SOAL UAS BASIC

12 Juni 2015
Questions 1-3
Ms. A 16 years old comes with chief complaint of primary amenorrhea. There is no
remarkable medical history. Physical exams show no breast development and no
pubic hair growth. US shows uterine hypoplasia and gonads are difficult to be
identified. Karyotype analysis shows 45, X0.
1. What is the problem of this patient?
a. Amenorrhea happens due to loss of no. 18 chromosome
b. Amenorrhea happens due to loss of X chromosome
c. Amenorrhea happens due to loss of Y chromosome
d. Amenorrhea happens due to mosaics chromosome
e. Amenorrhea happens due to additional of no. 21 chromosome
2.

Chromosome analysis can be done using which method?

a. Enzyme Linked Absorbent Assay
b. Polymerase Chain Reaction
c. Fluorescent in Situ Hybridization
d. Immuno Flow Cytometry
e. Western blot

3. This kind of disorders can be classified as

a. Gene mutation
b. Polyploidy
c. Mosaic chromosome
d. Aneuploidy
e. Gene deletion
Questions 4-6
Ms. F 24 years old P1 came with her boy 6 years old. She said her boy was being
diagnosed for having hemophilia. She is quiet worry about her future pregnancy.
Therefore she would like to have consultation regarding how big the chance for
having another child with same disease.
4. One of the theory of hemophilia says that the disease suppose to be inherited
by recessive X-linked disease. What is the common profile for X-linked
disease?
a. Females should be affected
b. Females may be carriers
c. Males should be carriers
d. 50% of the daughters of a carrier female will be affected
e. 50% of sons of a carrier female will be carriers
5. What is the cause of recessive X-linked disease?
a. Gene mutation on X chromosome
b. Polymorphisms of X chromosome
c. Aneuploidy of X chromosome

d. Polyploidy of X chromosome
e. Structural abnormality of X chromosome
6. How to identify recessive X-linked disease?
a. Western blot
b. Southern blot
c. DNA sequencing
d. Microarrays
e. Immuno-blotting
Questions 7-9
39 years old lady comes to outpatient clinic with chief complain of primary infertility.
She was married for 15 years and never gets pregnant. There is no remarkable clinical
finding. US observation shows small ovaries with total follicle numbers less than 6.
Patient is still having regular menstrual cycle.
7. From where is the origin of primordial germ cells?
a. Yolk sac
b. Gonadal ridge
c. Genital tubercle
d. Mullerian duct
e. Coeloemic epithelium
8. Why total numbers of oocytes during pubarche is only 400,000 left
a. Most of follicles will arrest upon folliculogenesis
b. Most of follicles will undergo apoptosis
c. At least more than two follicles ovulated for each cycle
d. Most of follicles will complete their meiosis
e. Most of follicles loss due to effect of gonadotrophic
9. Therefore, what is the most likely fertility problem of this lady?
a. Ovarian insufficiency
b. Pituitary disorders
c. Hypothalamic disorders
d. Diminished ovarian reserve
e. Endometrial disorders
Questions 10-12
20 years old lady visit our outpatient clinic due to primary amenorrhea. Upon clinical
examination breast is fully develop (M3), and there is also pubic hair growth. No
ambiguous genitalia can be observed. US findings: there is no uterus, but both ovaries
are within normal limit.
10. Uterine corpus does embryologically developed from?
a. Pronephros
b. Mesonephros
c. Metanephros
d. Mullerian duct
e. Urogenital sinus

11. What kind of congenital malformation that can be identify on this patient?
a. Uterine hypoplasia
b. Didelphys uterus
c. Subseptus uterus
d. Agenesis uterus
e. Arcuate uterus
12. What is the name of the syndrome if patient also have kidney malformation?
a. Turner Syndrome
b. Klinefelter syndrome
c. MRKH syndrome
d. Down syndrome
e. Patau syndrome
Questions 13-14
35 years old lady G2 P1 28 weeks of gestation, comes to obstetric outpatient clinic
due to over distended abdomen. Vitas signs are normal. Upon obstetric examination
found fundal height 35cm. Part of fetus difficult to be palpated. US exam shows
normal fetus (estimated fetal weight 1,100 gram) and placenta with amniotic fluid
index 30.
13. What is the problem of this patient based on US finding?
a. Polyhydramnios
b. Oligohydramnios
c. Greenish amniotic fluid
d. Normal amniotic fluid
e. Amnionitis
14. Based on physiological mechanism of amniotic fluid production and
circulation, which problem is most likely can be suspected?
a. Placental tumor
b. Dysfunction of fetal swallowing
c. Overproduction of amniotic cells
d. Excessive transudation through fetal skin
e. Excessive transudation through umbilical cord
Questions 15-17
You are a resident in charge over the nightshift at delivery ward. 32 years old lady G2
P1 35 weeks of gestation comes with PROM since 6 hours ago. No remarkable
clinical findings have been found. CBC shows normal limit. CTG result shows:
baseline 144 bpm, variability 5-15 bpm, acceleration 2x10, variable deceleration
found 3 times in 10 minutes observation. There is shouldering sign and FHR falls into
80 bpm but return to baseline. Contraction found 2-3x in 10 minutes irregular, but
fetal movement still positive.
15. What is the most likely mechanism of variable deceleration in this patient?
a. Placental insufficiency
b. Congenital anomalies
c. Scanty amniotic fluid

d. Intra-uterine infections
e. Head compression
16. What does the mechanism of shouldering sign prior to variable deceleration?
a. Parasymphathetic activity
b. Chemoreceptor activity
c. Occluusin of both umbilical artery and vein
d. Occlusion of umbilical artery
e. Occlusion of umbilical vein
17. Ultrasound has been done to measuere condition of amniotic fluid. Amniotuc
fluid index is, if pelvic score of this patient is 3, with estimated fetal weight
2300 gr and CBC still normal, what is your plan for this patient?
a. Give tocolytic an lung maturation for 2 days
b. Give lung maturation once and continued with labour induction
c.Directly perform labor induction
d. Give lung maturation once and continued with labor induction
e. Plan for immediate C-section
Question 18-20
27 years old lady G1 term pregnancy, were referred by midwivess due to labor
dystocia. According to the partograph, cervical opening of 4cm was happen at 8.00
am. At 12.00 am contraction was 2x/10 with duration of 20s. Cervical opening still
4cm. Membrane still intact, estimated of fetal weight is 2.700 gr and good feto-pelvic
proportion.
18. This labor dystocia can be classified as :
a. Protraction disorder
b. Arrest disorder
c. Incoordinate uterine action
d. Prolonged of latent phase
e. Prolonged of active phase
19. What is the meaning of hypotonic uterine diysfunction?
a. High basal tonus
b. Asynchronous
c. Contraction starts from mid-segmental part
d. Pressure gradient is distorrted
e. Insufficient to dilate the cervix
20. What is your plan for this patient?
a. Ask the patient to take a rest
b. Perform immediate C-section
c. Starts augmentation by oxytocin infusion
d. Starts labor induction by misoprostol
e. Perform stripping of amniotic membrane
38 year old lady G4P3 36 weeks of gestation comes to delivery wardd due to vaginal
bleeding along with abdominal cramps. Vital sgns show BP 90/60mmHg, PR 110x/m,
RR 24x/m, afebrile. FHR cannot be dentified. Upon palpation uterus is hypertonic.
Speculum examination found only a minimal dark blood flow through the ostium.
21. What is the most likely diagnosis of this pattient?
a. Vasa previa

b. Total placenta previa

c. Preterm labor
d. Placental abruption
e. Coagulation disorders
22. What is one of the risk factor can cause this problem ?
a. Baby with congenital anomalies
b. Thrombophilia
c. Thyroid disorders
d. Intra- uterine infection
e. Fetal distress
23. How would you classify the severity of this case?
a. Grade I
b. Grade II
c. Grade III
d. Grade IV
e. Cannot be classified
Question 24-26
26 years old lady G1 41 week of gestation was sent from outpatient clinic for
pregnancy termination. Vital siigns are normal. No remarkable history upon her
antenatal care visits. Fundal height iis 34cm, head presentation, estimated fetal weight
3.200 gr, FHR 144 bpm, and no contraction. Pelvic score is 3. US findings found AFI
12. CTG shows category 1.
24. What is the most likely cause of post term pregnancy?
a. Intra-uterine infection
b. High cortisol release
c. High estrogen : progesteron ratio
d. Decrease placental sulfatase activity
e. High prostaglandin release
25. Choose the changes on amniotic fluuid that related with poor fetal
outcomes?
a. Release of lamelar bodies
b. Fluids become milky and cloudy
c. Green discoloration
d. L/S ratio greater than 4:1
e. AFI between 10-15
26. Which complication on the newborn that do not correlated with post-term
pregnancy?
a. Fetal trauma
b. Caput succedaneum
c. Meconium aspiration
d. Intrapartum fetal distress
e. Perinatal death
Questions 27-29
29 years old lady G1 34 week of gestation has been referred by a midwife due to
hypertension. Her BP was 170/100mmHg. Prior to pregnancy she was having history
of high blood pressure since 2 years ago. She was having anti-hypertensive
medication regularly. No proteinuria has been found.

27.What is the clinical diagnosis of this patient?

a. Chronic hypertension
b. Gestational hypertension
c. Preeclampsia without severe features
d. Preeclampsia with severe features
e. Nephrotic syndrome
28. Choose anti-hypertensive agent that works as a vasodilator!
a. Furosemides
b. Nifedipine
c. Methyldopa
d. Propanolol
e. Thiazides
29. What characteristic below that does not belong to Nifedipine?
a. Blocks neural-end plate
b. Causing vascular relaxation
c. Mostly eliminated by kidney
d. Serum peak level reaches in 30 minutes
e. No deleterious effects on uteroplacental circulation
Questions 30-32
24 years old lady G1 34 weeks of gestation comes to emergency with dyspnea, cough
and wheezing. She has admitted that she was having asthma since she was a child.
Asthma attack mostly triggered by severe physical activities.
30. Choose any concept below that do not correlated with the management of
asthma during pregnancy
a. Avoidance of precipitating factors
b. Perform desensitization
c. Assessment on pulmonary function
d. Pharmacological therapy
e. Patients education
31. Which statement below does not true for physiological changes on respiratory
function during pregnancy!
a. Increases on vital capacity
b. Increases on Tidal volume
c. Increases on minute ventilation
d. Increased ventilation due to more frequent breathing
e. Increases on basal oxygen consumption
32. Choose the first line medication for this patient!
a. Theophyline
b. Beta agonists
c. Cromolyn
d. Hydration
e. Corticosteroids

Questions 33-35
27 yo G1 15 wga comes to outpatient clinic with chief complaint of running nose,
sore throat, and cough without fever. She would like to ask you about her immune
system during pregnancy
33. How maternal immune system works during pregnancy in order to induce
maternal tolerance to semi allogenic fetus?
a. Increase Th1 cytokines
b. Increase Th2 cytokines
c. Increase APS antibodies
d. Reduces T-helper lymphocyte
e. Reduces macrophages
34. Choose the correct statement regarding to leukocyte condition during
pregnancy!
a. During pregnancy leukocyte is less than 5.000
b. During pregnancy the highest level for leukocyte count is 25.000
c. During late trimester the proportion of T cytotoxic cell increases
d. High number of leukocyte count during puerperium is due to high
activity of the bone marrow
e. Adhesion molecule on circulating leukocyte decrases
35. Choose the incorrect condition of immune system in pregnancy, which is
close to the condition of inflammatory state
a. High CRP
b. High erythrocyte sedimentation rates
c. High fibrinogen level
d. Low C3 level
e. High globin level
Questions 36-38
25 yo lady G2 P1 28 wga of gestation comes to outpatient clinic. She said that she
was having cardiac problems. She is having mild mitral insufficiency. At these
moments she does not have any complaint.
36. Choose the correct physiological changes of hemodynamic in pregnancy!
a. Low MAP
b. Low SVR
c. Low CO
d. Low HR
e. Low pulmonary capillary wedge pressure
37. Explain how is the mechanism to maintain blood pressure during pregnancy?
a. Estrogen will activates RAA system
b. Progesterone will activates RAA system
c. Increased sensitivity of blood vessels to angiotensin
d. Refractoriness of blood vessel to angiotensin can induce hypertension
e. Refractoriness of blood vessel to angiotensin does not related with
progesterone
38. What is the prognosis for having mild mitral insufficiency during pregnancy?
a. The prognosis is bad due to increase of plasma volume
b. The prognosis is good since mitral insufficiency can narrowed
spontaneously

c. The prognosis is bad since cardiac output increases

d. The prognosis is good since systemic vascular resistance decreases
e. The prognosis is bad since hear rate increases
Questions 39-41
31 years old lady G4P0 A3 12 wga were referred to obstetric outpatient clinic with
history of nephritic lupus. At this moment she is considered free of disease under
regular medication.
39. Choose the incorrect physiological change of urinary system during
pregnancy?
a. Dilatation of pelvis and calyces
b. Dilatation of ureters
c. Decrease renal plama flow
d. Increase renal size
e. Increases GFR
40. Please choose the incorrect statement regarding to urinalysis results in
pregnancy!
a. Glucosuria still can be considered as normal
b. Impaired tubular reabsorption can induce glucosuria
c. Glucosuria finding should initiate evaluation for gestational diabetes
d. Proteinuria still can be considered as normal
e. 24 hour urine protein excretion does not different from each trimester
41. Please choose the incorrect statement upon physiological changes on Urinary
tract in pregnancy!
a. Ureteral dilatation
b. Left side is bigger than the right side
c. The difference is caused by cushioning of the sigmoid colon
d. The difference is caused by uterine dexorotation
e. The difference is caused by dilatation of the right ovarian vein
complex
Questions 42-44
22 yo lady G1 term pregnancy sends to delivery ward with chief complaint of regular
contraction (3x/10min) and bloody show.
42. Upon clinical examination cervical opening already 4 cm, intact membrane
and head already in Hodge II. Please choose the incorrect statement
regarding to this clinical data!
a. Patient still in the latent phase
b. Cervical opening will be expected around 1.2cm per hour for
nulliparous
c. Descent will be expected around 1 cm per hour for nulliparous
d. Labor progress now can be observed in partograph
e. Complete cervical opening will be expected happen in 6 hours time
43. Please choose the correct statemtent for protraction disorder in active phase!
a. Rapid rate of cervical dilatation
b. Rapid rate of descent
c. Cervical dilatation is less than 1,5cm per hour for nulliparous

d. Descent is less than 2 cm per hour for nulliparous

e. One of the risk factor is fetal malposition
44. Please choose the correct statement for arrest disorder in active phase!
a. Slow cervical dilatation
b. Slow descent
c. No cervical dilatation within 2 hours time
d. Recommended treatment is expectant management
e. 10% is caused by CPD
Questions 45-47
20 years old lady G1 37wga sends to delivery ward with chief complaint of irrefular
contraction (3x/10 minutes) without bloody show and no water broke.
45. Please choose the correct statement below for true labor!
a. Contraction occur at irregular intervals
b. Intervals remain long
c. Intensity remain unchanged
d. Cervix does not dilate
e. Discomfort is not stopped by sedation
46. Please choose the correct statement below for false labor!
a. Discomfort is in the back and abdomen
b. Intervals gradually shorten
c. Intensity gradually increases
d. Cervix dilate
e. Discomfort usually relieved by sedation
47. During observation patient also complaints for leakage of fluid from vagina.
Please choose the correct statement below in order to confirm water broke!
a. pH is around 4.5-5.5
b. Amniotic membrane cannot be palpated
c. Clear fluid is passing from external os
d. False positive happens when fluid is scanty
e. False negative happens when there is a blood
Questions 48-50
24 yo P1 just deliver 2700gram baby boy with Apgar Score 9/10. Now she is entering
third stage of labor.
48. Please choose incorrect statement regarding to signs of placental separation!
a. Sudden gush of blood
b. The umbilical cord protrudes farther out of the vagina
c. Uterus become globular
d. The uterus rises in the abdomen
e. Patient feel like passing stools
49. What is the most serious complication if someone does not do proper control
cord traction?
a. Placental retention
b. Uterine inversion
c. Uterine rupture
d. Extension of perineal rupture
e. Urinary retention
50. Oxytocin has been used during active management of the third stage. Please
choose correct statement regarding to oxytocin administration!

a.
b.
c.
d.
e.

Is a synthetic decapeptide oxytocin

The half life of infused oxytocin is approximately 10 minutes
Oxytocin can be given intravenously as a large bolus
Oxytocin has an antidiuretic effect
Oxytocin prevents water intoxication

Questions 51-53
24 yo P1 just deliver 2700gram baby boy with AS 9/10. Placenta delivered
spontaneously. Upon observation she was having second degree perineal tear.
51. Please select which muscle is involce in second degree perineal tear?
a. Bulbocavernosus muscle
b. Puborectalis muscle
c. External spinchter ani muscle
d. Transverse perinei profunda muscle
e. Ishciocavernosus muscle
52. Please select a correct statement below for midline episiotomy!
a. Faulty healing is more common
b. Postoperative pain is common
c. Blood loss is less
d. Surgical repair is more difficult
e. Dyspareunia is occasional
53. Please select a correct statement below for medio-lateral episiotomu!
a. Anatomical result is excellent
b. Post-operative pain is rare
c. Dyspareunia is rare
d. Extensions is uncommon
e. Faulty healing is rare
Questions 54-56
24 years old P1 just deliver 2700gram baby boy with Apar score 9/10. Today is her
first day care at the obstetric ward. Her general condition is normal, however she still
cannot breastfeed her baby properly.
54. Explain the endocrinology of breast-milk production in puerperium period!
a. Prolactin does responsible for the development of mammary glands
b. Prolactin withdrawal will initiates breast-milk production
c. Progesterone withdrawal increase a-lactalbumin production
d. A-lactalbumin works to inhibits lactose synthase
e. Oxytocin increase contractions of mammary glands
55. Please choose the correct below statement for immunology in breastfeeding
a. Major immunoglobulin in colostrum is IgM
b. Immunoglobulin prevents rotavirus infection that mostly infeting
respiratory tract
c. Immunoglobulin prevents infection by induce complement activation
d. T lymphocytes in breast milk will transfer maternal immune
experience to neonates
e. Antibodies in human colostrum will be highly absorbed by infants.

56. Please choose incorrect statement below regarding contraindications for

breastfeeding!
a. HIV positive patients
b. Hepatitis C
c. Untreated TB
d. Breast cancer
e. Herpes simplex with breast lesion
57. 3 days postpartum she is having breast tenderness and fever. Please choose the
correct statement below regarding to mastitis.
a. Commonly happens bilateral
b. Commonly isolated microorganism is E Coli
c. Most microorganisms is originated from neonatal nose and throat
d. Toixc shock syndrome commonly caused by S. viridans
e. Bacteria enter the breast mostly from blood circulation
Questions 53-60
24 yp P1 just deliver 2700gram baby boy with Apgar score 9/10. Today is her second
day care at the obstetric ward. Her general condition is normal. She is preparing
herself for going home.
58. Please choose the correct statement below regarding to bladder care
postpartum!
a. It is normal if voiding happens for every more than 6 hours.
b. Should check for the presence of cystic mass supra-pubic
c. The ability to empty the bladder cannot be affected by episiotomy
d. Should minimize water intake regarding to antidiuretic effect of
oxytocin
e. Is still considered as normal if post void volume is 400 mL
59. Please choose the incorrect statement below regarding to post-partum blues
factors!
a. Discomfort feeling after delivery
b. Fatigue due to loss of sleep
c. Fears to become less attractive after delivery
d. Parenthood anxiety
e. Fears for having contraception
60. She is having a plan to become pregnant after 2 years. However, she do not
want to have IUD for contraceptive method. And she would like to breastfeed
her baby exclusively for at least 4 months. What would you like to suggest for
a proper contraceptibe method at this moment?
a. Combined oral contraceptive pills
b. Monthly injection
c. Implant
d. Condoms
e. Lactation amenorrhea

Extended Matching Questions

Questions 61-70
Statements below are associated with the cause
of cardinal signs of inflammation:
61. Rubor?
62. Tumor?
63. Dolor
Statements below are associated with the origin
of particular inflammatory mediators
64. Complement?
65. Mast cells?
66. The blood circulation?
Statements below are associated with the cause
of chronic inflammation
67. Organism?
68. Cell mediated hypersensitivity
69. Poor blood supply?
70. Chemical?
Extended Matching Questions
Questions 71-80
Statements below are associated with phases of
parturition
71. Phase 0
72. Phase 1
73. Phase 2
74. Phase 3
Please state mechanism of pain in labor which
associated with these particular organ:
75. Myometrium
76. Nerve ganglia
77. Cervix
78. Fundus
Kinds of placental separation and delivery:
79. Central retro-placental hematoma?
80. Placental separation starts from the
peripheral site?

a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.

Varicose ulcers
Kinins
Increased local blood flow
Prstaglandins
C3a and C5a
Peptic ulcerations
Increased capillary
permeability
Leukocyte migration
Stimulation of nociceptive
nerve fibers
Fungi
Histamines
Tuberculosis

a. Uterine preparedness for

labor
b. Schultze mechanism
c. Rintgen mechanism
d. Stretching during dilatation
e. Uterine involution
f. Hypoxia
g. Active labor
h. Latent phase
i. Stretching of the peritoneum
j. Duncan mechanism
k. Contractile unresponsiveness
l. Compression
m. Friedman mechanism

Short Answer Question

Question 81-90
Oxygen is transferred to fetal blood in the capillaries present in the 81 The
oxygenated blood is returned to the fetus via the placental 82. To the 83. Which
passes superiorly beneath the anterior abdominal wall and distributes blood in
thoroughly equal proportions between the 84. And branches of the portal venous
system. Blood returning via the portal veins passes through the liver into the hepatic
veins and thens to the 85. And streamed through the 86. Directly into the 87
across the 88.. ehich is patent in fetal life. Some blood also goes to the right
ventricle and ejected to the main pulmonary artery. However, this vessel has a channel
called 89 which connecting between pulmonary artery and 90.

Questions 91-100
The control of myometrial contraction is at the heart of understanding both the
maintenance of pregnancy and the onset of labor. The initial process is the increase of
91. Level in cytoplasm by mechanism of 92. from extracellular and release
from 93. It will bind and activates 94. Leadint to activates 95.. this process
will be followed by phosphorylation of 96 which is going to interact with 97.
And activates 98. Through the hydrolysis of 99. The force that required for
100 will be developed.