NBME 7 Anatomy question

[LuckiestOne]

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A 42-year-old woman has the sudden onset of abdominal pain 1 day after undergoing abdominal hysterectomy because of leiomyomata uteri. Her temperature is 38.3°C (101°F). Abdominal examination shows tenderness over the right lower quadrant. Retrograde pyelography shows contrast in the left renal pelvis and none in the right renal pelvis. A structure that passes inferior to which of the following was most likely severed during the operation?

A. Ovarian artery
B. Ovarian ligament
C. Mesosalpinx
D. Round ligament of the uterus
E. Uterine artery

I assume the structure that was damaged is right ureter. I specifically remember that ureter passes UNDER gonadal arteries and OVER the uterine and external/internal iliac bifurcation..

What is the real answer here? Lots of people say it's Uterine Artery but the question asks for the structure that lies above the ureter which is the severed structure here...

Thanks in advance!

 

[Ronin786]

A 42-year-old woman has the sudden onset of abdominal pain 1 day after undergoing abdominal hysterectomy because of leiomyomata uteri. Her temperature is 38.3°C (101°F). Abdominal examination shows tenderness over the right lower quadrant. Retrograde pyelography shows contrast in the left renal pelvis and none in the right renal pelvis. A structure that passes inferior to which of the following was most likely severed during the operation?

A. Ovarian artery
B. Ovarian ligament
C. Mesosalpinx
D. Round ligament of the uterus
E. Uterine artery

I assume the structure that was damaged is right ureter. I specifically remember that ureter passes UNDER gonadal arteries and OVER the uterine and external/internal iliac bifurcation..

What is the real answer here? Lots of people say it's Uterine Artery but the question asks for the structure that lies above the ureter which is the severed structure here...

Thanks in advance!

Absence of contrast in the right renal pelvis means that the right ureter is damaged. They expect you to know that easily and are asking what structure the ureter passes underneath.

In First Aid page 505, it says the ureters pass under the ductus deferens and under the uterine artery, so the answer would be E.

Also it is of note that the uterine artery runs in the cardinal ligament, which is why they put all those different ligaments to try and confuse you. So if uterine artery isn't an option, then the answer would likely be cardinal ligament or ductus defferens.

 

[thehundredthone]

I think you might be confused there, LuckiestOne. The ureter passes under the uterine artery. FA says something like water under the bridge I think.

 

[LuckiestOne]

Ah, thank you very much everyone. I must've gotten stuff mixed up, glad to have found this error now. I guess I just got really confused because of this Gray's diagram: http://upload.wikimedia.org/wikipedia/commons/d/d4/Gray589.png

Looks like uterine artery passes under the ureter..

 

[thehundredthone]

If you look at the label at the bottom it says "Vagina cut open behind", so you're looking at the posterior view. The diagram is shown from behind to display the vascular plexus.

 

[LuckiestOne]

If you look at the label at the bottom it says "Vagina cut open behind", so you're looking at the posterior view. The diagram is shown from behind to display the vascular plexus.

Thank you, need to pay attention more!