1 A 25-year-old woman who has normal, 28-day menstrual cycles visits her physician

for a routine physical examination. She is currently experiencing no complications

and is in excellent health. She is knows that she is at day 21 of her cycle. Which of
the following conditions is present during this stage of the cycle?
A. Lutheinizing hormone and follicle-stimulating hormone levels are low
B. Progesterone levels are low
C. The viscosity of the cervical mucus is low
D. The corpus luteum has involuted
E. Follicle-stimulating hormone levels are low, and luteinizing hormone are high

2 A healthy 25-year-old G1P0 at 40 weeks gestational age comes to your office to see
you for a routine OB visit. The patient complains to you that on several occasions she
has experienced dizziness, light-headedness, and feeling as if she is going to pass out
when she lies down on her back to take a nap. What is the appropriate plan of
management for this patient?
A. Do an ECG examination
B. Do 24 h monitor with a Holter to rule out arrhythmia
C. Do an arterial blood gas analysis
D. Refer her immediately to a neurologist
E. Encourage her not to lie flat on her back.

3 A 46-year-old woman visits her gynecologist and complains of hot flashes, irritability,
and amenorrhea. Her serum estrogen levels are very low. Considering her signs and
symptoms, the underlying cause of the amenorrhea is which of the following?
A. Decreased anterior pituitary function
B. Decreased posterior pituitary function
C. Decreased hypothalamic function
D. Decreased endometrial response
E. Decreased ovarian response

4 As a medical student, you have been asked to counsel a pregnant 26-year-old

woman. She has missed one period and was due to have her next period today. She
normally has a mentrual cycle of 28 days. Which of the following terms would you
use to most closely describe the developing conceptus:
A. Zygote
B. Morula
C. Gastrula
D. Embryo
E. Fetus
5 A patient comes to your office with LMP 4 weeks ago. She denies any symptoms
such as nausea, fatigue, urinary frequency, or breast tenderness. She thinks that she
may be pregnant because she has not gotten her period yet and is very anxious to find
out because she has a history of a previous ectopic pregnancy and wants to be sure to
get early prenatal care. Which of the following evaluation methods is the most
sensitive in diagnosing pregnancy?
A. No evaluation
B. Serum pregnancy test
C. Detection of fetal heart tones
D. Abdominal ultrasound
E. Bimanual exam to assess uterine size

6 A 38-year-old (gravida 0, para 0) woman is recently married and pregnant. The

zygote is a result of a haploid ovum fertilized by her husband’s sperm. Which of the
following is required for continuation of the second meiotic division to produce the
haploid ovum?
A. Elevation of progesterone titers
B. Expulsion from the mature follicle
C. The environment of the oviduct and uterus
D. Fertilization by a spermatozoon
E. The presence of human chorionic gonadotropin (hCG)

7 A couple is trying to conceive a child. Following intercourse, which of the following

is responsible for the prevention of polyspermy?
A. Resumption of the first meiotic division
B. Resumption of the second meiotic division
C. Capacitation
D. The zone reaction
E. The release of enzyme from the sperm acrosome

8 A 32-year-old oman present at her physician’s office complaining of nausea and

vomiting. The history reveals that her symptoms have been present for over a month
and that they seem to be worse in the morning. A urine sample is taken and shows that
 the woman is pregnant. Physiological changes that occur during pregnancy include
which of the following?
A. Decreased production of cortisol and corticosterone
B. Increased conversion of glucose to glycogen
C. Hypercapnia
D. Increased hematocrit
E. Reduced circulating gonadotropin levels

9 A 25-year-old female is treaed with a course of broad-spectrum antibiotics for severe

pelvic inflammatory disease. She now reports a thick milky white pruritic vaginal
discharge. Which of the following is the more prevalent microorganism in the vagina
and may also be protective?
A. α-Hemolytic Streptococci
B. B. fragilis
C. E. coli
D. Lactobacillus
E. S. Epidermidis

10 A 25-year-old primigavid woman at 42 weeks gestation delivers a 4 kg baby after

induction of labor with oxytocin. The first and second stages of labor lasted 14 and 3
hours, respectively. A midline episiotomy was done and the placenta appeared to be
intact. Ten minutes after delivery, she has vaginal bleeding estimated to be 500 ml
over a 5 minute period; the fundus is soft and boggy. Which of the following is the
most likely cause of the hemorrhage?
A Cervical laceration
B Disseminated intravascular coagulation
C Retained placental tissue
D Uterine atony
E Uterine inversion

11 Which of the following is the best immediate management of the probable cause of
this postpartum hemorrhage?
A Massage and compression of the uterine fundus
B Intravenous administration of 20 units of oxytocin
C Abdominal hysterectomy
D Uterine artery embolization
E Hypogastric artery ligation
12 A 18 years old woman came to ER with abdominal pain at the right lower quadrant
since 3 days ago. Initially her complaint resolved after she took paracetamol for her
pain, but after that pain was stabilized. She got menarche at 11 years old, regularly,
 28 days cycle, and the past menstruation only spotting. She unmarried but she had
done intercourse with her boyfriend. What is the next management?
A Intravenous analgetic
B Pelvic examination
C Hematological examination
D Pregnancy test
E Colposcopy examination

13 A 26 years old woman G1P0A0, 10 weeks pregnancy, came to Puskesmas for

antenatal care. Her blood pressure 150/90 mmHg, there was no proteinuria and no
edema. She had history of hypertension before she got pregnant. What is the most
likely diagnosis?
A Gestational hypertension
B Preeclampsia
C Eclampsia
D Superimposed preeclamsia
E Chronic hypertension

14 A 30 years old woman, G1P0A0, 18 weeks pregnancy, comes to Puskesmas with a

large amount of vaginal bleeding since 2 hours ago after she felt down at bath room.
She also complaint abdominal cramp. She still alert, BP is 100/70 mmHg, pulse 100
x/ minute. Speculum exam shows open ostium cervix with moderate bleeding comes
out of ostium. What is the most likely diagnosis?
A Abruptio placenta
B Placenta previa
C Bladder rupture
D Abortus insipiens
E Intrauterine fetal death

15 A 25 years old woman who is 39 weeks pregnant with her second child is having
regular uterine contractions every 3 minutes. Which criterion is best for assessing if a
parturient has entered the active phase of labor?
A The cervix is effaced over 90 %
B The contraction duration is over 30 seconds
C The presenting part is low in the pelvis
D The cervical dilation is at least 4 cm
E The membranes are ruptured
16 A 31 year old woman who is 29 weeks pregnant with her three child presents to the
obstetric unit with onset of painless vaginal bleeding 2 hours ago, accompanied by
passage of significant blood and clots. Fetal heart rate is regular at 140 beats/min. She
is having no uterine contractions. The best working diagnosis is
 A Vasa previa
B Bloody show
C Placenta previa
D Abruptio placentae
E DIC

17 A 27 year old woman in the thirty second week of pregnancy with her first child
presents with a blood pressure of 160/100 mmHg, 3+ proteinuria, edema and
confusion. Which medication would be indicated in the treatment of this patient?
A Indomethacin
B Magnesium sulfate
C Ritodrine
D Terbutaline
E Frusemide

18 A primigravida (16 years old) singleton term pregnancy with no previous antenatal
visit was referred to the hospital by a midwife with high blood pressure (170/110
mmHg) and severe edema. Further investigation had been done at the hospital. The
patient was found to have proteinuria+++, with normal coagulation and liver function
test. There was no complaint of cerebral and epigastric pain. What is the diagnosis for
this patient?
A Eclampsia
B HELLP syndrome
C Mild preeclampsia
D Gestational hypertension
E Severe preeclampsia

19 What is the risk factor for this patient?

A Proteinuria
B Term pregnancy
C Primigravida
D Hypertension
E Singleton pregnancy

20 What is the definitive management of treatment for this patient?

A Antihypertensive drug
B Antioxidant supplementation
C Diet
D Bed rest
 E Delivery

21 A 30 year old mother, has a 4 month baby, comes to dr. Kristin. After delivering baby,
she does not have any menstruation. She is afraid that she has been pregnant. Dr.
Kristin sends her to the laboratory to take pregnancy test. The result is negative. Dr.
Kristin explains that her menstruation is inhibited by hormone:
A Oxytocin
B Prolactin
C Thyroxine
D hCG
E Estrogen

22 She also asks why a pregnant woman does not have menstruation. Dr. Kristin explain
that in a pregnant woman, the menstrual system is controlled by a hormone below
which keep the function of endometrium:
A Oxytocin
B Prolactin
C Thyroxine
D hCG
E Estrogen

23 Keeping the function of endometrium means that the body must keep the existence
and function of the structure below:
A Follicle de Graff
B The mature ovum in the ovarium
C Corpus luteum
D Thecal cells
E Antrum of follicle

24 A 30 year old woman visits dr. Kristin with several complains. She missed her period
for several months. Insomnia because of headache and her sight become worse. Dr.
Kristin sends her to the laboratory for pregnant test, which the result is negative. Dr.
Kristin also found a change in funduscopic examination, and there is impairment of
visual field. Blood pressure 120/80 mmHg. According to dr. Kristin, the amenorrhea
condition of her patient is caused by:
 A The impairment of visual field
B The impairment of circadian rhythm
C Stress
D Pituitary tumor
E Insomnia

25 According to the picture, the transfer of nutrient and O2 from the mother circulation
to the fetal
A Directly through capillary
B Directly through venule
C Directly through lymphatic
system
D Through diffusion process
E Directly through intervillous
space

26 A 28-year-old woman had endometriosis that has resulted in significant scarring,

fibrosis, and blockage of both uterine tubes proximal to the ampulla. Her husband is
60 years old with a normal sperm count and motility. The most likely cause for this
woman’s infertility would be:
A Prevention of release of mature ovum
B Inability of sperm to enter the uterine os
C Husband’s abnormal sperm count and motility
D Lack of sperm at the normal fertilization site
E Inability of fertilized ovum to implant in the uterus

27 A 23-year-old woman, gravida 1, para 0, spontaneous abortions 1, has undergone

colposcopy for evaluation of a high-grade lesion found on Pap smear. The
squamocolumnar junction was visible in its entirety, and the endocervical curettage
was normal. A directed biopsy of the cervix revealed a 1-mm focus of invasion. The
next best step in management is:
A Radical trachelectomy
B Cryotherapy of cervix (Cryo)
C Cold knife conization of cervix (CKC)
 D Simple hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO)
E Radical hysterectomy (Rad Hyst)

28 A 19-year-old primigravida is expecting her first child; she is 12 weeks pregnant by

dates. She has vaginal bleeding and an enlarged-for-dates uterus. In addition, no fetal
heart sounds are heard. The ultrasound exam reveals a "snow storm" pattern and no
fetus. The most likely diagnosis of this woman’s condition is
A Sarcoma botryoides
B TB endometritis
C Uterus Adenoca
D Hydatidiform mole
E Ectopic pregnancy

29 A 25 year old female has had constant abdominal pain for several months. On
Physical examination reveals a right adnexal mass. An USG confirms the presence of
a 9 cm circumscribed mass involving the ovary .The gross appearance of the ovary
shows a cystic tumor with a mass hair in the lumen. The best diagnosis is :
A Serous cystadenoma
B Mucinous cystadenoma
C Cystic teratoma
D Dysgerminoma
E ChorioCarcinoma

30 The mother of a 4 year old girl notes that her daughter has blood stained under
wear.The girls is examined by gynecologist who reveals a soft, lobulated, fragile and
reddish mass that almost protudes from introitus. Which of the following conditions
is most likely to be present ?
A Mola Hydatidosa
B Sarcoma botryoides
C Squamous carcinoma
D Leiomyosarcoma
E Phylloides tumor
31 A 22-year-old primiparous woman is in premature labor at 30 weeks’ gestation.
Despite administration of tocolytic agents, it seems she will deliver soon. Pulmonary
maturity might be enhanced by the administration of which of the following drugs?
A Magnesium sulfate
B Betamethasone
C Hydroxyprogesterone
D Chloroprocaine
E Digitalis
32 A single, 30-year-pld woman presents to her physician with complain of a slightly
increased, malodorous vaginal discharge that is gray-white in color, thin, and
homogenous. Clue cells are discovered when the discharge is examined
microscopically. Which of the following organisms is the most likely cause of her
infection?
A Candida albicans
B Trichomonas vaginalis
C Escherichia coli
D Gardnerella vaginalis
E Staphylococcus aureus

33 A 37-year-old woman in her 32nd wk of gestation (G2P1) presents with a seizure.

She has been healthy and does not smoke cigarettes, drink alcohol, or use illicit drugs.
She has been poorly compliant in receiving her prenatal care. Physical examination
reveals a blood pressure of 150/95 mm Hg. The patient’s face and hands appear
edematous. Other than the patient being postictal (confused and disoriented after the
seizure), the neurologic examination is normal. Urinalysis reveals proteinuria. The
rest of the laboratory data is normal. Which of the following is the most likely
diagnosis?
A HELLP syndrome
B Preeclampsia
C Eclampsia
D Essential hypertension
E Primary seizure disorder

34 A patient presents for her first initial obstetrics visit after performing a home
pregnancy test and gives a last menstrual period of about 8 weeks ago. She says she is
not entirely sure of her dates, however, because she has a long history of irregular
menses. Which of the following is the most accurate way of dating the pregnancy?
A Determination of uterine size on pelvic examination
B Quantitative serum human chorionic gonadotropin (HCG) level
C Crown-rump length on abdominal or vaginal ultrasound
D Determination of progesterone level along with serum HCG level
E Abdominal circumference on abdominal ultrasound
35 A 20-year-old G1 at 38 weeks gestation presents with regular painful contractions
every 3 to 4 minutes lasting 60 seconds. On pelvic examination, she is 3 cm dilated
and 90% effaced; an amniotomy is performed and clear fluid is noted. The patient
receives epidural analgesia for pain management. The fetal heart rate tracing is
reactive. One hour later on repeat examination, her cervix is 5 cm dilated and 100%
effaced. Which of the following is the best next step in her management?
A Begin pushing
B Initiate Pitocin augmentation for protracted labor
C No intervention; labor is progressing normally
D Perform cesarean delivery for inadequate cervical effacement
E Stop epidural infusion to enhance contractions and cervical change

36 A 23-year-old woman presents to your office for a prenatal visit. She has not received
any previous prenatal care and does not know the date of her last menstrual period.
On physical examination, the fundal height is palpated to be at the level of the
umbilicus. Which of the following is the estimated number of weeks of gestation?
A 10 wk
B 15 wk
C 20 wk
D 25 wk
E 30 wk

Mrs. V, 28 years old, has delivered spontaneously a healthy full-term baby (weighed 3300
gram) two weeks ago. She has discharged three days after delivery with a good condition.
Today, she came to your clinic with bleeding vaginally about 3 full-napkins, with faulty
odour. Vital sign was normal, except temperature is 37,8 degree of Celcius. Breasts are
full with milk, no tenderness. Your gynecological examination finds the uterine fundus is
palpable about half umbilicus-symphisis pubis, perineum intact, faulty smell lochia rubra.
37 What is your working diagnosis for Mrs. V?
A Infection of perineal laceration wound
B Early post-partum hemorrhage
C Uterine subinvolution due to endometritis
D Breast enggorgement
 E Peritonitis

38 What is the management of the case above?

A Endometrial curettage
B Uterotonic and antibiotic
C Breast massage
D Perineum repair and antibiotic
E Antipyretic and antibiotic

39 A 22-year-old woman is noted to have hemorrhage due to ectopic pregnancy of the

isthmus of the left tube. Which of the following artery is ruptured?
A Branch of Uterine artery
B Pudendal artery
C Vaginal artery
D Vesical artery
E Internal iliac artery

40 A 1-year-old boy brought to your clinic by his mother with a complaint of difficulties
when urinating. On the examination of the penis you found a hole on the ventral part
near the frenulum, and there is leakage of urine from the hole. What is the most likely
diagnosis for this patient?
A Epispadia
B Bladder exsotrophy
C Cloacal exsotrophy
D Phimosis
E Hypospadia

41 A 7 years old girl , have poorly coordinated gait and trunk movement, lost hand skill
since 30 month old, stereotyped hand movement (hand-wringing or hand washing),
deceleration of head growth since 45 month old. Prenatal and perinatal development
is normal.
A. ADHD
B. Autistic Disorder
C. Asperger Disorder
D. Rett’s Disorder
E. Attention Deficits Disorder

42 A 6 years old boy have frequently eye blinking, head jerking and facial grimacing.
Some times coughing, grunting and sniffing. Since 6 months ago hitting himself.
Coprolalia and echolalia. What is your diagnose :
A. Pica
 B. Asperger Disorder
C. Rett’s Disorder
D. Gilles de la Tourette’s syndrome
E. Munchaussen syndrome

43 A 10 year boy have repetitive and persistent pattern of behavior since childhood. He
often bullies, threatens or intimidates others, often initiates physical fight, sometimes
use weapons, physical cruel to animal and people, destruction of property,
deceifulness and serious violation of rules. What is the diagnosis?
A. Oppositional defiant disorder
B. ADHD
C. Pica
D. Conduct Disorder
E. Mental retardation

44 A 5-year-old boy has problem repeated passage of feces into inappropriate places.
This event already repeated for 3 months. What is the diagnosis?
A. Enuresis
B. Pica
C. Echolalia
D. Encopresis
E. Emesis

45 A person 15 year old with intentional act of doing bodily harm to another person,
assault, rape, robbery and homicide. What is the diagnosis?
A. Suicide behavior
B. Passive-aggressive personality disorder
C. Histrionic personality disorder
D. Violent behaviour
E. Avoidant personality disorder
46. A 5 years old boy , have poorly attention, often difficulty in task schoolwork because
distractibility and often leaves seat in class room to disturb his friend. What is the
dignosis ?
A. Conduct Disorder
B. Asperger Disorder
C. Rett’s Disorder
D. Attention Deficits Disorder
E. Attention Deficits Hyperactivity Disorder

47. A girl 7 years old have problem learning exactly at reading lesson, she always make
wrong although repetition. The teacher often angry to hers and call her mother
because this problem. What is the diagnosis?
A. Discalculi
B. Disgrafia
C. Dislexia
D. Dislalia
 E. Ekolalia

48. A boy 3 year old have communication disorder, exactly difficulties with speech and
vocabulary and word, so his speak using simplified sentence. He truly have language
problem. His intelligence is normal, average 110.
What is the diagnosis ?
A. Receptive disorder
B. Expressive disorder
C. Phonological disorder
D. Stuttering Disorder
E. Mental retardation

49. If you, as a doctor, working in a hospital and receive in your outpatient department a
case whereby a child was brought by its mother who reported that the child fell down
from a chair and became black & blue, hematoma around whole body, from head to
toe, usually followed by multiple fractures. Mother seems to be worried, what sort of
question do you think is the most important to ask in the anamnesis which could lead
you to the right diagnosis?
A. What is the cause of this hematoma and the multiple fractures?
B. When did these happen? Day, date, time, and how?
C. How many times did these happen to the child?
D. Where usually the child being brought for treatment?
E. Is there somebody else besides mother when this happened? Who?

50. A 14 year old male, came to a psychiatric clinic brought by his grandparent because
since childhood he was very erratic and naughty, used to steal money from his
parents, and showed very unpredictable delinquent behavior, such as faking the marks
at school which were bad and tried to correct badly with correction liquid, so that
people would know it was being corrected by him. After some time his naughty
behavior seemed to increase and he used to run away from home, and he would keep
his feces in the cupboard when the family used to keep some food. He also began to
be abusive to mother by showing his penis to her and shouted ‘would you like this?’
What is the most likely diagnosis of this adolescent?
A. Simple adolescent delinquency
B. Adolescent delinquency with neurotic personality
C. Adolescent delinquency due to psychotic background
D. Pure neurotic personality disorder
E. Pure schizophrenic disorder
51. A 3 year old boy is having an involuntary or intentional wetting, usually we accept
that boy under a certain age still wet, at what age do we in medical profession accept
it as normal and beyond that we decide it as abnormal and would advise for
treatment:
A. 1 year
B. 2 years
C. 3 years
D. 4 years
E. 5 years

52. Which of the following treatment is most appropriate for the condition above?
A. Toilet training
B. Discipline
C. Spanking and scolding the child
D. Imipramine of 5-25 mg according to the child’s development
E. Just let it go until it stops by itself

53. A newborn is delivered at an estimated gestational age of 36 weeks by emergent

cesarean section for fetal distress. The maternal history is significant for prolonged
rupture of membranes. The infant has evidence of respiratory distress, and the chest
radiograph shows patchy infiltrates and pleural effusion, as indicated by obliteration
of both costophrenic angles. Which of the following is the most likely cause of these
chest radiographic findings in this infant is:
A. Hyaline membrane disease.
B. Meconium aspiration syndrome.
C. Neonatal pneumonia.
D. Pulmonary edema.
E. Pulmonary hemorrhage.

53. A 29-week-old, 1000-g boy is admitted to the neonatal intensive care unit, where he
receives routine care. He does well until day 5 of life, when he develops an increased
respiratory rate, mild subcostal retractions, and a widened pulse pressure, but no
cyanosis or increased oxygen requirement. A continuous murmur is heard along the
 left sternal border. Chest radiography shows pulmonary vascular congestion. Which
of the following medications may best relieve his symptoms?
A. Albuterol
B. Epinephrine
C. Indomethacin
D. Digoxin
E. Furosemide

54. A term, 3700-g infant is born vaginally without complications. At 24 hours of age, a
II/VI systolic murmur is noted in the mitral area that radiates to the back. A similar
murmur is noted in the right axilla. The infant is pink and breathing easily, and his
bedside chart shows that he has been taking 30 cc of formula approximately every 2
hours. Initial management should include which of the following?
A. Chest radiography, ECG, and four extremity blood pressures.
B. Immediate administration of prostaglandin E1.
C. Transfer to a neonatal intensive care unit.
D. Consultation by a pediatric cardiologist.
E. Discharge home with follow-up in the pediatric clinic at 3 days of life.

55. You are evaluating a 10-month-old girl who has had a temperature to 38.9°C for 2
days. Her parents deny other symptoms except a slight increase in fussiness. Her
immunizations are up to date.
Findings on physical examination are normal, and she appears well. Which of the
following tests is most helpful in establishing a diagnosis in this child?
A. Blood culture.
B. Chest radiograph.
C. Complete blood count.
D. C-reactive protein.
E. Urine culture.

56. You are taking call one night when a worried mother phones you because her 2-year-
old son had a temperature of 39.5°C, 1 hour ago that has not resolved with a dose of
acetaminophen. She reports that he is eating well and still playful, and she denies
other symptoms. Of the following, which is the most appropriate advice?
A. She should encourage fluids and monitor for the development of other
symptoms.
B. She should give another dose of acetaminophen immediately.
C. She should place the boy in a cool bath until his temperature is normal.
 D. The child needs immediate attention because the lack of response to antipyretics
indicates a serious bacterial infection.
E. The height of the fever indicates a bacterial infection, so antibiotics should be
given.

57. A 21-year-old pregnant woman has history of type 1 diabetes mellitus. Her blood
glucose has been poorly controlled throughout pregnancy, including the first
trimester. Fetal echocardiography is performed at 24 weeks of gestational age. Of the
following, the congenital heart disease most associated with maternal diabetes
mellitus present during fetal organogenesis is:
A. Coarctation of the aorta.
B. Pulmonary infundibular stenosis.
C. Tetralogy of Fallot.
D. Total anomalous pulmonary venous return.
E. Transposition of the great arteries

58. A 3-day-old infant with a single second heart sound has had progressively deepening
cyanosis since birth but no respiratory distress. Chest radiography demonstrates no
cardiomegaly and normal pulmonary vasculature. An electrocardiogram shows an
axis of 120° and right ventricular prominence. The congenital cardiac malformation
most likely responsible for the cyanosis is
A. Tetralogy of Fallot
B. Transposition of the great vessels
C. Tricuspid atresia
D. Pulmonary atresia with intact ventricular septum
E. Total anomalous pulmonary venous return below the diaphragm

59. A 3 month well baby boy full term is put to bed after breast feeding normally, infant
is placed on prone position on the flat surface of fluffy bed. When the caregiver check
the baby, the bay appear limp and cyanotic and apnea.
What is the most important risk factor for SIDS in this case
A. Male gender
B. Winter months
C. Prone sleeping position
D. Low birth weight
 E. Breast feeding

60. A 8 month baby came to you with history of vomiting and diarrhea, on examination
the baby shown lethargic and look pale, RR is 57x/mnt no retraction and good breath
sound, HR is 150x/mnt with weak pulse, capillary filling is 5 seconds
Which is the following diagnosis is most consistent in this case
A. Cardiorespiratory failure
B. SVT with poor perfusion
C. Hypovolemic shock
D. Acute Gastroenteritis without dehydration
E. Early septic shock

61. A 7 year old child come to you with history of fever for 5 days and on examination
noted the child in toxic looking, stridor, drooling of saliva, tachipnea and retraction
intracostal. What is the most diagnosis
A. Acute epiglotitis
B. Croup
C. Acute Pharyngitis
D. Pertussis
E. Upper airway obstruction due to foreign body
62. Baby born fullterm via caesarean section due to prolonged labour, body weight 3.500
grams, apgar score 9/9, 20 minutes after delivered baby become tachipnea and
cyanosis, RR 100x/mnt, HR 160 x/mnt and saturation oxygen < 70%. Analysis blood
gasses shown low PO2 35, on examination : baby conscious, cyanosis no murmur.
What do you want to do?
A. Intubation
B. Perform Hyperoxia challenge test
C. Insert umbilical catheter
D. CPR
E. Thorax photo

63. Baby was born per vaginam, cyanosis, no breathing effort, HR 80x/mnt, covered by
Meconium and from the amniotic fluid shown thick Meconium.
What do you want to do?
A. Inserted Umbilical cathether
B. Bagging and give oxygen 100%
C. Try to stimulate the baby by slap in the baby’s sole
D. Intubation and connect to ventilator
E. Suck the Meconium via oropharyng and trachea using Meconium aspirator

64. Baby born normally but after few minutes become cyanosis and tachipnoe, from hest
x ray show cardiomegaly and feature of egg on side.
What is the possibility?
A. Congenital pneumonia
B. Persistant Plmonary Hypertension
 C. Tetralogy of fallot
D. Transposition of Great Artery
E. Large Arterial Fetal Defect

65. Young mother 29 yo was delivered a 32 weeks baby and never given antenatal steroid
before,baby born pervaginam, baby boy 1.750 gram, a/s 6/9 crying and pink,
unfortunately after 30 minutes become tachypnoe and retraction and also shown
grunting saturation 70%.
What is the most possibility the baby’s problem?
A. Congenital heart disease
B. Pneumonia
C. Hyaline Membrane Disease
D. Meconium Aspiration syndrome
E. Transient Tacyphneu of the Newborn

66. A 4 year old boy suffers from an under-provision of its basic needs, both physical
& psychological, such as omission of care by parents, deprived of the necessary
food, shelter & clothing, emotionally deprived of attention, nurturing, love and
affection, medical care immunization, medication & surgery, then you would
categorize this child as:
A. Child abuse
B. Child neglect
C. Child torture
D. Child abandonment
E. Neonaticide

67. A 3 year old boy frequently soils her underwear at school. This conditition is an
inability to control the bowel. In a child, this anatomically is normal in lower part
of the digestive organ beyond a certain age. What is the treatment for this child?
A. Discipline
B. Spanking & scolding the child
C. By laxative medication & behavior management so that the can sit on the
toilet until the stools is coming out, and repeat it for several times until the
child is conditioned
D. By medicating with imipramine 5-25 mg according to the child’s
development
E. Just let it go until it stops by itself.

68. A 15-year-old boy comes to your office for a health supervision visit. He
expresses concern that he is only 125 cm tall and is not competitive in track. On
physical examination, he appears healthy, has a height of 62 in, and weighs 96 lb.
His testes are 8 mL in volume bilaterally, there is slight pubertal phallic
enlargement, and he has Sexual Maturity Rating 3 pubic hair. He has a small
 amount of subareolar breast tissue. His last health supervision visit was 2 years
ago. He did not have pubic hair at the last visit, and his testes were described as
"prepubertal" in size.
Which of the following is the MOST likely cause of his short stature?
A. constitutional delayed puberty
B. exercise-induced growth delay
C. Klinefelter syndrome
D. prolactinoma
E. undernutrition

69. A 16-year-old high school boy sustained an abrasion of the knee after a fall while
Rollerblading in the school yard. School records reveal that his last DPT booster was
at age 6. In this situation, which of the following is appropriate?
A. Tetanus toxoid
B. Adult tetanus and diphtheria toxoid (Td)
C. DPT booster
D. Tetanus toxoid and tetanus immune globulin
E. No immunization

70. The nurse calls you to evaluate a baby. The infant, born at 32 weeks’ gestation, is now
1 week old and had been doing well on increasing nasogastric feedings. This
afternoon, however, the nurse noted that the infant has vomitted the last two feedings
and seems less active. Your examination reveals a tense and distended abdomen with
decreased bowel sounds. As you are evaluating the child, he has a grossly bloody
stool. Which of the following management is most appropriate for this infant?
A. Surgical consultation for an emergent exploratory laparotomy
B. Continued feeding of the infant, as gastroenteritis is usually self-limited
C. Stool culture to identify the etiology of the bloody diarrhea and an infectious
diseases consultation
D. Stopping feeds, beginning intravenous fluids, ordering serial abdominal films,
and initiating systemic antibiotics
E. Upper GI series and barium enema to evaluate for obstruction