UNAS JULI 2019

A 33-year-old woman, GIPOAO, came to hospital with major complaint, watery leakage. She
was on her 33 weeks of gestational age. Data from medical record showed that she came
previously a week ago, complaining vaginal discharge. Vaginal swab has been done.

1. In case above, what kind of examination should you performed for establishing diagnosis.
a. Vaginal examination
b. Speculum examination
c. Blood test
d. Ultrasound
e. Simple urine test

2. You found on Leopold I, hard, round with ballottement(+). Contraction was infrequent
and weak. A What was your next plan?
a. Went for labour induction
b. Immediate C-section
c. Tocolytic and corticosteroid provision
d. Performed ultrasound
e. Performed external version

3. Ultrasound examination showed that trans-cerebellar diameter was proper to gestational

age, abdominal circumference was lower than 2.5 centile and amniotic fluid deepest pocket
was 1.2 cm. What is the most likely diagnosis?
a. Growth restriction with oligohydramnios
b. Normal Growth with olygohydramnios
c. Growth restriction with normal amniotic fluid
d. Normal growth with normal amniotic fluid
e. Need another examination for establishing diagnosis.

4. Cardiotocography, showed low variability with checkmark pattern and no acceleration.

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 28-year-old G3P1A1 presents with a history of fatigue, mild palpitation and dyspnue upon
exertion. She was unable to tolerate her prenatal vitamins during pregnancy, because of
nausea. Examination reveals pallor and spooning of her nails. Vital signs are normal. There is
no lymphadenopathy or hepatosplenomegaly.
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5. If her Hb level is 8.2 g/dl., MCV 70 L, MCH 25 picograms/red cell, MCHC 22 g/dL,
RDW 16%, peripheral blood smear result was microcytic and hypochromic red cells. The
most likely diagnosis is : (RDW normal : 11.5 – 14.5%)
a. Iron deficiency anemia
b. Megaloblastic anemia
c. Haemolytic anemia
d. Aplastic anamia
e. Acute blood loss anemia

6. To provide accurate diagnostic, your next diagnostic tools is:

a. Platelet count
b. Hb electrophoresis
c. Reticulocyte count
d. Coombs test
e. Serum ferritin

7. If the symptoms were worsening to cardiac compromise, ie, symptomatic at rest with
dyspnea, chest pain, or presyncope, your advice is :
a. High fiber diet
b. Red cell tranfusion
c. Adjunct ascorbic acid
d. Oral iron supplementation
e. Parenteral iron replacement

8. A primi gravida aged 26 is admitted with threatened preterm labour at 30 weeks and
seeks counselling with regards to antenatal corticosteroids. What are the three
recognised fetal benefits associated with antenatal corticosteroid administration in the
case of premature delivery?
a. Reduced respiratory distress syndrome, reduced incidence of hypoglycemia,
reduced neonatal death rates
b. Reduced respiratory distress syndrome, reduced VII nerve damage, reduced
incidence of hypoglycemia
c. Reduced respiratory distress syndrome, reduce incidence of pneumothorax
formation,reduced retinal disease of prematurity
d. Reduced respiratory distress syndrome, reduced intra-ventricular haemorrhage
reduced neonatal death rate
e. Reduced respiratory distress syndrome, reduced intraventricular haemorrhage
reduced necrotising enterocolitis rates
UNAS JULI 2019

9. A 36-year-old para 3 woman attends day assessment unit a er a growth scan for large for
gestational age at 28 weeks' gestation. She had three previous normal vaginal deliveries
and was low risk at booking. She declined 1st trimester screening, but had normal dating
and anomaly scans. Growth scan showed polyhydramnios, small for gestation fetus with
a double bubble sign, and she was referred to the fetal medicine unit by the
sonographers. Which one of the aneuploidies is the foetus more likely to have?
a. Down syndrome
b. Edwards syndrome
c. Klinefelter syndrome
d. Patau syndrome
e Turner syndrome

10. Which of the following imaging finding increased suspicion of placenta accreta?
a. A small intraplacental lakes .
b. A distance less than 5 mm between uterine serosa and retroplacental vessels
c. Heterogenous signal intensity within the placenta on MRI examination
d. Presence of no intraplacental bands on T2-weighted imaging
e. Uterine bulging in ultrasound

11. Which method that can be used for PPH patient that we apply vertical sutures for the
uterine corpus and several transverse cervicoisthmic sutures ?
a. Pereira sutures
b. O'Leary sutures
c. Bakry Sutures
d. Hayman Sutures
e. Cho Sutures

A 30 years old patient came with complaint of infertility. Her husband is a 33-year-old who
has had a semen analysis, which was reported as normal. On further history, the patient
reports that her periods have been quiet irregular over the last year and that she has not
had period in the last 3 months. She also reports insomnia, vaginal dryness, and decreased
libido

12. What is the most likely diagnosis for this patient based on her history
a. Polycystic ovarian syndrome
b. Primary ovarian insufficiency
c. Endometriosis
d. Kallmann syndrome
e. Spontaneous pregnancy

13. Which of the following condition that corresponds to the above possible diagnosis?
a. Day 3 FSH level 40 IU
b. Serum AMH level 2,6 ng/ml
c. Positive Clomiphene citrate challenge test
d. Midluteal progesterone level of 15 ng/ml
e. Follicle antral basal count of 12
UNAS JULI 2019

14. If the diagnosis was confirmed, what is her best option to achieve pregnancy?
a. Clomiphene citrate-IUI
b. Gonadotropin-IUI
c. Minimal stimulation
d. IVF with Oocyte donation
e. High dose gonadotropin IVF

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.

15. What is the most appropriate step of management?

a. Examine TSH and prolactin
b. Measure FSH, LH and estradiol
c. Measure serum testosterone level
d. Give Aromatase inhibitor
e. Start ovulation induction using gonadotropin

16. The patient later on given clomiphene citrate 1x50 mg for 5 days, but during follow up
there were no dominant follicle. Which of the following is appropriate?
a. We should increase the dose to 100 mg/day for 5 days
b. The patient corresponds to CC resistance and should undergo laparoscopy ovarian
drilling
c. The patient corresponds to CC failure and should switch to FSH
d. Give aromatase inhibitor
e. Combine metformin with CC

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 60 mm in diameter. Her husband
sperm examination was within normal limit

17. 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
UNAS JULI 2019

18. Her AMH level was 0.9 ng/ml. What is the reason for performing surgery in subfertile
patient with bilateral endometrioma and diminished ovarian reserve?
a. Removal of endometrioma
b. Ablation of all endometriosis lesion
c. To prevent infection in endometrioma
d. To improve access for follicle aspiration
e . Removal of deep infiltrating endometriosis lesions

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

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 1. From vaginal
examination found a blind vaginal pouch and no uterus and cervix

20. 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

21. 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

22. 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
UNAS JULI 2019

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.

23. 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

24. 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

25. 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

A 34 year 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
male pattern scalp balding. Her BMI was 30 kg/m2. 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 g/dL (reference value of 30-250 ng/dL), CT of the abdomen and
pelvis showed normal adrenal glands. Pelvic ultrasound of the pelvis demonstrated mildly
prominent ovaries, containing numerous small follicles around the periphery.

26. What is your most probable diagnosis?

a. Multicystic ovary
b. Congenital adrenal hyperplasia
c. Polycystic ovary syndrome
d. Hyperprolactinemia
e. Microadenoma pituitary

27. 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
UNAS JULI 2019

d. Presence of hyperandrogenism, ovarian dysfunction and exclusion of related

disorders
e. Polycystic ovaries on ultrasound, hirsutism, obesity

A 27-year-old woman presents to your office with a positive home pregnancy test and a 3-
day history of vaginal bleeding. She is concerned that she may be having a miscarriage. On
examination, the uterine fundus is at the level of the umbilicus. By her last period, she
should be around 8 weeks gestation. On pelvic examination, there is a moderate amount of
blood and vesicle-like tissue in the vaginal vault, and the cervix is closed. The lab then calls
you to say that her serum B-hCG result is greater than 1,000,000 mU/mL.

28. Which of the following is the best next step in this patient's evaluation?
a. Complete pelvic ultrasound
b. Determination of Rh status
c. Surgical intervention (suction curettage)
d. Methotrexate administration
e. Schedule a follow-up visit in 2 to 4 weeks to recheck a B-hCG level

29. The patient undergoes an uncomplicated suction D&C. The pathology report is available
the next day and is consistent with a complete molar gestation. What is the best next step
in the care of this patient's condition.
a. Repeat pelvic imaging
b. Radiation therapy
c. Chemotherapy
d. Surveillance of serum B-hCG
e. No further follow-up is required

30. During further visit, you meet with her in your office about 3 months after the index
visit. Which of the following interventions is most important to emphasize during her follow-
up period?
a. No further pregnancies are recommended
b. Await pregnancy attempt for 2 years
c. Reliable contraception during surveillance
d. Prophylactic antibiotic use during surveillance
e. Prophylactic chemotherapy to decrease the risk of persistent and recurrent
disease

A 46 years old woman experiences irregular vaginal bleeding of 3 months duration. You
perform an endometrial biopsy, which obtains 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.

31. Which of the following is the best way to advise the patient?
a. She should be treated to estrogen and progestin hormone therapy.
b. The tissue will progress to cancer in approximately 10% of cases.
UNAS JULI 2019

c. The tissue may be weakly premalignant and progresses to cancer in approximately

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

32. She agreed for a medical treatment, which of the following is the most appropriate?
a. Norethsiterone acetate 1x5 mg for 14 days on-off.
b. MPA 1x2,5 mg for 14 days on-off
c. Nomegestrel 1x2,5 mg for 14 days on-off
d. LNG IUS
e. Combined oral contraception

33. A 7-year-old girl presents to her pediatrician with her parents who are concerned about
her early sexual development. She is developing breasts, axillary hair, and pubic hair, and
they are noticing body odor. A thorough clinical workup reveals the child has an irregular,
echogenic, thickly septated ovarian mass on her left ovary. What type of tumor is
responsible for this child's clinical presentation?
a. Dysgerminoma
b. Embryonal carcinoma
c. Sertoli-Leydig cell tumor
d. Endodermal sinus tumor
e. Granulosa-theca cell tumor
A 36 years old patient, Po, 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.

34. Which of the following examination that is not included in basic workup in the patient
above?
a. Hysterosalpingography
b. Ultrasonography
c. Semen analysis
d.Mid luteal progesterone examination
e. Serum AMH
UNAS JULI 2019

35. The following month she came back with the result of hysterosalpingography
(see the picture below)

What will be your next plan?

a. Repeat HSG next month
b. Schedule diagnostic laparoscopy
c. Gives clomiphene citrate and plan for natural conception
d. Gives clomiphene citrate and plan for intrauterine insemination
e. Plan for IVF

A 52-year-old woman presents to your office. She complained about her sexual problems of
lowself 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 - 129 mg/dl; Hb 10.6 mg/dl, Urea 21: Creatinine 0.5, Chest x-ray and
pelvic ultrasound studies showed no abnormalities

36. What is your diagnosis

a. Sexual desire disorder
b. Genital arousal disorder
c. Vaginismus
d. Orgasmic dysorder
e. All of above

37. The most possible cause of sexual disorders of this patient is

a. Menopause
b. Multiparity
c. Alcohol uses
d. Sexual abuse
e. Pain

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.

38. By which mechanism does fibroid creates a hyperestrogenic environment requisites for
their growth?
UNAS JULI 2019

a. Fibroid contains higher level of cytochrome P450 aromatase, which allows for
conversion of androgens to estrogen.
b. Fibroid converts more estradiol to estrone X
c. Fibroid cells contain less density of estrogen receptors compared with normal
myometrium
d. Increased adipose conversion of androgens to estrogen
c. All of the above

39. What is the cause of necrotic and degenerative process in fibroids?

a. Mitotic activity
b. Limited blood supply within tumors
c. Chromosomal defects
d. Hyper perfusion
e. Cytogenetic mutations

40. 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. Conservative management with pelvic floor muscle exercises and weight loss
b. Colpocleisis obliterative procedure
c. Gellhom pessary
d. Round ligament suspension
e. Hysterectomy

41. A 62-year-old G2 P2 presents to the urogynecology clinic with complaints of urinary

incontinence. She has urinary urgency and can't 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. Stress incontinence, mid-urethral sling
b. Urgency incontinence, oxybutynin (anticholinergic medication)
c. Overflow incontinence, oxybutynin (anticholinergic medication)
d. Urinary fistula, surgical repair
e. Functional incontinence, bladder suspension

42. Childhood neoplastic ovarian masses most commonly originate from:

a. Gonadal epithelium
b. Gonadal stroma
c. Sex cords
d. Germ cells
e. Metastatic disease

43. Your patient is a 13-year-old adolescent girl who presents with cyclic pelvic pain. She
has never had a menstrual cycle. She denies any history of intercourse. She is afebrile and
her vital signs are stable. On physical examination, she has age-appropriate breast and
pubic hair development and normal external genitalia. However, you are unable to locate
UNAS JULI 2019

a vaginal introitus. Instead, there is a tense bulge where the introitus would be expected.
You obtain a transabdominal ultrasound, which reveals a hematocolpos and hematometra.
What is the most likely diagnosis?
a. Transverse vaginal septum
b. Longitudinal vaginal septum
c. Imperforate hymen
d. Vaginal atresia
e. Bicomuate uterus

44. 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

45. A 89-year-old female patient with multiple, serious medical comorbidities presents to
discuss options for treatment of her high-grade prolapse. The prolapse is externalized and
becoming ulcerated from friction against her undergarments. She cannot tolerate a pessary.
Her main priority is to "fix or get rid of this thing." but her primary care provider has
cautioned against a lengthy or open abdominal procedure. She is not interested in
future intercourse. What can you offer this patient?
a. Nothing can be done
b. Open abdominal sacral colpopexy
c. Robot-assisted laparoscopic sacral colpopexy
d. Hysterectomy with anterior and posterior colporthaphy, vault suspension
e. Colpocleisis

46. A patient returns 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 metthylene
blue dye test, which is negative and an indigo carine test, which is positive. The most
likely diagnosis is:
a. Rectovaginal fistula
b. Uretro vaginal fistula
c. Vesico vaginal fistula
d. Uretero vagina fistula
e. Impossible to distinguish
UNAS JULI 2019

47. A 38 years old multi gravid woman complains of the painless loss of urine, begining
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

48. 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 СIN 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

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.

49. What should you tell her regarding the psychological symptoms of the climacteric?
a. They are not related to her changing levels of estrogen and progesterone.
b. They commonly include insomnia, irritability, frustration, and malaise.
c. They are related to a drop in gonadotropin levels.
d. They are not affected by environmental factors.
e. They are primarily a reaction to the cessation of menstrual flow

50. Which of the following is an absolute contraindication for hormonal therapy?

a. Diabetes mellitus
b. Coronary heart disease
c. Endometriosis
d. Impairment of liver function
e. Migraine

51. 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
UNAS JULI 2019

Mrs. 24 years old comes to emergency room with complaints of shortness of breath since 3
days ago. She is 38 weeks of gestation and this is her first pregnancy. On physical
examination BP 130/90 HR 110 beats per minute, RR 28 times per minute. Chest
examination reveals soft rales on both lungs. cardiomegaly and systolic murmur
on the apex.

52. What further cardiac evaluation that is appropriate for this case to assess ventricle
function?
a. Electrocardiogram
b.Echocardiography
c. Chest x ray
d. Troponin T
e. CKMB

53. Which of the following is included in classical criteria for peripartum cardiomyopathy?
a. Electrocardiogram showing atrial fibrillation
b. Development of cardiac failure within 5 months post partum
c. Ejection fraction less than 50 percent
d. Presence of mitral regurgitation
e. Dilated atrial dimension on echocardiography

54. This patient later on diagnosed having peripartum cardiomyopathy and decided to
reduce her preload. What kind of medication that can achieve that goal?
a. Hydralazine
b. Digoxin
c. Enalapril
d. Furosemide
e. Amlodipine

55. Which of the following is not included in diagnostic criteria of peripartum

cardiomyopathy
a. Development of cardiac failure in the last month of pregnancy
b. Absent of an identifiable cause of cardiac failure
c. Left ventricular systolic dysfunction
d. Decreased ejection fraction
e. Development of cardiac failure within 8 months of pregnancy
UNAS JULI 2019

A 34-year-old lady, G3P2A0 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
reduced variability. Her blood. pressure was 160/100 mmHg, pulse rate 106 bpm.
Conjungtiva was pale. 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.

56. The most likely diagnosis is :

a. Vasa previa
b. Preterm labor
c. Placenta previa
d. Placental abruption
e. Preterm Premature Rupture of Membrane (PPROM)

In this case, your ultrasound findings are posteriorly implanted placenta, retroplacental
hematoma, increased placental thickness and echogenicity and massive subchorionic
collection of blood.

57. The most likely complication that might be occur is:

a. Mild preeclampsia
b. Severe preeclampsia
c. Eclampsia
d. DIC
e. HELLP Syndrome

58. From obstetrical examination you found her cervix was unfavorable. Your next plan is to
deliver the baby by:
a. Vaginal delivery
b. Elective C-section
c. Emergency C-section
d. Operative vaginal delivery
e. Observation until the cervix was favorable

59. 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%
b. Between 2% and 5%
c. Between 15-20%
UNAS JULI 2019

d. Depend on the length of her labor

e. Depend on the location and proximity of the scar site to the placental
implantation

60. What is the most concerning complication related to multiple repeated cesarean
deliveries?
a. Bladder injury
b. Placenta accreta
c. Organs adhesion
d. Prolonged wound recovery
e. Placenta previa

A 17-years-old G2P1 woman with no prenatal care at 29 weeks' gestation presents with
painful contractions and pressure. Her cervix is 1 cm, 40% effaced, and breech at station 2.
There is no evidence of ruptured membranes. Her contractions are every 4 minutes. FHR are
150 bpm with accelerations. Matemal vital signs are temperature 36.8°C, pulse 96x/m, BP
110/72 mmHg.

61. What should you do?

a. C-section
b. Performed fetal fibronectin
c. Begin tocolytic agents and corticosteroids
d. Observe the cervical changes and labor progress
e. Perform amniocentesis to rule out chorioamnionitis

62. What fetal complication is associated with the nonsteroidal anti-inflamatory agent
Indomethacin as tocolytics agent?
a. Hydramnios
b. Achondroplasia
c. Pulmonary valve atresia
d. Bronchopulmonary dysplasia
e. Premature closure of the ductus arteriosus

63. The nonstress test (NST) has which of the following characteristics?
a. Low positive predictive value
b. Low specificity (with reactive NST)
c. Low false-positive rate (with nonreactive NST)
d. FHR reactivity depends on normal cardiac development
e. Acceleration without fetal movement should not be accepted

64. 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
UNAS JULI 2019

e. 72 hours

65. A 24-year-old patient (Parity 2) has just delivered vaginally an infant weighing 4300 g
after a spontaneous uncomplicated labor. Her prior obstetric history was a low uterine
segment transverse cesarean section for breech. She has had no problems during the
pregnancy and labor. The placenta delivers spontaneously. There is immediate vaginal
bleeding of greater than 500 cc. Although all of the following can be the cause for
postpartum hemorrhage,
which is the most frequent cause of immediate hemorrhage as seen in this patient?
a. Uterine atony
b. Coagulopathies
c. Uterine rupture
d. Retained placental fragments
e. Vaginal and/or cervical lacerations

Mrs. X, 24 yo 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 90 x/m,
breathing 16 x/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 11.5 g%, platelets 49.000 mm3, LDH 754 iu/L, Proteinuria +2, ALT 60 u/L,
AST 75 u/L

66. What is the best diagnosis for Mrs. X

a. Preeclampsia
b. HELLP syndrome
c. Chronic hypertension
d. Gestational hypertension
e. Superimposed preeclampsia

67. What is the most clinically effective antihypertensive agent for Mrs. X
a. ISDN
b. Atenolol
c. Nifedipine
d. Furosemide
e. Methyldopa

68. Which antihypertension drugs can cause fetal growth restriction?

a. Nifedipine
b. Atenolol
c. Hydralazine
d. Captopril
e. Methyldopa
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69. A woman is being treated with magnesium sulphate. There is concern about magnesium
toxicity. What is the first sign of magnesium toxicity?
a. Bradycardia
b. Reduced consciousness
c. Respiratory depression
d. Decreased urine output
e. Loss of deep tendon reflexes

70. With two home pregnancy tests and ultrasound revealed 6-7 WGA pregnancy. As her
pregnancy continues, you would expect her cardiac output to increase by which of the
following mechanisms:
a. An increased heart rate alone
b. A decrease in systemic vascular resistance
c. first an increase in stroke volume, then an increase in heart rate
d. Cardiac output would not change significantly until the third trimester
e. An increase in systemic vascular resistance facilitated by elevated progesterone
levels

71. Which of the following is true regarding the physiologic changes she might expect during
her pregnancy?
a. An overall decrease in the number of WBC and platelets
b. Gastric emptying and large bowel motility are increased in pregnancy
c. An increase in the tidal volume along with an increase in total lung capacity (TLC)
d. BUN and creatinine will decrease as a result of an increase in glomerular filtration
rate (GFR)
e. Nausea and vomiting that should be treated aggressively with antiemetics and
intravenous hydration

72. A woman with a previous stillbirth and postpartum DVT is found to have lupus
anticoagulant and medium-titre Immunoglobulin M (IgM) anticardiolipin antibodies
(aCL) on two occasions. In a subsequent pregnancy:
a. Warfarin should be discontinued
b. She has an increased risk of miscarriage
c. She requires antibiotic prophylaxis to cover delivery
d. Low dose aspirin should be discontinued at 34 weeks
e. She does not require postpartum heparin if she has vaginal delivery

A 28-year-old GIP1 woman is being discharged from the hospital on 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 no complication and
her hospital course was also no complication.
Ten days after Cesarean section, the patient came complaining of abdominal pain and fever.
Fundal height 2 fingers below navel

73. What is the most likely probable diagnosis of the patient?

a. Metritis
b. Mastitis
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c. Typhoid fever
d. Urinary tract infection
e. Breast engorgement

74. A patient calls your clinic complaining of continued heavy vaginal bleeding. She had an
"uncomplicated" vaginal birth 2 weeks ago of her second child. What is the most likely
diagnosis from the following differentials?
a. Uterine atony
b. Uterine rupture
c. Coagulopathies
d. Vaginal lacerations
e. Retained placental fragments

A 29-year-old G2P1 woman came to outpatient clinic with obesity, a history of GDM in the
prior pregnancy, and a strong family history for type 2 diabetes mellitus (T2DM) presents at
7 weeks' gestation. In her previous pregnancy, she required insulin therapy. She delivered at
39 weeks and her baby boy weighed 4.300 g.

75. In addition to the routine prenatal laboratory tests, what other testing will you obtain at
this point?
a. HbA1c
b. No other testing needed
c. An ultrasound to estimate gestational age
d. Perform a glucose challenge test at first visit
e. Perform a glucose challenge test at 24 weeks' gestation

76. Laboratory test results return, and her fasting blood glucose is 145 mg/dL. An ultrasound
reveals the pregnancy to be 7 weeks and 2 days, consistent with LMP. Hemoglobin A1c is
7,5%. Her diagnosis is:
a. GDM
b. T1DM
c. T2DM
d. no diabetes in pregnancy
e. Impaired glucose tolerance

77. By which mechanism of transfer does glucose cross the placenta?

a. Carrier mediated active transport
b. Channels
c.Facilitated diffusion
d. Simple diffusion
e. Solvent drag
78. A 41-year-old women present at 36 weeks of gestation in active labour. The ultrasound
scan at 32 weeks showed low lying placenta. Immediately after rupture of the membrane,
she started bleeding vaginally with associated cardiotocography (CTG) of non reassuring.
What is the most likely diagnosis?
a. Vasa praevia
b. Placenta previa
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c. Placenta accreta
d. Abruptio placenta
e. Low lying placenta

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.

79. 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. In twin-to-twin transfusion syndrome, the haemoglobin levels for both twins are
often not discordant
d. In a twin pregnancy with one fetal loss in the third trimester, in 90 per cent of
cases the remaining twin will be delivered within 72 h
e. Twin reversed arterial perfusion sequence is associated with high mortality in the
recipient twin due to prematurity and intra-uterine cardiac failure

80. 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

81. Regarding twin to twin transfusion syndrome:

a The donor develop hydrops
b. The recipient develops polyhydramnios
c. Quinterro classification is up to Quinterro IV
d. The perinatal mortality in twins reaches to 85%
e. Complicates up to 35 per cent of dichorionic multiple pregnancies

82. The most frequent twin pregnancy is:

a. Conjoined twins
b.Dizygotic twins
c. Dichorionic diamniotic
d. Monochorionic diamniotic
e. Monochorionic monoamniotic

83. Which of the following statements regarding chorionocity is true?

a. A dichorionic pregnancy is always dizygotic
b. Monochorionic membranes have four layers
c. Monochorionic twins are always monozygotic
d. Determination of chorionicity is easiest in the second trimester
e. Complications in twin pregnancy is more frequent in dichorionic preganancy
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A 38 years old P6 lady is being operated for abdominal delivery. Unfortunately uterine
contraction is not good. The patient suffers for massive bleeding. The operator quickly
decides to perform uterine removal in order to stop the bleeding.

84. Which artery that should be blocked if the operator would like to stop the blood flows to
the uterine artery?
a. Pudenda artery
b. Abdominal aorta
c. Hypogastric artery
d. Common iliac artery
e. Uterine and ovarian arteries

85. The uterine artery:

a. Gives a branch to ovary
b. Runs at the back of the ureter
c. May anastomose with femoral artery
d. Gives myometrium vascularization only
e. Is a branch of the anterior division of the internal iliac artery

86. The ovarian arteries:

a. Are crossed by the ureters
b. Arise just above the renal artery
c. Reach the ovary through round ligament
d. Reach the ovary through infundibulo-pelvic ligament
e. Anastomose with the descendent branch of uterine artery

A 22 years old female, Gl at 26 weeks gestation, presents to the office for her routine
obstetrical visit. Currently, she is complaining shortness of breath. She has no other
complaints. On physical examination: Blood pressure 100/70 mmHg, PR 90 bpm, RR 22x/m.
No abnormality was found in chest examinations. BGA results: pH 7,45 (7.35 - 7,45), pO2
103 mmHg (75 - 100), pCO2 28 mmHg (35-45), HCO3' 17 mEq/L (22-26), BE 2 mmol/L (-2 -2),
O2 sat 99% (>95%)

87. What is your explanation about the cause of symptom of this patient?
a Cardiac output increases 20%
b. Maternal blood volume increases 50%
c. Decrease in stroke volume and blood viscosity
d. The uterus and the diaphragm becomes elevated
e. The heart is displaced upward, and somewhat to the right with rotation on its long
axis.

88. What is the result of blood gas analysis (BGA) stated above?
a. Normal BGA
b. Metabolic acidosis
c. Metabolic alkalosis
d. Respiratory acidosis
e. Respiratory alkalosis
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89. What is the most appropriate next management in this patient?

a. Ask patient to perform echocardiography examination
b. Ask patient to perform chest radiography examination
c. Admit the patient to the hospital and give non-rebreathing mask
d. Counsel the patient that this is physiologic changes during pregnancy
e. Terminate the pregnancy because the symptom will become worsen in 32 weeks
pregnancy

90. What is ECG finding consider normal during pregnancy?

a. Specific ST changes
d. Increased heart rate (15%)
c. Inverted T waves in lead II
d. 15 degree right axis deviation
e. Irreversible ST waves changes

A 32 years 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/m. No remarkable past medical history is noted.

91. According to WHO Asian criteria, her BMI is classified as:

a. Normal
b. Underweight
c. Overweight
d. Obese type 1
c. Obese type 2

92. 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

93. What is the most likely risk of this patient?

a. Anemia
b. Congenital anomaly
c. Gestational diabetes
d. Spontaneous abortion
e. Post partum haemorrhage
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94. A 29 year old woman with a positive pregnancy test presents with a good history of
tissue expulsion vaginally. A transvaginal ultrasound scan shows an empty uterus with an
endometrial thickness of 11 mm. Regarding her diagnosis, you consider that:
a. She has had a complete miscarriage and needs no further treatment
b. She has had a pregnancy of unknown location and needs further investigations
c. She should be offered a hysteroscopy
d. She should be offered medical management of miscarriage
e. A laparoscopy should be performed to exclude an ectopic pregnancy

95. A 39 years old female G2P1AO, 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%

96. You have checked her CA125 serum level and the result was 350 /ml. You performed
conservative surgical staging by laparotomy because her frozen section revealed malignancy
cyst. After 1 week, pathology result serous papillary carcinoma of the left ovary. She is
planned for chemotherapy. What will you inform to her regarding chemotherapy for ovarian
cancer during pregnancy?
a. In a patient with ovarian cancer in pregnancy receiving chemotherapy the delivery
should be planned at completion of chemotherapy
b. Use of chemotherapy in pregnancy generally considered safe after 20 weeks of
gestation
c. CNS and neural tube complications occur during the week 8-12 weeks in
pregnancy
d. This percentage of patients receiving chemotherapy in pregnancy who develop
major congenital malformations is 30-40%
e. Cardiovascular defects are common congenital malformations in platin based
chemotherapy regimens

A 28 yo woman. Gl 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.

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

98. 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.

Mrs. B, 37-years-old came to your office at 32 weeks of gestation according to her last
menstrual period. She has no ultrasound examination before and did not do her routine
antenatal care. The vital sign is within normal limit. She has body mass index 19 kg/m2.
During physical examination the uterine fundal height is 27 cm. From ultrasound
examination, the fetus has biometric values that correlate with 30 weeks fetus

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

100. 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