Final MDE Reproductive System Twinning 09 Part 2

1. 33 years old with positive B-HCG test, which cell produced this homone? A. Inner multinucleated cytotrophoblast B. Outer multinucleated cytotrophoblast C. Inner mononucleated syncytiotrophoblast D. Outer multinucleated syncytiotrophoblast E. Decidua 2. HCG showed adhesion in widest part of uterine tube.which part affect this problem? A. Ostium B. Isthmus C. ampulla D. Intramural E. Fimbriae 3. primary oocytes surround by one or more layers of cuboidal granulosa cells and zona pellucida.what is that follicle? A. Primary follicle B. Primordial follicle C. Secondary follicle D. Mature follicle E. Graafian follicle 4. Anti spermatozoa antibodies cause male infertility by mechanism? A. Agglutinate spermatozoa B. Reduce sperm ability to penetrate ovum C. Block sperm on cervix D. Immobilize spermatozoa E. All correct 5-8 9. What is d microscopic feature of complete dyhatidiform mole? A. B. C. D. E. slight trophoblastic proliferation adequate a/vascularization of villi? hydrophic swelling of villi shows tissue from fetus focal edema of villi

10. Which one is NOT a risk factor of getting aneuploid infant? A. B. women who prev. carried a fetus w triple X(47XXX) or klinefelter synd.(47XXY)

TWP 09, MDE/Repro/Final/P2

C. D. E. 11. Primordial germ cells 1st appear at an early stage of development among endodermcells in d wall of yolk sac n migrate by ameboid movement of gonad.Which one of following cell follows d pathway stated above ? A. B. C. D. E. follicle cell oogonia sertoli cell leydig cell epithelial cell

12.which one is CORRECT about amniocentesis? A. B.risk for infection 3.7% C. D. 13. specific fetal indication for pericutaneous umbilical cord exam A. B. C. D. 14. Fetal development at the end of 8 weeks A. morula B.blastocyst C. embryo D. fetus 15. during gasturation..... A. gastrula B. morula C. embroblast D.fetus 16.? 17. A 25 years old pregnant women LNMP: 25 december 2006 EDD: ??? A. 1 September 07 B. 2 September 07 C. 1 October 07

TWP 09, MDE/Repro/Final/P2

D. 2 October 07 18. High volume of amniotic fluid associated with CNS. Which cause above condition A.Esophageal atresia B. obstructive uropathy C.renal agenesis D.idiophathic polyhydramion E.umbilical compression 19. amniotic fluid has function in normal development of fetus. What function amniotic fluid A.prevent adherence decidua parietalis to embryo /fetus B.permit normal lung development C.control maternal body temperature D.Permit asymetrical external growth of fetus &embyo 20.Which of reason is descripe reason for varicoele occur for more commonly as isolated A. left internal spermatic vein (LISV) shorter than right SIV (RISV) B. absence of incompetence valve within RSIV C. oblique angle insertion of LSV into renal vein D. high hydrostatic pressure within LSIV m result from nutcracker phenomena E. result from compression of left renal vein between superior mesenteric artery and inferior mesentric artery 21.During late state of pregnancy, which separates maternal blood from fetal blood? A. B. C. D. E. Syncytiotrophoblast Cytotrophoblast Syncytiotrophoblast and cytotrophoblast Syncytiotrophoblast, cytotrophoblast, connective tissue and blood Syncytiotrophoblast and fetal connective tissue

22.Which layers form the amnion? A. B. C. D. E. Syncytiotrophoblast Trophoblast Cytotrophoblast Hypoblast and epiblast Epiblast and amnioblast

23.Which period is most highly sensitive for critical periods in human development for inducing birth defects? A. B. C. D. 1-2 weeks 3-8 weeks 9-14 weeks 5-20 weeks

TWP 09, MDE/Repro/Final/P2

E. >20 weeks 24.Which parts will form the placenta? A. B. C. D. E. 25-28? 29. A 30 year old woman, 12 weeks pregnancy, have vaginal bleeding last 2 days due to lack of hormone level in blood. What type of hormone that cause bleeding? A. dehydroepiandrosterone B. 17- estradiol C. progesterone D. estrone E. estriol 30. Hormonal regulation of testosterone biosynthesis which stimulate by LH, is mediated by elevation of intracellular c-AMP through acute and chronic effect. Which is chronic effect of c-AMP on regulation? A. increase transcription of gene encodes steroidogenic enzyme B. activation of adenylate cyclase C. activation of protein kinase enzyme D. phosphorylation of cellular protein E. induction of sTAR protein 31. Testosterone is major secretory product Leydieg cell. It is directly synthesized by: A. cholesterol B. progesterone C. 17- estradiol D. pregnenolone E. androstenedione 32. What enzyme that catalyze cholesterol to pregnenolone? A. aromatase B. 17- hydroxylase C. 3-OH dehydrogenase D. 17-OH dehydrogenase E. cyt p450 33-36? 37. choose the correct statement about menstrual cycle A. on day 1-5 estrogen and progesterone are low B. on day 7 the dominant follicle is selected Decidua basalis & smooth chorion Decidua parietalis & chorion frondosum Decidua capsularis & villous chorion Decidua basalis & chorion frondosum Decidua capsularis & smooth chorion

TWP 09, MDE/Repro/Final/P2

C. on day 7-12 plasma estradiol increase because of secretion by coronal cell surrounding the dominant follicle D. on day 14 ovulation occur before LH surge E. on day 25-28 corpus luteum secretion is dominant, plasma estradiol and progesterone concentration increase 38. exhibit progesterone secretion during an ovulatory menstrual cycle A. [graph] B. [graph] C. [graph] D. [graph] E. [graph] 39. the only one of the following hormone that is produced other than the placenta A. HCG B. oxytocin C. HCS D. estrogen E. progesterone 40. in a normal healthy young women with a menstrual cycle of 28 days A. the proliferative phase of the uterus is caused by the estrogen produced by the Graafiaan follicle B. menstruation is caused by progesterone from the corpus luteum C. oral estrogen and/or progesterone will caused on enlargement of the ovary and an increase in production of mature secretion follicle D. the concentration estrogen in the plasma begin to fall at ovulation and continue to fall until menstruation E. the concentration of progesterone in the plasma begin to fall at ovulation and continue to fall until menstruation 41. During pregnancy : A. B. C. D. A. E. Spontaneous contraction of uterus are usually absent until 36th weeks. Breast enlarge because of release of prolactin from the anterior pituitary. The oxygen concentration in umbilical artery exceed that in umbilical vein. The blood in umbilical vein has an oxygen concentration similar to or greater than the blood in an average systemic vein of mother. hCG reach a peak at 2-3 month gestation, then decline.

42. Concept of placenta as an endocrine, autocrine and paracrine organ in fetals life can provide some hormonal changes. Which of the following organ play an important role in the endocrine function of placenta? A. Kidney B. Adrenal C. Heart D. Liver

TWP 09, MDE/Repro/Final/P2

E. Ovary For question 43-45, please refer to the scenario below. A 28 years old woman with previously regular menstrual cycle since 12, she had accident that nearly that nearly caused her drowning about 10 years ago. After the accident, she frequently has recurring nightmares, her period gradually become irregular and ceased completely since 6 years ago. 43. Which of the following hormone most likey cause this condition? A. Progesterone B. Luitenizing Hormone C. Cortisol Releasing Hormone D. Gonadotrophin releasing Hormone E. Growth hormone Releasing hormone 44. After 1 year treatment, the patient has normal menstrual cycle. Which of the following hormonal changing happen? A. Prolactin & FSH B. Androgen & LH C. CRH & FSH D. TRH & LH E. LH & FSH 45. The patient undergoes sonographic examination for therapy follow up at day 21 from the last menstrual cycle. Which of the following finding can be found from the gynaecologic scanning? A. Primary follicle growth and develop to secondary follicle B. Functional endometrium and gland C. Secondary follicle develop to Graafian follicle D. Necrotic endometrium from previous cycle is shed E. Endothelial glands start to create and become tortuous Question 46 and 47 A 21 years old woman with normal menstrual cycle came to gynaecology clinic complaining about mild lower abdominal pain 2 weeks after menstrual. 46. Which of the following was the most likely cause of these conditions? A. Dysmenorrhoeal B. Estrogen deficiency C. Premenstrual syndrome D. Progesterone withdrawal E. Rupture of Graafian follicle 47. Which of the following hormone changes is happened in this condition? A. Estrogen increase, progesterone decrease B. Estrogen and progesterone both increase C. Estrogen and progesterone both decrease

TWP 09, MDE/Repro/Final/P2

D. Estrogen and progesterone both decrease E. Estrogen decrease, progesterone increase 48. 28 years old women in 39 weeks gestational age come to emergency felling regular contraction. There is no water or bloody release from vagina. Which of the following changes is initiating the contraction? A. Increase HCG concentration B. Increase prolactin concentration C. Increase estrogen concentration D. Decrease progesterone concentration E. Decrease oxytocin concentration 49. Major found in partial hydatidiform mole A. triploid B. tetraploid A. C.diploid 50. 17 yrs old women missed her menstrual period this month,normally her period is at 8th-10th each month,but now already 20th day.she has regular 28 days cycle.she also feel nausea,vomit,fatigue,breast discomfort. What are abnormalities on her? A. B. C. D. E. Missing period,nausea,vomiting Excessive vomiting,low turgor Nausea,vomit,fatigue Fatigue,vomiting,uterine enlargement Missing period,breast discomfort,fatigue

51. Naegles formula? A. B. C. D. E. +7 to LMP,-3 month -14 to LMP,-3 month +14 to LMP,-3 month -7 to LMP,-3 month none is correct

52. Best test for her? A. B. C. D. E. A.x-ray USG hormone assessment magnetic resonance imaging(MRI) E histopathilogic findings

53. Positive sign for pregnancy A. Cessation of menses B. Perception of active fetal movement by the examiner

TWP 09, MDE/Repro/Final/P2

C. Exchange in size of uterus D. Positive pregnancy test E. Increase skin pigmentation 54. Which statements fits characteristic of gonococcus A. Can be observed by dark field microscope B. Never stays intracellular C. Easily grows on simple culture media D. Gram negative diplococci E. Can grow in an obligate anaerobic condition 55. 32 y.o women suffer lower abdominal pain and vaginal discharge. Symptom frequently occur during or after menses. Doctor in charge finds out that the cervix appears red, and bleeding easily and mucopurulent discharge, yellow-green swab shows gram negative diplococcic, intracellular. Medium of culture? A. Mc Conkey agar B. Nutrient agar C. Blood agar D. Thayer Martin agar E. Mueller Hinton agar 56. 28 y.o women was taken to the hospital on last 2 days. 3 days ago, she delivered a baby assisted by midwife. On examination, doctor found uterus soft, large and tender. Profuse lochia and molodorous. Gram stain lochia shows gram positive coccus in cluster. Which is the most appropriate cause? A. Gonococcus B. Streptocossus C. Staphylococcus D. Pneumococcus E. Enterococcus 57. A young women visits a clinic because itching, burning vulvar, with thick and white discharge. doc do wet mount exm of vaginal dischargewith KOH solution. Result show budding yeast. which is the medium for organism? A. nutrient agar B. Mc Conkey agar C. Blood agar D. subaroud agar F. chocolate agar No. 58-60 refer to this situation: A newborn is brought to hosp. because of jaundice. doc in charge found hepatosplenomegaly, thrombocytopenia, microcephaly and retinitis. doc thought mom got viral infection during pregnancy.

TWP 09, MDE/Repro/Final/P2

58. which is the virus? A. B. C. D. E. varicella-zoster virus morbilli virus CMV coxsakie virus rubella virus

59. which Ig to detect current infection? A. B. C. D. E. 60? 61. Vaginal specimen are taken...ph>4.5 , presence of clue cell in saline wet mount. E. Trichomonas vaginalis 62.Reliable syphilis VDRL (1:4) in his serum...?? C.FTA/ABS/MHA should be done to establish for past syphilis 63.Causative bacteria diplococcus, mucopurulent...??? B.Nesseria gonorrhoea. 64. Medium for Nesseriagonorrhea?? B.Thayer Martin agar. 65. GIP0A0, 18 year old ,present in MHCH with severe headache and blurred vision. She first discovered that her blood pressure increased markedly at that time , it is 180/110mmhg. Baby in tranverse lie. Fetal heart rate normal. Mother given MgSO4, caesarean section is performed and a preterm baby born of 35 week gestational agea and weight 1800g was delivered.During resuscitation, baby is pale, limp, gasping, no response to stimuli ang heart rate 110bpm. The risk MgSO4 administration in this baby is? A. B. C. D. E. tetany jittery respiratory distress convulsion hypertensive Ig A Ig D Ig E Ig G Ig M

66. 28yo women in 30th weeks of gestation age complain fever. chill, back pain, burning sensation during urination. Gave birth to premature infant. No meconium , resuscitation

TWP 09, MDE/Repro/Final/P2

success, but 2nd day the baby emerge signs of neonatal sepsis , most common early onset of sepsis in A. B. C. D. E. E.coli B.GBS pneumococcal lysteria monocytogenes pseudomonas aeruginesa

67. Which of the following maternal n neonatal factor will increase the infants risk of early onset neonatal sepsis? A. B. C. D. prolonged rupture membrane maternal fever more than 90 farenheit maternal collonization with e. coli 5 minute APGAR score less than 9

Refer to this situation for question 68-70 : baby normal APGAR n weight 2000 g, length 43 cm, GA: 37 weeks and 3 days later the baby got jaundice 68.? 69. The management of this baby during neonate period is A. B. C. D. E. Preventing hyperthermia and infection Administer Vitamin K and mechanical ventilation Artificial feeding and fluid therapy Caring for cord and oxygen therapy Monitoring body weight and vital sign

70. What is pathophysiology of jaundice in this baby? A. B. C. D. E. Increased billirubin production following breakdown of fetal RBC Increased billirubin conjugation by liver Inhibit glucoranyl transferase enzyme due to asphyxia Lack of intestinal bacteria due to LBW Intestinal obstruction due to neonatal infection

71. Selected teratogens that cause Amelia A. B. C. D. E. Phenytoin Thalidomide Retinoic acid Alcohol Warfarin

72. Abnormalities on neck and shoulder cause by traumatic delivery A. Sublageal hemorrhage B. Horners syndrome C. Erbs paralysis

TWP 09, MDE/Repro/Final/P2

D. Subcutaneous fat necrosis E. Dislocation

73-80 81. For evaluation of the risk of the breast in women, which of the factor is least important? A. menarche B. family history C. Menopause D. 1st pregnant E. cigarette

82. Women with reddish nodule and tubercle with necrosis cell. What is the diagnosis? A. mastitic tuberculosis B. fat necrosis 83. Women with 3cm lump at upper lateral right breast with malignancy criteria & peau de orange . What is the diagnosis? A. invasive ductal carcinoma B. ductal carcinoma in situ C. lobular carcinoma D. invasive lobular carcinoma E. muccinous carcinoma 84. Microscopically, villous invade myometrium & present of avascular hydropic cell with cytotrophoblast & syncytiotrophoblast. A. choriocarcinoma B. partial hydatidiform mole C. complete hydatidiform mole D. invasive mole E. placental site trophoblastic tumor 85. If it a benign lession, what is the common benign breast Tumor A. Fibroadenoma B. ? C. ? D. ? E. ?

TWP 09, MDE/Repro/Final/P2

86.If there a lession, and there are fat necrosis in the space of intra lobular. What are the type of breast disease? 87.If it show a malignant lession, what is the most common malignant type. 88. Macroscopically, tissue sample show bunch of grape, no fetal parts & microscopically, shows scallope villi, hydropic degeneration,proliferate trophoblast. A. abortion B. complete hydatidiform mole C. partial hydatidiform mole D. Choriocarcinoma E. placenta site trophoblastic tumor

89. Macroscopically, tissue sample contained blood clot & necrotic tissue, no fetal parts were seen & microscopically, tissue consist villi, decidual cells & blood clot. A. abortion B. complete hydatidiform mole C. partial hydatidiform mole D. Choriocarcinoma E. placenta site trophoblastic tumor 90. Macroscopically, tissue sample contained blood clot & necrotic tissue, no fetal parts & microscopically, tissue consist necrotic & atypical syncytio & cytotrophoblast & no villi were seen. A. abortion B. complete hydatidiform mole C. partial hydatidiform mole D. Choriocarcinoma E. placenta site trophoblastic tumor 91. Macroscopically, the tissue sample contain blood clot, necrotic tissue and no fetal part. Microscopically, necrotic and hyperblastic intermediate, no villi or other trophoblast. A. Abortion B. Complete hydatidiform mole C. Partial hydatidiform mole D. Choriocarcinoma E. Placental site trophoblast tumor

92. 19 years old woman gave birth to a healthy male infant at term. Already breastfeed the baby for a month. The breast become swollen and painful to touch a few weeks ago. Her body temperature is 38C.

TWP 09, MDE/Repro/Final/P2

A. Acute mastitis B. Fibrocystic change C. 93 ? 94.curretage is performed because bleeding from vagina,tissue sample shows dilated villi with hydropic degeneration and some of the villi is normal.trophoblast cell are proliferative.which type of trophoblast might show this disease A. Cytotrophoblast B. Syncytiotrophoblast C. Intermediate trophoblast D. Cytotrophoblast and syncytiotrophoblast E. Atypical trophoblast

95.Strongest evidence of ectopic from tissue sample are A. Necrotic tissue and blood vessel B. Decidual tissue and villi chorialis C. Endometrial glands D. Proliferation of vascular endothelial E. None of above correct 96.Risk factor for breast cancer is A. Low fat diet B. Early menopause C. Late menarche D. Giving birth to 1st child at 35 E. Family history with any cancer 97-99 ? 100. What is ritual change for human life cycle.. 101. Which of the following is the characteristics of popular sector?? 102. The study of man and social and culture??? p/s : tuk soaln2 nie ,sume psl MEDICAL ANTHROPOLGY..bce insyaallh leh jwb..sory xlengkap...:) 110. What is meaning of "prestige food"? A.easy to obtain B. C.

TWP 09, MDE/Repro/Final/P2

D. Dark colour food E. Light colour food 111-113 ? 114. Cause specific mortality rate for lung cancer in district X A. 0.45 B. 0.45 per 1000 C. 45 D. 45 per 1000 E. 4.5% 115. proportionate mortality ratio(PMR) A. 0.45 B.0.45 per 1000 C.45 D.45 per 1000 E.4.5% 116. most likely ease fatality rate for lung cancer A.45 B. 45 per 100 000 C. 45 per 1000 D. 45 per 100 E.45 per 50=90%

117.from 1000 birth in subdistinct X,7 babies die because stillbirth and 15 babies die under one week of age. What is the perinatal morbidity rate? A. num of death of infant under one week of age B. num of death infant under 28 days of age C.num stillbirth/total num of birth D.num death under one week of age/total num birth E. num of stillbirth+death under one week of age/total num birth

118119base on this statement. 85200 people Life birth:2000 Stillbirth:30 Death under one week:12

TWP 09, MDE/Repro/Final/P2

Neonatal death:50 Post neonatal death:40 118.still birth rate? A. 30 B.30 per 1000 C. 30 per 85000 D. 30 per 2000 E. 30 per 2030 119.perinatal mortality rate? A. 12 per 2000 B. 12 per 2030 C. 42 per 85000 D. 42 per 2000 E. 42 per 2030 120.success hiv prevention depend on changing risk behavior. One of promotion effort for sexually active people? A. delay 1st intercourse B. increase condom use.decrease sex partner C. reduce needle share D. forbid intercourse before marriage E. provide condom in prison 121. Local government authorities (LGA) has important role in taking action against epidemic of HIV/AIDS. Why should LGA address HIV/AIDS? A. LGA is the only one institution who has resources to fight against HIV/AIDS B. LGA is chosen by people C. LGA are responsible for the social & economic development of the communities they serve through the delivery of many services D. Fight against HIV/AIDS need authorities permission E. Every country has their LGA to fight against HIV/AIDS 122.? 123)A mother stop breastfeeding her baby because she wants to have anohtr one. She substitute th breast milk with water and sugar which is low in quantity n quality of protein. What will happen to th child? A. Kwashiorkor B. Marasmus C. Gigantism D. Obesity E. Under nutrition

TWP 09, MDE/Repro/Final/P2

124)community program development comprises of A. Planning,implementing,evaluating B. Planning and implementing C. Assessment and planning D. Assessment , planning, implementing, evaluating E. Same as D + budgeting 125)assumption of community organizing A. Government takes responsibilities in community development B. Ppl should participate in making, adjusting or contributing in major changes taking place in their communities C. Ppl hv free choices in their life D. Government has authority EPpl want to change and can change under government control

TWP 09, MDE/Repro/Final/P2