1. A 36 years of G2P1 presents to the antenatal clinic.

She had an emergency caesarean

section for sudden onset hypertension and placental abruption at 30 weeks in her previous
pregnancy. She is currently 20 weeks of gestation and enquiries about further plan of fetal
monitoring in this pregnancy. What is the most appropriate advice?
A. Serial cardiotocography monitoring from 28 weeks
B. Serial scans starting from 24 weeks
C. Uterine artery doppler at 22 weeks
D. No extra monitoring in required
E. Serial scans from 28 weeks

2. A 30 years 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 demonstrated the fundus was soft. What is the most
appropriate next step?
A. Misoprostol administration
B. Balloon tamponade
C. Suture the laceration
D. Uterine packing
E. Intravenous access for fluid resuscitation

3. A 32-year-old gravida 2 Para 1 has been transferred from a midwifery-led unit for lack
of progress in labour at 4 cm. Her previous baby weighed 3100 g and was a normal delivery at
38 weeks gestation. On admission, her observations are normal and the cardiotocography
(CTG) was reassuring. The midwife who examined her has diagnosed a complete breech
presentation and this is confirmed on scan. The woman is very keen to have a vaginal delivery
and decision has been taken to allow labour to continue. After 2 hours, there is no progress in
labour and the CTG has become suspicious. What is the most appropriate action?
A. Advice emergency caesarean section
B. Augment labor with oxytocin
C. Continue observation for one hour
D. Discuss External Cephalic Version with the mother
E. Perform fetal blood sampling
4. A 35-year-old grandmultipara has had a major postpartum haemorrhage (PPH)
following a normal delivery. Mechanical and pharmacological measures have failed to control
the bleeding. Examination has confirmed that there are no retained placentaltissue in the uterine
cavity and absence of trauma to genital tract. What is the most appropriate first-line surgical
management?
A. B-Lynch or modified compression sutures
B. Balloon tamponade
C. Ligation of internal iliac artery
D. Postpartum hysterectomy
E. Selective arterial embolization

5. A 23 year-old G1 32 weeks is being admitted to the hospital because of preterm

contraction. The patient complaint regular contraction. Antenatal care was done regularly in
PHC. No remarkable abnormality was found during ANC. BMI before pregnancy was 30
kg/m2, weight gain during pregnancy is 14 kg. Abdominal examination showed FUT 36 cm,
regular contractions, fetal heart beats 154 bpm. Speculum examination showed closed ostium
uteri externa. An ultrasound shows the estimated fetal weight 2400 g, AFI 30 cm, no fetal
morphology abnormalities, placenta implanted in anterior corpus, cervical length 1.8 cm,
funneling positive. Laboratory results were Hb 10,7 g/dL, Ht 33%, Leucocyte 13.500,
Thrombocyte 315.000 MCV 82 MCH 30. What is the most appropriate next step in the
management of this patient?
A. Give intravenous iron
B. Schedule for OGTT test
C. Give antibiotic prophylaxis
D. Schedule for cervical cerclage
E. Give MgSO4 for neuroprotection

6. A 35-year-old woman, G3P2, presents to labor and delivery (L&D) at 33-week

gestation referred by midwife with BP 180/110 mmHg. BP on arrival is 170/105 mmHg. Urine
protein is 1+ on dipstick. Patient had history of high blood pressure in her previous pregnancy.
ANC was done in midwife. Blood pressure at first trimester was 130-145/90-95 mmHg, urine
protein was negative on dipstick. No antihypertension drug was given. The patient denies any
complaints today. What is the most likely diagnosis of the patient:
A. Preeclampsia
B. Chronic hypertension
C. Gestational hypertension
D. Superimposed preeclampsia
E. Preeclampsia with severe feature

7. A 26-years-old woman, G1P0A0 was admitted to ER 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 87
x/min, RR 18x/min, Temperature 36.50C. You notice there is an icteric sclera. Other physical
examination was remarkable. Obstetrical examination reveals no fetal heartbeat was detected.
Laboratory examination reveals CBC 10.2/29.9/8900/263.000; Ur/Cr 18/0,8; AST/ALT
458/878; RBG 32; Urinalysis was within normal limit. What is the best next management in
this case?
A. Abdominal ultrasound
B. Induction of labor
C. Emergency Caesarean section
D. Whole Blood transfusion
E. Injections of 40% Dextrose

8. 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 a relaxed uterus. 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

9. A 28-year-old G1 at 26 weeks present for her scheduled obstetric appointment. You

ordered OGTT examination that shows fasting blood glucose 102 mg/dL and 2 hours after 75
g oral glucose 185 mg/dL. Her gestational weight gain during pregnancy is 12 kg. Her BMI
before pregnancy was 26 kg/m2. What is the most likely diagnosis?
A. Normal OGTT
B. Gestational diabetes
C. Impaired glucose test
D. Diabetes melitus type 1
E. Diabetes mellitus type 2

10. A 28-year-old G2P1 is seen for her first prenatal visit at 16 weeks’ gestation by
menstrual history. Her first child was born at 32 weeks spontaneously. She is worried this
pregnancy also will be ended with spontaneous preterm birth. What is the most accurate
examination that can be done at 16 weeks to predict the risk of preterm birth?
A. IGFBP-1 examination
B. Fibronectin examination
C. Measure cervical length
D. Vaginal swab to exclude bacterial vaginosis
E. Urinary test to exclude urinary tract infectionhedule routine antenatal care in 4 weeks

11. What is the implantation of a placenta in which there is a defect in the fibrinoid layer at
the implantation site, allowing the placental villi to invade and penetrate into but not through
the myometrium called?
A. Placenta accreta
B. Placenta increta
C. Placenta percreta
D. Placental infarct
E. Placenta previa

12. A 26-year-old G2P1 (no live child) is seen for her first prenatal visit at 18 weeks’
gestation by menstrual history. She had history of preterm birth at 28 weeks and her first child
was died after hospitalized for 1 month in NICU. She is worried this pregnancy also will be
ended with spontaneous preterm birth. Transvaginal ultrasound scan shows her cervical length
is 30 mm, and there is amniotic sludge. What is the most accurate intervention to prevent the
risk of preterm birth?
A. Antibiotic and progesterone should be given
B. She should be offered fibronectin examination
C. Evaluate the cervical length at 22 weeks gestational age
D. Cervical cerclage should be performed to prevent preterm birth
E. She should be offered for Anti-Phospholipid Syndrome screening

13. How much calcium intake daily is recommended by for high risk pregnant women?
A. 300 mg
B. 500 mg
C. 1000 mg
D. 1300 mg
E. 1500 mg

14. A 21-year-old G1 P0 patient presents to your office with vaginal bleeding at

approximately 6 weeks’ gestation by her last menstrual period. Her examination is benign with
a 6-week-sized uterus, a closed cervical os, and a small amount of blood within the vaginal
vault. You order a complete pelvic ultrasound that shows as follow:
The gestational sac diameter 12 mm
What is the most likely diagnosis?
A. Blighted ovum
B. Threatened abortion
C. Embryonic demise
D. Interstitial pregnancy
E. Normal intrauterine pregnancy

15. Which one is correct regarding Eisenmenger syndrome?

A. Caesarean section can reduce mortality rates
B. Most of patients with Eisenmenger syndrome died in intrapartum
C. Patients should be counseled to do antenatal care in secondary or tertiary hospital
D. May be a common cause of pulmonary hypertension due to chronic overperfusion
of the pulmonary vasculature
E. Physiologic changes during pregnancy such as high systemic vascular resistance are
attributed to worsening hypoxia

16. Which of the following is high risk factor for preeclampsia (NICE CRITERIA)?
A. First pregnancy
B. Age > 40 years
C. Diabetes mellitus
D. BMI > 35 kg/m2
E. Family history of preeclampsia

17. Which of the following is true regarding COVID-19 in pregnancy?

A. No anti-viral was approved by FDA for pregnant women
B. Preterm delivery and preeclampsia are increased in pregnant women with
COVID-19
C. Vertical transmission is unlikely because placenta has low expression of ACE2
receptor
D. Recommendation mode of delivery in pregnant women with COVID-19 is caesarean
section
E. Evidence showed that pregnancy offers an altered immunity scenario which may
allow severe COVID-19 disease

18. A 32 year old primiparous woman 32 weeks gestation arrives at emergency room. She
was reffered by midwives due to high blood pressure. She is fully alert with BP 160/
110mmHg; PR 98x/m;RR 18x/min: afebris. Sclera look icteric with pale conjunctiva. Heart
and lung are normal. Fundal height 32cm, head presentation, FHR 144bpm, with no
contraction. Her laboratory findings show: CBC Hb 9;Ht 30; L 15,000; platelet 75.000.
SGOT/SGPT 80/72. LDH 720. Albumin 2.5g/dL. Urinalysis: protein +++. Peripheral blood
smear shows anisositosis pattern.
What is the cause of patient’s anemia?
A. Iron deficiency
B. Microangiopathy
C. B12 deficiency
D. Auto immune
E. Thallasemia

19. A 36 years old patient, P0, presents to your clinic for fertility workup. She had been
married for 2 years with regular intercourse. Her menstrual cycle is normal. Her general status
was normal. Vaginal examination revealed normal findings. Which of the following
examination that is not included in basic workup in the patient?
A. Hysterosalpingography
B. Ultrasonography
C. Semen analysis
D. Endometrial dating according to Noyes criteria
E. Mid luteal progesterone examination

20. A 34-year old women with primary infertility 3 years, oligomenorrhea and a body mass
index (BMI) of 26. Day 23 progesterone level result was 5 ng/ml. Transvaginal ultrasound
shows multiple small follicle size 5-8 mm in both ovary. HSG shows bilateral patent tubes. Her
partner’s semen analysis show a volume of 3 ml, pH of 7 and a sperm count of 20 million/ml.
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

21. A 18-year-old adolescent female complains of not having started her menses. Her
breast development is Tanner stage II, Pubic hair development was stage I. From vaginal
examination found a small uterus and normal vagina and vulva. Which of the following
describes the most likely diagnosis?
A. Partial androgen insensitivity syndrome
B. Complete androgen insensitivity syndrome
C. Turner syndrome
D. Late onset congenital hyperplasia
E. Polycystic ovarian syndrome
22. A 18-year-old adolescent female complains of not having started her menses. Her
breast development is Tanner stage II, Pubic hair development was stage I. From ultrasound
examination found small uterus and ovaries. Which of the following is a long term risk if this
patient left untreated?
A. Risk of gonadoblastoma
B. Risk of fractures
C. Risk of endometrial carcinoma
D. Risk of pulmonary infection
E. Risk of cervical carcinoma

23. Mrs. N, 37 years old with chief complain of infertility for 2 years with history of severe
dysmenorrhea. From hysterosalpingography, both tubes were patent. Pelvic ultrasound found
bilateral cystic mass with internal echo sized 25 and 40 mm in diameter, her antral follicle
count was 12. Her husband sperm examination was within normal limit. What is the next
appropriate management?
A. Offer her IUI
B. Perform laparoscopy cystectomy and adhesiolysis
C. Give GnRH analog for 3 months continue with IUI
D. Give Dienogest 1x2mg for 6 months
E. Offer her IVF

24. A 28 years old patient, P0, presents to your clinic for fertility workup. She had been
married for 2 years with regular intercourse. Her menstrual cycle is normal. Her general status
was normal. Vaginal examination revealed normal findings. The following month she came
back with the result of hysterosalpingography (see the picture below)
What will be your next step ?
A. Order semen analysis
B. Schedule operative laparoscopy
C. Gives clomiphene citrate and plan for natural conception
D. Gives clomiphene citrate and plan for intrauterine insemination
a. Plan for IVF
25. Mrs. 32-year old, P0, comes to your outpatient clinic due to her prolonged menstrual
duration. She reports her menstrual duration until 14 days and using 10 pads per day. She feels
fatigue easily. On physical examination, you palpate an irregularly enlarged uterus, non tender
with firm contour. Cervix appears to be hyperemic without mass appearance or other
abnormalities. What is the cause of necrotic and degenerative process in fibroids?
A. Mitotic activity
B. Limited blood supply within tumors
C. Chromosomal defects
D. Hyperperfusion
E. Cytogenetic mutations

26. A 45-year-old presents for evaluation because her primary care physician has diagnosed
her with pelvic organ prolapse while performing annual care. She denies any pelvic pressure,
bulge, or difficulty with urination. Her only medical comorbidity is obesity. For asymptomatic
grade 1 pelvic organ prolapse, what do you recommend?
A. Pelvic floor muscle exercises
B. Weight loss programme
C. Laser vaginal rejuvenation
D. Pessary
E. Reconstructive surgery

27. An 18-year-old nulligravid woman presents to the student health clinic with a 4-week
history of yellow vaginal discharge. She also reports vulvar itching and irritation. She is
sexually active and monogamous with her boyfriend. They use condoms inconsistently. On
physical examination, she is found to be nontoxic and afebrile. On genitourinary examination,
vulvar and vaginal erythema is noted along with a yellow, frothy, malodorous discharge with
a pH of 6.5. The cervix appears to have erythematous punctuations. There is no cervical,
uterine, or adnexal tenderness. The addition of 10% KOH to the vaginal discharge does not
produce an amine odor. Wet prep microscopic examination of the vaginal swabs is performed.
What would you expect to see under microscopy?
A. Branching hyphae
B. Multinucleated giant cells
C. Scant WBC
D. Flagellated, motile organisms
E. Epithelial cells covered with bacteria

28. A 45 years old woman presents to your office for consultation regarding her symptoms
of menopause. She stopped having periods 13 months ago after TAH-BSO operation and is
having severe hot flushes. The hot flushes are causing her considerable stress. What is the
management option for this patient?
A. Monophasic combined oral contraceptive pills
B. Biphasic combined oral contraceptive pills
C. Sequential estrogen-progestin therapy
D. Estrogen only pills
E. Progestin only pills

29. A 72 years old woman P6 came to outpatient clinic with chief complaint of bulging
mass protrudes from vagina since 3 months ago. The mass usually occurs during activity and
also when she defecate , and disappear when lying down. There were no difficulty in voiding
and defecation. No urinary leakage during coughing and sneezing. She is not sexually active.
If on the Pelvic Organ Prolapse Quantification examination result showing below, what is the
diagnosis of this patient?

Aa Ba C
+3 +4 +6
GH Pb TVL
5 2 8
Ap Bp D
+2 +2 +4

A. Uterine prolapse grade 2, cystocele grade 2, rectocele grade 1

B. Uterine prolapse grade 4, cystocele grade 3, rectocele grade 2
C. Uterine prolapse grade 3, cystocele grade 3, rectocele grade 2
D. Uterine prolapse grade 3, cystocele grade 2, rectocele grade 2
E. Uterine prolapse grade 4, cystocele grade 3, rectocele grade 3

30. A 25 year old lady come with abnormal pap smear result. She underwent colposcopy
examination and the result is a acetowhite lesion with punctation and atypical vessels. Biopsy
result confirms CIN I with HPV DNA test positve. 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

31. A 45 years old woman presents to your office for consultation regarding her symptoms
of menopause. She stopped having periods 13 months ago after BSO operation and is having
severe hot flushes. The hot flushes are causing her considerable stress. Which of the following
medication that you will give for hormonal therapy?
A. Estrogen only therapy
B. Biphasic combined oral contraception
C. Monophasic combined oral contraception
D. Triphasic combined oral contraception
E. Sequential estrogen-progestin therapy

32. A 25 years-old women G1 20 weeks of gestational age came to outpatient clinics with
a mass in perineum sized 1 cm flesh-colored and cauliflower like appearance. She also feels
itchy and discomfort during sexual intercourse. On speculum examination we can see a small
verrucous mass sized 0,5 cm on vaginal side wall. What is the most probable cause of this
condition?
A. Herpes simplex virus
B. HPV type 6 and 11
C. HPV type 16,18
D. Syphilis
E. Molluscum contagiosum

33. A 28 women present to your clinic with feeling of fullness in the vagina. On
examination you find a bluish cystic mass came from the right lateral forniks sized 6 cm. The
bulge is not tender on palpation. What is the cause of this condition?
A. Blockage of the glands opening
B. Infection
C. Endometriosis
D. Remnant of Mullerian duct
E. Remnant of Wollfian duct
34. Mrs. 32-year old, P0, comes to your outpatient clinic due to her prolonged menstrual
duration. She reports her menstrual duration until 14 days and using 10 pads per day. She feels
fatigue easily, she denies to experience dysmenorrhea. On physical examination, you palpate
an irregularly enlarged uterus, non-tender with firm contour. Cervix appears to be hyperemic
without mass appearance or other abnormalities. What is the most likely diagnosis?
A. AUB-P
B. AUB-A
C. AUB-L
D. AUB-M
E. AUB-C

35. A 30-year-old P0 obese woman is noted to have irregular menses and hirsutism. On
ultrasound examination, there are many small follicles in both ovaries. She was diagnosed with
PCOS and receive combined oral contraception for menstrual regulation. She noticed a
decreased hirsutism after taking COC, what is the most probable mechanism?
A. Suppression of HPO axis
B. Increased level of SHBG
C. Resumption of ovulation
D. Suppression of prolactin secretion
E. Suppression of androgen receptor in the peripheral tissue

36. A 18 years old girl come to the emergency room with an abruptly pelvic pain for 2 days.
She had already started felt pain on and off for the past 2 weeks especially when she was
moving. She has also nausea and vomiting. She has no fever. She has regular menstrual cycle.
From the physical examination an intense of low abdominal pain was marked even more on
palpation. There was a muscle defence, on the right lower abdomen quadrant. She tends to
bend her abdomen a bit on the bed. On abdominal ultrasound reveal a mass measuring 12 cm
in the largest diameter on her pelvic, characterized with multiple hyperechogenic interfaces in
a cystic mass in the right ovary, no blood flow could be detected in the cyst except only in the
one pole near the uterus. Uterus anteflexed within normal limit. Left ovary within normal limit.
There is no fluid in pelvic cavity. What would be the working diagnosis?
A. Functional cyst
B. Endometriosis
C. Ovarian fibroma
D. A torsion cyst
E. Ruptured cyst

37. A parity 3 40-year-old woman complains of cyclical heavy and painful menstrual
bleeding. On examination she is found to have an enlarged globular uterus and a transvaginal
sonography revealed diffuse adenomyosis. She has completed her family and currently relies
on condoms for contraception. She smokes 10 cigarettes per day but is otherwise fit and well.
Which treatment would you consider most appropriate? Choose the single best answer.
A. LNG-IUS
B. COCP
C. Hysterectomy
D. GnRH analogue
E. Endometrial ablation

38. A 29 years old woman with a positive pregnancy test presents with a good history of
tissue expulsion vaginally passing tissue per vagina. A transvaginal ultrasound scan shows on
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 should be offered medical management of misscariage
C. Laparoscopy should bee performed to exclude an ectopic pregnancy
D. She has had a pregnancy of unknown location and needs further investigations
E. She should be offered of hysterescopy

39. A patient present to you with pain and swelling in the vulva. On examination you find
a reddish bulge on the vaginal introitus at 4 o’clock positions sized 3 cm, cystic and pain on
palpation.
Which of the following is the most common causative organism for formation of this
condition?
A. Neisseria gonorrhoeae
B. Staphylococcus aureus
C. Trichomonas vaginalis
D. Bacterial vaginosis
E. Streptococcus epidermidis

40. A triple test is performed for Own’s screening at 16 weeks in a 40 years old woman.
the result suggests a high risk of trisomy 21.
What would the results typically show?
A. Increased AFP, increased estriol, increase β-hCG
B. Increased AFP, reduced estriol, increase β-hCG
C. Reduced AFP, reduced estriol, increase β-hCG
D. Reduced AFP, increased estriol, increase β-hCG
E. Reduced AFP, increased estriol, reduced β-Hcg

41. Mrs. N, 37 years old with chief complain of infertility for 6 years with history of severe
dysmenorrhea. From hysterosalpingography, both tubes were non-patent. Pelvic ultrasound
found bilateral cystic mass with internal echo sized 50 and 60mm in diametere. Her husband
sperm examination was within normal limit.
what is the next appropriate management?
A. Offer her IUI
B. Offer her IVF
C. Perform laparoscopy cystectomy and adhesiolysis
D. Give Dienogest, 1x2mg for 6 months
E. Give GnRH analog for 3 months continue with IUI

42. A 52-year-old woman presents to your office. She complained about her sexual
problems of low self esteem and difficulties of initiating sexual intercourse, vaginal dryness
and pain during intercourse. She has the history of 3 full term normal vaginal delivery and
she had already menopause and she has no history of hereditary disease. She underwent the
lab investigation such RBG 129mg/dL; Hb 10,6 mg/dL; Urea 21; Creatinine 0.5. Chest x-ray
and pelvic ultrasound studies showed no abnormalities. What is your diagnosis?
A. Sexual desire disorder
B. All of above
C. Vaginismus
D. Orgasmic disorder
E. Genital arousal disorder
43. A 24 y.o old patient, P2 has just delivered vaginally an infant weighing 3000g after a
spontaneous uncomplicated VBAC. Her prior obstetric history was a low uterine segment
transverse caesarian section breech. She has had no problems during preganancy and labor.
The placenta delivers spontaneously. There is immediate vaginal bleeding of greater than
500cc. Although all of the following can be the cause for postpartum hemorrhage, which is the
most frequent cause of all immediate hemorrhage as seen in this patient?
A. Uterine atony
B. Retained placental fragments
C. Coagulopathies
D. Uterine rupture
E. Vaginal and/or cervical lacerations

44. Mrs N, 37 years old with chief complain of infertility for 6 years with history of severe
dysmenorrhea from hysterosalphingography. Both tubes were non-patent. Pelvic ultrasound
found bilateral cystic mass with internal echo sized 50 and 60 mm in diameter. Her husband
sperm examination within normal limit. Which of the following is true regarding low ovarian
reserve in endometriosis?
A. Low ovarian reserve in endometriosis only happen after surgery
B. Ovulation rate in ovary with endometrioma is higher compared to ovary without
endomterioma
C. Loss of ovarian stromal appearance and fibrosis are present in ovarian cortex
with endometrioma
D. There is a higher density of follicle in ovary with endometrioma
E. Ovary with endometrioma has a higher response rate to gonadotropin

45. A 62 years old G2P2 presents to the urogynecology clinic with complaints of urinary
incontinence. She has urinary urgency and cant make it to the bathroom before leaking a large
amount of urine. She gets up two to three times per night to urinate. A urinalysis and urine
culture done 1 week ago at her PCP’s office are both negative. What is the most likely diagnosis
and appropriate treatment option for this type of urinary incontinence?
A. Urinary fistula, surgical repair
B. Urgency incontinence, oxybutynin (anticholinergic medication)
C. Stress incontinence, mid-urethral sting
D. Functional incontinence, bladder suspension
E. Overflow incontinence, oxybutynin (anticholinergic medication)

46. A maternal fetal medicine specialist is consulted and performs on indepth sonogram.
The sonogram indicates that the fetuses are both males and the placenta appears to be
diamniotic and monochorionic. Twin B is noted to have oligohydroamniosis and to be much
smaller than twin A. in this clinical picture, all of the following are concerns for twin A except
A. Hydramnion
B. Congestive heart failure
C. Policythemia
D. Anemia
E. Hypervolemia

47. A 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. After use of 20 units of
oxytocin in 1000mL of crystalloid solution to increase the tone of her uterus to stop bleeding,
however you continue to notice a massive bleeding from the vagina. What is the most
appropriate next step in the evaluation of this patients bleeding?
A. Perform a bedside ultrasound for retained products of conception
B. Consult interventional radiology for uterine artery embolization
C. Perform a bedside ultrasound to look for blood in the abdomen for uterine rupture
D. Perform a manual exploration of the uterine fundus and exploration for retained
clots or products

48. Examine the perineum and vaginal for laceration during delivery A 35 year old 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 fetus by means of
a C-section by indication transverse lie. Blood pressure measurement was 150/100 mmHg. She
lost conscioussness for 30 seconds five hours after operation. The laboratory studies gave the
following results : serum aspartate aminotrasaminase (AST), 225 Iu/L; serum alanin
amnotransaminase (ALT), 140 IU/L; serum lactate dehydrogenase (LDH), 1017 IU/L; serum
urea and creatinine were normal; hemoglobin, 10.6 mg/dL; platelet count, 50x10 3 µ/mL. A
brain computed tomography (CT) scan was performed on patient which revealed the lest frontal
lobe lacunar infarction. The patient was transfered to intensive care unit.
A. HELLP syndrome
B. Acute fatty liver in pregnancy
C. DIC
D. Thrombotic thrombositopenic purpura
E. Severe puerpural infection

49. A 45 years old woman presents to your office for consultation regarding her symtptoms
of menopause. She stopped having periods 13 months ago after TAH-BSO operation and is
having severe hot flushes. The hot flushes are considerab;e stress.
Which of the following is an absolute contraindication for hormonal therapy?
A. Diabetes melitus
B. Endometriosis
C. Coronary heary disease
D. Migraine
E. Imparment of liver function

50. Mrs. E, 32 yo referred from midwife with antepartum hemorrhage. She is G3P2 term
pregnancy. On examination her blood pressure is 180/100 mmHg. HR 100 bpm. She looks
anemia, not icteric. Obstetrical examinations reveal contraction 4-5x/10 minutes. FHR 170
bpm, head presentation 3/5. After through examination it is concluded that there is a placental
abruption with retroplacental hematoma size 6x5 cm. This patient is planned to do caesarean
section. Postoperative period is very crucial in this patient. Which of the following is not
included as parameter needed to be evaluated in early warning system.
A. Blood pressure
B. Heart rate
C. Urine production
D. All of the above
E. Central venous pressure
51. A 22 year old primiparous woman presents for her first prenatal evaluation. On physical
examination you hear a grade 3/6 pansystolic murmur. Which is the most common CHD in
pregnancy that would cause that type of murmur?
A. Ventricular septal defect (VSD)
B. Pulmonary stenosis
C. Atrial septal defect (ASD)
D. Patent ductus arteriosus (PDA)
E. Aortic stenosis

52. On prenatal ultrasound, which of the following feature characterise 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 visualised.

53. The patient does not believe that she has ovarian cyst during pregnancy. She is really
concern about the possibility of malignancy. Regarding this situation, what would you inform
her?
A. The most common mode of presentation of an adnexal mass is pain
B. The sensitivity of detection of ovarian cysts on clinical examination alone 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 ultrasound 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
A 28 yo woman, G1 36 weeks of gestational age, went to your clinic to do routine antenatal
care. During ultrasound, the doctor told her that she will be expecting baby boy with estimated
fetal weight 2500 g, however, amniotic fluid considered to be less than normal. Then you asked
the patient to drink minimal of 2L of water a day and get herself another ultrasound within 3
days to evaluate the amniotic fluid.

54. Oligohydramnios is defined as which of the following?

A. Amniotic fluid index < 5 cm
B. Single deepest pocket < 2 cm
C. Amniotic fluid index < 90th percentile
D. All of the above
E. None of the above

55. 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

56. In a normal fetus at term, what is the daily volume of fetal urine that contributes
to the amount of amniotic fluid present?
A. 200 mL
B. 250 mL
C. 500 mL
D. 750 mL
E. 1000 mL

57. According to algorithm for management of fetal-growth restriction, you evaluate

the Doppler Velocimetry then find reversed 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 lung maturation
D. Deliver the baby
E. Reevaluate middle cerebral arteries and ductus venosus

58. 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 rehidration
F.
59. A 32-year-old woman G2P1A0 presented to delivery ward at 30 weeks gestation with
worsening abdominal pain for few hours. She had also had some vaginal bleeding within the
past hour. Her uterus was tender and firm to palpation. She was found to have low-amplitude,
high-frequency uterine contractions, and the fetal heart rate tracing showed recurrent late
decelerations and reduced variability. Her blood pressure was 160/100 mmHg and she has had
a +2 proteinuria. She did her antenatal care in your hospital and ultrasound examination was
performed 3 times with no remarkable abnormalities.
The most likely diagnosis is :
A. Vasa previa
B. Preterm labor
C. Placenta previa
D. Placental abruption
E. Preterm Premature Rupture of Membrane (PPROM)

60. You are counseling a couple in your clinic who desire VBAC. Her baby is in a vertex
presentation, appropriate size for 37 weeks, and her previous low transverse procedure was for
breech presentation. You have to give inform consent about VBAC. In providing informed
consent, in which of the following ways do you explain the risk of uterine rupture?
A. Less than 1% ( RCOG 1x less 1%)
B. Between 2% and 5 %
C. Between 15-20%
D. Depend on the length of her labor
E. Depend on the location and proximity of the scar site to the placental implantation

61. Corticosteroids administered to women at risk for preterm birth have been demonstrated
to decrease rates of neonatal respiratory distress if the birth is delayed for at least what amount
of time after the initiation of therapy?
A. 12 hours
B. 24 hours
C. 36 hours
D. 48 hours
E. 72 hours

A 18-year-old adolescent female complains of not having started her menses. Her breast
development is Tanner stage IV, Pubic hair development was stage I. From vaginal
examination found a blind vaginal pouch and no uterus and cervix (CAIS )
62. Which of the following describes the most likely diagnosis?
A. Partial androgen insensitivity syndrome
B. Complete androgen insensitivity syndrome
C. Kallman syndrome
D. Turner syndrome
E. Polycystic ovarian syndrome

63. From ultrasound examination found no uterus and there was difficulty in identifying
the gonads. What is the next plan?
A. Prolactin measurement
B. Kariotyping
C. FSH and LH examination
D. FSH, LH and E2 examination
E. TSH, FT4 examination

64. Which of the following management will be appropriate for this condition?
A. Give progestin 14 days on of
B. Give estrogen-progestin sequential
C. Give combined oral contraception
D. Vaginal reconstructive surgery
E. Laparoscopy gonad removal

An 18-year-old young woman presents to you with a complaint of amenorrhea. She notes that
she has never had a menstrual period, but that she has mild cyclic abdominal bloating. She is
sexually active, but she complains of painful sexual intercourse. Her past medical and surgical
history is unremarkable. On physical examination, you note normal appearing axillary and
pubic hair. Her breast development is normal. Pelvic examination reveals normal appearing
external genitalia, and a shortened vagina ending in a blind pouch.
65. Which of the following tests would be your first step in determining the diagnosis?
A. Karyotype
B. Pelvic ultrasound
C. Serum FSH
D. Serum FSH, E2
E. Diagnostic laparoscopy

66. From further examination it was found that uterus cannot be visualized but both ovaries
were normal. What is the most likely diagnosis
A. Imperforate hymen
B. Transverse vaginal septum
C. Müllerian agenesis
D. Androgen insensitivity syndrome
E. Gonadal dysgenesis

67. Which additional organ system should you be evaluating in a patient with this disorder?
A. Pancreas and duodenum
B. Cerebral circulation
C. Olfactory system
D. Renal and urinary collecting system
E. Distal gastrointestinal tract

68. Your diagnosis according to ASRM/ESHRE definition, based on two of the following
criteria:
A. Polycystic ovaries on ultrasound, oligo-or amenorrhea, or evidence of
hyperandrogenism
B. Polycystic ovaries on ultrasound, amenorrhea, obesity
C. Polycystic ovaries on ultrasound, amenorrhea, hirsutism
D. Presence of hyperandrogenism, ovarian dysfunction and exclusion of related disorders
E. Polycystic ovaries on ultrasound, hirsutism, obesity

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

A. Acute hepatocellular destruction
B. Incomplete clearance of bile acids
C. Microvascular thrombus accumulation
D. Eosinophil infiltration of the liver
E. Hepatocellular injury

70. 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 velocymetri
D. Category three, went for doppler velocymetry ultrasound exam.
E. Category three, delivered the baby

A Women 28 years old came to outpatient clinic referred by obgyn specialist due to continuous
leakage of urine since 2 weeks ago, she underwent cesarean section due to dystocia on second
stage of labor. The baby’s weight was 4200 g. On examination the cervix was torn at 11
O’clock position until anterior fornix, but the hole was not seen clearly
71. What is the next step to confirm diagnosis in this case?
A. Intravenous pyelography
B. Ultrasound
C. Indigo carmine test ( untuk ureterovagina) masukin cairan iv , urinnya keluar warna
orange
D. Consult to urologist
E. Blue dye test ( operasi obstetrik)
72. What is the best management of this case at this time?
A. Put indwelling transurethral catheter, evaluate 3 months post Cesarean section
B. Transvaginal fistula repair with Latzcko procedure as soon as possible
C. Transabdominal fistula repair as soon as possible
D. Trans-vesical fistula repair 3 months from now
E. Antibiotics for 7 days continue with transvaginal fistula repair

73. What is the criteria of simple vesicovaginal fistula?

A. Size < 1,5 cm
B. Size < 2 cm
C. Size < 2,5 cm
D. Size < 3 cm
E. Size < 4 cm

74. A 39 years old female G2P1A0, 15 weeks pregnant presents 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 10 cm (in diameter)
in her left adnexa. No free fluid in her abdomen and pelvis. What is your consideration in this
case?
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 benign ovarian cyst in pregnancy is a mature 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%

Mrs. X, 24 y.o came to the ER with complaints of headaches since the last day of examinations
obtained expecting her first child, gestational age 32 weeks with blurred vision and denied
heartburn. On physical examination found BP 190/120 mmHg, pulse 90x/m, breathing 16x/m.
Leopold found the lower left back head, FHR 140 bpm, irregular contraction. Pelvic score of
1 was found, pelvis size wide. Laboratory investigation; hemoglobin 11,5g%, platelets
9000/mm3, LDH 510 IU/L, proteinuria +2, ALT 10 u/L, AST 15 u/L.
75. What is the best diagnosis for Mrs. X?
A. Severe preeclampsia
B. Gestational hypertension
C. Superimposed preeclampsia
D. Chronic hypertension
E. HELLP syndrome

76. What is the most clinically effective antihypertensive agent for Mrs. X?
A. Methyldopa
B. Nifedipine
C. ISDN
D. Atenolol
E. Furosemide

77. Which antihypertension drugs can cause fetal growth restriction?

A. Methyldopa
B. Hydralazine
C. Captopril
D. Atenolol
E. Nifedipine

78. A woman is being treated with magnesium sulphate. There is concern about magnesium
toxicity. What is the first sign of magnesium toxicity?
A. Loss of deep tendon reflexes
B. Reduced consciousness
C. Respiratory depression
D. Bradycardia
E. Cardiac arrest

79. What fetal complication is associated with the Nonsteroidal anti-inflammatory agent
Indomethacin as tocolytic agent?
A. Hydramnios
B. Achondroplasia
C. Premature closure of the ductus arteriosus
D. Bronchopulmonary dysplasia
E. Pulmonary valve atresia
A woman has a booking scan in 16 weeks gestation, which reveals a monochorionic diamniotic
twin pregnancy. She asks you about the risks regarding her pregnancy.
80. Regarding complications of twin pregnancy:
A. Caesarean section is the preferred route of delivery
B. With significant growth discordance, particularly when the first twin is the smaller
C. Twin reversed arterial perfusion sequence is associated with high mortality in the
recipient twin due to prematurity and intra-uterine cardiac failure
D. In a twin pregnancy with one fetal loss in the third trimester, in 90% cases the remaining
twin will be delivered in 72 h
E. In twin-to-twin transfusion syndrome, the haemoglobin levels for both twins are
often not discordant

81. The timing of separation of the embryo in monochorionic diamniotic is:

A. Up to 4 days
B. 4-7 days
C. 7-14 days
D. >14 days
E. >28 days

82. Regarding twin to twin transfusion syndrome:

A. The donor develop hydrops
B. Quinterro classification is up to Quinterro IV
C. The recipient develop polyhydramnios
D. The perinatal mortality in twins reaches to 85%
E. Complicates up to 35% of dichorionic multiple pregnancies

83. The most frequent twin pregnancy is:

A. Dizygotic twins
B. Dichorionic diamniotic
C. Monochorionic diamniotic
D. Monochorionic monoamniotic
E. Conjoined twins
84. Which of the following statements regarding chorionocity is true?
A. A dichorionic pregnancy is always dizygotic
B. Complications in twin pregnancy is more frequent in dichorionic pregnancy
C. Monochorionic membranes have four layers
D. Monochorionic twins are always monozygotic
E. Determination of chorionicity is easiest in the second trimester

A 32 yr old female, G1 at 8 weeks gestation, presents to the office for her routine obstetrical
visit. She asks you about the nutrition demand during pregnancy. Her BMI is 24 kg/m2. No
remarkable past medical history is noted.
85. According to WHO Asian criteria, her BMI is classified as:
A. Overweight iyaaaa
B. Underweight
C. Normal
D. Obese type 1
E. Obese type 2

86. She ask you what is the optimal total weight gain during her pregnancy:
A. <5 kg
B. 5-9 kg
C. 7 - 11,5 kg
D. 11,5 – 16 kg
E. 12,5 – 18 kg

87. When performing a hysterectomy, the surgeon should be aware that at its closest
position to the cervix, the ureter is normally separated from the cervix by which of the
following distances?
A. 1.2 mm
B. 12 mm
C. 2 cm
D. 0.5 mm
E. 5 cm

A 28 yo G1P1 woman is being discharged from the hospital in postoperative day 4 after having
received a primary low transverse cesarean section for breech presentation, with an estimated blood
loss of 700 mL. her pregnancy was otherwise uncomplicated and her hospital course was also
uncomplicated. Ten days after cesarean section, the patient came complaining of abdominal
pain and fever. Fundal height 2 fingers below navel.
88. What is the most likely probable diagnosis of the patient?
A. Metritis
B. Mastitis
C. Typhoid fever
D. Urinary tract infection
E. Breast enlargement

89. Lower urinary tract symptoms with pyuria but a steriole urine culture are likely due to
which pathogen?
A. Candida
B. E. coli
C. Proteus mirabilis
D. Klensiella pneumoniae
E. Clamidya tracomatiz

A 45 years old women came to hospital with major complaint chronic leucorrhea. She had
been treated by various antibiotics given by general practitioner and midwives. Recently she
got bleeding each after intercourse. General condition is unwell with anemic appearance. BP
70/palpable, pulse weak 120x/minute.
90. What is the best step for this patient?
A. Performed bimanual examination
B. Performed ultrasound examination
C. Giving oxygen and putting the IV line
D. Performed emergency curettage
E. Giving tranexamic acid

91. By first impression, what would the diagnosis would like to be?
A. Uterine sarcoma
B. Cervical polyps
C. Endometrial cancer
D. Uterine myoma
E. Cervical cancer

92. What is the etio pathogenesis of the diagnosis above?

A. Malignant transformation of myocyte
B. Hyperestrogenic intracavitary condition
C. Human papilloma virus type 6 infection
D. Herpes simplex virus infection
E. Human pappiloma virus type 16 infection

93. our patient is a 13 yo adolescent girl who presents with cyclic pelvic pain. She has
never had a menstrual cycle. She denies any history on intercourse. She is afebrile and her
vital signs are stable. On physical examination, she has qge appropriate breast and pubic hair
development and normal external genitalia. However, you are unable to locate a vaginal
introitus. Instead there is a tense bulge where the introitus would be expected. You obtain a
transabdominal ultrasound, which reveals a hematocolps and hematometra. What Is the most
likely diagnosis?
A. Transverse vaginal septum
B. Longitudinal vaginal septum
C. Imperforate hymen
D. Vaginal atresia
E. Bicornuate uterus

94. A patient retumns for a postoperative checkup 2 weeks after a total abdominal
hyserectomy for fibroids. She is distressed because she is having continous leakage of urine
from the vagina. Her leakage is essentially continous and worsens with coughing, laughing,
or movement. Given her history and physical,you perform both a methylene blue dye test,
which is negative and an indigo carnine test, which is positive. The most likely diagnosis is:
A. Rectovaginal flstula
B. Uretro vaginal fistula
C. Vesico vaginal fistula
D. Uretero vagina fistula
E. Impossible to distinguish
95. A 38 years old multi gravid 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
A. Fistula
B. Stress incontinence
C. Urge incontinence
D. Urethral diverticulum
E. UTI

96. A 31-year-old G4P0A3 woman presents to the hospital with vaginal bleeding and
abdominal pain. She appears pale and states that she feels lightheaded when sitting up or
standing. She reports that she is currently 8 weeks’ pregnant. On arrival, her temperature is
37°C, BP is 80/50, pulse rate is 115 beats per minute, and respiratory rate is 20 breath per
minute. Abdominal examination reveals a rigid abdomen with rebound tenderness to palpation.
Pelvic examination reveals a small amount of vaginal bleeding, a 6-week-size uterus, and
fullness at the right adnexa. A urine β-hCG confirms that she is pregnant. A pelvic ultrasound
reveals a right-sided ectopic pregnancy as well as large amounts of fluid, thought to be blood
in the abdomen. She now has IV access and a bolus of IV fluids is being given. Her BP is now
75/45 and her pulse rate is 120 beats per minute. Her hematocrit returns as 25,2%. How is the
next management for this patient?
A. Proceed with emergency laparoscopic salpingectomy
B. Proceed with emergency laparotomy (BLUEPRINT)
C. Administer IM methotrexate
D. Transfuse the patient with two units of packed RBCs and transfer her to the ICU
E. Start vasopressors and transfer the patient to the ICU

97. A 30-year-old G2P1 woman at 28 weeks’ GA comes to your office for a routine prenatal
visit. Her child was recently send home with a rash and fever. She states that the child had a
rash on both cheeks and the pediatrician said it was a viral infection called fifth disease. Her
baby is moving well and denies any vaginal bleeding, abnormal vaginal discharge, or
contractions but she wonders if she needs any more testing to see if she has been affected. What
is the most likely causative organism of the child’s infection?
A. Varicella
B. CMV
C. Parvovirus
D. Toxoplasmosis
E. Listeriosis

98. While working in the emergency department, a 25 year old female patient arrives with
severe acute abdominal pain. Before the start of her abdominal pain, the patient recalls having
some fever and chils. She reports that her menses is regular and that she is sexually active. She
recently started having intercourse with a new partner. Pregnancy test is negative and urinalysis
is normal. On physical examination, the patient has muscular guarding and rebound tenderness.
On pelvic examination, patient has cervical motion tenderness. Vital signs are significant for
tachycardia and fever (T 40 derajat celcius) which of the following is the most likely diagnosis
?
A. Ovarian torsion
B. Endometriosis
C. PID
D. Kidney stone
E. Ruptured ovarian cyst

99. A 36 year old woman has had a LETZ procedure for cervical glandular intraepithelial
neoplasia (CGIN). The histopathology result showed negative margins. Six months later the
repeat cervical smear is negative but the HPV test of cure is positive. What will be your next
management?
A. Cervical biopsy
B. Colposcopy
C. Re excision
D. Smear and HPV test of cure in six months
E. Smear and HPV test of cure in 12 months

100. A 40-year-ald G1P0 woman presents for prenatal care at B weeks by LMP. She has
regular menses every 28 to 30 days and you confirn her gestational age with an ullrasound
today in the office. She has no past medical or surgical history. She and her husband of 6
months planned the pregnanry and they have both been reading about pregnancy and prenatal
care. You discuss the prenatal tests for the flrst visit as well as lhe plan throughout the rest
of the pregnancy. The patient opts to undergo first-trimester screening, which returns 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 sc;een, and her estriol, beta hCG, and c-fetoprotein (AFP) were all low. She has
an ultrasound, which shows a fetus consistent wiih 16 weeks' size, increased amniotic fluid,
clubfoot, omphalocele , choroid plexus cyst and possible heart defecl. On the basis of the
palient’'s history and data provided, whai is the most likeiy diagnosia?
A. Trisomy 21
B. Trisomy 18
C. Trisomy 13
D. Tumer syndrome
E. Klinefelter syndrome