A 34 years old G3P2A0 women at 38 weeks and 6 days was admitted to labor and delivery unit

for active management of laborafter it was determinedthat her membranes had ruptured and
she was dilated to 3 cm. Her cervix has been steadily dilating and now she is at 6 cm. She is
very uncomfortable and finds her contractions very painful. Her partner is also very concerned
that she needs pain felief

1. You advise your patient that :

A. Narcotics are available, but should be reserved for closer to the time of delivery
when her pain will be greatest
B. If she continuous with natural dhildbirth and eventually needs a caesarean section
she will require general anesthia
C. Spinal anesthesia is the best option because it gives a constant infusion of medicine
over a long period of time
D. She cannot have an epidural yet becaune she is not yet in the active phase of labor
E. A variety of relaxation techniques can be incorporuted into her labor in addition to
pain medication
2. With adequate pain control she dilates to 10 cm and second stage begins. Which of the
following is the correct order of the cardinal movements of labor ?
A. Internal rotation, engagement, descent, flexion, external rotation
B. Engagement, descent, internal rotation, flexion, external rotation
C. Internal rotation, descent, engagement, flexion, extemal rotation
D. Engagement, descent, flexion, Internal rotation, external rotation
E. Engagement, descent, external rotation, flexion internal rotation
3. An uncomplicated vaginal delvery typically includes which maneuver ?
A. Perineal support to decreased perineal trauma
B. An episiotomy to hasten delivery
C. Vacuum extraction if the fetal station is fow
D. Forceps to aid maternal efforts
E. The McRoberts maneuver
4. Stage 3 begins following the delivery of the infants and typically involves which of the
following?
A. Placental separation
B. Stopping axytocin drips if they were used during stage 2
C. An abrupt increase in the size of the intrauterine cavity
D. Uterine prolapse
 E. A delay of 60 minutes before the placenta is delivered
5. Which of the following is the most common cause of first trimester pregnancy loss ?
A. uterine anomalies
B. Incompetent cervix
C. Intrauterine Infection
D. Fetal chromosomal abnormalities
E. Placenta adhesive
6. Which of the following NOT clinical indicator af heart disease during pregnancy ?
A. Cyanosis
B. Clubbing fingers
C. Systolic murmur grade 2/6
D. Diastolic murmur
E. Cardiomegaly
7. Fetal hyperinsulinemia in the second half of pregnancy is NOT associated with which of
the following?
A. Macrosomia
B. Neonatal hypoglycemia
C. Maternal hyperglycemia
D. Increased maternal weight
E. Increased chance of neanatal acidosis
8. Which of the following statements regarding intrapartum managernent of HIV is true?
A. If caesarean delivery is planned, it should be scheduled at 36 weeks gestation
B. Caesarean delivery is recommended for women with a viral load >1000 copies/mL
C. in labor, with a plan for vaginal delivery amniotomy should be performed as soon as
possible to hasten delivery
D. In labor, internal monitors should be placed because fetuses of HIV-infected women
are at increased risk for distress
E. No vertical transmission risk increased if there is PROM > 38 weeks
9. increased serum free thyroxine levels in women with hydatiform.moles stem from
increases in which of the following?
A. Maternal estrogen levels
B. Fetal thyroxine production
C. Maternal progesterone levels
D. Maternal beta-human chorionic gonadotropin levels
 E. Maternal estriol levels

A33-years-old GOPO woman comes to your office for her initial prenatal visit. She tested
positive with to home pregnancy test and has been experiencing breast tenderness and mild
nausea for a few weeks. She has a history of regular menstrual periods occurring every 28-30
days. This was a planned pregnancy and is the first child for her and for her patner.

10. Your patient was actively tracking her menstrual cycle and is certain that the first day of
the last menstrual period (LMP) was 12/2/11 using nacgele rule, estimate her date of
delivery
A. 5/12/11
B. 2/11/11
C. 19/12/11
D. 19/11/11
E. 19/10/11
11. AS her pregnancy continues, you would expect her cardiac output to increase by which
of the following mechanism
A. First an increase in stroke volume, then an increase in herat rate
B. A deceased In systemic vascular resistance
C. Cardiac output would not change significantly until the third trimester
D. An increase In systemic vascular resistance facilitated by elevated progesterone
levels
E. Increased heart rate alone
12. Wich of the following Is true regarding the physiologis. changes she might expect during
her pregnancy?
A. Gastric emptying and large bowel motility are increased In pregnancy
B. BUN and creatinine will decreased by 25% as a result of an increase in glomerular
filtration rafe (GFR). Which will be maintained until delivery.
C. An overall deceased in the number of WBC and platelets
D. Nausea and vorniting that should be treated aggressively with antiemetics and
Intravenops hydeation
E. An Increase in the tidal volume along with an increase In total lung capacity (TLC)
13. Miscarriage can be diagnosed with certainty on ultrasound in which of the following
situations ?
A. Gestational age greater than 9 weeks.
 B. The presence of an embryo measuring 10 mm with no evidence of cardiac activity.
C. A gestational sac with yolk sac measuring more than 12 mm.
D. An empty uterus on the follow up scan in a women diagnosed with an intrauterine
pregnancy on a previous scan
E. A falling serum βHCG measurement over 48 hours in a Pregnancy of Unknown
Location (PUL)
14. As woman, Is also a long distance runner and wants to continue to train during her
planned pragnancy. She wants to know If there are any potential adverse effect to her
fetus If she pursues program of regular exercise throughout gestation. You advice her to
A. During pregnancy, women should stop exercising because such activity is commonly
associated with Intrauterine growth retardation in the fetus
B. Exercise Is best performed in the Supine position to maximize venous retum and
cardiac output.
C. It is acceptable to continue to exercise throughout pregnancy as long as the maternal
pulse does not exceed 160
D. Non-weight-bearing exercises are optimal because they minimize the risks of
maternal and fetal Injuries
E. Immediately following delivery, patients can continue to exercise at prepregnancy
levels.
15. A 19-year-old woman comes to atenatal visit with a history of trace glucosuria and today,
she undergoes a urinalysis. The dipstick done by the nurse indicates the presence of
trace glucosuria.all other parameters of the urine test are normal. What is the most likely
etiology of the Inceased sugar detected In the urine ? ,
A. The patient has diabetes
B. The patient has a urine infectian
C. The patlent's urinalysis Is consistent with normal pregnancy

A 22 years old G2 P0 at 33 weeks gestation is found to have BP of 166/114 mmHg on a

routine visit. Her BP at her first prenatal visit at 7 weeks was 124/72. Her urine drip at this
most current visit show +3 protein although it previously had 0 to trace protein. The patient is
also complaining of a persistent headache although she has no history of migraines.Her
ALT and AST are…

16. What physical diagnostic examination Is important in that situation (cervical carcinoma)?
A. Palpation of the cervical mass
 B. Rectal examination
C. Rectovaginal examination
D. Palpation of the vagina
E. Vagnal examination
17. What is the most Ilkely stage of tie cases?
A. Stage Ia 1
B. Stage Ia 2
C. Stage IIIa
D. Stage Ib 1
E. Stage Ib 2

A 69-year-old woman with pelvic pressure anda palpable bulge presents for evaluation. She
recalis some mention of a cyctocele diagnosis, given by her primary care provider. Today, she
requests formal evaluation by a gynaecologist.

18. When performing the physical examination, what Is one type of staging system to
describe prolapse?
A. Pelvic organ prolapse quantificatjon scale (POP-O)
B. Gray scale
C. Visuala analog score
D. vreslow scale
E. Clark scale
19. A 25-year-old lady G1 term pregnancy comes to delivery room In active phase of labor.
Your perform CTG, and you find the CTG as the following. This deceleration most likely
reflect which of the following? pict.
A. Head compression
B. cord compression
C. Maternal chronic anemia
D. Severa pre eclampsia
E. Uteroplacental insufficiency
20. The sonographic appearance of the endometriom during the menstrual cycle correlates
with the phasic changes in its histologic anatomy. Which phase of the cycle is depicted
with the classic trilaminar appearances.as shown below? pict.
A. Menstrual
B. Secretory
 C. Proliferative
D. Periovulatory
E. lutheal phase
21. Which of the following, which Is the most common cause of death from the case above?
A. Infection
B. Uremia
C. Congestive heart failure
D. Fevel
E. Cereabral hemorrhage
22. Which of the following is the caracteristic histologic renal lesion of pre eclampsia cases?
A. Glomerular endotheliosis
B. Interstitial fibrosis
C. Crescebt formation
D. Renai cortical necrosis
E. Glomerular sclerosis
23. Which of the following test would be the most effective in identifying an underiying
cause of recurrent miscarriage?
A. Antithrombin lll assay
B. Serum progesterone level
C. lupus anticoagulant assay
D. luteinizing hormone assay
E. Serum estrogen level
24. A 29-year-oid G3 P1 presents complaining of no menses for 4 months after stopping
her birth control pills. She is concerned that the use of the oral birth control pills (OCPs)
has left har with amenorrhea. The patient has had no recent changes in weight,
exeercises two to three times week, and notes noparticular changes in either her work or
home ilfe. Her obstetric history Includes a therapeutic abortion at age 21, a normal
spontaneous delivery at 25, and a miscarriage at age 27. After the dilation and curettage
at all time of miscarriage, the patient was hospitalized with an infection her uterus. Since
that time, she has taken OCPs. Given this history, which of the following Is the most
Iikely etiology of this patient's amenorrhea?
A. vaginal agenesis
B. asherman’s syndrome
C. Mayer-Rokitansky Kuster Hauser syndrome
 D. Testicular feminization
E. Hypogonadotropic hipogonadism
25. A 65-year-old G2P2002 presents to the urogynaecolagy ciinic with complaints of urinary
Incontinence. She leaks urine occaslonally when she coughs, but also leaks urine
without any provocation. She often has difficulty making it ti the restroom in time. She
has even leaked urine shortiy after having normal emptying of her bladder. She normally
gets up at least 2 to 3 times per night to urinate. Urinalysis and urine culture performed
last week at her PCPs office are both negative. What is the most likely diagnosis and
appropriate treatment for this type of this incontinence?
A. Stress urinary Incontinence, ditropan (oxybutyrin chloride)
B. Detrusor Overactivity, Detrol (tollerodine)
C. Overfiow Incontinence, cholonergic agent
D. Destrusor overactivity, suburethral sling
E. Stress urinary Incontinence, suburethral sling
26. An 18 year old G0 presents to your clinic with prismary-amenorrhea. She has normal
breast development, but has limites development of pubic or axillary hai On pelvic,
examination, you note that she has a foreshortened vagina. Transvaginal and trans
abdominal ultrasound is unable to identify a uterus. Chromosomal analysis shows that
the patient is 46XY What Is this patient's diagnosis?
A. Testicular feminzation
B. gonadal agnesia
C. Mayer Rokitansky Kuster Hauser syndrome
D. Swyer syndrome
E. Tumer syndrome
27. A 33-year old G3POS3 comes to you for a history of recurrent miscarriage. Each of her
miscarriages occured during the first trimester and presented with heavy but self limited
bleeding. She had a thrombopholia evaluation, whic was normal. evaluation of the
uterine cavuty with hysterosialpingogram and sonoohysterogram both sugest a Uterine
septum. An MRI was obtained that also showed a uterine septum and no evidance of
bicornuate uterus. The reaider of the pelvic and urologic structures appeared to be within
normal limits. The patient and her husband would like to Conceive again but are very
afraid of another miscarriage. How would you advise them to proceed?
A. surgical resection Of the uterine septum priop to attempting conception again
 B. inform them that the uterine septm Is not related to their history of recurrent
miscarriage and the can start attempting pregnancy again
C. Procees to Infertility evaluation and In vitro fertilization
D. Pian fora gestasional carrier
E. Attempt to adopt
28. A young woman with Factor V leiden and a prior history of mid pre-ecdampsia fesulting
in birth of small for gestasional age child presents for pre-pregnancy counselhng. She
has no prior personal history of venous thromhoembolism. Which of the following should
be recommended?
A. An oral anticoagulant In the antepartum and post partum perlods
B. Low molecular weight heparin in the antepartum and post partum periods
C. Low molecular weight heparin postpartum, at least while in hospital
D. Low moleular weight heparin postpartum for 6 months
E. No antepartum or post partum anticoagulants
29. Y 29 yar old woman presents at 36 weeks of gestation will shortness of breath without 3
clear alternative diagnosis on history or examination. She is short of breath while
climbing half a flight of stairs. She has left leg oedema more than right leg oedema Your
next step in diagnostic management would be which og the following?
A. Apply the Welis dinical model for puimonary embolism
B. D-diner test
C. Bilateral leg ultrasound Imaging
D. CT scann of the chest
E. V/Q scan
30. In the presence of proteinuria and hypertension after 20 gestasional week, with unknown
previous history.
A. The differential diagnosis between PET and CKD Is always possible if prepregnancy
data are available
B. Severely Impaired utero-placental if flows and fetal growth suggest CKD
C. Normal fit PIGF ratio suggest CKD
D. Protemuria 3 day suggest CKD
E. Proteinuria above 6g/day suggest CKD
31. Which of the following drugs should be discontinued during pregnancy?
A. low dose aspirin .
B. bisoprolol
 C. atenolol
D. aglotensin Converting Enzyme Inhibitors (ACEI)
E. Furosemid
32. A 75-year old woman has a bilateral, solid adnexal masses. Mammography is normal,
Gastrointestinal studies show a stomach lesion suspicinus.for malganncy. Which of the
following Is the most likely diagnosis?.
A. Pick’s adenoma
B. Krukenberg’s tumor
C. brenner tumor
D. struma ovarii
E. Carcinoid
33. perinatal HIV transmission is most accurately correlated with which of the following?
A. CD4 count
B. CD4 cell proportion
C. Viral load
D. Presence of an AIDS-defineing illness
E. Rapid test

Mrs. S, 29 years old. G3P1A1 39 weeks of gestasional age, referred by midwife with prolonged
second stage. in examination, revealed normal vital sign in. Obstetric examination recealed
contraction was 3x/10'/25*. Fetal heart rate was 160x/m. examination fetal weight was 3100
gams. Previos baby was 3000 gams. Vaginal examination revealed: full dilatation, amniotic
membrane was absent thick and greenish, lowes part was head with descents or the head was
hodge IV. Denominator was minor fontanella at the left anterior

34. What will you choose to terminate this condition

A. Spontaneous delivery
B. Augmentation
C. Embryology
D. Forceps extraction
E. Cesarean section
35. What are Indicatlon for assisted vaginal delivery?
A. Uterine rupture
B. PPROM
C. Pastpartum haemorrhage
 D. Fetal anomaly
E. Fetal or maternal distress
36. Frequent compilation of the action above is
A. Uterine rupture
B. cephal haematoma
C. Erb's paralysis
D. Fracture os femur
E. Parese NVII

An 18 year old G0 F presents to your office for contraceptive counseling. She has never used
any method of contraceotion before and is engaged in a monogamous sexual relatonship.
Gynecologic history is significant for regular, heavy menstrual cycles using Up to tight pads per
day, lasting up to 7 days at a time, with severe pain (dysmenorrhea). She smokes one-half pack
of cigarettes per day and tells you that her mother and aunt have Factor V Leiden disease, but
that se has never been tested herseif or had a thromboembalic event. She will attend college
soon and has no plans for a pregnancy in the near future. She indicates her desire for the
“most reliable” method of contaceptionthat you can offer.

37. Which of the following methods of contraception has the least efficacy?
A. Orto evra patch
B. Combined oral contraceptive pills
C. Mirena IUD
D. Condoms with spermicide
E. Coitus interuptus
38. Physical examination In the office reveals a blood pressure of 140/85mmHg, pulse of 80,
and BMI Of 40, Abdomen is soft, nonender, and genitourinary exam is unremarkable
with no cervical inflamation. Which of the following would be the best Choice
contraception for this patient?
A. Orto evra patch
B. Combined oral contraceptive pilis
C. Mirena IUD
D. Condoms with spermicide
E. Coitus interuptus
39. Of course, during your discussion at this Visi, you Could encourage soking cessation
and recommend weight loss to help improve her overali health. You and the patient have
 decided to proceed with IUD replacement. Prior to placement, It is important to perform
which of the following test?
A. FSH level
B. Prolactin level
C. Urine pregancy test
D. Gonorrheal/chlamydia testing
E. Both c and d

A 19 year old woman complain of a golf bali sized mass at the entrance of her vagina. She says
that this area is “store all the time” and began hurting “about 3 days go”. On examiantion, the
patient has a tender4 cm mass on the lateral aspect of the labia mnora Rt the 5 o'clock position.
There is erythema and edema, and the area Is very tender and fluctuant. No celulitis Is noted

40. What Is the most appropriate tratement for this condition?

A. Trimethoprim/suifamethoxazole
B. Azithromycin for the patient and any sexual partners
C. Incision and drainage of the mass followed by 3 course of trimethoprim /
sutfarnethoxazole
D. incisio and drainage of the mass
E. incision and drainage otf the mass with placement of Word catheter
41. Bartholin gland duct cyst form indirect response to which of the following?
A. Vulvar irritation
B. Cervical gonorrhea
C. Glanc duct obstruction
D. Chronic lichen sclerosis
E. All of the above
42. Which of the following is generally the treatment of choice for recurrent Bartholin gland
duct abscess?
A. Systemicantibiotics
B. 5-percent lidocaine ointment
C. Bartholine gland duct marsupialization
D. Warm compresses and freguent sitz baths

A 62-year old woman presents ti the office complaining of watery discharge and bleeding for the
pass 2 months. She h as not had a Pap test In 14 years. She states she had a mildiy abnormal
pap in her 30s, but that was treated with cryotherapy. She states she went trough menopause at
age 50 and has never been on hormone replacement therapy. She does admit to smoking obe
half-pack a day for 40 years. Her husband is deceased, and she has not been sexually actibe in
10 years. Her examination reveals a cervical necrotic mass approximatety 5 cm in size.
Reectovaginal examination is suspicious for left parametrial involvement. There is no evidence
of adnexal masses, but exaination of the uterus and adnexa is limited by the patient's body
habitus.

You suspect this may be cervical cancer. You obtain a Pap smear and take biopsy of her
cervical abnormality. The Pap test returns with a reading of SCC, and the biopsy confirms this
diagnosis. She also received a cystoscopy for hematuri with positive urine cytology. The biopsy
also show SCC. You order a CT scan which shows a cervical mass measuring 7,7x315.0 cm
as wel as an avid left internal iliac Iymph node consisten with localty metastatic disease.

43. What is the International Federation of Gynecology and Obstetrics (FIGO) stage for her
cancer?
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
44. What do you recommend for the next step treatmen of her cervical cancer?
A. Cold knife cone
B. Simple hysterectomy
C. Chemotherapy alone
D. Palliative care/chemorad
45. She Is treated with chemoradiation anda 3 years later has a recurrence. Yoy proceed
with pelvic exenteration for her recurrent cancer. What is her 5 year survival rate after
the Pelvic exenteration? ,
A. 5%
B. 10%
C. 25%
D. 50%
E. 90%

The couple came to klinik with complaint : want to get pregnant. This couple has been married 3
years. Current wife age 36 tahun, height 151cm, and weight 73 kg, a history of sexual
intercourse 2-3 times a week. From anamnesis we found a history of menstrual pain since the
age of 20 years and intermitten treatment for vaginal discharge odor complaint and itchy since
before married

46. In this case, the couple should get treatment at facilities :

A. Primary level infertility services
B. Secondary level infertility ervices
C. Tertiary level infertility source
D. Basic level of infertility source
E. Advanced infertility services
47. In this couple :
A. Infertility services can be given by qualifie pratitioners who can provide Consultation,
education, and advice to both partners and have knowledge of the terms of
reproductive succes and problems
B. Given infertilty services by health workers who have experience and documented
certified to perform the procedure endocrine, gynaecology, and uroloy, have
extensive knowledge about he effectiveness, side effects, the cost of doing the
diagnpsis and treatment og infertility.
C. Treatment Is aimed to be abie to determine the caue of infertility from both sides as
wel as determine whether the couple needs to get sercvices at a higher level of
service
D. Intertility service tak require special expertise because It Indudes the actions
assisted reproductive technology that can only be prformed In spedalized infertility
clinik
E. Having practitioner qualification cer fication and experience in TRB, urology of
andrology, and qualifies as an infertility counselor

You are going to make Clinical skill training. There are some problems that you are worried, In
reaction of successtuliy of taht training approach.

48. The trairing appproach describe in this chapter Is gulded by prindpies of adult learning
These penciples are based on the assumption that people participate In traing Courses
beacuse :
 A. they are Interested In the topic, wish to improve their knowledge or skilis, and thus
their jov performance. Desire to be thus their job erformance, desire to be actively
Involve in course activities
B. Uses behavior modeling Is competency-based, Incorporates humanistic traing
echniques.
C. Competency based, which means assessment is keyed to the course objective ang
emphasized acquaring the essential knowldge, atitudinal conceps and skills need to
perform a job, not simply acquiring new knowledge.
D. Less steressfull because from the outset participant, both individually and as a
group, know what they are expected to learn and where to find the information, and
have ample opportunity for discussion with the clinical trainer.

Mrs. A, 24 years promogravida, 39 weeks gestational age, undergoes caesarean delivery due to
breech presentation. She deivereg female baby, with Dody weigh 3600 gr, APGAR score was
8/9

49. Post operatively maintenance intravenous adminsteres fluids are :

A. Ringer solution or a similar crystalloid solution with 5-percent dextrose.
B. 10% dextrose
C. Colloid solution
D. Crystakoid solution with 40-percent dertrose
E. Amino acid based fluid
50. Solid food 25 one f the source Of nutritional diet in post caesarean patient will be offered
within
A. 2 hours post operative
B. 3 hours post operative
C. 8 hours postoperative
D. 12 hours post operative
E. 2 hours post operative
51. Woman undergoing caesarean delivery have an inceased risk oof venous
thromboembolism comare with those delivering. In order to decrease the risk, what is
your suggestiont these women:
A. early ambulation
B. early feeding
C. Administered ansigesic
 D. Inspected the Incision each day
E. Removed the skin closure on the fourth post operative day.

Mrs A, 24 years old, G2P1AO 39 weeks gestational admitted to your emergency room with
plained abdominal cramping with bloody show. in exemination, revealed normal vital sign,
rection was 3x10'/35”. Fetal heart rate was 146x/m. Estimated fetal weight was 290Ogram.
Previous baby was 3200 gram. Vagial examination revealed : dilatation was 4 cm, efficement
100%, amniotic membrane was intake, lowest part was head with descent of the lowest part
was hodge II. Denominator was minor fontanella at the left side.

52. What is the condition of this patient?

A. Not in labour yet
B. In labour, stage 1 latent phase
C. In labour, stage 1 active phase
D. In labour, stage 2
E. inlabour, stage 3
53. According the vignette above, what wil be happened to that mother?
A. she will continue the progress of labour and will give birth normally
B. The progress of labour will be stucked in this phase of labour
C. She will underwent prolonged second stage
D. The second stage of labour must be terminated by vacuum or forcipal extraction
E. The mother will face the possibility of post partum haemorrhage

Mrs. Seliy 20 year old primipara Is 36 hours post partum following caesarean delivery for allure
to progress. She is compiaining of abdominal pain and has a fever of 38C. She is not yet
tolerating oral Intake because of nausea. you diagnose metritis

54. Which of the following Is the most Imortant criterionfor the diagnosis of post partum
metritis?
A. uterine tenderness
B. fever
C. Foul-smelling lochia
D. Leucocytosis
E. Leukopenia
55. Which of the following Is the most frewuent cause metritis?
A. Group A streptococcus
 B. Group B strreptococcus
C. Chlamydia trachomais
D. Mycoplasma homonis
E. Ureaplasma ureatyticum
56. A defect in the anterior abdominal wal that abdominal content of the fetus Covered only
by a two-layerd sac af amnion and peritoneum
A. Omphalocele
B. Gastroschisis
C. Diaphragrnatic hernia .
D. Duodenal atresia
E. Post uretral value
57. In case of severe hyperemesis gravidarum, all EXCEPT of the following initial Initial
complication are common?
A. Acidosis
B. dehydration
C. Hypokalemi
D. Hyponatremi
E. Mild transaminitis
58. Which of the following twin pregnancies would be candidates for fetoscopic las laser
ablation therapy for twin-twin transfusio syndrome (TTTS)?
A. Monochorionic diamniotic twins at 23 weeks of gestation with stage I TTTS
B. Dichorionic diamniotic twins at 19 weeks gestation with stage II TTTS
C. Monochorionin diamniotic twins at 15 weeks gestation with stage IV TTTS
D. Monochorion diamniotic twins at 21 weeks gestation with stage III TTTS
E. Monochorionic diamniotic twins at 14 weeks gestation with stage III TTTS,
59. Which of of the following symptoms of adenmosis is correctiyy paired with Its etiology?”
A. Dysmenorrhea incrased prostaglandin production
B. Dysmenorrhea-hemerrhage within the ectopic glandular foci
C. Menorrhagia increased and abnormal vascularization of th eadenornyotic tissue
D. Infertility Increased and abnornal vascularization of the adenomyotic tissue
E. Its severity does not correlate with ectopic foci and degree ofinvasion
60. What Is the most common site Of metastatic spreas of choriocarcinoma.?
A. Brain
B. Liver
 C. Lungo
D. Vagina
E. Tuba
61. Regarding coagulation system in preganancy, which of the following statement Is true?
A. Mean platelet counts Is 250.000/ul
B. fibbrinotytic activity Is usualy reduced
C. fibibrinogen levels are increased
D. Decreases in platelet concentration are solely due to haemodilution
E. Is responsible for dependent edema In the lower extremities
62. A 55-year old healthy woman undergoes exploration for a large pelvic mass. Frozen
section analysis of her right ovary notes “mucinous low malignant potential, cannot
exclude Invasian"”, There s no othe obvious disease. What surgical procedures should
be performed, in addition to total abdominal hysterectomy and bilateral
salpngooophorectomy?
A. Pelvic washing, omentectomy, multiple peritoneal biopsies
B. Pelvic washings, omentectomy, multiple peritoneal biopsies, bilateral pelvic and para
aortic Iymph node dissection
C. Pelvic washings, omentectomy, multiple, peritoneal biopsies, bilateral pelvic and
para aortic lymph node dissection, appendictomy
D. the procedure done was completed
E. Omentectomy, multiple peritoneal biopsies pelvic and para aortic Iymph node
dissection
63. A 32 year old G1P1 woman presents to your office with th echief complaint of
amenorrhea since her most recent vaginal delivery 1 year ago. She notes that she had
an uncomplicate pregnancy, followed by the delivery of a healthy baby boy. Her delivery
was complicated by an post partum hemorrhage requiring a post partum dilatation and
curettage. After her delivery, she breastfed for 6 months, and during this time she had
scant and iregularvaginal bleeding. After stopping breastfeeding 6 months ago she notes
the absence of menses, but instead has monthly painful cramping, which seems to be
getting worse. She remarks that prior to her pregnancy, she had normal, regular
menses, which were not too heavy or painfuli. She and her husband would Ike to have
another child, and have been having unprotected Intercourse for the past 6 months
without achieving a pregnancy. Your review of system is otherwise negative. You
perform a physical examination, which Is normal other than a siightly enlargde, teder
 uterus. A uterine pregnancy test in the office Is negative. What Is the most lIikely
diagnosis?
A. sheehan's syndrome
B. Lactational amenorrhea
C. Asherman’s syndrome
D. Premature ovarian failure
E. Kalimann syndrome
64. From a hysterosalpingogram, you find out multipel synechiae within the uterus. What Is
your step in therapy of his patient?
A. Diagnostic and operative hysteroscopy
B. Provera 10 mg daily for 5 days in an attempt to achieve a withdrawal bieed
C. In vitro fertilization
D. Place an intra uterine device
E. Inform your patient that unfortunatety, she Is “barren" and will not be able to Carry a
pregnancy again
65. The following are acceptable methods for confirmation of ovulation
A. drop in basal body temperature of at least 0,5°C on day 14
B. Blood progesterone level on day21
C. Menstruation
D. Endocervical biopsy
E. Gonadotrophin level

A 27 year old patient and her husband present to you with primary infertility. The patient, reports
regular periods every 28 to 30 days. The patient has no significant medical history and does not
take any medication other than prenatal vitamins. Her husband is also in a good health, is 30
years old, and has two children from a previous marriage. When you asked the patient how long
they have been trying to achieve a pregnancy, they tell you 6 months

66. Your instruction to the couple are the following

A. They will likely need IVF to achieve a pregnancy
B. They will likely need IUI cycles
C. Continue trying appropriately timed intercourse for 6 more months and if no
pregnancy Is achieved, come back to see you
D. Consider donor egg
E. Consider adoption
67. The couple comes back to you after appropriately timed intercourse, not having
achieved a pregnancy. At this time you embark on a workup that Includes a semen
analysis, an HSG, and an endocrine evaluation induding FSH, E2, TSH, prolactin levels,
and ovarian reserve testing. All of the test come back normal. Your next
recommendation
A. Have 6 more months of timed intercourse and if no pregnancy is achieved, come
back to see you
B. Clomphene citrate wit IUI
C. IVF
D. Donor egg
E. Human gonadotropin (hMG)
68. Which of the following defines heterotopic pregnancy?
A. One tubal and one abdominal pregnancy
B. One etopic and one intrauterine pregnancy
C. Two pregnancies, one in each fallopian tube
D. Two pregnancies In one fallopian tube
E. Two tubal and one abdominal pregnancy
69. The American College of Obstetricians and Gynecologist considers which of the
following factors the most Important in selecting a suitable canidate for trial of labor after
cesarean Section (TOLAC)?
A. Prior uterine incision type
B. Infection at the time of the original surgery
C. Gestasional age at the time of the origina: surgery
D. Degree of uterine distention during the current pregnancy
E. Cervical dilatation at the time of hospital admission
70. Post operatively after the urinary catheter removal the most common pronlem In the
female bladder Is
A. Urinary tract infection
B. Bladder atony cause by over distention
C. Overactive bladder
D. Bladder and uretral trauma
E. Urge incontinence
71. The incuhatian period of syphils Is which af tbe following?
A. 1-7 days
 B. 10 days
C. 3-90 days
D. 120-180 days
E. 210 days
72. From pelvic examination findings : petvic brm round, diagonal conjugate 12cm,
symphisis parallel to sacrum, subpubic angle Is acute, convergent side walls, bituberous
diameter is 7 cin. By analizing your finding, which cause below is unlikely to be?
A. Android petns
B. Anthropoid pelvis
C. High assimilation elvis
D. platypelloid pelvis
E. Oblique pelvis
73. Which of the following Is a factor predisposing to the development.of malignant mixed
mullerin tumors? –
A. Prenatal exposure to diethylstiibestrol (DES)
B. Exposure to mumps virus
C. Family history of ovarian cancer .
D. Previous pelvic irradiaton
E. Perineal use of talk

Mrs. S, 32 years old G4P3A0 gravid with chronic hypertension had a normal tabor that arrested
in second stage at +1 station..She complained of mild dyspneu and fatigue. The fetus had a left
occiput anterior presentation and was delivered hy forceps. Completion ofthird stage followed
qulckiy, and the fundus was noted to be firm. The OBGYN was carefully examined, and no
laceration were noted. The examiner then noted the lower uterine segment was boggy

74. Mrs. S one dose uterotonic agent Is given and the fundus is massaged. Despited this,
she continues to bleed. Which of the following is suit. Is suitable treatment in this
situation?
A. administer methergin 0,2 mg Intramuscularly
B. mobilize a team that inciude obstetrician, nurse, anf anrstesiologist
C. Perform laparotomy to prepare post partum hysterectomy
D. Apply ballon catheter
E. Uterine and ovarian artery ligation
 75. The patient continues to blees and you have initiated whole blood transfusion. Which Of
the following Is suitable treatmet in this slituation?
A. Continues to adnminister hemabate Intamuscularly every 20 minutes
B. Insert bakri post partum ballon or large folle catheter ballon into the uterine cavity
and inflate the ballon
C. Cinsider laparotomy and uterine compression suture placement
D. All of the above
E. A and B

Mrs. A, 24 years primigramda, 39 weeks gestational age, undergoes caesarean delivery due to
breech presentation She delivery female baby. with body weight 3600 grams, and APGAR
Score was 8/9.

76. Post operatively maintenance intravenous administered fluids are:

A. ringer soluiton or a Similar crystalloid Solution with 5-percent dextrose.
B. 10% dextrose
C. Colloid solution
D. Crystalloid solution wih 40-percent dextrose
E. Amino acid based fluid
77. Solid food as one of the source Of nutritional diet in post carsarean patient will be
offered within
A. 2 hours post operative
B. 3 hours post operative
C. 8 hours post operative
D. 12 hours post operative
E. 24 hours post operative
78. Women undergoing cesarean delivery have an increased risk of venous
thromboembolism compared with those delivering vagnaly. In order to decrease the risk,
what is your suggestion to Ihese women
A. Early ambulation
B. Earty feeding
C. Adamnistered analgesic
D. Inspected ihe incision each day
E. Removed the skin closure on the fouth postoperatifve day
Mrs. A 24 years, G2P1A0 39 weeks gestational, admitted to your emergency room with
complained abdominal cramping with bloody show. In examination, revealed normal vital sigh,
contraction, was 3x/10/35. Fetal, heart rate was 146x/m. Estimatod fetal weight was 1 gram.
baby was 2900 gram. examination revealed: dilatation was 4 cm, effacement 100% amniotic
membrane was intake. lowest pan as head with descent of the head was Hodge II. Denominator
was minor fentanella at the left side.

79. What is the condition of this patient?

A. Not in labour yet
B. In labour, stage 1 talent phase
C. In labour, stage 1 active phase
D. In labour, stage 2
E. In labour, stage 3
80. According the vignette above, what will to happened to that mother?
A. She will continue the progress of labour and will give birth normally
B. The progress of labour will be stucked in this phase of labour
C. She will underwent prolongned second stage
D. The second stage of labour must be lerminated by vacuum or forcipal extraction
E. The mother will face the possibility of post parfum haemorrhage

Mrs. Selly 20 year-old primipara. Is 36 hours postpartum following cesarean dalivery for failure
lo progress She Is complaning of abdominal pain and has a fever of 38 C. She is not yet
tolerating oral intake because of nausea, You diagnosis metritis

81. Which of the following is the most Important criterion for the diagnosis of postpartum
metritis?
A. Uterine tenderness
B. Fever
C. Foul-smelling lochia
D. Keukocytosis
E. leukopenia
82. which of the following is the most frequent cause metritis?
A. Group A streptococcus
B. Group B streptococcus
C. Chlamydia hominis
D. Mycoplasmna hominis
 E. Ureaplasma urealyticum
83. A defect In the anterior abdominal wall that abdominal contents of the fetus covered only
by a two-layered sac of amniomn and peritoneum
A. Omphalocele
B. Gastroschisis
C. Diaphragmatic hernia
D. Duodenal atresia
E. Posturethral value
84. in cases dl severe hyperemesis gravidarum, al EXCEPT which of the followng initial
complications are common?
A. Acidosis
B. Dehydration
C. Hypokalemia
D. Hyponatremia
E. Mild transminitis
85. Which of the following twin pregnancies would be candidates for fetoscopic laser
ablation therapy for twin-twin translusion syndrome (TTTS)
A. Monochorionic diamnionie twins at 23 weeks of gestation with stage I TTTS.
B. Dichorionic diamnionic twins at 19 weeks Of gestation with stage II TTTS.
C. Monochorionic diamnionic twins at 15 weeks gestation with stage IVTTTS
D. Monochorionic diamnionic twins at 21 weeks gestation with stage III TTS.
E. Monochorionic diamnionic twins at 14 weeks gestation with stage III TTTS.
86. Which of the following Symptoms of adenomyosis is correctly pared with its etiology?
A. Dysmenorrhea-increased prostaglandin production
B. Dysmenorrhea- hemorrhage within the ectopic glandular foci
C. Menorrhagia-increased and abnormal vascularization of the adenomyotic tissue
D. Infertility- increased and abnormal vascularization of the adenomyotic tissue
E. its seventy does not correlate with ectopic loci and degree of invasion
87. What is the most common sile ol metastatic spread of choriocarinoma?
A. Brain
B. Liver
C. Lung
D. Vagina
E. Tuba
88. Regarding coagulation System in pregnancy, which of the following Statements is true?
A. Mean platelet count is 250.000/uL
B. Fibrinolytic acivity is usually reduced.
C. Fibninogen levels are increased.
D. Decreases In ptatelet concentration are solely due io hemodilution.
E. Is respansibls for dependent edema in the lower extremities.
89. A 55-year-old healtty woman undergoes exploration for a large pelvic mass. Frozen
section analysis of her right ovary notes “mucinous low malignant potential, cannot
exclude invasion.” What surgical procedures should be performed, in addition to total
abdominal hysterectomy and bialteral –salpingoophoreciomy?
A. Pelvic washings, omentectomy, multiple peritoneal biopsies
B. Pelvic washings, omentectomy, multiple peritoneal biopsies, bilateral pelvic and
para-aortic Iymph node dissection
C. Pelvic washings, omentectomy, multiple peritoneal biopsies, bilateral pelvic and
para-aortic tymph node dissection appendectomy
D. The procedure done was completed
E. Omenteclomy, multiple peritoneal biopsies, bilateral pelvic and para-aortic Iymph
node dissection
90. A 32-year-old G1P1 woman presents to your office with the chief complaint of
amenorrhea Since her most recent vaginaldelivery 1 year ago. She notes that she had
an uncomplicated pregnancy, followed by the delivery of a healthy baby boy. Her
delivery was Compicaled by an Intra-amniokc Inection as well as a postpartum
hemomhage requiring a postpartum dilation and curettage. After her delivery, she
breastfed for 6 months, and during this time she had scant and irregular vaginal
bleeding. After stopping breastfeeding 6 monts ago she notes the absence of menses,
but instead has monthly painful cramping, which Seems to be getting worse. She
remarks that. prior to her pregnancy, she had normal, regular menses, which were not
too heavy or painful. She and her husband would like to have another child, and have
been having unprotected intercourse for the past 6 months wihout achleving a
pregnancy. Your review of Systems Is otherwise negative. You perform a physical
examination, which is normal other than a slightly enlarged, lender uterus. A urine
pregnancy test in Ihe Office is negative.
What is the most likely diagnosis?
A. Sheehan's syndrome
 B. Lactational amenorrhea
C. Asherman's syndrome
D. Premature ovarian failure
E. Kallmann syndrome
91. From a hysterosalpingogram, you find out multiple synechiae within the uterus. What is
your next step in therapy of this patient?
A. Diagnostic and operative hysteroscopy
B. Provera 10 mg daily for 5 days in an attempt to achieve a withdrawal bleed
C. In vitro fertilizatio
D. Place an intrauterine device
E. Inform your patient that unfortunately, she is “barren” and will not be able lo carry a
pregnancy again
92. The following are acceptable methods for confimation of oyulation
A. A drop in basal body temperature of at least 0.5°C on day 14
B. Blood progesterone level on day 21
C. Menstruation
D. Endocervical biopsy
E. Gonadotrophin level

A 27-year-old patient and her husband present to you primary infertility. The patient reports
regular periods every 28 to 30 days. The patient has no significant medical history and does not
take any medications. Her husband is also in good health, is 30 year of age, and has two
children from a previous marriage. When you asked the patient how long they have been trying
to achive a pregnancy, they tell you 6 months.

93. Your instructions to the couple ara he following

A. They will likely need IVF to achieve a pregnancy
B. They will likely need IUI cycles
C. cotineu trying appropriately timed intercourse for 6 more months and if no pregnancy
Is achieved, come back to sae you
D. Consider donor egg
E. Consider adoption
94. The couple comes back to you after appropniately timed intercourse, not having
achieved a pregnancy. At this time you embark on a workup that inludes a semen
analysis, an HSG, and an endocrine evaluaton including FSH, E2, TSH, prolactin levels,
 and ovarian reserve testing. All of the tests come back normal Your next
recommendation:
A. Have 6 more months of timed intercourse and if no pregnancy is achieved, come
back to see you
B. Clomphene citrate with IUI
C. IVF
D. Donor egg
E. Human gonadotropin (hMG)
95. Which Of the following delines heterotopic pregnancy?
A. One tubal and one abdomnad pregnancy
B. One eclopic and one Intrauterine pregnancy
C. Two pregnancies, one in each fallopian tube
D. Two pregnancies in one fallopian tube
E. Two tuba and one abdominal pregnancy
96. The american College of Obstetricians and Gynecologists considers which of the
following factors the most important in selecting a suitable candidate for trial of fabor
after cesarean section (TOLAC)?
A. Prior uterine incision type
B. Infection at the time of the orginal surgery
C. Gestational age at the time of the original
D. Degree of uterine distention during the current pregnancy
E. Cervical dilatation at the timee of hospital admission
97. Post operatively, after the urinary catheter removal the most common problem in the
female bladder is
A. Urinary tract infecton
B. Bladder atony caused by over distention
C. Overactive bladder
D. Bladder and urethral trauma
E. Urge incontinence
98. The incubation period Of Syphilis Is which Of the following?
A. 1-7 days
B. 10days
C. 3-90 days
D. 120180 days
 E. 210 days
99. From pelvic examination findings: pelvic brim: round: diagonal conjugale 12 cm,
symphisis parallet to sacrum, subpubic angle is acute, convergent side walls, bituberous
diameter is 7 cm. By analyzing your findings which causes below is unlikely to be?
A. Android pelvis
B. Anthropoid pelvic
C. High assimilation pelvis
D. Platypelloid pelvis
E. Obique pelvis
100. Which of the following is a factor predisposing to the development of malignant
mixed mullerian tumors?
A. Prenatal exposure to diethyistilbestrol (DES)
B. Exposure to mumps virus
C. Family history of ovarian cancer
D. Previous pelvic irradiation
E. Perineal use of talc