• salivary center is in medulla.

• The neuro-hypophysis containing the Herring bodies is formed from neuroectoderm*.

• Best place to sample for hematopoiesis- Sternum. Other sites are ribs, vertebrae, iliac crest, skull and prximal
femor. Long bones of adults are not suitable sincethey become dominated by yellow marrow.
• In angina pectoris the pain radiating down the left arm is mediated by incresed activity in afferent fibers
contained in- Thoracic splanchnic nerves
• Last segment of GIT to become fully closed into a tube and separated from the yolk sac is *Ileum. Failure of
closure results in persistant vitelline fistula, whereas partial obliteration results in Mickel's diverticulum.
• Tendon of which muscle is involved when the tuberosity of 5th metatarsal bone is avulsed in an inversion
fracture- Peroneus brevis
• Each of embryonic germ layers is continuous with an extra-embronic structure-
▪ Ectoderm- continuous with *amniotic membrane
▪ Mesoderm- continuous with extra-embronic mesoderm
▪ Endoderm- continuous with lining of yolk sac
• In Rectal cancer lymph is drained in following LN-
▪ Superior to pectineal line- Internal iliac nodes and pre-aortic nodes
▪ Inferior to pectineal line- Superficial inguinal nodes
• Apart from the transmission of the medulla oblongata and its membranes, the foramen magnum transmits the
spinal accessory nerve,vertebral arteries, the anterior and posterior spinal arteries, the membrana tectoria and
alar ligament. All except XII* N.
• Two point discrimination is carried by the dorsal column-medial leminiscal system. Dorsal column runs
ipsilaterally while medial lemniscus runs contralaterally. So if medial lemniscus is lesioned on the right*
side, the loss of two point discrimination will be lost on the opposite side i.e. left side.
• The respiratory diverticulum is an endodermal evagination of the foregut that gives rise to the parenchymal
epithelial surfaces of the respiratory system. The stroma of the entire respiratory system including the
cartilaginous, fibrous and muscular elements of the respiratory system are derived from mesoderm. Thyroid
epithelium is derived from the thyroglossal duct, another endodermal evagination of the foregut that is rostral
to the respiratory epithelium.
◦ First branchial pouch--> endodermal evagination that forms eustachian tube and middle ear linings
◦ First branchial cleft--> ectodermal evagination that forms the external ear canal

Femoral triangle-

Femoral Sheath-
Femoral ring: The upper end of femoral canal is called Femoral ring. It contains a large LN known as Cloquet's
gland that becomes swollen as a result of foot or leg infections. The femoral ring is bounded as follows:
• anteriorly by the inguinal ligament.
• posteriorly by the pectineus covered by the pectineal fascia.
• medially by the crescentic base of the lacunar ligament.
• laterally by the fibrous septum on the medial side of the femoral vein.

Posterior mediastinum structures--> there are 4 birds:

• The esophaGOOSE (esophagus)
• The vaGOOSE (Vagus) nerve
• The azyGOOSE vein
• The thoracic DUCK (duct)

Q- Hyaluronic acid present in vitreous or synovial fluid ?

Answer- It is present in both. But if you have to choose one, mark Synovial fluid. Hyaluronic acid is chief
constituent of synovial fluid. Charge on hyaluronic acid molecule causes them to repel. The conc. of hyaluronic acid
in vitreous is quite less in comparison to synovial fluid.

 The embryo can be differentiated as human at 8th week

Pelvic Splanchic Parasympathetic

Sacral Splanchic Sympathetic
Chordae tendineae attaches directly to free margins of mitral and tricuspid valves...

• The optic nerve (and chiasm) is located medial to the bifurcation of the internal carotid into it’s two main terminal
branches. An enlargement of the vessel may encroach upon the optic nerve and produce visual field deficits.

Branches Of External Carotid Artery- Sister Lucy's Powdered Face Often Attracts Medical Students.
• S= Superior Thyroid
• L= Lingual
• P= Posterior Auricular
• F= Facial
• O= Occipital
• A= Ascending Pharyngeal
• M= Maxillary
• S= Superficial Temporal
FORMULA FOR INTERNAL ILIAC ARTERY BRANCHES (SOME INHERIT MONEY U INHERIT
VIRTUAL IDIOCY SUCH IS LIFE):
• SOME superior vesical art → gives rise to artery of ductus deferens
• INHERIT inferior gluteal artery
• MONEY middle rectal artery
• U uterine artery
• INHERIT internal pudendal art
• VIRTUAL vaginal art
• IDIOCY inferior vesical art
• SUCH superior gluteal art
• IS iliolumbar art
• LIFE lateral sacral artery
(last 3 posterir branches)
I-Optic
II-Olfactory
III-Oculomotor
IV-Trochlear
V-Trigeminal,
VI-Abducens
VII-Facial
VIII-Acoustic (Vestibulocochlear),
IX-Glossophrayngeal,
X-Vagus,
XI-Accessory(Spinal)
XII-Hypoglossal
(Oh! Oh! Oh! To Touch…And Feel A Girl's Vein……Ah Heaven)

 Upper spinal nerves say T5 are more prone to injury during Sx relative to lower like L5 (injured less easily) as
lower ones are more protected (because longer the length of nerve, the more it can be moved away/manipulated
i.e. protected while performing Sx)

1. Primordial germ cells are derivatives of-

1. Epiblast----------------ans
2. Ectoderm
3. Mesoderm
4. Endoderm
Discussion-

5. All is true about migration of primordial germ cell except-

1. Present at primitive streak by week 2
2. Reach wall of yolk sac from the primitive streak
3. Pass through the dorsal mesentery of gut by week 4
4. Reach genital ridge by week 7----------------ans
Discussion-Remember all other options

6. First polar body is released-

1. 24 hrs before ovulation-----------ans (AA-I-749)
2. At ovulation
3. 12 hrs after ovulation
4. At fertilization
9. Corneal endothelium develop from-
1. Mesoderm
2. Endoderm
3. Ectoderm
4. Neutral crest cells----------------ans
Discussion-

1. Surface ectoderm-
• Forms surface epithelium of Cornea-->St. Squamous epithelium(Rest of cornea-->NCC)
• Conjunctival epithelium
• Glands- Lacrimal, tarsal, conjunctival
• Lens
2. Neuro-ectoderm(Neural Plate)--> Specialised ectoderm-
◦ Forms CNS
◦ Forms Optic nerve-->not a true nerve-->but diencephalon(part of fore-brain)
◦ Optic vesicle and cup
◦ Form Retina
◦ Muscles of Iris (sphincter pupillae, dilator pupillae)
◦ Vitreous(secondary)
3. Neural Crest Cells-
• Forms Cornea--> except surface epithelium
• Forms Iris-->except muscles
• Forms Peripheral Nervous System
• Forms EYE(exception that NCC an ectoderm forms eye-->mesoderm)
• All the skull bones are derived from the neural crest cells(ectoderm) except--> Occipital bone which is
derived from mesoderm also.
4. Mesoderm-
◦ Extra-ocular muscles
◦ Sclera*
 ◦ Ciliary body
◦ Vascular endothelium of eye and orbit
◦ Vitreous(Primary)
◦ Upper/medial walls of orbit
◦ Substantia propria

For detailed list refer Xerox-AA-198 also Parson- 5

26. Dorsal root ganglion is derived from-

1. Ectoderm------------ans
2. Mesoderm
3. Endoderm
4. Notochord
Discussion- NCC-->PNS-->Ganglia

11. All developed up to the adult size at birth except-

1. Mastroid antrum
2. Tympanic cavity
3. Orbital cavity-------------ans
4. Ear ossicle
Discussion- Orbit grows upto 7 yrs of life
Antrum-->Space
Mastoid antrum 1 ml at birth-->remains same throughout-->but wall thickness grows at 1mm/yr(actually temporal
bone)

12. All are derivatives of mesoderm except-

1. Mandible---------------ans
2. Femur
3. Trigone of bladdar
4. Upper 1/3 of vagina
Discussion-Most of the H+N region is from NCC-->it forms skull bones (So mandible and most of skull bones are
derived from NCC)

13. Urothelium present in all except-

1. Major calyx
2. Ureter
3. Urinary bladder
4. Membranous urethra----------------ans
Discussion-
Urothelium=Trasitional epithelium (B+L= P-1334)
14. Gall bladder epithelium is-
1. Simple squammous
2. Simple cuboidal with stereocilia
3. Simple columnar
4. Simple columnar with brush border------ans

15. Straight columnar epithelium is seen in-

1. Gall bladder
2. Proximal convoluted tubule
3. Epididymis
4. Small intestine-----------------ans

16. Wrong about neuroepithelium-

1. Simple cuboidal epithelium----------------ans
2. Present in cochlea & vestibule
3. Present in nasal mucosa
4. Are sensory cells for reception of taste
Discussion- It is a columnar epithelium(Gray's)-->ENT-
• Ear-->Hearing, Balance
• Nose-->Smell
• Tongue-->Taste

17. Neuro-epithelium type of sensor receptors are present in the following system except-
1. Visual---------------ans
2. Auditory
3. Gustatory
4. Olfactory

18. Atypical synovial joint is-

1. Temporomandibular-------------ans
2. Elbow
3. Femoro-patellar
4. Subtalar
Discussion-

Articular Cartilage in TM joint is--> Fibrocartilage-

• Since articular cartilage usually hyaline-->hence TM joint is atypical joint
• Also fibrocartilage is vascular-->exception among articular cartilage(see P=5 ROAMS)
• There is also a articular disc in jt. and it is also made up of fibrocartilage-->central part of articular disc is
 least vascular since arterial supply comes from periphery-->reason for perforation in centre

19. Fibro-cartilage is usually not present at-

1. Temporomandibular
2. Glenoid labrum
3. Intervertebral disc
4. Articular cartilage------ans(not present in articular disc except at TM joint)

20. Not true about vascularity of cartilage is-

1. Elastic shows late vascularization-------------ans
2. Hyaline usually vascularizes
3. Fabro-cartilage is vascular
4. Articular cartilage of TM joint is vascular
Discussion-
Cartilages-
• Hyaline--> Very high tendency to become vascular
• Fibro-->vascular
• Elastic--> never become vascular

When hyaline cartilage acts like articular cartilage then-

• it will never vascularise
• it will never calcify

25. Joint between thyroid and cricoid cartilage is-

1. Primary cartilaginous
2. Secondary cartilaginous
3. Fibrous
4. Synovial----------------ans*
Discussion-

29. Cells of the adrenal medulla are derived from the same cells as those that from-
1. Kidney collecting tubules
2. Preganglionic sympathetic neurons
3. AP septum of heart----------------------ans
4. Oligodendrocytes
Discussion-
NCC--> Mesenchyme--> CVS:
• AP Septum (Aortopulmonary Septum)
• Tunica media of great vessels

Pregnant mothers--> high Vit. A--> Teratogen--> NCC killed--> TOF

30. Neural tube closure starts from which region-

1. Cranial
2. Cervical-------------ans
3. Thoracic
4. Lumbar
31. Non-closure of caudal neuropore leads to-
1. Anencyphaly
2. Rachis-chisis---------------ans
3. Omphalocelo
4. Gastroschisis

32. Somatic afferent column arises from which plate of the neural tube-
1. Alar-------------------------------ans
2. Basal
3. Roof
4. Floor
Discussion-

33. Which of the following brainstem nuclei is not derived from alar plate-
1. Dentate
2. Inferior olivary
3. Hypoglossal----------------ans*(AIPGE)
4. Substantia nigra
Discussion- Because it is a pure motor nucleus--> anterior basal plate

34. Anterior horn cells of spinal cord contains the neuron type-
1. Upper motor
2. Lower motor-------------ans
3. Autonomic
4. Sensory
Discussion-

Lower motor neurons:

• hence flaccid paralysis
• all reflexes lost
• Polio

Upper motor neuron is in cerebrum(not spinal cord)

35. Preganglionic sympathetic neurons are located in-

1. Cervical and sacral spinal cord
2. Thoracic and lower lumbar spinal cord
3. Brainstem and sacral spinal cord
4. Thoracic spinal cord----------------ans
Discussion-
37. The following statements are true about Cauda equina syndrome except-
1. Spinal segments affected are L-3 to Cx vertebral levels
2. Saddle shaped Anaesthesia is observed
3. Knee and ankle reflexes are lost
4. Bladder/bowel & sexual functions are damaged severely---------ans
Discussion-

Cauda equina-(also MK-I P=120,383 Q-5) also Shaw's P-170 (fig. 16.5)
• m/c cause-->slipped disc
• involvement-
▪ Pudendal nerve(somatic nerve)-->compressed first-->saddle shaped anesthesia or perineal anesthesia
▪ Nervi erigentes(parasympathetic nerve)--> B/B movement compromised-->late feature

36. All true about Conus medullaris syndrome except-

1. Begins S-3 spinal level
2. Absent knee and ankle jerks---------------ans
3. Flexor planter reflex
4. Saddle anaesthesia
Discussion-
Muscle-

Skeletal muscles Somatic--> GSE--> CN III,IV,VI,XII

Pharyngeal arch muscles--> SVE-->CN V,VII,IX,X,XI
Smooth muscles/Cardiac muscles/Glands Visceral--> GVE--> CN III,VII,IX,X

SVE It Supplies PAM (Pharyngeal arch muscles via 2nd arch to muscles of facial expression)

All nerve given below are used in english numerals........

So cranial nerve 3-12 originate from brain stem...

GSE in Brain stem: 3,4,6,12

Pharyngeal arch muscles/SVE:

Arch Nerve Muscles

I 53 (Mandibular division of trigeminal nerve) Mastication eg. Messeter
II 7 Facial expression eg. Orbicularis oculi
III 9 Stylopharyngeus*
IV 10(SLN) Palate(x), Pharynx(y)
VI 10(RLN) Larynx(z)
Pharyngeal arch muscles in Brainstem-

Nucleus ambiguous-->Controls xyz muscles-->present in lateral medulla-->damaged in lateral medullary

syndrome(Wallenberg Syndrome)-->d/t blockade of Vertebral artery*/PICA-->difficulty in speech and swallowing
and loss of pain/temp sensation of opp (ck) side(PICA is a branch of vertebral artery-->supplies lateral medulla) ck

GVE in Brainstem: CN 3,7,9,10

Q-49. Post ganglionic parasympathetic fibers from ciliary ganglion are carried by:
1. Occulomotor nerve-upper division
2. Long ciliary nerves
3. Short ciliary branch of trigeminal ophthalmic nerve
4. Oculomotor nerve-third division
Answer….3

 Nerve III,VII,IX,X Parasympathetic nerve always carry preganglionic parasympathetic

 Postganglionic Trigeminal

40. Following nuclei are under general visceral efferent column except-
1. Edinger Westphal nucleus
2. Superior salivatory nucleus
3. Nucleus Ambigus----------------ans(SVE)
4. Dorsal nucleus of Vagus
41. Edinger Westphal Nucleus is situated in the mid-brain at the level of superior colliculi and is-
1. Parasymphathetic motor--------------ans
2. Sympathetic motor
3. Parasymphathetic sensory
4. Symphathetic sensory

43. Special visceral efferent column innervates the muscles derived from branchial arches. Which of the
following muscle is not included in the SVE system-
1. Masseter
2. Orbicularis oculli
3. Styloglossus--------------------------------ans(GSE)
4. Posterior cricoarytenoid(VI arch)

45. All is true about ciliaris muscle except-

1. Controlled by Edinger Westphal nucleus
2. Decreases anterior convexity of eye lens----------------------ans(it increases)
3. Contracts in near vision
4. Paralysed by anticholinergic drugs

Q-46. LPS is innervated by:

1. Oculomotor nerve
2. Oculomotor and T-1 Sympathetic nerve-------------ans
3. Trigeminal
4. Facial
Discussion-
• LPS:
◦ Skeletal part Supplied by III N.
◦ Smooth muscle part Sup. tarsal muscle Supplied by T-1 Sympathetic fibers Compromised in
Horner’s Syndrome Paralysis of Superior tarsal muscle Partial ptosis (partial since LPS Skeletal part
is still working to keep eyelids up)…..also Antagonist muscle Orbicularis Oculi muscle of facial
expression supplied by facial nerve(which normally shuts eyelid) is less opposed Ptosis(Partial)

Q-47. Ptosis is due to unopposed action of a particular muscle supplied by nerve:

1. Oculomotor
2. Sympathetic T-1
3. Trigemianl
4. Facial------------------ans

Q-48. Which of the following conditions could occur if the chorda tympani nerve is injured:
1. Hyperacusis
2. Loss of taste from the palate
3. Lack of sublingual gland secretion-----------------ans
4. Lack of parotid gland secretion
Discussion-
Q-51. A patient has a dry eye and reduced nasal secretions. The location of a lesion might be in the:
1. Otic ganglion
2. Pterygopalatine ganglion
3. Ciliary ganglion
4. Superior cervical ganglion
Answer….2

Q-52. The taste pathway from palate goes through:

1. Chorda tympani branch of facial nerve
2. Greater petrosal nerve branch of facial nerve
3. Palatine branch of vagus nerve
4. Palatine branch of Glossophryngeal nerve
Answer…..2

39. GVE nucleus of glossopharyngeal nerve is-

1. Nucleus tractus solitarius
2. Nucleus ambigus
3. Inferior salivatory---------------ans
4. Inferior olivary
Discussion-

 Parotid pathway:
Q-50. Secretomotor fibers involved in parotid secretion are carried in which of the following nerve:
1. Greater superficial petrosal nerve:
2. Deep petrosal nerve
3. Lacrimal nerve branch of trigeminal
4. Lesser/superficial petrosal nerve----------------ans

Q-53. All are elevetors of mandible except:

1. Anterior belly of digastric
2. Masseter
3. Medial pterygoid
4. Temporalis
Answer…1

Q-55. Chief action of lateral pterygoid on mandible:

1. Retraction
2. Protraction
3. Depression
4. Elevation
Answer….2

Q-59. Internal auditory meatus is present in the bone:

1. Squamous petrosal
2. Petrous temporal
3. Sphenoid
4. Occipital
Answer…2

Q-61. Enophthalmos is caused by:

1. Superior levator palpebrae paralysis
2. Orbicularis oculi paralysis
3. Orbitalis paralysis
4. Tarsal muscle paralysis
Answer….3

AIIMS Why en-ophthalmos is produced in Horner’s Syndrome: Orbitalis* Muscle Smooth muscle found
in orbit Produces slight protrusion of eyeball Supplied by T-1 Sympathetic fibers Paralysed in Horner’s
Syndrome en-ophthalmos

Q-57. Which of the following cranial nerves present in the posterior fossa:
 1. 3-12
2. 5-12
3. 7-12
4. 9-12
Answer….1

Q-58. Which of the following nerves pass through the foramina in posterior fossa:
1. 3-12
2. 5-12
3. 7-12
4. 9-12
Answer….3

Q-62. All is true about Trochlear Nerve except:

1. Exits dorsally from brain
2. Longest intracranial nerve
3. Innervates ipsilateral superior oblique
4. Lies outside the annulus of Zinn
Answer….3 Contralateral

Remember (SO4,LR6)3
Pnemonic: SIN All superior muscles are introiters both introiters are supplied contralaterally i.e. in the
lesions of left side right eye will loose intortion

Q-63. Untrue about trochlear nerve:

1. The only cranial nerve with dorsal exit
2. Shows internal decussation
3. Has the longest intracranial subarachnoid course
4. Carries GVE fibers
Answers…4
 GVE:
 Smooth muscle
 Cardiac muscle
 Glands
 SO Skeletal muscle GSE

Q-64. The cranial nerve with the longest intra-dural course is:
 1. Abducent nerve-----------ans
2. Trochlear nerve
3. Optic nerve
4. Trigeminal nerve
Discussion- 4th nerve overall longest intra-cranial Route Dorsal exit

Q-66. The actions of inferior oblique are all except:

1. Elevation
2. Abduction
3. Intortion
4. Extortion
Answer….3 Only superiors can do intortion(SIN)
• Here intortion is caused by SO (not SRit is relaxed during intortion)
• SO-->DOI(Out/Down/Intorsion)

• Clinical testing: Cover the other eye bring your finger medially(from outside) towards the root of the nose
of patient and then vertically downwards towards the tip of the nose test is negative in a patient having SO
lesion also in DM (rarely) associated with isolated lesion of Cochlear N.

Q-69. The muscle having contralateral innervation is:

1. IO
2. SR
3. LR
4. LPS
Answer….2
All superiors are introitors and innervated contralaterally

Q-71. Down and out eye occurs in the lesion of the nerve:
1. Oculomotor
2. Trochlear
3. Abducent
4. Sympathetic T-1
Answer….1
Remember(SO4,LR6)3  3rd nerve damagedeye down and out
Q-75. In lateral Medullary syndrome due to PICA occlusion; all of the following are lesioned except:
1. Hypoglossal nucleus
2. Trigemino-spinal tract
3. Nucleus ambigus
4. Inferior cerebellar peduncle
Answer….1
Ipsilateral horner’s syndrome occur.

Medial medulla-->supplied by-->Ant. Spinal Artery(branch of vertebral artery). Medial medullary syndrome: 12th N
palsy, cotralateral loss of position and vibration

Q-77. Number of trigeminal motor nuclei is/are:

1. 1
2. 2
3. 3
4. 4
Answer….1
Trigeminal N.  4 Nuclei:
 1 Motor (Derived from 1st Pharyngeal arch)Mastication
 3 Sensory

PONS:

Q-79. All are seen in Horner’s syndrome except:

1. Heterochromia iridis
2. Ptosis
3. Miosis
4. Apparent exophthalmos------------ans
Dicussion-
 Iris in a newborn Blue after 2 yrs(T-1 Sympathetic fibers control melanin concentration on iris)iris
becomes brown
 In a baby with klumpke’s paralysis(C-8,T-1)… left side(injury from birth upto 2 yrs) T-1 sympathetic fibers
damagedblue iris at 2 yrs(left side) Hetrochromia iris

Q-81. Loss of sympathetic activity leads to following changes in the skin:

1. Dry and hot
2. Dry and cold
3. Moist and hot
4. Moist and cold
Answer….1(Horner’s syndrome Anhydrosis)
Q-82. Sympathetic activation leads to all except:
1. Sweating
2. Skeletal muscle vasoconstriction
3. Mydriasis
4. Upper lid elevation
Answer…..2
 Sympathetic:
1. Alpha Vasoconstrictor Skin,Mucosa,GIT
2. Beta Vasodilator Bain,Heart,Skeletal muscles

Q-83. Fright leads to following changes in the blood flow except:

1. Gut Increased
2. Heart Increased
3. Brain Increased
4. Skin Decreased
Answer….1

Q-86. A patient with injury to the base of skull presents with difficulty in swallowing and hoarseness.
Radiographic analysis of the skull reveals fractured jugular foramen. Further examination confirms paralysis
of the following muscles, the only muscle spared will be:
1. Stylopharyngeus
2. Sternomastoid
3. Palatoglosus
4. Styloglossus
Answer….4
Choice 1 Supplied by IX N.
 Tongue muscles All supplied by XII N. Comes through hypoglossal canal-->hence spared
 Except Palatoglossal Supplied by XI N. (Cranial part).
 XI N.
1. Cranial Assessory N.  Meets Vagus Forms Vago-accesory complex Supplies following xyz
muscles:
a. Palate(Palatoglossus) supplied by vago-accesory complex
b. Pharynx
c. Larynx
2. Spinal Accesory N.  Supplies Trapezius, Sternocleidomastoid (Option 2)

 Subclavian Steal Syndrome:

BCT Brachiocephalic Trunk

ECA External Carotid Artery
LCCA Lt. Common Carotid Artery
LSA Left Subclavian Artery
ICA Internal Carotid Artery
RCCA Rt. Common Carotid Artery
RSA Right Subclavian Artery
SAM Scalaneus anterior muscle

 Vertebral Artery  Lies in Sub-arachnoid space Before it enters Foramen magnum

 In Subclavian Steal Syndrome ischaemia of hand arising out of excessive work blood is stolen from the
circle of willis for perfusion of hand using Vertebral Artery and through Subclavian Artery(R/L) Leading to
reversal of blood flow in the V.A. of same side.

Coarctation of aorta usually occurs just distal to the origin of left subclavian artery.

Q-90. Which of the following statements is false regarding subclavian steal syndrome:
1. Results from thrombosis of the left subclavian artery distal to vertebral artery
2. Reversal of blood flow in ipsilateral vertebral artery
3. Blood reaches left vertebral artery via carotid circulation
4. Vertigo occurs due to vertibro-basilar artery
Answer…1(proximal)

Q-91.Subclavian Artery Stenosis is most common:

1. Proximal to scalene anterior
2. Deep to scalene anterior
3. Distal to scalene anterior
4. At the outer border of first rib
Answer….1

Q-92. Acquired curvatures of vertebral column are:

1. Cervical and lumbar--------ans
2. Thoracic and sacral
3. Cervical and thoracic
4. Thoracic and lumbar
Discussion-
Newborn Vertebral Column: Kyphosis N

Adult vertebral column:

 • Cervical region become convex anteriorly-->when baby starts holding neck-->i.e. at 2 mths
• Lumbar region become convex anteriorly-->when baby starts walking-->comes at 10 mths

Q-93. Centre of gravity passes through:

1. Thoracic and sacral
2. Cervical and lumbar
3. Cervical and sacral
4. Thoracic and lumbar
Answer…2

Q-94.*Typical cervical vertebra can be differentiated from thoracic by all of the following except:
1. Oval body
2. Foramen transversarium
3. Superior articular facet directed backwards and upwards
4. Small body
Answer….3common feature of both the vertebra
1,2,4  Belong to Cervical Vertebra

Cervical Vertebra Smaller Size Oval shape

Thoracic Vertebra Bigger Size Heart shaped or Triangular shape

Q-96. In an infant of age two months, spinal cord ends at:

1. Lower border of T-12
2. Lower border of L-1
3. Upper border of L-3
4. Lower border of L-3
Answer…..2
 At >2 mths Adult level of spinal cord achieved Ref. Gray’s Anatomy (But anaesthetists say2 yrs)
Q-99. Filum terminale chiefly consists of:
1. Piamater
2. Arachnoid mater
3. Duramater
4. Nervous tissue
Answer…1

1. The first major system to start functioning-

1. Respiratory
2. Cardiovascular--------------ans
3. Nervous
4. Renal

2. Heart begins to beat in the week-

1. 4-----------ans
2. 5
3. 6
4. 7
Discussion- D-22= 4th week(from day of ovulation)

3. Heart tube is a derivative of mesenchyme derived from-

1. Mesoderm
2. Neural crest cells
3. Mesoderm and neural crest cells---------------ans
4. Mesoderm and ectoderm
Discussion-

4. Untrue about cardiac jelly-

1. Secreted by mesoderm surrounding primitive heart tube
2. Found exterior to endothelium
3. Forms myocardium----------------------------------------------ans(forms connective tissue)
 4. Transforms into the connective tissue of the endocardium
Discussion-

6. Obtuse marginal artery is a branch of-

1. Right coronary
2. Left anterior descending
3. Circumflex------------------ans
4. Posterior interventricular
Discussion-

• SANA- SinoArterial Nodal artery

PIVA Supplies Post. 1/3 of IV Septum

AIVA Supplies Ant. 2/3 of IV Septum
Bundle branches run in middle portion of septum supplied by LCA. So RBB+LBB is supplied by AIVA but *LBB
post. fascicle supplied by--> PIVA
11. Posterior interventricular artery is a branch of right coronary artery in most of the people(right
dominance). In 10% of population it arises from-
1. Circumflex artery-----------------ans
2. Left coronary artery
3. Pulmonary artery
4. Right coronary artery

14. Radial nerve is continuation of which cord of branchial plexus-

1. Posterior-----------------ans
2. Medial
3. Lateral
4. Medial & lateral
Discussion-

1) # mid-shaft humerous*-->damage at lower part of radial groove-->additionally wrist drop* with problems
below coz now ECRL is also paralysed
2) # Lateral Epicondyle--> Lower Radial N. Injury before it terminates. Additionally sensory loss will be
present along with fingerdrop.
3) PIN entrapment injury-->
◦ Ext. Digitorum--> Extension at-->
◦ Wrist(spared)--> d/t ECRL
◦ MCP*--> mostly affected(finger drop at knuckle jt.)
◦ PIP/DIP--> Spared(due to lumbricals and interossei-->muscles of
palm-->insert on insertion of extensor digitorum-->help extensor
digitorum)

Brachioradialis can cause both pronation as well as supination

21. Which of the following muscles get completely paralysed when the radial nerve is cut just after its entry into
the radial groove: (ai)
1. Long head of triceps
2. Lateral head of triceps----------------ans
3. Medial head of triceps
 4. Flexor carpi radialis
Discussion- (Maheshwari-53, Table 10-3)
• Muscles supplied by radial nerve-

• Triceps heads- LML

◦ Long
◦ Medial
◦ Lateral
• Anconeus
• BEES-
◦ B- Brachioradialis
◦ E- Extensor carpi radialis longus
◦ E- Extensor carpi radialis brevis
◦ S- Supinator

PIN goes around radial head in forearm like common peroneal goes around fibula

15. Neurovascular bundle commonly damaged in fracture at mid-shaft region of humerus is-
1. Axillary nerve & Posterior circumflex humeral vessels
2. Radial nerve & Profunda brachii vessels----------------------ans
3. Ulnar nerve & Ulnar collateral vessels
4. Median nerve & Branchial vessels

19. In C-5,6 lesion following pair of muscles may not be paralysed-

1. Coraco-brachialis---------------ans
2. Biceps brachii
3. Brachialis
4. Brachio-radialis
Discussion-

Erb's Palsy(C-5/6)-

Musculocutaneous C-5,6 Biceps brachii: elbow flexion(impaired--> policeman tip hand); Supinator
Nerve (BBC) when forearm is flexed, flexor of the elbow, flexor of the arm(short head)
Brachialis(Flexes the forearm)
C-7 (escapes in Coracobrachialis
Erb's palsy)

Lost BR reflex C-5/6

Biceps reflex C-5/6
20. Root value of musculocutaneous nerve is cervical-
1. 5
2. 5,6
3. 5,6,7--------------ans
4. 5,6,7,8

21. Claw hand is hyperextension at metacarpo-phalangeal joint & flexion at the interphalangeal(s). Which
muscles have become non-functional-
1. Lumbricals
2. Lumbricals & palmar interossei
3. Lumbricals & dorsal interossei
4. Lumbricals & all interossei---------ans
Discussion-

C8, T1 M. N. Damaged
Ul. N.

L(4) L-1,2 M. N.
L+I: helps ED in- Primary
L-3,4 Ul. N.
PIP Ext. action at *Flexion at MCP jt.
MCP I(8) I-4 PAD--> Palmar ADduction
DIP Ul. N.
I-4 DAB-->Dorsal ABduction

Klumpke's paralysis-->damaged C8,T1 --> Unopposed muscles

Claw hand deformity
L+I MCP--> Flexion MCP-->hyper-extension ED
(Axn. together)
IP--> Extension IP-->flexion FDS/FDP

22. Action of dorsal interossei-

1. Extension at metacarpo-phalangeal joint
2. Adduction at metacarpo-phalangeal joint
3. Flexion at metacarpophalangeal joints----------ans(DAB not in option)
4. Flexion at interphalangeal joints

23. Wrist drop is caused by lesion of-

1. Radial nerve in front of lateral epicondyle
2. Radial nerve in the radial groove---------------------ans
3. Posterior interosseous nerve
4. Anterior interosseous nerve

24. Interphalangeal extension is produced by-

1. Extensor digitorum
2. Extensor digitorum & lumbricals
3. Extensor digitorum,dorsal interossei & lumbricals
4. Extensor digitorum, interossei & lumbricals----------ans

25. Which of the following is not seen with lower radial nerve injury-
1. Weakness of branchioradialis--------------------ans
2. Inability to extend fingers
3. Paralysis of extensor carpi radialis brevis
4. Loss of sensations over dorsum of hand
26. All is true about lumbricals except-
1. Origin from flexor digitorum superficialis---------------------------ans(FDP)
2. Insertion into extensor expansion at the at the back of fingers`
3. Second lumbrical is supplied by median nerve
4. Cause flexion at metacarpo-phalangeal joint

27. All are composite muscles except-

1. Branchioradialis----------ans
2. Branchialis
3. Pectoralis major
4. Flexor pollicis brevis
Discussion-
BR-->Only Radial Nerve
Brachialis-->Musculocutaneous(mainly); Radial Nerve
Pectoralis major--> Medial pectoral nerve; Lateral pectoral nerve
Fl. PB--> Medial Nerve/Ulnar Nerve

30. Scapular anastomosis is between-

1. Dorsal scapular and suprascapular artery
2. Suprascapular and posterior circumflex artery
3. Deep branch of the traverse cervical artery and Subscapular artery-----------ans
4. Anterior circumflex artery and subscapular artery
Discussion- Xerox-AA P-245 Q-6

29. The axillary artery has become progressively occluded deep to the pectoralis minor muscle. Which pair of
blood vessels would most likely provide a significant collateral circulation around the blockage-
1. Posterior humeral circumflex artery and anterior humeral circumflex artery
2. Subscapular artery and posterior humeral circumflex artery
3. Subscapular artery and suprascapular artery-----------------------------------ans
4. Posterior humeral circumflex artery and profunda brachii artery

31. Circumflex scapular artery is a branch of-

1. Subclavian -3rd part
2. Axillary -1st part
3. Axillary -2nd part
4. Axillary -3rd part---------ans
32. Suprascapular artery is a branch of-
1. Subclavian -1st part----------ans
2. Subclavian -3rd part
3. Axillary -1st part
4. Axillary -3rd part

33. Thoracic dust passes through an opening in the diaphragm. The incorrect statement is-
1. Lies in middle of the aorta & azygous vein
2. Passes through the medial arcuate ligament----------ans (median)
3. The opening is osseoaponeurotic
4. Passes posterior to the diaphragm
Dicussion-

36. Transpyloric plane passes through-

1. T-12
2. L-1--------------ans
3. L-2
4. L-4
Discussion-

38. All of the following lie at transpyloric plane except-

1. Neck of gall bladder----------ans (not neck but fundus of GB)
2. Lower end of spinal cord
3. Hila of both kidneys
4. Tip of ninth costal cartilage

39. Which structure supplied by a branch of the celiac artery is not derived from foregut endoderm-
1. Head of pancreas
2. Pyloric duodenum
3. Cystic duct
4. Body of spleen---------ans (spleen is mesoderm)

41. Liver is divided into two surgical halves by all except-

1. Cantlie’s line
 2. Right hepatic vein--------------------ans
3. Portal vein at porta hepatis
4. Biliary duct at porta hepatis
Discussion-

The central area where the Common bile duct, Portal vein and Hepatic artery proper(DAV) enter is called PORTA
HEPATIS(PH).

Hepatic angiomas are the m/c of all liver tumors. They don't undergo malignant transformation but they may
enlarge and become symptomatic more readily in women after multiple pregnancies or during the use of estrogen or
oral contraceptives. The risk of rupture or severe hemorrhage is extremely low. Management is by angiographic
embolisation and resection should be reserved for the rare patient with symptomatic or complicated hemangioma.

Porta hepatis:(DAV)
Caudate lobe-

• Recently 9th segment separated-->Still considered part of 1st

• 4th segment is large and hides 1st segment(caudate lobe) from anterior view
• 4th lobe has two parts-
◦ Superior(a)
◦ Inferior(b): Quadrangular-->Quadrate lobe-->Only seen from posterior view -->hence
Caudate and quadrate lobe are seen from posterior view only.

• Middle hepatic vein passes through middle of GB and middle IVC

• Cantlie's line(America)-->follow middle hepatic vein

44. According to Couinaud’s segmentation all is true about hepatic veins except-
1. Are intrasegmental--------------------ans (Inter)
2. Drain into the inferior vena cave
3. Left hepatic vein lies along the falciform ligament
4. Divides the liver into four parts mainly

45. Segment of liver lying between fossa for gall bladder and umbilical fissure is-
1. 1
2. 4
3. 4a
4. 4b--------------ans

48. Number of sphincter of Oddi-

1. 2
2. 3
3. 4----------------ans
4. 5
Discussion- also told as the ans in vidyasagar and speed (AA and ROAMS say 3).
49. Which of the following is not derived from midgut-
1. First part of duodenum----------ans(foregut)
2. Distal duodenum
3. Jejunum
4. Caecum and ascending colon

50. Griffith’s water–shed area lies at-

1. Hepatic flexure
2. Splenic flexure------------ans
3. Descending colon
4. Sigmoid colon
Discussion-

• Watershed areas, including the splenic flexure, or Griffith's point, Sudeck's point, and the ileocecal region,
are high-risk regions for the development of ischemic colitis.

55. Vagus nerve supplies the gut tube till-

1. Opening of hepato-pancreatic duct into the duodenum
2. Right 1/3 of transverse colon
3. Right 2/3 of transverse colon--------------ans
4. Hepatic flexure of transverse colon
Discussion-
Parasympathetic Artery Sympathetic Vertebral Patients
Supply Supply level
Vagus Foregut Coeliac Greater T 5-9 Cong. Stomach distended-->pain
Trunk splanchnic Hypertrophic carried by Gr. Splanchnic
nerve Pyloric stenosis nerve-->Pain referred to
*epigastrium
Mid-gut* SMA Lesser T 10-11 Ac. Appendicitis Pain in peri-umblical area
splancnic
nerve
Kidney Renal Least T-12 Renal Colic Pain in area below 12th rib
Artery splancnic and above inguinal
nerve ligament(i.e. Radiating pain
from loin to groin)
**Nervi-erigentes Hind-gut IMA Lumbar L-1,2(*S2- Hirschprung's d/e More common in middle
(Pelvic splanchnic splancnic S4 spinal rectum (upper rectum dilates)
nerves) nerve level)

• Sympathetic Supply called Splanchnic nerves--> Carries pain (visceral pain)

• Nervi-erigentes also called Pelvic splanchnic nerves--> Supply pelvic viscera like: UB/Uterus/Rectum

Supply from nervi-erigentes-

L-1:
• Inguinal Ligament
• Uppper Medial thigh
• Ant. Genitalia
L-2:
 • Ant. thigh and medial thigh

Referred pain from uterus-

In DnC--> with Cx dilator-->Pain-

• S-2--> *Posterior thigh
• S-3,4--> Perineum

Upper ureteric colic referred to loin and groin is carried by Iliohypogastric* and Ilioinguinal nerve. When ureteric
colic pain is referred to testicles/thigh then Genitofemoral nerve is involved.

69. Locate the renal stone with pain radiation to medial side of thigh and perineum due to slipping of stone in
males- (Q. from Sx II)
1. At pelvic brim-----------------------------------------ans (ROAMS-29)
2. Intramural opening of ureter
3. Junction of ureter and renal pelvis
4. At crossing of gonadal vessels and ureter

60. Which nerve accompany branches of the inferior mesenteric artery that decreases peristalsis in the GI
tract-
1. Greater splanchnic
 2. Lesser splanchnic
3. Vagus
4. Lumbar splanchnic----------ans
Discussion-
• Inf. MA--> Hind-gut
• Decrease peristalsis--> Sympathetic--> LS

68. Urogenital diaphragm is contributed by all except-

1. Sphincter urethra
2. Perineal body
3. Colles’ fascia--------------ans
4. Perineal membrane
Discussion- Colle's is in superficial perineal pouch

Deep perineal pouch(Male)-

Contents-
1. Membranous urethra(Urethra and vagina in female)
2. PB
3. Muscles (EUS+DTP)
4. Pudendal N. Branches-
1. Perineal Nerve
2. Dorsal N. of penis(or dorsal N. of clitoris in females)
5. Cooper's bulbourethral gland
Supports (prevents prolapse):
• Urogenital diaphragm
• Perineal diaphragm
• Perineal body

72. All are content of sphincter of vagina except-

1. Pubovaginalis
2. External urethral sphincter
3. Internal urethral sphincter---------------ans
4. Bulbospongiosus
Discussion-

Deep perineal pouch (Female)-

Sphincters of vagina-
1. Bulbospongiosis
2. EUS
3. Pubovaginalis

In pudendal block sphincter urethrae is paralysed

73. Damage to the fundus of urinary bladder leads to extravasation of urine into the space-
1. Intraperitoneal-------------------------ans
2. Retrapubic space of Retzius
3. Retroperitoneal
4. Anterior abdominal wall
Discussion-
If urine extravasates in Sup. Pouch-
• can-not reach deep pouch d/t perineal membrane
• also can-not go to Ichiorectal fossa d/t Colle's fascia
• can reach Ant. Abdominal wall-->post. to Scarpa's fascia and ant. to EOM

See the position of patients in figure above-

1. # penile shaft with intact buck's fascia--> hematoma confined to penile shaft only
2. # PS with ruptured BF--> *Butterfly shaped perineal hematoma--> Urine+Blood in Scrotum,blood in ant.
Abdominal wall also. So there is blood in- Penis/Scrotum/Ant.abdominal wall
3. Bulbous rupture of Urethra--> Same as 2 above
4. Membranous rupture of Urethra- may be d/t pelvic #:
• Urine in deep pouch
• Can go in Superficial pouch if PM is ruptured
5. Fundal rupture of UB--> eg. Bomb explosion:
• Peritoneal rupture--> Intraperitoneal ascites
• In females--> Urine in POD

77. While a patient was being given an obstetric nerve block she gradually lost her voluntary control over
urination. The mucle which got anaesthetized is located in-
1. Trigone of the bladder
2. Urogenital diaphragm-------------ans (Ex. Urethral Sphincter zone)
3. Superficial perineal pouch
4. Pelvic diaphragm

78. Flexion at hip join is mainly produced by-

1. Psoas major----------ans
2. Pectineus
3. Glutei
4. Rectus femoris
Discussion-

Lower limb-

HIP
Posterior Anterior
Extension Flexion
eg. G. maximus-->chief muscle of extension eg. iliopsoas(chief muscle of flexion at hip joint)
-->Supplied by-->Inf. Gluteal N.-->it supplies only one
muscle

Superior gluteal nerve G. medius

(Ab-MR-->at hip jt. When foot is off the ground)
G. minimus
*Tensor fascia lata

When foot is fixed to the ground then- G. medius-

Sup. Gluteal N. damage Unilateral Pelvis sags(rt. in above diagram)--> Trendelenberg's test positive for damaged
side(Lt. Side)--> Can-not clear foot off the ground--> Lurching gait
Bilateral Waddling gait

Medial thigh--> 5 adductors at hip joint-

1. Pectineus
2. Adductor longus
3. Adductor brevis
4. Gracilis
5. Adductor magnus

Rt. Iliotibial tract(TFL)-

 • POLIO-
◦ ITT Contracture--> Short length
◦ Flexion deformity--> Hip/Knee
◦ Lateral rotation-->Hip/Knee
◦ G. Valgus at knee
◦ Abduction deformity

UnLocking *Popliteus--> Femur laterally

Locking Last 30 degree of knee extension--> Q. femoris--> Femur--> Medial rotation--> Locking of Knee jt.
Most stable position of jt.--> all ligaments are taut (When ligaments maintain extension--> muscles
relax--> Quadriceps femoris relax)

Rt. Knee joint-

• Central meniscal tear(M/C): Resection

• Peripheral meniscal tear--> Reconstructive Sx is recommended

Terrible Triad (football players)--> Following structures are damaged/torn:

1. Tibial collateral ligament
 2. Medial meniscus
3. Ant. Cruciate ligament* (Tibia comes anterior)

Lachman's test- Most sensitive test for ACL injury-->used for screening-->can be done on playground-->if false
positive-->do Ant. Drawer Test-->More specific-->more painful

89. Untrue about knee menisci is-

1. Menisci are fibrocartilage
2. Are vascular structures
3. Coronary ligament connects menisci to the femur-----------------------------------ans (tibia)
4. Reconstructive surgery is recommended in the peripheral part of meniscus

81. True about Trendelenburg test is-

1. Right pelvis drops down in left inferior gluteal nerve lesion
2. Right pelvis drops down inleft inferior gluteal nerve lesion
3. Right pelvis drops down in left superior gluteal nerve lesion--------ans(+ve for left side damage)
4. Left pelvis drops down in left superior gluteal nerve lesion

83. All are the actions of tensor fascia lata except-

1. Hip flexion
2. Hip adduction------------ans(5 adductors at hip joint)
3. Knee flexion
4. Knee extension

85. A 22 year patient is unable to “lock” the knee joint at the extreme extension. Which of the following muscle
is most likely damaged-
1. Vastus medialis----------ans (it is a part of Quadriceps)
2. Semimembranosus
3. Popliteus
4. Gastrocnemius

86. All of the following actions occur during the final phase of extension of the knee joint except-
1. The anterior & posterior cruciate ligaments become taut
2. Medial rotation of femur on tibia
3. Popliteus muscle contract actively--------------------------------------ans (popliteus should relax since it unlocks)
4. Lateral & medial collateral ligaments are twisted & tightened

87. Polio results in iliotibial tract contracture and leads to following deformity-
 1. Adduction & lateral rotation at hip joint
2. Adduction & lateral rotation at knee joint
3. Flexion, adduction & lateral rotation at hip and knee joint
4. Flexion, abduction & lateral rotation at hip and knee joint-----------ans

88. Wrong about cruciate ligaments of knee joint is-

1. Middle genicular artery supplies cruciate ligaments
2. ACL passes backwards & medially towards femur------------ans(Laterally)
3. ACL is injured in “Terrible triad” injury of soccer
4. Lachman test is the most sensitive test for ACL injury

90. A boy playing soccer has suffered trauma to the medial meniscus from a blow to the lateral aspect of the
knee and the knee has become unstable. What other structure is most likely to be injured-
1. Deltoid ligament
2. Lateral meniscus
3. Anterior cruciate ligament-------------ans
4. Patellar-ligament

91. Which of the following is not a component of the unhappy triad-

1. MCL
2. PCL----------ans (unhappy triad=terrible triad)
3. ACL
4. Medial Meniscus

92. Toes do not buckle under during walking, due to the action of-
1. Tibialis anterior
2. Lumbricals---------------ans (normally L+I prevents buckling)
3. Tibialis posterior
4. Gastrocnemius
Discussion-
 Claw foot deformity
L+I (foot axn. Same as hand) MTP-->flexion MTP--> hyper-extension
IP-->Extension IP--> flexion (buckling of toes)

Posterior Thigh-

Q-97. Slip disc at L-5, S-1 leads to compression of nerve root:

1. L-4
2. L-5
3. S-1
4. S-2
Answer….3
 Funda is to add +1 to the vertebra which is higher..
 Pain of little toe area S-1 dermatome
93. Inversion-eversion occur mainly at the joint-
1. Ankle
2. Talo-calcaneal------------ans(i.e. Subtalar jt.)
3. Talo-navicular
4. Calcaneo-cuboid

Flat foot is characterised by disappearence of medial portion of longitudinal arch--> the planter
calcaneonavicular(spring) ligament that supports the medial side of longitudinal arch.

96. A patient has altered sensation in the dorsum of the foot and has weakness in the ability to evert the foot.
The nerve that has been lesioned is the-
1. Superficial peroneal------------------ans
2. Sural
3. Saphenous
4. Tibial

97. A tight below knee cast will compress the nerve-

1. Tibial
2. Common peroneal--------------ans(foot drop may result)
3. Deep peroneal
4. Superficial peroneal
Discussion-
• Injury to common peroneal nerve- loss of *dorsiflexion and eversion
• Musles supplied by common peroneal nerve-
◦ Tibialis anterior
◦ Peroneus longus/brevis
◦ Extensor digitorum longus

98. Common fibular nerve is commonly damaged at the neck of fibula-

1. Anteriorly
2. Posteriorly
3. Medially
4. Laterally-----------------ans
100. Deltoid ligament is not attached to-
1. Medial cuneiform-----------------------ans
2. Medial malleolus
3. Sustentaculum tali
4. Spring ligament
Discussion: Medial side of rt. Ankle-

STRUCTURES UNDER FLEXOR RETINACULUM (LEG):

FROM MEDIAL TO LATERAL--> TINA DESERVES A NICE HUSBAND
• T- Tibialis poterior
• D- Flexor digitorum longus
• A- POST TIBIAL ARTERY
• N-TIBIAL NERVE
• H- FLEXOR HALLUCIS LONGUS

10. Which of the following statement is incorrect regarding the arches of the foot(ai)-
1. Their main function is to distribute the body weight to the weight bearing areas of the sole
2. Talipes calcaneus means to walk on the heel
3. The keystone of the medial longitudinal arch of the foot is calcaneum------------ans(talus)
4. Commonest deformity of the foot is talipes equino varus
Discussion- BDC-II-159
• Option 4 imp. (mug)
• Medial longitudinal arch (read more about it)-
◦ Spring ligament
◦ Bone- Talus
◦ Main joint- Talocalcaneonavicular joint
◦ Muscle- Tibiallis posterior