1 ANATOMY

1. Thoracic duct enters thorax by passing through opening in

diaphragm at .................. level.
1. T6
2. T8
3. T10
4. T12
Answer: is 3 i.e. T10 (Ref: BD Chaurasia, Lasts Anatomy, Grays
Anatomy, Platinum Notes)

Openings of diaphragm and vertebral levels:

ä Vena caval opening:
– Thoracic 8 level
– Inferior vena cava
– Rt phrenic nerve
ä Esophageal opening:
– Thoracic 10 level
– Esophagus
– Vagus nerves
– Esophageal branch of lt. gastric artery
ä Aortic opening:
– Thoracic 12 level
– Aorta
– Thoracic duct
– Azygous vein

Answer : 3. T10
 SELF ASSESSMENT & REVIEW (JKBOPEE) 2012

2. All the signs and symptoms indicative of an extra pyramidal

system lesion EXCEPT
1. Athetosis
2. Chorea
3. Hemiballismus
4. Intention tremors

Answer: is 4 i.e. Intention tremors (Ref: BD Chaurasia, Lasts

Anatomy, Grays Anatomy, Platinum Notes)

The term Extrapyramidal refers “to the anatomic and functional

characteristics that distinguish the basal ganglia-regulated motor
system from the pyramidal (corticospinal) and cerebellar systems”

Extrapyramidal movement disorders are divided descriptively

into hypokinesias, characterized by poverty and slowness of
Anatomy

movement; hyperkinesias, manifested by abnormal involuntary

movements; and miscellaneous motor disturbances
p Athetosis is a slow form of chorea characterized by
twisting, writhing movements.
p Chorea consists of continuous, abrupt, rapid, brief, flowing,
unsustained, irregular, and random jerklike movements.
Choreic patients frequently mask the abnormal
movements by voluntary semipurposeful activities. A
characteristic feature of chorea is the inability to maintain
voluntary sustained contraction. Examples include an
inability to sustain manual grip or tongue protrusion and
the dropping of objects.
p Ballism is a form of forceful, flinging, high-amplitude,
coarse chorea. Because the involuntary movement usually
affects only one side of the body, the term hemiballism is
used.
p Kinetic (intention) tremors are slow and more irregular
movements with a rate of 1.5 to 3Hz. Kinetic tremors
usually indicate an abnormality of the cerebellum or its
outflow pathways (the dentate nucleus, the superior
cerebellar peduncle, and contralateral red nucleus).
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 ANATOMY
The main difference between the Pyramidal and Extrapyramidal
tracts:
Pyramidal
1. One neurone carries the impulse
from the cerebral cortex to the ant.
horn cells [A.H.Cs].[It is a “non-
stop” or a “jet” tract!!]
2. In the medulla it occupies
pyramid.
3. Arises from a localized area in the
precentral gyrus called the
“MOTOR AREA” or area 4.
4. All fibers cross to reach the
opposite side; the main crossing
(85% of the fibers) occurs in the
lower part of the medulla forming
the “pyramidal” or “motor”
decussation.
5. Function
(a) On tone: It is a facilitatory, i.e.
its stimulation increases the tone
and the reflexes and its
destruction decreases the tone
and reflexes. (b) On movement:
It is responsible for the fine,
isolated, precise and specific
movements which are necessary
for all activities which need skill,
e.g. typing or playing the piano.
Answer : 4. Intention tremors
Extrapyramidal
1. Many neurones (with many
synapses) carry the impulse from
the cerebral cortex to the ant. horn
cells [A.H.Cs].[It is similar to a
train with “many stops”]
2. In the medulla they do not occupy
the pyramid but are scattered in
different areas.
3. Arise from widely distributed area
from the different lobes of the
cerebral cortex.
4. Some tracts are direct while other
are crossed, but the crossing
occurs at the level of the origin of
Anatomy
the extrapyramidal tract.
5. Function
(a) On tone: some tracts are
facilitatory; others are inhibitory or
suppressive. Stimulation of an
inhibitory tract decreases the tone
& reflexes while its destruction
increases both tone and reflexes.
(b) On movement: they are
responsible for the gross, synergic
movements which require the
activity of large groups of muscles,
e.g. the movements which are
necessary for the equilibrium of
the posture; also the
semiautomatic movements that do
not need much skill, e.g. swinging
the arm while walking.
Extrapyramidal tracts “set the
background” for the subsequent
activity of the pyramidal tract.
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 SELF ASSESSMENT & REVIEW (JKBOPEE) 2012

3. Inferior thyroid artery is related closely to .................. nerve

1. Recurrent laryngeal
2. External laryngeal
3. Internal laryngeal
4. Vagus
Answer: is 1 i.e. Recurrent laryngeal (Ref: BD Chaurasia, Lasts
Anatomy, Grays Anatomy, Platinum Notes)

The upper part of the recurrent laryngeal nerve has a close but
variable relationship to the inferior thyroid artery: it may pass in
front of, behind, or parallel to, the artery. The nerve enters the larynx
either by passing deep to or between the fibers of cricopharyngeus
at its attachment to the lateral aspect of the cricoid cartilage. It
supplies cricopharyngeus as it passes. At this point, the nerve is in
intimate proximity to the posteromedial aspect of the thyroid gland.
Anatomy

Important structures accompanying:

Extra Edge
p Axillary nerve accompanies posterior humeral circumflex
artery.
p Radial nerve accompanies profunda brachii vessels
p Short saphenous vein accompanies sural nerve.
p Great saphenous vein accompanies saphenous nerve.
p Superior thyroid vessels accompany external laryngeal
nerve
p Superior laryngeal vessels accompany internal laryngeal
nerve
p Inferior laryngeal vessels accompany recurrent laryngeal
nerve

Answer : 1. Recurrent laryngeal

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4. Submandibular gland is divided in two parts by ..................

muscle
1. Hyoglossus
2. Mylohyoid
3. Digastric
4. Styloglossus
Answer: is 2 i.e. Mylohyoid (Ref: BD Chaurasia, Lasts Anatomy, Grays
Anatomy, Platinum Notes)
The superficial part of the gland is situated in the digastric triangle
where it reaches forward to the anterior belly of digastric and back
to the stylomandibular ligament, by which it is separated from the
parotid gland.The deep part of the gland extends forwards to the
posterior end of the sublingual gland. It lies between mylohyoid
inferolaterally, hyoglossus and styloglossus medially, the lingual

Anatomy
nerve superiorly, and the hypoglossal nerve and deep lingual vein
inferiorly. Mylohyoid is called the oral diaphragm and separates
the superficial part of submandibular gland from its deep part.

Answer : 2. Mylohyoid
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5. Arterial supply to suprarenal gland includes branches from

all EXCEPT
1. Inferior phrenic artery
2. Abdominal aorta
3. Gonadal artery
4. Renal artery
Answer: is 3 i.e. Gonadal artery (Ref: BD Chaurasia, Lasts Anatomy,
Grays Anatomy, Platinum Notes)
p The adrenal glands are bilateral retroperitoneal organs
located on the superior medial aspect of the upper pole of
each kidney.
p The normal adrenal cortex is bright yellow and thicker
than the red-brown adrenal medulla.
p The adrenal cortex arises from coelomic mesoderm
Anatomy

adjacent to the urogenital ridge between the fourth and

sixth gestational weeks. The gland then differentiates into
a thin outer definitive cortex and a thick inner fetal cortex
by the eighth week. The fetal cortex actively produces fetal
steroids during gestation but involutes rapidly after birth.
p The adrenal medulla arises from the neural crest cells
which migrate towards the medial aspect of the developing
adrenal fetal cortex.
p The adrenal glands are highly vascular and derive their
blood supply from branches of the inferior phrenic artery
superiorly, the aorta medially, and the renal artery
inferiorly.
p The primary blood supply of the right adrenal comes from
the superior and inferior adrenal arteries, while the left
adrenal is supplied primarily by the middle and inferior
adrenal arteries. Additionally, numerous small arterial
branches enter the perimeter of the gland.
Microvasculature within each adrenal integrates function
of the cortex and medulla. A number of small vessels pass
directly through the cortex to the medulla, but the majority
enter the cortical plexus and form cortical sinusoids that
empty into medullary sinusoids.
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 ANATOMY

Blood supply of suprarenals:

á Superior suprarenal artery: branch of Inferior Phrenic
artery
á Middle suprarenal artery: branch of Abdominal aorta
á Inferior suprarenal artery: branch of Renal artery.

Anatomy

Answer : 3. Gonadal artery

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6. Boundaries of Epiploic foramen include all EXCEPT

1. Inferior vena cava
2. Caudate lobe of liver
3. Fundus of gallblader
4. First part of duodenum
Answer: is 3 i.e. Fundus of gallblader (Ref: BD Chaurasia, Lasts
Anatomy, Grays Anatomy, Platinum Notes)

The Epiploic foramen (Foramen of Winslow, Aditus to

the Lesser Sac)
p It is a short, vertical slit, c.3 cm height in adults, in the
upper part of the right border of the lesser sac. It leads into
the greater sac.
p The hepatoduodenal ligament, which is formed by the
thickened right edge of the lesser omentum extending from
Anatomy

the flexure between the first and second parts of the

duodenum, forms the anterior margin of the foramen. The
anterior border contains the common bile duct (on
the right), portal vein (posteriorly) and hepatic artery (on
the left) between its two layers.
p Superiorly the peritoneum of the posterior layer of the
hepatoduodenal ligament runs over the caudate lobe of
the liver which forms the roof of the epiploic foramen. This
layer of peritoneum is then reflected onto the inferior vena
cava which forms the posterior margin of the epiploic
foramen.
p At the upper border of the first part of the duodenum the
peritoneum runs forwards from the inferior vena cava,
above the head of the pancreas, and is continuous with
the posterior layer of the lesser omentum, forming the floor
of the epiploic foramen.
p The roof is continuous with the peritoneum on the inferior
surface of the right hepatic lobe. The anterior and posterior
walls of the foramen are normally apposed.

Answer : 3. Fundus of gallbladder

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 ANATOMY

7. Interphalangeal joint is an example of ________ joint

1. Plane synovial
2. Ellipsoid
3. Hinge
4. Saddle
Answer: is 3 i.e. Hinge (Ref: BD Chaurasia, Lasts Anatomy, Grays
Anatomy, Platinum Notes)

Fibrous joints:
• Sutures: Skull
• Syndesmosis: Inf. Tibiofibular joint
• Gomphosis: Tooth in socket

Cartilaginous joints:
• Primary cartilaginous (Synchondrosis): Joint between epiphysis and
diaphysis, First costochondral joint.

Anatomy
• Secondary cartilaginous (Symphisis): Symphisis pubis, Manubriosternal
joint
• Syndesmosis: Inferior tibiofibular joint
• Hinge joint: Elbow, ankle, IP joint
• Pivot Joint: Sup and inf radioulnar joint
• Condyloid joint TM joint
• Ellipsoid joint: Wrist joint, MCP
• Saddle/sellar joint: Ist MCP, sternoclavicular
• Ball and Socket variety: Shoulder, Hip

Answer : 3. Hinge
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8. Fundic glands in stomach have all the following EXCEPT

............... cells
1. Zymogen
2. Kupffer
3. Parietal
4. Argentaffin
Answer: is 2 i.e. Kupffer (Ref: BD Chaurasia, Lasts Anatomy, Grays
Anatomy, Platinum Notes)

Cells of Stomach

The Mucus neck cells:

3 Called so as they are present in the necks of glands.
3 They secrete mucin which serves as a protective layer against
HCL.
3 They appear pale because of dissolved mucin.
Anatomy

3 They are low columnar with basal flat nuclei.

The Chief cells (The Peptic cells or the Zymogen cells)
3 Called as chief because they line the main part of the body
of the gland.
3 They are low columnar with basal round nuclei.
3 They secrete pepsinogen.
Oxyntic cells (parietal cells)
3 They are scattered in between peptic cells.
3 They are highly acidophilic.
3 Intrinsic factor of Castle is secreted by parietal cells
3 They secrete HCl.
3 They contain secretory canaliculi and are rounded.
The Argentaffin cells:
3 They are chromaffin Positive and stain positive with Silver
salts.
3 They also contain acidophilic granules and are oval in shape.

“Von Kupffer’s cells” are cells present in liver

(phagocytes ) and not stomach
n Monocyte-derived members of the mononuclear
phagocyte system,
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 ANATOMY

n These are interspersed among the sinusoidal endothelial

cells and on their luminal surfaces.
n They contain ovoid nuclei, many mitochondria, a well-
developed Golgi complex, scattered lysosomes,
Phagosomes, and RER.
n They are more easily distinguished from the endothelial
cells in standard H&E preparations when they have
phagocytosed colored particles, (India ink) prior to fixation.
Can be stained by vital stains.

Anatomy

Answer : 2. Kupffer
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9. Medulla oblongata develops from

1. Mesencephalon
2. Metencephalon
3. Myelencephalon
4. Prosencephalon
Answer: is 3 i.e. Myelencephalon (Ref: BD Chaurasia, Lasts Anatomy,
Grays Anatomy, Platinum Notes)

Embryology of Nervous System:

á The nervous system develops from the neural plate which
appears at the beginning of the third week as thickening
of the ectoderm.
á Its lateral edges soon elevate to form the neural folds.
á With further development, the neural folds continue to
elevate, and form a tube known as neural tube.
Anatomy

á The neural tube has an enlarged cranial part that forms

the brain, and a narrow caudal part that becomes the spinal
cord.
á The wall of the neural tube at first has a single layer of
cells. They multiply and form three layers- ependymal,
mantle and marginal layer.

The mantle layer divides into a

á ventral part, the basal lamina, and
á Dorsal part, the alar lamina, separated by a groove, the
sulcus limitans.
Alar plate gives rise to sensory areas of the spinal cord and the
sensory nuclei.
Basal plate forms the motor areas of the spinal cord and motor
nuclei.
The cerebellum and its nuclei develop from the dorsal parts of the
alar plate.
Inferior olivary and Substantia nigra are sensory nuclei and thus
derived from the alar plate.

118 Hypoglossal is a motor nuclei and develops from the basal plate.
 ANATOMY

The wall of the spinal cord

Neuroepithelial layer Mantle layer Marginal layer

1. These cells extend 1. Once the neural 1. The outermost layer

over the entire tube closes, neuroe- of the spinal cord, the
thickness of the pithelial cells begin marginal layer, contains
wall and form to give rise to another nerve fibers emerging
a thick cell type. from neuroblasts in the
PSEUDOS- mantle layer.
TRATIFIED
EPITHELIUM
2. Junctional 2. These cells are charac- 2. As a result of
complexes at the terized by a large myelination of nerve
lumen connect round nucleus with fibers, this layer takes on
them pale nucleoplasm a white appearance and
and a dark- staining therefore is called the
nucleolus.These White matter of the
are primitive nerve spinal cord.

Anatomy
cells,or
NEUROBLASTS.
3. After closure of 3. They form the
neural tube, they mantle layer, a zone
divide rapidly, around the neuroe-
producing more pithelial layer.
and more The mantle layer later
neuroepithelial forms the gray
cells matter of the
spinal cord.

Remember:
Forebrain
(Prosencephalon) Telencephalon Cerebral hemispheres
Diencephalon Thalamus
Hypothalamus
Posterior Pitutary
Pineal body

Mid Brain
(Mesencephalon) No division Tectum
Hind brain

Contd...
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Contd...

(Rhombencephalon) Metancephalon Pons

Cerebellum
Myelencephalon Medulla

Remainder of neural Tube No division Spinal cord

3 rd ventricle develops from diencephalon.

4 th ventricle develops from rhombencephalon
Anatomy

Answer : 3. Myelencephalon
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10. All the derivatives of mesonephric duct and tubules in

females EXCEPT
1. Epoophoron
2. Paroopharon
3. Gartner’s duct
4. Bartholin’s gland
Answer: is 4 i.e. Bartholin’s gland (Ref: BD Chaurasia, Lasts
Anatomy, Grays Anatomy, Platinum Notes)

Embryology of Genital tract:

Gonads Ovary Testis

Paramesonephric duct • Uterine tubes Appendix testis

or Mullerian duct • Uterus
• Cervix

Anatomy
• Hydatid of morgagni
Mesonephric “duct” Appendix vesiculosa Epididymis, ductus
or Wollfian duct Duct of Garnier deferens
Seminal vesicles
Ejaculatory ducts
Appendix epididymis
Mesonephric “tubules” Epoophoroon Efferent ductules
Paraphooron Paradidymis

Phallus Clitoris Glans penis

Urethral folds Labia minora
Genital swellings Labia majora Scrotum

Answer : 4. Bartholin’s gland

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11. Coracoid process of scapula is a _________epiphysis.

1. Pressure
2. Traction
3. Atavistic
4. Aberrant
Answer: is 3 i.e. Atavistic (Ref: BD Chaurasia, Lasts Anatomy, Grays
Anatomy, Platinum Notes)

TYPES OF EPIPHYSIS
Pressure epiphysis 1. Articular
2. Takes part in transmission of weight
EXAMPLES :
3 Head of femur
3 Lower end of Fibula
Traction epiphysis 1. Non articular
Anatomy

2. Does not take part in transmission of weight

3. Provide attachment to one or more tendons
which exert traction on epiphysis
EXAMPLES:
3 Tubercles of humerus
3 Trochanters of femur
3 Mastoid process
Atavistic epiphysis 1. Phylogenetically an independent bone which in
man becomes fused to another bone.
EXAMPLE:
3 Coracoid process of Scapula
3 Os Trigonum
Aberrant epiphysis EXAMPLES
3 Ephysis of head of first metacarpal
3 Epiphysis at the base of other metacarpal bones

Answer : 3. Atavistic
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12. The following muscles are supplied by deep peroneal nerve

EXCEPT
1. Peroneus longus
2. Tibialis anterior
3. Extensor digitorum longus
4. Extensor hallucis longus
Answer: is 1 i.e. Peroneus longus (Ref: BD Chaurasia, Lasts Anatomy,
Grays Anatomy, Platinum Notes)

Nerves of lower limb:

X Femoral nerve (posterior Anterior compartment of thigh
division of L2,L3,L4)
X Obturator nerve (anterior Medial compartment of thigh
division of L2,L3,L4)
X Tibial nerve Posterior compartment of thigh

X Common peroneal nerve
X Superficial peroneal nerve
X Deep peroneal nerve
Anatomy
Posterior compartment of leg
Short head of biceps femoris
Lateral compartment of leg
Injury causes loss of eversion of foot.
Anterior compartment of leg.
TEEP
Tibialis Anterior
Extensor Digitorum Longus
Extensor Hallicus longus.
Peroneus “Tertius”
Injury causes foot drop.

Superior gluteal nerve Gluteus minimus, gluteus medius, tensor fascia lata
(Very important) NOT Gluteus maximus .
injury Causes
loss of abduction of limb
Impairment of gait
Patient cannot keep pelvis level when standing on
one leg. Tredlenburgs sign +
Inferior gluteal nerve Gluteus maximus. Injury causes:
Weakened hip flexion
Difficulty rising from sitting position

Answer : 1. Peroneus longus

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13. Oblique popliteal ligament is an expansion of

1. Semitendinosus
2. Semimembranosus
3. Adductor magnus
4. Popliteus
Answer: is 2 i.e. Semimembranosus (Ref: BD Chaurasia)

Ligaments of knee joint

p Capsular ligament
p Coronary ligament
p Short lateral ligament
p Ligamentum patellae
p Cruciate ligaments
p Tibial collateral ligament
Anatomy

p Fibular collateral ligament

p Menisci
p Arcuate popliteal ligament
p Transverse ligaments
p Oblique popliteal ligament is an extension of
semimembranosus.

Oblique popliteal ligament passes from insertion of the

semimembranous on posteromedial aspect of tibia obliquely and
laterally upward to insertion of semimembranosus on the
posteromedial aspect of the tibia obliquely and laterally upward
toward insertion of the lateral gastrocnemius head; it acts as
important stabilizing structure on posterior aspect of knee.

Answer : 2. Semimembranosus
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14. The nerve passing between two heads of supinator is:

1. Median
2. Ulnar
3. Posterior interosseous
4. Anterior interosseous
Answer: is 3 i.e. Posterior interosseous (Ref: BD Chaurasia, Lasts
Anatomy, Grays Anatomy, Platinum Notes)

Arcade of Frohse:
æ Supinator arch
æ It is the most superior part of the superficial layer of the
supinator muscle, and is a fibrous arch over the posterior
interosseous nerve.
æ The arcade of Frohse is the most frequent site of posterior

Anatomy
interosseous nerve entrapment, and is believed to play a
role in causing progressive paralysis of the posterior
interosseous nerve, both with and without injury.

Structures pasing between/piercing:

3 Structure passing between two heads of gastrocnemius:
sural nerve
3 Structure passing between two heads of lateral pterygoid:
Maxillary artery
3 Structure passing between pronator teres: median nerve
3 Structure passing between two plains of fibers of
supinator: posterior interosseous nerve
3 Structure passing through tarsal tunnel: posterior tibial
nerve
3 Structure passing through choroid fissure of eye: hyaloids
artery
3 Structure passing through foramen of Vesalius: emissary
vein
3 Structure passing through carotid sheath: internal carotid/
common carotid artery, internal jugular vein, vagus nerve.
External carotid is External to sheath
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3 Structure piercing corocabrachialis : Musculocutaneous

nerve
3 Structure piercing clavipectoral fascia(encloses
subclavius):
lateral pectoral nerve, thoracoacromial vessels Cephalic
vein
3 Structure piercing thyrohyoid membrane: Internal
laryngeal nerve
Anatomy

Answer : 3. Posterior interosseous

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15. Quadrangular nerve is bounded by all EXCEPT

1. Surgical neck of humerus
2. Long head of triceps
3. Lateral head of triceps
4. Teres major
Answer: is 3 i.e. Lateral head of triceps (Ref: BD Chaurasia)

Quadrangular space
p Superiorly: subscapularis, Teres minor
p Inferiorly: Teres major
p Medially: long head of triceps
p Laterally: humerus
p Contents: Axillary nerve and posterior circumflex humeral
vessels.

Anatomy

Answer : 3. Lateral head of triceps

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16. All are related to mediastinal surface of right lung EXCEPT

1. Superior vena cava
2. Inferior vena cava
3. Azygous vein
4. Arch of aorta
Answer: is 4 i.e. Arch of aorta (Ref: BD Chaurasia, Lasts Anatomy,
Grays Anatomy, Platinum Notes)

Relations and impressions on Mediastinal Surface of

right lung
3 cardiac impression of right atrium and right auricle
3 small part of right ventricle
3 superior vena cava
3 azygos vein
Anatomy

3 the right side of the esophagus

3 inferior vena cava
3 the trachea and
3 right vagus nerve
3 right phrenic nerve

Relations and impressions on mediastinal surface of left lung

3 the cardiac impression of left auricle and left ventricle
3 pulmonary trunk
3 the aortic arch and descending aorta
3 thoracic duct
3 esophagus
3 left brachiocephalic vein
3 esophagus
3 left vagus
3 left phrenic nerve
3 left recurrent laryngeal nerve

Answer : 4. Arch of aorta

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