Embryology: ureteric duplication: practice question

A Anatomy question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anatomy · Embryology: ureteric duplication

Sample item

A 5-year-old girl has continuous urinary dribbling despite normal voiding. Ultrasound shows a duplex kidney with a hydronephrotic upper moiety. Where does the upper moiety ureter most likely open?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Ectopically, below and medial to the normal orifice, into the urethra or vagina, as the Weigert-Meyer rule predicts

A second ureteric bud gives a duplex system. By the Weigert-Meyer rule the upper pole ureter opens inferomedially to the normal site, often ectopically in the urethra or vagina in girls, and is frequently obstructed. The lower pole ureter opens superolaterally and tends to reflux. Ectopic insertion below the sphincter causes continuous incontinence with normal voiding.

Option by option

  • A. Above and lateral to the normal orifice, within the bladder, causing reflux into the lower pole

    The lower moiety ureter opens above and lateral and is the one that refluxes.

  • B. At the bladder apex through a patent urachus

    A urachal opening does not relate to ureteric duplication.

  • C. At the normal orifice, with a stenotic valve at the pelvic ureteric junction

    A normally placed orifice would not cause incontinence.

  • D. Ectopically, below and medial to the normal orifice, into the urethra or vagina, as the Weigert-Meyer rule predicts (correct)

    Correct. The upper moiety ureter opens lower and more medial, which can bypass the sphincter and cause constant dribbling.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Anatomy question

What is the answer to this Anatomy question?

The best answer is D, Ectopically, below and medial to the normal orifice, into the urethra or vagina, as the Weigert-Meyer rule predicts. A second ureteric bud gives a duplex system.

Why is "Above and lateral to the normal orifice, within the bladder, causing…" not the answer?

The lower moiety ureter opens above and lateral and is the one that refluxes.

Why is "At the bladder apex through a patent urachus" not the answer?

A urachal opening does not relate to ureteric duplication.

Why is "At the normal orifice, with a stenotic valve at the pelvic ureteric j…" not the answer?

A normally placed orifice would not cause incontinence.

What concept does this question test?

It tests Embryology: ureteric duplication in Anatomy. By the Weigert-Meyer rule the upper pole ureter opens inferomedially to the normal site, often ectopically in the urethra or vagina in girls, and is frequently obstructed. The lower pole ureter opens superolaterally and tends to reflux. Ectopic insertion below the sphincter causes continuous incontinence with normal voiding.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Embryology: ureteric duplication?

Learn every nerve by its route, its muscles and what a lesion looks like at the bedside. That one habit answers a large share of questions. Then use the flashcards and the other Anatomy questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.