Anatomy P1

ANATOMY
QUICK REVISION NOTES

BASIC CONCEPT, TRICKS AND •• Legs together with toes in front
MAGIC OF ANATOMY
Different types of layers of body superficially to
deep: -
•• Roof :-
–– Skin
–– Superficial fascia (fat , cutaneous nerves &
vessels)
–– Deep fascia (includes collagen fibers)
•• Floor :-
1. Supine - lying on back - Cardiothoracic surgeries
–– Muscles
2. Prone - lying on abdomen - Spine or back surgeries
–– Bone
3. Lithotomy - patient lying on the back with both
Transverse dissection diagram feet supported with footrest.
•• Perineum area is exposed.
•• For
Obstetric-
gynaecological
procedures
and
Genito-
Urinary
surgeries.
Vein – thin walled & collapsing

Artery – thick walled & recoil
Nerve – no lumen, solid cord
•• All neurovascular bundle of our body have

Q
sequence as vein-artery-nerve except -
–– 1st Intercostal space
–– Popliteal fossa
4. Lateral decubitus - lie on one side of the body -
•• HILTON’S LAW: - Hilton observed that Best for ear surgeries.
nerves supplying the MUSCLE also innervate
the SKIN overlying the muscle and the JOINT
over which that muscle acts.
Position, Planes And Terminiology

Anatomical position
•• Body is erect
•• Eyes looking forward
•• Hands on side with palms directed forward
2
Cerebellum Quick Revision Notes
Planes
1. Mid-sagittal plane - Plane divides the plane into two equal halves.
2. Sagittal plane - Any plane parallel to mid-sagittal plane.
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
•• Proximal - Near to trunk.
JOINTS
Gliding:-
•• Flat surfaces of two bones glide across each other Gliding occurs between
–– Carpals
3
Anatomy
–– Articular processes of vertebrae

•• Angular movement:- movement in which there
–– Tarsals
is a change in angle
(Carpal bones mnemonic :- She Looks Too Pretty Try
a. Flexion
To Catch Her)
b. Extension
c. Adduction
d. Abduction
e. Internal rotation
f. External rotation
g. Circumduction
h. Supination
i. Pronation
j. Unlocking: Popliteal
k. Locking : Quadricops Femoris
4
l. Invertor of foot:- tibialis Anterior &

Posterior
m. Evertor of foot:- Peroneus longus & brevi •• Fusiform muscle :- biceps

•• Basic rules of muscle identification in cadaveric
images:-
2. Oblique muscle
–– Pennate
Unipennate :- 1st & 2nd lumbrical ,
Q
Palmar interosseous
Bipennate:- 3rd & 4th lumbrical, all

1. Parallel muscles dorsal interosseous
Q
•• Strap muscle fiber
–– Sternohyoid
–– Sternothyroid
–– Omohyoid
–– Longest muscle of body :- Sertorius a.k.a.
honeymoon muscle / tailor’s muscle Multipennate:- middle fiber of deltoid,
•• Strap muscle fiber with tendinous subscapularis muscle
intersections: Rectus abdominis
•• Quadrilateral muscle fiber
–– Thyrohyoid
5
Anatomy
PECTORAL REGION
Circumpennate
PECTORAL REGION
Bones of pectoral region
3. Cruciate Clavicle:-
Which crossing each other, ex:- Sternocleidomastoid,
•• It is aka collarbone / beauty bone / key bone
masseter (strongest muscle of body)
•• Clavicle parts:- medial 2/3rd & lateral 1/3rd
(Mc fracture location) < Medial 3/5th & Lateral
2/5th (GRAY'S 42nd Edition update)
•• Clavicle is the only long bone having 2
Q
ossification center
•• Clavicle is the only long bone which pierced
by the nerve – Intermediate supraclavicular
4. Twisted / spiral :- pectoralis nerve
Q
majorQ
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Scapula:-
•• Coracoid process located in infra clavicular
groove / fossa aka delto- pectoral groove
•• Above the spine of Scapula there is supraspinous
Fossa & below infraspinous Fossa.
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,
Q
responsible for winging of scapula .
•• Subclavius
•• Pectoralis minimus
•• Winging of Scapula:- In this, Medial border
•• Rectus sternalis
of Scapula elevated and person is not able to
Q
lift weight or do lifting exercises , serratus
anterior muscles responsible for this.
•• Forward movement of Scapula known as
protraction of scapula
Humerus / funny bone:-

•• Parts:- head, neck, greater & smaller tubercle
(intertubercular groove between them), Medial
& Lateral epicondyle
•• Below lesser tubercle there is Inter tubercular
sulcus aka bicipital groove (from here, long head
of biceps with his synovial sheets & ascending AXILLA (AXILLARY ARTERY)
branch of anterior circumflex artery is passing)
It is a truncated pyramidal shaped space on
•• At the Medial epicondyle, the ulnar nerve is the lateral side of the chest wall and medial
passing. to the upper end of the humerus.
7
Anatomy
Biceps - Short head is related to Coracobrachialis

muscle.
Contents of Axilla
V - Axillary Vein
A - Axillary Artery
N - Axillary Nerve
Lymph nodes - Axillary group of lymph nodes
Axillary Artery
BoundariesQ
Continuation of Subclavian artery.
1. Lateral wall - Intertubercular Sulcus, Biceps
2. Medial wall - Serratus anterior
3. Anterior wall - Pectoralis major & Pectoralis
minor
4. Floor - Skin and fascia
5. Apex - directed towards the neck
6. Posterior wall - Coracobrachialis, Teres major
& Scapula
Mnemonic : “STA, ATA, LTA → ACHA, PCHA, SSA”

KEY Muscle of Axillary region - Pectoralis Minor
Note:
Mnemonic for Branches of axillary artery which
supply to breast - SALI
S - Superior Thoracic Artery (STA)
A - Acromiothoracic Artery (ATA)
L - Lateral Thoracic Artery (LTA)
I - Internal Mammary Artery (IMA)
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Brachial Plexus anatomical relation with axillary artery).
Note-Sometime contribution from other segments

also present:
•• C4 - Pre-fixed brachial plexus
•• T2 - Post-fixed brachial plexus
•• Thickest cord of Brachial Plexus - Posterior cord
•• Thickest nerve of Brachial Plexus - Radial
nerve
About cords -
•• All posterior divisions unite to form →
Posterior Cord (Radial nerve)
•• Anterior divisions of Upper and Middle trunks
Parts of brachial plexus - (Ramu Tailor Drinks Cold
Beer)/ RTDCB → Lateral Cord (Median nerve)
•• Roots - Part of nerve attached to the spinal •• Anterior divisions of Lower trunk → Medial
cord. 5 in number → C5-C8 and T1. Cord (Ulnar nerve)
•• Trunk - 3 in numbers → Upper, Middle & Lower (Note - Main continuation of respective Cords)
Trunk.
•• Divisions - 1 anterior and 1 posterior from each Branches from Brachial Plexus
Trunk.
•• Cords - 3 in number → Medial, Lateral &
Posterior Cord (named according to the
1. Nerve from roots

•• Dorsal Scapular nerve
•• Long Thoracic nerve (aka Nerve of Bell - C5-C7 → to Serratus Anterior)
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Anatomy
2. Nerves arises from upper trunk (only

Upper Trunk gives branches) (C5-C6)
•• Nerve to Subclavius muscle
•• Suprascapular nerve
3. No Branches from Divisions

Q
4. Branches from Lateral Cord (Mnemonic

LML) (C5-C6)
•• Lateral root of Median nerve
•• Musculocutaneous nerve
Defects -
•• Lateral Pectoral nerve
•• Adducted arm - defect in Deltoid
5. Branches from Posterior Cord (Mnemonic
•• Medial Rotation of arm - defect in Teres
ULTRA)
minor
•• U - Upper subscapular nerve (C5-C7)
•• Pronated hand - defect in Biceps,
•• L - Lower subscapular nerve (C5-C7) Brachioradialis and Radial nerve weakness.
•• T - Thoracodorsal nerve (nerve to Latissimus •• Extended elbow - defect in Coracobrachialis,

dorsi) (C6-C8) Biceps, Brachioradialis.
•• R - Radial nerve (C5-T1)

•• A - Axillary nerve (C5-C7)
6. Branches from Medial Cord (Mnemonic

M4U)
•• M - Medial root of Median nerve
•• M - Medial cutaneous nerve of Arm
Aka Waiter’s/Porter’s Tip hand OR Policeman’s Tip
•• M - Medial cutaneous nerve of Forearm hand.
•• M - Medial Pectoral nerve B. KLUMPKE’s Paralysis
•• U - Ulnar nerve Causes -
•• Overstretching of Arm/Axillary area.
Clinical Integration
•• Pulling of hand during delivery.
A. ERB’s Paralysis Defects -
Injury between Head and shoulder → involve Upper Ulnar Claw hand - Ulnar nerve damage
Q
trunk (C5-C6 involve) Horner’s Syndrome - due to T1 damage
Causes -
•• Fall with a stretched arm or on shoulder.
•• Shoulder dystocia during delivery.
Erb’s point - Junction of 6 nerves

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BACK
Triangle of Auscultation
Less muscles - easily get LUNGS sounds
•• Lateral border - medial border of Scapula
•• Medial border - Trapezius
Dissection / Surgery •• Base - Latissimus dorsi
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. Latissimus Dorsi - by Thoracodorsal

nerve
3. Levator scapulae - by Dorsal Scapular

nerve
4. Rhomboid Major & Minor - by Dorsal

Scapular nerve NOTE -
Winging of scapula due to paralysis of → Serratus
anterior > Trapezius > Rhomboids
SHOULDER/SCAPULAR REGION
Muscles
Deltoid - Give rounded contour to the shoulder
Rotator Cuff (SITS) - Supraspinatus, Infraspinatus,
Q
Teres minor & Subscapularis .
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Anatomy
Bursa of the Body

Largest Bursa - Iliopsoas Bursa > Subacromial
Bursa
Uses -
•• Nerve supply of deltoid : Axillary nerve •• Act as Shock absorber.

Q
(related to Surgical neck of Humerus)
•• Provide proper joint movement.
•• Teres Minor - supplied by nerve to teres minor
(branch of Axillary Nerve → Pseudoganglion Clinical - Inflammation is called Bursitis.
present).
Subacromial Bursitis → Positive Dawbarn’s Sign
•• Teres Major - by Lower Subscapular nerve.
(Pain disappear on Abduction of arm)
Regimental Badge Anaesthesia

•• Due to injury to Axillary Nerve. (It’s posterior
branch is sensory to upper part of the lateral
arm area via cutaneous branch known as
regimental badge)
•• Cause - During Intramuscular injection or
(Mnemonic for muscles in Bicipital Groove - Lady injury at the surgical neck of the humerus.
Between the 2 Majors)
•• Subscapularis muscle (Multipennate) - Hybrid ARM
muscle → from upper and lower Subscapular
nerve.
•• Muscle least damage in Rotator Cuff injury
- Subscapularis → hence called as Forgotten
muscle of the Rotator Cuff.
•• Muscle most commonly damaged in Rotator
Q
Cuff injury - supraspinatus
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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
Nerve Site of injury Muscles Clinical

Affected Features
Axillary Surgical neck Deltoid - Regimental
of Humerus Teres minor batch
anaesthesia
- 0-90 degree
Abduction
weakness
- Loss of
rounded
contour of
shoulder
- medially
rotated arm
13
Anatomy
Supracondylar humerus Fracture

Radial Artery damage → Volksmann’s Ischaemia → Gun Stock deformity
FOREARM
A. Anterior Compartment A.1. Superficial Muscles:

1. Pronator teres (PT)
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.
Nerve supply : All are supplied by the Median nerve
Q
(Labourer nerve) except Flexor carpi ulnaris .
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A.2. Deep Muscles: B. Posterior Compartment

1. Quadratus pronator (QP) B.1. Superficial Group
2. Flexor digitorum profundus (FDP) (Hybrid
1. Anconeus → responsible
Muscle) → give rise to Lumbricals
for screwing movement
3. Flexor pollicis longus (FPL) 2. Brachioradialis → end at Direct branch from
Nerve supply : (All supplied by Anterior Interosseus styloid process of radius Radial nerve
nerve (Deep branch of Median nerve) except medial 3. Extensor carpi radialis
½ of FDP (supplied by ulnar nerve)
Q
longus (ECRL)
4. Extensor carpi radialis
brevis (ECRB)
by Posterior interosseous
5. Extensor Digitorum (ED)
nerve (PIN) (deep) Branch
6. Extensor digit minimi
of radial nerve
(EDM)
7. Extensor Carpi Ulnaris
B.2. Deep Group

•• Supplied by Posterior interosseous nerve (PIN)
1. Abductor pollicis brevis

(AbPL)
2. Extensor Pollicis Brevis Boundaries of anatomical
(EPB) snuff box
3. Extensor Pollicis longus
(EPL)
4. Supinator → pierce by posterior interosseous nerve
5. Extensor Indicis
•• About FDP - Hybrid muscle

•• Medial half - Ulnar nerve
•• Lateral half - Anterior Interosseous nerve >
Median nerve
Cubital Fossa
•• Triangular, muscular depression in front of the
elbow.
Importance of cubital fossa -
1. Measurement of Blood Pressure
2. Biceps jerk reflex
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Anatomy
3. Intravenous injection site •• Base - Imaginary line joining Medial and Lateral
epicondyle.
•• Roof - Skin, superficial and Deep fascia.
Content (medial to lateral → MBBR)Q

1. Median nerve
2. Brachial artery
3. Bicipital aponeurosis
4. Radial nerve (Superficial nerve) → emerges
between Brachioradialis & Pronator teres.
Floor of Cubital Fossa (BSF)Q

B - Brachialis
BoundariesQ
•• Lateral - medial border of Brachioradialis. S - Supinator
•• Medial - lateral border of Pronator teres. F - Floor
•• Apex - meeting point of Pronator teres and

Brachioradialis. 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
•• Most common site - Medial half
•• Most common finger - Ring finger
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Anat - FMT Integration Palmar interosseiQ

Wrist Cut Injury •• Unipennate - 4/3 in number → by Ulnar nerve
Structure cut - all 5 structures above Flexor •• Function - Adduction of fingers
Retinaculum
•• Middle finger has no Palmar interossei
1. Palmaris longus tendon
•• Test - Card test
2. Ulnar nerve and artery
3. Palmar cutaneous branch of ulnar nerve and Dorsal interosseiQ
flexor retinaculum •• Bipennate - 4 in number → by Ulnar nerve
4. Palmar cutaneous branch of median nerve •• Function - Abduction of fingers
5. Palmar aponeurosis •• 2 Dorsal interossei in Middle finger
In case of suicidal cut injury Hesitation Marks/ •• Test - Egawa test
Tentative Marks.
Lumbricals
ARTERIES & VEINS OF UPPER

LIMB
Artery of upper limb
Branches of arch of Aorta (BSC)
•• 1st and 2nd Lumbricals - Unipennate → Median B - Brachiocephalic artery (Right) → give Right
Nerve. Subclavian and common carotid artery.
•• 3rd and 4th Lumbricals - Bipennate → Ulnar S - Subclavian artery (Left) → make Axillary artery
nerve.
C - Common carotid artery (Left)
•• Function - Flexion at metacarpophalangeal
Q
Joints extension at Interphalangeal Joints .
•• Test → Pen holding position (Babaji ka thullu
position)
•• Complete Claw hand → injury of both Ulnar
and Median nerve.
Palmar & Dorsal Interossei
Subclavian artery branches : (VITamin CD)

Q
17
Anatomy
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)
Reverse Allen’s test

•• Instead of Ulnar artery, release Radial artery.
(for patency of Deep arch)
Veins of Upper limb
•• Main artery of the thumb - Princeps pollicis Important veins of Upper limb
artery 1. Dorsal venous arch
•• Main artery of Index fingers - Radialis indicis 2. Cephalic vein
3. Basilic vein
Allen’s testQ
4. Medial cubital vein (Antecubital vein) → Best vein
•• Make a fist → pallor occur → compress both for Intravenous Infusion (as Fixed and easily
radial and ulnar artery → open the fist → seen)
Release Ulnar artery 1st →
5. Median vein of forearm
•• If redness, then ulnar artery patency is present.
(for patency of Superficial arch)
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NERVE OF UPPER LIMB Dermatomes of hand

•• Sensory branch supplying the Lateral 3 & half
1. Median nerve :-
of Palmar & dorsal side(known as eye of hand)
•• Have nerve root of C5 to T1 ( C5, C6, C7 :- and nail beds
Lateral root, C8, T1 :- medial root)
•• Motor branch supplies 5 muscles of hand :- all
•• This nerve gives no branch in the arm 3 thenar muscles except adductor pollicis & 1st
•• Then this nerve passes in between the two & 2nd lumbrical
head of pronator teres Muscle (pronator teres –– Different signs of medial nerve injury:-
syndrome - if this nerve compress here) (CAP-BPT)
•• In forearm it is divided into Superficial branch C:- Carpal tunnel syndrome
& deep branch (aka anterior interosseous
A:- Ape thumb deformity
nerve)
P:- Pointing index/ Oschner’s class test
•• Deep branch supply all deep flexor Muscle
(flexor pollicis longus, pronator quadratus & B:- Benediction hand / pope hand deformity
medial Half of flexor digitorum profundus) P:- Phalen’s sign
•• At the wrist joint the superficial branch T:- Tinel sign
passes through the carpal tunnel below the
flexor retinaculum. Here injury to this nerve OK sign:- AIN > median
known as carpal tunnel syndrome (commonly
seen with connective tissue disorder as RA,
myxoedema and computer worker)
19
Anatomy
Treatment of tunnel syndrome •• At the wrist, it passes through Guyon’s

tunnel:- Compression here known as Guyon
•• Exercise Q
canal syndrome .
•• Multivitamins
•• Sensory branch Supplies medial 1½ of palm &
•• Painkiller - NSAIDs medial 2½ of dorsal hand.
•• Steroid •• Motor branch supplies all hypothenar muscles
•• Surgery & one thenar muscle [adductor pollicis] (aka
graveyard of Ulnar nerve), all Palmar & dorsal
2. Ulnar nerve - Q
interossei .
•• It is the branch of the medial cord of brachial
Ulnar nerve Tests (ABCDEFGH)
plexus, nerve root is C7, C8 & T1.
•• A:- A/Ulnar nerve
•• Runs medially to the axillary artery in the •• B:- Book test
axilla.
•• C:- Card test (positive in Palmar interossei
•• Passes through medial epicondyle. damage)
•• Ulnar nerve getting thickened in leprosy •• D:- aDDuctor pollicis test

behind medial epicondyle. •• E:- Egawa test( positive in dorsal interossei
damage)
•• The nerve passes through 2 heads of flexor
carpi ulnaris (here compression of nerve known •• F:- Froment test
as cubital tunnel syndrome) & supplied FCU & •• G:- Guyon’s tunnel syndrome
Q
medial ½ of flexor digitorum profundus .
•• H:- Handlebar palsy
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NERVE OF UPPER LIMB - 2 –– Anconeus

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

roots make 1 Posterior cord which continue as –– Elbow joint
a radial nerve. •• At forearm radial nerve divides into
•• This nerve passes behind the humerus through –– Superficial branch:- runs towards wrist
radial groove & coming in front at cubital fossa. and makes roof of Anatomical snuff box &
gives cutaneous branches to the lateral 2½
•• It will give rise to 3 branches Above radial dorsum of hand except nail beds.
groove or axilla :- (LMP)
–– Deep branch/ PIN:- pierces supinator
–– Long head of triceps muscle
–– Medial head of triceps
Clinical
–– posterior cutaneous nerve of arm
•• Crutch palsy
•• Gives 5 branches (3 muscular) in radial groove
(spiral groove):- (MLA) –– If fracture at axilla (loss of extension of
elbow, wrist and fingers)
–– Medial head of triceps
–– Lateral head of triceps
–– if fracture at spiral groove (loss of extension at wrist and fingers )

–– if fracture below radial groove (loss of extension of fingers)
•• Saturday night palsy
•• Wrist drop
•• Finger drop
•• Honeymoon palsy
21
Anatomy
Anatomical snuff box –– 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
•• Boundaries:- of this, we can perform a finkelstein test.
–– Lateral/anterior border:- abductor pollicis
longus & extensor pollicis brevis
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ANTERIOR COMPARTMENT OF
THIGH
Bones of Lower limb
PSM-Anat-Pedia Integration
•• Vastus Lateralis - site for Intramuscular
injection during Vaccination.
•• Nerve of anterior compartment - Femoral

nerve
•• All nerves by Posterior divisions of femoral
nerve except
–– SARTORIUS - Anterior division of femoral
nerve
•• Aka Tailor’s or Palthi muscle
•• Movements - Flexion at knee and hip +
Abduction & lateral rotation of thigh.
•• Also Abduction of hip →opens perineum
area for sexual intercourse → hence, aka
Honeymoon muscle.
–– Footballer’s Muscle or Kick muscle or
Locking muscle
–– Extension at knee → Quadriceps Femoris
•• Most common dislocation of hip joint - Posterior

•• Therefore, Most common nerve affected is
the Sciatic nerve.
•• Great saphenous vein - Pierces the Cribriform

fascia by making an opening called as saphenous
opening and receive 3 tributaries:
23
Anatomy
1. Superficial external pudendal vein •• Femoral Ring → Uppermost part of femoral

canal.
2. Superficial epigastric vein
•• Femoral fossa - Depression over Femoral
3. Superficial circumflex iliac vein
septa (Fat over the Femoral canal).
•• Skin over the femoral triangle is supplied by
- 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 Hernia
1. Wider pelvis
2. Smaller vessels
•• Femoral hernia reduction - By Cutting of
Lacunar ligament.
Femoral Triangle B. Inguinal Hernia → more common in males.
•• Triangular Muscular depression below inguinal
•• External Obliques modifications:
ligament.
(Mnemonic - LIP)
•• Floor (Mnemonic - APPI) - Adductor longus,
1. Lacunar Ligament
Pectineus, Psoas major tendon & Iliacus.
2. Inguinal Ligament
•• Lateral boundary - Medial border of
sartorius 3. Pectineal Ligament
•• Medial boundary - Medial border of Adductor MEDIAL & POSTERIOR

longus COMPARTMENTS OF THIGH
Content - (Medial to Lateral → VAN)
Medial Compartment
V - Femoral vein •• Muscles - Adductor muscles →Adduction of
A - Femoral artery thigh
•• All are Supplied by → Obturator Nerve
N - Femoral nerve
•• 5 muscles : Mnemonic for adductors - LBW/M
•• Femoral sheath - Deep fascia modification
1. Adductor longus
around femoral vessels.
2. Adductor brevis
–– Contents : Femoral vein, artery and
3. Adductor magnus → also by Sciatic nerve [Ischial
Lymph nodes (Not Femoral Nerve). Q
Head] (Hybrid muscle) .
•• Femoral canal → medial most part of 4. Pectineus → also by femoral nerve (Hybrid
Femoral sheath (contain Deep Inguinal Lymph muscle).
node- → aka Lymph nodes of Rossenmuller 5. Gracilis
and Cloquet).
24
FMT-Anatomy Integration
Q
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.
Gluteal Region
Muscles:
1. Gluteus maximus
2. Gluteus medius Anat-Medicine-Paedia- Ortho Integration
3. Gluteus minimus •• Duchenne Muscular Dystrophy: GOVER’S SIGN
4. Piriformis → Key muscle of Gluteal region
5. Obturator internus - related with 2 gamelli
Superior gamelli
Inferior gemelli
6. Quadratus femoris
•• Gluteus Maximus •• Defect in Gluteus Muscle (Paralysis)

•• Origin - Posterior gluteal line, Area behind •• Nerve involve - Inferior Gluteal nerve
posterior gluteal line, outer lip of the iliac
crest & adjacent surface of sacrum/coccyx. Anat-Ortho
•• Insertion - Into Gluteal tuberosity (¼th) & IntegrationQ
Ilio-tibial tract (¾th). Trendlenberg’s Sign:
Normal = During elevation
•• Movement - Chief extensor of Hip joint → help of one limb → Gluteus
from sitting to standing position. medius, minimus & Tensor
fascia lata of opposite side
•• Nerve - Inferior Gluteal nerve contract → Pulling/Elevate
•• Gluteus medius and minimus the opposite side
ASIS/Pelvis → Preventing
•• Nerve supply : Superior gluteal nerve Sagging of Pelvis.
•• Movement - Abduction of the hip joint. 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 -
Waddling gait
25
Anatomy
BACK OF THIGH & POPLITEAL •• Lower part of ischial tuberosity divides by

FOSSA longitudinal ridge into inferolateral {gives origin
to add Magnus (ischial head)} & intermedial
All back of thigh muscles are having same
part (known as ischial bursa).
•• Origin (from ischial tuberosity)
•• Ischial bursitis is known as weaver’s bottom.
•• Insertion (at bone of leg)
•• Nerve supply (sciatic nerve)
•• Action (runner’s action)
–– Extension at hip
–– Flexion at knee
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.
26
•• Boundaries of popliteal fossa:- •• Iliohypogastric & ilioinguinal L1: situated at

the posterior surface of kidney.
–– Supero-lateral - biceps femoris
–– Supero-medial - semitendinosus & semi •• Cremaster reflex (Genito femoral nerve L1
membranes L2 is involved) - when we scratch at Inner
part of thigh then due to this reflex, testis
–– Infero-lateral - lateral head of gastroc-
nemius elevated.
–– Infero-medial - medial head of gastroc- •• Compression of Lateral cutaneous nerve of the

nemius (ossification of bone here known as thigh causes abnormal sensation characterized
Fabella) by tingling, numbness and burning pain in the
•• Content of popliteal fossa (medial to lateral outer part of the thigh as known as Meralgia
- Artery → vein → nerve (AVN) paresthetica.
–– Tibial nerve •• Obturator nerve have root value of L 234
–– Common peroneal nerve ventral division
–– Popliteal vein
–– Popliteal artery
–– Popliteal lymph nodes
NERVES OF LOWER LIMB

ANATOMY
Lumbar plexus
27
Anatomy
1. Femoral nerve
•• Longest cutaneous nerve of the body is the Saphenous nerve.

2. Obturator nerve 3. Sciatic nerve
28
Bumper’s fracture
•• Superior Gluteal Nerve (SGN L4,L5,S1)

supplies to gluteus medius, minimus and
tensor fascia lata(damage leads to positive
Q
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
Q
NERVE . LEG COMPARTMENT
•• Superficial peroneal nerve at Lateral
compartment of leg.
Foot Drop
Transverse Section Of Leg

1. Anterior compartment of leg
29
Anatomy
•• 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. Posterior compartment:-
•• Superficial group - have gastrocnemius, soleus
(helping in cardiac output so it is aka Peripheral
Q
heart), plantaris “(GSP) ”
•• Plantaris & palmaris longus both use in tendon
grafting operations.
•• In lateral compartment of leg :- Peroneus

longus & Peroneus brevis both innervated by
Q
SPN
•• Deep structures of this compartment - Tibialis

Posterior, flexor digitorum longus, Posterior
Tibial artery, Tibial nerve, flexor hallucis
longus.
30
FOOT ANATOMY
Q
–– mnemonic : Tom Dick And Nervous Harry
–– Tom - Tibialis posterior
Arches of Foot
–– Dick- Digitorum longus
–– And - Artery (Posterior tibial artery)
–– Nervous- nerve (Tibial nerve)
–– Harry - Hallucis longus
•• Achilles tendon - The strongest Tendon of
body
•• Largest bone of foot - calcaneus
–– Gastrocnemius (lateral & medial head) +

Soleus = Achilles tendon
–– Ankle jerk reflex has root value S1 & S2.
NOTE:-
•• Medial compartment: is absent but at upper
part 3 muscles insertion present :
•• Contains Sartorius, gracilis, semitendinosus
and Tibial collateral ligament
•• Radiology integration:
•• Inversion and eversion of foot occurs at the

subtalar joint.
•• Upper part of calcaneus which support the
talus known as sustentaculum tali.
31
Anatomy
•• Talo calcaneo-navicular is ball & socket joint.
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:
Clubfoot aka CTEV

•• Most common congenital abnormality in the
world.
–– Talipes
–– Equino
–– Varus
•• Presentation – CAVE:-
–– Cavus
–– Adductus
•• Deltoid ligament’s1upper end is attached to
–– Varus Q
the medial malleolus .
–– Equinus •• This ligament has Superficial & deep fibers.
•• Calcaneo-navicular ligament is aka spring
ligament.
32
•• Clinical:-
–– Smoking leads to atherosclerosis, gangrene,
thromboangiitis obliterans or buerger’s
disease.
–– Palpable arteries of LL:-
Femoral Artery - at head of femur
Popliteal Artery - lower border of
Popleteus
ATA- between 2 malleoli
PTA- behind medial malleolus
DPA- palpable against navicular bone
–– Venous drainage of lower limb:-
ARTERIES AND VEINS OF •• Lower limb vein damage can lead to deep venous
LOWER LIMB ANATOMY thrombosis
Arteries of lower limb

Vascular sign of Narath
33
Anatomy
Clinical HEAD, NECK AND FACE

•• Phlebotomy :- cutting the vein
Scalp & Face
•• Hemochromatosis :- excessive iron
Q
•• Sural nerve having S1 nerve root
•• Medial part of leg and foot have L4 dermatome
•• GSV used for bypass surgery in 40 – 50% MI
blockage , now a days we use internal mammary
Q
artery (radial & ulnar vein also)
34
5 Layers of scalp Dissection of face

1. Skin 1. Skin
2. Connective tissue
2. Superficial Fascia
3. Aponeurosis
3. Deep Fascia -nt but only present in buccopharyngeal
4. Loose areolar connective tissue
fascia & parotido-masseteric fascia (In all other
5. Pericranium part of face, thorax and abdomen Deep Fascia is
absent)
Clinical 4. Subcutaneous Muscles (in animal it is known as
•• Loose areolar connective tissue layer is panniculus carnosus)
Dangerous area of scalp
•• Remnants of this panniculus carnosus are -
•• Surgical layers of scalp
face muscle, Palmaris Brevis, dartos muscle,
•• Black eye cutis ani.
•• Cephalhematoma
Q
•• 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
•• Caput succedaneum (Risk factor - vacuum
delivery) •• Grief muscle - Depressor labii inferioris
•• 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
Q
Palpebrae Superioris : by 3rd cranial nerve)
35
Anatomy
Superior Thyroid artery
2 posterior branches
Occipital artery
Posterior auricular artery
2 terminal branches
Superficial Temporal artery (Clinical:-
Temporal arteritis) → give 1 branch:-
Transverse Facial artery
Maxillary artery
Branches of facial artery

•• Inferior labial artery
•• Bell’s palsy - Loss of Wrinkling, Wide palpebral
•• Superior labial artery
fissure, Whistling loss, loss of nasolabial fold
and drooling of saliva. •• Lateral Nasal artery
•• Angular artery → anastomoses with dorsal
Nasal artery which is the branch of Ophthalmic
artery
VESSELS & NERVES OF FACE •• Strongest muscle of the body :- Masseter

muscle
Face •• Facial artery palpable along lower margin of
mandible, in front of masseter attachment
•• Common Carotid artery branches;- divides into
ECA & ICA
Dangerous area of face
External Carotid artery (ECA)
1 medial branch:
•• Ascending pharyngeal artery (APA) → is the
only medial branch
•• It is smallest branch of ECA
It is also the 1st branch from ECA.
3 anterior branches:
Lingual artery
Facial artery
36
•• Lower part of nose & upper lip = known as Exception: Angle of mandible supplied by greater
Dangerous area of the face auricular nerve
•• Deep Facial vein uniting with the veins of •• Cutaneous lesions of herpes zoster
pterygoid plexus
ophthalmicus:- spreads along nerve roots
•• 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 →
emissary veins → Cavernous sinus → death
Trigeminal neuralgia
Carbamazepine > valproate , Gabapentin > Surgery
NECK
Dissection / Surgery integration
•• Skin
•• Superficial Fascia (with platysma)
•• Deep Fascia (deep cervical fascia have 6
Maxillofacial death pyramid
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
Q
axillary sheath .
3. Pretracheal fascia :- form false capsule of
thyroid gland and suspensory ligament of

Q
berry .
4. Bucco- pharyngeal fascia
Nerves of face
5. Pharyngobasilar fascia
•• Motor :- 7th Cranial nerve except LPS ( by 3rd
Cranial nerve) •• Carotid sheath - Contain 9th, 10th, 11th and
Q
•• Sensory :- 5th nerve ( V1, V2, V3) 12th CN

–– Have 2 walls - Anterior (pretracheal
fascia), Posterior (prevertebral fascia &
have sympathetic trunk)
–– Ansa cervicalis - loop of the nerve in neck
Q
(present in anterior wall
37
Anatomy
•• Digastric muscle have dual nerve supply -

Anterior branch of digastric muscle supplied
by V3 & post branch supplied by 7th CN , so it’s
Q
the only hybrid muscle of the neck .
•• Sternocleidomastoids divides neck into 2
triangles -
A. Anterior triangle of neck (by 2 muscles -

Digastric & Superior belly of Omohyoid)
It is divided into 4 sub triangles
Muscles of neck
38
1. Submandibular or digastric triangle - Contain B. Supraclavicular/ subclavian triangle :

submandibular gland
2. Carotid triangle :- contain Carotid sheath,
3. Submental triangle :- contain submental LN
4. Muscular triangle:- contain different strap
muscles (sternothyroid, sternohyoid , omohyoid
, thyrohyoid) - these all have parallel muscle
fibers & all supplied by ansa cervicalis except
thyrohyoid which is supplied by C1 root.
B. Posterior triangle of neck :-

•• Anterior border - SCM
•• Posterior border - trapezius
•• Floor by middle 1/3rd of Clavicle
CRANIAL CAVITY, NERVE, VESSELS
•• By inferior belly of omohyoid it is divided into
2 sub triangles : CCranial cavity divided into 3 parts -
a. Occipital triangle 1. Anterior cranial fossa
b. Supraclavicular / subclavian triangle 2. Middle cranial fossa
3. Posterior cranial fossa
•• CSF rhinorrhea - occur via cribriform plate

after damage of the latter.
A. Occipital triangle : •• Sella turcica/ Turkish saddle
Q
is a part of
the body of a sphenoid.
Main contents
NOTE - Mnemonic for foramina
1. Main Nerve of auricular:- Greater auricular
nerve ( C2,C3) - it is related with Frey’s Important structures & foramen from midline to
Q
syndrome and have 2 divisions - lateral
•• Anterior division - Supply angle of mandible or •• King - Pituitary
shaving area ;
•• Queen (Shy) - Foramen Lacerum
•• Posterior division - Supply auricle
•• R - Foramen Rotundum - Maxillary Nerve
2. Nerve supply of Sternocleidomastoid &
Q •• O - Foramen Ovale (MALE)
trapezius - 11th CN (Spinal root)
•• Se - Foramen Spinosum (MEN)
39
Anatomy
Foramen Ovale (MALE)

Q
Foramen Spinosum (MEN)
Q damage to Nasal fibres of Optic Chiasma mainly
→ Bitemporal Hemianopia →Tubular Vision.
•• Mandibular •• Middle meningeal
•• Accessory meningeal artery, •• Middle Meningeal artery rupture can lead to
artery, •• Emissary vein (+/-) extradural hemorrhage - biconcave/idly/ lens
shape opacity.
•• Lesser Petrosal nerve, •• Nervi spinosum
•• Emissary vein
Foramen Jugulare Foramen magnum

•• Cranial nerves 9th, •• Largest foramen of
10th & 11th pass skull
through this. •• For Spinal cord and
other associated
structures.
•• Hardest bone of the skull - Petrous part of

temporal bone / Bony labyrinth
•• Optic canal : II CN & ophthalmic artery
•• From Superior Orbital Fissure - 3rd, 4th, 6th
and V1 cranial nerves passes.
•• Content of Dorello’s Canal - 6th Cranial nerve.
•• Internal Acoustic Meatus - 7th & 8th nerve
pass via this.
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.
Clinical correlation:-
•• Pituitary Tumor → Damage to Optic Chiasma →
40
Dural venous sinuses

41
Anatomy
Cavernous sinus LARYNX, PHARYNX NOSE &

PALATE
Formula for HNF Cadaveric section

C T M V
Cavernous sinus thrombosis : S H P O
Ophthalmoplegia:
F P M T
Cricopharyngeal junction
•• located at level of C6
•• it is the narrowest part of GIT
•• Here the pharynx ends & esophagus starts.
•• Here the larynx ends & the trachea starts.
Pharynx
Upper part of Oesophagus
•• In case of increased intracranial pressure /
Boundaries:-
head injury :- Most common CN damage is 6th
Cranial nerve. •• Nasopharynx:- Anterior - Nasal cavity ,
Superior - Base of skull, Posterior - C1, Inferior
•• Central part of Pterion → k/a Sylvian point → - Oropharynx
Cranium is very thin here (CRANIOTOMY) →
deep to it Middle meningeal vessels lies → so •• Oropharynx:- Anterior - oral cavity, Superior
ruptures easily → results in EDH
Q
– Nasopharynx, Posterior - C2,C3,
Inferior – Laryngopharynx
•• Laryngopharynx:- Anterior - larynx, Superior
– Oropharynx,Posterior - C4-C6, Inferior –
esophagus
42
PARASYMPATHETIC GANGLION Basic concept of head & neck ganglion

Nucleus, ganglion & pseudoganglion •• 4 ganglion
Q
–– Ciliary ganglion - Eye - III CN
Q
–– Otic ganglion - Parotid gland - IX CN
–– Submandibular ganglion – Submandibular &
Sublingual gland - VII CN
–– Pterygopalatine ganglion – Lacrimal, Nasal
and Palatine gland - VII CN
•• 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
•• Collection of many cell bodies within the CNS
its branch. 5th nerve is the anatomical/
is known as nucleus & outside the CNS is known structural & topographical nerve of all
as ganglion. ganglions.
•• Fibers before the ganglion are known as –– Motor or Parasympathetic - Secretomotor
preganglionic fibers & after it are known as pathway of different glands.
post ganglion fibers. –– Sympathetic - from T1
•• Pseudoganglion is a collection of fat & connective 1. Ciliary ganglion:-
tissue, no nerve elements are present but it
•• It is a parasympathetic Ganglion which is
appears like ganglion. It is present in the nerve
related to 3rd CN
to teres minor which is a branch of axillary
nerve & in the radial nerve too .
Q
•• Size - pin head size
43
Anatomy
•• It is present between the 2nd CN & Lateral 2. Otic ganglion:-

Rectus muscle.
•• Every Cranial nerve has 2 relations :-

Anatomical/structural/ topographical (5th CN)
& physiological (3rd CN)
•• Parasympathetic action of ciliary ganglion:-
–– 3rd CN is running to the Lateral wall of

Cavernous sinus & in its apex, it is divided
into superior & inferior division .
–– It passes through superior orbital fissure,

here superior division gives branches to
Superior rectus muscle & Levator palpebrae
superioris.
–– Inferior division supplies Medial rectus,

Inferior rectus & Inferior oblique muscle
and ends into ciliary ganglion.
–– from ciliary ganglion Short ciliary nerves

arise, which supply to constrictor pupillae.
44
3. Submandibular ganglion:-
•• Secretomotor pathway of Submandibular & tympani → join to lingual nerve → Relay

sublingual gland:- Submandibular glanlion → Post ganglionic
fibres arises→join to Submandibular gland
–– Tasty food → activate Superior Salivatory
→ secretion
nucleus → impulse go to 7th nerve → chorda
45
Anatomy
•• Secretomotor pathway of lacrimal, Nasal Foetus - Spinal cord ending at the L3 vertebrae.
and Palatine ganglion. Filum terminale - Extension of pia mater from conus
–– Superior salivatory nucleus → 7th Cranial medullaris up to the coccyx. It has 2 parts namely
nerve → Greater Superficial Petrosal nerve F.T. Internal (15 cm) and F.T. External (5 cm).
→ In pterygoid canal/ vidian’s canal → it
joins with Deep Petrosal nerve (T1 ) to form Structures ending at S2 level
vidian’s nerve → vidian’s nerve in pterygoid 1. Arachnoid mater
canal join to V2 and relay into sphenopalatine 2. Dura mater
ganglion → further communicating maxillary
nerve, zygomatic nerve → impulse reaches 3. Subarachnoid space
to zygomatico-temporal nerve → join to
Lacrimal nerve & supply Lacrimal gland → At L3-L4 junction-
Lacrimation
Q
1. Lumbar puncture done
–– Cutting vidian’s nerve known as vidian’s 2. Iliac crest level

neurectomy 3. Location of Umbilicus
Spinal Cord Adult Child

Spinal cord L1 (Middle > lower L3-L4 junction
Nervous System ending border) > L1-L2
A. Central nervous system → Brain, Brain stem junction
& Spinal cord. Lumbar L3-L4 junction L4-L5 junction
B. Peripheral nervous system → Somatic & puncture
Autonomic nervous system. level
Autonomic nervous system Anat-Peds-Anesthesia Integration

1. Sympathetic - from thoraco-lumbar part.
Activate during fight, flight and fright. Lumbar puncture → done from Lumbar Cistern at
L3-L4 junction (Best).
2. Parasympathetic - from cranio-sacral spinal
cord. Structures pierced during L.P. :
3. Enteric nervous system → from neural crest Mnemonic :
cells → brain of Gut.
3 S ILE DAS
Brain stem → Midbrain, Pons & Medulla.
•• Skin
•• Superficial fascia
Spinal cord •• Supraspinous ligament
•• Downward cord like extension from medulla •• Interspinous ligament
oblongata. •• Ligamentum flavum
•• 2 enlargements - at Cervical (gives Brachial •• Epidural space

Plexus) and Lumbar (gives Lumbar Plexus). •• Dura mater
•• Arachnoid
•• Terminal enlargement known as Conus
•• Subarachnoid
medullaris.
space containing
•• 31 pairs (C8 T12 L5 S5 Co1) of Spinal nerves cerebrospinal fluid
which give a tail-like appearance after
termination of the spinal cord called the Cauda
equina.
Adult - Spinal cord ending at the middle of the L1
Q
vertebrae > L1 lower border> L1 L2 Junction
46
Transverse section of spinal cord 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
–– Outside CNS (After spinal cord) - Ganglion
Mnemonic - SAME
•• Area around central canal – Nissl’s granules → •• SA - Sensory/Afferent/Ascending

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

–– Function - Pain & Temperature → Inhibited Pyramidal tracts (Cortico-spinal tract) →
by Morphine Decussate and form
C - Clark nucleus & Chief sensory nucleus 1. Lateral cortico-spinal tract
In - Interneuron 2. Medial cortico-spinal tract
R - Ranchow cells
Extra Pyramidal tracts:(ROVT)
A - Alpha motor neuron
1. Rubro-spinal tract
G - Gamma motor neuron
2. Olivaro-spinal tract
•• White matter also having 3 parts 3. Vestibulospinal tract
A. Posterior white column 4. Tectospinal tract
B. Lateral white column

C. Anterior white column
47
Anatomy
Anat-Physio-Medicine Integration Descending Tracts:

Brown Sequard Syndrome: Hemi-sectioning of Pyramidal tract
Q
spinal cord
•• 80% decussate at Medulla oblongata, called
•• I/L loss of Fine touch the Lateral Corticospinal tract.
•• C/L loss of Pain & Temperature •• 20% - Don't cross and pass anteriorly, called
•• I/L loss of Position sense the Anterior Corticospinal tract.
•• I/L motor paralysis •• Start from Area number 4 (Motor area) called
Q Pyramidal cells of Betz.
Syringomyelia: Dilatation of Central canal
•• Form Corona radiata after leaving Cortex of
•• Abnormal dilatation → Lateral spinothalamic
cerebrum.
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.
48
•• Passing through the Posterior limb of the

Internal Capsule.
Anat-Physio-Medicine Integration
Tabes Dorsalis morphology:
(Mnemonic DORSALIS)
•• Fasciculus gracilis and
•• Fasciculus cuneatus damage.
•• Dorsal column degeneration
•• Orthopaedic pain (Charcot joints)
•• Reflexes decreased (deep tendon)
•• Shooting pain
•• Argyll-Robertson pupils
•• Locomotor ataxia
•• Impaired proprioception
•• Syphilis
•• Medulla is a truncated bulb-like structure.

(Medulla = Bulb)
•• Hence medullary paralysis means Bulbar
paralysis .
•• At Medulla , 9th, 10th, 11th and 12th Cranial
nerve attached → so Medullary paralysis =
Bulbar paralysis = IX , X, XI, XII paralysis
•• At pontomedullary junction - 6th , 7th, 8th
BRAIN STEM cranial nerve .
•• 7th cranial nerve has 2 divisions:
Brain stem is divided into 3 parts:
a. Medial division : motor
1. Medulla
b. Sensory division : lateral
2. Pons
•• Sensory division of 7th CN is known as the
3. Midbrain 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),
49
Anatomy
•• V CN ganglion is covered with a fold of dura located. So lesions in this area lead to death.
mater known as meckle’s cave.
•• In hanging, fracture of the odontoid process
•• Above Pons there is crus cerebri → medial to leads to compression of these vital centres
it, 3rd cranial nerve attached and 4th cranial which results in death. (ANAT- FMT
nerve attached posteriorly. Integration)
•• 1st & 2nd CN are attached on the inferior •• In the floor of IV ventricle, Area Postrema is
surface of the frontal lobe. located. This area lacks a Blood Brain Barrier.
Just below it , there is a chemoreceptor
Clinical Integration trigger zone which functions as a vomiting
Q
center. (ANAT- PHARMA Integration)
Clinical Integration :
•• 4 important facts about 4th cranial nerve:
•• In Medial medullary syndrome / Dejerine
Q
“DDLT” (Dilwale Dulhania Le Thahrenge)
syndrome – midline part of medulla is damaged
–– D:- Dorsal attachment
→ hence 12th CN damage à ipsilateral tongue
Q
deviation is seen . –– D:- Decussates
•• In Lateral medullary syndrome/ PICA –– L:- Longest intracranial nerve

syndrome / Wallenberg syndrome / Vertebral –– T:- Thinnest cranial nerve, because it has
artery syndrome → Lateral part of medulla the least axons → hence it is considered as
is damagedà laterally 10th nerve is located the smallest cranial nerve.
hence 10th cranial nerve damage → palatal &
Q
pharyngeal reflexes lost . (Anat-Pharma-Medicine Integration)
Pineal gland/ 3rd eye of lord Shiva

•• Here tryptophan converts → to 5- HT /
serotonin → N-acetyl serotonin → Melatonin.
•• Facial colliculus lesion : 7th cranial nerve
•• Melatonin responsible for biological clock
fibres > 6th cranial nerve nucleus damage. activity.
•• Damage at floor of 4th Ventricle leads to •• So, it can be used for treatment of disturbed
damage of 6th, 7th, 8th, 10th & 12th cranial biological clock activity like sleep. Eg.
nerves. a. Day night shift workers
•• At the floor of IV ventricle vital centres like b. treatment of jet lag effect
Cardiac centre & Respiratory centre are
c. insomnia
50
•• Substantia nigra :- Here dopamine synthesis –– Decrease in dopamine → leads to increase

occurs. relative level of Ach → leads to hypertonia,
rigidity, resting tremor, hypokinesia,
–– Phenylalanine → Tyrosine → Dopa shuffling gait, pill rolling movement, mask
→ Dopamine. (ANAT-BIOCHEM like face etc. This clinical situation is known
INTEGRATION) as Parkinsonism / Paralytic agitans.
–– Dopamine is an inhibitory neurotransmitter

and responsible for muscle tone.
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

51
Anatomy
Brain stem syndrome •• 3 - 3 Anatomical lobe, 3 physiological lobe, 3

phylogenetic lobe, 3 fissures , 3 cerebellar
•• Medullary syndrome peduncles and 3 histological layers.
–– Lateral Medullary syndrome - 9, 10 & 11 CN •• 4 - 4 nuclei
damage
•• 5 - 5 neurons
–– Medial Medullary syndrome - 12th CN
damage :- I/L deviation of tongue
•• Pontine syndrome:-
–– Facial colliculus syndrome:- damage to 6th,
7th CN
–– Millard gubler syndrome:- damage to 6th,
7th, 8th CN
•• Midbrain syndrome:-
–– Posterior part damage :- parinaud's
syndrome
•• 3 Anatomical lobes - Anterior, Middle/
–– Middle part damage :- Benedikt syndrome
Posterior, flocculonodular lobe.
–– W part damage :- weber syndrome
•• 3 physiological lobes -
•• Revision:-
–– Optic chiasma damage :- bitemporal –– Median zone :- which control axial movement
hemianopia
–– Intermediate zone :- hands & foot
–– Cranial nerve supplying EOMs:- SO4 > LR6
–– Lateral zone :- Pyramidal tract & brain
–– Nerve supply to tonsil :- 9th Cranial Nerve
•• 3 phylogenetic lobes -
–– Tensor palatini is supplied by :- 5th Cranial
Nerve (3rd Part - Mandibular Nerve) –– Archicerebellum - oldest , having connection
–– Stylopharyngeus supplied by :- 9th Cranial with vestibular apparatus – so help in
Nerve
equilibrium.
–– Cricothyroid supplied by :- External
Laryngeal Nerve –– Paleocerebellum - have connection with
spinal cord – so responsible for posture
–– Palatoglossus supplied by :- 5th Cranial
Nerve < 10th Cranial Nerve ,tone and crude movements.
–– Neocerebellum - connected with the cerebral

CEREBELLUM cortex – so related to fine Movements.
Cerebellum Considered as
a. Little brain
b. Arbor vitae (life of tree)
c. Fern tree like appearance of section & histology
d. Coordination & balancing organ
Magic of 1,2,3,4,5
•• 1 - Vermin
•• 3 histological layers - Little brain “MPG”
•• 2 - Cerebellar hemisphere
52
–– M - Molecular layer •• Blood supply -

–– P - Purkinje layer a. PICA: Posterior Inferior Cerebellar Artery
–– G - Granular cell layer b. AICA: Anterior Inferior Cerebellar Artery
•• 4 Nuclei (DEGF - in large to small & Lateral to c. SCA: Superior Cerebellar Artery
medial sequence)
–– D:- Dentate nuclei
–– E:- Embolism nuclei
–– G:- Globose nuclei
–– F :- Fastigial nuclei
•• 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
–– D - Dysdiadochokinesia
–– R - Rhomberg sign
–– A - Ataxia, Asynergia
•• 5 neurons of cerebellum:- (BSP GoGa)
–– B - Basket cells
–– S - Stellate cells
–– P - Purkinje cells :- largest, only efferent
fibers present, inhibitory to deep cerebellar
nuclei.
–– Go - Golgi cells
–– Ga (sir):- Granular cells
•• Basket cells & Stellate cells located in the
molecular layer.
•• Purkinje cells in the purkinje layer.
•• Golgi & Granular cells – located in the granular
layer.
53
Anatomy
CEREBRAL HEMISPHERE Superolateral area of brain

1. Frontal lobe
•• At frontal lobe - Motor area (area 4) present
from which the pyramidal tract arises.
Damage of this area can lead to contra-lateral
Q
paralysis .
•• Premotor area (area 6) gives origin to the

extra pyramidal tract and its damage can lead
to Parkinson-like symptoms and tremors.
•• Middle frontal gyrus - responsible for 2. Temporal lobe -

horizontal eye movements and damage leads
•• Superior Temporal gyrus have area 41, 42 -
to loss of conjugated saccadic movements. Q
are 1° auditory / Auditory Sensory area .
•• Pre-frontal lobe - responsible for individual –– Area 22 - 2° auditory or auditory psychic
skills, judgements & personality and damage area and due to its damage, a person will be
leads to pre-frontal lobe syndrome. able to hear but not able to analyze what it
•• Inferior frontal gyrus - divides into pars means (auditory agnosia).
orbitalis , pars triangulation & pars opercularis –– Posterior part of Area 22 known as
(broca’s area 44,45), responsible for speech , Wernicke's area or Sensory speech area
Q
damage lead to motor/ broca’s aphasia .
Q
and its damage leads to sensory aphasia .
54
–– Medial part of this lobe is known as Area 28 Revision

(olfactory area).
•• 1, 2, 3 : Sensory
3. Parietal lobe •• 4 : Motor
•• Impulse from Area 22 passes to area 39 & •• 5, 7 : Vibration & stereognosis
40, known as speech association area, then
impulse goes to area 44 and 45. •• 6 : premotor area
•• Area 5,7 - responsible for vibration & •• 8 : frontal eye field area
stereognosis, so, damage leads to pallesthesia, •• 9, 10, 11, 12 : Prefrontal lobe
& Astereognosis.
•• 17 : visual sensory area
•• Area 2,1,3 - is Sensory area, damage leads to
•• 18, 19 : visual psychic area
loss of sensation.
•• 22 : Sensory speech area , auditory sensory
•• Area 43 - for taste.
area
4. Occipital lobe •• 28 : olfactory area
•• Calcarine sulcus present which is an example •• 39 : speech association area
of Complete sulcus.
•• 43 : taste sensation area
•• Semilunar sulcus, around the calcarine sulcus,
•• Motor speech - 44, 45
is known as lunate sulcus.
•• paracentral lobule : Perineum area
•• Area 17 - is 1° visual area, damage leads to
blindness. •• Loss of Vibration - pallesthesia
•• Area 18,19 - known as 2° visual area, damage
leads to visual agnosia. BLOOD SUPPLY OF BRAIN
Medial surface of brain Sensory & motor homunculus
–– Para central lobule - where perineum area
representsq
Bladder
Bowel
Genital area
Inverted homunculus representation
–– Have visual-striated areas or lines of

Genneri.
55
Anatomy
Largest presentation - Face and Lips 4. Posterior communicating artery

5. Posterior cerebral artery
Artery Area of brain Damage lead to
1. MCA (Middle
Supplies Damage leads to Clinical
superolateral aphasia paralysis
cerebral artery) •• Aneurysm of COW is known as Berry aneurysm.
surface of upper limbs
Damage leads •• Berry aneurysm rupture lead to subarachnoid
to paraplegia, hemorrhage → Blood in CSF (complain of patient
2. ACA (Anterior Supplies medial patient do - worst headache of my life/ thunderbolt
cerebral artery) surface urination and headache/ thunder clapping headache)
defecation in
bed. Blood supply to brain
3. PCA (Posterior supplies inferior Damage lead to 5 branches of Internal Carotid artery
cerebral artery) surface visual problem
•• 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
5 components of circle of willis (COW) •• Pontine - damage lead to pontine hemorrhage,
1. Anterior cerebral artery pinpoint pupil , Pyrexia
2. Anterior communicating artery •• Labyrinthine artery
3. Internal Carotid artery •• Superior cerebellar artery
•• Posterior Cerebellar artery
56
WHITE MATTER AND BASAL

NUCLEI
White matterQ
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
FornixQ
Commissural fiber. Ex - corpus callosum.
•• Have all 3 types of white matter fibres.
•• Projection fiber :- connect areas from inside
•• Hippocampus - convert short term memory to
to outside of the brain . Ex - all tracts
long term memory.
•• Impulses go from hippocampus to mammillary

bodies via fornix.
•• So hippocampus is afferent for fornix &

mammillary bodies are efferent for fornix.
Papez circuit
•• Responsible for memory.
•• Corpus callosum:- •• Impulses go from the anterior nucleus of

thalamus → to cingulate gyrus (center for
–– Largest band of white matter satisfaction ) → hippocampus → mammillary
–– Type of commissural fibre. body → finally to the anterior nucleus of
thalamus again.
–– Have 4 parts - Rostrum, Genu, Body/Trunk,
Selenium.
Projection fibers
Include all tracts
57
Anatomy
Ascending:- •• Wilson’s disease aka hepato-lenticular

•• LSTT (Lateral Spino-thalamic Tract) degeneration.
•• FG (Fasciculus Gracilis)
THORACIC WALL INTERCOSTAL
•• FC (Fasciculus Cuneatus)
SPACE
Descending:-
•• Internal capsule (bundle of tracts)
•• corona radiata
Basal nuclei
Means collection of Grey matter (nuclei) at the base
of the brain.
•• T2-T8 are typical vertebrate, rest all are

atypical.
•• Basic components of Basal nuclei :- ACC SS
–– A - Amygdala is small almond like structure Contents of Intercostal space (ICS)
of brain related with food & sex activity, •• Intercostal muscles:-
so, damage to this lead to hyperphagia and
–– External Intercostal muscles - outermost;
hyper sexuality known as kluver-bucy
hands in pocket direction,runs downward,
syndrome
forward, medially. (DFM)
–– C - Corpus Striatum has 2 nucleus
–– Internal Intercostal muscles- hands in opp
Caudate nucleus pocket; move downward, backward, lateral.
(DBL)
Lentiform nucleus - has medial globus
palladium & lateral putamen –– Transversus thoracis - DIVIDED INTO 3
GROUPS:
–– C : Claustrum
a. Sterno + costal,
–– S:- Substantia nigra → damage results in
b. Innermost intercostals/ intercostal intimi,
Parkinson disease
c. Subcostalis.
–– S:- Subthalamic nucleus of luy → damage
leads to hemiballismus. •• Vessels :- VAN (Vein, Artery, Nerve) in costal
groove.
•• Best site for Thoracentesis is 8th Intercostal
58
Space > 9th at mid-axillary line, at the lower PLEURA & LUNG
part of Intercostal space and along the upper
Q
border of the rib .
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
Bronchopulmonary segments (BPS)
cervical artery (SIT).
•• Right lung -
•• C:- Costocervical trunk :- Superior intercostal –– Has 3 lobes
artery, Deep cervical artery.
Upper lobe - has Apical, Anterior,
•• D:- Dorsal scapular artery. Posterior segments
Middle lobe - has Medial & Lateral
segments
Lower lobe - has Apical Basal , Anterior
Basal, Lateral Basal, Posterior Basal,
Medial Basal segments.
59
Anatomy
•• Left lung :- –– Right posterior aortic sinus

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

CIRCULATION
•• Heart is conical muscular hollow viscera which
is responsible for pumping the blood. RCA: Course & Branches
•• it is located in the middle mediastinum within Main Branches: MTP
the pericardium.
External Features of Heart :
•• Right border of the heart - RA

•• Apex of the Heart – LV
•• Posterior surface of the heart (Base) – LA
(2/3rd) + RA (1/3rd)
LCA: Course & Branches
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
60
Main Branches “DAL”Q •• Largest vein – Coronary sinus (situated in the

Q
•• Diagonal artery left posterior Interventricular sulcus)
•• Anterior Interventricular artery (AIVA) – •• All the cardiac veins drain into the coronary
supplies the Apex sinus except 2 –
•• Left Circumflex artery –– Anterior cardiac veins & Venae Cordis
minimae – drain into Rt. Atria
Patho/Medicine-Anatomy Integration
•• Great cardiac vein runs with the AIVA & Lt.
AIVA is aka LADA (MC in →)
CXA
•• Left Anterior descending artery – Mc artery
involved in MI/Angina (40-50%) •• Middle cardiac vein running with the PIVA
•• Most common cause of Angina/ MI is •• Right Marginal vein making the small cardiac
Atherosclerosis vein which is draining into the Coronary sinus
Widow’s artery/ Widow maker artery – LADA
Angioplasty
Small Branches
CABG
•• Lt. Conus artery
•• Great saphenous vein was used earlier for the
•• Atrial branches
coronary graft
•• Ventricular branches
•• When there is damage to the GSV then the
Conducting system of the Heart nerve getting damaged in the lower limb is the
•• SA NODE → AV NODE → BUNDLE OF HIS → Saphenous nerve – loss of sensation along
RBB & LBB the medial part of the leg
•• All are supplied by the RCA except for the LBB •• Left Internal Mammary Artery (LIMA) is the
which is supplied by the LCA best arterial graft for CABG
Anterior Abdominal Wall

•• Abdominal cavity : 2 walls
a. anterior abdominal wall (AAW)
b. posterior abdominal wall (PAW)
•• Anterior Abdomen wall :
Venous Drainage of the Heart
–– AAW is divided into 9 quadrants by 2

vertical lines & 2 horizontal lines.
–– Transpyloric plane passing through the
Q
lower border of L1 .
61
Anatomy
–– Subcostal plane passing through upper

border of L3 level.
–– Transtubercular plane passing through
upper border of L5.
–– Umbilicus is situated at L3,L4 ( it’s a site for
Iliac crest & Lumbar puncture).
–– External Oblique modification (LIP):-
L:- participate in the formation of Lacunar
ligament.
I:- Inguinal ligament
P:- Pectineal ligament
•• 8 Layers of abdominal wall:
PERITONEUM & ABDOMINAL

LIGAMENTS
Skin
Superficial fascia
External oblique
Internal oblique
Transverse abdominis
Transversalis Fascia
Extra peritoneal fat
Peritoneum
62
–– Peritoneum fold :- responsible for

Movements & peristalsis.
–– If Peritoneum fold is attached with
Stomach → it is known as omentum

(greater & lesser).
Intestines → it is known as mesentery,

with duodenum known as mesoduodenum.
Transverse colon → known as Transverse

mesocolon.
Appendix → known as mesoappendix.
Viscera → gastrosplenic ligament,

lienorenal ligament.
Abdominal Viscera have 3 types

1. Intraperitoneal :- free Movements.
2. Retroperitoneal :- behind, it is fixed, ex :-

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

organs.
–– Foramen of Winslow:- It is communication

between greater & lesser sac aka epiploic
foramen.
63
Anatomy
Mesogastrium has 2 parts : b. Dorsal mesogastrium (DMG): It divides

into 2 parts →
a. Ventral mesogastrium (VMG): It divides
into 2 parts → –– Ventral part - give rise to gastro-splenic
ligament→ short gastric vessels run within
–– Ventral part - give rise to falciform ligament
it
–– Dorsal part - give rise to lesser omentum
–– Dorsal part - give rise to lino-renal
ligament→ splenic vessels run within it
•• Pringle’s maneuver:-
64
Q
Epiploic Foramen (Boundaries) -
Anterior - Right free margin of lesser omentum
Posterior-
•• IVC
•• Right Suprarenal
•• T 12
Superior-Caudate process of liver
For Portal hypertension
Mickey Mouse signs

ESOPHAGUS & STOMACH
•• Portal triad in Portal Hypertension.
Esophagus
•• Midbrain of progressive supranuclear palsy. 4 constrictions of the Esophagus – measured from
the upper incisors
•• Polyostotic Paget's disease
•• Pelvic Mickey Mouse sign: bilateral inguinal

vesical hernia
•• Dysmorphic Mickey Mouse RBCs & Ureteropelvic

junction obstruction (UPJO)
65
Anatomy
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
Tricks & Magics

Structures having length – 25cms = DUDES
•• D – Duodenum
•• U – Ureter
•• D – Descending colon
•• E – Esophagus
•• S – Stomach
Surgery-Anatomy Integration
Parts of Esophagus Artery Vein Lymph node
Inferior thyroid vein –
Upper 1/3rd part Inferior thyroid artery Deep cervical LN
Brachiocephalic vein (BCV)
Esophageal br. from Descending
Middle 1/3rd part Azygous vein Mediastinal LN
thoracic aorta
Left gastric artery (esophageal
Lower 1/3rd part Left gastric vein “BAL” – mnemonic Left gastric LN
branches) “OIL” – mnemonic
Stomach ANAT-PATHO-MEDICINE-SURGERY
Parts of Stomach INTEGRATION
1. Cardiac part Pyloric antrum is the 2nd most common site for the
a. Fundus Duodenal Ulcer Disease (DUD)
b. Body Incisura Angularis is most common site for Gastric
2. Pyloric part ulcer Disease (GUD)
a. Pyloric Antrum
b. Pyloric Canal
66
MAGIC OF 2 Left gastroepiploic artery

Q
•• 2 ends –– Common hepatic artery
•• 2 curvatures Proper hepatic artery
•• 2 surfaces ○○ Left hepatic branch
•• 2 angles ○○ Right hepatic branch
•• 2 parts – further divided into 2 Cystic artery (to gallbladder)
Anat-Patho-Medicine-Surgery ○○ Right gastric artery (anastomose

Integration with the left)
Right gastroduodenal artery
○○ Right gastroepiploic artery
(anastomose with the left)
○○ Superior pancreaticoduodenal artery
Anastomose with the inferior
pancreaticoduodenal artery – br. of
the IMA
•• Anastomosis between superior and inferior
pancreaticoduodenal artery
–– Junction between foregut and midgut
Arterial Supply of Stomach –– Opening of CBD
GIT – Anat-Surgery Integration

Q
•• FOREGUT – Celiac Trunk – T12-L1 Esophageal Replacement Surgery
•• MIDGUT – SMA – L1
•• In case of esophageal replacement surgery,
•• HINDGUT – IMA – L3 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
•• Give 3 main branches

–– Left gastric artery – supply lower end of
the esophagus
–– Splenic artery –
Arteria pancreatica magna – supply body
of pancreas
Short gastric vessels
67
Anatomy
Lymphatic Drainage of Stomach
•• ● All the LNs drain into the Celiac nodes
Anat-Patho Integration
In case of Stomach Ca – enlargement of left
supraclavicular LN =
•• Virchow’s LN
•• Troisier’s sign
Duodenum
In case of Stomach Ca – enlargement of left
•• Shorterst , widest & most fixed part of small
axillary LN = Irish LN
intestine
In case of Stomach Ca – enlargement of •• 4 parts : D1, D2, D3, D3
periumbilical LN = Sister Mery Joseph Nodules
•• Extension : between L1 to L3 Vertebra, above
In case of Stomach Ca – there is trans celomic umbilicus
spread – Ovarian Ca = Krukenberg’s tumor
•• Total length : 25 cm
–– D1 → 2 inches → located at L1
SMALL & LARGE INTESTINES –– D2 → 3 inches → L2
–– D3 → 4 inches → L3
–– D4 → 1 inch
–– Total 10 inches × 2.5 = 25 cm
•• IMPORTANT Relations
–– 1st part of Duodenum: anterior to head of
pancreas
–– 2nd part of Duodenum: anteriorly related
to Rt. Kidney
–– Gallbladder fundus is in front of 2nd part of
duodenum
–– SMA & vein passing anterior to 3rd part of
Duodenum
68
•• 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
Parts of large intestine
1. Ascending colon
2. Transverse colon
3. Descending colon
4. Sigmoid colon
5. Caecum & Appendix
6. Rectum
7. Anal canal
Q
•• Main 3 Features of Large Intestine
1. H :- Haustra / Saccule
2. A :- Appendices epiploicae = small pouch of
fat
3. T :- Taenia coli (3 in no.)
69
Anatomy
ARTERIES & VEINS OF GIT
SMA – Artery of The Midgut –

Branches
•• Abdominal Aorta pierces the diaphragm and

runs in downward direction.
•• At the lower border of L4 or L4-L5 junction, it
is bifurcating into common iliac arteries
•• Abdominal Aorta aneurysm are most common in

SMA – Arise at the level of L1
Infrarenal position and also Aortic Dissections. 6 branches of SMA :
•• Inferior pancreatico duodenal artery – to
duodenum and pancreas
•• Jejunal branches
•• Ileal branches
•• Ileocolic Artery – to ileum as well as cecum
•• Right colic artery
•• Middle colic artery
•• 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
70
•• Sigmoidal Artery ABDOMINAL VISCERA ORGANS

•• Superior rectal artery
Venous Drainage of the Abdomen

•• Portal vein = Splenic vein + SMV
•• Behind the neck of pancreas
•• At the level of L2
Parts of pancreas: Head, neck, body, tail

Q
Important relations:
1. Head : located within the C loop of duodenum .
2. Neck : behind it formation of portal vein .
3. Body : along upper border splenic artery runs
Micro-Parasito/Surgery/Medicine- 4. Tail : located within hilum of spleen
Anatomy Integration
Parts of duodenum & their corresponding
Entamoeba histolytica infection and also vertebral level:
Hepatocellular cancer case:
•• D1 : L1
•• Due to shorter right sided division of the
portal vein, all the infection is going to the •• D2; L2
right lobe of the liver •• D3: L3
•• Rt lobe – more common for ↑ HCC & ↑ infection •• Epiploic foramen: T12
•• This is known as Streamline phenomenon •• Portal vein formation: behind neck of pancreas
at L2
•• Portal vein = Splenic vein + Superior mesenteric
vein
•• 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.
71
Anatomy
LIVER
•• Weight: 1.5 kg
Magic of 5 :
•• 5 ligaments:
•• Harris dictum : Magic of Odd numbers. 1, 3, 7,
9, 11 –– Falciform: ventral part of Ventral
mesogastrium.
–– 1” 3” 5” : Dimensions
–– Ligamentum Venosum
–– 7 : ounce is weight
–– Ligamentum Teres
–– 9, 10, 11 : Ribs are costal relations.
–– Coronary ligament (superior & inferior
•• Axis along 10th rib layers)
•• Two surfaces –– Triangular ligament (right & left)
: Diaphragmatic ( outer ) ( Rib & intercostal 9,
•• Porta hepatis: 5 cm
10, 11 )
•• 5 structures within Porta hepatis:
: Visceral (inner)
–– Portal Vein
Visceral surface → gastric, colic, renal,
pancreas –– Hepatic artery
impressions “GCRP” –– Bile duct
(In uncinate process tumor: compression of –– Hepatic plexus
SMV + SMA) –– Hepatic Lymph nodes
•• Artery: splenic artery •• 5 viscera at inferior surface:

•• Vein: splenic Vein –– For stomach
•• Clinical correlation: –– For Gallbladder
–– splenomegaly –– For duodenum
seen in Hemolytic anemias, Sickle cell –– For right kidney
anemia and Thalassemia.
–– For Hepatic flexor
–– Hypersplenism
•• Clinical correlation:
–– Hepatitis: Acute & chronic
–– Tumor: Benign (Hepatic adenocarcinoma) &
Malignant (Hepatocellular cancer)
–– Hepatectomy (right & left lobectomy)
–– Jaundice (pre-hepatic, intra hepatic, post
hepatic)
–– Hyperbilirubinemia: Conjugated &
Unconjugated
72
––Liver failure: liver transplantation

–– Cirrhosis
Extrahepatic Biliary Apparatus
KIDNEY
•• Kidney is the main excretory organ in humans.

•• it has 2 poles , 2 borders & 2 surfaces
Gallbladder •• Structure at renal hilum: Anterior to posterior
•• 3 Parts: Fundus, body, neck - VAU (Vein, Artery, Ureter)
•• Hartman’s pouch is present at the neck →

Q
common site for stone
•• Cystic duct presents a spiral valve of Heister
(false valve).
Relations of Kidney (Magic of 1, 2, 3, 4, 5, 6)
Q
•• Artery: Cystic Artery.
•• Vein: Cystic Vein. •• 1 rib (12th) & 1 Vessel (subcostal) are related
to posterior surface of kidney (NOTE - 11th
•• Nerve: 10th cranial nerve.
rib & vessel on left side along with the above
Q
•• Lymph node: Cystic Lymph node of Lund . mentioned structures)
•• 2 Ligaments: Medial arcuate ligament and

Lateral arcuate ligament.
•• 3 nerves: subcostal Nerve (T12), Iliohypogas-

tric Nerve, ilioinguinal Nerve.
73
Anatomy
•• 4 muscles: diaphragm, psoas major, quadratus (Anterior surface) → left Suprarenal gland,
lumborum, transverse abdominis. colon, intestinal loop, stomach, spleen, pancreas.
•• 5 Structures impression on right kidney

(Anterior surface) → right Suprarenal gland, PERINEUM AND PELVIC VISCERA
colon, intestinal loop, liver, 2nd part of •• Anterior triangle (Urogenital triangle)
duodenum. •• Posterior triangle (Anal triangle)
•• 6 structures impressions on left kidney
•• Lateral – Ischial Tuberosity

Boundaries of perineum:
•• Anterolateral- Ischiopubic rami
•• Anterior- Pubic symphysis
•• Posterolateral- Sacro tuberous ligament
•• Posterior- Sacral and Coccyx
74
Urethra Central tendon of perineum (Perineal

Parts of Urethra:
body)
•• Insertion of 10 muscles in perineal body
•• Prostatic urethra (Horseshoe shaped)
–– Superficial transverse perineal muscle-2
•• Membranous urethra
–– Deep transverse perineal muscle-2
•• Bulbar urethra
–– Bulbospongiosus muscle-2
•• Penile urethra
–– Anterior fiber of levator ani-2
–– External anal sphincter 1
–– External urinary sphincter 1
75
Anatomy
OBG-Anat- Surgery Integration

Damage the perineal body →→ Paralysis of all 10
muscles→ Prolapse of uterus and rectum
Pelvic diaphragm and Urogenital Diaphragm

↓
Levator ani + Ischiococcygeus (IsC)
↓
Pubococcygeus (PC) and iliococcygeus (IC)= Levator
Q
Ani
Pelvic diaphragm = Ilium + Pubis + Ischium
Q Episiotomy process on the postero-lateral
Pelvic diaphragm = IC+ PC + IsC
part to avoid injury to perineal body.
Anat-OBG Integration:
76
Supply of pudendal nerve Urinary bladder: Magic of 4

Urogenital part supplied by the pudendal nerve. Tetrahedral structure has 4 angles, 4 borders, 4
surfaces and 4 connections
Relations of urinary bladder:
•• Right and left ureters – posterolateral side
•• Inferiorly- Urethral opening
•• Anteriorly- Median umbilical ligament
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.
Relation with Posterior surface of bladder -
Pelvic Viscera
•• Rectovesical pouch
•• Vas deferens located here
•• Seminal vesicle
•• fascia of Denonvilliers
•• Prostate gland
Extra Edge:
–– Fascia of denonvilliers' fascia- behind
urinary bladder
–– Fascia of Waldeyer- behind rectum
77
Anatomy
–– Posterior
Surgery Integration- Urethral InjuryQ
–– median
•• If rupture of bulbar or penile urethra- urine
–– right lateral
accumulates into Superficial perineal pouch,
scrotal and penile area. In very severe cases –– left lateral
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
swelling over scrotum & Perineum area
Clinical Anat-Surgery-Radio Integration

•• Posterior Urethra = Prostatic Urethra +
Membranous Urethra •• Ejaculatory duct opens in Prostatic urethra
•• Anterior Urethra = Bulbar Urethra + Penile (Semilunar/Horse-shoe shaped → due to
Urethra pressure by median lobe)
Radio images of urethra •• Opening of prostatic utricle (remnant of
Paramesonephric duct) → in Prostatic urethra
•• Paramesonephric duct → Forms Uterus and
vagina in females
Anat-Physio Integration
•• Retrograde ejaculation or Urinary reflux - Inhibited
by Internal urethral sphincter (Involuntary →
Q
Smooth muscles)
•• TURP (Transverse Urethral resection of Prostate)
– Lead to removal of Internal urethral sphincter
Prostate gland causing Retrograde ejaculation and Urine reflux.
Q
•• 5 Anatomical lobes : •• Urine reflux → Causes increased risk of infections.
–– Anterior
78
Clinical integration:
•• Benign tumor - BPH (Benign prostatic
Hyperplasia) → Compression symptoms as it
occurs in Periurethral zone - Urinary hesitancy,
Urgency and increased Frequency.
•• Prostate carcinoma – Peripheral zone involved Abdominal Aorta

It is divided into Two Common Iliac artery, which
Anat-Pharma-Medicine Integration further divided into two -
BPH (Benign prostatic Hyperplasia/Hypertrophy) 1. External iliac artery
•• Management - Alpha-blockers (Prazosin, 2. Internal iliac artery

Phentolamine) → Anterior division - supply Pelvic viscera
•• Side effect of prazosin – Postural hypotension •• Blood supply of Urinary Bladder - Superior &
→ prescribed at night before sleep and gradually Inferior vesical artery
increases in dose.
•• Blood supply of URETHRA - inferior vesical
•• Selective Alpha-1a blocker - Tamsulosin (Less side artery (No need in female)
effects and selective)
•• Blood supply of Rectum -
–– Along with 5-alpha reductase inhibitors – –– Superior Rectal artery - from Inferior
Finasteride Mesenteric artery ranch
•• If Medical management fails - Surgery (TURP) –– Middle Rectal artery - from Internal Iliac
artery
–– Inferior Rectal artery - from Internal
Pudendal artery
79
Anatomy
Q
→ Posterior division
Branches from Posterior Division of Internal iliac
artery
(Mnemonic - ILS - I Love Salman)
1. Iliolumbar artery
2. Lateral sacral Artery
3. Superior Gluteal artery
Female Genital Organ
1. Fallopian tube
Length : 10 cm.
80
Parts: –– Antero-superior to Fallopian tube

a. Fimbria
Spaces/Pouches in Female
b. Ampulla - site of fertilisation
c. Isthmus - Physiological sphincter
d. Intramural part - Anatomical sphincter
→ Most dependent part in supine position - Pouch of

Q
Douglas (Recto-uterine pouch)
→ Most dependent part in supine position -
Q
Hepatorenal/Morrison’s Pouch
Supports of uterus
Q
2. Uterus 1. Primary Supports/ Major Support
a. Fundus •• Muscular/ Active Support: (Mnemonic: PPU)
b. Body 1. Pelvic Diaphragm
c. Cervis 2. Perineal Body
Uterine Artery - Tortuous Course and present in 3. Urogenital Diaphragm

broad ligament at the lateral border of Body of •• Fibromuscular & Mechanical Support:
Uterus → anastomosis with ovarian artery. (Mnemonic: PUT RU)
Anat-Obg-Surgery Integration 1. Pubocervical Ligaments
•• HYSTERECTOMY - surgical removal of 2. Uterosacral Ligaments

uterus prevent ureteric injury and ligation as 3. Transverse-Cervical (Cardinal; Macken-
it is in close relation with the uterine artery rodt’s)
at the lower part of the body of the uterus.
4. Round Ligaments of The Uterus
Angle of Anteversion and Anteflexion 5. Uterine Axis
Function - Prevention of Uterine Prolapse.

•• Relation at Cornua of Uterus (Posterior to
Anterior)
2. Secondary Supports/ Minor Supports (BRU)
1. Ovarian Ligament
1. Uterovesical Fold of Peritoneum
–– Postero-inferior to Fallopian tube
2. Rectovaginal Fold of Peritoneum
2. Fallopian tube
3. Broad Ligaments
3. Round ligament of uterus (Homologous to
Spermatic Cord)
81
Anatomy
Basics of Histo-Pathology How to Identify Epithelium

•• Histo- Pathology is important for Diagnosis of Characteristic of Nucleus Epithelium
Clinical Diseases Nucleus parallel to Flat squamous epithelium
•• 2 basic requirements to observe cell structures Basement membrane
Rounded nucleus Cuboidal epithelium
1. Microscope Nucleus perpendicular to Columnar epithelium
Basement membrane
Different powers of the Objective lens are used for
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)
82
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
83
Anatomy
1. Squamous epithelium b. Cornea,

•• Nucleus is parallel to the basement membrane . c. Nasal vestibule,
•• Cells are flat & pavement like in appearance. d. Oral cavity,
•• Function: Gaseous / Nutrition exchange, e. Tip of urethra and
Diffusion like Lung alveoli, endothelium, henle’s f. Glans penis,
loop
g. lower part of Vaginal canal,
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
•• 2 types - Simple or Stratified

•• Stratified squamous epithelium are of 2 types
1. Keratinized Stratified squamous epithelium (Dry
area) - Skin
2. Non-keratinized Stratified squamous epithelium
Q
(Wet areas with Friction) - E.g .
a. Conjunctive,
84
•• In Thyroid, PCT and DCT. •• Triad of Kartagener Syndrome (Mnemonic -

SBI)
•• Update - Thyroid with high activity – Simple
Columnar epithelium S - Situs inversus
B - Bronchiectasis
Thyroid with low activity – Simple Squamous
epithelium I - Infertility
Q
•• Thyroidization of Kidney → Chronic Pyelonephritis
[Anat-Patho-Medicine Integration]
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
•• Stored material present in the Apical area.
4. Urothelium/Transitional Epithelium
•• Present in the urinary system hence known as
Urothelium.
•• It shows transition / change in appearance
when stretched hence known as transitional
epithelium.
•• Upper most cell appear like Umbrella hence
known as Umbrella cells.
Umbrella cells :
Q
•• No colour - •• Thick glycoprotein layer present → Prevent

absorption.
1. Fat - globular / Rounded Shape
•• May appear Binucleate.
2. Air - Uneven/ Irregular Shape
•• Internalisation of cell membrane present.
•• Present in Urinary system distal to the
Collecting duct like Bladder, Urethra (Except
Membranous part & tip of urethra) etc.
GLANDSQ
3 types on the basis of Mode of Secretions
A. Holocrine glands - Entire glands are ruptured

and secretion released. E.g. Sebaceous
Glands. Block of duct → Acne occurs.
Clinical integration : B. Apocrine glands - Only the apical portion of
the gland is ruptured and secretions released
•• Immotile Cilia Syndrome/Kartagener
in the surroundings or duct. E.g. Modified
Syndrome - because of absence of Cilia/
Sweat gland → Pheromones secreting glands
Dysfunctional cilia → repeated Infections →
repeated inflammation → Dilatation/ Ectasia (present in Axilla, Perineum) Breast.
of bronchus occurs → aka Bronchiectasis.
85
Anatomy
C. Merocrine / Eccrine glands - Secretions

show Exocytosis (No destruction). E.g. Sweat
glands of Palms and soles.
HAIR
KERATIN
SEBACCOUS
GLAND
•• Cardiac Muscle
(HOLOCRINE)
Muscle
•• Smooth Muscle
CARTILAGE & BONE

A. Cartilage
•• Skeletan Muscle
•• Identify (Chondrocytes) - contain Chondroitin
Sulphate → Attract basic stain → Blue stain.
•• On histology slide -
Group of cells with blue stained nucleus and clear
Lacuna.
Q
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

86
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
3. Fibrocartilage I - Intervertebral Disc

(Mnemonic - FIAT Logo) A - Articular disc (Menisci, TMJ disc)
F - Fibrocartilage T - Tendon insertion
Logo - Labrum (of Glenoid & Acetabulum)
87
Anatomy
Collagen NEET Pattern 2022

•• Most common protein in body
•• Types = 28
Important
Types of Locations
collagen
I Bone, Aponeurosis & Ligaments (BAL)
II Cartilages
IV Basement Membrane (Kidney, Lungs)
Few Recent Question
FMGE 2021
NEET PG 2021
Pharyngeal Apparatus
•• Pharyngeal apparatus : Special structures
developing near pharynx
•• Pharyngeal Apparatus : Pharyngeal Arches +
Ph. Pouch + Ph. Cleft + Ph. Membrane
•• Arches- Mesodermal thickenings
•• Pouches – Endodermal out bulgings
•• Cleft – Ectodermal in dipping
•• Pharyngeal membrane : Meeting points in
between ectoderm, mesoderm & endoderm in
pharyngeal apparatus.
88
•• Endoderm, mesoderm, ectoderm meeting Pharyngeal Arch

→ Pharyngeal membrane → 1st pharyngeal
•• Mesodermal in origin
membrane → tympanic membrane.
•• 6 arches develops
•• 5th arch disappears
•• so 5 arches persist
89
Anatomy
Pharyngeal Nerves:
Pharyngeal Arch Pharyngeal nerve
I → V3
Pharyngeal Arch: Mesodermal
II → VII
Each pharyngeal arch gives rise to 4 structures:
III → IX
a. Pharyngeal nerve IV → Superior Laryngeal Nerve > X
b. Pharyngeal muscle VI → Recurrent Laryngeal Nerve > X
c. Pharyngeal cartilage
•• Along caudal border → Pre- trematic nerve
d. Pharyngeal artery
90
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 •• 1st arch cartilage: Meckle’s cartilage → 5 ‘M’
Facial nerve. (SPF)
1. Malleus & Incus
1. Stylohyoid
2. Malleolar (Anterior) ligament
2. Stapedius
3. SphenoMandibular ligament
3. Platysma
4. Mandible
4. Posterior Belly of Digastric
5. Maxilla
5. Facial muscle except Levator Palpebrae
•• 2nd arch cartilage: Reichert cartilage → 5 ‘S’
Superioris (eye muscle)
1. Stapes (except footplate & Otic capsule)
•• 3rd arch muscle:
2. Styloid process
Stylopharyngeus
3. Stylohyoid ligament
•• 4th arch muscle → All are supplied by 10th nerve
4. Smaller cornu of hyoid
1. All muscles of palate except Tensor Veli
Palatini (1st arch : V 3 ) 5. Superior ½ of body of the hyoid
2. All muscles of pharynx except •• 3rd arch cartilage:

STYLOPHARYNGEUS (3rd arch : IX nerve) 1. Greater cornu of hyoid
3. Cricothyroid → by 10th < SLN < RLN 2. Inferior ½ of hyoid
•• 6th arch muscle → supplied by RLN •• 4th & 6th arch cartilage:
All larynx muscle except Cricothyroid –– Laryngeal cartilage
91
Anatomy
First Arch Syndromes

Pharyngeal arch Nerve Muscle Cartilage
1 st
V3 •• 4 muscles of mastication 5M
•• Mylohyoid
•• Anterior Belly of Digastric
•• Tensor Tympani
•• Tensor veli Palatini
2nd 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
5 th
Disappear - - -
6 th
RLN Larynx Laryngeal cartilage
All muscles of Supplied by Except Supplied by

Palate IX → X < VAC < pharyngeal plexus TP V3
Pharynx X Stylopharyngeus IX
Larynx X (recurrent laryngeal) Cricothyroid X (superior laryngeal)
Tongue XII Palatoglossus X
Pharyngeal Cleft
•• Ectoderm is dipping in between 2 arches known as Pharyngeal cleft.
•• 1st cleft: forms External auditory canal → 6 hillocks develops around 1st cleft → pinna is formed
•• 2nd, 3rd & 4th clefts disappear.
–– 2nd arch grows rapidly & adjoins with basal part. In between (includes 2nd, 3rd, 4th cleft), it makes
cervical sinus
92
Any embryonic tract with abnormal :

•• 2 openings: fistula
•• 1 opening: sinus
•• No opening: cyst
Pharyngeal Pouch
•• Endodermal out bulging in between 2 arches
Clinical :
known as pharyngeal pouches.
•• total 4 in no. DIGEORGE SYNDROME:
•• 1st pouch: make auditory tube (tubo + tympanic •• Features Vary Widely
recess) and tympanic membrane cavity.
•• CATCH 22
•• 2nd pouch: make tonsil
•• Cardiac Abnormality (Interrupted Aortic
Arch, Truncus Arteriosus, Tetralogy of Fallot)
•• Abnormal Facies
•• Thymic Aplasia
•• Cleft Palate
•• Hypocalcemia/Hypoparathyroidism
•• Velocardio-Facial Syndrome or Shprintzen
Syndrome:
•• 3rd pouch: dorsal part makes 2 inferior –– Cause: Microdeletion of chromosome 22

parathyroid glands ; ventral part makes thymus.
•• 4th pouch: dorsal part makes 2 superior
parathyroid glands ; ventral part makes lateral
lobe of thyroid.
93
Anatomy
Pierre Robin Syndrome (GCR)

•• Anomalies of chromosome 17>> 2/ 11
–– Glossoptosis
–– Cleft Palate
–– Retrognathia
First Arch Syndromes GENERAL EMBRYOLOGY

•• First Arch Syndromes occur due to the failure Study of Formation, Development and Maturation of
of the migration of neural crest cells into the the Embryo is known as Embryology.
first arch.
•• Site of fertilization – Ampulla > Ampullary-
•• The First Arch Syndrome includes Treacher- Isthmic Junction
Collins Syndrome and Pierre-Robin Syndrome •• Morula – 16-cell stage (3rd day)
1. Treacher-Collins Syndrome •• Advanced morula : 32 cell stage without cyst
2. Mandibulofacial Dysostosis > 16 to 32 cell stage
1. Treacher-Collins Syndrome •• Blastocyst – on 4th day, 32 cell stage with

cavity
•• Mandibulofacial Dysostosis
•• Implantation of Blastocyst – 6th day (6th –
–– Mutation in Chromosome 10th/12th day)
–– Mandibular Hypoplasia
94
•• Blastocyst shows 2 types of cell lines : → it decides cranio-caudal axis

a. Inner cell mass : Forms 1st cell line of •• Opposite to prechordal plate → proliferation
embryonic stage known as Epiblast → Forms of epiblast occurs → forms primitive streak →
true embryo decides right & left side of embryo.
b. Outer cell mass : Forms trophoblast → •• Formation of a new layer in between the
gives nutrition to embryo → divides into Epiblast and endoderm is the Mesoderm.
i. Cytotrophoblast (CTB) •• Remaining cells of epiblast → converted into

ectoderm.
ii. Syncytiotrophoblast (SCTB)
•• Sequence of Germ cell layer formation –
•• Epiblast cells give rise to → Hypoblast cells →
–– 1st – Endoderm
Hypoblast forms the Endoderm
–– 2nd – Mesoderm
•• Bilayered Embryonic Disc
–– Epiblast –– 3rd – Ectoderm (last)
–– Endoderm –– Neural crest cells are considered as 4th

germ cell layers.
•• Endoderm proliferates → forms Prochordal
plate – it is formed near Cranial end of embryo
95
Anatomy
General Embryology Simplified

96
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
97
Anatomy
•• Amniotic cavity - Nutrition to the baby –– Bucco-pharyngeal membrane – forms the

oral cavity
•• Outer layer – Ectoderm
–– Anal membrane – forms Anal Canal
•• Mesoderm develops everywhere except for 2
areas – If mesoderm persists here – causes Anal
98
Stenosis – Fecal material will not pass – Important Days

requires surgery
•• 2 Days: 2 Cell Stage
•• Vitello – Intestinal duct
•• 3 Days: Morula Formation
Surgery-Anatomy Integration •• 4 Days: Blastocyst
Vitello – Intestinal duct •• 8 Days: Bilaminar Disc Formation
•• Remnant → Meckel’s Diverticula (2% Rule) •• 14/ 15 Days: Head & Tail End Is Decided
[Prochordal Plate & Primitive Streak Appears]
•• 16 days: Gastrulation /3 Layered Embryonic
Disc Is Formed /IEM Appears
99
Anatomy
CNS DEVELOPMENT •• Vitamin B9- Folic acid is required for neural

tube formation in fetus
–– ↓Vitamin B9 – NTD
•• Notochord disappears
–– Remnant of Notochord – Nucleus Pulposus
(inside the IVD)
Anterior Neuropore defect

Cranial vault is absent
•• Exophthalmos
•• Chin resting over thorax
•• Vth Ventricle: Cavity of Septum Pellucidum •

VIth Ventricle: Cavum Vergae
–– False/ misnomer
•• The 2 corners meet together and form a tube
like structure known as Neural Tube
–– 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
1st site – cervical region
•• If no proper fusion of the neural tube, this is

known as Neural Tube Defect (NTD)
100
–– Absence of Hyaluronic acid – leads to

Q
NCC migration failure
Achalasia Cardia
Hirschsprung Disease
NCC Derivatives
Tricks & Magic
•• BHU – Banaras Hindu University, founder was –
MMM – Madan Mohan Malviya
Q
•• PAEDS doing DiSCo in front of MMM
–– P- Parasympathetic ganglion
Posterior Neuropore defect –– E- Enteric plexus – Auerbach plexus
A. Spina bifida occulta – two halves not uniting –– A- ANS ganglion
together but SC and meninges are in their original
–– D- Dorsal root ganglion
position.
–– S- Schwann cell
•• Only tuft of hair seen
–– D- Dentine tissue[odontoblast]
•• No symptoms
–– S- Sclera
B. Spina Bifida with meningocele – meninges coming
out with CSF –– C- Choroid, connective tissue of thyroid,
parathyroid, thymus, connective tissue of
C. Spina Bifida with meningomyelocele – meninges gland –lacrimal, nasal, oral, salivary gland,
coming outside as well as nerve elements palatine gland.
D. Spina Bifida with Myeloschisis – meninges getting –– M- Melanocyte
ruptured so CSF leaking out and spinal nerves visible –– M- Mesenchymal bone of HEAD & FACE
on the back side
–– M- Meninges
–– Adrenal medulla
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
101
Anatomy
GIT DEVELOPMENT
which forms the Urinary Bladder and Rectum.

Surgery-Anatomy Integration
Vitello – Intestinal duct
•• Remnant – 1 opening – is Meckel’s Diverticula
(2% Rule)
•• 2 opening – Fecal Fistula (FMGE 2021)
•• Mesoderm develops everywhere except for 2

areas –
–– 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
•• Foregut – from stomach up to the opening of
the CBD
•• Midgut – from 2nd part of the duodenum up to

the Ileum
–– Artery of the midgut – SMA – for Rotation

of the GIT
Part above the artery – Pre Arterial

Pedia/Surgery-Anatomy Integration segment
Proctodeum
Persistence of mesoderm results in Part below the artery – Post Arterial
segment
•• Anal Atresia
•• Anal Stenosis •• Hindgut – from left 1/3rd of the transverse
•• Distal to the Allantoic diverticulum is the cloaca colon up to to anal canal (dentate line)
102
Development of Tongue
Embryonic part Nerve supply

Part of tongue
from which derived General sensation Taste Motor
Mandibular (V3) – Chorda tympani (branch
Anterior 2/3rd 1st Arch Q Q -
lingual nerve of VII)
Glossopharyngeal Glossopharyngeal nerve
Posterior 1/3rd 3rd Arch Q -
nerve (IX) (IX)
Posterior most part 4th Arch Vagus nerve (X) Vagus nerve (X) -
Muscles of the tongue Occipital myotome - Hypoglossal nerve (XII)
Pharyngeal plexus > VAC >
Palatoglossus muscle - Q
X Nerve
103
Anatomy
CVS DEVELOPMENT •• The development of this area will create the

beginning of the formation of the heart. So
•• In the embryo, development of the heart this area is known as the Cardiogenic area
starts near the 3rd week of intrauterine life
•• Development of the heart starts near the
i.e., 21st day
pharynx
•• Bilaminar disc where there is development of
–– In case of MI/ Angina – pain can be referred
intraembryonic mesoderm developing from the to the neck area near to the left jaw
epiblast cells and proliferating near the head end.
•• Ventricles will proliferate and will come Mnemonic – BVAS: BV Aur Saas (kyunki saas
forward and downward. Atria will go backwards bhi kabhi bahu thi)
Q
and superiorly.
•• B - Bulbus cordis
•• Now the heart shows a conical structure where •• V – Ventricle
Atria is above and posteriorly – forms the base •• A – Atria
of the heart.
•• S – Sinus venosus
104
•• Umbilical vein on the left side forms

Ligamentum Teres
•• Formation of the spiral septa – Conotruncal

septa derived from the NCC – this will help
Pedia/Medicine- Anatomy Integration
the blood from the left ventricle be pumped
Failure in the development of the spiral septa, there
will be the common trunk of AA and PT – Truncus to the AA and from the right ventricle to the
Arteriosus (Right to Left shunt) pulmonary trunk.
105
Anatomy
3. Ebstein’s Anomaly
Pedia/ Medicine- Anatomy
Integration 4. Transposition of Great Vessels
Coeur en Sabot (French for “clog-shaped heart”) 5. Truncus Arteriosus
Or 6. Total Anomalous Pulmonary Venous Return
Boot shaped heart (TAPVR)
Pedia/Medicine- Anatomy 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)
Pharyngeal arch Artery
•• 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
CHD: Left to Right Shunt (Anat- 1. 1st ,2nd & 5th arch arteries disappear
Medicine-Pedia Integration) 2. Remnant of 1st arch artery → Inferior alveolar
•• ASD artery – Br. of Maxillary Artery
3. Remnant of 2nd arch artery → Stapedial artery &
•• VSD
Hyoid artery
•• PDA
4. 3rd arch artery → divides into 2 parts:
•• Ductus Arteriosus Aneurysm
a. Proximal part → CCA
•• Aortico -Pulmonary Window
b. Distal part → ICA
CHD: Right to Left Shunt (Anat- c. New growth → ECA
Medicine-Pedia Integration) •• 4th arch artery →
1. Tetralogy of Fallot a. On right side: Right subclavian artery
2. Tricuspid Atresia b. On left side: Arch of Aorta

106
•• 5th arch artery → disappears

–– Proximal part: right pulmonary artery
–– Distal part: disappears
•• 6th arch artery →
–– On right side
Proximal part: right pulmonary artery
Distal part: disappears
–– On left side
Proximal part: Left pulmonary artery
Distal part: DUCTUS ARTERIOSUS →

Q
Ligamentum Arteriosum (on left side)

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ANATOMY

QUICK REVISION NOTES

Vein – thin walled & collapsing

•• All neurovascular bundle of our body have

Position, Planes And Terminiology

•• Proximal - Near to trunk.

–– Articular processes of vertebrae

l. Invertor of foot:- tibialis Anterior &

m. Evertor of foot:- Peroneus longus & brevi •• Fusiform muscle :- biceps

 Bipennate:- 3rd & 4th lumbrical, all

Muscles of Pectoral region

Humerus / funny bone:-

Biceps - Short head is related to Coracobrachialis

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

Brachial Plexus anatomical relation with axillary artery).

Note-Sometime contribution from other segments

1. Nerve from roots

2. Nerves arises from upper trunk (only

3. No Branches from Divisions

4. Branches from Lateral Cord (Mnemonic

•• T - Thoracodorsal nerve (nerve to Latissimus •• Extended elbow - defect in Coracobrachialis,

•• R - Radial nerve (C5-T1)

6. Branches from Medial Cord (Mnemonic

Erb’s point - Junction of 6 nerves

2. Latissimus Dorsi - by Thoracodorsal

3. Levator scapulae - by Dorsal Scapular

4. Rhomboid Major & Minor - by Dorsal

Bursa of the Body

•• Nerve supply of deltoid : Axillary nerve •• Act as Shock absorber.

Regimental Badge Anaesthesia

Radial Radial groove Extensors Wrist drop

Median Supracondylar Flexors of - Median Claw

Student’s/Miner’s Elbow - Inflammation of

Nerve Site of injury Muscles Clinical

Supracondylar humerus Fracture

A. Anterior Compartment A.1. Superficial Muscles:

A.2. Deep Muscles: B. Posterior Compartment

B.2. Deep Group

1. Abductor pollicis brevis

•• About FDP - Hybrid muscle

Content (medial to lateral → MBBR)Q

Floor of Cubital Fossa (BSF)Q

•• Medial - lateral border of Pronator teres. F - Floor

•• Apex - meeting point of Pronator teres and

•• Musician nerve - Ulnar nerve

Anat - FMT Integration Palmar interosseiQ

ARTERIES & VEINS OF UPPER

Palmar & Dorsal Interossei

Subclavian artery branches : (VITamin CD)

It is divided by scalenus anterior muscle into 3 parts:

Reverse Allen’s test

Veins of Upper limb

NERVE OF UPPER LIMB Dermatomes of hand

Treatment of tunnel syndrome •• At the wrist, it passes through Guyon’s

•• Ulnar nerve getting thickened in leprosy •• D:- aDDuctor pollicis test

NERVE OF UPPER LIMB - 2 –– Anconeus

•• Root value:- C5, C6, C7, C8, T1 . These all –– Brachioradialis

–– if fracture at spiral groove (loss of extension at wrist and fingers )

Anatomical snuff box –– Medial/Posterior border:- extensor pollicis

–– Inflammation to this tendon leads to De

•• Nerve of anterior compartment - Femoral

•• Most common dislocation of hip joint - Posterior

•• Great saphenous vein - Pierces the Cribriform

1. Superficial external pudendal vein •• Femoral Ring → Uppermost part of femoral

Bipennate:- 3rd & 4th lumbrical, all

Superior Thyroid artery