SOAL UNAS AGUSTUS 2017

1. A 21 y.o G0 present for her first gynecologic examination. She states that she became sexually
active 2 weeks ago for the first time. She has no significant medical history. She has regular
menses with some mild dysmenorrheal. During the speculum examination, you observe a small
raised 0,5 cm lesion 0,5 cm. It is smooth and light-bluish in color with the appearance of a
bubble under the epithelial surface and a blood vessel running over the top. What is your
diagnosis?
a. Bartholini’s gland cyst
b. Cervical dysplasia
c. Nabothian cyst
d. Skene’s gland cyst
e. Cervical cancer

2. A 45 y.o 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

3. The following statement is true regarding the physiological adaptations to pregnancy?

a. The increase in maternal heart rate contributes to an increase in cardiac output during
pregnancy
b. Mean arterial blood pressure falls because of a rising in systemic vascular resistance
c. Anatomical and physiological changes in the lungs allow a pregnant woman to with stand
hypoxia better than a non-pregnant woman
d. The lower bicarbonate levels in pregnant women relect a state of metabolic acidosis
e. TSH (thyrotropin) levels fall in the first trimester but return fastly to normal by term

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

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5. A patient who underwent an abdominal hysterectomy a few days ago complains of numbness
over the skin over the anterior aspect of the upper thigh. This could be attributed to
neuropathy of the :
a. Femoral nerve
b. Obturator nerve
c. Perineal nerve
d. Podendal nerve
e. Sciatic nerve

6. A 45 y.o woman undergoes an abdominal hysterectomy for a large fibroid uterus. She is found
to have a fibroid in broad ligament, and there is a concern that her ureter may have been
damaged during the difficult surgery. Which of the following is the least possible site of ureteric
injury in this surgery?
a. At the level of the uterosacral ligament
b. Lateral to the uterine vessels
c. Renal pelviureteric junction
d. The area of the ureterovesical junction close to the cardinal ligaments
e. The base of the infundibulopelvic ligament as the ureters cross the pelvic brim at the
ovarian fossa

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

8. On prenatal ultrasound, which of the following feature characteristic gastroschisis?

a. The abdominal wall defect is superior to cord insertion
b. Ectopia cordis is present
c. The abdominal wall defect is lateral to cord insertion
d. The abdominal wall defect is lower than cord insertion
e. The bladder cannot be visualized

9. A 39 y.o female G2P1A0, 15 weeks pregnant present to your clinic for having routine ANC. On
physical examination, you found her fundal height equals umbilical point. You performed
ultrasound and saw a multilocular hypoechoic mass sized 10cm (in diameter) in her left adnexa.
No free fluid in her abdomen and pelvis. What is your consideration in this case?

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 a. The incidence of adnexal masses in pregnancy is 1%
b. The incidence of ovarian cancers in pregnancy is between 1:1000
c. The most common type of bening ovarian cyst in pregnancy is a marute teratoma
d. The most common histopathological subtype for malignant ovarian tumor in pregnancy is
epithelial ovarian tumor
e. The resolution rate of adnexal masses in the second trimester of pregnancy is 60-70%

10. Regarding to question above. The patient does not believe that she has ovarian cyst during
pregnancy. She really concern about the possibility of malignant cyst. What will you inform
regarding this to her?
a. The most common mode of presentation of an adnexal mass is pain
b. The sensitivity of detection of ovarian cyst on clinical examination aline is less than 5%
c. The size of ovarian cyst that should prompt investigation for malignancy is 10 cm
d. The validated sensitivity and specificity of IOTA rules on US evaluation of an ovarian cyst is
sensitivity : 78%, specificity 87%
e. The sensitivity and specificity of MRI in the diagnosis of a malignancy is 100 and 94%
respectively

11. Regarding to question number 9. You have checked her Ca125 serum level and the result was
350µ/ml. you performed conservative surgical staging per laparatomy because her frozen
section result revealed malignancy cyst. After 1 week, the pathology result comes with serous
papillary carcinoma of left ovary. She is palnned for chemotherapy. What will you inform to her
regarding chemotherapy for ovarian cancer during pregnancy?
a. In a patient with ovarian cancer in pregnancy receiving chemotherapy the delivery should
be planned at completion chemotherapy
b. Chemotherapy use in pregnancy is generally considered safe beyond 20 weeks of gestation
c. CNS and neural tube complications occur during the week 8-12 week in pregnancy
d. This percentage of patients receiving chemotherapy in pregnancy who develop major
congenital malformations in 30-40%
e. Cardiovascular defect are common congenital malformations in platin based chemotherapy
regimens
12. A 40 y.o G4P3A0, 18 weeks pregnant, has had post coital bleeding for the last month. Speculum
examination showed a vaginal discharge and a 1 cm exophitic lesion on the anterior cervical lip.
She does not remember when she last time had a smear test. Which of the following
statements is true regarding her further management?
a. She should have a pap smear tes performed
b. Punch biopsy of the lesion is indicated
c. Prescribe a dose of antibiotics and reassess the cervix when the vaginal discharge has
settled down
d. In view of the findings and the gestational age a cone biopsy should be offered as treatment
of the lesion

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 e. Assuming that the lesion has been biopsied and histology result showed cancer cells, MRI
without contrast should be considered as next step

A 28 y.o woman, G1 36 weeks of gestational age, went to your clinic to do routine antenatal care.
During ultrasound, the doctor told that she will be expecting bay boy with estimated fetal weight
of 2500 grams, however amniotic fluid considered to be less than normal. Then you 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

13. Oligohydramnios is defined as which of the following?

a. Amniotic fluid index < 5 cm
b. Single deepest pocket < 2 cm
c. Amniotic fluid index < 90 percentile
d. All of the above
e. None of the above

14. Amniotic fluid volume is a balance between production and resorption. What is the primary
mechanism of fluid resorption?
a. Fetal breathing
b. Fetal swallowing
c. Absorption across fetal skin
d. Absorption by fetal kidneys
e. Filtration by fetal kidneys

15. In a normal fetus at term, what is the daily volume of fetal urine that contributes to the amount
of amniotic fluid present?
a. 200ml
b. 250 ml
c. 500 ml
d. 750 ml
e. 1000 ml

Mrs A, 26 y.o, G1P0A0, according to her last LMP is 34 weeks pregnant, came for her first antenatal care.
She admit to have 20 kg weight gain during pregnancy with swelling ankles for the past 4 weeks. She never
took any iron or vitamin supplementation. From the physical findings, BP 145/95 mmHg, HR 86 x/min, RR 20
x/min, BMI 35 kg/m2. Ultrasound examination confirmed twins in breech presentation. Result from
urinalysis were as follows color cloudy yellow, specific gravity 1.013, albumin +2, RBC 0-1, WBC 2-5, bacteria
negative

16. What is the most likely diagnosis?

a. Acute fatty necrosis of the liver
b. Chronic hypertension
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 c. Preeclampsia
d. Renal disease
e. Pyelonephritis

17. Given the history of this patient, several more laboratory and diagnostics tests were obtained. She was
stable and the fetuses have reassuring heart rate tracings. Which of the following do you expect to see
in the test results?
a. Chest x ray to show decreased pulmonary vascular markings
b. Urine to show infection
c. Creatinin clearance to be increased above normal pregnancy levels
d. Serum uric acid to be increased
e. A decreased hematocrit

Mrs B, 37 years old came to your office at 32 weeks of gestation according to menstrual period. She has no
ultrasound examination before and did not get antenatal care routinely. The vital signs is within normal
limits. She ahs body mass index 19 kg/m 2 . During physical examination, the uterine fundal is 22 cm. from
ultrasound examination, the fetus has biometric values that correlate with 30 weeks fetus.

18. Which of the following is the next best step in managing this patient?
a. Antenatal care routinely for the next 2 weeks
b. Evaluate maternal status and comorbidities
c. Consider deliver the baby
d. Repeat sonography for fetal growth in 2 weeks
e. Doppler velocimetry evaluation every 3 days

19. According to algorithm for management of fetal growth restriction, you evaluate the Doppler
Velocimetry then find a reserved end diastolic flow and oligohydramnios. What is the appropriate
management at this time?
a. Regular fetal testing
b. Weekly evaluation of amniotic fluid
c. Consider corticosteroids for fetal lung maturation
d. Deliver the baby
e. Reevaluate middle cerebral arteries and ductus venosus

20. Fetal growth restriction is associated with all of the following , EXCEPT
a. Anti phospolipid Antibody Syndrome
b. Inherited thrombophilias
c. Infertility
d. Immunosuppressive drugs
e. Social deprivation

21. 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
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 b. A detailed fetal ultrasound at 18 to 20 weeks and again in the third trimester should be performed
given the increased risk of fetal goiter
c. Fetal echocardiogram to evaluate for cardiac abnormalities
d. Umbilical Doppler to monitor for placental dysfunction
e. MCA Doppler to monitor for fetal anemia

22. Regarding TSH in pregnancy, which statement is true?

a. Serum TSH levels in early pregnancy decline
b. TSH crosses the placenta
c. Pituitary TSH secretion is suppressed when hCG level is decreasing
d. It cannot be used for diagnosis of many thyroid disorder sin pregnancy
e. TSH level is static at midpregnancy

23. Management of hypothyroidism in pregnancy is:

a. Women after thyroidectomy may require higher dose of levothyroxine
b. TSH levels measured weekly
c. Thyroxine dose is adjusted by 100 mcg increments until TSH values become normal
d. Increased thyroxine requirements begin as early as 12 weeks
e. None above

Mrs E, 32 y.o referred from midwife with antepartum hemorrhage, She is G3P2 term pregnancy. On
examination her blood pressure is 160/100 mmHg, HR 100 bpm. She looks anemic, not icteric. Obstetrical
examinations reveal contraction 4-5 x/ min, FHR 179 bpm, head presentation 3/5. After thorough
examination it is concluded that there is a placental abruption with retropacental hematoma size 6 x 5 cm.
This patient planned to do cesarean section.

24. If the patient above during cesarean section found to be in atonic condition, which of th following are
not a pre requisite for performing b-lynch suture?

a. Patient in lithotomy position during operation

b. Bimanual compression reduce the amount of bleeding
c. Availability of suture material
d. Patient in stable hemodynamic condition
e. None of the above

25. If during operation the uterus is couvelaire but with good contraction, how would you manage the
condition?

a. Perform prophylactic b-lynch suture

b. Ascending uterine artery ligation
c. Hypogastric artery ligation
d. Sub total hysterectomy
e. Uterotonic and observation

26. Postoperative period is very crucial in this patient. Which of the following is not included as a parameter
needed to be evaluated In early warning system?

a. Blood pressure
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 b. Heart rate
c. Urine production
d. Central venous pressure
e. All of the above

27. What is the best next step?

a. Obstetrical examination consist of sterile speculum examination followed by vaginal examination

b. Abdominal ultrasound
c. Transvaginal ultrasound
d. Stabilized patient, obtain two large bore iv, and start iv fluid bolus with 30 cc/kgBB
e. Emergency cesarean section

28. What is the most important laboratory test to the patient?

a. CBC
b. Urinalysis
c. PT, APTT
d. AST/ALT
e. Blood type and cross match

A 26 years old woman, G1P0A0 was admitted to emergency room because she lost her consciousness
around 1 hour ago, according to the husband, she is 36 weeks pregnant. She performed antenatal care at
scheduled time, and never missed one. Her husband said, she never had severe nausea and omitting.
Physical examination reveals BP 120/80 mHg, pulse rate 86 x/min, RR 18 x/min, temperature 36.5 C. You
notice there is an icteric sclera. Other physical examination was remarkable. Obstetrical examination reveals
no heart beat was detected.
Laboratory examination reveals CBC 10.2/29.9/8900/253.000, Ur/C 18/0,8, AST/ALT 458/878, RBG 32,
urinalysis was within normal limit

29. What is the best next management in this case?

a. Abdominal ultrasound
b. Induction of labor
c. Emergency cesarean section
d. Whole blood transfusion
e. Injection of 40 % dextrose

30. All EXCEPT which of the following are clinical characteristics that increase for acute fatty liver of
pregnancy?

a. Nulliparity
b. Female fetus
c. Male fetus
d. Twin gestation
e. Third trimester

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

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 a. Acute hepatocellular destruction
b. Incomplete clearance of bile acids
c. Microvascular thrombus accumulation
d. Eosinophil infiltration of the liver
e. Hepatocellular injury

A 17-year old G1P0 woman present at 25 weeks gestation complaining of headache for the past 36 hours.
She has had regular prenatal visit going back to her first prenatal visit at 8 weeks gestation. A 20 weeks
ultrasound redated her pregnancy by 2 weeks as it was 15 days earlier than her LMP dating. She has a BP of
155/104 mmHg

32. You review her medical record and determine that she does not have chronic hypertension. The patient
denies having RUQ pain but because of your high suspicion of severe preeclampsia you order a CBC,
liver enzymes, renal function test and a 24-hour urine protein collection. Her laboratory test result
reveal a normal platelet count and liver enzymes but a slightly elevated creatinine and proteinuria off
550 mg in 24 hours. Her headache has resolved after a dose of acetaminophen. What is the next best
step in her management?
a. Give her a prescription for labetalol and have her follow up in clinic in 2 weeks
b. (a) plus bed rest
c. Hospitalization for futher evaluation and treatment
d. immediate delivery
e. Begin Induction of labor

33. Over the next 12 hours, her SBPs rise above 16o mmHg on several occasions, most notably to 174/102
mmHg hours after admission and to 168/96 mmHg 9 hours after admission. Her headache does not
return and she has no RUQ pain or visual symptoms. A set of repeat laboratory test results are
unchanged and by increasing her labetalol dose to 400 mg TID, her BPs decrease to 140s- 150s/70-90
mmHg. She is also started on magnesium sulfate. What change in physical or laboratory examination do
you observe that would indicate delivery?

a. Another BP of 174/102 mmHg

b. Headache returning
c. Double vision
d. Platelets of 108
e. AST of 265

A 43 y.o woman, G4P3, at 37 weeks gestation presented in hospital with a ten day history of low extremities
edema, with idiopathic hypertension for 1 year. At presentation, she had a blood pressure of 170/100
mmHg. Laboratory findings were normal except urinalysis (protein 2+). She was diagnosed with
superimposed severe preeclampsia. It was decided to deliver the fetus by means of C section by indication
of transverse lie. Blood pressure measurement was 150/100 mmHg. She lost consciousness for 30 seconds
five hours after operation. The laboratory studies gave the following results serum aspartate
aminotransaminase (AST) 225 IU/L, serum alanine aminotransaminase (ALT) 140 IU/L, serum lactated

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dehidrogenase (LDH) 1017 IU/L. serum urea and creatinine were normal, hemoglobin 10.6 mg/dL, platelet
count 50 x 103 µ,mL. A brain computed tomography (CT) scan was performed on patient which revealed the
left frontal lobe lacunar infarction. The patient was transferred to intensive care unit.

34. What is the most appropriate diagnosis

a. DIC
b. Acute Fatty Liver in pregnancy
c. HELLP syndrome
d. Severe puerperal infection
e. Thrombotic thrombositopenic purpura

35. What is the best management after, for this case?

a. Fresh frozen plasma and thrombocytes concentrate
b. Anti-platelets
c. Anti-oxydant
d. Corticosteroid
e. Magnesium sulfate

36. 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, G1P0A0, came to the 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.

37. In case above, what kind of examination should you performed for establishing diagnosis?

a. Vaginal examination
b. In speculo
c. Blood test
d. Ultrasound
e. Simple urine test

38. You found on Leopold 1,hard, round, with ballottement +, contraction was infrequent and weak. What
was your plan?

a. Went to labor induction

b. Immediate C-section
c. Tocolytic and corticosteroid provision
d. Performed ultrasound
e. Performed external version

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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 are denied

39. Ultrasound examination showed that trans-cerebellar diametes was proper to gestational age,
abdominal circumference was lower than 2.5 percentile and amniotic fluid deepest pocket was 1.2 cm.
what is the most likely diagnosis?

a. Growth restriction with oligohydramnion

b. Normal growth with oligohydramnion
c. Growth restriction with normal amniotic fluid
d. Normal growth with normal amniotic fluid
e. Need another examination for establishing diagnosis

40. Lack of baby movement had been felt for two days, fetal heart rate was 146 bpm. What was your 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 restriction

41. Cardiotocography showed low variability with checkmark pattern and no desceleration. 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 after
c. Category two, went for Doppler velocimetry
d. Category three, went for Doppler velocimetry ultrasound exam
e. Category three, delivered baby

42. A 24 y.o G2P1 woman at 39 weeks and 3 days is seen in the 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 woud be a contra indication to a trial of
labor after cesarean (TOLAC)?

a. Prior classical hysterotomy

b. Prior Kerr hysterotomy
c. Small for gestational agefetus
d. Oligohydramnios
e. GBS + mother

43. A 29 y.o G3P2 A0 presents to the emergency center with complaints of abdominal discomfort for 2
weeks. Her vital signs are BP 120/70mmHg, pulse 90 beats/min, temperature 36 C, respiratory rate 18

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 breath/minute. A pregnancy test was positive and an ultrasound of the abdomen and pelvis reveals a
visible 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. Ectopic ovarian tissue

b. Fistula between the peritoneum and the uterine cavity
c. Primary peritoneal implantation of the fertilized ovum
d. Tubal abortion
e. Uterine rupture of prior cesarean section scar

44. Invasive cervical cancer identified only microscopically, invasion is limited to measured stromal invasion
with a maximum depth of 3 mm and no wider than 7 mm should be treated with
a. Observation
b. Tissue ablation
c. LEEP/LLETZ
d. Simple total hysterectomy
e. Radical hysterectomy

45. The majority of vulvar, vaginal and cervical cancer appear to have a common cause and usually caused
by:

a. High risk types of herpes simplex virus (HSV) infection

b. High risk types of human papilloma virus (HPV) infection
c. Increased exposure to endogenous estrogen
d. Increased exposure to exogenous estrogen
e. Chronic bacterial and parasitic infection

46. Childhood neoplastic ovarian masses most commonly originate from

a. Gonadal epithelium
b. Gonadal stroma
c. Sex cord
d. Germ cell
e. Metastatic disease

47. A patient returns for a postoperative checkup 2 weeks after a total abdominal hysterectomy for fibroids.
She is distressed because she is having continuous leakage of urine from the vagina. Her leakage
is essentially continuous and worsens with coughing, laughing, or movement. Given her history and
physical, you perform both a methylene blue dye test, which is negative and indigo carmine test, which
is positive. The most likely diagnosis is

a. Rectovaginal fistula
b. Uretrovagina fistula
c. Vesicovaginal fistula
d. Ureterovagina fistula
e. Impossible to distinguish

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48. A 38 years old multigravid woman complaints 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. The history is most suggestive of

a. Fistula
b. Stress incontinence
c. Urge incontinence
d. Urethral diverticulum
e. UTI

49. Select the incorrect regarding guidelines for Nuchal Translucency (NT) measurement is
a. The margins of NT edges must be clear enough for proper caliper placement and the fetus is not
necessary in the midsagital plane
b. The image must be magnified so that is filled by the fatal head, neck and upper thorax
c. The fetal neck must be in a neutral position, not flexed and not hyperextended
d. The amnion must be seen as separate from NT line, and the calipers must be placed on the inner
borders of the nuchal space with none of the horizontal crossbar itself protruding into the space
e. The calipers must be placed perpendicular to the long axis of the fetus and the measurement must
be obtained at the widest space of the NT

50. Choose the wrong statement about the Down Syndrome

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. Approximately one third of the fetuses with increased nuchal translucency thickens will have a
chromosome abnormality, nearly half of which are Down Syndrome
d. Down syndrome is caused by an autosomal trisomy, is the most common non lethal trisomy
e. All cases of Down Syndrome is caused by trisomy 21

51. A 32 years old presets for an infertility work up. She and her partner have been trying to conceive for 2
years without success. She has regular menstruation, though she mentions she has severe cramping
during her cycles. She also notes she experiences pelvic pain during sex. On examination, she is a
thin,well developed woman. She is afebrile, and she experiences a great deal of pain during the pelvic
examination. You do not note discharge on examination. Which of the the following tests is required for
diagnosis of the patient infertility?

a. Ultrasound
b. Beta hCG level
c. Pap smear
d. Laparoscopy
e. Hysterosalpingogram

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52. Mrs XY is a primigravida who is 34 weeks pregnant. Her last two serial scans have shown an small
gestational age growing on the 9 th centile. Her last scan shows positive end diastolic flow with a normal
PI. She reports having good fetal movements. How should further fetal surveillance be undertaken?

a. Fortnightly umbilical artery Doppler

b. Twice weekly CTG
c. Twice weekly umbilical artery Doppler
d. Weekly CTG
e. Weekly umbilical artery Doppler + CTG

A 25 y.o woman in her first pregnancy is noted to have prolonged first and second stage of labor. 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 demonstrated a relaxed uterus.

53. What is the most likely cause of bleeding?

a. Uterine atony
b. Uterine rupture
c. Retained placenta
d. Genital tract laceration
e. DIC

54. What should we do if the fundus not firm after placenta delivery?

a. Methylergonevine (Methergine)
b. Carboprost (Hemabate, PF 2- alpha)
c. Fundal massage
d. Misoprostol
e. Dinoprostone prostaglandine E2

55. Which of the following medications would be contraindicated in the treatment for this patient?

a. Methylergonevine (Methergine)
b. Carboprost (Hemabate, PF 2- alpha)
c. Intramuscular Pitocin
d. Misoprostol (PgEs)
e. Dinoprostone prostaglandine E2

A 30 y.o 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.

57. What is the most appropriate next step?

a. Intravenous access for fluid resuscitation

b. Uterine packing
c. Balloon tamponade
d. Hecting laceration
e. Misoprostol administration
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58. What is the most likely cause of bleeding

a. Uterine atony
b. Uterine rupture
c. Retained placenta
d. Genital tract laceration
e. DIC

59. After use of a 20 units of oxytocin in 1000 ml of cystaloid solution to increase the tone of her uterus,
stop the bleeding, however you can continue to notice a massive bleeding from the vagina. What is the
most appropriate next step in the evaluation of this patients’s bleeding?

a. Perform a bedside ultrasound for retained product 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 product
d. Examine the perineum and vaginal for laceration during delivery
e. Consult interventional radiology for uterine artery exploration

A 32 years old woman comes to your clinics due to shortness of breath, that worsen since 2 days ago. On
history taking, she told you that she had ever diagnosed of having significant mitral stenosis. She is 33
weeks pregnant. The fetus is size-date appropriate. She has had a recent echocardiography showing ejection
fraction of 54% with moderate-severe pulmonary hypertension

60. What is the best management for this patient currently?

a. Perform emergency C section
b. Lung maturation and C section
c. Conservative management until term pregnancy
d. Second stage acceleration
e. Induction of labor

61. 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

62. For patients with congenital heart disease, what is the most common adverse cardiovascular event
encountered in pregnancy?
a. Heart failure
b. Arrhytmia
c. Thromboembolic event
d. Cerebrovascular hemorrhage
e. Heart axis changes

63. A 55 years old woman presents to your office for consultation regarding her symptoms of menopause.
She stopped having periods 8 months ago and is having severe hot flushes. The hot flushes are a causing

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 her considerable stress. What should you tell her regarding the psychological symptoms of the
climacteric?

a. They are not related to her changing levels of estrogen and progesterone
b. They commonly include insomnia, irritability frustration and malaise
c. They are related to a drop in gonadotropin levels
d. They are not affected by environmental factors
e. They are primarily a reaction to the cessation of menstrual flow

64. A 62 years old woman present for annual examination. Her last spontaneous menstrual period was 9
years ago and she has been reluctant to use postmenopausal 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

A 49 year old woman experiences irregular vaginal bleeding for 3 months duration. You performed
endometrial biopsy, which obtains copious tissue with a velvety, lobulated texture. The pathologist reports
shows proliferation of glandular and stromal elements with dilated endometrial glands, consistent with
simple hyperplasia. Cytologic atypia is absent.

65. Which of the following is the best way to advise the patient?

a. She should 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 1 % of cases
d. She requires hysterectomy
e. No further therapy is needed

66. Which of the following factors is protective against endometrial hyperplasia?

a. Obesity
b. Tamoxifen
c. Oral contraceptive pills (OCP)
d. Early menarche or late menopause
e. Unopposed exogenous estrogen therapy

You see a 16 y.o 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 hairs were noted within one year of
referral. An outside ultrasound showed no uterus or ovaries. Physical examination reveals a normal vaginal
introitus with hymen present. Breast are Tanner 3, but seem to be more fatty than mammary tissue.

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67. Lab test were significant for absent estradiol, elevated gonadotropins and mildly elevated DHEAS with
normal testosterone. A karyotype was requested by the endocrinologist and was found to be 46 XY (SRY
gene +). What is the working diagnosis following her initial work up?

a. Androgen insensitivity
b. Disorders of testicular development
c. Mullerian agenesis
d. A and B
e. B and C

68. The MRI showed an infantile uterus with no discernible gonads. During a laparoscopic evaluation, two
dysplastic gonads attached to small fallopian tubes and a rudimentary uterus was visualized. The final
diagnosis is:

a. Swyer syndrome
b. Androgen insensitivity
c. Mullerian agenesis
d. Partial gonadal dysgenesis
e. Testicular regression syndrome

69. What type of tumor is a significant for such condition?

a. Mature teratoma
b. Leydig cell tumors
c. Germ cell tumors
d. Stromal cell tumor
e. Granulose cell tumors

Miss 25 yo P3 comes to Gynecologic outpatient clinic with cytology result low grade SIL.She curious about
the result since her last cytology result was normal 3 years ago. She has no complaint recently. She began
sexually active since 10 years ago and has six partners. She smokes 10 cigarettes per day since 4 years ago.
Her mother was diagnosed for cervical cancer at 44 yars old and just died 3 months ago, her child is at 6
years old now.

70. What are patient risk factor for CIN?

a. Her smoking habits

b. Onset of sexual activity
c. Six sex partners
d. Early child nearing
e. All mention above

71. What is next proper management for patient?

a. IVA test
b. Colposcopy

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 c. No procedure need in her treatment
d. HPV DNA test
e. Endocervical curettage

72. The result showing a condylomatous acetowhite lesion with punctuation and atypical vessels. Biopsy
result confirms CIN 1 with 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

A 19 years old woman came to clinic with chief complaint of irregular menstruation. She had menstruation
once every 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
normal limit.

73. Which of the following criteria diagnosis of polycystic ovarian syndrome (PCOS) is not part of the
Rotterdam Criteria?

a. Oligo/ anovulation
b. Appearance of polycystic ovaries by gynecologic ultrasound
c. Excess androgen activity
d. Ferriman Gallwey score > 8
e. All statement is true

74. In PCOS, increased testosterone production from the ovaries is secondary to stimulation by which of the
following hormones?

a. Inhibin
b. Estradiol
c. Prolactin
d. Follicle stimulation hormone (FSH)
f. Luteinizing hormone (LH)

A 55 years old nulliparous woman who underwent menopause at age 50 years complaint of a 1 month
history of vaginal bleeding and smells. Her medical history reveals she has hypertension and controlled with
antihypertensive agent, and also she has diabetes mellitus controlled with an oral hypoglycemic agent. On
examination , she weights 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.

75. What is the probable diagnosis of this patient?

a. Cervical cancer
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 b. Hyperplasia endometrium
c. Endometrial carcinoma
d. Uterine fibroids
e. Ovarian cancer

76. Which of the following does not increase woman’s risk of developing endometrial cancer?
a. Obesity
b. Smoking
c. Diabetes mellitus
d. Tamoxifen
e. Unopposed estrogen

A 40 y.o G2P0 woman at 7 weeks GA by LMP present for her first prenatal visit. She spontaneously conceid
after 18 months of trying. She is ecited about the pregnancy. But at the same time is concerned about
potential risks for herself as well as the baby because of her age. Her husband is 52 y.o, healthy and has
fathered two children from a prior marriage. Thw week prior to the visit, she experienced spotting that
lasted 3 days and then resolved. Currently she has no past medical or surgical history except for a
miscarriage 3 years ago. She has regular periods every 30 days

77. Three second-trimester analyze level abnormalities in a pregnancy at increased risk for Down Syndrome
a. Decreased MSAFP, increased unconjugated estriol, increases inhibin, increased beta hCG
b. Decreased MSAFP, decreased unconjugated estriol, increased inhibin, increased beta hCG
c. Increased MSAFP, increased unconjugated estriol, decreased inhibin, decreased beta hCG
d. Decreased MSAFP, decreased unconjugated estriol, decreased inhibin, increased beta hCG
e. Decreased hemoglobin

78. Patient undergo first trimester screening, which return with a risk for Down syndrome of 1 in 1,214 and
risk of trisomy 18 of 1 in 987. At 18 weeks she gets a quad screen, and her estriol, beta hCG, and AFP
were all low. She has an ultrasound which shows a fetus consistent with 16 weeks size, increased
amniotic fluid, clubfoot, omphalocele, choroid plexus cyst and possible heart defect. On the basis of the
patients history and data provide what is the most likely diagnosis?
a. Trisomy 21
b. Trisomy 18
c. Trisomy 13
d. Turner syndrome
e. Klinefelter syndrome

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