Hacker & Moore's Essentials of Obstetrics andG
f f f f f f f
ynecology 6th Edition by Hacker, Gambone
f f f f f
"classic"fformfisfmostfseverefandfpresentsfasfafnewbornfinfantfgirlfwithfambiguousfgenitaliaf
andfadrenalfinsufficiencyf(withforfwithoutflife-
threateningfsaltfwasting).f"Nonclassic"fisfaflate-
onsetfformfthatfpresentsfwithfandrogenfexcessforfcouldfbefasymptomatic.fCannotfconvertf1
7-fhydroxyprogesteroneftof11-
deoxycortisolf→f↓fcortisolfsynthesisf→f↑fadrenalfstimulationf→
↑f ACTHfandfandrogens.
FirstfAidfUSMLEfStepf2fCKf-f10thfEd,fP366
80.fPatientfdidfbilateralfoophorectomyfandfsalpingectomy.fWhatfisftheftypefoffhormonefrepl
acementftherapy?
A. LevonprogesteronefIUD
B. OCP
C. Progesteronefpatchf-f:fA.
ThefA,fherefisfProgesteronefonlyf(Levonprogesterone)f/fMirenafIfft
hefquestionfwasfmissingfafcluefaboutfHysterectomy
1-putfthefpatientfintoflateralfrecumbent,f2-freducefoxytocinfinfusion,f3-
f increaseffluids.fCategoryf 3fmanagementfstartsfbyf thef samefmanagementfasf categoryf 2ffir
st,fthenfgofseriesfoffstepsfdiscussedfinfhacker.
Source:fhackerfandfMoorefpf133
142. Afprimigravidafatf32weeksfGAfwithfBPfoff150/90mmhg.Therefisfassociatedfedemafoffh
andsfandflegs.Whatftofdo?
A. DiureticsfB.
B. TabsfLabetalol
C. Continuedfevaluationf-fisfC
Explanation:ffurtherfevaluationfisfneededfasfthefpositionfoffthefmotherfmightfaffectfbloodfpre
ssure,fandfforfmeasuringfbpfpositionfeitherfsittingforflateralfdecubitus.
Swellingfoffhandfandflegsfisfafnormalfphysiologyfinfpregnancyffurtherfevaluationfisfneededff
orfpreeclampsiafdiagnosisfandftreatment.fAsfforfgestationalfHTNfclosefmonitoringfonly.
Source:fhackerfandfMoorefp185
143. Placentafimplantedfdeepfintofuterinefwall.fDiagnosis?
A. Placentafaccretaf(superfici'lfmyometrium)
B. Placentafincretaf(deepfmyometrium)
C. Placentafpercretaf(serosa)fA,fisfBfS
ource:fhackerfandfMoorefp139
,144. Post-
deliveryf6fweeks.fExclusivefbreastffeeding.fDoesn'tfwantfkidsfforfatfleastf2fyears.fWhichfc
ontraceptivefmethod?
A. Depofproverafinjection
B. Transdermalfpatch
C. Vaginalfring
D. OralfcombinedfcontraceptivefA,fisfA
Explanation:fchoicefAfisfanfinjectionfthatfisfgivenfeveryf12-
14wfwhichfwillfbefmorefconvenient,fthusfmorefcompliancefandfisfsafefwithfbreastfeeding.fBfi
sfchangedfeveryfweek,fCfisfchangedfeveryfmonth.
Source:fhackerfandfMoorefp331,fuptodate
145. Pregnantfatfthefthirdftrimesterfshefisfcrohn'sfpatientfonf'azathioprinef+fbiologicalfage
ntfaskfaboutfherfchildfvaccines?
A. givefall
B. delayftillf3fmonth
C. delayftillf6monthfA,fisfnotfknown
Explanation:fIffoundfafresearchfsayingfthatfbiologicalfagentsfarefsafefforfchild,fbutfIfcan'tfbef
surefaboutfazathioprinefasfhackerfandfMoorefonlyfmentionedfthatftherefisfincreasedfriskfoff
pretermfandffetalfanomalies.fIfwouldfsuggestfAfasfanfA,fcuzfIffoundfafresearchfthatfsaidfitfisfs
afefandfchildrenfhadfnofproblemsfwithfthefvaccines.
Source:fhackerfandfMoore,fhttps://academic.oup.com/ecco-jcc/article/5/2/95/475727
146. CTGfshowfdecreasefvariabilityf'andfhefisfonfmgfsulphatefcausefis?
A.fmgfsulphateftoxicityfA,fisfA
Explanation:fMagnesiumffreelyfcrossesfthefplacenta
16fyearfoldfgirlfwithfirregularfmenstrualfcycle.fShefwasfuncomfortablefandfagitated.fWhatfisf
herfproblem?
A. Mood
B. Behavioral
C. Anxietyf-f:fC?
12
,22fYO,ffemale,fcomplainingfoffbreastfpainfbeforefmenstruationf -
24fyearsfoldfmarried,fneverfhadfpapftest?
A.fDofitfnowf-f:fA.
40
29fyearsfoldffemalefhadfafnegativefpapfsmear.fWhatftofdo?
A. Repeatfwithfcytology
B. Dofitfafterf3fyearsf-f:fB.
Infasymptomatic,fimmunocompetentfwomen,fcervicalfcancerfscreeningfwithfPapfsmearfsta
rtsfatfagef21,fregardlessfoffsexualfactivity.fInfwomenfyoungerfthanf30fyearsfold,fscreeningfw
ithfPapfalonefisfdonefeveryf3fyears.fAfterfagef30,feitherfdofPapfsmearfalonefeveryf3fyearsforf
dofPapfsmearfwithfHPVfco-testingfeveryf5fyearsfforfasflongfasfbothftestsfarefnegative.
MasterfthefBoardsfUSMLEfStepf2fCKf-f5thfEd,fP972
41
41f yearf Dysfunctionalf UBf bestf initialf ‼?
A. D&Cfforfbiopsy
B. Endometrialfablation
Dysfunctionalfuterinefbleedingfmeansfyoufexcludedforganicfcauses.fPapfsmearftofrulefoutf
cervicalfcancer.fUltrasonographyftoflookfforfuterinefmasses,fpolycysticfovaries,fandfthickne
ssfoffthefendometrium.
■ Performfendometrialfbiopsy:
■ Iffthefendometriumfisf≥f4fmmfinfafpostmenopausalfwoman,forfiffthefpatientfisf>f45fyearsf
offage.
■ Iffthefpatientfisf>f35fyearsfoffagefwithfriskffactorsfforfendometrialfhyperplasiaf(eg,fobesi
ty,fdiabetes)
FirstfAidfUSMLEfStepf2fCKf-f10thfEd,fP364
17f-
A. admitfforfobserve
B. followfupf4wks
C. admitfforfevacuationfThef -fis:fN/A
, Explanation:fWomenfwithfanfincomplete,finevitable,forfmissedfabortionfcanfbefmanagedfwit
hfsurgicalfuterinefaspirationforfmedicationfuterinefevacuationforfwithfexpectantfmanageme
nt.fAllfthreefapproachesfhavefsimilarfefficacy,fandfthefchoicefofftreatmentfmethodfdependsf
mainlyfuponfpatientfpreference.
Note:fsurgicalfevacuationfisfrequiredfforfwomenfwithfheavyfbleedingforfintrauterinefsepsisfi
nfwhomfdelayingftherapyfcouldfbefharmful.fItfisfalsofrequiredfforfwomenfwithfcontraindicatio
nsftofmisoprostolf.
Source:https://www.uptodate.com/contents/spontaneous-abortion-
fmanagement?search=Missed%20Abortion&source=search_result&selectedTitle=1~32& fu
sagfe_type=default&display_rank=1&id=spontaneous-abortion-
fmanagement&languageCode=en
289. Pregnantfasymptomaticfwithfurinefanalysisfshowingfbacteriuriafdiagnosis?
A.fAsymptomaticfbacteriuriafThefA,fis:fA
Explanation:fForfasymptomaticfwomen,fbacteriuriafisfformallyfdefinedfasftwofconsec
utivefvoidedfurinefspecimensfwithfisolationfoffthefsamefbacterialfstrainfinfquantitativefc
ountsfof
≥105fcolony-
formingfunitsf(cfu)/mLforfafsinglefcatheterizedfurinefspecimenfwithfonefbacterial
speciesfisolatedfinfafquantitativefcountfoff≥102fcfu/mLf[2].fInfclinicalfpractice,fhowever,fonlyf
onefvoidedfurinefspecimenfisftypicallyfobtained,fandfdiagnosisf(andftreatmentfinitiation)fisf
madefinfwomenfwithf≥105fcfu/mLfwithoutfobtainingfafconfirmatoryfrepeatfculture.
Source:https://www.uptodate.com/contents/urinary-tract-infections-and-asymptomatic-
f bacteriuria-in-
fpregnancy?search=Asymptomatic%20bacteriuria&source=search_result&selectedTitle= f
2~6f9&usage_type=default&display_rank=2#H253489103
290. Pregnantfwithfasymptomaticfbacteriuriaf,fallergicftofpenicillinfandfsulfafdrugs?
A.fNitrofurontoinfThefA,fis:fA
Explanation:fAsymptomaticfbacteriuriafisftreatedfwithfanfantibioticftailoredftofthefsus
Abruptiofplacentafmanagement:
A.fMultidisciplinaryfteamf-f:fA.
20
agef>65,fonlyfwithfhistoryfoffsignificantfCIN,fAfterftotalfhysterectomyfcytologyfnotfneed
ed.
f f f f f f f
ynecology 6th Edition by Hacker, Gambone
f f f f f
"classic"fformfisfmostfseverefandfpresentsfasfafnewbornfinfantfgirlfwithfambiguousfgenitaliaf
andfadrenalfinsufficiencyf(withforfwithoutflife-
threateningfsaltfwasting).f"Nonclassic"fisfaflate-
onsetfformfthatfpresentsfwithfandrogenfexcessforfcouldfbefasymptomatic.fCannotfconvertf1
7-fhydroxyprogesteroneftof11-
deoxycortisolf→f↓fcortisolfsynthesisf→f↑fadrenalfstimulationf→
↑f ACTHfandfandrogens.
FirstfAidfUSMLEfStepf2fCKf-f10thfEd,fP366
80.fPatientfdidfbilateralfoophorectomyfandfsalpingectomy.fWhatfisftheftypefoffhormonefrepl
acementftherapy?
A. LevonprogesteronefIUD
B. OCP
C. Progesteronefpatchf-f:fA.
ThefA,fherefisfProgesteronefonlyf(Levonprogesterone)f/fMirenafIfft
hefquestionfwasfmissingfafcluefaboutfHysterectomy
1-putfthefpatientfintoflateralfrecumbent,f2-freducefoxytocinfinfusion,f3-
f increaseffluids.fCategoryf 3fmanagementfstartsfbyf thef samefmanagementfasf categoryf 2ffir
st,fthenfgofseriesfoffstepsfdiscussedfinfhacker.
Source:fhackerfandfMoorefpf133
142. Afprimigravidafatf32weeksfGAfwithfBPfoff150/90mmhg.Therefisfassociatedfedemafoffh
andsfandflegs.Whatftofdo?
A. DiureticsfB.
B. TabsfLabetalol
C. Continuedfevaluationf-fisfC
Explanation:ffurtherfevaluationfisfneededfasfthefpositionfoffthefmotherfmightfaffectfbloodfpre
ssure,fandfforfmeasuringfbpfpositionfeitherfsittingforflateralfdecubitus.
Swellingfoffhandfandflegsfisfafnormalfphysiologyfinfpregnancyffurtherfevaluationfisfneededff
orfpreeclampsiafdiagnosisfandftreatment.fAsfforfgestationalfHTNfclosefmonitoringfonly.
Source:fhackerfandfMoorefp185
143. Placentafimplantedfdeepfintofuterinefwall.fDiagnosis?
A. Placentafaccretaf(superfici'lfmyometrium)
B. Placentafincretaf(deepfmyometrium)
C. Placentafpercretaf(serosa)fA,fisfBfS
ource:fhackerfandfMoorefp139
,144. Post-
deliveryf6fweeks.fExclusivefbreastffeeding.fDoesn'tfwantfkidsfforfatfleastf2fyears.fWhichfc
ontraceptivefmethod?
A. Depofproverafinjection
B. Transdermalfpatch
C. Vaginalfring
D. OralfcombinedfcontraceptivefA,fisfA
Explanation:fchoicefAfisfanfinjectionfthatfisfgivenfeveryf12-
14wfwhichfwillfbefmorefconvenient,fthusfmorefcompliancefandfisfsafefwithfbreastfeeding.fBfi
sfchangedfeveryfweek,fCfisfchangedfeveryfmonth.
Source:fhackerfandfMoorefp331,fuptodate
145. Pregnantfatfthefthirdftrimesterfshefisfcrohn'sfpatientfonf'azathioprinef+fbiologicalfage
ntfaskfaboutfherfchildfvaccines?
A. givefall
B. delayftillf3fmonth
C. delayftillf6monthfA,fisfnotfknown
Explanation:fIffoundfafresearchfsayingfthatfbiologicalfagentsfarefsafefforfchild,fbutfIfcan'tfbef
surefaboutfazathioprinefasfhackerfandfMoorefonlyfmentionedfthatftherefisfincreasedfriskfoff
pretermfandffetalfanomalies.fIfwouldfsuggestfAfasfanfA,fcuzfIffoundfafresearchfthatfsaidfitfisfs
afefandfchildrenfhadfnofproblemsfwithfthefvaccines.
Source:fhackerfandfMoore,fhttps://academic.oup.com/ecco-jcc/article/5/2/95/475727
146. CTGfshowfdecreasefvariabilityf'andfhefisfonfmgfsulphatefcausefis?
A.fmgfsulphateftoxicityfA,fisfA
Explanation:fMagnesiumffreelyfcrossesfthefplacenta
16fyearfoldfgirlfwithfirregularfmenstrualfcycle.fShefwasfuncomfortablefandfagitated.fWhatfisf
herfproblem?
A. Mood
B. Behavioral
C. Anxietyf-f:fC?
12
,22fYO,ffemale,fcomplainingfoffbreastfpainfbeforefmenstruationf -
24fyearsfoldfmarried,fneverfhadfpapftest?
A.fDofitfnowf-f:fA.
40
29fyearsfoldffemalefhadfafnegativefpapfsmear.fWhatftofdo?
A. Repeatfwithfcytology
B. Dofitfafterf3fyearsf-f:fB.
Infasymptomatic,fimmunocompetentfwomen,fcervicalfcancerfscreeningfwithfPapfsmearfsta
rtsfatfagef21,fregardlessfoffsexualfactivity.fInfwomenfyoungerfthanf30fyearsfold,fscreeningfw
ithfPapfalonefisfdonefeveryf3fyears.fAfterfagef30,feitherfdofPapfsmearfalonefeveryf3fyearsforf
dofPapfsmearfwithfHPVfco-testingfeveryf5fyearsfforfasflongfasfbothftestsfarefnegative.
MasterfthefBoardsfUSMLEfStepf2fCKf-f5thfEd,fP972
41
41f yearf Dysfunctionalf UBf bestf initialf ‼?
A. D&Cfforfbiopsy
B. Endometrialfablation
Dysfunctionalfuterinefbleedingfmeansfyoufexcludedforganicfcauses.fPapfsmearftofrulefoutf
cervicalfcancer.fUltrasonographyftoflookfforfuterinefmasses,fpolycysticfovaries,fandfthickne
ssfoffthefendometrium.
■ Performfendometrialfbiopsy:
■ Iffthefendometriumfisf≥f4fmmfinfafpostmenopausalfwoman,forfiffthefpatientfisf>f45fyearsf
offage.
■ Iffthefpatientfisf>f35fyearsfoffagefwithfriskffactorsfforfendometrialfhyperplasiaf(eg,fobesi
ty,fdiabetes)
FirstfAidfUSMLEfStepf2fCKf-f10thfEd,fP364
17f-
A. admitfforfobserve
B. followfupf4wks
C. admitfforfevacuationfThef -fis:fN/A
, Explanation:fWomenfwithfanfincomplete,finevitable,forfmissedfabortionfcanfbefmanagedfwit
hfsurgicalfuterinefaspirationforfmedicationfuterinefevacuationforfwithfexpectantfmanageme
nt.fAllfthreefapproachesfhavefsimilarfefficacy,fandfthefchoicefofftreatmentfmethodfdependsf
mainlyfuponfpatientfpreference.
Note:fsurgicalfevacuationfisfrequiredfforfwomenfwithfheavyfbleedingforfintrauterinefsepsisfi
nfwhomfdelayingftherapyfcouldfbefharmful.fItfisfalsofrequiredfforfwomenfwithfcontraindicatio
nsftofmisoprostolf.
Source:https://www.uptodate.com/contents/spontaneous-abortion-
fmanagement?search=Missed%20Abortion&source=search_result&selectedTitle=1~32& fu
sagfe_type=default&display_rank=1&id=spontaneous-abortion-
fmanagement&languageCode=en
289. Pregnantfasymptomaticfwithfurinefanalysisfshowingfbacteriuriafdiagnosis?
A.fAsymptomaticfbacteriuriafThefA,fis:fA
Explanation:fForfasymptomaticfwomen,fbacteriuriafisfformallyfdefinedfasftwofconsec
utivefvoidedfurinefspecimensfwithfisolationfoffthefsamefbacterialfstrainfinfquantitativefc
ountsfof
≥105fcolony-
formingfunitsf(cfu)/mLforfafsinglefcatheterizedfurinefspecimenfwithfonefbacterial
speciesfisolatedfinfafquantitativefcountfoff≥102fcfu/mLf[2].fInfclinicalfpractice,fhowever,fonlyf
onefvoidedfurinefspecimenfisftypicallyfobtained,fandfdiagnosisf(andftreatmentfinitiation)fisf
madefinfwomenfwithf≥105fcfu/mLfwithoutfobtainingfafconfirmatoryfrepeatfculture.
Source:https://www.uptodate.com/contents/urinary-tract-infections-and-asymptomatic-
f bacteriuria-in-
fpregnancy?search=Asymptomatic%20bacteriuria&source=search_result&selectedTitle= f
2~6f9&usage_type=default&display_rank=2#H253489103
290. Pregnantfwithfasymptomaticfbacteriuriaf,fallergicftofpenicillinfandfsulfafdrugs?
A.fNitrofurontoinfThefA,fis:fA
Explanation:fAsymptomaticfbacteriuriafisftreatedfwithfanfantibioticftailoredftofthefsus
Abruptiofplacentafmanagement:
A.fMultidisciplinaryfteamf-f:fA.
20
agef>65,fonlyfwithfhistoryfoffsignificantfCIN,fAfterftotalfhysterectomyfcytologyfnotfneed
ed.
