1.

Which of the following is a disadvantage of uterine exteriorization to repair the hysterotomy

during cesarean delivery? (Lange)
a. Increased blood loss
b. Increased operative injury rate
c. Increased neusea and vomiting
d. Increased postoperative infection rate
e. Increased the operative time

A 28-year-old G1P0 woman at 28 weeks GA comes to your office for a routine prenatal visit. She
works as a kindergarten teacher and one of her students was recently sent home with a rash
and fever. She states that the child had a rash on both cheeks and the pediatrician said it was a
viral infection called fifth disease. She relates the baby is moving well and denies any vaginal
bleeding, abnormal vaginal discharge, or contractions. She wonders if she needs any more
testing to see if she has been affected.

2. What is the most likely causative organism of the child’s infection ?

a. Parvovirus
b. Varicella
c. CMV
d. Toxoplasmosis
e. Listeriosis

3. You send serologies for the agent above and they come back showing the patient has a
positive IgM and negative IgG consistent with an acute infection. What is the most common
fetal/neonatal complication of this infection during pregnancy?
a. Fetal anemia
b. Preterm labor
c. Premature preterm ROM
d. Fetal anomalies
e. Oligohydramnios

A 34-year-old G3P2002 woman at 38 weeks and 6 days was admitted to labor and delivery unit
for active management of labor after it was determined that her membranes had ruptured and
she was dilated to 3 cm. Her cervix has been steadily dilating and now she is at 6 cm. She is very
uncomfortable and finds her contractions very painful. Her partner is also very concerned that
she needs pain relief.
4. You advise your patient that
a. narcotics are available, but should be reserved for closer to the time of delivery when her
pain will be greatest
b. if she continues with natural childbirth and eventually needs a cesarean section she will
require general anesthesia
c. spinal anesthesia is her best option because it gives a constant infusion of medicine over a
long period of time
d. she cannot have an epidural yet because she is not yet in the active phase of labor
e. a variety of relaxation techniques can be incorporated into her labor in addition to pain
medication

5. With adequate pain control she dilates to 10 cm and second stage begins. Which of the
following is the correct order of the cardinal movements of labor?
a. Internal rotation, engagement, descent, flexion, external rotation
b. Engagement, descent, internal rotation, flexion, external rotation
c. Internal rotation, descent, engagement, flexion, external rotation
d. Engagement, descent, flexion, internal rotation, external rotation
e. Engagement, descent, internal rotation, flexion, external rotation

A 38-year-old G3P2002 woman presents at 40 weeks 3 days withcontractions to labor and

delivery triage. Contractions started 1 hour ago and are very painful. The patient denies leaking
fluid but did notice blood and mucus on her underwear. The baby has not been particularly
active since contractions started. Her pregnancy has been complicated by A2GDM. Fasting
blood glucose are usually between 80 and 90 mg/dL with 1-hour postprandial values between
120 and 140 mg/dL. Her prepregnancy weight was 130 lb and she is 5 ft 5 in (BMI 21.6). She
has gained 30 lb this pregnancy (BMI 26.6). Hemoglobin A1C is 6.0%. Fetal ultrasound at 20
weeks demonstrated normal fetal anatomy. Repeat ultrasound for growth at 38 weeks
demonstrated fetus with weight in the 90th percentile and an EFW of 4,350 g. Her last
pregnancy was complicated by A1GDM and she delivered a 4,200 g infant without
complications. Initial cervical examination reveals dilation of 6 cm, 50% effacement, and 21
station. Two hours later the nurse calls you to the room after the patient’s water breaks.
Examination shows complete dilation and effacement, and fetus at 11 station. The patient has
a strong urge to push and begins pushing. The delivery is complicated by a second5degree
perineal laceration and a postpartum hemorrhage of 600 mL. Fetal weight is 4,560 g and the
Apgar scores are 6, 8.

6. What neonatal risks are most commonly present in macrosomic fetuses?

 1. Jaundice
2. Hypoglycemia
3. Hyperglycemia
4. Birth trauma
5. Asthma
6. Hypocalcemia
a. 1, 2, 4, 6
b. 1, 3, 4, 5
c. 3, 4, 5
d. 1, 3, 5, 6
e. 2, 4, 5, 6

A 36-year-old G7P50015 woman has just delivered a 4,500 g female infant at 39 weeks
gestation. She underwent induction of labor with oxytocin for severe preeclampsia diagnosed
with systolic BPs elevated to 160 mm Hg. Her pregnancy was complicated by uncontrolled
gestational diabetes and resultant polyhydramnios. She was placed on magnesium throughout
her induction for seizure prophylaxis. She had an epidural placed during the first stage of labor
and remained on a normal labor curve throughout. Her second stage of labor lasted 3½ hours;
she was, however, able to deliver vaginally with preemptive McRoberts maneuvers and steady
traction. The third stage of labor lasted 10 minutes and the placenta was delivered intact.
Immediately after the third stage her bleeding was significant with the expulsion of blood clots
and a fundus that was notable for bogginess.

7. Which of the following are not risk factors for postpartum hemorrhage?
a. Advanced maternal age
b. Grand multiparity
c. Prolonged use of oxytocin during labor
d. Polyhydramnios
e. Prolonged exposure to magnesium during labor

8. Which of the following medications would be contraindicated in the treatment of uterine

atony in this patient?
a. Methylergonovine (Methergine)
b. Carboprost (Hemabate, PGF2-alpha)
c. Intramuscular Pitocin
d. Misoprostol (PGE1)
e. Calcium gluconate
9. Your next patient is a 13-year-old adolescent girl who presents with cyclic pelvic pain. She
has never had a menstrual cycle. She denies any history of intercourse. She is afebrile and
her vital signs are stable. On physical examination, she has age-appropriate breast and pubic
hair development and normal external genitalia. However, you are unable to locate a vaginal
introitus. Instead, there is a tense bulge where the introitus would be expected. You obtain a
transabdominal ultrasound, which reveals a hematocolpos and hematometra.
What is the most likely diagnosis?
a. Transverse vaginal septum
b. Longitudinal vaginal septum
c. Imperforate hymen
d. Vaginal atresia (MRKH)
e. Bicornuate uterus

10. A 23-year-old G0 woman presents complaining of increasing pelvic pain with her menses
over the last year since she stopped her OCPs. In particular, she has noticed more pain on
her left side in the last couple of months. She denies any changes in her bladder or bowel
habits but reports that she has begun to have pain with deep penetration during intercourse.
She started OCPs when she was 17 for painful irregular cycles but stopped them a year ago
when her insurance changed. She has had only one lifetime sexual partner and no history of
sexually transmitted infections. She would like to preserve fertility. On examination, she has
no abnormal discharge but her uterus is tender as well as her left adnexa. You appreciate a
fullness that you suspect may be a mass. On pelvic ultrasound she has a 5 cm cystic ovarian
mass thought to be an endometrioma. It persists in repeat ultrasound 8 weeks later and the
patient is still symptomatic.
What would be the most appropriate next step in her care?
a. Resume an oral contraceptive
b. Schedule diagnostic laparoscopy with left ovarian cystectomy
c. Prescribe an NSAID for her pain and repeat the ultrasound in 6 to 8 weeks
d. Prescribe a GNRH agonist (i.e., Depo-Lupron)
e. Refer her to a gynecologic oncologist

11. You perform a laparoscopic left ovarian cystectomy and notethat the cyst is a “chocolate
cyst.” She also has other superficial implants of endometriosis on the uterosacral ligaments.
The final pathology report is consistent with an endometrioma. At your patient’s
postoperative visit 2 weeks after surgery she tells you that her pain is resolved and she is
feeling well. What do you recommend for the continued postoperative management of her
endometriosis?
 a. Because endometriosis cannot be cured medically, she should undergo total
hysterectomy with bilateral salpingo-oophorectomy
b. You were able to completely remove the cyst, so she does not need any further therapy
at this time
c. Wait 6 months and then schedule a repeat laparoscopy to make sure there is no further
endometriosis that needs to be treated
d. Initiate therapy with a combined oral contraceptive or a progestin to delay the return of
her previous symptoms
e. Endometrial ablation because that will destroy her endometrium and decrease the risk
of new implants developing from retrograde menstruation.

13. A 21-year-old nulligravid woman presents to her gynecologist with a 3-day history of
painful genital ulcer. Last week she had a low-grade fever and generalized malaise, which
has since resolved. She denies any history of genital ulcers. She has had four new sexual
partners in the last year and uses oral contraceptives. She reports using condoms
inconsistently. On genitourinary examination, several 1 to 2 mm painful vesicles are noted
on the left labia minora. There is no inguinal lymphadenopathy.
Which of the following is the most likely causal organism?
a. Treponema pallidum
b. Herpes simplex virus
c. Trichomonas vaginalis
d. Chlamydia trachomatis L1, L2, or L3
e. Haemophilus ducreyi

14. Assuming that additional testing was performed, which of thefollowing results would
you most likely expect to find?
a. T. pallidum particle agglutination assay (TPPA), positive
b. H. ducreyi culture, positive
c. HSV-2 IgG, positive
d. HSV-1 IgG, positive
e. None of the above. Diagnostic testing is not reliable and treatment should be based on
clinical suspicion

15. What is the best initial treatment for this patient?

a. Ceftriaxone 250 mg IM once
b. Imiquimod (Aldara) applied to affected area three times per week
c. Acyclovir 200 mg orally five times daily for 7 days
d. Benzathine penicillin G 2.4 million units IM once
 e. Doxycycline 100 mg orally twice daily for 21 days

16. A 69-year-old woman with pelvic pressure and palpable bulge presents for evaluation.
She recalls some mention of a cystocele diagnosis, given by her primary care provider.
Today, she requests formal evaluation by a gynecologist.
When performing the physical examination, what is one type of staging system to describe
prolapse?
a. Pelvic organ prolapse quantification scale (POP-Q)
b. Gray scale
c. Visual analog scale
d. Breslow scale
e. Clark scale

17. In discussing her symptoms, the patient points out that her voiding function has
changed as the prolapse has grown in severity. Initially, the patient reported stress urinary
incontinence, but as the prolapse worsened, the incontinence improved. While she is happy
with the resolution of her incontinence, she currently experiences some incomplete bladder
emptying, which is improved upon manual reduction of the prolapse. How do you counsel
her about her risk of incontinence after an isolated anterior wall repair (with no other
concomitant surgery)?
a. High likelihood of de novo urgency and urge urinary incontinence
b. High likelihood of urinary frequency
c. High likelihood that her stress incontinence will be cured by anterior repair
d. High likelihood that an anterior repair will unmask and potentially “worsen” her stress
urinary incontinence symptoms
e. High likelihood of de novo fecal incontinence

18. In assessing the above patient, you also find a posterior vaginal wall defect. What is a
common symptom that is associated with rectoceles?
a. Urinary urgency
b. Hematuria
c. Incomplete evacuation of stool
d. Vaginal bleeding
e. Vaginal wall erosion

19. On pelvic examination the vagina is well-healed, and you do not see any lesions or
active leaking of urine into the vagina. Further testing at this time may include:
a. Cystourethroscopy
 b. Dye testing with retrograde filling of the bladder with methylene blue or indigo carmine
c. IV dye testing with indigo carmine
d. All of the above
e. None of the above

20. 63-year-old G3P2 woman is referred to the urogynecology clinic for evaluation of urinary
incontinence. Urinalysis and urine culture done by her PCP 1 week earlier were negative.
Her medical history is positive for hypertension and osteoarthritis. She is complaining of
leakage of urine following an overwhelming need to void. She runs to the bathroom, but
leaks a large amount before she makes it to the toilet. She also has urinary frequency and
empties her bladder every 1 to 1.5 hours during the day and gets up four times at night to
void. She denies loss of urine with cough, sneeze, and exercise.
From this patient’s history, what is your initial diagnosis?
a. Urgency incontinence
b. Overflow incontinence
c. Stress incontinence
d. Mixed incontinence
e. Continuous incontinence secondary to a urinary fistula

21. As her pregnancy continues, you would expect her cardiac output to increase by which of
the following mechanisms:
a. First an increase in stroke volume, then an increase in heart rate
b. A decrease in systemic vascular resistance
c. Cardiac output would not change significantly until the third trimester
d. An increase in systemic vascular resistance facilitated by elevated progesterone levels
e. Increased heart rate alone

22. Which of the following is true regarding the physiologic changes she might expect during
her pregnancy?
a. Gastric emptying and large bowel motility are increased in pregnancy
b. BUN and creatinine will decrease by 25% as a result of an increase in glomerular filtration
rate (GFR), which will be maintained until delivery
c. An overall decrease in the number of WBC and platelets
d. Nausea and vomiting that should be treated aggressively with antiemetics and
intravenous hydration
e. An increase in the tidal volume along with an increase in total lung capacity (TLC)
23. A 32-year-old G1P1001 woman presents to your office with the chief complaint of
amenorrhea since her most recent vaginal delivery 1 year ago. She notes that she had an
uncomplicated pregnancy, followed by the delivery of a healthy baby boy. Her delivery was
complicated by an intra-amniotic infection as well as a postpartum hemorrhage requiring a
postpartum dilation and curettage. After her delivery, she breastfed for 6 months, and
during this time she had scant and irregular vaginal bleeding. After stopping breastfeeding
6 months ago, she notes the absence of menses, but instead has monthly painful cramping,
which seems to be getting worse. She remarks that prior to her pregnancy,she had normal,
regular menses, which were not too heavy or painful. She and her husband would like to
have another child, and have been having unprotected intercourse for the past 6 months
without achieving a pregnancy. Your review of systems is otherwise negative. You perform
a physical examination, which is normal other than a slightly enlarged, tender uterus. A
urine pregnancy test in the office is negative. What is the most likely diagnosis?
a. Sheehan’s syndrome
b. Lactational amenorrhea
c. Asherman’s syndrome
d. Premature ovarian failure

24. You suspect Asherman’s syndrome, and perform a hysterosalpingogram,which reveals

multiple synechiae within the uterus, confirming your suspicions. Your next step in therapy
is which of the following?
a. Diagnostic and operative hysteroscopy
b. Provera 10 mg daily for 5 days in an attempt to achieve a withdrawal bleed
c. In vitro fertilization
d. Place an intrauterine device
e. Inform your patient that unfortunately, she is “barren” and will not be able to carry a
pregnancy again

25. An 18-year-old G0 F presents to your office for contraceptive counseling. She has never
used any method of contraception before and is engaged in a monogamous sexual
relationship. Gynecologic history is significant for regular, heavy menstrual cycles using up
to eight pads per day, lasting up to 7 days at a time, with severe pain (dysmenorrhea). She
smokes one-half pack of cigarettes per day and tells you that her mother and aunt both
have Factor V Leiden disease, but that she has never been tested herself or had a
thromboembolic event. She will attend college soon and has no plans for a pregnancy in
the near future. She indicates her desire for the “most reliable” method of contraception
that you can offer.
Which of the following methods of contraception has the least efficacy?
 a. Ortho Evra patch
b. Combined oral contraceptive pills
c. Mirena IUD
e. Condoms with spermicide
f. Coitus interruptus

26. Of course, during your discussion at this visit, you could encourage smoking cessation and
recommend weight loss to help improve her overall health. You and the patient have
decided to proceed with IUD placement. Prior to placement, it is important to perform
which of the following tests?
a. FSH level
b. Prolactin level
c. Urine pregnancy test
d. Gonorrhea/Chlamydia testing
e. Both c and d

27. 30-year-old G0 comes in for her annual examination and tells you that she plans to become
pregnant sometime in the next year. She had a LEEP procedure 5 years ago at another
facility for moderate dysplasia. You verify her Pap tests have all been negative since the
LEEP, but her last pap was 2 years ago.
What is the recommended cervical cancer screening for this patient?
a. Pap testing every 6 months
b. Pap testing and colposcopy every 6 months
c. Pap testing every 3 years
d. Pap testing and high-risk HPV testing every 5 years
e. She has been treated with the LEEP, so she no longer needs pap smears

28. Her Pap test returns HSIL and she is high-risk HPV positive. You have her return for
colposcopy. After the application of acetic acid, you see a large, dense, white area with
mosaic vessels encompassing the entire anterior cervix and extending into the endocervical
canal. You obtain a biopsy of this area and performan endocervical curettage. The
pathology report for both biopsies is CIN III. What treatment do you recommend?
a. LEEP in office
b. Cryotherapy
c. Cold-knife cone or two-stage LEEP in OR
d. Simple hysterectomy
e. Radical hysterectomy
29. A 62-year-old woman presents to the office complaining of watery vaginal discharge and
bleeding for the past 2 months. She has not had a Pap test in 14 years. She states she had a
mildly abnormal pap in her 30s, but that was treated with cryotherapy. She states she went
through menopause at age 50 and has never been on hormone replacement therapy. She
does admit to smoking one-half pack a day for 40 years. Her husband is deceased, and she
has not been sexually active in 10 years. Her examination reveals a cervical necrotic mass
approximately 5 cm in size. Rectovaginal examination is suspicious for left parametrial
involvement. There is no evidence of adnexal masses, but examination of the uterus and
adnexa is limited by the patient’s body habitus. You suspect this may be cervical cancer.
You obtain a Pap smear and take a biopsy of her cervical abnormality. The Pap test returns
with a reading of SCC, and the biopsy confirms this diagnosis. She also received a
cystoscopy for hematuria with positive urine cytology. The biopsy also shows SCC. You
order a CT scan, which shows a cervical mass measuring 7.7 3 5.0 cm as well as an avid left
internal iliac lymph node consistent with locally metastatic disease.
What is the International Federation of Gynecology and Obstetrics (FIGO) stage for her
cancer?
a. Stage I
b. Stage II
c. Stage III
d. Stage IV

30. Mrs. S, 34 years, G4P3A139 weeks gestational age, second stage of labour. The head of the
baby was delivered but the shoulder was stuck. Turtle sign (+). The mother has an
uncontrolled diabetes for 5 years. Estimated fetal weight by ultrasound was 4200 gram.
What is this condition called ?
a. After coming head
b. Compaction
c. Retention of the baby
d. Shoulder dystocia
e. Collision

31. Mrs. S, 32-year-old G4P3Ao gravid with chronic hypertension had a normal labor that
arrested in second stage at +1 station. She complained of mild dyspneu and fatigue . The
fetus had a left occiput anterior presentation and was delivered by forceps. Completion of
third stage followed quickly, and the fundus was noted to be firm . The OBGYN was
carefully examined, and no laceration were noted. The examiner then noted the lower
uterine segment was boggy.
Which of the following is suitable treatment in situation above?
 a. Hemabate, 250 μg intramuscularly
b. Methergin, 0,2 mg intramuscularly
c. A 20-unit oxytocin intravenous bolus
d. Misoprostol 400 mg, intrarectally
e. Carboprost 0,25 mg, intramuscularly

32. For Mrs. S, one dose uterotonic agent is given and the fundus is massaged. Despite this, she
continues to bleed. Which of the following is suitable treatment in this situation?
a. Administer methergin 0,2 mg intramuscularly
b. Mobilize a team that include obstetricians, nurses, and anesthesiologists
c. Perform laparotomy to prepare postpartum hysterectomy
d. Apply balloon catheter
e. Uterine and ovarian artery ligation

33. The patient continues to bleed and you have initiated whole blood transfusion. Which of
the following is suitable treatment in this situation?
a. Continue to administer Hemabate intramuscularly every 20 minutes
b. Insert Bakri postpartum Balloon or large Folley catheter balloon into the uterine cavity
and inflate the balloon
c. Consider laparotomy and uterine compression suture placement
d. all of the above
e. a and b

34. A pelvic ultrasound reveals a right-sided ectopic pregnancy as well as large amounts of
fluid, thought to be blood in the abdomen. She now has IV access and a bolus of IV fluids
is being given. Her BP is now 78/45 and her pulse rate is 112 beats perminute. Her
hematocrit returns as 27.2%. How will you proceed?
a. Administer IM methotrexate
b. Transfuse the patient with two units of packed RBCs and transfer her to the ICU
c. Proceed with a laparoscopic salpingectomy
d. Proceed with emergent laparotomy
e. Start vasopressors and transfer the patient to the ICU

35. An 89-year-old female patient with multiple, 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. She cannot tolerate a
pessary. Her main priority is to “fix or get rid of this thing,” 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. 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

36. The drug that blocks the conversion of arachidonic acid to thromboxane A2 while sparing
prostacyclin production in treatment APAs
A. Unfractionated heparin
B. Aspirin
C. Azathioprine
D. Cyclosporine
E. Cyclophosphamid

37. A 28-year-old G2P0 at 39 weeks is in early labor. She is 2 cm dilated and 90% effaced, with
contractions every 4 to 5 minutes. The fetal heart tones are reassuring. Her nurse steps
out for a moment and returns to find her having a seizure. The nurse administers a 4-g
magnesium bolus. The seizure stops. The fetal heart tone variability is flat, but there are
no decelerations. This patient is most at risk for mortality from which of the following
complications?
(A) infection
(B) uremia
(C) congestive heart failure
(D) fever
(E) cerebral hemorrhage

38. A 40-year-old woman is seen for a routine examination. Her menses have been regular,
and she has no complaints. Findings, including those on pelvic examination, are normal.
Ten days later, her Pap smear is returned as “high-grade squamous intraepithelial
lesion.” Which of the following options is the best course of action?
(A) immediate wide-cuff hysterectomy
(B) repeated Pap smears at 3-month intervals
(C) fractional dilation and curettage (D&C)
(D) punch biopsy of anterior cervical lip
(E) colposcopy with biopsy
39. A pelvic ultrasound reveals a right-sided ectopic pregnancy as well as large amounts of
fluid, thought to be blood in the abdomen. She now has IV access and a bolus of IV fluids
is being given. Her BP is now 78/45 and her pulse rate is 112 beats per minute. Her
hematocrit returns as 27.2%. How will you proceed?
A. Administer IM methotrexate
B. Transfuse the patient with two units of packed RBCs and transfer her to the ICU
C. Proceed with a laparoscopic salpingectomy
D. Proceed with emergent laparotomy
E. Start vasopressors and transfer the patient to the ICU

40. G3P2A0, 32 years old, referred from primary health care with term pregnancy and post
cesarean section. She has a history of cesarean delivery of her first child due to placenta
previa. Factors affecting the likelihood of succesful trial of labor in this patient is :
a. Prior cesarean for malpresentation
b. Spontaneous labor with advanced cervical dilatation on admission
c. Prior vaginal delivery
d. Increased maternal age
e. Recurrent indication for initial cesarean delivery

41. With regard to HIV in Pregnancy :

A. A positive HIV blood test in pregnancy is not reliable
B. A high maternal HIV RNA load decreases the mother-to-child transmission of HIV
C. Use of antiretroviral agents is always commened in the first trimester of pregnancy
D. HIV infection increases the mother to-child transmission of the hepatitis C virus
E. If there are ruptured membrane for 6 hours, there is no advantage to delivery baby by
C – Section

42. A One woman, married, G3P3A0, 43 yo, no history of abdominal surgery, has been getting
a diagnosis as cystic ovarian neoplasm with a size of 6 months pregnant. Limited mobility
mass, not pain. Hb 11,5 gr%, Ca-125 IU. Other laboratory examinations, investigations and
cytology smears perioperative smear within normal limits.
Choose the correct answer :
A. Vertical midline incision offers inferior access to the upper abdomen if greater space or
access is needed
B. Transverse incision are used commonly in gynecologic malignancy surgery.
C. Vertical midline incision was not recommended in patients who have coagulopathy,
declined transfusion, or are administered systemic anticoagulation
 D. Nerve injury to the iliiohypogastric, ilioinguinal and femoral nerves in Pfannenstiel
incision was more commonly involve sensory functionand typically are transient

43. The couple came to the clinic with complaint to get pregnant. This couple has been
married 3 years. Current wife age 36 years, height 151 cm and weight 73 kg, a history of
sexual intercourse 2-3 time a week. From anamnesis we found a history of menstrual pain
since the age of 20 years and intermittent treatment for vaginal discharge odor
complaints and itchy since before marriage. In this couple :
A. Infertility services can be given by qualified practitioners who can provide consultation,
education and advice to both partners and have knowledge of the terms of
reproductive success and problems
B. Given infertility service by health workers who have experience and documented
certified to perform the procedure endocrine, gynaecologic and urology, have
extensive knowledge about the effectiveness, side effects, the cost of doing the
diagnosis and treatment of infertility.
C. Treatment is aimed to be able to determine the cause of infertility from both sides as
well as determine whether the couple need to get service at a higher level of service
D. Infertility service that require special expertise because it includes the action assisted
reproductive technology that can only be performed in specialized infertility clinic
E. Having practitioner qualification certification and experienced in TRB. Urology or
andrology and qualifies as an infertility counselor. You are going to make critical skill
training. There are some problems that you are worried to get in relation of
successfully of the training approach.

44. Mrs. S, 29 yo, G3P1A1 39 weeks GA, referred by midwife with prolonged second stage. In
examination, revealed normal vital sign, obstetric examination revealed contraction was
3x/10’/35’. FHR was 160 x/m, estimated fetal weight was 3100 gr, previous baby was
3000 gr. Vaginal examination revealed : full dilatation, amniotic membrane was absent,
thick and greenish, lowest part head with descent of the head was Hodge IV.
Denominator was minor fontanella at the left anterior.
What will you choose to terminate this condition ?
a. Spontaneous delivery
b. Augmentation
c. Embryotomy
d. Forcipal extraction
e. C-Sec
45. Frequent complication of the action above is :
A. Uterine rupture
 B. Cephalhematoma
C. Parese N. VII
D. Erb’s Paralysis
E. Fracture of os femur.

46. FHR shows declining arises from beginning of contraction and goes to normal baseline as
soon as the contraction ends. This finding refer to ?
A. Fetal distress
B. Fetal head compression
C. Fetal hypoxia
D. Umbilical cord compression
E. Threatened uterine rupture

47. A 19-year-old primigravida at 29 weeks gestation is noted to have anemia with a

hemoglobin concentration of 8 g/dL. The peripheral blood smear below is obtained.
Which of the following laboratory findings are microcytic hypokrom ?
a. Decreased serum ferritin level
b. Elevated mean corpuscular volume
c. Decreased total iron binding capacity
d. Positive sickle-cell screen (Sickledex) result

48. Ms. Smith is a 37-year-old multigravida who presents to your office at 32 weeks' gestation
as calculated by her last menstrual period. Her hematocrit is 29 volume percent, and she
has sickle cell trait. During sonographic evaluation, the fetus has biometric values that
correlate with a 28-week fetus.
What is the most likely explanation?
a. Aneuploidy
b. Chronic hypoxia
c. Poor pregnancy dating
d. First-trimester cytomegalovirus infection

49. Your next obstetrical sonographic evaluation of the patient in Question 74-76 is
performed 4 weeks after the fust one and now at an estimated gestational age of 36
weeks. The fetus now has measurements similar to a 30-week fetus. Growth restriction
seems more likely. What is appropriate at this time?
a. Delivery
b. Strict bed rest
c. Umbilical artery Doppler velocimetry
 d. Sonographic fetal biometry in 1 week

50. Solid food as one of the source of nutritional diet in post caesarean patient will be offered
within:
a. 2 hours post operative
b. 3 hours post operative
c. 8 hours post operative
d. 12 hours post operative
e. 24 hours post operative

51. A 19-year-old woman complain of a golf ball-sized mass at the entrance of her vagina. She
says that this area is “sore all the time” and began hurting “about 3 days ago”. On
examination, the patient has a tender 4 cm mass on the lateral aspect of the labia minora
at the 5 o’clock position. There is erythema and edema, and the area is very tender and
fluctuant. No cellulitis is noted.
What is the most appropriate treatment for this condition?
a. Trimethoprim/sulfamethoxazole
b. Azithromycin for the patient and any sexual partners
c. Incision and drainage of the mass followed by a course of
trimethoprim/sulfamethoxazole
d. Incision and drainage of the mass
e. Incision and drainage of the mass with placement of a Word catheter.

52. Which of the following is generally the treatment of choice for recurrent Bartholin gland
duct abscess?
a. Systemic antibiotics
b. 5-percent lidocaine ointment
c. Bartholin gland duct marsupialization
d. Warm compresses and frequent sitz baths
e. All of the above

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

A. 1-7 days
B. 10 days
C. 3-90 days (10-90 days after initial infection)
D. 120-180 days
E. 210 days
54. A 30-year-old multigravida presents with ruptured membranes at term but without labor.
Following induction with misoprostol, her labor progresses rapidly, and she
spontaneously delivers a liveborn 3300-g neonate. Immediately after delivery, she
complains of dyspnea. She becomes apneic. Her autopsy reveal fetal squames within
pulmonary vasculature. How would her death be classified?
A. Perinatal death
B. Nonmaternal death
C. Direct maternal death
D. Indirect maternal death
E. Occasional maternal death

55. From pelvic examination findings, pelvic brim : round, diagonal conjugate 12 cm,
symphisis parallel to sacrum, subpubic angle is acute, convergent side walls, bituberous
diameter is 7 cm. By analyzing your findings, which causes bellow is unlikely to be?
A. Android pelvis
B. Anthropoid pelvic
C. High assimilation pelvis
D. Platypelloid pelvis
E. Oblique pelvis

56. Your patient has microcytic anemia with a hemoglobin 9 and normal iron stores (normal :
41-141). What is the most likely diagnosis?
(A )folate deficiency
(B) vitamin B12 deficiency
(C) thalassemia beta minor
(D) vitamin B6 deficiency
(E) acute blood loss

57. Match the following fetal heart rate tracing (Figure 11–2) with the descriptive term that
best fits the situation.

(A) early decelerations

(B) late decelerations
(C) normal tracing
 (D) poor variability
(E)sinusoidal pattern
58. You are counseling a 30-year-old woman who wants to become pregnant. Which of the
following is the most accurate method for her to time intercourse?
(A) thermogenic shift in basal body temperature (BBT)
(B)urinary luteinizing hormone (LH) kit testing
(C)serum progesterone level
(D) profuse, thin, acellular cervical mucus
(E)mittelschmerz

60. Fecal incontinence is most likely related to which of the following?

(A) interplay between the pubococcygeus muscle and rectum
(B)innervation of the pelvic floor and the anal sphincters
(C)normal colonic transit time
(D) nulliparity
(E)urinary retention

61. What should be advised to this woman regarding her delivery plan?
A. If cesarean delivery is planned, it should be scheduled at 36 weeks gestation
B. In labor, internal monitors should be placed because fetuses of HIV-infected women
are at increased risk for distress
C. In labor, with a plan for vaginal delivery, amniotomy should be performed as soon as
possible to hasten delivery
D. Cesarean delivery is recommended for women with viral load > 1000 copies/mL
E. Cesarean delivery is only performed based on obstetrical indication

62. When creating a Pfannenstiel incision, which vessels should be anticipated halfway
between the skin and fascia, several centimeters from the midline?
a. External pudendal
b. inferior epigastric
c. Superficial epigastric
d. Superficial circumflex iliac
e. iliac vein

63. The sonographic appearance of endometrium during menstrual cycle cprrelates with the
phasic change in histological anatomy. Which phase of the cycle is depicted with the
classic trilaminar appearance shown below
A. Menstrual
 B. Secretory
C. Proliferatif
D. Periovulatory

64. For surgical treatment of endometriomas which following approaches superior?

A. Drainage
B. Cystectomy
C. Cys wall ablation
D. Oovorectomy

65. Sonography endometriomas are typicaly describe as which following?

A. Solid with intracystic internal echoes
B. Cystic with hyperechoic internal choes
C. Solid diffuse internal low level echoes
D. Cystic with diffuse internal low level echoes
E. Cystic with intracystic blood flo

66. In PCOS increased testosterone production from the ovaries is secondary to stimulation
by which of the following hormone?
A. Inhibin
B. Estradiol
C. LH
D. FSH

67. Which of the following is a not risk factor for vulvar cancer?
A. Lichen planus.
B. Tobacco abuse
C. Lichen sclerosus
D. HPV
E. HSV

68. What most common site of metastatic spread of choriocarsinoma

A. Brain
B. Liver.
C. Lungs
D. Vagina

69. Regarding the coagulation system in pregnancy, which of the following statement is true.
 A. Mean platelet count is 250000
B. Fibrinolityc activity is usualy reduced
C. Fibrinogen level are increased to a median of 250mg/dl
D. Decreases in platelet concentration are solely due to hemodilution

70. Compared with a normally shaped placenta, which complication of 3rd stage labor is
more common with underdiagsed succenturiate lobe?
A. Cord avultion
B. Chorioamnitis
C. Uterine invertion
D. Retained Cotelidon

71. In the US which of the following twin pregnancies would be candidate for fetoscopic laser
ablation therapy for TTTS?
A. Monochorionic diamnionic twins at age 23 week gestation with stage 1 TTTS
B. Dichorionic diamnionic twins at 19 weeks gestation with stage 11 TTTS
C. Monochorionic, diamniotic twins at 15 weeks gestation with stage IV TTTS
D. Monochorionic diamniotic twins at 21 weeks gestation with stage III TTTS

72. Which of the following defines heterotopic pregnancy?

A. One tubal and one abdominal pregnancy
B. One ectopic and one intrauterine pregnancy
C. Two pregnancy, one in each fallopian tube
D. Two ectopic pregnancys in one fallopian tube

73. This deceleration most likely reflects which of the following? (late deceleration)
A. Head compression
B. Cord compression
C. Maternal chronic anemia
D. Preeclampsia
E. Uteroplasenta insufficiency

74. When performing step down in this image as a part of a peripartum hysterectomy
particular care must be taken avoid injury to what structure?
A. Ureter
B. Bladder
C. Urethra
D. Bowel
75. Ninety five percent of patiens with SLE experienced all except which of the following
clinical manifestation?
A. Fever
B. arthralgia
C. Proteinuria
D. Weight loss
E. Myalgia
76. Which of the following clinical scenarios meets the definition of amenorrhea?
A. 12 yo with Tanner stage breast development
B. 16 yo with tanner stage II breast development
C. 14 yo with tanner stage III breast development
D. 18 yo with tanner stage V breast development and cessation of menses for the last one
cycles
E. 18 yo with tanner stage V breast development and cessation of menses for the last two
cycles

77. A 25 yo lady G1 term pregnancy comes to delivery room in active phase of labor. You
perform CTG, and you find the CTG as the following (di gambar : early deceleration)
This deceleration most likely reflects which of the following?
a. Head compression
b. Cord compression
c. Maternal chronic anemia
d. Severe preeclampsia
e. Uteroplacental insufficiency

78. Which of the following twin pregnancies would be candidate for fetoscopic laser ablation
therapy for TTTS?
a. Monochorionic diamnionic twins at age 23 week gestation with stage I TTTS
b. Dichorionic diamnionic twins at 19 weeks gestation with stage II TTTS
c. Monochorionic diamniotic twins at 15 weeks gestation with stage IV TTTS
d. Monochorionic di amniotic twins at 21 weeks gestation with stage III TTTS
e. Monochorionic di amniotic twins at 14 weeks gestation with stage III TTTS

79. A 55 year old healthy woman undergoes exploration for a large pelvic mass. Frozen
section analysis of her right ovary notes “mucinous low malignant potential, cannot
exclude invasion”. There is no othe obvious disease. What surgical procedures should be
performed, in addition to TAH and BSO ?
 a. Pelvic washing, omentectomy, multiple peritoneal biopsy
b. Pelvic washing, omentectomy, multiple peritoneal biopsy, bilateral pelvic and oara
aortic lymph node dissection
c. Pelvic washing, omentectomy, multiple peritoneal biopsy, bilateral pelvic and oara
aortic lymph node dissection, appendectomy
d. The procedure done was completed
e. Omentectomy, multiple peritoneal biopsy, bilateral pelvic and oara aortic lymph node
dissection

80. In the post menopausal woman with uterine bleeding, evaluation of the endometrium
maybe accomplished by endometrial biopsy, hysteroscopy, or TVS. Which of the following
sonographic endometrial thickness is commonly used as a threshold to indicate low risk
for endometrial hyperplasia or cancer?
a. 1 mm
b. 5 mm
c. 7 mm
d. 10 mm
e. 12 mm

81. A defect in the anterior abdominal wall that abdominal contents of the fetus covered only
by a two layered sac of amnion and peritoneum :
a. Omplalocele
b. Gastroshisis
c. Diaphragmatic hernia
d. Duodenal atresia
e. Posturethral value

82. Which of the following is not risk factor for vulvar cancer?
a. Lichen planus
b. Tobacco abuse
c. Lichen sclerosis
d. Human papilloma virus
e. Herpes simplex virus

83. Which of the following is the most common cause of first trimester pregnancy loss?
a. Uterine anomalies
b. Incompetence cervix
c. Intrauterine infection
 d. Fetal chromosomal abnormality
e. Placenta adhesive

84. Which of the following NOT clinical indicator of heart disease durng pregnancy?
a. Cyanosis
b. Clubbing
c. Systolic murmur grade 2/6
d. Diastolic murmur
e. Cardiomegaly

85. Fetal hyperinsulinemia in the second half of pregnancy is NOT associated with which of the
following?
a. Macrosomia
b. Neonatal hypoglycemia
c. Maternal hyperglycemia
d. Increased maternal weight
e. Increased chance of neonatal acidosis

86. Increased serum free thyroxyne levels in women with hydatiform moles stem from
increases which of the following?
a. Maternal estrogen levels
b. Fetal thyroxyne production
c. Maternal progesterone levels
d. Maternal BhCG levels
e. Maternal estriol levels

87. A 35 year old, G$P#, woman at 32 weeks of GA referred to you from internal medicine with
TB in pregnancy. Her LMP correspond to 32 weeks of GA. BMI during pregnancy is 7 kg. ANC is
done by midwife, never had an ultrasound examination before. Her fundal height is 24 cm no
contraction and FHR xxx. With regard to TB in pregnancy
a. It is caused by xxxx Mycobacterium
b. Delayed treatment in pregnancy is associated with IUGR and prematurity
c. Vertical transmisi to the fetus is common
d. The drugs isoniazid, ethambutol and streptomycin are save in pregnancy
e. TB is not a risk factor for preterm labor

88. With regard to the diagnosis of malaria in pregnancy

a. Severe malaria is defined as parasitemia of >50%
 b. Her full blood count will show normal Hb but low PLT
c. She is not likely to have the disease if she has been compliant with prophylaxis
d. A rapid detection test should be performed to exclude malaria
e. Three negative malaria smear 12-24 hours apart will rule out malaria if the patient is
febrile

89. A 33 year old G2P1 presents at 35 weeks gestation with complaints of nausea and vomiting.
Laboratory evaluation reveals markedly decrease glucose level, elevated transaminase
level, renal dysfunction and coagulopathy. What is the possibility diagnosis in this patient?
a. Intrahepatic cholestasis
b. Acute fatty liver of pregnancy
c. Acute hepatitis
d. Mon alcoholic fatty liver disease
e. Cirrhosis hepatis

90. Which of the following is the characteristic histologic renal lesion of preeclampsia cases?
a. Glomerular endotheliosis
b. Interstitial fibrosis
c. Crescent formation
d. Renal cortical necrosis
e. Glomerular sclerosis

91. Which of the following test would be the most efective in identifying an underlying cause of
recurrent miscarriage ?
a. Antithrombin III
b. Serum progesterone levels
c. Lupus anticoagulant assay
d. Luteinizing hormone assay
e. Serum estrogen level

A 22 year old G1P0 at 36 weeks by LMP presents via ambulance to car accident,she’s
complaining of severe abdominal pain and profuse vaginal bleeding. The patient is unstable and
unable to communicate coherently. The ambulance paramedic repots that initially her BP was
130/80 mmHg and pulse was 110 bpm, but she has lost at least 500 mL blood in route. On
examination her BP is 90/50 mmHg, pulse rate is 120 bpm, she appears to be in significant
pain, is unable to answer question, and her abdomen feel rigid.

92. What is the best next step?

 a. Sterile speculum examination, followe by senile vaginal examination
b. Abdominal ultrasound
c. Stabilize the patient, obtain two large bore IV catheters, and start IV fluid bolus while
checking for fetal heart tones
d. Emergent CS
e. TVS

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

94. 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. The maneuver most likely
worsen the situations would be to
a. Immediately finish delivering the placenta by removing it from the inverted uterus
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 direction of
the long axis vagina
e. Have anesthesiologist administer halothane anesthesia for uterine relxation

95. A 40 years old lady came to antenatal clinic for routine check up. She is G3P2, in 16 weks of
gestation. Her previous history is unremarkable, and physical examination corresponds to
16 weeks of gestation. She is really concern about her pregnancy in advanced maternal
age. Which of the following is not included in the quadruple test for aneuploidy?
a. NT examination
b. Maternal s erum AFP
c. hCG
d. Unconjugated estriol
e. Inhibin alpha

96. Which of the following symptoms of adenomyosis is correctly paired with its etiology?
a. Dysmenorrhea – Increased prostaglandine production
b. Dysmenorrhea – hemorrhage within the ecopic glandular foci
 c. Menorrhagia - increased and abnormal vascularization of the adenomyotic tissue
d. Infertility – increased and abnormal vascularization of the adenomyotic tissue
e. Its severity doesn’t correlate with ectopic foci and degree of invasion

97.A 24 year old G3PP2 present with vaginal bleeding, a BhCG level 300,000 miU/mL, utetrine is
consistent with a 12 week gestation, B negative blood tupe and the sonographic correspond to
honeycomb appearance. What is the most appropriate management?
a. Plan for hysterectomy
b. Rhogam administration and bed rest
c. Plan for dilatation and curettage
d. Repeat a serum BhCG level in 48 hours
e. Repeat a serum BhCG level in 24 hours

98. A 30 yo G1 32 weeks came to policlinic with dysuria since 3 days before. Her BP was 120/80
mmHg, pulse 92 bpm, RR 20 x/I. Fever was denied, urinary frequency was present. Lower
abdominal tenderness was positive, no sign of costovertebral pain. From her complete blood
count reveals Hb 10,8 g/dL, HCT 32%, leucocyte 14000, PLT 167000. Urinary tract changes in
pregnancy:
a. During pregnancy, the rs of upper urinary tract infection is similar compared to non
pregnant women
b. Urinary tract changes during pregnancy caused by progesterone induced relaxation of
the muscularis
c. some changes in urinary tract develop after 14 weeks of pregnancy
d. Glomerular filtration rate usually decreased 20% in pregnancy
e. During pregnancy, kidney become smaller and renal calyces become dilated

A 27 yo patient and her husband present to you with primary infertility. The patient reports
regular periods every 28 to 30 days. The patient has no significant medical history aand destnt
take any medications other than prenatal vitamins. Her husband is also in good health, is 30
year of age, and has two children from a previous marriage. When you asked the patient how
long they have been trying o achieve a pregnancy, they tell you 6 months.

99. Your instructions to the couple are the following:

a. They will likely need IVF to acheve a pregnancy
b. They will likely need IUI cycles
c. Continue trying appropriately timed intercourse for 6 more moths and if no pregnancy
is achieved, come back to see you
d. Consider donor egg
 e. Consider adoption

100. The couple comes back to you after appropriately timed intercourse not having achieved a
pregnancy. At this time you embark on a workup that includes a semen analysis , an HSG, and
an endocrine evaluation including FSH, E2, TSH, prolactin levels. And ovarian reserve testing. All
of the tests come back normal. Your next recommendation :
a. Have 6 more months of times intercourse and if no pregnancy is achieved come ack to
see you
b. Clomiphene citrate with IUI
c. IVF
d. Donor egg
e. Human gonadotropin (hMG)