Unas Nov 2015
Unas Nov 2015
Unas Nov 2015
unit for active management of labor after it was determined that 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 relief.
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, external rotation
d. Engagement, descent, flexion, internal rotation, external rotation
e. Engagement, descent, internal rotation, flexion, external rotation
6. For the patient described in Question 5, what is the most appropriate initial treatment?
a. Red cell transfusion
b. Folic acid, 4 mg orally daily
c. Hydroxyurea, 1 g orally daily
d. Elemental iron, 200 mg orally daily
7. Of medical conditions associated with anemia of chronic disease, which is most frequently
encountered in pregnancy?
a. Crohn disease
b. Hodgkin lymphoma
c. Chronic renal insufficiency
d. Systemic lupus erythematosus
Ms. Smith is a 37-year-old multigravida who presents to your office at 32 weeks' gestation
as calculated by her last menstrual period. Her hematocrit is 29 volume percent, and she has
sicklecdl trait. During sonographic evaluation, the fetus has biometric values that correlate
with a 28-week fetus.
8. What is the most likely explanation?
a. Aneuploidy
b. Chronic hypoxia
c. Poor pregnancy dating
d. First-trimester cytomegalovirus infection
9. For the patient in Question 8, when will you reevaluate fetal growth?
a. 1 week
b. 2 weeks
C. 3 weeks
d. 6weeks
Your next obstetrical sonographic evaluation of the patient in Question 44-27 is performed 4
weeks after the fust one and now at an estimated gestational age of 36 weeks. The fetus
now has measurements similar to a 30-week fetus. Growth restriction seems more likely.
10. What is appropriate at this time?
a. Delivery
b. Strict bed rest
c. Umbilical artery Doppler velocimetry
d. Sonographic fetal biometry in 1 week
11. For the patient in Question 10, studies indicate Sistolic/diastolic (S/D) ratio of 4, and the
patient has an amnionic fluid index (AFI) of 9 em. What is appropriate at this time?
a. Delivery
b. Betamethasone administration
C. Sonographic fetal biometry in 1 week
d. Serial umbilical artery Doppler studies and AFI assessment
12. For the patient in Question 11, during the next week, umbilical artery Doppler
velocimetry indicates reversed end-diastolic flow (RED F), and the amnionic fluid index (AFI)
is 4 em. What is appropriate at this time?
a. Deliver the fetus
b. Plan delivery at 38 weeks after amniocentesis for pulmonary maturity
c. Continue serial umbilical artery Doppler studies and AFI assessment
d. All are reasonable
A 20-year-old woman in her first trimester come to the antenatal clinic (ANC) for routine
care. After counseling she volunteered for HIV testing and was found to be HIV positive.
13. During pregnancy HIV transmission occurs mostly during:
a. 1st trimester
b. 2nd trimester
c. 3rd trimester
d. During labour
e. During lactation
14. With regard to HIV in pregnancy:
a. A positive HIV blood test in pregnancy is not reliable
b. A high maternal HIV RNA load decreases the mother-to-child transmission of HIV
c. Use of antiretroviral agents is always commeneed in the first trimester of pregnancy
d. HIV infection increases the mother to-child transmission of the hepatitis C virus
e. If there are ruptured membranes for 6 hours, there is no advantage to delivery baby
by caesarean section
15. A woman with a previous stillbirth and postpartum DVT is found to have lupus
anticoagulant and medium-titre Immunoglobulin M (IgM) anticardiolipin antibodies
(aCL) on two occasions. In a subsequent pregnancy:
a. She has an increased risk of miscarriage
b. Low dose aspirin should be discontinued at 34 weeks
c. Warfarin should be continued
d. She does not require postpartum heparin if she has vaginal delivery
e. She requires antibiotic prophylaxis to cover delivery
16. The following drugs is NOT appropriate for a woman with SLE who is 35 weeks
pregnant:
a. Diclofenac
b. Prednisolone
c. Hydroxychloroqujne
d. Sulfasalazine
e. Azathioprine
A 69-year-old woman with pelvic pressure and palpable bulge presents for evaluation. She
recalls some mention of a cystocele diagnosis, given by her primary care provider. Today,
she requests formal evaluation by a gynecologist.
17. In discussing her symptoms, the patient points out that her voiding function has
changed as the prolapse has grown in severity. Initially, the patient reported stress
urinary incontinence, butas the prolapse worsened, the incontinence improved. While
she is happy with the resolution of her incontinence, she currently experiences some
incomplete bladder emptying, which is improved upon manual reduction of the
prolapse. How do you counsel her about her risk of incontinence after an isolated
anterior wall repair (with no other concomitant surgery)?
a. 90% of de novo urgency and urge urinary incontinence
b. 90% of urinary frequency
c. 95% that her stress incontinence will be cured by anterior repair
d. 95% that an anterior repair could 'worsen" her stress urinary incontinence
symptoms
e. 90% of de novo fecal incontinence
18. In assessing the above patient, you also find a posterior vaginal wall defect. What is a
common symptom that is associated with rectoceles?
a. Urinary urgency
b. Hematuria
c. Incomplete evacuation of stool that may require splinting
d. Vaginal bleeding
e. Vaginal wall erosion
Ny X 24 years came to the ER with complaints of headaches since the last day of
examinations obtained. Expecting her first child, gestational age 37-38 weeks blurred vision
denied heartburn (-) on physical examination found BP 190/120 mmHg pulse 90 x / m
breathing 16 x m . at Leopold found the lower left back head FHR 140 x / m contraction
irregularity in the examination pelvic score of 1 was found, pelvis size is wide laboratory
investigation hb obtained 11.5 g% platelets 90000 / mm3 LDH 510 I u/ L Proteinuri +2. SGOT
10 u/L SGPT 15 u/L
Mrs. Selly 20 year – old primipara is 36 hours postpartum following cesarean delivery for
failure to progress. She is complaining of abdominal pain and has a fever of 38 C. She is not
yet tolerating oral intake because of nausea. You diagnose metritis.
25. 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. Leukocytosis
e. Leukopenia
26. Which of the following is the most frequent cause metritis:
a. Group A streptococcus
b. Group B streptococcus
c. Chlamydia trachomatis
d. Mycoplasma hominis
e. Ureaplasma urealyticum
The couple came to the clinic with complaints : want to get pregnant. This couple has been
married 3 years. Current wife age 36 years. Height 151 cm 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 intermittent treatment for vaginal discharge odor complaints
and itchy since before marriage.
You get going to make clinical skill training. There are some problems that you are worried
to get, in relation of successfully of that training approach.
31. The training approach described in this chapter is guide by principles of adult learning.
These principles are based on the assumption that people participate in training courses
because :
a. They are interested in the topic. Wish to improve their knowledge or skills, and
thus their job performance, desire to be actively involved in course activities
b. Uses behavior modeling, is competency- base, incorporates humanistic training
techniques
c. Competency-based, which means assessment is keyed to the course objectives and
emphasizes acquiring the essential knowledge, attitudinal concepts and skills
needed to perform a job. not simply acquiring new knowledge
d. Less stressful, because from the outset participants, 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
A woman 45 years old with 2 children came to the specialist clinic in the international
hospital with the complain of post coital bleeding since 3 months ago. The lady had the first
menstruation at the age of 13 years old and got married at the age of 17 years old. From the
vaginal examination, 0,5 cm mass was seen in the upperlip of the vagina without
involvement of the vaginal mucosa.
32. What is the most likely initial procedure has to be taken after seeing the condition of
the cervix:
a. VIA
b. Biopsy
c. Leep
d. Pap smear
e. Endocervical curettage
33. What physical diagnostic examination is important in that situation:
a. Palpation of the cervical mass
b. Rectal examination
c. Rectovaginal examination
d. Palpation of the vagina
e. Vaginal examination
34. What is the most likely stage of the cases:
a. Stage Ia1
b. Stage Ia2
c. Stage IIIa
d. Stage Ib1
e. Stage Ib2
Mrs A. 24 years. G2P1A0 39 weeks gestational age, admitted to your emergency room with
complained abdominal cramping with bloody show. In examination, revealed normal vital
sign, contraction was 3x/10/35. Fetal heart rate was 146x/m. estimated baby was 3200
gram. Vaginal examination revealed: dilatation was 4 cm, effacement 100%, amniotic
membrane was intake, lowest part was head with descent of the head was Hodge II.
Denominator was minor fontanella at the left side.
Mrs. S, 29 years, G3P1A1 39 weeks gestational age, referred by midwife with prolonged
second stage. In examination, revealed normal vital sign Obstetric examination revealed
contraction was 3x/10/25. Fetal heart rate was 160x/m. Estimated fetal weight was 3100
gram. Previous baby was 3000 gram. Vaginal examination revealed: full dilatation, amniotic
membrane was absent thick and greenish, lowest part was head with descent of the head
was Hodge IV. Denominator was minor fontanella at he left anterior.
Mrs. S, 34 years, G4P3A1 40 weeks gestational age, second stage of labour, the head of the
baby was delivered but the shoulder was stuck. Turtle sign (+), the mother has an
uncontrolled diabetes for 5 years. Estimated fetal weight by ultrasound was 4200 gram.
Your patient delivered a healthy baby 2 weeks ago and wishes to use contraception method
after her puerperium. She is breastfeeding exclusively.
42. For which of the following is there strong evidence that use decrease the quantity and
quality of brest milk?
a. Progestin-only pills
b. Depo medroxyprogesteron acetate
c. Combination hormonal contraception
d. IUDs
e. Implant
43. Your patient has diabetes mellitus and hypertension but she prefer to use “pills” for
contraception. She is considering progestin-only pill and combination oral contraception
(COC). You give counseling to her about the advantage and disadvantage of progestin
only pill compare with COCs
a. More appropriate for diabetic and hypertention patient
b. Lower failure rate
c. Low rate of irregular bleeding
d. Low relative ectopic pregnancy rate
e. Relative more nausea and vomiting
44. Which of the following is an advantage of progestin-only emergency contraception
regimens compare with estrgogen progestin combination for this purpose?
A 30 years woman complain of colorless vaginal discharge with she feel that the smell very
bad odor then she feel low self esteem
Patient refered from private practise with poor general condition, somnolent. She has been
conducted on delivery for two hours. Vital signs by 70/palpable blood pressure, 120 bpm
heart rate.
54. What is your initial management ?
a. Performing holistic clinical obstetrics examination
b. Performing ultrasound
c. Ask for help
d. Giving oxygen
e. Put IV line
55. In your examination you find that there isn't any contraction, distended abdomen,
shifting dullness. In vaginal examination, you find cervic is not fully dialted, and head
could be pushed upward. What is the most appropriate diagnosis?
a. Threatened uterine rupture
b. Uterine rupture
c. Unprogressed labot with ascites
d. Incoordinate uterine
e. Prolonged second stage
56. Which additional examination is mainly vital for preparation of next management:
a. Ultrasound exam
b. Routine blood exam
c. Coagulation factor exam
d. Blood gas analysis
e. Urine analysis
57. One of the parameter that could be easily measured for prognosting acute kidney injury
is?
a. Urine output
b. Serum creatinine levels
c. Thrombocyte count
d. Amount of blood loss
e. Hemoglobin levels
You are attending delivery, patient had already bearing down with good contraction for half
hour but there is no further descent of head. Occiput is at left posterior.
59. Fetal heart rate shows declining arises from beginning of contraction and goes to
normal baseline as soon as the contraction ends. This findings could refer to:
a. Fetal distress
b. Fetal Head compression
c. Fetal hypoxia
d. Umbilical cord compression
e. Threatened uterine rupture
60. You find that descent of the head is on station -1, what action is most appropriate:
a. Giving oxytocin drip
b. Waiting for internal rotation by left lateral position
c. Vacuum extraction
d. Forceps extraction
e. Caesarean section
64. Which of the following statements most accurately describes postpartum hemorrhage?
a. lts prevented primarily by the increased concentration of clotting factors in maternal
blood
b. Grand multiparity is a risk factor
c. Women with severe preclampsia are more tolerant of heavy blood loss.
d. Changes in pulse and blood pressure are good early indicators of excessive blood
loss.
e. Placenta accreta is the most frequent cause
65. A relative contraindication for induction of labor includes which of the following?
a. Prolonged pregnancy
b. Severe pre-eclampsia
c. Intrauterine growth restriction
d. Previous myomectomy entering the uterine cavity at the fundus
e. Prolonged rupture of membranes without labor
66. What is the maximum normal time for the second stage of labor in a primigravida
without anesthesia?
a. 20 minutes
b. 60 minutes
c. 120 minutes
d. 240 minutes
e. No normal maximum
67. A 21 -year-old G1 now P1 just delivered after a prolonged induction of labor due to
being postdates. After the placental delivery she continues to bleed excessively. Your
initial intervention to address this bleeding is to activate the normal physiologic
mechanisms. Which of the following is the most important hemostatic mechanism in
combating postpartum hemorrhage?
A. Contraction of interlacing uterine muscle bundles
B. Fibrinolysis inhibition
C. Increased blood-clotting factors in pregnancy
D. Intramyometrial vascular coagulation due to vasoconstriction
E. Markedly decreased blood pressure in the uterine venules
68. Worldwide, which of the following is the most common problem during pregnancy?
A. Diabetes
B. Preeclampsia
C. Heart disease
E. Iron-deficiency anemia
A 33-year-old G0P0 woman comes to your office for her initial prenatal visit. She tested
positive with two home pregnancy tests and has been experiencing breast tenderness and
mild nausea for a few weeks. She has a history of regular menstrual periods occurring every
28 to 30 days. This was a planned pregnancy and is the first child for her and for her partner.
69. Your patient was actively tracking her menstrual cycle and is certain that the first day
of her last menstrual period (LMP) was 12/2/11. Using Nagele rule, estimate her date of
delivery.
a. 5/7/11
b. 2/9/11
c. 16/9/11
d. 19/9/11
e. 26/8/11
70. As her pregnancy continues, you would expect her cardiac output to increase by
which of the following mechanisms:
a. First an increase in stroke volume, then an increase in heart rate
b. A decrease 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
71. Which of the following is true regarding the physiologic changes she might expect
during her pregnancy?
a. Gastric emptying and large bowel motility are increased in pregnancy
b. BUN and creatinine will decrease by 25% as a result of an increase in glomerular
filtration rate (GFR), which will be maintained until delivery
c. An overall decrease in the number of WBC and platelets
d. Nausea and vomiting that should be treated aggressively with antiemetics and
intravenous hydration
e. An increase in the tidal volume along with an increase in total lung capacity (TLC)
Mrs. A, 24 years primigravida, 39 weeks gestational age, undergoes caesarean delivery due
to breech presentation. She delivered female baby, with body weight 3600 gram, and
APGAR Score was 8/9.
A 19-year-old woman complain of a golf ball-sized mass at the entrance of her vagina. She
says that this area is “sore all the time” and began hurting “about 3 days ago”. On
examination, the patient has a tender 4 cm mass on the lateral aspect of the labia minora at
the 5 o’clock position. There is erythema and edema, and the area is very tender and
fluctuant. No cellulitis is noted.
78. Bartholin gland duct cysts form in direct response to which of the following?
a. Vulvar irritation
b. Cervical gonorrhea
c. Gland duct obstruction
d. Chronic lichen sclerosis
e. All of the above
79. Which of the following is generally the treatment of choice for recurrent Bartholin
gland duct abscess?
a. Systemic antibiotics
b. 5-percent lidocaine ointment
c. Bartholin gland duct marsupialization
d. Warm compresses and frequent sitz baths
e. All of the above
A 32-year-old G3P2002 woman presents for routine prenatal care at 37 weeks. Her
pregnancy is complicated by Rh-negative status, depression, and a history of LSIL Pap smear
with normal colposcopy in the first trimester. Today she reports good fetal movement and
denies leaking fluid or contractions. During your examination you measure the fundal height
at an appropriate 37 cm, and find fetal heart tones located in the upper aspect of the
uterus. A bedside ultrasound reveals frank breech presentation
80. Which of the following findings would deter you from offering this patient a trial of
breech delivery?
a. Frank breech presentation
b. Fetal weight of 3,200 g
c. Complete breech presentation
d. Fetal weight of 4,100 g
e. Maternal body weight
81. Which of the following is not associated with increased risk for breech presentation?
a. Fetal anencephaly
b. Uterine anomalies
c. Polyhydramnios
d. Chorioamnionitis
e. Hydrocephaly
82. What is the most common complication that might happen to the baby that might
happen when you performing vaginal breech delivery?
a. After coming head
b. Bleeding
c. Femoral fracture
d. Erb’s Palsy
e. Brachial Palsy
An 18-year-old G0 F presents to your office for contraceptive counseling. She has never used
any method of contraception before and is engaged in a monogamous sexual relationship.
Gynecologic history is significant for regular, heavy menstrual cycles using up to eight 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 both have Factor V
Leiden disease, but that she has never been tested herself or had a thromboembolic 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 contraception that you can offer.
83. Which of the following methods of contraception has the least efficacy?
a. Ortho Evra patch
b. Combined oral contraceptive pills
c. Mirena IUD
d. Condoms with spermicide
e. Coitus interruptus
84. Physical examination in the office reveals a blood pressure of 140/85 mm Hg, pulse of
80, and BMI of 40. Abdomen is soft, nontender, and genitourinary exam is unremarkable
with no cervical inflammation. Which of the following would be the best choice of
contraception for this patient?
a. Ortho Evra patch
b. Combined oral contraceptive pills (COCs)
c. Mirena (Levonorgestrel) IUD
d. Condoms with spermicide
e. Coitus interruptus
85. Of course, during your discussion at this visit, you could encourage smoking cessation
and recommend weight loss to help improve her overall health. You and the patient have
decided to proceed with IUD placement. Prior to placement, it is important to perform
which of the following tests?
a. FSH level
b. Prolactin level
c. Urine pregnancy test
d. Gonorrhea/Chlamydia testing
e. Both c and d
A 21 years old G4P2 at 17 weeks gestation presents for her first prenatal care visit. She has a
history of prostitution, but she denies engaging in such activities for the past month. During
examination, a painless lesion is noted on the right labia.
88. The best perfom for the patient to ascertain a definitive diagnosis is which of the
following:
A. Rapid plasma regain (RPR)
B. Bacterial culture of lesion exudates
C. Dark field examination of lesion exudates
D. Serum assay for herpes simplex virus 1 and 2 antibodies
E. serology examination
89. Which of the following does not increase the risk of transmission of syphilis?
A. Cervical inversion
B. Cervical hyperemia
C. Cervical friability
D. Abrasions of the vaginal mucosa
E. Cervical cancer
A 62-year-old woman presents to the office complaining of watery vaginal discharge and
bleeding for the past 2 months. She has not had a Pap test in 14 years. She states she had a
mildly abnormal pap in her 30s, but that was treated with cryotherapy. She states she went
through menopause at age 50 and has never been on hormone Replacement therapy. She
does admit to smoking one-half pack a day for 40 years. Her husband is deceased, and she
has not been sexually active in 10 years. Her examination reveals a cervical necrotic mass
approximately 5 cm in size. Rectovaginal examination is suspicious for left parametrial
involvement. There is no evidence of adnexal masses, but examination 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 a 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 hematuria with positive urine cytology. The biopsy also shows SCC. You order a CT scan,
which shows a cervical mass measuring 7.7 3 5.0 cm as well as an avid left internal iliac
lymph node consistent with locally metastatic disease.
91 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
92. What do you recommend for the next step treatment of her cervical cancer?
a. Cold-knife cone
b. Simple hysterectomy
c. Radiation and chemotherapy
d. Chemotherapy alone
e. Palliative care
93. She is treated with chemoradiation and 3 years later has a recurrence. You proceed with
pelvic exenteration for her recurrent cancer. What is her 5-year survival rate after pelvic
exenteration?
a. 5%
b. 10%
c. 25%
d. 50%
e. 90%
A 69-year-old woman with pelvic pressure and palpable bulge presents for evaluation. She
recalls some mention of a cystocele diagnosis, given by her primary care provider. Today,
she requests formal evaluation by a gynecologist
94. When performing the physical examination, what is one type of staging system to
describe prolapse?
a. Pelvic organ prolapse quantification scale (POP-Q)
b. Gray scale
c. Visual analog scale
d. Breslow scale
e. Clark scale
95. In discussing her symptoms, the patient points out that her voiding function has
changed as the prolapse has grown in severity. Initially, the patient reported stress
urinary incontinence, but as the prolapse worsened, the incontinence improved. While
she is happy with the resolution of her incontinence, she currently experiences some
incomplete bladder emptying, which is improved upon manual reduction of the prolapse.
How do you counsel her about her risk of incontinence after an isolated anterior wall
repair (with no other concomitant surgery)?
a. High likelihood of de novo urgency and urge urinary incontinence
b. High likelihood of urinary frequency
c. High likelihood that her stress incontinence will be cured by anterior repair
d. High likelihood that an anterior repair will unmask and potentially “worsen” her
stress urinary incontinence symptoms
e. High likelihood of de novo fecal incontinence
96. In assessing the above patient, you also find a posterior vaginal wall defect. What is a
common symptom that is associated with rectoceles?
a. Urinary urgency
b. Hematuria
c. Incomplete evacuation of stool that may require splinting
d. Vaginal bleeding
e. Vaginal wall erosion
A 30-year-old multigravida presents with ruptured membranes at term but without labor.
Following induction with misoprostol, her labor progresses rapidly, and she spontaneously
delivers a liveborn 3300-g neonate. Immediately after delivery, she complains of dyspnea.
She becomes apneic. Her autopsy reveal fetal squames within pulmonary vasculature
97. How would her death be classified?
a. Perinatal death
b. Nonmaternal death
c. Direct maternal death
d. Indirect maternal death
e. Occasional maternal death