Anatomy Solved Papers 2009 to 2013

ANATOMY RAPID AND EASY REVIEW Solved Five years Question Papers for First MBBS students

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

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

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

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

DEDICATION This work is dedicated to all medical students

TABLE OF CONTENTS

ANATOMY I FEBRUARY 2009 ..............................................................Error! Bookmark not defined. I. Essay Questions: .........................................................................Error! Bookmark not defined. II. Write Short notes on: .................................................................Error! Bookmark not defined. III. Short Answer Questions: ....................................................................................................... 9 ANATOMY I AUGUST 2009 .................................................................Error! Bookmark not defined. I. Essay Questions: .........................................................................Error! Bookmark not defined. II. Write Short notes on: .................................................................Error! Bookmark not defined. III. Short Answer Questions: ...........................................................Error! Bookmark not defined. ANATOMY I FEBRUARY 2010 ..............................................................Error! Bookmark not defined. I. Essay Questions: .........................................................................Error! Bookmark not defined. II. Write Short notes on: .................................................................Error! Bookmark not defined. III. Short Answer Questions: ...........................................................Error! Bookmark not defined. ANATOMY I AUGUST 2010 .................................................................Error! Bookmark not defined. I. Essay Questions: .........................................................................Error! Bookmark not defined. II. Write Short notes on: .................................................................Error! Bookmark not defined. III. Short Answer Questions: ...........................................................Error! Bookmark not defined. ANATOMY I FEBRUARY 2011 ..............................................................Error! Bookmark not defined. I. Essay Questions: .........................................................................Error! Bookmark not defined. II. Write Short notes on: .................................................................Error! Bookmark not defined. III. Short Answer Questions: ...........................................................Error! Bookmark not defined. ANATOMY I AUGUST 2011 .................................................................Error! Bookmark not defined. I. Essay questions: ..........................................................................Error! Bookmark not defined. II. Write short notes on: .................................................................Error! Bookmark not defined. III Short Answer Questions:............................................................Error! Bookmark not defined.

ANATOMY I FEBRUARY 2012 ..............................................................Error! Bookmark not defined. I. Elaborate on: ..............................................................................Error! Bookmark not defined. II. Write notes on: ..........................................................................Error! Bookmark not defined. III. Short Answers: ..........................................................................Error! Bookmark not defined. ANATOMY I AUGUST 2012 .................................................................Error! Bookmark not defined. I. Elaborate on: ..............................................................................Error! Bookmark not defined. II. Write notes on: ..........................................................................Error! Bookmark not defined. III. Short answers on: .....................................................................Error! Bookmark not defined. ANATOMY I FEBRUARY 2013 ..............................................................Error! Bookmark not defined. I. Elaborate on: ..............................................................................Error! Bookmark not defined. II. Write notes on: ..........................................................................Error! Bookmark not defined. III. Short answers on: .....................................................................Error! Bookmark not defined. ANATOMY I AUGUST 2013 .................................................................Error! Bookmark not defined. I. Elaborate on: ..............................................................................Error! Bookmark not defined. II. Write notes on: ..........................................................................Error! Bookmark not defined. III. Short answers on: .....................................................................Error! Bookmark not defined. ANATOMY II FEBRUARY 2009 .............................................................Error! Bookmark not defined. I. Elaborate on ...............................................................................Error! Bookmark not defined. II. Write Short notes on ..................................................................Error! Bookmark not defined. III. Short Answer Questions: ...........................................................Error! Bookmark not defined. ANATOMY II AUGUST 2009 ................................................................Error! Bookmark not defined. I. Essay Questions: .........................................................................Error! Bookmark not defined. II. Write Short notes on: .................................................................Error! Bookmark not defined. III. Short Answer Questions: ...........................................................Error! Bookmark not defined. ANATOMY II FEBRUARY 2010 .............................................................Error! Bookmark not defined.

I. Essay Questions: .........................................................................Error! Bookmark not defined. II. Write Short notes on: .................................................................Error! Bookmark not defined. III. Short answers ...........................................................................Error! Bookmark not defined. ANATOMY II AUGUST 2010 ................................................................Error! Bookmark not defined. I. Essay Questions: .........................................................................Error! Bookmark not defined. II. Write Short notes on: .................................................................Error! Bookmark not defined. III. Short Answer Questions: ...........................................................Error! Bookmark not defined. ANATOMY II FEBRUARY 2011 .............................................................Error! Bookmark not defined. I. Essay Questions: .........................................................................Error! Bookmark not defined. II. Write Short notes on: .................................................................Error! Bookmark not defined. III. Short Answer Questions: ...........................................................Error! Bookmark not defined. ANATOMY II AUGUST 2011 ................................................................Error! Bookmark not defined. I. Essay questions: ..........................................................................Error! Bookmark not defined. II. Write short notes on: .................................................................Error! Bookmark not defined. III. Short Answer Questions: ...........................................................Error! Bookmark not defined. ANATOMY II FEBRUARY 2012 .............................................................Error! Bookmark not defined. I. Elaborate on: ..............................................................................Error! Bookmark not defined. II. Write notes on: ..........................................................................Error! Bookmark not defined. III. Short Answers: ..........................................................................Error! Bookmark not defined. ANATOMY II AUGUST 2012 ................................................................Error! Bookmark not defined. I. Elaborate on: ..............................................................................Error! Bookmark not defined. II. Write notes on: ..........................................................................Error! Bookmark not defined. III. Short Answers on: .....................................................................Error! Bookmark not defined. ANATOMY II FEB 2013 .......................................................................Error! Bookmark not defined. I. Elaborate on: ..............................................................................Error! Bookmark not defined.

II. Short Notes ................................................................................Error! Bookmark not defined. III Short answers ............................................................................Error! Bookmark not defined. ANATOMY II AUGUST 2013 ................................................................Error! Bookmark not defined. I Elaborate on ................................................................................Error! Bookmark not defined. II SHORT NOTES .............................................................................Error! Bookmark not defined. III Short answers ............................................................................Error! Bookmark not defined.

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

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

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

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

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

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

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

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

Person in supine position

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

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

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

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

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

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

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

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

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

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

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

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

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

Medial

Lateral

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Major lobes of superolateral surface

Major gyri and sulci areas

major functional

Frontal lobe

Gyri and sulci

Functional areas

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

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

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

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

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

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

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

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

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

L.S of muscle

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

8. Barr body

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

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

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