UNAS MEI 2020 ( SULE)

Yang dianggap soal baru

1. A 16-year-old girl presents with primary amenorrhea. Her breast development is Tanner
stage 2. Pubic and axillary hair show stage I development. The girl appears otherwise well.
Ultrasound shows the presence of a normal uterus and tubes. Her height is 140 cm. What
karyotype that shows that syndrome?
a. 45 X
b. 69,XXX
c. 47, XXY
d. 47, XXX
e. 47,XX+13

2. A 82 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. On
Pelvic Organ Prolapse Quantification examination result showing below. If the patient
choose to use pessary instead of surgery, how to choose the right size of the pessary
Aa Ba C
+3 +4 +5
GH Pb TVL
5 2 8
Ap Bp D
0 0 +3
a. The intermediate size that do not fall off, but dosent cause pain and obstruction of
urination and defecation
b. By measuring the genital hiatus of the patient
c. By measuring the total vaginal length
d. The biggest size that do not fall off, but doesn’t cause pain and obstruction of urination
and defecation
e. The smallest size that do not fall off and doesn’t cause pain obstruction of urination and
defecation

3. Women 25 years old came to outpatient clinic referred by obgyn specialist due to
continuous leakage of urine 2 weeks ago and had given birth dystocia on second stage of
labor. The baby’s weight 4000 g. On examination the …… form at 11 o’clock position until
anterior fornix, but …… What is the best management of this case ? Select one
a. Trans-vesical fistula repair 3 months from now
b. Put indwelling transurethral catheter, evaluate 3 months post Cesarean section
c. Antibiotics for 7 days continue with transvaginal fistula repair
d. Transvaginal fistula repair with Latzcko procedure as soon as possible
e. Transabdominal fistula repair as soon as possible
4. 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. What is the best management for this patient currently? Select
one
a. Induction of labor
b. Lung maturation and C-section
c. Perform emergency C-section
d. Second stage acceleration
e. Conservative management until term pregnancy

5. A 18-year-old adolesecent female complaints of not having started her menarche. 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. From ultrasound
examination found no uterus and there was difficulty in identifying the gonads. What is the
next plan?
a. FSH, LH, and E2 examination
b. Kariotyping
c. FSH and LH examination
d. TSH, fT4 examination
e. Prolactin measurement

6. A 30 years old patient came with complaint of infertility. Her husband is 33 years old has
semen analysis, which was reported as normal. On further history, the patient respons that
her menstruation have been quiet irregular over the last year and that she has not had
period in the last 6 months. She also reports insomnia, vaginal dryness, and decreased
libido. What is the most likely diagnosis for this patient based on her history?
a. Primary ovarian insufficiency
b. Polycistic ovarian syndrome
c. Spontaneous pregnancy
d. Endometriosis
e. Kallmann syndrome

7. A 26 years old woman complaints of recurrent of bacterial vaginosis (BV) despite successful
initial treatment. She does not douche or smoke and has been in a monogamous
relationship for 6 years. Recurrence of BV after initial treatment is common (up to 30
percent), which can be frustrating of the patient. Which of the following consistently
decreases recurrence rates and should be recommended to this patient? Select one:
a. Use of acidiying vaginal gels
b. Treatment of male partners
c. Treatment of long continuous antibiotic
d. Probiotics and reintroduction of lactobacilli
 e. No intervention consistently decreases recurrence (WILLIAM)

8. A 35 year old P3 with a positive high risk HPV on DNA testing and a Pap smear showing high
grade squamous intraepithelial lesion of the cervix (CIN II) has and inadequate colposcopy.
If the histopathology result shows squamous cell cancer that has invaded only 1 mm of the
basement membrane. There are no confluent tongue of tumor and there are no evidence of
lymphatic or vascular invasion. The margins of the biopsy… disease. How would you classify
or stage this patient’s disease?
a. Microinvasive cancer
b. Carcinoma in situ
c. Atypical squamous cells of undetermined significance
d. Carcinoma of low malignant potential
e. Invasive cancer stage IA  simple HT

9. A 28 year old G2P1 is seen for her first prenatal visit at 18 weeks gestation by menstrual
history. Her first child was born at 32 weeks spontaneously. She is worried this pregnancy
will spontaneous preterm birth. What is the next appropriate management for this patient?
a. Treat asymptomatic bacterial vaginosis
b. Schedule for cervical cerclage
c. Intervention modifiable risk factors for preterm
d. Give tocolytics for inhibiting preterm labor
e. Progesterone prophylaxis

10. 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 an
empty uterus with endometrial thickness of 11 mm. Regarding her diagnosis, you consider
that
a. She should be offered medical management of miscarriage
b. She has had a pregnancy of unknown location and needs further investigations
c. She has had a complete miscarriage and needs no further treatment
d. A laparoscopy should be performed to exclude an ectopic pregnancy
e. She should be offered a hysteroscopy

11. A 35 year old P3 with a positive high risk HPV on DNA testing, and a Pap smear showing high
grade squamous intraepithelial lesion of cervix (CIN III) has an inadequate colposcopy. What
is the best next step for this patient?
a. Cone biopsy
b. Proceed to simple hysterectomy
c. Repeat pap smear after 3 months
d. Punch biopsy
e. Cryotherapy
12. A 25 years old women Para 16 weeks after delivery. She want to use contraception. She is
asking about the oral contraceptive pills. The mechanism of action of oral contraceptive pills
is
a. Increasing cervical mucous hostility
b. Inducing endometritis
c. Inhibiting ovulation by suppression of serum FSH
d. Inhibiting prolactin
e. Inducing endometrial atrophy

13. A 39 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 a 20
units of oxytocin in 1000 ml of crystalloid solution to increase the tone of her uterus stop
the bleeding. However, you continue to notice a massive bleeding from the vagina. What is
the most appropriate next step in the evaluation of this patient’s bleeding?
a. Perform a bedside ultrasound for retained products of conception
b. Examine the perineum and vaginal for laceration during delivery
c. Consult interventional radiology for uterine artery embolization
d. Perform a bedside ultrasound to look for blood in the abdomen significant for uterine
rupture
e. Perform a manual exploration of the uterine fundus and exploration of the uterine
fundus and exploration for retained clots or products

14. A 46 years old woman experiences irregular vaginal bleeding of 3 months duration. You
perform an endometrial biopsy, which obtain copious tissue with a velvety lobulated
texture. The pathologist report shows proliferation of glandular and stromal elements with
dilated endometrial glands consistent with simple hyperplasia. Cytologic atypia is absent.
She agreed for a medical treatment, which of the following is the most appropriate?
a. Combined oral contraception
b. Nomegestrol 1x2.5 mg for 14 days on-off
c. LNG-IUS
d. Norethsiterone acetate 1x5 mg for 14 days on-off
e. MPA 1x25 mg for 14 days on-off

15. A women P2 came to outpatient clinic due to inability to control defecation since 3 months
ago after delivering her 3rd child with vacuum extraction. On examination you identify
perineal wound break with external anal sphincter totally torn, but internal sphincter and
anal mucous were still intact. What is the most likely diagnosis of this patient?
a. Chronic perineal rupture grade II
b. Chronic perineal rupture grade IIIA
c. Chronic perineal rupture grade IIIC
d. Chronic total perineal rupture
e. Chronic perineal rupture grade IIIB
16. A 28 years old G1 at 26 weeks present for her scheduled obstetrics 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. Impaired glucose test
b. Normal OGTT
c. Gestational diabetes
d. Diabetes mellitus type 2
e. Diabetes mellitus type 1

17. Which of the following is true regarding injury related to trocar insertion in laparoscopy?
a. Hasson technique has the lowest injury
b. Open umbilical entry has the lowest rate of injury
c. All techniques have similar rate of injury
d. Optical trocar insertion has the lowest rate of injury
e. Closed entry using veres needle has the highest rate of injury

18. A 22 years old G1 at 10 weeks presents for her scheduled obstetric (OB) appointment.
Laboratory examination showed hemoglobin 11.2 g/dL, hematocrit 34%, MCV 88 FL, MCH
32 pg. What is total iron need during pregnancy?
a. 750 mg
b. 1500 mg
c. 500 mg
d. 1000 mg
e. 2000 mg

19. A 25 years old G1P0 presents to the emergency room with vaginal bleeding. Her last normal
menstrual period was 6 weeks earlier. She reports that she is sexually active with male
partners and does not use any hormonal or barrier methods for contraception. On arrival,
her temperature is 37oC, blood pressure is 115/80, pulse is 75 beats per minute, respiratory
rate is 16 breaths per minute, and she has 100% oxygen saturation on room air. A pelvic
examination reveals a small amount of dark blood in the vagina. The external cervical os
appears 1 to 2 cm dilated. Her uterus is mildly enlarged, anteverted, and nontender. A urine
pregnancy test is positive. A pelvic ultrasound is obtained and shows an intrauterine
gestational sac with a yolk sac. No fetal pole or cardiac motion is seen. Bilateral adnexa are
normal. What is her diagnosis?
A. Missed abortion
B. Inevitable abortion
C. Incomplete abortion
D. Ectopic pregnancy
E. Threatened abortion

20. 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-BSA 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. Triphasic combined oral contraception
b. Estrogen only therapy
c. Monophasic combined oral contraception
d. Sequential estrogen progestin therapy
e. Biphasic combined oral contraception

21. A 21 years old G1 patient presents to your office with vaginal bleeding at approximately 8
weeks gestation by her last menstrual period. Her examination is benign with a 9 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 an intrauterine gestational sac containing a fetus
measuring approximately 7 weeks gestation. Doppler sonography is unable to demonstrate
any fetal heartbeat. Which of the following is the common chromosomal abnormality found
in tissue from first trimester spontaneous abortions?
a. Sex chromosome polysomy
b. Autosomal trisomy ( WILL I AM)
c. Sex chromosome monosomy
d. Tetraploidy
e. Triploidy

22. Patient 65 years old, P4 came to outpatient clinic with chief complaint of frequent urination.
Since 6 months ago she fells the urge to void every hour and also she has to wake up 3-4
times in the night to void. She never leaks urine. She doesn’t feel any pain during urination
and no blood in the urine. She already came to general practitioner and got antibiotics for 7
days but the symptoms remained. What is the most likely diagnosis of this patient?
a. Painfull bladder syndrome
b. Overactive bladder
c. Pyelonephritis
d. Urge incontinence
e. Stress urinary incontinence

23. A primigravida at 36 weeks gestation is measuring large for dates. Ultrasound shows AC >
97th percentile. GTT performed shows poorly controlled gestational diabetes. What. Is the
immediate management plan?
a. Wait and watch
b. Start insulin therapy
c. Give steroids
d. Start induction
e. Start siding scale and deliver

24. A 25 years old women P1, 6 weeks after delivery. She want to use contraception. She is
asking about the oral contraceptive pills. If the women missed 3 pills on day 18 of the pack
 (for 28 day pill packs) and had unprotected intercourse 3 days ago, what is the management
plan for this women?
A. Take the most recent missed pill as soon as possible and discard other missed pills.
Continue taking the remaining pills as usual
B. Take the most recent missed pill as soon as possible and discard other missed pills.
Continue taking the remaining pills and start the new pack without the hormone free
interval. No need to take emergency contraception pills use additional contraceptive
protection for 7 days
C. Take the most recent missed pill as soon as possible and discard other missed pills.
Continue taking the remaining pills and start the new pack without the hormone free
interval
D. Take the most recent missed pill as soon as possible and discard other missed pills.
Continue taking the remaining pills as usual, take emergency contraception pills and no
additional contraceptive protection is needed
E. Take the most recent missed pill as soon as possible and discard other missed pills.
Continue taking the remaining pills and start the new pack without the hormone free
interval. Take emergency contraception pills. No additional contraceptive precaution is
needed.

25. A 35 year old P2 is 36 weeks pregnant. Clinically there is a suspicion of left calf DVT. CTG is
normal. What is the next step in the immediate management
a. Plan delivery
b. Prophylactic dose of tinzaparin
c. Thrombophilia screen
d. Therapeutic dose of tinzaparin
e. FBC, coagulation screen, LFTs

26. A 22 years old G1 at 10 weeks presents her scheduled obstetric (OB) appointment.
Laboratory examination showed hemoglobin 11.2 g/dL, hematocrit 34%, MCV 86 fl, MCH 32
pg. Which of the following shows iron deficiency anemia?
a. Low ferritin, serum iron, and transferrin
b. Normal hemoglobin level, low ferritin, and serum iron
c. Microcytic hyperchromic, low serum iron and transferrin saturation
d. Low ferritin, normal serum iron
e. Microcytic hypochromic, low serum iron and transferrin saturation

27. 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 previa
b. Placenta percreta
c. Placenta accrete
d. Placenta increta
e. Placental infarct
28. A 34 years old female, para 1, presented to our clinic with secondary amenorrhea and
severe progressive hirsutism. On clinical examination she was noted to have severe
hirsutism and more pattern scalp balding. Her BMI was 30 kg/m 2. Laboratory results showed
an elevated total testosterone (T) level of 140 ng/dl (reference value in our laboratory is 0-
80 ng/dl) and androstenedione of 272 ng/dl (reference value of 30-250 ng/d). CT of the
abdomen and pelvis showed normal adnexal glands. Pelvic ultrasound of the pelvis
demonstrated mildly prominent ovaries, containing numerous small follicles around the
periphery. Your diagnosis according to ESHRE definition based on two of the following
criteria:
a. Polycistic ovaries on ultrasound, amenorrhea, hirsutism
b. Polycystic ovaries on ultrasound, amenorrhea, obesity
c. Presence of hyperandrogenism, ovarian dysfunction and exclusion of related disorders
d. Polycystic ovaries on ultrasound, hirsutism, obesity
e. Polycystic ovaries on ultrasound, oligo or amenorrhea, or evidence of
hyperandrogenism

29. A 28 years 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. Measure cervical length
b. Vaginal swab to exclude bacterial vaginosis
c. IGFBP-1 examination
d. Fibronectin examination
e. Urinary test to exclude urinary tract infection

30. With abdominal entry using the Veress needle, what threshold or initial abdominal pressure
is used to reassure the surgeon regarding correct intraperitoneal needle placement?
a. < 8 mmHg
b. < 20 mmHg
c. < 25 mmHg
d. < 15 mmHg
e. < 3 mmHg

31. A 22 years old primiparous woman presents to her first prenatal evaluation. On physical
examination you hear a grade 3/6 pansystolic murmur. What is the most common CHD in
pregnancy that would cause that type of murmur?
a. VSD
b. Pulmonary stenosis
c. PDA
d. Aortic stenosis
e. ASD
32. A 18 years 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. Which of the following
describes the most likely diagnosis?
a. Artial androgen insensitivity syndrome
b. Turner syndrome
c. Polycystic ovarian syndrome
d. Complete androgen insensitivity syndrome
e. Kallman syndrome

33. A 16 years old girl presents with primary amenorrhea. Her breast development is Tanner
stage 2. Pubic and axillary hair show stage I development. The girl appears otherwise well.
Ultrasound shows the presence of a normal uterus and tubes. Her height is 140 cm.
Structural abnormalities that can happened in this syndrome:
a. All of the answers
b. Deletion of short arms
c. Ring chromosomes
d. Isochromosome
e. Deletion of long arms

34. A 35 years old P3 with a positive high risk HPV on DNA testing and a Pap smear showing
high grade squamous intraepithelial lesion of the cervix (CIN III) has an inadequate
colposcopy. If the histopathology result shows squamous cell cancer that has invaded only 1
mm beyond the basement membrane. There are no con fluent tongues of tumor and there
is no evidence of lymphatic or vascular invasion. The margins of the biopsy specimen are
free of disease. Of the following, appropriate therapy for patient is:
a. External beam radiation
b. Simple hysterectomy with pelvic lymphadenectomy
c. Radical hysterectomy
d. Simple hysterectomy
e. Implantation of radioactive cesium

35. 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-BSA operation and is
having severe hot flushes. The hot flushes are causing her considerable stress. Which of the
following is an absolute contraindication for hormonal therapy>
a. Endometriosis
b. Migraine
c. Coronary heart disease
d. Diabetes mellitus
e. Impairment of liver function

36. A 18 years old adolescent female complaints 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. Which of the following
management will be appropriate for this condition
a. Laparoscopy gonad removal
b. Vaginal reconstructive surgery
c. Give progestin 14 days on off
d. Give estrogen – progestin sequential
e. Give combined oral contraception

37. A 32 year old woman has a pelvic ultrasound that bilateral 5 cm kissing ovarian cysts in the
pouch of Douglas. Both of which contain diffuse, low level echoes giving a ground glass
appearance. She reports severe dysmenorrhea and dyspareunia. Which of the following
condition that can be found associated with this finding?
a. Fifty percent risk of malignant transformation
b. Normal level of Ca125
c. Increased level or He4
d. Increased level of serum AMH
e. Adenomyosis in the posterior uterus

38. A 21 years ole G1 patient presents to your office with vaginal bleeding at approximately 8
weeks of gestation by her last menstrual period. Her examination is benign with a 9 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 an intrauterine gestational sac containing a
fetus measuring approximately 7 weeks gestation, doppler sonography is unable to
demonstrate any fetal heartbeat. You decide to perform a suction DC. When giving
informed consent, you discuss the risk most commonly encountered in this operation.
Which of the following is the most common risk associated with suction DC
a. Infection
b. Need for future surgery
c. Uterine perforation
d. Damage to the bladder
e. Uterovaginal bleeding

39. A 22 year old G1 at 10 weeks present for her scheduled obstetric (OB) appointment.
Laboratory examination showed hemoglobin 11.2 g/dl, hematocrit 34%, MCV 86 fl, MCH 32
pg. How much iron is recommended by WHO for pregnant women in Indonesia?
(prevalence of anemia in Indonesia based on RISKESDAS 48%)
a. 60 mg
b. 30 mg
c. 27 mg
d. 100 mg
e. 200 mg

40. Mrs. 32 years 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. By which mechanism does fibroid creates a hyperestrogenic
environment requisites for their growth?
a. Fibroid converts more estradiol to estrone
b. Fibroid cells contain less density of estrogen receptors compared with normal
myometrium
c. Increased adipose conversion of androgens to estrogen
d. Fibroid contains higher level of cytochrome P450 aromatase, which allows for
conversion of androgens to estrogen
e. All of the above

41. A 17 years old G1P0 woman presents at 25 weeks gestation complaining of headache for
the past 36 hours. She has had regular prenatal visits going back to her first prenatal visit at
8 weeks gestation. A 20 week ultrasound redated her pregnancy by 2 weeks as it was 15
days earlier than her LMP dating. She has a BP 155/104 mmHg. 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 lab test
results reveal a normal platelet count and liver enzymes but a lightly elevated creatinine
and proteinuria of 550 mg in 24 hours. Her headache has resolved after a dose of
acetaminophen. What is the next best step in her management?
a. Immediate delivery
b. Begin induction of labor
c. Bed rest
d. Hospitalization for further evaluation and treatment
e. Giver her a prescription for labetalol and have her follow up in clinic in 2 weeks

42. A parity 3 40 years old woman complaints 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?
a. Endometrial ablation
b. Hysterectomy
c. GnRH analogue
d. LNG-IUS
e. COCP

43. A 27 years old nulligravida presents with 6 months of amenorrhea and is diagnosed with
hyperprolactinemia. Laboratory tests measuring which of the following should also be
obtained?
a. Insulin like growth factor I
b. Thyroid stimulating hormone
 c. Anti Mullerian Hormone
d. 24 hour urinary free cortisol
e. Total testosterone

44. A 28 years 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 195 mg/dl. Her gestational weight gain during pregnancy is 12 kg. BMI
before pregnancy was 26 kg/m2. What is the most likely fetal consequences cause by
patient’s condition?
a. Fetal hypoxia
b. Fetal large for gestational age
c. Intrauterine growth restriction
d. Spina bifida
e. Congenital valvular heart disease

45. 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. What
is the criteria of simple vesicovaginal fistula?
a. Size < 3 cm
b. Size < 2.5 cm
c. Size < 4 cm
d. Size < 2 cm
e. Size < 1,5 cm

46. A 22 yeas old primiparous woman presents for her first prenatal evaluation. On physical
examination you hear a grade 3/6 pansystolic murmur. Numerous physiologic changes
develop over the course of pregnancy, however the greatest impact on potentially
compromised cardiovascular system is
a. The red cell mass rises by 40%
b. Increased 30% total plasma volume in 28 weeks
c. Decreased SVR in the first trimester and increase after 32 weeks
d. Cardiac output increases to 30-50% above prepregnancy levels by the end of the third
trimester
e. Increase in cardiac output occurs by 24 weeks

47. A 21 years old G1 patient presents to your office with vaginal bleeding at approximately 8
weeks gestation by her last menstrual period. Her examination is benign with a 9 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 an intrauterine gestational sac containing a fetus
measuring approximately 7 weeks gestation. Doppler sonography is unable to demonstrate
any fetal heartbeat. What is the most likely diagnosis?
a. Incomplete abortion
 b. Ectopic pregnancy
c. Complete abortion
d. Embryonic demise ( BLUEPRINT ) di soal yang lain jwbnnya Missed Abortion
e. Threatened abortion

48. 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. What is the most common cause of heart failure during pregnancy and the
puerperium?
a. Pulmonary artery hypertension
b. Obesity
c. Chronic hypertension with severe preeclampsia
d. Viral myocarditis
e. Valvular heart disease

49. A 28 years old G1 at 26 weeks present for her scheduled obstetrics 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 appropriate next step in the management of
this patient?
a. Schedule nonstress test (NST)
b. Schedule routine antenatal care in 4 weeks
c. Advise insulin in order to lowering blood glucose
d. Schedule fetal growth ultrasound
e. Admit to hospital for fetal monitoring

50. All except which of the following are clinical characteristics that increase the risk for acute
fatty liver of pregnancy?
a. Female fetus
b. Twin gestation
c. Nulliparity
d. Third trimester
e. Male fetus

51. Which of the following is true regarding low ovarian reserve in endometriosis?
a. There is a higher density of follicle in ovary with endometrioma
b. Loss of ovarian stromal appearance and fibrosis are present in ovarian cortex with
endometrioma
c. Ovulation rate in ovary with endometrioma is higher compared to ovary without
endometrioma
d. Low ovarian reserve in endometriosis only happen after surgery
 e. Ovary with endometrioma has a higher response rate to gonadotropin

52. A 28 years old woman is hoping to become pregnant soon. She is worried about her history
of acute pelvic inflammatory disease (PID) when in college 8 years ago. What is her
approximate risk of infertility due to this one about acute PID?
a. 75 percent
b. 15 percent ada soal lain yang 12%
c. 25 percent
d. 55 percent
e. 35 percent

53. A triple test is performed for Down’s screening at 16 weeks in a 40 years old woman. The
result suggest a high risk of trisomy 21. What would the results typically show?
a. Increased AFP, reduced estriol, increased B-HCG
b. Reduced AFP, increased estriol, increased B-HCG
c. Increased AFP, increased estriol, increased B-HCG
d. Reduced AFP, reduced estriol, increased B-HCG
e. Reduced AFP, increased estriol, reduced B-HCG

54. A 28 years old G1 at 26 weeks present for her scheduled obstetrics 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 appropriate next step in the managemen of
this patient?
A. Advise insulin in order to lowering blood glucose
B. Schedule fetal growth ultrasound
C. Admit to hospital for fetal monitoring
D. Schedule nonstress test
E. Schedule routine antenatal care in 4 weeks

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

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

56. A 22 years old primiparous woman presents to her first prenatal evaluation. On physical
examination you hear a grade 3/6 pansystolic murmur. Which of the following mothers
cardiac abnormalities is the greatest risk for fetal structural congenital heart disease?
a. Pulmonary stenosis
b. VSD (11-16%) WILL I AM
c. Tetralogy of Fallot
d. ASD
e. Aortic coarctation (14%)