SOAL UNAS JULI 2022

1. An 18-year-old young woman presents to you with a complaint of amenorrhea.

She notes that she has never had a menstrual period, but that she has mild cyclic
abdominal bloating. She is sexually active, but she complains of painful sexual
intercourse. Her post medical and surgical history is unremarkable On physical
examination, you note normal appearing axillary and pubic hair. Her breast
development is normal. Pelvic examination reveals normal appearing external
genitalia. Which of the following tests would be your ?
a. Pelvic ultrasound
b. Serum FSH
c. Diagnostic laparoscopy
d. Karyotype
e. Serum FSH, E2

2. A parity 3 40-year-old woman complains of cyclical heavy and painful menstrual

bleeding. On examination she is found to have an enlarged globular uterus and a
transvaginal sonography revealed diffuse adenomyosis. She has completed her
family and currently relies on condoms for contraception. She smokes 10
cigarettes per day but is otherwise fit and well.Which treatment would you
consider most appropriate? Choose the single best answer.
a. LNG – IUS
b. Endometrial ablation
c. COCP
d. GnRH analogue
e. Hysterectomy

3. Which of the following is true regarding COVID-19 in pregnancy?

a. No anti-viral was approved by FDA for pregnant women
b. Preterm delivery and preeclampsia are increased in pregnant women with
COVID-19 o.k sitokin tinggi
c. Vertical transmission is unlikely because placenta has low expression of
ACE2 receptor
d. Recommendation mode of delivery in pregnant women with COVID-19 is
normal delivery with 1 health provider
e. Evidence showed that pregnancy offers an altered immunity scenario which
may allow severe COVID-19 disease

4. A 20-year-old primigravida presents at 39 weeks. She has been healthy up to this

point. She has a headache and a loss of appetite. Her face and hands are swollen,
and she cannot wear her rings. Her BP is 168/90 mm Hg, and she has 1+ protein.
The fetus has a reassuring monitoring strip. Which of the following is the best
treatment for her preeclampsia?
A) magnesium sulfate
B) delivery either by cesarean or by vaginal
C) an antihypertensive drug that does not affect uterine blood flow
D) gentle diuresis, with careful monitoring of intake and output
E) modified bed rest
5. A 28 years old patient, P0, presents to your clinic for fertility workup. She had
been married for 2 years with regular intercourse. Her menstrual cycle is normal.
Her general status was normal. Vaginal examination revealed normal findings.
The following month she came back with the result of hysterosalpingography (see
the picture below)

What will be your next step ?

a. Order semen analysis

b. Schedule operative laparoscopy
c. Gives clomiphene citrate and plan for natural conception
d. Gives clomiphene citrate and plan for intrauterine insemination
e. Plan for IVF

6. A 38 years old multi gravid woman complains of the painless loss of urine,
beginning immediately with coughing, laughing, lifting, or straining. cessation of
the activity do not stops the urine loss. She also complains of frequency with
small-voided volume of urine, but no urgency. This history is most suggestive of
a. Fistula
b. Stress incontinence
c. Urge incontinence
d. Overflow incontinence
e. Mixed incontinence

7. Ms. S, POAO, 21 y/o came to the outpatient clinic with chief complain of heavy
menstrual bleeding for almost 2 weeks.Her last menstrual period was 3 months
ago. The vital sign was 100/70, pulse 90x/minutes, respiration 20x/m and the
temperature was normal. Her BMI was 35. Her face and conjuctivas looked pale
The heart and lungs were normal. There is excessive growth of hair in the lower
Iimbs. The abdominal exam revealed no abdominal mass. There was no pain
during abdominal palpation. During vaginal inspection, some blood cloths were
expelled from the vaginal introitus. From ultrasound examination revealed normal
uterus and both adnexas. The laboratory results showed Hb level of 9 gr/dl. The
platelet count was 200.000/mm? and the leucocyte count was 10.500/mm3. The
pregnancy test result was negative.
Which of the following is the appropriate medication to use for controlling acute
and heavy bleeding?
a. Danazol
b. Noretisterone
 c. GnRH agonist
d. combined hormonal injection
e. Medoxyprogesterone acetate injection

8. A 57-year-old presents with complain of protruding mass came out from vagina
for 6 months. She has difficulty in urination. On physical examination found a
grade 3 cystocele grade 2 uterine prolapse and grade 2 rectocele. Which structure
that correspond to pathophysiology of Cystocele?
a. Pubocervical fascia
b. Levator ani muscle
c. Cardinal ligament prolaps uteri
d. Endopelvic fascia
e. Uterosacral ligament

9. You see a patient in you office who had a thyroidectomy frome graves disease.
She is now hypothyroid on hormone replacement. You monitor her TSH and keep
it between 0,5 and 2,5. You increased her thyroid hormone replacement each
semester and her tsh remains around 2.0 during the entire pregnancy. In addition to
monitoring her TSH, what other additional testing should you perform during her
pregnancy?
a. Amniocentesis to determine if the fetus is affected by Graves disease
b. A detailed fetal ultrasound at 18 to 20 weeks and again in the third
trimester shoul be performed given the risk of increased fetal goiter
c. Fetal echocardiogram to evaluate for cardiac abnormalities
d. Umbilical Doppler to monitor for placental dysfunction
e. MCA Doppler to monitor for fetal anemia

10. Mrs. D 39 years old G4 P3 34 weeks of gestation arrives at delivery ward with
severe dyspnoe. She looks really anxious, her vital signs show: BP 180/110
mmHg; PR 110x/min; RR 26x/min; 36.4°C, SpO2 95%. Conjunctiva not pale.
Heart; normal heart sound, no murmur or gallop. Lung: Vesicular with rales and
no wheezing. Fundal height 30cm, head presentation, FHR 170bpm, no
contraction Laboratory findings: CBC Hb 10;Ht 32;L 12,000; Platelet 120,000
What is the mechanism that can induce this condition?
a. Community acquired pneumonia
b. Right heart failure
c. Immune response
d. High oncotic pressure
e. Diastolic dysfunction

11. A 32-year-old gravida 3 Para 2, 36 weeks of gestation was transferred from a

midwifery-led unit for high blood pressure. Her blood pressure was 170/100
mmHg, PR 90 bpm, RR 24 x/minute. Abdominal examination showed FUT 30
cm, irregular contraction, fetal heart beats 154 bpm. Vaginal examination showed
soft cervix, mid-position, 2 cm dilated, 50% effaced, -2 station . An ultrasound
 shows the estimated fetal weight 2600 g, AFI 12 cm, no fetal morphology
abnormalities, SDAU 2.9. She has experienced twice vaginal delivery, baby’s
weighed were 3100 g and 3300 g for first and second baby. On admission, her
observations are normal and the cardiotocography (CTG) was reassuring. You
decided to give her MgSO4 and antihypertension with nifedipine for preeclampsia
with severe feature management, and also induction of labor with Oxytocin 5 IU.
Adequate contraction was achieved on 8 mIU/minute. Five hours observation, she
complaint rupture of membrane. Vaginal examination showed clear amniotic fluid
came out from vagina, cervix dilated 6 cm, 0 station. CTG has become suspicious
(baseline 156 bpm, variability 3-5 bpm, no acceleration, no deceleration,
contraction 4x/10’/30”) . What is the most appropriate cause of CTG findings?
a. Cord compression
b. Head compression
c. Magnesium sulphate
d. Placental insufficiency
e. Hyperstimulation of uterus

12. A 27 years old patient, P1, come with 7 months of amenorrhea. Her pregnancy
test showed negative result. Her general status was normal. On ultrasound
examination revealed hyperechoic, 14 mm endometrial line. On the right ovary
there was anechoic mass size 20 mm, left ovary was normal. Which of the
following is clinical consequences if this condition left untreated?
a. Increased risk of ovarian cancer
b. Increased risk of intermenstrual bleeding
c. Increased risk of chronic kidney disease
d. Increased risk of endometrial cancer
e. Increased risk of breast cancer

13. A 34-year-old G1 at 26 4/7 weeks for her scheduled obstetric (OB) appointment.
The patient denies any complaints today Fetal movement is active. BMI before
pregnancy was 29.6 kg/m2, gestational weight gain is 9 kg. vital sign are normal.
Abdominal examination today shows a gravid uterus measuring 26 cm. fetal heart
tones (FHTs) are in the 140s. laboratory results were Hb 10.1 g/dL, Ht 30%,
leucocyte 10.500, thrombocyte 165.000, MCV 78, MCH 28, OGTT result was
fasting 102 (95) mg/dL and 2 hours after 75 glucose 156 (153) mg/dL. What is the
most likely diagnosis for this case?
a. Pre-gestational diabetes mellitus
b. Gestational diabetes mellitus
c. Iron deficiency anemia
d. Inadequate maternal weight gain
e. Maternal overweight

14. A previously energetic woman complains of crying, loss of appetite, difficulty in

sleeping, and feeling of low self-worth, beginning approximately 3 days after a
normal vaginal delivery. These feelings persisted for approximately 1 week and
then progressively diminished. Patient with psychiatric disorders can result to
poor pregnancy outcome such as?
a. Low birthweight
b. Increased risk of post partum hemorrhage
c. Increased rate of cesarean section
 d. Preeclampsia
e. Major congenital anomaly

15. A 40-year-old Parity 3 comes to your office to discuss contraception. She has
been married for 15 years and never smokes cigarette. She had a history of
repeated preeclampsia in all of her pregnancies before. She was diagnosed with
systemic lupus erythematosus (SLE) at the age of 20 years with history of
musculoskeletal and hematologic flare. Her BMI is 26, haemoglobin level is 9,9
g/dl. Which of the following method is the preferred method of contraception?
a. COC pills
b. Progestin only pills
c. Copper T IUD
d. Progestin injection
e. Tubal sterilization

16. You are counselling a couple in your clinic who desire VBAC (Vaginal Birth
After Cesarean Section). Her baby is in a vertex presentation, appropriate size
for 37 weeks, and her previous low transverse procedure was for breech
presentation. In providing informed consent, in which of the following ways
do you explain the risk of uterine rupture?
a. Less than 1%
b. Between 2% and 5%
c. 15–20%
d. Dependent on the length of her labor
e. Dependent on the location and proximity of the scar site to the placental
implantation

17. A 23 year-old G1 32 weeks is being admitted to the hospital because of preterm

contraction. The patient complaint regular contraction. Antenatal care was done
regularly in PHC. No remarkable abnormality was found during ANC. BMI
before pregnancy was 30 kg/m2, weight gain during pregnancy is 14 kg.
Abdominal examination showed FUT 36 cm, regular contractions, fetal heart
beats 154 bpm. Speculum examination showed closed ostium uteri externa. An
ultrasound shows the estimated fetal weight 2400 g, AFI 30 cm, no fetal
morphology abnormalities, placenta implanted in anterior corpus, cervical length
1.8 cm, funneling positive. Laboratory results were Hb 10,7 g/dL, Ht 33%,
Leucocyte 13.500, Thrombocyte 315.000 MCV 82 MCH 30. What is the most
appropriate next step in the management of this patient?
A) Give intravenous iron
B) Schedule for OGTT test
C) Give antibiotic prophylaxis
D) Schedule for cervical cerclage
E) Give MgSO4 for neuroprotection

18. You explain ti the couple that you will be monitoring fetal growth of their twins
closely because they are at risk for SGA and twin to twon transfusion syndrome.
In twin to twin transfusion syndrome, the recipient twin may suffer from which of
the following complications?
a. Fetal hydrops
b. Anemia
 c. Oligohyramnion
d. Growth restriction
e. hypovolemia

19. A 35-year-old woman (gravida 7, para 5, abortus 1) is in the active phase of labor
with the vertex at –1 station. She complains of abdominal pain with the
contractions. At the height of one contraction, the pain becomes very intense.
Following this intense pain, uterine contractions cease. The maternal systolic BP
drops 15 mm Hg. What is the best course of action?
(A) immediately perform a pelvic examination
(B) place the patient on her side and reassure her
(C) manage expectantly
(D) begin oxytocin
(E) perform an ultrasound

20. A 27 years old patient, P1, come with 7 months of amenorrhea. Her pregnancy
test showed negative result. Her general status was normal. On ultrasound
examination revealed hyperechoic, 14 mm endometrial line. On the right ovary
there was anechoic mass size 20 mm, left ovary was normal.Which of the
following should be the next step of management?
A) Perform endometrial sampling using hysteroscopy
B) Give noretisterone acetate 2x5 mg for 10 days
C) Give combined oral contraception
D) Perform FSH, LH and estradiol examination
E) Perform prolactin examination

21. A 19-year-old G1P0 patient complains of spotting and right-side pain. She had a
positive urine pregnancy test 3 weeks ago. Ultrasound does not identify an
intrauterine pregnancy. On laparoscopy 125 cc of blood is seen in the pelvis.
There is minimal blood from the tube and a small bit of tissue is recovered
floating free in the peritoneal cavity. This pregnancy is likely which of the
following?
A) spontaneous abortion
B) delivery
C) tubal abortion
D) decidual cast
E) Arias-Stella phenomenon

22. A 28-year-old G1 at 26 weeks present for her scheduled obstetric appointment.

You ordered OGTT examination that shows fasting blood glucose 102 mg/dL and
2 hours after 75 g oral glucose 185 mg/dL. Her gestational weight gain during
pregnancy is 12 kg. Her BMI before pregnancy was 26 kg/m2. What is the
appropriate next step in the management of this patient?
A) Schedule nonstress test (NSTs)
B) Schedule fetal growth ultrasound
C) Admit to hospital for fetal monitoring
D) Advise insulin in order to lowering blood glucose
E) Give metformin 3x500mg orally
23. A 33 years old woman with morbid obesity was plan for laparoscopy cystectomy
due to endometriosis cyst. Patient had history of laparotomy cystectomy 2 years
before. Which technique use to avoid complication for this patient?
A) Open technique
B) Direct trocar insertion
C) Veress needle
D) Anterior abdominal wall elevation
E) Optical primary trocar

24. A 30-year-old G3P2002 presents to the obstetrician’s office at 34 weeks for a

routine prenatal visit. She has a history of two prior cesarean sections (low-
transverse). The first cesarean section was performed secondary to fetal
malpresentation (footling breech). The patient then had an elective repeat cesarean
section for her second pregnancy. This pregnancy, the patient has had an
uncomplicated prenatal course. The patient is interested in permanent sterilization
and wonders if it would be better to undergo another scheduled cesarean section
so she can have a bilateral tubal ligation performed at the same time. Which of the
following statements is true and should be relayed to the patient?
a. A history of two previous cesarean sections is a contraindication to vaginal
birth after cesarean section (VBAC)
b. Her risk of uterine rupture with attempted VBAC after two prior cesarean
sections is 5%
c. Her chance of having a successful VBAC is less than 70%
d. The patient should schedule an elective induction if not delivered by 40 weeks
e. If the patient desires a bilateral tubal ligation, it is safer for her to undergo a
vaginal delivery followed by a postpartum tubal ligation rather than an
elective repeat cesarean section with intrapartum bilateral tubal ligation

25. A 45 years old woman presents to your office for consultation regarding her
symptoms of menopause. She stopped having periods 13 months ago after BSO
operation and is having severe hot flushes. She is considering hormonal therapy to
alleviate it. Which of the following is true regarding menopause condition?
a. Hormonal therapy are contraindicated in patient with chronic kidney disease
b. Combine E-P hormonal therapy has a lower risk of breast cancer in compared
to Estrogen only therapy
c. Combined oral contraception is a first line therapy for menopause
d. Early intervention by giving hormone therapy will lower risk of CVD in
menopause patients
e. Hormonal therapy in menopause patient has a higher risk of colorectal cancer

26. A 26-year-old G2 P1 woman at 7 weeks’ gestation was seen 1 week ago with
crampy lower abdominal pain and vaginal spotting. Her hCG level was 1000
mIU/mL at that time. Today, the woman does not have abdominal pain or
passage of tissue per vagina. Her repeat hCG level is 1100 mIU/mL. A
transvaginal ultrasound examination today shows no clear pregnancy in the
uterus and no adnexal masses. Which of the following can be concluded based
on the information presented?
a. The woman has a spontaneous abortion and needs a dilation and curettage.
b. The woman has an ectopic pregnancy.
 c. No clear conclusion can be drawn from this information, and the hCG needs
to be repeated in 48 hours.
d. The woman has a nonviable pregnancy, but its location is unclear.
e. She is not pregnant, but having hormone secreting tumor

27. An 18 years old young woman presents to you with a complaint of

amenorrhea. She notes that she has never had a menstrual period, but she has mild
cyclic abdominal bloating. She is sexually active, but she complains of painful
sexual intercourse. Her past medical and surgical history is unremarkable. On
physical examination, you note normal appearing axillary and pubic hair. Her
breast development is normal. Pelvic examintation reveals normal appearing
external genitalia, and a shortened vagina ending in a blind pouch.
From further examination it was found that uterus cannot be visualized, but both
ovaries were normal.
What is the most likely diagnosis?
Mullerian agenesis
A. Androgen insensitivity syndrome
B. Gonadal dysgenesis
C. Imperforate hymen
D. Transverse vaginal
septum

28. A 35 year old woman, G3P2 presents to labor and delivery (L&D) suite at 33
week gestation referred by a midwife with BP 180/120 mmHg. BP on arrival is
170/105 mmHg. Urine protein is negative on dipstick. The patient no history of
high blood pressure before pregnancy and denies any complaint today. Her body
mass index prior to pregnancy was 28 kg/m2. What is the appropriate maternal
weight gain of this case (based on ASIAN BMI category criteria?)
a. 11.5-16 kg
b. <9 kg
c. 7-11.5 kg
d. 5-9 kg
e. 12.5-18 kg

29. A 89 year old female patient with serious medical comorbidities presents to
discuss options for treatment of her high-grade prolapse. The prolapse is
externalized and becoming ulcerated from friction against her undergarments.
Her main priority is to “fix or get rid of this this things”, but her primary care
provider has cautioned against a lengthy or open abdominal procedure. She is not
interested in future intercourse. What can you offer this patient?
a. Manchester fothergyl operation
b. Ring pessary
c. Sacrospinous hysteropexy
d. Partial colpocleisis
e. Total colpocleisis
30. A 30-year-old G1 at 26 weeks present for her scheduled obstetric appointment.
She has been married for 4 years, and had oligomenorrhea. You ordered OGTT
examination that shows fasting blood glucose 98 mg/dL, after 75 g oral glucose 1
hour 175 mg/dL, and 2 hours 167 mg/dL. Her gestational weight gain during
pregnancy is 12 kg. Her BMI before pregnancy was 27 kg/m2. What is the
appropriate next step in the management of this patient?
A) Exercise 120 minutes/week
B) Modification nutrition intake
C) Give metformin 3x500mg orally
D) Ultrasonographic biophysical profile
E) Advise insulin in order to lowering blood glucose

31. Kindly choose the suggested management options of placenta accreta?

a. C-section followed by hysterectomy, Leaving the placenta in situ, Routine

MTX administration
b. C-section followed by B-Lynch trial before hysterectomy, leaving the placenta
in situ, perioperative arterial catheterization
c. C-section followed by hysterectomy, Leaving the placenta in situ, The best
option for placenta increta and placenta percreta is hysterectomy,
d. Perioperative venous catheterization, Leaving the placenta in situ, The best
option for placenta increta and placenta percreta is hysterectomy,
e. Routine MTX administration, Leaving the placenta in situ, The best option for
placenta increta and placenta percreta is hysterectomy,

32. A 35 years old P3 with a positive high-risk HPV on DNA testing and a Pap smear
showing high-grade squamous intraepithelial lesion of the cervix (CIN III) has an
inadequate colposcopy. If the histopathology result shows squamous cell cancer
that has invaded only 1 mm beyond the basement membrane. There are n
confluent tongues of tumor, and there is no evidence of lymphatic or vascular
invasion. The margins of the biopsy specimen are free of disease. Of the
following, appropriate therapy for patient is?

a. Simple hysterectomy with pelvic lymphadenectomy

b. External beam radiation
c. Radical hysterectomy
d. Simple hysterectomy
e. Implantation of radioactive cesium

33. A 18-year-old adolescent female complains of not having started her menses. Her
breast development is Tanner stage I, Pubic hair development was stage I. From
vaginal examination found a small uterus and normal vagina and vulva. Which of
the following describes the most likely diagnosis?
A) Partial androgen insensitivity syndrome
B) Complete androgen insensitivity syndrome
C) Gonadal dysgenesis
D) Late onset congenital hyperplasia
E) Swyer syndrome
34. A 18 years old girl come to the emergency room with pelvic pain for 2 days. She
has low grade fever. She has regular menstrual cycle. From the physical
examination an intense of low abdominal pain was marked even more on
palpation. There was a muscle defence, on the right lower abdomen quadrant. On
abdominal ultrasound reveal a mass measuring 10 cm in the largest diameter on
her pelvic, characterized with multiple hyperechogenic interfaces in a cystic mass
in the right ovary. Uterus anteflexed within normal limit. Left ovary within
normal limit. There is no fluid in pelvic cavity. What would be the working
diagnosis?
A) Functional cyst
B) Endometriosis
C) Ovarian torsion
D) An infected cyst
E) Ruptured cyst

35. Which of the following is NOT a classic symptom of menopause?

a. Hot flashes
b. Insomnia
c. Visual Changes
d. Vaginal atrophy
e. Night sweats

36. A 26-year-old parity Ízero woman comes to emergency department complaining

of moderate lower abdominal pain and nausea-vomiting. She has trouble in her
oral intake and has difficulties of taking medication. Her LMP was 1 week
ago. She has history of untreated STIs, with multiple sexual partners and
intermittent condom usage as risk factors. On physical examination, her
temperature is 38.4°C. Physical examination shows lower abdominal quadrant
tenderness and mucopurulent cervical discharge and cervical motion tenderness;
whereas bilateral adnexa are unremarkable. Which of the following antibiotics is
the drug of choice for this patient?
A) Ampicillin sulbactam 2x375 mg orally
B) Metronidazol 3x500 mg orally
C) Ceftriaxone injection 2x1 gram/day
D) Clindamycin injection 2x300mg/day
E) Meropenem 3x1 gram /day

37. A 24 year old female came to emergency department with right lower quadranat
abdominal pain since 6 hours ago. She has no fever. Her last menstrual period was
2 week ago. Her cycle 28 days. On physical examination found vital sign with in
normal limit, right lower quadrant abdominal tenderness without sign of
peritonitis, and on ultrasounf found uterus and left ovary normal, seen mass on
right ovary sized 3,5 cm, with thin wall and spider web sign, no flree fluid found.
Pregnancy test was negative. Hb level 12,3 g/dl.
 What is the most likely diagnosis of this patient?
a. Dermoid cyst
b. Hemorrarghic of the corpus luteum
c. Tubo ovarial abcess
d. Torsion of the ovarian cyst

38. A. 56 years old lady presents to gynecology outpatient with postmenopausal

bleeding. A through clinical workup reveal an endometrial thickness of 7 mm, a
regular basement membrane. She underwent hysteroscopy biopsy, and the
histopathology result was simple hyperplasia without atypia. What is the best
management option for this patient ?
a. LNG IUS
b. Endometrial ablation
c. Total hysterectomy and bilateral salpingo-oophorectomy
d. Total hysterectomy
e. Curretage

39. A 38-year-old woman presents to the office with sudden onset of pelvi pain. If on
physical examination reveal a right adnexal mass with tenderness. She has no
history if cervical discharge. From Ultrasound examination revealed right adnexal
mass with whirlpool appereance from doppler examination. What is the most
likely cause of this condition?
A) Infected ovarian cyst
B) Ruptured of endometriosis cyst
C) Ovarian torsion
D) Appendicitis
E) Fitz-Hugh Curtis syndrome
40. An 8-year-old African American girl is brought to your office by her parents
concerned that she has started developing breasts too soon. Physical examination
reveals a Tanner stage II breast and pubic hair growth. You reassure the parents
that this is normal. What is typical pubertal sequence?
a. Menarche, pubarche, thelarche, accelerated growth
b. Pubarche, thelarche, accelerated growth, menarche
c. Thelarche, pubarche, accelerated growth, menarche
d. Accelerated growth, thelarche, pubarche, menarche
e. Pubarche, accelerated growth, thelarche, menarche

41. A 27-year- old, G1 40 weeks gestation, was referred b midwifes due to labor
dystocia. Based on partograph, cervical dilatation of 4 cm was happened at 08.00
am. At 12.00 pm, cervical dilatation remains the same, with contraction
2x/10’/20” and intact membrane. Estimated fetal weight is 3000 grams with
adequate pelvic examination. This condition canbe classified as?
a. Prolonged of active phase
b. Prolonged of latent phase
c. Protraction disorder
d. Incoordinate uterine action
e. Arrest disorder

42. A39-year-old 02P1 presents to your outpatient clinic with pregnancy test was
positive. She has history of 10 weeks amenorrhea. Her first child has Down
Syndrome, she is asking regarding aneuploidy screening. Which of the following
isthe most appropriats regarding aneuploidy screening?
a. Risk of miscarriage is greater in amniocentesis than chorionic
villussampling
b. If fetal structural anomaly is identified on ultrasound examination,
diagnostic testing cfDNA should be offered
c. cfDNA testing as a diagnostic test
d. The letal fraction, the amount of the cell-tree DNA in the maternal
blood that is of fatall origin, at least 4% is required for accurate test
results
e. CfDNA has a high sensitivity and specificity for trisomy 18 and
trisomy 21

43. A 27 year old G3P2 who is 34 weeks gestational age calls the on call obstetrician
on a Saturday night at 10.00 PM complaining of decreased fetal movement. She
says that for the past several hours, her baby has moved only once per hour. She is
healthy, has had regular prenatal care, and denies any complications so far during
the pregnancy. How should the on call physician counsel the patient?
a. Counsel the patient that the baby is probably sleeping and that she should
continue to monitor fetal kicks
b. Reassure the patient that one fetal movement per hour is whitin normal limits
and she does not need to worry
c. Instruct the patient to go to labor and delivery dor nonstress test
d. Instruct the patient to go to labor and delivery for contraction stress test
 e. Recommend the patient be admitted to hospital for delivery

44. A 40-year-old Female Parity 3 comes to your office to discuss contraception. She
has been married for 15 years and smokes one pack of cigarettes per day. She was
diagnosed with systemic lupus erythematosus (SLE) at the age of 20 years and has
only been hospitalized once for an acute exacerbation of joint swelling and
fatigue. Her BMI is 24, and she has light to normal menstrual flow. She has no
plans for a future pregnancy but is not ready to commit to permanent
sterilization. Which of the following condition is NOT an absolute
contraindication to COC pill use?
A) History of or current thromboembolism
B) Coronary artery disease
C) Tobacco use of greater than or equal to 15 cigarettes/day over the age of 35
years
D) History of breast lump
E) Abnormal liver function

45. A 34 year old woman came to clinic to have her 6 weeks postpartum check. She
just gave birth to a 3200 gram baby delivered vaginally 3 months ago. She had
complain unable to hold liquid stool and flatus. On examination the external
genitalia looks normal. What is the next management of this case?
a. Give constipating agent to prevent liwuid stool
b. Reconstructive surgery
c. Sacral neuromodulation
d. Observation the symptom and reevalutaion 3 months
e. High fiber diet, hydration of minimum 2 L and reevaluation 6 weeks

46. A 35 years old lady G2 P1 28 weeks of gestation, comes to obstetric emergency

due to irregular contraction since 8 hours BA. Vital signs are normal. On obstetric
examination found fundal height 35 cm. Fetal part is difficult to identify. US exam
shows estimated fetal weight 1,800 grams, placenta on anterior corpus with
amniotic fluid index 30. Which problem is most likely can be suspected ?
A) aneuplodies
B) Gestational diabetes mellitus
C) Dysturbed fetal swallowing
D) Duodenal atresia
E) Fetal infections
47. During an operation, a midline incision was made at an anatomic location 2 cm
below the umbilicus. Which of the following lists (in order) the layers of the
anterior abdominal wall as they would be incised or separated?
a.Skin, subcutaneous fat, superficial fascia (Camper’s), deep fascia (Scarpa’s),
fascial muscle cover (anterior rectus sheath), rectus muscle, a deep fascial
muscle cover (posterior rectus sheath), preperitoneal fat, and peritoneum
b. Skin, subcutaneous fat, superficial fascia (Scarpa’s), deep fascia
(Camper’s), fascial muscle covering (anterior abdominal sheath), transverse
abdominal muscle, a deep fascial muscle cover (posterior rectus sheath),
preperitoneal fat, and peritoneum
c.Skin, subcutaneous fat, superficial fascia (Camper’s), deep fascia (Scarpa’s),
fascial muscle cover (anterior rectus sheath), rectus muscle, a deep fascial
muscle cover (posterior rectus sheath), peritoneum, and preperitoneal fat
d. Skin, subcutaneous fat, superficial fascia (Scarpa’s), deep fascia
(Camper’s), fascial muscle cover (anterior rectus sheath), rectus muscle, a
deep fascial muscle cover (posterior rectus sheath), preperitoneal fat, and
peritoneum
e.Skin, subcutaneous fat, superficial fascia (Camper’s), deep fascia (Scarpa’s),
fascial muscle cover (anterior rectus sheath), transverse abdominal muscle, a
deep fascial muscle covering (posterior rectus sheath), preperitoneal fat, and
peritoneum

48. An 80-year-old woman presents to the office with complaints of leaking large
amounts of urine when she hears running water. Her symptoms began about 1
month ago and have gotten progressively worse. She denies any previous history
of abdominal or pelvic pain. Medical history is complicated by hypertension
treated with hydrochlorothiazide and lisinopril. What is the next best step in her
workup?
a. Cystoscopy
b. Basic metabolic panel
c. Urine culture
d. Voiding diary
e. Urine cytology

49. A 36-year-old patient, G4P3 wga, obese patient come into policlinic with
diagnosis diabetes mellitus in pregnancy and history of previous CS 2x. She is
scheduled for elective cesarean section at 38 completed weeks of gestational
age. She had a poor glycemic control with oral antidiabetic regiments. 6 hours
prior to her surgery you found that her random blood glucose is 297 g/dL. What
do you think is the best method for herpre-operative glycemic control?
a. Sliding scale insulin
b. Combine her oral antidiabetic with long-acting insulin
c. Postpone her surgery due to uncontrolled blood glucose level
d. Combine her oral antidiabetic with another type of oral antidiabetic
e. Increase the dose of her oral antidiabetic medication
50. A 34 year old women with primary infertility 3 years, oligomenorrhea and a
body mass index (BMI) of 26. Day 23 progesterone level result was 5 ng/ml.
Transvaginal ultrasound shows multiple small follicle size 5-8 mm in both ovary.
HSG shows bilateral patent tubes. Her partner’s semen analysis show a volume of
3 ml, pH of 7 and a sperm count 0f 20 million/ml. according to the current
international guidelines. Which of the following is true regarding ovulation
induction in PCOS?
a. Use of aromatase inhibitor reserved for Clomiphene failure patient
b. If there are more than two mature follicles ovulation trigger should be
cancelled
c. Clomiphene citrate has a similar risk of multiple pregnancy compared to
aromataseinhibitor
d. Gonadotropin cannot be used as a first line treatment
e. Use of gonadotropin correlate with lower cost of ovulation induction

51. A hirsute obese, 24-year-old woman presents with irregular periods. Pelvic
sonogram demonstrates bilateral ovaries with multiple peripheral follicles. Which
of the following structure can be the production source of androgen?
A) Granulosa cells
B) Adrenal gland medulla
C) Anterior pituitary
D) External theca cells
E) Internal theca cells

52. A 39-year-old woman (G4P4) has had a complicated pregnancy with Graves'
disease. She has delivered 4 hours ago. Her thyroid levels and TSH levels
have been in the normal range throughout gestation. Among which of the
following will her infant most likely be?
A) hypothyroid infant
B) mongoloid infant
C) hyperthyroid infant
D) Infertile infant
E) infant with ambiguous genitalia

53. A 24-year-old woman (gravida 2, para 0, abortus 1) is seen in the emergency

department because of vaginal bleeding and abdominal cramps. Her LMP was 10
weeks ago. History is unrevealing except for an induced abortion 2 years ago
without complications. She presently denies instrumentation for abortion. Physical
examination reveals a BP of 110/70 mm Hg, pulse 120, and temperature 101.8°F.
The abdomen is tender with slight rebound in the lower quadrants. The pelvic
examination reveals blood in the vault and a foul-smelling discharge from the
cervix, which is dilated to 2 cm. The uterus is 8- to 10-week size and tender, and
no adnexal masses are palpated. What is the most likely diagnosis?
A) choriocarcinoma
B) hydatidiform mole
C) pelvic inflammatory disease (PID)
D) septic abortion
E) twisted ovarian cyst
54. A 29-year-old G3P2A0 presents to the emergency center with complaints of
abdominal discomfort for 2 weeks. Her vital signs are BP 120/70mmHg, pulse 90
beats/min, temperature 36 C, respiratory rate 18 breath/minute. A pregnancy test
was positive and an ultrasound of the abdomen and pelvis reveals a visible 16
weeks gestation located behind a normal appearing 10x6x5.5 cm uterus. Both
ovaries appear normal. No free fluid is noted. Which of the following is the most
likely cause of these findings?
A) Ectopic ovarian tissue
B) Fistula between the peritoneum and the uterine cavity
C) Primary peritoneal implantation of the fertilized ovum
D) Tubal abortion
E) Uterine rupture of prior cesarean section scar

55. Which of the following is the best term to diagnose maternal primary CMV
infection?
a. Ig M negative, Ig G positive
b. Ig M negative, Ig G negative
c. Ig M positive, Ig G negative
d. Ig M positive, Ig G positive high avidity
e. Ig M positive, Ig G positive low avidity

56. Which one of the following gives the highest score in Placenta Acreta Index
? What is the most potential perioperative problem of this patient?
A) Lacunae Grade 3
B) Bridging Vessels
C) > 2 Caesarean deliveries
D) Anterior Placenta Previa
E) Sagital Smallest Myometrial Thickness 1mm

57. Ms N, 37 years old with chief complain of severe dysmenorrhea. Pelvic

ultrasound found diffuse adenomyosis with uterus size 16x10x6cm. There is no
history of abnormal uterine bleeding. Which of the following is the most
appropriate management?
A) Noretisterone 5 mg/day
B) Dienogest 4 mg/day
C) Extended OCP regimen
D) Sequential estrogen-progestin pills
E) LNG IUS
58. A 18-year-old G1 at 32 4/7 weeks presents for her scheduled obstetric (OB)
appointment. Ultrasound charts showed below.

The patient denies any complaints today. Fetal movement is active. BMI before
pregnancy was 19.6 kg/m2, gestational weight gain is 7 kg. Vital sign are normal.
Abdominal examination today shows a gravid uterus measuring 29 cm. Fetal heart
tones (FHTs) are in the 140s. What is the most appropriate diagnosis of this patient?
a. Underweight
b. Small for gestational age
c. Appropriate for gestational age
d. Symmetrical intrauterine growth restriction
e. Asymmetrical intrauterine growth restriction

59. A 26-years-old woman, G1P0A0 was admitted to ER because she lost her
consciousness around 1 hour ago. According to her husband, she is 36 weeks
pregnant. She performed antenatal care at scheduled time, and never missed one.
Her husband said, she never had any hypertension or any other disease before.
Three days prior hospitalization, she had severe nausea and vomiting. Physical
examination reveals, BP 145/93 mmHg, pulse rate 87 x/min, RR 18x/min,
Temperature 36.50C. You notice there is an icteric sclera. Other physical
examination was remarkable. Obstetrical examination reveals no fetal heartbeat
was detected. Laboratory examination reveals CBC 10.2/29.9/10900/143.000;
Ur/Cr 38/1,1; AST/ALT 458/878; RBG 32; Urinalysis was within normal limit.
What is the most likely diagnosis?
a. Preeclampsia
b. HELLP syndrome
c. Acute viral hepatitis
d. Acute fatty liver in pregnancy
e. Intrahepatic cholestasis of pregnancy
60. Concerning middle cerebral artery Doppler velocimetry, which of the following is
true?
a. It is useful for detection and management of fetal anemia of any cause
b. It was found to be inferior to amniocentesis and amnionic fluid spectral
analysis for predicting fetal anemia
c. It is superior to the modified biophysical profile in forecasting pregnancy
outcomes
d. In those with brain sparing, decreased blood flow from reduced
cerebrovascular impedance is detected (hrsnya lebih tinggi)
e. It is useful to detect fetal growth restriction

61. Mrs. S, 29 YO, G3PIAI 39 weeks GA, referred by a midwife with prolonged
second stage. Physica examination revealed normal vital sign. Obstetric
examination revealed contraction was 3x/10'/35" and FHR was 160 bpm.
Estimated fetal weight was 3100 gr with previous baby was 3000 gr. Vaginal
examination: fully dilated, no amniotic membrane, lowest part of the fetus was
head with descent of the head in Hodge IV. Denominator was minor fontanelle at
the left anterior. What are the indication for assisted vaginal delivery?
a. Uterine rupture
b. Fetal anomaly
c. Postpartum hemorrhage
d. Fetal or maternal distress
e. PPROM

62. You see a patient in your office who had a thyroidectomy from Graves Disease.
She is now hypothyroid on thyroid hormone replacement. You monitor her TSH
and keep it between 0.5 and 2.5. You increase her thyroid hormone replacement
each trimester and her TSH remains around 2.0 during the entire pregnancy.
Management of hypothyroidism in pregnancy is:
a. None of the above.
b. Increased thyroxine reguirements begin as early as 12 weeks.
c. Women after thyroidectomy may reguire higher doses of levothyroxine.
d. TSH levels measured weekly.
e. Thyroxine dose is adjusted by 100 mcg increments until TSH values become
normal.

63. Mrs. N, 39 years old had just undergone laparoscopic procedures. Her chief
complaint was infertility for 6 years with history of severe dysmenorrhea.
Intraoperative findings were patent both tubes and AFS stage III-IV
endometriosis. Which of the following is true regarding management in this
patient?
a. GnRH agonist 3 time prior to surgery wil give better results
b. Intrauterine insemination is the preferred methods of infertility treatment in
this case
c. Patient should be given secondary prevention with oral progestin Dienogest 2
mg/day
d. Medical management with GNRH agonist should be given for 3 months
followed with In Vitro Fertilization
e. C a125 level must be measured before starting tertility treatment after surgery
64. A-30 years old patient came with complaint of infertility. Her husband is a 33-
year-old who has had a semen analysis, which was reported as normal. On further
history, the patient reports that her periods have been guiet irregular over the last
year and that she has not had period in the last 3 months. She also reports of
weight gain and abnormal hair growth. From Ultrasound we found multiple
follicles size 2-8 mm in both ovaries. Which of the following correlate to this
condition?
a. Serum AMH level 2,6 ng/mi
b. Follicle antral basal count of 12
c. Midluteal progesterone level of 4 ng/mi
d. Positive Clomiphene citrate challenge test
e. Day 3 FSH level 20 IU

65. 40-year-old Parity 3 comes to your office to discuss contraception. She has been
married for 15 years and smokes one pack of cigarettes per day. Her BMI is 24,
and she has light to normal menstrual flow. She has no plans for a future
pregnancy but is not ready to commit to permanent sterilization. After
counselling, she decided to use progestin-only pills. Which of the following is true
regarding drospirenone only pill?
a. Daily dose is drospirenone 2 mg/day
b. It has a lower risk for ectopic pregnancy
c. It can suppress follicle growth and prevent ovulation
d. It has a better bleeding profile compared to other progestin only pills
e. It is given in a 21-7 regimen

66. Which of the following factors are least likely to be linked with higher first-
Trimester miscarriage rates?
a. Maternal age >40 years old
b. Obesity
c. Thyroid disorder
d. Parvovirus infection
e. Diabetes mellitus

67. A 35 year old P3 with a positive high risk HPV on DNA testing, and a Pap smear
showing high-grade squamous intraepithelial lesion of the cervix (CIN III) has an
inandequate colposcopy. If the histopathology result shows squamous cell cancer
that has invaded only 1 mm beyond the basement membrane. There are no
confluent tongues of tumor, and there is no evidence of lymphatic or vascular
invasion. The margins of the biopsy specimen are free of disease. In CIN III,
which of the following statement is correct?
A) Neoplastic cells extend into the proximal cervical glands whereas the
basal membrane remains intact
B) Neoplastic cells derive form both squamous and glandular endocervical
epithelium
C) Cytoplasmic maturation in the upper third mucosa
D) Glandular acinar fomrations extends into the endocervical stroma
E) There is extension of neoplastic epithelium into endocervical glands and
the connective tissue
68. A 49-year-old woman had a radical hysterectomy and lymph node sampling for
stage 1B squamous cell cancer of the cervix. A suprapubic catheter was placed at
the time of surgery. She is now 8 weeks postoperative and has not been able to
void. She is also leaking urine with activity, coughing, and sneezing. What is the
most likely diagnosis of this patient?
A) Vesicovaginal fistula
B) Urge incontinence
C) Stress incontinence
D) Overflow incontinence
E) Mixed incontinence

69. Your patient is a 13 year-old adolescent girl who presents with cyclic pelvic pain.
She has never had a menstrual cycle. She is afebrile and her vital sign are stable.
On physical examination, she has age-appropriate breast and pubic hair
development and normal external genitalia. There is no bulge in the introitus of
vagina and no hymenal structure seen. You obtain a transabdominal ultrasound,
which reveals a hematocolpos and hematometra. What is the most likely
diagnosis?
a. Distal transverse vaginal septum
b. Distal vaginal agenesis
c. Imperforate hymen
d. Longitudinal vaginal septum
e. MRKH

70. A 25 years old woman came with chief complain amenorrhea. She notes that she
diagnosed missed abortion and had a dilatation and curettage (D&C) 4 months
ago. After D&C she had scant vaginal bleeding for a month, and for the last 3
months, she notes the absence of menses but instead has monthly painful
cramping. She and her husband would like another pregnancy. Her urinary HCG
test was negative. To confirm your suspect diagnosis, which test would you first
perform?
A) Provera 10 mg daily to achieve withdrawal bleeding
B) Check blood HCG examination
C) Pelvic Ultrasound examination
D) Dilatation and curretage
E) Check Serum FSH and LH level

71. A 36 years of G2P1 presents to the antenatal clinic in tertiary referral hospital. She
had an emergency caesarean section for sudden onset hypertension and placental
abruption at 30 weeks in her previous pregnancy. She is currently 12 weeks of
gestation and enquiries about further plan of fetal monitoring in this
pregnancy. What is the most accurate advice to do at 12 weeks?
A) BMI calculation
B) Check sFLT-1/PLGF ratio
C) Check urine microalbuminuria
D) Mean arterial pressure calculation
E) Pulsality index uterine artery doppler

72. A 26 years old unmarried woman came with chief complain of abdominal mass
since 5 months ago. She also has a history of heavy menstrual bleeding with
 regular cycle since 6 months accompanied with dysmenorrhea VAS 8. From
examination the uterus enlarged globular with limited mobility, no mass was
palpable on both adinexas. Which of the following ultrasound features that
correlate with this pathology?
a. Circumterential vascularity around the mass in the uterus
b. Thickened endometrial line
c. Lobulated mass in the myometrium with clear border
d. Normal junctional zone
e. Fan shaped shadowing with ill-defined border

73. A previously energetic woman complains of crying, loss of appetite, difficulty in

sleeping, and feeling of low self-worth, beginning approximately 3 days after a
normal vaginal delivery. These feelings persisted for approximately 1 week and
then progressively diminished. Pregnancy could exacerbates some coexisting
mental disorders due to?
a. Body changes cannot easily accepted by women
b. Pregnancy-related shifts in monoamine neurotransmitter levels
c. Lack of affection from spouse and family members
d. Certain medication could interfere brain function during pregnancy
e. Lack of certain minerals in pregnancy that could affect limbic system

74. A 456 year-old P2 obese woman is referred from her primary-care

physician because of increasingly heavy and painful menses over the last 18
months. She tried an oral contraceptive with some improvement of her bleeding
but no improvement in her pain. She has never had an abnormal Pap smear and
states she has never had any infections, “down there”. Her only medical problems
are her obesity and hypertension. On examinations, you note normal external
genitalia, vagina, and cervix. Hov=wever, her uterus is slightly enlarged, midly
tender, and softer than you expected. She has no adnexal mass or tenderness.
Which imaging study listed below would best differentiate between adenomyosis
and uterine fibroids?
a. Pelvic ultrasound
b. Pelvic MRI
c. Pelvic CT
d. Sonohysterogram
e. Hysterosalpingogram

75. Mrs. A, 24-year-old came to the ER with complaints of headaches since the last
day of examinations obtained expecting her first child, gestational age 32 weeks
with blurred vision and denied heartburn. On physical examination found BP
190/120 mmHg, pulse 90 x/m, breathing 16 x/m. Leopold found the lower left
back head, FHR 140 bpm, irregular contraction. Pelvic score of 1 was found,
pelvis size wide. Laboratory investigation; hemoglobin 11.5 g%, platelets 9000/
mm3, LDH 510 iu/L, Proteinuria +2, ALT 10 u/L, AST 15 u/L What is the best
diagnosis for Mrs. A?
a. HELLP syndrome
b. Severe preeclampsia
c. Chronic hypertension
d. Gestational hypertension
 e. Superimposed preeclampsia

76. A patient present to you with pain and swelling in the vulva. On examination you
find reddish bulge on the vaginal introitus at 4 o’clock positions sized 3 cm, cystic
and pain on palpation. What treatment of choice for this condition?
a. Marsupialization
b. Cystectomy
c. Excision of the glands
d. Antibiotic for 7 days

77. 52 years old woman came to the ER with a complaint of shortness of breath since
2 days ago. She also noticed an abdominal enlargement since 6 months ago. On
physical examination found tachypnea and chest examination reveal dullness to
percussion on lower right hemithorax and on abdominal examination found
shifting dullness and a solid mass on pelvic examination. What is the most likely
diagnosis in this case?
a. Mature cystic teratoma
b. Malignant ovarian tumor
c. Meigs syndrome
d. Colon cancer
e. Tuberculosis

78. An 8-year-old African American girl is brought to your office by her parents
concerned that she has started developing breasts too soon. Physical examination
reveals a Tanner stage II breast and pubic hair growth. When can the patient
expect her first menses?

a. At 14 years of age
b. At 12 years of age
c. At 11 years of age
d. At 13 years of age
e. It is impossible to tell from the data provided

79. Numerous physiologic changes develop over the course of pregnancy and
postpartum; however the greatest impact on potentially compromised
cardiovascular system is:

a. Stroke volume decrease after delivery of placenta

b. Increased total plasma volume in second trimester
c. Maximum heart rate increases in the second trimester
d. Decreased SVR in the first trimester, and increase after 32 weeks
e. Maximal increase in cardiac output occurs during second stage of labor
80. A 40-year-old GIPO at 36 weeks of gestation presents to labor and delivery
complaining of aseveral-day history of generalized malaise, anorexia, nausea, and
emesis. She denies any headache or visual changes. Her fetal movement has been
good, and she denies any regular uterine contractions, vaginal bleeding, or rupture
of membranes. On physical examinations, you notice that she is mildly jaundiced
and appears to be a little confused. Her vital signs indicate a temperature of
36.9”C, pulse of 70 beats per minute, and blood pressure of 100/70 mmHg. Blood
is drawn and the following results are obtained: WBC - 25,000, Hct - 42,0,
platelets - 61,000, SGOT/PT - 600/550, glucose - 33, creatinine - 2.0, fibrinogen -
135, serum ammonia level - 90 mmol/L (ni - 11-35). Urinalysis is positive for 3
protein and large ketones. What is the most likely diagnosis?
a. HELLP syndrome
b. Acute Hepatitis
c. Cholestasis in pregnancy
d. Preeclampsia with severe feature
e. Acute fatty liver in pregnancy

81. Mrs. 37 years old, 03P2,35 wga, come to ER referred from nearby PHC due
to high blood pressure, on admission her blood pressure was 170/110 mmHg. She
complained of epigastric pain followed by nausea and vomitting. She denied
having contraction, water broke, and bloody show, from her physical examination
you found her fundal height was 3 fingers above navel, head presentation, there
was no contraction and no dilation of cervix. You decided to terminate the
pregnancy by emergency cesarean section due to impending eclampsia. The baby
born with Apgar Score 6/8 bodyweight 1480 g, and diminished amniotic fluid.
When you were performing informed consent before the cesarean section, you
were explaining the neonatal complication of IUGR, one of them is ?

a. Susceptibility to infection
b. Transient tachypneu of the newborn
c. Delayed lung maturation
d. Retinopathy
e. Cerebral palsy

82. A 29-year-old G1P0 patient at 15 weeks gestational age presents to your office
complaining of some shortness of breath that is more intense with exertion. She
has no significant past medical history and is not on any medication. The patient
denies any chest pain but sometimes feels as through her heart is pounding. She is
concerned because she has always been very athletic and cannot maintain the
same degree of exercise that she was accustomed to prior to becoming pregnant.
On physical exam, her pulse is 90/min. her blood pressure is 90/50 mmHg. On
cardiac exam, a systolic ejection murmur is identified. The lungs are clear to
auscultation and percussion. What is the most possible cause of her complain?
a. Pulse pressure is decreased
b. Pulmonary blood pressure is increased
c. Cardiac output is increased 1.5L/min
d. Blood flow to the uterus increase by 200 ml/min
e. Stroke volume remains unchanged during pregnancy
83. A hirsute obese, 24-year-old woman patients with irregular periods. Pelvic
sonogram demonstrates bilateral ovaries with multiple peripheral follicles.
What is the most appropriate for this patient?
a. Surgical management
b. Combine oral contraceptive pills
c. Observation
d. Metformin
e. GnRH Agonist

84. A 32 year old G1P0 reports to your office for a routine visit at 14 weeks
gestational age. Labs drawn at her first prenatal visit 4 weeks ago reveal a platelet
count 60.000. All her other labs were within normal limits. During the present
visit, the patient has a blood pressure of 120/70. Her urine dip reveals the presence
of trace protein. The patient denies any complaints. The only medication she is
currently taking is a prenatal vitamin. On taking a more in depth history you learn
that, prior to pregnancy, your patient had a history of occasional nose and gum
bleeds, but no serous bleeding episodes. She has considered herself to be a person
who just bruises easily. What is this patient's most likely diagnosis?
a. Gestational thrombocytopenia
b. Systemic lupus erythematosus in pregnancy
c. CMV infection
d. HELP syndrome
e. Immune thrombocytopenic purpura

85. A-35-year-old woman with a history of primary infertility presents with her
partner for initial prenatal visit. They had been attempting pregnancy for the past
3 years and have now conceived through IVF. She had one embryo transferred 7
weeks ago. She is overweight in reviewing their family history, she tells you that
her grandmother was a twin and there is no family history of congenital
abnormalities or known genetic disorders in their family. You perform a
transvaginal ultrasound and notice not one but two embryos. There appears to be a
thin dividing membrane between the two. Heart rate for each embryo is around
150 bpm. At what stage of division in the embryonic disc does monochorionic-
diamniotic twining occur?
a. Not until after day 13 of development
b. Before the differentiation of the trophoblast
c. Days 1-3
d. After trophoblast differentiation and before amnion formation
e. After amnion formation

86. A healthy 20-year-old G1P0 presents for her first OB visit at 10 weeks gestational
age. She denies any significant medical history both personally and in her family.
Which of the following test is not part of the recommended first trimester blood
testing for this patient?
a. Hepatitis B surface antigen
b. Complete blood count (CBC)
c. Blood type and screen
d. Screening for human immunodeficiency virus (HIV)
e. One-hour glucose challenge test
87. A 30 years old woman came with chief complain of no menstruation for 6 month.
She has a history of 3 times surgery for endometriosis cyst. From ultrasound
uterus size and shape within normal limit, endometrial line 3 mm, both ovaries
size is smaller than noemal without any follicles present.
Which of the following management is appropriate for this condition?
a. Administer progestin challenge test
b. Non of the above
c. Measure FSH and estradiol level
d. Administer E-P challenge test using combined oral contraception
e. Measure C1125 and CRP level

88. A-35-year-old woman, G3P2, presents to labor and delivery (L&D) suite at 33-
weeks gestation reffered by a midwife with BP 180/120 mmHg. BP on arrival is
170/105. Urine protein is megative on dipstick. The patient has no history of high
blood pressure before pregnancy and denies any complains today.
What is the most likely diagnosis of the patient?
a. Chronic hyoertension
b. Superimposed preeclampsia
c. Gestational hypertention
d. Preeclampsia with severe feature
e. Preeclampsia

89. A patient presents with vulvar irritation and pruritis. Speculum examination
reveals a hyperemic, edematous, vaginal vault with odorless discharge. The pH is
4.0. These symptoms had been reccurent more than 4 times during the last 1 year.
What is the treatment of choice for this condition?
a. 2000 mg of metronidazole weekly for 6 months
b. Fluconazole 150 mg every alternate day for 3 doses
c. Fluconazole 150 mg weekly for 6 months
d. Single dose of 150 fluconazole
e. Single dose of 2000 metronidazole

90. A 46-year-old P2 obese woman I reffered from her primary-care physician

because of increasingly heavy and painful menses over the last 18 months. She
has tried an oral contraceptive with some improvement of her bleeding but no
improvement in her pain. She has never had an abnormal pap smear and states that
she never had any infections “down there”. Her only medical problems are her
obesity and hypertension. On examination, you note normal external genitalia,
vagina and cervix. However, her uterus is slightly enlarged, mildly tender, and
softer than you expected. She has no adnexal mass or tenderness. After further
evaluation suggesting adenomyosis, your patient wants to proceed with
hysterectomy because she is tired of bleeding and experiencing pain. You explain
to her that she needs to undergo a test prior to scheduling her hysterectomy.
What test does the patient need to undergo?
a. Endometrial biopsy
b. Colposcopy
c. Chest x-ray
d. Mammogram
e. Colonoscopy
91. A 31-year-old women come to outpatient clinic to discuss about her laboratory
result. You tell the patient that she has tested positive for a Chlamydia infection.
She tells you that her friend had chlamydia and told her that it causes a weird
vaginal discharge. She questions the result saying she didn’t have any weird
discharge.
What would be the best response?
a. The false positivity rate of the examination is around 10%
b. The majority of patients with chlamydia are asymptomatic
c. Vaginal discharge only occurs when chlamydia progresses to pelvic
inflammatory disease
d. Patient can take a NAATs test from urine sample to confirm the diagnosis
e. Vaginal discharge is not actually a symptomof chlamydia

92. A 35-year-old woman, G3P2presents to labor and delivery (L&D) suite at 33-
week gestation reffered by midwife with BP 180/120 mmHg. BP on arrival is
170/105. Urine protein is megative on dipstick. The patient has no history of high
blood pressure before pregnancy and denies any complains today.
What is appropriate next step in the management of this patient?
a. Schedule for a biophysical profile (BPP)
b. Schedule for fetal growth ultrasound next week
c. Admit patient to hospital for termination pregnancy
d. Ask patient to increase nutrient intake, particularly protein intake
e. Admit patient to the hospital for lung maturation

93. A 34-year-old woman came to clinic to have her 6 weeks postpartum check. She
just gave birth to a 3200 grams-baby delivered vaginally 3 months ago. She had a
complain of unable to hold liquid stool and flatus. On examination the external
genitalia looks normal.
What is the next diagnostic plan for this patient?
a. Anal manometry
b. Ultrasound of the anal sphincter
c. Defecography
d. Pelvic CT scan
e. Electromyography of the anal sphincter

94. At outpatient clinic, you are now examining a 38 week-pregnant patient with BMI
of 15. She denies history of chronic diseases but she admits that she has lost her
appetite since the first trimester. Her vital signs are within normal limit. Her
fundal height is only at the level of 2 finger above her umbilicus and the fetus is
easily palpated. The CTG reveals poor variability.
Which of the following is true regarding maternal nutrition during pregnancy?
a. For all maternal weight categories, maternal weight gain the second and third
trimesters that is less than recommended is associated with restriction
b. Providing micronutrient supplementation to undernourished women
consistenly lowers rates of newborns
c. For all maternal weight categories, maternal weight gain in the first trimester
that is less than recommended is associated with restriction
d. Providing macronutrient supplementation to undernourished women
consistenly lowers rates of newborns
 e. For all maternal weight categories, excessive maternal weight gain during
pregnancy is associated with newborns.

95. What is the nex management plan for this patient?

a. Emergency laparotomy
b. Antibiotic intravenous for 5 days
c. Puncture of the Douglass pouch
d. Conservative management
e. Emergency laparoscopic cystectomy

96. Mrs. 37 years old, G3P2, 35 wga, came to ER referred from nearby PHC due
to high blood pressure, on admission her blood pressure was 170/110 mmHg.
She complained of epigastric pain followed by nausea and vomiting. She
denied having contraction, water broke, and bloody show, from her physical
examination you found her fundal height was 3 fingers above navel, head
presentation, there was no contraction and no dilation of cervix. You decided
to terminate the pregnancy by emergency cesarean section due to impending
eclampsia. The baby born with Apgar score 6/8, bodyweight 1480 g, and
diminished amniotic fluid. You suspected placental insufficiency due to high
blood pressure as the risk factor of IUGR, to confirm the diagnosis, the
macroscopic appearance of the placenta and umbilical cord should be?
a. Umbilical cord length &lt; 50 cm
b. Umbilical cord with single umbilical artery
c. Thick wharton jelly
d. Placental weight less than 1/7 baby weight
e. Maternal side with wide hematoma

97. A 35-year-old P3 with a Pap smear showing high-grade squamous

intraepithelial lesion of the cervix (CIN III) has an inadequate colposcopy.
Cone biopsy shows squamous cell cancer that has invaded only 1 mm beyond
the basement membrane. There are no confluent tongues of tumor, and there is
no evidence of lymphatic or vascular invasion. The margins of the cone biopsy
 specimen are free of disease. How would you classify or stage this patient’s
disease?
a. Carcinoma of low malignant potential
b. Microinvasive cancer
c. Atypical squamous cells of undetermined significance
d. Carcinoma in situ
e. Invasive cancer, stage Ia

98. A 34 yo woman came to clinic to have her 6 weeks postpartum check. She just
gave birth to a 3200 gram baby delivered vaginally 3 months ago. She had a
complain of unable to hold liquid stool and flatus. On examination the external
genitalia looks normal. If we want to do a reconstructive surgery this patient, what
is the recommended suture material that should be use?
a. Polypropylene
b. Poliglecaprone
c. Chromic catgat
d. Polyglactin
e. Polyethylene teraphalate

99. Which of the following is the most common ultrasound findings in CMV
infection?
a. Placentomegaly
b. Intrauterine growth restriction
c. Hepatomegaly
d. Ventriculomegaly
e. Fetal hydrops

100. Regarding premature of ovarian failure, which statement is true?

a. Incidence is about 5%
b. Symptoms are related to the levels of LH and FSH
c. Hot flushes occur in about 50% of patients
d. It corresponds to a Asherman syndrome
e. It occurs in 50% of patients presenting with secondary amenorrhea