SOAL LATIHAN UGM OKTOBER 2023 (PART I)

1. A 33 year old G8P6A1 woman with fundal height of 39 cm presents for initial prenatal
visit in your clinic. She is currently an inmate at a local jail. She is imprisoned on charges ofn
marijuana possession. She has had no prenatal care. She is unsure of her last period but
reports that started feeling the baby move approximately 5 months ago. She denies vaginal
bleeding, leaking fluid, or contractions during the pregnancy. Ultrasound performed in your
clinic shows gestational age tobe approximately 40 weeks 3 days. What is the most common
cause of diagnosis of postterm pregnancy?
a. Multiparity
b. Delayed presentation to prenatal care
c. Inaccurate dating
d. Fetal anomaly
e. Advanced maternal age

2. A 27 year old, P1A0 and her husband desire to use natural family planning for
contraception. They decide to use the calendar method. Based on her regular 28-day cycle,
which of the following represents her fertile period?
a. Days 14 through 21
b. Days 12 through 19
c. Days 16 through 25
d. Days 10 through 17
e. Days 17 through 14

3. A 29 year old G3P2A0 presents to the emergency center with complains of abdominal
discomfort for 2 weeks. Her vital signs are : blood pressure 120/70mmHg, pulse 90 beats per
minute, temperature 36,9 0C, respiratory rate 18 breaths per minute. A pregnancy test is
positive and an ultrasound of the abdomen and pelvis reveals a viable 16 weeks gestation
located behind a normal appearing 10x6x5.5 cm uterus. Both ovaries appear normal. No free
fluid is noted. Which of the following is the most likely cause of these findings?
a. Fistula between the peritoneum and uterine cavity
b. Tubal abortion
c. Uterine rupture of prior caesarean section
d. Primary peritoneal implantation of the fertilized ovum
e. Ectopic ovarian tissue
4. A 14-year-old girl complains of irregular vaginal bleeding. Her general examination and
pelvic organs are normal. Which of the following is the most likely cause of anovulatory
bleeding (dysfunctional uterine bleeding [DUB]) in this patient?
a. pituitary adenoma
b.hypothyroidism
c.polycystic ovary syndrome (PCOS)
d. congenital adrenal hyperplasia (CAH)
e. hypothalamic immaturity

5. A 16-year-old girl has not experienced menarche. Examination shows absence of breast
development and small but otherwise normal female pelvic organs. Which of the following
diagnostic tests is most useful in determining the etiology of the amenorrhea?
a. serum follicle-stimulating hormone (FSH)
b. serum estradiol
c. ovarian biopsy
d. magnetic resonance imaging (MRI) of the head
e. serum testosterone

6. A 22-year-old G1P0 African-American woman at 36 weeks by LMP consistent with 12-

week ultrasound with limited prenatal care presents via ambulance to the L&D triage unit
complaining of severe abdominal pain and profuse vaginal bleeding. The patient is unstable
and unable to communicate coherently. The emergency medical technician (EMT) reports
that initially her BP was 180/100 mm Hg and pulse rate was 110 beats per minute, but she
has lost at least 500 mL blood in route. On the examination, her BP is 90/50 mm Hg, pulse
rate is 120 beats per minute, she appears to be in significant pain, is unable to answer
questions, and her abdomen feels rigid. What is the most likely diagnosis in this patient?
a. Cervical tear after intercourse
b. Normal labor
c. Vasa previa
d. Placenta previa
e. Placental abruption

7. A 22-year-old P0 woman presents to the clinic for an annual examination. She reports that
her last normal menstrual period was 5 weeks prior. Her menstrual cycles are irregular and
she reports that she frequently skips a month between periods. She reports that she is sexually
active and uses condoms sporadically for birth control. Pelvic examination reveals a mildly
enlarged, anteverted, nontender uterus with palpably normal adnexa bilaterally. The patient
consents to a urine pregnancy test that returns as positive. The patient expresses that she is
uncertain if this is a desired pregnancy. You perform an in-office transvaginal ultrasound;
however, neither an ectopic or IUP is visualized. What step do you take next?
a. Send the patient for an official ultrasound with a high-resolution machine
b. Offer the patient IM methotrexate for a presumed ectopic pregnancy
c.Explain to the patient that she likely had a miscarriage
d. Obtain a serum quantitative β-hCG level.
e.Explain that the patient likely has a chemical pregnancy that will not develop into a viable
pregnancy

8. A 23-year-old G1P0 woman at 30 weeks 3 days presents to clinic for routine prenatal care.
Her pregnancy is dated by last menstrual period (LMP) consistent with a 10-week ultrasound.
She has had three prenatal visits, and her pregnancy has been complicated by vaginal
bleeding in the first trimester and the development of heartburn at 25 weeks. She has no
complaints today. She continues to smoke half a pack of cigarettes daily, which has decreased
from one pack per day at the beginning of her pregnancy. Her medical history is significant
for asthma. Ultrasound at 20 weeks' gestation showed no evidence of fetal abnormality,
posterior placenta, AFI of 10.6 cm, and fetal growth in the 20th percentile. Her current
weight is 130 lbs, and her height is 5 ft 6 in. She has gained 10 lbs so far in pregnancy. Urine
dip is negative for protein, glucose, ketones, and leukocytes. BP is 112/64 mm Hg and heart
rate is 80 beats per minute. Fetal heart tones are in the 130s. Fundal height measures 25
weeks. Of note, at her last visit at 25 weeks, fundal height measured 23 weeks, and she had a
normal glucose tolerance test and complete blood count. Which of the following is the next
best step in managing this patient's pregnancy?
a. Group B streptococcus culture
b. Nonstress test (NST)
c. TORCH titers
d. Fetal ultrasound
e. Amniocentesis

9. A 24-year-old G1P0 woman presents for prenatal care at 8 weeks by LMP. She has regular
menses every 28 to 30 days and you confirm her GA with an ultrasound today in the office.
She has no past medical or surgical history. She and her husband of 6 months planned the
pregnancy and they have both been reading about pregnancy and prenatal care. You discuss
the prenatal tests for the first visit as well as the plan throughout the rest of the pregnancy. As
part of this discussion, you offer her which of the following prenatal screening/diagnostic
tests?
a. First-trimester screening
b. CVS
c. Amniocentesis
d. Quad screening
e. All of the above

10. A 24-year-old G2P1001 Hispanic woman at 38 weeks by LMP consistent with 10-week
ultrasound presents to L&D triage, complaining of painful uterine contractions every 4 to 5
minutes. She has no significant PMH. Her obstetrical history is significant for one prior low-
transverse cesarean section for breech at 39 weeks' gestation. On sterile vaginal examination,
the patient is initially found to be 2 cm dilated, 50% effaced, and −3 station. The patient
strongly desires to have a vaginal delivery if at all possible. What is the best initial
management for this patient?
a. Admission to L&D triage and repeat cesarean delivery without a trial of labor
b. Admission to L&D triage, continuous fetal monitoring, and start oxytocin augmentation
c. Discharge home and follow-up in 1 week at clinic
d. Close observation in triage with continuous fetal monitoring and repeat sterile vaginal
exam in 2 to 4 hours

11. A 24-year-old G2P1001 woman at 39 weeks and 3 days is seen in clinic. She has been
experiencing more frequent contractions and thinks she might be in labor. Her last pregnancy
ended with a cesarean delivery after a stage 1 arrest. There was no evidence of cephalopelvic
disproportion. Earlier in the course of her current pregnancy, she had desired a scheduled
repeat cesarean, but now that she might be in labor she would like to try and deliver
vaginally. What would be a contraindication to a trial of labor after cesarean (TOLAC)?
a. Oligohydramnios
b. Prior Kerr hysterotomy
c. GBS + mother
d. Prior classical hysterotomy
e. Small-for-gestational-age (SGA) fetus

12. A 25-year-old G2P1 woman presents at 9 weeks' gestation for routine prenatal care. She
has a history of a prior term birth 2 years earlier in which she developed preeclampsia and
required induction of labor at 38 weeks' gestation, leading to a vaginal delivery of a viable
baby girl. She is interested in first-trimester screening. Which of the following is true about
first-trimester screening?
a. First-trimester screening has a sensitivity for Down syndrome that is greater than the
sequential screen
b. First-trimester serum screening has an 80% sensitivity for Down syndrome
c. Combined first-trimester screening has a 90% sensitivity for Down syndrome
d. NT screening alone has a 70% sensitivity for Down syndrome
e. Increased NT in the setting of normal karyotype is associated with limb anomalies

13. A 25-year-old woman experiences galactorrhea and amenorrhea of 8 weeks' duration with
irregular vaginal bleeding. Which of the following serum assays should initially be
performed?
a. hCG
b. prolactin
c. FSH
d. progesterone
e. luteinizing hormone (LH)

14. A 26-year-old G2P2001 woman at 40 weeks and 2 days is seen in clinic for prenatal care.
She is experiencing occasional contractions and has a sense of pressure in her vagina, but
does not feel like she is in labor (as she experienced in her first delivery). Her first child was
born at 41 weeks following an induction, resulting in a normal spontaneous vaginal delivery.
She is interested in an induction for this pregnancy as well. You perform a cervical
examination and discuss options with her. Which of the following cervical examinations is
the most favorable for induction of labor?
a. Cervix soft, midposition, 3 cm dilated, 50% effaced with −2 station
b. Cervix closed, posterior, firm with 0% effacement
c. Cervix medium, posterior, consistence, 2 cm dilated, 30% effaced
d. Cervix soft, midposition, 3 cm dilated, 50% effaced with −3 station
e. Cervix soft, anterior, 4 cm dilated, 80% effaced with −1 station

15. A 27-year-old azoospermic male undergoes a testicular biopsy revealing normal

seminiferous tubules. He is diagnosed with hypogonadotropic hypogonadism and receives
FSH and human chorionic gonadotropin (hCG) injections. What is the minimal time required
before repeating the semen analysis for spermatogenesis response?
a. 60 days
b. 120 days
c. 90 days
d. 30 days
e. 15 days

16. A patient presents to your clinic complaining of nausea and vomiting. She is currently
ingesting combined oral contraceptive pills (OCP) and has used them for over a year. When
you tell her she has a positive pregnancy test, she reports that her last bleeding on the OCPs
was 8 weeks ago. In such a situation, determination of the most accurate estimated date of
delivery can then be made by which of the following?
a. obtaining fetal biometry by ultrasound prior to 20 weeks' gestation
b. eliciting when breast tenderness or morning sickness began
c. counting 280 days from the first positive serum pregnancy test
d. asking the patient when she first felt pregnant
e. assessing uterine size by physical examination

17. A patient is seen in the early third trimester of pregnancy with acute onset of chills and
fever, nausea, and backache. Her temperature is 102°F. The urinary sediment reveals many
bacteria and WBCs. Which of the following is the most likely diagnosis?
a. pyelonephritis
b. acute appendicitis
c. ruptured uterus
d. abruptio placentae
e. labor

18. In the United States, it appears that maternal mortality is increasing after years of decline.
To address this increase, efforts must be directed toward the leading causes. Which of the
following choices lists those leading causes?
a. human immunodeficiency virus (HIV) and infections related to immunodeficiency
b. embolism, hypertension, and ectopic pregnancy
c. motor vehicle accidents, homicide, and suicide
d. complications related to abortion and anesthesia
e. infection, cardiomyopathy, and stroke

19. A 17-year-old single female (gravida 1, para 0), last menstrual period (LMP) 32 weeks
ago, menstruasi formula (MF) 12/28/4–5, with occasional cramps and no history of
contraception, comes for her first OB clinic visit and routine care. The patient admits to a 40-
1b weight gain during pregnancy with ankle swelling for the past 4 weeks. Rings on her
fingers are tight. Otherwise, she feels well. She has Een staying with a cousin who is on
welfare. She has had no prior prenatal care and no iron or vitamin supplementation. History:
Noncontributory except for appendectomy; age 14. Generally in good health. Social history:
High school dropout; parents divorced. Family history: No history of renal disease, diabetes,
cancer, hypertension, congenital anomalies, bor twins. Physical findings: BP, 135/85; P, 84;
T, 37; R, 20. BMI 35. Head ears eyes nose throat (HEENT): Fundi not examined. Neck:
Thyroid, 1 to 1½ times enlarged; chest, clear; breasts, full, slightly tender; heart, grade 11/VI,
systolic murmur at the left sternal border (LSB). Abdomen: Uterus, 42 cm; fetal heart tones
(FHTs), 136 and 156 taken simultaneously; extremities, 2+ edema, 3+ reflexes. Brief
ultrasound confirms twins in breech presentation. Pelvis: Normal measurements; cervix, one-
half effaced, soft, and not dilated, station +1. The above findings were all confirmed 6 hours
later. Laboratory tests: Urinalysis (UA), color cloudy yellow; specific gravity, 1.013; protein,
2+; RBCs, rare; WBC, 2 to 5; bacteria, 0; WBC, 9800; Rh, VDRL, rubella titer, and Pap
smear were obtained but not yet returned.. Given the history of this patient, several more
laboratory and diagnostic tests are obtained. She is stable and the fetuses have reassuring
heart rate tracings. Which of the following do you expect to See in the test results?
a. urine to show infection
b. chest X-ray to show decreased pulmonary vascular markings
c. a decreased hematocrit
d. creatinine clearance to be increased above normal pregnancy levels
e. serum uric acid to be increased

20. A 28-year-old G2P0 at 39 weeks is in early labor. She is 2 cm dilated and 90% effaced,
Alt contractions every 4 to 5 minutes. The fetal heart tones are reassuring. Her nurse steps out
for a moment and returns to find her having a seizure.. The nurse administers a 4-g
magnesium bolus. The seizure stops. The fetal heart tone variability is flat, but there are no
decelerations. What would your next therapies be aimed at?
a. reducing edema with diuretics
b. prepare for immediate delivery by cesarean section
c. giving hypotensive agents until the blood pressure is 110/70 mm Hg
d. keeping the patient free of convulsions, coma, and acidosis
e. giving 3 g of magnesium sulfate every 3 hours
21. All except which of the following statements regarding delivery of the fetal body are
true?
a. Usually delivers without delay after the shoulders.
b. Hooking the axillae can be employed to hasten delivery of the body.
c. Moderate outward traction on the head may be used to help delivery.
d. Immediate nasopharyngeal suction should be performed after delivery.

22. What are the benefits of delayed cord clamping in preterm infants?
a. Decrease IVH
b. Decrease NEC
c. Decrease need for blood transfusion
d. All of the above
23. A 24-year-old primigravida presents to labor and delivery at 38 weeks’ gestation. She is
contracting regularly and on exam she is 4 cm dilated, 25% effaced, –3 station, and the fetal
presenting part is suspected to be a foot. What is the next most appropriate step in her
management?
a. Ultrasound for confirmation of fetal presentation
b. Anesthesia consultation for pain management during labor
c. Leopold maneuvers for further characterization of fetal position
d. Preparation for cesarean delivery due to non-cephalic presentation in labor

24. The Term Breech Trial has heavily influenced mode of delivery since its publication.
Which of the following is a criticism of the study?
a. Mode of delivery was not randomized.
b. More than 10% of study participants had radiologic pelvimetry, which may have
influenced management.
c. Many of the outcomes included in the “serious neonatal morbidity” composite did not
portend long-term infant disability.
d. All of the above

25. Internal podalic version is best characterized in which of the following?

a. Manipulation within the uterus to yield a breech presentation, typically reserved for
delivery of a second twin
b. Manipulation within the uterus to yield a vertex presentation, typically reserved for the
delivery of a second twin
c. Manipulation within the uterus to yield a vertex presentation for a preterm breech fetus
immediately after rupture of membranes
d. None of the above

26. A 23-year-old G1P1 patient is using barrier contraception and is 1 week past onset of her
last mense. She is found to have bilaterally equal adnexal pain; cervical motion tenderness;
direct abdominal tenderness; temperature, 101.3°F; and WBC, 12,000/mL. Which of the
following is the most likely diagnosis?
a. ectopic pregnancy
b. urinary tract infection (UTI)
c. ruptured corpus luteum cyst of the ovary
d. endometriosis
e. PID

27. A gravida 3 Para 2 is diagnosed with anterior placenta reaching to the os at 20 weeks
gestation. She has had 2 previous caesarean sections. Further imaging with colour flow
doppler at 32 weeks has confirmed major placenta praevia and placenta accreta. What would
be the recommendation for delivery?
a. Elective caesarean section at 36–37 weeks
b. Elective caesarean section at 39 weeks
c. Category 3 caesarean section as soon as possible
d. Elective caesarean section at 38 weeks
28. 34. A 20-year-old woman at 12 weeks' gestation is involved in a serious automobile
accident and is brought to the emergency department with multiple traumas. The emergency
department physician believes that imaging studies of the abdomen are needed to assess the
patient's acute injuries. Regarding this imaging, what should you counsel the managing team?
a. Imaging should be limited to no more than two views of the abdomen.
b. Imaging can only be done if the uterus is shielded during the procedure.
c. There are no contraindications to the needed tests.
d. Only imaging above the level of the uterine fundus should be carried out.
e. Imaging at this stage of pregnancy should not be carried out.

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

30. A 20-year-old patient complains of painful vulvar ulcers present for 72 hours.
Examination reveals three tender, punched-out lesions with a yellow exudate but no
induration. Which of the following is The most likely diagnosis?
a. chancroid
b. herpes
c. syphilis
d. lymphogranuloma venereum
e. granuloma inguinale

31. All except which of the following are acceptable indications for operative vaginal
delivery?
a. Aortic stenosis
b. Maternal exhaustion
c. Pelvic floor protection
d. 2nd stage labor ≥2 hours in a multipara with an epidural

32. A 31-year-old primigravida undergoing induction of labor reaches the 2nd stage of labor
after 36 hours. Before beginning to push she says she is too tired and desires an operative
vaginal delivery. Which of the following precludes her from having an elective operative
vaginal delivery?
a. Head is at +1 station
b. Head is in occiput anterior position
c. Scalp is visible at the introitus without labial separation
d. All of the above

33. Which of the following is a prerequisite for vacuum extraction, but not a forceps-assisted
vaginal delivery?
a. Epidural anesthesia
b. Minimum +2 station
c. Assistant to create suction
d. Minimum 34 weeks’ gestation

34. For women who deliver vaginally with persistent occiput posterior (OP) position, which
of the following is true?
a. Transabdominal ultrasound can aid in identifying the OP position.
b. There is increased blood loss compared to occiput anterior position.
c. There are more third- and fourth-degree lacerations compared to occiput anterior position.
d. All of the above

35. A 22-year-old primigravida has been pushing for 3 hours. The fetus is in persistent
occiput posterior position with caput, and the fetal head is noted to protrude slightly through
the introitus with each contraction. Which of the following features must be considered prior
to attempted forceps delivery?
a. The head may not be engaged
b. At this station the pelvis is adequate
c. Diagnosed visually the station is +5
d. At this point low forceps may be applied without further evaluation

36. Which of the following defines shoulder dystocia?

a. Clinical perception of the delivering physician.
b. Maneuvers are needed to free the anterior shoulder.
c. Head to body delivery time is greater than 60 seconds.
d. All of the above

37. A patient with hypogonadotropic hypogonadism desires ovulation. What is the initial
treatment of choice?
a. bromocriptine mesylate
b. clomiphene citrate
c. low-dose estrogen therapy
d. cyclic progesterone
e. hMG therapy

38. A patient presents as an emergency with urinary retention. Upon taking a history, you
also discover that the patient has been having hematuria for several weeks. What is an
absolute contraindication to inserting a suprapubic catheter?
a. Bladder tumor
b. Clotting disorders
c. Unable to fill the bladder to a volume excess of 300 ml
d. History of extensive bladder reconstruction
e. Ascites

39. Vulval cancers account for 6% of gynaecological cancers in The United Kingdom. In
2009, a new FIGO staging was introduced with greater emphasis on the inguino-femoral
lymph node status to understand prognosis. What is the FIGO stage for a woman who has a
3cm vulval cancer involving the anus with metastases in 2 lymph nodes <5mm?
a. Stage IIIa
b. Stage IIIb
c. Stage IVa
d. Stage IVb
e. Stage IIIc

40. Which of the following is the most common benign neoplasm of the cervix and
endocervix?
a. leiomyoma
b. polyp
c. nabothian cyst
d. Gartner's duct cyst
e. endometriosis

41. Following a spontaneousmiscarriage at 8/40 gestation, a woman is referred to the

gynaecology clinic with persistent irregular vaginal bleeding. What initial investigation
should be performed?
a. Urinary pregnancy Test
b. Endocervical swab to screen for chlamydia and gonorrhoea
c. Serum βHCG level
d. Pelvic ultrasound scan
e. Endometrial biopsy

42. A 32-year-old G0P0 patient presents complaining of secondary dysmenorrhea that is

increasing Ni severity. The pain is triggered by deep thrusting with coitus. Which of the
following is the Nast common cause of deep-thrust dyspare-unia?
a. vestibulitis
b. vaginismus
c. atrophic change
d. endometriosis
e. depression

43. A woman with blood type O gave birth to an AB infant. She and her partner are quite
concerned that there may be a mix-up in the nursery. What is the most likely diagnosis?
a. Lyon hypothesis
b. a maternal blocking antibody
c. Bombay phenotype
d. chimerism
e. laboratory error
44. Which form of contraception is most strongly associated with a delay in return of
fertility?
a. Copper-containing intrauterine device
b. Progestogen-only pil
c. Etonorgestrel-containing subdermal implant
d. Depo medroxyprogesterone acetate
e. Levonorgestrel containing intrauterine system

45. What screening test should be offered to all sexually active women who present to the
gynaecology clinic with chronic pelvic pain?
a. Transvaginal ultrasound
b. Serum CA125
c. Endocervical swabs for Chlamydia and Gonorrhoea
d. Magnetic resonance imaging
e. Serum C-reactive protein
46. Treatments of primary dysmenorrhea are directed toward addressing the cause, which is
associated with elevations in which of the following?
a. progesterone
b. estrogen
c. FSH
d. prostaglandin E2
e. prostaglandin F2alpha

47. A woman attends her first ultrasound scan in pregnancy. What is the maximum crown
rump length (CRL) that is accurate for canting before you measure gestational age by head
circumference (HC)
a. 84mm
b. 24mm
c. 44mm
d. 14mm
e. 94mm
48. On pelvic examination of a 28-year-old mul-tiparous patient, several 3–5 mm yellowish
translucent or opaque, raised cystic structures are seen on the surface of the cervix. The
patient is asymptomatic. What is the most appropriate next step in the management of these
findings?
a. incision and drainage of cysts
b. topical estrogen therapy
c. oral antibiotic therapy
d. excisional biopsy
e. counseling and reassurance

49. A 33-year-old patient has been diagnosed as having adenomyosis. Which of the following
symptoms is most consistent with this diagnosis?
a. mood swings
b. secondary dysmenorrhea
c. dyspareunia
d. infertility
e. painful defecation

50. A patient who is now ovulating on clomiphene citrate has not conceived. You wish to do
a postcoital test to see if there has been a negative cervical response to the anti-estrogen
effects of the clomiphene citrate. She asks for information about the postcoital test (PCT).
Which of the following best describes this test?
a. It is performed within 1 hour of coitus.
b. It predicts whether pregnancy can occur.
c. It correlates the number of sperm in the cervical mucus with the pregnancy rate.
d. It is performed in the secretory phase of the cycle.
e. It examines the ability of sperm to reach and survive in the mucus.

.
51. A 28-year-old woman who has received single-agent chemotherapy because of a
persistent rise in her chorionic gonadotropin levels after evacuation of a complete
molar pregnancy asks about her future fertility options.
What will you tell her?
a. She cannot conceive because of the chemotherapy.
b. She can conceive but after one year of completion of her treatment and follow-up.
c. She can conceive after two years of undetectable gonadotropin levels (hCG)
levels.
d. She can conceive after two years of a contraceptive.
e. She can conceive but only with oocyte donation.

52. To improve the results of treatment of gestational trophoblastic disease (GTD), what
audit topic would you recommend?
a. The proportion of women with GTD registered with the relevant screening
centre.
b. The proportion of women with a histological diagnosis of molar pregnancy who
were diagnosed by ultrasound before evacuation of the molar pregnancy.
c. The proportion of women who receive medical management for the evacuation
of a molar pregnancy.
d. The proportion of women who had histological examination of the products of
conception after an induced abortion.
e. The proportion of women who did not use contraception during the follow-up
period.

53. You are counselling a couple who have had two consecutive miscarriages. She is
22 years old and wants to know if there are any age-related risks of miscarriage.
Which of the following age groups is associated with the smallest risk of
miscarriage?
a. 12–19 years.
b. 20–24 years.
c. 25–29 years.
d. 30–34 years.
e. 35–40 years.

54. There are cases of women who have recurrent miscarriages.

What percentage of these women have antiphospholipid antibodies?
a. 5%.
b. 10%.
c. 15%.
d. 25%.
e. 40%.

55. A couple who have had three consecutive miscarriages have come to see you for
advice after having a thrombophilia screen. The result showed that she was positive
to one of the antiphospholipid antibodies.
Which of the following is an antiphospholipid antibody?
a. Anti-B2-glycoprotein-1 antibody.
b. Anti-B1-glycoprotein-1 antibody.
c. Anti-B2-glycoprotein-2 antibody.
d. Anti-B2-glycoprotein-3 antibody.
e. Anti-B3-glycoprotein-1 antibody.

56. A 36-year-old woman is complaining of having had heavy menstrual bleeding (HMB)
for two years. Abdominal examination reveals a 20-week sized uterus and her pelvic
scan shows multiple interstitial fibroids. Her haemoglobin level is 9 gm/dL. She is
nulliparous and wishes to preserve her fertility.
What management option would you recommend?
a. Gonadotropin-releasing hormone (GnRH) analogue for six months followed by
myomectomy.
b. MRI-focused ultrasonography.
c. Open/laparoscopic myomectomy.
d. Ulipristal acetate.
e. Uterine artery embolization.

57. A 24-year-old woman is counselled regarding surgical treatment of a 7-cm symptomatic

fibroid. She is keen to know all the facts and particularly wants to hear about new
techniques. She wants to know the effect of the procedures on her future fertility.
What information can you give her?
a. Laparoscopic myomectomy is associated with a lower chance of conception.
b. Hysteroscopic resection is feasible for almost all types of myomas.
c. Laparoscopic myomectomy is her best option.
d. Myolysis and cryomyolysis offer the best chance of conception.
e. Pregnancy rates are higher after laparoscopic myomectomy when compared to
the open approach.

58. A 50-year-old woman has had two previous episodes of abnormal uterine bleeding.
She had a cervical smear a year previously, which was normal. Pelvic ultrasound
scanning shows an endometrial thickness of 15 mm. She is on anticoagulation for
recurrent thromboembolic events.
What is your next step in management?
a. Book for inpatient dilatation and curettage.
b. Inpatient hysteroscopy and biopsy.
c. LNG-IUS.
d. Outpatient office hysteroscopy and biopsy.
e. Pipelle biopsy in the clinic and offer LNG-IUS.

59. An 18-year-old woman is referred to you because of her concerns about the irregularity
of her menstrual cycle. She thinks she has very frequent cycles, which come every
25 days but may increase to every 38 days. She also thinks that she loses a lot of blood.
Her general practitioner says she is not anaemic and a 2D ultrasound scan was
normal. He tried to reassure her but she insists on referral.
How best can you handle the situation?
a. Ask her to measure her menstrual blood loss for the next two periods and report
it if it is >120 mL.
b. Reassure her and explain that the average cycle length is between 24 days and
38 days.
c. Counsel her for an endometrial sample.
d. Repeat the haemoglobin after three months.
e. Request a 3D ultrasound.

60. A 20-year-old woman with learning difficulties comes with her caregiver who states
that she has frequent irregular menstruation, which is also causing her problems with
her hygienic care. Her pelvic scan is normal and her BMI is 22.
What will you advise when prescribing medical treatment for her?
a. A three-month continuous use of combined oral contraceptive pills (COCP) and
restart a new three-cycle after the end of the withdrawal bleed.
b. Depot medroxyprogesterone acetate (DMPA).
c. LNG-IUS.
d. Surgical options, including endometrial ablation or hysterectomy.
e. The combined transdermal contraception patch

61. A 35-year-old woman (gravida 4, para 4) complains that she loses urine intermittently and
without
warning. At other times, she cannot get to the bathroom in time when she first feels the urge
to void and
also loses urine. She denies dysuria or loss of urine with exercise. Pelvic examination is
normal,
except for a first-degree cystocele. Postvoid residual is 150 mL. Of the following options,
which is the
best plan?
a instruct in Kegel exercises
b teach clean intermittent self-catheterization
c do an intravenous pyelogram (IVP) looking for a urinary fistula
d perform urodynamic testing looking for a neurogenic bladder
e give her a trial of anticholinergic medication

62. Which of the following is the most common cause of rectovaginal fistula?
a obstetrical delivery
b irradiation to the pelvis
c carcinoma
d hemorrhoidectomy
e Crohn’s disease

63. If a rectovaginal fistula is identified, which of the following should initial treatment
include?
a diverting colostomy
b bowel resection
c rectal pull-through operation
d vaginal repair of the fistula
e systemic steroids and antibiotics

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

a interplay between the pubococcygeus muscle and rectum
b innervation of the pelvic floor and the anal sphincters
c normal colonic transit time
d nulliparity
e urinary retention

65. When performing a vaginal hysterectomy for any indication, prevention of future
enterocele or vaginal
vault prolapse is aided by which of the following?
a reattachment of the round ligaments to the vaginal cuff
b closing the vaginal mucosa
c reattachment of the cardinal and uterosacral ligaments to the vaginal cuff
d complete a purse string suture closure of the cul-de-sac peritoneum
e placing a vaginal pack for 24 hours postoperatively
66. A 45-year-old woman complains of pelvic pressure and abnormal uterine bleeding.
Ultrasound reveals
an enlarged uterus with an intramural 4 cm mass. Which of the following is the most
common uterine
neoplasm?
a sarcoma
b adenocarcinoma
c adenomyosis
d choriocarcinoma
e leiomyoma

67. During a presentation to a group on women’s health a discussion of

gynecologic/reproductive cancers
including their etiology risk, factors, and normal clinical course is presented. Which of the
following
types of cancer is the leading cause of gynecologic/reproductive cancer death in women?
a cervical
b uterine
c ovarian
d breast
e vulva

68. A 69-year-old postmenopausal woman is being admitted for surgical treatment of

endometrial cancer.
She has no health insurance and would like to know which is the most important preoperative
screening
test to look for metastasis?
a chest X-ray
b hysterosalpingogram
c pelvic ultrasound
d intravenous pyelogram (IVP)
e barium enema

69. A 58-year-old woman develops postmenopausal bleeding. An endometrial biopsy shows

adenocarcinoma. She undergoes a total abdominal hysterectomy with pelvic lymph node
sampling. The
final pathology shows tumor extending from the uterus into the cervix but no other invasion
(see Figure
22–1).
Lymph nodes were negative for metastasis. The cancer is classified as which stage?
Figure 22–1.
a0
bI
c II
d III
e IV

70. A patient has just been diagnosed with endometrial cancer by endometrial biopsy. During
her
counseling regarding the disease, staging, management, and prognosis the patient is told that
most
endometrial cancers are diagnosed as which of the following stages
aI
b II
c III
d IV
e recurrent

71. A 45-year-old Laotian woman is visiting her daughter. She comes to your office
complaining of
frequent intermenstrual bleeding for years. You examine her and feel that her pelvis is
“firmly fixed,”
with little mobility of the organs. You perform an endometrial biopsy. The pathology report
returns
stating that “frequent giant cells, caseous necrosis, and granuloma formation” are seen.
Which of the
following is the most likely cause of this woman’s condition?
a syphilis
b. trachomatis
c tuberculosis
d N. gonorrhoeae
e L. monocytogenes

72. A 43-year-old woman has had a history of frequency, urgency, and dysuria for the past 8
years. She
has had five negative urine cultures and urinalyses in the last year. Cystoscopy 1 month ago
showed a
normal bladder and reddened urethra. An intravenous pyelogram (IVP) is normal. What is the
most
likely diagnosis?
a surreptitious use of antibiotics by the patient to mask her laboratory results
b tuberculous urethritis
c vulvar vestibulitis syndrome
d urethral syndrome
e urethral gonorrhea

73. A 51-year-old woman presents complaining of dysuria, dyspareunia, frequency of

urination, dribbling
of urine from the urethra when she stands after voiding, and a painful swelling under her
urethra. Which
of the following is the most likely diagnosis?
a simple cystitis
b urethral syndrome
c infection of the Skene’s glands
d infected urethral diverticulum
e urethral carcinoma

Questions 74 and 75 apply to the following patient:

On the evening after a vaginal hysterectomy, a patient develops a temperature of 100.4°C.

You are called
to evaluate her.
74. Which of the following do you consider most likely prior to examining the patient?
a She probably has a UTI.
b Ureteral obstruction is likely.
c Her fever may be factitious.
d She may be having an allergic reaction to her medications.
e The temperature elevation is most likely unrelated to a surgical infection.

75. The same patient continues to have fever in the 102°F to 104°F range over the next few
days. A pelvic
examination is repeated and a midline, tender mass approximately 8 cm in diameter is noted
over the
vaginal cuff. What is the most appropriate next step in this patient’s management?
a obtain an ESR and WBC, and start or change antibiotics
b get an infectious disease consult
c send a vaginal culture to assess the coverage of your antibiotics
d open the vaginal cuff in the midline
e aspirate the vaginal cuff for culture
76. A 25 years-old women G1 20 weeks of gestational age came to outpatient clinics with a mass
in perineum sized 1 cm flesh-coloured 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?
a. Podophyllum resin
b. Surgical excision
c. Trichloroacetic acid
d. Fluorouracil
e. Imiquimod

77. 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 75 g oral glucose1 hour 175 mg/dL, and 2 hours 167
mg/dl. Her gestational weight gain during pregnancy is 12 kg. Her BMI before pregnancy was
27 kg/m2. What is the appropriate next step in the management of this patient?
a. Exercise 120 minutes/week
b. Ultrasonographic biophysical profile
c. Modification nutrition intake
D. Advise insulin in order to lowering blood glucose
E. Give metformin 3x500 mg orally

78. 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. Inflammatory response followed with fibrosis to protein released by chlamydia
b. Inflammation that hinders spermatozoa movement inside the uterus
c. Direct destruction of tubal mucosa by chlamydia
d. Ovulatory dysfunction due to pelvic inflammatory disease
e. Inflammation of the endometrium

79. 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 body mass index is 35 kg/m². For asymptomatic grade
1 pelvic organ prolapse.
What do you recommend?
a. Weight loss program
b. Pelvic floor muscle exercises
 c. Pessary
d. Reconstructive surgery
e. Laser vaginal rejuvenation

80. A 38-year-old woman presents to the office with a six months history of low pelvic pain. If on
physical examination reveal a right adnexal pails and also accompany with right upper quadrant
abdominal pain,
What is the most likely etiology of this condition?
a. Hepatic abscess
b. Cholecystitis
c. Appendicitis
d. Fitz-Hugh Curtis syndrome
e. Hepatitis
81. You discuss the potential meaning of the elevated MSAFP. After a long conversation, the
patient decides to undergo her second trimester ultrasound. Which of the following findings
seen on ultrasound would NOT be an explanation for the elevated MSAFP?
a. Double bubble-duodenal atresia
b. A membrane-covered mass protruding through the abdominal wall
c. Fetal bowel floating around in the amniotic fluid
d. Lack of a fetal skull
e. A small membrane-covered outpouching in the lower back/spine

82. For women undergoing induction of labor with a Bishop score of 5 or less, which of
the following is a commonly used first step?
a. Nonstress test
b. Oxytocin drip
c. Cervical application of prostaglandin E2
d. Cesarean section
e. Attempts at induction should be avoided at a Bishop score of less than 5

83. Which of the following is not a contraindication to use of prostaglandins in labor

induction?
a. Maternal asthma
b. Nonreassuring fetal testing
c. A prior cesarean section
d. Maternal glaucoma
e. Maternal SLE
84. A 34-year-old primigravida has a water birth. There is significant perineal trauma. On
examination the external anal sphincter is completely severed, as is the internal anal sphincter,
although the rectal mucosa is intact.
What classification of perineal tear is this?
a. 3a.
b. 3b.
c. 3c.
d. 3d.
e. 4.

85. A 22-year-old G1P0 African American woman at 36 weeks by LMP consistent with
12-week ultrasound with limited prenatal care presents via ambulance to the L & D triage unit
complaining of severe abdominal pain and profuse vaginal bleeding. The patient is unstable
and unable to communicate coherently. The EMT reports that initially her BP was 180/100 mm
Hg and pulse rate was 110 bpm, but she has lost at least 500 mL blood in route. On examination
her BP is 90/50 mm Hg, pulse rate is 120 bpm, she appears to be in significant pain, is unable
to answer questions, and her abdomen feels rigid. What is the most likely diagnosis in this
patient?
a. Placenta previa
b. Normal labor
c. Vasa previa
d. Cervical tear after intercourse
e. Placental abruption

86. A 24-year-old G1P0 at 13 weeks’ gestation who has sickle-cell anemia requests genetic
counseling to learn about the risk of transmission to her fetus. If her partner is a heterozygous
carrier for this condition, what is the risk that their offspring will be affected?
a. 25%
b. 50%
c. 75%
d. 80%
e. 100%

87. A 30-year-old woman has a twin pregnancy at 12 weeks gestation. During her initial
prenatal care visit, you review risks for multifetal pregnancies. Which of the following
statements reflects the most frequent risks in twin pregnancies?
a. Cesarean delivery is necessary in all of twin deliveries
b. Shoulder dystocia occurs more in the aftercoming vertex twin, as compared to a
singleton
c. Pregnancy-induced hypertension occurs at a higher rate than in singleton
d. Perinatal death rate is less than that of singleton
b. Congenital anomalies occur at the same rate as in singletons

88. From this patient’s history, what is your initial diagnosis?

a. Mixed incontinence
b. Stress incontinence
c. Urgency incontinence
d. Overflow incontinence
e. Continuous incontinence secondary to a urinary fistula

89. What is the most likely cause of this patient’s urinary incontinence?
a. Pelvic mass
b. Bladder outlet obstruction
c. Neurogenic bladder
d. Urinary fistula
e. Idiopathic urgency incontinence

90. On physical examination she has mild pelvic organ prolapse that is not bothersome,
vaginal atrophy, and her BMI is 32. Which of the following would you recommend for this
patient as initial management for her condition?
a. Midurethral sling
b. Sacral neuromodulation
c. Botulinum toxin A
d. Lifestyle and behavioral modifications including, weight loss, caffeine restriction, fluid
management, bladder training, pelvic floor muscle exercises, and physical therapy
e. Vaginal hysterectomy
91. Medications used in the treatment of idiopathic central precocious puberty include
a. Exogenous gonadotropins
b. Ethinyl estradiol
c. GnRH agonists
d. Clomiphene citrate
e. Conjugated estrogens (e.g., Premarin)

92. Which of the following pubertal events in girls is not estrogendependent?

a. Menses
b. Vaginal cornification
c. Hair growth
d. Reaching adult height
e. Production of cervical mucus

93. Transvaginal ultrasound with Doppler color flow imaging is used to detect malignant
ovarian tumors on the basis of the
a. Different temperature of tumor tissue
b. Ultrasonographic pattern of ovarian tumors
c. Increased blood flow of ovarian arteries
d. Neovascularity of tumor blood supply
e. Discordance of ovarian artery blood supply between the left and right ovaries

94. A 34-year-old woman (gravida 4, para 3) at 38½ weeks whose pregnancy is complicated
by gestational diabetes is in labor. The head delivers, but the shoulders do not follow. An
efficacious method of delivery for a shoulder dystocia includes McRoberts maneuver.
McRoberts maneuver is described as which of the following?
a fundal pressure
b extreme flexion of the maternal thighs
c rotation to an oblique position after delivery of posterior arm
d strong traction on the head
e rotation of the posterior shoulder to the anterior
95. A GP woman at 38 weeks’ gestation presents with contractions of minimal strength but
occurring every 2 to 3 minutes lasting 45 to 50 seconds. The FHTs are reactive and reassuring.
Her cervix is soft, 1cm dilated, 25% effaced, and the vertex is at —1 station. Her cervix is
unchanged since yesterday when she was seen in clinic. With what is this labor pattern is
consistent?
a prodromal labor
b normal uterine wake sleep cycles
c primary arrest of labor
d secondary arrest of labor
e tachysystole

96. Which of the following patients would be at greatest risk for ectopic pregnancy?
a a healthy woman on birth control pills for longer than 18 months’ duration
b a woman with past history of three incidents of PID
c a woman with history of endometriosis
d a healthy woman with irregular menses
e a woman with past history of several urinary tract infections (UTIs)

97. You are called to the operating room. The general surgeons have operated on a woman
to rule out appendicitis and they find signs of an abdominal pregnancy with a 14-week fetus
and placenta attached to the omentum. What is the best course of action in this case?
a removal of both fetus and placenta
b laparoscopic ligation of umbilical cord
c removal of the fetus only
d closely follow until viability and then deliver by laparotomy
e IV methotrexate and removal of the fetus

98. A 38 years old woman present to the office with a six months history of low pelvic
pain. Which of the following is the LEAST likely cause?
a. Adenomysosis
b. Pelvic inflammatory disease
c. Interstitial cystitis
d. Ectopic pregnancy
e. Inflammatory bowel disease

99. 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 afer 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 labor
e. short inter pregnancy interval

100. A 27 years 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. Perform prolactin examination
b. Give combined oral contraception
c. Perform FSH, LH and estradiol examination
d. Give noretisterone acetate 2x5 mg for 10 days
e. Perform endometrial sampling using hysteroscopy