DEPARTEMEN OBSTETRI DAN GINEKOLOGI FAKULTAS KEDOKTERAN

UNIVERSITAS SRIWIJAYA/ RS Dr. MOHAMMAD HOESIN PALEMBANG

Jalan Jenderal Sudirman Palembang 30126
Telp. : (0711) 354088, 311466 Ext. (709, 710, 711, 712)
(0711) 355550 Fax. : (0711) 373135
E-Mail : [email protected]

Soal Usulan Ujian Nasional Agustus 2009

1. Antiphospholipid syndrome (APS) is associated with all of these obstetric complications

except:
A. Fetal death
B. Abruption
C. Thrombosis
D. Severe preclampsia
E. Thrombocytopenia

2. Placental pathology associated with APS includes all of these except

A. Spiral artery vasculopathy
B. Placental infarction
C. Previllous fibrin deposition
D. Decidual vascular artherosis
E. Choriamniotic membrane necrosis

3. The most common reason for new-borns readmission to hospital is

A. Sepsis
B. Hyperbilirubinemia
C. Dehydration
D. Feeding difficulties
E. Breathing problems

4. Which of the following immunoglobulins crosses the placenta most rapidly?

A. IgG1
B. IgG2
C. IgM
D. IgA
E. IgE

5. A pregnant woman with mild asthma (1-2 episodes per week) is usually best treated with
A. Inhaled cromolyn sulfate
B. Inhaled beta agonist
C. Systemic corticosteroids
D. Inhaled corticosteroids
E. None of the preceding
6. Of the total 1000 g net gain of protein in normal pregnancy, how much is used by the
fetus and placenta?
A. 100 g
B. 300 g
C. 500 g
D. 750 g
E. 800 g

7. Increased risk of preterm birth is indicated by

A. Positive fetal fibronectin in vagina
B. Sonographic evidence of cervical shortening
C. Sonographic evidence of cervical dilatation
D. All of the preceding
E. None of the preceding

8. Which of the following antepartum fetal testing methods is least applicable in the outpatient
setting?
A. Nonstress test
B. Contraction stress test
C. Biophysical profile
D. Fetal movement counts
E. Fetal breathing

9. Engagement is best defined as which of the following

A. When the presenting part goes through the pelvic inlet
B. When the presenting part is level with the ischial spines
C. When the greatest biparietal diameter of the fetal head passes the pelvic inlet
D. When the greatest biparietal diameter of the head is level with the ischial spines
E. When the greatest diameter of the fetal presenting part passes through the narrowest
and lowest part of the maternal pelvis

10. Toxoplasmosis is transmitted to the infant by which of the following

A. Ascending passage of the virus
B. Delivery through the infected tissue
C. Transplacental passage of the protozoa
D. Sexual intercourse by the mother during pregnancy
E. Hematogenesis spread of the bacteria

11. Which of the following statements regarding caffeine consumption during pregnancy is
most strongly supported by research?
A. Teratogenic in lab animals
B. Increases the risk of pregnancy-induced hypertension
C. Increases the risk of preterm birth
D. Increases the risk of spontaneous abortion at extremely high level
 E. Increases the risk of fetal distress

12. How many weeks after an abortion does ovulation usually occur?
A. 2 to 3
B. 4 to 5
C. 5 to 6
D. 6 to 7
E. 7 to 8

13. Optimally, when should prophylactic cerclage procedures be performed?

A. Preconceptionally
B. Between 6 to 12 weeks gestation
C. Between 12 to 16 weeks gestation
D. At first sign of cervical dilatation
E. At term

14. Complications of vacuum aspiration first trimester abortion include all of the following
EXCEPT
A. Uterine synechiae
B. Cervical laceration
C. Retained products of conception
D. Preterm delivery in future pregnancies
E. Endometritis

15. Exposure to which of the following hormones is most likely to cause virilization of the
female fetus?
A. Danazol
B. Medroxyprogesterone acetate
C. Norethindrone
D. Norgestimate
E. Estradiol

16. What is the usual pH of amnionic fluid?

A. 4.5 to 5.5
B. 5.5 to 6.5
C. 7.0 to 7.5
D. 7.5 to 8.0
E. 8.0 to 8.5

17. During the third stage of labor, which of the following is not a sign of placental separation?
A. A gush of blood
B. Uterus rises in the abdomen
C. Umbilical cord protrudes farther out of the vagina
D. Uterus become flaccid
E. Globullar uterus
18. Which of the following complications is not associated with intrapartum amnioinfusion ?
A. Maternal seizures
B. Cord prolapse
C. Chorioamnionitis
D. Uterine hypertonus
E. Fetal distress

19. When is cephalocentesis performed

A. Transabdominally during latent labor
B. Transabdominally during second stage of labor (3-4 cm)
C. Transvaginally during latent labor
D. Transvaginally during active labor (3-4 cm)
E. Transvaginally before labor

20. Which medication, when given orally to mothers, decreases fetal urine output ?
A. Aspirin
B. Cimetidine
C. Bromocriptine
D. Indomethacin
E. Paracetamol

21. Spontaneous fertilization of two ova within the same menstrual cycle but not at the same
coitus is termed which of the following?
A. Superfetation
B. Superfertilization
C. Superfecundation
D. Superinsemination
E. Superovulation

22. What is the average blood loss during vaginal delivery of a twin gestation?
A. 500 mL
B. 750 mL
C. 1000 mL
D. 1500 mL
E. 1750 mL

23. One of the twins that your patient is carrying dies at 32 weeks gestation. This was the donor
twin in a pregnancy complicated by twin-to-twin transfusion syndrome. The surviving twin
display reassuring signs such as a biophysical profile score of 8 and reactive nonstress test.
Appropiate management of this pregnancy includes which of the following?
A. Expectant management
B. Prompt heparin administration and expectant management
C. Prompt delivery to avoid maternal coagulopathy
D. Prompt delivery to avoid neurological damage in the surviving twin
 E. Prompt heparin administration and delivery

24. Interlocking twins is associated with which of the following presentation?

A. Cephalic-cephalic
B. Cephalic-breech
C. Breech-breech
D. Breech-cephalic
E. Breech-transverse

25. According to the American College of Obstertricians and Gynecologists, what maximum
time interval should be allowed between delivery of first twin and the second?
A. 15 min
B. 30 min
C. 45 min
D. 60 min
E. No specific recommendation

26. What is the MOST common cause of chronic hypertension in pregnancy?

A. Essential
B. Obesity
C. Diabetes
D. Renal disease
E. Heart disease

27. Which of the following is characteristic glomerular lesion of preeclampsia?

A. Endotheliosis
B. Capillary leaks
C. Burst cells
D. Clang cell
E. Macrophage invasive

28. At what plasma magnesium level most often prevents seizures?

A. 3 to 4 mEq/L
B. 4 to 7 mEq/L
C. 7 to 10 mEq/L
D. 10 to 15 mEq/L
E. Over 15 mEq/L

29. How is magnesium toxicity treated?

A. Calcium gluconate 1 g intravenously
B. Calcium gluconate orally
C. Calcium gluconate 1 g intravenously and discontinue magnesium
D. Dialysis
E. Furosemide intravenously
30. The coagulopathy following placental abruption involves lowering of which of the following
maternal serum hematological components?
A. Plasmin
B. D-dimers
C. Fibrinogen
D. Fibrinogen-fibrin degradation products
E. Thromboplastin

31. Which of the following is the most common benign neoplasm of the cervix and
endocervix?
a. Polyp
b. Leiomyoma
c. Nabothian cyst
d. Endometriosis
e. Gartner’s duct cyst

32. Childhood neoplastic ovarian masses most commonly originate from which of the
following?
a. Gonadal epithelium
b. Gonadal stroma
c. Germ cells
d. Sex cords
e. Metastatic disease

33. You are called to evaluate a 1-day-old female neonate with a palpable anterior abdominal
mass. The baby was born by vaginal breech delivery. Which of the following is the most
likely diagnosis?
a. Distended bladder
b. Follicular cyst
c. Corpus luteum cyst
d. Ovarian fibroma
e. Theca lutein cysts

34. The colposcope permits one to do which of the following?

a. View the cervix at 1 to 4 power magnification
b. See the entire transition zone in all patients
c. Choose the most suspicious areas on the cervical portio to biopsy
d. Treat invasive cancer with a biopsy
e. Make the diagnosis of cancer
35. Which of the following factors is most indicative of invasive cancer on colposcopic
examination?
a. White epithelium
b. Leukoplakia
c. Abnormal blood vessels
d. Punctuation
e. Mosaic pattern

36. Which of the following is a factor predisposing to the development of malignant mixed
müllerian tumors?
a. Prenatal exposure to diethylstilbestrol (DES)
b. Exposure to mumps virus
c. Family history of ovarian cancer
d. Previous pelvic irradiation
e. Perineal use of talc

37. A 75-year-old woman has a bilateral, solid adnexal masses. Mammography is normal.
Gastrointestinal studies show a stomach lesion suspicious for malignancy. Which of the
following is the most likely diagnosis?
a. Pick’s adenoma
b. Krukenberg’s tumor
c. Brenner tumor
d. Struma ovarii
e. Carcinoid

38. What is the most common pathologic type of breast malignancy?

a. Lobular in situ
b. Ductal in situ
c. Paget’s
d. Infiltrating lobular carcinoma
e. Infiltrating ductal carcinoma

39. Regarding immunization during pregnancy, which of the following vaccines would be the
safest to receive during pregnancy?
a. Mumps
b. Polio
c. Rabies
d. Rubella
e. Rubeola
 40. A patient wishes to breast-feed. With which of the following active infections in the
immediate postpartum period would it still be acceptable for a woman to breast-feed?
a. Cytomegalovirus (CMV)
b. Genital herpes
c. Hepatitis B
d. Human immunodeficiency virus (HIV)
e. Varicella

41. Which of the following is NOT a synonym for a type of CIN?

a. Cervical dysplasia
b. CIS
c. High-grade squamous intraepithelial lesion (HGSIL)
d. LGSIL
e. Metaplasia

42. A high-spiking fever wich developes within the first 24 hours of the puerperium is most
likely caused by wich of the following:
A. Brest engorgement
B. Atelectasis
C. Chlamydial pelvic infection
D. Group A streptococcal pelvic infection

43. Which of the following is associated with the greatest risk of puerperal metritis after vaginal
delivery?
A. Prolonged rupture of the membranes
B. Prolonged labor
C. Intrapartum chorioamnionitis
D. Multiple cervical examination

44. Which of the following has been associated with toxic shock-like syndrome?
A. Staphylococcus epidermidis
B. Escherichia coli
C. Group A ß-hemolitic streptococcus
D. Klebsiella pneumoniae

45. Clinical findings of toxic shock syndrome in its early stages may include wich of the
following:
A. Erithematous rash
B. Conjunctivitis
C. Vertigo
D. Herpetiform skin eruptions
46. Elevated blood pressure associated with oral contraceptive use is likely related to the
increased production of wich of the following:
A. Angiotensinogen
B. Antidiuretic hormone
C. ndothelin
D. Aldosterone

47. Wich of the following is true of emergency contraception (EC)?

A. Advanced provision of EC decreases the use of routine contraception
B. Combination estrogen-progestin EC is more effective than progestin-only EC
C. EC should be taken within 72 hours of unprotected intercouse of optimal efficacy
D. EC can harm established pregnancies

48. Which puerperal tubal sterilization procedure is least likely to fail but most difficult to
perform?
A. Pomeroy
B. Irving
C. Parkland
D. Fimbriectomy

49. With regard to preeclampsia, proteinuria is defined as how much urinary excretion?
A. >100 mg/24 hr
B. >200 mg/24 hr
C. >300 mg/24 hr
D. >500 mg/24 hr

50. At what serum level of magnesium do patellar reflexes dissapear?

A. 6 mEq/L
B. 8 mEq/L
C. 10 mEq/L
D. 12 mEq/L

51. Operative hysteroscopy is the best approach for which uterine anomaly?
A. Bicornuate uterus
B. Septate uterus
C. Uterine didelphys
D. Unicornuate uterus
52. What is the average fetal exposure from a single abdominal radiograph?
A. <0,1 mrad
B. 10 mrad
C. 100 mrad
D. 1 rad

53. How many hours following vaginal delivery should anticoagulation therapy for a
mechanical prosthetic valve be reinstated?
A. 6
B. 18
C. 24
D. 36

54. Which of the following maternal conditions would most likely prompt the recommendation
for pregnancy termination?
A. Atrial septal defect
B. Aortic regurgitation
C. Bacterial endocarditis
D. Eisenmenger syndrome

55. Angiotensin-converting enzyme inhibitors are contraindicated in pregnancy due to what fetal
effects?
A. Cardiac defects
B. Fetal renal defects
C. Thrombocytopenia
D. Patent ductus arteriosus

56. Which agent may be used to treat refractory postpartum hemorrhage in women with asthma?
A. Prostaglandin E2
B. Prostaglandin F2α
C. 15-methyl PGF2α
D. None of the above

57. Which of the following antituberculosis agents is associated with severe congenital deafness
if given during pregnancy?
A. Streptomycin
B. Isoniazid
C. Rifampin
D. Ethambutol
58. Management of gravidas who are homozygous for the factor V Leiden mutations should
include which of the following?
A. Adjusted-dose heparin prophylaxis
B. Full anticoagulation with heparin
C. Low dose aspirin
D. Full anticoagulation with warfarin

59. What is true of asymptomatic bacteriuria during pregnancy?

A. It has its highest incidence among affluent Caucasians of low parity
B. If not treated, it will develop into an acute symptomatic infection during pregnancy in
25% of women
C. It has not been associated with adverse pregnancy outcomes
D. It is diagnosed by catheterized specimen containing >100 organisms/ml in asymptomatic
women

60. Which of the following vitamin deficiencies is associated with hyperemesis?

A. A
B. B
C. C
D. K

61. What is the etiology of acute fatty liver of pregnancy?

A. Autosomal recessive
B. Mitochondrial inheritance
C. X-linked recessive
D. Polygenic

62. What is the treatment for pregnancy-induced megaloblastic anemia?

A. Nutritious diet only
B. 1000 ug vitamin B12 every month
C. 200 mg/day iron (supplemental)
D. Folic acid 1 mg/day, nutritious diet and iron

63. Which of the following is increased in pregnancies complicated by sickle-cell trait?

A. Perinatal mortality
B. Abortion (spontaneous)
C. Low birthweight
D. Urinary tract infection

64. Use of which of the following medications early in pregnancy is associated with congenital-
esophageal atresia and aplasia cutis?
 A. Propylthiouracil
B. Methimazole
C. Verapamil
D. Captopril

65. Chorea gravidarum is more commonly associated with which of the following conditions?
A. Hyperthyroidism
B. Hydrocephalus
C. Systemic lupus erythematosus
D. Benign intracranial hypertension

66. A 32 year-old at 14 weeks gestation has abnormal cervical cytology and unsatisfactory
colposcopy during initial evaluation. What is the most appropriate plan?
A. Cervical cone biopsy
B. Endocervical curettage
C. Loop excision
D. Repeat colposcopy in 6 to 12 weeks

67. Which of the following ultrasound measurements is the most reliable index of fetal size?
A. biparietal diameter
B. abdominal circumference
C. femur length
D. intrathoracic ratio

68. Spontaneous fertilization of two ova within the same menstrual cycle but not at the same
coitus is termed which of the following:
A. Superfetation
B. Superfertilization
C. Superfecundation
D. Superinsemination

69. Vaginal atresia is seen in which of the following disorders?

A. Androgen insensitivity syndrome
B. Asherman syndrome
C. Congenital adrenal hyperplasia
D. 5α-reductase deficiency

70. Of the following, what is the number of deaths per 1000 birtha occurring during the first 28
days of life?
A. Stillbirth rate
B. Fetal death rate
 C. Perinatal mortality rate
D. Neonatal mortality rate

71. Which of the following ara characteristics of the hymen?

A. Richly innervated
B. Contains sebaceous glands
C. Contains muscular elements
D. Covered by stratified squamous epithelial

72. Which of the following time periods corresponds to the perinatal period?
a. 20 weeks gestation to 4 weeks postpartum
b. 22 weeks gestation to 2 weeks postpartum
c. 34 weeks gestation to 3 months postpartum
d. 38 weeks gestation to 1 year postpartum

73. The uterine artery is a main branch of which of the following arteries?
a. aorta
b. internal iliac artery
c. external iliac artery
d. common iliac artery

74. Which of the following is the stage at which cells destined to be either trophoblast or
fetus first differentiatie?
a. zygote
b. morula
c. embryo
d. blastocyst

75. What is the approximately crown-rump length of the fetus by the end of the 12th week of
pregnancy?
a. 1 to 2 cm
b. 3 to 5 cm
c. 6 to 7 cm
d. 8 to 9 cm

76. What mechanism refers to peripheral separation of the placenta so that blood collects
between the membranes and uterine wall and then escapes causing the maternal surface
of the placenta to present upon delivery?
a. Schultze
b. Duncan
 c. Cunnnigham
d. Pritchard

77. Some neural-tube defects are associated with a mutation in the gene for what enzyme?
a. acid phosphate
b. folate decarboxylase
c. methylene tetrahydrofolate reductase
d. 5-alpha reductase

78. At what gestational age should laboratory testing for gestational diabetes be performed?
a. 10 to 16 weeks
b. 20 to 24 weeks
c. 24 to 28 weeks
d 23 to 36 weeks

79. Your patient describes evens relating to her first pregnancy, which spontaneously aborted
at 18 weeks. She tells of arriving in labor and delivery with complaints of pelvic pressure
but without contractions. Examination showed bulging membranes and a dilated cervix.
Her membranes ruptured shortly thereafter with spontaneous expulsion of the abortus.
You explain to her that in some cases one of the underlying causes for this type of
abortion may include which of the following?
a. prior cervical conization
b. prior syphilitic infection
c. maternal toxoplasmosis infection during pregnancy
d. colposcopic examination during pregnancy

80. Safe, effective second trimester abortifacients include all of the following, EXCEPT
a. oxytocin
b. indomethacin
c. prostaglandin E1
d. prostaglandin E2

81. In which surgical approach to ectopic pregnancy is the tube opened to remove the
gestational products, then left unsutured?
a. salpingectomy
b. salpingotomy
c. salpingorraphy
d. salpingostomy

82. Choriocarcinom is spread metastically by which of the following methods?

a. lymphatic
 b. hematogenous
c. contiguous invasion
d. disseminated via peritoneal fluid

83. Your patient presents with complaints of persistent, heavy, dark brown vaginal bleeding 8
weeks after delivery of a term neonate. Initial testing in her avaluations, in addition to a
serum hCG level, should include which of then following?
a. uterine curettage
b. chest radiography
c. CT imaging of the head
d. MR imaging of the abdomen

84. What is the most common chromosomal abnormality in early spontaneous abortions?
a. 45 x
b. 47 xxy
c. 47 xxx
d. trisomy 16

85. What is the American College of Obstetricians and Gynecologists (ACOG) definition of a
reactive nonstress test (NST)?
a. 1 acceleration in 20 min
b. 2 acceleration in 20 min
c. 8 acceleration in 20 min
d. 15 acceleration in 20 min

86. Which of the following is used to describe an elongation and downward displacement of the
cerebellum?
a. lemon sign
b. pickle sign
c. melon sign
d. banana sign

87. The “double-bubble” sign is an ultrasonographic finding of which of the following

animalies?
a. cystic hygroma
b. duodenal atresia
c. aqueductal stenosis
d. two-vessel umbilical cord

88. The active phase of labor is divided into three phases. What is the earliest of these phases
called?
 a. acceleration phase
b. phase of maximum slope
c. latent phase
d. deceleration phase

89. Which of the following is true regarding the routine use of episiotomy?
a. decrease the risk of anal sphincter laceration
b. increase the risk of anal sphincter laceration
c. does not affect the risk of urethral lacerations
d. increase the risk of urethral lacerations

90. The physiological changes in the fetal heart rate baseline seen with increasing gestational age
are attributed to which of the following fetal changes?
a. increasing body mass
b. maturing parasympathetic system
c. increasing density of arterial chemoreceptor
d. decreasing density of myocite calcium channels

91. Which of the following is generally true concerning cardiovascular manifestations of local
anesthetic toxicity?
a. they develop before CNS toxicity
b. they develop simultaneously with CNS toxicity
c. they develop later than CNS toxicity
d. there are no cardiovascular manifestations from local anesthetic toxicity

92. Which of the following nerve blocks would provide complete analgesia for labor pain and
vaginal delivery?
a.T8-S2
b. T10-S5
c. T12-S2
d. T8-L4

93. Which of the following scenarios most strongly predisposes to later development of pelvic
floor dysfunction in the parturient?
a. spontaneous vaginal delivery, birth weight 3850 g
b. first-degree laceration at the time of delivery, birth weight 3850 g
c. forceps-assisted delivery, birth weight 4000 g
d. cesarean delivery for dystocia, birth weight 4300 g

94. Which class of drugs is strongly associated with oligohydramnion?

a. angiotensin-converting enzyme inhibitiors
 b. α-adrenergic blockers
c. calcium-channel blocking agents
d. hydralazine

95. At what gestational age does the uterine response to oxytocin increase?
a. 6 to 10 weeks
b. 10 to 18 weeks
c. 20 to 30 weeks
d. 32 to 36 weeks

96. When forceps are applied to the fetal head with the scalp visible at the introitus and without
manual separation of the labia, what type of delivery occurs?
a. outlet forceps
b. low forceps
c. mid forceps
d. either outlet or low forceps

97. Compared with patients undergoing elective repeat cesarean delivery, women undergoing
trial of labor following cesarean delivery have a higher risk of all of the following
EXCEPT?
a. endometritis
b. uterine rupture
c. thromboembolisme
d. fetal hypoxic ischemic encephalopathy

98. Which type of placenta contains small accessory lobes in the fetal membranes distant from
the main placenta?
a. fenestrated placenta
b. membranaceous placenta
c. placenta bilobata
d. placenta succenturiata

99. Exogenous surfactant therapy to prevent hyaline membrane disease is enhanced by

antepartum maternal treatment with which of the following?
a. aspirin
b. glucocorticoids
c. magnesium sulfate
d. thyrotropin

100.Which of the following is a confirmed benefit to ambulation early in the purperium?

a. hastens episiotomy repair
b. lessens severity of postpartum blues
c. decreases constipation
d. lessens duration of lochia