AGUSTUS 2020

1. A 34-year old women with primary infertility 3 years, oligomenorrhea and a body mass
index (BMI) of 26. Day 23 progesterone level result was 5 ng/ml. Transvaginal ultrasound
shows multiple small follicle size 5-8 mm in both ovary. HSG shows bilateral patent
tubes. Her partner’s semen analysis show a volume of 3 ml, pH of 7 and a sperm count of
20 million/ml.
What is the most appropriate step of management?
A. Examine TSH andprolactin
B. Measure FSH, LH and estradiol
C. Measure serum testosteronelevel
D. Give Aromatase inhibitor
E. Start ovulation induction using gonadotropin

2. A 34-year old women with primary infertility 3 years, oligomenorrhea and a body mass
index (BMI) of 26. Day 23 progesterone level result was 5 ng/ml. Transvaginal ultrasound
shows multiple small follicle size 5-8 mm in both ovary. HSG shows bilateral patent
tubes. Her partner’s semen analysis show a volume of 3 ml, pH of 7 and a sperm count of
20 million/ml. According to the current International Guidelines, which of the following
medication is considered to be the first line of therapy for ovulationinduction?
A. Letrozole 1x 2,5 mg
B. Clomiphene citrate starting at dose 50 mg/ day for 5 days
C. Clomiphene citrate 50 mg/day combined with metformin 2x500 mg
D. Metformin 2x500 mg
E. Gonadotropin injection 75IU/day

3. A 18-year-old adolescent female complains of not having started her menses. Her breast
development is Tanner stage IV, Pubic hair development was stage I. From
vaginalexamination found ablind vaginalpouchandnouterusand cervix. Whichof the
following describes the most likely diagnosis?
A. Partial androgen insensitivitysyndrome
B. Complete androgen insensitivity syndrome
C. Kallman syndrome
D. Turner syndrome
E. Polycystic ovarian syndrome

4. A 18-year-old adolescent female complains of not having started her menses. Her breast
development is Tanner stage IV, Pubic hair development was stage I. From vaginal
examination found a blind vaginal pouch and no uterus and cervix. From ultrasound
examination found no uterus and there was difficulty in identifying the gonads. What is
the next plan?
A. Prolactin measurement
B. Kariotyping
C. FSH and LHexamination
D. FSH, LH and E2 examination
E. TSH, fT4 examination

5. 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 insomnia, vaginal dryness, and
decreased libido. What is the most likely diagnosis for this patient based on herhistory
a. Polycystic ovarian syndrome
b. Primary ovarian insufficiency
c. Endometriosis
d. Kallmann syndrome
e. Spontaneous pregnancy

6. 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. Shealso reports insomnia, vaginal dryness, and decreased
libido. Which of the following condition that corresponds to the above possible diagnosis?
a. Day 3 FSH level 40 IU
b. Serum AMH level 2,6 ng/ml
c. Positive Clomiphene citrate challenge test
d. Midluteal progesterone level of 15 ng/ml
e. Follicle antral basal count of 12

7. Mrs. N, 37 years old with chief complain of infertility for 6 years with history of severe
dysmenorrhea. From hysterosalpingography, both tubes were non-patent. Pelvic ultrasound
found bilateral cystic mass with internal echo sized 50 and 60 mm in diameter. Her
husband sperm examination was within normal limit. What is the next appropriate
management?
a. Offer her IUI
b. Perform laparoscopy cystectomy and adhesiolysis
c. Give GnRH analog for 3 months continue with IUI
d. Give Dienogest 1x2mg for 6 months
e. Offer her IVF

8. Mrs. N, 37 years old with chief complain of infertility for 6 years with history of severe
dysmenorrhea. From hysterosalpingography, both tubes were non-patent. Pelvic ultrasound
found bilateral cystic mass with internal echo sized 50 and 60 mm in diameter. Her husband
sperm examination was within normal limit. Her AMH level was 0,9 ng/ml. What is the reason
for performing surgery in subfertile patient with bilateral endometrioma and diminished
ovarian reserve?
a. Removal of endometrioma
b. Ablation of all endometriosis lesion
c. To prevent infection in endometrioma
d. To improve access for follicle aspiration
e. Removal of deep infiltrating endometriosis lesions

9. Mrs. N, 37 years old with chief complain of infertility for 6 years with history of severe
dysmenorrhea. From hysterosalpingography, both tubes were non-patent. Pelvic ultrasound
found bilateral cystic mass with internal echo sized 50 and 60 mm in diameter. Her
husband sperm examination was within normal limit. Which of the following is true
regarding low ovarian reserve in endometriosis?
a. Ovulation rate in ovary with endometrioma is higher compared to ovary without
endometrioma
b. There is a higher density of follicle in ovary with endometrioma
c. Ovary with endometrioma has a higher response rate to gonadotropin
d. Loss of ovarian stromal appearance and fibrosis are present in ovarian cortex with
endometrioma
e. Low ovarian reserve in endometriosis only happen after surgery

10. A 27-year-old woman presents to your office with a positive home pregnancy test and a
3-day history of vaginal bleeding. She is concerned that she may be having a miscarriage.
On examination, the uterine fundus is at the level of the umbilicus. By her last period, she
should be around 8 weeks gestation. On pelvic examination, there is a moderate amount
of blood and vesicle-like tissue in the vaginal vault, and the cervix is closed. The lab then
calls you to say that her serum β-hCG result is greater than 1,000,000 mIU/mL. Which of
the following is the best next step in this patient’s evaluation?
a. Complete pelvic ultrasound
b. Determination of Rh status
c. Surgical intervention (suctioncurettage)
d. Methotrexate administration
e. Schedule a follow-up visit in 2 to 4 weeks to recheck a β-hCG level

11. A 27-year-old woman presents to your office with a positive home pregnancy test and a
3-day history of vaginal bleeding. She is concerned that she may be having a miscarriage.
On examination, the uterine fundus is at the level of the umbilicus. By her last period, she
should be around 8 weeks gestation. On pelvic examination, there is a moderate amount
of blood and vesicle-like tissue in the vaginal vault, and
the cervix is closed. The lab then calls you to say that her serum β-hCG result is greater
than 1,000,000 mIU/mL. The patient undergoes an uncomplicated suction D&C. The
pathology report is available the next day and is consistent with a complete molar
gestation. What is the best next step in the care of this patient’s condition.
a. Repeat pelvic imaging
b. Radiation therapy
c. Chemotherapy
d. Surveillance of serumβ-hCG
e. No further follow-up is required

12. A 7-year-old girl presents to her pediatrician with her parents who are concerned about
her early sexual development. She is developing breasts, axillary hair, and pubic hair, and
they are noticing body odor. A thorough clinical workup reveals the child has an
irregular, echogenic, thickly septated ovarian mass on her left ovary. What type of tumor
is responsible for this child's clinical presentation?
a. Dysgerminoma
b. Embryonal carcinoma
c. Sertoli-Leydig cell tumor
d. Endodermal sinus tumor
e. Granulosa-theca cell tumor

13. A 36 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. Which of the following
examination that is not included in basic workup in the patient?
a. Hysterosalpingography
b. Ultrasonography
c. Semen analysis
d. Endometrial dating according to Noyes criteria
e. Mid luteal progesterone examination

14. A 36 years old patient, P0, presents to your clinic for fertility workup. She had been
married for 2 years with regular intercourse. Her menstrual cycle is normal. Her general
status was normal. Vaginal examination revealed normal findings. The following month
she came back with the result of hysterosalpingography (see the picture

below)
What will be your next plan ?
a. Repeat HSG next month
b. Schedule diagnostic laparoscopy
c. Gives clomiphene citrate and plan for natural conception
d. Gives clomiphene citrate and plan for intrauterine insemination
e. Plan for IVF

15. A 52-year-old woman presents to your office. She complained about her sexual problems
of low self esteem, and difficulties of initiating sexual intercourse, vaginal dryness and pain
during intercourse She has the history of 3 Full term normal vaginal delivery and she had
already menopause and she has no history of hereditary disease. She underwent the lab
investigation such RBG – 129 mg/dl; Hb 10.6 mg/dl, Urea 21; Creatinine 0.5, Chest x-ray
and pelvic ultrasound studies showed no abnormalities. What is your diagnosis
a. Sexual desire disorder
b. Genital arousal disorder
c. Vaginismus
d. Orgasmic dysorder
e. All of above

16. A 52-year-old woman presents to your office. She complained about her sexual problems
of low self esteem, and difficulties of initiating sexual intercourse, vaginal dryness and pain
during intercourse She has the history of 3 Full term normal vaginal delivery and she had
already menopause and she has no history of hereditary disease. She underwent the lab
investigation such RBG – 129 mg/dl; Hb 10.6 mg/dl, Urea 21; Creatinine 0.5, Chest x-ray
and pelvic ultrasound studies showed no abnormalities. The most possible cause of sexual
disorders of this patient is
a. Menopause
b. Multiparity c.Alcohol uses
d. Sexual abuse
e. Pain

17. Mrs. 32-year old, P0, comes to your outpatient clinic due to her prolonged menstrual
duration. She reports her menstrual duration until 14 days and using 10 pads per day. She
feels fatigue easily. On physical examination, you palpate an irregularly enlarged uterus,
non tender with firm contour. Cervix appears to be hyperemic without mass appearance or
other abnormalities. By which mechanism does fibroid creates a hyperestrogenic
environment requisites for their growth?
a. Fibroid contains higher level of cytochrome P450 aromatase, which allows for conversion
of androgens to estrogen.
b. Fibroid converts more estradiol to estrone -> Estrone to estradiol
c. Fibroid cells contain less density of estrogen receptors compared with normal
myometrium -> Fibroid lebih banyak reseptor estrogen
d. Increased adipose conversion of androgens to estrogen -> Adipose to estrone (E1)
e. All of theabove

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

19. A 45-year-old presents for evaluation because her primary care physician has diagnosed
her with pelvic organ prolapse while performing annual care. She denies any pelvic pressure,
bulge, or difficulty with urination. Her only medical comorbidity is obesity. For
asymptomatic grade 1 pelvic organ prolapse, what do you recommend?
a. Conservative management with pelvic floor muscle exercises and weight loss
b. Colpocleisis obliterative procedure
c. Gellhorn pessary
d. Round ligament suspension
e. Hysterectomy

20. A 62-year-old G2 P2 presents to the urogynecology clinic with complaints of urinary

incontinence. She has urinary urgency and can’t make it to the bathroom before leaking a
large amount of urine. She gets up two to three times per night to urinate. A urinalysis and
urine culture done 1 week ago at her PCP’s office are both negative. What is the most likely
diagnosis and appropriate treatment option for this type of urinary incontinence?
a. Stress incontinence, mid-urethral sling
b. Urgency incontinence, oxybutynin (anticholinergic medication)
c. Overflow incontinence, oxybutynin (anticholinergic medication)
d. Urinary fistula, surgicalrepair
e. Functional incontinence, bladder suspension

21. Your 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,youare 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
e. Bicornuate uterus

22. An 18-year-old nulligravid woman presents to the student health clinic with a 4-week history
of yellow vaginal discharge. She also reports vulvar itching and irritation. She is sexually active
and monogamous with her boyfriend. They use condoms inconsistently. On physical
examination, she is found to be nontoxic and afebrile. On genitourinary examination, vulvar
and vaginal erythema is noted along with a yellow, frothy, malodorous discharge with a pH
of 6.5. The cervix appears to have erythematous punctuations. There is no cervical, uterine, or
adnexal tenderness. The addition of 10% KOH to the vaginal discharge does not produce an
amine odor. Wet prep microscopic examination of the vaginal swabs is performed. What
would you expect to see under microscopy?
a. Branching hyphae
b. Multinucleated giant cells
c. Scant WBC
d. Flagellated, motile organisms
e. Epithelial cells covered with bacteria

23. 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. 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

24. A patient returns for a postoperative checkup 2 weeks after a total abdominal hyserectomy
for fibroids. She is distressed because she is having continous leakage of urine from the vagina.
Her leakage is essentially continous and worsens with coughing, laughing, or movement.
Given her history and physical, you perform both a metthylene blue dye test, which is
negative and an indigo carnine test, which is
 positive. The most likely diagnosis is:
a. Rectovaginal fistula
b. Uretro vaginal fistula
c. Vesico vaginal fistula
d. Uretero vagina fistula
e. Impossible to distinguish

25. A 38 years old multi gravid woman complains of the painless loss of urine, beginning
immediately with coughing, laughing, lifting, or straining. Immediate cessation of the activity
stops the urine loss after onlya fewdrops. This history is most suggestive of
a. Fistula
b. Stress incontinence
c. Urge incontinence
d. Urethral diverticulum
e. UTI

26. A 25 year old lady come with abnormal pap smear result. She underwent colposcopy
examination and the result is a acetowhite lesion with punctation and atypical vessels.
Biopsy result confirms CIN I with HPV DNA test positve. What do you suggest for patient ?
a. LEEP procedure
b. Reevaluation of HPVDNA
c. Cold knife conization
d. Repeat cytology in 12 months -> Kalau HPV DNA negatif
e. Repeat cytology in 6 months

27. A 45 years old woman presents to your office for consultation regarding her symptoms of
menopause. She stopped having periods 13 months ago after TAH-BSO operation and is having
severe hot flushes. The hot flushes are causing her considerable stress. What should you tell
her regarding the psychological symptoms of the climacteric?
a. They are not related to her changing levels of estrogen and progesterone.
b. They commonly include insomnia, irritability, frustration, and malaise.
c. They are related to a drop in gonadotropin levels.
d. They are not affected by environmental factors.
e. They are primarily a reaction to the cessation of menstrual flow

28. A 45 years old woman presents to your office for consultation regarding her symptoms of
menopause. She stopped having periods 13 months ago after TAH-BSO operation and is having
severe hot flushes. The hot flushes are causing her considerable stress. Which of the
following is an absolute contraindication for hormonal therapy?
a. Diabetes mellitus
b. Coronary heart disease -> KI Relatif
c. Endometriosis
d. Impairment of liver function -> Hormon EP dimetabolisme di hepar
e. Migraine

A 45 years old woman presents to your office for consultation regarding her
symptoms of menopause. She stopped having periods 13 months ago after BSO
 operation and is having severe hot flushes. The hot flushes are causing her considerable
stress. Which of the following medication that you will give for hormonal therapy?
a. Estrogen only therapy
b. Biphasic combined oralcontraception
c. Monophasic combined oralcontraception
d. Triphasic combined oral contraception
e. Sequential estrogen-progestin therapy
29. A 25 years-old women G1 20 weeks of gestational age came to outpatient clinics with a
mass in perineum sized 1 cm flesh-colored and cauliflower like appearance. She also
feels itchy and discomfort during sexual intercourse. On speculum examination we can
see a small verrucous mass sized 0,5 cm on vaginal side wall. What is the most probable
cause of this condition?
a. Herpes simplex virus
b. HPV type 6 and 11
c. HPV type 16,18
d. Syphilis
e. Molluscum contagiosum

30. A 25 years-old women G1 20 weeks of gestational age came to outpatient clinics with a mass in
perineum sized 1 cm flesh-colored and cauliflower like appearance. She also feels itchy and
discomfort during sexual intercourse. On speculum examination we can see a small verrucous
mass sized 0,5 cm on vaginal side wall. What is the recommended treatment for this patient?
f. Podophyllum resin
g. Fluorouracil
h. Trichloroacetic acid -> Aman bumil
i. Imiquimod
j. Surgical excision

31. 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. Which of the following is the most common causative organism for
formation of this condition?
f. Trichomonas Vaginalis
g. Bacterial vaginosis
h. Streptococcus epidermidis
i. Neisseria gonorrhoeae □ Bartholin
j. Staphylococcus aureus

32. 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. Antibiotic for 7days
b. Incision and drainage
c. Marsupialization
d. Cystectomy
e. Excision of the glands

33. A 28 women present to your clinic with feeling of fullness in the vagina. On
 examinationyou find abluishcysticmasscamefrom the rightlateral fornikssized6 cm. The
bulge is not tender on palpation. What is the most probable diagnosis of this condition?
f. Gartner’s duct cyst
g. Skene duct cyst □ Parautehral
h. Bartholin cyst
i. Vaginal inclusion cyst
j. Endometriosis cyst

34. A 28 women present to your clinic with feeling of fullness in the vagina. On examination
you find a bluish cystic mass came from the right lateral forniks sized 6 cm. The bulge is not
tender on palpation. What is the cause of this condition?
f. Blockage of the glands opening
g. Infection
h. Endometriosis
i. Remnant of Mullerian duct
j. Remnant of Wollfianduct

35. Mrs 21 years old came to outpatient clinic with primary amenorrhea. She has a complaint
of impaired sense of smell. Which of the following can be found during additional
examination?
Kallman □ Hypo-Hypo (Class I), Kompartemen IV
a. Breast tanner stage 3 □ Ovarium bagus
b. Pubic hair tanner stage 3
c. Absent of uterus□ MRKH
d. FSH level of 30 IU/L □ Hyper
e. LH level 0.9 IU/L (N 5-20 IU/L pada ovulasi)

36. Mrs 21 years old came to outpatient clinic with primary amenorrhea. She has a complaint
of impaired sense of smell. She is diagnosed with Kallman syndrome. She has a family history of
diabetes, currently her BMI is 29 kg/m2 with waist circumference of 90 cm. Which of the
following drugs can be used for ovulation induction in this condition?
a. Letrozole 1x2.5 mg for 5 days
b. Clomiphene citrate 1x50 mg for 5 days
c. Metformin 2x500 mg
d. Clomiphene citrate 1x50 mg combined with metformin 2x500 mg
e. Human menopausal gonadotropin injection

37. Mrs. 32-year old, P0, comes to your outpatient clinic due to her prolonged menstrual
duration. She reports her menstrual duration until 14 days and using 10 pads per day. She feels
fatigue easily, she denies to experience dysmenorrhea. On physical examination, you
palpate an irregularly enlarged uterus, non-tender with firm contour. Cervix appears to
be hyperemic without mass appearance or other abnormalities. What is the most
likely diagnosis?
a. AUB-P
b. AUB-A
c. AUB-L
d. AUB-M
e. AUB-C
38. Mrs. N, 37 years old had just undergone laparoscopic procedures. Her chief complaint
was infertility for 6 years with history of severe dysmenorrhea. From
hysterosalpingography, both tubes were non-patent. Pelvic ultrasound found bilateral
cystic mass with internal echo sized 50 and 60 mm in diameter. Her husband sperm
examination was within normal limit. From laparoscopy findings, normal size uterus with
adhesion of posterior part to colon and Douglas pouch was also severely adhered. Both of
ovaries were enlarged approximately 50 – 60 mm with severe adhesion at the right and left
adnexae. After adhesiolysis, both of tubes could be identified and were blocked. Chocolate fluid
was spilled from the cysts. The pathology of the cysts wasendometriosiscyst.Which oneis the
TRUE statement ?
f. The patient should directly undergo surgery to solve her pain and infertility problem
g. Laparoscopic procedures should be done if infertility problem already more than 3 years
h. Laparoscopic cystectomy was done because the cyst have diameter 50 and 60 mm
i. GnRH agonist 1 time prior to surgery will give better results
j. Male factor and ovarian reserve should be measured prior to decision of surgery k.
39. A 25-year-old woman underwent a uterine curettage after a miscarriage and has had no menses
since. Pregnancy test was negative. Intrauterine adhesions were suspected. Which of the
following is associated with asherman syndrome?
f. Associated with low cortisol levels
g. Associated with low estradiol levels
h. It is associated with class 1 anovulation
i. Presence of monthly LH surge
j. Associated with a positive estrogen-progestin test

40. A 30-year-old P0 obese woman is noted to have irregular menses and hirsutism. On
ultrasound examination, there are many small follicles in both ovaries. Which of the
following is consistent with polycystic ovarian syndrome?
f. BMD showing osteopenia
g. Finding of a 9-cm right ovarian mass
h. Elevated 17-hydroxyprogesterone level
i. Elevated level of AMH produced by theca cells □ Harusnya meningkat
j. Positive progestinchallenge test

41. A 30-year-old P0 obese woman is noted to have irregular menses and hirsutism. On
ultrasound examination, there are many small follicles in both ovaries. She was diagnosed
with PCOS and receive combined oral contraception for menstrual regulation. She
noticed a decreased hirsutism after taking COC, what is the most probable mechanism?
a. Suppression of HPOaxis
b. Increased level ofSHBG
c. Resumption of ovulation
d. Suppression of prolactinsecretion
e. Suppression of androgen receptor in the peripheral tissue

42. A 18 years old girl come to the emergency room with an abruptly pelvic pain for 2 days.
She had already started felt pain on and off for the past 2 weeks especially when she was
moving. She has also nausea and vomiting. She has no fever. She has regular menstrual cycle.
From the physical examination an intense of low abdominal pain
 was marked even more on palpation. There was a muscle defence, on the right lower abdomen
quadrant. She tends to bend her abdomen a bit on the bed. On abdominal ultrasound reveal a
mass measuring 12 cm in the largest diameter on her pelvic, characterized with multiple
hyperechogenic interfaces in a cystic mass in the right ovary, no blood flow could be detected
in the cyst except only in the one pole
near the uterus. Uterus anteflexed within normal limit. Left ovary within normal limit.
There is no fluid in pelvic cavity. What would be the working diagnosis?
f. Functional cyst
g. Endometriosis
h. Ovarian fibroma
i. A torsion cyst
j. Ruptured cyst

43. What type of cyst that frequently associated with ovarian torsion?
a. Ovarian fibroma
b. Follicular cyst
c. Dermoid cyst □ Ada komponen padat
d. Endometrioma
e. Mucinous cyst

44. A parity 3 40-year-old woman complains of cyclical heavy and painful menstrual
bleeding. On examination she is found to have an enlarged globular uterus and a
transvaginal sonography revealed diffuse adenomyosis. She has completed her family and
currently relies on condoms for contraception. She smokes 10 cigarettes per day but is otherwise
fit and well. Which treatment would you consider most appropriate? Choose the single
best answer.
a. LNG-IUS
b. COCP
c. Hysterectomy
d. GnRH analogue
e. Endometrial ablation

45. A 32-year-old woman has a pelvic ultrasound that bilateral 5 cm ‘kissing’ ovarian cysts
in the pouch of Douglas. Both of which contain diffuse, low-level echoes giving a solid ‘ground-
glass’ appearance. She reports severe dysmenorrhoea and dyspareunia. Which of the
following condition that can be found associated with this finding?
f. Fifty percent risk of malignanttransformation □ 1% endometrioid dan clearcell type
g. Normal level of Ca 125 □ Increase
h. Increased level of serum AMH □ Decrease
i. Increased level of He4□ Pada Ca ovarium
j. Adenomyosis in the posterior uterus

46. 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?
f. Treatment of male partners
g. Use of acidiying vaginal gels
h. Probiotics and reintroduction of lactobacilli
i. No intervention consistently decreases recurrence
j. Treatment of long continous antibiotic

47. 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. What is her
approximate risk of infertility due to this acute PID?
f. 15 percent □ Di buku 12%
g. 25 percent
h. 35 percent
i. 55 percent
j. 75 percent

48. A 82 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?
Aa +3 Ba +4 C +5
GH Pb TVL
5 2 8
Ap Bp D
0 0 +3
f. Uterine prolapse grade 2, cystocele grade 2, rectocele grade 1
g. Uterine prolapse grade 4, cystocele grade 3, rectocele grade 2
h. Uterine prolapse grade 3, cystocele grade 3, rectocele grade 2
i. Uterine prolapse grade 3, cystocele grade 2, rectocele grade 2
j. Uterine prolapse grade 4, cystocele grade 4, rectocele grade 3

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 in the night to void. Shenever leaksurine. Shedoesn’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 this patient?
a. Urine culture
b. Pelvic floor ultrasaound
c. Gynecology ultrasound
d. Bladder diary
e. Urodynamic evaluation

50. A 26-year-old G2P1 (no live child) is seen for her first prenatal visit at 18 weeks’
gestation by menstrual history. Her first child was born at 28 weeks spontaneously, the
baby was died after hospitalized for 1 month in NICU. She is worried this
pregnancy also will be ended with spontaneous preterm birth.What is the most
accurate examination that can be done at 18 weeks to predict the risk of preterm birth?
a. Cell-free fetal DNA □ First trimester loss
b. IGFBP-1 examination □ PPROM
c. PAMG-1 examination □ PPROM
d. Fibronectin examination □ prediksi preterm labor, kalau sudah ada tanda inpartu
e. Measure cervical length

51. 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 likely etiology of preterm contraction in this
case?
f. Maternal obesity
g. Maternal anemia
h. Bacterial vaginosis
i. Uterine overdistention
j. Excessive gestational weight gain

52. 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?
f. Give intravenous iron
g. Schedule for OGTTtest
h. Give antibiotic prophylaxis
i. Schedule for cervicalcerclage
j. Give MgSO4 for neuroprotection

53. A 18-year-old G1 at 30 4/7 weeks presents for her scheduled obstetric (OB) appointment.
A 28-week ultrasound showed the fetus to be in the 13th percentile for estimated fetal
weight. 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 27 cm. Fetal heart tones (FHTs) are in the
140s. Laboratory results were Hb 10,1 g/dL, Ht 30%, Leucocyte 10.500, Thrombocyte 215.000,
MCV 78, MCH 28. OGTT result was fasting 92 mg/dL and 2 hours after 75 glucose 148
mg/dL. What is the appropriate next step in the management of this patient?
f. Schedule for serum ferritin test
g. Perform fetal growth ultrasound
h. Schedule for a biophysical profile (BPP)
i. Give elemental iron 100-200 mg per oral
j. Admit patient to the hospital for lung maturation

54. A 18-year-old G1 at 30 4/7 weeks presents for her scheduled obstetric (OB) appointment.
A 28-week ultrasound showed the fetus to be in the 13th percentile for estimated fetal
weight. 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 27 cm. Fetal heart tones (FHTs) are in the 140s. Laboratory results were Hb 10,1 g/dL,
Ht 30%, Leucocyte 10.500, Thrombocyte 215.000, MCV 78, MCH 28. OGTT result was fasting
92 mg/dL and 2 hours after 75 glucose 148 mg/dL. What is the most likely predisposition
factor for this case?
f. Maternal anemia
g. Genetic abnormalities
h. Placental insufficiency
i. Inadequate maternal nutrition (Peningkatan BB N 11-16 kg)
j. Pre-gestational diabetes mellitus

55. A 35-year-old woman, G3P2, presents to labor and delivery (L&D) at 33-week gestation
referred by midwife with BP 180/110 mmHg. BP on arrival is 170/105 mmHg. Urine
protein is 1+ on dipstick. Patient had history of high blood pressure in her previous
pregnancy. ANC was done in midwife. Blood pressure at first trimester was 130-145/90-95
mmHg, urine protein was negative on dipstick. No antihypertension drug was given. The
patient denies any complaints today. What is the most likely diagnosis of the patient:
a. Preeclampsia
b. Chronic hypertension
c. Gestational hypertension
d. Superimposed preeclampsia
e. Preeclampsia with severefeature

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

57. Mrs A, 26-years-old, G1P0A0, according to her last LMP is 34 weeks pregnant, came for her first
antenatal care. She said that she had 20 kg of weight gain during her pregnancy with
swelling ankles for the past 4 weeks. She never took any iron or vitamin supplementation.
From the physical findings, BP 145/95 mmHg, HR 86x/min, RR 20x/min, BMI 35 kg/m2.
Ultrasound examination confirmed twins in breech presentation. Results from urinalysis
were as follows: color cloudy yellow, spesific gravity 1.013, albumin 2+, RBC 0 - 1, WBC
2-5, negative bacterial count. What is the most likely diagnosis?
A. Acute fatty necrosis of the liver
B. Chronic hypertension
C. Preeclampsia
D. Renal disease
E. Pyelonephritis

58. Mrs. B, 37-years-old came to your office at 32 weeks of gestation according to her last
menstrualperiod. Shehasnoultrasoundexamination before anddid notdoher routine antenatal
care. The vital sign is within normal limit. She has body mass index 19 kg/m2. During physical
examination, the uterine fundal height is 22 cm. From ultrasound examination, the fetus has
biometric values that correlate with 30 weeks fetus. Which of the following is the next best
step in managing this patient?
A. Antenatal care routinely for the next 2 weeks
B. Evaluate maternal status and comorbidities
C. Consider deliver thebaby
D. Repeat sonography for fetal growth in 2 weeks
E. Doppler velocimetry evaluation every 3 days

59. Mrs E, 32 yo referred from midwife with antepartum hemorrhage. She is G3P2 term
pregnancy. On examination her blood pressure is 160/100 mmHg, HR 100 bpm. She looks
anemic, not icteric. Obstetrical examinations reveal contraction 4-5x/10 minutes,
FHR 170 bpm, head presentation 3/5. After thorough examination it is concluded that there
is a placental abruption with retroplacental hematoma size 6x5 cm. This patient is planned to
do cesarean section. If during operation the uterus is couvelaire but with good
contraction, how would you manage that condition?
F. Perform prophylactic b-lynchsuture
G. Ascending uterine artery ligation
H. Hypogastric artery ligation
I. Sub total hysterectomy
J. Uterotonic and observation

60. Mrs E, 32 yo referred from midwife with antepartum hemorrhage. She is G3P2 term
pregnancy. On examination her blood pressure is 160/100 mmHg, HR 100 bpm. She looks
anemic, not icteric. Obstetrical examinations reveal contraction 4-5x/10 minutes, FHR
170 bpm, head presentation 3/5. After thorough examination it is concluded that there is a
placental abruption with retroplacental hematoma size 6x5 cm. This patient is planned to do
cesarean section. Postoperative period is very crucial in this patient. Which of the
following is not included as a parameter needed to be evaluated in early warning system ?
F. Blood pressure
G. Heart rate
H. Urine production
I. Central venous pressure
J. All of theabove

61. A 26-years-old woman, G1P0A0 was admitted to ER because she lost her consciousness
around 1 hour ago. According to her husband, she is 36 weeks pregnant. She performed
antenatal care at scheduled time, and never missed one. Her husband said, she never had any
hypertension or any other disease before. Three days prior hospitalization, she had
severe nausea and vomiting. Physical
 examination reveals, BP 120/80 mmHg, pulse rate 87 x/min, RR 18x/min, Temperature
36.50C. You notice there is an icteric sclera. Other physical examination was remarkable.
Obstetrical examination reveals no fetal heartbeat was detected. Laboratory examination
reveals CBC 10.2/29.9/8900/263.000; Ur/Cr 18/0,8; AST/ALT 458/878; RBG 32; Urinalysis
was within normal limit. What is the best next management in this case?
A. Abdominal ultrasound
B. Induction of labor
C. Emergency Caesarean section
D. Whole Blood transfusion
E. Injections of 40% Dextrose

62. Which of the following is not included in clinical characteristics that increase the risk for
acute fatty liver of pregnancy?
A. Nulliparity
B. Female fetus
C. Male fetus
D. Twin gestation
E. Third trimester

63. What is the underlying pathophysiology of intrahepatic cholestasis of pregnancy?

A. Acute hepatocellular destruction
B. Incomplete clearance of bile acids
C. Microvascular thrombus accumulation
D. Eosinophil infiltration of the liver
E. Hepatocellular injury

64. A 17-year-old G1P0 woman presents at 25 weeks’ gestation complaining of headache for
the past 36 hours. She has had regular prenatal visits going back to her first prenatal visit at 8
weeks’ gestation. A 20- week ultrasound redated her pregnancy by 2 weeks as it was 15
days earlier than her LMP dating. She has a BP of 155/104 mm Hg. You review her medical
record and determine that she does not have chronic hypertension. The patient denies having
RUQ pain but because of your high suspicion of severe preeclampsia you order a CBC, liver
enzymes, renal function test, and a 24-hour urine protein collection. Her laboratory test results
reveal a normal platelet count and liver enzymes but a slightly elevated creatinine and
proteinuria of 550 mg in 24 hours. Her headache has resolved after a dose of
acetaminophen. What is the next best step in her management?
A. Give her a prescription for labetalol and have her follow-up in clinic in 2 weeks
B. (a) plus bed rest
C. Hospitalization for further evaluation and treatment
D. Immediate delivery
E. Begin induction of labor

65. A 17-year-old G1P0 woman presents at 25 weeks’ gestation complaining of

headache for the past 36 hours. She has had regular prenatal visits going back to her first prenatal
visit at 8 weeks’ gestation. A 20- week ultrasound redated her pregnancy by 2 weeks as it
was 15 days earlier than her LMP dating. She has a BP of 155/104 mm Hg. Over the next 12
hours, her BP’sriseabove 160 mmHg on several occasions, most notably to 174/102 mmHg
2 hours after admission and to 168/96 mmHg 9 hours after
 admission. Her headache does not return and she has no RUQ pain or visual symptoms. A
set of repeat laboratory test results are unchanged and by increasing her labetalol dose to 400
mg TID, her BP’s decrease to 140s–150s/70– 90 mmHg. She is also started on magnesium
sulfate. What change in physical or laboratory examination do you observe that would
indicate delivery?
A. Another BP of 174/102 mmHg
B. Headache returning
C. Double vision
D. Platelets of 108
E. AST of 265

66. A 35-year-old woman, G4P3, at 37 weeks gestation presented in hospital with a ten- day history of
low extremities edema, with idiopathic hypertension for 1 year. At presentation, she had a
blood pressure of 170/100 mmHg. Laboratory findings were normal except urinalysis (protein 2+).
She was diagnosed with superimposed severe preeclampsia. It was decided to deliver the fetus
by means of a C-section by indication transverse lie. Blood pressure measurement was 150/100 
mmHg. She lost consciousness for 30 seconds five hours after operation. The laboratory studies
gave
the following results: serum aspartate aminotransaminase (AST), 225 IU/L; serum alanine
aminotransaminase (ALT), 140 IU/L; serum lactate dehydrogenase (LDH), 1017 IU/L;
serum urea and creatine were normal; hemoglobin, 10.6 m g/dL; platelet count, 50 × 103 
μ/mL. A brain computed tomography (CT) scan was performed on patient which revealed
the left frontal lobe lacunar infarction. The patient was transferred to intensive care unit.
What is the most appropriate diagnosis
B. DIC
C. Acute Fatty Liver in Pregnancy
D. HELLP Syndrome
E. Severe puerpural infection
F. Thrombotic thrombositopenic Purpura

67. A 35-year-old woman, G4P3, at 37 weeks gestation presented in hospital with a ten- day history of
low extremities edema, with idiopathic hypertension for 1 year. At presentation, she had a
blood pressure of 170/100 mmHg. Laboratory findings were normal except urinalysis (protein 2+).
She was diagnosed with superimposed severe preeclampsia. It was decided to deliver the fetus
by means of a C-section by indication transverse lie. Blood pressure measurement was 150/100 
mmHg. She lost consciousness for 30 seconds five hours after operation. The laboratory studies
gave the following results: serum aspartate aminotransaminase (AST), 225 IU/L; serum alanine
aminotransaminase (ALT), 140 IU/L; serum lactate dehydrogenase (LDH), 1017 IU/L; serum urea and
creatine were normal; hemoglobin, 10.6 m g/dL; platelet count, 50 × 103 μ/mL. A brain
computed tomography (CT) scan was performed on patient which revealed the left frontal
lobe lacunar infarction. The patient was transferred to intensive care unit. What is the best
management after, for this case
A. Fresh-frozen plasma and trombocytes concentrates
B. Anti-platelets
C. Anti-oxidant
D. Corticosteroid
E. Magnesium sufate

68. A 35-year-old woman, G4P3, at 37 weeks gestation presented in hospital with a ten-
 day history of low extremities edema, with idiopathic hypertension for 1 year. At
presentation, she had a blood pressure of 170/100 mmHg. Laboratory findings were normal except
urinalysis (protein 2+). She was diagnosed with superimposed severe preeclampsia. It was
decided to deliver the fetus by means of a C-section by indication transverse lie. Blood
pressure measurement was 150/100 mmHg. She lost consciousness for 30 seconds five hours after
operation. The laboratory studies gave the following results: serum aspartate aminotransaminase
(AST), 225 IU/L; serum alanine aminotransaminase (ALT), 140 IU/L; serum lactate dehydrogenase
(LDH), 1017 IU/L; serum urea and creatine were normal; hemoglobin, 10.6 m g/dL; platelet
count, 50 × 103 μ/mL. A brain computed tomography (CT) scan was performed on patient
which revealed the left frontal lobe lacunar infarction. The patient was transferred to
intensive care unit. During twelve hours observation showed urine production was 100
ml.
A. Immediately giving diuretics bolus iv.
B. Immediately giving diuretics maintained by syringe-pump.
C. Check albumin level, giving diuretic justified after hipoalbuminemia condition had been
confirmed.
D. Renal failure due to micro thrombopathy suspected, heparin provision could be
considered
E. Immediately step on fluid rescucitation

69. A primigravida at 36 weeks gestation is measuring large for dates. Ultrasound shows AC
> 97 th centile. GTT performed shows poorly controlled gestational diabetes. What is the
immediate management plan?
A. Give steroids
B. Start induction
C. Start hypoglycaemics
D. Wait and watch
E. Start sliding scale and deliver

70. A 36 year old G2P1 presents to the antenatal clinic. She had an emergency caesarean section for
sudden onset hypertension and placental abruption at 30 weeks in her previous
pregnancy. She is currently 20 weeks of gestation and enquires about further plan of fetal
monitoring in this pregnancy. What is the most appropriate advice?
F. No extra monitoring is required
G. Uterine artery Doppler at 22 weeks
H. Serial scans starting from 24 weeks
I. Serial cardiotocograph monitoring from 28 weeks
J. Serial scans from 28 weeks

71. A 34 year old pregnant lady, G2P1 has been diagnosed with ductal carcinoma of the right breast
(Stage1). She is currently 22 weeks pregnant. What is the initial treatment of choice for
her?
F. Termination of pregnancy
G. Local mastectomy with reconstruction
H. Local mastectomy withoutreconstruction
I. Local radiotheraphy
J. Single dose chemotheraphy with trastuzumab
72. Atripletest isperformed for Down’s screeningat 16 weeks ina 40-year oldwoman. The result
suggests a high risk of trisomy 21. What would the results typically show?
F. Reduced AFP, reduced estriol, increased β-hCG
G. Increased AFP, reduced estriol, increased β-hCG
H. Reduced AFP, increased estriol, increased β-hCG
I. Reduced AFP, increased estriol, reduced β-hCG
J. Increased AFP, increased estriol, increased β-hCG

73. Women with one or more previous caesarean section scars and an anterior placenta are at of
placenta accreta. Which test has been shown in recent research to provide the highest
sensitivity and specificity for antenatal diagnosis of placentaaccreta?
F. Colour Doppler
G. 3D Power Doppler
H. Contrast CT
I. Gadolinium Contrast MRI
J. Grey Scale Ultrasound

74. A 22 year old unbooked primigravida presents to the Emergency Department at 26 weeks
of gestation with a history of spontaneous painless bleeding af about 500 ml. What is the
best investigation to secure a diagnosis?
F. MRI scan
G. Transabdominal scan
H. CTG
I. Transvaginal scan
J. CT scan

75. A primigravida at 35 weeks of gestation presents with pain in the right hypochondrium
and right side of her back. There is no history of nausea or vomiting, hypertension,
urinary symptoms and bowel problems. Vital signs: pulse-106, temperature 38.1, BP
128/75. Abdominal examination is unremarkable. Chest is clear. Fetal monitoring is normal.
Urine shows 2+ leucocytes and 1+ blood. White cell count 16 x 109/L. What is the most likely
diagnosis?
A. Appendicitis
B. Cholecystitis
C. Pyelonephritis
D. Abruption
E. Right basal pneumonitis

76. A 25-year-old G1P0 presents to the emergency room with vaginal bleeding. Her last normal
menstrual period was 6 weeks earlier. She reports that she is sexually active with male partners
and does not use any hormonal or barrier methods for contraception. On arrival, her
temperature is 37°C, blood pressure is 115/80, pulse is 75 beats per minute, respiratory rate
is 16 breaths per minute, and she has 100% oxygen saturation on room air. A pelvic
examination reveals a small amount of dark
blood in the vagina. The external cervical os appears 1 to 2 cm dilated. Her uterus is
mildly enlarged, anteverted, and nontender. A urine pregnancy test is positive. A pelvic
ultrasound is obtained and shows an intrauterine gestational sac with a yolk sac. No fetal
pole or cardiac motion is seen. Bilateral adnexa are normal. What is her diagnosis?
B. Incomplete abortion
C. Threatened abortion
D. Ectopic pregnancy
E. Missed abortion
F. Inevitable abortion

77. During a routine return OB visit, an 18-year-old G1P0 patient at 23 weeks gestational age
undergoes a urinalysis. The dipstick done by the nurse indicates the presence of trace glucosuria.
All other parameters of the urine test are normal. Which of the following is the most
likely etiology of the increased sugar detected in the urine?
F. The patient has diabetes
G. The patient has a urine infection
H. The patient’s urinalysis is consistent with normal pregnancy
I. The patient’s urine sample is contaminated
J. The patient has kidney disease

78. A maternal fetal medicine specialist is consulted and performs an indepth sonogram. The sonogram
indicates that the fetuses are both male, and the placenta appears to be diamniotic and
monochorionic. Twin B is noted to have oligohydramnios and to be much smaller than
twin A. In this clinical picture, all of the following are concerns for twin Aexcept
A. Congestive heart failure
B. Anemia
C. Hypervolemia
D. Polycythemia
E. Hydramnion

79. You are called in to evaluate the heart of a 19-year-old primigravida at term. Listening
carefully to the heart, you determine that there is a split S1, normal S2, S3 easily audible
with a 2/6 systolic ejection murmur greater during inspiration, and a soft diastolic
murmur. You immediately recognize that
F. The presence of the S3 is abnormal
G. The systolic ejection murmur is unusual in a pregnant woman at term
H. Diastolic murmurs are rare in pregnant women
I. The combination of a prominent S3 and soft diastolic murmur is a significant abnormality
J. All findings recorded are normal changes in pregnancy

80. A 25-year-old woman in her first pregnancy is noted to have prolonged first and second
stages of labour. She was induced at 38 weeks’ pregnancy. The baby was delivered by
forceps. After delivery the placenta she is noted to have heavy vaginal bleeding. Abdominal
examination demonstrates a relaxed uterus. What should we do if the fundus not firm after
placental delivery.
F. Methylergonovine (Methergine)
G. Carboprost (Hemabate, PGF2-alpha)
H. Fundal Massage
I. Misoprostol (PGE1)
J. Dinoprostone-prostaglandin E2

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

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

83. A 32-years-old woman comes to your clinics due to shortness of breath, that worsen since 2
days ago. On history taking, she told you that she had ever diagnosed of having
significant mitral stenosis. She is 33 weeks pregnant. The fetus is size-date appropriate.
She has had a recent echocardiography showing ejection fraction of 54% with moderate-
severe pulmonary hypertension. What is the best management for this patient currently?
A. Perform emergency Csection
B. Lung maturation and C section
C. Conservative management until term pregnancy
D. Second stage acceleration
E. Induction of labor

84. What is the most common cause of heart failure during pregnancy and the
puerperium?
F. Chronic hypertension with severe preeclampsia
G. Viral myocarditis
H. Obesity
I. Valvular heart disease
J. Pulmonary Artery Hypertension

85. For patients with congenital heart disease, what is the most common adverse
cardiovascular event encountered in pregnancy?
A. Heart failure
B. Arrhythmia
C. Thromboembolic event
D. Cerebrovascular hemorrhage
E. Heart axis changes
86. A 24-year-old patient, P2, has just delivered vaginally an infant weighing 3000 g after a
spontaneous uncomplicated VBAC. Her prior obstetric history was a low uterine segment
transverse cesarean section for breech. She has had no problems during the pregnancy and labor.
The placenta delivers spontaneously. There is immediate vaginal bleeding of greater than 500 cc.
Although all of the following can be the cause for postpartum hemorrhage, which is the
most frequent cause of immediate hemorrhage as seen in this patient?
F. Uterine atony
G. Coagulopathies
H. Uterine rupture
I. Retained placental fragments
J. Vaginal and/or cervical lacerations

87. A 22-year-old G1A0 at 10 weeks presents for her scheduled obstetric (OB)
appointment. Laboratory examination showed hemoglobin 11.2 g/dL, hematocrit 34%,
MCV 86 fl MCH 32 pg. Which of the following showsirondeficiencyanemia:
A. Low ferritin, normal serum iron
B. Low ferritin, serum iron and transferrin
C. Normal hemoglobin level, low ferritin and serum iron

D. Microcytic hypochromic, low serum iron and transferrin saturation

E. Microcytic hyperchromic, low serum iron and transferrin saturation

88. What is total iron need during pregnancy?

F. 500 mg
G. 750 mg
H. 1000 mg
I. 1500 mg
J. 2000 mg

89. How much iron is recommended by WHO for pregnant women in Indonesia? (prevalence of
anemia in Indonesia based on RISKESDAS 48%)
F. 27 mg
G. 30 mg
H. H. 60 mg
I. 100 mg
J. 200 mg

90. A 22-year-old primiparous woman presents for her first prenatal evaluation. On physical
examination you hear a grade 3/6 pansystolic murmur. Which is the most common CHD
in pregnancy that would cause that type of murmur?
F. Aortic stenosis
G. Pulmonary stenosis
H. Atrial septal defect(ASD)
I. Patent ductus arteriosus (PDA)
J. Ventricular septal defect (VSD)

91. Numerous physiologic changes develop over the course of pregnancy; however the greatest
impact on potentially compromised cardiovascular system is:
F. The red cell mass rises by 40%
G. Increased 30% total plasma volume in 28 weeks
H. Increase in cardiac output occurs by 24 weeks
I. Decreased SVR in the first trimester, and increase after 32 weeks
J. Cardiac output increases to 30-50% above pre-pregnancy levels by the end of the third trimester

92. A 28-year-old G1 at 26 weeks present for her scheduled obstetric appointment. You ordered
OGTT examination that shows fasting blood glucose 102 mg/dL and 2 hours after 75 g oral glucose
185 mg/dL. Her gestational weight gain during pregnancy is 12 kg. Her BMI before pregnancy
was 26 kg/m2. What is the most likely diagnosis?
F. Normal OGTT
G. Gestational diabetes
H. Impaired glucose test
I. Diabetes melitus type 1
J. Diabetes mellitus type 2

93. A 28-year-old G1 at 26 weeks present for her scheduled obstetric appointment. You ordered
OGTT examination that shows fasting blood glucose 102 mg/dL and 2 hours after 75 g oral glucose
185 mg/dL. Her gestational weight gain during pregnancy is 12 kg. Her BMI before pregnancy
was 26 kg/m2. What is the appropriate next step in the management of this patient?
B. Schedule nonstress test(NSTs)
C. Schedule fetal growth ultrasound
D. Admit to hospital for fetal monitoring
E. Advise insulin in order to lowering blood glucose
F. Schedule routine antenatal care in 4 weeks

94. A 28-year-old G1 at 26 weeks present for her scheduled obstetric appointment. You ordered
OGTT examination that shows fasting blood glucose 102 mg/dL and 2 hours after 75 g oral glucose
185 mg/dL. Her gestational weight gain during pregnancy is 12 kg. Her BMI before pregnancy
was 26 kg/m2. What is the most likely fetal consequences cause by patient’s condition?
A. Spina bifida
B. Fetal hypoxia
C. Intrauterine growth restriction
D. Fetal large for gestational age
E. Congenital valvularheart disease

95. A 28-year-old G2P1 is seen for her first prenatal visit at 16 weeks’ gestation by menstrual
history. Her first child was born at 32 weeks spontaneously. She is worried this pregnancy also
will be ended with spontaneous preterm birth. What is the most accurateexamination that
can be done at 16 weeks to predict the risk of preterm birth?
B. IGFBP-1 examination
C. Fibronectin examination
D. Measure cervical length
E. Vaginal swab to exclude bacterial vaginosis
F. Urinary test to exclude urinary tract infection

96. What is the next appropriate management for the patient?

A. Progesterone prophylaxis
B. Schedule for cervicalcerclage
C. Treat asymptomatic bacterial vaginosis
D. Give tocolytics for inhibiting preterm labor
E. Intervention modifiable risk factors for preterm

97. What is the implantation of a placenta in which there is a defect in the fibrinoid layer at
the implantation site, allowing the placental villi to invade and penetrate into but not
through the myometrium called?
A.Placenta accreta
B. Placenta increta
C. Placenta percreta
D. Placental infarct
E. Placenta previa

98. A 21-year-old G1 P0 patient presents to your office with vaginal bleeding at

approximately 8 weeks’ gestation by her last menstrual period. Her examination is
benign with a 9-week-sized uterus, a closed cervical os, and a small amount of blood within the
vaginal vault. You order a complete pelvic ultrasound that shows an intrauterine
gestational sac containing a fetus measuring approximately 7 weeks’ gestation. Doppler
sonography is unable to demonstrate any fetal heartbeat. What is the most likelydiagnosis?
A.Ectopic pregnancy
B. Complete abortion
C. Embryonic demise (Missed ab)
D. Incomplete abortion
E. Threatened abortion

99. A 21-year-old G1 P0 patient presents to your office with vaginal bleeding at

approximately 8 weeks’ gestation by her last menstrual period. Her examination is
benign with a 9-week-sized uterus, a closed cervical os, and a small amount of blood within the
vaginal vault. You order a complete pelvic ultrasound that shows an intrauterine
gestational sac containing a fetus measuring approximately 7 weeks’ gestation. Doppler
sonography is unable to demonstrate any fetal heartbeat. You decide to perform a suction
D&C. When giving informed consent, you discuss the risk most commonly encountered in
this operation. Which of the following is the most common risk associated with suction
D&C?
A.Infection
B. Uterine perforation
C. Damage to thebladder
D. Uterovaginal bleeding
E. Need for futuresurgery