Soal UAasic 120615
Soal UAasic 120615
Soal UAasic 120615
12 Juni 2015
Questions 1-3
Ms. A 16 years old comes with chief complaint of primary amenorrhea. There is no
remarkable medical history. Physical exams show no breast development and no
pubic hair growth. US shows uterine hypoplasia and gonads are difficult to be
identified. Karyotype analysis shows 45, X0.
1. What is the problem of this patient?
a. Amenorrhea happens due to loss of no. 18 chromosome
b. Amenorrhea happens due to loss of X chromosome
c. Amenorrhea happens due to loss of Y chromosome
d. Amenorrhea happens due to mosaics chromosome
e. Amenorrhea happens due to additional of no. 21 chromosome
2.
d. Polyploidy of X chromosome
e. Structural abnormality of X chromosome
6. How to identify recessive X-linked disease?
a. Western blot
b. Southern blot
c. DNA sequencing
d. Microarrays
e. Immuno-blotting
Questions 7-9
39 years old lady comes to outpatient clinic with chief complain of primary infertility.
She was married for 15 years and never gets pregnant. There is no remarkable clinical
finding. US observation shows small ovaries with total follicle numbers less than 6.
Patient is still having regular menstrual cycle.
7. From where is the origin of primordial germ cells?
a. Yolk sac
b. Gonadal ridge
c. Genital tubercle
d. Mullerian duct
e. Coeloemic epithelium
8. Why total numbers of oocytes during pubarche is only 400,000 left
a. Most of follicles will arrest upon folliculogenesis
b. Most of follicles will undergo apoptosis
c. At least more than two follicles ovulated for each cycle
d. Most of follicles will complete their meiosis
e. Most of follicles loss due to effect of gonadotrophic
9. Therefore, what is the most likely fertility problem of this lady?
a. Ovarian insufficiency
b. Pituitary disorders
c. Hypothalamic disorders
d. Diminished ovarian reserve
e. Endometrial disorders
Questions 10-12
20 years old lady visit our outpatient clinic due to primary amenorrhea. Upon clinical
examination breast is fully develop (M3), and there is also pubic hair growth. No
ambiguous genitalia can be observed. US findings: there is no uterus, but both ovaries
are within normal limit.
10. Uterine corpus does embryologically developed from?
a. Pronephros
b. Mesonephros
c. Metanephros
d. Mullerian duct
e. Urogenital sinus
11. What kind of congenital malformation that can be identify on this patient?
a. Uterine hypoplasia
b. Didelphys uterus
c. Subseptus uterus
d. Agenesis uterus
e. Arcuate uterus
12. What is the name of the syndrome if patient also have kidney malformation?
a. Turner Syndrome
b. Klinefelter syndrome
c. MRKH syndrome
d. Down syndrome
e. Patau syndrome
Questions 13-14
35 years old lady G2 P1 28 weeks of gestation, comes to obstetric outpatient clinic
due to over distended abdomen. Vitas signs are normal. Upon obstetric examination
found fundal height 35cm. Part of fetus difficult to be palpated. US exam shows
normal fetus (estimated fetal weight 1,100 gram) and placenta with amniotic fluid
index 30.
13. What is the problem of this patient based on US finding?
a. Polyhydramnios
b. Oligohydramnios
c. Greenish amniotic fluid
d. Normal amniotic fluid
e. Amnionitis
14. Based on physiological mechanism of amniotic fluid production and
circulation, which problem is most likely can be suspected?
a. Placental tumor
b. Dysfunction of fetal swallowing
c. Overproduction of amniotic cells
d. Excessive transudation through fetal skin
e. Excessive transudation through umbilical cord
Questions 15-17
You are a resident in charge over the nightshift at delivery ward. 32 years old lady G2
P1 35 weeks of gestation comes with PROM since 6 hours ago. No remarkable
clinical findings have been found. CBC shows normal limit. CTG result shows:
baseline 144 bpm, variability 5-15 bpm, acceleration 2x10, variable deceleration
found 3 times in 10 minutes observation. There is shouldering sign and FHR falls into
80 bpm but return to baseline. Contraction found 2-3x in 10 minutes irregular, but
fetal movement still positive.
15. What is the most likely mechanism of variable deceleration in this patient?
a. Placental insufficiency
b. Congenital anomalies
c. Scanty amniotic fluid
d. Intra-uterine infections
e. Head compression
16. What does the mechanism of shouldering sign prior to variable deceleration?
a. Parasymphathetic activity
b. Chemoreceptor activity
c. Occluusin of both umbilical artery and vein
d. Occlusion of umbilical artery
e. Occlusion of umbilical vein
17. Ultrasound has been done to measuere condition of amniotic fluid. Amniotuc
fluid index is, if pelvic score of this patient is 3, with estimated fetal weight
2300 gr and CBC still normal, what is your plan for this patient?
a. Give tocolytic an lung maturation for 2 days
b. Give lung maturation once and continued with labour induction
c.Directly perform labor induction
d. Give lung maturation once and continued with labor induction
e. Plan for immediate C-section
Question 18-20
27 years old lady G1 term pregnancy, were referred by midwivess due to labor
dystocia. According to the partograph, cervical opening of 4cm was happen at 8.00
am. At 12.00 am contraction was 2x/10 with duration of 20s. Cervical opening still
4cm. Membrane still intact, estimated of fetal weight is 2.700 gr and good feto-pelvic
proportion.
18. This labor dystocia can be classified as :
a. Protraction disorder
b. Arrest disorder
c. Incoordinate uterine action
d. Prolonged of latent phase
e. Prolonged of active phase
19. What is the meaning of hypotonic uterine diysfunction?
a. High basal tonus
b. Asynchronous
c. Contraction starts from mid-segmental part
d. Pressure gradient is distorrted
e. Insufficient to dilate the cervix
20. What is your plan for this patient?
a. Ask the patient to take a rest
b. Perform immediate C-section
c. Starts augmentation by oxytocin infusion
d. Starts labor induction by misoprostol
e. Perform stripping of amniotic membrane
38 year old lady G4P3 36 weeks of gestation comes to delivery wardd due to vaginal
bleeding along with abdominal cramps. Vital sgns show BP 90/60mmHg, PR 110x/m,
RR 24x/m, afebrile. FHR cannot be dentified. Upon palpation uterus is hypertonic.
Speculum examination found only a minimal dark blood flow through the ostium.
21. What is the most likely diagnosis of this pattient?
a. Vasa previa
Questions 33-35
27 yo G1 15 wga comes to outpatient clinic with chief complaint of running nose,
sore throat, and cough without fever. She would like to ask you about her immune
system during pregnancy
33. How maternal immune system works during pregnancy in order to induce
maternal tolerance to semi allogenic fetus?
a. Increase Th1 cytokines
b. Increase Th2 cytokines
c. Increase APS antibodies
d. Reduces T-helper lymphocyte
e. Reduces macrophages
34. Choose the correct statement regarding to leukocyte condition during
pregnancy!
a. During pregnancy leukocyte is less than 5.000
b. During pregnancy the highest level for leukocyte count is 25.000
c. During late trimester the proportion of T cytotoxic cell increases
d. High number of leukocyte count during puerperium is due to high
activity of the bone marrow
e. Adhesion molecule on circulating leukocyte decrases
35. Choose the incorrect condition of immune system in pregnancy, which is
close to the condition of inflammatory state
a. High CRP
b. High erythrocyte sedimentation rates
c. High fibrinogen level
d. Low C3 level
e. High globin level
Questions 36-38
25 yo lady G2 P1 28 wga of gestation comes to outpatient clinic. She said that she
was having cardiac problems. She is having mild mitral insufficiency. At these
moments she does not have any complaint.
36. Choose the correct physiological changes of hemodynamic in pregnancy!
a. Low MAP
b. Low SVR
c. Low CO
d. Low HR
e. Low pulmonary capillary wedge pressure
37. Explain how is the mechanism to maintain blood pressure during pregnancy?
a. Estrogen will activates RAA system
b. Progesterone will activates RAA system
c. Increased sensitivity of blood vessels to angiotensin
d. Refractoriness of blood vessel to angiotensin can induce hypertension
e. Refractoriness of blood vessel to angiotensin does not related with
progesterone
38. What is the prognosis for having mild mitral insufficiency during pregnancy?
a. The prognosis is bad due to increase of plasma volume
b. The prognosis is good since mitral insufficiency can narrowed
spontaneously
a.
b.
c.
d.
e.
Questions 51-53
24 yo P1 just deliver 2700gram baby boy with AS 9/10. Placenta delivered
spontaneously. Upon observation she was having second degree perineal tear.
51. Please select which muscle is involce in second degree perineal tear?
a. Bulbocavernosus muscle
b. Puborectalis muscle
c. External spinchter ani muscle
d. Transverse perinei profunda muscle
e. Ishciocavernosus muscle
52. Please select a correct statement below for midline episiotomy!
a. Faulty healing is more common
b. Postoperative pain is common
c. Blood loss is less
d. Surgical repair is more difficult
e. Dyspareunia is occasional
53. Please select a correct statement below for medio-lateral episiotomu!
a. Anatomical result is excellent
b. Post-operative pain is rare
c. Dyspareunia is rare
d. Extensions is uncommon
e. Faulty healing is rare
Questions 54-56
24 years old P1 just deliver 2700gram baby boy with Apar score 9/10. Today is her
first day care at the obstetric ward. Her general condition is normal, however she still
cannot breastfeed her baby properly.
54. Explain the endocrinology of breast-milk production in puerperium period!
a. Prolactin does responsible for the development of mammary glands
b. Prolactin withdrawal will initiates breast-milk production
c. Progesterone withdrawal increase a-lactalbumin production
d. A-lactalbumin works to inhibits lactose synthase
e. Oxytocin increase contractions of mammary glands
55. Please choose the correct below statement for immunology in breastfeeding
a. Major immunoglobulin in colostrum is IgM
b. Immunoglobulin prevents rotavirus infection that mostly infeting
respiratory tract
c. Immunoglobulin prevents infection by induce complement activation
d. T lymphocytes in breast milk will transfer maternal immune
experience to neonates
e. Antibodies in human colostrum will be highly absorbed by infants.
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
Varicose ulcers
Kinins
Increased local blood flow
Prstaglandins
C3a and C5a
Peptic ulcerations
Increased capillary
permeability
Leukocyte migration
Stimulation of nociceptive
nerve fibers
Fungi
Histamines
Tuberculosis
Questions 91-100
The control of myometrial contraction is at the heart of understanding both the
maintenance of pregnancy and the onset of labor. The initial process is the increase of
91. Level in cytoplasm by mechanism of 92. from extracellular and release
from 93. It will bind and activates 94. Leadint to activates 95.. this process
will be followed by phosphorylation of 96 which is going to interact with 97.
And activates 98. Through the hydrolysis of 99. The force that required for
100 will be developed.