16.

Which of the following is NOT appropriate test in first trimester for

screening preclampsia?
A. PlGF
B. sFLT-1
C. PAPP-A
D. PI uterine artery
E. Mean arterial pressure

26. Which of the following is high risk factor for preeclampsia?

A. First pregnancy
B. Age > 40 years
C. Diabetes mellitus
D. BMI > 35 kg/m2
E. Family history of preeclampsia

36. 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
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 caesarean section

E. Evidence showed that pregnancy offers an altered immunity scenario

which may allow severe COVID-19 disease
46. Which of the following is the indication for anti-viral treatment in
pregnant women with hepatitis B?

A. HBsAg positive

B. AntiHBe positif

C. AntiHBs positive

D. HBeAg positive, HBV DNA 2000 copies/mL

E. HBV DNA 200.000 copies/mL

56. Three weeks after delivery, a 29-year-old primipara, who is breast-feedin

g twin girls, presents to the clinic, complaining of a tender right breast mass. On
physical examination, you find a 5-cm fluctuant, swollen, reddened mass in her
right breast that is exquisitely tender to the touch. Axillary lymph nodes on the i
psilateral side are enlarged and tender. What is the most appropriate next step in
the management of this patient ?
a. excisional biopsy of the mass
b. needle aspiration of the mass
c. intravenous antibiotic therapy for the mother and infants
d. Have the patient continue to breast-feed on the other side
e. incision and drainage of the mass plus oral antibiotics for the mother

66. A 25-year-old woman in her first pregnancy is noted to have prolonged fi

rst and second stages of labour. She was induced at 38 weeks’ pregnancy. The b
aby was delivered by forceps. After delivery the placenta she is noted to have he
avy vaginal bleeding. Abdominal examination demonstrates a relaxed uterus. W
hat should we do if the fundus not firm after placental delivery.
A. Methylergonovine (Methergine)
B. Carboprost (Hemabate, PGF2-alpha)
C. Fundal Massage
D. Misoprostol (PGE1)
E. Dinoprostone-prostaglandin E2

76. A 30-year-old multiparous woman has rapid delivery soon after arriving i
n emergency room. After delivery the placenta she is noted to have heavy vagin
al bleeding. Help has been summoned. Abdominal examination demonstrates th
e fundus was soft. What is the most appropriate next step?
A. Intravenous access for fluid resuscitation
B. Uterine packing
C. Balloon tamponade
D. Suture the laceration
E. Misoprostol administration

86. A 30-year-old multiparous woman has rapid delivery soon after arriving i
n emergency room. After delivery the placenta she is noted to have heavy vagin
al bleeding. Help has been summoned. Abdominal examination demonstrates th
e fundus was soft. After use of a 20 units of oxytocin in 1000 mL of crystalloid
solution to increase the tone of her uterus stop the bleeding; however, you conti
nue to notice a massive bleeding from the vagina. What is the most appropriate
next step in the evaluation of this patient’s bleeding?
A. Perform a bedside ultrasound for retained products of conception
B. Perform a bedside ultrasound to look for blood in the abdomen significant f
or uterine rupture
C. Perform a manual exploration of the uterine fundus and exploration for retai
ned clots or products
D. Examine the perineum and vaginal for laceration during delivery
E. Consult interventional radiology for uterine artery embolization

96. A 32-years-old woman comes to your clinics due to shortness of breath, t

hat worsen since 2 days ago. On history taking, she told you that she had ever di
agnosed of having significant mitral stenosis. She is 33 weeks pregnant. The fet
us is size-date appropriate. She has had a recent echocardiography showing ejec
tion fraction of 54% with moderate-severe pulmonary hypertension. What is the
best management for this patient currently?
A. Perform emergency C section
B. Lung maturation and C section
C. Conservative management until term pregnancy
D. Second stage acceleration
E. Induction of labor

106. What is the most common cause of heart failure during pregnancy and the
puerperium?
A. Chronic hypertension with severe preeclampsia
B. Viral myocarditis
C. Obesity
D. Valvular heart disease
E. Pulmonary Artery Hypertension

11. An 18-year-old nulligravid woman presents to the student health clinic wi

th a 4-week history of yellow vaginal discharge. She also reports vulvar itching
and irritation. She is sexually active and monogamous with her boyfriend. They
use condoms inconsistently. On physical examination, she is found to be nontox
ic and afebrile. On genitourinary examination, vulvar and vaginal erythema is n
oted along with a yellow, frothy, malodorous discharge with a pH of 6.5. The ce
rvix appears to have erythematous punctuations. There is no cervical, uterine, or
adnexal tenderness. The addition of 10% KOH to the vaginal discharge does not
produce an amine odor. Wet prep microscopic examination of the vaginal swabs
is performed. What would you expect to see under microscopy? ( blueprint)
A. Branching hyphae
B. Multinucleated giant cells
C. Scant WBC
D. Flagellated, motile organisms
E. Epithelial cells covered with bacteria

12. A 25 year old lady come with abnormal pap smear result. She underwent
colposcopy examination and the result is a acetowhite lesion with punctation an
d atypical vessels. Biopsy result confirms CIN I with HPV DNA test positve.
What do you suggest for patient ?
A. LEEP procedure
B. Reevaluation of HPV DNA
C. Cold knife conization
D. Repeat cytology in 12 months
E. Repeat cytology in 6 months

A Women 28 years old came to outpatient clinic referred by obgyn specialist du

e to continuous leakage of urine since 2 weeks ago, she underwent cesarean sect
ion due to dystocia on second stage of labor. The baby’s weight was 4200 g. On
examination the cervix was torn at 11 O’clock position until anterior fornix, but
the hole was not seen clearly
13. What is the next step to confirm diagnosis in this case?
A. Intravenous pyelography
B. Ultrasound
C. Indigo carmine test ( untuk ureterovagina) masukin cairan iv , urinnya kel
uar warna orange
D. Consult to urologist
E. Blue dye test ( operasi obstetrik)

14. What is the best management of this case at this time?

A. Put indwelling transurethral catheter, evaluate 3 months post Cesarean se
ction
B. Transvaginal fistula repair with Latzcko procedure as soon as possible
C. Transabdominal fistula repair as soon as possible
D. Trans-vesical fistula repair 3 months from now
E. Antibiotics for 7 days continue with transvaginal fistula repair

15. What is the criteria of simple vesicovaginal fistula?

A. Size < 1,5 cm
B. Size < 2 cm
C. Size < 2,5 cm
D. Size < 3 cm
E. Size < 4 cm

16. 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
180/110mmHg; PR 110x/min; RR 26x/min; 36.4oC, SpO2 95%.
Conjunctiva not pale.
Heart: normal heart sound, no murmur or gallop.
Lung: Vesiculer 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 primary treatment for this patient?
a. Increase myometrial contractility
b. Reduces pre-load
c. Increases systemic vascular resistance
d. Reduces heart rate
e. Put her into ventilator machine

17. Mrs. A 34 years old G3 P2 A0 36 weeks of gestation reffered from

district hospital. She felt contraction since 5 hours ago and water broke since
one day ago. She was having antenatal care regularly at midwives since 6
months of gestation. Since 2 months ago she said that she cannot tolerate with
heat and easy to get sweat. Physical findings shows BP 130/90; PR 110x/min;
RR 18x/min; 37.6oC. Conjungtiva not pale. Thyroid gland do not enlarge. Heart
and lung are normal. Slight edema at lower extremities. Fundal height 29cm,
head presentation, FHR 144bpm. Laboratory findings show CBC
12.0/36%/10,900/230,000. Random plasma glucose 120mg/dL. Urinalysis
shows E 0-1; L 3-5; Nitrit (-); Bacterial (+), LEA (-), protein (-), keton (-)
What is the most potential perioperative problem of this patient?
a. Urinary tract infection
b. Anemia
c. Intra-uterine infection
d. Hyperthyroidism
e. Gestational diabetes
18.Mrs. A 34 years old G3 P2 A0 36 weeks of gestation reffered from district
hospital. She felt contraction since 5 hours ago and water broke since one day
ago. She was having antenatal care regularly at midwives since 6 months of
gestation. Since 2 months ago she said that she cannot tolerate with heat and
easy to get sweat. Physical findings shows BP 130/90; PR 110x/min; RR
18x/min; 37.6oC. Conjungtiva not pale. Thyroid gland do not enlarge. Heart and
lung are normal. Slight edema at lower extremities. Fundal height 29cm, head
presentation, FHR 144bpm. Laboratory findings show CBC
12.0/36%/10,900/230,000. Random plasma glucose 120mg/dL. Urinalysis
shows E 0-1; L 3-5; Nitrit (-); Bacterial (+), LEA (-), protein (-), keton (-)
What laboratory evaluation should be done next?
a. Urinary culture
b. Peripheral blood smear
c. Cervical swab
d. TSH and FT4
e. Hba1c

19.A 32 year old primiparous woman 32 weeks gestation arrives at emergency

room. She was reffered by midwives due to high blood pressure. She is fully
alert with BP 160/ 110mmHg; PR 98x/m;RR 18x/min: afebris. Sclera look
icteric with pale conjunctiva. Heart and lung are normal. Fundal height 32cm,
head presentation, FHR 144bpm, with no contraction. Her laboratory findings
show: CBC Hb 9;Ht 30; L 15,000; platelet 75.000. SGOT/SGPT 80/72. LDH
720. Albumin 2.5g/dL. Urinalysis: protein +++
Which of the following is appropriate?
a. Immediately perform Cesarean section
b. Labour induction by misoprostol
c. Labour induction after complete lung maturation
d. Conservative until term gestation
e. Conservative until 34 weeks

20. A 32 year old primiparous woman 32 weeks gestation arrives at emergency

room. She was reffered by midwives due to high blood pressure. She is fully
alert with BP 160/ 110mmHg; PR 98x/m;RR 18x/min: afebris. Sclera look
icteric with pale conjunctiva. Heart and lung are normal. Fundal height 32cm,
head presentation, FHR 144bpm, with no contraction. Her laboratory findings
show: CBC Hb 9;Ht 30; L 15,000; platelet 75.000. SGOT/SGPT 80/72. LDH
720. Albumin 2.5g/dL. Urinalysis: protein +++. Peripheral blood smear shows
anisositosis pattern.
What is the cause of patient’s anemia?
a. Iron deficiency
b. Microangiopathy
c. B12 deficiency
d. Auto immune
e. Thallasemia
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 of 20 million/ml.

21.What is the most appropriate step of management?

a. Examine TSH and prolactin
b. Measure FSH, LH and estradiol
c. Measure serum testosterone level
d. Give Aromatase inhibitor
e. Start ovulation induction using gonadotropin

22. According to the current International Guidelines, which of the following

medication is considered to be the first line of therapy for ovulation induction?
A. Letrozole 1x 2,5 mg
B. Clomiphene citrate starting at dose 50 mg/ day for 5 days
C. Clomiphene citrate 50 mg/day combined with metformin 2x500 mg
D. Metformin 2x500 mg
E. Gonadotropin injection 75IU/day

Mrs. N, 37 years old with chief complain of infertility for 6 years with history
of severe dysmenorrhea. From hysterosalpingography, both tubes were non-
patent. Pelvic ultrasound found bilateral cystic mass with internal echo sized 50
and 60 mm in diameter. Her husband sperm examination was within normal
limit

23.What is the next appropriate management?

A. Offer her IUI
B. Perform laparoscopy cystectomy and adhesiolysis
C. Give GnRH analog for 3 months continue with IUI
D. Give Dienogest 1x2mg for 6 months
E. Offer her IVF

24.Her AMH level was 0,9 ng/ml. What is the reason for performing surgery in
subfertile patient with bilateral endometrioma and diminished ovarian reserve?
A. Removal of endometrioma
B. Ablation of all endometriosis lesion
C. To prevent infection in endometrioma
D. To improve access for follicle aspiration
E. Removal of deep infiltrating endometriosis lesions

25. Which of the following is true regarding low ovarian reserve in

endometriosis?
a. Ovulation rate in ovary with endometrioma is higher compared to ovary
without endometrioma
b. There is a higher density of follicle in ovary with endometrioma
c. Ovary with endometrioma has a higher response rate to gonadotropin
d. Loss of ovarian stromal appearance and fibrosis are present in ovarian cortex
with endometrioma
e. Low ovarian reserve in endometriosis only happen after surgery

26.A primigravida at 36 weeks gestation is measuring large for dates.

Ultrasound shows AC > 97 th centile. GTT performed shows poorly controlled
gestational diabetes. What is the immediate management plan?
A. Give steroids
B. Start induction
C. Start oral hypoglycaemics agent
D. Observe for 1 week
E. Start sliding scale and deliver
27.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
180/110mmHg; PR 110x/min; RR 26x/min; 36.4oC, SpO2 95%.
Conjunctiva not pale.
Heart: normal heart sound, no murmur or gallop.
Lung: Vesiculer 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 most likely diagnosis of this patient?
a. Acute respiratory distress syndrome
b. Cor-pulmonale
c. Acute pulmonary edema
d. Pneumonia
e. Chronic obstructive pulmonary disease

28.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
180/110mmHg; PR 110x/min; RR 26x/min; 36.4oC, SpO2 95%.
Conjunctiva not pale.
Heart: normal heart sound, no murmur or gallop.
Lung: Vesiculer 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. Right heart failure
b. Community acquired pneumonia
c. High oncotic pressure
d. Diastolic dysfunction
e. Immune response
29. A 26-year-old G2P1 (no live child) is seen for her first prenatal visit at 18 w
eeks’ gestation by menstrual history. Her first child was born at 28 weeks spont
aneously, the baby was died after hospitalized for 1 month in NICU. She is worr
ied this pregnancy also will be ended with spontaneous preterm birth.What is th
e most accurate examination that can be done at 18 weeks to predict the risk of
preterm birth?
a. Cell-free fetal DNA
b. IGFBP-1 examination
c. PAMG-1 examination
d. Fibronectin examination
e. Measure cervical lengt

30.A 29 year old woman with a positive pregnancy test presents with a good
history of tissue expulsion vaginally passing tissue per vagina. A
transvaginal ultrasound scan shows an empty uterus with an endometrial
thickness of 11 mm. Regarding her diagnosis, you consider that :
a. She has had a complete miscarriage and needs no further treatment
b. She has had a pregnancy of unknown location and needs further
investigations
c. She should be offered a hysteroscopy
d. She should be offered medical management of miscarriage
e. A laparoscopy should be performed to exclude an ectopic pregnancy

31. 32-year-old woman presents to your office. She complained about her sex
ual problems of pain during sexual intercourse since giving spontaneous birth of
her second child 6 months ago. She feels a normal desire to engaged in sexual in
tercourse. She is now still breatsfeed the baby and she is in combine oral contra
ceptive pills. What is the pathophysiology of sexual dysfunction in breastfeedin
g women?
a. Fatigue
b. Stress
c. Low estrogen levels
d. Low progesterone levels
e. Low oxytocin levels

32. Mrs. 32-year old, P0, comes to your outpatient clinic due to her prolonge
d menstrual duration. She reports her menstrual duration until 14 days and using
10 pads per day. She feels fatigue easily. On physical examination, you palpate
an irregularly enlarged uterus, non tender with firm contour. Cervix appears to b
e hyperemic without mass appearance or other abnormalities. What is the cause
of necrotic and degenerative process in fibroids?
a. Mitotic activity
b. Limited blood supply within tumors
c. Chromosomal defects
d. Hyperperfusion
e. Cytogenetic mutations

33. Mrs. 32-year old, P0, comes to your outpatient clinic due to her prolonge
d menstrual duration. She reports her menstrual duration until 14 days and using
10 pads per day. She feels fatigue easily. On physical examination, you palpate
an irregularly enlarged uterus, non tender with firm contour. Cervix appears to b
e hyperemic without mass appearance or other abnormalities. By which mechan
ism does fibroid creates a hyperestrogenic environment requisites for their grow
th?
a. Fibroid contains higher level of cytochrome P450 aromatase, which allow
s for conversion of androgens to estrogen.
b. Fibroid converts more estradiol to estrone
c. Fibroid cells contain less density of estrogen receptors compared with nor
mal myometrium
d. Increased adipose conversion of androgens to estrogen
e. All of the above

34. A 45-year-old presents for evaluation because her primary care physician
has diagnosed her with pelvic organ prolapse while performing annual care. She
denies any pelvic pressure, bulge, or difficulty with urination. Her only medical
comorbidity is obesity. For asymptomatic grade 1 pelvic organ prolapse, what d
o you recommend?
a. Pelvic floor muscle exercises
b. Weight loss programme
c. Laser vaginal rejuvenation
d. Pessary
e. Reconstructive surgery

35. A 60-year-old P2 presents to the urogynecology clinic with complaints of

urinary incontinence. She has urinary urgency and can’t make it to the bathroom
before leaking a large amount of urine. She urinate 12 time during the day and g
ets up two to three times per night to urinate. What is the next examination plan
for this case?
a. Voiding diary
b. Urinalysis
c. Pelvic floor ultrasound
d. Pad test
e. Urodynamic study

A 32-year-old woman G2P1A0 presented to delivery ward at 30 weeks gestatio

n with worsening abdominal pain for few hours. She had also had some vaginal
bleeding within the past hour. Her uterus was tender and firm to palpation. She
was found to have low-amplitude, high-frequency uterine contractions, and the f
etal heart rate tracing showed recurrent late decelerations and reduced variabilit
y. Her blood pressure was 160/100 mmHg and she has had a +2 proteinuria. She
did her antenatal care in your hospital and ultrasound examination was performe
d 3 times with no remarkable abnormalities.
36. The most likely diagnosis is :
A. Vasa previa
B. Preterm labor
C. Placenta previa
D. Placental abruption
E. Preterm Premature Rupture of Membrane (PPROM)

37. From obstetrical examination you found her cervix was unfavorable. You
r next plan is to deliver the baby by :
A. Vaginal delivery
B. Elective C-section
C. Emergency C-section
D. Operative vaginal delivery
E. Observation until the cervix was favorable
38. You are counseling a couple in your clinic who desire VBAC. Her baby i
s in a vertex presentation, appropriate size for 37 weeks, and her previous low tr
ansverse procedure was for breech presentation. You have to give inform conse
nt about VBAC. In providing informed consent, in which of the following ways
do you explain the risk of uterine rupture?
A. Less than 1% ( RCOG 1x less 1%)
B. Between 2% and 5 %
C. Between 15-20%
D. Depend on the length of her labor
E. Depend on the location and proximity of the scar site to the placental imp
lantation

39. Corticosteroids administered to women at risk for preterm birth have been
demonstrated to decrease rates of neonatal respiratory distress if the birth is dela
yed for at least what amount of time after the initiation of therapy?
A. 12 hours
B. 24 hours
C. 36 hours
D. 48 hours
E. 72 hours

40. A 89-year-old female patient with multiple, serious medical comorbiditie

s presents to discuss options for treatment of her high-grade prolapse. The prola
pse is externalized and becoming ulcerated from friction against her undergarme
nts. She cannot tolerate a pessary. Her main priority is to “fix or get rid of this t
hing,” but her primary care provider has cautioned against a lengthy or open abd
ominal procedure. She is not interested in future intercourse. What can you offer
this patient?
A. Nothing can be done
B. Open abdominal sacral colpopexy
C. Robot-assisted laparoscopic sacral colpopexy
D. Hysterectomy with anterior and posterior colporrhaphy, vault suspension.
E. Colpocleisis

A 32 years old female, G1 at 8 weeks gestation, present to the office for her rout
ine obstetrical visit. She ask you about the nutrition demand during pregnancy,
Her BMI is 24kg/m2. no remarkable past medical history is noted

41. According to WHO Asian criteria, her BMI Classified as:

a. Normal
b. Underweight
c. Overweight
d. Obese type 1
e. Obese type 2

42. she ask you what is the optimal total weigt gain during her pregnancy
a. < 5 kg
b. 5-9 kg
c. 7-11,5 kg
d. 11,5-16 kg
e. 12,5-18 kg

43. what is the most likely rosk of this patient?

a. Anemia
b. Congenital anomaly
c. Gestational diabetes
d. Spontaneous abortion
e. Post partum hemorrhage

44. A 29 years old woman with a positive pregnancy test presents with a good
history of tissue expulsion vaginally. A transvaginal ultrasound scan shows an
empty uterus with an endometrial thickness of 11 mm. regarding her diagnosis,
you consider that:
a. She has had a complete miscarriage and needs no further investigations
b. She has had a pregnancy of unknown location and needs further investiga
tions
c. She should be offered a hysteroscopy
d. She should be offered medical management of miscarriage
e. A laparascopy should be perform to exclude an ectopic pregnancy

45. A 39 years old female G2P1A0, 15 weeks pregnant present to your clinic for
having routine ANC. On physical examination, you found her foundal height eq
uals umbilical point. You performed ultrasound and saw a multilocular hypoech
oic mass size 10 cm (in diameter) in her left adnexa. No free fluid in her abdom
en and pelvis. What is your consederation inyhis case?
a. The incidence of adnexal masses in pregnancy is 1%
b. The incidence of ovarian cancers in pregnancy is between 1; 1000
c. The most common type of benign ovarian cyst in pregnancy is a mature t
eratoma
d. The most common histopathological subtype for malignant ovarian tumor
in pregnancy is epithelial ovarian tumor
e. The resolution rate of adnexal masses in the second trimester of pregnanc
y is 6-70%
A 28 y.o woman, G1 36 wga, went to your clinic to do routine anc. During ultra
sound, the doctor told her that she will be expecting baby boy with estimated fet
al weigth 2500g, however, amniotic fluid considered to be less than normal. The
n you asked the patient to drink minimal of 2L of water a day and get herself an
other ultrasound within 3 days to evaluate the amniotic fluid.

46. oligyhidramnios is defined as which of the following “

a. AFI < 5 cm
b. SDP < 2 cm
c. AFI <90th percentile
d. all of the above
e. none of the above

47. amniotic fluid volume is balanced between production and resorption, wh

at is the primary mechanism of fluid resorption ?
a. fetal breathing
b. fetal swallowing
c. absorption across fetal skin
d. absorption by fetal kidneys
e. filtration by fetal Kidneys

48. in a normal fetus at term, what is the daily volume of fetal urine that contr
ibutes to the amount of amniotic fluid present?
a. 200 ml
b. 250 ml
c. 500 ml
d. 750 ml
e. 1000 ml

Mrs A, 26 y.o, G1P0A0, according to her LMP is 34 wga, came for her first anc.
She said she had 20 kg of weight gain during her pregnancy with swelling ankl
es for the past 4 weeks. She never took any iron of vitamin supplementation. Fr
om the physical findings, BP 145/95 mmHg, HR 86x/min, RR 20x/min, BMI 35
kg/m2. US exam confirmed twins in breech presentation. Results from urinalysi
s were as follows : color cloudy yellow, specific gravity 1/013, albumin +2, RB
C 0 -1, WBC 2-5, negative bacterial count.

49. what is the most likely diagnosis ?

a. acute fatty necrosis of the liver
b. chronis hypertension
c. preeclampsia
d. renal disease
e. pyelonephritis

Mrs B, 37 y.o came to your office at 32 wga according to her LMP. She has no
US exam before and didn’t do her routine anc. The vital sign is within normal li
mit. She has body mass index 19 kg/m2. During physical examination, the uteri
ne fundal height is 22 cm. from US exam, the fetus has biometric values that cor
relate with 30 week fetus.

50. which of the following is the next best step in managing this patient?
a. anc routinely for next 2 weeks
b. evaluate maternal status and comorbidities
c. consider deliver the baby
d. repeat sonography for fetal growth in 2 weeks
e. Doppler velocimetry evaluation every 3 days

51. A 34 years old female, para 1 presented to our clinic with secondary ame
norrhea and severe progressive hirsutism. On clinical examination she was note
d to have severe hirsutism and male-pattern scalp balding. Her BMI was 30 kg/
m2. Laboratory result showed and elevated total testosterone (T) level of 140 ng
/dl (reference value in our laboratory is 0 – 80 ng/dl) and androstenedione of 27
2 ng/dl (reference value of 30 -250 ng/dl) CT of the abdomen and pelvis showed
normal adrenal glands. Pelvic ultrasound of the pelvis demonstrated mildly pro
minent ovaries, containing small follicles around the periphery. What is your m
ost probable diagnosis?
a. Multicystic ovary
b. Congenital adrenal hyperplasia
c. Polycystic ovary syndrome
d. Hyperprolactinemia
e. Microadenoma pituitary

52. Your diagnose according to ARSM / ESHRE definition, based on two of t

he following criteria :
a. Polycystic ovaries on ultrasound, oligo or amenorrhea, or evidence of hyp
erandrogenism
b. Polycystic ovaries on ultrasound, amenorrhea, obesity
c. Polycystic ovaries on ultrasound, amenorrhea, hirsutism
d. Presence of hyperandrogenism, ovarian dysfunction and exclusion of rela
ted disorders
e. Polycystic ovaries on ultrasound, hirsutism, obesity

53. A 27 years old woman presents to your office with a positive home pregn
ancy test and a 3 days history of vaginal bleeding. She is concerned that she ma
y be having a miscarriage. On examination, the uterine fundus is at the level of
umbilicus. By her last period, she should be around 8 weeks gestation. On pelvi
c examination, there is a moderate amount of blood and vesicle like tissue in the
vaginal vault, and the cervix is closed. The lab then calls you to say that her seru
m B-hCG result is greater than 1.000.000 mlU/ml. Which on the following is th
e best next step in this patient’s evaluation?
a. Complete pelvic ultrasound
b. Determination of Rh status
c. Surgical intervention (suction curettage)
d. Methotrexate administration
e. Schedule a follow up visit in 2 to 4 weeks to recheck a B-hCG level

54. The patient undergoes an uncomplicated suction D&C. The pathology rep
ot is available the next day and is consistent with a complete molar gestation. W
hat is the best next step in the care of this patient’s condition?
a. Repeat pelvic imaging
b. Radiation therapy
c. Chemotherapy
d. Surveillance serum of B-hCG
e. No further follow up is required

55. During further visit, you meet with her in your office about 3 months afte
r the index visit. Which of the following intervention is most important to emph
asize during her follow up period?
a. No further pregnancies are recommended
b. Awaits pregnancy attempt for 2 years
c. Reliable contraception during surveillance
d. Prophylactic antibiotic use during surveillance
e. Prophylactic chemotherapy to decrease the risk of persistent and recurrent
disease

56. the most frequent twin pregnancy is

a. Conjoined twins
b. Dizygotic twins
c. dichorionic diamniotic
d. monochorionic diamniotic
e. monochorionic monoamniotic

57. which of the following statement regarding chorionocity is true

a. A dichorionic pregnancy is always dizygotic
b. Monochorionic membran have four layers
c. Monochorionic pregnancy is always monozygotic
d. Determination of chorionocity is easiest in the second trimester
e. Complication in twin pregnancy is more frequent in dichorionic pregnancy
A 38 years old P6 lady is being operated for abdominal delivery. Unfortunately
uterine contraction is not good. The patient suffer for massive bleeding, the oper
ator quickly decides to perform uterine removal in order to stop bleeding

58. Which artery that should be blocked if the operator would like to stop the
blood flow to the uterine artery ?
a. Pudenda artery
b. Abdominal aorta
c. Hypogastric artery
d. Common iliac artery
e. Uterine and ovarian arteries

59. the uterine artery:

a. Gives the branch to ovary
b. Runs at the back of the ureter
c. May anastomose with femoral artery
d. Gives myometrium vascularization only
e. Is a branch of anterior division of the internal iliac artery

60. the ovarian arteries

a. Are crossed by the ureters
b. Arise just above the renal artery
c. Reach the ovary through round ligament
d. Reach the ovary through infundibulo-pelvic ligament
e. Anastomose with the descendent branch of the uterine artery

61. A 28 Y/o woman present to the antenatal clinic at 14 weeks pregnant with
mild lower abdominal pain and frequency in micturition. An ultrasound scan
notes a solid adnexal mass. Her serum lactate dehydrogenase (LDH) an human
chorionic gonadotropin (hCG) levels are raised
Which of the following tuours is the most likely cause of her symptoms?
a. Dysgerminoma
b. Endodermal sinus tumour
c. Germ cell tumour
d. Immature teratoma
e. Mature teratoma

62. What are complications of surgical excisional procedures of the cervix?

a. Cervical stenosis, cervical insufficiency, infection, bleeding
 b. Cervical stenosis, infertility, infection, bleeding
c. Cervical insufficiency, cervical polyp infection and amenorrhea
d. Vaginitis and bleeding
e. There are no known complications

63. A baby presents with ambiguous genitalia. A full chromosome count is sent
and will return in 72 hours. Your laboratory can perform a test for barr body so
you can provide a preliminary answer sooner. What is the barr body?
a. The condensed, non functioning X chromosome
b. The darkest, widest band found on chromosomes
c. An extra lobe on the female polymorphonuclear leukocytes
d. Found only in the female
e. The largest chromosome in the female genotype

64.A 22 year old G3P2002 who has a hematocrit of 36% at her initial obstetrical
examination at 12 weeks is found to have a hematocrit of 30% at 28 weeks
when checked along with her 1 hour glucola. Based on the indices of the red
blood cells on the CBC, you diagnose iron deficiency. She asks why that
occurred since she has been taking her prenatal vitamins. As part of the
explanation, you note that. Which of the following maternal measurement or
findings is first decreased by the iron requirements or pregnancy?
a. Bone marrow iron
b. Hemoglobin
c. Jejunal absorption of iron
d. Red cell size
e. Serum iron binding capacity
65. A patient returns for a postoperative checkup 2 weeks after a total
abdominal hysterctomy for fibroids. She is distressed because she is having
continuous leakage of urine from the vagina. Her leakage is essentially
continuous and worsens with coughing, laughing, or movement. Giver her
history and physical, you perform both a methylene blue dye test, which is
negative and an indigo carmine test, which is positive. The most likely
diagnosis is:
a. Rectovaginal fistula
b. Uretro vaginal fistula
c. Vesico vaginal fistula
d. Uretero vagina fistula
 e. Impossible to distinguish

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 o
f LSIL Pap smear with normal colposcopy in the first trimester. Today she repor
ts good fetal movement and denies leaking fluid or contractions. During your ex
amination you measure the fundal height at an appropriate 37 weeks, and find fe
tal heart tones located in the upper aspect of uterus. A bedside ultrasound reveal
s frank breech presentation.
66. Which of the following is the next step in management of this patient?
a. Schedule a cesarean delivery at 39 weeks
b. Return visit in 1 week to reassess fetal position
c. Schedule an external cephalic version
d. Offer a trial of vaginal breech delivery
e. Offer emergency cesarean delivery

67. Prior to discharging the patient from labor and delivery triage after her su
ccessful external cephalic version, which of the following should you do first?
a. Schedule induction for 39 weeks
b. Palce abdominal binder to help hold fetus in cephalic presentation
c. Prescribe tocolytic
d. Give RhoGAM
e. Check fetal position with ultrasound

68. Which of the following findings would deter you form offering this patie
nts a trial of breech delivery?
a. Frank breech presentation
b. Fetal weight of 3200 g
c. Complete breech presentation
d. Fetal weight of 4100 g
e. Footling presentation
A 31-year-old G1P0 woman at 39 weeks and 4 days presents to labor and delive
ry unit, with regular contractions occuring every 3 to 5 minutes. Her contraction
last 30 to 90 seconds. She not sure if she’s been leaking any fluid from her vagi
na. You take her history and conduct a physical examination.
69. Preterm rupture of the membranes is most strictly defined as spontaneous
rupture at any time prior to which of the following?
a. A stage of fetal viability
b. Second stage of labor
c. 32 weeks of gestation
d. 37 weeks of gestation
e. Onset of labor
70. You determine her membranes have ruptures and admit her for active ma
nagement of labor. The first stage of labor...
a. Includes an active and latent phase
b. Begins when the cervix has completely dilated
c. Is considered prolonged if its duration is longer than 2 hours in nulliparou
s woman
d. Begins with the onset of Braxton Hicks contractions
e. Is commonly associated with repetitive early and variable decelerations

71. a 40 yo P3 is delivered by spontaneous vaginal delivery and oxytosin 10 I

U is given intramuscularly. During cord traction the woman screams in severe p
ain, the uterus is no longer palpable abdominally and the uterine fundus can be f
elt inverted in the vagina. The emergency buzzer is pressed. What is the nexy i
mmediate step that should be performed?
a. administer tocolytic
b. Hydrostatic pressure with warm sodium chloride
c. Immediate manual replacement and stimulatneous resuscitation
d. Immediate transfer to theatre for general anaesthetic and manual replace
ment in theatre
e. Verbal consent for hutingdon’s procedure

72. After a prolonged secod stage, a 28 yo woman delivers the vertex with an
immediate turtle sign with the head retracting against the perineum. Mc Robber
t’s maneuver does not affect delivery. Which of the following would be a helpfu
l meneuver in managing this shoulder dystocia?
a. Fundal pressure
b. Internal podalic version
c. Increased maternal pushing effort
d. Wood’s crew maneuver
e. Ritgen maneuver

73. A 36 yo G2P1 with one prior cesarean delivery presents at 36 weeks gest
ation with active vaginal bleeding and now requires emergency cesarean hysterc
tomy due to placenta previa with accrete. Compared with patients who have ele
ctive surgery, this woman is at increased risk or which of the following complic
ations?
a. Bowel injury
b. Urinary tract injury
c. Venous thromboembolism
d. External iliac vessels injury
e. Hypogastric nerve injury

74. A 30 yo G1P0 woman at 40 weeks and 4 day presents to labor and deliver
y unit with second stage of labor. She pushes the head to the perineum and you
deliver the bay without complication. You examine her for lacerations. Classific
ation of perineal tear caused by either tearing or episiotomy in which injury to t
he perineum involves less than 50% of the external anal spincter thickness torn,
is classified as
a. Second degree
b. Third A degree (3A)
c. Third B degree (3B)
d. Third C degree (3c)
e. Fourth degree

75. A 28 yo G1P0 woman at 39 weeks and 6 days presnts to labor and deliver
y unit, with regular contractions occurring every 3 minutes. Her contractions las
t 30 to 50 seconds. She not sure is she’s been leaking any fluid from her vagina.
You take her history and conduct a physical examination. Rupture of membrane
would be best supported by which of the following?
a. Nitrazine paper remaining orange when exposed to fluid in the vagina
b. A negative fern test
c. An ultrasound with a normal AFI
d. A negative tampon test
e. Speculum examination with evidence of pooling in the vagina

76. She pushes the head to the perineum and you deliver the head and the sho
ulders without complication. The cord is clamped and the placenta delivered. Y
ou examined her for lacerations. A second degree laceration...
a. Involves the anal mucosa
b. Is commonly associated with buttonhole lacerations
c. Involves the mucosa or the skin only
d. Will heal well without repair
e. Extends into the perineal body, but does not involve the anal sphingter
You are providing prenatal care to a 22-year-old G1P0 woman at 16 weeks GA
by LMP. She has had a relatively smooth pregnancy without complication thus f
ar. At 5950 and 215 lb she has obese BMI, otherwise without medical or surgica
l history. She presented to prenatal care at 14 weeks and so missed first-trimeste
r screening. She undergoes the quad screen and has an elevated level of materna
l serum alpha-fetoprotein (MSAFP).

77. Which of the following statements about twinning is true?

a. The frequencies of monozygosity and dizygosity are the same
b. Division after formations of the embryonic disk results in conjoined twins
c. The incidence of monozygotic twinning varies with race
d. A dichorionic twin pregnancy always denotes dizygosity
e. Twinning causes no appreciable increase in maternal morbidity and morta
lity over singleton pregnancy

78. You are following a 38-year-old G2P1 at 39 weeks in labor. She has had
one prior vaginal delivery of a 3800 g infant. One week ago, the estimated fetal
weight was 3200 g by ultrasound. Over the past 3 hours her cervical examinatio
n remains unchanged at 6 cm. Fetal heart rate tracing is reactive. An intrauterine
pressure catheter (IUPC) reveals two contractions in 10 minutes with amplitude
of 40 mm Hg each. Which of the following is the best management for this patie
nt?
a. Ambulation
b. Sedation
c. Administration of oxytocin
d. Cesarean section
e. Expectant

79. A primipara is in labor and an episiotomy is about to be cut. Compared w

ith midline episiotomy, which of the following is an advantage of mediolateral e
pisiotomy?
a. Ease of repair
b. Fewer breakdown
c. Less blood loss
d. Less dyspareunia
e. Less extension of the incision

80. A 24-year-old primigravid woman, at term, has been in labor for 16 hours
and has been dilated 8 cm for 3 hours. The fetal vertex is in the right occiput pos
terior at +1 station and molded. There have been mild late decelerations for the
past 30 minutes. Twenty minutes ago, the fetal scalp pH was 7.27, it is now 7.20.
For above clinical description, select the most appropriate procedure.
a. External version
b. Internal version
c. Midforceps rotation
d. Low transverse cesarean section
e. Classic cesarean section

81. Laceration of abdominal wall vessets can increase blood loss and risk of p
ostoperative hematoma formation. The superficial epigastic, superficial circumfl
ex iliac and superficial external pudendal arteries all arise from which of the foll
owing?
A. Femoral artery
B. External iliac artery
C. Deep circumflex artery
D. Internal thoracic artery

82. Early treatment of hidradenitis suppurativa involves which of the followi

ng?
A. Topical corticosteroid ointment
B. Infliximab, a monoclonal antbody
C. Surgical excision of apocrine gland sinus tracts
D. Warm compresses, topical antiseptics and systematic antibiotisc

83. Which of the following is a painful, self limited mucosal lesion?

A. Vitiligo .
B. Aphthous ulcer
C. Pemphigus vulgaris
D. All of the above

84. By defnition, patients with severe Oligospermia have sperm counts less th
an which of the follwing per milliliter of semen?
A. <5 million/mL
B. <15 million/mL
C. <25 million/mL
D. <35million/mL

85. Mrs. P, a 45-year-old pregnant woman at term collapses in front of the nu

rsing staff while waiting in the delivery room. She is unresponsive and has no p
ulse. The midwife activates the emargency response System and begins chest co
mpressions. A team of 2 doctors and 2 nurses arrive with the emergency equipm
ent.
A. The first thing one should do is displace the uterus to the left while chest
compressions is ongoing
B. One should follow BLS guidelines and perform chest compressions on th
e sternum at the inter-nipple Iine
C. One should do 2 minutes of CPR before considering defitrilation in this p
atient.
D. The doctors should transfer the patient to theatre for an urgent Caesarean
delivery
E. Intubation should only be considered after retum of spontaneous circulati
on

86. Cardiotocography, showed low variability with checkmark pattern and no

desceleration. What was your interpretation and the best management through ?
A. Category one continued for fetal lung maturation
B. Category two, intrauterine resuscitation for 24 hours and reevaluation afte
r
C. Category two, went for Doppler velocymetry
D. Category three, went for Doppler ultrasound ultrasound exam
E. Category three, delivered the baby

87. A patient wishes to consider pregnancy after treatment for her breast canc
er. What is the most important predictor of a good prognosis ?
A. Young age
B. Herceptin positivity
C. Estrogen receptor positivity
D. BRCA gene positivity
E. Family history of treatable breast cancer

88. A primigravida at 36 weeks gestation is measuring large for dates. Ultras

ound shows AC > 97 th canticle GTT performed shows poorly controlled gestat
ional diabetes. What is the immediate management plan?
A. Give steroids
B. Start induction
C. Start hypoglycaemics
D. Wait and watch
E. Start sliding scale and deliver

89. A 36 year old G2P1 presents to the antenatal clinic. She had an emergenc
y caesarean section for sudden onset hypertension and placental abruption at 30
weeks in her previous pregnancy. She is currently 20 weeks of gestation and en
quires about further plan of fetal monitoring in this pregnancy. What is the most
appropriate advice?
A. No extra monitoring is required
B. Uterine artery Doppler at 22 weeks
C. Serial scans starting form 24 weeks
D. Serial cardiotocograph monitoring from 28 weeks
E. Serial scans from 28 weeks

90. A 34 year old pregnant lady, G2P1 has been diagnosed with ductal carcin
oma of the right breast (Stage 1). She is currently 22 weeks pregnant. What is th
e initial treatment of choice for her ?
A. Termination of pregnancy
B. Local mastectomy with reconstruction
C. Local mastectomy without reconstruction
D. Local radiotherapy
E. Single close chemotherapy with frastuzumab

A 69-year-old woman with pelvic pressure anda palpable bulge presents for eva
luation. She recalis some mention of a cyctocele diagnosis, given by her primar
y care provider. Today, she requests formal evaluation by a gynaecologist.
91. When performing the physical examination, what Is one type of staging s
ystem to describe prolapse?
A. Pelvic organ prolapse quantificatjon scale (POP-O)
B. Gray scale
C. Visuala analog score
D. vreslow scale
E. Clark scale

92. A 25-year-old lady G1 term pregnancy comes to delivery room In active

phase of labor. Your perform CTG, and you find the CTG as the following. This
deceleration most likely reflect which of the following? pict.
A. Head compression  early
B. cord compression  variabel
C. Maternal chronic anemia  sinusoidal
D. Severa pre eclampsia
E. Uteroplacental insufficiency  late

93. The sonographic appearance of the endometriom during the menstrual cy

cle correlates with the phasic changes in its histologic anatomy. Which phase of
the cycle is depicted with the classic trilaminar appearances.as shown below? pi
ct.
A. Menstrual
B. Secretory
C. Proliferative
D. Periovulatory
E. lutheal phase

For question No. 94-95

Mrs. S, 29 yo, G3P1A1 39 weeks GA, referred by midwife with prolonged seco
nd stage. In examination, revealed normal vital sign.examination revealed contr
action was 3x/10’/35” and FHR was 160 bpm. Estimated fetal weight was 3100
gr with previous baby was 3000 gr. Vaginal examination revealed : fully dilated,
no amniotic membrane, lowest part was head with descent of he head in Hodge
IV. Denominator was minor fontanella at the left anterior
94. What will you choose to terminate in this condition?
a. Spontaneus delivery
b. Augmentation
c. Embryotomi
d. Forceps extraction
e. Cesarean section

95. What are the indication for assisted vaginal delivery?

a. Uterine rupture
b. PPROM
c. Post partum hemorrhage
d. Fetal anomaly
e. Fetal or maternal distress

96. Your patient delivered a healthy baby 2 weeks ago and wishes to use cont
raception method after her puepuerim. She is breastfeedig exclusively. For whic
h of the following is there strong evidence that use the decrease the quantity and
quality of breast milk?
a. Progestin only pills
b. Depomedroxyprogesteroacetate
c. Combination hormonal contraception
d. IUDs
e. Implant

97. Which of the following is the most common cause of first trimester pregn
ancy loss ?
A. uterine anomalies
B. Incompetent cervix
C. Intrauterine Infection
D. Fetal chromosomal abnormalities
E. Placenta adhesive
98. Which of the following NOT clinical indicator af heart disease during pre
gnancy ?
A. Cyanosis
B. Clubbing fingers
C. Systolic murmur grade 2/6
D. Diastolic murmur
E. Cardiomegaly

99. In cases of severe hyperemesis gravidarum, all EXCEPT which of the follo
wing initial complications are common?
a. Acidosis
b. Dehydration
c. Hypokalemia
d. Hyponatremia
e. Mild transaminase

100. A 22 year old G1P0, has just undergone a spontaneous vaginal delivery. As
the placenta is being delivered, an inverted uterus prolapses out of the vagina. T
he maneuver most likely worsen the situations would be to
a. Immediately finish delivering the placenta by removing it from the inverted u
terus
b. Call for immediateassistance from other medical personnel
c. Obtain intravenous access and give lactated Ringer solution
d. Apply pressure t the fundus with the palm of the hand and fingers in the direc
tion of the long axis vagina
e. Have anesthesiologist administer halothane anesthesia for uterine relxation