1.

A 36 years old patient, G4P3, 37 wga, obese patient came into policlinic with
diagnosis diabetes mellitus in pregnancy and history of previous CS 2x. She is
scheduled for elective caesarean section at 38 completed weeks of gestational age.
She had a poor glycemic control with oral antidiabetic regiments.6 hours prior to her
surgery you found that her random blood glucose is 297g/dL. What do you think is
the best method for her pre-operative glycemic control?
a. Sliding scale using insulin
b. Combine her oral antidiabetic with long acting insulin
c. Postpone her surgery due to uncontrolled blood glucose level
d. Combine her oral antidiabetics with another type of oral antidiabetic
e. Increase the dose of her oral antidiabetic medication
2. A 39 years old woman (G4P4) has had a complicated pregnancy with Graves disease.
She has delivered 4 hours ago. Her thyroid levels and TSH levels have been in the
normal range throughout gestation. Among which of the following will her infant
most likely be?
a. Mongoloid infant
b. Hyperthyroid infant
c. Hypothyroid infant
d. Infant with ambiguous genitalia
e. Infertile infant
3. A previously energetic woman complains of crying, loss of appetite, difficult in
sleeping, and feeling of low self-worth, beginning approximately 3 days after a
normal vaginal delivery. These feelings persisted for approximately 1 week and then
progressively diminished. Patient with psychiatric disorders can result to poor
pregnancy outcome such as?
a. Increased risk of post partum hemorrhage
b. Major congenital anomaly
c. Preeclampsia
d. Increased rate of cesarean section
e. Low birthweight
4. A 56 year old lady present to gynecology outpatient clinic with postmenopausal
bleeding. A thorough clinical workup reveals an endometrial thickness of 7 mm with
a regular basement membrane. She underwent hysteroscopy biopsy, and the
histopathology result was simple hyperplasia without atypia. What is the best
management option for this patient?
a. Curettage
b. Total hysterectomy and bilateral salpingo-oophorectomy
c. LING-IUS
d. Endometrial ablation
e. Total hysterectomy
5. A 18 year old adolescent female complains of not having started her menses. Her
breast development is Tanner stage I. Pubic hair development was stage I. from
vaginal examination found a small uterus and normal vagina and vulva. Which of the
following describes the most likely diagnosis?
 a. Partial androgen insensitivity syndrome
b. Gonadal dysgenesis
c. Complete androgen insensitivity syndrome
d. Late onset congenital hyperplasia
e. Swyer syndrome
6. A 18 years old girl come to the emergency room with pelvic pain for 2 days. She has
low grade fever. She has regular menstrual cycle. From the physical examination an
intense of low abdominal pain was marked even more on palpation. There was a
muscle defense, on the right lower abdomen quadrant. On abdominal ultrasound
reveals a mass measuring 10 cm in the largest diameter on her pelvic characterized
with multiple hyperechogenic interfaces in a cystic mass in the right ovary. Uterus
anteflexed within normal limit. Left ovary within normal limit. There is no fluid in
pelvic cavity. What would be the working diagnosis?
a. Ovarian torsion
b. Endometriosis
c. An infected cyst
d. Ruptured cyst
e. Functional cyst
7. Numerous physiologic changes develop over the course of pregnancy and postpartum
however the greatest impact on potentially compromised cardiovascular system is?
a. Maximal increase in cardiac output occurs during second stage of labor
b. Decreased SVR in the first trimester and increase after 32 weeks
c. Increased total plasma volume in second trimester
d. Stroke volume decrease after delivery of placenta
e. Maximum heart rate increases in the second trimester
8. A 49 year old woman had a radical hysterectomy and lymph node sampling for stage
1B squamous cells cancer of the cervix. A suprapubic catheter was placed at the time
of surgery. She is now 8 weeks postoperative and has not been able to void. She is
also leaking urine with activity, coughing and sneezing. What is the most likely
diagnose of this patient?
a. Overflow incontinence
b. Mixed incontinence
c. Vesicovaginal fistula
d. Urge incontinence
e. Stress incontinence
9. Mrs A 24 years old came to the ER with complaint of headaches since the last day of
examination obtained expecting her first child, gestational age 32 weeks with blurred
vision and denied heartburn. On physical examination found BP 190/120mmHg, pulse
90x/m, breathing 16x/m. Leopold found the lower left back head, FHR 140 bpm,
irregular contraction. Pelvic score of 1 was found, pelvis size wide. Laboratory
investigation, hemoglobin 11.5 g%, platelet 9000/m3, LDH 510iu/L, LDH 510 iu/L,
Proteinuria +2, ALT 15 u/L, AST 15 u/L. What is the best diagnosis for Mrs. A?
a. Gestational hypertension
b. HELLP syndrome
 c. Superimposed preeclampsia
d. Chronic hypertension
e. Severe preeclampsia
10. A previously energetic woman complains of crying, loss of appetite, difficult in
sleeping, and feeling of low self-worth, beginning approximately 3 days after a
normal vaginal delivery. These feelings persisted for approximately 1 week and then
progressively diminished. Pregnancy could exacerbate some coexisting mental
disorders due to?
a. Pregnancy-related shifts in monoamine neurotransmitter levels
b. Lack of certain minerals in pregnancy that could affect limbic system
c. Lack of affection from spouse and family members
d. Certain medication could interfere brain function during pregnancy
e. Body changes cannot easily accepted by women
11. A patient present to you with pain and swelling in the vulva. On examination you find
a reddish bulge on the vaginal introitus at 4 o’clock positions sized 3 cm, cystic and
pain on palpation. What treatment of choice for this condition?
a. Marsupialization
b. Antibiotic for 7 days
c. Incision and drainage
d. Excision of the glands
e. Cystectomy
12. Mrs. N 27 years old with chief complain of infertility for 2 years with history of
severe dysmenorrhea. From hysterosalpingography, both tubes were patent. Pelvic
ultrasound found bilateral cystic mass with internal echo sized 25 and 40 mm in
diameter, her antral follicle count was 12. Her husband sperm examination was within
normal limit. What is the next appropriate management?
a. Give Dienogest 1x2 mg for 6 months
b. Give GnRH analog for 3 months continue with IUI
c. Offer her IVF
d. Offer her IUI
e. Perform laparoscopy cystectomy and adhesiolysis
13. A 33 year old woman come to outpatient clinic with recurrent pregnancy loss. Patient
has been married for 5 years, has already examined for infertility workup with normal
results. Patient has experienced 3 times abortion. The first and the second pregnancy
was in 6 weeks gestation, the third pregnancy was in 8 weeks gestation. Patient had
never performed diagnostic work up regarding this condition. What cells contribute in
the early implementation process of pregnancy?
a. Natural killer cell
b. T cells
c. Antiphosfolipid antibodies
d. Basophil
e. Eosinophil
14. Concerning middle cerebral artery Doppler velocimetry, which of the following is
true?
 a. It is useful to detect fetal growth restriction
b. It was found to be inferior to amniocentesis and amnionic fluid spectral
analysis for predicting fetal anemia
c. In those with brain sparing, decreased blood flow from reduced
cerebrovascular impedance is detected
d. It is useful for detection and management of fetal anemia
e. It is superior to the modified biophysical profile in forecasting pregnancy
outcomes
15. A 52 years old woman came to ER with complaint of shortness of breath since 2 days
ago. She also noticed an abdominal enlargement since 6 months ago. If on Ultrasound
examination reveal a regular 7 cm solid tumor with non vascular appearance and
ascites. And on chest X-Ray reveal a right moderate pleural effusion with no
abnormality in lung parenchym. What is the most likely diagnosis of this condition?
a. Mature cystic teratoma
b. Meigs syndrome
c. Tuberculosis
d. Colon cancer
e. Malignant ovarian tumor
16. Which of these following gives the highest score in Placenta Acreta index? What is
the most potential perioperative problem of this patient?
a. >2 caesarean deliveries
b. Bridging vessels
c. Lacunae grade 3
d. Sagittal smallest myometrial thickness 1mm
e. Anterior placenta previa
17. A 45 years old woman presents to your office for consultation regarding her
symptoms of menopause. She stopped having periods13 months ago after BSO
operation and is having sense hot flushes. She is considering hormonal therapy to
alleviate it. Which of the following is true regarding menopause condition?
a. Hormonal therapy are contraindicated in patient with chronic kidney disease
b. Combine E-P hormonal therapy has a lower risk of breast cancer in compared
to Estrogen only therapy
c. Combine oral contraception is a first line therapy for menopause
d. Early intervention by giving hormone therapy will lower risk of CVD in
menopause patient
e. Hormonal therapy in menopause patient has a higher risk of colorectal cancer
18. A 25 year old woman underwent a uterine curettage after miscarriage and has had no
menses since. Pregnancy test was negative. Intrauterine adhesions were suspected.
Which of the following is associated with asherman syndrome?
a. It is commonly caused by curettage due to miscarriage
b. Associated with low estradiol levels
c. It is associated with anovulation
d. Associated with low cortisol levels
e. It is classified into 6 types according to American Fertility Society
19. A 36 year old woman presents to the office with a six months history of low pelvic
pain. Which of the following is the LEAST likely cause?
a. Ectopic pregnancy
b. Adenomyosis
c. Pelvic inflammatory disease
d. Inflammatory bowel disease
e. Interstitial cystitis
20. A 27 year old patient, P1, come with 7 months of amenorrhea. Her pregnancy test
showed negative result. Her general status was normal. On ultrasound examination
revealed hyperechoic 14 mm endometrial line. On the right ovary there was anechoic
mass size 20 mm, left ovary was normal. Which of the following is clinical
consequences if this condition left untreated?
a. Increased risk of ovarian cancer
b. Increased risk of breast cancer
c. Increased risk chronic kidney disease
d. Increased of intermenstrual bleeding
e. Increased risk of endometrial cancer
21. A 23 year old G1 32 weeks is being admitted to the hospital because of preterm
contraction. The patient complaint regular contraction Antenatal care was done
regularly in PHC. No remarkable abnormality was found during ANC. BMI before
pregnancy was 30 kg/m2, weight gain during pregnancy is 14 kg. Abdominal
examination showed FUT 36 cm, regular contractions, fetal heart beats 154 bpm.
Speculum examination showed closed ostium uteri externa. An ultrasound shows the
estimated fetal weight 2400 g, AFI 30 cm, no fetal morphology abnormalities,
placenta implanted in anterior corpus, cervical length 1.8 cm, funneling positive.
Laboratory results were Hb 10,7 g/dL, Ht 33%, Leucocyte 13.500, Thrombocyte
315.000 MCV 82 MCH 30. What is the most appropriate next step in the management
of this patient?
a. Schedule for cervical cerclage
b. Give intravenous iron
c. Give MgS04 for neuroprotection
d. Schedule for OGTT test
e. Give antibiotic prophylaxis
22. A 34-year-old woman attends for her booking in her third pregnancy. She had a
caesarean section in her first pregnancy 4 years ago and has had a successful vaginal
birth after caesarean section (VBAC) 2 years ago. She has a BMI OF 26. What is the
best predictor for a successful VBAC?
a. Previous vaginal birth
b. Less than 35 years old
c. BMI of less than 30
d. Spontaneous onset of labour
e. Short inter-pregnancy interval
23. You are doing postpartum rounds on a 22-year-eld G1P1: who vaginally delivered an
male infant at 36 weeks following an induction due to severe preeclampsia. During
 her labor she required hydralazine to control her blood pressures. She is on
magnesium sulfate for seizure prophylaxis. Her vital signs are: blood pressure 154/98
mm Hg, pulse 93 beats per minute, respiratory rate 24 breaths per minute, and
temperature 37.3C. She has adequate urine output at greater than 40 cc/h. On
examination, she is oriented to time and place, but she is somnolent and her speech is
lured. She has good movement and strength of her extremities, but her deep tendon
reflexes are absent. Which of the following is the most likely cause of her symptoms?
a. Hypertensive stroke
b. Transient ischematic attack
c. Sinus venous thrombosis
d. Magnesium toxicity
e. Adverse reaction to hydralazine
24. A 24-year-old woman (gravida 2, para 0, abortus 1) is seen in the emergency
department because of vaginal bleeding and abdominal cramps. Her LMP was 10
weeks ago. History is unrevealing except for an induced abortion 2 years ago without
complications. She presently denies instrumentation for abortion. Physical
examination reveals a BP of 110/70 mm Hg, pulse 120, and temperature 101.8F. The
abdomen is tender with slight rebound in the lower quadrants. The pelvic examination
reveals blood in the vault and a foul-smelling discharge from the cervix, which is
dilated to 2 cm. The uterus is 8- to 10-week size and tender and no adnexal masses are
palpated. What is the most likely diagnosis?
a. hydatidiform mole
b. twisted ovarian cyst
c. septic abortion
d. pelvic inflammatory disease (PID)
e. choriocarcinoma
25. A hirsute obese, 24-year-old woman presents with irregular periods. Pelvic sonogram
demonstrates bilateral ovaries with multiple peripheral follicles. Which structure
produce gonadotropins?
a. Posterior pituitary
b. Ovarian cortex
c. Hipothalamus
d. Anterior pituitary
e. Ovarian stroma
26. A 29 year-old G1P0 patient at 15 weeks gestational age presents to your office
complaining of some shortness of breath that is more intense with exertion. She has
no significant past medical history/and.is not on any medication. The patient denies
any chest pain but sometimes feels as though her heart is pounding. She is concerned
because she has always been very athletic and cannot maintain the same degree of
exercise that she was accustomed to prior to becoming pregnant. On physical exam,
her pulse is 90/min. Her blood pressure is 90/50 mmHg. On cardiac exam, a systolic
ejection murmur is identified. The lungs are clear to auscultation and percussion.
What would you explain to the patient above?
a. Pulse pressure is decreased
 b. Pulmonary blood pressure is increased
c. Cardiac output is increased 1.5 L/min
d. Blood flow to uterus is increase by 200mL/min
e. Stroke volume remains unchanged during pregnancy
27. You had a patient, 3-4 years old with secondary amenorrhea and based on your
examination you suspected she had premature ovarian insufficiency (POI). Her FSH
level is 40 /U/L and estradiol level is 5 pg/mi, What is the best medication to be used
in this patient?
a. Combine injectable contraception monthly
b. Sequential estradiol valerate 1 mg with drospirenone 2 mg
c. Estradiol valerate 2 mg/day continuously
d. Combined oral contraceptive pill ethinil estradiol 30 ug/drospirenone 2 mg
e. Conjugated equine estrogen 0.625 mg/day continuously
28. Mrs. 37 years old, G3P2, 35 wga, came to E referred from nearby PHC due to high
blood pressure, on admission her blood pressure was 170/110 mmHg She complained
of epigastric pain followed by nausea and vomiting. She denied having contraction,
water broke, and bloody show, from her physical examination you found her fundal
height was 3 fingers above navel, head presentation, there was no contraction and no
dilation of cervix You decided to terminate the pregnancy by emergency cesarean
section due to impending eclampsia. The baby born with Apgar Score 678,
bodyweight 1480 g and diminished amniotic fluid. YOu suspected placental
insufficiency due to high blood pressure as the risk factor of IUGR, to confirm the
diagnosis the macroscopic appearance of the placenta and umbilical cord should be?
a. Umbilical cord length < 50 cm.
b. Umbilical cord with single umbilical artery
c. Thick wharton jelly
d. Placental weight less than 1/7 babyweight
e. Maternal side with wide hematome
29. Which of the following factors are least likely to be linked with higher first-trimester
miscarriage rates?
a. Diabetes mellitus
b. Obesity
c. Maternal age > 40 years old
d. Parvovirus infection
e. Thyroid disorders
30. At outpatient clinic, you are now examining a 38 week-pregnant patient with a BMI
of 16. She denies history of chronic diseases but she admits that she has lost her
appetite since the first trimester. Her vital signs are within normal limit. Her fundal
height is only at the level of 2 fingers above her umbilicus and the fetus is easily
palpated. The CTG reveals poor variability. During the ultrasonography examination,
the findings that will bo found related to her conditions are
a. Oligohydramnions and S/D ratio <3.
b. Normal AF and S/D ratio > 3.
c. Normal AF and S/D ratio «3.
 d. Oligohydramnions and S/D ratio0 > 3
e. Both normal AF, and oligrohydramnions are possible, and S/D ratio <3
31. Which waveform demonstrates reversed end-diastolic flow?

a. AC
b. C
c. B
d. A
e. BC
32. What is the appropriate next step in the management of this patient?
a. Ask patient to increase nutrient intake, particularly protein intake
b. Schedule for fetal growth ultrasound next week
c. Schedule for a biophysical profile (BPP)
d. Admit patient to the hospital for lung maturation
e. Admit patient to hospital for termination pregnancy
33. A patient presents with vulvar irritation and pruritis, Speculum examination reveals a
hyperemic, edematous, vaginal vault with odorless discharge. The pH is 4.0. These
symptoms had been recurrent more than 4 times during the last 1 year. What is the
most likely the cause of this condition?
a. Bacterial vaginosis
b. Candida sp
c. Neisseria Gonorrhoea
d. Trichomonas Vaginalis
e. Chlamydia trachomatis
34. A 29 years old patient, P0, presents to your clinic for fertility workup. She had been
married for 2 years with regular intercourse. Her menstrual cycle is normal. Her
general status was normal. Vaginal examination revealed normal findings. The
following month she came back with the result of hysterosalphyngography (see the
picture below). What will be your next step?
 a. Gives clomiphene citrate and plan for intrauterine insemination
b. Gives clomiphene citrate and plan for natural conception
c. Schedule operative laparoscopy
d. Plan for IVF
e. Order Semen Analysis
35. A parity 3 40-year-old woman complains of cyclical heavy and painful menstrual
bleeding. On examination she is found to have an enlarged globular uterus and a
transvaginal sonography revealed diffuse adenomyosis. She has completed her family
and currently relies on condoms for contraception. She smokes 10 cigarettes per day
but is otherwise fit and well. Choose the single best answer, which treatment would
you consider most appropriate
a. COCP
b. LNG-IUS
c. Endometrial ablation
d. GARH analogue
e. Hysterectomy
36. A 27 year old patient, P1, come with 7 months of amenorrhea. Her pregnancy test
showed negative result. Her general status was normal. On ultrasound examination
revealed hyperechoic 14 mm endometrial line. On the right ovary there was anechoic
mass size 20 mm, left ovary was normal. Which of the following might be the cause
of secondary amenorrhea in this patient?
a. Central amenorrhea
b. Anovulatory cycle
c. Kallman syndrome
d. Primary ovarian insufficiency
e. PCOS
37. At outpatient clinic, you are now examining a 38 week-pregnant patient with a BMI
of 15. She denies history of chronic diseases but she admits that she has lost her
appetite since the first trimester. Her vital signs are within normal limit. Her fundal
height is only at the level of 2 fingers above her umbilicus and the fetus is easily
palpated. The CTG reveals poor variability. During the ultrasonography examination,
the findings that will be found related to her conditions are
a. Oligohydramnions and S/D ratio <3.
b. Normal AFI and S/D ratio > 3.
 c. Normal AFI and S/D ratio <3.
d. Oligohydramnions and S/D ratio > 3
e. Both normal AFI, and oligohydramnions are possible, and S/D ratio <3.
38. A hirsute obese, 24-year-old woman presents with irregular periods. Pelvic sonogram
demonstrates bilateral ovaries with multiple peripheral follicles. Which is the most
likely laboratory result from this patient?
a. High estradiol level
b. High FSH level
c. High LH level
d. High prolactin level
e. High progesterone level
39. Which of the following is the best term to diagnose maternal primary CMV infection?
a. Ig M negative, Ig G positive
b. Ig M positive, Ig G positive high avidity
c. Ig M negative, Ig G negative
d. Ig M positive, Ig G positive low avidity
e. Ig M positive, Ig G negative
40. Mrs. 37 years old G3P2, 35 wga came to ER referred from nearby PHC due to high
blood pressure, on admission her blood pressure was 170/110 mmHg. She complained
of epigastric pain followed by nausea and vomiting. She denied having contraction
water broke, and bloody show, from her physical examination you found her fundal
height was 3 fingers above navel, head presentation, there was no contraction and no
dilation of cervix. You decided to terminate the pregnancy by emergency cesarean
section due to impending eclampsia. The baby born with APGAR score 6/8,
bodyweight 1480 g, and diminished amniotic fluid. When you were performing
informed consent before the cesarean section, you were explaining the neonatal
complication of IUGR one of them is ?
a. Cerebral Palsy
b. Susceptibility to infection
c. Retinopathy
d. Transient tachypneu of the newborn
e. Delayed lung maturation
41. A30-year-old G3P2002 presents to the obstetrician's office at 34 weeks for a routine
prenatal visit. She has a history of two prior cesarean sections (low-transverse). The
first cesarean section was performed secondary to fetal malpresentation (footling
breech). The patient then had an elective repeat cesarean section for her second
pregnancy. This pregnancy; the patient has had an uncomplicated prenatal course. The
patient is interested in permanent sterilization and wonders it would be better to
undergo another scheduled cesarean section so she can have a bilateral tubal ligation
performed at the same time. Which of the following statements is true and should be
relayed to the patient?
a. The patent should schedule an elective induction if not delivered by 40 weeks
b. Her risk of uterine rupture with attempted VBAC after two prior cesarean
sections is 5%
 c. A history of two previous cesarean sections is a contraindication to vaginal
birth after cesarean section (VBAC)
d. d. If the patient desires a bilateral tubal ligation, it is safer for her to undergo a
vaginal delivery followed by a postpartum tubal ligation rather than an
elective repeat cesarean section with intrapartum bilateral tubal ligation
e. Her chance of having a successful VBAC is less than 70%
42. A 30 years old patient came with complaint of infertility. Her husband is a 33-year-
old who has had a semen analysis, which was reported as normal. On further history,
the patient reports that her periods have been quiet irregular over the last year and that
she has not had period in the last 3 months. She also reports of weight gain and
abnormal hair growth. From ultrasound we found multiple follicles size 2-8 mm in
both ovaries. Which of the following correlate to this condition?
a. Midluteal progesterone level of 4 ng/ml
b. Serum AMH level 2,6 ng/ml
c. Positive Clomiphene citrate challenge test
d. Day 3 FSH level 20 IU
e. Follicle antral basal count of 12
43. A 26-year-old woman complains of recurrent bouts of bacterial vaginosis (BV)
despite successful initial treatment. She does not douche or smoke and has been in a
monogamous relationship or 6 years. Recurrence of BV after initial treatment is
common (up to 30 percent), which can be frustrating of the patient. Which of the
following consistently decreases recurrence rates and should be recommended to this
patient?
a. Probiotics and reintroduction of lactobacilli
b. Treatment of long continuous antibiotic
c. Use of acidifying vaginal gels
d. No intervention consistently decreases recurrence
e. Treatment of male partners
44. A 20-year-old primigravida presents at 39 weeks. She has been healthy up to this
point. She has a headache and a loss of appetite. Her face and hands are swollen, and
she cannot wear her rings. Her BP is 168/90 mm Hg, and she has 1+ protein. The
fetus has a reassuring monitoring strip. Which of the following is the best treatment
for her preeclampsia?
a. delivery either by cesarean or by vaginal
b. modified bed rest
c. gentle diuresis, with careful monitoring of intake and output
d. an antihypertensive drug that does not affect uterine blood flow
e. magnesium sulfate
45. Your patient is a 13-year old adolescent girl who presents with cyclic pelvic pain. She
has never had a menstrual cycle. She is afebrile and her vital signs are stable. On
physical examination, she has age-appropriate breast and pubic hair development and
normal external genitalia, there is no bulge in the introitus of vagina and no hymenal
structure seen. You obtain a transabdominal ultrasound, which reveals a hematocolpos
and hematometra. What is the most likely diagnosis?
 a. Imperforate hymen
b. MRKH
c. Distal Transverse vaginal septum
d. Distal Vaginal agenesis
e. Longitudinal vaginal septum
46. A 35-year-old woman (gravida 7, para 5, abortus 1) is in the active phase of laborwith
the vertex at ?1station. She complains of abdominal pain with the contractions. At the
height of one contraction, the pain becomes very intense. Following this intense pain,
uterine contractions cease. The maternal systolic BP drops 15 mmHg. What is the best
course of action?
a. Begin oxytocin
b. Perform an ultrasound
c. Place the patient on her side and reassure her
d. Immediately perform a pelvic examination
e. Manage expectantly
47. A 29 years old G3P2A0 presents to the emergency center with complaints of
abdominal discomfort for 2 weeks. Her vital signs are BP120/70 mmHg, pulse 90
beats / min, temperature 36C, respiratory rate 18 breath / minute. A pregnancy test
was positive and an ultra sound of the abdomen and pelvis reveals a visible 16 weeks
gestation located behind a normal appearing 10x6x5.5cm uterus. Both ovaries appears
normal. No free fluid noted. Which of the following is the most likely cause of these
finding?
a. Tubal Abortion
b. Uterine Rupture of Prior Cesarean Section Scar
c. Ectopic ovarian tissue
d. Primary Peritoneal Implantation of the fertilized ovum
e. Fistula between the peritoneum and the uterine cavity
48. A 23 years old G1 26 weeks gestation come to your outpatient clinic for routine
prenatal screening. Patient had known with monozygotic twin gestation. Estimated
fetal weight for fetus A is 804 grams, where as fetus B is 643grams. Deepest vertical
pocket fetus A is 9.6cm and fetus B 2.2cm. Which of the following condition most
likely explained these finding?
a. Gestational diabetes mellitus
b. Twin – twin transfusion syndrome
c. Preterm premature rapture membrane in fetus B
d. Congenital anomaly in fetus A
e. Selective IUGR
49. Patient 65 years old, P4 came to outpatient clinic with chief complaint of frequent
urination. Since 6 months ago she feels the urge to void every hour and also she has to
wake up 3-4 times to void. She never leaks urine. She doesn’t feel any pain during
urination and no blood in the urine. She already came to general practitioner and got
antibiotics for 7 days but the symptoms remained. What is the most useful supporting
examination in these patient?
a. Bladder diary
 b. Pelvic floor ultrasound
c. Gynecology ultrasound
d. Urine culture
e. Urodynamic evaluation
50. A 36 years old of G2P1 presents to antenatal clinic in tertiary referral hospital. She
had an emergency cesarean section for sudden onset hypertension and placental
abruption at 30 weeks in her previous pregnancy. She is currently 12 weeks of
gestation and enquiries about farther plan of fetal monitoring in this pregnancy. What
is the most accurate advice to do at 12 weeks?
a. BMI calculation
b. Check sFLT-1/PLGF ratio
c. Check urine microalbuminuria
d. Mean arterial pressure calculation
e. Pulsality index uterine artery doppler
51. A 29 year-old G1P0 patient at 15 weeks gestational age presents to your office
complaining of some shortness of breath that is more intense with exertion. She has
no significant past medical history/and.is not on any medication. The patient denies
any chest pain but sometimes feels as though her heart is pounding. She is concerned
because she has always been very athletic and cannot maintain the same degree of
exercise that she was accustomed to prior to becoming pregnant. On physical exam,
her pulse is 90/min. Her blood pressure is 90/50 mmHg. On cardiac exam, a systolic
ejection murmur is identified. The lungs are clear to auscultation and percussion.
What is the most possible cause of her complain ?
a. Pulmonary embolism
b. Eisenmenger syndrome
c. Normal cardiovascular changes
d. Myocardial infarction
e. Valvular heart disease
52. A 40 year old parity 3 comes to your office to discuss contraception. She has been
married for 15 years old and smokes one pack of cigarettes per day. She was
diagnosed with systemic lupus erythematosus (SLE) at the age of 20 years and has
only been hospitalized once for an acute exacerbation of joint swelling and fatigue.
Her BMI is24,and she has light to normal menstrual flow. She has no plans for a
future pregnancy but is not ready to commit to permanent sterilization. After
counseling, she decided to use progestin-only pills. Compared to users of combination
OCs, users of progestin-only OCs (minipills) are less likely to experience which of the
following?
a. Intrauterine pregnancy
b. Ectopic pregnancies
c. Mood swings
d. Irregular vaginal bleeding
e. Gonadotropin supression
53. Which of the following is the most common ultrasound findings in CMV infection?
a. Ventriculomegaly
 b. Fetal hydrops
c. Hepatomegaly
d. Intrauterine growth restriction
e. Placentomegaly
54. A 45 years 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 body mass index is 35
kg/m2. For asymptomatic grade 1 pelvic organ prolapse, what do you recommend?
a. Pelvic floor muscle exercise
b. Weight loss program
c. Reconstructive surgery
d. Pessary
e. Laser vaginal rejuvenation
55. A 34 year old G1 at 26 4/7 weeks presents for her scheduled obstetric (OB)
appointment. The patient denies complaints today. Fetal movement is active. BMI
before pregnancy was 29 kg/m2, gestational weight gain is 9 kg. Vital sign are
normal. Abdominal examination today shows a gravid uterus measuring 26 cm. fetal
heart tones (FHT) are in the 140s. Laboratory results were Hb 10,1 g/dL, Ht 30%,
Leucocyte 10.500, Thrombocyte 165.000 MCV 78 MCH 28. OGTT result was fasting
102 mg/dL and 2 hours after 75 glucose 156 mg/dL. What is the most likely diagnosis
for this case?
a. Inadequate maternal weight gain
b. Pre-gestational diabetes mellitus
c. Iron deficiency anemia
d. Maternal overweight
e. Gestational diabetes mellitus
56. 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 semen analysis show a volume 3 ml,pH of 7 and a
sperm count of 20million/ml. according to the current International Guidelines which
oh the following is true regarding ovulation induction in PCOS?
a. Use of aromatase inhibitor reserved for Clomiphene failure patient
b. Clomiphene citrate has a similar risk of multiple pregnancy compared to
aromatase inhibitor
c. Gonadotropin cannot be used as a first line treatment
d. Use of gonadotropin correlate with lower cost of ovulation induction
e. If there are more than two mature follicles ovulation trigger should be
cancelled
57. A 28 year old woman is hoping to become pregnant soon. She is worried about her
history of acute pelvic inflammatory disease (PID) when in college 8 years ago.
Which of the following is the pathogenesis of infertility due to history of PID?
a. Direct destruction of tubal mucosa by chlamydia
b. Ovulatory dysfunction due to pelvic inflammatory disease
 c. Inflammation of the endometrium
d. Inflammatory response followed with fibrosis to protein released by
chlamydia
e. Inflammation that hinders spermatozoa movement inside the uterus
58. Which of the following is true regarding COVID 19 in pregnancy?
a. Evidence showed that pregnancy offers an altered immunity scenario which
may allow severe COVID-19 disease
b. Vertical transmission is unlikely because placenta has low expression of
ACE2 receptor
c. Recommendation mode of delivery in pregnant women with COVID-19
isnormal delivery with1 health provider
d. Preterm delivery and preeclampsia are increase in pregnant woman with
COVID-19
e. No anti-viral was approved by FDA for pregnant woman
59. A 17 year old G1 20 weeks gestation come to your outpatient clinic for routine
antenatal care. No complaint regarding pregnancy. During sonographic examination,
you find ventriculomegaly appearance as seen below

Severe ventriculomegaly is diagnosed when lateral ventricular atrial width exceed

what threshold?
a. 7 mm
b. 15 mm
c. 5 mm
d. 10 mm
e. 19 mm
60. A 40 year old parity 3 comes to your office to discuss contraception. She has been
married for 15 years old and never smokes cigarette. She had history of repeated
preeclampsia in all of her pregnancies before. She was diagnosed with systemic lupus
erythematosus (SLE) at the age of 20 years and with history of musculoskeletal an
hematologic flare. Her BMI is 26, haemoglobin level is 9.9 g/dl. Which of the
following method is the preferred method of contraception?
a. Progestin injection
b. Copper T IUD
c. Tubal sterilization
 d. COC pills
e. Progestin only pills
61. You are counseling a couple at your clinic who desire VBAC (Vaginal Birth After
Caesarean Section). Her baby is in a vertex presentation appropriate size for 37
weeks, and her previous low transverse procedure was for breech presentation. In
providing informed consent, in which of the following ways do you explain the risk of
uterine rupture?
a. Dependent on the location and proximity of the scar site to the placental
implantation
b. Less than 1%
c. 15-20%
d. Dependent on the length of her labor
e. Between 2% and 5%
62. During an operation,a midline incision was made at an anatomic location 2 cm below
the umbilicus. Which of the following lists (in order) the layers of the anterior
abdominal wall as they would be incised or separated?
a. Skin, subcutaneous fat, superficial fascia (Camper’s), deep fascia (Scarpa’s),
fascial muscle cover (anterior rectus sheath), rectus muscle, a deep fascial
muscle cover (posterior rectus sheath), preperitoneal fat, and peritoneum
b. Skin, subcutaneous fat, superficial fascia (Camper’s), deep fascia (Scarpa’s),
fascial muscle cover (anterior rectus sheath), transverse abdominal muscle, a
deep fascial muscle cover (posterior rectus sheath), preperitoneal fat, and
peritoneum
c. Skin, subcutaneous fat, superficial fascia (Camper’s), deep fascia (Scarpa’s),
fascial muscle cover (anterior rectus sheath), rectus muscle, a deep fascial
muscle cover (posterior rectus sheath), peritoneum, and preperitoneal fat
d. Skin, subcutaneous fat, superficial fascia (Scarpa’s), deep fascia (Camper’s),
fascial muscle cover (anterior rectus sheath), transverse abdominal muscle, a
deep fascial muscle cover (posterior rectus sheath), preperitoneal fat, and
peritoneum
e. Skin, subcutaneous fat, superficial fascia (Scarpa’s), deep fascia (Camper’s),
fascial muscle cover (anterior rectus sheath), rectus muscle, a deep fascial
muscle cover (posterior rectus sheath), preperitoneal fat, and peritoneum
63. A hirsute obese, 24-year-old woman presents with irregular periods. Pelvic sonogram
demonstrates bilateral ovaries with multiple peripheral follicles. What is the most
appropriate management for this patient?
a. Surgical management
b. GnRH agonist
c. Observation
d. Metformin
e. Combine oral contraceptive pills
64. A 33 years old woman with morbid obesity was plan for laparoscopy cystectomy due
to endometriosis cyst. Patient had history of laparotomy cystectomy 2 years before.
 Regarding her condition, which of following that cannot be used to compensate for
difficulties during laparoscopy?
a. Placement of additional ancillary ports to assist ini lifting a father omentum
from the operating field
b. Use of gel pad beneath the patient and tucking of patient to limit patient
slippage while Trendelenburg position
c. Steeper Trendelenburg position to improve patient ventilation
d. Veres needle insertion at an angel that is nearly perpendicular to the skin
e. Placement of initial trochar in Lee Huang’s point
65. A healthy 20 year old G1P0 presents for her first OB visit at 10 weeks gestational age.
She denies any significant medical history both personally and in her family. Which
of the following tests is not part of the recommended first trimester blood testing for
this patient?
a. Complete blood count (CBC)
b. Blood type and screen
c. Hepatitis B surface antigen
d. Screening for human immunodeficiency virus (HIV)
e. One hour glucose challenge testing
66. A 40 year old parity 3 comes to your office to discuss contraception. She has been
married for 15 years old and smokes one pack of cigarettes per day. She was
diagnosed with systemic lupus erythematosus (SLE) at the age of 20 years and has
only been hospitalized once for an acute exacerbation of joint swelling and fatigue.
Her BMI is 24, and she has light to normal menstrual flow. She has no plans for a
future pregnancy but is not ready to commit to permanent sterilization. Which of the
following condition is NOT an absolute contraindication to COC pill use
a. History of current thromboembolism
b. Abnormal liver function
c. Coronary artery disease
d. History of breast lump
e. Tobacco use of greater than or equal to 15 cigarettes/day over the age of35
years
67. A 27 year old patient, P1, come with 7 months of amenorrhea. Her pregnancy test
showed negative result. Her general status was normal. On ultrasound examination
revealed hyperechoic 14 mm endometrial line. On the right ovary there was anechoic
mass size 20 mm, left ovary was normal. Which of the following should be the next
step of management?
a. Give combined oral contraception
b. Perform FSH, LH and estradiol examination
c. Perform prolactin examination
d. Given noretisterone acetate 2x5 mg for 10 days
e. Perform endometrial sampling using hysteroscopy
68. A 28 year old G1 at 26 weeks present for her scheduled obstetric appointment. She
has been married for 4 years and had oligomenorrhea. You ordered OGTT
examination that shows fasting blood glucose 98 mg/dL, after 75g oral glucose 1 hour
 175 mg/dL, and 2hours 167 mg/dL. Her gestational weight gain during pregnancy is
12 kg. Her BMI before pregnancy was 27 kg/m2. What is the appropriate
management of this patient?
a. Exercise 120 minutes/week
b. Advise insulin in order to lowering blood glucose
c. Ultrasonographic biophysical profile
d. Give metformin 3x500mg orally
e. Modification nutrition intake
69. A patient presents with vulvar irritation and pruritis, Speculum examination reveals a
hyperemic, edematous, vaginal vault with odorless discharge. The pH is 4.0. These
symptoms had been recurrent more than 4 times during the last 1 year. What is the
treatment of choice for this condition?
a. 2000 mg of metronidazole weekly for 6 months
b. Fluconazole 150mg weekly for 6 months
c. Single dose of 2000mg metronidazole
d. Fluconazole 150mg every alternate day for 3 doses
e. Single dose of 150mg of fluconazole
70. A 52 years old woman came to ER with complaint of shortness of breath since 2 days
ago. She also noticed an abdominal enlargement since 6 months ago. If on Ultrasound
examination reveal a regular7 cm solid tumor with non-vascular appearance and
ascites. And on chest X-Ray reveal a right moderate pleural effusion with no
abnormality in lung parenchym. Which of the following non-malignant adnexal
masses can give rise to this condition?
a. Endometrioma
b. Ovarian fibroma
c. Mucinous cystadenoma
d. Mature cystic teratoma
e. Intra-ligament Leiomyoma
71. A 32 year old woman present to your office. She complained about her sexual
problems of pain during sexual intercourse since giving spontaneous birth of her
second child6 months ago. She feels a normal desire to engaged in sexual intercourse.
She is now still breastfeed the baby and she is in combine orl contraceptive pills.
What is the most common cause of the problem?
a. Combine oral contraceptive pills
b. Breastfeeding
c. Infection
d. Episiotomy scar
e. fatigue
72. Mrs. D 39 years old G4 P3 34 weeks of gestation arrives at delivery ward with severe
dyspnoe. She looks really anxious. Her vital signs show: BP 180/110 mmHg; PR
110x/min; RR26x/min; 35.4oC; SpO2 95%, conjunctiva not pale. Heart: normal heart
sound, no murmur or gallop. Lung: vesicular with rales and no wheezing. Fundal
height 30cm, head presentation, FHR 170bpm, no contraction. Laboratory findings:
 CBC Hb 10; Ht 32; L 12.000; platelet 120.000. What is the mechanism that can
induce this condition?
a. Right heart failure
b. Community acquired pneumonia
c. Immune response
d. High oncotic pressure
e. Diastolic dysfunction
73. A 39 year old G2P1 present to your outpatient clinic with pregnancy test was positive.
She has history of 10 weeks amenorrhea. Her first child has Down Syndrome. She is
asking regarding aneuploidy screening. Which of the following is the most
appropriate regarding aneuploidy screening?
a. cfDNA testing as a diagnostic test
b. cfDNA has a high sensitivity and specificity for trisomy 18 and trisomy 21
c. The fetal fraction the amount of the cell free DNA in the maternal blood that is
of fetal origin, at least 4% is required for accurate test result
d. Risk of miscarriage is greater in amniocentesis than chorionic villus sampling
e. If a fetal structural anomaly is identified on ultra-sound examination
diagnostic testing cfDNA should be offered
74. A 35 year old woman G3P2 presents to labor and delivery (L&D) at 33 week
gestation referred by midwife with BP 180/120 mmHg. BP on arrival is 170/105
mmHg. Urine protein is negative on dipstick. Patient no history of high blood
pressure before pregnancy. The patient denies any complaint today. What is the most
likely diagnose of the patient?
a. Preeclampsia
b. Preeclampsia with severe feature
c. Chronic hypertension
d. Gestational hypertension
e. Superimposed preeclampsia
75. A 19 year old G1P0 patient complains of spotting and right side pain. She had a
positive urine pregnancy test 3 weeks ago. Ultrasound does not identify an
intrauterine pregnancy. On laparoscopy 125 cc of blood is seen in the pelvis. There is
minimal blood from the tube and small bit of tissue is recovered floating free in the
peritoneal cavity. The pregnancy is likely which of the following?
a. Decidual cast
b. Delivery
c. Arias-Stella phenomenon
d. Spontaneous abortion
e. Tubal abortion
76. What is the appropriate maternal weight gain of this case (based on ASIAN BMI
category criteria)?
a. 5 - 9 kg
b. 7 - 1.5 kg
c. < 9kg
d. 11.5 – 16 kg
 e. 12.5 – 18 kg
77. A 26 year old parity zero woman comes to emergency department complaining of
moderate lower abdominal pain and nausea vomiting. She has trouble in her oral
intake and has difficulties of taking medication. Her LMP was 1 week ago. She has
history of untreated STIs, with multiple sexual partners and intermittent condom
usage as risk factor. On physical examination, her temperature 38.4C. physical
examination shows lower abdominal quadrant tenderness and mucopurulent cervical
discharge and cervical motion tenderness, whereas bilateral adnexa are unremarkable.
Which of the following antibiotics is the drug of choice for this patient?
a. Ceftriaxone injection 2x1 gram/day
b. Metronidazole 3x500mg orally
c. Meropenem 3x1 gram/day
d. Clindamycin injection 2x300 mg/ay
e. Ampicillin sulbactam 2x375 mg orally
78. A 32 year old woman presents to your office complaining of prolonged vaginal
bleeding. She has never been pregnant in her 3 years of marriage. Her periods were
regular monthly. Her last normal period was 2 month ago. For the past week she has
been bleeding heavily and passing large clots. On pelvic examination, the external
genitalia are normal. Speculum examination reveals smooth cervix. The uterus is
equal with 12 weeks of pregnancy. The ovaries are normal in palpation. Her urine
pregnancy test is negative. Which type of pathology that can cause this kind of
complaint?
a. Coagulation defect
b. Chronic anovulation
c. Cervical polyps
d. Uterine fibroid FIGO type 6-7
e. Uterine fibroid FIGO type 2-5
79. A 38 year old multi gravid woman complaint of the painless loss of urine, beginning
immediately with coughing, laughing, lifting or straining cessation of the activity do
not stops the urine loss. She also complains of frequency with small voided volume of
urine, but no urgency. This history is most suggestive of?
a. Stress incontinence
b. Urge incontinence
c. Mixed incontinence
d. Fistula
e. Overflow incontinence
80. Mrs. N 39 years old had just undergoes laparoscopic procedures. Her chief complaint
was infertility for 6 years with history of severe dysmenorrhea. Intraoperative findings
were patient both tubes and AFS stage III-IV endometriosis. Which of the following
is true regarding management in this patient?
a. GnRH agonist 3 time prior to surgery will give better result
b. Patient should be given secondary prevention with oral progestin Dienogest
2mg/day
 c. Intrauterine insemination is the preferred methods of infertility treatment in
this case
d. Medical management with GnRH agonist should be given for 3 months
followed with In Vitro Fertilization
e. AMH level must be measured before starting fertility treatment after surgery
81. A 72 years old woman P6 came to outpatient clinic with chief complaint of bulging
mass protrudes from vagina since 3 months ago. The mass usually occurs during
activity and also when she defecate, and disappear when lying down. There were no
difficulty in voiding and defecation. No urinary leakage during coughing and
sneezing. She is not sexually active. If on the Pelvic Organ Prolapse Quantification
examination result showing below. What is the diagnosis of this patient?
a. Uterine prolapse grade 2, cystocele grade 3, rectocele grade 2
b. Uterine prolapse grade 2, cystocele grade 2, rectocele grade 1
c. Uterine prolapse grade 3, cystocele grade 2, rectocele grade 2
d. Uterine prolapse grade 4, cystocele grade 3, rectocele grade 2
e. Uterine prolapse grade 3, cystocele grade 3, rectocele grade 2
82. A 29 year old G4P3003 with to prior C-Sections is diagnosed with a placenta accreta
at 28 weeks during follow up ultrasound of a low anterior placental location. Where is
placenta accreta most likely to cause bleeding?
a. Prior to labor
b. During the first stage of labor
c. During attempts to remove it
d. After amniotic membrane rupture
e. Because of consumption coagulopathy
83. 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 en endometrial thickness 11 mm. Regarding her
diagnosis, you consider that
a. She should be offered a hysteroscopy
b. She has had a pregnancy of unknown location and needs further investigations
c. She should be offered medical management of miscarriage
d. She has had a complete miscarriage and needs to further treatment
e. A laparoscopy should be performed to exclude an ectopic pregnancy
84. A 33 years old woman with morbid obesity was plan for laparoscopy cystectomy due
to endometriosis cyst. Patient had history of laparotomy cystectomy 2 years before.
What technique use to avoid complication for this patient?
a. Open technique
b. Complete androgen insensitivity syndrome
c. Partial androgen insensitivity syndrome
d. Swyer syndrome
e. Late onset congenital hyperplasia
85. A 60 year old P2 presents to the urogynecology clinic with complaint 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 times during the day and gets up twot
 o three times per night to urinate. She also complaint of urinary leakage during
coughing and sneezing. If the urinalysis is revealed normal, what is the next
diagnostic plan?
a. Pad test
b. Voiding diary
c. Post void residual urine measurement
d. Urodynamic study
e. Pelvic floor ultrasound
86. At outpatient clinic, you are now examining 38 week pregnant patient with a BMI of
15. She denies history of chronic diseases but she admits that she has lost her appetite
since the first trimester. Her vital signs are within normal limit. Her fundal height is
only at the level of 2 fingers above her umbilicus and the fetus is easily palpated. The
CTG reveals poor variability. Which of the following is true regarding maternal
nutrition during pregnancy?
a. Providing micronutrient supplementation to undernourished women
consistently lower rates of newborn
b. For all maternal weight categories, maternal weight gain in the first trimester
that is less than recommended is associated with restriction
c. For all maternal weight categories, excessive maternal weight gain during
pregnancy is associated with newborns
d. For all maternal weight categories, maternal weight gain in the second and
third trimester is less than recommended is associated with restriction
e. Providing macronutrient supplementation to undernourished women
consistently lowers rates of newborns
87. A 38 year old woman presents to the office with six months history of low pelvic
pain. If on physical examination reveal a right adnexal pain also accompany with right
upper quadrant abdominal pain, what is the most likely etiology of this condition?
a. Appendicitis
b. Hepatic abscess
c. Cholecystitis
d. Hepatitis
e. Fitz-Hugh Curtis Syndrome
88. A 35 years old lady G2P1 28 weeks of gestation, comes to obstetric emergency due to
irregular contraction since 8 hours BA. Vital sign are normal. On obstetric
examination found fundal height 35 cm. fetal part is difficult to identify.US exam
shows estimated fetal weight 1.400 grams, placenta on anterior corpus with amniotic
fluid index 30. Based on physiological mechanism of amniotic fluid production and
circulation. Which problem is most likely can be suspected?
a. Dysfunction of fetal swallowing
b. Excessive transudation through umbilical cord
c. Excessive transudation through fetal skin
d. Placental pathology
e. Overproduction of amniotic cells
89. A 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. 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. Partial colpocleisis
b. Manchester Fothergyl operation
c. Ring pessary
d. Total copocleisis
e. Sacrospinous hysteropexy
90. A 18 year old G1 at 32 4/7 weeks present for her scheduled obstetric (OB)
appointment. Ultrasound charts showed below

The patient denies any complaints today. Fetal movement is active. BMI before
pregnancy was 19.6 kg/m2, gestational weight gain is 7 kg. Vital sign are normal.
Abdominal examination today shows a gravid uterus measuring 29 cm. Fetal heart
tones (FHTs) are in the 140s. What is the most appropriate diagnosis of this patient?
a. Underweight
b. Appropriate for gestational age
c. Small for gestational age
d. Symmetrical intrauterine growth restriction
e. Asymmetrical intrauterine growth restriction
91. Regarding premature ovarian failure, which statement is true?
a. Incidence is about 5 %
b. It occurs in 50% of patients presenting with secondary amenorrhea
c. It corresponds to Asherman’s Syndrome
d. Symptoms are related to the levels of LH and FSH
e. Hot flushes occur in about 50% of patients
92. Ms. S, P0A0, 21 yo came to the outpatient clinic with chief complain of heavy
menstrual bleeding against 2 weeks. Her last menstrual period was 3 months ago. The
vital sign was 100/70, pulse 90x/minutes, respiration 20x/m and the temperature was
normal. Her BMI was 35. Her face and conjunctivas looked pale. The heart and lungs
were normal. There is excessive growth hair in the lower limb. The abdominal exam
 revealed no abdominal mass. There was no pain during abdominal palpation. During
vaginal inspection, some blood cloth were expelled from the vaginal introitus. From
ultrasound examination revealed normal uterus and both adnexes. The laboratory
result showed Hb level of 9 gr/dl. The platelet count was 200.000/mm3 and the
leucocytes count was 10.600/mm3. The pregnancy test result was negative. Which of
the following is the appropriate medication to use for controlling acute and heavy
bleeding?
a. Medoxyprogesterone acetate injection
b. Danazol
c. Combined hormonal injection
d. GnRH agonist
e. Noretisterone
93. A 25 years old woman came with chief complain amenorrhea. She notes that she
diagnosed missed abortion and had a dilatation and curettage (D&C) 4 months ago.
After D&C she had scant vaginal bleeding for a month, and for last 3 months, she
notes the absence of menses but instead has monthly painful cramping. She and her
husband would like another pregnancy. Her uriary HCG test was negative. To confirm
your suspect diagnosis, which test would you first perform?
a. Check blood HCG examination
b. Check serum FSH and LH level
c. Provera 10mg daily to achieve withdrawal bleeding
d. Dilatation and curettage
e. Pelvic ultrasound examination
94. A 27 year old, G1 40 weeks gestation, was referred by midwifes due to labor dystocia.
Based on partograph, cervical dilatation of 4 cm was happened at 08.00 am. At 12.00
pm, cervical dilatation remains the same, with contraction2x/10’/20” and intact
membrane. Estimated fetal weight is 3000 gram with adequate pelvic examination.
This condition can be classified as?
a. Prolonged of active phase
b. Incoordinate uterine action
c. Arrest disorder
d. Prolonged of latent phase
e. Protraction disorder
95. A 29 y.o G3P2at 35 weeks of gestation came to your outpatient clinic. She is
complained decreased fetal movement. Her previous pregnancy went uncomplicated,
ended in full term with normal spontaneous vaginal delivery. You found an indication
for early delivery, but you concern on his lung maturity. Regarding fetal lung
maturity, which of the following is true?
a. A lecithin to sphingomyelin (L/S) ratio greater than 2 is indicated for early
delivery
b. Typically, lecithin decreases as the lung matures
c. A low US ratio is associated with fewer cases of respiratory distress syndrome
(RDS)
d. Sphingomyelin decreases beyond 24 weeks
 e. Type I pneumocytes secrete surfactant FP
96. A 30 years old patient came with complaint of infertility. Her husband is a 33-year-
old who has had a semen analysis, which was reported as normal. On further history,
the patient reports that her periods have been quiet irregular over the last year and that
she has not had period in the last 3 months. She also reports of weight gain and
abnormal hair growth. From ultrasound we found multiple follicles size 2-8 mm in
both ovaries. Which of the following might contribute to this condition?
a. Low level of androgen from the ovary
b. Decreased visceral fat deposition
c. High level of vitamin D
d. Low level of LH
e. Insulin resistance
97. A 32 year old gravida 3 para 2, 36 weeks of gestation was transferred from
midwifery- led unit for high blood pressure. Her blood pressure was 170/100 mmHg,
PR 90 bpm, RR 24x/minute. Abdominal examination showed FUT 30 cm, ireguler
contraction, fetal heart beats 154 bpm. Vaginal examination showed soft cervix, mid-
position, 2 cm dilated, 50% effaced, -2 station. An ultrasound shows the estimated
fetal weight 2600 g, AFI12 cm, no fetal morphology abnormalities, SDAU 2.9. She
has experienced twice vaginal delivery, baby weighed were 3100 g and 3300 g for
first and second baby. On admission, her observations are normal and the
cardiotocography (CTG) was reassuring. You decided to give her MgSO4 and
antihypertension with nifedipine for preeclampsia with severe feature management,
and also induction of labor with Oxytocin 5 IU. Adequate contraction was achieved
on 8 mIU/minute. Five hours observation, she complaint rupture of membrane.
Vaginal examination showed clear amniotic fluid came out from vagina, cervix
dilated 6 cm, 0 station. CTG has become suspicious (baseline 156 bpm, variability 3-5
bpm, no acceleration, nod deceleration, contraction 4x/10’/30”). What is the most
appropriate cause of CTG findings?
a. Cord compression
b. Head compression
c. Hyperstimulation of uterus
d. Magnesium sulphate
e. Placental insufficiency
98. A 30 year old G1 at 26 weeks present for her scheduled obstetric appointment. She
has been married for 4 years and had oligomenorrhea. You ordered OGTT
examination that shows fasting blood glucose 98 mg/dL, after 75g oral glucose 1 hour
175 mg/dL, and 2hours 167 mg/dL. Her gestational weight gain during pregnancy is
12 kg. Her BMI before pregnancy was 27 kg/m2. What is the appropriate
management of this patient?
a. Exercise 120 minutes/week
b. Give metformin 3x500mg orally
c. Modification nutrition intake
d. Ultrasonographic biophysical profile
e. Advise insulin in order to lowering blood glucose
99. Mrs. N 37 years old with chief complaint dysmenorrhea. Pelvic ultrasound found
diffuse adenomyosis with uterus size 16x10x6cm.there is no history of abnormal
uterine bleeding. Which of the following is the most appropriate management?
a. Noretisterone 5 mg/day
b. LNG IUS
c. Extended OCP regimen
d. Dienogest 4 mg/day
e. Sequential estrogen-progestin pills
100. A 80 year old woman presents to the office with complaints of leaking large
amounts of urine when she hears running water. Her symptom began about month
ago and have gotten progressively worse. She denies any previous history of
abdominal or pelvic pain. Medical history is complicated by hypertension treated
with hydrochlorothiazide and lisinopril. If the urinalysis related normal, what is the
next best step in her workup?
a. Voiding diary
b. Urine cytology
c. Basic metabolic panel
d. Cystoscopy
e. Urine culture