ANATOMY RAPID AND EASY REVIEW

Solved Five years Question Papers
for First MBBS students

Dr Lakshmi Venkataraman
MD, DNB (Path) DCP
exampill.blogspot.in

ABOUT MYSELF
I completed my MBBS from SRMC & RI Porur Chennai in 1993. Thereafter I
have completed my Diploma in Clinical Pathology from MMC Chennai, which
has given me a deeper understanding of the Basic sciences. Further to this I did
my Post graduate MD in Pathology from PGIBMS Tharamani Chennai. I have
also passed the National Boards in Pathology earning my DNB.
Though not actively working as a Pathologist at present, nevertheless, due to
my strong academic grounding in the Basic Sciences I decided to compile
answers to previous years TN Dr MGR University Questions in order to make
the preparation easier for students who find it difficult to assimilate huge
quantities of subject matter in the short time available.
In this offering I have endeavored to give the answers as clearly as possible and
in a point wise manner to make reading easier. Illustrations have also been
given. Extensive reference has been made to standard textbooks.
I sincerely hope that medical students benefit from this effort covering
Anatomy, Physiology and Biochemistry.
Lastly students are encouraged to give their constructive feedback and help
improve the content matter and correct mistakes that are bound to creep in,
despite my best efforts to avoid them.
Lakshmi Venkataraman
(lakshmidr70@gmail.com, drexampill@gmail.com)

This is a preview of the full material. To get the full material kindly visit
exampill.blogspot.in.

ACKNOWLEDGEMENT
I wish to thank my mother Dr Sankari Venkataraman, a Prof of Physiology
(Retd), for going through my answers patiently and helping me to improve
upon the contents especially in Physiology with her numerous valuable
suggestions and inputs.
My children put up with me spending more time at the Computer than with
them and bore me out patiently for the last few months. Thank you for your
patience.
I should mention here my husband’s valuable advice and suggestions for
managing the documents properly while they were getting ready. I also wish to
thank his office team for helping to put the book on the web with suitable
modifications.

DEDICATION
This work is dedicated to all medical students

TABLE OF CONTENTS

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Histology of duodenum
The 4 layers of the GIT are mucosa, sub mucosa, muscularis externa and serosa.
A. MUCOSA of the small intestine is lined by a simple columnar epithelium which consists primarily
of absorptive cells (enterocytes), with scattered goblet cells and occasional enteroendocrine cells. In
crypts, the epithelium also includes Paneth cells and stem cells.
The other layers of the mucosa include lamina propria and muscularis mucosa.
1. Epithelium
(i) Enterocytes are responsible for absorbing nutrients from the intestinal lumen and transporting
across the epithelium to the lamina propria, whence they diffuse into capillaries.
(ii) Goblet cells secrete mucus to promote movement and effective diffusion of gut contents.
(iii) Enteroendocrine cells secrete hormones to regulate secretion into the GI tract.

2. Lamina propria
of each villus is richly supplied with capillaries and also includes a single lacteal, for transporting
absorbed nutrients. Lamina propria also includes thin strands of smooth muscle (presumably
allowing
some motility for individual villi, to encourage thorough fluid mixing at the absorptive surface) and
numerous white blood cells
3. The muscularis mucosa of the small intestine forms a thin layer (only a few muscle fibers in
thickness) beneath the deep ends of the crypts.

.B. The SUBMUCOSA of the small intestine is relatively unspecialized, except in the duodenum
where it is packed with the mucous-secreting Brunner's glands.
C. MUSCULARIS EXTERNA of the small intestine has the standard layers of inner circular and outer
longitudinal smooth muscle, with ganglia of Auerbach's plexus scattered in between.
D. Over most of the small intestine, the outer layer is a SEROSA attached to mesentery. The
exception is the duodenum, which is retroperitoneal.

III. Short Answer Questions:
1. Name the structures piercing clavipectoral fascia.
The cephalic vein, the thoraco-acromial artery, and the lateral pectoral nerve.
2. Give the action of lumbrical muscle.
Flex the metacarpophalangeal and extend the interphalangeal joints.
3. Name the structures deep to flexor retinaculum of hand.
Long flexor tendons of the fingers and thumb together with the Median N.
4. Boundaries of epiploic foramen
(i) anteriorly — the free edge of lesser omentum, containing the common bile duct to the right,
hepatic artery to the left and portal vein posteriorly;
(ii) posteriorly— the inferior vena cava;
(iii) inferiorly — the 1st part of the duodenum, over which runs the hepatic artery before this
ascends into the anterior wall of the foramen;
(iv) superiorly— the caudate process of the liver.
5. Importance of pouch of Douglas
A cul de sac between the rectum and the bladder/uterus.
Collections of fluid, malignant deposits, prolapsed uterine tubes and ovaries or coils of distended
bowel
may be felt in the pouch of Douglas.
6. What is annular pancreas?
During development of the pancreas, the 2 parts from which the pancreas develops may completely
encircle the duodenum causing its obstruction.
7. Branches of external iliac A
Inferior epigastric A, deep circumflex iliac A and terminal branch Femoral A.
8. Structures piercing oblique popliteal ligament
Middle genicular vessels and nerve
9. Arteries forming trochanteric anastomoses
Anastomosis between the ascending branch of the medial circumflex femoral artery and descending
branches of the superior and inferior gluteal arteries.
10. Contents of subsartorial canal
The femoral artery and vein, the descending genicular and muscular branches of the femoral artery
and their corresponding venous tributaries, the saphenous nerve, and the nerve to vastus medialis
(until it enters its muscle).
1. Describe the uterus under the following headings:
a) Position & parts, b) Relations, c) Blood supply , d) Ligaments & supports, e) Development, f)
Histology, g) Applied anatomy.
Also shows anterior and posterior relations

Positions
In most women, the long axis of the uterus is
bent forward on the long axis of the vagina.
This position is referred to as anteversion of
the uterus. Furthermore, the long axis of the
body of the uterus is bent forward at the level
of the internal os with the long axis of the
cervix. This position is termed anteflexion of
the uterus.
Thus, in the erect position and with the
bladder empty, the uterus lies in an almost
horizontal plane.
In some women, the fundus and body of the
uterus are bent backward on the vagina so
that they lie in the rectouterine pouch
(pouch of Douglas). In this situation, the
uterus is said to be retroverted. If the body of
the uterus is, in addition, bent backward on
the cervix, it is said to be retroflexed.
Anterior
Post
Parts
(i) It is divided into the fundus, body, and cervix.
(ii) The fundus is the part of the uterus that lies above the entrance of the uterine tubes.
(iii) The body is the part of the uterus that lies below the entrance of the uterine tubes.
(iv) The cervix is the narrow part of the uterus. It pierces the anterior wall of the vagina and is
divided into the supravaginal and vaginal parts of the cervix.
Blood supply
(i) The arterial supply to the uterus is mainly from the uterine artery, a branch of the internal iliac
artery and partly from the Ovarian A.
It reaches the uterus by running medially in the base of the broad ligament and crosses above and at
right angles to the ureter to reach the uterus at the level of the internal os. The artery then ascends
in a tortuous manner alongside the uterus, supplying the corpus, and then anastomoses with the
ovarian artery within the broad ligament, close to the lateral angle of the uterus.
2. Blood supply of long bone
Bone is richly supplied with blood. Blood vessels, which are especially abundant in portions of bone
containing red bone marrow, pass into bones from the periosteum. We will consider the blood
supply of a long bone such as the mature tibia (shinbone).
(i) Periosteal arteries, small arteries accompanied by nerves, enter the diaphysis through many
perforating (Volkmann’s) canals and supply the periosteum and outer part of the compact bone.
(ii) Near the center of the diaphysis, a large nutrient artery passes through a hole in compact bone

called the nutrient foramen. On entering the medullary cavity, the nutrient artery divides into
proximal and distal branches that course toward each end of the bone. These branches supply both
the inner part of compact bone tissue of the diaphysis and the spongy bone tissue and red bone
marrow as far as the epiphyseal plates.
(iii) The ends of long bones are supplied by the metaphyseal and epiphyseal arteries, which arise
from arteries that supply the associated joint. The metaphyseal arteries together with the nutrient
artery, supply the red bone marrow and bone tissue of the metaphyses. The epiphyseal arteries
supply the red bone marrow and bone tissue of the epiphyses.
(iv) Veins that carry blood away from long bones are evident in three places:
(1) One or two nutrient veins accompany the nutrient artery and exit through the diaphysis;
(2) numerous epiphyseal veins and metaphyseal veins accompany their respective arteries and exit
through the epiphyses;
(3) many small periosteal veins accompany their respective arteries and exit through the periosteum
3. Axillary lymph nodes
Axillary lymph nodes about 20-30 in number drain the lymphatics from
(i) Upper limb
(ii) most of the mammary gland
(iii) Cutaneous lymphatics from trunk above level of umbilicus
They are arranged in five groups
1. anterior or pectoral— lying deep to pectoralis major along the lower border of pectoralis minor;
They drain most of the breast. Axillary tail of Spence, when present is in direct contact with these
nodes. Carcinoma affecting this part of the breast may be wrongly diagnosed as enlarged lymph
node.
2. posterior or subscapular — along the subscapular vessels;
Drain lymphatics from dorsal part of trunk as far below as the iliac crest.
3. lateral— along the axillary vein;
Drain the entire upper limb except those lymphatics which accompany the Cephalic V

4. central— in the axillary fat;
Receive afferent lymphatics from the previous 3 groups; its efferent drain into the apical group.
5. apical (through which all the other axillary nodes drain) - immediately behind the clavicle at the
apex of the axilla above pectoralis minor and along the medial side of the axillary vein.
Receive afferents from
(i) lymphatics that accompany the cephalic V
(ii) other axillary group of lymph nodes
(iii) Upper margin of the breast
Efferents form the subclavian trunk.
Applied anatomy
Examination of axillary nodes forms an essential aspect of clinical examination of breast.
4. Describe the shoulder joint under articular surfaces, capsule, ligaments, movements and
muscles causing them, applied aspects.
a) Articulating parts:
In the shoulder joint, stability has been sacrificed to provide the most freely moving joint of the
body.
(i) The shoulder joint is a ball-and-socket joint.
(ii) The large hemispherical head of the humerus fits in the small, shallow glenoid cavity of the
scapula like a golf ball sitting on a tee.
b) Ligaments:
The few ligaments reinforcing the shoulder joint are located primarily on its anterior aspect. The
superiorly located coracohumeral ligament provides the only strong thickening of the capsule and
helps support the weight.
Three glenohumeral ligaments namely Superior, middle and inferior, strengthen the front of the
capsule somewhat but are weak and may even be absent.
The transverse humeral ligament strengthens the capsule and bridges the gap between the two
tuberosities.
Accessory ligaments:
The coracoacromial ligament extends between the coracoid process and the acromion. Its function is
to protect the superior aspect of the joint
c) Capsule, Synovial membrane, and bursae
The synovial membrane lines the capsule and is attached to the margins of the cartilage covering the
articular surfaces. It forms a tubular sheath around the tendon of the long head of the biceps brachii.
(i) It extends through the anterior wall of the capsule to form the subscapularis bursa beneath the
subscapularis muscle.
In addition to bursae that communicate with the articular cavity through apertures in the fibrous
membrane, other bursae are associated with the joint but are not connected to it.
(ii) These occur between the acromion (or deltoid muscle) and supraspinatus muscle (or joint
capsule) (the subacromial or subdeltoid bursa);
(iii) between the acromion and skin;

(iv) between the coracoid process and the joint capsule;
(v) and in relationship to tendons of muscles around the joint (coracobrachialis, teres major, long
head of triceps brachii, and latissimus dorsi muscles).
5. Hepato renal pouch (Pouch of Morison)
Two sub-hepatic peritoneal recesses lie below the liver. The right sub-hepatic recess is known as the
Pouch of Morison.

Person in supine position

Boundaries
1. Front – undersurface of Right lobe of liver
Behind – Right kidney and right colic flexure
Below – the recess is open and continuous with the right paracolic gutter
Above – inferior layer of Coronary ligament
Left side – communicates with the lesser sac through the epiploic foramen
Clinical importance
It is the most dependent part of the peritoneal cavity in the upper abdomen. The best method of
draining the supracolic subdivision of the peritoneal cavity is to pass a tube through the hepatorenal pouch of Morrison.
(i) The entrance to this pouch lies lateral to the gall bladder between the inferior margin of the liver
above and the right flexure of the colon below.
6. Describe the stomach under the following headings: parts, relations, blood supply, lymphatic
drainage and applied aspects.
The stomach is the most dilated part of the gastrointestinal tract and has a J-like shape. Positioned
between the abdominal esophagus and the small intestine, the stomach is in the epigastric, umbilical
and left hypochondrium regions of the abdomen.
The stomach is divided into four regions:
a) the cardia, which surrounds the opening of the esophagus into the stomach;

b) the fundus of stomach, which is the area above the level of the cardiac orifice;
c) the body of stomach, which is the largest region of the stomach;
d) the pyloric part, which is divided into the pyloric antrum and pyloric canal and is the distal end of
the stomach
Other features of the stomach include:
a) the greater curvature, which is a point of attachment for the gastrosplenic ligament and the
greater omentum;
b) the lesser curvature, which is a point of attachment for the lesser omentum;
c) the cardiac notch, which is the superior angle created when the esophagus enters the stomach;
and
d) the angular incisure, which is a bend on the lesser curvature.

RELATIONS
Anteriorly:
(i) The anterior abdominal wall,
(ii) the left costal margin,
(iii) the left pleura and lung, the diaphragm, and
(iv) the left lobe of the liver
Posteriorly:
(i) The lesser sac,
(ii) the diaphragm,
7. D. RADIAL NERVE IN HAND
The only part of the radial nerve that enters the hand is the superficial branch.
(i) It enters the hand by passing over the anatomical snuffbox on the dorsolateral side of the wrist.
(ii) Terminal branches of the nerve can be palpated or "rolled" against the tendon of the extensor
pollicis longus as they cross the anatomical snuffbox.
(iii) The superficial branch of the radial nerve innervates skin over the dorsolateral aspect of the
palm
and the dorsal aspects of the lateral three and one-half digits distally to approximately the terminal
interphalangeal joints.

APPLIED ANATOMY
Radial nerve injury
(i) Lesions of the radial nerve at its origin from the posterior cord in the axilla may be caused by
pressure from a long crutch (crutch palsy). Triceps is only involved when lesions occur at this level
and is usually spared in the more common lesions of the radial nerve in the arm
(ii) The most common radial nerve injury is damage to the nerve in the radial groove of the
humerus, which produces a global paralysis of the muscles of the posterior compartment resulting
in wrist drop. Radial nerve damage can result from fracture of the shaft of the humerus as the radial
nerve spirals around in the radial groove. The typical injury produces reduction of sensation in the
cutaneous distribution, predominantly over the posterior aspect of the hand. Such an injury may
occur by putting the outstretched arm on an arm chair in a drunken state. It is then referred to as
“Saturday night palsy”.
(iii) Severing the posterior interosseous nerve (continuation of deep branch of radial nerve) may
paralyze the muscles of the posterior compartment of the forearm, but the nerve supply is variable.
Typically, the patient may not be able to extend the fingers.
(ii) The distal branches of the superficial branch of the radial nerve can be readily palpated as
"cords"
passing over the tendon of the extensor pollicis longus in the anatomical snuffbox. Damage to these
branches is of little consequence because they supply only a small area of skin.

8. Structure of hyaline cartilage
(i) Hyaline cartilage is distinguished by a homogeneous, amorphous matrix. The matrix of hyaline
cartilage appears glassy in the living state: hence, the name hyaline.
(ii) Throughout the cartilage matrix are spaces called lacunae. Located within these lacunae are the
chondrocytes.
Hyaline cartilage is not a simple, inert, homogeneous substance but a complex living tissue. It
provides a low-friction surface, participates in lubricating synovial joints and distributes applied
forces to underlying bone.
(iii) Components of the hyaline cartilage matrix are not uniformly distributed. Because the
proteoglycans of hyaline cartilage contain a high concentration of bound sulfate groups, ground
substance stains with basic dyes and hematoxylin. Thus, the basophilia and metachromasia seen in
stained sections of cartilage provide information about the distribution and relative concentration
of sulfated proteoglycans.

9. Turners syndrome
Chromosomal disorder
Three types of karyotypic abnormalities are seen in individuals with Turner syndrome.
Approximately 57% are missing an entire X chromosome, resulting in a 45,X karyotype.
Of the remaining 43%, approximately one third (approximately 14%) have structural abnormalities of
the X chromosomes, and two thirds (approximately 29%) are mosaics.
Clinical features
(i) Bilateral neck webbing and persistent looseness of skin on the back of the neck.
(ii) Congenital heart disease esp Coarctation of Aorta is also common; most important cause of
increased mortality in children with Turner syndrome
(iii) Broad chest and widely spaced nipples, pigmented nevi
(iv) Cubitus valgus
(v) Failure to develop normal secondary sex characteristics. The genitalia remain infantile, breast
development is inadequate, and there is little pubic hair.
(vi) Shortness of stature (rarely exceeding 150 cm in height) and amenorrhea; streak ovaries
(vii) Auto antibodies that react with the thyroid gland, and up to half of these develop clinically
manifest
hypothyroidism.
(viii) Presence of glucose intolerance, obesity, and insulin resistance in a minority of patients.

10. Describe the brachial plexus in detail under the following headings – formation, branches and
applied anatomy.
FORMATION

1. Five roots derived from the anterior primary rami of C5, 6, 7, 8 and T1, which link up to
2. Three trunks formed by the union of
(i) C5 and 6 (upper);
(ii) C7 alone (middle);
(iii) C8 and T1 (lower)
which split into:
3. Six divisions formed by each trunk dividing into an anterior and posterior division; which link up
again into:
4. Three cords
(i) a lateral, from the fused anterior divisions of the upper and middle trunks;
(ii) a medial, from the anterior division of the lower trunk;
(iii) a posterior, from the union of all three posterior divisions.

The roots lie between the anterior and middle scalene muscles. The trunks traverse the posterior
triangle of the neck. The divisions lie behind the clavicle. The cords lie in the axilla. The cords
continue distally to form the main nerve trunks of the upper limb.
11. Locking and unlocking of knee joint.
This mechanism of flexion or extension of knee occurs when the foot is on the ground and the tibia
is fixed. Therefore it is the femoral condyles that rotate on the tibia as described below.
However when the foot is not on the ground, the tibial condyle with its meniscus rotates laterally in
extension and medially during flexion.
Locking mechanism (during extension)
(i) When the flexed knee extends, both femoral condyles roll forwards on the menisci of tibia.
(ii) During this extension, the lateral condyle reaches the lateral meniscus on the tibia earlier than
the medial femoral condyle coming into contact with the medial meniscus on the tibia. This is

because the lateral meniscus is shorter. Thus the lateral menisco-femoral compartment becomes
obliterated.

(iii) Thereafter forward movement of the condyles is arrested in the transverse axis by tension of
posterior part of fibrous capsule, oblique popliteal ligament and posterior cruciate ligament.
(iv) At this point, full extension is still short by 300.
12. Formation of blastocyst
On the sixth post ovulatory day, most cells of the morula migrate to the periphery called the
trophoblast and a clump of cells stays inside called the embryoblast or inner cell mass. This is the
formation of blastocyst with a cavity in the centre.
The trophoblast cells move closer to one another, which makes the tissue firmer. The divisions
continue
within the shell of the zona pellucida. The embryo does not grow.

The embryo floats passively on the stream of fluid in the oviduct as it is transported to the uterus.
On the sixth day when the zygote is in the uterus, the zona pellucida breaks through. The embryo is
now out of its rigid zona pellucida and can start to grow.
13. Flexor retinaculum

The flexor retinaculum is a strong, fibrous band forming the roof of the carpal tunnel.
It crosses the front of the carpus and converts its anterior concavity into the carpal tunnel, which
transmits the flexor tendons of the digits and the median nerve.
The retinaculum is short and broad, measuring 2.5–3 cm both transversely and proximodistally.
It is attached medially to the pisiform and the hook of the hamate.
Laterally, it splits into superficial and deep laminae. The superficial lamina is attached to the tubercles
of the scaphoid and trapezium. The deep lamina is attached to the medial lip of the groove on the
trapezium.

Medial

Lateral

The retinaculum is crossed superficially by the ulnar vessels and nerve – immediately radial to the
pisiform – and by the palmar cutaneous branches of the median and ulnar nerves.
Muscles attached to it
The tendons of palmaris longus and flexor carpi ulnaris are partly attached to the anterior surface of
the retinaculum. Distally some of the intrinsic muscles of the thumb and little finger are attached to
the retinaculum.
14. Extrahepatic biliary apparatus
It consists of 1.Hepatic ducts 2.Common hepatic ducts 3.Gall bladder 4.Cystic duct 5.Bile duct
It helps to transport bile stored in gall bladder to the second part of duodenum.
1. The right and left hepatic ducts emerge from the liver and unite near the right end of the porta
hepatis as the common hepatic duct. The extrahepatic right duct is short and nearly vertical while the
left is more horizontal and lies along the base of segment IV.
2. The common hepatic duct descends approximately 3 cm before being joined on its right at an acute
angle by the cystic duct to form the common bile duct.
3. The gallbladder is a flask-shaped, blind-ending diverticulum divided into fundus, body and
neck, the latter opening into the cystic duct.
The gall bladder normally holds about 50ml of bile and acts as a bile concentrator and reservoir. It lies
in a fossa separating the right and quadrate lobes of the liver and is related inferiorly to the duodenum
and transverse colon.
Supplied by Cystic artery and drained by Portal V.
4. The cystic duct drains the gallbladder into the common bile duct. It is between 3 and 4 cm long,
passes posteriorly to the left from the neck of the gallbladder, and joins the common hepatic duct to

form the common bile duct. It usually runs parallel to, and is adherent to, the common hepatic duct
for a short distance before joining it.

15. Great saphenous vein
The great saphenous vein originates from the medial side of the dorsal venous arch, and then
ascends up the medial side of the leg, knee, and thigh to connect with the femoral vein just inferior
to the
inguinal ligament.

(i) The great saphenous vein, which is the
longest vein in the body.
(ii) It drains the medial end of the dorsal
venous arch of the foot and passes upward
directly in front of the medial malleolus.
(iii) It then ascends in company with the
saphenous nerve in the superficial fascia over
the medial side of the leg.
(iv) The vein passes behind the knee and
curves forward around the medial side of the
thigh.
(v) It passes through the lower part of the
saphenous opening in the deep fascia and
joins the femoral vein about 1.5 in. (4 cm)
below and lateral to the pubic tubercle to
form the ext iliac vein.

16. Describe the interior of right atrium and correlate it with its development.

(i) The right atrium receives the superior vena cava in its upper and posterior part, the inferior vena
cava and coronary sinus in its lower part, and the anterior cardiac vein (draining much of the front
of the heart) anteriorly.
(ii) Running more or less vertically downwards between the venae cavae is a distinct muscular ridge,
the crista terminalis (indicated on the outer surface of the atrium by a shallow groove — the sulcus
terminalis).
(iii) This ridge separates the smooth-walled posterior part of the atrium, derived from the sinus
venosus, from the rough-walled anterior portion which is prolonged into the auricular appendage
and which is derived from the true fetal atrium.

(iv) The openings of the inferior vena cava and the coronary sinus are guarded by rudimentary
valves; that of the inferior vena cava being continuous with the annulus ovalis around the shallow
depression on the atrial septum, the fossa ovalis, which marks the site of the fetal foramen ovale.
Correlation with development of Heart

17. Facial A
Course
It branches from the anterior surface of the external carotid artery, passes up through the deep
structures of the neck and appears at the lower border of the mandible after passing posterior to the
submandibular gland.
Curving around the inferior border of the mandible just anterior to the masseter, where its pulse can

be felt, the facial artery then enters the face. From this point the facial artery runs upward and
medially in a tortuous course. It passes along the side of the nose and terminates as the angular
artery at the medial corner of the eye.
Relations
Along its path, the facial artery is deep to the platysma, risorius, and zygomaticus major and minor,
superficial to the buccinator and levator anguli oris, and may pass superficially to or through the
levator labii superioris.
Branches
a. Cervical branches
(i) Ascending palatine – supplies soft palate, tonsil and Eustachian tube
(ii) tonsillar – palatine tonsil
(iii) submental A – Supplies the skin and muscles overlying submandibular gland, chin and lower lip
(iv) glandular branches – supply submandibular salivary gland and associated lymph nodes, adjacent
muscles and skin
b. Facial branches
(i) include the superior and inferior labial branches
The labial branches arise near the corner of the mouth. The inferior labial branch supplies the lower
lip; the superior labial branch supplies the upper lip, and provides a branch to the nasal septum.
Near the midline, the superior and inferior labial branches anastomose with their companion
arteries from the opposite side of the face. This provides an important connection between the
facial arteries and the external carotid arteries of opposite sides.

18. Histology of cornea
The cornea consists of a thin surface epithelium (non-keratinized stratified squamous) overlying a
layer of dense fibrous connective tissue, called substantia propria.
Although the corneal tissues are made of the same tissue elements as other body parts (i.e.,
epithelial cells, collagen, fibroblasts, etc.), the cornea is quite unlike most tissues in that it is perfectly
transparent.
(i) Corneal epithelium is very thin (only a few cells thick).
Notably (i.e., unlike most other stratified squamous epithelial), corneal epithelium lies flat against
the underlying substantia propria. The absence of connective tissue papillae (compare with skin,
where the basal surface of the epidermis is indented by many dermal papillae).
Corneal epithelium contains free nerve endings.
19. Pleural recesses
The lungs do not completely fill the anterior or posterior inferior regions of the pleural cavities. This
results in recesses in which two layers of parietal pleura become opposed. Expansion of the lungs
into these spaces usually occurs only during forced inspiration; the recesses also provide potential
spaces in which fluids can collect and from which fluids can be aspirated.

1. Costomediastinal recesses
Anteriorly, a costomediastinal recess occurs on each side where costal pleura is opposed to
mediastinal pleura. The largest is on the left side in the region overlying the heart.
20. Explain the typical intercostal space.
The intercostal space is the space lying between two costae (ribs and their costal cartilages) there
are about 11 intercostal space and they contain.
1. Intercostal muscles.
2. Intercostal nerve, artery, and vein.
3. Lymphatic vessel.
Typical space that contains a typical nerve, rib and vertebra. The spaces between the 3rd – 5th ribs
are typical spaces.
Within each space lie 1 posterior intercostal artery and 2 anterior intercostal arteries, making 11
posterior intercostal arteries and 22 anterior intercostal arteries in the eleven intercostal spaces.
Typical rib has the following features (Ribs 3 to 10)

1. Head has 2 facets (demifacets) for
joints with adjacent vertebral bodies and
an intermediate crest for attachment
with intervertebral disc
2. Neck,
3. tubercle(joint with transverse proc.),
4.Angle,
5. Costal cartilage
6. Costal groove
7. R3 -7 joint to sternal body
R8 -10 attach to the costal cartilage of
the rib above ( → costal arch)

Typical intercostal nerve
A typical intercostal nerve supplies only the intercostal space; they include T3 to T6.
T1, T2 and T7 to T11 are atypical as their distribution extends beyond the thoracic cavity.
21. Tympanic membrane
(i) The tympanic membrane separates the external acoustic meatus from the middle ear.
(ii) It is a thin, fibrous membrane that is pearly gray. The membrane is obliquely placed, facing
downward, forward, and laterally. It is concave laterally, and at the depth of the concavity is a small
depression, the umbo, produced by the tip of the handle of the malleus.
When the membrane is illuminated through an otoscope, the concavity produces a “cone of light,”
which radiates anteriorly and inferiorly from the umbo.
(iii) The tympanic membrane is circular and measures about 1 cm in diameter. The circumference is
thickened and slotted into a groove in the bone.
The groove, or tympanic sulcus, is deficient superiorly, which forms a notch. From the sides of the
notch, two bands, termed the anterior and posterior malleolar folds, pass to the lateral process of
the malleus. The small triangular area on the tympanic membrane that is bounded by the folds is
slack and is called the pars flaccida. The remainder of the membrane is tense and is called the pars
tensa.
The handle of the malleus is bound down to the inner surface of the tympanic membrane by the
mucous membrane.

Relations
22. Describe the superolateral surface of the cerebral hemisphere under the following headings:
Sulci and Gyri, functional areas and arterial supply.
The superolateral surface of the cerebral hemisphere comprises the frontal, parietal, temporal and
occipital lobes.
Each of the lobes and its important sulci and gyri with functional areas will be described.
(refer figs to understand)

Major lobes of superolateral surface

Major gyri and sulci
areas

major functional

Frontal
lobe

Gyri and sulci

Functional areas

The frontal lobe occupies the area
anterior to the central sulcus and
superior to the lateral sulcus.
The superolateral surface of the frontal
lobe is divided by three sulci into four
gyri.
The precentral sulcus runs parallel to the
central sulcus, and the precentral gyrus
lies between them. Extending anteriorly
from the precentral sulcus are the
superior and inferior frontal sulci. The
superior frontal gyrus lies superior to
the superior frontal sulcus, the middle
frontal gyrus lies between the
superior and inferior frontal sulci and
the inferior frontal gyrus lies inferior to
the inferior frontal sulcus. The inferior
frontal gyrus is invaded by the anterior
and ascending rami of the lateral sulcus.

The precentral area may be divided into
posterior and anterior regions.
(i) The posterior region, which is referred to
as the motor area, primary motor area, or
Brodmann area 4, occupies the precentral
gyrus extending over the superior border
into the paracentral lobule.
(ii) The anterior region is known as the
premotor area, secondary motor area, or
Brodmann area 6 and parts of areas 8, 44,
and 45. It occupies the anterior part of the
precentral gyrus and the posterior parts of
the superior, middle, and inferior frontal
gyri.
(iii) The motor speech area of Broca is
located in the inferior frontal gyrus between
the anterior and ascending rami and the
ascending and posterior rami of the lateral
fissure (Brodmann areas 44 and 45).
(iv) The prefrontal cortex is an extensive
area that lies anterior to the precentral
area. It includes the greater parts of the
superior, middle, and inferior frontal gyri;
the orbital gyri; most of the medial frontal
gyrus; and the anterior half of the cingulate
gyrus (Brodmann areas 9, 10, 11, and 12).
The prefrontal area is concerned with the
makeup of the individual's personality.

23. Vocal cord.
One of two pairs of mucomembranous folds in the larynx. The upper pair (false vocal cords) is not
concerned with vocal production; the lower pair (true vocal cords or vocal folds) can be made to
vibrate and produce sound when air from the lungs is forced over them.

It is avascular and white in color. The vocal fold moves with respiration and its white color is easily
seen when viewed with a laryngoscope.
24. Carotid sheath
The carotid sheath is a condensation of deep cervical fascia around the common and internal carotid
arteries, the internal jugular vein, the vagus nerve and the constituents of the ansa cervicalis as they
pass through the neck. It is thicker around the arteries than the vein, an arrangement that allows the
vein to expand. Peripherally the carotid sheath is connected to adjacent fascial layers by loose
areolar tissue.

Applied aspect
1. The common carotid artery can be exposed through a transverse incision over the origin of the
sternocleidomastoid immediately above the sternoclavicular joint. The carotid sheath lies
immediately deep to the junction between the sternal and clavicular heads of the
sternocleidomastoid and is
revealed either by retracting this muscle laterally or by splitting between its heads. Opening the
sheath then reveals the artery lying medial to the internal jugular vein.
2. A stellate ganglion block is performed by first palpating the large anterior tubercle (carotid
tubercle) of the transverse process of the 6th cervical vertebra, which lies about a fingerbreadth
lateral to the cricoid cartilage.
The carotid sheath and the sternocleidomastoid muscle are pushed laterally and the needle of the

anesthetic syringe is inserted through the skin over the tubercle.
25. Right coronary A
The right coronary artery arises from the right aortic sinus and travels through the coronary
groove;
Course
It passes anteriorly and to the right between the right auricle and the pulmonary trunk and then
descends vertically in the coronary sulcus, between the right atrium and right ventricle. On reaching
the inferior margin of the heart, it turns posteriorly and continues in the sulcus onto the
diaphragmatic surface and base of the heart. During this course, several branches arise from the
main stem of the vessel.
Branches
1. An early atrial branch passes in the groove between the right auricle and ascending aorta, and
gives off the sino-atrial nodal branch, which passes posteriorly around the superior vena cava to
supply the sino-atrial node;
2. A right marginal branch is given off as the right coronary artery approaches the inferior (acute)
margin of the heart and continues along this border toward the apex of the heart;
3. As the right coronary artery continues on the base/diaphragmatic surface of the heart, it supplies
a small branch to the atrioventricular node before giving off its final major branch,
4. the posterior interventricular branch, which lies in the posterior interventricular sulcus.

Short Answer Questions:
1. Mention different parts of Diencephalon.
The diencephalon comprises the thalamus and hypothalamus.
2. Emissary veins
Venous sinuses of the dura communicate with the veins of the scalp, face and neck via emissary
veins that pass through a number of the foramina in the skull.
3. Lacus lacrimalis
The medial canthus is separated from the eyeball by a small triangular space, the lacrimal lake (lacus
lacrimalis), in which a small, reddish body called the lacrimal caruncle is situated.
4. Lymphatic drainage of face
(i) Lymph vessels from the frontal region above the root of the nose drain to the submandibular
nodes.
(ii) Vessels from the rest of the forehead, temporal region, upper half of the lateral auricular aspect
and anterior wall of the external acoustic meatus drain to the superficial parotid nodes, which lie
just
anterior to the tragus, either on or deep to the parotid fascia.
(iii) These nodes also drain lateral vessels from the eyelids and skin of the zygomatic region, and
their efferent vessels pass to the upper deep cervical nodes.
(iv) A strip of scalp above the auricle, the upper half of the cranial aspect and margin of the auricle,
and the posterior wall of the external acoustic meatus all drain to the upper deep cervical and
posterior auricular nodes.

(v) The posterior auricular nodes are superficial to the mastoid attachment of sternocleidomastoid
and deep to auricularis posterior, and drain to the upper deep cervical nodes.
(vi) The auricular lobule, floor of the external acoustic meatus and skin over the mandibular angle
and
lower parotid region all drain to the superficial cervical or upper deep cervical nodes.
5. Horner’s syndrome
Horner’s syndrome results from interruption of the sympathetic fibres to the eyelids and pupil.
The pupil is constricted (miosis, due to unopposed parasympathetic innervation via the
oculomotor nerve), there is ptosis (partial paralysis of levator palpebrae) and the face on the
affected side is dry and flushed (sudomotor and vasoconstrictor denervation).
6. Histology of skeletal muscle
The cellular units of skeletal muscle are enormous multinucleate muscle fibres.
Individual muscle fibres are long, cylindrical structures that tend to be consistent in size within a
given muscle, but in different muscles may range from 10 to 100 μm in diameter and from
millimetres to many centimeters in length.
T.S

Endomysium – Connective tissue around individual fibre
Perimysium – C.T around each fascicle or muscle fibre group
Epimysium – C.T around entire muscle

L.S of muscle

The cytoplasm of each fibre, sarcoplasm, is surrounded by a plasma membrane that is often called
the sarcolemma. The contractile machinery is concentrated into myofibrils, long narrow structures
(1–2 μm in diameter) that extend the length of the fibre and form the bulk of the sarcoplasm.
Numerous moderately euchromatic, oval nuclei usually occupy a thin transparent rim of sarcoplasm
between the myofibrils and the sarcolemma.
7. Triangle of Koch
Is formed in the heart by the attachment of the septal cusp of the tricuspid valve inferiorly, the
ostium of the coronary sinus basally, and the tendon of Todaro superiorly.

8. Barr body

In females, 3% of the nuclei of neutrophils show a conspicuous ‘drumstick’ formation that represents
the sex chromatin of the inactive X chromosome (Barr body). It is in contact with the nuclear
membrane.
9. Types of chromosomes
Somatic chromosomes or autosomes and Sex chromosomes
10. Bones derived from 1st pharyngeal arch
Incus, malleus, spine of sphenoid, genial tubercle of mandible
26. Paranasal sinuses - Name, function, opening area, applied aspects
Air cavities, which in the nasal cavity are paired, between certain bones in the skull are known as
paranasal sinuses. The bones which surround these sinuses and create the cavity are also
responsible for the naming of the particular sinus.
1. They are the frontal, ethmoidal, sphenoid and maxillary.
2. Function
a) The most vital aspect of these sinus cavities is to produce a structural strength for the skull which
in turn lightens the overall weigh of the skull.
b) assist the process of warming and moistening the incoming air.
c) Sound resonance to assist with vocalization is also produced throughout these sinuses.
3. Opening areas
a) Frontal sinus - drains onto the lateral wall of the middle meatus via the frontonasal duct
b) the anterior ethmoidal cells - open into the ethmoidal infundibulum or the frontonasal duct;
the middle ethmoidal cells open onto the ethmoidal bulla, or onto the lateral wall just above this
structure;
the posterior ethmoidal cells open onto the lateral wall of the superior nasal meatus.
27. Parts and constituent fibres of internal capsule
The internal capsule is an area of white matter in the brain that separates the caudate nucleus and
the thalamus from the putamen and the globus pallidus. The internal capsule contains both
ascending and descending axons.
2. It consists of axonal fibres that run between the cerebral cortex and the pyramids of the medulla.
It is a V shaped structure.
a the bend in the V is called the genu
b) the anterior limb or crus anterius is the part in front of the genu, between the head of the
caudate nucleus and
the lenticular nucleus (globus pallidus and putamen).
c) the posterior limb or crus posterius is the part behind the genu, between the thalamus and
lenticular nucleus.

The internal capsule is V-shaped and has the following parts when cut transversely (horizontally) See figure
Fibres within Internal Capsule

BIBLIOGRAPHY
1. CLINICAL ANATOMY BY REGIONS 9th Edition
Richard Snell
2. Langmans Medical Embryology 12th Edition
3. Clinical Anatomy, A revision and applied anatomy
for clinical students , 11th Edition
HAROLD ELLIS
4. Grays Anatomy for Students, 2nd Edition
5. Gray’s Anatomy 40th Edition
6. Clinical Anatomy 7th Edition
Richard Snell
7. Essentials of Human Anatomy Volumes 1-4
A.K Dutta, 9th Edition
8. BRS Embryology 3rd Edition