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Latihan Soal Tahap I

1 . Which of the following is an example of an indirect maternal death?


a. Septic shock following abortion
b. Aspiration following eclampsia seizure
c. Hemorrhage following uterine atony
d. Aortic rupture secondary to Marfan syndrome
2. A death of a newborn at 5 days of life due to congenital heart disease
would be classified as which of the following?
a. Fetal death
b. Infant death
c. Late neonatal death
d. Early neonatal death
3. Which of the following correctly identifies the trends in fertility and live
birth rates in the United States since 2002?
a. There has been no change in either rate.
b. Fertility and live birth rates have increased.
c. Fertility and live birth rates have decreased.
d. Fertility rate has decreased but live birth rate is increased.
4. Most infant deaths occur in which of the following groups?
a. Low-birthweight infants
b. Infants of diabetic mothers
c. Infants with congenital infections
d. Infants with congenital anomalies
5. Which of the following events has contributed to the rise in the U. S.
cesarean delivery rate?
a. Increase in deliveries performed by midwives
b. Decline in vaginal births following cesarean delivery
c. Reduction in reimbursement by insurance companies for cesarean
delivery
d. Improved outcomes in infants with congenital abnormalities
delivered by cesarean delivery

6. On the basis of an American College of Obstetricians and


Gynecologists survey, which of the following is the most common
citation for obstetric malpractice claims?
a. Shoulder dystocia
b. Electronic fetal monitoring
c. Stillbirth or neonatal death
d. Neurologically impaired neonate
7. The field of obstetrics encompasses all EXCEPT which of the
following?
a. Prenatal care
b. Management of labor
c. Infertility treatments
d. Immediate newborn care
8. "Preterm" defines neonates born before what gestational age?
a. 34 completed weeks
b. 36 completed weeks
c. 37 completed weeks
d. 38 completed weeks
9. Wha t is the leading indication for hospitalization during pregnancy not
related to delivery?
a. Influenza
b. Diabetes mellitus
c. Chronic hypertension
d. None of the above
10 . Which of the following is defined as the number of maternal
deaths that result from the reproductive process per 100,000 live
births?
a. Maternal mortality rate
b. Maternal mortality ratio
c. Direct maternal death rate
d. Pregnancy-related death rate

11 . Which of the following is NO T among the top three causes of


pregnancy-related death?
a. Embolism
b. Hemorrhage
c. Cardiomyopathy
d. Hypertensive disorders
1 2 . Which of the following in general is true of vertical abdominal
incisions?
a. Heal better than Pfannenstiel incisions
b. Follow vertically oriented dermal fibers (Langer lines)
c. Yield inferior cosmetic results compared with transverse incisions
d. Sustain decreased lateral tension
13 . Which vulvar structure is homologous to the male scrotum?
a. Labia minora
b. Urethra
c. Vestibule
d. Labia majora
14 . With regard to the vestibule, which of the following statements is
correct?
a. It is derived from embryonic urogenital membranes.
b. Th e posterior portion between the fourchette and the vaginal
opening is called the fossa annulares.
c. It is perforated by four openings.
d. The fossa navicularis is usually observed only in nulli- parous
women.
15 . The internal pudendal artery supplies which of the following?
a. Proximal vagina
b. Posterior vaginal wall
c. Distal vaginal wall
d. Bladder trigone
16. Which of the following is true concerning the anal sphincters?

a. The external anal sphincter receives blood supply from the


superior rectal artery.
b. The internal anal sphincter contributes the bulk of anal canal
resting pressure.
c. The external anal sphincter measures 3 to 4 cm in length.
d. The external sphincter remains in a state of constant relaxation.
17 . Th e perineal body is formed partly by which of the following
muscles?
a. Ischiocavernosus muscle
b. Gluteus maximus muscle
c. Bulbocavernosus muscle
d. Levator ani muscle
18 . Which of the following is the potential space between the anterior
surface of the uterus and the posterior wall of the bladder?
a. Pouch of Douglas
b. Rectovaginal septum
c. Morison pouch
d. Vesicouterine space
19. During postpartum tubal sterilization, which of the following correct
anatomical information may assist you?
a. The fallopian tube lies anterior to the round ligament.
b. The fallopian tube lies posterior to the uteroovarian ligament.
c. The round ligament lies anterior to the fallopian tube.
d. The uteroovarian ligament lies anterior to the round ligament.
20 . The ovarian artery is a direct branch of which of the following
vessels?
a. Internal iliac artery
b. Aorta
c. Uterine artery
d. External iliac artery

21 . The right ovarian vein empties into which of the folic ing veins?

a. Vena cava
b. Renal vein
c. Internal iliac vein
d. External iliac vein
22 . Ovarian vessels are found in which of the following liga ments?
a. Broad
b. Round
c. Uterosacral
d. Infundibulopelvic
23 . The internal pudendal artery arises from which of the following
vessels?
a. External iliac artery
b. Internal iliac artery
c. Vaginal artery
d. Inferior epigastric artery
24 . The uterine artery is a main branch of which of the following
vessels?
a. External iliac artery
b. Internal iliac artery
c. Common iliac artery
d. Iliolumbar artery
25 . Which of the following bone(s) forms the pelvis?
a. Innominate
b. Sacrum
c. Coccyx
d. All of the above

26. Which of the following is true regarding relaxation of the pelvic joints

at term in pregnancy?
a. It allows for an increase in the transverse diameter of the
midpelvis.
b. It results in marked mobility of the pelvis at term because of a
downward gliding movement of the sacroiliac (SI) joint.
c. Displacement of the SI joint increases outlet diameters by 1.5 to
2.0 cm in the dorsal lithotomy position.
d. It is permanent and not accentuated in subsequent pregnancies.
27 . The shortest anteroposterior diameter of the pelvic inlet is which of
the following?
a. True conjugate
b. Obstetrical conjugate
c. Diagonal conjugate
d. None of the above
28 . The clinical evaluation of the pelvic inlet requires direct
measurement ofwhich diameter?
a. True conjugate
b. Obstetrical conjugate
c. Diagonal conjugate
d. Pelvic inlet transverse diameter
29 . Engagement occurs when the biparietal diameter of the fetal
head descends below the level ofwhich of the following?
a. Midpelvis
b. Pelvic inlet
c. Pelvic floor
d. Ischial tuberosities
30. What is the narrowest pelvic dimension that must be navigated by the
fetal head?
a. Inferior strait
b. Obstetrical conjugate
c. Interspinous diameter
d. Transverse diameter of the pelvic inlet

31 . Which of the following is true of the midpelvis?

a. It is measured at the level of the ischial tuberosities.


b. It usually measures no more than 9 cm.
c. It is measured at the level of the ischial spines.
d. It usually is the largest pelvic diameter.
32 . Which of the following is the most common pelvic shape?
a. Gynecoid pelvis
b. Anthropoid pelvis with gynecoid tendency
c. Android pelvis
d. Gynecoid pelvis with android tendency
33. The pubococcygeus muscle is now preferably called which of the
following?
a. Puborectalis muscle
b. Iliococcygeus muscle
c. Puboperinealis muscle
d. Pubovisceral muscle
34. Which hormone is required for the late-stage development of
antral follicles?
a. Luteinizing hormone (LH)
b. Follicle-stimulating hormone (FSH)
c. Estradiol
d. Androstenedione
35 . During the follicular phase of the menstrual cycle, estrogen is
primarily produced by which cells of the dominant follicle?
a. Theca
b. Decidual
c. Granulosa
d. Endometrial
36 . The process through which the corpus luteum develops from the
remains of the Graafian follicle is called which of the following?
a. Luteinization
b. Thecalization
c. Decidualization
d. Graafian transformation
37 . Which of the following is the most biologically potent naturally

occurring estrogen?
a. Estriol
b. Estrone
c. Estetrol
d. 17 (3 estradiol)
38 . Which of the following is the endometrial layer that is shed with every
menstrual cycle?
a. Basalis layer
b. Decidual layer
c. Luteinized layer
d. Functionalis layer
39 . Which of the following is the first histological sign of ovulation?
a. Cessation of glandular cell mitosis
b. Vacuoles at the apical portion of the secretory nonciliated cells
c. Secretion of glycoprotein and mucopolysaccharide by secretory
nonciliated cells
d. Subnuclear vacuoles and pseudostratification in the basal portion
of the glandular epithelium
40 . What is the Nitabuch layer?
a. A layer of the decidua composed of large, distended glands
b. An area of the decidua with large, closely packed epithelioid,
polygonal cells
c. A zone of fibrinoid degeneration in which the invading
trophoblasts meet the decidua
d. An area of superficial fibrin deposition at the bottom of the
intervillous space and surrounding the anchor ing villi
41 . Which of the following gives rise to the chorionic struc tures that
transport oxygen and nutrients between fetus and mother?
a. Villous trophoblast
b. Interstitial trophoblast
c. Extravillous trophoblast
d. Endovascular trophoblast

42. Which of the following statements is accurate regarding the chorion

frondosum?
a. Is the same as the chorion laeve
b. Is the maternal component of the placenta
c. Is the avascular area that abuts the decidua parietalis
d. Is the area of villi in contact with the decidua basalis

43 . Maternal regulation of trophoblast invasion and vascular growth is


mainly overseen by which of the following?
a. Decidual natural killer (dNK) cells
b. C D4+ T cells
c. Progesterone
d. Cellular adhesion molecules
44 . All EXCEPT which of the following is true regarding fetal
fibronectin?
a. Is a matrix metalloproteinase
b. Is also known as "trophoblast glue"
c. Is a prognostic indicator of preterm labor
d. Plays a role in trophoblast invasion of the endometrium
45 . Regarding the orientation of spiral blood vessels in relationship to the
uterus, which of the following is true?
a. Both arteries and veins are parallel to the uterine wall
b. Both arteries and veins are perpendicular to the uterine wall
c. Arteries are perpendicular, and veins are parallel to the
uterine wall
d. Veins are perpendicular, and arteries are parallel to the
uterine wall
46. The phenomenon that describes how fetal cells can be come
engrafted in the mother during pregnancy and then be identified
decades later is called which of the following?
a. Microchimerism
b. Histocompatibility
c. Hemochorial invasion
d. Immunological neutrality
47 . The amnion is composed of all EXCEP T which of the following?

a. Lymphatics
b. Interstitial collagen
c. Basement membrane
d. Acellular zona spongiosa
48 . The amino acid sequence of the a-subunit of human chorionic
gonadotropin (hCG) is identical in all EXCEP T which of the
following?
a. LH
b. Corticotropin-releasing hormone (CRH)
c. FSH
d. Thyroid-stimulating hormone (TSH)
49 . Abnormally low levels of hC G may be found in which of the following?
a. Down syndrome
b. Ectopic pregnancy
c. Erythroblastosis fetalis
d. Gestational trophoblastic disease
50 . Known biological actions of hC G include all EXCEP T which of the
following?
a. Maternal thyroid stimulation
b. Inhibition of relaxin secretion
c. Sexual differentiation of the male fetus
d. Rescue and maintenance of the corpus luteum
51 . Which of the following has the greatest production rate of any known
human hormone?
a. Progesterone
b. Huma n placental lactogen
c. Chorionic adrenocorticotropin
d. hCG

52 . Among placental peptide hormones, which of the following has shown

a correlation with birthweight?


a. Leptin
b. Activin
c. Inhibin
d. Neuropeptide Y
53 . Which of the following is true of bilateral oophorectomy at 9
weeks' gestation?
a. Will cause miscarriage
b. Will cause a significant drop in progesterone levels
c. Will not alter the excretion of urinary pregnanediol
d. None of the above
54 . Wha t is the precursor of placental progesterone?
a. Fetal high-density lipoprotein (HDL) cholesterol
b. Fetal low-density lipoprotein (LDL) cholesterol
c. Maternal HD L cholesterol
d. Maternal LDL cholesterol
55 . Besides being an X-linked disorder that affects male fetuses,
true statements regarding ichthyosis include which of the
following?
a. It is seen with fetal adrenal hypoplasia.
b. It is seen with fetal adrenal hyperplasia.
c. It is associated with fetal placental sulfatase deficiency.
d. It is associated with fetal placental aromatase
deficiency.
56 . Which of the following conditions is associated with elevated
estrogen levels in pregnancy?
a. Down syndrome
b. Fetal erythroblastosis
C. Glucocorticoid therapy
d. Fetal placental aromatase deficiency

57. Oxygen, carbon dioxide, and water are transferred across the
placenta via which mechanism?
a. Facilitated diffusion
b. Simple diffusion
c. Active transport
d. Carrier-mediated diffusion
58 . Which of the following hormones blocks maternal pe ripheral uptake
and use of glucose while promoting mo bilization and use of free
fatty acids by maternal tissues?
a. Huma n chorionic gonadotropin (hCG)
b. Human placental lactogen (HPL)
c. Relaxin
d. Leptin
59 . Which of the following statements about placental transport is
true?
a. The placenta concentrates a large number of amino acids.
b. Large proteins are freely transferred across the placenta.
c. Copper levels are higher in fetal plasma than maternal plasma
because of carrier-mediated transfer.
d. Vitamin C crosses the placenta by simple diffusion.
60. Which of the following immunoglobulins crosses the placenta in
large amounts?
a. Immunoglobulin A
b. Immunoglobulin E
C. Immunoglobulin M
d. Immunoglobulin G
61 . Which of the following statements about fetal circulation is
correct?
a. Ventricles of the fetal heart work in series.
b. The oxygen content of the blood entering the left ventricle is
less than that entering the right ventricle.
c. The right atrium directs entering blood to the left atrium or
right ventricle depending on the oxygen content of the
blood.
d. Most of the right ventricular output enters the pulmonary
vasculature.

62 . Whe n do the distal hypogastric arteries undergo atrophy and


obliteration postnatally?
a. Day of life 1
b. 3-4 days after birth
c. 1 week after birth
d. 6 months of age
63 . The umbilical arteries become which of the following?
a. Ligamentum teres
b. Ligamentum venosum
c. Uterine ligaments
d. Umbilical ligaments
64 . Which of the following statements about immunoglobulin is correct?
a. Th e bulk of maternal IgG transport to the fetus occurs in the
second trimester.
b. Increased levels of IgM are found in newborns with congenital
rubella, cytomegalovirus infection, or toxoplasmosis.
c. The newborn acquires significant passive immunity from the
absorption of humoral antibodiesingested in colostrum.
d. Preterm neonates have an adequate amount of protective
maternal antibodies.
65 . Which of the following fetal activities, not present until 24 weeks, is
the last to develop?
a. Opening the mouth
b. Swallowing
c. Breathing
d. Sucking
66 . In regard to the passage of unconjugated bilirubin across the
placenta, which of the following is correct?
a. It only passes from the fetal to the maternal side.
b. It only passes from the maternal to the fetal side.
c. It is not exchanged to any significant degree between mother and
fetus.
d. It is bidirectional.

67 . Which of the following is correct in regard to fetal urine?


a. At term, the fetus produces 650 mL/d.
b. It is hypertonic with respect to fetal plasma.
c. Hemorrhage and hypoxia result in increased urine output.
d. Fetal kidneys start to produce urine at 6 weeks' gesta
tion.
68 . The limits of fetal viability are determined by which of the following
process?
a. Hepatic development
b. Fetal immunocompetence
c. Kidney formation
d. Pulmonary growth
69 . Which of the following statements regarding the sex- determining
region is true?
a. It is located on the long arm of the Y chromosome.
b. It directs development of the testis.
c. It is expressed in spermatozoa.
d. It is located on chromosomes 4 and 8.
70 . Which of the following stimulates the fetal testes to secrete
testosterone?
a. Follicle-stimulating hormone (FSH)
b . 5a-dihydrotestosterone
c. hCG
d. HPL
71 . In pregnancy, the midline of the abdominal skin be comes
especially pigmented and is called which of the following?
a. Melasma gravidarum
b. Lineaalba
c. Chloasma
d. Linea nigra

72 . By the third trimester, which of the following describes the maternal


basal metabolic rate?
a. Decreased by 5%
b. Increased by 10% to 20 % compared with the nonpregnant state
c. Increased an additional 25 % above normal pregnancy values in
women with twin gestations
d. None of the above
73 . Concerning iron requirements in pregnancy, which of the following
is true?
a. 500 mg of iron is required for normal pregnancy.
b. Of the iron requirement, 300 gm is used for the increased total
volume of circulating erythrocytes.
c. Iron requirements of pregnancy are usually not available from iron
stores in most women.
d. 500 mg of iron is transferred to the placenta and fetus.
74 . Concerning immunological function during pregnancy, which of the
following is true?
a. Th l response is suppressed.
b. There is up regulation of T-cytotoxic cells.
c. Th 2 cells are downregulated.
d. All of the above
75 . Concerning the coagulation system in pregnancy, which of the
following is true?
a. Fibrinogen levels are increased to a median of 300mg/dL.
b. Decreases in platelet concentration are solely due to
hemodilution.
c. Fibrinolytic activity is normally reduced.
d. Mean platelet count is 250,000/piL
76 . Which of the following is true concerning the liver and its proteins
and enzymes produced during pregnancy?
a. Liver size increases.
b. Albumin concentration increases.
c. Alkaline phosphate activity almost doubles.
d. Portal vein diameter remains unchanged.
77 . Which of the following is true concerning the gallbladder during

pregnancy?
a. It has reduced contractility caused by progesterone.
b. It empties more completely.
c. Stasis leads to formation of pyruvate-containing stones.
d. Cholestasis is linked to high circulating levels of progesterone.
78 . Concerning the pituitary gland during pregnancy, which of the
following is true?
a. Pituitary prolactinoma incidence is increased.
b. Compression of the optic chiasm sufficient to reduce visual fields
is rare.
c. Microadenomas usually measure > 15 mm.
d. None of the above
79 . Concerning the thyroid gland during pregnancy, which of the
following is true?
a. It undergoes enlargement through hypertrophy.
b. Free T4 increases its mean value by term.
c. Total T4 increases during pregnancy.
d.

Huma n chorionic gonadotropin (hCG), which mimics thyroidstimulating

hormone,

has

declining

levels

beginning

at

approximately 20 weeks.
80 . Concerning the parathyroid gland during pregnancy, which of the
following is true?
a. Increase in magnesium concentration stimulates release of
parathyroid hormone (PTH).
b. All markers of bone turnover increase.
c. Estrogen tends to facilitate the action of PT H on bone
resorption.
d. Calcium for the fetal skeleton is derived from exogenous sources.
81 . Concerning the adrenal gland during pregnancy, which of the
following is true?
a. It increases in 15% in size.
b. Its rate of Cortisol secretion increases.
c. It decreases aldosterone secretion significantly at 15 weeks.
d. Maternal plasma levels of androstenedione and testosterone
are increased.

82 . Of the four phases of parturition, phase 3 is characterized by which of

the following?
a. Activation b
b. Involution
c. Quiescence
d. Stimulation
83 . During phase 1 of parturition, which of the following is true regarding
uterine and cervical changes?
a. Rare uterine contractions, cervical ripening
b. Rare uterine contractions, cervical softening
c. Rhythmic uterine contractions, cervical ripening
d. Rhythmic uterine contractions, cervical effacement
84 . Of the following, which is a significant factor in the cervical changes
found during phase 2 of parturition?
a. Smooth muscle atrophy
b. Collagen disorganization
c. Smooth muscle hypertrophy
d. Decreases in low-molecular-weight hyaluronidase levels
85 . Compared with the uterine body, the cervix has a significantly lower
percentage of which of the following?
a. Collagen
b. Proteoglycans
c. Smooth muscle
d. Glycosaminoglycans
86 . Which of the following is the LEAST important to the normal
progress of labor?
a. Cervical position
b. Uterine conttactions
c. Resistance of maternal tissues
d. Maternal intra-abdominal pressure
87. Which of the following are considered plausible causes of uterine
contraction pain?
a. Myometrial hypoxia
b. Uterine peritoneum stretching
c. Compression of nerve ganglia in the cervix
d. All of the above

88 . Which of the following is the average amnionic fluid pressure (in mm


Hg) generated by contractions during phase 3 of parturition?
a. 20
b . 40
C. 80
d. 100
89 . To allow effective fetal expulsion, which of the following changes is
needed during labor?
a. Uterine anteflexion
b. Thickening of the levator ani muscles
c. Lengthening and narrowing of the uterine body
d. Thinning of the fundal myometrium and lower uterine segment
90 . After complete cervical dilatation, which of the following is the most
important factor in the expulsion of the fetus?
a.
b.
c.
d.

Uterine contractions
Perineal body elasticity
Levator ani tensile strength
Maternal intra-abdominal pressure

91. During stage 3 of labor, which of the following forces is the primary
mechanism for placental separation?
a. Gravity
b. Maternal pushing
c. Uterine contraction
d. Spiral artery pressure
92. Phase 4 of parturition is known clinically by what name?
a . Involution
b. Puerperium
c. Latent phase of labor
d. Active phase of labor

93 . Compared with skeletal muscle, uterine smooth muscle offers which


of the following advantages?
a. Generates forces along one axis
b. Has greater muscle fiber shortening
c. Displays more structured alignment of muscle fibers
d. All of the above
94 . Which of the following is important for myometrial contraction?
a. Extracellular magnesium
b. Actin-tubulin protein pairs
c. G-protein-coupled receptors
d. Gap junctions composed of decorin subunits
95. In most mammals, the implementation of phase 1 of parturition is
due to which of the following?
a. Cortisol withdrawal
b. Progesterone withdrawal
c. Inflammatory cell activation
d. Increases in oxytocin receptors
96 . Ritodrine and terbutaline bind to beta-adrenergic receptors to create
which of the following cellular responses?
a. Decreased cGMP levels to prompt cervical softening
b. Increased cAMP levels to prompt myometrial relaxation
c. Decreased intracellular Ca + levels to halt cervical ripening
d. Increased extracelluar Mg +

levels to halt myometrial relaxation

97. Which of the following is the initial and rate-limiting enzyme in


prostaglandin inactivation?
a. Cyclooxygenase
b. PhospholipaseA2
c. Prostaglandin isomerase
d. Prostaglandin dehydrogenase

9 8 . Nonsteroidal anti-inflammatory drugs affect myometrial activity


through which of the following actions?
a. Phospholipase A2 activation to create relaxation
b. Prostaglandin synthase inhibition to create relaxation
c. Prostaglandin isomerase inhibition to create contraction
d. 15-hydroxyprostaglandin dehydrogenase activation to create
contraction
99 . Mifepristone acts as an abortifacient through antagonism of which
of the following?
a. Cortisol
b. Estrogen
c. Progesterone
d. Prostaglandin E2
100 . In humans, which of the following placenta-derived hormones has
been strongly linked as a primary initiator ofparturition?
a. Oxytocin
b. Growth hormone variant (hGH-V)
c. Corticotropin-releasing hormone (CRH)
d. Growth hormone-releasing hormone (GHRH )