THE USMLE TIMES - #103
Welcome To The USMLE Times Newsletter
Hi there 👋
Welcome to issue #103 of The USMLE Times! Welcome to all new members—and welcome back to those returning!
I’m Paul Ciurysek, MD, founder of The USMLE Guys, and this is The USMLE Times. This daily newsletter aims to provide super high-yield USMLE concepts commonly tested on exam day. All content is FREE! If you’d like to work with me and my team, please see the options at the bottom of today’s newsletter. If you’d like to support my efforts, please share the newsletter with a friend.
Here’s what’s on tap for issue #103 of the USMLE Times:
Question of the Week (Reproductive anatomy)
This week’s video training (A Must-Know Cardio Concept)
Question deep-dive & breakdown
Let’s dive in!
You are assisting your OBGYN attending during an elective cesarean section on a 31-year-old patient who is 39-weeks pregnant. The patient has requested for a tubal ligation following the safe delivery of her baby. To ensure the safety and integrity of the ureters during the procedure, it is your responsibility to monitor their course from the renal pelvis into the bladder. Which of the following statements about ureteral anatomy is correct?
A) The proximal ureter is supplied by the common and internal iliac arteries
B) The ureters travel over top of the gonadal arteries
C) The middle part of the ureter is supplied by the gonadal artery
D) The ureter travels over top of the uterine artery
E) The distal ureter is supplied by the gonadal and common iliac arteries
The answer & question breakdown is at the bottom of the post 👇🏼
🔗 LINKS TO RECENT POSTS
USMLE Times Issue #102 - READ HERE
USMLE Practice Question #98 - TRY IT HERE
USMLE Practice Question #97 - TRY IT HERE
This week’s recommended video 👇🏼
ANSWER + QUESTION BREAKDOWN
The mental model used to answer this question comes from our detailed test-taking skills masterclass (check it out if you want to elevate your USMLE test-taking skills) Here’s how to think through this question:
Step 1. Read the vignette and get the actual question: “Which of the following statements about ureteral anatomy is correct?”
Step 2. Determine if this is a 1st order, 2nd order, or 3rd order question. This is 1st order: 1st. Identify the correct statement about ureteral anatomy.
Step 3. Based on our conclusions from steps 1-2 above, there are many potential “true statements” about ureteral anatomy. Thus, we should examine the answer choices and select the correct option.
Step 4. Look at the answer choices and select the “most correct” option.
** Aim to take this mental model into all of your USMLE practice questions **
GENERAL ANALYSIS
This vignette presents a 31-year-old woman undergoing a cesarean section with a request for tubal ligation. The question asks about the correct anatomical relationship and blood supply of the ureters, which is crucial to avoid injury during pelvic surgery. The ureters have a complex course, and understanding their vascular supply and anatomical relations is essential during procedures like tubal ligation or hysterectomy.
ANSWER CHOICES:
CHOICE A: The proximal ureter is supplied by the common and internal iliac arteries
Explanation: The proximal ureter, which is closest to the kidney, receives its blood supply primarily from the renal artery and other branches such as the gonadal artery (ovarian/testicular artery) and direct branches from the abdominal aorta. The common and internal iliac arteries supply the pelvic portion of the ureter, not the proximal portion.
CHOICE B: The ureters travel over top of the gonadal arteries
Explanation: The ureters do not travel over the gonadal arteries. Instead, they pass underneath the gonadal vessels (ovarian or testicular arteries).
CHOICE C: The middle part of the ureter is supplied by the gonadal artery
Explanation: The middle portion of the ureter receives its blood supply from several sources, including the gonadal artery (ovarian/testicular artery), as well as branches from the abdominal aorta and common iliac arteries.
CHOICE D: The ureter travels over top of the uterine artery
Explanation: In females, an important anatomical relationship to remember is that the ureter passes underneath the uterine artery. This relationship is often remembered with the mnemonic "water under the bridge" (where "water" refers to urine in the ureter and "bridge" refers to the uterine artery).
CHOICE E: The distal ureter is supplied by the gonadal and common iliac arteries
Explanation: The distal portion of the ureter receives its blood supply primarily from branches of the internal iliac artery, specifically from vesical arteries (superior and inferior vesical arteries). It does not receive significant supply from either the gonadal or common iliac arteries.
THE VERDICT…
The anatomy of the ureters involves a complex network of arterial supplies that vary along their length.
The proximal portion (closest to the kidney) is supplied primarily by branches from the renal artery.
The middle portion receives blood from multiple sources, including direct branches from the abdominal aorta, common iliac arteries, and, importantly, from the gonadal artery (ovarian/testicular artery).
The distal portion, near its entry into the bladder, is supplied by branches from internal iliac-derived vessels such as superior and inferior vesical arteries.
Thus, option C correctly identifies that one of the main arterial supplies to the middle part of the ureter comes from the gonadal artery.
Correct answer: C) The middle part of the ureter is supplied by the gonadal artery
That’s it for issue #103 of The USMLE Times!
1) 1-ON-1 STEP 1 COACHING: If you’re looking for a personalized approach and guidance designed for your specific needs, goals, and challenges, then 1-on-1 coaching might be what you’re looking for. Choose between daily sessions with Dr. Paul for four, six, or eight weeks. CLICK HERE TO LEARN MORE ABOUT 1-ON-1 COACHING.
2) 1-ON-1 CONSULTATION: If you need some guidance or a plan to get to where you’re going, join me for a 1-on-1 strategy session. This will help you clarify a plan, identify and overcome potential challenges, and give you the best chance for a smooth ride from where you are now to your dream residency program. These are done 1-on-1 with me (Dr. Paul), so space is limited. SET UP YOUR 1-ON-1 STRATEGY SESSION HERE
3) THE MASTER CLASSES: I've created two masterclasses based around two of the most commonly experienced challenges I've helped students overcome in the last 15+ years: Test-taking skills and How to get into Residency. These will give you the knowledge, skills, and tools to crush your USMLE exams and match into your dream Residency program. LEARN ABOUT THE MASTERCLASSES HERE
4) ASSESSMENT EXAMS: Save those valuable NBME assessments! Our assessment exam platform was designed to help you identify your strengths, weaknesses, and exam readiness without prematurely wasting your NBME exams. With our USMLEDx assessment platform, you can assess yourself early and often while saving those highly valuable NBMEs for the final stretch of your exam prep. CHECK OUT THE ASSESSMENT EXAM OPTIONS HERE
See ya next week 👋