A 28 yo woman G1 36 weeks of gestational age went to your clinic to do routine ANC.

During
ultrasound the doctor told that she will be expecting baby boy with EFW 2500 gram, however
amniotic fluid considered to be less than normal. Then u asked the patient to drink minimal 2 L
of water a day and get herself another ultrasound within 3 days to evaluate the amniotic fluid.

1. Oligohydramnios is defined as which of the following?

a. Amniotic fluid index < 5cm
b. SDP < 2 cm
c. AFI < 90 th percentile
d. All of the above
e. None of the above
2. Amniotic fluid volume is a balance between production and resorption. What is the
primary menchanism of fluid resorption?
a. Fetal breathing
b. Fetal swallowing
c. Absorption across fetal skin
d. Absorption by fetal kidney
e. Filtration by fetal kidney
3. In a normal fetus at term what is the daily volume of fetal urine that contributes to the
amount of AFI present?
a. 200mL
b. 250mL
c. 500Ml
d. 750mL
e. 1000mL

A patient came with chief complaint of spotting two hours ago. Her LMP was 3 rd january 2017
and she had not had any pregnancy test. She appears well and complaint of slight cramps on
her lower abdomen. On examination you found that she is normotensive and there is no
tachycardia, her general status appears normal. During gynecological exam her external ostium
is closed, her uterus is enlarged slightly with no active bleeding. By trans vaginal ultrasound
examination you found gestational sac intra uterine with crown rump lenght appropriate for 8
weights gestation with FHR 186 bpm.

4. What is the best management for this patient?

a. Bed rest and progestogen
b. Bed rest and tocolytic
c. Long maturation
d. Bed rest only
 e. Progesterone only
5. What is the following is least likely to be associated with preterm delivery?
a. Incompetent cervix
b. Hydramnios
c. Uterine fibroid
d. Abdominal pregnancy
e. Hydrops fetalis
6. Which one of the following is most likely to be contraindication for tocolysis at 28 weeks
gestation
a. Suspected abruption
b. Group 8 streptococcal bacteriuria
c. Recent laparotomy for appendicitis
d. Uterine fibroid
e. Preterm premature rupture of the membrane
7. Each of the following is a side effect of terbutaline, except for:
a. Fetal tachycardia
b. Hyperglycemia
c. Hyperkalemia
d. Hypokalemia
e. Increase pulse pressure

Mrs. A 26 Years old G1P0A0 according to the her LMP is 34 weeks pregnant, came for her 1 st
ANC. She admitted to have 20 kg weight gain during pregnancy with swelling ankles for the past
weeks. She never too any iron or vitamin supplementation. Fo the physical finding 145/95
mmHg. HRb86x/m, RR20x/m, BMI 35kg/m2. Ultrasound examination confirm twins in breech
presentation. From urinalysis were as follows color scludy yellow specific gravity 1.013, albumin
2+ RBC 0 -1, WBC 2-5, bqcteria negative.

8. What is the most likely diagnosis?

a. Acute fatty necrosis
b. Chronic hypertension
c. Preeclampsia
d. Renal disease
e. Pylonepriis
9. Given the history of this patient several more laboratory and diagnostic test were
abtained. She was stable and the fetuses have ressuring heart rate tracing. Which of the
following do you expect to see in the rest result?
a. Chest x ray to show decreased pulmonary vascular marking
b. Urine to show infection
 c. Cratinin clearance to be increased above normal pregnancy level
d. Serum uric acid to be increased
e. A decreased hematocrit

Mrs B 37 yo came to your office at 32 weeks of gestation according to her last menstrual
period. She has no ultrasound examination before and didn’t get ANC routinely. The vital sign is
within normal limit. She has BMI 19 kg/m2. During physical examination the uterine fundal
height is 22 cm. From ultrasound examination the fetus has biometric value that correlate with
30 weeks fetus.

10. Which of the is the next best step in managing this patient?
a. ANC routinely for the next 2 weeks
b. Evaluate maternal status and comorbidities
c. Considar deliver the baby
d. Repeat sonography for fetal growth in 3 weeks
e. Doppler velocimetry evaluation every 3 weeks
11. According to the algorithm for management of fetal growth restriction you evaluate the
doppler velocimetry then find resersed and distoli flow and oligohydramnios. What is
the appropriate management at this time?
a. Regular fetal testing
b. Weekly evaluation of amniotic fluid
c. Considar corticostetroid for lung maturation
d. Deliver the baby
e. Reevalute middle cerebral arterises and ductus venosus
12. Fetl growth restriction is associated with all the following EXCEPT
a. APS antibody
b. Inherited trombhophilas
c. Infertility
d. Immunosuresive drugs
e. Social deprivation

A 29 yo GSPOA2 woman at 12 weeks gestation came to Vour office for prenatal visit. She has
history of miscarriage in the 1" trimester. She admitted fatigue arthralgia, and photosensitivity.
Her BP was 130.80 mmHg. On physical examination you found the malar rash and anemic
conjunctiva. Laboratory result from urinalysis revealed proteinuria 3+ and cellular cast.
Hemoglobin level was 7.2 gr/dl with peripheral biood smear showing spherocytes and
reticulocytosis, platelet count 98.000/mm and leucocyte cunt 2600/mm.

13. Which of the following specific laboratory test to establish the diagnosis?
a. Antinuclear (ANA) nd anti cardiolipin antibodies ( ACA)
 b. High titer anti double stranded (ds) - DNA and anti SM (Smith)
c. igG and IgM 82 gicoprotein
d. Anti Ro (SS-A) and anti La (SS-B)
e. Antipiatelet and anti erythrocyte C.
14. According to the disorder above the pregnancy outcome is best in those woman in
which?
a. Does not develop superimposed preeclampsia
b. No evidence of antiphospholipid syndrome
c. No nephritis manifest by proteinuria and renal disfunction dab
d. The disease has been quiescent for at least 6 months before conception
e. All of the above
15. The exacerbation flare is becoming the risk of the disorder. If there is no indication to
terminate the pregnancy the following treatment are true, EXCEPT
a. Immunosupresive agent suach as azathioprinecan be used to contral the active
disease with daily aral dose 2-3 mg/kg
b. Mycophenolate mofetil and MTX should be avoide
c. Antimalarias (hydrochloroquin) cant"t be useddue to association with congenital a
malformation
d. High dose glucocorticoid can be the alternative for methylprednisolone 1000mg
intravenously
e. Cyclopospamide can be used after 12 weeks gestation
You see a patient in you office who had a thyroidectomy from graves disease. She is now
hypothyroid on hormone replacement. You monitor her TSH and keep it between 0,5 and 2,5.
You increased her thyroid hormone replacement each semester and her tsh remains around 2.0
during the entire pregnancy.
16. In addition to monitoring her TSH, what other additional testing should you perform
during her pregnancy?
a. Amniocentesis to determine if the fetus is affected by Graves disease
b. A detailed fetal ultrasound at 18 to 20 weeks and again in the third trimester should
be perrformed given the risk of increased fetal goiter
c. Fetal echocardiogram to evaluate for cardiac abrnormaliti es
d. Umbilical Doppler to monitor for placental dysfunction
e. MCA Doppler to monitor for fetal anemia
17. Regarding TSH in pregnancy, which statement is true?
a. Serum TSH levels in early pregnancy decline
b. Tsh crosses the placenta
c. Pitultary TSH Secretion is suppress ran HCG serum level is decreasing
d. It cannot be used for diagnosis of many thyroid disorder in pregnancy
 e. TSH level is static at mid pregnancy
18. Management of hypothyroidism in pregnancy is: X
a. Woman after thyroidectomy may require doses of levothyroxine
b. TSH levels measured weekly
c. Thurosine dose is adjusted by 100mcg increment until TSH values become normal
d. Increased thyroxine requirement begin as early as 22 weeks
e. None above

Mrs. E 32 yo referred from midwife with antenartum bemorrhage, She is G3P2 term pregnancy.
On ekamination her blood pressure is 160/100 mmHe HR 100 bom. She looks anemic not
icteric. Obstetrical examination reveal contraction 4-5x/10minutes EHR 170 bpm, head
presentation 3/5. Arter thorough examination it is concluded that there is a placenta abruption
with retroplacenta hematom size Gx5 cm. This patient planned to do cesarean section.

19. If the patient above during cesarean section found to be in atonic condition, which of
the following are not prerequisite for performing b lynch suture?
a. Patient in lithotomy position during operation
b. Bimnual compression reduce the amount of bleeding
c. Availability of suture material
d. Patient in stable hemodynamic condition
e. None of the above
20. If during operation the uterus is couvelaire but with good contraction, how would you
manage this condition?
a. Perform prophylactic b lynch suture
b. Ascending uterine arteri ligation
c. Hypogastric artery ligation
d. Sub total hysterectomy
e. Uterotonic and observation
21. Post operative period is very crucial in this patient. Which of the following is not
included as a parameter nedded to be evaluated in early waming system
a. Blood pressure
b. Heart rate
c. Urine production
d. Central venous pressure
e. All of the above
A 22 yo G1POat 25 weeks gestation with HIV infection on ARV therapy has purified protein
derivative (PPD) has performed. Two days later the induration at the test site is noted to be 7
mm. She has no symptomsTBC and her chest radiography shows normal finding.
22. Your plan is which of the following
 a. Treat post partum because the chest radiograph is normal
b. Star treatment now isoniazid because she has an 8% annual risk for active disesase
c. Start treatment now with 4 drugs therapy because she has an 8 % annual risk for
active disesase
d. No treatment is required for a reading of 7 mm
e. All of the above
23. You are taking care for a pregnant woman who has complaint of cough for a month,
intermittent fever and night sweat, You are concerned about TB. Which ofthe following
statements is most accurate regarding TB in pregnancy?
a. All woman with those symptoms should have a chest x ray in pregnancy
b. if a patient is treated adequately during pregnancy. TB generally has no deleterious
effect in b. mother or child
c. Mantoux test have unusually high false positive rate in pregnancy
d. The best single drug for therapy of TB in pregnancy is streptomycin
e. 2 drug anti TB therapy is pregnancy is contraindicated
21 vears old at 37 weeks of gestasional age was referred to the hospital due to profuse varinal
iesdina Previously patient felt severe abdominal pain around 2 hours ago. On physical
examination patient was unstable and in delirium stage. Her initial BP was 130/80 mmHg and
pulse rate war 1E beat/minute. Her abdomen feels rigid
24. What is the best next step?
a. Obstetrical examination consist of sterile speculum followed by vaginal examination
b. Abdominal ultrasound
c. Transvaginal ultrasound
d. Stabilized patient, obtain two large bore IV and start fluid boluswith 30 cc/kgBB
e. Emergency SC
25. What is the most important laboratory test to do in this patient?
a. CBC
b. Urinalysis
c. PT, apt
d. AST/ ALT
e. Bloos type and cross match
26. These factors are precipitating or predisposing factors of placental abruption, EXCEPT?
a. Hypertension
b. Nullipara
c. Previous placental abruption a.
d. Abdominal trauma
e. Short umbilical cord
A 26 yo woman G1POAD was admitted to emergency room 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 87x/mnt, RR
18x/mnt, temperature 36,5 C. You notice there is an icteric sclera. Other physical examination
was remarkable. Obstetrical examination reveals no fatal heart beat was detected. Laboratory
examination reveals CBC 10,2/ 29,9/8900/263000 Ur/Cr 18/0,8 AST/ALT 458/878, RBG 32,
urinalyisis was within normal limit.
27. What is the best next management in this case?
a. Abdominal ultrasound
b. induction of labour
c. Emergency SC
d. Whole blood transfusion
e. Injection of 40O % dextrose
28. All EXCEPT which of the following are clinical characteristic that increase the risk for
acute fatty liver of pregnancy
a. Nulliparity
b. Fernale fetus
c. Male fetus
d. Twin gestation
e. Third trimester
29. What is the underlying pathophysiology of intrahepatic cholestasis of pregnancy?
a. Acute hepato cellular destruction
b. Incomplete clearance of bile acid
c. Microvascular thrombus accumulation
d. Eosinophil infiltration of the liver
e. Hepatocellular injury
Mrs P, 30 ya G2P1A0 30 weeks gestation came to your out patient clinic for routine prenatal
visit She complained of dizzy and fatique lately. No sign of contraction of fetal kick count was
12x/10 hours, Her BP 110.70 mmHg and pulse rate 92x/mnt. You asked for CBC panel and the
result was Hb level 10gr/dl Ht 30,5 % Leucocyte 11.700, tromb 237.000/ul MCV BORL, MCH 26,
MCHC 31gr/dl, RBC 53 10/microliter, Her 1" child was delivered in 38 weeks gestation with birth
weight 2500 gram.
30. What is next management for this patient?
a. Perform 3" trimester obstetrical ultrasonography screening
b. Asked for complete iron studies (FEP, serum iron, TIBC, ferritin)
c. Administer iron supplementation
 d. Asked for peripheral blood smear
e. Perform bone marrow examination
31. Your diagnostic examination result showing pirmal FEP plasma iron 95 ug/dL, TIBC
350ug/dL, and ferritin 50 ng/dL What will be possible diagnosis
a. Iron and deficiency anemia
b. Sideroblastic anemia
c. A thalassaemia
d. Sickle cell anemia
e. Anemia of chronic disease
32. What is the cause of this condition?
a. Deletion of one or all a genes on chromosomes 16
b. Deletion of one or all a genes on chromosomes 11
c. Deletion of one or all B genes on chromosomes 11
d. Deletion of one or all B genes on chromosomes 16
e. Deletion of one or all a genes on chromosomes 18
A 17 year old G1PO woman present at 25 weeks gestation complaining of headache for the
past 36 hours. She has had regular prenatal visit going back to her 1" prenatal visit at 8 weeks
gestation. A 20 weeks ultrasound redated her pregnancy by two weeks as it was 15 days earlier
than her LMP dating. She has a BP of 155/104 mmHg.
33. 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 pf
severe preeclampsia you order a CBC, liver enzyme, renal function test, and a 24 hours
urine protein collection. Her laboratory test result reveal a normal platelet count and
liver but a slightly elevated creatinine and proteinuria f 550mg 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 labetolol and have her follow up in cinic in 2 weeks
b. (a) plus bed rest
c. Hospitalization for further evauation and treatment
d. Immediate delivery
e. Begin induction of labor
34. Over the next 12 hours er BP rise above 160mmHg on several occasion, most notably to
172/ 102 mmHg. 2 hours after admission and to 168/96 mmHg 9 hours after admission
pain. Her head ache does not return and she had no RUQ or visual symptoms. A set of
repeat laboratory test result are unchanged and by increasing her labetolol dose to 400
mg TID, her BPs decrease to 140s-1502/70- 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 08
e. AST 265
A 43 vears old woman G4P3 at 37 weeks gestabon presented in hospital with a ten day history
of low extrimities edema, with idiopatic hypertension, for 1 year. At presentation she had a
blood pressure of 170/100 mmHg. Laboratory finding was normal except urinalysis (protein 2+).
She was diagnosed with superimposed severe precciampsia. It was decided to deliver the fetus
by mean of a C section by indication of tranverse lle. Blood pressure measurement was 150/100
mmHg. She lost consciousness for 30 second five hours after operation. The laboratory studies
give the following result AST 225, AT t90 JDH 1017. serum urea and creatini were normal, Hb
10,6, plateet 50.000, CT sean was performed on patient which revealed the left frontal lobe
lacunar infarction. The patient was transferred to Jcu
35. What is the most apporopriate diagnose
a. DIC
b. Acute fatty liver in pregnancy
c. HELLP syndrome
d. Severe purpuraal infection
e. Trombotic trombositopenic purpura
36. What is the best management after, for this case
a. Fresh-frozen plasma and thrombocytes concentrates
b. Anti-platelets
c. Anti-oxidant
d. Corticosteroid
e. Magnesium sulfate
37. 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 hypoalbuminemia condition had
been distinguished
d. Renal failure due to micro thrombopathy suspected, heparin provision could be
considered
e. Immediately step on fluid rescucitation
A 33 year old woman G1POAO,came to hospital with major complaint, watery leakage. She was
on her 33 weeks of gestational age. Data from medical record showed that she came previously
a week ago, complaining vaginal discharge. Vaginal swab has done.
 38. In case above, what kind of examination should you performed for eshtablishing
diagnosis.
a. Vaginal examination
b. inspeculo
c. Blood test
d. Ultrasound
e. Simple urine test
39. You found leopold 1, hard, round with ballottement (+). Contraction was infrequent and
weak. What was your next plan.
a. Went for labour induction t e ms C EA
b. Immediate C-section
c. Tocolytic and costicosteroid provision
d. Performed ultrasound
e. Performed external version
Woman refer from primary health care due considerably low maternal body weight. She is on
her 35 weeks of gestation, height 150 cm weight 32 kg. She had previous history of severe
hyperemesis. Other medical problems were denied.
40. Ultrapound examination showed that trans-cerebellar diameter was proper to
gestationalage, abdominal circumference was lower than 2.5 centile and amniotic fluid
deepest pocket was 1.2 cm.What is the most likely diagnosis?
a. Growth restriction with olygohydramnion
b. Normal growth with olygohydramnion
c. Growth restriction with normal amniotic fluid
d. Normal growth with normal amniotic fluid
e. Need another examination for establishing diagnosis
41. Lack of baby movement had been felt for two days, fetal heart rate was 146 bpm. What
was vour next step?
a. Termination of pregnancy
b. Giving oxygenation and left lateral position
c. Ensuring fetal well-being by manning criteria
d. Fetal lung maturation
e. Giving intravenous fluid rehydration
42. Cardiotocography, showed low variability with checkmark pattern and no deceleration.
What was your interpretation and the best management through?
a. Category one, continued for fetal lung maturation
b. Category two, intrauterine resuscitation for 24 hours and reevaluation aftar
c. Category two, went for Doppler velocymetry
d. Category three, went for Doppler velocimetry, ultrasound exam e.
 e. Category three, delivered the baby
A 24 year old G2P1 woman at 39 weeks and 3 days is šeen in clinic. She has been experiencing
more frequent congtractions and thinks she might he in labour, Her läst pregnancy ended with
a caesarean delivery after stage 1 arrest. There was no evidenre of cenhalorielvic disproportion.
Earlier in the course of her current pregnancy she had desired a scheduled repeat caesarean,
but now she might be in labour she would like to try and delivery vaginally.
43. What would be a contraindication to a trial of labour after caesarean (TOLAC)? .
a. Prior classical hysterotomy
b. Prior Kerr hysterotomy
c. Small for gestational age fetus
d. Olygihydramnions
e. GBS + mother
44. 44 A 33 year old GSP6A1 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
on 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 fiuid, 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. Inaccurate dating
b. Fetal anomaly
c. Delayed presentation to prenatal care
d. Advanced maternal age
e. Multiparity
45. 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 10 through 17
c. Days 17 through 14
d. Days 12 through 19
e. Days 16 through 25
46. A 29 year old G3PZAD presents to the emergency center with complains of abdominal
discomfort for 2 weeks. Her vital sigris are : blood pressure 120/70mmHg, pulse 90
beats per minute, temperature 36,9 "C, 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 behinda normal appearing 10x6x5.5 cm uterus. Both ovaries
 appear normal. No free fluid is noted. Which of the fallowing is the most likely cause of
these findings?
a. Ectopic ovarian tissue
b. Fistula between the peritoneum and uterine cavity
c. Primary peritorieal implantation of the fertilized ovum
d. Tubal abortion
e. Uterine rupture of prior caesarean
47. Obesity in pregnancy increase risk of which of the following in the baby?
a. An autism spectrum disorder
b. Intra-uterine growth restriction
c. Hydrocephaly
d. Type 1 diabetes in childhood
e. Childhood cancer
48. The stage of gestational development at which endometrial implantation occurs is
a. Eight cell embryo
b. Zygote
c. Morula formation
d. Blastocyst
e. mbryonic disk
49. During early pregnancy, which of the following replaces the ovary as the main source of
progesterone production?
a. Amnion
b. Chorion
c. Trophoblast
d. Myometrium
e. Yolksac
50. Anti D Immunoglobulin should not be given for Rh-negative women in which of the
following settings?
a. Threatened abortion
b. Following complete hydatidiform mole evacuation
c. Before external cephalic version
d. After first trimester elective pregnancy
e. Following complete abortion.
51. To preserve the pneumoperitoneum when placing secondary trocars, it is important to:
a. Ensure the surgeon is in proper position
b. Close the stopcock on the secondary port before insertion
c. Ensure the stopcock on the secondary port is open before insertion a.
d. Ensure the blade on the trocar is sharp
 e. Close the insufflation stopcock on the primary port e.
52. Clinical features suggestive of hyperandrogenism include all of the following, except:
a. Facial acne
b. Seborrhea
c. Alopecia
d. Anovulation
e. Hirsutism
53. Invasive cervical cancer identified only microscopically, invasion is limited to measured
stromal invasion with maximum depth of 3mm and no wider than 7 mm should be
treated with:
a. Observation
b. Tissue ablation
c. LEEP/LETZ
d. Simple total hysterectomy
e. Radical hysterectomy
54. The majority of vulvar, vaginal dan cervical cancers appear to have a commoncause and
usually caused by
a. High risk of herpes simplex virus (HSV) infection
b. High risk of human papilloma virus (HPV) infection
c. Increased exposure to endogenous estrogen
d. Increased exposure to exogenous estrogen Chronic bacterial and parasitic infection
A
55. Childhood neoplastik ovarian Mass most commonly originate from:
a. Gonadal epitelium
b. Gonadal stroma
c. Sex cords
d. Germ cells
e. Metastatic disease
56. A patient returns for postoperative checkup 2 weeks after a total abdominal
hysterectomy for fibroids. She distressed because she is having continuous leakage of
urine from the vagina. Her Teakage is essentially continuous and worsen with coughing,
laughing, or movement. Given her history and physical, you perform both a methylene
blue dye test, which is negative and indigocarmine test, which is positive. The most
likely diagnosis is:
a. Rectovaginal Fistula
b. Uretro vaginal fistula
c. Vesico vaginal fistula
d. Uretero vaginal fistula
 e. Impossible to distinguish
57. A 38 years old multigravida 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 only a few drops. This history is most suggestive of L
a. Fistula
b. Stress incontinence
c. Urge incontinence
d. Urethral diverticulum
e. UTI
58. Family planning services in Indonesia is important because it has a role in efforts to
reduce maternal mortality. Select the statement that is not true:
a. The maternal mortality rate (MMR) by IDHS in 2012 amounted to 259/100,000
births
b. Number of maternal death related to pregnancy or childbirth in Indonesia based on
the demographic and health survey in 2012 a number of 17,000 up to
18,000mothers during one b. year
c. Estimated of number of maternal death related to pregnancy or childbirth in
Indonesia is about 50 deaths per day
d. Family planning services for mothers immediately after delivery ofplacenta s/d 2
days postpartum included as postpartum family planning services
e. In planning services we prioritize contraceptive lang term contraception method
(LTM), the IUD, Implant or tubal ligation or vasectomy
A 40 years old G2P1A0 gestational age of 12 weeks. The first child 10 years of age. Never use
contraception. Weight 80 kg, height 156 cm. has never antenatal care. 1 = 22r
59. The conclusion below is not true:
a. High risk pregnancy due to maternal age of 40 years
b. Including overweight
c. Have history of secondary infertility
d. There is possibility of pregnancy termination by caesarean section
e. Need for ultrasound screening
60. Select the incorrect regarding guidelines for nuchal translucency (NT) measurement is:
a. The margin of NT edges must be dear enough for proper calliper placement and the
fetus is not necessary in the midsagittal plane
b. The image must be magnified so that it is filled by fetal head, neck, and upper thorax
c. The fetal neck must be in neutral position, not flexed and not hyperextended
d. The amnion must be seen as separate from the NT line, and the + calipers must be
placed on d. vhe inner borders of the nuchal space with none of the horizontal
crossbar itself protruding into the space.
 e. The callipers must be placed perpendicutar to the long axis of the fetus and the
measurement must be obtained at the widest space of the NT
61. Choose the wrong statement about Down syndrome is
a. An increased NT thickness itself is not a fetal abnormality
b. Nuchal translucency is a marker that confers increased risk of fetal abnormality
c. wererimately one third of fetishes with increased nuchal gtranslucency thickness will
have a chromosome abnormality, nearly haif of which are Down syndrome
d. Down syndrome is caused by an autosomal trisomy, is the most common nonlethal
trisamy
e. All cases of down syndrome is caused by trisomy 21 10

One mother after normal delivery, P4 age 35 weight 160 cm, having delivery one day ago, 3000
grams birth weight, breastfeeding, want injectable contraceptives before returning home.

62. If in the cases mentioned above, the mother wanted contraception progesterone-only
contraceptives (POCS), is the correct statement below is
a. Breastfeeding woman who are <6 weeks postpartum should not use levonorgestrel
(LNG) and etonogestrel (ETG) implants. B
b. Breastfeeding women who are c6 weeks postpartum generally should not use
progesterone- only injectables (DMPA)
c. There is no theoretical concern about the potential exposure of the neonate to
DMPA/NET- EN during the first 6 weeks postpartum
d. Breastfeeding women who are <48 hours postpartum can generaly use LNG-IUDS
e. Progesterone-only contraceptives (POCS) consist of POPS, progestogen-only
injectables (DMPA and NET-EN) and LNG and ETG implants.
63. In Indonesia, pregnancy related morbidity and mortality risk are high, and access to
servicesis limited, the correct statement below is : D
a. DMPA may be one of the few types of methods widely available and accessible to
breastfeeding woman immediately postpartum
b. in Indonesia DMPA injections should not be given one day after the delivery as early
postpartum contraception
c. Breastfeeding women who are 6 weeks to <6 months postpartum can use without
restriction the following contraceptive methods : progestogen-only injectables
(DMPA), and LNG and ETG implants
d. Breastfeeding (and non-breastfeeding) women are generally should not have an
LNG-IUD inserted from 48 hours to<4 weeks postpartum.
e. Avallable data from clinical and observational trials do not suggest an increased risk
for either breastfeeding performance or infant health outcomes with use of
 progestogen-only injectables compared to outcomes in studies using other
progestogen-only methods.
A 27 years old P3A2 returns to your clinic to follow up the result of her annual PAP-SMEAR. She
has had a full annual examination including Pap Smear since the age of 21 and has never had
abnormal cervical cytology. Her STD screening at her last examination was normal. The cytology
of her pap smear showed high-grade squamous intraepithelial lesion (HGSIL). You discuss the
management option for the patient, and she decides to have colposcopy. The biopsy result of
the colposcopy you perform are not insufficient to give a histology report.
64. Which of the following option is the next best step in management for this patient?
a. Repeat Pap smear at 6-month interval for a year
b. Repeat colposcopy to obtain better sample
c. Perform diagnostic excisional procedure such as look electrical excision procedure
(LEEP)
d. Request that the lab repeats their test on the biopsy samples given
e. Conisation
65. A 32 years old presents for an Infertility workup. She and her partner have been trying
to conceive for 2 years without success. She has regular menstruation, though she
mention she has severe cramping during cycles. She also notes she experiences pelvie
pain during sex,. On examination, she is a thin, weli developed woman. She is afebrile
and she experiences a great deal of pain during pelvic examination. Which of the
following tests is required for diagnosis of the patients infertility?
a. Ultrasound
b. 8-hCG level
c. Pap smear
d. Laparoscopy
e. Hysterosalpingogram
66. A 29 year old G2P1AO woman is 22 weeks pregnant with reports of pelvic bulge and
bothersome pressure, Physical examination reveal cervical prolapse, approaching the
opening of vaginal Introitus, She worried that the prolapse will worsen as the pregnancy
progress. What can you offer this patient for her symptomatic prolapse?
a. Pessary trial
b. Reassessment
c. Cerclage
d. Hysteropexy
e. Uterosacral ligament fixation
67. Mrs. XY is a primigravida who is 34 weeks pregnant. Her Jast two serial scan have shown
a small gestational age fetus growing on the gh centile. Her last scan shows positive end
 diastolic flow with a normal Pl. She reports having good fetal movements, How should
further fetal surveillance be undertaken?
a. Forth nightly umbilical artery Doppler
b. Twice weekly CTG
c. Twice weekly umbilical artery Doppler
d. Weekly CTG
e. Weekly umbilical artery Doppler + CTG
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 as relaxed uterus.
68. What is the most likely cause of bleeding
a. Uterine atony
b. Uterine rupture
c. Retained placenta
d. Genital tract laceration
e. DIC
69. What should we do if the fundus not firm after placental delivery?
a. Methylergonovine (methergine)
b. Carboprost (hemabate, PGF2-alpha)
c. Fundal massage
d. Misoprostol (PGE1)
e. Dinoprostone-prostaglandin E2
70. Which of the following medications would be contraindicated in the treatment for this
patient?
a. Methylergonovine (methergine)
b. Carboprost (hemabate, PGF2-alpha)
c. Intramuscular pitocin
d. Misoprostol (PGE1)
e. Dinoprostone-prostaglandin E2
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
71. What is the most appropriate next step?
a. intravenous access for fluid resuscitation
b. Uterine packing
c. Balloon tamponade
d. Hecting laceration
 e. Misaprostol administration
72. What is the most likely cause of bleeding?
a. Uterine atony
b. Uterine rupture
c. Retained placenta
d. Genital tract laceration
e. DIC
73. After use of a 20 units 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.
b. Perform a bedside ultrasound to look for blood in the abdomen significant for
uterine ruptune
c. rerndrm a manual exploration of the uterine fundus and exploration for retained
dots or products
d. Examine the perineum and vaginal for laceration during delvery
e. Consult interventional radiology for uterine artery embolization
A 31 year old woman came to the hospital with chief complaint of weter broke. She is G3P2 at
36 weeks' gestation with one prior caesarean delivery on second baby due to fetal distress. She
wants to try trial labor. On physical examination, you find 3 em cervical dilatation, clear
amniotic fluid leakage with inadequate contraction and other examinations reveal no
contraindication. You will start the oxytocin infusion and you inform to the patient about the
risk.
74. According to a large study conducted by the Maternal-Fetal Medicine Units Network,
the use of oxytocin increases the risk for uterine rupture by what magnitude in women
with a prior caserean delivery?
a. Threefold
b. Sixfold
c. Tenfold
d. Sixteenth fold
e. No difference with normal delivery
75. Labor induction and augmentation are NOT assaciated with which of the following risk?
a. Postpartum hemorrhage fram uterine atony is more common in women undergoing
induction or augmentation
b. Amniotic fluid emobolism in a laboring patient receiving oxytocin can be occurred
c. The increased risk for caesarean delivery undergoing Induction is related with
cervical favorability (Bishop Score)
 d. The uterine rupture risk is increased threefold for women in spontaneous labar with
uterine Scar
e. Woman whose labor is managed with amniotomy have lower incidence of
chorioamnionitis compared with those in spontaneous labour.
76. According to the patient above, what is the most favorable condition for successful trial
labor after cesarean birth?
a. Water broke with clear amniotic fluid
b. A previous vaginal delivery
c. in a hospital with available facility of anesthesia
d. Only one previous cesarean delivery
e. induction given at term pregnancy
A 32 years old waman comes to your clinic 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 size appropriate. She has had a recent
echocardiography showing ejection fraction of 54% with moderate-severe pulmonary
hypertension,
77. What is the best management for this patient currently?
a. Performed emergency C-section
b. Lung maturation and e section
c. Conservative management until term pregnancy
d. Second stage acceleration
e. Induction of labour
78. What is the most common cause of heart failure during pregnancy and the puerperium?
a. Chronic hypertension with severe preeclampsia
b. Viral myocarditis
c. Obesity
d. Valvular heart disease
e. Pulmonary artery hypertension
79. Far patients with congenital heart disease, what is the most common adverse
cardiovascular event encountered in pregnancy?
a. Heart failure
b. Arrythmia
c. Thromboembolic event
d. Cerebrovascular hemorrhage
e. Heart axis changes
A 18 year-old G1PO woman at 10 weeks GA presents for an initial prenatal visit. From history
taking she had a history of IV drugs use. You ordered a rapid test and showed reactive for HIV.
She had never been on HAART medication prior to this pregnancy. You order a viral load and it
returns at 10,000. Her CD4 count is normal (500). She is otherwise healthy and has no other
significant medical history.
80. When is transmission of human immunodeficiency virus (HIV) from a woman to her
baby most likely to occur?
a. Intrapartum
b. Before 36 weeks gestation
c. In the days before delivery
d. Transmission occurs equally throughout gestation
e. in the first trimester
81. When would you recommend she start HAART ?
a. At this visit
b. At 37 weeks in preparation for delivery
c. At the beginning of the second trimester
d. Immediately after delivery
e. Only if it is medically indicated for maternal health
82. Which of the folowing statements about the treatment of HIV pregnancy is true ?
a. Treatment is recommended for all HIV-infected pregnant women.
b. All medications used for the treatment of HIV are safe in pregnancy
c. Treatment is only required if the HIV-infected woman would qualify for treatment
when not pregnant
d. Zidovudine must be added to whatever regimen the woman is already taking, even if
her viral load is adequately suppressed
e. Treatment is recommended only for woman with high viral load
83. Which of the following statements regarding intrapartum management HIV Is true?
a. If cesarean delivery is planned, it should be scheduled at 36 weeks' gestation
b. Cesarean delivery is recormmended for women with a viral load > 1000 copies/ml
c. In labor, with a plan for vaginal delivery, amniotomy should be performed as soom
as possible to hasten delivery
d. in labor, internal monitors should be placed because fetuses of HIV-infected women
are at a. increased risk for distress
e. The HAART should be suspended during labor
84. A 55 year menopause. She stopped having periods 8 months ago and is having severe
hot flushes The hot flushes are causing her considerable stress. What should you tell her
regarding thepsychological symptoms of climacteric?
a. They are not related to her changing levels of estrogen and progesterone K
b. They commonly include insomnia, irritability, frustration and malaise
c. They are related to a drop in ganadotropin levels
d. They are not affected by environmental factors
 e. They are primarily a reaction to the cessation of menstrual flow
85. A 62 vear old woman presents for annual examination. Her last spontaneous menstrual
period was 9 vears ago and she has been reluctant to use postmenopousal hormone
replacement because of a strong family history of breast cancer. She now complains of
diminished interest in SeXual activity Which of the following is the most likely cause of
her complaint?
a. Decreased vaginal length
b. Decreased ovarian function
c. Alienation from her partner
d. Untreatable sexual dysfunction
e. Physiologic anorgasmia
86. A 58 year old post menopause, Caucasian woman comes in to vour office for advice
regarding her risk factors for developing osteoporosis, She is 5 ft 1 in tall and weighs 195
lb. She stopped old woman presents to your office for consultation regarding her
symptoms of having periods at age 49. She is healthy but smokes one pack of cigarettes
a day, She does not take any medications. She has never taken hormone replacement
for menopause, Her mother died at age 71 after she suffered spontaneous hip fracture.
Which of the following will have the least effect on this patient's risk for developing
osteoporosis?
a. Her family history
b. Her race
c. Her history of smoking cigarettes
d. Her menopause status
e. Her obesity
A 49 year old woman experiences irregular vaginal bleeding for 3 months duration. You
performed endometrial biopsy, which copious tissue with a delivery, lobulated texture. The
pathologist report shows proliferation of glandular and stromal elements with dilated
endometrial glands, consistent with simple hyperplasia. Cytologic atypia is absent.
87. Which of the following is the best way to advised the patient ?
a. She shouid be treated to estrogen and progestin hormone therapy
b. The tissue will progress to cancer in approximately 10 % of cases
c. The tissue may be weakly premalignant and progress to cancer in approximately of
1% cases
d. She requires a hysterectomy
e. No further therapy is needed
88. Which of the following factors is protective against endometrial hyperplasia?
a. Obesity
b. Tamoxifen
 c. Oral contraceptive pills (OCPS)
d. Early menarche or late menopause
e. Unopposed exogenous estrogen therapy
You see a 16 yo female who presented with primary amenorrhea. Breast development was
noted at 13 years but there has been no increase in breast size. Pubic and axillary hair were
noted within one year of referral. An outside ultrasound showed no uterus or ovaries. Physical
exam reveals a normal vagina introitus with hymen present. Breast are Tanner 3, but seem to
be more fatty than mammary tissue.
89. Lab test were significant for absent estradiol, eievated gonadotropins and mildly
elevated DHEAS with normal testosterone, A karyotype was requested by the
endocrinologist and was found to be 45 XY (SRY gene +), What is the working diagnosis
following her initial workup?
a. Androgen insensitivity
b. Disorders of testicular development
c. Mullerian Agenesis d
d. A and B
e. B and C
90. The MRI showed an infantile uterus with no discernible gonads. During a laparoscopic
evaluation, two dysplastic gonads attached to small fallopian tubes and rudimentary
uterus was visualized. The final diagnosis is:
a. Swyer syndrame
b. Androgen Insensitivity
c. Mullerian Agenesis
d. Partial gonadal dysgenesis
e. Testicular Regression Syndrome
91. What type of tumor is a significant risk for such condition?
a. Mature Teratoma
b. Leydig cell tumors
c. Germ cell tumors
d. Stromal Cell Tumors
e. Granulose Cell Tumors
Miss 25 years old P3 comes to Gynecology outpatient elinic with cytology result low grade SIL
Sne curious about the result since her tast cytology result was normal 3 years ago. She has no
complame recently. She began sexualy active since 10 years ago and has had six partners. She
smokes 10 cigarrettes per day since 4 years ago. Her mother was diagnosed for cervical cancer
at 44 years old and just died 3 months ago. Her child now is 6 years old.
92. What are patient risc factor for CIN ?
a. Her smoking habits
 b. Onset of sexual activity
c. Six sex partnes
d. Early childbearing
e. All mention above
93. What is next proper management for patient ?
a. IVA test
b. Colposcopy
c. No procedure need in her treatment
d. HPV DNA test
e. Endocervical curettage
94. The result showing a condylomatous acetowhite lesion with punctuatian and atypical
vessels. Biopsy result confirms CIN 1 and HPV DNA test positive. What do you suggest
for patient ?
a. LEEP procedure
b. Reevaluation of HPV DNA
c. Cold knife conization
d. Repeat cytology in 12 months
e. Repeat cytology in 6 months
Mrs. A 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 echo interna 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 was endometriosis cyst.
95. Which one is the TRUE statement?
a. The patient should not undergo surgery because the best procedure to solve her
pain and infertility problem was giving GnRH agonist then performaned IVF
b. Laparoscopic procedure should be done if infertility problem already more than 3
years
c. Laparoscopic cystectomy was done because the cyst have diameter 50 and 60 mm
d. GnRH agonist 1 time prior to surgery will give better results
e. None of the above
96. Which of the statement below IS NOT TRUE regarding the surgery?
a. Bilateral cystectomy could be done without any precautionis on ovarian reserved.
b. Patient has severe grade of endometriosis because its AFS score more than >40
 c. Since she has not conceived yet we should conserve both of her tubes
d. A and C
e. B and C
A 19 years old woman came to clinic with chiel complaint of irregular menstruation. She had
menstruation once every three months. She is also obese (BMI 32). Physical examination
reveals she has hirsutism (Ferriman Gallwey score 9), other physical examination within normal
limit. Gynecologic examination within narma! limit.
97. Which of the following criteria diagnosis of polycystic ovarian syndrome (PCOS) is not
part of Rotterdam criteria ?
a. Oligo/anovulation
b. Appearance of polycystic ovaries by gynecologic ultrasound
c. Excess androgen activity de
d. Ferriman Gallwey score >8
e. All statement is true
98. In PCOS, increased testosterone production from the following hormones?
a. Inhibin
b. Estradiol
c. Prolactin
d. FSH
e. LH
A 55 years old nulliparous woman who underwent menopause at age 50 years complaint of a 1
history of vaginal bleeding and smells. Her medical history reveals she has hypertension and
controlled with anti hypertensive agent, and also she has diabetes mellitus controlled with an
oral hypoglycemic agent. On examination, she weighs 89 kg and 152 cm tall. Her blood pressure
is 150/90 mmHg. Heart and lung examination are normal. The abdomen is obese and no masses
are palpated. The external genitalia appear normal, and the uterus seems to be enlarged,
without adnexal masses palpated. 1 month
99. What is the probable diagnosis of this patient?
a. Cervical cancer
b. Hyperplasia Endometrium
c. Endometrial carcinoma
d. Uterine Fibroid Ovarian Cancer
100. Which of the following does not increase a woman's risk of developing endometrial
cancer?
a. Obesity
b. Smoking
c. Diabetes Mellitus
d. Tamoxifen
e. Unopposed estrogen