Embryology: paramesonephric duct anomalies: 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: paramesonephric duct anomalies

Sample item

A 17-year-old girl has primary amenorrhoea. She has normal breast development, normal pubic and axillary hair, a short blind-ending vagina and a 46,XX karyotype. Ultrasound shows normal ovaries but no uterus. What is the embryological basis?

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

The answer and the reasoning

B. Agenesis of the paramesonephric ducts

In Mayer-Rokitansky-Kuster-Hauser syndrome the paramesonephric ducts fail to develop, so the uterus, tubes and upper vagina are absent while the ovaries and secondary sexual characteristics are normal.

Option by option

  • A. Gonadal dysgenesis with streak ovaries

    Streak ovaries would cause absent breast development and raised gonadotrophins.

  • B. Agenesis of the paramesonephric ducts (correct)

    Correct. Absent paramesonephric ducts explain a missing uterus with normal ovaries and normal puberty.

  • C. Failed canalisation of the vaginal plate alone

    Failure of vaginal plate canalisation alone leaves a uterus present and causes cryptomenorrhoea.

  • D. Androgen receptor failure in target tissues

    Androgen insensitivity occurs in 46,XY individuals with scanty pubic hair.

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 B, Agenesis of the paramesonephric ducts. In Mayer-Rokitansky-Kuster-Hauser syndrome the paramesonephric ducts fail to develop, so the uterus, tubes and upper vagina are absent while the ovaries and secondary sexual characteristics are normal.

Why is "Gonadal dysgenesis with streak ovaries" not the answer?

Streak ovaries would cause absent breast development and raised gonadotrophins.

Why is "Failed canalisation of the vaginal plate alone" not the answer?

Failure of vaginal plate canalisation alone leaves a uterus present and causes cryptomenorrhoea.

Why is "Androgen receptor failure in target tissues" not the answer?

Androgen insensitivity occurs in 46,XY individuals with scanty pubic hair.

What concept does this question test?

It tests Embryology: paramesonephric duct anomalies in Anatomy. The correct option holds because: Correct. Absent paramesonephric ducts explain a missing uterus with normal ovaries and normal puberty.

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: paramesonephric duct anomalies?

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.