HY lecture notes:
If you get a Q of a hysterosalpingogram, the obgyn shelf and USMLE are obsessed with you knowing simply that the fallopian tubes are normally open on each end, so of course you will see leakage of dye into the peritoneal cavity. Don’t be choosing answers like uterine rupture, etc.
Obgyn shelf + USMLE want you to know your “celes,” i.e., your herniations through the vaginal wall:
Anterior superior vaginal wall herniation: cystocele.
Anterior inferior: urethrocele.
Posterior superior: enterocele.
Posterior inferior: rectocele.
So if they tell you there’s a structure herniating through the vaginal wall at any of those locations, those are your answers.
Also be aware that “high on the vaginal wall” simply = superior; “low on the vaginal wall” simply means inferior. There’s a shelf Q where they give enterocele as the answer, where the descriptor was a herniation high on the posterior vaginal wall.
For urethrocele, a HY variant of the Q is they will say the vaginal wall appears well-supported, so immediately you’re like, “oh so it must not be a herniation then.” But they will then go on to say that a cotton-tip applicator places in the urethral meatus moves at a 45-degree angle when the patient coughs, and the answer is urethrocele. The implication being: even if the vaginal wall appears well-supported on gynecologic exam; if the cotton-tip applicator moves, then it means the wall isn’t in fact as well-supported as the digital exam suggested.
For enterocele, another HY point is that they might not mention the location of the herniation, but will instead say the woman feels occasional movement within her vagina. The implication is that she can literally feel the GI peristalsis because of the enterocele.
Uterine inversion will be the answer if the woman has hypotension + uterus is not palpable following gentle cord traction during stage III of labor (delivery of placenta). Some students get thrown off, as though, “well they didn’t say vigorous cord traction though.” That’s true, but the Q on the shelf will say “gentle” cord traction, so that’s all you need.
Most common cause of abnormal AFP measurement is dating error. Do not remeasure the AFP. By all means the actual measurement of the AFP was probably correct. The answer = re-ultrasound in order to determine more accurately the gestational age of the fetus.
If AFP measurement is truly abnormal:
High AFP on maternal screening: spinal cord defects (i.e., spina bifida, myelomeningocele, etc.), anencephaly, omphalocele, gastroschisis.
Low AFP: Down syndrome, Edward syndrome.
Down syndrome on first-trimester tri-screen: increased nuchal translucency (widened area behind the fetal neck), high b-hCG, decreased PAPPA (pregnancy-associated plasma protein A). Those are the components of the first-trimester tri-screen, however hypoplastic or aplastic nasal bone detected on ultrasound is also exceedingly HY, despite not formally being part of the tri-screen. Don’t forget Down classically presents with flattened facies.
Down syndrome on 2nd trimester quad screen: low AFP, low estriol, high b-hCG, high inhibin A.
Edward syndrome on 2nd trimester quad screen: AFP, estriol, b-hCG, inhibin A are all decreased.
