LATIHAN TIM SUKSES

unas
1. Severe malformations may be seen with use of all EXCEPT which of
the following vitamin A-derived compounds?
a. Acitretin
b. Bexarotene
c. Isotretinoin
d. Beta carotene
2. A syndrome of multiple congenital anomalies including microcephaly,
cardiac anomalies, and growth retardation has been described in
children of women who are heavy users of
a. Amphetamines
b. Barbiturates
c. Heroin
d. Methadone
e. Ethyl alcohol
3. Screening for anemia in triplet pregnancy is advised at:
A. Booking, 20–24 weeks and 28 weeks
B. Booking, 20–24 weeks
C. Booking, 28 weeks and 34 weeks
D. Booking, 28 weeks
E. Booking, 26 weeks
4. What is the recurrence risk for an open neural-tube defect after a
couple has had one child born with anencephaly?
a. 3% to 5%
b. 10%
c. 25%
d. Unknown
5. 27-year-old woman presents to your clinic after having a positive pregnancy test.
She reports menarche at age 13, and irregular menses occurring every 1 to 3
months. She is unsure of her last menstrual period (LMP) but believes that it was
around 6 weeks ago. Her past medical history includes type 2 diabetes which is well
controlled with metformin. What is true about the dating of her pregnancy?
(A) Her LMP would be the most reliable dating method
(B) Perform an U /S; if she is in the first trimester, the accuracy is within 1 week of
GA
(C) Perform an U /S; if she is in the second trimester, the accuracy is within 1 week
of GA
(D) Due to her irregular menses, you will not be able to reliably date her pregnancy
6. 23-year-old primigravid woman at 26 weeks’ gestation comes to the physician for a
prenatal visit. Her pregnancy has been uncomplicated thus far. She is screened for
gestational diabetes using the 50-g, 1-hour glucose test. Her result is 150 mg/dL. A 100-
g, 3-hour glucose test is then performed that demonstrates an elevated fasting glucose
and elevated 2-hour value, but normal 1- and 3-hour values. This patient would be
characterized as having diabetes in pregnancy of which of the following classes?
(A) Class A1
(B) Class A2
(C) Class B
(D) Class H
(E) This patient does not have diabetes
7. 14-year-old girl is referred to the physician for primary amenorrhea. She has never
had a menses but does note some cyclic abdominal pain that seems to occur each
month. She has no other medical problems and has never had surgery. She takes a
multivitamin every day and has no known drug allergies. A thorough evaluation of the
patient, including imaging studies, reveals that the patient has Mayer-Rokitansky-Kuster-
Hauser syndrome. Which of the following is this patient likely to require, given her
condition?
(A) Creation of a neovagina
(B) Creation of breasts
(C) Hormone replacement therapy
(D) Intrauterine device
(E) Medroxyprogesterone acetate injections
8. Maternal serum screening screens for all of the following conditions,
except:
a. Down syndrome
b. Trisomy 18
c. Fragile X syndrome
d. Abdominal wall defects
e. Neural tube defects
9. In a women younger than 40 years, what ollicle-stimulating hormone
(FSH) level, persistent or 1 month or more, is diagnostic o premature
ovarian ailure?
a. 5 mIU/mL
b. 15 mIU/mL
c. 25 mIU/mL
d. 40 mIU/mL
10. A 40-year-old woman with regular menstruation returns for assessment of vulvar
pruritus. She has had itchy vulvar skin for over a year; the symptoms vary in severity over
time. She has been treated with oral and topical antifungal creams. She has adhered to vulvar
skin care guidance. She had a prior vulvar biopsy that described squamous cell hyperplasia
without evidence of a fungal infection. She has been applying a moderate-potency topical
steroid since her last visit with you; she says it helps for a while and then her symptoms recur
and she has to use it again. On examination, you note thickened epithelium of the inner labia
majora and labia minora, with several small red erosions suggestive of excoriation. What do
you recommend?
a. Punch biopsy of vulvar skin
b. Topical clobetasol ointment
c. Laser vaporization of affected area
d. Prolonged course of antifung
11. A 27-year-old woman at 30 weeks’ gestation comes to the physician for a routine
prenatal visit. She has had an uneventful pregnancy but has a history of one previous
cesarean section for breech presentation. At this visit, she tells the physician that she
wants to have natural birth. Her records indicate that both of her previous incisions were
in transverse fashion in the lower uterine segment. She is otherwise healthy and has had
no other surgeries. Which of the following is the best next step in management?
(A) Discourage vaginal delivery
(B) Discuss risks of vaginal delivery
(C) Encourage forceps delivery
(D) Recommend an emergency cesarean section when she goes into labor spontaneously
(E) Schedule cesarean section at 38 weeks
12. A 22-year-old G2P 1 at 13 weeks presents for routine prenatal care. In
review of her routine prenatal labs, a positive urine culture Staphylococcus
saprophyticus is noted. A urinalysis today reveals negative nitrites. Upon
review of systems, she denies any urinary frequency, urgency, or other
symptoms. What is your rationale for antibiotic treatment?
(A) Prevent kidney stones
(B) Prevent preterm labor
(C) Prevent development of antibiotic resistance
(D) Decrease the risk of chorioamnionitis
(E) Prevent second-trimester bleeding
13. What is the name of the maneuver used to relieve the shoulder dystocia?
a. Mc Roberts maneuver
b. Wood maneuver
c. Corkscrew maneuver
D. Rubin Maneuver
E. Zavanelli maneuver
14. A 60-year-old 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 urinate 12 time
during the day and gets up two to three times per night to urinate. What is
the next examination plan for this case?
a. Urinalysis
b. Urodynamic study
c. Pad test
d. Pelvic floor ultrasound
e. Voiding diary
15. What fetal complication is associated with the Nonsteroidal anti-inflamatory agent Indomethacin
as tocolytics agent?
A. Hydramnios
B. Achondroplasia
C. Pulmonary valve atresia
D. Bronchopulmonary dysplasia
E. Premature closure of the ductus arteriosus
16. Which of the following is the appropriate immediate first line therapy? lange
A. Propanolol
B. Lorazepam
C. Hydrocortisone
D. Radioactive iodine
E. Propylthiouracil (PTU)
17. Advantages of ultrasound nuchal translucency over biochemical
screening for Down syndrome include
a. Uses transvaginal approach
b. More consistent measurements than lab tests
c. Better in multiple gestation
d. Wide gestational age range
e. More convenient for patients
18. Ms. XY is brought to the A + E department, unwell. She is a para 1, post-SVD 3
days ago with ragged membranes noted at delivery. Her observations include
pulse 128 bpm, BP 80 systolic, RR 24 breaths/min and temp 39° C and she feels
cold and clammy. She reports heavy offensive lochia. She has been fl uid
resuscitated now and commenced on oxygen by mask. What is the next
immediate step in her management?
A. Broad spectrum IV antibiotics
B. Blood cultures, HVS, MSU
C. EUA in theatre with removal of retained tissue
D. Imaging—pelvic USS
E. Measurement of serum lactate
19. Concerning lactation.
a Lactation is successfully suppressed by demand feeding to empty the
engorged breasts.
b Colostrum is secreted for seven days after the birth.
c Bromocryptine promotes milk production.
d Lactation will fall with Sheehan’s syndrome.
e The staphylococcus organism is associated with puerperal mastitis
20. A 25-year-old G3P0 presents for preconception counseling. She has had
three first-trimester pregnancy losses. As part of her evaluation for
recurrent abortion, she had karyotyping done on herself and her husband.
Her husband is 46, XY. She carries a balanced 13;13 translocation. What is
the likelihood that her next baby will have an abnormal karyotype?
a. < 5%
b. 10%
c. 25%
d. 50%
e. 100%
21. woman who is 11 weeks pregnant with confirmed miscarriage was very
hesitant in deciding on medical or surgical management. She was still keen
on avoiding the anaesthetic and surgical risks, if possible. What will you tell
her about her chances of not having surgery if she opts for medical
management?
A. It avoids the need for surgery in over 30% of women.
B. It avoids the need for surgery in over 40% of women.
C. It avoids the need for surgery in over 50% of women.
D. It avoids the need for surgery in over 60% of women.
E. It avoids the need for surgery in over 70% of women.
22. A woman who is 22 weeks pregnant comes to the emergency department
complaining of flu-like symptoms. She is pyrexial with no other clinical signs.
What is the most relevant information in her history that makes you suspect
malaria infection?
A. History of night shivering.
B. History of contact with another pregnant woman who had parvovirus
infection.
C. Travel to an endemic area.
D. She is not immune to rubella and did not receive pre-pregnancy vaccination.
E. She has recently been in contact with pets
23. Management of hypothyroidism in pregnancy is :

a.Woman after thyroidectomy may require doses of

levothyroxine
b.TSH levels measured weekly
c.Thyrosine dose is adjusted by 100mcg increment until TSH
values become normal
d.Increased thyroxine requirement begin as early as 22 weeks
e.None above
24. After a prolonged second stage, a 28-year-old woman delivers the vertex
with an immediate turtle sign with the head retracting against the perineum.
McRobert’s maneuver does not affect delivery. Which of the following would be a
helpful maneuver in managing this shoulder dystocia?
a. Fundal pressure
b. Internal podalic version
c. Increased maternal pushing effort
d. Wood’s screw maneuver
e. Ritgen maneuver
25. Regarding mode of delivery:
A. Maternal mortality after Caesarean section is no higher than after
vaginal delivery.
B. There is no role for prophylactic antibiotics at the time of Caesarean
section.
C. Vacuum delivery results in less maternal morbidity than forceps delivery.
D. The use of a vacuum extractor compared to forceps is associated with
fewer cases of cephalhaematoma.
E. The use of a vacuum
26. Five-year-old girl presents with a history of accelerated growth,
menarche and signs of sexual development. Examination revealed light
to dark brown spots, predominantly noticeable on one side of the body
without crossing the midline. What is your differential diagnosis?
A. Central precocious puberty.
B. Cushing syndrome.
C. Exogenous oestrogen exposure.
D. Iatrogenic excessive use of cortisol
E. McCune–Albright syndrome.
27. In 2006, a National Institutes of Health (NIH) State-of-the-Science
Conference summarized the associations between stress urinary incontinence
and delivery route. Which of the following reflects their findings?
a. There is no pelvic floor protection from cesarean delivery.
b. The pelvic floor receives substantive durable protection from cesarean
delivery.
c. The duration of pelvic floor protection from cesarean delivery is clearly
defined.
d. The evidence implicating vaginal delivery as the main putative agent in stress
urinary incontinence and other pelvic floor disorders is weak and fails to favor
either delivery route
28. According to the current International Guidelines, which of
the following medication is considered to be the first line of
therapy for ovulation induction?
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
29. Istilah konstitusi identik dengan...

A. Undang-undang dasar
B. Undang-undang
C. Peraturan
D. Hukum
30. Bentuk negara Indonesia berdasarkan UUDS adalah...

A. Kesatuan
B. Federasi/serikat
C. Presidensial
D. Parlementer
31. 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
32. All EXCEPT which of the following laboratory findings may be
consistent with a diagnosis of systemic lupus erythematosus?
a. Anemia
b. Leukopenia
c. Decrease d- Dimer levels
d. False-positive Venereal Disease Research Laboratory (VDRL) test
result
33. Haemoglobinopathies:
A. If both parents are carriers of beta-thalassaemia, the newborn has 1:2 risk of
acquiring thalassaemia major.
B. Alpha-thalassaemia is always due to a deletional defect.
C. The thalassaemia syndrome is an inherited defect of haemoglobin resulting in a
structural abnormality of globin.
D. HbA (2 alpha 2 beta) should comprise over 50 per cent of the total circulating
haemoglobin in the adult.
E. Sickle-cell haemoglobin is a variant of the alpha globin chain where there is one
amino acid substitution at the sixth position. F. A patient suffering from sickle-cell
anaemia is more likely to be dehydrated during labour
34. A mother presents with her seven-year-old daughter. The girl has
developed noticeable pubic and axillary hair growth. The daughter is
otherwise asymptomatic with no history of vaginal bleeding. On
examination, pubic hair was easily noticeable, but the area covered is
smaller than in most adults without spread to the medial side of the
thighs. Her breasts had not developed beyond a small bud. Physical
examination did not reveal any abnormality with a normal linear
growth pattern. What is your provisional diagnosis?
A. Central precocious puberty. B. Cushing syndrome. C. Pseudopuberty.
D. Physiological premature adrenarchy. E. Virilizing ovarian tumours
35. A woman who is 13 weeks pregnant has screened positive to HIV
infection. During counselling, you felt it was important to explain the declining
rate of mother-to-child transmission (MTCT) because of interventions. What is
the current rate of MTCT of HIV infection?

a. < 0,5 %
b. 20 %
c. 12%
d. 0,05%
e. 16%
36. What is the most common respiratory cause of maternal death in
the UK in the three MBRRACE-UK reports?
A. Asthma.
B. Bronchiectasis.
C. Cystic fibrosis.
D. Pulmonary hypotension.
E. Tuberculosis.
37. Secondary post-partum haemorrhage:
a is abnormal bleeding that occurs 12 hours post-partum
b may be due to infection
c cannot be controlled by uterine contracting agents
d occurs following 5% of births
e can usually be diagnosed by ultrasound examination of the pelvic
organs
38. Which one of the following statements is correct in relation to
postpartum depression?
A. Antidepressants (paroxetine, sertraline, tricyclic group) are
contraindicated if breastfeeding.
B. Postpartum blues occur in around 5 % of new mothers.
C. Postpartum depression affects around 10 % of women,
D. Postpartum psychosis has a low risk of recurrence.
E. Women with postpartum blues commonly think about committing
infanticide.
39. The most respected Hero, and also as a father of Singapore
modernization, the late Mr. Lee Kuan Yew, passed away one week ago,
when he has …..
A.85
B.90
C. 91
D. 95
E. 98
40. You perform an ultrasound of the fetus to evaluate for fetal anemia and hydrops. The
ultrasound shows elevated middle cerebral artery (MCA) Doppler peak systolic velocity
measurements consistent with fetal anemia. There is no evidence of fetal hydrops. What is
the mechanism by which parvovirus infection causes fetal anemia?
a. Hemolysis
b. Bone marrow suppresion
c. Sequestration of RBCs in the spleen
d. Fetal intracranial hemorrhage
e. Fetomaternal hemorrhage
41. Which of the following are not recommended as part of routine prenatal
laboratory test screening ?

a. Herpes simples antibody screen

b. Chlamydia PCR
c. Urine culture
d. Rubella Immune status
e. HIV antibody screen
42. A 23 -year-old G1P1 just delivered a 3,120 g neonate via spontaneous
vaginal delivery after a long induction for postdates and pushing for over 2
hours. Estimated blood loss was 800 cc. Her medical history is significant for
seasonal allergies and asthma. Her pregnancy was complicated by gestational
diabetes. Which of the following should be avoided when in this patient?
(A) Methylergonovine
(B) Misoprostol
(C) Oxytocin
(D) Prostaglandin E1
(E) Carboprost tromethamine
43. Micturition is voluntary and occurs with relaxation of the urethra and
sustained contraction of the bladder until emptying is complete. Sustained
contraction of the detrusor muscle of the bladder requires parasympathetic
stimulation. Parasympathetic control of the detrusor is supplied by which
of the following nerves?
a.Hypogastric nerve
b.Pudendal nerve
c. Peroneal nerve
d. Pelvic nerve
e. Sciatic nerve
44. A 23-year-old G1P0 Caucasian woman at 12 weeks GA presents for a routine
prenatal visit. Her medical history is unremarkable. Her temperature is 37.3°C,
blood pressure is 120/84 mm Hg, pulse is 85 per minute, and respirations are 13
per minute. BMI is 24. Her best friend was diagnosed with gestational diabetes,
and the patient is concerned she may develop it as well. Gestational diabetes is
seen at higher rates in all of the following except?
a. Caucasian race
b. Family history of diabetes
c. Hispanic ethnicity
d. Increasing maternal age
e. Native American race
45. A previously healthy, 31-year-old woman has a vaginal itch and discharge. She also
complains of pain with urination and intercourse. She takes oral doxycycline daily for
acne. Her sexual partner is asymptomatic. Examination reveals erythema and edema of
the vulva and a thick, white, clumpy discharge. The vaginal pH is 4.4. The remainder of
the examination is unremarkable. Potassium hydroxide application to a sample of the
discharge shows pseudohyphae and spores. Which of the following is the most
appropriate pharmacotherapy?
(A) Acyclovir
(B) Azithromycin
(C) Ceftriaxone
(D) Clotrimazole
(E) Metronidazole
46. A 35 -year-old G2P0 101 Hispanic woman at 34 weeks presents for a
prenatal visit. The patient is dated by last menstrual period (LMP) as this is
her first visit to the clinic. She complains of swollen feet and difficulty sitting.
Her BP is 1 1 0/65 with a pulse of 85 beats/min. Fetal HR is 135 mmHg, and
fundal height is 44 em. What would you expect to find on ultrasound (US)?
(A) Normal pregnancy
(B) Uteroplacental insufficiency
(C) Esophageal atresia
(D) Potter syndrome
(E) Trisomy 13
47. What is the most common cause of infant death in the United
States?
a. Preterm birth
b. Motor vehicle accidents
c. Major congenital anomalies
d. Complications from maternal hypertension
48. The risk of recurrent urinary tract Infection in pregnancy is:
A. 1–2 %
B. 4–5 %
C. 10–15 %
D. 15–18 %
E. 20 %
49. The patient returns to the office still undelivered at 43 weeks
gestation. She agrees to undergo induction. Her cervix remains
unchanged from the previous week. All of the following are options for
cervical ripening except
a. Laminaria
b. Cervidil
c. Misoprostil
d. Preperdil
e. Pitocin
50. Hyperthermia has been associated with what specific type of
neural-tube defect?
a. Anencephaly
b. Lumbar defects
c. Sacral defects
d. Cervical defects
1. D 11.B 21.E 31. D 41. D
2. E 12.B 22.C 32. C 42. E
3. A 13.D 23.A 33. E 43. D
4. A 14.A 24.D 34. D 44. E
5. B 15.E 25.C 35. A 45. D
6. B 16.A 26.E 36. A 46. C
7. A 17.C 27.D 37. B 47. C
8. C 18.C 28.A 38. C 48. B
9. D 19.D 29.A 39. C 49. E
10.B 20.E 30.A 40. B 50. A