of pregnant: leukocytes - 4000, erythrocytes - 1000, cylinders 0-1 in the field of view, which corresponds to the

* +norm

* pyelonephritis

* preeclampsia

* glomerulonephritis

* urate diathesis

! The relative density of the morning urine of a healthy person varies

* 1,005, tо 1,014

* +1,015, tо 1,026

* 1,027, tо 1,030

* 1,031, tо 1,035

* 1. 036, tо 1,046

! The thyroid gland of the fetus begins to function at the next weeks of pregnancy

* 5-11

* +12-16

* 17-22

* 23-32

* 33-40

! The symptoms such as palpitations, increased nervousness, hand tremors, sweating are the following disease of the thyroid gland

* Diffuse toxic goiter

* Nodular toxic goiter

* Autoimmune thyroiditis

* Endemic goiter

* hypothyroidism

! The symptoms such as lethargy, drowsiness, memory loss, dry skin, persistent constipation are the following disease of the thyroid gland

* Diffuse toxic goiter

* Autoimmune thyroiditis

* +Nodular toxic goiter

* Endemic goiter

* hypothyroidism

! The surgical treatment of pregnant women with diffuse toxic nodular goiter is advisable in the following weeks of pregnancy

* 5-11

* +12-14

* 17-22

* 23-28

* 29-32

! One of the complications in pregnant women with hyperthyroidism is

* anemia

* hypotension

* long time carrying of pregnancy

* +noncarrying of pregnancy

* Polyhydramnios, oligohydramnios

! The most frequent complication at the second stage of labor among pregnants with diabetes is

* +shoulder dystocia

* Placenta previa

* Cervical dystocia

* Excessive labor activity

* Untimely amniorrhea

! In anamnesis of pregnant woman with diabetes at the period of 8-9 weeks in the biochemical analysis of the blood the level of glucose was 6.6 mmol/L and glycosuria. The clinical picture is

* prediabetes

* gestational diabetes

* +mild diabetes

* moderate diabetes

* severe diabetes

! When hospitalizing a pregnant woman with diabetes in 25-26 weeks of pregnancy her severe condition, confused mind and smell of acetone breath were marked. The clinical picture is

* eclampsia

* Renal coma

* Hypoglycemic coma

* +Hyperglycemic coma

* Acute cardiovascular insufficiency

! A pregnant woman with diabetes at the 28-29 week has deterioration of state after the injection of 20 units of insulin in 30 minutes, weakness, dizziness, palpitations, trembling of the limbs. Objectively she is excited, the face hyperemic, blood pressure is 110/70, pulse 100 beats per minute, skin is moist. The clinical picture is

* eclampsia

* pre-eclampsia

* Renal coma

* Hyperglycemic coma

* +Hypoglycemic coma

! To address the issue about prolongation of pregnancy with diabetes needs the examination in the 1-st trimester of pregnancy at the

* polyclinics

* the day hospital

* women’s clinic

* +Department of Endocrinology

* Department of Pathology of pregnant

Obstetric injuries ! Rupture of the posterior commissure and the skin of the perineum corresponds to the following type of birth canal trauma * +First degree laceration of perineum * Second degree laceration of perineum * Third degree laceration of perineum * First degree laceration of cervix * Second degree laceration of cervix

! Rupture of the skin and muscles of the perineum, the vaginal wall corresponds to the following type of birth canal trauma * First degree laceration of cervix * Second degree laceration of cervix

* First degree laceration of perineum * Third degree laceration of perineum * +Second degree laceration of perineum

! Unrepaired second degree laceration of perineum subsequently leads to following possible complications * Dyspareunia * Urinary fistulas * Rectovaginal fistula * +Prolapse of the vaginal walls * Varicose of vagina veins ! Rupture of the skin and muscles of the perineum, the vaginal wall, the external anal sphincter and rectal mucosa corresponds to the following type of birth canal trauma * First degree laceration of cervix * Second degree laceration of cervix * First degree laceration of perineum * Second degree laceration of perineum * +Third degree laceration of perineum

! The most common cause of vaginal rupture during delivery * Preeclampsia * Postterm labor * +precipitate labor * Premature labor * Pre-labor discharge of amniotic fluid

! Usually cervix is lacerated in its * posterior lip * +lateral lip * anterior lip

* lateral and posterior lips * lateral and anterior lips ! Cervical laceration of I degree is its rupture up * +To 2 cm * To fundus of uterus * To fallopian tubes * For more than 2 cm, not reaching the vault * Reaching the vault or going over it ! Cervical laceration of II degree is its rupture up * To 2 cm * To fundus of uterus * To fallopian tubes * For more than 2 cm, not reaching the vault * Reaching the vault or going over it ! Cervical laceration of III degree is its rupture up * To 2 cm * To fundus of uterus * To fallopian tubes * +For more than 2 cm, not reaching the vault * Reaching the vault or going over it ! Postpartum bright bleeding from maternal passages. After the speculum inspection of the cervix, cervical laceration is ​​found with the transition to the vaginal vault. The clinical picture corresponds to the following diagnosis * Uterine rupture * vaginal laceration * cervical laceration I stage. * cervical laceration II stage. * +cervical laceration III st. ! Classification of uterine rupture according to the time of occurrence * Complete, incomplete, crack * +During pregnancy and childbirth * threatening, beginning, accomplished * Spontaneous, violent, mixed * In the fundus, corpus, lower segment of the uterus and separation from the vaginal vaults ! Classification of uterine rupture according to etiology and pathogenesis * Complete, incomplete, crack * During pregnancy and childbirth * threatening, beginning, accomplished * +Spontaneous, violent, mixed * In the fundus, corpus, lower segment of the uterus and separation from the vaginal vaults ! Classification of uterine rupture localization * Complete, incomplete, crack * During pregnancy and childbirth * threatening, beginning, accomplished * Spontaneous, violent, mixed * In the fundus, corpus, lower segment of the uterus and separation from the vaginal vaults ! Classification of uterine rupture according the clinical course * Complete, incomplete, crack * During pregnancy and childbirth * threatening, beginning, accomplished * Spontaneous, violent, mixed * +In the fundus, corpus, lower segment of the uterus and separation from the vaginal vaults

! Classification of uterine rupture according to the type of damage * +Complete, incomplete, crack * During pregnancy and childbirth * threatening, beginning, accomplished * Spontaneous, violent, mixed * In the fundus, corpus, lower segment of the uterus and separation from the vaginal vaults

! Incomplete rupture of the uterus is the damage of its following layers * All

* Serous * Mucous * Serous and muscular. * +mucosa and muscularis

! Uterine rupture occurs more frequently * In the I stage of labor * In the III stage of labor * +In the period of exile * During pregnancy * In the early postpartum period ! What must be done when uterine rupture along the scar is likely to happen * Epidural anesthesia * fetal destruction operation * induction of labor with oxytocin * Caesarean section routinely * +Emergency laparotomy, caesarean section ! Normally, changes in pubic symphysis during the pregnancy should not exceed * +0,4-0,5 cm * 0,6-0,7 cm * 0.8-0.9 cm * 1,0-1,1 cm * 1,2-1,3 cm ! To confirm the separation of symphysis pubis in pregnancy, the following examination must be done * +ultrasonography * percussion * palpation * Doppler * Radiography ! Treatment of symphysis pubis diastasis after labor * Operational * Physiotherapy * Medication * Spa * +Bed rest, pillowtop hammock ! Long term position of the fetus head in one plane may cause * nuchal arms * prolapse of cord loops * Stormy labor * +genitourinary fistula formation * neglected transverse presentation

! The classification of obstetric fistula * Typical, atypical * Primary, secondary * Intact, infected * Complicated, uncomplicated * +Spontaneous, violent ! In puerperal week after childbirth of macrosomic fetus involuntary leakage of urine from the vagina occurs. The clinical picture corresponds to the following diagnosis * Enteric fistula * Ureteral fistula * +Vesicovaginal fistula * Cervicovaginal fistula * Vaginal-perineal fistula ! In a puerperal week after forceps delivery involuntary discharge of feces from the vagina is marked. The clinical picture corresponds to the following diagnosis * +Enteric fistula * Ureteral fistula * Vesicovaginal fistula * Cervicovaginal fistula * Vaginal-perineal fistula

! Treatment of obstetric fistula * Douching * Physiotherapy * Ointment tampons * +surgery * Antibiotic therapy ! In a puerperal week after birth vesico-vaginal fistula is found, surgical treatment is required. Optimal time after delivery for reconstructive and plastic surgery is * 6-12 years * 6-12 days * 6-12 hours * 6 -12 weeks * +6-12 months

Postpartum hemorrhages

! Active management of the third stage of labor to reduce the probability of postpartum hemorrhage involves the use within the first minute after birth oxytocin 10 IU in the next part of the body * shoulder * +hip * buttocks * forearm * cervix ! Coagulation factors (fresh frozen plasma, cryoprecipitate, platelets), Antifibrinolytics, YII recombinant blood factor - are drugs used for the causal treatment of postpartum obstetric hemorrhage caused by one of the following reasons * Trauma - trauma of the birth canal * +Thrombin – impaired coagulation * Tissue - delay part of placenta in the uterus * Dysfunctional uterine bleeding * Tone - a disorder of the contractile function of the uterus ! Massage of the uterus, uterotonics, bimanual compression of the uterus - causal treatment of postpartum obstetric hemorrhage caused by one of the following reasons * Trauma - trauma of the birth canal * Thrombin – impaired coagulation * Tissue - delay part of placenta in the uterus * Dysfunctional uterine bleeding * +Tone - a disorder of the contractile function of the uterus ! Closure of gaps soft tissues of the birth canal, the correction of inversion of the uterus, uterine rupture laparotomy - causal treatment of postpartum obstetric hemorrhage caused by one of the following reasons * +Trauma - trauma of the birth canal * Thrombin – impaired coagulation * Tissue - delay part of placenta in the uterus * Dysfunctional uterine bleeding * Tone - a disorder of the contractile function of the uterus ! Polyhydramnios, multiple pregnancy, large fetal lead to hyperinflation of the uterus and are clinical risk factors of postpartum hemorrhage due to * +disorder of the contractile function of the uterus ("T" - the tone) * Dysfunctional uterine bleeding * Delay part of placenta in uterine ("T" - tissue) * Coagulation disorders ("T" - thrombin) * Trauma of the birth canal ("T" - injury) ! Precipitate and prolonged labor, high parity lead to the depletion of the uterus and are clinical risk factors of postpartum hemorrhage due to * +disorder of the contractile function of the uterus ("T" - the tone) * Dysfunctional uterine bleeding * Delay part of placenta in uterine ("T" - tissue) * Coagulation disorders ("T" - thrombin) * Trauma of the birth canal ("T" - injury) ! Chorioamnionitis, fever during labor are clinical risk factors of postpartum hemorrhage due to * +disorder of the contractile function of the uterus ("T" - the tone) * Dysfunctional uterine bleeding * Delay part of placenta in uterine ("T" - tissue) * Coagulation disorders ("T" - thrombin) * Trauma of the birth canal ("T" - injury) ! Uterine myoma, placenta previa are clinical risk factors of postpartum hemorrhage due to * +disorder of the contractile function of the uterus ("T" - the tone) * Dysfunctional uterine bleeding * Delay part of placenta in uterine ("T" - tissue) * Coagulation disorders ("T" - thrombin) * Trauma of the birth canal ("T" - injury) ! Defect of the placenta, uterine scar, high parity, placenta accreta are clinical risk factors of postpartum hemorrhage due to * disorder of the contractile function of the uterus ("T" - the tone) * Dysfunctional uterine bleeding * +Delay part of placenta in uterine ("T" - tissue) * Coagulation disorders ("T" - thrombin) * Trauma of the birth canal ("T" - injury) ! In caesarean section fetal malposition and malpresentation are risk factors of postpartum hemorrhage due to * disorder of the contractile function of the uterus ("T" - the tone) * Dysfunctional uterine bleeding * Delay part of placenta in uterine ("T" - tissue) * Coagulation disorders ("T" - thrombin) * +Trauma of the birth canal ("T" - injury) ! During vaginal delivery the scar on the uterus is a risk factor of postpartum hemorrhage due to * disorder of the contractile function of the uterus ("T" - the tone) * Dysfunctional uterine bleeding * Delay part of placenta in uterine ("T" - tissue) * Coagulation disorders ("T" - thrombin) * +Trauma of the birth canal ("T" - injury) !A high parity, placenta location in fundus of the uterus, a wrong management of the 3rd stage of labor are clinical risk factors of postpartum hemorrhage due to * disorder of the contractile function of the uterus ("T" - the tone) * Dysfunctional uterine bleeding * Delay part of placenta in uterine ("T" - tissue) * Coagulation disorders ("T" - thrombin) * +Trauma of the birth canal ("T" - injury) ! Hereditary coagulopathy, liver disease, hematoma, preeclampsia, eclampsia, HELLP-syndrome, fetal death, chorioamnionitis are clinical risk factors of postpartum hemorrhage due to * disorder of the contractile function of the uterus ("T" - the tone) * Dysfunctional uterine bleeding * Delay part of placenta in uterine ("T" - tissue) * +Coagulation disorders ("T" - thrombin) * Trauma of the birth canal ("T" - injury) ! One of the main causes of bleeding in the late postpartum period is * uterine atony * syndrome of intravascular coagulation * vaginal lacerations

* cervical lacerations * +retained placental fragments ! After delivery of macrosomic fetus in early postpartum period hemorrhage begins. The uterus is flabby, bleeding with clots. Blood loss is 600.0 and continues. The most probable cause of bleeding is * syndrome of intravascular coagulation * Uterine rupture * +Uterine atony * vaginal lacerations * perineal lacerations

! In early postpartum period uterus is flabby, bleeding with clots. Blood loss is 700 ml and goes on. The most probable cause of bleeding

* +Uterine atony * syndrome of intravascular coagulation * vaginal lacerations * cervical lacerations * perineal lacerations ! When a defect of placenta is found, the recommended management is * Speculum examination of the cervix * Waiting for 30 minutes * intravenous uterotonics * Instrumental removing of placental fragments * +Manual removing of placental fragments ! After placental expulsion bright bleeding starts. The uterus is firmly contracted. There is no defect of placenta. The most probable cause of bleeding is * +Birth canal laceration * syndrome of intravascular coagulation * Uterine atony * Thrombophilia * Uterine rupture ! The indication for blood transfusion is hemoglobin level less than (g / l) * +70 * 80 * 90 * 100 * 110 ! Early postpartum hemorrhage due to uterine atony begins. Introduction of uterotonics and bimanual compression were done, but uterus is still soft. Blood loss is 800 ml and goes on. Further management * +Laparotomy, a surgical hemostasis * Curettage * Manual examination of the uterus * Laparotomy, adnexectomy * Laparotomy, hysterectomy

! After delivery of macrosomic fetus in early postpartum period hemorrhage begins. Blood loss is 500 ml and continues. The placenta is not damaged. Recommended management is

* +introduction of uterotonics * Laparotomy, subtotal hysterectomy * Bimanual compression of the uterus * Manual examination of the uterus * Laparotomy, a surgical hemostasis ! Recommended management in case of placenta accreta * Intravenous methylergometrinum * Manual removal of the placenta * Intravenous oxytocin * Curettage * +Laparotomy, hysterectomy. ! According to Clinical protocols (2010) in the early postpartum period postpartum vaginal blood loss at 600.0 and against the background necessary to make uterotonic * Manual removal of the placenta and isolation * +Bimanual compression of the uterus * Laparotomy, a surgical hemostasis * Curettage * Laparotomy, hysterectomy

Purulent septic diseases of newborns.

! One of the clinical forms of common infectious newborn skin diseases is

* sepsis

* erythema

* omphalitis

* conjunctivitis

* +exfoliative dermatitis of Ritter

! One of the clinical forms of common infectious mucosal diseases among newborns is

* omphalitis

* pneumonia

* +conjunctivitis

* necrotic flegmona

* Figner’s pseudofurunculosis

! One of the clinical forms of common infectious diseases of the umbilical wound among newborns is

* +omphalitis

* pneumonia

* conjunctivitis

* necrotic flegmona

* Figner’s pseudofurunculosis

! Classification of sepsis among newborns

* Early and late

* +Prenatal, postnatal

* Acute, subacute, chronic

* Primary, secondary, metastatic

* Compensated, decompensated

! The ways of spread of nosocomial infection among newborns

* Endogenous, exogenous, combined

* Primary, secondary, metastatic

* Parenteral, canalicular, contact

* Hematogenous, lymphogenous, intra canalicular

* +Contact, enteral, airborne

! Mother and newborn’s rooming-in in the ward prevents from

* incidence of newborns with intrauterine sepsis

* +spread of infection in the postnatal department

* Infection of the child with the hands of personnel

* Bacillus carrier among medical personnel

* Infection of medical personnel

! One of the basic contributing factors of infectious and inflammatory diseases among full term infants is

* +asphyxia

* macrosomia

* Congenital malformations

* Artificial feeding

* Intrauterine growth retardation

! The divisional pediatrician diagnosed a necrotic phlegmon of the right shoulder of the newborn. The future management of the doctor is

* ambulatory monitoring

* monitoring in the day hospital

* consultation of allergist, dermatologist.

* planned hospitalization to the surgical department

* +emergency hospitalization to the surgical department

! Currently the lethality of postnatal sepsis is

* 11-20%

* 21-30%

* +31-40%

* 41-50%

* 51-60%

! The duration of dispensary observation of children who endured neonatal sepsis is

* 3 days

* 3 weeks

* 3 months

* 3 quarters

* +3 years