BASIC CONCEPT, TRICKS AND MAGIC OF

ANATOMY

What is Anatomy:- cut & observe the Cadaver

Different types of layers of body superficially to
deep: -
•• Roof :-
–– Skin
–– Superficial fascia (fat , cutaneous nerves &
vessels)
–– Deep fascia (includes collagen fibers)
•• Floor :-
–– Muscles
–– Bone
•• Why Anatomy is important & how to study :- •• Proper coordination, balance & integration
among different subjects = cerebellum

•• Dissection: autopsy /surgery

For Proper Coordination Balance & Integration Among Different
Subjects
•• Conceptual Brainstorming integration: -
2
Anatomy

Transverse dissection
diagram :- Revision capsule/PYQs:-
•• Roof is formed by skin, superficial fascia,
deep fascia
•• Floor is formed by muscles, bone
•• Contents of any space: - neuromuscular
bundle (VAN)
Q. Neurovascular bundle is absent in which
compartment of leg? [AllMS MAY 18]

1. Anterior

2. Lateral
Vein – thin walled & collapsing 3. Superficial posterior
Artery – thick walled & recoil
4. Deep posterior
Nerve – no lumen, solid cord
Q. Neurovascular bundle in abdomen runs in
•• All neurovascular bundle of our body have between? (DEC FMGE 21)
sequence as vein-artery-nerve except -
1. Between external & internal oblique
–– 1st Intercostal space
–– Popliteal fossa 2. Between external oblique & transversus
abdominis
•• HILTON’S LAW: - Hilton observed that
nerves supplying the MUSCLE also innervate 3. Between internal oblique & transversus
the SKIN overlying the muscle and the JOINT abdominis
over which that muscle acts.
4. Between transversus abdominis & fascia
transversalis

FOCUS AREA FOR EXAM: -

•• Femoral triangle & hernia
•• Inguinal canal & hernia
•• Triangle Of neck
•• Cadaveric images
•• Surgery & ENT integration
 POSITION, PLANES AND TERMINIOLOGY

Anatomical position

1. Supine - lying on back - Cardiothoracic surgeries

2. Prone - lying on abdomen - Spine or back surgeries
3. Lithotomy - patient lying on the back with both
feet supported with footrest.
Perineum area is exposed.
For Obstetric-gynaecological procedures and
Genito-Urinary surgeries.

4. Lateral decubitus - lie on one side of the body -

•• Body is erect Best for ear surgeries.

•• Eyes looking forward

PLANES
•• Hands on side with palms directed forward
1. Mid-sagittal plane - Plane divides the plane into
•• Legs together with toes in front two equal halves.
2. Sagittal plane - Any plane parallel to mid-sagittal
plane.
2
Anatomy

3. Coronal/Frontal Plane - Divides the plane into

front & back.
4. Transverse/Horizontal plane - Divides plane into
upper and lower parts, parallel to the ground.
5. Oblique plane - Any plane making angle with the
ground

•• Superior/Cranial - Near to Head

•• Inferior/Caudal - Near to Foot
•• Anterior/Ventral - Any point in Front of the body.
•• Posterior/Dorsal - Any point in the back of the
body.
•• Proximal - Near to trunk.
•• Distal - Away from trunk.
TERMINOLOGY •• Medial - Close to Midline.
•• Lateral - Away from Midline.

Focus Areas for Exams:-

Direct question may not be asked BUT ..
•• In each subject & questions patient position
is described in anatomical position (if not
specified).
•• Planes Of the body are very important for
radiology especially.
•• Anatomy Terminology is also commonly used
in each subject.

PYQs:-
Frontal plane section is termed as? (DEC
FMGE 2021)
1. Sagittal Section
2. Coronal Section
3. Horizontal Section
4. Oblique Section
 JOINTS

Definition : Junction between 2 bones which makes possible movement.

TYPES

FIBROUS JOINT CARTILAGINOUS JOINT SYNOVIAL JOINT

1. Fibrous Joint obliquely with each other. E.g. - Tempro-parietal

suture.
3. Serrated suture - Articulating surfaces have
serrated margins with fibrous tissue in between.
E.g. - Interparietal suture
4. Dentate suture - One is fitted into the other with
fibrous tissue in between. E.g. - Lambdoid suture.
5. Wedge and Groove/Schindylesis suture.
E.g. - Sphenoid bone & Vomer.

B. Syndesmosis
Not movable 2 bones are connected via Ligaments.
Present in skull bones - fibrous tissue in between 2 E.g. - Middle Radio-Ulnar joint, Middle Tibio-fibular
bones. Interosseous Membrane, Inferior Tibio-fibular joint.
Types of Fibrous joint (Mnemonic - SaSu G)
C. Gomphosis
Sa - Sutures
Joint found in Gums.
Su - Syndesmosis
G - Gomphosis 2. Cartilaginous joints
A. Sutures A. Primary Cartilaginous/Synostosis/Synchondrosis-

1. Plane suture - Articulating surfaces parallel to → Ossified in later stages of life.

each other with fibrous tissue in between. E.g. - Growth plate
E.g. - Intranasal suture
B. Secondary Cartilaginous joint/Symphysis joint -
2. Squamous suture - Articulating surfaces placed
•• Ends of Bone covered with Hyaline Cartilage
2
Anatomy

while the in-between space has fibrous So - Superior Tibio-fibular joint

connective tissue.
•• Show partial Movements. C.Hinge joint (Mnemonic - IEA)
→ Only Uniaxial movement possible (due to bony
•• Present in midline of the body (except
prominences)
Symphysis menti - 10 Cartilaginous) (Mnemonic
- SIM/MIS) I - Interphalangeal movement
S - Symphysis pubis, Sacro-coccygeal joint E - Elbow joint
I - Intervertebral Disc A - Ankle joint
M - Manubrio-strenal joint, Xiphi-sternal joint.
D. Ellipsoid joint
3. Synovial Joints → Convex-concave surfaces face each other.
→ Multi-axial with Restricted movements.
E - M - W
Metacarpo-phalangeal joint Wrist joint
Atlanto-occipital joint (Yes movement - Above atlas)

E. Saddle joint (Mnemonic - PICS)

→ Concavo-convex surfaces in each bone.
P - Patello-femoral joint (Anatomically)
I - Incudomalleolar joint
C - Carpo-metacarpal joint (1st joint)
S - Sterno-clavicular joint

F. Pivot joint
→ Rotatory movements between bones around an axis.
Atlanto-axial joint → between C1 and C2 (No movement
- Below atlas)
Superior (via annular ligament) and Inferior Radio-
A. Ball and socket joint (Mnemonic - SHIP) ulnar joint

S - Shoulder joint - most movable joint G. Condylar joint

H - Hip joint → Condyles of the 2 bones fit into each other.
I - Incudo-stapedial joint Knee - Bicondylar > Condylar joint
T - Talo-calcaneo-navicular joint Temporomandibular joint (TMJ) - Bicondylar joint
B. Plane synovial joint (Mnemonic PICASo)
Cartilaginous Joint
→ Articulating surfaces are plane and only gliding
movement present.
P - Patello-femoral joint (Functionally only)
I - Intercarpal & Intertarsal joints
C - Costovertebral and costotransverse joint
A - Acromio-clavicular joint
 3
Joints
4
Anatomy

Focus Areas for Exams PYQs

•• Identification of joint & its type based on: Q. The type of joint marked in the image below
a. Osteology is (NEET PG 2020)
A. Syndesmosis
b. Radiology
B. Synarthrosis
•• Sure shot questions from Joint directly and
also related to Orthopaedics. C. Synchondrosis
D. Synovial
Q. Which type of joints is involved in shown
Revision Capsule / PYQs movement in image (June FMGE 2022)
•• Joint permits a person to look to the right A. Pivot joint
and left (NEET PG 2019) : …................. B. Saddle joint
•• The joint between the attachment of the C. Ball & socket joint
8th & 9th rib to the 7th rib is (NEET PG D. Hinge joint
2018): ……............
Q. At a marked arrow which type of joint is
•• MiddIe radioulnar joint is (FMGE 2022)
shown? (DEC FMGE 2021)
...................
A. Saddle synovial
•• lnferior tibiofibular joint is (AIMS 2017):
B. Secondary
...................
cartilaginous
C. Primary cartilaginous
D. Ellipsoid synovial
 MUSCLE & MOVEMENT

•• Total 639 muscles in our body ƒƒ Articular processes of vertebrae

•• Muscle is modified cell with contractile protein:- ƒƒ Tarsals
actin & myosin
(Carpal bones mnemonic :- She Looks Too Pretty Try
•• 2 parts of Muscle:- Belly (soft & contractile) To Catch Her)
and Tendon (non contractile)
–– Sometime tendon is becoming flat known as
aponeurosis
•• Raphe:- it is Inter-digitation of Muscle fibers

•• Movements at a joint:-
–– Muscle only help to movement of joints when
it’s crossing 2 joints
–– If any Muscle crossing joint from front can
make forward movement & if crossing from
back can perform backwards movement
•• Gliding:-
–– Flat surfaces of two bones glide across each
other Gliding occurs between
ƒƒ Carpals
2
Anatomy

–– Popliteus Muscle having action of unlocking(

beginning of flexion is known as unlocking)
–– Quadriceps femoris known as footballer’s
muscle Which responsible for kick action
& it’s doing extension of knee (unlocking-
popliteal muscle, locking – Quadriceps
femoris)
–– Inversion Muscle of foot:- tibialis Anterior
& Posterior

–– Evertor of foot:- Peroneus longus & brevi

•• Angular movement:- movement in which there
•• Basic rules of muscle identification in cadaveric
is a change in angle
images:-
–– Decrease in angle called flexion movement
–– Increase in angle called extension movement
–– Movements towards midline called adduction
–– Movements away from midline called
abduction
–– Movements as rotating towards midline
called internal rotation
–– Movement as rotating away from midline
called external rotation
–– Circumduction is the combination of
Movements (ex. During bowling)
–– Surfacing the palm upward called supination
–– Surfacing the palm downward called
pronation (supination & pronation occur
between sup. & inf. radio ulnar joint)

•• Foot drop:- due to paralysis of some muscles no

upward movement in foot which mainly involves
common peroneal muscle
 3
Muscle & Movement

1. Parallel muscles:- ƒƒ Bipennate:- 3rd & 4th lumbrical , all

dorsal interosseous
•• Strap muscle fiber
–– Sternohyoid
–– Sternothyroid
–– Omohyoid
–– Longest muscle of body :- Sertorius a.k.a.
honeymoon muscle / tailor’s muscle ƒƒ Multipennate:- middle fiber of deltoid,
subscapularis muscle
•• Quadrilateral muscle fiber
–– Thyrohyoid
–– Rectus abdominis:- have Tendinous
intersection

ƒƒ Circumpennate

•• Fusiform muscle :- biceps

3. Cruciate:-
Which crossing each other, ex:- Sternocleidomastoid,
masseter (strongest muscle of body)

2. Oblique muscle :-
4. Twisted / spiral :- pectoralis major
–– Pennate
(NEET 18)
ƒƒ Unipennate :- 1st & 2nd lumbrical , Palmar
interosseous
4
Anatomy

Focus Areas for Exams:

1. Identification of muscles in cadaveric
images
2. Action of muscle
3. Nerve supply of muscle
4. Muscle & nerves related different clinical
tests & signs.

PYQs:
Q. What is the function of the lumbricals at the
metacarpophalangeal joint? (NEET PG 2018)
A. Flexion
B. Extension
C. Adduction
D. Abduction
Q. What is the nerve supply of the first lumbrical?
(INI-CET 2022 Pattern)
A. Radial nerve
B. Median nerve
C. Ulnar nerve
D. Musculocutaneous nerve
Q. Action performed by marked muscle? (June
FMGE 2022)
A. Abduction of shoulder joint
B. Adduction of shoulder joint
C. Protraction of scapula
D. Retraction of scapula
 PECTORAL REGION

Bones of pectoral region:- •• Clavicle is the only bone which pierced by the
nerve – Intermediate supraclavicular nerve
Clavicle:-
•• It is aka collarbone / beauty bone / key bone
Scapula:-
•• Coracoid process fits in infra clavicular groove
•• Clavicle parts:- medial 2/3rd & lateral 1/3rd (
/ fossa aka delto- pectoral groove
Mc fracture location) < Medial 3/5th & Lateral
2/5th •• Above the spine of Scapula there is supraspinous
Fossa & below infraspinous Fossa.
•• Clavicle is the only bone having 2 ossification
center
2
Anatomy

Muscles of Pectoral region :

•• Pectoralis major & minor
•• Serratus anterior aka boxer’s muscle because it
has punching & pushing ability & it’s supplied by
bell’s nerve aka long thoracic nerve, responsible
for winging of scapula.
•• Subclavius
•• Pectoralis minimus
•• Rectus sternalis

•• Winging of Scapula:- In this, Medial border of PYQs:

Scapula elevated and person is not able to lift
•• Mc congenital absent Muscle is pectoralis
weight or do lifting exercises (FMGE 2020),
major, this situation is known as Poland
serratus anterior muscles responsible for this.
syndrome.
•• Forward movement of Scapula known as
•• Climber's Muscle / extensor of shoulder joint
protraction of scapula
are P. Major & latissimus dorsi
Humerus / funny bone:- •• Key Muscle of the pectoral region is P. Minor
•• Parts:- head, neck, greater & smaller tubercle •• Boxer's Muscle is supplied by bell's nerve
(intertubercular groove between them), Medial •• Alman's classification: - It tells about
& Lateral epicondyle fracture of Clavicle and divide it into 3 parts: -
•• Below lesser tubercle there is Inter tubercular med 1/3rd (5%), lateral 1/3rd middle 1/3rd (80%)
sulcus aka bicipital groove (from here, long head
of biceps with his synovial sheets & ascending
branch of anterior circumflex artery is passing)
•• At the Medial epicondyle, the ulnar nerve is
passing.
 AXILLA-1 (AXILLARY ARTERY)

It is a truncated pyramidal shaped space on

the lateral side of the chest wall and medial
to the upper end of the humerus.

Boundaries: 4. Floor - Skin and fascia

1. Lateral wall - Intertubercular Sulcus, Biceps 5. Apex - directed towards the neck
2. Medial wall - Serratus anterior 6. Posterior wall - Coracobrachialis, Teres major &
Scapula
3. Anterior wall - Pectoralis major & Pectoralis
minor
2
Anatomy

Biceps - Short head is related to N - Axillary Nerve

Coracobrachialis muscle.
Lymph nodes - Axillary group of lymph nodes
Contents of Axilla:
Axillary Artery
V - Axillary Vein
Continuation of Subclavian artery.
A - Axillary Artery

Mnemonic : “STA, ATA, LTA → ACHA, PCHA, SSA”

NOTE:
KEY Muscle of Axillary region - Pectoralis Minor
Mnemonic for Branches of axillary artery which supply
Focus Areas for Exams & PYQs to breast - SALI

•• Axillary artery S - Superior Thoracic Artery (STA)

•• Parts of axillary artery & its branches A - Acromiothoracic Artery (ATA)

L - Lateral Thoracic Artery (LTA)
Revision Capsule / PYQs I - Internal Mammary Artery (IMA)
1. Branches of axillary artery which supply to
breast:
2. Largest branch of axillary artery:
 AXILA-2 (BRACHIAL PLEXUS)

Brachial Plexus

Parts of brachial plexus - (Ramu Tailor Drinks Cold Thickest cord of Brachial Plexus - Posterior cord
Beer)/ RTDCB
Thickest nerve of Brachial Plexus - Radial nerve
Roots - Part of nerve attached to the spinal cord. 5 in
About cords -
number → C5-C8 and T1.
All posterior divisions unite to form → Posterior Cord
Trunk - 3 in numbers → Upper, Middle & Lower Trunk.
(Radial nerve)
Divisions - 1 anterior and 1 posterior from each Trunk.
Anterior divisions of Upper and Middle trunks →
Cords - 3 in number → Medial, Lateral & Posterior Lateral Cord (Median nerve)
Cord (named according to the anatomical relation with
Anterior divisions of Lower trunk → Medial Cord
axillary artery).
(Ulnar nerve)
Note - Sometime contribution from other segments
also present: (Note - In bracket - Main continuation of respective
•• C4 - Pre-fixed brachial plexus Cords)

•• T2 - Post-fixed brachial plexus

2
Anatomy

Branches from Brachial Plexus:-

1. Nerve from roots •• R - Radial nerve (C5-T1)

•• Dorsal Scapular nerve •• A - Axillary nerve (C5-C7)
•• Long Thoracic nerve (aka Nerve of Bell - C5-C7 6. Branches from Medial Cord (Mnemonic
→ to Serratus Anterior)
M4U)
2. Nerves arises from upper trunk (only
Upper Trunk gives branches) (C5-C6) •• M - Medial root of Median nerve

•• Nerve to Subclavius muscle •• M - Medial cutaneous nerve of Arm

•• Suprascapular nerve •• M - Medial cutaneous nerve of Forearm

3. No Branches from Divisions •• M - Medial Pectoral nerve

•• U - Ulnar nerve
4. Branches from Lateral Cord (Mnemonic
LML) (C5-C6)
Clinical Integration -
•• Lateral root of Median nerve
A. ERB’s Paralysis
•• Musculocutaneous nerve
•• Lateral Pectoral nerve Injury between Head and shoulder → involve Upper
trunk (C5-C6 involve)
5. Branches from Posterior Cord (Mnemonic
ULTRA) Causes -
•• U - Upper subscapular nerve (C5-C7) •• Fall with a stretched arm or on shoulder.
•• L - Lower subscapular nerve (C5-C7) •• Shoulder dystocia during delivery.
•• T - Thoracodorsal nerve (nerve to Latissimus
dorsi) (C6-C8)
 3
Axilla-2

Erb’s point - Junction of 6 nerves

Defects - Revision Capsule / PYQs

•• Adducted arm - defect in Deltoid •• Parts of Brachial plexus:
•• Medial Rotation of arm - defect in Trapezius •• Phrenic nerve root value:
minor
•• Thickest nerve of brachial plexus:
•• Pronated hand - defect in Biceps, Brachioradialis
and Radial nerve weakness. •• Thickest cord of brachial plexus:

•• Extended elbow - defect in Coracobrachialis, •• Nerves with all root values in brachial plexus:
Biceps, Brachioradialis.
Aka Waiter’s/Porter’s Tip hand OR Policeman’s Tip UPDATES: GRAY’S 42nd UPDATE
hand.
Q. Root value of Ulnar nerve?
B. KLUMPKE’s Paralysis
A. C5,6,7
Causes -
B. C6,7,8
•• Overstretching of Arm/Axillary area.
•• Pulling of hand during delivery. C. C7,8 T1

Defects - D. C7,8

Ulnar Claw hand - Ulnar nerve damage •• Axillary nerve : C5-C6

Horner’s Syndrome - due to T1 damage •• Musculocutaneous nerve : C5-C7
•• Pectoralis minor supplied by :
Focus Areas for Exams
a. Lateral pectoral nerve
•• Brachial Plexus Formation & Branches
b. Medial pectoral nerve
•• Brachial Plexus Injury
•• Erb's Palsy
•• Klumpke's Palsy
•• Formation of Radial, Median, Ulnar Nerves
 BACK

2. Latissimus Dorsi - by Thoracodorsal nerve

3. Levator scapulae - by Dorsal Scapular nerve

4. Rhomboid Major & Minor - by Dorsal

Scapular nerve

Triangle of Auscultation -
Less muscles - easily get LUNGS sounds
•• Lateral border - medial border of Scapula
•• Medial border - Trapezius
•• Base - Latissimus dorsi

Dissection / Surgery :
Superficial to deep
Skin → Superficial fascia → Deep fascia → Muscles
→ Bones

Muscles:-
1. Trapezius - by XI / Accessory spinal
nerve
•• Shrugging of shoulder → Upper fibres
•• Retraction of scapula → Middle fibres
•• Overhead abduction → Lower fibres
2
Anatomy

NOTE - Q. What is the shape of Trapezius muscle?

Winging of scapula due to paralysis of → Serratus (CONTROVERSIAL QUESTION: AllMS NOV 17)
anterior > Trapezius > Rhomboids
A. Triangular
Focus Areas for Exams B. Quadrangular
•• Cadaveric images
C. Strap
•• Clinically integrated questions
D. Fusiform
Revision Capsule / PYQs
Q. Which muscle is known as Climber's muscle?
•• TRAPEZIUS is supplied by:
(CONTROVERSIAL QUESTION)
•• Stand at ease muscle is:
A. Serratus anterior
•• Dorsal scapular nerve & muscles supplied by
it: B. Levator scapulae
•• Winging Of scapula (controversial question):
C. Pectoralis major
PYQs D. Latissimus dorsi
Q. The muscle marked by the arrow in the image
below is innervated by the? (NEET PG 2020)

A. Dorsal scapular nerve

B. Suprascapular nerve
C. From the dorsal rami of C1
D. Subscapular nerve
 SHOULDER/SCAPULAR REGION

Dissection/ Surgery : Deltoid - Give rounded contour to the shoulder

Skin → Superficial fascia → Deep fascia → Muscles Rotator Cuff (SITS) - Supraspinatus, Infraspinatus,
Teres minor & Subscapularis.
Muscles

(Mnemonic for muscles in Bicipital Groove - Lady

Between the 2 Majors)
•• Subscapularis muscle (Multipennate) - Hybrid
muscle → from upper and lower Subscapular
nerve.
•• Muscle least damage in Rotator Cuff injury
- Subscapularis → hence called as Forgotten
muscle of the Rotator Cuff.

•• Nerve supply of deltoid : Axillary nerve •• Muscle most commonly damaged in Rotator
(related to Surgical neck of Humerus) Cuff injury - supraspinatus
•• Teres Minor - supplied by nerve to teres minor
(branch of Axillary Nerve → Pseudoganglion
present).
•• Teres Major - by Lower Subscapular nerve.
2
Anatomy

Bursa of the Body

PYQs:
Largest Bursa - Iliopsoas Bursa > Subacromial Bursa Q. Action performed by marked? (June FMGE
2022)
(Inflammation → Subacromial Bursitis)

Uses -

•• Act as Shock absorber.

•• Provide proper joint movement.

Clinical - Inflammation is called Bursitis.

Subacromial Bursitis → Positive Dawbarn’s Sign

(Pain disappear on Abduction of arm)

A. Abduction of shoulder joint
Regimental Badge Anaesthesia - B. Adduction of shoulder joint
Due to injury to Axillary Nerve.
C. protraction of scapula
(It’s posterior branch is sensory to upper part of D. Retraction of scapula
the lateral arm area via cutaneous branch known as
Q. A patient who has taken the first COVID vaccine
regimental badge) comes for the second dose. An astute nurse
noticed that the Shoulder was flabby, fat, and
Cause - During Intramuscular injection or injury at
was asymmetrical. There was an associated
the surgical neck of the humerus. loss of Contour of the Shoulder joint. Injury
to which of the structures might have resulted
Focus Areas for Exams:
and was avoidable? (INICET 2021 Pattern)
•• Cadaveric images
A. Rotator cuff
•• Clinically integrated questions
•• Rotator cuff & Injury B. posterior Circumflex artery

•• Shoulder abduction C. Lateral cutaneous nerve of arm

D. Deltoid muscle
Revision Capsule:
Deltoid & Shoulder abduction: Q. 0 to 15 degree of abduction of joint is caused
by? (CONTROVERSIAL QUESTION: AIIMS
Deltoid is supplied by:
NOV 17)
Another muscle supplied by axillary nerve:
A. Supraspinatus
Characteristic Of nerve to Teres minor is:
B. Infraspinatus
Nerve supply Of Teres major:
Rotator / Musculo - tendinous cuff is formed by: C. Deltoid

Most Common muscle getting injury in Rotator cuff: D. A & C both

Least common muscle getting injury in Rotator cuff:
Example of Multipennate muscle fibres:
 ARM

Nerve Site of injury Muscles Clinical

Affected Features
Axillary Surgical neck Deltoid - Regimental
of Humerus batch
Teres minor anaesthesia

- 0-90 degree
Abduction
weakness
- Loss of
rounded
contour of
shoulder
- medially
rotated arm
Radial Radial groove Extensors Wrist drop
of Upper
limb
Ulnar Medial Small Ulnar/Partial
epicondyle muscles of Claw hand
hand
Median Supracondylar Flexors of - Median Claw
Area Wrist hand
- Benediction
hand
deformity

Student’s/Miner’s Elbow - Inflammation of Olecranon

Bursa (Olecranon Bursitis)

ORTHO-RADIO-ANAT INTEGRATION:
Humerus connected to 4 nerves
2
Anatomy

Supracondylar humerus Fracture Q. A male presented with symptoms of inability to

Radial Artery damage → Volksmann’s Ischaemia → flex the distal interphalangeal joint of the 4th
Gun Stock deformity
and 5th digits. He was also not able to hold a
Focus Areas for Exams: piece of paper between his fingers. What is the
•• Cadaveric images likely site of injury? (INI-CET 2021 Pattern)
•• Fracture Of humerus & nerve injured
•• Radio Ortho & Anatomy Integration
•• Controversial questions

Revision Capsule:
•• Cadaveric images
•• Nerve supply of BBC:
•• Clinical integration With Radio & Ortho

PYQs
Q. A patient visited to trauma & casualty ward with
multiple fracture of shaft Of humerus. He was
having the difficulty in elbow flexion & supination.
He also complained about loss of sensation Over
lateral side of forearm. nerve is most probably A. A
damaged? (NEET PG 2021)
B. B
A. Musculocutaneous nerve
C. C
B. Median nerve

C. Ulnar nerve D. D

D. Radial nerve
 3
ARM

Q. A patient Who has taken the first COVID vaccine

Comes for the second dose. An astute nurse
noticed that the Shoulder Was flabby, flat, and
was asymmetrical. There Was an associated
loss Of Contour Of the shoulder joint. Injury
to which of the structures might have resulted
and was avoidable? [INI.CET 2021 Pattern]

A. Rotator cuff

B. posterior circumflex artery

C. Lateral cutaneous nerve of arm

D. Deltoid muscle
A. Axillary nerve
Q. After a road traffic accident, a 35 yr. old
male presents in emergency with fracture at B. Radial nerve
the arrow marked location. He presents with
C. Ulnar nerve
inability to extend his wrist. On examination,
there is loss of sensation of dorsum of lateral D. Median nerve
aspect of hand and fingers. Which nerve will be
injured in this case? (FMGE 2020)
 FOREARM

→ give rise to Lumbricals

3. Flexor pollicis longus (FPL)
Nerve supply : (All supplied by Anterior Interosseus
nerve (Deep branch of Median nerve) except medial ½
of FDP (supplied by ulnar nerve)

A. Anterior Compartment

About FDP - Hybrid muscle

Medial half - Ulnar nerve
Lateral half - Anterior Interosseous nerve > Median
nerve

A.1. Superficial Muscles: B. Posterior Compartment

1. Pronator teres (PT) B.1. Superficial Group
2. Flexor carpi radialis (FCR)
3. Palmaris longus (PL) → used for tendon grafting
operation of upper limb.
4. Flexor digitorum superficialis (FDS)
5. Flexor carpi ulnaris(FCU) → Pisiform bone ossify in
this muscle.
B.2. Deep Group
Nerve supply : All are supplied by the Median nerve
(Labourer nerve) except Flexor carpi ulnaris. •• Supplied by Posterior interosseous nerve (PIN)

A.2. Deep Muscles:

1. Quadratus pronator (QP)
2. Flexor digitorum profundus (FDP) (Hybrid Muscle)
2
Anatomy

Focus Areas for Exams:

•• Cadaveric images
•• Nerve supply of muscles
•• Clinically integrated questions
•• Cubital fossa, boundaries & contents

Revision Capsule:
•• Cadaveric images
Cubital Fossa: •• Nerve supply of BBC:
•• Triangular, muscular depression in front of the •• Clinical integration with Radio & Ortho
elbow.
Importance of cubital fossa - PYQs:
1. Measurement of Blood Pressure Q. A patient visited to trauma & casualty ward with
multiple fracture of shaft of humerus. He was
2. Biceps jerk reflex having the difficulty in elbow flexion & supination.
3. Intravenous injection site He also complained about loss of sensation over
lateral side of forearm. Which nerve is most
probably damaged? (NEET PG 2021)
A. Musculocutaneous nerve

B. Median nerve

C. ulnar nerve

D. Radial nerve
Q After a road traffic accident, a 35 yr old male
presents in emergency with fracture at the
arrow marked location. He presents with inability
Boundaries - to extend his wrist. On examination, there is
•• Lateral - medial border of Brachioradialis. loss of sensation of dorsum of lateral aspect of
•• Medial - lateral border of Pronator teres. hand and fingers. Which nerve will be injured in
•• Apex - meeting point of Pronator teres and this case? (FMGE 2020)
Brachioradialis.
•• Base - Imaginary line joining Medial and Lateral
epicondyle.
•• Roof - Skin, superficial and Deep fascia.

Content (medial to lateral → MBBR) -

1. Median nerve
2. Brachial artery
3. Bicipital aponeurosis
4. Radial nerve (Superficial nerve) → emerges
between Brachioradialis & Pronator teres. A. Axillary nerve
Floor of Cubital Fossa (BSF) B. Radial nerve
B - Brachialis C. Ulnar nerve
S - Supinator D. Median nerve
F - Floor
 HAND

Short intrinsic muscles of hand → 20 in numbers.

Musician nerve - Ulnar nerve

Labourer’s nerve - Median nerve
Eye of the hand - Median nerve
Dupuytren's contracture- Fibrosis of palmar
aponeurosis

Causes
•• Chronic Alcoholism
•• Connective Tissue Disorder
•• Rheumatoid arthritis

3 Grades are there -

1. Nodule formation
2. Cords like structure ANAT - FMT INTEGRATION:
Wrist Cut Injury
3. Flexion contracture of finger(s)
Structure cut - all 5 structures above Flexor
Most common site - Medial half
Retinaculum
Most common finger - Ring finger 1. Palmaris longus tendon
2. Ulnar nerve and artery
3. Palmar cutaneous branch of ulnar nerve and
flexor retinaculum
2
Anatomy

4. Palmar cutaneous branch of median nerve Dorsal interossei -

5. Palmar aponeurosis •• Bipennate - 4 in number → by Ulnar nerve
In case of suicidal cut injury Hesitation Marks/ •• Function - Abduction of fingers
Tentative Marks.
•• 2 Dorsal interossei in Middle finger

Lumbricals: •• Test - Egawa test

Focus Areas for Exams:

•• Cadaveric images with clinical tests & signs
•• Nerve supply of muscles

•• 1st and 2nd Lumbricals - Unipennate → Median

Revision Capsule:
Nerve. •• All thenar muscles are supplied by median
nerve except:
•• 3rd and 4th Lumbricals - Bipennate → Ulnar
nerve. •• Adductor pollicis is supplied by
•• Function - Flexion at metacarpophalangeal •• Grave yard of ulnar nerve:
Joints extension at Interphalangeal Joints.
•• & 2nd lumbricals are supplied by:
•• Test → Pen holding position (Babaji ka thullu
position) •• 3rd & 4th lumbricals are supplied by:
•• Complete Claw hand → injury of both Ulnar and •• Clinical integration With Radio & Ortho
Median nerve.
PYQs:
Palmar & Dorsal Interossei:-
Q. What is the nerve supply Of the Structure
marked in the image? [INI-CET 2022 Pattern)

Palmar interossei -
•• Unipennate - 4/3 in number → by Ulnar nerve
A. Radial nerve
•• Function - Adduction of fingers
B. Median nerve
•• Middle finger has no Palmar interossei
•• Test - Card test C. Ulnar nerve

D. Musculocutaneous nerve
 ARTERIES & VEINS OF UPPER LIMB

Artery of upper limb Brachial Artery branches

Branches of arch of Aorta (BSC) 1. Radial artery
B - Brachiocephalic artery (Right) → give Right 2. Ulnar artery
Subclavian and common carotid artery.
3. Profunda brachii artery
S - Subclavian artery (Left) → make Axillary artery
4. Nutrient artery to humerus
C - Common carotid artery (Left)

Subclavian artery branches : (VITamin CD)

It is divided by scalenus anterior muscle into 3 parts:

1st part -
Vertebral artery → Lateral Medullary syndrome
Internal mammary artery → use for CABG
Thyrocervical branch → Suprascapular artery,
Inferior thyroid artery & Transverse cervical artery
(Mnemonic - SIT).
2nd part -
Costocervical trunk (only one branch)
3rd part -
Dorsal scapular artery (only one branch)
2
Anatomy

•• Main artery of the thumb - Princeps pollicis

artery
•• Main artery of Index fingers - Radialis indicis

Allen’s test
Make a fist → pallor occur →
compress both radial and ulnar artery →
open the fist → Release Ulnar artery 1st →
Reverse Allen’s test
If redness, then ulnar artery patency is present. Instead of Ulnar artery, release Radial artery.
(for patency of Superficial arch) (for patency of Deep arch)

Veins of Upper limb

Important veins of Upper limb: 4. Medial cubital vein (Antecubital vein) → Best vein
1. Dorsal venous arch for Intravenous Infusion (as Fixed and easily seen)

2. Cephalic vein 5. Median vein of forearm

3. Basilic vein
 3
Arteries & Veins Of Upper Limb

Revision Capsule: PYQs:

•• Branches of Subclavian artery Q. All Of the following are branches of thyro
•• Branches of Thyrocervical trunk cervical trunk except?

•• Branches of Axillary artery A. Suprascapular artery

•• Main artery of thumb B. Transverse cervical artery

•• Main artery of index finger
C. Superior thyroid artery

D. Inferior thyroid artery

 NERVE OF UPPER LIMB -1

Brachial plexus:- MBBR:- Median nerve, Brachial artery, Biceps

tendon, Radial artery)
•• Then this nerve passes in between the two
head of pronator teres Muscle (pronator teres
syndrome - if this nerve compress here)
•• In forearm it is divided into Superficial branch
& deep branch (aka anterior interosseous
nerve)
•• Deep branch supply all deep flexor Muscle
(flexor pollicis longus, pronator quadratus &
medial Half of flexor digitorum profundus)
•• At the wrist joint the superficial branch passes
through the carpal tunnel below the flexor
retinaculum. Here injury to this nerve known as
carpal tunnel syndrome (commonly seen with
connective tissue disorder as RA, myxoedema
and computer worker)

Dermatomes of hand:-
•• Sensory branch supplying the Lateral 3 & half
of Palmar & dorsal side(known as eye of hand)
and nail beds
•• Motor branch supplies 5 muscles of hand :- all
3 thenar muscles except adductor pollicis & 1st
& 2nd lumbrical
–– Different signs of medial nerve injury:-
(CAP-BPT)
1. Median nerve :- C:- Carpal tunnel syndrome
•• Have nerve root of C5 to T1 ( C5, C6, C7 :- A:- Ape thumb deformity
Lateral root, C8, T1 :- medial root)
P:- Pointing index/ Oschner’s class test
•• This nerve gives no branch in the arm
B:- Benediction hand / pope hand deformity
•• It passes Lateral to brachial artery and at
P:- Phalen’s sign
coracobrachialis, it crossing it & come medially
& reach to cubital fossa T:- Tinel sign

(Relation of structures at cubital Fossa Medial OK sign:- AIN > median

to Lateral
2
Anatomy

Treatment of tunnel syndrome:- •• Sensory branch Supplies medial 1½ of palm &

medial 2½ of dorsal hand.
•• Exercise
•• Motor branch supplies all hypothenar muscles
•• Multivitamins
& one thenar muscle [adductor pollicis] (aka
•• Painkiller - NSAIDs graveyard of Ulnar nerve), all Palmar & dorsal
•• Steroid interossei.

•• Surgery Ulnar nerve Tests:- (ABCDEFGH)

2. Ulnar nerve - •• A:- A/Ulnar nerve

•• It is the branch of the medial cord of brachial •• B:- Book test

plexus, nerve root is C7, C8 & T1. •• C:- Card test (positive in Palmar interossei
•• Runs medially to the axillary artery in the axilla. damage)

•• Passes through medial epicondyle. •• D:- aDDuctor pollicis test

•• Ulnar nerve getting thickened in leprosy behind •• E:- Egawa test( positive in dorsal interossei
medial epicondyle. damage)

•• The nerve passes through 2 heads of flexor •• F :- Froment test

carpi ulnaris (here compression of nerve known •• G :- Guyon’s tunnel syndrome
as cubital tunnel syndrome) & supplied FCU &
•• H :- Handlebar palsy
medial ½ of flexor digitorum profundus.
•• At the wrist, it passes through Guyon’s tunnel:-
Compression here known as Guyon canal
syndrome.
 3
Nerve of Upper Limb -1

Focus Areas for Exams: Q. Identify the nerve involved in test? (NEET PG
2021)
•• Cadaveric images & Nerve supply of muscles
•• Clinical tests I signs integrated with Medicine
& Orthopaedics

Revision Capsule/PYQs:
•• Which nerve is known as "Labourer’s nerve”: A. Musculocutaneous nerve

•• Which nerve is known as "Musician nerve”: B. Median nerve

C. Ulnar nerve
•• Which nerve is known as "Eye of the Hand”:
D. Radial nerve
•• Identify the nerve related with tests:
Q. A patient was undergoing leprosy treatment. On
A. BOOK TEST: a follow up checkup, the patient presented with
following presentation. Which nerve is involved
B. CARD TEST: here? (Dec FMGE 2021)
C. EGAWA TEST:
D. FROMENTS SIGN:
E. TINEL' SIGN
F. POINTING INDEX:
G. OK SIGN:
A. Ulnar nerve
H. BENEDICTION HAND:
B. Median nerve
C. Radial nerve

D. Musculocutaneous nerve
 NERVE OF UPPER LIMB -2

3. Radial nerve:- •• Below radial groove, it gives 4 branches:- (BEBE)

•• It is the thickest nerve of brachial plexus & it –– Brachialis
is continuation of thickest cord of B. Plexus.
–– External carpi radialis longus
•• Root value:- C5, C6, C7, C8, T1 . These all
roots make 1 Posterior cord which continue as –– Brachioradialis
a radial nerve.
–– Elbow joint
•• This nerve passes behind the humerus through
radial groove & coming in front at cubital fossa. •• At forearm radial nerve divides into

•• It will give rise to 3 branches Above radial –– Superficial branch:- runs towards wrist and
groove or axilla :- (LMP) makes roof of Anatomical snuff box & gives
–– Long head of triceps cutaneous branches to the lateral 2½ dorsum
of hand except nail beds.
–– Medial head of triceps
–– Deep branch/ PIN:- pierces supinator
–– posterior cutaneous nerve of arm
muscle
•• Gives 5 branches (3 muscular) in radial groove
(spiral groove):- (MLA)
Clinical :-
–– Medial head of triceps
•• Crutch palsy
–– Lateral head of triceps
–– If fracture at axilla ( loss of extension of
–– Anconeus elbow, wrist and fingers)

–– if fracture at spiral groove (loss of extension •• Wrist drop

at wrist and fingers )
•• Finger drop
–– if fracture below radial groove (loss of
•• Honeymoon palsy
extension of fingers)
•• Saturday night palsy
2
Anatomy

Anatomical snuff box:- –– Lateral/anterior border:- abductor pollicis

longus & extensor pollicis brevis
–– Medial/Posterior border:- extensor pollicis
longus
–– Roof:- Skin, Superficial fascia (Cephalic vein
– site for IV inj., cutaneous branch of radial
nerve – cause wrist watch neuropathy), deep
fascia.
–– Floor:- Styloid process of radius , scaphoid
bone (2nd Mc bone getting AVN [Mc is neck
of femur, 3rd Mc is talus] → glass holding
cast use in scaphoid fracture), trapezium,
base of 1st metacarpal bone
–– Inflammation to this tendon leads to De
•• Content:- radial artery Quervain’s tenosynovitis:- for diagnosis of
this, we can perform a finkelstein test.
•• Boundaries:-

Focus Areas for Exams: Revision Capsule:

•• Cadaveric images & Nerve supply of muscles •• Cadaveric images
•• Clinical tests I signs integrated with Medicine, •• Clinical integration With Radio & Ortho
Orthopaedics & Radiology
•• Branches of radial nerve above the radial
•• ANATOMICAL SNUFF BOX CLINICAL groove:
INTEGRATION
•• Branches of radial nerve in the radial groove:
•• Branches Of radial nerve below the radial
groove:
 3
Nerve of Upper Limb -2

PYQs: Q. Nerve supply of the area marked by arrow in the

image is? (NEET PG 2019)
Q. Which of the following forms the lateral boundary
of the marked space? (NEET PG 2020/ FMGE
2022)

A. Radial nerve

B. Posterior interosseus nerve

C. Median nerve
A. Extensor pollicis brevis and abductor pollicis
D. Ulnar nerve
longus

B. Extensor pollicis longus and abductor pollicis

brevis

C. Extensor pollicis longus and extensor pollicis

brevis

D. Abductor pollicis longus and abductor pollicis

brevis

Q. Which Of the following is true regarding De

Quervain's tenosynovitis? (NEET PG 2019)

A. Fingers are held in mild extension

B. It affects APL and EPB

C. Most common involvement is index finger

D. Treatment is surgery
 Anterior Compartment of Thigh

Bones of Lower limb 6. Medial malleolus

7. Tibial Tuberosity
8. Shin of tibia
Inguinal ligament is attached in between ASIS &
Pubic tubercle.

THIGH

Thigh is Divided into 3 compartment

•• Anterior compartment (Femoral nerve)
•• Medial compartment (Obturator nerve)
SURGICAL LANDMARKS : ORTHO
•• Posterior compartment ( Sciatic nerve )
& SURGERY INTEGRATION
Most common dislocation of hip joint - Posterior
1. ASIS - Anterior Superior Iliac spine
Therefore, Most common nerve affected is the
2. Pubic tubercle
Sciatic nerve.
3. Pubic crest
4. Pubic symphysis
5. Lateral Malleolus
2
Anatomy

•• Transverse section of thigh:

Roof - Skin, Superficial fascia and Deep fascia.
Boundaries - Muscles
Floor - Muscles and bone
5 Muscles of anterior compartment
of thigh
1. Sartorius - Longest Muscle of
body (45 cm)
2. Rectus femoris - Bipennate
Quadriceps Femoris → form
3. Vastus Medialis common tendon → Ligamentum
Patellae (Patella ossified in it)
4. Vastus Lateralis
5. Vastus Intermedius

•• Aka Tailor’s or Palthi muscle

PSM-ANAT-PEDIA INTEGRATION
•• Movements - Flexion at knee and hip + Abduction
•• Vastus Lateralis - site for Intramuscular
& lateral rotation of thigh.
injection during Vaccination.
•• Also Abduction of hip →opens perineum area
•• Nerve of anterior compartment - Femoral for sexual intercourse → hence, aka Honeymoon
nerve muscle.

•• All nerves by Posterior divisions of femoral –– Footballer’s Muscle or Kick muscle or

nerve except Locking muscle

–– SARTORIUS - Anterior division of femoral –– Extension at knee → Quadriceps Femoris

nerve
 3
Anterior Compartment of Thigh

Femoral Triangle
•• Triangular Muscular depression below inguinal
ligament.
•• Floor (Mnemonic - APPI) - Adductor longus,
Pectineus, Psoas major tendon & Iliacus.
•• Lateral boundary - Medial border of sartorius
•• Medial boundary - Medial border of Adductor
longus
Content - (Medial to Lateral → VAN)
V - Femoral vein
A - Femoral artery
N - Femoral nerve
•• Femoral sheath - Deep fascia modification
around femoral vessels.
•• Contents : Femoral vein, artery and Lymph
Great saphenous vein - Pierces the Cribriform fascia nodes (Not Femoral Nerve).
by making an opening called as saphenous opening and •• Femoral canal → medial most part of Femoral
receive 3 tributaries: sheath (contain Deep Inguinal Lymph node- →
1. Superficial external pudendal vein aka Lymph nodes of Rossenmuller and Cloquet).

2. Superficial epigastric vein •• Femoral Ring → Uppermost part of femoral

canal.
3. Superficial circumflex iliac vein
•• Femoral fossa - Depression over Femoral septa
•• Skin over the femoral triangle is supplied by
(Fat over the Femoral canal).
- Femoral branch of the Genito-femoral nerve.
•• Lateral cutaneous nerve of thigh → Meralgia
paresthetica
•• Cause : Compression under Inguinal ligament
Injury during injection or trauma.

SURGERY-ANAT INTEGRATION
A. Femoral Herni
1. Wider pelvis
2. Smaller vessels
Femoral hernia reduction - By Cutting of Lacunar
ligament.
4
Anatomy

PYQs:
Q. Identify the type of muscle shown in the image
below? (NEET PG / INICET PATTERN)

B. Inguinal Hernia → more common in males.

External Obliques modifications:
(Mnemonic - LIP)
1. Lacunar Ligament
2. Inguinal Ligament A. Cruciate

3. Pectineal Ligament B. Spiral

Focus Areas for Exams: C. parallel

•• Cadaveric images D. Unipennate

•• Sartorius (INICET NOV 2022) Q. All are Content Of femoral Sheath except:
•• FEMORAL TRIANGLE & HERNIA
A. Femoral artery

Revision Capsule: B. Femoral vein

•• Floor Of femoral triangle is formed by:
C. Femoral nerve
•• Content of femoral canal:
D. Lymph node
•• Longest muscle of body:
•• Vaccination in thigh is done in which muscle:
•• Locking muscle is:
•• Unlocking muscle is:
 Medial & Posterior Compartments of
Thigh

Medial Compartment Gluteal Region

Muscles:
•• Muscles - Adductor muscles →Adduction of 1. Gluteus maximus
thigh 2. Gluteus minimus
•• All are Supplied by → Obturator Nerve 3. Gluteus minimus
•• 5 muscles : Mnemonic for adductors - LBW/M 4. Piriformis → Key muscle of Gluteal region
1. Adductor longus 5. Obturator internus - related with 2 gamelli
2. Adductor brevis Superior gamelli
3. Adductor magnus → also by Sciatic nerve [Ischial Inferior gemelli
Head] (Hybrid muscle).
6. Quadratus femoris
4. Pectineus → also by femoral nerve (Hybrid muscle).
5. Gracilis
FMT-ANATOMY INTEGRATION
Gracilis → also known as Anti-rape muscle/Custodian of
virginity.
•• Smooth and fragile → easily break/tear during
opposite forces.
•• Use to assess cases of rape and forced sexual
offences. •• Gluteus Maximus
Origin - Posterior gluteal line, Area behind posterior
gluteal line, outer lip of the iliac crest & adjacent
surface of sacrum/coccyx.
Insertion - Into Gluteal tuberosity (¼th) & Ilio-tibial
tract (¾th).
Movement - Chief extensor of Hip joint → help
from sitting to standing position.
Nerve - Inferior Gluteal nerve

Posterior Compartment
2
Anatomy

ANAT-MEDICINE-PAEDIA- ORTHO INTEGRATION

Duchenne Muscular Dystrophy: GOVER’S SIGN

Defect in Gluteus Muscle (Paralysis)

Nerve involve - Inferior Gluteal nerve
•• Gluteus medius and minimus

•• Nerve supply : Superior gluteal nerve

Movement - Abduction of the hip joint.
 3
Medial & Posterior Compartments of Thigh

ANAT-ORTHO INTEGRATION
Trendlenberg’s Sign:
Normal = During elevation of one limb → Gluteus medius, minimus & Tensor fascia
lata of opposite side contract → Pulling/Elevate the opposite side
ASIS/Pelvis → Preventing Sagging of Pelvis.
Superior Gluteal nerve injury → Sagging of Pelvis occurs
i.e. Positive Trendelenburg’s sign.
Gait is known as
In case of Unilateral palsy - Lurching gait
In case of Bilateral palsy - Duck gait or Waddling gait

Focus Areas for Exams: PYQs:

Q. In Trendelenburggait which muscles are involved?
•• Cadaveric images
(INICET NOV 2022)
•• Gluteal region
A. Gluteus maximus, Gluteus medius, Gluteus
•• Clinical based questions minimus

B. Gluteus medius, Gluteus minimus, Tensor

Revision Capsule/PYQs: fascia lata

•• Gluteus maximus is supplied by: C. Gluteus minimus, Tensor fascia lata &
Piriformis
•• Gluteus medius is supplied by:
•• Abduction Of hip is done by: D. All are correct

•• 1M injection in gluteal region is given in: Q. Which muscle is attached in this indicated part?
[NEET PG PATTERN]
•• Identify the Piriformis & Quadratus femoris
(NEETPG 2016) A. Gluteus maximus

B. Gluteus medius

C. Gluteus minimus

D. Tensor fascia lata

 BACK OF THIGH & POPLITEAL FOSSA

All back of thigh muscles are having same

•• Origin (from ischial tuberosity)
•• Insertion (at bone of leg)
•• Nerve supply (sciatic nerve)
•• Action (runner’s action )
So, they combinedly known as hamstring muscles (includes semitendinosus , semimembranosus, long head of
biceps femoris, add magnus)

•• Long head of biceps femoris originates from ischial tuberosity.

•• Lower part of ischial tuberosity divides by longitudinal ridge into inferolateral {gives origin to add Magnus
(ischial head)} & intermedial part (known as ischial bursa).
•• Ischial bursitis is known as weaver’s bottom.
2
Anatomy

–– Popliteal vein
–– Popliteal artery
–– Popliteal lymph nodes

Focus Areas for Exams:

•• Hamstring muscles
•• Cadaveric images
•• Contents of popliteal fossa
•• Clinical integration

Revision Capsule/PYQs:
•• Hamstring muscles are supplied by:
•• Action Of hamstring:
•• Weaver’s bottom is:
•• Boundaries of popliteal fossa:
•• Boundaries of popliteal fossa:-
•• Relation of contents of popliteal fossa from
–– Supero-lateral - biceps femoris superficial to deep is:
–– Supero-medial - semitendinosus & semi
membranes PYQs:
–– Infero-lateral - lateral head of gastrocnemius Q. Popliteal artery ends at?
–– Infero-medial - medial head of gastrocnemius
A. Upper border of popliteus
( ossification of bone here known as Fabella)
•• Content of popliteal fossa (medial to lateral - B. Lower border of popliteus
Artery → vein → nerve (AVN)
C. Upper border of plantaris
–– Tibial nerve
D. Lower border of plantaris
–– Common peroneal nerve
 NERVES OF LOWER LIMB ANATOMY

Lumbar plexus

•• Iliohypogastric & ilioinguinal L1: situated at the posterior surface of kidney.

•• Cremaster reflex (Genito femoral nerve L1 L2 is involved) - when we scratch at Inner part of thigh
then due to this reflex, testis elevated.
•• Compression of Lateral cutaneous nerve of the thigh causes abnormal sensation characterized by tingling,
numbness and burning pain in the outer part of the thigh as known as Meralgia paresthetica.
•• Obturator nerve have root value of L 234 ventral division
2
Anatomy

1. Femoral nerve

•• Longest cutaneous nerve of the body is the 3. Sciatic nerve:-

Saphenous nerve.

2. Obturator nerve

•• Superior Gluteal Nerve (SGN L4,L5,S1)

supplies to gluteus medius, minimus and
 3
Nerves Of Lower Limb Anatomy

tensor fascia lata(damage leads to positive Bumper’s fracture:-

Trendelenburg sign).
•• Inferior Gluteal Nerve (IGN L5,S1,S2)
supplies to gluteus maximus.
•• Tibial nerve root value is L4, L5, S1 S2 S3.
•• Common Peroneal Nerve (CPN) root value is
L4-5 and S1-2 and take a round at the neck of
fibula.
•• Deep Peroneal Nerve (DPN) supplies the
anterior compartment of the leg.
•• Foot drop - Injury of CPN > DPN > SCIATIC
NERVE.
•• Superficial peroneal nerve at Lateral
compartment of leg.

FOOT DROP

Revision Capsule/PYQS:
•• Sartorius is supplied by:
•• Referred pain of knee is felt at hip joint due
to:
•• Root value of sciatic nerve:
•• Root value of superior gluteal nerve:
•• Root value of inferior gluteal nerve:
 LEG COMPARTMENT

TRANSVERSE SECTION OF LEG

2
Anatomy

Leg have 3 compartments:-

•• Anterior/ Extensor compartment - Deep
Peroneal Nerve (DPN)
•• Lateral/ Peroneal compartment - Superficial
Peroneal Nerve (SPN)
•• Posterior/ Flexor compartment - have
Superficial & deep group :- Tibial Nerve (TN)

•• In lateral compartment of leg :- Peroneus

longus & Peroneus brevis both innervated by
SPN
1. Anterior compartment of leg:-
The - tibialis anterior ANAT- ORTHO INTEGRATION :
Hospitals - Hallucis longus
Jones Fracture:-
Are - artery (Anterior tibial artery )
Never - nerve (Deep peroneal nerve )
Dirty - Digitorum longus
Places- Peroneus tertius

•• March Fracture:-

2. Lateral compartment of leg

 3
Leg Compartment

3. Posterior compartment:-
•• Superficial group - have gastrocnemius, soleus
(helping in cardiac output so it is aka Peripheral
heart), plantaris “(GSP)”
•• Plantaris & palmaris longus both use in tendon
grafting operations.

Focus Areas for Exams:

•• Leg compartments & their contents
•• Inversion & eversion of foot
•• Cadaveric images
•• Ortho-Radio & Anatomy integrated questions

•• Deep structures of this compartment - TibialisRevision Capsule:

Posterior, flexor digitorum longus, Posterior
Tibial artery, Tibial nerve, flexor hallucis longus. •• Foot drop is due to paralysis of muscles of:
–– mnemonic : Tom Dick And Nervous Harry •• Invertors of foot:
–– Tom - Tibialis posterior •• Evertors of foot:
–– Dick- Digitorum longus •• Inversion & eversion occurs at which joint:
–– And - Artery (Posterior tibial artery) •• Ankle jerk performed at which tendon:
–– Nervous- nerve (Tibial nerve) PYQs:
–– Harry - Hallucis longus Q. Neurovascular bundle is absent in which
•• Achilles tendon - The strongest muscle of body compartment of leg? (AIIMS MAY 18)

A. Anterior

B. Lateral

C. Superficial posterior

D. Deep posterior

Q. Which of the following muscle is not responsible

–– Gastrocnemius (lateral & medial head) + for inversion of foot? (AllMS NOV 18)
Soleus = Achilles tendon
A. Tibialis anterior
–– Ankle jerk reflex has root value S1 & S2.
B. Tibialis posterior
NOTE:-
C. Extensor hallucis longus
Medial compartment: is absent but at upper part 3
muscles insertion present : D. peroneus longus
Contains Sartorius, gracilis, semitendinosus and
Tibial collateral ligament
 FOOT ANATOMY

Arches of Foot •• Inversion and eversion of foot occurs at the

subtalar joint.
•• Upper part of calcaneus which support the talus
known as sustentaculum tali.

•• Largest bone of foot - calcaneus

Arches of foot -
•• It is due to special arrangements of foot bone
due to close interlocking short & small bones.
•• Arches are helpful for running , walking and
standing.
•• Deformities of foot:

Radiology integration :
2
Anatomy

Clubfoot:- aka CTEV

Most common congenital abnormality in the world.
–– Talipes
–– Equino
–– Varus
ƒƒ Presentation – CAVE:-
–– Cavus
–– Adductus
–– Varus
–– Equinus
•• Deltoid ligament’s1upper end is attached to the
ƒƒ Calcaneo-navicular ligament is aka spring
medial malleolus.
ligament.
•• This ligament has Superficial & deep fibers.
ƒƒ Talo calcaneo-navicular is ball & socket
joint.
 3
Foot Anatomy

PYQs:
Q. Ligaments not attached to talus?

A. Talo-navicular ligament

B. Spring ligament

C. Deltoid ligament

D. Cervical ligament

A. Talo-navicular ligament?

B. Spring ligament
•• The lisfranc ligament connects the medial
cuneiform to the base of the 2nd metatarsal. C. Deltoid ligament

•• Lisfranc ligament is a cuneometatarsal D. Cervical ligament

interosseous ligament.
Q. Ligament supporting head of talus?
•• It’s the strongest among all 3 cuneometatarsal
int ligament. A. Talo-navicular ligament

•• Deformity of this ligament can lead to instability B. Spring ligament

& Deformity of tarsometatarsal joint.
C. Deltoid ligament
Focus Areas for Exams:
D. Cervical ligament
•• Identification of foot bones: Anat-Radio
Integration Q. Which ligament connects medial cuneiform to

•• Arches of foot & foot deformities the base of the 2nd metatarsal? [INI-CET 2022
Pattern]
•• Ligaments of foot
A. Chopart
B. Spring
Revision Capsule/PYQs:
C. Lisfranc
•• Ligament below head of talus/ supporting
head of talus: D. Deltoid

•• Spring & deltoid ligament supports which

arch:
•• Most common congenital deformity of foot:
•• Most important arch of foot is:
 ARTERIES AND VEINS OF LOWER LIMB
ANATOMY

Arteries of lower limb:-

Vascular sign of Narath

•• Mid-inguinal point where we feel the femoral •• At lower border of Popleteus muscles:-
artery pulses is known as the Vascular sign of popliteal artery continue into Anterior Tibial
narath. Artery (ATA) & Posterior Tibial Artery (PTA).
•• Hiatus Magnus:- where femoral artery converts •• ATA ends between 2 malleoli & continues as
into popliteal artery. Dorsalis Pedis Artery (DPA).
•• PTA is palpable just behind the medial malleolus.
2
Anatomy

•• Clinical:-
–– Smoking leads to atherosclerosis, gangrene,
thromboangiitis obliterans or buerger’s
disease.
–– Palpable arteries of LL:-
ƒƒ Femoral Artery - at head of femur
ƒƒ Popliteal Artery - lower border of Popleteus
ƒƒ ATA- between 2 malleoli
ƒƒ PTA- behind medial malleolus
ƒƒ DPA- palpable against navicular bone

–– Venous drainage of lower limb:-

•• Lower limb vein damage can lead to deep venous
thrombosis
 3
Arteries And Veins Of Lower Limb Anatomy
4
Anatomy

CLINICAL : PYQs:
•• Phlebotomy :- cutting the vein Q. A patient Who underwent Varicose veins surgical
•• Hemochromatosis :- excessive iron treatment now presents with loss of sensation in
medial leg. Which Of the following is injured in
•• Sural nerve having S1 nerve root
this patient? [NEET pattern 2021 & 2022]
•• Medial part of leg and foot have L4 dermatome
A. Sural Nerve
•• GSV used for bypass surgery in 40 – 50% MI
blockage , now a days we use internal mammary B. Saphenous Nerve
artery (radial & ulnar vein also)
C. Obturator Nerve

D. Plantar Nerve

PYQs:
Q. Which artery is palpated here? (June FMGE
2022 & Dec FMGE 2021)

Revision Capsule:
Femoral artery is palpable against:
Popliteal artery is palpable against:
Dorsalis pedis artery is palpable against:
Posterior tibial artery is palpable against: A. post tibial artery
Great saphenous vein is related to which nerve:
B. Medial plantar artery
Short saphenous vein is related to which nerve:
C. Anterior tibial artery

D. Dorsalis pedis artery

 SCALP & FACE

Scalp is having magic of 5:- •• 5 nerves in front of ear

•• 5 layers •• 5 nerves behind ear

•• 5 arteries & veins •• 5 applied parts

5 Layers of scalp:-
1. Skin
2. Connective tissue
3. Aponeurosis
4. Loose areolar connective tissue
5. Pericranium

Clinical:-
•• Loose areolar connective tissue layer is
Dangerous area of scalp
•• Surgical layers of scalp
•• Black eye
•• Cephalhematoma
2
Anatomy

•• Caput succedaneum (Risk factor - vacuum •• Grief muscle - Depressor labii inferioris
delivery)
•• Dimple location:- Modiolus

Muscles of facial expressions:- Motor nerve branches of face : VII nerve

It gives 5 terminal branches within parotid gland
which supplies all facial muscles
•• Temporal, zygomatic, buccal, mandibular,
cervical.
•• Muscles derived by 2nd pharyngeal arch and
supplied by facial nerve except LPS (Levator
Palpebrae Superioris : by 3rd cranial nerve)

Dissection of face -
1. Skin
2. Superficial Fascia
3. Deep Fascia -nt but only present in buccopharyngeal
fascia & parotido-masseteric fascia (In all other
part of face, thorax and abdomen Deep Fascia is
absent)
4. Subcutaneous Muscles (in animal it is known as
panniculus carnosus)
•• Remnants of this panniculus carnosus are - face
muscle, Palmaris Brevis, dartos muscle, cutis ani.
•• Bell’s palsy - Loss of Wrinkling, Wide palpebral
fissure, Whistling loss, loss of nasolabial fold
and drooling of saliva.

•• Winking muscle of eye - orbicularis oculi

•• Whistle muscle - Buccal
•• Smiling muscle - Zygomatic major
•• Sad muscle - levator anguli superioris
•• Grinning muscle/ winner smile muscle - Risorius
•• Horror muscle - Platysma
•• Doubt muscle - Mentalis
 3
Scalp & Face

Focus Areas for Exams: PYQs:

•• Dangerous area of scalp Q. A 6-month-old boy was brought to the casualty
•• Clinical integration with seizures. The pediatrician tries to do CSF
sampling. What are the structures punctured by
•• Facial muscles (Old pattern)
the pediatrician While piercing through anterior
•• Bell's palsy fontanelle during ventricular tapping? (INI-CET
2021 pattern)
Revision Capsule: A. Scalp, dura, arachnoid
•• Dangerous area of face is:
B. Scalp, epicranium, endocranium and dura
•• Emissary vein is:
C. Scalp, synchondral membrane, dura,
•• Smile muscle is:
arachnoid
•• Muscle responsible for winner's smile is:
D. pericranium, dura, arachnoid
•• All facial muscles are supplied by 7th cranial
nerve except:
•• Bell's palsy is LMNP of facial nerve (true /
false).
 VESSELS & NERVES OF FACE

Face:- 2 posterior branches

•• Common Carotid artery branches;- divides into ƒƒ Occipital artery
ECA & ICA ƒƒ Posterior auricular artery

External Carotid artery (ECA) 2 terminal branches

1 medial branch: ƒƒ Superficial Temporal artery (Clinical:-

Temporal arteritis) → give 1 branch :-
•• Ascending pharyngeal artery (APA) → is the Transverse Facial artery
only medial branch
ƒƒ Maxillary artery
•• It is smallest branch of ECA
Branches of facial artery
It is also the 1st branch from the external
•• Inferior labial artery
carotid.
•• Superior labial artery
3 anterior branches: •• Lateral Nasal artery
ƒƒ Lingual artery •• Angular artery → anastomoses with dorsal
Nasal artery which is the branch of Ophthalmic
ƒƒ Facial artery
artery
ƒƒ Superior Thyroid artery

•• Strongest muscle of the body :- Masseter

muscle
•• Facial artery palpable along lower margin of
mandible, in front of masseter attachment
2
Anatomy

Venous drainage of face

•• Supra trochlear vein & supraorbital vein :- both •• Facial vein + anterior division of Retro
are uniting near the medial Angle of eye → make mandibular vein = Common Facial vein
Angular vein
•• Angular vein continues into Facial vein •• Posterior division of Retromandibular vein +
Posterior auricular vein = External jugular vein
•• Superficial Temporal Vein → uniting with
Maxillary vein = together they make •• Sigmoid sinus continues into Internal jugular
Retromandibular vein vein
•• Retromandibular vein divides into Anterior & •• EJV is used for measurement of JVP (MEDICINE
posterior division
INTEGRATION)

Dangerous area of face :- •• Lower part of nose & upper lip = known as
Dangerous area of the face
•• Deep Facial vein uniting with the veins of
pterygoid plexus
•• In brain we have 1 sinus which have multiple
caves = known as Cavernous sinus
•• Emissary veins = connects extra Cranial veins &
Intracranial veins
•• Way of spreading infection of Dangerous area
:-
–– Lower part of nose / upper lip → Facial vein
→ Deep facial vein → pterygoid plexus →
 3
Vessels & Nerves Of Face

emissary veins → Cavernous sinus → death –– Zygomatico-facial nerve

•• Mandibular division (V3) branches :- (MBA)
–– Mental nerve
–– Buccal nerve
–– Auriculo Temporal nerve
•• Angle of mandible supplied by greater auricular
nerve
•• Cutaneous lesions of herpes zoster
ophthalmicus:- spreads along nerve roots

Maxillofacial death pyramid :-

Trigeminal neuralgia :-
Type of treatment Mode of treatment
Medical treatment Carbamazepine
`
Levetiracetam
Nerves of face:-
Topiramate
•• Motor :- 7th Cranial nerve except LPS ( by 3rd
Cranial nerve) Phenytoin

•• Sensory :- 5th nerve ( V1, V2, V3) Gabapentin

Surgical treatment Alcohol Block
Cryotherapy
Radiosurgery
Gangliolysis

Treatment of choice :-
Carbamazepine > valproate , Gabapentin > Surgery
•• Ophthalmic division (V1) branches :- “(Su Su
LIE)”
–– Supratrochlear nerve
–– Supraorbital nerve
–– Lacrimal nerve
–– Infratrochlear nerve
–– External Nasal nerve → supplies tip of nose
•• Maxillary division (V2) branches :- (ZIZa)
–– Zygomatico Temporal division
–– Infra orbital nerve
4
Anatomy

Revision Capsule: PYQs:

•• 8 Branches of ECA Q. Which is not a branch of facial artery in the
•• Branches of facial artery face? (INI-CET 2022 Pattern)

•• Formation of EJV A. Lateral nasal

•• Dangerous area of Face & Scalp B. Mental
•• Sensory & motor nerves of face
C. Superior labial
•• Trigeminal neuralgia
D. Inferior labial
 NECK

Dissection / Surgery integration:- Muscles of neck -

•• Skin
•• Superficial Fascia (with platysma)
•• Deep Fascia (deep cervical fascia have 6
modification) - aka fascia colli
1. Investing layer of Deep Fascia
2. Prevertebral fascia - Form Floor of posterior
triangle of neck, cover phrenic nerve &
scalenus anterior and making axillary sheath.
3. Pretracheal fascia :- form false capsule of
thyroid gland and suspensory ligament of
berry.
4. Bucco- pharyngeal fascia
5. Pharyngobasilar fascia
•• Digastric muscle have dual nerve supply -
•• Carotid sheath - Contain 9th, 10th, 11th and
12th CN Anterior branch of digastric muscle supplied by
V3 & post branch supplied by 7th CN , so it’s the
–– Have 2 walls - Anterior (pretracheal fascia), only hybrid muscle of the neck.
Posterior (prevertebral fascia & have
sympathetic trunk) •• Sternocleidomastoids divides neck into 2
–– Ansa cervicalis - loop of the nerve in neck triangles -
(present in anterior wall
A. Anterior triangle of neck (by 2 muscles -
Digastric & Superior belly of Omohyoid)

It is divided into 4 sub triangles

2
Anatomy

1. Submandibular or digastric triangle - Contain A. Occipital triangle :

submandibular gland
Main contents
2. Carotid triangle :- contain Carotid sheath,
3. Submental triangle :- contain submental LN 1. Main Nerve of auricular:- Greater auricular
4. Muscular triangle:- contain different strap nerve ( C2,C3) - it is related with Frey’s
muscles (sternothyroid, sternohyoid , omohyoid syndrome and have 2 divisions -
, thyrohyoid) - these all have parallel muscle
fibers & all supplied by ansa cervicalis except •• Anterior division - Supply angle of mandible or
thyrohyoid which is supplied by C1 root.
shaving area ;
B. Posterior triangle of neck :-
•• Posterior division - Supply auricle
•• Anterior border - SCM
2. Nerve supply of Sternocleidomastoid & trapezius
•• Posterior border - trapezius
- 11th CN (Spinal root)
•• Floor by middle 1/3rd of Clavicle
•• By inferior belly of omohyoid it is divided into 2 B. Supraclavicular/ subclavian triangle :
sub triangles :
a. Occipital triangle
b. Supraclavicular / subclavian triangle
 3
Neck

Muscles attached to Hyoid bone

Revision Capsule:
•• Contents of carotid sheath:
•• Nerve supply of trapezius:
•• Nerve supply of digastric:
 CRANIAL CAVITY, NERVE, VESSELS

Cranial cavity divided into 3 parts -

1. Anterior cranial fossa 2. Middle cranial fossa 3. Posterior cranial fossa

Foramen Ovale (MALE):- Foramen Spinosum

•• CSF rhinorrhea - occur via cribriform plate (MEN):-
after damage of the latter. •• Mandibular •• Middle meningeal
•• Sella turcica/ Turkish saddle is a part of the •• Accessory meningeal artery,
body of a sphenoid. artery, •• Emissary vein (+/-)
•• Lesser Petrosal nerve, •• Nervi spinosum
NOTE - Mnemonic for foramina
•• Emissary vein
Important structures & foramen from midline
to lateral Foramen Jugulare Foramen magnum
King - Pituitary •• Cranial nerves 9th, 10th •• Largest foramen of
& 11th pass through skull
Queen (Shy) - Foramen Lacerum this. •• For Spinal cord and
R - Foramen Rotundum - Maxillary Nerve other associated
O - Foramen Ovale (MALE) structures.

Se - Foramen Spinosum (MEN)

2
Anatomy

•• Hardest bone of the skull - Petrous part of Clinical correlation:-

temporal bone / Bony labyrinth
•• Pituitary Tumor → Damage to Optic Chiasma →
•• Optic canal : II CN & ophthalmic artery damage to Nasal fibres of Optic Chiasma mainly
•• From Superior Orbital Fissure - 3rd, 4th, 6th → Bitemporal Hemianopia →Tubular Vision.
and V1 cranial nerves passes. •• Middle Meningeal artery rupture can lead to
•• Content of Dorello’s Canal - 6th Cranial nerve. extradural hemorrhage - biconcave/idly/ lens
shape opacity.
•• Internal Acoustic Meatus - 7th & 8th nerve
pass via this.

Focus Areas for Exams: Q. Which of the marked sites SARS- COVID 19
•• Foramen & structures passing through it spread to the brain? (INI-CET2021 pattern)

•• Cranial nerves & vessels

•• Clinical integration A. D

PYQs: B. C
Q. A patient after a road traffic accident presents C. B
to the emergency room with difficulty in
Swallowing and slurred speech. Investigations D. A
reveal fractures in the occipitotemporal region.
Which of the following areas should be tested in
order to find the nerve which is involved? [INI-
CET2021 pattern)

A. 1
B. 2
C. 3
D. 4
FOLDS OF DURA MATER & SINUSES OF BRAIN

Duramater has 2 layers :

a. Outer : Endosteal layer

b. Inner : Meningeal layer

4 folds of dura mater is located within brain:

a. Falx cerebri: in between 2 cerebral hemisphere.

b. Falx cerebelli : in between 2 cerebellar hemisphere.

c. Tentorium cerebelli : above cerebellar hemisphere.

d. Diaphragma sellae : above pituitary gland.

Dural venous sinuses:-
2
Anatomy

Cavernous sinus:-
 3
Folds Of Dura Mater

Cavernous sinus thrombosis : Ophthalmoplegia: •• Internal Jugular vein formed by:- sigmoid sinus

Revision Capsule:
•• Great cerebral vein drains into the:
•• Straight sinus is formed by:
•• Pterion is related to Which artery:
•• IJV is formed by:
•• EJV is formed by:
•• pulsatile exophthalmos is seen in:
•• In case of increased intracranial pressure /
head injury :- Most common CN damage is 6th
Cranial nerve. PYQs:
•• Cavernous sinus thrombosis :- Dangerous area Q. Which structure is related to marked point?
of face, if Internal Carotid artery is damaged
then the ophthalmic artery also involves which
leads to pulsatile exophthalmos.
•• Central part of Pterion → k/a Sylvian point →
Cranium is very thin here (CRANIOTOMY) →
deep to it Middle meningeal vessels lies → so
ruptures easily → results in EDH

A. Middle meningeal artery

B. Mandibular nerve

C. Accessory meningeal artery

D. Ascending pharyngeal artery

Q. Dorello's canal passes in tip of temporal bone?

•• 2 internal cerebral veins unite → form great A. Middle meningeal artery

cerebral vein of Galen B. Mandibular nerve
•• Great cerebral vein of galen drains into :- C. Superior alveolar branch of maxillary
Straight sinus
D. Abducent nerve
•• Straight sinus is formed by:- Great cerebral
vein of galen + Inferior sagittal sinus
•• Pterion is related to which artery:- Middle
Meningeal artery
 LARYNX, PHARYNX NOSE & PALATE

ANAT- RADIO INTEGRATION :

Formula for HNF Cadaveric section

C T M V
S H P O
F P M T

Cricopharyngeal junction :
•• located at level of C6
•• it is the narrowest part of GIT PYQs
•• Here the pharynx ends & esophagus starts. Q. A patient after a road traffic accident presents
•• Here the larynx ends & the trachea starts. to the emergency room With difficulty in
swallowing and slurred speech. Investigations
Pharynx:- reveal fractures in the occipitotemporal region.
Upper part of Oesophagus Which of the following areas should be tested in
Boundaries:- order to find the nerve which is involved? (INI-
CET 2021 pattern]
•• Nasopharynx:- Anterior - Nasal cavity ,
Superior - Base of skull, Posterior - C1, Inferior A. 1
- Oropharynx
•• Oropharynx:- Anterior - oral cavity, Superior B. 2
– Nasopharynx, Posterior - C2,C3,
C. 3
Inferior – Laryngopharynx
•• Laryngopharynx:- Anterior - larynx, Superior D. 4
– Oropharynx,Posterior - C4-C6, Inferior –
esophagus
2
Anatomy

Q. A 12 year old presented with fever and Q. Which skull foramina is formed by 3 bones?
difficulty swallowing. He had swelling in the (INI-CET 2022 Pattern)
marked region and was advised to undergo
surgery. Post-surgery the gauze continued A. Foramen lacerum
to soak with blood. Which of the following B. Foramen magnum
vessels must have been injured? (INI-CET
2021 Pattern) C. Foramen rotundum

D. Foramen jugulare

A. Tonsillar branch of facial artery

B. Ascending pharyngeal artery

C. Paratonsillar vein

D. Retromandibular vein
 PARASYMPATHETIC GANGLION

Nucleus, ganglion & pseudoganglion :- –– Pterygopalatine ganglion – Lacrimal, Nasal

and Palatine gland
•• Otic , Submandibular & pterygopalatine ganglion
associate with secretion under secretomotor
pathway.
•• This all ganglion having 4 (actually 3) roots:-
–– Sensory - related to the 5th nerve or
its branch. 5th nerve is the anatomical/
structural & topographical nerve of all
ganglions.
–– Motor or Parasympathetic - Secretomotor
pathway of different glands.
–– Sympathetic - from T1

1. Ciliary ganglion:-
•• It is a parasympathetic Ganglion which is
related to 3rd CN
•• Collection of many cell bodies within the CNS •• Size - pin head size
is known as nucleus & outside the CNS is known
as ganglion.
•• Fibers before the ganglion are known as
preganglionic fibers & after it are known as
post ganglion fibers.
•• Pseudoganglion is a collection of fat & connective
tissue, no nerve elements are present but it
appears like ganglion. It is present in the nerve
to teres minor which is a branch of axillary
nerve & in the radial nerve too.

Basic concept of head & neck

ganglion:-
•• 4 ganglion
–– Ciliary ganglion - Eye •• It is present between the 2nd CN & Lateral
Rectus muscle.
–– Otic ganglion - Parotid gland
•• Every Cranial nerve has 2 relations :-
–– Submandibular ganglion – Submandibular & Anatomical/structural/ topographical (5th CN)
Sublingual gland & physiological (3rd CN)
2
Anatomy

•• Parasympathetic action of ciliary ganglion:- Superior rectus muscle & Levator palpebrae
superioris.
–– 3rd CN is running to the Lateral wall of
Cavernous sinus & in its apex, it is divided –– Inferior division supplies Medial rectus,
into superior & inferior division . Inferior rectus & Inferior oblique muscle
and ends into ciliary ganglion.
–– It passes through superior orbital fissure,
here superior division gives branches to –– from ciliary ganglion Short ciliary nerves
arise, which supply to constrictor pupillae.

2. Otic ganglion:- •• Topographical - V3 (Auriculo temporal nerve) &

Physiologically - 9th Cranial nerve
•• Related with parotid gland secretion.
•• Superior salivatory nucleus related to
•• Size → 2-3 mm
Submandibular gland & Sublingual gland; inferior
•• Situated just below the foramen ovale, Medial salivatory nucleus related to otic ganglion &
to V3 & lateral to tensor palatini muscle. Parotid gland.
 3
Parasympathetic Ganglion

•• Inferior salivatory nuclei will give impulses to goes to the otic ganglion → mpulse continues
9th Cranial nerve → which gives its branch to into the Auriculotemporal nerve → which gives
the tympanic cavity, known as Jacobson’s nerve. parasympathetic supply to parotid gland →
which leads to salivary secretion.
•• Tympanic branch of the 9th Cranial nerve forms
the tympanic plexus inside middle ear → and •• Frey’s syndrome (or Auriculotemporal nerve/
continues as Lesser petrosal nerve. ATN syndrome):- It is due to abrrent connection
of ATN to Great auricular nerve fibres / fibres
•• The Lesser petrosal nerve → comes out of the
supplying to sweat gland over parotid region.
cranial cavity from the foramen ovale → and
4
Anatomy

3. Submandibular ganglion:-

•• Secretomotor pathway of Submandibular & nucleus → impulse go to 7th nerve →

sublingual gland:- chorda tympani → join to lingual nerve →
Submandibular gland
–– Tasty food → activate Superior Salivatory
 5
Parasympathetic Ganglion

Secretomotor pathway of lacrimal, Nasal and Palatine

ganglion.
PYQs:
Q. Vidian's nerve passes through?
•• Superior salivatory nucleus → 7th Cranial nerve
→ Greater Superficial Petrosal nerve → In A. Inferior orbital fissure
pterygoid canal/ vidian’s canal → it joins with
Deep Petrosal nerve (T1 ) to form vidian’s nerve B. Incisive foramen
→ vidian’s nerve in pterygoid canal join to V2 and
C. Tympanomastoid fissure
relay into sphenopalatine ganglion → further
communicating maxillary nerve, zygomatic nerve D. Pterygoid canal
→ impulse reaches to zygomatico-temporal
nerve → join to Lacrimal nerve & supply Lacrimal Q. Jacobson's nerve is branch of?
gland → Lacrimation
A. III
•• Cutting vidian’s nerve known as vidian’s
neurectomy B. VII
Focus Areas for Exams: C. IX
•• Secretomotor pathways of glands
D. X
•• Clinical integration
•• Frey’s Syndrome
•• Vidian's nerve & Vidian's neurectomy

Revision Capsule:
Q. Which cranial nerves are parasympathetic:
Related cranial nerves with:

A. Ciliary ganglion:

B. Otic ganglion:

C. Sphenopalatine ganglion:

D. Submandibular ganglion:
 SPINAL CORD

Nervous System Spinal cord

A. Central nervous system → Brain, Brain stem •• Downward cord like extension from medulla
& Spinal cord.
oblongata.
B. Peripheral nervous system → Somatic &
Autonomic nervous system. •• 2 enlargements - at Cervical (gives Brachial

Autonomic nervous system Plexus) and Lumbar (gives Lumbar Plexus).

1. Sympathetic - from thoraco-lumbar part. •• Terminal enlargement known as Conus medullaris.

Activate during fight, flight and fright.
2. Parasympathetic - from cranio-sacral spinal •• 31 pairs (C8 T12 L5 S5 Co1) of Spinal nerves
cord.
which give a tail-like appearance after
3. Enteric nervous system → from neural crest
cells → brain of Gut. termination of the spinal cord called the Cauda

Brain stem → Midbrain, Pons & Medulla. equina.

Adult - Spinal cord ending at the middle of the L1 1. Arachnoid mater

vertebrae > L1 lower border> L1 L2 Junction
2. Dura mater
Foetus - Spinal cord ending at the L3 vertebrae.
3. Subarachnoid space
Filum terminale - Extension of pia mater from conus
At L3-L4 junction -
medullaris up to the coccyx. It has 2 parts namely F.T.
Internal (15 cm) and F.T. External (5 cm). 1. Lumbar puncture done
2. Iliac crest level
Structures ending at S2 level
3. Location of Umbilicus
2
Anatomy

Adult Child •• Epidural space

Spinal cord L1 (Middle > lower L3-L4 junction •• Dura mater
ending border) > L1-L2
junction •• Arachnoid

Lumbar L3-L4 junction L4-L5 junction •• Subarachnoid space containing cerebrospinal

puncture fluid
level

ANAT-PEDS-ANESTHESIA
INTEGRATION
Lumbar puncture → done from Lumbar Cistern at
L3-L4 junction (Best).
Structures pierced during L.P. :
Mnemonic :
3 S ILE DAS
•• Skin
•• Superficial fascia
•• Supraspinous ligament
•• Interspinous ligament
Transverse section of spinal cord:
•• Ligamentum flavum
•• Area around central canal – Nissl’s granules →
 3
Spinal Cord

Grey appearance •• Outside CNS (After spinal cord) - Ganglion

•• Rest of the area – Myelin sheath present → Mnemonic - SAME

white/yellow appearance SA - Sensory/Afferent/Ascending
ME - Motor/Efferent
•• 3 projections from grey matter → called as
HORNS ANAT-PHYSIO INTEGRATION
1. Dorsal horn - Sensory → Afferent tract A. ASCENDING TRACTS
(Ascending tract) Fasciculus Gracilis and Cuneatus functions:
1. Fine touch
2. Ventral horn - Motor → Efferent tract
(Descending tract) 2. Tactile localization
3. Tactile discrimination
3. Lateral horn - Sympathetic in nature →
4. Vibration → Tunic fork test
present in Thoraco-lumbar spinal (T1-L2)
5. Stereognosis → Identify objects with closed
cord only. eyes
ANAT-PHYSIO INTEGRATION 6. Proprioception → Sense of position
On basis of Histocytology, Raxed divide Gray matter • Dorsal & Ventral Spinocerebellar Tract →
into 10 Lamina: Subconscious Kinesthetic sensations
(MSC In RAG) • Lateral spino-thalamic tract - Pain and
M - Marginal nucleus (Lateral most) Temperature

S - Substantia Gelatinosa nucleus [in Lamina 2] • Anterior spinothalamic tract - Crude touch

Function - Pain & Temperature → Inhibited by B. DESCENDING TRACT

Morphine
Pyramidal tracts (Cortico-spinal tract) → Decussate
C - Clark nucleus & Chief sensory nucleus and form
In - Interneuron 1. Lateral cortico-spinal tract
R - Ranchow cells 2. Medial cortico-spinal tract
A - Alpha motor neuron Extra Pyramidal tracts:(ROVT)
G - Gamma motor neuron
1. Rubro-spinal tract
•• White matter also having 3 parts 2. Olivaro-spinal tract

A. Posterior white column 3. Vestibulospinal tract

4. Tectospinal tract
B. Lateral white column

C. Anterior white column

Tracts in White matter:

Tract - bundle of axons which are having similar
Origin, Coarse, Termination & Function.

Collection of cell bodies

•• Inside CNS (Up to spinal cord) - Nucleus

4
Anatomy

ANAT-MEDICINE INTEGRATION
1st sensation to be lost in senile age - Vibration & DORSAL AND SPINOTHALAMIC
Sensation(Pallanesthesia)
TRACTS:
Stereognosis loss → Astereognosis
 5
Spinal Cord

In medulla ANAT-PHYSIO-MEDICINE INTEGRATION

1. Gracile Tubercle → 1st relay site of First order Tabes Dorsalis morphology:
neuron of Dorsal tract from Lower limb. (Mnemonic DORSALIS)
2. Cuneate Tubercle → 1st relay site of First order •• Fasciculus gracilis and
neuron of Dorsal tract from Upper limb.
•• Fasciculus cuneatus damage.
Decussation of both the above tract occurs at
•• Dorsal column degeneration
MEDULLA → Internal arcuate Fibres.
•• Orthopaedic pain (Charcot joints)
Medial Lemniscus = Fasciculus Gracilis + Fasciculus
Cuneatus •• Reflexes decreased (deep tendon)
•• Shooting pain
ANAT-PHYSIO-MEDICINE INTEGRATION
Brown Sequard Syndrome: Hemi-sectioning of •• Argyll-Robertson pupils
spinal cord •• Locomotor ataxia
•• I/L loss of Fine touch •• Impaired proprioception

•• C/L loss of Pain & Temperature •• Syphilis

•• I/L loss of Position sense

•• I/L motor paralysis
Syringomyelia: Dilatation of Central canal
•• Abnormal dilatation → Lateral spinothalamic
tract affected - Loss of Pain and Temperature.
•• Anterior Spinothalamic tract is intact. Other
sensations are normal.
•• Cause - Syphilis (Treponema pallidum).
•• Dissociative anaesthesia seen → also in
Ketamine.

DESCENDING TRACTS:
Pyramidal tract Focus Areas for Exams:
•• Spinal cord section, tracts & related
•• 80% decussate at Medulla oblongata, called the
syndromes
Lateral Corticospinal tract.
•• Spinal nerves
•• 20% - Don't cross and pass anteriorly, called
the Anterior Corticospinal tract. •• Spinal cord ending & Lumbar puncture

•• Start from Area number 4 (Motor area) called Revision Capsule:

Pyramidal cells of Betz.
•• Pain & temperature is carried by:
•• Form Corona radiata after leaving Cortex of
•• Fine touch sensation is carried by:
cerebrum.
•• Which sensation is lost 1st in Tabes dorsalis:
•• Passing through the Posterior limb of the
Internal Capsule. •• Polio is example of UMNP: True / False
6
Anatomy

PYQs: Q Which Of the following indicated area is involved

in pain relieving in case of massage at painful
Q. During lumbar puncture which structure is
site? (AllMS NOV 18 PATTERN)
pierced by needle before entering the lumbar
cistern? (NEET PG 2021)

A. Ligamentum flavum

B. Arachnoid mater

C. Pia mater

D. Dura mater

Q. In adults, spinal cord in adults ends at? (AllMSP A. A

MAY 18)
B. B
A. L1
C. C
B. L2
D. D
C. L3
Q. Spinal cord ends at Which level in new born?
D. L4 (DEC FMGE 2021)
Q. What is the extent of the spinal cord in an adult? A. L1
(NEET 16 SESSION 6)
B. L2
A. Lower border of L1
C. L3
B. Upper border of L3
D. L4
C. S2

D. Tip Of the coccyx

 BRAIN STEM

Brain stem is divided into 3 parts : •• At Medulla , 9th, 10th, 11th and 12th Cranial
nerve attached → so Medullary paralysis =
1. Medulla
Bulbar paralysis = IX , X, XI, XII paralysis
2. Pons
•• At pontomedullary junction - 6th , 7th, 8th
3. Midbrain cranial nerve .
•• 7th cranial nerve has 2 divisions:
a. Medial division : motor
b. Sensory division : lateral
•• Sensory division of 7th CN is known as the
nerve of Wrisberg or Nervous intermedius.
•• 8th cranial nerve also has 2 divisions:
a. Cochlear division
b. Vestibular division
•• At the ventral surface of Pons, 5th cranial
nerve present & it is divided into 3 divisions (V1,
V2, V3),
•• V CN ganglion is covered with a fold of dura
mater known as meckle’s cave.
•• Above Pons there is crus cerebri → medial to
it, 3rd cranial nerve attached and 4th cranial
nerve attached posteriorly.
•• 1st & 2nd CN are attached on the inferior
surface of the frontal lobe.

Clinical Integration :
Clinical Integration :
•• In Middle medullary syndrome / Dejerine
syndrome – midline part of medulla is damaged
→ hence 12th CN damage à ipsilateral tongue
•• Medulla is a truncated bulb-like structure. deviation is seen.
(Medulla = Bulb) •• In Lateral medullary syndrome/ PICA
•• Hence medullary paralysis means Bulbar syndrome / Wallenberg syndrome / Vertebral
paralysis . artery syndrome → Lateral part of medulla
is damagedà laterally 10th nerve is located
2
Anatomy

hence 10th cranial nerve damage → palatal & Pineal gland :

pharyngeal reflexes lost.
•• Here tryptophan metabolism occurs. (ANAT-
BIOCHEM INTEGRATION) Tryptophan → 5-
HydroxyTryptophan → 5 Hydroxy Tryptamine
→ N-acetyl serotonin → Melatonin
•• Melatonin responsible for biological clock /
circadian rhythm regulation (ANAT-PHYSIO
INTEGRATION).
•• Melatonin is given for treatment of disturbance
in biological clock condition like
a. Day night shift worker
b. Jet lag effect
c. Insomnia
(ANAT-PHARMA-MEDICINE INTEGRATION)

•• Facial colliculus lesion : 7th cranial nerve fibres

> 6th cranial nerve nucleus damage.
•• Damage at floor of 4th Ventricle leads to
damage of 6th, 7th, 8th, 10th & 12th cranial
nerves.
•• At the floor of IV ventricle vital centres like
Cardiac centre & Respiratory centre are
located. So lesions in this area lead to death.
•• In hanging, fracture of the odontoid process
leads to compression of these vital centres which
results in death. (ANAT- FMT Integration)
•• In the floor of IV ventricle, Area Postrema is
located. This area lacks a Blood Brain Barrier.
Just below it , there is a chemoreceptor trigger
Pineal gland/ 3rd eye of lord Shiva -
zone which functions as a vomiting center. •• Here tryptophan converts → to 5- HT /
(ANAT- PHARMA Integration) serotonin → N-acetyl serotonin → Melatonin.

•• 4 important facts about 4th cranial nerve: •• Melatonin responsible for biological clock
“DDLT” (Dilwale Dulhania Le Thahrenge) activity.

–– D:- Dorsal attachment •• So, it can be used for treatment of disturbed

biological clock activity like sleep. Eg.
–– D:- Decussates
a. Day night shift workers
–– L:- Longest intracranial nerve
b. treatment of jet lag effect
–– T:- Thinnest cranial nerve, because it has the
least axons → hence it is considered as the c. insomnia
smallest cranial nerve.
 3
Brain Stem

•• Substantia nigra :- Here dopamine synthesis

occurs.

–– Phenylalanine → Tyrosine → Dopa

→ Dopamine. (ANAT-BIOCHEM
INTEGRATION)

–– Dopamine is an inhibitory neurotransmitter

and responsible for muscle tone. Focus Areas for Exams:
–– Decrease in dopamine → leads to increase •• Cranial nerves, nuclei & attachment
relative level of Ach → leads to hypertonia, •• pyramid & Olive
rigidity, resting tremor, hypokinesia,
•• Floor of IV ventricle
shuffling gait, pill rolling movement, mask
•• Facial colliculi, superior colliculi & inferior
like face etc. This clinical situation is known
colliculi
as Parkinsonism / Paralytic agitans .
4
Anatomy

Revision capsule:
Cranial nerve Nuclei Attachment Foramen Function & clinical
I
II
III
IV
V
VI
VII
VIII
IX
X
XI
XII

PYQs - Q. Which structure is supplied by the nerve causing

this elevation? (INI-CET 2022)
Q. Identify the marked structure in image?

A. Lateral rectus
B. Superior oblique
C. Risorius
A. Olive
D. Levator palpebrae superioris
B. Pyramid
Q. At which level does the nerve supply for the
C. Accurate nude us marked structure arise? (INI-CET 2021
Pattern)
D. Hypoglossal nucleus

Q. A patient underwent surgery of submandibular

gland, during Which a suspected injury to
hypoglossal nerve occurred, which clinical
feature will be seen in this patient to confirm?

A. Deviation Of the tongue to the same side of

the lesion

B. Deviation of the tongue to the opposite side A. Red nucleus

of the lesion
B. Sub thalamic nuclei
C. Inability to protrude tongue
C. Decussation of pyramidal tract
D. Loss of taste sensation D. Olivary nucleus
 5
Brain Stem

Q. At which level of brain the nucleus supplying to

the marked muscle is situated?

A. Facial colliculus

B. Superior colliculus

C. Inferior colliculus

D. Inferior olivary

Q. Thrombosis Of posterior inferior cerebellar

artery causes?

(NEET PG 2018 & 2019 PATTERN)

A. Lateral medullary syndrome

B. Weber syndrome

C. Medial medullary syndrome

D. None
 CEREBELLUM

Cerebellum:- Considered as •• 3 Anatomical lobes - Anterior, Middle/

a. Little brain Posterior, flocculonodular lobe.
b. Arbor vitae (life of tree) •• 3 physiological lobes -
c. FERN TREE LIKE APPEARANCE OF SECTION
& HISTOLOGY –– Median zone :- which control axial movement
d. Coordination & balancing organ –– Intermediate zone :- hands & foot

–– Lateral zone :- Pyramidal tract & brain

•• 3 phylogenetic lobes -

–– Archicerebellum - oldest , having connection

with vestibular apparatus – so help in
equilibrium.

–– Paleocerebellum - have connection with spinal

cord – so responsible for posture ,tone and
crude movements.
Magic of 1,2,3,4,5:-
•• 1 - Vermin –– Neocerebellum - connected with the cerebral
•• 2 - Cerebellar hemisphere cortex – so related to fine Movements.
•• 3 - 3 Anatomical lobe, 3 physiological lobe, 3
phylogenetic lobe, 3 fissures , 3 cerebellar •• 3 cerebellar peduncles -
peduncles and 3 histological layers.
•• 4 - 4 nuclei
•• 5 - 5 neurons

●
2
Anatomy

•• 3 histological layers - Little brain “MPG” •• 4 Nuclei (DEGF - in large to small & Lateral to
medial sequence)
M - Molecular layer
–– D:- Dentate nuclei
P - Purkinje layer –– E:- Embolism nuclei

G - Granular cell layer –– G:- Globose nuclei

–– F :- Fastigial nuclei

•• 5 neurons of cerebellum:- (BSP GoGa) •• Basket cells & Stellate cells located in the
molecular layer.
–– B - Basket cells
•• Purkinje cells in the purkinje layer.
–– S - Stellate cells
•• Golgi & Granular cells – located in the granular
–– P - Purkinje cells :- largest, only efferent layer.
fibers present, inhibitory to deep cerebellar •• Blood supply -
nuclei.
a. PICA: Posterior Inferior Cerebellar Artery
–– Go - Golgi cells b. AICA: Anterior Inferior Cerebellar Artery
–– Ga (sir):- Granular cells c. SCA: Superior Cerebellar Artery
 3
Cerebellum

•• Functions of cerebellum -
–– Having proper 3 dimensional balance.
–– Maintain rate and range of direction.
–– Holding things by proper force.
•• Defect lead to - “NIDRA”
–– Loss of tone, posture and equilibrium.
–– Ataxia
–– N - Nystagmus
–– I -Intentional tremor
•• Wallenberg syndrome / Lateral medullary –– D - Dysdiadochokinesia
syndrome:- loss of pain & temperature of 1 side
–– R - Rhomberg sign
of face and opposite side of body along with
vagus nerve damage. –– A - Ataxia, Asynergia

Focus Areas for Exams: Revision Capsule:

•• Dangerous Of scalp •• Fern tree like pattern is found in:
•• Clinical integration •• Arbor vitae is:
•• Facial muscles (Old pattern) •• Only efferent neuron of cerebellum is:
•• Bell's palsy •• Inhibitory to deep nucleus of cerebellum is:
•• Which drug Shows toxicity:
4
Anatomy

PYQs:
Q. In given MRI image identify the structure?
(NEET 2019 PATTERN)

A. Hypothalamus

B. Thalamus

C. Cerebellum

D. Pituitary

Q. Most lateral nucleus of cerebellum? (NEET 16

SESSION 15)

A. Dentate

B. Emboliform

C. Globose

D. Fastigial
 BLOOD SUPPLY OF BRAIN

Sensory & motor homunculus

Inverted homunculus representation

Largest presentation - Face and Lips

5 components of circle of
willis(COW):-
1. Anterior cerebral artery
2. Anterior communicating artery
3. Internal Carotid artery
4. Posterior communicating artery
5. Posterior cerebral artery

Clinical :
•• Aneurysm of COW is known as Berry aneurysm.
•• Berry aneurysm rupture lead to subarachnoid
hemorrhage → Blood in CSF (complain of patient
2
Anatomy

- worst headache of my life/ thunderbolt 5 branches of Internal Carotid

headache/ thunder clapping headache) artery:-
Blood supply to brain •• Anterior Cerebral artery
•• Ophthalmic artery
•• Middle Cerebral artery
•• Anterior choroidal artery
•• Posterior Cerebral artery

5 Branches of vertebral artery -

•• Anterior spinal artery
•• Posterior spinal artery
•• Meningeal artery
•• Medullary artery
•• Posterior inferior cerebellar artery - damage
lead to Wallenberg syndrome or Lateral
medullary syndrome

Branches of basilar artery -

•• Anterior inferior cerebellar artery
•• Pontine - damage lead to pontine hemorrhage,
pinpoint pupil , Pyrexia
•• Labyrinthine artery
•• Superior cerebellar artery
•• Posterior Cerebellar artery
 3
Blood Supply Of Brain

Exam PYQs- Q. What is the blood supply of the structure marked

•• Main artery of medial surface of brain - in the image below?
Anterior Cerebellar artery
•• Main artery of inferior surface of brain -
Posterior Cerebellar artery
•• Main artery of superolateral surface of brain
- Middle Cerebellar artery

Focus Areas for Exams:

•• Blood supply of brain A. Anterior cerebral artery
•• Circle Of Willis
B. Middle cerebral artery
•• Clinical integrated question (Stroke & TIA)
C. Posterior cerebral artery

Revision Capsule: D. posterior inferior cerebellar artery

•• Main artery of superolateral surface of brain:
Q. What is the blood supply of the structure marked
•• Main artery of medial surface of brain:
in the image below? (INI.CET 2022 Pattern)
•• Main artery of inferior surface of brain:

PYQs:
Q. Blood supply of medial surface of brain is? (NEET
16 SESSION 10)
A. Anterior cerebral artery
B. Basilar artery
C. Middle cerebral artery A. Anterior cerebral artery and middle
cerebral artery
D. posterior cerebral artery
Q. Which artery supplies the paracentral lobule? B. Anterior cerebral artery and posterior
(NEET 16 SESSION2) cerebral artery
A. Medial striate artery
C. Anterior cerebral artery and anterior
B. Calloso-pericallosal artery communicating artery
C. Frontopolar artery D. Middle cerebral artery and posterior
D. marginal artery cerebral artery

Q. A patient presented With Vision loss. On

radiological investigation, an aneurysm causing
damage to the optic chiasma was noted. Which
of the following artery is most likely to be that
artery? (NEET PG 2021)
A. Anterior communicating artery
B. Anterior choroidal artery
C. Middle cerebral artery
D. Anterior cerebral artery
 CEREBRAL HEMISPHERE

Cerebral hemisphere:-

Superolateral area of brain :- of this area can lead to contra-lateral paralysis.

1. Frontal lobe •• Premotor area (area 6) gives origin to the

extra pyramidal tract and its damage can lead
•• At frontal lobe - Motor area (area 4) present to Parkinson-like symptoms and tremors.
from which the pyramidal tract arises. Damage
2
Anatomy

•• Middle frontal gyrus - responsible for Medial surface of brain -

horizontal eye movements and damage leads to
–– Para central lobule - where perineum area
loss of conjugated saccadic movements.
represents
•• Pre-frontal lobe - responsible for individual
ƒƒ Bladder
skills, judgements & personality and damage
leads to pre-frontal lobe syndrome. ƒƒ Bowel
•• Inferior frontal gyrus - divides into pars ƒƒ Genital area
orbitalis , pars triangulation & pars opercularis
(broca’s area 44,45), responsible for speech ,
damage lead to motor/ broca’s aphasia.

2. Temporal lobe -
•• Superior Temporal gyrus have area 41, 42 -
are 1° auditory / Auditory Sensory area.
–– Area 22 - 2° auditory or auditory psychic
area and due to its damage, a person will be
able to hear but not able to analyze what it
means (auditory agnosia).
–– Posterior part of Area 22 known as
Wernicke's area or Sensory speech area
and its damage leads to sensory aphasia.
–– Medial part of this lobe is known as Area 28
–– Have visual-striated areas or lines of Genneri.
(olfactory area).

3. Parietal lobe Revision:-

•• Impulse from Area 22 passes to area 39 & 40, •• 1,2, 3 : Sensory
known as speech association area, then impulse •• 4 : Motor -
goes to area 44 and 45.
•• 5,7 : Vibration & stereognosis
•• Area 5,7 - responsible for vibration &
•• 6 : premotor area
stereognosis, so, damage leads to pallesthesia,
& Astereognosis. •• 8 : frontal eye field area
•• Area 2,1,3 - is Sensory area, damage leads to •• 9,10,11,12 : Prefrontal lobe
loss of sensation.
•• 17 : visual sensory area
•• Area 43 - for taste.
•• 18, 19 : visual psychic area
•• Nominal aphasia - confuse with names
•• 22 : Sensory speech area , auditory sensory
4. Occipital lobe area

•• Calcarine sulcus present which is an example of •• 28 : olfactory area

Complete sulcus. •• 39 : speech association area
•• Semilunar sulcus, around the calcarine sulcus, is •• 43 : taste sensation area
known as lunate sulcus.
•• Motor speech - 44,45
•• Area 17 - is 1° visual area, damage leads to
•• paracentral lobule : Perineum area
blindness.
•• Loss of Vibration - pallesthesia
•• Area 18,19 - known as 2° visual area, damage
leads to visual agnosia.
 3
Cerebral Hemisphere

Focus Areas for Exams: Revision Capsule:

Function areas of brain •• Sensory speech area is:

•• ANATOMY •• Motor speech area is:

•• PHYSIOLOGY •• Sensory area is:

•• MEDICINE •• Motor area is:

•• Frontal eye field area is:
PYQs: •• Loss of vibration sensation is:
Q. Broca's area situated in? •• 1st sensation lost in senile age is:
A. Inferior frontal gyrus

B. Superior temporal gyrus

C. Angular gyrus

D. None Of the above

 WHITE MATTER AND BASAL NUCLEI

White matter:- Fornix:-

3 types - (ACP/ CAP)
•• Association fiber :- They connect adjacent
different areas in the same hemisphere.
•• Commissural fiber :- connect the same area in
the different hemisphere known as Commissural
fiber. Ex - corpus callosum.
•• Projection fiber :- connect areas from inside to
outside of the brain . Ex - all tracts

•• Have all 3 types of white matter fibres.

•• Hippocampus - convert short term memory to
long term memory.
•• Impulses go from hippocampus to mammillary
bodies via fornix.
•• Corpus callosum:-
•• So hippocampus is afferent for fornix &
–– Largest band of white matter
mammillary bodies are efferent for fornix.
–– Type of commissural fibre.
–– Have 4 parts - Rostrum, Genu, Body/Trunk, Papez circuit -
Selenium. •• Responsible for memory.
•• Impulses go from the anterior nucleus of
thalamus → to cingulate gyrus (center for
satisfaction ) → hippocampus → mammillary
body → finally to the anterior nucleus of
thalamus again.

Projection fibers :-
Include all tracts
Ascending:-
•• LSTT (Lateral Spino-thalamic Tract)
•• FG (Fasciculus Gracilis)
2
Anatomy

•• FC (Fasciculus Cuneatus) •• Basic components of Basal nuclei :- ACC SS

Descending:- –– A - Amygdala is small almond like structure
•• Internal capsule (bundle of tracts) of brain related with food & sex activity, so,
•• corona radiata damage to this lead to hyperphagia and hyper
sexuality known as kluver-bucy syndrome
Basal nuclei
Means collection of Grey matter (nuclei) at the base –– C - Corpus Striatum has 2 nucleus
of the brain.
ƒƒ Caudate nucleus

ƒƒ Lentiform nucleus - has medial globus

palladium & lateral putamen

–– C : Claustrum

–– S:- Substantia nigra → damage results in

Parkinson disease

–– S:- Subthalamic nucleus of luy → damage

leads to hemiballismus.
 3
White Matter And Basal Nuclei

Focus Areas for Exams:

•• Types of white matter
•• Corpus
•• Fornix
•• Section of brain (Cadaveric images)

Revision Capsule:
•• Corpus callosum is which type of white matter:
•• Fornix is Which type Of White matter:
•• Lateral spinothalamic tract is which type of
white matter:
•• Lesion to subthalamic nucleus of Luys results
in:
•• Lesion to substantia nigra results in:
•• Lesion to cerebellum results in:

PYQs:
Q. A Patient presents with Ballistic involuntary
movements. Which Of the following is
Responsible? (NEET PG 2022)

A. Caudate Nucleus

B. Thalamus

C. Substantia N

•• Wilson’s disease aka hepato-lenticular D. Subthalamic nuclei

degeneration.
4
Anatomy

Q. Fibres of the given structure originate from? Q. Which fibre is marked by the arrow in the image
(INI-CET 2022 pattern) given below? (NEET PG 2019)

A. Amygdala

B. Mammillary body
A. Short association
C. Caudate nucleus
B. Long association
D. Hippocampus
C. Projection
Q. A Woman With right -Sided loss of sensations
of both the upper and lower limb complains D. Commissural
of shooting pain from her fingers to the right
shoulder and a burning sensation when touching
cold water. Motor functions are normal. Which
of the following is likely to be involved?

(INI-CET 2021 Pattern)

A. A

B. B

C. C

D. D
 CRANIAL NERVES

Cranial nerve Nuclei Attachment Foramen Damage can lead to

I – olfactory No nucleus Inferior surface Cribriform Plate Anosmia
of frontal lobe of ethmoid
II - optic No Nucleus Inferior surface Optic canal Anopia
of frontal Lobe
III - oculomotor Midbrain - Medial to Crus Superior Orbital Squint
Superior Colliculus Cerebri Fissure
IV - trochlear Midbrain - Lateral to Crus Superior Orbital Squint
Inferior Colliculus Cerebri Fissure
V- trigeminal Pons Ventral surface V1- Superior Trigeminal neuralgia
of pons Orbital Fissure
jaw deviation
V2- F. Rotundum
V3- F. Ovale
VI - Abducens Pons Ponto-medullary Superior Orbital Med squint
Junction Fissure
VII - Facial Pons Ponto-medullary Internal Acoustic Bell’s palsy
Junction Foramen
VIII - Cochleo- Pons Ponto-medullary Internal Acoustic Loss of hearing
vestibular Junction Foramen
IX - Medulla Behind olive Jugular Foramen Loss of taste (Posterior
Glossopharyngeal 1/3rd of tongue)
X - Vagus Medulla Behind olive Jugular Foramen Loss of taste (Posterior
most part of tongue)
XI - Accessory Medulla Behind olive Jugular Foramen Paralysis of trapezius &
Spinal sternocleidomastoid
XII - Hypoglossal Medulla Behind pyramid Hypoglossal canal I/L deviation of tongue

Note : CN formula : 2,2,4,4 –– Pontine syndrome:-

ƒƒ Facial colliculus syndrome:- damage to
Brain stem syndrome:- 6th, 7th CN
–– Medullary syndrome ƒƒ Millard gubler syndrome:- damage to 6th,
7th, 8th CN
ƒƒ Lateral Medullary syndrome - 9, 10 & 11 CN
damage –– Midbrain syndrome:-
ƒƒ Posterior part damage :- parinaud's
ƒƒ Medial Medullary syndrome - 12th CN syndrome
damage :- I/L deviation of tongue
ƒƒ Middle part damage :- Benedikt syndrome
2
Anatomy

ƒƒ W part damage :- weber syndrome

PYQs:
•• Revision:-
Q Identify the cranial nerve is related with given
–– Optic chiasma damage :- bitemporal
hemianopia structure? (INI-CET 2021 pattern)

–– Cranial nerve supplying EOMs:- SO4 > LR6

–– Nerve supply to tonsil :- 9th Cranial Nerve
–– Tensor palatini is supplied by :- 5th Cranial
Nerve (3rd Part - Mandibular Nerve)
–– Stylopharyngeus supplied by :- 9th Cranial
Nerve
–– Cricothyroid supplied by :- External Laryngeal
Nerve A. III
–– Palatoglossus supplied by :- 5th Cranial Nerve B. V
< 10th Cranial Nerve
C. IV
Focus Areas for Exams:
D. VI
•• Cranial nerves identification
•• Cadaveric images
•• Clinical integration

Revision Capsule:
•• Optic chiasma damage results in:
•• Cranial nerves supplying EOMs:
•• Right side deviation of tongue is due to:
•• Nerve supply of tonsil is:
•• Tensor palatine is supplied by:
•• Stylopharyngeus is supplied by:
•• Cricothyroid is supplied by:
•• Palatoglossus is supplied by:
THORACIC WALL & INTERCOSTAL SPACE

•• T2-T8 are typical vertebrae , rest all are

atypical.

Contents of Intercostal space (ICS)

•• Intercostal muscles:-
–– External Intercostal muscles - outermost;
hands in pocket direction,runs downward,
forward, medially. (DFM)
–– Internal Intercostal muscles- hands in opp
pocket; move downward, backward, lateral.
(DBL)
–– Transversus thoracis - DIVIDED INTO 3
GROUPS:
a. Sterno + costal,
b. Innermost intercostals/ intercostal
intimi,
c. Subcostalis.
•• Vessels :- VAN (Vein, Artery, Nerve) in costal
groove.

•• Best site for Thoracentesis is 8th Intercostal

Space > 9th at mid-axillary line, at the lower
part of Intercostal space and along the upper
border of the rib.
2
Anatomy

Subclavian artery branches:-

( VIT – CD)

•• V:- Vertebral artery - Circle of Willis

•• I:- Int mammary artery - CABG

•• T:- Thyrocervical trunk - Supra scapular artery,

Inferior thyroid artery, transverse cervical
artery (SIT).

•• C:- Costocervical trunk :- Superior intercostal

artery , Deep cervical artery.

•• D:- Dorsal scapular artery.

Intercostal artery (ICA):

 3
Thoracic Wall

Intercostal veins:-
4
Anatomy

Exam:
•• Intercostal muscles, nerves, arteries & veins
•• "VAX” relation in intercostal space
•• Thoracocentesis
Revision: In costal relation of vessels are: VAN
(Vein, Artery, Nerve)
VAN Relation is not present in which Intercostal
space: 1st
Best artery CABG: left Mammary artery mammary
artery divides in which Intercostal space;
6th Intercostal space Left superior intercostal vein
drains into; Left Brachiocephalic vein

PYQs:
Q. Inferior thyroid artery supply which of the
following structures? (INI-CET 2021 Pattern)

1. Thyroid

2. Parathyroid

3. Esophagus

4. Thymus

A. 1, 2, 3, and 4

B. 1, 2, and 3 only

C. 1 and 2 only

D. 1, 2 and 4 only

Q. Left superior intercostal vein drains into?

(AIIMS NOV 18 PATTERN)

A. Hemi azygous vein

B. Accessory hemi azygous vein

C. Azygous Vein

D. Brachiocephalic vein
 PLEURA & LUNG

Pleura:- ƒƒ Hence thoracocentesis is done in between

the 8th & 10th rib.
It is an envelope of lung lined by mesothelium.
•• Has 2 layers :- Pleura Clinical -
–– Parietal :- It is made by Fibrous connective •• Pleural effusion
tissues and functions as a protection layer. •• Hemothorax
It has 4 Parts - •• Pyothorax
1. Cervical •• Pneumothorax
2. Costal
3. Mediastinal
4. Diaphragmatic

Bronchial tree - extends from C6 to T4

•• External diameter of trachea - 2 cm

▪ Visceral pleura - It is firmly attached to lungs
•• Internal diameter - at 1-3 years → 3mm
and made by mesothelium
•• Then every year +1mm till 12 years.
▪ tumor of mesothelium known as Mesothelioma
[most common by asbestosis] mainly involve •• If foreign body is stuck in the esophagus - on
diaphragmatic pleura) X-RAY AP view

•• looks like a rounded coin (if it is in trachea, it

looks flat from AP view).

•• Right bronchus is more straight than the left so

chances of foreign body lodging is more in the
ƒƒ Lungs end at the 8th rib. right bronchus.
ƒƒ Pleura is ending at the mid-axillary line at
10th rib.
2
Anatomy

ƒƒUpper lobe - has Apical, Anterior,

Posterior segments
ƒƒMiddle lobe - has Medial & Lateral
segments
ƒƒLower lobe - has Apical Basal , Anterior
Basal , Lateral Basal, Posterior Basal,
Medial Basal segments.

•• Left lung :-
–– Upper lobe :-has Apical, Anterior, Posterior,
Superior & Inferior lingual
–– Lower lobe :- has Apical Basal, Anterior Basal,
Lateral Basal, Posterior Basal, Medial basal
(+/-)

Impressions on medial surface -

•• Right lung :- from above to below : “Bhai Atal
Bihari Vajpeyi”
–– B :- bronchus
Exam: -
–– A :- Artery ( PA ) •• Parts of pleura
–– B :- Bronchus •• Pleural recesses
–– V :- Vein ( PV) •• Differences between Right & Left Lungs
From Anterior to Posterior - VAB ( vein, artery, •• Lung impressions
bronchus) •• Bronchopulmonary segments
•• Left lung - from above to below “Atal Bihari Revision: -
Vajpeyi”
•• Thoracentesis is done in which Intercostal
–– A :- artery space: 8th Intercostal space.
–– B :- bronchus •• How many Bronchopulmonary segments in the
right lung: 10.
–– V :- vein
•• How many Bronchopulmonary segments in the
From Anterior to Posterior - Same as right lung ie. left lung: 10 > 9 > 8.
VAB ( vein, artery, bronchus) •• Most common Bronchopulmonary segments
getting infection in supine
Bronchopulmonary segments (BPS) •• position: Apical basal of right lung.
•• Right lung - •• Most common Bronchopulmonary segments
get infected in a prone position: Posterior
–– Has 3 lobes
Basal of the right lung.
 3
Pleura & Lung

PYQs:
Q. Arrange lung hilar structures from anterior to
posterior? (INI-CET 2022 Pattern)

1. Primary bronchus

2. Pulmonary vein

3. Bronchial artery

4. Pulmonary artery

A. 1,2,3,4

B. 2,3,4,1

C. 3,4,1,2

D. 4,3,2,1

Q. Identify the structure marked given in following

image? (FMGE 2021)

A. Circular muscle layer of esophagus

B. Longitudinal muscle layer of esophagus

C. Trachealis

D. Hyoid Bone
 MEDIASTINUM, PERICARDIUM & SINUSES

Clinical integration:
•• Esophagus & trachea is having common
communication = known as Tracheo-esophageal
fistula.
•• Which Leads to aspiration pneumonia
2
Anatomy

Pericardium •• Increase in pericardial fluid → pericardial

effusion
•• it is an envelope around the heart

Pericardial sinuses
1. Transverse sinus
•• anterior boundary : formed by Ascending aorta
& pulmonary trunk
•• clinical : it is used to ligate ascending aorta &
pulmonary trunk

2. Oblique sinus
•• Anterior Boundary formed by left Atria → have
openings of 4 pulmonary veins
•• clinical : This sinus indirectly maintain the
cardiac output
 3
Mediastinum, Pericardium & Sinuses

Focus Areas for Exams:

•• Mediastinum for clinical
•• pericarditis & pericardiocentesis
•• pericardial sinuses: Clinical

Revision Capsule:
•• Sterna' angle is located at which vertebral
level:
•• Important content of middle mediastinum:
•• Important content of posterior mediastinum:
•• Important content of superior mediastinum:
 HEART & CORONARY CIRCULATION

•• Heart is conical muscular hollow viscera which is Right Atria: Internal Features
responsible for pumping the blood.
•• Rough part
•• it is located in the middle mediastinum within –– Crista terminalis
the pericardium.
–– Musculi pectinati
EXTERNAL FEATURES OF HEART : •• Smooth part
–– All venous openings are present here
•• Inter Atrial Septum
–– Fossa Ovalis
–– Annulus fossa ovalis
AV Node: Located within Triangle of KOCH

•• Right border of the heart - RA

•• Apex of the Heart – LV
•• Posterior surface of the heart (Base) – LA
(2/3rd) + RA (1/3rd)

RADIOLOGY-ANATOMY INTEGRATION
Right heart border – RA + SVC + IVC
Arterial Supply of the Heart
•• The root of the ascending aorta has semilunar
valve which is having 3 leaflets
–– Anterior leaflet
–– Left Posterior leaflet
–– Right posterior leaflet
•• Cavity b/w the aortic wall and leaflet margins is
the Aortic Sinus
–– Anterior Aortic Sinus – gives rise to Right
Coronary Artery → Rt. Conus artery
–– Left posterior aortic sinus – gives rise to
Left Coronary Artery
–– Right posterior aortic sinus
2
Anatomy

RCA: Course & Branches PATHO/MEDICINE-ANATOMY

INTEGRATION
AIVA is aka LADA (MC in →)
Left Anterior descending artery – Mc artery
involved in MI/Angina (40-50%)
Most common cause of Angina/ MI is Atherosclerosis

RISK FACTORS
•• Non – modifiable
–– Age
LCA: Course & Branches
–– Sex
–– Genetic factor
–– Familial factor
•• Modifiable
–– Major RF –
ƒƒ Hypertension
ƒƒ Hyperlipidemia
ƒƒ Hyperglycemia
ƒƒ Smoking
–– Minor RF –
Main Branches “DAL” ƒƒ Alcohol
•• Diagonal artery
ƒƒ Estrogen – preventive
•• Anterior Interventricular artery (AIVA) –
ƒƒ Homocysteine
supplies the Apex
•• Left Circumflex artery Widow’s artery/ Widow maker artery – LADA
 3
Heart & Coronary Circulation

Small Branches ANAT- MEDICINE-

•• Lt. Conus artery CARDIOTHORACIC SURGERY
•• Atrial branches INTEGRATION
•• Ventricular branches 1. ANGINA
Conducting system of the Heart •• Stable Angina
•• Unstable Angina
•• SA NODE → AV NODE → BUNDLE OF HIS →
RBB & LBB •• Prinzmetal Angina
•• All are supplied by the RCA except for the LBB 2. MI
which is supplied by the LCA
•• STEMI
•• NSTEMI

3. ECG

4. ANGIOGRAPHY

5. ANGIOPLASTY

6. CABG

7. Best Artery for CABG:

Venous Drainage of the Heart ANGIOGRAPHY

ANGIOPLASTY
•• Largest vein – Coronary sinus (situated in the
left posterior Interventricular sulcus)
•• All the cardiac veins drain into the coronary
sinus except 2 –
–– Anterior cardiac veins & Venae Cordis
minimae – drain into Rt. Atria
•• Great cardiac vein runs with the AIVA & Lt.
CXA
•• Middle cardiac vein running with the PIVA
•• Right Marginal vein making the small cardiac
vein which is draining into the Coronary sinus
4
Anatomy

ANTI-ANGINAL DRUGS

CABG Focus Areas for Exams

•• Great saphenous vein was used earlier for the •• CORONARY CIRCULATION
coronary graft
•• CLINICAL INTEGRATION
•• When there is damage to the GSV then the
nerve getting damaged in the lower limb is the
Saphenous nerve – loss of sensation along the Revision Capsule / PYQs
medial part of the leg •• Right border of heart is formed by: RA
•• Left Internal Mammary Artery (LIMA) is the •• Apex of heart is formed by: LV
best arterial graft for CABG
•• Base of heart is formed by: LA >> RA
•• MC artery blocked in Ml: LADA
•• Apex of heart is supplied by: LADA
•• •3rd coronary artery is: Rt. Conus artery

PYQs
Q. Base of the heart is formed by: (NEETP 16
SESSION 2)

A. Right atria

B. Left atria

C. Right ventricle

D. Left ventricle
 5
Heart & Coronary Circulation

Q. All Of the following are true about the right

coronary artery except (NEET PG 2019)

A. Its diameter is less than left coronary

artery

B. It arises from the anterior aortic sinus

C. It gives rise to circumflex coronary branch

D. Right conal artery is its first branch

Q. Right coronary artery arises from? (Al 2019

PATTERN)

A. Left anterior aortic sinus

B. Left posterior aortic sinus

C. Right aortic sinus

D. Coronary sinus
 ANTERIOR ABDOMINAL WALL

•• Thoracoabdominal diaphragm divides the trunk –– Umbilicus is situated at L3,L4 ( it’s a site for
into thorax and abdomen. Iliac crest & Lumbar puncture).

•• Abdomen is divided into 2 parts by pelvic –– External Oblique modification (LIP):-

diaphragm :
ƒƒ L:- participate in the formation of Lacunar
a. Abdominal cavity proper ligament.
b. Pelvic cavity ƒƒ I:- Inguinal ligament
•• Abdominal cavity : 2 walls
ƒƒ P:- Pectineal ligament
a. anterior abdominal wall (AAW)
•• 8 Layers of abdominal wall:
b. posterior abdominal wall (PAW)

•• Anterior Abdomen wall :

1. Skin
–– AAW is divided into 9 quadrants by 2 vertical 2. Superficial fascia
lines & 2 horizontal lines.
3. External oblique
–– Transpyloric plane passing through the lower
4. Internal oblique
border of L1.
5. Transverse abdominis
–– Subcostal plane passing through upper border
of L3 level. 6. Transversalis Fascia
7. Extra peritoneal fat
–– Transtubercular plane passing through upper
border of L5. 8. Peritoneum
2
Anatomy
 3
Introduction
•• Boundaries of Inguinal canal :-
PYQs:
Q. What is the level of the indicated plane in the
abdomen? (June FMGE 2022)

A. T12

B. L1

C. L2

D. L3

Q. What is the vertebral level of the marked

–– Ant :- Skin, Superficial fascia, External structure? (June FMGE 2022)
oblique aponeurosis
A. T12-L1 Junction
–– Post :- Transversalis Fascia, Extra peritoneal
B. L1-L2 Junction
fat, Peritoneum
C. L3-L4 Junction
–– Roof :- Internal oblique, Transverse
abdominis, conjoint tendon D. L2 - L3 Junction

ƒƒFloor :- Inguinal ligament Q. Neurovascular bundle in abdomen runs in

between? (DEC 2021)
–– Neurovascular bundle presents in between
Internal oblique and Transverse abdominis. A. Between external & internal oblique muscles

Exam:- B. Between external oblique & transversus

•• Camper's fascia: - Superficial fatty layer abdominis muscles
•• Scarpa's fascia: - Deep membranous layer C. Between internal Oblique & transversus
muscles
PYQs:
Q. Which of the following Structure is not the D. Between transversus abdominis & fascia
extension of External oblique? (Al 2019 transversalis muscles
PATTERN)
A. A Inguinal ligament

B. pectineal ligament

C. Lacunar ligament

D. Arcuate ligament

Q. Identify the conjoint tendon in the given

image? (AIMS MAY 2017)
A. A

B. B

C. C

D. D
 PERITONEUM & ABDOMINAL LIGAMENTS

2. Retroperitoneal :- behind, it is fixed, ex

:- pancreas, kidney & related structures,
duodenum.
3. Subperitoneal :- below peritoneum eg. pelvic
organs.

–– Peritoneum fold :- responsible for Movements

& peristalsis.
–– If Peritoneum fold is attached with
ƒƒ Stomach → it is known as omentum
(greater & lesser).
ƒƒ Intestines → it is known as mesentery,
with duodenum known as mesoduodenum.
ƒƒ Transverse colon → known as Transverse
mesocolon.
ƒƒ Appendix → known as mesoappendix.
ƒƒ Viscera → gastrosplenic ligament,
lienorenal ligament.

Abdominal Viscera :- have 3 types

1. Intraperitoneal :- free Movements.
2
Anatomy

–– Foramen of Winslow:- It is communication between greater & lesser sac aka epiploic foramen.

Mesogastrium has 2 parts :

a. Ventral mesogastrium (VMG): It divides –– Ventral part - give rise to gastro-splenic
into 2 parts → ligament→ short gastric vessels run within it
–– Ventral part - give rise to falciform ligament –– Dorsal part - give rise to lino-renal ligament→
–– Dorsal part - give rise to lesser omentum splenic vessels run within it

b. Dorsal mesogastrium (DMG): It divides into

2 parts →
 3
Peritoneum & Abdominal Ligaments

•• Pringle’s maneuver:-
4
Anatomy

Focus areas for Exams:

•• peritoneum & peritonitis.

•• Peritoneal Folds/Ligamentsof Abdomen.

•• Epiploic foramen & its boundaries.

•• Clinical Integration.

Exams:-
•• Superior Boundary of Foramen of Winslow:
Liver
•• Contents of free margin of lesser omentum:
VAD (Vein, Artery. Duct)
•• Artery within gastrosplenic ligament:
Gastrosplenic & Short Gastric
Epiploic Foramen (Boundaries) -
•• Artery within lienorenal ligament :splenic
Anterior - Right free margin of lesser omentum artery
Posterior-
IVC
Right Suprarenal
T 12
Superior-Caudate process of liver

For Portal hypertension:-

Pyqs:-
Q A 30 yr old male presented in the clinic with
pain in left hypochondrium. On examination,
the spleen was measured 18 cm & extending
to the umbilical region. This extension of the
spleen is prevented by? (NEETPG 2021)

Mickey Mouse signs:- A. Transverse colon

•• Portal triad in Portal Hypertension. B. Lienorenal ligament

C. Tail of pancreas
•• Midbrain of progressive supranuclear palsy.
D. Phrenicocolic ligament
•• Polyostotic Paget's disease

•• Pelvic Mickey Mouse sign: bilateral inguinal

vesical hernia

•• Dysmorphic Mickey Mouse RBCs & Ureteropelvic

junction obstruction (UPJO)
 5
Peritoneum & Abdominal Ligaments
Q Ligament derived from the marked structure?
(NEET pattern 2022)
A. Gastrophrenic Ligament
B. Phrenicocolic Ligament
C. Falciform Ligament
D. Leinorenal Ligament

Q A patient came after splenic trauma. To ligate the

splenic artery, you will occlude which structure?
(FMGE JAN 2023)
A. B
B. A
C. D
D. C
 ESOPHAGUS & STOMACH

ESOPHAGUS from oral cavity to the stomach

•• It is a muscular tube which joins the pharynx to 4 constrictions of the Esophagus – measured from the
the stomach. upper incisors

•• It is responsible for the chewed food transport

Constrictions due to Vertebra level Measurement

1. Pharyngoesophageal junction/ Cricopharyngeal C6 vertebra 6” x 2.5 cm = 15cms
junction – narrowest part of GIT
2. AOA T4 vertebra. 9” = 22.5cms
3. left bronchus, T6 vertebra 11” = 27.5cms
4. Diaphragm T10 vertebra 15” = 37.5cms

CLINICAL INTEGRATION RADIOLOGY-ANATOMY INTEGRATION

Forceful insertion of the Ryle’s tube into the 5th Narrowing is due to the left Atria – this is only
esophagus can lead to esophageal rupture due to related in radiology not anatomy
which food material will leak into the mediastinum
and cause mediastinitis. •• Length of the Esophagus = 40cms – 15cms =
25cms
1. Boerhaave Syndrome
2. Mallory Weiss Syndrome
2
Anatomy

TRICKS & MAGICS •• D – Descending colon

Structures having length – 25cms = DUDES •• E – Esophagus

•• D – Duodenum •• S – Stomach

•• U – Ureter

SURGERY-ANATOMY INTEGRATION
Parts of Esophagus Artery Vein Lymph node
Upper 1/3rd part Inferior thyroid Inferior thyroid vein – Deep cervical LN
artery Brachiocephalic vein (BCV)
Middle 1/3rd part Esophageal br. from Azygous vein Mediastinal LN
Descending thoracic
aorta
Lower 1/3rd part Left gastric artery Left gastric vein Left gastric LN
(esophageal branches)
“BAL” – mnemonic
“OIL” – mnemonic

Clinical – 1 Ques Sure MAGIC OF 2

1. Esophagitis – Acute or Chronic •• 2 ends

2. Tumor – Benign or Carcinoma (SCC or AdenoCa)
•• 2 curvatures
3. Barett’s esophagus
•• 2 surfaces
4. GERD
5. Esophageal rupture •• 2 angles

6. Esophageal motility disorder •• 2 parts – further divided into 2

7. Achalasia Cardia
ANAT-PATHO-MEDICINE-SURGERY
8. Killian’s Dehiscence INTEGRATION
9. Zenker’s Diverticula

STOMACH
Parts of Stomach
1. Cardiac part
a. Fundus
b. Body
2. Pyloric part
a. Pyloric Antrum
b. Pyloric Canal

ANAT-PATHO-MEDICINE-SURGERY
INTEGRATION
Pyloric antrum is the 2nd most common site for the
Duodenal Ulcer Disease (DUD)
Incisura Angularis is most common site for Gastric
ulcer Disease (GUD)
 3
Esophagus & Stomach

GUD CLASSIFICATION

ANAT-PSYCHIATRY INTEGRATION ARTERIAL SUPPLY OF STOMACH

Sometimes patients (More common females) are GIT –
having psychiatric illness due to which they are
•• FOREGUT – Celiac Trunk – T12-L1
pricking the hair and eating them. These hairs are
coming in the stomach but are not able to digest it •• MIDGUT – SMA – L1
because of keratin. •• HINDGUT – IMA – L3
Therefore, the hair is getting accumulated in
the stomach and taking exactly the shape of the
stomach. The habit of hair eating is known as
Trichophagia.
The large mass accumulated is known as Trichobezoar
If any vegetarian person is eating the uncooked
green leafy vegetables, these get accumulated in
the stomach as it cannot be digested due to the
presence of cellulose. This is known as Phytobezoar
4
Anatomy

ANAT-SURGERY INTEGRATION
ESOPHAGEAL REPLACEMENT SURGERY
•• In case of esophageal replacement surgery,
the best site for the graft is the part
of the stomach where the left and right
gastroepiploic artery anastomosis or also the
lesser curvature part where the right and
left gastric arteries are anastomosing
•• To prevent the bleeding from the Duodenal
ulcer, the artery ligated will be Gastroduodenal
artery

LYMPHATIC DRAINAGE OF
•• Give 3 main branches
STOMACH
–– Left gastric artery – supply lower end of the
esophagus
–– Splenic artery –
ƒƒ Arteria pancreatica magna – supply body of
pancreas
ƒƒ Short gastric vessels
ƒƒ Left gastroepiploic artery
–– Common hepatic artery
ƒƒProper hepatic artery
○○ Left hepatic branch
○○ Right hepatic branch
Cystic artery (to gallbladder)
○○ Right gastric artery (anastomose with
•• ● All the LNs drain into the Celiac nodes
the left)
ƒƒ Right gastroduodenal artery ANAT-PATHO INTEGRATION
○○ Right gastroepiploic artery In case of Stomach Ca – enlargement of left
(anastomose with the left) supraclavicular LN =
○○ Superior pancreaticoduodenal artery
•• Virchow’s LN
Anastomose with the inferior
pancreaticoduodenal artery – br. of •• Troisier’s sign
the IMA In case of Stomach Ca – enlargement of left
•• Anastomosis between superior and inferior axillary LN = Irish LN
pancreaticoduodenal artery In case of Stomach Ca – enlargement of periumbilical
–– Junction between foregut and midgut LN = Sister Mery Joseph Nodules
–– Opening of CBD In case of Stomach Ca – there is trans celomic
spread – Ovarian Ca = Krukenberg’s tumor
 5
Esophagus & Stomach

Focus Areas For Exams Q . During examination an endoscope is being passed

by the clinician and he felt some resistance
•• Constrictions of Oesophagus:
when the endoscope reached 25 cm from the
•• Arterial, venous & lymphatic drainage Of incisor teeth. The endoscope has reached till
Oesophagus for surgery: which landmark? (FMGE Jan 2023)
•• Structures having 25 cm length:
A. Arch of aorta
•• Stomach (surgical anatomy)
B. Right bronchus
•• Coeliac trunk & its branches (for surgery)
•• Clinical integration C. Main bronchus

D. Left bronchus
Revision Capsule:
•• Constrictions of oesophagus Q. Left atrium is present at which level? (FMGE Jan
2023)
•• Vascular supply of oesophagus & stomach
•• Vagotomy operation
•• Virchow's lymph node

PYQs
Q. In case of duodenal ulcer bleeding which artery
is ligated to check it ?
A. Right gastroepiploic artery

B. Left gastroepiploic artery

C. Gastroduodenal artery

D. Proper hepatic artery

A. A

B. B

C. C

D. D
 SMALL & LARGE INTESTINES

Duodenum: –– D4 → 1 inch

•• Shorterst , widest & most fixed part of small –– Total 10 inches × 2.5 = 25 cm
intestine •• IMPORTANT Relations
•• 4 parts : D1, D2, D3, D3 –– 1st part of Duodenum: anterior to head of
pancreas
•• Extension : between L1 to L3 Vertebra, above
umbilicus –– 2nd part of Duodenum: anteriorly related to
Rt. Kidney
•• Total length : 25 cm
–– Gallbladder fundus is in front of 2nd part of
–– D1 → 2 inches → located at L1 duodenum
–– D2 → 3 inches → L2 –– SMA & vein passing anterior to 3rd part of
–– D3 → 4 inches → L3 Duodenum
2
Anatomy

•• At L3 , L4 level → Umbilicus, Iliac crest

located, & it is the site for Lumbar puncture
•• Distance between Minor duodenal papilla & major
duodenal papilla / opening of main pancreatic
duct is = 2 cm
•• Junction between duodenum & jejunum →
duodenojejunal flexure
•• At duodenojejunal flexure, the suspensory
ligament of Treitz is attached.
•• Celiac trunk pierces the suspensory ligament of
Treitz
•• Suspensory ligament of Treitz is used for Upper
& lower GI bleeding landmarks. Bleeding above
suspensory ligament of Treitz known as upper
GI bleeding & below to it known as lower GI
bleeding.

Large Intestine
•• 8 parts of large intestine
–– Ascending colon
–– Transverse colon
–– Descending colon
–– Sigmoid colon
–– Caecum
Caecum
•• Junction between small & large intestine
–– Appendix represented by Ileo-caecal junction (ICJ)
–– Rectum •• ICJ is opening into caecum
–– Anal canal •• ICJ It is the most common site for:
•• Main 3 Features of Large Intestine –– Abdominal TB
1. H :- Haustra / Saccule –– Intussusception
2. A :- Appendices epiploicae = small pouch of –– Crohn’s Disease (Inflammatory Bowel
fat Disease)

3. T :- Taenia coli (3 in no.) –– Vit. B12 Absorption

 3
Small & Large Intestines

and Lateral 1/3rd of spino- umbilical line (It is

imaginary line in between Umbilicus and Anterior
superior iliac spine.
–– Is the most common site for referred pain
of Appendicitis.
–– Appendix is Supplied by
ƒƒ Parasympathetic:- X nerve
ƒƒ Sympathetic:- T10 (Umbilicus iss
dermatome of T10 , so that’s why the pain
of Appendicitis starts from umbilicus can
Shifts towards Anterior superior iliac
•• Caecum is cul-du- sac like pouch
spine)
•• length : 6 cm & width : 7.5 cm
ƒƒBlood supply:
•• Structures of our body which are having less
length & more width: CP4
–– C – Ceacum
–– P4 – Pineal gland, Pons, Pituitary gland &
Prostate

Clinical :
•• Inflammation of Caecum → Typhlitis → 2 types
: acute & chronic

Appendix
•• Worm like structure which is vestigial now.
•• length : 2 to 20 cm.
•• lumen 1 mm. (narrower than CPJ)
•• Appendicular artery = Example of end artery ,
•• fold of mucosa present in between appendix Most commonly involve in Appendicitis
& caecum known as valve of Geralach. It is a •• The accessory appendicular artery, also known
pseudo valve. as the artery of Seshachalam, is a branch of
the posterior cecal artery. It arises from the
•• most common site of pain due to appendicitis –
ileocolic artery, and runs in the mesoappendix.
McBurney's point → junction at medial 2/3rd
•• Positions of appendix :
4
Anatomy

–– Post-ileal → most dangerous position Clinical:

–– Most common position → retrocolic •• Acute → characterized by Murphy’s triad : pain,
–– 2nd Most common position → pelvic vomiting, fever
•• Chronic

RECTUM & ANAL CANAL

•• Rectum length : 12 cm
•• Anal canal length : 3.8 cm > 4 cm
•• Internal hemorrhoid plexus → abnormal
dilatation → Piles.
 5
Small & Large Intestines

Valve of Hauston : 3 in no. Anal canal:

a. Superior valve •• Length from anorectal junction to dentate line
b. Middle valve :- 15 mm
c. Inferior valve •• From dentate junction to white line :- 15 mm
These are only folds of mucosa , hence these are also •• Below it - 8 mm
pseudo valve.
•• Total 38 mm ~ 40 mm = 4 cm
•• Blood supply:
a. Superior rectal artery
b. Middle rectal artery
c. Inferior rectal artery

Anal sphincter : 2. Internal Anal sphincter

1. External Anal sphincter - 3 parts White line of hilton : Intersphincteric groove

presents a pale line on dissection aka white line of
a. Subcutaneous hilton
b. Superficial
c. Deep
6
Anatomy

FOCUS AREA FOR EXAM: - PYQs:-

•• Disease Of small intestine Q. Identify the pelvic Diaphragm? (AllMS,2017)
•• Disease affecting IC junction
•• Appendicitis
•• Rectal disease
•• Anal canal diseases

Revision capsule: -
•• Length Of Duodenum: 25 cm
•• Length of Rectum: 12 cm
A. A
•• Length of Anal Canal: 3.8 cm > 4 cm
B. B
•• Characteristic Features of Large Intestine:
HAT/SAT C. C
•• No. of Houston's Valve Present in Rectum: 3 D. D
 ARTERIES & VEINS OF GIT

•• Abdominal Aorta pierces the diaphragm and •• At the lower border of L4 or L4-L5 junction, it
runs in downward direction. is bifurcating into common iliac arteries
2
Anatomy

•• Abdominal Aorta aneurysm are most common in

Infrarenal position and also Aortic Dissections.

•• Middle colic artery

SMA – ARTERY OF THE MIDGUT –
BRANCHES •• Marginal arteries of Drummond – small arteries
coming out and supplying the large intestine

IMA – artery of Hindgut – at the level

of L3
3 branches of IMA :
•• Left colic artery
•• Sigmoidal Artery
•• Superior rectal artery

SURGERY-RADIO-ANATOMY
INTEGRATION
•• When the lower pole of the kidney gets fused
– Horseshoe Kidney. So, when this fused
kidney is ascending upwards at that time this
IMA will arrest it.
SMA – arise at the level of L1
•• Radiology – horseShoe kidney is seen at the
6 branches of SMA : L3-L4 vertebrae
•• Inferior pancreatico duodenal artery – to
duodenum and pancreas VENOUS DRAINAGE OF THE
•• Jejunal branches ABDOMEN
•• Ileal branches •• Portal vein = Splenic vein + SMV

•• Ileocolic Artery – to ileum as well as cecum •• Behind the neck of pancreas

•• Right colic artery •• At the level of L2

 3
Arteries & Veins Of Git

•• Due to shorter right sided branch of the portal

vein, all the infection is going to the right lobe
of the liver
•• Rt lobe – more common for ↑ HCC & ↑ infection
•• This is known as Streamline phenomenon

MICRO-PARASITO/SURGERY/MEDICINE-
ANATOMY INTEGRATION
Entamoeba histolytica infection and also
Hepatocellular cancer case:

Clinical Portal Hypertension

•• Chronic Alcohol – Cirrhosis/ Liver failure ƒƒ Around the umbilicus via the paraumbilical
veins – appears as Caput Medusae
–– There is fibrosis of the liver, so the blood is
not drained through the liver which causes ƒƒ At the lower part of the rectum-anal canal,
↑ blood within the portal vein and results in there is abnormal dilatation and rupture
Portal HTN. of the blood vessels causing Melena. This
can lead to Hemorrhoids.
–– Blood accumulating is spleen – Splenomegaly
ƒƒ Abnormal dilatation and rupture of vessels
–– Blood accumulating in the SMV & IMV – Ascites
at the lower end of the esophagus
–– When the blood is not passing through the resulting in the esophageal varices which
portal vein, then there are certain sites causes bleeding
where there is a meeting of the portal vein
with the vena cava vein. This is known as
Porto-Caval shunt.
4
Anatomy

Revision Capsule / PYQs

•• Vertebral Level Of Coeliac Trunk: T12-L1
•• Vertebral Level Of SMA: L1
•• Vertebral Level Of IMA: L3
•• Vertebral Level of Abdominal Aorta
Bifurcation:
L-4-L-5 junction/ L4 lower border

Q. Ovarian artery is branch of

A. Internal iliac artery

FOCUS areas for Exams B. External iliac artery

•• Branches of Abdominal Aorta C. Common iliac artery

•• Branches of Coeliac Trunk D. Abdominal aorta
•• Branches Of Superior Mesenteric Artery
•• Branches of Inferior Mesenteric Artery
•• portal Vein
 ABDOMINAL VISCERA ORGANS

Parts of duodenum & their corresponding vertebral

Parts of pancreas : Head , neck , body , tail
level :
Important relations : •• D1 : L1
1. Head : located within the C loop of duodenum . •• D2; L2
2. Neck : behind it formation of portal vein . •• D3: L3
3. Body : along upper border splenic artery runs Epiploic foramen : T12
4. Tail : located within hilum of spleen
2
Anatomy

Portal vein formation : behind neck of pancreas –– splenomegaly

: at L2 ƒƒ seen in Hemolytic anemias, Sickle cell
anemia and Thalassemia.
Portal vein = Splenic vein + Superior mesenteric
vein –– Hypersplenism
•• In an uncinate process tumor → compression of
Superior mesenteric vessels

SPLEEN
•• Located in the left hypochondrium region.
•• Costal Surface → 9th, 10th (45°) and 11th ribs.
•• Visceral surface → Gastric, Colic, Renal and
Pancreas impressions.

LIVER

•• Weight: 1.5 kg

•• Harris dictum : Magic of Odd numbers. 1,3,7,9,11 •• Magic of 5 :

–– 1” 3” 5” : Dimensions •• 5 surfaces:
–– 7 : ounce is weight
–– Superior
–– 9, 10, 11 : Ribs are costal relations.
–– Right
•• Axis along 10th rib
•• Two surfaces –– Inferior
: Diaphragmatic ( outer ) ( Rib & intercostal 9, –– Anterior
10, 11 )
–– Posterior
: Visceral (inner)
Visceral surface → gastric, colic, renal, pancreas •• 5 ligaments:

impressions “GCRP” –– Falciform: ventral part of Ventral

(In uncinate process tumor: compression of mesogastrium.
SMV + SMA) –– Ligamentum Venosum
•• Artery: splenic artery
–– Ligamentum Teres
•• Vein: splenic Vein
•• Clinical correlation: –– Coronary ligament (superior & inferior layers)

–– Triangular ligament (right & left)

•• Porta hepatis: 5 cm
 3
Abdominal Viscera Organs

•• 5 structures within Porta hepatis: ––Cirrhosis

–– Portal Vein
Extrahepatic Biliary Apparatus
–– Hepatic artery

–– Bile duct

–– Hepatic plexus

–– Hepatic Lymph nodes

•• 5 viscera at inferior surface:

–– For stomach

–– For Gallbladder

–– For duodenum
–– For right kidney
–– For Hepatic flexor
•• Clinical correlation:
Gallbladder:
•• 3 Parts: Fundus, body, neck
––Hepatitis: Acute & chronic
––Tumor: Benign (Hepatic adenocarci-
noma) & Malignant (Hepatocellular
cancer)
––Hepatectomy (right & left lobectomy)
––Jaundice (pre-hepatic, intra hepatic,
post hepatic) •• Hartman’s pouch is present at the neck →
common site for stone
––Hyperbilirubinemia: Conjugated & •• Cystic duct presents a spiral valve of Heister
Unconjugated (false valve).

––Liver failure: liver transplantation •• Artery: Cystic Artery.

•• Vein: Cystic Vein.
•• Nerve: 10th cranial nerve.
•• Lymph node: Cystic Lymph node of Lund.
4
Anatomy

KIDNEY rib & vessel on left side along with the above
mentioned structures)
•• 2 Ligaments: Medial arcuate ligament and
Lateral arcuate ligament.
•• 3 nerves: subcostal Nerve (T12), Iliohypogastric
Nerve, ilioinguinal Nerve.
•• 4 muscles: diaphragm, psoas major, quadratus
lumborum, transverse abdominis.
•• 5 Structures impression on right kidney
(Anterior surface) → right Suprarenal gland,
colon, intestinal loop, liver, 2nd part of
duodenum.

•• Kidney is the main excretory organ in humans. •• 6 structures impressions on left kidney
(Anterior surface) → left Suprarenal gland,
•• it has 2 poles , 2 borders & 2 surfaces
colon, intestinal loop, stomach, spleen, pancreas.
•• Structure at renal hilum: Anterior to posterior
•• Clinical correlation of kidney:
- VAU (Vein, Artery, Ureter)
–– Glomerulonephritis
ƒƒ Acute → Post-infectious
glomerulonephritis, Minimal change
disease, Membranoproliferative
glomerulonephritis, Focal segmental
glomerulosclerosis.
ƒƒ Chronic
–– Tumor → Wilms tumor

Relations of Kidney (Magic of 1,2,3,4,5,6)

•• 1 rib (12th) & 1 Vessel (subcostal) are related
to posterior surface of kidney (NOTE - 11th
 5
Abdominal Viscera Organs

Focus Areas for Exams: Q. Indicated triangle is?

•• Surgery, Medicine & Radiology Integration of:

•• Spleen
•• pancreas
•• Liver
•• Kidney

Revision Capsule:
•• In Acute Pancreatitis Which Arterial A. Calot's triangle
Aneurysm Is Common:
B. Hepatobiliary triangle
•• Which Vessel Is Compressed in Case of Cancer
of Uncinated process of pancreas: C. Hessalbach's triangle
•• Portal Vein is Formed At: D. Gastrinoma triangle
•• Which Muscle is Not Related to Posterior
Surface of Ureter:

PYQs:
Q. Cholecystocaval line is in between?

A. Caudate and quadrate lobe

B. Caudate lobe and IVC

C. Gall bladder & IVC

D. Demarcation between right and left lobe of

liver
 Perineum and Pelvic Viscera-1

Abdomen •• Anterior triangle (Urogenital triangle)

•• Posterior triangle (Anal triangle)

Perineum
•• Perineum is the area between two thighs

Boundaries of perineum:
•• Anterior- Pubic symphysis

•• Posterior- Sacral and Coccyx

•• Lateral – Ischial Tuberosity

Perineum divided into 2 triangles: •• Anterolateral- Ischiopubic rami

•• Posterolateral- Sacro tuberous ligament

2
Anatomy

Central tendon of perineum (Perineal –– Bulbospongiosus muscle-2

body):
–– Anterior fiber of levator ani-2
•• Insertion of 10 muscles in perineal body
–– External anal sphincter 1
–– Superficial transverse perineal muscle-2
–– External urinary sphincter 1
–– Deep transverse perineal muscle-2

OBG-ANAT- SURGERY INTEGRATION Episiotomy process on the postero-lateral part

to avoid injury to perineal body.
Damage the perineal body →→ Paralysis of all 10
muscles→ Prolapse of uterus and rectum
Supply of pudendal nerve:
Pelvic diaphragm and Urogenital Diaphragm Urogenital part supplied by the pudendal nerve.
↓
Levator ani + Ischiococcygeus (IsC)
↓
Pubococcygeus (PC) and iliococcygeus (IC)= Levator Ani
Pelvic diaphragm = Ilium + Pubis + Ischium

Pelvic diaphragm = IC+ PC + IsC

Anat-OBG Integration:

Clinical Significance:
Pudendal nerve supplies the penis and gives a branch
to the scrotum as posterior scrotal nerve therefore,
for any hydrocele surgery pudendal nerve is to be
blocked.
 3
Perineum and Pelvic Viscera-1

Urethra:
Extra Edge:
Parts of Urethra:
–– Fascia of denonvilliers' fascia- behind
urinary bladder •• Prostatic urethra (Horseshoe shaped)

–– Fascia of Waldeyer- behind rectum •• Membranous urethra

•• Bulbar urethra

•• Penile urethra
4
Anatomy

SURGERY INTEGRATION- URETHRAL

INJURY:
•• If rupture of bulbar or penile urethra- urine
accumulates into Superficial perineal pouch,
scrotal and penile area. In very severe cases
it may reach up to the clavicle.

•• If posterior Urethra gets ruptured →

urine will come out from urinary bladder→
accumulate into deep perineal pouch → No Relation with Posterior surface of bladder -
swelling over scrotum & Perineum area •• Rectovesical pouch

•• Vas deferens located here

CLINICAL ANAT-SURGERY-RADIO
INTEGRATION: •• Seminal vesicle

•• Posterior Urethra = Prostatic Urethra + •• fascia of Denonvilliers

Membranous Urethra •• Prostate gland
•• Anterior Urethra = Bulbar Urethra + Penile
Urethra Prostate gland
•• 5 Anatomical lobes :
Radio images of urethra
–– Anterior

–– Posterior

–– median

–– right lateral

–– left lateral

Urinary bladder: Magic of 4

Tetrahedral structure has 4 angles, 4 borders, 4
surfaces and 4 connections
Relations of urinary bladder:

•• Right and left ureters – posterolateral side •• Ejaculatory duct opens in Prostatic urethra
(Semilunar/Horse-shoe shaped → due to
•• Inferiorly- Urethral opening
pressure by median lobe)
•• Anteriorly- Median umbilical ligament
•• Opening of prostatic utricle (remnant of
Paramesonephric duct) → in Prostatic urethra

•• Paramesonephric duct → Forms Uterus and

vagina in females
 5
Perineum and Pelvic Viscera-1

ANAT-PHYSIO INTEGRATION ANAT-PHARMA-MEDICINE

•• Retrograde ejaculation or Urinary reflux - Inhibited
INTEGRATION
by Internal urethral sphincter (Involuntary → Smooth BPH (Benign prostatic Hyperplasia/Hypertrophy)
muscles)
•• Management - Alpha-blockers (Prazosin,
•• TURP (Transverse Urethral resection of Prostate) –
Phentolamine)
Lead to removal of Internal urethral sphincter causing
•• Side effect of prazosin – Postural hypotension
Retrograde ejaculation and Urine reflux.
→ prescribed at night before sleep and gradually
•• Urine reflux → Causes increased risk of infections.
increases in dose.
•• Selective Alpha-1a blocker - Tamsulosin (Less side
Clinical integration: effects and selective)

1. Benign tumor - BPH (Benign prostatic –– Along with 5-alpha reductase inhibitors –
Hyperplasia) → Compression symptoms as Finasteride
it occurs in Periurethral zone - Urinary •• If Medical management fails - Surgery (TURP)
hesitancy, Urgency and increased Frequency.

2. Prostate carcinoma – Peripheral zone

involved
 Perineum and Pelvic Viscera-2

Abdominal Aorta •• Blood supply of Rectum -

It is divided into Two Common Iliac artery, which –– Superior Rectal artery - from Inferior
further divided into two - Mesenteric artery ranch
1. External iliac artery –– Middle Rectal artery - from Internal Iliac
2. Internal iliac artery artery

→ Anterior division - supply Pelvic viscera –– Inferior Rectal artery - from Internal
Pudendal artery
•• Blood supply of Urinary Bladder - Superior &
Inferior vesical artery

•• Blood supply of URETHRA - inferior vesical

artery (No need in female)
2
Anatomy
→ Posterior division 2. Uterus
Branches from Posterior Division of Internal iliac a. Fundus
artery
b. Body
(Mnemonic - ILS - I Love Salman)
c. Cervis
1. Iliolumbar artery
Uterine Artery - Tortuous Course and present in broad
2. Lateral sacral Artery ligament at the lateral border of Body of Uterus →
3. Superior Gluteal artery anastomosis with ovarian artery.
ANAT-OBG-SURGERY INTEGRATION
Female Genital Organ: HYSTERECTOMY - surgical removal of uterus
Prevent ureteric injury and ligation as it is in close
relation with the uterine artery at the lower part of
the body of the uterus.

Angle of Anteversion and Anteflexion

Function - Prevention of Uterine Prolapse.

Relation at Cornua of Uterus (Posterior to Anterior)
1. Ovarian Ligament
1. Fallopian tube
ƒƒ Postero-inferior to Fallopian tube
Length : 10 cm.
Parts: 2. Fallopian tube

a. Fimbria 3. Round ligament of uterus (Homologous to

Spermatic Cord)
b. Ampulla - site of fertilisation
ƒƒ Antero-superior to Fallopian tube
c. Isthmus - Physiological sphincter
d. Intramural part - Anatomical sphincter Spaces/Pouches in Female

→ Most dependent part in supine position - Pouch of

Douglas (Recto-uterine pouch)
→ Most dependent part in supine position -
Hepatorenal/Morrison’s Pouch
 3
Introduction

Supports of uterus: Revision Capsule:

1. Primary Supports/ Major Support URETHRAL TRAUMA:
•• Muscular/ Active Support: (Mnemonic: PPU) •• MCC: Instrumentation
1. Pelvic Diaphragm •• 2nd MCC: External Trauma
2. Perineal Body
•• MCS: Bulbar urethra And the Membranous
3. Urogenital Diaphragm Urethra
•• Fibromuscular & Mechanical Support: •• BPH: Periurethral Zone
(Mnemonic: PUT RU)
•• prostate Carcinoma: peripheral Zone
1. Pubocervical Ligaments
•• Cervical Carcinoma
2. Uterosacral Ligaments
3. Transverse-Cervical (Cardinal; Mackenrodt’s)
PYQs:
4. Round Ligaments of The Uterus
Q A primigravida female after delivery continued
5. Uterine Axis
bleeding from uterus. patient Was taken to OT
& planned for uterine devascularization. Mark
the correct order of devascularization? (NEET
PG 2021)

a. Uterine artery, internal iliac artery, Obturator

artery

b. Uterine artery, Pudendal artery, vaginal artery

c. Uterine artery, ovarian artery, internal iliac

artery
2. Secondary Supports/ Minor Supports (BRU)
d. Uterine artery, ovarian artery, external iliac
1. Uterovesical Fold of Peritoneum artery
2. Rectovaginal Fold of Peritoneum Q A patient with H/O pain in both legs while taking
3. Broad Ligaments long walk, He has developed toe gangrene and he
admits to have erectile dysfunction. Which Of the
Focus Areas for Exams: following artery is involved in this patient? [N EET
•• Surgery, Medicine & Radiology Related Clinical Pattern 2022]
Questions a. Right Internal Iliac Artery
•• Bladder Carcinoma b. Right External Iliac Artery

•• Urethral Injury & Cystourethrogram c. Left Internal lIiac A Artery

•• Fecal Fistula & Fissure d. Aorto-iliac Junction

•• Blood Supply of Pelvic Organs

•• BPH & Prostate Carcinoma

•• Uterus, Cervix & Vagina Related Diseases: OBG

Integration
 BASICS OF HISTO-PATHOLOGY

•• HISTO- PATHOLOGY IS IMPORTANT FOR 1. Microscope

DIAGNOSIS OF CLINICAL DISEASES
Different powers of the Objective lens are used for
•• 2 basic requirements to observe cell structures various purposes.

2. Contrast agent/ Dye/ Staining

colour
•• Pink/Red - Eosin Dye → AcidIc dye, hence
attracted by Cytoplasm (pH = 7.3-7.4).
•• Blue/Black - Hematoxylin → Basic dye, hence
attracted by Nucleus (Acidic histone proteins).
•• Cell membrane - just like cytoplasm → Appear
Pink (line structure)
2
Anatomy

How to Identify Epithelium:

Characteristic of Epithelium
Nucleus
Nucleus parallel to Flat squamous epithelium
Basement membrane
Rounded nucleus Cuboidal epithelium
Nucleus perpendicular Columnar epithelium
to Basement membrane

ANAT-PATHOLOGY INTEGRATION 3. After fixing → Cutting of tissue along with a

paraffin block of desired thickness (5 micron)
Steps for making slides using Microtome.

1. Submerge tissue sample in Formalin solution.

4. Put a tissue ribbon into the Water bath & then

onto the slide
2. L-block is used → Put Paraffin Wax and tissue
sample inside the space created by L-block.

5. Dip in acetone/ alcohol (organic solvent) followed

by Staining.
 EPITHELIUM

•• The term "epithelium" refers to layers of cells

that line hollow organs and glands.
•• It is also those cells that make up the outer
surface of the body
2
Anatomy

1. Squamous epithelium - •• In Thyroid, PCT and DCT.

•• Nucleus is parallel to the basement membrane . •• Update - Thyroid with high activity – Simple
Columnar epithelium
•• Cells are flat & pavement like in appearance.
•• Function : Gaseous / Nutrition exchange, Thyroid with low activity – Simple Squamous
Diffusion like Lung alveoli , endothelium, , epithelium
henle’s loop •• Thyroidization of Kidney → Chronic
Pyelonephritis causes thyroid-like appearance
of PCT & DCT of kidneys.

3. Columnar Epithelium -
•• Nucleus is Perpendicular to the basement
membrane .
•• Height of the cell is more.
•• Function : Synthesis and Storage function

•• 2 types - Simple or Stratified •• Stored material present in the Apical area.

•• Stratified squamous epithelium are of 2 types

1. Keratinized Stratified squamous epithelium (Dry
area) - Skin
2. Non-keratinized Stratified squamous epithelium
(Wet areas with Friction) - E.g.
a. Conjunctive,
b. Cornea,
c. Nasal vestibule,
d. Oral cavity,
e. Tip of urethra and •• No colour -
f. Glans penis, 1. Fat - globular / Rounded Shape
g. lower part of Vaginal canal, 2. Air - Uneven/ Irregular Shape
h. lower part of Anal canal etc.

2. Cuboidal epithelium -
•• Nucleus is rounded .
•• All dimensions of cells are equal hence cube like
appearance.
•• Function : Synthesis and secretion

Clinical integration :
•• Immotile Cilia Syndrome/Kartagener
Syndrome - because of absence of Cilia/
Dysfunctional cilia → repeated Infections →
repeated inflammation → Dilatation/ Ectasia
of bronchus occurs → aka Bronchiectasis.
 3
Epithelium

•• Triad of Kartagener Syndrome (Mnemonic -

SBI) Focus Areas for Exams:
S - Situs inversus •• Classification Of Epithelium
B - Bronchiectasis •• Image based identification Of epithelium
I - Infertility
[ANAT-PATHO-MEDICINE INTEGRATION]
Revision Capsule:
Transitional epithelium/Urothelium
Skin
Sebaceous gland

Q. Which of the following epithelium seen in

fallopian tube? (DEC FMGE 2021)

A. Ciliated Simple Columnar

B. Ciliated Simple Cuboidal

4. Urothelium/Transitional Epithelium: C. Stratified Columnar

•• Present in the urinary system hence known as D. Pseudostratified Ciliated Columnar
Urothelium.
•• It shows transition / change in appearance Q. Which types of gland is depicted here? [AIIMSP
when stretched hence known as transitional NOV. 16]
epithelium.
•• Upper most cell appear like Umbrella hence
known as Umbrella cells.

Umbrella cells:
•• Thick glycoprotein layer present → Prevent
absorption.
•• May appear Binucleate. A. Apocrine gland
•• Internalisation of cell membrane present.
B. Merocrine gland
•• Present in Urinary system distal to the
Collecting duct like Bladder, Urethra (Except C. Holocrine gland
Membranous part & tip of urethra) etc.
D. Endocrine gland
GLANDS:
Q. Transitional epithelium is seen in?
3 types on the basis of Mode of Secretions
A. PCT
A. Holocrine glands - Entire glands are ruptured
and secretion released. E.g. Sebaceous Glands. B. Loop of Henle
Block of duct → Acne occurs.
C. Renal pelvis
B. Apocrine glands - Only the apical portion of
the gland is ruptured and secretions released D. Terminal part of urethra
in the surroundings or duct. E.g. Modified
Sweat gland → Pheromones secreting glands
(present in Axilla, Perineum) Breast.

C. Merocrine / Eccrine glands - Secretions show

Exocytosis (No destruction). E.g. Sweat glands
of Palms and soles.
 CARTILAGE & BONE

A. Cartilage •• On histology slide -

•• Identify (Chondrocytes) - contain Chondroitin Group of cells with blue stained nucleus and
Sulphate → Attract basic stain → Blue stain. clear Lacuna.

1. Hyaline cartilage F - Foetal cartilage

(Mnemonic - Hii - GF - CAR) C - Costal cartilage

Hii - HYAline A - Articular cartilage

G - Growth plate R - Respiratory tube cartilage

2. Elastic cartilage T - Tip of nose

(Mnemonic - ETC NEWS) T - Tip of arytenoid cartilage

E - Ear pinna T - Tritiate cartilage

E - Eustachian tube C - Corniculate

E - Epiglottis C - Cuneiform
2
Anatomy

3. Fibrocartilage A - Articular disc (Menisci, TMJ disc)

(Mnemonic - FIAT Logo) T - Tendon insertion

F - Fibrocartilage Logo - Labrum (of Glenoid & Acetabulum)

I - Intervertebral Disc

B. BONE ANAT-PATHO-MEDICINE-PEDIA
•• No stain needed INTEGRATION:
•• At centre - Haversian Canal Good Pasture Syndrome
•• Volkman’s canal - joins 2 haversian canals •• Mutation/Abnormality in Collagen type IV
•• Osteocytes are seen. •• Defect in Basement membrane of Kidney :
lead to Hematuria
Collagen
•• Defect in Basement membrane of Lungs : lead
•• Most common protein in body to Hemoptysis
•• Types = 28
Focus Areas for Exams:
Important Types Locations
of collagen •• Types Of cartilage with examples

I Bone, Aponeurosis & •• Image based Identification of cartilages &

diseases
Ligaments (BAL)
•• Image based Identification of bones & bone
II Cartilages
diseases
IV Basement Membrane (Kidney,
•• Collagen & its types
Lungs)
•• Collagen diseases (Connective tissue
disorders)
 3
Cartilage & Bone

Revision Capsule/PYQs:
•• Types Of cartilage:
•• Examples Of Hyaline cartilage:
•• Examples of Elastin cartilage:
•• Examples Of Fibro cartilage:
•• Type I Collagen is found in:
•• Which type of collagen is found in Cartilage:
•• In Good Pasture syndrome which type of
collagen is mutated:

Q. The following hematoxylin and eosin stained

specimen is similar in appearance to which of the
following structures? (AllMSP Nov16)

A. Articular disc

B. Pinna

C. Epiphyses

D. Intervertebral disc

Q. Type I Collagen is found in all of the following

except?

A. Bone

B. Cartilage

C. Tendon

D. Ligament
 LYMPHOID TISSUE

Lymphatic tissue: •• Spleen

Specialised connective tissue consists of Immune •• Lymph node
cells.
•• Tonsil
Types: •• Appendix
1. Primary/ Central Lymphoid organs :
•• MALT
2. Secondary/ Peripheral Lymphoid organs :
2.1. LYMPH NODE
1. Primary/ Central Lymphoid organs: •• Bean shaped with peripheral Cortex and central
Organs which are responsible for generation of Medulla.
Lymphoid tissue.
•• Afferent lymphatic vessels → on the Convex
•• Thymus
surface.
•• Bone marrow
•• Efferent lymphatic vessels → at the hilum
(Concave surface).
2. Secondary/ Peripheral Lymphoid
organs: •• Having lymphatic nodules with Peripheral density
(mature cells → Dark blue) & Central clearance
Organs which are responsible for Activation of
lymphatic structures like Lymphocytes, Plasma cells (Synthesis site, Immature cells) 2.
etc.
2
Anatomy

2.2. THYMUS within the thymic medulla

•• Presence of septa and Lobules. •• degenerated reticuloendothelial cells

→ Eosinophilic appearance & arranged
•• Hassal’s Corpuscles : groups of epithelial cells
concentrically.

2.3. SPLEEN •• White pulp : WBCs aggregation around central

•• Capsule present arteriole give rise to whitish appearance.

•• Characterised by White pulp) and Red pulp •• Red pulp : Remaining area in medulla , outside
the white pulp, is known as red pulp → filled
•• In between each lymphoid follicle, one central with RBCs.
arteriole is present.

2.4. TONSILS •• Lymphatic nodules are seen below to epithelium.

•• Covered with Stratified Non-keratinized •• Crypta magna - Largest crypt in tonsil on the
squamous epithelium. medial side.
 3
Lymphoid Tissue

NOTE - Foliate papillae is rudimentary in

humans.

Focus Areas for Exams:

•• Classification Of lymphoid organs
•• Image based
•• Lymphoid organs involvement in Lymphoma &
•• Leukaemia (pathology & Medicine Integration)

(NEET Pattern 2022)

Revision Capsule/PYQs:
•• Example of Primary lymphoid organ:
•• Example Of Secondary lymphoid organ:
•• White pulp is:
•• Hassal's corpuscles are found in:

(FMGE 2021)

(NEET PG 2021)
 PHARYNGEAL APPARATUS – PART-1

•• Pharyngeal apparatus : Special structures •• Pouches – Endodermal out bulgings

developing near pharynx
•• Cleft – Ectodermal in dipping
•• Pharyngeal Apparatus : Pharyngeal Arches +
•• Pharyngeal membrane : Meeting points in
Ph. Pouch + Ph. Cleft + Ph. Membrane
between ectoderm, mesoderm & endoderm in
•• Arches- Mesodermal thickenings pharyngeal apparatus.
2
Anatomy

•• Endoderm, mesoderm, ectoderm meeting Pharyngeal arch: mesodermal

→ Pharyngeal membrane → 1st pharyngeal
Each pharyngeal arch gives rise to 4 structures:
membrane → tympanic membrane.
a. Pharyngeal nerve
PHARYNGEAL ARCH b. Pharyngeal muscle
•• Mesodermal in origin c. Pharyngeal cartilage
•• 6 arches develops d. Pharyngeal artery
•• 5th arch disappears
•• so 5 arches persist

Pharyngeal nerves:
Pharyngeal Arch Pharyngeal nerve
 3
Pharyngeal Apparatus – Part-1

I → V3 IV → Superior Laryngeal Nerve > X

II → VII VI → Recurrent Laryngeal Nerve > X
III → IX •• Along cranial border → Post-trematic nerve

•• Along caudal border → Pre- trematic nerve 4. Posterior Belly of Digastric

5. Facial muscle except Levator Palpebrae
Superioris (eye muscle)
•• 3rd arch muscle:
Stylopharyngeus
•• 4th arch muscle → All are supplied by 10th
nerve
1. All muscles of palate except Tensor Veli
Palatini (1st arch : V 3 )
2. All muscles of pharynx except
STYLOPHARYNGEUS (3rd arch : IX nerve )
3. Cricothyroid → by 10th < SLN < RLN
•• 6th arch muscle → supplied by RLN
All larynx muscle except Cricothyroid

PHARYNGEAL MUSCLES PHARYNGEAL ARCH CARTILAGES

•• 1st arch muscles → These are supplied by V3.
→ 4 muscles of mastication:
1. Temporalis
2. Masseter
3. Med. Pterygoid
4. Lat. Pterygoid
(MAT 2):
•• Mylohyoid
•• Anterior Belly of Digastric
•• Tensor Tympani
•• Tensor veli Palatini
•• 2nd arch muscles → These are supplied by the
Facial nerve. (SPF)
1. Stylohyoid
2. Stapedius
3. Platysma
•• 1st arch cartilage: Meckle’s cartilage → 5 ‘M’
4
Anatomy

1. Malleus & Incus 4. Smaller cornu of hyoid

2. Malleolar (Anterior) ligament 5. Superior ½ of body of the hyoid
3. SphenoMandibular ligament •• 3rd arch cartilage:
4. Mandible 1. Greater cornu of hyoid
5. Maxilla 2. Inferior ½ of hyoid
•• 2nd arch cartilage: Reichert cartilage → 5 ‘S’ •• 4th & 6th arch cartilage:
1. Stapes (except footplate & Otic capsule) –– Laryngeal cartilage
2. Styloid process
FIRST ARCH SYNDROMES
3. Stylohyoid ligament

Pharyngeal arch Nerve Muscle Cartilage

1 st
V3 •• 4 muscles of mastication 5M
•• Mylohyoid
•• Anterior Belly of Digastric
•• Tensor Tympani
•• Tensor veli Palatini
2 nd
VII •• Stylohyoid 5S
•• Stapedius
•• Platysma
•• Posterior Belly of Digastric
•• Facial muscle except Levator
Palpebrae Superioris (eye muscle)
3rd IX Stylopharyngeus Greater Cornu & lower ½ of hyoid
4 th
SLN / ELN Palate, pharynx, CT Laryngeal cartilage
5th Disappear - - -
6 th
RLN Larynx Laryngeal cartilage

All muscles of Supplied by Except Supplied by

Palate IX → X < VAC < pharyngeal TP V3
plexus
Pharynx X Stylopharyngeus IX
Larynx X (recurrent laryngeal) Cricothyroid X (superior laryngeal)
Tongue XII Palatoglossus X

1. Treacher-Collins Syndrome
2. Mandibulofacial Dysostosis

1. Treacher-Collins Syndrome
•• Mandibulofacial Dysostosis
–– Mutation in Chromosome
–– Mandibular Hypoplasia
 5
Pharyngeal Apparatus – Part-1

PIERRE ROBIN SYNDROME (GCR) PYQs

•• Anomalies of chromosome 17>> 2/ 11
Q. Which of The Following Muscle Develops From
–– Glossoptosis 1st Pharyngeal Arch?
–– Cleft Palate A. Anterior Belly of Digastric
–– Retrognathia
B. Posterior Belly of Digastric
Focus Areas for Exams: C. Stapes
•• Pharyngeal Nerves
D. Stylohyoid
•• Derivatives of Each Pharyngeal Arch
Q. A Patient Presented With Underdeveloped
•• Clinical Integration with ENT, SURGERY,
Mandible & Small Chin. It is Related With Which
MEDICINE & RADIOLOGY
of The Followings? (June FMGE 2022)

Revision Capsule: A. 1st arch

•• Pharyngeal Arch Nerves
B. 2nd arch
•• Pharyngeal Arch Muscles
C. 3rd arch
•• Pharyngeal Arch Cartilage
D. 4th arch
•• 1st Arch Deformity
 PHARYNGEAL APPARATUS – PART-2

PHARYNGEAL CLEFT •• 2nd , 3rd & 4th clefts disappear.

•• Ectoderm is dipping in between 2 arches known –– 2nd arch grows rapidly & adjoins with basal
as Pharyngeal cleft.
part. In between (includes 2nd, 3rd, 4th
•• 1st cleft: forms External auditory canal → 6
cleft), it makes cervical sinus
hillocks develops around 1st cleft → pinna is
formed

Any embryonic tract with abnormal :

•• 2 openings: fistula
•• 1 opening: sinus
•• No opening: cyst
2
Anatomy

PHARYNGEAL POUCH
•• Endodermal out bulging in between 2 arches
known as pharyngeal pouches.
•• total 4 in no.
•• 1st pouch: make auditory tube (tubo + tympanic
recess) and tympanic membrane cavity.
•• 2nd pouch: make tonsil

Clinical :

DIGEORGE SYNDROME:
•• Features Vary Widely
•• CATCH 22
•• 3rd pouch: dorsal part makes 2 inferior
•• Cardiac Abnormality (Interrupted Aortic Arch,
parathyroid glands ; ventral part makes thymus.
Truncus Arteriosus, Tetralogy of Fallot)
•• 4th pouch: dorsal part makes 2 superior
•• Abnormal Facies
parathyroid glands ; ventral part makes lateral
lobe of thyroid. •• Thymic Aplasia
•• Cleft Palate
•• Hypocalcemia/Hypoparathyroidism
•• Velocardio-Facial Syndrome or Shprintzen
Syndrome:
–– Cause: Microdeletion of chromosome 22
 3
Pharyngeal Apparatus – Part-2

PYQs:
Q. Developmental Defect in Which of The Following
Structures Can Cause Tetany & Absent Thymus
Gland? (AIIMSP MAY 2017 / FMGE)

FIRST ARCH SYNDROMES

•• First Arch Syndromes occur due to the failure
of the migration of neural crest cells into the
first arch.
•• The First Arch Syndrome includes Treacher- A. A
Collins Syndrome and Pierre-Robin Syndrome
B. B

C. C
Focus Areas for Exams:
D. D
•• Derivatives of Each Pharyngeal Cleft
•• Derivatives of Each Pharyngeal Pouch
•• Clinical Integration with ENT, SURGERY,
MEDICINE & RADIOLOGY

Revision Capsule:
•• Pharyngeal Clefts Derivative
•• Pharyngeal Pouch Derivatives
•• Di George’s Syndrome
 General Embryology

Embryology –
Study of Formation, Development and Maturation of
the Embryo is known as Embryology.
Spermatogenesis & Spermiogenesis
•• Formation of the spermatozoa or mature
sperm from the Spermatogonium is known as
Spermatogenesis
•• Type A Spermatogonium cells (2n) are the
immature cells or the stem cells giving rise to
the same type of cells.
•• Type B Spermatogonium cells (2n) are going
under spermatogenesis. MCQ
•• 1st meiotic division occurs in primary
spermatocyte (2n)
•• Conversion of Spermatids into Mature
Spermatozoa is known as Spermiogenesis.
2
Anatomy

•• Sperm head is contributed by Nucleus 4. Human Sperm Remains Fertile in Female Genital
•• Acrosome is formed by the Golgi Apparatus Tract For: 24- 48 hrs/ 2 days
–– Release of hydrolytic enzymes from 5. Reproductive Life of Sperm: 24- 72 hrs [3 days]
acrosome – degrades the outer covering of
the ovum i.e., Zona pellucida and helps in the 6. Reproductive Life of Ovum: 12- 24 hrs [1 day]
penetration of ovum
7. Polyspermy is Prevented by: Calcium Released by
•• Proximal Centriole is close to the head while Intracellular Ovum
Distal Centriole is making the Annulus
•• Middle piece part is made by the Mitochondria •• Interstitial cells (of Leydig) – responsible for
Testosterone hormone synthesis
•• Sustentacular cells (Sertoli cells) – supporting
cells in between the spermatogonia for support
and nutrition

Oogenesis

•• Primary oocyte → growth arrested before

puberty in prophase I diplotene stage
•• Kartagener Syndrome/ Immobile Cilia Syndrome (Mnemonic PPD)
–– S – Situs Inversus –– P – Primary oocyte
–– B – Bronchiectasis –– P – Prophase I
–– I – Infertility –– D – Diplotene phase

Crux Point •• Secondary oocyte arrested in metaphase II

1. Spermatogenesis Occurs At: Seminiferous Tubule •• 1st polar body is formed when primary oocyte is
2. Temperature needed Lower Than Body Core converted to secondary oocyte
Temperature
•• 2nd polar body is formed after fertilization.
3. Meiosis Occurs During: Primary to Secondary
•• Site of fertilization – Ampulla > Ampullary-
Spermatocyte Transformation Isthmic Junction
 3
General Embryology

•• Morula – 16-cell stage (3rd day) •• Blastocyst – on 4th day , 32 cell stage with
•• Advanced morula : 32 cell stage without cyst > cavity
16 to 32 cell stage •• Implantation of Blastocyst – 6th day (6th –
10th/12th day)

•• Blastocyst shows 2 types of cell lines : –– Epiblast

a. Inner cell mass : Forms 1st cell line of –– Endoderm
embryonic stage known as Epiblast → Forms •• Endoderm proliferates → forms Prochordal
true embryo plate – it is formed near Cranial end of embryo
b. Outer cell mass : Forms trophoblast → gives → it decides cranio-caudal axis
nutrition to embryo → divides into •• Opposite to prechordal plate → proliferation
i. Cytotrophoblast (CTB) of epiblast occurs → forms primitive streak →
decides right & left side of embryo.
ii. Syncytiotrophoblast (SCTB)
•• Formation of a new layer in between the Epiblast
•• Epiblast cells give rise to → Hypoblast cells → and endoderm is the Mesoderm.
Hypoblast forms the Endoderm
•• Remaining cells of epiblast → converted into
•• Bilayered Embryonic Disc ectoderm.
4
Anatomy

•• Sequence of Germ cell layer formation – –– 3rd – Ectoderm (last)

–– 1st – Endoderm –– Neural crest cells are considered as 4th
germ cell layers.
–– 2nd – Mesoderm

General Embryology Simplified

 5
General Embryology
6
Anatomy
 7
General Embryology

•• Mitochondrial Inherited Disease – common in Mesoderm

Maternal side
3 Parts -
•• Outer cell mass – forms the Trophoblast
L – Lateral plate Mesoderm
•• GIT is lined by – Endoderm
I – Intermediate Mesoderm
•• 3 Germ Cell layer formation – Gastrulation
P – Para Axial Mesoderm
8
Anatomy

•• Amniotic cavity - Nutrition to the baby ƒƒ If mesoderm persists here – causes Anal
Stenosis – Fecal material will not pass –
•• Outer layer – Ectoderm
requires surgery
•• Mesoderm develops everywhere except for 2
•• Vitello – Intestinal duct
areas –
–– Bucco-pharyngeal membrane – forms the oral SURGERY-ANATOMY INTEGRATION
cavity Vitello – Intestinal duct
–– Anal membrane – forms Anal Canal •• Remnant → Meckel’s Diverticula (2% Rule)
 9
General Embryology

Important Days Paraxial Mesoderm

•• 2 Days: 2 Cell Stage •• It is the most Medial Mesoderm.
•• 3 Days: Morula Formation •• It is divided into cubical masses Called Somites
•• 4 Days: Blastocyst (42- 44 Pairs).
•• 8 Days: Bilaminar Disc Formation •• Formation of Somites starts at the 20th Day
•• 14/ 15 Days: Head & Tail End Is Decided formation of one pair at cranial region.
[Prochordal Plate & Primitive Streak Appears]
•• Somites are classified into: 4 Occipital, 8
•• 16 days: Gastrulation /3 Layered Embryonic Cervical, 12 Thoracic, 5 Lumbar, 5 Sacral And
Disc Is Formed /IEM Appears 8-10 Coccygeal.

Somites –– Occipital Myotome – forms the Muscles of

•• Segmented structure the Myotome

•• Created by Para-Axial Mesoderm FMT/RADIO-ANATOMY

INTEGRATION
Somites are helpful in various tests for Age
Determination
10
Anatomy
 11
General Embryology

Focus Areas for Exams: PYQs

•• Spermatogenesis & Oogenesis Q. Advance Morula Is
•• Important Stages In Primitive Streak A. 8 to 16 Cell Stage
Formation
B. 16 to 32 Cell Stage
•• Endoderm, Mesoderm & Ectoderm Formation
•• Somites C. 32 to 64 Cell Stage

D. 64 to 128 Cell Stage

Revision Capsule:
•• Morula Is Formed On : 3rd day Q. Implantation Occures On

•• Morula Is Having How Many Numbers of Cells A. 5th Day

: 16 cell
B. 7th Day
•• Blastocyst is Formed on : 4th day
C. 9th Day
•• Blastocyst Is having how may numbers of cells
: 32 cells D. 11th Day
•• Cranio caudal axis is decided by : prochordal
plate
•• Mesoderm divides into : LIP
 CNS DEVELOPMENT

•• Vth Ventricle: Cavity of Septum Pellucidum •• VIth Ventricle: Cavum Vergae

–– False/ misnomer

––
2
Anatomy

(Refer to page no 197) •• Notochord disappears

•• The 2 corners meet together and form a tube –– Remnant of Notochord – Nucleus Pulposus
like structure known as Neural Tube (inside the IVD)

–– Opening on the above - Anterior Neuropore

(closed on 25th day)

–– Another opening on the downside – Posterior

Neuropore (closed on 28th day)

•• Complete Neural tube formation is known as

Neurulation and is completed by 28th day of IUL

–– Multiple fusion sites

ƒƒ 1st site – cervical region

•• If no proper fusion of the neural tube, this is

known as Neural Tube Defect (NTD)

•• Vitamin B9- Folic acid is required for neural

tube formation in fetus

–– ↓Vitamin B9 – NTD

OBG/PEDIA- ANAT INTEGRATION

NEURAL TUBE DEFECTS

Anterior Neuropore defect

•• Anencephaly (FMGE 2021)

Posterior Neuropore defect

•• Meningocele
•• Meningomyelocele
•• Spina bifida
•• Rachischisis

Vitamin B9 dose to female = 4mg/ 400μg

•• Before conception
•• After conception
•• Female with Previous h/o NTD

PHARMA-ANATOMY INTEGRATION ORTHO-ANATOMY INTEGRATION

Drugs that inhibit B9 Absorption Disc prolapse
•• Anti-Epileptic drugs •• Intervertebral disc getting ruptured and
•• Phenytoin, Carbamazepine, Valproate the gelatinous material coming out and is
compressing the spinal nerve which is coming
•• Methotrexate
from the spinal cord.
•• OCPs
•• There is pain along the roots of the nerves
known as Radiculopathy
 3
CNS Development

(Refer to page no 200)

Causes of Folic Acid Deficiency:

Mnemonic: A Folic POD
•• Alcoholism
•• Folic Acid Antagonists (e.g. Methotrexate,
Trimethoprim)
•• Oral Contraceptive
•• Low Dietary Intake (e.g. Excessive Goat Milk)
•• Infection with giardia
•• Celiac Sprue Posterior Neuropore defect
•• Pregnancy / Psoriasis A. Spina bifida occulta – two halves not uniting
together but SC and meninges are in their original
•• Old Age
position.
•• Dilantin Aka Phenytoin
•• Only tuft of hair seen

Anterior Neuropore defect •• No symptoms

•• Cranial vault is absent B. Spina Bifida with meningocele – meninges coming

out with CSF
•• Exophthalmos
C. Spina Bifida with meningomyelocele – meninges
•• Chin resting over thorax coming outside as well as nerve elements
D. Spina Bifida with Myeloschisis – meninges getting
ruptured so CSF leaking out and spinal nerves visible
on the back side

NCC
•• Terrorist cells – can go anywhere and do their
job
•• During embryonic development there is release
of the hyaluronic acid and creates the pathway.
Through these pathways NCC migrate to
different parts of the body
4
Anatomy

–– Absence of Hyaluronic acid – leads to NCC

migration failure
ƒƒ Achalasia Cardia
ƒƒ Hirschsprung Disease

NCC Derivatives:
Tricks & Magic
•• BHU – Banaras Hindu University, founder was –
MMM – Madan Mohan Malviya
•• PAEDS doing DiSCo in front of MMM
–– P- Parasympathetic ganglion
–– E- Enteric plexus – Auerbach plexus
–– A- ANS ganglion
–– D- Dorsal root ganglion
–– S- Schwann cell
–– D- Dentine tissue[odontoblast]
–– S- Sclera
–– C- Choroid, connective tissue of thyroid,
parathyroid, thymus, connective tissue of
gland –lacrimal, nasal, oral, salivary gland,
palatine gland.
–– M- Melanocyte Hirschsprung disease'
–– M- Mesenchymal bone of HEAD & FACE
–– M- Meninges
–– Adrenal medulla

Achalasia Cardia
•• Hyaluronic Acid - Most abundant MPS in the
body
–– Absent – failure of migration of NCC
•• At lower esophageal junction, NO is released
→ which ↑ cAMP → causing Smooth muscle
relaxation
–– If NCC not reaching to the lower part of the
esophageal junction, then there is no release
of NO → no ↑ cAMP → no smooth muscle
relaxation → narrowing of the Lower part of
the esophagus (Aganglionic disease)
–– Radiology – Bird beak appearance
 5
CNS Development

Revision Capsule:
•• Neuralisation : 28th day
•• Anterior Neuropore Is Closed on : 25th day
•• Posterior Neuropore Is Closed on : 28th day
•• NCC Derivatives
•• Achalasia Cardia
•• Hirschsprung Disease

PYQs
Q. Identify The Embryological Basis Of This
Congenital Defect Shown in The Image (FMGE
Dec 2021)

A. Anterior Neuropore Defect

B. Posterior Neuropore Defect

C. Anterior & Posterior Neuropore Defect

D. None
Focus Areas For Exams
•• Parts of Primitive Brain & Its Cavities
•• Neural Tube Formation
•• Neural Tube Defects
•• NCC Derivatives
•• Failure of Migration of NCC
 CVS DEVELOPMENT

•• In the embryo, development of the heart starts •• The development of this area will create the
near the 3rd week of intrauterine life i.e., 21st beginning of the formation of the heart. So this
day area is known as the Cardiogenic area

•• Bilaminar disc where there is development of •• Development of the heart starts near the
intraembryonic mesoderm developing from the pharynx
epiblast cells and proliferating near the head –– In case of MI/ Angina – pain can be referred
end. to the neck area near to the left jaw

•• Ventricles will proliferate and will come forward Mnemonic – BVAS: BV Aur Saas (kyunki saas
and downward. Atria will go backwards and bhi kabhi bahu thi)
superiorly.
•• B - Bulbus cordis
•• Now the heart shows a conical structure where
Atria is above and posteriorly – forms the base •• V – Ventricle
of the heart. •• A – Atria
2
Anatomy

•• S – Sinus venosus

•• Umbilical vein on the left side forms Ligamentum

PEDIA/MEDICINE- ANATOMY Teres
INTEGRATION
Failure in the development of the spiral septa, there
will be the common trunk of AA and PT – Truncus
Arteriosus (Right to Left shunt)
 3
CVS Development

•• Formation of the spiral septa – Conotruncal

septa derived from the NCC – this will help
the blood from the left ventricle be pumped
to the AA and from the right ventricle to the
pulmonary trunk.

PEDIA/ MEDICINE- ANATOMY PEDIA/MEDICINE- ANATOMY

INTEGRATION INTEGRATION
Coeur en Sabot (French for “clog-shaped heart”)
•• Failure in the development of the spiral septa,
Or there will be the common trunk of AA and PT
Boot shaped heart – Truncus Arteriosus (Right to Left shunt)
•• Spiral valve not developing in the midline and
is shifting then Aorta is occupying more space
while Pulmonary valve becomes narrow causing
-Pulmonary Stenosis
•• Due to the shift of the spiral valve the
interventricular septum covers more area of
the Aorta which is further covering the area
of both the ventricles – Overriding of the
Aorta
4
Anatomy

CHD: Left to Right Shunt (ANAT- 5. Truncus Arteriosus

MEDICINE-PEDIA INTEGRATION) 6. Total Anomalous Pulmonary Venous Return (TAPVR)
•• ASD
•• VSD
•• PDA
•• Ductus Arteriosus Aneurysm
•• Aortico -Pulmonary Window

CHD: Right to Left Shunt (ANAT-

MEDICINE-PEDIA INTEGRATION)
1. Tetralogy of Fallot
2. Tricuspid Atresia
3. Ebstein’s Anomaly
4. Transposition of Great Vessels
Pharyngeal arch Artery
 5
CVS Development

ƒƒ Distal part: disappears

–– On left side
ƒƒ Proximal part: Left pulmonary artery
ƒƒ Distal part: DUCTUS ARTERIOSUS →
Ligamentum Arteriosum (on left side)

PEDIA/MEDICINE-ANATOMY
INTEGRATION
Persistent Ductus Arteriosus leads to

1. 1st ,2nd & 5th arch arteries disappear •• Patent Ductus Arteriosus (CHD)

2. Remnant of 1st arch artery → Inferior alveolar •• Rx – Indomethacin (PG synthesis inhibitor) is
artery – Br. of Maxillary Artery given (DOC)

3. Remnant of 2nd arch artery → Stapedial artery &

Hyoid artery
4. 3rd arch artery → divides into 2 parts:
a. Proximal part → CCA
b. Distal part → ICA
c. New growth → ECA
•• 4th arch artery →
a. On right side: Right subclavian artery
b. On left side: Arch of Aorta
•• 5th arch artery → disappears
–– Proximal part: right pulmonary artery
–– Distal part: disappears Aortic arches - Each arch connects the aortic sac
•• 6th arch artery → to the dorsal aorta. Note that actually all arches are
never present at the same time. The first and second
–– On right side
arches have retrogressed by the time the sixth
ƒƒ Proximal part: right pulmonary artery appears.
6
Anatomy

Fate of aortic arches: Disappearance of 1st, 2nd and Relationship of the Vagus and
5th arches. Recurrent Laryngeal Nerves to the
aortic arches

(A) The arch of the aorta is derived from (1) the

aortic sac, (2) its left horn, and (3) the left 4th arch
artery.
(B) The descending aorta is derived from (1) the left
dorsal aorta, and (2) fused dorsal aortae.
(C) The brachiocephalic artery is derived from the
right horn of the aortic sac.
•• Dividing into Right Common Carotid Artery and •• Left recurrent laryngeal nerve hooking the
Right Subclavian Artery Arch of aorta and Ligamentum Arteriosum
Reverse Arch of Aorta – developing on the right side •• Vagus nerve on the right side gives the Right
(Abnormal condition) Recurrent Laryngeal Nerve hooking the Right
Subclavian Artery and then it is ascending
upside.

(A) The Right Subclavian Artery is derived

1. from the right 4th arch artery and
2. from the right 7th cervical intersegmental artery.
The Left Subclavian Artery is formed only from the
left 7th cervical intersegmental artery.
(B) The Common Carotid Artery is derived from the Anomalies associated with the development of aortic
proximal part of the 3rd arch artery. arches. The abnormal vessels are shown in yellow.
(C) The Internal Carotid Artery is derived from
1. distal part of the 3rd arch artery and
2. dorsal aorta (cranial-most part).
 7
CVS Development

PYQs
Q. Development of hart starts at which marked
area (AIIMSP NOV 17)

A. A

B. B

C. C

D. D

Q. The long left recurrent laryngeal nerve is due to

the persistence of which arch artery (NEET PG
2020)

A. 3rd arch

B. 4th arch

C. 5th arch

D. 6th arch

Q. The heart starts to beat in the (NEET PG 2018)

A. 2nd week

B. 4th week

Focus Areas for Exams C. 6th week

•• Heart Tube & Its 4 Dilatations
D. 10th week
•• Development of atria & ventricles
•• Spiral septa formation in truncus arteriosus
•• Clinical integration specially TOF
•• Right to left & left to right shunt (Pedia &
Medicine CBI)
•• Pharyngeal Arch Derivatives
•• Left & right recurrent laryngeal nerves
 GIT DEVELOPMENT

SURGERY-ANATOMY PEDIA/SURGERY-ANATOMY
INTEGRATION INTEGRATION
Vitello – Intestinal duct Proctodeum
Persistence of mesoderm results in
•• Remnant – 1 opening – is Meckel’s Diverticula
(2% Rule) •• Anal Atresia
•• 2 opening – Fecal Fistula (FMGE 2021) •• Anal Stenosis

•• Mesoderm develops everywhere except for 2 •• Distal to the Allantoic diverticulum is the cloaca
areas – which forms the Urinary Bladder and Rectum.

–– Stomodeum - Bucco-pharyngeal membrane –

forms the oral cavity
–– Proctodeum - Anal membrane – forms Anal Canal
•• If mesoderm persists here – causes Anal
Stenosis – Fecal material will not pass – requires
surgery
2
Anatomy

•• Foregut – from stomach up to the opening of GIT Rotation

the CBD
•• Midgut – from 2nd part of the duodenum up to
the Ileum
–– Artery of the midgut – SMA – for Rotation
of the GIT
ƒƒ Part above the artery – Pre Arterial
segment
ƒƒ Part below the artery – Post Arterial
segment
•• Hindgut – from left 1/3rd of the transverse
colon up to to anal canal (dentate line)

•• Umbilical opening is very large as the GIT tube

is coming out of the umbilicus and causing the
Physiological Hernia (Normal in every baby)
•• SMA – Midgut Artery – Axis of Rotation
•• In the post arterial segment there is formation
of a small diverticula which will form the Caecum
– Caecal Bud
 3
GIT Development

•• Fig B – 1st 90 → of rotation –– Colon

•• Fig D – 2nd 90 → of rotation –– Artery
•• Fig E – 3rd 90 → of rotation –– Duodenum
•• Total - 270 → of rotation – Anticlockwise
PEDIA/SURGERY-ANATOMY
INTEGRATION
Duodenum is lying on the front of the transverse
colon which will lead to the Intestinal obstruction.

•• Structures sequence From posterior to anterior

–– Duodenum
–– SMA
–– Colon
•• Abnormal rotation of the GIT
–– Duodenum comes in the front of the transverse •• Due to improper rotation of the GIT, intestinal
colon and compress it, food material will not loops come out of the Umbilicus even after the
pass and cause colon obstruction birth with the covering of the Amnion. This
condition is known as Exomphalos
Non Rotation •• Exomphalos - Coils of intestine derived from
•• Small intestine loops on the left side and large the midgut loop fail to return into the abdominal
intestine on the right side is associated with cavity.
Congenital condition – Non Rotation of the GIT
PEDIA/SURGERY-ANATOMY
•• Cecum and Appendix are situated in the left INTEGRATION
Iliac Fossa

Vitello-Intestinal Duct
Reversed Rotation •• Persist with 2 opening – Fistula
•• Rotation of the GIT occurs not in the •• Presence of 1 opening and another is obliterated
Anticlockwise direction but clockwise also. – Fecal/ Umbilicus Sinus
•• From posterior to anterior •• Both ends getting obliterated and presentation
4
Anatomy

of cavity only – Cyst Development of Anal Canal

•• VID is obliterating but the proximal part is
persisting making the Meckel’s Diverticula

PATHO-ANATOMY INTEGRATION
Meckel’s Diverticulum developing opposite to the
mesentery – present at the Antimesenteric Border

Meckel ‘s Diverticulum Rule of 2s

•• Affects 2% of population
•• About 2 inches (5cm) long
•• Occurs 2 feet from the ileocecal valve
•• Male patients 2 times more affected
•• Patients < age 2 •• Hindgut – endoderm
•• Only 2% of patients symptomatic •• Cloacal membrane – ectoderm
•• Affects 2 types of ectopic tissue (gastric and •• No mesoderm
pancreatic)

•• Hindgut → Cloaca → Proctodaeum

SURGERY-ANATOMY
•• Anal membrane – no mesoderm INTEGRATION
–– Rupture of the membrane and this is the Dentate Line
site where Endoderm & Ectoderm are in
continuity •• Above the line, there is Endoderm – Viscera
which is supplied by Visceral nerve (painless
–– If mesoderm persists – Anal Atresia hemorrhoids)
–– If small remnants are there then narrowing •• Below the line, there is Ectoderm – Somatic
is seen – Anal Stenosis part which is supplied by the Somatic nerve
•• In b/w the junction of the endoderm and (painful hemorrhoids)
ectoderm there is presence of Anal columns of
Morgagni
•• The lower margin of the Anal column – Dentate
Line
 5
GIT Development

Development of Tongue
6
Anatomy

Focus Areas for Exams Fmge Dec 2021

•• Parts of GIT Q. In a newborn baby meconium was coming from
•• Junction of foregut, mid gut & hind gut umbilicus. It occurs due to abnormal persistence
of which of the following embryological
•• Rotation of GIT
structures
•• Arteries of foregut, mid gut and hind gut
A. Urachus
•• Congenital disorders
B. Allantois
•• Development of tongue
C. Vitellointestinal duct

Revision Capsule: D. Mesonephric duct

•• Direction of GIT rotation : Anti clockwise Q. Primitive gut is derivative of
•• Total degree of GIT rotation : 270º
A. Amniotic cavity
•• Axis of GIT rotation is formed by : SMA
B. Allantonic cavity
•• Omphalocele Vs Gastroschisis
•• Anterior 2/3rd of tongue develops from : 1st C. Primitive yolk sac
Arch D. Cloaca
•• Posterior 1/3rd of tongue develops from : 3rd
Arch NEET PG 12 PATTERN
•• Posterior most part of tongue develops from Q. Duodenum is derived from
: 4th Arch
A. Foregut

B. Midgut

C. Foregut & Midgut

D. Midgut & hindgut

Q. Rectum develops from

A. Allantoic diverticula

B. Cloaca

C. Hind gut

D. Urogenital sinus
KIDNEY, MALE & FEMALE GENITAL TRACT
DEVELOPMENT
2
Anatomy

PATHO/SURGERY/MEDICINE/
PEDIA- ANATOMY INTEGRATION
Multiple Nephron – the part of the kidney where
there is the collection of the urine, giving rise to
multiple structure k/a Polycystic Kidney Disease
(PCKD)
•• Type 1 – Chr 16 mutation
•• Type 2 – Chr 4 mutation
 3
Kidney, Male & Female Genital Tract Development

•• Cloaca – distal part of the hindgut which is distal to the Alantois, responsible for the formation of the
Urinary Bladder, Rectum and Anal canal.

•• Epididymis homologous structure in females – Epoophoron

•• Ductus Deferens homologous structure in females – Gartner’s duct
4
Anatomy

Formation of the uterovaginal canal by fusion of the

caudal parts of paramesonephric ducts.

•• Vesico-urethral canal (Primitive Uro-Genital

Sinus)– participates in the formation of the
urinary bladder and urethra
–– Except Trigone part – formed by the
Mesonephric Duct
•• Urogenital sinus – formation of the Urethra
•• Urachus – joins with the umbilicus IN MALES: PMND → ATP
–– Obliterative – later forms the Median
AT: Appendix of Testis
Umbilical Ligament (NEET PG 2023)
•• Persistent of the MUL – forms the Urachal P: Prostatic utricle
fistula – urinary excretion happens through the
umbilicus part (FMGE 2022)

Female Genital Tract

Development
 5
Kidney, Male & Female Genital Tract Development

Vagina Development

Focus Areas for Exams: Revision Capsule / PYQs

•• 2 embryological parts of kidney •• Excretory part of kidney - MNB
•• Development of kidney •• Collecting part of kidney – Ureteric Bud
•• Congenital diseases •• Wolffian duct derivatives - ♂
•• Wolffian duct derivatives •• Mullerian duct derivatives - ♀
•• Mullerian duct derivatives
•• Clinical integration