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Dermatomes and corresponding Nerve supply !!


Posted: November 20, 2013 by Dr. Amit Singh in ANATOMY, ANESTHESIA, NEUROLOGY
Tags: dermatomes, neurology
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Posted: August 18, 2013 by Dr Sujeet Kumar in ANATOMY, SURGERY


2
Q1 ]The COUINADS SEGMENTAL NOMENCLATURE is based on position of [AI 2004]
Hepatic veins & Portal veins
Hepatic vein & biliary ducts
Portal vein & Biliary ducts
Portal vein & Hepatic artery
Q2] A surgeon excises a portion of liver to the left of the attachment of falciform ligament .The segments that
have been resected are[AI 2008]
Segment I & IVa
Segment I & IVB
Segment II & III
Segment I & II
Q3] Right hepatic vein drains all except[AIIMS MAY 2009]
Segment V
Segment III
Segment VI
Segment VII
Q4] The right lobe of liver consists of ..[AIIMS 2004]
V , VI , VII , VIII Segments
IV , V , VI , VII , VIII Segments
I , II, V , VI , VII
III , IV , V, VI
Q5] Aprroximately what % of total blood supply comes from hepatic artery.
< 10%
25%
50%
75%
Q6] False about Hepatic Duct [ AIIMS MAY 2009]
Left hepatic duct formed in umblical fissure
Caudate lobe is drained only by left hepatic duct
Right anterior hepatic duct formed by V & VIII Segments
Left hepatic duct crosses IV segment
Q7] Most common variant of normal anatomy of hepatic artery.
division into right and left hepatic artery after giving off gastroduodenal artery
division into right and left hepatic artery before giving off gastroduodenal artery
replaced right hepatic artery ie origin of right hepatic artery from superior mesentric artery
replaced left hepatic artery ie origin of right hepatic artery from superior mesentric artery
Q8 ] which of the following is arranged in correct order of % of total cardiac output received
kidney > liver > skeltal muscle > brain
liver > kidney > skeltal muscle > brain
skeltal muscle > brain > kidney > liver
liver > skeltal muscle > brain > kidney
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Q9] True about common bile duct all except[AI 2000]


Opens 10 cm distal to pylorus
lies anterior to IVC
Portal vein lies posterior to it
usually opens into duodenum separate from the main pancreatic duct
Q 10] which of following is false .
Right anterior hepatic duct is formed from segments V & VIII
Right posterior hepatic duct is formed from segments V & VIII
left anterior hepatic duct drains segment III , IV
left posterior hepatic duct drains segment II
ALTERNATIVELY U CAN ANSWER THESE Q IN QUIZZ FORMAT BY CHOOSING OPTIONS AT
FOLLOWING LINK http://pguploads.polldaddy.com/s/liver-anatomy-10-q
(http://pguploads.polldaddy.com/s/liver-anatomy-10-q)
Answers (Highlighted and star marked )
Q.1 The COUINADS SEGMENTAL NOMENCLATURE is based on position of [AI 2004]
****Hepatic veins & Portal veins
Hepatic vein & biliary ducts
Portal vein & Biliary ducts
Portal vein & Hepatic artery
Q.2 A surgeon excises a portion of liver to the left of the attachment of falciform ligament .The segments that
have been resected are[AI 2008]
Segment I & IVa
Segment I & IVB
***Segment II & III
Segment I & II
Q.3 Right hepatic vein drains all except[AIIMS MAY 2009]
Segment V
***Segment III
Segment VI
Segment VII
Q.4 The right lobe of liver consists of ..[AIIMS 2004]
***V , VI , VII , VIII Segments
IV , V , VI , VII , VIII Segments
I , II, V , VI , VII
III , IV , V, VI
Q.5 Aprroximately what % of total blood supply comes from hepatic artery.
< 10%
***25%
50%
75%
Q.6 False about Hepatic Duct [ AIIMS MAY 2009]
Left hepatic duct formed in umblical fissure
***Caudate lobe is drained only by left hepatic duct
Right anterior hepatic duct formed by V & VIII Segments
Left hepatic duct crosses IV segment
Q.7 Most common variant of normal anatomy of hepatic artery.
Division into right and left hepatic artery after giving off gastroduodenal artery
Division into right and left hepatic artery before giving off gastroduodenal artery
***Replaced right hepatic artery ie origin of right hepatic artery from superior mesentric artery
Replaced left hepatic artery ie origin of right hepatic artery from superior mesentric artery
Q.8 whic of the following is arranged in correct order of % of total cardiac output received
kidney > liver > skeltal muscle > brain
***liver > kidney > skeltal muscle > brain
skeltal muscle > brain > kidney > liver
liver > skeltal muscle > brain > kidney
Q.9 True about common bile duct all except[AI 2000]
Opens 10 cm distal to pylorus
Lies anterior to IVC
Portal vein lies posterior to it
***Usually opens into duodenum separate from the main pancreatic duct
Q.10 which of following is false .
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Right anterior hepatic duct is formed from segments V & VIII


****Right posterior hepatic duct is formed from segments V & VIII
Left anterior hepatic duct drains segment III , IV
Left posterior hepatic duct drains segment II

LUMBAR TRIANGLE AND LUMBAR HERNIA


Posted: April 17, 2013 by Dr Sujeet Kumar in ANATOMY, SURGERY
Tags: Anatomy mcq
0
Q1] Which of the following statements is not true about lumbar hernia.
[a] Lumbar hernia is congenital in 20% cases and congenital lumbar hernia are usually bilateral.
[b] Herniation is more common through superior lumber triangle and more commonly occurs in left side as
compared to right.
[c] Lumbar hernia tend to increase in size and should be repaired whenever found.
[d] Howship -Romberg sign is positive in lumbar hernias.
[e] In erect posture presence of reducible and often tympanitic mass in flank usually makes the diagonosis.
ANS [D] Howship -romberg sign : pain abdomen extends down the medial aspect of thigh with abduction,
extension or internal rotation of thigh. This is most specific clinical finding of a OBTURATOR HERNIA
SEE THE FIGURE BELOW

(http://pguploads.files.wordpress.com/2013/04/lumbar-triangle-and-hernia2.jpg)
Ref CSDT pg no 794 / 11 ed.

ROTATOR CUFF : ANATOMY ,


PATHOLOGY ,ORTHOPEDICS
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Posted: April 14, 2013 by Dr Sujeet Kumar in ANATOMY, ORTHOPEDICS


0
Q1] Rotator cuff/ musculotendinous cuff of shoulder is a fibrous sheath formed by four flattened
tendons which blend with capsule of shoulder joint and enforces it. Which of the following
statements is false about rotator cuff.
A] All four muscle arise from scapula and are inserted into tuberosity of humerous.
B] All four muscle do external rotation of arm.
C] Rotaror cuff gives strength to capsule of shoulder joint all around except inferiorly.
D] Rotator interval is space between supraspinatous and subscapularis.
ANS [B] SEE THE TABLE BELOW

(http://pguploads.files.wordpress.com/2013/04/rotator-cuff-anatomy.png)
Q2] Which part of rotator cuff is in greatest tension during overhead abduction and hence is most
commonly affected tendon in rotator cuff tendinitis/tear
A] SUPRASPINATUS
B] INFRASPINATUS
C] TERES MINOR
D] SUBSCAPULARIS
ANS [A] SEE FIGURE BELOW

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(http://pguploads.files.wordpress.com/2013/04/rotator-cuff-anatomy-copy.png)
Q3] All of following specificaly indicate complete rotator cuff tear in a patient presenting with
shoulder pain except.
A] Neer impingement sign positive
B] JOBES test positive
C] Contrast flooding subacromial bursa when injected into glenohumeral joint during arthrography.
D] Hyperintense signals on T2 MRI that extends throughout tendon.
E] Diffusely hypoechoic tendon on USG.
ANS: [A] , [B], [E]
[A] = NEER IMPINGEMENT SIGN IS +VE in any cause of anterosuperior impingement as in
subacromial bursitis or partial tendon tear.
[B] JOBES TEST can be +ve in partial tears also.
[E] normally tendon is echoic structure whereas fluid is hypoechoic so diffusely hypoechoic tendon
denotes tendinitis and not tear.
NOTE : ON T2 WATER IS HYPERINTENSE IE WHITE SO TENDON TEAR APPEAR AS
HYPERINTENSE SIGNAL.
SEE FIGURE BELOW:

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(http://pguploads.files.wordpress.com/2013/04/rotator-cuff-anatomy-copy-2.png)
NOTE POINTS: 1] LIFT OFF TEST IS DONE TO ASCESS ISOLATED SUBSCAPULARIS TEAR=
FORGOTTEN TENDON [AI 2010]
2] SHOULDER JOINT CAPSULE HAS 2 OPENINGS ONE FOR LONG HEAD OF BICEPS AND BY
OTHER IT COMMUNICATES WITH SUBSCAPULAR BURSA.
3] THOUGH JOINT CAPSULE IS LEAST REINFORCED INFERIORLY ,MOST COMMON TYPE OF
SHOULDER DISLOCATION IS ANTERIOR OF SUBCORACOID TYPE.
4]In subacromial bursitis pressure over deltoid below acromian in adducted arm produces pain but
this pain dissapears when same test is repeated in abducted position . This sign is clled as
DAWBARNS SIGN.
References [1]. CODT 3ed page 191. [2] BDC vol 1 page 79 4th ed [3] campbells orthopedics 11th ed page 2607
[4] @medscape

Hyoid bone
Posted: April 4, 2013 by Dr Sujeet Kumar in ANATOMY
Tags: ANATOMY, mcq
1
Hyoid bone is present at level of base of mandible & C3 vertebra . It is kept suspended at this level by muscle
and ligament attachment.
DEVELOPMENT : SEE FIGURE BELOW

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(http://pguploads.files.wordpress.com/2013/04/hyoid.jpg)
OSSIFICATION: It ossifies from 6 centres [ 2 primary centre for each greater cornu + 2 secondary centre
for each lesser cornu + 2 secondary for body].
MUSCLE ATTACHMENT :
[A] BODY ;1.anterior surface = geniohyoid + myelohyoid+ hyoglossus(also from greater cornu)
2. upper border = genioglossi & thyrohyoid membrane.
3. lower border = 3 strap muscle = sternohyoid , thyrohyoid( some par extend to greater cornu) ,omohyoid (
note that sternothyroid is also a strap muscle but as the name suggests it is not attached to hyoid)
[B] GREATER CORNU = Thyrohyoid memb (also on body) +digastric pulley + stylohyoid muscle+
thyrohyoid muscle ( also on body)
so hyoglossus originates from body + greater cornua (q)
[C] LESSER CORNU = stylohyoid ligament ( note that stylohyoid muscle originate from greater cornua)
note: Middle constrictor originate from lesser cornua + greater cornua.
NERVE SUPPLY OF STRAP MUSCLE :see the figure below

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(http://pguploads.files.wordpress.com/2013/04/ansa.jpg)
1. superior belly of omohyoid= by superior root ie descending branch of hypoglossal nerve fibres of which are
derived from C1 ventral ramus.
2. sternohyoid + sternothyroid+ inferior belly of omohyoid = ANSA CERVICALIS.
3 NOTE THAT thyrohyoid is not supplied by ansa cevicalis , it alongwith geniohyoid is supplied by C1
through hypoglossal nerve.
Note : hyoid fracture is most likely to occur in THROTTLING > STRANGULATION> HANGING.
REF: bdc 3rd ed page 30, Langman embryology 10ed page 261
diagram : sujeet kumar

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