A 34-year-old G3P2002 woman at 38 weeks and 6 days was admitted to labor and delivery

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.

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 continues with natural childbirth and eventually needs
a cesarean section she will require general anesthesia
c. spinal anesthesia is her best option because it gives a constant infusion of medicine over a
long period of time
d. she cannot have an epidural yet because she is not yet in the active phase of labor
e. a variety of relaxation techniques can be incorporated 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, external rotation
d. Engagement, descent, flexion, internal rotation, external rotation
e. Engagement, descent, internal rotation, flexion, external rotation

3. An uncomplicated vaginal delivery typically includes which maneuver?

a. Perineal support to decrease perineal trauma
b. An episiotomy to hasten delivery
c. Vacuum extraction if the fetal station is low
d. Forceps to aid maternal efforts
e. The McRoberts maneuver

4. Stage 3 begins following the delivery of the infant and typically

involves which of the following?
a. Placental separation
b. Stopping oxytocin 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
A 19-year-old primigravida at 29 weeks' gestation is noted to have anemia with a
hemoglobin concentration of 8 g/dL. The peripheral blood smear below is obtained.
5. Which of the following laboratory findings are microcytic hypokrom ??
a. Decreased serum ferritin level
b. Elevated mean corpuscular volume
c. Decreased total iron binding capacity
d. Positive sickle-cell screen (Sickledex) result

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

19. What is the best diagnose for Ny. X ?

a. Chronic hypertension
b. HELLP Syndrome
c. Gestational hypertension
d. Severe pre eclampsia
e. Superimposed pre eclampsia
20. What is the most clinically effective antihypertensive agent for Ny. X ?
a. Magnesium sulfat
b. Diazepam
c. Hidralazin
d. Hydrochlorothiazide
e. Clonidine
21. What is the best management for Ny. X ?
a. Induction of labour
b. Cervical rippening
c. Caesarean section
d. Forcep extraction
e. Vaccum ectraction
22. If Ny. X breastfeeding what is the best antihypertensive agent should you give ?
a. Hydrochlorothiazide
b. Furosemide
c. Spironolactone
d. Labetalol
e. Dopamine
Mrs. Ani 38 year-old, grandemultiparous, post vaginal delivery with oxytocin drips and spinal
anesthesia 2 hours ago Baby born weight 4200 gr, alive The happen early HPP with blood
pressures 80/40 mm/Hg and the mother is shock.

23. Etiology early HPP Mrs.Ani is:

a. Uterine atony
b. Laceration
c. Retained placenta
d. Coagulopathy
e. Rupture uterine
24. It NOT risk factors early HPP Mrs. Ani is:
a. Grande multiparous
b. Oksitokxin drips
c. Makrosomia
d. Spinal anesthesia
e. Prolonged labor

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

A woman, married, G3P3A0, 43 years, no history of abdominal surgery, has gained as

myoma uteri diagnosis. Uterine size of 4 months pregnant, good mobility. Hb 12,5 gr% and
other laboratory examinations. Investigations and cytology smears perioperative within
normal limits.

27. Choose the correct answer below:

a. Incision of the abdominal wall can be selected midline vertical incision or
Pfannentsiel incision
b. Vertical midline incision offers a quick entry, but the resulting extensive blood loss
than Pfannentsiel minimal insision
c. Performed Pfannentsiel incision was excellent cosmetic results can not be achieved
d. Pfannentsiel incision decreased rates of postoperative pain
e. Pfannentsiel increased rates of incisional hernia
28. Choose the correct answer below:
a. No difference in sexual satisfaction after hysterectomy among the subtotal and
total hysterectomy
b. Vaginal prolapse is lower rates in the subtotal hysterectomy
c. There are differences in bladder function in postoperative total hysterectomy and
subtotal hysterectomy
d. Post subtotal hysterectomy lower risk of bowel disfunction events rather than post
hysterectomy
e. After subtotal hysterectomy patients do not need to do a pap smears again

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.

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

a. Primary level infertility services
b. Secondary level infertility services
c. Tertiary level infertility services
d. Basic level of infertility services
e. Advanced infertility services
30. In this couple:
a. Infertility services can be given by qualified practitioners who can provide
consultation, education and advice to both partners and advice to both partners and
have knowledge of the terms of reproductive success and problems
b. Given infertility services by health workers who have experience and documented
certified to perform the procedure endocrine, gynecology and urology, have
extensive knowledge about the effectiveness, side effects, the cost of doing the
diagnosis and treatment of infertility
c. Treatment is aimed to be able to determine the cause of infertility from both sides
as well as determine whether the couple needs to get service at a higher level of
service
d. Infertility services that require special expertise because it includes the actions
assisted reproductive technology that can only be performed in specialized
infertility clinic
e. Having practitioner qualification certification and experience in TRB, Urology or
andrology and qualifies as an infertility counselor

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.

35. What is the condition of this patient ?

a. No in labour yet
b. in labour, stage 1 laten phase
c. in labour, stage 1 active phase
d. in labour. stage 2
e. in labour, stage 3
36. According the vignette above, what will be happen 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. 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.

37. What will you choose to terminate this condition ?

a. Spontaneous delivery
b. Augmentation
c. Embriotomy
d. Forcipal extraction
e. Cesarean section

38. What are indication for assisted vaginal delivery ?

a. Uterine rupture
b. PPROM
c. Postpartum haemorrhage
d. Fetal anomaly
e. Fetal or maternal distress
39. Frequent complication of the action above is:
a. Uterine rupture
b. Cephalhaematoma
 c. Parese n. VII
d. Erb’s paralysis
e. Fracture of os femur

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.

40. What is this condition called ?

a. After coming head
b. Compaction
c. Retention of the baby
d. Shoulder dystocia
e. Collision
41. What is predisposing factor for this condition ?
a. Preterm
b. PPROM
c. Macrosomia
d. Acrania
e. Breech presentation

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. More effective in pregnancy prevention

b. Effective if taken beyond 5 days after intercourse
c. Provides better protection against STD
d. More side effect
e. More simple use
45. Which of the following is not an absolute contraindication for using of Combination of
Oral Contraseptives ?
a. Thrombotic disorder
b. Cholestatic Jaundice
c. Migraines with focal neurologic deficits
d. Uncomplicated SLE (including negative test for APA)
e. Uncontrol hypertension

A 30 years woman complain of colorless vaginal discharge with she feel that the smell very
bad odor then she feel low self esteem

46. What is the possible infection of this woman?

a. Candidiasis
b. Gonorrhoe
c. Tricomoniasis
d. Bacterial vaginosis
e. Clamidia Trachomatis
47. What is the antibiotic which is usually use to threat this symptoms?
a. Ampicillin
b. Doxycyclin
c. Amoxycilin
d. Metronidazole
e. Trimethoprim

48. What is the typical range of normal vaginal pH ?

a. 3.0-3.5
b. 4.0-4.5
c. 5.0-5.5
d. 6.0-6.5
e. 7.0-7.5

Primigravida full-term pregnancy is referred to hospital by midwife due to unprogressed

labor. General condition is weak, normal blood pressure with heart rate 100 bpm. In clinical
examination you find uterine contraction is weak and rare, with midline measurement of 30
cm and only two fifth of the head is palpated. Fetal heart rate is 144 bpm.

49. By using Johnson's formula, what is estimated fetal weight?

a. 2790 gram
b. 2945 gram
c. 3000 gram
d. 3200 gram
e. Could not be measured due to unfulfiled criteria
50. You are doing internal examination and found cervix is already dilated 8 cm, no
amniotic membranes palpated with mentum on 6 o’clock, what would the diagnosis
likely to be ?
a. Occipito posterior persistent
b. Deep transverse arrest
c. Brow presentation
d. Vertex presentation
e. Face presentation
51. From pelvic examination findings pelvic brim: round, diagonal conjugate 12 cm,
symphisis parallel to sacrum, subpubic angle is acute, convergent side walls bituberous
diameter is 7 cm. by analyzing your findings, which causes bellow is unlikely to be ?
a. Android pelvis
b. Anthropoid pelvis
c. High assimilation pelvis
d. Platypelloid pelvis
e. Oblique pelvis
52. Which of the followings is the most appropriate etiology of case above ?
a. Uterine inertia
b. Malpresentation
c. Cephalopelvic disproportion
d. Macrosomia
e. Uterine anomaly
53. What is the most appropriate management for this case:
a. Auqmentation of labor
b. Advising cardiotocgraphy examination
c. Forceps extraction
d. Vacuum extraction
e. Caesarean section

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.

58. What is the diagnosis :

a. Prolonged latent phase
b. Incoordinate uterine action
c. Unprogressed second stage
d. Deep transverse arrest
e. Uterine rupture

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

A 32-year-old woman (gravida 3, para 1, abortus 1) at term is admitted in labor with an

initial cervical examination of 6-cm dilatation, complete effacement, and the vertex at -1
station. Estimated fetal weight is 8 lb, and her first pregnancy resulted in an uncomplicated
vaginal delivery of an 8 lb infant. After 2 hours, there is no cervical change. An intrauterine
pressure catheter is placed. This shows three contractions in a 10 minute period, each with
a strength of 40 mm Hg.

61. What is this abnormality of labor termed?

a. Prolonged latent phase
b. Active-phase arrest
c. Failure of descent
d. Arrest of latent phase
e. Protraction of descent
62. What is the best course of action at this time?
a. Wait 2 more hours and repeat the cervical examination
b. Start oxytocin augmentation
c. Perform a cesarean section
d. Discharge the patient, instructing her to return when contractions become stronger
e. Therapeutic rest with analgesia and short-acting anti-anxiety medication
63. The routine use of midline episiotomy during delivery has been shown to do which of
the following ?
a. Prevent urinary stress incontinence in the fourth decade of life
b. Decrease the incidence of fetal cranial molding
c. Decrease maternal blood loss
d. Increase the incidence of third and fourth degree lacerations
e. Prevent the development of a rectocele and uterine prolapsed postmenopausal

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

D. Urinary tract infection (UTI)

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)

72. Which of the following is true regarding hCG in your patient?

a. The corpus luteum produces hCG throughout pregnancy
b. It is composed of two dissimilar alpha and beta units
c. Levels double every 3 to 4 days in early pregnancy
d. Levels peak after 24 weeks of pregnancy
e. The alpha subunits are identical to subunits of prolactin and human growth hormone

73. The major function of human placental lactogen is:

a. To cause a diuretic effect
 b. To cause relaxation of smooth muscle
c. To maintain the corpus luteum in early pregnancy
d. To act as an insulin agonist
e. To induce lipolysis and protein synthesis leading to a constant nutrient supply to the
fetus

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.

74. Post operatively maintenance intravenous administered fluids are:

a. Ringer solution or a similar crystalloid solution with 5-percent dextrose
b. 10% dextrose
c. Colloid solution
d. Crystalloid solution with 40-percent dextrose
e. Amino acid based fluid
75. Solid food as one of 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 post operative
d. 12 hours post operative
e. 24 hours post operative

76. Women undergoing cesarean delivery have an increased risk of venous

thromboembolism compared with those delivering vaginally. In order to decreased the
risk, what is your suggestion to this women:
a. Early ambulation
b. Early feeding
c. Administered analgesic
d. Inspected the incision each day
e. Removed the skin closure on the fourth postoperative day

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.

77. What is the most appropriate treatment for this condition?

a. Trimethoprim/sulfamethoxazole
 b. Azithromycin for the patient and any sexual partners
c. Incision and drainage of the mass followed by a course of
trimethoprim/sulfamethoxazole
d. Incision and drainage of the mass
e. Incision and drainage of the mass with placement of a Word catheter.

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.

87. The most likely diagnosis is which of the following?

A.Chancroid
B. Primary syphilis
C. Bartholin gland duct abcess
D. Herpers simplexvirus infection
E. Condiloma acuminate

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

90. The incubation period of syphilis is which of the following?

A. 1-7 days
B. 10 days
C.3-90 days
D. 120-180 days
 E. 210 days

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

98. What is maternal mortality ratio?

a. Ratio of number of maternal deaths and neonatal deaths
b. Ratio of number of maternal deaths per 10000 live biths
c. Ratio of number of maternal deaths per 100000 live births
d. Ratio of number of maternal deaths per 1000000 live births
e. Ratio of number of maternal deaths per year per national population

99. Concerning the epidemiology of maternal mortality, what is the definition of

coincidental maternal death?
a. Direct deaths per 100 000 live births
b. Direct deaths per 100 000 maternities
c. Indirect deaths per 100 000 live births
d. Maternal deaths resulting from causes unrelated to pregnancy
e. Maternal deaths resulting from complications unique to pregnancy