51. The risk of malignancy index (RMI) is one method of differentiating between benign and malignant masses.

Utilization of
this index may facilitate better triage of suspicious pelvic masses to gynaecologic oncologists. The RMI incorporates the
menopausal status, an ultrasonic score, and the serum CA125 level. The cut-off point of RMI score for suspicion of malignancy
is :
a. 200.
b. 250.
с. 150.
d. 300
e. 100.
Sumber: Initial Evaluation and Referral Guidelines for Management of Pelvic/Ovarian Masses. SOGC

52. A 35-year-old lady, 03 P2, presents to delivery suite at 33-week's gestation. She was referred by a midwife due to high blood
pressure (BP 180/120 mmHg). BP on arrival is 170/105 mmHg. Protein is negative on urine dipstick test. The patient has history
of high blood pressure on her previous pregnancy. After her second child born, she never measures her blood pressure. She
complaints headache and blurred vision for a long time. Eye examination finds retinopathy hypertensive.
What is the most likely diagnosis of this patient?
a. Superimposed preeclampsia
b. Preeclampsia with severe feature
c. Preeclampsia
d. Gestational hypertension
e. Chronic hypertension

Sumber: PNK Hipertensi dalam Kehamilan POGI 2016

53. You are about to counsel a woman with major placenta previa at 32 weeks who has just had a repeat scan for placental
localization. The ultrasound scan shows an anterior placenta covering the internal os with irregular retroplacental sonolucent zone
and hypervascularity in serosa-bladder interface. Fetal parameters are appropriate for gestational age. She had her previous
caesarean section for breech presentation 4 years back and has not had any episodes of bleeding in this pregnancy. What is the
most appropriate course of action?

a. Plan for elective caesarean at term with appropriate precautions for placenta acreta
b. Rescan for placental localization at 36 weeks as in a majority of cases; there is upward migration of placenta due to
development of the lower uterine segment
c. Immediate caesarean section
d. Immediate MRI as it will definitively diagnose or rule out placenta accrete
e. Plan caesarean hysterectomy

Sumber: william obstetric ed 26

54. It is important to optimize pre-pregnancy health in a woman with sickle cell disease. You have advised many blood test and
systemic evaluations to a 29-year-old woman with sickle cell disease to help determine her pre-pregnancy health status. She is
asking you for a clarification regarding the exact 'eye test' you have advised.
It is most likely to be:
a. Retinal screening
b. Visual acuity screening
c. Corneal opacity screening
d. Glaucoma screening
e. Cataract screening

Sumber: american academy of ophtalmology, 2014

Sumber: williams obstetric edisi 26

Vasculopathy salah satunya jika terkena pada vaskularisasi pada retina dapat menyebabkan retinopathy sehingga pada wanita
dengan anemia sickle cell diperlukan untuk screening retina rutin terutama sebelum kehamilan.

55. Concerning middle cerebral artery Doppler velocimetry, which of the following statement is true?
a. It is superior to the modified biophysical profile in forecasting pregnancy outcomes
b. In the normal situation the fetal MCA has a low resistance flow (seharusnya high resistance flow)
c. Peak systolic velocity decreased in fetal anemia of any cause (harusnya enhanced bukan decreased)
d. In those with brain sparing, decreased blood flow from reduced cerebrovascular impedance is detected (harusnya increased
blood flow pada brain-sparing)
e. An axial section of the brain, including the thalami and the sphenoid bone wings,
should be obtained

Sumber: ISUOG practice guidelines (update): use of doppler velocimetry in obstetrics. 2021

56. Locally invasive GTN develops in 15% of patients after evacuation of a complete mole and infrequently after other
gestations. These patients, instead of with persistently elevated serum hCG levels, usually present clinically with one or more of
the following:
a. Regular vaginal bleeding, functional cysts, and enlarged uterus.
b. Regular vaginal bleeding, functional cysts, and normal uterus.
c. Irregular vaginal bleeding, theca lutein cysts, and enlarged uterus.
d. Irregular vaginal bleeding, functional cysts, and enlarged uterus.
e. Regular vaginal bleeding, theca lutein cysts, and enlarged uterus.

Sumber: william gynecologi edisi 4e (bab gestational trophoblastic disease)

57. An ultrasonography examination is needed to exclude malignancy in AUB. The cut-off-point for the endometrial thickness
for this case to rule in suspicion of malignancy is:
a. = 5
mm
b. > 5
mm
c ≤= 5
mm
d. >= 5
mm
e. < 5
mm
Sumber: william gynecology edisi 4e (bab abnormal uterine bleeding)

58. A 20-year-old primigravida with 30 weeks gestation has presented in the delivery suite with preterm labour pains. She has
history of productive cough and fever since 15 days. She has a BMI of 19 and was diagnosed with gestational diabetes at 20
weeks. She has had a poor gestational weight gain. It is true to say that in this condition:
a. If the partner does not carry the mutation, then risk of having affected child is around1:250 (1:2500 kelahiran di jurnal
internasional)
b. FEV1<80% is an absolute contraindication to pregnancy (kontraindikasi kehamilan jika FEV1 < 50% sesuai di buku william
obstetric)
c. Women are usually infertile
d. About 5% of women have pre-existing or gestational diabetes (10% sesuai di buku william obstetric)
e. Premature delivery is seen in more than half of pregnancies (resiko 20-30% menjadi preterm delivery sesuai di buku william
obstetric)

Vignette dari kasus ini mengarah kepada cystic fibrosis ditandai dengan adanya diabetes gestasional dan keluhan batuk serta
demam dan malnutrisi
Sumber: william obstetric edisi 26

Sumber:
female reproductive health in cystic fibrosis. journal of cystic fibrosis. 2019

wanita dengan cystic fibrosis rentan memiliki cervical mucus yang lebih kental dan masalah ovulasi akibat malnutrisi sehingga
sebagian besar wanita dengan cystic fibrosis akan infertil atau sulit untuk hamil
59. A 28-year-old woman is meeting you at the antenatal clinic for her booking visit. This is her third pregnancy and she had an
uneventful pregnancy 3 years back with a term delivery of a healthy girl. She has been on a diet for reducing weight off and in
the past 2 years. Her present BMI is 22 and you notice pallor during clinical examination. You have explained the risk of
nutritional deficiency issues. Her hemoglobin level is 10.2 g/dL. What is the next step in her care?
a. Oral iron supplements
b. Blood transfusion
c. Parenteral iron
d. Iron chelation therapy
e. Diet modification alone

Sumber: buku anemia dalam kehamilan (terbitan POGI 2021)

60. Jamilah is a 31-year-old woman who consults her OBGYN with complaints of irregular menstrual periods, breast tenderness,
and milk discharge from her nipples. After a thorough evaluation, she is diagnosed with hyperprolactinemia.
What might be the cause related to her symptoms?
a. Low levels of estrogen
b. An overproduction of insulin
c. Overactive adrenal glands
d. Elevated levels of thyroid hormone
e. Medications, stress or pituitary tumours

Sumber: william obstetric edisi 26

Sumber: gardner and shoback. 2011. melmed et al. journal clinical endocrinology metabolic