Hacker & Moore's Essentials of Obstetrics andG
v v v v v v v
ynecology 6th Edition by Hacker, Gambone
v v v v v
"classic"vformvisvmostvseverevandvpresentsvasvavnewbornvinfantvgirlvwithvambiguousvgenital
iavandvadrenalvinsufficiencyv(withvorvwithoutvlife-
threateningvsaltvwasting).v"Nonclassic"visvavlate-
onsetvformvthatvpresentsvwithvandrogenvexcessvorvcouldvbevasymptomatic.vCannotvconve
rtv17-vhydroxyprogesteronevtov11-
deoxycortisolv→v↓vcortisolvsynthesisv→v↑vadrenalvstimulationv→
↑vACTHvandvandrogens.
FirstvAidvUSMLEvStepv2vCKv-v10thvEd,vP366
80.vPatientvdidvbilateralvoophorectomyvandvsalpingectomy.vWhatvisvthevtypevofvhormonevre
placementvtherapy?
A. LevonprogesteronevIUD
B. OCP
C. Progesteronevpatchv-v:vA.
ThevA,vherevisvProgesteronevonlyv(Levonprogesterone)v/vMirenavIf
vthevquestionv wasvmissingv avcluevaboutvHysterectomy
1-putvthevpatientvintovlateralvrecumbent,v2-vreducevoxytocinvinfusion,v3-
vincreasevfluids.v Categoryv3vmanagementvstartsvbyvthevsamevmanagementvasvcategoryv2
vfirst,vthenv gov seriesvofvstepsvdiscussedvinvhacker.
Source:vhackervandvMoorevpv133
142. Avprimigravidavatv32weeksvGAvwithvBPvofv150/90mmhg.Therevisvassociatedvedemavof
vhandsvandvlegs.Whatvtovdo?
A. DiureticsvB.
B. TabsvLabetalol
C. Continuedvevaluationv-visvC
Explanation:vfurthervevaluationvisvneededvasvthevpositionvofvthevmothervmightvaffectvbloodv
pressure,vandvforvmeasuringvbpvpositionveithervsittingvorvlateralvdecubitus.
Swellingvofvhandvandvlegsvisvavnormalvphysiologyvinvpregnancyvfurthervevaluationvisvneede
dvforvpreeclampsiavdiagnosisvandvtreatment.vAsvforvgestationalvHTNvclosevmonitoringvonl
y.
Source:vhackervandvMoorevp185
143. Placentavimplantedvdeepvintovuterinevwall.vDiagnosis?
A. Placentavaccretav(superfici'lvmyometrium)
B. Placentavincretav(deepvmyometrium)
C. Placentavpercretav(serosa)vA,visvBv
Source:vhackervandvMoorevp139
,144. Post-
deliveryv6vweeks.vExclusivevbreastvfeeding.vDoesn'tvwantvkidsvforvatvleastv2vyears.vWhic
hvcontraceptivevmethod?
A. Depovproveravinjection
B. Transdermalvpatch
C. Vaginalvring
D. OralvcombinedvcontraceptivevA,visvA
Explanation:vchoicevAvisvanvinjectionvthatvisvgivenveveryv12-
14wvwhichvwillvbevmorevconvenient,vthusvmorevcompliancevandvisvsafevwithvbreastfeeding.
vBvisvchangedveveryvweek,vCvisvchangedveveryvmonth.
Source:vhackervandvMoorevp331,vuptodate
145. Pregnantvatvthevthirdvtrimestervshevisvcrohn'svpatientvonv'azathioprinev+vbiologicalva
gentvaskvaboutvhervchildvvaccines?
A. givevall
B. delayvtillv3vmonth
C. delayvtillv6monthvA,visvnotvknown
Explanation:vIvfoundvavresearchvsayingvthatvbiologicalvagentsvarevsafevforvchild,vbutvIvcan'tv
bevsurevaboutvazathioprinevasvhackervandvMoorevonlyvmentionedvthatvtherevisvincreasedvri
skvofvpretermvandvfetalvanomalies.vIvwouldvsuggestvAvasvanvA,vcuzvIvfoundvavresearchvthatvs
aidvitvisvsafevandvchildrenvhadvnovproblemsvwithvthevvaccines.
Source:vhackervandvMoore,vhttps://academic.oup.com/ecco-jcc/article/5/2/95/475727
146. CTGvshowvdecreasevvariabilityv'andvhevisvonvmgvsulphatevcausevis?
A.vmgvsulphatevtoxicityvA,visvA
Explanation:vMagnesiumvfreelyvcrossesvthevplacenta
16vyearvoldvgirlvwithvirregularvmenstrualvcycle.vShevwasvuncomfortablevandvagitated.vWhatv
isvhervproblem?
A. Mood
B. Behavioral
C. Anxietyv-v:vC?
12
,22vYO,vfemale,vcomplainingvofvbreastvpainvbeforevmenstruationv -
24vyearsvoldvmarried,vnevervhadvpapvtest?
A.vDovitvnowv-v:vA.
40
29vyearsvoldvfemalevhadvavnegativevpapvsmear.vWhatvtovdo?
A. Repeatvwithvcytology
B. Dovitvafterv3vyearsv-v:vB.
Invasymptomatic,vimmunocompetentvwomen,vcervicalvcancervscreeningvwithvPapvsmearvs
tartsvatvagev21,vregardlessvofvsexualvactivity.vInvwomenvyoungervthanv30vyearsvold,vscreen
ingvwithvPapvalonevisvdoneveveryv3vyears.vAftervagev30,veithervdovPapvsmearvaloneveveryv3
v yearsvorvdovPapvsmearv withvHPVvco-
testingveveryv5vyearsvforvasvlongvasvbothvtestsvarevnegative.
MastervthevBoardsvUSMLEvStepv2vCKv -v5thvEd,vP972
41
41vyearvDysfunctionalvUBvbestvinitialv‼?
A. D&Cvforvbiopsy
B. Endometrialvablation
Dysfunctionalvuterinevbleedingvmeansvyouvexcludedvorganicvcauses.vPapvsmearvtovrulevo
utvcervicalvcancer.vUltrasonographyvtovlookvforvuterinevmasses,vpolycysticvovaries,vandvthi
cknessvofvthevendometrium.
■ Performvendometrialvbiopsy:
■ Ifvthevendometriumvisv≥v4vmmvinvavpostmenopausalvwoman,vorvifvthevpatientvisv>v45vye
arsvofvage.
■ Ifvthevpatientvisv>v35vyearsvofvagevwithvriskvfactorsvforvendometrialvhyperplasiav(eg,vob
esity,vdiabetes)
FirstvAidvUSMLEvStepv2vCKv-v10thvEd,vP364
17v-
A. admitvforvobserve
B. followvupv4wks
C. admitvforvevacuationvThev-vis:vN/A
, Explanation:vWomenvwithvanvincomplete,vinevitable,vorvmissedvabortionvcanvbevmanagedv
withvsurgicalvuterinevaspirationvorvmedicationvuterinevevacuationvorvwithvexpectantvmanag
ement.vAllvthreevapproachesvhavevsimilarvefficacy,vandvthevchoicevofvtreatmentvmethodvde
pendsvmainlyvuponvpatientvpreference.
Note:vsurgicalvevacuationvisvrequiredvforvwomenvwithvheavyvbleedingvorvintrauterinevsepsi
svinvwhomvdelayingvtherapyvcouldvbevharmful.vItvisvalsovrequiredvforvwomenvwithvcontraindi
cationsvtovmisoprostolv.
Source:https://www.uptodate.com/contents/spontaneous-abortion-
vmanagement?search=Missed%20Abortion&source=search_result&selectedTitle=1~32& v
usagve_type=default&display_rank=1&id=spontaneous-abortion-
vmanagement&languageCode=en
289. Pregnantvasymptomaticvwithvurinevanalysisvshowingvbacteriuriavdiagnosis?
A.vAsymptomaticvbacteriuriavThevA,vis:vA
Explanation:vForvasymptomaticvwomen,vbacteriuriavisvformallyvdefinedvasvtwovconse
cutivevvoidedvurinevspecimensvwithvisolationvofvthevsamevbacterialvstrainvinvquantitati
vevcountsvof
≥105vcolony-
formingvunitsv(cfu)/mLvorvavsinglevcatheterizedvurinevspecimenvwithvonevbacterial
speciesvisolatedvinvavquantitativevcountvofv≥102vcfu/mLv[2].vInvclinicalvpractice,vhowever,von
lyvonevvoidedvurinevspecimenvisvtypicallyvobtained,vandvdiagnosisv(andvtreatmentvinitiation
)visvmadevinvwomenvwithv≥105vcfu/mLvwithoutvobtainingvavconfirmatoryvrepeatvculture.
Source:https://www.uptodate.com/contents/urinary-tract-infections-and-asymptomatic-
vbacteriuria-in-
vpregnancy?search=Asymptomatic%20bacteriuria&source=search_result&selectedTitle=
v2~6v9&usage_type=default&display_rank=2#H253489103
290. Pregnantvwithvasymptomaticvbacteriuriav,vallergicvtovpenicillinvandvsulfavdrugs?
A.vNitrofurontoinvThevA,vis:vA
Explanation:vAsymptomaticvbacteriuriavisvtreatedvwithvanvantibioticvtailoredvtovthevsus
Abruptiovplacentavmanagement:
A.vMultidisciplinaryvteamv-v:vA.
20
agev>65,vonlyvwithvhistoryvofvsignificantvCIN,vAftervtotalvhysterectomyvcytologyvnotvne
eded.
v v v v v v v
ynecology 6th Edition by Hacker, Gambone
v v v v v
"classic"vformvisvmostvseverevandvpresentsvasvavnewbornvinfantvgirlvwithvambiguousvgenital
iavandvadrenalvinsufficiencyv(withvorvwithoutvlife-
threateningvsaltvwasting).v"Nonclassic"visvavlate-
onsetvformvthatvpresentsvwithvandrogenvexcessvorvcouldvbevasymptomatic.vCannotvconve
rtv17-vhydroxyprogesteronevtov11-
deoxycortisolv→v↓vcortisolvsynthesisv→v↑vadrenalvstimulationv→
↑vACTHvandvandrogens.
FirstvAidvUSMLEvStepv2vCKv-v10thvEd,vP366
80.vPatientvdidvbilateralvoophorectomyvandvsalpingectomy.vWhatvisvthevtypevofvhormonevre
placementvtherapy?
A. LevonprogesteronevIUD
B. OCP
C. Progesteronevpatchv-v:vA.
ThevA,vherevisvProgesteronevonlyv(Levonprogesterone)v/vMirenavIf
vthevquestionv wasvmissingv avcluevaboutvHysterectomy
1-putvthevpatientvintovlateralvrecumbent,v2-vreducevoxytocinvinfusion,v3-
vincreasevfluids.v Categoryv3vmanagementvstartsvbyvthevsamevmanagementvasvcategoryv2
vfirst,vthenv gov seriesvofvstepsvdiscussedvinvhacker.
Source:vhackervandvMoorevpv133
142. Avprimigravidavatv32weeksvGAvwithvBPvofv150/90mmhg.Therevisvassociatedvedemavof
vhandsvandvlegs.Whatvtovdo?
A. DiureticsvB.
B. TabsvLabetalol
C. Continuedvevaluationv-visvC
Explanation:vfurthervevaluationvisvneededvasvthevpositionvofvthevmothervmightvaffectvbloodv
pressure,vandvforvmeasuringvbpvpositionveithervsittingvorvlateralvdecubitus.
Swellingvofvhandvandvlegsvisvavnormalvphysiologyvinvpregnancyvfurthervevaluationvisvneede
dvforvpreeclampsiavdiagnosisvandvtreatment.vAsvforvgestationalvHTNvclosevmonitoringvonl
y.
Source:vhackervandvMoorevp185
143. Placentavimplantedvdeepvintovuterinevwall.vDiagnosis?
A. Placentavaccretav(superfici'lvmyometrium)
B. Placentavincretav(deepvmyometrium)
C. Placentavpercretav(serosa)vA,visvBv
Source:vhackervandvMoorevp139
,144. Post-
deliveryv6vweeks.vExclusivevbreastvfeeding.vDoesn'tvwantvkidsvforvatvleastv2vyears.vWhic
hvcontraceptivevmethod?
A. Depovproveravinjection
B. Transdermalvpatch
C. Vaginalvring
D. OralvcombinedvcontraceptivevA,visvA
Explanation:vchoicevAvisvanvinjectionvthatvisvgivenveveryv12-
14wvwhichvwillvbevmorevconvenient,vthusvmorevcompliancevandvisvsafevwithvbreastfeeding.
vBvisvchangedveveryvweek,vCvisvchangedveveryvmonth.
Source:vhackervandvMoorevp331,vuptodate
145. Pregnantvatvthevthirdvtrimestervshevisvcrohn'svpatientvonv'azathioprinev+vbiologicalva
gentvaskvaboutvhervchildvvaccines?
A. givevall
B. delayvtillv3vmonth
C. delayvtillv6monthvA,visvnotvknown
Explanation:vIvfoundvavresearchvsayingvthatvbiologicalvagentsvarevsafevforvchild,vbutvIvcan'tv
bevsurevaboutvazathioprinevasvhackervandvMoorevonlyvmentionedvthatvtherevisvincreasedvri
skvofvpretermvandvfetalvanomalies.vIvwouldvsuggestvAvasvanvA,vcuzvIvfoundvavresearchvthatvs
aidvitvisvsafevandvchildrenvhadvnovproblemsvwithvthevvaccines.
Source:vhackervandvMoore,vhttps://academic.oup.com/ecco-jcc/article/5/2/95/475727
146. CTGvshowvdecreasevvariabilityv'andvhevisvonvmgvsulphatevcausevis?
A.vmgvsulphatevtoxicityvA,visvA
Explanation:vMagnesiumvfreelyvcrossesvthevplacenta
16vyearvoldvgirlvwithvirregularvmenstrualvcycle.vShevwasvuncomfortablevandvagitated.vWhatv
isvhervproblem?
A. Mood
B. Behavioral
C. Anxietyv-v:vC?
12
,22vYO,vfemale,vcomplainingvofvbreastvpainvbeforevmenstruationv -
24vyearsvoldvmarried,vnevervhadvpapvtest?
A.vDovitvnowv-v:vA.
40
29vyearsvoldvfemalevhadvavnegativevpapvsmear.vWhatvtovdo?
A. Repeatvwithvcytology
B. Dovitvafterv3vyearsv-v:vB.
Invasymptomatic,vimmunocompetentvwomen,vcervicalvcancervscreeningvwithvPapvsmearvs
tartsvatvagev21,vregardlessvofvsexualvactivity.vInvwomenvyoungervthanv30vyearsvold,vscreen
ingvwithvPapvalonevisvdoneveveryv3vyears.vAftervagev30,veithervdovPapvsmearvaloneveveryv3
v yearsvorvdovPapvsmearv withvHPVvco-
testingveveryv5vyearsvforvasvlongvasvbothvtestsvarevnegative.
MastervthevBoardsvUSMLEvStepv2vCKv -v5thvEd,vP972
41
41vyearvDysfunctionalvUBvbestvinitialv‼?
A. D&Cvforvbiopsy
B. Endometrialvablation
Dysfunctionalvuterinevbleedingvmeansvyouvexcludedvorganicvcauses.vPapvsmearvtovrulevo
utvcervicalvcancer.vUltrasonographyvtovlookvforvuterinevmasses,vpolycysticvovaries,vandvthi
cknessvofvthevendometrium.
■ Performvendometrialvbiopsy:
■ Ifvthevendometriumvisv≥v4vmmvinvavpostmenopausalvwoman,vorvifvthevpatientvisv>v45vye
arsvofvage.
■ Ifvthevpatientvisv>v35vyearsvofvagevwithvriskvfactorsvforvendometrialvhyperplasiav(eg,vob
esity,vdiabetes)
FirstvAidvUSMLEvStepv2vCKv-v10thvEd,vP364
17v-
A. admitvforvobserve
B. followvupv4wks
C. admitvforvevacuationvThev-vis:vN/A
, Explanation:vWomenvwithvanvincomplete,vinevitable,vorvmissedvabortionvcanvbevmanagedv
withvsurgicalvuterinevaspirationvorvmedicationvuterinevevacuationvorvwithvexpectantvmanag
ement.vAllvthreevapproachesvhavevsimilarvefficacy,vandvthevchoicevofvtreatmentvmethodvde
pendsvmainlyvuponvpatientvpreference.
Note:vsurgicalvevacuationvisvrequiredvforvwomenvwithvheavyvbleedingvorvintrauterinevsepsi
svinvwhomvdelayingvtherapyvcouldvbevharmful.vItvisvalsovrequiredvforvwomenvwithvcontraindi
cationsvtovmisoprostolv.
Source:https://www.uptodate.com/contents/spontaneous-abortion-
vmanagement?search=Missed%20Abortion&source=search_result&selectedTitle=1~32& v
usagve_type=default&display_rank=1&id=spontaneous-abortion-
vmanagement&languageCode=en
289. Pregnantvasymptomaticvwithvurinevanalysisvshowingvbacteriuriavdiagnosis?
A.vAsymptomaticvbacteriuriavThevA,vis:vA
Explanation:vForvasymptomaticvwomen,vbacteriuriavisvformallyvdefinedvasvtwovconse
cutivevvoidedvurinevspecimensvwithvisolationvofvthevsamevbacterialvstrainvinvquantitati
vevcountsvof
≥105vcolony-
formingvunitsv(cfu)/mLvorvavsinglevcatheterizedvurinevspecimenvwithvonevbacterial
speciesvisolatedvinvavquantitativevcountvofv≥102vcfu/mLv[2].vInvclinicalvpractice,vhowever,von
lyvonevvoidedvurinevspecimenvisvtypicallyvobtained,vandvdiagnosisv(andvtreatmentvinitiation
)visvmadevinvwomenvwithv≥105vcfu/mLvwithoutvobtainingvavconfirmatoryvrepeatvculture.
Source:https://www.uptodate.com/contents/urinary-tract-infections-and-asymptomatic-
vbacteriuria-in-
vpregnancy?search=Asymptomatic%20bacteriuria&source=search_result&selectedTitle=
v2~6v9&usage_type=default&display_rank=2#H253489103
290. Pregnantvwithvasymptomaticvbacteriuriav,vallergicvtovpenicillinvandvsulfavdrugs?
A.vNitrofurontoinvThevA,vis:vA
Explanation:vAsymptomaticvbacteriuriavisvtreatedvwithvanvantibioticvtailoredvtovthevsus
Abruptiovplacentavmanagement:
A.vMultidisciplinaryvteamv-v:vA.
20
agev>65,vonlyvwithvhistoryvofvsignificantvCIN,vAftervtotalvhysterectomyvcytologyvnotvne
eded.
