USULAN SOAL UJIAN SELEKSI

CALON PESERTA DIDIK SUB SPESIALIS FER

1. During the menstrual cycle the histologic appearance of the endometrium will change
significantly. During the first half of the menstrual cycle, the endometrium becomes
thicker and rebuilds largerly in response to …….. In the second half of the cycle the
endometrial arteries becomes spiraled in appearance, the gland produce vacuoles, and the
endometrium becomes more compact. This is in response to……
a. progesterone, estrogen.
b. FSH,LH.
c. Estrogen, progesterone.
d. LH, FSH.
e. GnRH, prolactin.

2.An ovary is is remove from frozen section pathologic examination. The ovary is
enlarged with small surface excrescences. Pathologic examination reveals numerous cyst
lined by epithelium with six to eight cell layers piled on top of one another to form the
cyst walls. The cells show marked cytologic atypia and nests of similar cells are present
in the ovarian stroma. Round laminated calcium bodies are also seen. This histologic
description indicates a diagnosis of
a. Normal proliferative phase follicle.
b. Corpus luteum cyst
c. ovarian endometriosis
d. Borderline ovarian carcinoma
e. Serous cystadenocarcinoma.

3. Which of the following best describes composition of nucleic acids such as DNA or
RNA?
a. a five carbon sugar, a nitrogen containing base and a phosphate
b. two purine bases and two pyrimidine bases
c. a double helix composed of interlocking codons
d. a combination of polypeptide proteins and protein isomers.
e. a base, a phosphate, and a sugar.

4. A patient presents with amenorrhea and galactorrhea. Her prolactin level are elevated.
She is not and never has been pregnant. In addition to evaluating her for a prolactinoma,
one also needs to evaluate for other causes that would increase prolactin such as elevated.
a. dopamine
b. gamma-aminobutyric acid
c. hystamin type II receptor activation
d. Thyrotropin releasing hormone
e. corticotrophin releasing hormone.
5. Which of the following sequences best describes estrogen action?
a. cell membrane diffusion, steroid receptor,-DNA complex formation, transcription,
translation
b. cell membrane receptor activation, steroid receotor DNA complex formation,
translation, transcription, transcription
c. cell membrane diffusion' steroid receptor-DNA complex formation, translation,
transcription
d. cell membrane diffusion, adenylate cyclase activation, cAMP production, protein
phosphorylation
e. cell membrane receptor activation, adenylate cyclase activation, c AMP production,
protein phosphorilation..

6. A year old menopausal patient wishes to stay on her oral contraceptive pill. Her health
care provider tries to explain that this provides more estrogen than she needs post
menopausally. What does of ethinyl estradiol is roughly biologically equivalent to the
typical post menopausal dose of 0,625 mg of conjugated estrogen.
a. 0,005-0,010 mg
b. 0,05 - 10 mg
c. 0,50 - 1,0 mg
d. 5,0 -10,0 mg
e. 50,0 - 100,0 mg.

The following clinical description should be used in answering question 7 through 8.

A mother and her 16-year old daughter present to your office because the daughter has
not yet menstruated. They are very concerned that something is wrong. By applying
principles of puberty to this patient, it is possible to determine if the teen is simply
undergoing a slightly delayed puberty versus potentially manifesting a significant
problem.

7. Which of the following pubertal events is not mediated by gonadal estrogen production
and therefore would occur even in the absence of estrogen production?
a. menstruation
b. pubic hair growth
c. breast development
d. skeletal growth
e. vaginal cornification

8. Which of the following causes of delayed puberty accompanies elevated circulating

gonadotropin levels?
a. Kallman's syndrome
b. Hypothalamic tumors
c. gonadal dysgenesis
d. malnutrition
e. chronic illness
.
The following clinical description should be used in answering question 9

A-47-year old patient present wondering if her problem s with mood swings, insomnia,
and vaginal dryness represent menopause.She had a hysterectomy 10 years ago for
abnormal uterine bleeding but the ovaries were not removed. Since she can not afford
hormonal testing, a maturation index is done on her pap smear.

9. Ideally, cytologic cells for evaluation of hormonal status should be obtained from
a. endocervix
b. lateral vaginal wall
c. posterior vaginal fornix
d. ectocervix
e. labia minora.

10. Prior initiating estrogen replacement therapy, the patient is counseled regarding the
long term risk of estrogen deficiency associated with menopause. These are osteoporosis
and cardiovascular disease. With osteoporosis the accelerated bone loss occurring 1-6
years after menopause
a. primarily affect cortical bone
b. causes increased urinay loss of phosphorous and hydroxyproline
c. causes an elevation in circulating parathyroid hormone levels.
d. does not influence trabecular bone.
e. none of the above.

11. This post menopausal patient is interested in estrogen replacement therapy ( ERT)
with progesterone but is concerned about its dangers. Which of the following statements
should be included in your discussion regarding the risks of ERT with combined therapy
relative to no ERT?
a. just as oral contraceptives may increase blood coaguability, ERT will also due to higher
doses
b. ERT may increase the risk of cholelithiasis
c. ERT may increase the risk of endometrial carcinoma
d. ERT is likely to greatly increase the risk of breast carcinoma
e. ERT may increase the risk of renal dysfunction..

12. A 35 year old woman wearing an IUD complains of amenorrhea of 5 weeks duration.
A serum pregnancy test is positive. Because of the presence of the IUD, this patient is at
significantly increased likelihood of
a. ectopic pregnancy
b. fetal malformation
c. spontaneous abortion
d. septic abortion
e. placental abruption
13.A 28 year old woman is seen for her first obstetrical visit. Her last menstrual period
(LMP) was 8 weeks ago. Her history is significant for infertility due to chronic
salpingitis and she required in vitro fertilization (IVF) with multiple embryo transfer. A
serum pregnancy test is positive. A transabdominal ultrasound shows a enlarge uterus
containing 5 viable fetuses. You advise her that the optimal outcome can be achieved
only with which of the following?
a. close supervision
b. embryo reduction
c. intramuscular prostaglandin
d. progestin therapy
e. termination of the pregnancy.

14. An 18 year old patient has not experienced menarche. Examination shows normal
breast development and absence of a uterus. Which of the following diagnostic tests is
most useful of determining the etiology of the amenorhhea?
a. serum follicle stimulating hormone
b. serum estradiol
c. serum testosterone
d. magnetic resonance imaging of the head
e. ovarian biopsy.

15. A 14 year old female complains of irregular vaginal bleeding. Her general
examination and pelvics organs are normal. The most likely cause of anovulatory
bleeding (DUB) in this patient is
a. hypothyroidism
b. pituitary adenoma
c. polycystic ovary syndrome
d. congenital adrenal hyperplasia
e. none of the above.

16. A 15 year old female is seen in the emergency room. She has a sudden onset of heavy
vaginal bleeding. She has noted irregular, painless vaginal bleeding, of 6 months
duration. Her past medical history is unremarkable and she is not sexually active. Her
local physician has previously determined that serum prolactin and TSH levels are
normal. Physician and pelvic examinations are normal, but blood is coming through the
cervical os. A serum pregnancy test is negative, and hematocrit is 37% (normal 35-37%).
The best course of immediate action is
a. observation
b. estrogen therapy
c. clomiphen citrate therapy
d. dilatation and curettage
e. hysterectomy.
17. Ambiguous genitalia at birth is caused by
a. exposure of the male fetus to inadequate androgen stimulation
b. exposure of the female fetus to excessive androgen stimulation
c. both of the above
d. neither of the above.

18. Prolactin secreting pituitary adenomas (prolactinomas) usually

a. diminish in size during pregnancy
b. increase in size over time
c. are symptomatic during lactation
d. impinge upon the olfactory nerve
e. respond to medical therapy.

Pubertas precox is puberty which started at (Years old),

a. < 16
b. < 14
c. < 12
d. < 10
e. < 8

52. Secondary amenorrhoe is a woman who, missed period at least,

a. 1 day
b. 1 weeks.
c. 1 cycle.
d. 2 cycles.
e. 3. Cycles.

53. Ovulation induction with clomiphene will probably be ineffective in women with:

a. Endometriosis
b. Polycystic ovary
c. Anovulation
d. Hypoestrogenism
e. Sheehan syndrome
54. In fifth day of menstrual cycle the following condition will be obtained:

a. Elevation of progesterone secretion

b. Estrogen secretion starts decreasing
c. LH secretion starts decreasing
d. FSH secretion starts decreasing
e. Endometrium at phase secretion

55. Prolactinoma cause,

a. Hypergonadotropin-Hypogonadism
b. Hypogonadotropin-Hypogonadism
c. Abnormal Uterine Bleeding.
d. Risk of breast cancer, increase
e. Risk of osteoporosis, decrease

56. These hormone are produced in hypothalamus,

EXCEPT:

a. Prolactin Inhibiting Hormone.

b. Growth Hormone Releasing Hormone.
c. Cortocotrophin Releasing Hormone.
d. Thyrotrophin Stimulating Hormone.
e. Gonadotrophin Releasing Hormone

57. These statements are correct about the impact of GnRH,

EXCEPT:

a. Cause gonadotrophin secretion in pulsatile manner

b. Stimulate GnRH receptors production in pituitary.
c. Pituitary more sensitive to the next stimulation.
d. Enhanced by inhibin B
e. Stimulate both FSH and LH production.

58. This hormone have membrane receptors,

 a. Estrogen.
b. Progesterone
c. FSH
d. Testosterone.
e. Androstenedione.

59. This hormone is produced by pituitary

a. Adrenocorticotropin hormone
b. Thyrotropin releasing hormone
c. Growth hormone releasing hormone
d. Prolactin inhibiting hormone.
e. Gonadotropin releasing hormone

60. The following statements are correct about

estrogen at early follicular phase, EXCEPT:

a. Produced by granulosa cells

b. Negative effect to FSH secretion.
c. Positive effect to LH secretion
d. Androgens are the percusors
e. FSH stimulate the production

61. At normally cycles, the follicle dominant was selected at day (of cycle),

a. V
b. IX
c. XI
d. XIV
e. III

62. Follicle dominant has characteristic as followed,

EXCEPT
 a. Has highest estradiol level.
b. At selected day, have diameter > 18 mm
c. A lot of granulosa cells
d. More FSH receptors
e. Dominant estrogen microinvironment

63. This hormon contribute to select follicle dominant,

a. Inhibin –
b. Estrogen
c. Progesterone
d. Activin
e. LH

64. 64. The requirement of estradiol level for gonadotrophin surge is

a. < 50 pg/mL
b. <70 pg/mL
c. >100 pg/mL
d. >150 pg/mL.
e. >200 pg/ml

65. Steroid hormones are classified as

a. Amino acids
b. Phospholipid
c. Lipids
d. Glycoprotein
e. None of the above
66. Initial recruitment of follicles is,

a. Gonadotrophin dependence
b. Started immediately post natal.
c. Stop at pregnancy.
d. Enhanced by ovarian hyperstimulation.
e. Inhibited by Anti Mullerian Hormone

67. Menarche is,

a. The beginning of H-P-O axis.

b. The beginning of puberty.
c. The starting of initial recruitment.
d. Occurred after thelarche
e. Occurred before pubarche

68. These hormone can be used to predict the ovarian reserve, EXCEPT:

a. Inhibin- A
b. Follicle Stimulating Hormone
c. Estradiol
d. Anti Mullerian Hormone.
e. Antral Follicle Count.

69. Amenorrhea with elevated level of serum FSH , its mean there is disorder at :
 a. Hypothalamus.
b. Pituitary.
c. Feed Back mechanism.
d. Ovary
e. Uterine

70. These statement are correct about Turner syndrome, EXCEPT:

a. Amenorrhea
b. Short stature
c. Has webbing of neck.
d. Hirsutism
e. Wide-spaced nipples
1. This statement is related to Testicular feminization syndrome,

a. Hirsutisme.
b. Normally serum FSH
c. Elevated serum LH.
d. Elevated serum estradiol.
e. Short stature

72. Meyer Rokitansky Kusner Hauser syndrome can deferentiated to testicular feminization syndrome
measuring serum,

a. hCG.
b. FSH
c. LH.
d. Testosterone
e. Prolactin

73. Posterior pituitary produces hormone:

 a. Prolactine
b. TSH
c. LH
d. Inhibin
e. Vasopresin

74. Anti Mullerian Hormone (AMH) is produced by

a. Granulosa Cells
b. Theca cells
c. Ovarian Stroma
d. Oocyte
e. Sperm

75. A contraceptive method should be initiated:

a. In the first post partum month if breast feeding

b. In the third post partum week if breast feeding
c. In the first postpartum week if not breastfeeding
d. In the third postpartum week if not breastfeeding
e. In the third postpartum month if not breastfeeding

76. Cardioprotective actions of estrogen may include:

a. depression of high-density lipoprotein (HDL) levels

b. Dilatation of coronary vessels
c. Elevation of LDL levels
d. Production of thromboxane
e. Widening of pulse pressure

77. Besides infertility, the most common symptom of a luteal phase defect is:
 a. vaginal dryness
b. spontaneous miscarriage
c. tubal occlusion
d. breast tenderness
e. Ovarian enlargement

78. Fertilization between sperm and oocyte placed at:

a. Fallopian tube
b. Uterine
c. Ovarium
d. Cavum douglas
e. Cornu uterine

79. The goals of the treatment PCOS, EXCEPT:

a. Induction of ovulation to achieve pregnancy

b. Reduces the productionand circulating levels of androgens
c. Protect the endometrium against the effects of unopposed estrogen
d. Avoid the effects of hyperinsulinemia on the risk of cardiovascular diasease and
diabetes mellitus
e. Avoid ovarial malignancy

80. Luteinizing hormone (LH) and human chorionic gonadotropin (hCG) have similar biologic activity
for which of the following reasons?
 a. Their β-subunits have 80% homology
b. They have nearly homologous α-subunits
c. They are produced by the same pituitary cell type
d. They are converted to the same amino acid sequence
peripherally
e. They produced by placenta
81. Which of the following hormones is the primary androgen and/or androgen precursor
produced by the ovary?

a. Testosterone
b. Androstenedione
c. Dihydrotestosterone (DHT)
d. Dehydroepiandrosterone sulfate (DHEAS)
e. Dehydroepiandrosterone (DHEA)

82. Which of the following will most likely increase circulating sex hormone-binding globulin (SHBG) levels?

a. Insulin
b. Estrogen
c. Androgens
d. Progestins
e. Inhibin

83. Spinnbarkeit describes the

a. Amount of cervical mucus

b. Clarity of cervical mucus
c. Elasticity of cervical mucus
d. Ferning of cervical mucus
e. Viscosity of cervical mucus

84. Which of the following potentiates the release of prolactin from the anterior pituitary
gland?
 a. Dopamine
b. Thyrotropin-releasing hormone
c. Gonadotropin-releasing hormone
d. Corticotropin-releasing hormone
e. ACTH

85. At what stage of the female life is the highest number of oocytes found in the ovary?

a. Age 35
b. At birth
c. At puberty
d. In utero at 5 month’s gestation
e. At luteal phase

86. Meiosis I of the oocytes is completed at which of the following times?

a. Birth
b. Puberty
c. Ovulation
d. Fertilization
e. Conception

87. Steroidogenesis in the corpus luteum is mainly under the control of which of the following hormones?

a. Luteinizing hormone
b. Follicle-stimulating hormone
c. Activin
d. Follistatin
e. Relaxin

88. Formation of endometrium pinopods,important for embryo implantation, is dependent on which of t

following hormones?
 a. Estriol
b. Cortisol
c. Estradiol
d. Progesterone
e. Androstenedione

89. How long does the spermatogenesis process take, starting from stem cell to mature sperm?

a. 10 days
b. 30 days
c. 60 days
d. 90 days
e. 100 days

90. The left ovarian vein drains into the

a. Inferior vena cava

b. Left renal vein
c. Left external iliac vein
d. Inferior mesenteric vein
e. Left Internal iliac vein