1.

Gene transcription refers to the process whereby which of the

following occurs?
a. mRNA is spliced to the double stranded DNA and carried
outside the cell to centers for protein synthesis
b. mRNA is used to make new DNA
c. Nuclear DNA is used to make mRNA in the cell
nucleus
d. Cytososomes divide to form a new strand of DNA with
identical messages
e. Ribosomes synthesize new nuclear proteins
2. Important features of the second week of development in the
human embryo are:
a. Formation of intraembryonic mesoderm
b. Formation of the trilaminar embryonic disk
c. Proliferation and differentiation of the
trophoblast
d. Formation of the notochord
e. Formation of chorionic villi
3. Regarding implantation, which of the following is correct?
a. The trophoblast differentiates into cytotrophoblast and
syncytiotrophoblast as it contacts and penetrates the
endometrium
b. It begins at the end of the first week after fertilization
c. The zona pellucida degenerates prior to implantation
d. Is completed before the end of the second week after
fertilization
e. All of the above
4. Two cell
a.
b.
c.

two gonadotrophins theory:

Involves oocyte and granulose cells
Theca cell produces estrogen hormone
Androgen will be produce by granulose cells for estrogen
production
d. FSH will activate aromatase enzyme in granulose
cells
e. Initiated during pre-puberty period

5. The Mullerian duct gives rise to:

a. Distal part of vagina proximal
b. Ovary gonadal ridge
c. Clitoris sinus urogenital bagian bawah / distal
d. Ureter metanephric duct
e. Fallopian tube
6. Vaginal epithelium and the fibromuscular wall of the vagina
originate from which of the following respectively?
a. Mesonephric duct and endoderm of the urogenital sinus

b. Mesonephric duct and the uterovaginal primordium

c. Endoderm of the urogenital sinus and the mesonephric
duct
d. Endoderm of the urogenital sinus and the uterovaginal
primordium
e. Endoderm of the urogenital sinus and the
paramesonephric ducts
7. Three weeks after delivery, a 29-year old primipara, who is
breast feeding twin girls, presents to the clinic, complaining of a
tender right breast mass. On physical examination, you find a 5cm fluctuant, swollen, reddened mass in her right breast that is
exquisitely tender to the touch. Axillary lymph nodes on the
ipsilateral side are enlarged and tender. You decide to perform
incision, drainage and specimen collection for culture
examination of the mass. Which of the following statements Is
not correct regarding specimen collection for the culture
examination?
a. Specimen should always almost be taken before
treatment is commenced
b. The specimen should be kept at +4c and transported to
the laboratory as soon as feasible
c. Organism will continue to divide at ambient temperature
d. The use of the conventional deep freeze at -20c is
not satisfactory for preserving bacteria
e. It is not yet routinely possible to predict sensitivity to
antibiotic without exposure of actively diving organisms
to them
8. A 31 year old woman in her first trimester presents for her initial
visit. She complains of a painless raised lesion in her vulva.
Examination reveals a chancre. Rapid plasma regain (RPR) test
with elevated titer is positive along with fluorescent treponemal
antibody absorption (FTA-ABS), confirming the diagnosis of
primary syphilis. Which of the following statements is not correct
regarding syphyllis serology?
a. The regain tests depend upon antibody reaction with
cardiolipin
b. Cardiolipin is also used in VDRL and WR tests
c. The TPHA test makes use of immune fluorescence
aglutinasi
d. Regain test will be negative many years after effective
therapy
e. FTA-ABS becomes positive earlier in the disease than
TPHA
9. Three days after an elective termination of pregnancy, a 29 year
old woman presents to the emergency department with a history
of a mild abdominal pain and fever, a physical examination

showing pelvic tenderness, and a purulent cervical discharge. A

grams stain of the cervical discharge shows gram negative
intracellular diplococcic. What is the most likely causative agent
in this patients case?
a. Chlamydia trachomatis gram negatif, NAAT (nucleic
acid amplification tests)
b. E.coli batang gram negatif
c. Treponema pallidum spiral, mikroskop lapangan gelap
/ floresen
d. N. gonorrhea
e. S. aureus kokus gram positif bergerombol seperti
anggur

Questions 10-12
A 35 yo multiparous woman complains of an offensive odor after
sexual intercourse which is worse for the past 2 weeks. The patient
describe as discharge as thin in consistency and of a greyish white
color. No erythema or lesions of the vagina are noted. She denies a
history of any sexually transmitted diseases. She is currently on no
medications with the exception of her birth control pills. Last month
she took a course of amoxicillin for treatment of a sinusitis. On
physical exam, the vulva appears normal and the cervix is not
inflamed. There is a copious thin whitish discharge in the vaginal
wall and also adherent to the vaginal walls. A sample of fluid is
taken into posterior fornix and mixed with 10% potassium
hydroxide, which produce fishi odor. Wet smear indicates numerous
squamous cells with stripped borders.
10.

What is the most likely diagnosis

a. Trichomoniasis strawberry cx, sekret berbusa di fornix
posterior
b. Candidiasis white, lumpy (cottage cheese)
c. Gardnerella infection kriteria Amsel ph > 4.5,
clue cells, fishy odor, gambaran discharge
homogen
d. Physiologic discharge tidak gatal, tidak bau, tidak
berwarna
e. Chlamydia

11. Based on your presumptive diagnosis, which of the following

most likely is present
a. Ph<4,5 >
b. Heterogenous vaginal discharge homogen
c. Predominance anaerobes
d. Positive kleihauer-betke test mendeteksi jumlah fetal
Hb
e. Curdy or like cottage cheese discharge Candida

TATALAKSANA NYA?
12. Regarding normal genital tract flora of women, which of the
following statement is not correct?
a. The composition of vaginal flora can be influenced by
frequency of sexual intercourse
b. The presence of e2 leads to an environment rich in
glycogen
c. Glycogens favors the growth of lactobacilli
d. The metabolism of glycogen results in ph>4,5
e. Bacteria commonly present include anaerobic cocci
13. A 31 yo neonatal ICU nurse has just undergone an
uncomplicated term spontaneous vaginal delivery of a 2300-g
female neonate with a diffuse petechial rash. At 12 weeks
gestation she experienced a flulike syndrome with right upper
quadrant pain. Obstetric sonograms showed fetal growth was
only the fifth percentile. She was probabl suffered from CMV
during pregnancy. Your counseling to this patient should include,
except:
a. CMV may cause pneumonitis to the baby
b. It is associated with owls eyes inclusion bodies
c. May transmitted to the fetus transplacentally
d. May transmitted to the fetus in the birth canal
e. Cant be transmitted in the breast milk
Treatment: bisa pakai gancyclovir
14. A 30 yo woman arrives completely dilated to the hospital and
deliveres a term neonate vaginally. Shortly after the delivery, the
woman is discovered to have several blisters of the vulva that
are suspicious for herpes simplex virus. She states that she has
a history of herpes. Which of the following is the best
management of the baby?
a. Acyclovir to the neonate (IV 60 mg/kg setiap 8
jam)
b. Blood culture of the neonate for HSV antibodi atau
swab
c. Herpes culture of the lesions and isolation of the baby
until the culture
d. Vaccination of the neonate with herpes vaccine
e. Breast feeding should be avoided
15. A 26 yp primipara was admitted to the birthing unit at 39 wks
gestation in active labot at 6cm dilatation. During her second
trimester she experienced a mononucleosis like syndrome.
Uterine fundal growth behind that expected on the basis of first
US. Serial US showed symmetrical IUGR. She delivered a 2250g
male neonate who was diagnosed with microcephaly,

intracranial calcifications, and chorioretinitis. The doctor said

that this condition was dur to toxoplasmosis infection in
pregnancy. Which of the following should be include, when you
give the information in the patient:
a. Toxo is caused by bacteria transmitted parasite
b. Vertical transmission from mother to the fetus can only
occur during the paracitemia of a primary infection
c. <1% of the women are toxo IgG seropositive
d. 1st trimester infection is high >50%, but infections are
least serious
e. 3rd trimester infections are mostly asymptomatic
16. In the female endocrine system, GnRH is able to modulate two
hormones to result in the release of a single ovu,. This complex
system is vulnerable to disruption with resulting abnormal
uterine bleeding and infertility. GnRH stimulates the release of
FSH in addition to which of the following
a. Adrenocorticotropic hormone CRH
b. Growth hormone GHRH
c. LH
d. Opiate petptide dopamin
e. TSH TRH
17. Women perceive the menstrual flow as an indication that the
reproductive system is functioning well. In fact the actual
menstrual flow is associated with which of the following?
a. Prolonged maintenance of e2
b. Prolonged maintenance of progesterone
c. Withdrawal of FSH
d. Withdrawal of LH
e. Withdrawal of progesterone
18. A patient presents with amenorrhea and galactore. Her PRL
levels are elevated. She is not and has never been pregnant. In
addition to evaluating her for a prolactinoma, one also needs to
evaluate for other causes that would increase PRL, such as
elevated level of which of the following
a. CRH
b. Dopamine menurun
c. GABA
d. Histamine tipe II receptor activation
e. TRH
19. X-rays on nnn35 yo man after a motor vehicle accident revel
a basilar skull fracture and raise a concern about an interruption
of the hypophyseal portal circulation. This would cause a decline
in circulating which of the following?
a. AVP posterior
b. Dopamine di hipotalamus

c. gonadotropin
d. oxytocin posterior
e. prolactin increase
20. Concerning GI tract during pregnancy, which of the following
is true?
a. Gastric emptying time is increased in each
trimester
b. Pyrosis is caused by reflux of acidic secretions
into the lower esophagus
c. Epulis is a systemic highly vascular swelling of mucosal
membranes
d. Gastric emptying time is shortened during labor
e. No changes of GI tract during pregnancy
21.

The GI tract
a. During pregnancy the rate of gastric emptying is
increased
b. Cholecystokinin is produced by the gallbladder
c. Gastrin acts on the parietal cells of the stomach
d. Pepsin is produced by the oxyntic (PARIETAL) cells of the
stomach chief cells
e. The pH of the stomach is approximately 3

22.

Rhesus incompatibility
a. There are 3 rh antigens 5: D, C, c, E, e
b. ABO antibodies are IgG IgM
c. In haemolytic dss of the newborn, the haemolytic
process is maximal at the time of birth in liveborn infants
d. Severe rh sensitization causes recurrent 1st trimester
abortions after 28th weeks
e. Causes maternal death

23. Common features of APS include all except which of the

following?
a. Thrombocytosis???
b. CNS involvement
c. Recurrent arterial or venous thrombosis
d. Fetal loss in the second half of pregnancy
e. All of the above
Kriteria Sapporo:
Klinis:
- trombosis arteri vena or capiler
- abortus >10th week (sekali) atau rekuren dibawah 10
minggu

Laboratorium:
- anti cardiolipin
- apl
24. Fetal cells and DNA are present in maternal blood by what
time?
a. 1st trimester sejak sitotrofoblas masuk ke aliran
darah ibu
b. 2nd trimester
c. 3rd trimester
d. just before parturition
e. postpartum period
???
25.

Placental structure:
a. At term new placental villi stop to be substances formed
b. No correlation between placental weight and fetal
weight
c. Microvilli are present on the vasculosyncytial
membranes
d. The main factor governing the rate of O2 placental
blood flow is the vascular resistance of the spiral
arteries
e. At term the total blood flow to the placenta is
about 500ml

26.

The placenta produces the following:

a. Oestrone
b. 5 alpha reductase
c. histaminase
d. progesterone
e. all of the above

27.

Placental transfer:
a. The placenta is a complete barrier to substances with
molecular weights greater than 1500
b. 3-4 L of fluid are exchanged between the mother
and fetus per hour
c. the concentration of aminoacids is less in the fetal blood
than in the maternal blood
d. o2 delivery occurs by active transport from mother to
fetus
e. no right answer

28. In human, which of the following placenta-derived hormones

has been strongly linked as a primary initiator parturition?
a. Oxytocin
b. Growth hormone variant
c. Corticotropin releaseing hormone

d. Progesterone withdrawal
e. GnRH
29. Which of the following is true of the fetal adrenal gland near
term?
a. Equal size to that in adulthood
b. Daily steroid production equals than in adulthood
c. 1/3 larger in male fetus compared with that in females
d. 1/3 larger in female fetus compared with that in males
e. no right answer above
30.

Vaginal flora
a. L. acidophilus can produce lactic acid with unpleasant
smell
b. Leptotrichia cant produce lactic acid
c. The composition of vaginal flora can be influenced
by frequency of sexual intercourse
d. Vaginal douching will not affect vaginal flora
e. Antiviotic use will increase normal vaginal flora

31.

Component of the innate immunity of mucosal immunity

a. B lymphocyte
b. Antibodies
c. T-helper cell
d. Mucus release
e. Plasma cell

32.

HLA system
a. Within the HLA system there are 6 transplantation
antigens
b. HLA-C antigens are not present on normal trophoblastic
tissue
c. Blocking antibodies cause the rejection of the implanted
blastocyst
d. Is represented on chromosome 8
e. HLA DR antigens are called class I antigens

33.

What
a.
b.
c.
d.

is the main mechanisms by which APS cause damage

Deactivation of the tissue factor pathway
Increased protein C and protein S activity
Increased decidua production of prostaglandin E2
Exposure of endothelian and syncytiotrophoblast
basement membrane
e. Increased protein C activity only

34. Adaptive immunity include all of the following elements,

except
a. T cells
b. B cells

c. Null cells
d. Antibody
e. Acute phase proteins
35.

The following about acid base is true, except

a. Base excess is negative in metabolic acidosis
b. In pregnancy there is a resp alkalosis
c. Prolonged vomiting ma cause a metabolic acidosis
d. Metabolic alkalosis frequently accompanies hypokalemia
e. None of the above

36.

The distribution of electrolytes are as follows

a. Natrium and sodium are the major intracellular cations
b. Phosphate is the major intracellular anion
c. During pregnancy the plasma osmolarity rises
d. In acidosis there is decrease in anion gap
e. The concentration of sodium is more in the interstitial
fluid than in plasma

37. The electrical impulse of the heart stars in the SA node

located in the right atrium at the entry of:
a. Inferior vena cava
b. Aorta
c. Pulmonary vein
d. Superior vena cava
e. Pulmonary artery
38. The following receptors are present in the heart muscle and
conducting tisues, except
a. Cholinergic receptor T
b. Alfa adrenergic receptor
c. Beta 1 adrenergic receptor
d. Beta 2 adrenergic receptor
e. None of the above
39.

In pregnancy:
a. The blood volume increases by 1200-1400ml F -->
2600 to 3800
b. The cardiac output continues to increase until the end of
the third trimester F
c. The heart rate is increased by 40% T
d. The arterivenous o2 gradient increases F -->
Decreases
e. The diastolic blood pressure tends to rise slowly
throughtout F --> Decreases

40. The effect of feeling breatless and increase in ventilation in

pregnant woman is due to the hormone
a. Estrogen

b.
c.
d.
e.

Progesterone
Prolactin
LH
FSH

41.

The vital capacity in pregnant woman is

a. Increase
b. Decreased
c. Doubled
d. Remain unchanged
e. None of the above

42.

In pregnancy, the following changes happen in the kidney

a. Renal blood flow increase and GFR increase
b. Renal blood flow decrease and GFR decrease
c. Renal blood flow increase and GFR decrease
d. Renal blood flow decrease and GFR increase
e. None of the above

43. The following will be present in the urine of pregnant women

due to the increase in GFR and it is considered normal
a. Blood
b. Glucose
c. Protein
d. Bacteria
e. Erythrocyte
44. The damaged endometrial cells in pre-eclampsia will cause
the following, except
a. Increase capillary permeability
b. Platelet thrombosis
c. Increase vascular tone
d. Decrease fibrin formation
e. All of the above
45. Stimulation of the coagulation cascade in response to
endothelial damage may be more likely in women who have
predisposition to
a. Hypertension
b. Diabeates
c. Thrombosis
d. Hyperuricemia
e. Proteinuria
46.

Which of the following statements on coagulation is true:

a. Thromboplastin activates the intrinsic system
b. The intrinsic pathway is quicker than the extrinsic
pathway
c. Anti-thrombin III is an alfa 2globulin

d. In pregnancy factor XI and XII is increased

e. Heparin potentiates the action of anti-Xa
47.

DIC may result from the following except:

a. Pre-eclampsia
b. ITP
c. Amniotic fluid embolism
d. Abruption placentae
e. Sepsis

48. A female who possess an X-linked trait may do so because

either she inherited a recessive gene from both her mother and
father of which of the following?
a. She inherited a recessive gene from one of her parents
and may express the recessive characteristics as a
function of the Lyon hypothesis
b. She has undergone spontaneous mutation from an
environmental source
c. She is really a testicular feminization patient
d. She lacks the genetic expressor gene for dominance
e. She has a translocated Y determinant on one of her
autosomes

49. Each of the following statement about the placenta is true,

except
a. Retroplacental hematoma is related to, but not
synonymous with placental abruption
b. Trauma can cause retroplacental hematoma
c. Preeclampsia can cause retroplacental hematoma
d. Placental abruption can cause consumption
coagulopathy
e. Placental hydrops is associated with retroplacental
hematoma
50. The human placenta is a complex structure that serves as
interface between the fetus and maternal circulation to allow
excretory, resp, and nutritional function for the fetus. It does
which of the following?
a.
Allows maternal blood to enter the fetal circulation but
not vice versa
b. Allows only large molecules to pass
c. Allows total mixing of the maternal and fetal blood
d. Maintains absolute separation between maternal and
fetal circulations