Tonsil Develops From

5.
Tonsil develops from

a) First pharyngeal arch
b) Second pharyngeal pouch
c) Third pharyngeal pouch
d) Neural crest cells
6. Thymus develops from
a) Second pharyngeal pouch (ventral portion)
b) Third pharyngeal pouch (ventral portion)
c) Third pharyngeal pouch (dorsal portion)
d) Fourth pharyngeal pouch (ventral portion)
7. Which structure develops from all the 3 germ layers
a) Tympanic membrane
b) External acoustic meatus
c) Auditory tube
d) Middle ear
8. Within the figure below of a cross section of an embryo at the level of primitive pharynx, which
of the following structures will give rise to inferior parathyroid
a) 1(inside)
b) 2(inside)
c) 3(inside)
d) 4(inside)
Tongue and Thyroid (Embryology)

9. Tongue develops from all EXCEPT
a) Tuberculum impar
b) Hypobranchial eminence
c) Second arch
d) Lingual swellings
10. The taste pathway from circumvallate papillae of the tongue goes through
a) Chorda tympani branch of Facial nerve
b) Greater petrosal nerve branch of Facial nerve
c) Superior laryngeal branch of Vagus nerve
d) Lingual branch of Glossopharyngeal nerve
Cranial Cavity
11. Which of the following cranial nerves present in the posterior fossa
a) 3rd to 12th
b) 4th to 12th
c) 5th to 12th
d) 6th to 12th
12. CSF rhinorrhea leakage occurs through
a) Frontal sinus
b) Sphenoid sinus
c) Ethmoid sinus
d) Tegmen tympani
13. Which of the following is a tributary as well as drainage channel to cavernous sinus
a) Superior ophthalmic vein
b) Inferior ophthalmic vein
c) Spheno-parietal sinus
d) Superficial middle meningeal vein
14. Anterior ethmoidal nerve branch of nasociliary nerve supplies all EXCEPT
a) Dura mater in anterior cranial fossa
b) Ethmoidal cells
c) Internal nasal cavity
d) Maxillary sinus lining
15. All structures pass through foramen ovale EXCEPT
a) Accessory meningeal artery
b) Middle meningeal artery
c) Lesser petrosal nerve
d) Emissary vein
 Middle meningeal artery is a branch of maxillary artery, which passes through foramen spinosum to
enter cranial cavity. It may be ruptured in skull fracture leading to extradural haemmorhage, which
requires an emergency removal of clot putting burr holes to save the patient.
16. Structure passing through the tendinous ring of Zinn
b) Trochlear nerve
c) Naso-ciliary nerve
d) Lacrimal nerve
17. All are features of cavernous sinus thrombosis EXCEPT

a) Papilloedema
b) Proptosis
c) Sensory deficit on face due to involvement of three branches of trigeminal nerve
d) External ophthalmoplegia due to compression of three motor nerves to eyeball muscles
18. Which of the following is a direct content of cavernous sinus

a) Occulomotor nerve
b) Trochlear nerve
c) Maxillary branch of trigeminal
d) Abducent nerve
19. Mass in jugular foramen may result in all EXCEPT
a) Difficulty in swallowing
b) Hoarseness
c) Difficulty in turning the neck to opposite side
d) Tongue deviates to same side
 Membrana tectoria is continuation of posterior longitudinal ligament on vertebral column and enters cranial
cavity passing through foramen magnum
Questions: Head & Neck - I

20. Auricular hillocks develop from pharyngeal arch
a) 1
b) 2
c) 1 and 2
d) 2 and 3
21. TRUE statement regarding branchial anomalies
a) Most commonly second arch is involved
b) Cyst is more common than sinus
c) Sinus should always be excised
d) Cyst cause dysphagia & hoarseness
22. Choose the INCORRECT statement concerning pharyngeal plexus

a) Receives contributions from vagus nerve carrying cranial accessory nerve component
b) Supplies all pharyngeal muscles except stylopharyngeus
c) Supplies tensor tympani
d) Supply palatoglossus
 Most of the palate, pharynx and larynx muscles are supplied by cranial part of accessory nerve (fibres
distributed by vagus nerve branches) with few exceptions like stylopharyngeus(9), and tensor
palati(5).
 All the muscles of tongue are supplied by hypoglossal nerve(12) except palatoglossus (supplied by
cranial accessory nerve).
23. Right fourth arch artery gives rise to
a) Right subclavian artery
b) Common carotid artery
c) Internal carotid artery
d) External carotid artery
24. Double aortic arch occurs due to

a) Non – development of right 4th aortic arch
b) Non – development of left 4th aortic arch
c) Non- division of truncus arteriosus
d) Persistent distal portion of right dorsal aorta
 Double aortic arch occurs when an abnormal right aortic arch develops in addition to a left aortic arch
due to persistence of the distal portion of the right dorsal aorta. This forms a vascular ring around the
trachea and esophagus, which causes difficulties in breathing and swallowing.
25. Lesser petrosal nerve passes through
a) Foramen rotundum
b) Foramen ovale
c) Canaliculus innominatus
d) Foramen spinosum
26. Choose the INCORRECT statement about cranial nerves
a) Abducent has the longest intracranial course
b) Trochlear shows internal decussation
c) Olfactory is the shortest
d) Vagus has largest distribution
 Trochlear nerve decussates in the superior medullary velum.

 The primary (main) action of the superior oblique muscle is intorsion (internal rotation), the secondary
action is depression (primarily in the adducted position) and the tertiary action is abduction (lateral
rotation).
 Superior oblique is inserted into the posterior part of the eyeball; when it contracts, the back of the
eyeball is elevated, and the front of the eyeball is depressed (particularly in the adducted position).
27. All is true about trochlear nerve EXCEPT

a) Innervates contralateral superior oblique
b) Causes depression of eyeball in adducted position
c) Lies outside the ring of Zinn
d) Patient attains Ipsilateral head tilt, in lesion
Ans. d) Patient attains ipsilateral head tilt, in lesion
Explanation: Trochlear nucleus in the midbrain, send fibres to innervate the contralateral superior
oblique muscle. Superior oblique muscle causes depression and abduction of eyeball. Additionally it also
causes inward rotation (intortion). Trochlear nerve passes through the superior orbital fissure but stays
outside the ring of Zinn. Trochlear nerve is rarely paralyzed alone. It results in vertical diplopia (double
vision) on looking down, e.g. when going down stairs. This happens because the superior oblique normally
assists the inferior rectus in pulling the eye downward, especially when the eye is in a medial (adducted)
position. The patient develops contralateral (not ipsilateral) head tilt to compensate for extorted eye on the
affected side.
28. All is true about Trochlear nerve EXCEPT

a) Slender most cranial nerve
b) Has longest intradural course
c) Innervates contralateral superior oblique
d) Shows internal decussation
Additional Questions
29. Most skeletal elements of the face, for example, bone and cartilages are derived from which of
the following
a) Cranial intermediate mesoderm
b) Cervical somites
c) Neural crest cells migrating from the cranial neural tube
d) The somatic layer of cranial lateral plate mesoderm
Ans. c) Neural crest cells migrating from the cranial neural tube.
Explanation: Most of the skeletal elements of the head and neck are derived from neural crest cells
(secondary mesenchyme).
30. Upper body of hyoid bone develops from
a) First arch
b) Second arch
c) Third arch
d) Fourth arch
Ans. b) Second arch.
Explanation: Upper body of hyoid and lesser cornu develops in the second pharyngeal arch whereas,
lower body and greater cornu develops in third arch. Hyoid bone is derived from secondary mesenchyme
contributed by neural crest cells.
31. A patient presented with reddish spot (in circle) that is in the center of a slightly raised area just
anterior to his sternocleidomastoid muscle about one and a half inches superior to his jugular
notch. He has had this reddish raised area for as long as he can remember. If you push on it,
it feels attached to something that extends superiorly from this location. At times it leaks a
little clear fluid after he has been heavily exercising for long periods of time. What do you think
this congenital anomaly is
a) Internal branchial sinus

b) Branchial fistula
c) Hyperactive sebaceous gland
d) Thyroglossal duct cyst
Ans. b) Branchial fistula.
Explanation: Branchial fistula presents with an opening in the lower neck, at the anterior border of sterno-
cleido-mastoid muscle, discharging clear fluid (saliva), having through and through communication with
tonsillar fossa. Internal branchial sinus has an internal (not external) opening into the tonsillar fossa.
Hyperactive sebaceous gland presents with sebaceous (not watery) secretions. Thyroglossal cyst is a
midline presentation (not lateral).
32. Following are the pairs describing skull foramina and the nerves passing through them. Choose
the INCORRECT pair
a) Foramen ovale: Mandibular nerve
b) Foramen spinosum: Maxillary nerve
c) Foramen spinosum: Nervus spinosus
d) Internal acoustic meatus: Nervus intermedius
e) Foramen lacerum: Greater petrosal nerve
Ans. b) Foramen spinosum: Maxillary nerve; e) Foramen lacerum: Greater petrosal nerve.
Explanation: In the foramen spinosum pass nervus spinosus (mandibular nerve branch) and middle
meningeal artery. Maxillary nerve passes through foramen rotundum to enter the pterygopalatine fossa.
Nervus intermedius is also called as Wrisberg nerve and is a component of facial nerve (passes internal
auditory meatus). No structure passes through foramen lacerum, but at the floor are seen internal carotid
artery with sympathetic plexus around, deep petrosal nerve joining greater petrosal nerve to form nerve
of pterygoid canal.
33. Superior orbital fissure contains all EXCEPT

b) Inferior ophthalmic vein
c) Ophthalmic nerve
d) Naso-ciliary nerve
Ans. c) Ophthalmic nerve.
Explanation: Superior orbital fissure lets pass the three branches of ophthalmic nerve (and not the parent
nerve itself). The three branches are lacrimal, frontal and naso-ciliary nerves.
34. All of the following structures pass through optic foramen EXCEPT
a) Optic nerve
b) Ophthalmic artery
c) Ophthalmic nerve
d) Dura mater
Ans. c) Ophthalmic nerve.
Explanation: Ophthalmic nerve is a content of cavernous sinus, gives three branches, which pass
through superior orbital fissure to enter the orbit. Optic nerve passes along with the ophthalmic artery
through optic canal, which is an opening in the lesser wing of sphenoid at the apex of orbit. Optic nerve is
covered by meninges as it exits the optic canal.
35. Thinnest area of sclera

a) Limbus
b) Behind rectus insertion
c) Equator
d) In front of rectus insertion
Ans. b) Behind rectus insertion.
Explanation: Sclera is thinnest under the insertion of recti muscles.
36. Angular vein communicates with

a) Straight sinus
b) Cavernous sinus
c) Superior sagittal sinus
d) Inferior sagittal sinus
Ans. b) Cavernous sinus.
Explanation: Septic emboli from facial vein may enter the angular vein (at the medial angle of eye) and
then superior ophthalmic vein to enter the cavernous sinus, leading to cavernous sinus thrombosis.
37. Pain sensation from the ethmoid sinus is carried by

a) Frontal nerve
b) Lacrimal nerve
c) Nasociliary nerve
d) Infraorbital nerve
Ans. c) Nasociliary nerve.
Explanation: Pain sensation from ethmoid sinus is carried by ethmoidal nerves → nasociliary nerves →
ophthalmic nerve → trigeminal nerve → spinal sensory nucleus of trigeminal.
38. Afferent component of corneal reflex is carried by

a) Vagus nerve
b) Facial nerve
c) Trigeminal nerve
d) Glossopharyngeal nerve
Ans. c) trigeminal nerve.
Explanation: Corneal touch → nasociliary nerve → ophthalmic nerve → trigeminal nerve → main sensory
nucleus of trigeminal.
39. Ptosis is due to lesion of

a) Facial nerve
b) Somatic fibers of oculomotor nerve
c) Superior cervical ganglion
d) Edinger Westphal nucleus
Ans. b) Somatic fibres of oculomotor nerve > c) Superior cervical ganglion.
Explanation: Ptosis may occur due to lesion in the somatic fibres of occulomotor nerve leading to
paralysis of levator palpebrae superioris (skeletal muscle). Partial ptosis may result due to paralysis of
superior tarsal muscle (part of Muller) in a lesion of T-1 sympathetic pathway in the superior cervical
ganglion (Horner syndrome).
40. Floor of orbit formed by all EXCEPT
a) Maxilla
b) Ethmoid
c) Palatine
d) Zygomatic
Ans. b) Ethmoid.
Explanation: The floor (3 bones) of the orbit is chiefly contributed by the orbital plate of the maxilla which
articulates with the zygomatic bone anterolaterally and the small triangular orbital process of the palatine
bone posteromedially.
*Ethmoid bone is present on the medial wall of the orbit.
*Medial wall (4 bones) of orbit is formed by maxilla, lacrimal bone, ethmoid and the sphenoid (body).
*Lateral wall (2 bones)of orbit is formed by the zygomatic bone, and sphenoid (greater wing).
*Roof (2 bones) of orbit has frontal bone and sphenoid (lesser wing)
*Superior orbital fissure is formed between the lateral wall and the roof of orbit.
*Inferior orbital fissure is formed between the medial wall and the floor of orbit. Maxillary nerve passes
through it to run at the floor of the orbit as inferior orbital nerve.
41. UNTRUE statement about orbital articulation is
a) Medial wall of orbit is formed by maxilla, sphenoid, ethmoid and the lacrimal bone
b) Floor is formed by maxilla, zygomatic and palatine bone
c) Lateral wall of orbit is formed by the zygomatic bone and greater wing of sphenoid
d) Inferior orbital fissure is formed between the roof and the lateral wall of orbit
Ans. d) Inferior orbital fissure is formed between the roof and the lateral wall of orbit.
Explanation: Superior (not inferior) orbital fissure is present between the roof and lateral wall of orbit.
Inferior orbital fissure is at the junction of floor and lateral wall of the orbit.
42. Optic canal is present in which part of sphenoid bone
a) Greater wing
b) Lesser wing
c) Body
d) Pterygoid
Ans. b) Lesser wing.
Explanation: Optic canal is an opening in the lesser wing of sphenoid, where it attaches to the body of
sphenoid.
43. Blow-out fracture is present in which wall of orbit (PGIC)
a) Lateral wall
b) Medial wall only
c) Floor only
d) Medial wall and floor
e) Roof
Ans. d) Medial wall and floor.
Explanation: Blow-out fractures are more commonly seen in the floor > medial wall of the orbit.
44. Diplopia in superior oblique palsy is described as
a) Vertical on looking down
b) Vertical on looking up
c) Horizontal on looking in
d) Horizontal on looking out
Ans. d) Vertical on looking down.
Explanation: A patient with superior oblique palsy develops vertical diplopia on looking down. For e.g.,
while reading a book or going downstairs.
45. The muscle having contralateral innervation is

a) Inferior oblique
b) Superior rectus
c) Lateral rectus
d) Levator palpebrae superioris
Ans. b) Superior rectus.
Explanation: Superior rectus is suppled by the occulomotor nucleus on the opposite side. Hence a lesion
to the nucleus reults paralysis of contralateral superior rectus muscle.
 Both the superior muscles (superior rectus and superior oblique) have contralateral innervation, and
are the only muscles for intortion(SIN: only Superior muscles do INtortion).
 Levator palpebrae is supplied by a single central subnucleus. A lesion of the nucleus results in bilateral
ptosis.
46. Function of superior oblique muscle is
a) Intorsion, adduction and depression
b) Intorsion, abduction and elevation
c) Intorsion, abduction and depression
d) Extortion, abduction and depression
Ans. c) Intorsion, abduction and depression.

Explanation: Superior oblique muscle causes depression and abduction of eyeball. Additionally it also
causes inward rotation (intortion). Depression in adducted eye is chiefly carried out by superior oblique
muscle (assisted by inferior rectus).
47. Intortor(s) of the eyeball are

a) Superior oblique & superior rectus
b) Superior oblique & Inferior oblique
c) Superior rectus & inferior rectus
d) Inferior rectus & inferior oblique
Ans. a) Superior oblique & superior rectus.
Explanation: Only two muscles work for intortion(SIN: only Superior muscles do INtortion).
48. Following muscles are the abductors of eye EXCEPT

a) Superior oblique
b) Superior rectus
c) Inferior oblique
d) Lateral rectus
Ans. b) Superior rectus.
Explanation: Superior rectus pulls the eye inside (Adduction).
Head & Neck - II
Facial Nerve
49. A patient with crocodile tears syndrome has spontaneous lacrimation during eating due to
misdirection of regenerating autonomic nerve fibers. The lesion is located at
a) Facial nerve proximal to the geniculate ganglion
b) Chorda tympani in the infratemporal fossa
c) Facial nerve at the stylomastoid foramen
d) Lacrimal nerve
 Facial nerve has two parts: motor to facial expression muscles and nervus intermedius. The motor
part carries SVE component, while nervus intermedius carries GSA, SVA, and GVE fibers.
 SVE: Facial nerve supplies the muscles of facial expression (second pharyngeal arch). The fibres arise
from the motor nucleus of facial nerve (pons), loop around the abducent nucleus (internal genu), raising
facial colliculus, exit the brain stem at the ponto-medullary junction, to enter the internal auditory
meatus, pass through the facial canal in the middle ear cavity, give a branch to stapedius muscle, exit
the skull through the stylomastoid foramen to innervate the stylohyoid muscle, the posterior belly of
the digastric muscle, and enter parotid salivary gland and then send branches to innervate the face
muscles.
 Nervus intermedius (nerve of Wrisberg) carries fibres for taste, salivation, lacrimation, and general
sensation (from the external ear). The first-order sensory neurons are found in the geniculate ganglion
within the temporal bone.
 GSA component brings general sensations from the posterior surface of the external ear through the
posterior auricular branch.
 GVA fibers carry fibres from the soft palate and the adjacent pharyngeal wall.
 SVA component carries taste has from palate and the anterior two-thirds of the tongue to the nucleus
tractus solitarius.
 GVE component begins in the superior salivatory nucleus in the lower pons, carry preganglionic
parasympathetic secretomotor fibres to glands. a. Lacrimal pathway - Secretomotor fibres pass through
the nervus intermedius and greater petrosal nerves to the pterygopalatine (spheno-palatine) ganglion to
supply LNP (lacrimal, nasal, palatine) glands. b. Submandibular pathway - Secretomotor fibres pass
through the nervus intermedius and chorda tympani to the submandibular ganglion to innervate the
submandibular and sublingual salivary glands.
 Chorda tympani is given in the middle ear cavity, runs medial to the tympanic membrane and malleus.
It contains the SVA and GVE (parasympathetic) fibers. It carries pre-ganglionic fibres and is joined by
lingual nerve (a branch of mandibular nerve), which carries post-ganglionic parasympathetic fibres to
reach the submandibular and sublingual salivary glands..
50. All is true about facial colliculus EXCEPT
a) Raised by axons of facial nerve internal genu
b) Abducent nucleus lies deep to it
c) Located at the floor of fourth ventricle
d) Present on the dorsal aspect of upper pons
51. Vidian nerve passes through

a) Inferior orbital fissure
b) Foramen lacerum
c) Tympano-mastoid fissure
d) Pterygoid canal
52. Facial nerve has all the following neural columns EXCEPT
a) GVE
b) SVE
c) SVA
d) SSA
Hypoglossal Nerve
53. NOT seen in hypoglossal nerve injury
a) Atrophy of same side
b) Ipsilateral deviation of tongue
c) Loss of tactile sensation of anterior part of tongue
d) Larynx deviation toward the opposite side during swallowing
 Complete division of hypoglossal nerve causes unilateral lingual paralysis and eventual hemi-
atrophy; the protruded tongue deviates to the paralysed side, on retraction, the wasted and paralysed
side rises higher than the unaffected side. The larynx may deviate towards the active side in
swallowing, due to unilateral paralysis of the hyoid depressors associated with loss of the first
cervical spinal nerve which runs with the hypoglossal nerve.
Cervical Plexus
Larynx
54. FALSE about larynx
a) 9 cartilages: 3 paired and 3 unpaired cartilages
b) Extends from C3 to C6 vertebrae
c) External laryngeal nerve supply all larynx muscles except cricothyroid
d) Cricothyroid is a tensor of vocal cord
55. Damage to the external laryngeal nerve during thyroid surgery could result in the inability to
a) Relax the vocal cords
b) Tense the vocal cords
c) Widen the rima glottidis
d) Abduct the vocal cords
 Damage to the external laryngeal (branch of superior laryngeal) nerve can result when ligating the
superior thyroid artery during thyroidectomy. It can be avoided by ligating the superior thyroid artery at
its entrance into the thyroid gland. Injury to the nerve result in a weak voice with loss of projection, and
the vocal cord on the affected side appears flaccid.
 Unilateral damage to the recurrent laryngeal nerve can result while ligating inferior thyroid artery
during thyroidectomy. It results in a hoarse voice, inability to speak for long periods, and movement of
the vocal fold on the affected side toward the midline.
 Bilateral injury to the recurrent laryngeal nerve may result from while ligating inferior thyroid artery
during thyroidectomy. It results in acute breathlessness (dyspnea) since both vocal folds move toward
the midline and close off the air passage (and tracheostomy might be required).
Oesophagus
56. Marker ‘4’ in the following diagram shows oesophageal narrowing produced by
a) Crico-pharyngeus sphincter
b) Arch of aorta
c) Left principal bronchus
d) Left atrium
57. Venous drainage of oesophagus
a) Azygous vein, inferior thyroid vein, right gastric vein
b) Azygous vein, inferior thyroid vein, left gastric vein
c) Azygous vein, right gastric vein, left gastric vein
d) Superior thyroid vein, inferior thyroid vein, azygous vein, hemiazygous vein
58. Isthmus of thyroid gland overlies the
a) 1st tracheal cartilage
b) 1st and 2nd tracheal cartilage
c) 2nd, 3rd and 4th tracheal cartilage
d) 3rd and 4th tracheal cartilage
Arteries: Head & Neck
59. In subclavian steal syndrome there is reversal of blood flow in
a) Ipsilateral vertebral artery
b) Contralateral vertebral artery
c) Ipsilateral subclavian artery
d) Contralateral subclavian artery
 Subclavian stenosis proximal to the origin of the vertebral artery, results in a reversal of the blood
flow in the ipsilateral vertebral artery. Heavy manual exercise of the ipsilateral arm may increase
demand on vertebral flow, producing posterior circulation TIAs (subclavian steal syndrome).
60. In emergency tracheostomy the following structures are damaged EXCEPT
a) Isthmus of the thyroid
b) Inferior thyroid artery
c) Thyroid ima artery
d) Inferior thyroid vein
 Inferior thyroid veins drain into brachio-cephalic vein and are prone to injury in tracheostomy
procedure.
Neck Triangles and Fasciae

61. All of the following are in the anterior triangle of neck EXCEPT
a) Digastric
b) Subclavian
c) Muscular
d) Submental
 Posterior neck triangle is bounded by the trapezius, sternocleidomastoid, and clavicle and is
subdivided by the posterior belly of the omohyoid into the occipital and subclavian triangles. The
contents are spinal accessory nerve; cervical plexus; brachial plexus (roots and trunks); and subclavian,
transverse cervical & suprascapular arteries.
 Anterior neck triangle is bounded by the sternocleidomastoid, mandible, and midline of the neck and
is subdivided by the anterior & posterior bellies of digastric anterior and anterior belly of the omohyoid
into the submandibular, carotid, muscular, and submental triangles.
Triangle Main Contents and the underlying structures
A. Posterior triangle
1. Occipital triangle Spinal accessory nerve, brachial plexus (Trunks),
cervical plexus (branches), external jugular vein
2. Omoclavicular (subclavian) triangle Subclavian artery (3rd part), brachial plexus
(Trunks), cervical plexus (branches), external
jugular vein
B. Anterior triangle
1. Carotid triangle Carotid sheath (containing common carotid artery,
Internal jugular vein and vagus nerve), Ansa
cervicalis, sympathetic trunk, CN – XI and XII
2. Submandibular (digastric) triangle Submandibular salivary gland, CN – XII, mylohyoid
nerve, facial artery
3. Sub-mental triangle Sub-mental lymph nodes
4. Musculat triangle Strap (ribbon) muscles: sternothyroid, sternohyoid
 Brachial plexus can be blocked in the scalene triangle between scalenus anterior and medius.
 Carotid triangle contains the bifurcation of the common carotid artery (into internal & external carotid
artery at the level of C4). Carotid body and sinus are be found at the bifurcation.
 The carotid sheath contains the common and internal carotid arteries, internal jugular vein, and vagus
nerve. Sympathetic trunk lies posterior to the carotid sheath (embedded in the prevertebral fascia).
62. All is true about digastric triangle EXCEPT
a) On either side is anterior belly of digastric muscle
b) Floor is formed by mylohyoid muscle
c) Floor is formed by hyoglossus muscle
d) Contains mylohyoid nerve and vessels
63. If there is a superficial cut in the region of middle part of posterior triangle of neck, patient will
experience problem in
a) Adduction of arm
b) Protraction of scapula
c) Shrugging of shoulder
d) Overhead abduction of arm
64. All is true about cervical fascia EXCEPT
a) Ligament of Berry fixes thyroid gland to cricoid cartilage
b) Prevertebral fascia forms the roof of posterior triangle
c) Ansa cervicalis is embedded in the anterior wall of carotid sheath
d) Carotid sheath is formed by pretracheal and prevertebral fascia
 Deep cervical fascia forms a) investing layer, b) pretracheal layer and c) prevertebral layer.
a). Investing Layer encircles the neck and splits to enclose the trapezius and the sternocleidomastoid
muscles. It is at the roof of posterior triangle.
b). Pretracheal Layer surrounds the thyroid (and the parathyroid) glands, and encloses the infrahyoid
muscles.
c). Prevertebral Layer lies in front of the prevertebral muscles (like scalene muscles) behind the pharynx
& esophagus. It forms the floor of posterior triangl and extends laterally over the first rib into the axilla to
form axillary sheath (which encloses brachial brachial and axillary artery).
 Carotid sheath is condensation of the prevertebral, pretracheal, and the investing layers of the deep
cervical fascia.
 A thyroid mass usually moves with swallowing because the thyroid gland is enclosed by pretracheal
fascia.
Questions: Head & Neck - II
65. In the fracture of middle cranial fossa, lacrimation is affected in injury of
a) Nasociliary nerve
b) Greater petrosal nerve
c) Lesser petrosal nerve
d) Auriculotemporal nerve
66. Schirmer’s test evaluates the function of
a) Greater petrosal nerve
b) Lesser petrosal nerve
c) Chorda tympani nerve
67. Skin over angle of mandible is supplied by
a) Posterior primary rami of C-2,3
b) Greater auricular nerve
c) Maxillary nerve
d) Mandibular nerve
68. Relaxor of vocal cord is the muscle
a) Thyro-arytenoid
b) Cricothyroid
c) Posterior crico-arytenoid
d) Lateral cricoarytenoid
69. Ascending pharyngeal artery is a branch of

a) External carotid artery
b) Internal carotid artery
c) Common carotid artery
d) Maxillary artery
 Facial artery can be palpated at the anterior border of masseter muscle.

 Middle meningeal artery is a branch of 1st part of maxillary artery. It passes through foramen
spinosum. It is damaged in skull fracture at pterion, leading to extra(epi) dural haematoma.
70. The arteries labelled as ‘ABCD’ are
a) Internal Greater palatine → posterior ethmoidal → superior labial → lesser palatine

b) Greater palatine → anterior ethmoidal → superior labial → lesser palatine
c) Sphenopalatine → anterior ethmoidal → superior labial → greater palatine
d) Sphenopalatine → anterior ethmoidal → superior labial → lesser palatine
71. All is true about the openings in the lateral wall of nasal cavity and nasopharynx EXCEPT
a) Nasolacrimal duct opens in the inferior meatus
b) Posterior ethmoidal sinus open in the superior meatus
c) Inferior turbinate is a part of ethmoid bone
d) Eustachian tube opens in nasopharynx behind the inferior turbinate
 The nasolacrimal duct opens into the inferior meatus is partially covered by a mucosal fold (valve of
Hasner). Excess tears flow through nasolacrimal duct which drains into the inferior nasal meatus. It is
directed downward, backward and laterally.
 Maxillary sinus opens into the middle meatus (hiatus semilunaris).
72. Which of the following is the type of joints between malleus and incus
a) Primary cartilaginous
b) Secondary cartilaginous
c) Saddle synovial
d) Ball & socket synovial
 Atlanto-occipital joint is an ellipsoid (condylar) synovial joint. Neck flexion and extension occurs at this
joint for the nodding (yes) movement.
 Knee joint is a complex joint (involving more than two bones). Femoro-tibial joint structurally resembles
a hinge joint, but is considered as a condylar type of synovial joint between two condyles of the femur
and tibia. In addition, it includes a saddle joint between the femur and the patella.
73. Atlanto-occipital joint is of synovial variety

a) Trochoid
b) Ellipsoid
c) Condylar
d) Saddle
74. Nerve if Wrisberg carries (PGIC)
a) Motor fibres
b) Sensory fibres
c) Secretory fibres
d) Parasympathetic fibres
e) Sympathetic fibres
Ans. a) Motor fbres; b) Sensory fibres; c) Secretory fibres; d) Parasympathetic fibres.
Explanation: Nerve of Wrisberg (nervus intermedius) carry all the components of facial nerve except the
somatic motor fibres to the second pharyngeal arch (facial expression) muscles. Hence it carries
parasympathetic secreto-motor (GVE) fibres to the glands like lacrimal, palatine salivary glands etc. It
also carries sensory (GSA) fibres from the external ear canal. Taste (SVA) sensory fibres from palate and
anterior tongue are also carried along this nerve.
75. A patient has a dry eye and reduced nasal secretions. The location of a lesion might be in the
a) Otic ganglion
b) Pterygopalatine ganglion
c) Ciliary ganglion
d) Superior cervical ganglion
Ans. b) Pterygopalatine ganglion.
Explanation: Greater petrosal nerve (facial nerve branch) carries secretomotor fibres to the pterygo-
palatine ganglion which sends post-ganglionic fibres (along the trigeminal nerve branches) to supply
lacrimal, nasal and palatine glands. A lesion in pterygopalatine ganglion reults in dryness of eye, nose,
palate etc.
76. Lacrimal secretions are decreased when facial nerve injury occurs at the following site
a) Middle ear
b) Mastoid foramen
c) Geniculate ganglion
d) Sphenopalatine ganglion
Ans. c) Geniculate ganglion.
Explanation: This question specifically mentions facial nerve injury, hence pterygopalatine(sphenopalatine)
ganglion cannot be the answer, since it is not in the course of facial nerve. Here the answer is geniculate
ganglion. Lesion of facial nerve at the geniculate ganglion compromises the secreto motor fibres towards
the lacrimal, nasal and palatine glands, leading to dryness in the areas.
77. All is true about chorda tympani EXCEPT
a) Facial nerve branch given in temporal bone
b) Carries post-ganglionic parasympathetic fibres
c) Carries secretomotor fibres to sublingual & submandibular salivary gland
d) Joins lingual nerve in infratemporal fossa
Ans. b) Carries post-ganglionic parasympathetic fibres.
Explanation: Chorda tympani nerve is the third branch of facial nerve (in the facial canal), given in the
middle ear cavity (temporal bone), it joins the lingual nerve in the infra-temporal fossa and reaches the
submandibular ganglion. Pre-ganglionic parasympathetic secretomotor fibres are carried by chorda
tympani nerve, synapse in the sub-mandibular ganglion, the post-ganglionic fibres pass along the lingual
nerve (branch of mandibular; trigeminal nerve) to supply the salivary glands (submandibular & sublingual).
78. Which of the following do NOT supply submandibular gland
a) Lingual nerve
b) Chorda tympani
c) Sympathetic plexus
Ans. d) Auricuotemporal nerve.
Explanation: Auriculotemporal nerve (a branch of mandibular; trigeminal) carries the post-ganglionic para-
sympathetic secretomotor fibres to supply the parotid (and not submandibular) salivary gland.
79. Parasympathetic secretomotor fibers to parotid come from all EXCEPT
a) Otic ganglion
b) Greater petrosal nerve
c) Auriculotemporal nerve
d) Tympanic plexus
Ans. b) Greater petrosal nerve.
Explanation: Parotid salivary gland is supplied by lesser petrosal nerve (and not greater petrosal nerve).
Inferior salivatory nucleus in the lower pons send preganglionic parasympathetic fibres along the
tympanic branch of glossopharyngeal nerve towards the tympanic plexus (in the middle ear cavity).
Lesser petrosal nerve carry pre-ganglionic fibres further from the tympanic plexus to the otic ganglion.
Otic ganglion send the post-ganglionic fibres along the auriculotemporal nerve (branch of mandibular;
trigeminal) to supply the parotid salivary gland.
80. Nerve supply to platysma is
a) Ansa cervicalis
b) Marginal mandibular branch of facial nerve
c) Cervical branch of facial nerve
d) Mandibular nerve
Ans. c) Cervical branch of facial nerve.
Explanation: Platysma muscle develops in second pharyngeal arch (nerve:facial) and is present in the
neck (cervical) region hence, is supplied by cervical branch of facial nerve.
81. The culprit muscle in sleep apnea syndrome is
a) Hyoglossus
b) Genioglossus
c) Posterior cricoarytenoid
d) Lateral cricoarytenoid
Ans. b) Genioglossus.
Explanation: In sleep apnoea syndrome genioglossus muscle may not stay active during sleep and
tongue has the tendency to fall back into the respiratory pathway, leading to difficulty in breathing, which
wakes up the patient frequently during sleep.
82. Action of genioglossus
a) Elevation
b) Protrusion
c) Depression
d) Push the tongue towards midline
Ans. b) Protrusion > c) Depression and d) Push the tongue to midline.
Explanation: Genioglossus muscle pulls the tongue anterior and medial, thus protrusion in midlline
occurs. If one genioglossus muscle acts alone, the tip of the tongue deviates to the contralateral side, since
the medial vector is not being cancelled. Left genioglossus muscle acting alone turns the tip of tongue to
the right. Genioglossus muscle also pulls the tongue inferior (depression).
83. Incorrect statement(s) about tongue is/are (PGIC)
a) Facial nerve supplies fungiform papillae
b) Glossopharyngeal nerve supplies circumvallate papillae
c) Posterior most tongue develop from third pharyngeal arch
d) Genioglossus causes tongue protrusion
e) Blood supply is lingual artery
Ans. c) Posterior most tongue develop from third pharyngeal arch.
Explanation: Posterior most tongue develops in fourth pharyngeal arch and taste sensation is carried
by the superior laryngeal nerve (vagus branch). Fungiform papillae are present at the anterior aspect of
tongue and the taste sensation from the anterior 2/3 of tongue is carries by the chorda tympani (facial
nerve) branch. Posterior 1/3 of tongue develops in third pharyngeal arch and glossopharyngeal nerve
supplies the region (along with the circumvalate papillae). Genioglossus muscle takes the tongue
anterior, medial and inferior. Lingual artery is a branch of external carotid artery and supplies the tongue.
84. Ansa cervicalis innervates the following EXCEPT
a) Superior belly of omohyoid
b) Sternohyoid
c) Inferior belly of omohyoid
d) Thyrohyoid
Ans. d) Thyrohyoid.
Explanation: Ansa cervicalis supplies the anterior neck muscles, including strap muscles. Geniohyoid and
thyro-hyoid muscles (attaching to the hyoid bone) are supplied by C-1 fibres carried by hypoglossal nerve
(and not by ansa cervicalis).
]
85. Greater part of the auricle is supplied by

a) Auriculotemporal nerve
b) Lesser occipital nerve
c) Greater auricular nerve
d) Auricular branch of vagus
Ans. c) Greater auricular nerve.
Explanation: Greater part of auricle is supplied by greater auricular nerve (branch of the cervical plexus).
It innervates the lower part of auricle (including ear lobule) and supply posteromedial and posterolateral
aspect both. Lesser occipital nerve supplies upper and posterior part of the auricle (especially the helix).
Anterior part of the auricle (including tragus) is supplied by auriculo-temporal nerve (mandibular;
trigeminal). Facial nerve carries fibres of auricular branch of vagus to supply the concha and most of the
area around the auditory meatus.
86. Trachea begins at which level
a) Upper border of thyroid cartilage
b) Lower border of thyroid cartilage
c) Upper border of cricoid cartilage
d) Lower border of cricoid cartilage
Ans. d) Lower border of cricoid cartilage.
Explanation: Trachea and oesophagus begin at the lower border of cricoid cartilage of larynx (at the
lower border of C-6 vertebra).
87. Nerve supply to the larynx mucosa is
a) External laryngeal and recurrent laryngeal
b) Internal laryngeal
c) External laryngeal
d) Superior laryngeal
Ans. b) Internal laryngeal nerve.
Explanation: Larynx mucosa till the vocal cords is supplied by the internal laryngeal nerve (branch of
superior laryngeal nerve); below the vocal cord it is suppled by the recurrent laryngeal nerve. External
laryngeal nerve is a motor nerve to supply the tensor of the vocal cord – cricothyroid muscle.
88. Muscle relaxants are used routinely during anesthesia with resultant closure of the vocal folds.
Laryngeal intubation by the anesthesiologist is necessary because which of the following
muscle is unable to keep the glottis open
a) Cricothyroid muscle
b) Lateral cricoarytenoid muscles
c) Posterior cricoarytenoid muscles
d) Thyroarytenoid muscle
Ans. c) Posterior cricoarytenoid muscle.
Explanation: Posterior crico-arytenoid muscle is the safety muscle of larynx to (abduct) open the vocal
cords, if paralysed, leads to difficulty in breathing, and hence, endotracheal intubation is a pre-requisite
before giving muscle relaxants.
89. During thyroid surgery, a nerve coursing along the superior thyroid artery is injured. What can
be the possible consequence(s) (PGIC)
a) Loss of sensation above the vocal cords
b) Loss of sensation below the vocal cords
c) Paralysis of crico-thyroid muscle
d) Paralysis of posterior crico-arytenoid muscle
e) Loss of sensation in pyriform fossa
Ans. c) Paralysis of cricothyroid muscle.
Explanation: Superior thyroid artery is accompanied by the external laryngeal nerve (branch of superior
laryngeal nerve) to supply the cricothyroid muscle. Pyriform fossa is supplied by the superior laryngeal
nerve.
90. Constrictions of oesophagus when measured from upper incisors are present at
a) 15cm, 20 cm, 40 cm
b) 15 cm, 25 cm, 40 cm
c) 20cm,30 cm,40 cm
d) 30cm, 40 cm, 60 cm
Ans. b) 15cm, 25cm, 40 cm.
Explanation: According to Bailey and Love Surgery, oesophagus has three narrowings: 15
(cricopharyngeal), 25 (aorta-bronchial), 40 (diaphragmatic) cm from the upper incisors.
91. All lie at the vertebra level C-6 EXCEPT

a) Junction of pharynx with oesophagus
b) Junction of larynx with trachea
c) Cricoid cartilage
d) Isthmus of thyroid
Ans. d) Isthmus of thyroid.
Explanation: At the lower level of cricoid cartilage (at C-6 vertebra), pharynx becomes oesophagus and
larynx becomes trachea. Isthmus of thyroid gland lies below C-6 level, in front of the trachea (ring 2&3).
92. If a benign tumour is found where the common carotid artery usually bifurcates, it would be
located at the level of the
a) Cricoid cartilage
b) Angle of the mandible
c) Superior border of the thyroid cartilage
d) Jugular notch
Ans. c) Superior border of thyroid cartilage.
Explanation: Carotid body tumour lies at the bifurcation of common carotid artery at the superior border
of thyrod cartilage.
93. All of the following are branches of subclavian artery EXCEPT
a) Vertebral artery
b) Thyrocervical trunk
c) Subscapular artery
d) Internal thoracic artery
Ans. c) Subscapular artery.
Explanation: First part of subclavian artery gives thre branches: V(Vertebral), I (Internal thoracic artery),
T(thyro-cervical trunk). Sub-scapular artery is a branch of axillary artery and goes under the scapula.
94. Inferior thyroid artery is a branch of and is related to

a) External carotid artery; superior laryngeal nerve
b) Internal carotid artery; superior laryngeal nerve
c) Thyrocervical trunk; recurrent laryngeal nerve
d) Brachio-cephalic trunk; recurrent laryngeal nerve
Ans. c) Thyrocervicak trunk; recurrent laryngeal nerve.
Explanation: Inferior thyroid artery is a branch of thyrocervical trunk (first part of subclavian artery) and is
accompanied by the recurrent laryngeal nerve to supply the thyroid gland. During thyroid gland surgery,
recurrent laryngeal nerve might get damaged leading to paralysis of larynx muscle (except cricothyroid) and
laryngeal anaesthesia below the vocal cords.
95. Which structure passes through foramen magnum
a) Internal Carotid Artery
b) Sympathetic chain
c) Hypoglossal Nerve
d) Vertebral Artery
Ans. d) Vertebral artery.
Explanation: The two vertebral arteries enter the foramen magnum to enter the cranial cavity and join to
form the basilar artery at the ponto-medullary junction. Internal carotid artery and hypoglossal nerve has
one canal each to enter the cranial cavity. Sympathetic chain do not enter the cranial cavity, it begins
below the foramen magnum and terminates at the coccyx level.
96. Thoracic duct opens into
a) Subclavian vein
b) Brachiocephalic vein
c) Internal jugular vein
d) Jugulo-subclavian venous angle
Ans. d) Jugulo-subclavian angle.
Explanation: Thoracic duct opens into jugulosubclavian vein junction on the left side of the neck. It may
occasionally open into internal jugular vein or subclavian vein itself. Right lymphatic duct drains the
lymphatics of right upper quadrant of the body and opens into the right venous angle.
‘
97. True about pharyngo-tympanic tube is/are

a) 36 mm in length
b) 1/3 cartilaginous and 2/3 bony
c) Runs antero-medially making an angle of 30°with the sagittal plane
d) Tensor veli palati opens it
e) Narrowest diameter is at the isthmus
Ans. a) 36mm in length; d) Tensor veli palati opens it; e) Narrowest lumen is at the isthmus.
Explanation: Eustachian (pharyngo-tympanic) tube has a length of 36mm. It communicates the middle
ear cavity with the naso-pharynx. Lateral 1/3 (12mm) is bony and begins at the anterior wall of middle ear
cavity. Medial 2/3 (24mm) is made up of elastic cartilage and opens in the naso-pharynx, behind the
inferior turbinate of nasal cavity.
 It runs anterior, inferior and medial at an angle of 45°with the sagittal plane and 30°with the horizontal.
It is opened by dilator tubae (tensor veli palatini) and aided by salpingopharyngeus. Levator veli
palatini might allow passive opening.
 The diameter of the tube is greatest at the pharyngeal orifice, least at the junction of the two parts (the
isthmus), and widens again towards the tympanic cavity.
 Arteries to the pharyngotympanic tube arise from the ascending pharyngeal branch (external acrotid
artery branch), and from the middle meningeal artery & the artery of the pterygoid canal (maxillary
artery branches). The veins of the pharyngotympanic tube usually drain to the pterygoid venous
plexus.
 It is supplied by tympanic plexus (which itself is chiefly contributed by glossopharyngeal nerve).
98. Which of the following is condylar synovial joint

a) First carpo-metacarpal
b) Radio-carpal
c) Intercarpal
d) Metacarpo-phalangeal
Ans. d) Metacarpo-phalangeal > b) Radio carpal.
Wrist Explanation: This is a wrong question, because it has double answer. Still you may give preference
to metacarpo-phalangeal joint. Wrist (radiocarpal) joint and knuckle (metacarpo- phalangeal) joint, both
are structurally condylar but functionally ellipsoid synovial joint. First carpo-metacarpal joint is a saddle
synovial joint for the movement of thumb opposition. Intercarpal joints are plane synovial joints.
High Yield Facts

 Stylopharyngeus muscle develops in third pharyngeal archg and is supplied by glossopharyngeal
nerve.
 Posterior cricoarytenoid muscle abducts the true vocal cords by moving the muscular portion of
arytenoid cartilage of larynx.
 Ascending pharyngeal artery is a branch of external carotid artery. External carotid artery gives 8
branches - Superior thyroid artery, Lingual artery, Facial artery, Occipital artery, Posterior auricular
artery, Ascending pharyngeal artery, Maxillary artery, Superficial temporal artery.
 Portal system is a system of vessels in which blood collected from one capillary network passes
through a large vessel and then a second capillary network before it returns to the systemic
circulation – as in the hypophyseal portal system blood from the hypothalamic capillaries passes
through the hypophyseal portal veins and then the pituitary capillary sinusoids to reach the
hypophyseal veins.
 Middle ear (tympanic) cavity is located within the temporal bone and communicates with the
nasopharynx via the auditory tube. The cavity is supplied by tympanic plexus (chief innervation
from the glossopharyngeal nerve). Chorda tympani branch of facial nerve is given in the middle
ear cavity. The footplate of the stapes send sound vibrations into the oval window, creating a
traveling wave in the perilymph-filled scala vestibuli. Tensor tympani (mandibular; trigeminal nerve)
and stapedius (facial nerve) muscles present in the cavity dampen vibrations of the ossicular chain,
thus protecting the cochlea from loud low-frequency sounds (<1000 Hz).
 Risorius is a muscle of facial expression (Arch: II; nerve supply: facial nerve). It retracts the angle
of the mouth to produce grinning (insincere looking smile).
 Recurrent tentorial nerve (a branch of ophthalmic division of trigeminal nerve) supplies tentorium
cerebelli.
 Sensory supply to tonsil is by glossopharyngeal nerve and additional supply by lesser palatine
nerve (Trigeminal; maxillary nerve). Tonsillar pathology may be accompanied by pain referred to the
ear, due to common nerve supply (glossopharyngeal nerve).
 Waldeyer’s ring is an arrangement of MALT (mucosa-associated lymphoid tissue) which surrounds
the openings into the digestive and respiratory tracts. It is made up antero-inferiorly by the lingual
tonsil, laterally by the palatine and tubal tonsils, and postero-superiorly by the nasopharyngeal
tonsil.
 Cervical oesophagus is supplied by inferior thyroid artery.
 Suprameatal triangle lies over the mastoid antrum.
Section 5. Back
Back - Embryology
1. In a neonate, spinal cord ends at
a) Lower border of T12
b) Lower border of L I
c) Upper border of L 3
d) Lower border of L 3
 In a neonate, at birth, spinal cord extends till the upper border of L-3 vertebra. It takes less than two
months (post birth) to reach the lower border of L-1 (Gray’s Anatomy).
2. Following are the various structures related to spinal cord and their respective terminal extent.
Choose the WRONG pair
a) Adult spinal cord: Transpyloric plane
b) Pia mater: Coccyx
c) Duramater: S2 vertebra
d) Arachnoid sheath: S2 vertebra
3. During a procedure to remove cerebrospinal fluid from the subarachnoid space below the end of
the spinal cord, the needle was advanced too far and penetrated the ligament forming the anterior
border of the vertebral canal. Which of the following ligaments, not normally pierced during this
procedure, was accidentally penetrated
a) Anterior longitudinal
b) Ligamentum flava
c) Posterior longitudinal
d) Supraspinous
 In lumbar puncture supraspinous and interspinous are always punctured, ligamentum flava may be
punctured (if the needle is not in the midline); posterior longitudinal ligament is punctured accidently
and anterior longitudinal ligament can never be punctured.
 The spinal cord terminates at approximately the L1 vertebral level in 94% of individuals. In the remaining
6%, the conus extends to the L2-L3 interspace. LP is therefore performed at or below the L3-L4
interspace. A line drawn between the posterior superior iliac crests, which corresponds closely to the
level of the L3-L4 interspace is a guiding landmark.
 In lumbar puncture needle penetrates duramater and arachnoid mater to reach CSF space for injecting
spinal anaesthesia.
 The needle passes through skin → superficial fascia → supraspinous ligament → interspinous ligament
→ ligamentum flavum → epidural space → dura mater → arachnoid → subarachnoid space containing
CSF.
 Internal vertebral venous plexuses lie within the vertebral canal in the epidural space.
4. Disc herniation between L4 and L5 involves nerve root
a) L- 2
b) L- 3
c) L- 4
d) L- 5
 In slip disc, a simple formulae to derive the affected nerve root is to add 1 to the upper vertebrae
number (valid in cervical and lumbar vertebrae region). Here, L4 (+1) = L5 nerve root is involved. Slip
disc is rarely seen in thoracic region.
 Spinal cord has a cervical enlargement at spinal segment C3-T2, which contributes to brachial plexus
and supply the upper limb.
 The lumbar enlargement is at spinal segment L1-S3, which gives fibres for the lumbo-scaral plexus to
supply the lower limb. Lumbar enlargement at the level of 9-12 thoracic vertebra.
 The nerve roots exit at a level above their respective vertebral bodies in the cervical region (e.g., the
C7 nerve root exits at the C6-C7 level) and below their respective vertebral bodies in the thoracic and
lumbar regions (e.g., the T1 nerve root exits at the T1-T2 level). The cervical nerve roots follow a short
and horizontal intraspinal course before exiting. By contrast, the lumbar nerve roots follow a long and
oblique course and can be injured anywhere from the upper lumbar spine to their exit at the
intervertebral foramen.
 Pain-sensitive structures of the spine include the periosteum of the vertebrae, dura, facet joints, annulus
fibrosus of the intervertebral disk, epidural veins and arteries, and the posterior longitudinal ligament.
Herniated Compressed Dermatome Muscles Movement Nerve and Reflex
Disc Nerve Root Affected Affected Weakness Involved
between
C4 and C5 C5 C5 Deltoid Abduction of arm Axillary nerve
Lateral surface of biceps jerk
the arm
C5 and C6 C6 C6 Lateral surface Biceps Flexion of forearm Musculocutaneous
of the forearm Brachialis Supination/pronation Nerve
Thumb Index Brachioradialis biceps reflex
finger brachioradialis
(supinator) reflex
C6 and C7 C7 C7 Triceps Extension of for arm Radial nerve
Middle finger Wrist extensors Extension of wrist triceps jerk
L3 and L4 L4 L4 Quadriceps Extension of Knee Femoral nerve
Medial surface of knee jerk
the leg
L4 and L5 L5 L5 Tibialis anterior Dorsiflexion of ankle Common fibular
Lateral surface of Extensor hallucis ( patient cannot Nerve
leg longus stand on heels) No reflex loss
Dorsum of foot Extensor Extension of toes
Big toe digitorum longus
L5 and S1 S1 S1 Gastrocnemius Plantar flexion of Tibial nerve

Heel Soleus ankle( patient ankle jerk
Little toe cannot stand on
toes)
Flexion of toes
5. Primary curvatures of vertebral column are
a) Cervical & lumbar
b) Thoracic & sacral
c) Cervical & thoracic
d) Thoracic & lumbar
Ans. b) Thoracic & sacral.
Explanation: Primary curvatures are present since birth and are concave anteriorly (kyphosis).
Secondary curvatures are acquired after birth and are convex (lordosis) anteriorly. Lumbar lordosis
increases during pregnancy due to centre of gravity shifting more anterior (additional load of conceptus).
6. Numerical variation is least in which vertebrae

a) Cervical
b) Thoracic
c) Lumbar
d) Coccygeal
Ans. a) Cervical.
Explanation: The cervical region is reported to be the most constant, the coccygeal the most
variable.The usual grouping formula of 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal
vertebrae is found in only about 20% of individuals studied.
7. Typical cervical vertebrae can be differentiated from thoracic vertebra by
a) Triangular vertebral canal
b) Foramen transversarium
c) Superior articular facet directed backward and upwards
d) Large vertebral body
Ans. b) Foramen transversarium > a) Triangular vertebral canal and c) Superior articular facet
directed backward and upwards
Explanation: Cervical vertebrae are characterized by presence of foramen transversarium. The shape of
the body is oval and the vertebral canal is triangular. The superior articular facets are directed backward
and upwards. Cervical vertebrae has comparatively small body, thoracic vertebrae large and lumbar
vertebrae has the largest size.
 C-1 (Atlas) vertebra has no body. C-2 (Axis) vertebra has a vertical projection (dens/odontoid
process), which articulates with atlas to form atlanto-axial joint (pivot synovial) for rotatory movement
of ‘NO’ at neck region.
8. Vertebral artery passes through foramen transversaria of

a) All cervical vertebrae
b) 2nd to 5th cervical vertebrae
c) All except 1st cervical vertebra
d) All except 7th cervical vertebra
Ans. d) All except 7th cervical vertebra.
Explanation: Vertebral artery passes through the upper six foramen transversaria in most of the
population. Vertebral artery passes through the foramen transversarium of C-7 vertebra in 2% population.
9. Lumbar puncture is done at the vertebral level

a) L-2
b) L-3
c) L-4
d) L-5
Ans. c) L-4.
Explanation: Lumbar puncture for (CSF sample or spinal anaesthesia) is carried out at L – 3 and L-4
vertebra level (the highest point of iliac crest). It may also be done at L -4 and L-5 vertebra level.
10. All is true about spinal cord in vertebral canal EXCEPT
a) Transverse section is oval at cervical region
b) Cervical enlargement is present at C3-T2
c) Lumbar enlargement at L1-S3
d) Lumbar enlargement at 9-12 thoracic vertebra
Ans. a) Transverse section is oval at cervical region.
Explanation: Transverse section of spinal cord is triangular at cervical region and oval in thoracic region.
11. Which spinal segment corresponds to fourth thoracic vertebra
a) T- 2
b) T- 4
c) T- 6
d) T- 8
Ans. c) T – 6.
Explanation: In the upper thoracic region, we need to add 2 to the vertebral number to get the segment
number of spinal cord.
12. Boundary of triangle of auscultation is NOT formed by (AIIMS)

a) Scapula
b) Trapezius
c) Latissimus dorsi
d) Serratus anterior
Ans. d) Serratus anterior.
Explanation: Serratus anterior is inserted on the medial border of scapula but lies anterior to scapula
hence is not in the triangle of auscultation.
 Triangle of Auscultation is bounded by 2 muscles and scapula. Superiorly – Trapezius, Inferiorly –
Latissimus dorsi and Laterally – medial wall of Scapula. Rib 7 and Rhomboideus major lie in the floor of
the triangle.
 Applied anatomy: Since, minimal muscle fibres lie over the triangle, auscultation by stethoscope is
better over this triangle, especially, the sounds of swallowed fluids. Cardiac end of the stomach lies
deep to this triangle.
High Yield Facts

 C7 vertebra has the most prominent spinous process.
Section 6. THORAX
Embryology
 Cardiovascular tube develops from the ventral visceral (splanchnic) lateral plate mesoderm under
the influence of multiple signals, including those derived from neural crest cells.
 The myocardial cells secretes an extracellular matrix rich in hyaluronic acid (cardiac jelly) which
accumulates within the endocardial cushions, which are precursors cardiac valves.
 The crista terminalis is the junction of the smooth and rough (trabeculated) part of the right atrium. It is
a vertical muscular ridge running anteriorly along the right atrial wall from the opening of the SVC to the
opening of the IVC, providing the origin of the pectinate muscles and is indicated externally by the sulcus
terminalis.
 SA node is present in the right atrium at the opening of superior vena cava, at the upper end of crista
terminalis. It does not occupy the full thickness of the right atrial wall from epicardium to endocardium in
humans, but rather sits as a wedge of specialized tissue subepicardially.
 Pulmonary veins (total four) develop from the left atrial wall.
Heart tube derivatives:

Embryonic structure Adult derivative
Ascending Aorta
Truncus arteriosus
Pulmonary trunk
Smooth part of right ventricle (conus arteriosus)
Bulbus cordis
Smooth part of left ventricle (aortic vestibule)
Trabeculated part of right ventricle
Primitive ventricle
Trabeculated part of left ventricle
Trabeculated part of right atrium
Primitive atrium
Trabeculated part of left atrium
Right horn: Smooth part of right atrium (sinus venarum)
Sinus venosus
Left horn: Coronary sinus and oblique vein of left atrium
1. The structure present anterior to transverse pericardial sinus is
a) Inferior vena cava
b) Superior venae cava
c) Aorta
d) Pulmonary artery
 As the heart tube folds, a space develops between arterial and venous end – transverse pericardial
sinus. Anterior to the sinus are two arteries derived from truncus arteriosus: ascending aorta and
pulmonary trunk (and not pulmonary artery). A finger can be put into the sinus to pull the two major
arteries and a ligature put around, during cardio-thoracic surgeries. Superior vena cava lies posterior
to the sinus and bifurcation of pulmonary trunk is superior to it,
2. Transposition of great vessels occurs due to
a) Failure of cono-truncal ridge to fuse and descend towards the ventricles
b) Anterior displacement of aortico-pulmonary septum
c) Aortico-pulmonary septum not following its spiral course
d) Migration of neural crest cells towards truncal & bulbar ridges
 AP septum anomalies like PTA, TGV and TOF present with right to left shunt, blood reaches
systemic circulation without proper oxygenation, hence leading to cyanosis.
 If the AP septum is not spiral, the great vessels are not spiral and they open in the opposite ventricles
(transposition of great vessels). The aorta arises from the right ventricle, and the pulmonary artery
emerges leftward and posteriorly from the LV (two separate parallel circulations); some communication
between them must exist after birth to sustain life. Most patients have an interatrial communication,
two-thirds have a patent ductus arteriosus, and about one-third have an associated VSD.
 Failure of cono-truncal ridge to fuse and descend towards the ventricles result in absence of AP
septum – Persistent truncus arteriosus.
 Anterior displacement of aortico-pulmonary septum – Tetralogy of Fallot. It consists of: pulmonic
stenosis, a wider aorta (which over-rides the right and left ventricles), VSD and right ventricular
hypertrophy. Right-to-left shunt across the VSD results in cyanosis at an early stage.
 Fetal circulation: Oxygenated blood travels from the placenta along the left umbilical vein. Most
blood by-passes the liver in the ductus venosus joining the inferior vena cava and then travelling to
the right atrium.
 Most of the blood passes through the foramen ovale into the left atrium so that oxygenated blood can
enter the aorta and reach the brain at earliest. The remainder goes through the right ventricle with
returning systemic venous blood into the pulmonary trunk. The unexpanded lungs present high
resistance to flow so that blood in the pulmonary trunk tends to pass down the low-resistance ductus
arteriosus into the aorta.
 Blood returns to the placenta via the umbilical arteries (branches of the internal iliac arteries).
 At birth, when the baby breathes, the left atrial pressure rises, pushing the septum primum against the
septum secundum and closing the foramen ovale. Blood flow through the pulmonary artery increases
and becomes poorly oxygenated as it now receives systemic venous blood. Pulmonary vascular
resistance is abruptly lowered as lungs inflate and the ductus arteriosus is obliterated over the next
few hours to days.
 At removal of placenta, ligation of the umbilical cord causes thrombosis of the umbilical arteries
(becomes medial umbilical ligaments), vein (becomes ligamentum teres) and ductus venosus
(Becomes ligamentum venosum).
Heart Arteries
 Right coronary artery arises from the anterior aortic sinus of ascending aorta and left coronary
artery from left posterior.
 The term ‘dominant’ is used to refer to the coronary artery that gives the posterior interventricular
artery, which supplies the posterior part of the ventricular septum and often part of the posterolateral
wall of the left ventricle. The dominant artery is usually the right (60- 65%).
 The first branch of right coronary artery is called as conus artery. This is sometimes termed a ‘third
coronary’ artery (may arise separately from the anterior aortic sinus in 36% of individuals or may be
a branch of left coronary artery occasionally).
 The sinu-atrial node is supplied by the right (51–65%) or left (35–45%) coronary arteries, and fewer
than 10% of nodes receive a bilateral supply. The atrioventricular node is supplied by the right (80–
90%) or left (10–20%) coronary arteries.
3. The right coronary artery is the main supply to all of the following parts of the conducting system
in the heart EXCEPT
a) SA Node
b) AV Node
c) AV Bundle
d) Right bundle branch
Veins: Thorax
 The azygos vein is formed by the union of the right ascending lumbar and right subcostal veins. Its
lower end is connected to the IVC. It arches over the root of the right lung and empties into the SVC.
 The hemiazygos vein is formed by the union of the left subcostal and ascending lumbar vein, receives
the 9th, 10th, and 11th posterior intercostal veins, and enters the azygos vein. Its lower end is
connected to the left renal vein. The accessory hemiazygos vein receives the fifth to eighth posterior
intercostal veins and terminates in the azygos vein.
 The superior intercostal vein is formed by the second, third, and fourth intercostal veins and drains
into the azygos vein on the right and the brachiocephalic vein on the left.
4. IVC obstruction presents with
a) Oesophageal varices
b) Haemorrhoids
c) Para-umbilical dilatation
d) Thoraco-epigastric dilatation
Sternal Angle & Mediastinum
5. Arch of aorta begins at the vertebra level
a) T2
b) T3
c) T4
d) T5
 The sternal angle (of Louis) is the junction between the manubrium and the body of the sternum and
is located at the level where the second ribs articulate with the sternum, the aortic arch begins and
ends, and the trachea bifurcates into the right and left primary bronchi.
 Trachea bifurcates at the upper border of T-5 vertebra (Gray’s Anatomy).
 The posterior mediastinum contains the esophagus, thoracic aorta, azygos and hemiazygos veins,
thoracic duct, vagus nerves, sympathetic trunks, and splanchnic nerves.
6. Trachea bifurcates at the vertebra level
a) T2
b) T3
c) T4
d) T5
 Trachea bifurcates at the upper border of T-5 vertebra, in deep inspiration may be pulled down to
T-6 vertebrae level. In a cadaver, it terminates at T-4 level.
BPS (Broncho-Pulmonary Segments)

 The right principal bronchus is wider, shorter, and more vertical than the left principal bronchus, and
therefore, is where large aspirated objects commonly lodge. • The right lower lobar bronchus is most
vertical, most nearly continues the direction of the trachea, and is larger in diameter than the left, and
therefore, is where small aspirated objects commonly lodge and the fluid aspirations reach the right
lower lobes more often.
 A bronchopulmonary segment is defined by a segmental bronchus and accompanying segmental
artery (branch of pulmonary artery) that lie centrally, whereas the veins (branch of pulmonary vein) are
intersegmental and lie at the margins of bronchopulmonary segments.
7. A bed-ridden patient on liquid diet develops aspiration pneumonia. Which of the following is
bronchopulmonary segment is most likely affected
a) Posterior of right upper lobe
b) Inferior lingular of left upper lobe
c) Apical of right lower lobe
d) Posterior of right lower lobe
 In erect posture (sitting or standing) aspirated material most commonly enters the right lower lobar
bronchus and lodges within the posterior basal bronchopulmonary segment (no. 10) of the right lower
lobe.
 Aspiration in supine posture most commonly involves the right lower lobar bronchus and aspitare
lodges within the superior(apical) bronchopulmonary segment of the right lower lobe.
Intercostal Drainage
8. In pleural tap in the mid-axillary line, muscle NOT pierced is
a) External intercostal
b) Serratus anterior
c) Innermost intercostal
d) Transversus thoracis
Rib - I
9. All of the following lie between first rib and the apex of the lung EXCEPT
a) Superior intercostal artery
b) First intercostal vein
c) Thoracic duct
d) Sympathetic trunk
Questions: Thorax
10. Which of the following is NOT a boundary of the Koch’s triangle
a) Tendon of Todaro
b) Limbus fossa ovalis
c) Coronary sinus
d) Tricuspid valve ring
 Triangle of Koch : A roughly triangular area on the septal wall of the right atrium, bounded by the
base of the septal leaflet of the tricuspid valve, the anteromedial margin of the orifice of the
coronary sinus, and the tendon of Todaro; it marks the site of the atrioventricular node. In a case of
AV nodal re-entry tachycardia, radiofrequency ablation of this triangular area improves the symptoms.
 Koch’s triangle is usually supplied by right coronary artery.
11. In PA view CXR, right border of the heart is contributed by
a) Pulmonary trunk
b) Ascending aorta
c) Right auricle
d) Right ventricle
12. Pleural reflection on midaxillary line is in space

a) 5
b) 6
c) 8
d) 10
 The lower border of the lung (midway between inspiration and expiration) crosses sixth rib in the
midclavicular line, eighth rib in the midaxillary line and tenth rib at the lateral border of erector spinae
(paravertebral line).
13. UNTRUE about cardiac jelly (AIIMS)
a) Secreted by cardiac myocytes surrounding primitive heart tube
b) Found exterior to endothelium
c) Forms myocardium
d) Transforms into the connective tissue of the endocardium
Ans. c) Forms myocardium.
Explanation: Cardiac jelly is secreted by the cardiac myocytes (myocardium) around the endothelial lining
of heart tube, and transforms into the connective tissue of endocardium.
14. Limbus fossa ovalis and floor of fossa ovalis represents

a) Septum Primum
b) Septum secundum
c) Septum primum and septum secundum
d) Septum secundum and septum primum
 The primitive atrium is divided first by a septum primum, which grows down from the superior wall to
the atrio-ventricular cushions; as this fusion occurs, the midportion resorbs in the center forming the
ostium secundum. Rightward of the septum primum, a second septum secundum membrane grows
down from the ventral-cranial wall toward—but not reaching—the cushions, and covering most, but not
all, of the ostium secundum, resulting in a flap of the foramen ovale.
 As the septum primum and septum secundum get fused with each other, foramen ovale in septum
secundum is closed (becomes fossa ovalis), at it’s floor is seen septum primum.
 ASD: Secundum type ASD is the most common ASD. It is caused by either an excessive resorption of
the Septum primum or an underdevelopment and reduced size of the Septum secundum. Primum type
ASD is less common than secundum ASD and results from a failure of the septum premium to fuse with
the endocardial cushions
 Atrial septal defect (ASD) : Fusion between septum primum and septum secundum takes place at
about 3 months after birth. Ostium secundum type: If septum secundum is too short to cover foramen
secundum (in the septum primum), it allows shunting of blood from left to right atrium (Atrial septal
defect). Ostium primum type: If septum primum fails to fuse with endocardial cushions, the defect lies
immediately above the atrioventricular (AV) boundary (may also be associated with a ventricular septal
defect).
15. All is true about the development of heart EXCEPT
a) Sinus venarum develop from right horn of sinus venosus
b) Left horn of sinus venosus forms the coronary sinus
c) Fossa ovalis is a remnant of septum secundum
d) Ductus venosus connects portal vein and inferior vena cava
Ans. d) Ductus venosus connects portal vein and inferior vena cava.
Explanation: Ductus venosus connect left umbilical vein with inferior vena cava and becomes ligamentum
venosum of liver in the adults.
16. All of the following pairs for adult derivatives of embryonal structures is correct EXCEPT
a) Umbilical artery: Lateral umbilical ligament
b) Umbilical vein: Ligamentum teres
c) Ductus venosus: Ligamentum venosum
d) Foramen ovale: Fossa ovalis
Ans. a) Umbilical artery: Lateral umbilical ligament.
Explanation: Umbilical arteries become medial umbilical ligaments. Lateral umbilical ligaments are
raised by the inferior epigastric arteries. Median umbilical ligament is raised by urachus attaching to the
apex of urinary bladder.
17. Heart begins to beat in the week

a) 4
b) 5
c) 6
d) 7
Ans. a) 4.
Explanation: Heart beat begins by day 22 post-ovulation and can be detected by doppler ultrasound. It is
week 4 post-ovulation (or fertilization) and week 6 from LMP (Last Menstrual Period).
18. Pulmonary veins develops from

a) 6th aortic arch
b) Primitive left atrium
c) Left common cardinal vein
d) Left vitelline vein
Ans. b) Primitive left atrium.
Explanation: According to some authorities, pulmonary veins develop from the left atrial wall. There is no
consensus about whether the pulmonary vein as a branch from the left atrium obtains a connection to the
lung plexus or the pulmonary vein forms as a solitary vessel in the dorsal mesocardium and is only
secondarily incorporated into the atrium.
19. Anatomical closure of ductus arteriosus occurs at
a) Birth
b) 3-4 days
c) 10 days
d) 30 days
Ans. d) 30 days.
Explanation: Physiological closure of ductus arteriosus occurs within 1 – 4 days of birth. Often a small
shunt of blood stays for 24-48 hours in a normal full term infant. At the end of 24 hours (one day), 20 %
ducts are functionally close, 82 % by 48 hours and 100% at 96 hours (4 days). Anatomical closure of
ductus arteriosus oocurs within 2 – 12 postnatal weeks (1 month to 3 months).
20. Anatomical closure of ductus arteriosus occurs at
a) 2 weeks
b) 4 weeks
c) 12 weeks
d) 16 weeks
Ans. c) 12 weeks.
Explanation: Anatomical closure of ductus arteriosus oocurs within 2 – 12 postnatal weeks (1 month to
3 months).
21. Cardiac defects causing right to left shunt, leading to early cyanosis are all EXCEPT
a) Transposition of great vessels
b) Tetralogy of Fallot
c) Patent ductus arteriosus
d) Persistent truncus arteriosus
Ans. c) Patent ductus arteriosus.
Explanation: PDA carries the blood towards the lungs and promotes oxygenation thus, reduces cyanosis.
AP septum anomalies like PTA, TGV and TOF present with right to left shunt, blood reaches systemic
circulation without proper oxygenation, hence leading to cyanosis.
22. Absence of cono-truncal septum gives rise to
a) Tetralogy of Fallot
b) Patent truncus arteriosus
c) Transposition of great vessels
d) Coarctation of aorta
Ans. b) Patent truncus arteriosus.
Explanation: Absence of Aorta Pulmonary (AP) septum leads to persistent (patent) truncus arteriosus.
Conotruncal septum is the other name for AP septum.
23. Pentalogy of Fallot is characterized by
a) Ventricular septal defect
b) Patent ductus arteriosus
c) Atrial septal defect
d) Pulmonary stenosis
Ans. c) Atrial septal defect.
Explanation: Tetrology plus ASD (Atrial Septal Defect) is a feature of pentalogy of Fallot.
24. The base of the heart is formed by
a) Left and right ventricle
b) Left atrium and ventricle
c) Right atrium and ventricle
d) Left and right atrium
Ans. d) Left and right atrium
Explanation: Base of the heart is the posterior surface of heart and is mainly contributed by left atrium
and partly right atrium. Diaphragmatic surface of heart is majorly contributed by left ventricle and partly
right ventricle. Anterior sternocostal surface has all the four chmabers participating.
25. The Great cardiac vein lies in which groove

a) Anterior part of right coronary sulcus
b) Posterior part of right coronary sulcus
c) Anterior interventricular groove
d) Posterior interventricular groove
Ans. c) Anterior interventricular groove.
Explanation: Great cardiac vein runs along with the anterior interventricular artery (in anterior
interventricular groove) and next with circumflex artery (in coronary sulcus), to drain eventually into
coronary sinus.
26. Bleeding comes from the vein that is accompanied by the posterior interventricular artery.
Which of the following veins is most likely to be ruptured
a) Great cardiac vein
b) Middle cardiac vein
c) Small cardiac vein
d) Oblique veins of the left atrium
Ans. b) Middle cardiac vein.
Explanation: Posterior interventricular artery is accompanied by middle cardiac vein, which itself
drains into the coronary sinus.
27. Even if thrombosis is present in the coronary sinus, which of the following cardiac veins might
remain normal in diameter
a) Middle cardiac vein
b) Anterior cardiac vein
c) Small cardiac vein
d) Oblique cardiac vein
Ans. b) Anterior cardiac vein.
Explanation: Anterior cardiac veins drain directly into the right atrium and not into the coronary sinus,
hence, they might remain normal in coronary sinus thrombosis.
28. Occlusion of the left anterior descending artery will lead to infarction in which area of heart
a) Posterior part of the interventricular septum
b) Anterior wall of the left ventricle
c) Lateral part of the heart
d) Inferior surface of right ventricle
Ans. b) Anterior wall of left ventricle.

Explanation: LAD (Left Anterior Descending) artery is also known a santerio interventricular artery and
runs in the same named groove, supplying anterior 2/3 of interventricular septum lying deep to it and also
the adjacent anterior wall of the left ventricle. Posterior part of the interventricular septum and
inferior surface of right ventricle is supplied by PIVA (Posterio InterVentricular Artery). Left lateral
surface of the heart is suppled by circumflex artery.
29. Cardiac BPS of right lung is

a) Medial
b) Lateral
c) Medial basal
d) Anterior basal
Ans. c) Medial basal.
Explanation: Cardiac BPS of right lung is medial basal segment of lower lobe. This BPS is absent in the
left lung, the space being encroached by the heart.
30. Which is the most superior structure at hilum of left lung

a) Pulmonary vein
b) Pulmonary artery
c) Bronchus
d) Bronchial artery
Ans. b) Pulmonary artery.
Explanation: The arrangement of structures in the hilum of left lung is reebered by the mnemonic ABV
(Atal Bihari Vajpayi) in superior to inferior direction. Artery (pulmonary) → Bronchus (principal) → Vein
(pulmonary). It is the same sequence in right lung as well but with the addition of a bronchus above the
artery (epi-arterial bronchus). In all these structures bronchus is the most posterior structure at the lung
hilum.
31. Coronary dominance is determined by
a) Posterior interventricular artery
b) Anterior interventricular artery
c) Circumflex artery
d) Right coronary artery
Ans. a) Popsterior interventricular artery.
Explanation: Coronary dominance is determined by PIVA (Posterior InterVentricular Artery). In about 65%
of the poulation PIVA is given by right coronary artery alone (right cardiac dominance), in 10 % cases it’s
a branch of left coronary artery alone (left cardiac dominance) and in the remaining 25 % it is given by
both (balanced dominance).
32. Posterior interventricular artery is a branch of right coronary artery in most of the people (right
dominance). In 10% population it arises from
a) Circumflex artery
b) Left coronary artery
c) Pulmonary artery
d) Right coronary artery
Ans. a) Circumflex artery.
Explanation: In 10 % population, PIVA is a branch of the circumflex artery, which itself is a branch of left
coronary artery (left cardiac dominance).
33. Trachea lies in which mediastinum
a) Superior
b) Anterior
c) Middle
d) Posterior
Ans. a) Superior.
Explanation: Trachea and arch of aorta lies in the superior mediastinum. Oesophagus lies in the
superior mediastinum, passes through posterior medastinum and eventually enters the abdomen.
34. The order of neurovascular bundle in intercostal space from above to below is: vein-artery-
nerve. This order is NOT observed at rib number
a) 1
b) 2
c) 11
d) 12
Ans. a) 1.
Explanation: In first rib, the vein-artery-nerve order is medial to lateral. SVAN structures are sandwiched
between the lung apex and first rib. S – Sympathetic trunk, V – Vein (posterior intercostal), A – artery
(posterior intercostal), N – Nerve (T – 1).
35. All is true about vertebrae levels EXCEPT
a) Heart lies at T5 – 8 in recumbent position
b) Superior vena cava enters right atrium at T5
c) Azygous vein enters SVC at T4
d) Hemiazygous vein crosses left to right at T5
Ans. d) Hemiazygous vein crosses left to right at T5.
Explanation: Hemiazygous vein cross left to right at the level of T- 8 vertebrae, which is also the inferior
extent of heart in supine/recumbent position. IVC enters the heart at the same level after passing through
the central tendon of diaphragm. Azygous vein enters the SVC at T- 4 vertebra level, which then enters
heart at T- 5 level (superior extent of heart).
36. Which of the following veins drains into the brachiocephalic vein
a) Internal thoracic vein
b) Hemiazygos vein
c) Right superior intercostal vein
d) Left superior intercostal vein
Ans. d) Left superior intercostal vein.
Explanation: First posterior intercostal vein on each side drains into brachiocephalic vein. Posterior
intercostal veins of left intercostal space 2, 3 and 4 drains into the left superior intercostal vein, which
itself drains into the left brachiocephalic vein. Internal thoracic vein drains into subclavian vein. Hemi-
azygous vein drains into azygous vein.
37. All is true about phrenic nerve EXCEPT

a) Right is shorter and more vertical
b) Sole motor supply to diaphragm
c) Passes anterior to scalenus anterior
d) Passes posterior to hilum of lung
Ans. d) Passes posterior to the hilum of lung.

Explanation: Phrenic nerve passes anterior to the hilum of lungs, vagus nerve passes posterior to it.
Diaphragm receives somatic motor fibers solely from the phrenic nerve; its central part receives sensory
fibers from the phrenic nerve, whereas the peripheral part is supplied by intercostal nerves. Right dome of
diaphragm is at higher level (pushed up by liver) and the left dome of diaphragm is lower (pushed down by
heart).
High Yield Facts

 The true ribs are the first seven ribs (ribs 1 to 7), which attach to the sternum, the false ribs are the lower
five ribs (ribs 8 to 12). Last two ribs (ribs 11 and 12) are also known as floating ribs as their anterior ends
are floating with no bony articulation.
 Diaphragm is the chief muscle of inspiration, the accessory muscles are external, internal (interchondral
part), and innermost intercostal muscles, sternocleidomastoid, levator costarum, serratus anterior,
serratus posterior superior, scalenus, and pectoral muscles.
 Pump Handle movement: Elevation of upper 6 ribs causes sternum to be pushed forward and upward,
which increases the antero-posterior diameter of the thorax and lungs expand (inspiration).
 Bucket handle movement: The lower ribs elevate by swinging upward and laterally leading to an
increase in the transverse (lateral) diameter of the thorax for lung expansion (inspiration).
 Expiration is a largely a passive process caused by the elastic recoil of the lungs. Muscles of expiration
include anterior abdominal, internal intercostal (costal part), and serratus posterior inferior muscles.
 Great cardiac vein accompanies anterior interventricular artery in the anterior interventricular groove.
Section 7. Upper Limb
Embryology
1. Limb buds appear at week
a) 3
b) 4
c) 5
d) 6
2. During development, the scapula is formed by which of the following

a) Splanchnic lateral plate mesoderm
b) Neural crest cells
c) Axial mesoderm
d) Somatic lateral plate mesoderm
3. Root value of radial nerve is

a) C3,4,5,6,7
b) C4,5,6,7,8
c) C5,6,7,8; T1
d) C6,7,8; T1,2
Dermatomes and Axial lines

4. Dermatome of thumb and index finger is
a) C5; C6
b) C6; C6
c) C6; C7
d) C7; C7
 Upper limbs rotate laterally by 90 degrees, so that the thumb becomes lateral and little finger medial.
The flexor compartment comes anterior and the extensor compartment goes posterior.
 Lower limb rotates medially by 90-degree, so the extensor aspect of the leg faces anteriorly.
 Developmentally, radial artery is pre-axial and ulnar is a post-axial artery.
Brachial plexus
5. Which of the following is a branch from the trunk of brachial plexus
a) Dorsal scapular nerve
b) Long thoracic nerve
c) Nerve to subclavius
d) Suprascapular nerve
 The nerve to subclavius is small and arises near the junction of the fifth and sixth cervical ventral rami.
 Brachial plexus is formed by the ventral primary rami of the lower four cervical nerves and the first
thoracic nerves (C5–T1). It has roots & trunks (in the neck), divisions (passing behind clavicle), cords
and branches (in the axilla). It is covered by a prolongation of prevertebral fascia (axillary sheath)
around the nerves in the axilla.
 Two branches are given directly from the roots in the neck: 1. Dorsal scapular nerve (C5), which
supplies rhomboid major & monor levator scapulae muscles. 2. Long thoracic nerve of Bell (C5–
C7), which is given in the neck, enters axilla and descends on the external surface of the serratus
anterior muscle and supplies it.
 Lateral cord gives three branches (LML), medial and posterior cords give 5 branches each. Radial
nerve is a branch of posterior cord (STARS) and supplies posterior (extensor) compartment of upper
limb. Ulnar nerve is a branch of medial cord (UM4) and runs on the ulnar (medial) side of the limb.
Median nerve runs in the midline of the limb and has contributions from both medial and lateral
cords.
Nerve Injuries
Brachial Plexus – Cords and Branches (Axilla)
 Radial nerve is the largest branch of brachial plexus. It carries all the five root values of brachial
plexus.
 Ulnar nerve carries root value: C-7, 8; (T-1).
Median Nerve Injuries

Nerve involved Cause of injury Clinical features
Median nerve Supracondylar fracture Ape thumb deformity; Benediction hand; Weakness
(humerus); wrist slash in wrist flexion; hand deviates to ulnar side on flexion;
injury; carpal tunnel flexion of index and middle finger is lost; anterior
syndrome abduction, opposition and flexion of thumb is
compromised; sensory loss on the lateral 3 & 1/2
fingers; difficulty in making an ‘O’ with thumb and index
finger;
Hand of Benediction
6. Most common nerve damaged in supracondylar fracture is
a) Median
b) Anterior interosseous
c) Radial
d) Ulnar
SUPRA-CONDYLAR FRACTURE WRIST SLASH INJURY
7. Which of the following is the most commonly damaged nerve in wrist slash injury (AIIMS)
a) Median
b) Ulnar
c) Radial
d) Anterior interosseous
8. Which of the following nerve is damaged in wrist slash injury (UPSC)

a) Median
b) Ulnar
c) Median & ulnar
d) Median & radial
 Tinel sign is a tingling sensation in the distal end of a limb when percussion is made over the site of a
divided nerve. It indicates a partial lesion or the beginning regeneration of the nerve.
 Phalen test : The size of the carpal tunnel is reduced by holding the affected hand with the wrist fully
flexed or extended for 30 to 60 seconds, or by placing a sphygmomanometer cuff on the involved arm
and inflating to a point between diastolic and systolic pressure; appearance of numbness or
paresthesias indicates carpal tunnel syndrome.
9. Carpal tunnel syndrome produces inability to (AIIMS)
a) Abduct the thumb
b) Adduct the thumb
c) Flex the distal phalanx of the thumb
d) Oppose the thumb
10. Which of the following muscle has dual nerve supply
a) Flexor digitorum profundus
b) Interossei
c) Palmaris brevis
d) Flexor carpi ulnaris
Radial Nerve Injuries

Radial nerve Crutch palsy; Saturday Loss of extension at multiple joints; Wrist drop (loss of
night palsy; Fracture mid- wrist extension); weakness of supination and finger
shaft humerus extension; sensory loss on arm, forearm and dorsum of
hand
Wrist drop
11. Finger drop with no wrist drop is caused by lesion of
a) Radial nerve in the radial groove
b) Posterior interosseous nerve
c) Anterior interosseous nerve
d) Ulnar nerve behind medial epicondyle
Explanation: Injury to posterior interosseous nerve results in paralysis of extensor muscles in the posterior
forearm. Finger drop (loss of finger extension at metacarophalangeal joint) occurs, along with weakning of
wrist extension. Wrist extension is still possible (no wrist drop) because of the functional ECRL (Extensor
Carpii Radialis Longus) muscle, a powerful wrist extensor.
12. All are affected in low radial nerve palsy EXCEPT

a) Extensor carpi radialis longus
b) Extensor carpi radialis brevis
c) Finger extensors
d) Sensation on dorsum of hand
Explanation: Low radial nerve injuries occur around the elbow joint (for e.g., supracondylar fracture) and
may spare the ECRL (Extensor Carpi Radialis Longus) muscle. All the muscles supplied by radial nerve
distal to the lesion get paralysed.
13. Injury to radial nerve in lower part of spiral groove may result in all EXCEPT
a) Spare nerve supply to extensor carpi radialis longus
b) Results in paralysis of anconeus muscle
c) Leaves extension at elbow joint intact
d) Weakens supination movement
Explanation: Injury to radial nerve in lower part of radial groove results in paralysis (not sparing) of ECRL
(Extensor Carpi Radialis Longus). The muscle spared is triceps, and elbow extension is still possible.
Anconeus may (or may not) be paralysed, depending upon the involvement of the branch in the fracture.
Supinator muscle is paralysed , hence there will be difficulty in supination.
Arteries – Upper Limb
 Thyrocervical trunk is a branch from the first part of subclavian artery. It gives three branches SIT: S –
Supra-scapular artery; I – Inferior thyroid artery and T – Transverse cervical artery.
 Axillary artery has three parts and 6 branches. First part (1 branch – superior thyroid artery); second
part (2 branches – thoraco-acromial and lateral thoracic artery) and third part (3 branches – anterior
and posterior circumflex humeral arteries and subscapular artery).
Scapular Anastomosis
14. In a subclavian artery block at the outer border of first rib all of the following arteries help in
maintaining the circulation to upper limp EXCEPT
a) Thyrocervical trunk
b) Suprascapular
c) Subscapular
d) Superior thoracic
15. Which branch of subclavian contributes to scapular anastomosis

a) Vertebral
b) Internal thoracic
c) Thyrocervical truck
d) Dorsal scapular
 Dorsal scapular artery is often a direct branch of subclavian artery and participate in scapular
anastomosis. Thyrocervical trunk also participate in scapular anastomosis by giving suprascapular
artery and transverse cervical artery.
Allen Test
16. Allen’s test is done for checking
a) Neural disorders
b) Patency of ulnar artery
c) Patency of radial artery
d) Blood flow in cephalic vein
 Allen test is done to check the patency of the radial and ulnar arteries at the wrist and so determines
whether each individual artery is sufficient to maintain the arterial supply to the hand in isolation.
Questions: Upper Limb
17. All is true about clavicle EXCEPT
a) No marrow cavity
b) Long bone in horizontal disposition
c) Two secondary centres of ossification
d) Fractures at the junction of lateral and intermediate third
 Long bones generally have one primary centre of ossification, clavicle bein an exception to have
double primary centre of ossification. Clavicle is a membranous bone (intra-membranous
ossification). Fracture of the clavicle may result from a fall on the shoulder or outstretched hand. The
fracture is most often in the middle third (at the junction of lateral 1/3 and medial 2/3) and results in
upward displacement of the proximal fragment pulled by the sternocleido-mastoid muscle and
downward displacement of the distal fragment by the deltoid muscle and gravity.
18. The accompanying x-ray shows the shoulder of an 11-year-old girl who fell off the monkey bars,
extending her arm in an attempt to break her fall. The small arrows indicate the fracture area.
The large arrows indicate which of the following
a) Fracture at the surgical neck of the humerus

b) Glenohumeral joint
c) Joint space between the proximal humerus and the acromion of the scapula
d) Proximal humeral epiphyseal plate
19. All the pairs about bony attachments around shoulder joint are correctly matched EXCEPT
a) Latissimus dorsi : Floor of intertubercular sulcus
b) Short head of biceps : Tip of coracoid process
c) Subscapularis : Lesser tubercle
d) Teres major : Greater tubercle
 Rotator (Musculotendinous) cuff is contributed by the tendons of the supraspinatus, infraspinatus,
teres minor, and subscapularis (SITS); fuses with the joint capsule; and provides mobility. It keeps the
head of the humerus in the glenoid fossa during movements and stabilizes the shoulder joint.
Subscapularis muscle is sometime referred to as forgotten muscle, in the rotator cuff.
 Intertubercular (Bicipital) groove lies between the greater and lesser tubercles and lodges the tendon
of the long head of biceps brachii muscle, It provides insertions for the pectoralis major on its lateral lip,
the teres major on its medial lip, and the latissimus dorsi on its floor (Lady between two majors).
 Three muscles attach to the coracoid process of scapula: coraco-brachialis, short head of biceps
brachii and pectoralis minor.
 Greater and lesser tubercles of humerus are traction epiphysis and extracapsular.
 Quadrangular space is bounded superiorly by the teres minor (and subscapularis muscle), inferiorly by
the teres major muscle, medially by the long head of the triceps, and laterally by the surgical neck of the
humerus. It transmits the axillary nerve and the posterior circumflex humeral vessels.
 Upper triangular space is formed superiorly by the teres minor muscle, inferiorly by the teres major
muscle, and laterally by the long head of the triceps. Circumflex scapular vessels course through it.
 Lower triangular space is bounded superiorly by the teres major muscle, medially by the long head of
the triceps and laterally by the shaft of the humerus (and medial head of the triceps). Radial nerve and
the profunda brachii (deep brachial) vessels course through it.
20. The accompanying artery with axillary nerve in the quadrangular space is
a) Anterior circumflex humeral artery
b) Posterior circumflex humeral artery
c) Profunda brachii artery
d) Circumflex scapular artery
21. The cubital fossa is bounded laterally by the muscle
a) Brachioradialis
b) Pronator teres
c) Brachialis
d) Supinator
 Cubital fossa is a triangular space on the anterior aspect of the elbow that is bounded by the
brachioradialis muscle laterally, pronator teres muscle medially, and superiorly by an imaginary
horizontal line connecting the two epicondyles of the humerus. At the floor are brachialis and
supinator muscles. The contents (in lateral to medial order) are the radial nerve, biceps tendon,
brachial artery, and median nerve. Ulnar nerve passes behind the medial epicondyle (not a content of
cubital fossa). At its lower end, the brachial artery divides into the radial and ulnar arteries.
Antecubital vein lies at the roof draining cephalic vein into the basilic vein.
22. WRONG about the first metacarpal is
a) Epiphysis is at the head
b) Base is convexo-concave for sellar synovial joint
c) Doesn’t articulate with other metacarpals
d) More anterior and medially rotated
 Aberrant epiphyses are deviations from the norm (not always present). Epiphysis at the head of the
first metacarpal bone is an example.
23. A 43 year old sportsperson suddenly notices that he can no longer hit his normal three-point
shot in basketball. He has been suffering some mild neck pain of 6 weeks duration with pain
down the back of his right arm and extending to the dorsal surface of his hand, including his
middle finger. He has diminished triceps tendon reflex on the right side. Which of the following
investigation is ordered, because you are concerned he has herniated which intervertebral
disk
a) Lateral x-ray; C6–C7
b) Cervical MRI; C6–C7
c) Cervical MRI; C8–T1
d) CT; C6–C7
24. Content of anatomical snuff box
a) Radial nerve
b) Radial artery
c) Cephalic vein
d) Abductor pollicis longus
 Anatomic snuffbox is a triangular interval bounded antero-laterally by the abductor pollicis longus
(and extensor pollicis brevis) and postero-medially by the tendon of the extensor pollicis longus. it has
a floor formed by the styloid process of the radius, scaphoid, trapezium and the base of first
metacarpal bone. Radial artery is the content of the fossa, whereas, cephalic vein and cutaneous
branch of radial nerve lies on the roof.
 De Quervain's tenosynovitis: Inflammation of the two tendons forming antero-lateral boundary of
anatomical snuff box. The tendons involved are abductor pollicis longus and extensor pollicis
brevis and Finkelstein test becomes positive.
25. Froment test is to check which muscle

a) Opponens pollicis
b) Flexor pollicis brevis
c) Flexor pollicis longus
d) Adductor pollicis
 Froment sign: Abnormal flexion of the distal phalanx of the thumb when a sheet of paper is held
between the thumb and the radial surface of the index finger; a sign of a lesion of the ulnar nerve.
 Froment sign indicates thumb adductor weakness and consists of flexion of the thumb at the
interphalangeal joint when attempting to oppose the thumb against the lateral border of the second
digit.
26. Mammary gland is supplied by (PGIC)
a) Subscapular artery
b) Musculo-phrenic artery
c) Internal mammary artery
d) Superior thoracic artery
e) Superior epigastric artery
 Mammary gland receives blood from the axillary artery branches (lateral thoracic artery,
thoracoacromial artery); the posterior intercostal arteries and the internal thoracic (mammary)
artery branches.
27. The terminal axillary lymph nodes are
a) Apical
b) Central
c) Posterior
d) Anterior
 Lymphatics from mammary gland drain predominantly (75%) into the axillary nodes, more specifically
to the pectoral (anterior) nodes (including drainage of the nipple). 20% lymphatics enter the
parasternal (internal thoracic) nodes, which lie along the internal thoracic artery/vein. Some
lymphatic vessels drains to the apical nodes and may connect to lymphatics draining the opposite
breast and to lymphatics draining the anterior abdominal wall.
 Apical (medial or infraclavicular) nodes lie at the apex of the axilla (medial to the axillary vein) and
above the upper border of the pectoralis minor muscle, receive lymph from all of the other axillary
nodes and drain into the subclavian trunks.
 Mammary gland is supported by the suspensory ligaments (of Cooper), strong fibrous attachments,
from the dermis of the skin to the deep layer of the superficial fascia passing through the breast.
 Breast cancer in advanced stages. infiltrates Cooper’s ligaments, produces shortening of the
ligaments, causing depression or dimpling of the overlying skin. Advanced sign of inflammatory breast
cancer, peau d’orange (texture of orange peel) is the edematous swollen and pitted breast skin due
to obstruction of the subcutaneous lymphatics.
28. All of the following structures pierce the clavipectoral fascia EXCEPT
a) Lateral pectoral nerve
b) Lateral thoracic artery
c) Cephalic vein
d) Axillary lymphatics
 Clavipectoral fascia extends between the coracoid process, clavicle, and the thoracic wall and
envelops the subclavius and pectoralis minor muscles. It has a costocoracoid membrane, which lies
between the subclavius and pectoralis minor muscles and is pierced by the cephalic vein, the
thoracoacromial artery, and the lateral pectoral nerve.
29. Weight transmission from upper limb to axial skeleton is done by all EXCEPT (AIIMS)
a) Costo- clavicular ligament
b) Coraco-acromial ligament
c) Coraco-clavicular ligament
d) Inter-clavicular ligament
30. Which of the following movements DOESN’T happen in abduction of shoulder

a) Medial rotation of scapula
b) Elevation of humerus
c) Rotation of Clavicle at the sterno-clavicular joint
d) Rotation at the axis of acromioclavicular joint
 Supraspinatus muscle initiates shoulder abduction (0 - 15°), deltoid is the chief muscle for 15 - 90°
and overhead aduction (90 - 180°) is carried out by serratus anterior and trapezius muscles.
31. Anterior axial line reaches till
a) Shoulder
b) Elbow
c) Wrist
d) Knuckle
Ans. c) Wrist.
Explanation: An axial line is the junction between two dermatomes supplied by discontinuous spinal
nerves. AAL (anterior axial line) starts from sternal angle (2nd rib) and reaches the wrist joint level. PAL
(posterior axial line) begins at shoulder and reaches the elbow joint level.
32. Muscle forming the medial wall of axilla is

a) Subscapularis
b) Teres major
c) Pectoralis minor
d) Serratus anterior
Ans. d) Serratus anterior.
Explanation: Medial wall of the axilla has upper 4 ribs on the thoracic wall and the serratus anterior
muscle.
Anterior wall Pectoralis major & minor and subclavius muscle
Posterior wall Subscapularis, teres major and latissimus dorsi
Medial wall Serratus anterior and ribcage
Lateral wall Inter-tubercular sulcus and coracobrachialis & short head of biceps muscle
Roof Clavicle, scapula and first rib
Base Skin
Contents Axillary artery, vein & lymphatics, brachial plexus (cords and branches), long thoracic
nerve, intercostobrachial nerve
 During sentinel lymph node biopsy the nerves at risk are: intercostobrachial nerve (most common),
long thoracic nerve, thoracodorsal nerve.
 Axillary tail (tail of Spence) is a superolateral extension of the mammary gland and reaches the axilla.
33. Carpal bone(s) is/are
a) Capitate
b) Scaphoid
c) Cuboid
d) Cuneate
e) Navicular
Ans. a) Capitate; b) Scaphoid.
Explanation: There are 8 carpal bones in the upper limb. Proximal row (lateral to medial): Scaphoid,
Lunate, Triquestral, Pissiform; Distal row: Trapezium, Trapezoid, Capitate, Hamate. Mneomonic: She
Looks Too Pretty; Try To Catch Her. Lower limb has 7 tarsal bones:Talus, Calcaneum, Cuboid (lateral),
Navicular (medial), 3 Cuneiforms (medial intermediate and lateral). Cuneate is no bone in hand or foot.
34. Root value of hand muscles is

a) C - 5
b) C - 6
c) C - 7
d) C - 8
e) T - 1
Ans. d) C-8; e) T-1.
Explanation: Root value of hand muscles is C-8; T-1. All lumbrical & interossei muscles carry this root
value,and are paralysed in Klumpke’s palsy (C-8;T-1 lesion).
35. Claw hand is hyperextension at metacarpo-phalangeal joint & flexion at the interphalangeal(s).
Which muscles have become non-functional
a) Lumbricals
b) Lumbricals & palmar interossei
c) Lumbricals & dorsal interossei
d) Lumbricals and all interossei
Ans. d) Lumbricals and all interossei.
Explanation: 12 muscles: 4 lumbricals and 8 interossei (4 dorsal & 4 palmar) act together to achieve glass
holding position: MCP (meta-carpo-phalangeal) flexion and IP (Inter-phalangeal) extension. Paralysis of
these 12 muscles results in comparative increased activity of anatagonistic (opposite) muscles, leading to
Claw hand deformity: hyperextension at MCP and flexion at IP joints.
36. Action of dorsal interossei

a) Extension at metacarpo-phalangeal joint
b) Adduction at metacarpo-phalangeal joint
c) Flexion at metacarpo-phalangeal joints
d) Flexion at interphalangeal joints
Ans. c) Flexion at metacarpo-phalangeal joints.
Explanation: Digital abduction is a function of the 4 dorsal interossei (‘DAB’-dorsal abduction) and digital
adduction is a function of 4 palmar interossei (‘PAD’-palmar adduct). The 8 interossei muscles work along
with 4 lumbricals for MCP flexion and IP extension (glass holding position).
37. Nerve supply to dorsal interossei are by

a) Radial
b) Ulnar
c) Median
d) Ulnar & median
Ans. b) Ulnar.
Explanation: All the 8 interossei are supplied by the ulnar nerve.
Ulnar nerve Fracture medial Claw hand deformity; Weakness in wrist flexion;
epicondyle (humerus); hand deviates to radial side on flexion; flexion of
wrist slash injury ring and little finger is weak at distal IP joint; MCP
flexion and IP extension of ring & little finger lost;
loss of finger abduction and adduction; loss of
thumb adduction; sensory loss on palmar and
dorsal aspect of medial 1 & ½ fingers; Froment sign
positive, card test positive
Ulnar claw hand
38. Composite muscles are all EXCEPT

a) Flexor digitorum profundus
c) Opponens pollicis
d) Flexor carpi ulnaris
Ans. b) Flexor carpi ulnaris.
Explanation: Composite (hybrid) muscles have more than one motor supply. Flexor carpi ulnaris is
supplied by only ulnar nerve. The other muscles mentioned in the question have additional nerve supply
from medial nerve as well.
39. While skiing, a person catches a tree to stop and suffers hyper-abduction injury. The neural
involvement is/are (PGIC)
a) C-8; T-1 nerve root
b) Upper trunk of brachial plexus
c) Lower trunk of brachial plexus
d) Ulnar nerve
e) Median nerve
Ans. a) C-8; T-1 nerve root; c) Lower trunk of brachial plexus; d) Ulnar nerve; e) Median nerve.
Explanation: This a case of Klumpke’s palsy (C-8; T-1 lesion) due to stretching of lower trunk of brachial
plexus. It leads to partial injury of median and ulnar nerve and muscles of the hand like lumbricals and
interossei are paralysed (claw hand deformity)
40. TRUE about the upper trunk of brachial plexus

a) Carries root value C - 5, 6, 7
b) Can be blocked medial to scalenus anterior muscle
c) Long thoracic nerve arises from it
d) Lesion leads to partial injury of radial nerve
Ans. d) Lesion leads to partial injury of radial nerve.
Explanation: Upper trunk of brachial plexus carries C-5, 6 root values. Trunks of brachial plexus pass in
the scalene triangle bounded by scalenus anterior and medius muscle, It lies lateral (and not medial) to
the scalenus anterior muscle, where a block can be carried out. Long thoracic nerve arises directly from
the roots of brachial plexus (C-5, 6, 7). Lesion of upper trunk of brachial plexus (e.g., Erb’s palsy) leads to
partial injury of radial nerve.
41. Injury to the upper trunk of brachial plexus results in (PGIC)

a) Supination of forearm
b) External rotation of arm
c) Inability to initiate abduction
d) Decreased sensation on medial side of hand
e) Paralysis of deltoid muscle
Ans. c) Inability to initiate abduction; e) Paralysis of deltoid muscle.
Explanation: Injury to upper trunk of brachial plexus results in Erb’s palsy and policeman tip hand
deformity: Adduction and medial (internal) rotation at shoulder joint; extension at elbow joint and
pronation at radio-ulnar joint. Initiation of shoulder abduction (supraspinatus paralysed) and raising the
arm to 90° (deltoid paralysed) is not possible. Outer (lateral) surface of the upper limb (C-5, 6
dermatome) has sensory disturbance. Decreased sensation on medial side of hand (C-8 dermatome)
occurs in Klumpke’s palsy.
42. Which muscle may NOT be paralysed in Erb’s palsy

a) Brachioradialis
b) Coraco-brachialis
c) Teres minor
d) Deltoid
Ans. b) Coraco-brachialis.
Explanation: In Erb’s palsy there is C-5, 6 root value injury. Coracobrachialis (C- 5, 6, 7), may not be
completerly paralysed. Brachioradialis (C-5, 6) is found paralysed along with deltoid and teres minor.
43. All of the following features can be observed after fracture of surgical neck of humerus, EXCEPT
a) Loss of rounded contour of shoulder
b) Loss of sensation on skin over the upper part of deltoid
c) Weakness of abduction at shoulder joint
d) Atrophy of deltoid muscle
Ans. b) Loss of sensation on skin over the upper part of deltoid.
Explanation: There is loss of sensation on C- 5 dermatome - the upper lateral aspect of arm (on the
lower half of the deltoid). Fracture surgical neck of humerus may damage axillary nerve leading to
paralysis of deltoid (abduction) and teres minor (lateral rotation) problem at shoulder joint. Since deltoid
undergoes atrophy, rounded contour of shoulder is lost.
44. A patient is unable to adduct his thumb. The nerve involved is characterized by (PGIC)
a) Having C-8; T-1 root value
b) Arise from medial cord of brachial plexus
c) Arise from the medial and lateral cord of brachial plexus
d) Musician’s nerve
e) Supply first two lumbricals
Ans. a) Having C-8; T-1 root value; b) Arise from medial cord of brachial plexus; d) Musician’s
nerve.
Explanation: Loss of thumb adduction occurs due to paralysis of adductor pollicis (ulnar nerve lesion).
Ulnar nerve has C-(7), 8; T-1 root value, is the continuation of medial cord of brachial plexus, supplies
intrinsic muscles of the hand like all interossei and medial (last) two lumbricals, hence controls finer
movement of fingers for playing musical instruments (appropriately called musician’s nerve).
45. All is TRUE about median nerve EXCEPT

a) Labourer’s nerve
b) Injury produces total claw hand
c) Damaged in supracondylar fracture of humerus
d) Damaged in wrist slashing
Ans. b) Injury produces total claw hand.
Explanation: Total claw hand is due to injury of both median and ulnar nerve. Median nerve supplies the
anterior forearm and the thenar muscles, which are required for labourer’s job like pulling, pushing, lifting
heavy loads. In median nerve injuries the task of a labourer may get severely compromised. Median nerve
is the most commonly damaged nerve in supracondylar fracture and wrist slash injuries as well.
46. All is true about carpal tunnel syndrome EXCEPT

a) Most common entrapment mono-neuropathy
b) Rheumatoid arthritis is a cause
c) Wasting and weakness of adductor pollicis
d) Numbness in lateral 3 ½ fingers
Ans. c) Wasting and weakness of adductor pollicis.
Explanation: Carpal tunnel syndrome results in median nerve injury and not ulnar nerve (adductor pollicis
is not affected).
47. Pen test in the hand is performed to assess the neuromuscular status of
a) Opponens pollicis
c) Abductor pollicis brevis
d) 1st palmar interossei
Ans. c) Abductor pollicis brevis.
Explanation: Pen test is to check anterior abduction of thumb, carried out by abductor pollicis brevis
(median nerve supply).
48. Structure NOT passing deep to flexor retinaculum is

a) Flexor carpi radialis
b) Flexor digitorum superficialis
c) Flexor digitorum profundus
d) Median nerve
Ans. a) Flexor carpi radialis.
Explanation: Tendon of flexor carpi radialis is embedded in the substance of flexor retinaculum and is
neither superficial nor deep to the flexor retinaculum.
49. All are branches of the posterior cord of brachial plexus EXCEPT
a) Axillary nerve
b) Radial nerve
c) Long thoracic nerve
d) Thoracodorsal nerve
Ans. c) Long thioracic nerve.
Explanation: Long thoracic nerve arises directly from the roots of brachial plexus (C- 5, 6, 7). Posterior
cord of brachial plexus gives five branches (STARS): S – subscapular (upper), T - Thoracodorsal nerve, A
– Axillary nerve, R – Radial nerve, S – subscapular (lower).
50. All is true about Radial nerve EXCEPT

a) Continuation of lateral cord of brachial plexus
b) Root value is C-5,6,7,8 and T-1
c) Damaged in fracture shaft of humerus
d) Cock up splint is used for its injury in radial groove
Ans. a) Continuation of lateral cord of brachial plexus.
Explanation: Radial nerve is continuation of the posterior cord of brachial plexus. Lateral cord continues
as musculocutaneous nerve. Radial nerve has all the five root values of brachial plexus. Fracture mid-
shaft of humerus damagers the radial nerve in the radial groove leading to wrist drop, the patient is given
cock-up splint to prevent the resuting deformities.
51. All of the following are post-axial veins EXCEPT

a) Cephalic vein
b) Basilic vein
c) Axillary vein
d) Subclavian vein
Ans. a) Cephalic vein.
Explanation: Cephalic vein is a pre-axial vein.
52. Infection draining the ring finger goes to

a) Thenar space
b) Mid palmar space
c) Ulnar bursa
d) Radial bursa
Ans. B) Mid palmar space.
Explanation: Ring finger pus drains towards the midpalmar space.
 Fascial spaces of the palm are deep to the palmar aponeurosis and divided by a midpalmar (oblique
septum attached to third metacarpal) into the thenar space and the midpalmar space. Thenar Space is
the lateral space that contains the flexor pollicis longus tendon and the other flexor tendons of the index
finger. Midpalmar Space is the medial space that contains the flexor tendons of the medial three digits.
 The tendons of the second, third, and fourth digits have separate synovial sheaths so that the infection is
confined to the infected digit, but rupture of the proximal ends of these sheaths allows the infection to
spread to the midpalmar space. The synovial sheath of the little finger is usually continuous with the
common synovial sheath (ulnar bursa), and thus, tenosynovitis may spread to the common sheath and
thus through the palm and carpal tunnel to the forearm. Likewise, tenosynovitis in the thumb may spread
through the synovial sheath of the flexor pollicis longus (radial bursa).
 First lumbrical space communicates with thenar space whereas, 2, 3 and 4 lumbrical canals are
continuous with mid-palmar space.
 Infection from thumb and index finger passes towards the thenar space along the first lumbrical canal.
 Middle, ring finger and little finger drain towards mid palmar space along the 2, 3 & 4th lumbrical canals.
 Ulnar bursa is the common synovial flexor sheath which envelops the tendons of both the flexor
digitorum superficialis and profundus muscles. Radial Bursa is the synovial flexor sheath for flexor
pollicis longus.
Thumb infection may lead to inflammation of the radial bursa, whereas, little finger infection involves the
ulnar bursa.
 Fore arm space of Parona lies proximal to the flexor retinaculum and is continuous with the radial &
ulnar bursa.
Flexor retinaculum separates Fore arm space of Parona from the thenar & mid-palmar space and they are
non-continuous.
Note: Bursa is defined as a potential space lined by synovial membrane.
High Yield Facts

 Biceps brachii is a powerful supinator at the radio-ulnar joint and helps in screw driving movements.
 Guyon’s canal syndrome : Entrapment of the ulnar nerve in the Guyon’s canal, causing pain,
numbness, and tingling in the ring and little fingers, and motor weakness later. It can be treated by
surgical decompression of the nerve. Guyon’s canal (ulnar tunnel) is formed by the pisiform, hook of the
hamate, and pisohamate ligament, deep to the palmaris brevis and palmar carpal ligament and transmits
the ulnar nerve and artery.
 Common interosseous artery is a branch of ulnar artery near the elbow joint and divides into anterior
and posterior interosseous artery.
 Cephalic vein begins as a lateral continuation of the dorsal venous arch on hand, runs on the radial
side, and is connected with the basilic vein by the median cubital vein (at the roof of cubital fossa). It
ascends along the lateral surface of the arm and lies in the deltopectoral groove and pierces the
clavipectoral fascia to drain into the axillary vein.
 Median cubital vein connects the cephalic vein to the basilic vein over the cubital fossa. It lies
superficial to the bicipital aponeurosis and is the most commonly used vein in upper limb for
withdrawal of blood samples, intravenous injections, and blood transfusions.
 Impingement syndrome is a type of overuse injury with progressive pathologic changes resulting from
mechanical impingement by the acromion, coracoacromial ligament, coracoid process, or
acromioclavicular joint against the rotator cuff (especially supraspinatus muscle) ; changes may include
reversible edema and hemorrhage, fibrosis, tendinitis, pain, bone spur formation, and tendon rupture.
 Inferior angle of scapula corresponds to T – 7 vertebra (surface marking).
 There is often an enlargement or pseudoganglion on the axillary nerve branch to teres minor. The
termination of posterior interosseous nerve also shows a pseudo-ganglion Deep fibular nerve in lower
limb may also develop a pseudoganglion in a branch to extensor digitorum brevis.
Section 8. Abdomen
Embryology
Umbilical Cord Contents
1. Which is NOT associated with vitello-intestinal duct
a) Ileal diverticulum
b) Umbilical sinus
c) Enterocystoma
d) Mesenteric cyst
 Ileal (Meckel) diverticulum is found in about 2% of the population, located within 2 ft of the ileocecal
junction (on the anti-mesenteric side of the ileum), and is usually about 2 inches long. Often contain
two types of ectopic tissue (gastric and pancreatic). Peptic ulceration of adjacent ileal mucosa and
volvulus are complications.
2. Identify the clinical condition
a) Omphalocele
b) Gastroschisis
c) Morgagnian hernia
d) Bochdalek hernia
3. Regarding Gastroschisis and omphalocele, which one is FALSE

a) Intestinal obstruction is common in gastroschisis
b) Liver is the content of omphalocele
c) Gastroschisis is associated with multiple anomalies
d) Umbilical cord is attached in normal position in gastroschisis
Diaphram and Mesentery Development

4. All are derivatives of Septum Transversum EXCEPT
a) Falciform ligament
b) Ligamentum teres
c) Coronary ligament
d) Lesser omentum
5. The umbilical vein carries
a) Oxygenated blood towards the placenta
b) Deoxygenated blood towards the placenta
c) Oxygenated blood away from the placenta
d) Deoxygenated blood away from the placenta
6. Diaphragm develops from all EXCEPT
a) Septum transversum
b) Dorsal mesocardium
c) Pleuroperitoneal membrane
d) Cervical myotomes
 The diaphragm is a musculotendinous partition to separate the pleural and peritoneal cavities. It is
formed from fusion of the following structures: 1. Septum transversum, 2. Paired pleuroperitoneal
membranes 3. Dorsal meso-oesophagus (mesentery). 4. Cervical somites (Body wall), hence
innervated by the phrenic nerves (C3, C4, and C5).
 Deficiency in the pleuroperitoneal membrane or its failure to fuse with the other parts of the
diaphragm leads to Bochdalek hernia (congenital diaphragmatic hernia), presenting as neonatal
emergency. Abdominal contents are herniate into the left pleural cavity, leading to left lung hypoplasia
and right mediastinal shift (and resulting cyanosis). Mother presnts with polyhydramnios and baby has
scaphoid (flattened) abdomen, cyanosis, and difficulty in breathing. Immediate nasogastric intubation is
performed, and the surgery is postponed by few days till the patient is stabilised.
7. Bochdalek hernia occurs in
a) Antero-lateral part of the diaphragm
b) Postero-lateral part of diaphragm
c) Retrosternal area
d) Posterior to diaphragm
8. Structure passing through the marker B
a) Inferior vena cava

b) Oesophagus
c) Aorta
d) Morgagni hernia
 There are 3 major openings in the diaphragm:(a) the vena caval hiatus, which lies in the central
tendon at the level of T-8 and transmits the IVC and the right phrenic nerve branches; (b) the
esophageal hiatus, which lies in the muscular part of the diaphragm at the level of T-10 and transmits
the esophagus, vagus nerve and branches of left gastric vessels; and (c) the aortic hiatus, which lies
between the two crura at the level of T-12 and transmits the aorta, thoracic duct, azygos vein, and
sometimes greater splanchnic nerve.
 Right crus of diaphragm is longer than the left. Fibres of right crus surrounds the oesophagus at the
passage into the abdomen (? Sphincter action).
9. Which of the following structure DOESN’T develop in mesentery of stomach

a) Liver
b) Kidney
c) Spleen
d) Pancreas
Gut Rotation
10. Physiological hernia reduces at month
a) 1
b) 2
c) 3
d) 4
Physiological umbilical hernia: At week 6, the gut tube connected to the yolk sac herniates into the
region of umbilical cord. The hernia regresses at week 11 and the gut tube returns back to the abdominal
cavity. Non-regression of the hernia reults in Omphalocele.
11. The mesentery of small intestine, along its attachment to the posterior abdominal wall, crosses
all of the following structures EXCEPT
a) Left gonadal vessels
b) Third part of duodenum
c) Aorta
d) Right ureter
 The root of the mesentery lies along a line running diagonally from the duodenojejunal flexure on the
left side of the second lumbar vertebral body to the right sacroiliac joint. The root crosses over the
third part of the duodenum, aorta, inferior vena cava, right ureter and right psoas major.
Abdomen: NeuroVascular Supply
 The splanchnic nerves contain preganglionic sympathetic GVE fibers with cell bodies located in the
lateral horn (intermediolateral cell column) of the spinal cord and GVA fibers with cell bodies located in
the dorsal root ganglia.
12. Which of the following is the terminal group of lymph node in colonic drainage
a) Preaortic
b) Intermediate
c) Para colic
d) Epicolic
13. Testicular lymphatics drain into which lymph nodes
a) Superficial inguinal
b) Internal iliac
c) Preaortic
d) Paraaortic
 Gondas (testis and ovary) drain into the para-aortic lymph nodes→ cisterna chyli→thoracic duct
→Left jugulo-subclavian angle.
14. All is true about thoracic duct EXCEPT
a) Begins at level of T12
b) Enters thorax through aortic opening
c) Crosses from right to left at level of T8
d) Passes the superior aperture of thorax
e) Passes in posterior and superior mediastinum

Tonsil Develops From

Uploaded by

Copyright:

Available Formats

Tonsil Develops From

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Tonsil Develops From

Uploaded by

Copyright:

Available Formats

5.

Tonsil develops from

Tongue and Thyroid (Embryology)

17. All are features of cavernous sinus thrombosis EXCEPT

18. Which of the following is a direct content of cavernous sinus

Questions: Head & Neck - I

22. Choose the INCORRECT statement concerning pharyngeal plexus

24. Double aortic arch occurs due to

 Trochlear nerve decussates in the superior medullary velum.

27. All is true about trochlear nerve EXCEPT

28. All is true about Trochlear nerve EXCEPT

a) Internal branchial sinus

33. Superior orbital fissure contains all EXCEPT

35. Thinnest area of sclera

36. Angular vein communicates with

37. Pain sensation from the ethmoid sinus is carried by

38. Afferent component of corneal reflex is carried by

39. Ptosis is due to lesion of

45. The muscle having contralateral innervation is

Ans. c) Intorsion, abduction and depression.

47. Intortor(s) of the eyeball are

48. Following muscles are the abductors of eye EXCEPT

51. Vidian nerve passes through

Neck Triangles and Fasciae

69. Ascending pharyngeal artery is a branch of

 Facial artery can be palpated at the anterior border of masseter muscle.

a) Internal Greater palatine → posterior ethmoidal → superior labial → lesser palatine

73. Atlanto-occipital joint is of synovial variety

85. Greater part of the auricle is supplied by

91. All lie at the vertebra level C-6 EXCEPT

94. Inferior thyroid artery is a branch of and is related to

97. True about pharyngo-tympanic tube is/are

98. Which of the following is condylar synovial joint

High Yield Facts

L5 and S1 S1 S1 Gastrocnemius Plantar flexion of Tibial nerve

6. Numerical variation is least in which vertebrae

8. Vertebral artery passes through foramen transversaria of

9. Lumbar puncture is done at the vertebral level

12. Boundary of triangle of auscultation is NOT formed by (AIIMS)

High Yield Facts

Heart tube derivatives:

BPS (Broncho-Pulmonary Segments)

12. Pleural reflection on midaxillary line is in space

14. Limbus fossa ovalis and floor of fossa ovalis represents

17. Heart begins to beat in the week

18. Pulmonary veins develops from

25. The Great cardiac vein lies in which groove

Ans. b) Anterior wall of left ventricle.

29. Cardiac BPS of right lung is

30. Which is the most superior structure at hilum of left lung

37. All is true about phrenic nerve EXCEPT

Ans. d) Passes posterior to the hilum of lung.

High Yield Facts

2. During development, the scapula is formed by which of the following

3. Root value of radial nerve is

Dermatomes and Axial lines

Median Nerve Injuries

SUPRA-CONDYLAR FRACTURE WRIST SLASH INJURY